Immunology: MCQ on Immediate and Delayed Hypersensitivity

            Multiple Choice Question on Immediate and Delayed Hypersensitivity

1) Hypersensitivity reactions are broadly classified into four different types. 
Which of the following hypersensitivity occurs via IgE antibody?
a) Type I hypersensitivity
b) Type II hypersensitivity
c) Type III hypersensitivity
d) Type IV hypersensitivity

2) The T helper 1 cell releases cytokines to activate macrophage or T cells and cause direct cellular damage. 
Which of the following hypersensitivity reactions are mediated by sensitized T helper-1 cells?
a) Type I hypersensitivity
b) Type II hypersensitivity
c) Type III hypersensitivity
d) Type IV hypersensitivity

3) Which of the following hypersensitivity reactions is a result of massive deposition of immune complex in various tissues, and can induce complement activation and inflammation responses?
a) Type I hypersensitivity
b) Type II hypersensitivity
c) Type III hypersensitivity
d) Type IV hypersensitivity

4) Which of the following hypersensitivity reactions involve antibody-directed complement activation and antibody-dependent cell cytotoxicity?
a) Type I hypersensitivity
b) Type II hypersensitivity
c) Type III hypersensitivity
d) Type IV hypersensitivity

5) When allergen crosslinks with IgE bound to the Fc receptor on the mast cells, the allergen induces the release of mediators. 
Which of the following receptor have a high affinity towards IgE?
a) FcεRI
b) FcεRII
c) Both of the above
d) None of the above

6) A hereditary predisposition of the development of immediate hypersensitivity reaction against common environmental antigens are called.........................
a) Atrophy
b) Atopy
c) Anergy
d) Synergy

7) Which of the following domain present in the Fc region of IgE molecule enables the binding of glycoprotein receptors on the surface of the basophils and mast cells?
a)CH1
b)CH2
c) CH3
d) CH4

8) The high-affinity FcεRI receptor functions in signal transduction, activation, and degranulation of chemical mediators such as histamine, leukotrienes, and prostaglandins for the mast cells. 
Which of the following intracellular messenger serves this function?
a) Ca++
b) cAMP
c) cGMP
d) None of the above

9) The persistent level of which of the following second messenger inhibits the degranulation of the mast cells and release of the mediators of anaphylaxis?
a) Ca++
b) cAMP
c) cGMP
d) None of the above


10) Which of the following is not an example of Type I hypersensitivity reaction?
a) Asthma
b) Allergic Rhinitis
c) Systemic Lupus Erythematosus
d) Atopic Dermatitis

11) The type I early response occurs within minutes of allergic response. 
Which of the following is the early mediator of type I hypersensitivity reaction?
a) Histamine
b) Leukotrienes
c) Prostaglandins
d) All of the above

12) The type I late response occurs hours later and involves the following mediators.
a) IL4
b) IL-5
c) TNF-α
d) All of the above

13) All of the following drugs are involved in increased production or maintenance of cAMP level to prevent anaphylaxis, EXCEPT:
a) Theophylline
b) Epinephrine
c) Cromolyn sodium
d) Cortisone

14) During a blood transfusion, ABO incompatibilities lead to the recognition of A or B antigens present on the RBC resulting in complement-mediated cell lysis. 
Which of the following antibody isotype is primarily involved in this type II hypersensitivity reaction?
a) IgG
b) IgM
c) IgE
d) IgA

15) Erythroblastosis fetalis is a severe form of hemolytic disease developed when Rh+ fetus expresses Rh antigen on its blood that the mother does not express. 
Which of the following condition is true regarding this condition?
a) During the first pregnancy, the exposure of Rh antigen leads to the generation of memory cells and the IgG response that is harmful during the subsequent pregnancy
b) The condition may be prevented by infusing and reducing exposure to Rh antigen within 24-48 hours of pregnancy
c) Plasmapheresis may be used to remove the antibodies from the circulation
d) All of the above

16) Which of the following drugs can induce all four types of hypersensitive reactions?
a) Penicillin
b) Sulfonamides
c) Local anesthetics
d) Salicylates

17) Which of the following the disease is not the example of type III hypersensitivity reaction?
a) Systemic Lupus Erythematosus
b) Rheumatoid Arthritis
c) Good Pasture’s syndrome
d) Down Syndrome

18) All of the following statement regarding Type III hypersensitivity reaction is true, EXCEPT:
a) Antigen-antibody forms a large complex and is deposited in the nearby tissue
b) Immune complex activate the complement system and anaphylatoxins
b) The anaphylatoxin such as C3a, C3b recruits neutrophils at the site of immune complex deposition
c) Neutrophils and macrophages clear the immune complexes and tissue damage

19) Which of the following statement is not true regarding the sensitization phase of delayed-type hypersensitivity (DTH)?
a) The sensitization phase begins 1-2 weeks after the primary contact with antigens
b) T cell undergo activation and clonal expansion after interacting with antigen-MHC complex
c) CD8+ T Helper-1 cells are primarily activated after exposure to antigen
d) CD4+ T Helper-1 cells are primarily activated after exposure to antigen

20) Which of the following statement is not true regarding the effector phase of delayed-type hypersensitivity (DTH)?
a) The response generally peaks at 48-72 hours after a second exposure to the antigen
b) T Helper 2 cells secrete antibodies and activate antibody-dependent cell cytotoxicity
c) T Helper 2 cells secrete a variety of cytokines that recruit and activate macrophages
d) DTH response becomes self-destructive to the intense response that is visible as the granulomatous reaction.

Bonus Question:
Which of the following cytokines are important for DTH and also used for the diagnosis of Mycobacterium tuberculosis?
a) TNF-α
b) TNF-β
c) IFN-α
d) IFN-γ


Answers:
1- a) Type I hypersensitivity
2- d) Type IV hypersensitivity
3- c) Type III hypersensitivity
4- b) Type II hypersensitivity
5- a) FcεRI
6- b) Atopy
7- d) CH4
8- a) Ca++
9- b) cAMP
10- c) Systemic Lupus Erythematosus
11- d) All of the above
12- d) All of the above
13)- c) Cromolyn sodium
14- b) IgM
15- d) All of the above
16- a) Penicillin
17- d) Down Syndrome
18- c) Neutrophils and macrophages clear the immune complexes and tissue damage
19- c) CD8+ T Helper-1 cells are primarily activated after exposure to antigen
20- b) T Helper 2 cells secrete antibodies and activate antibody-dependent cell cytotoxicity


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