NR 507
MIDTERM EXAM
Advanced Pathophysiology
Chamberlain University
100 Exam-Style Practice Questions
Immunology, Hypersensitivity & Immunodeficiency
With Highlighted Answers & Detailed Rationales
✔ Correct answers are highlighted in green
📖 Rationales are highlighted in yellow
,1. Which of the following is the underlying pathology for hay fever?
tz tz tz tz tz tz tz tz tz tz tz
A. Formation of autoantibodies.
tz tz tz
B. Activation of complement.
tz tz tz
C. Destruction by T-cells.
tz tz tz
D. Mast cell degranulation.
tz tz tz
✔ Answer: D. Mast cell degranulation.
tz tz tz tz tz
📖 Rationale: Hay fever (allergic rhinitis) is a Type I (IgE-
tz tz tz tz tz tz tz tz tz tz
mediated) hypersensitivity reaction. Allergens cross-
tz tz tz tz
link IgE antibodies on mast cells, triggering degranulation and release of histamine and other mediators, causi
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
ng the classic symptoms of sneezing, itching, and nasal congestion.
tz tz tz tz tz tz tz tz tz
2. Which of the following assessment findings would be expected in a patient who presents with u
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
rticaria?
A. Eosinophilia.
tz
B. Decreased thyroid-stimulation hormone level.
tz tz tz tz
C. Thrombocytopenia.
tz
D. Leukopenia.
tz
✔ Answer: A. Eosinophilia.
tz tz tz
📖 Rationale: Urticaria (hives) is an allergic reaction involving IgE-
tz tz tz tz tz tz tz tz tz
mediated mast cell degranulation. Eosinophils are recruited to sites of allergic inflammation and are elevated i
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
n the blood (eosinophilia) during allergic reactions. Eosinophils help modulate the immune response by releasi
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
ng enzymes that inactivate mast cell mediators.
tz tz tz tz tz tz
3. The diagnosis for an individual who presents to the office with sudden swollen lips and eyes, s
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
hortness of breath, and throat tightness after a bee sting is:
tz tz tz tz tz tz tz tz tz tz
A. Anaphylaxis. tz
B. Asthma. tz
C. Angioedema. tz
D. Reactive airway disease. tz tz tz
✔ Answer: A. Anaphylaxis.
tz tz tz
📖 Rationale: Anaphylaxis is a severe, life-
tz tz tz tz tz tz
threatening systemic Type I hypersensitivity reaction triggered by allergens such as bee venom. It involves ma
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
ssive IgE- tz
mediated mast cell degranulation causing angioedema, bronchospasm (throat tightness/shortness of breath),
tz tz tz tz tz tz tz tz tz tz tz
and potentially circulatory collapse. Immediate epinephrine is the treatment of choice.
tz tz tz tz tz tz tz tz tz tz
4. Damage occurs with ABO incompatibility because:
tz tz tz tz tz tz
A. Mast cell degranulation. tz tz tz
B. Autoantibodies specific for thyroid tissue impair the receptors for TSH.
tz tz tz tz tz tz tz tz tz tz
C. Antigen/Antibody complexes attack the RBC.
tz tz tz tz tz
D. Complement damages RBC membrane causing cell lysis.
tz tz tz tz tz tz tz
Page 2 of 31 tz tz tz
,✔ Answer: D. Complement damages RBC membrane causing cell lysis.
tz tz tz tz tz tz tz tz tz
📖 Rationale: ABO incompatibility is a Type II (cytotoxic) hypersensitivity reaction. Preformed IgM antibodies
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
against incompatible ABO antigens activate the complement cascade, which damages and lyses the red bloo
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
d cell membrane, leading to intravascular hemolysis, hemoglobinuria, and potentially acute renal failure.
tz tz tz tz tz tz tz tz tz tz tz tz
5. Which of the following statements is true about a primary immunodeficiency?
tz tz tz tz tz tz tz tz tz tz tz
A. It is the result of a single gene defect.
tz tz tz tz tz tz tz tz tz
B. It appears primarily in older adults.
tz tz tz tz tz tz
C. It is usually inherited.
tz tz tz tz
D. It is the result of multiple gene defects.
tz tz tz tz tz tz tz tz
✔ Answer: C. It is usually inherited.
tz tz tz tz tz tz
📖 Rationale: Primary immunodeficiencies are disorders caused by intrinsic defects in the immune system,
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
most often due to genetic mutations inherited from one or both parents. They typically manifest in infancy or ea
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
rly childhood and may involve defects in B cells, T cells, complement, or phagocytes. While some are single-
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
gene defects, the defining feature is that they are usually inherited.
tz tz tz tz tz tz tz tz tz tz
6. ________________ is a predominant cause of secondary immune deficiencies worldwide.
tz tz tz tz tz tz tz tz tz tz
A. Malnutrition. tz
B. HIV infection. tz tz
C. Chemotherapy. tz
D. Autoimmune disease. tz tz
✔ Answer: A. Malnutrition.
tz tz tz
📖 Rationale: Malnutrition is the most common cause of secondary (acquired) immunodeficiency worldwide,
tz tz tz tz tz tz tz tz tz tz tz tz tz
particularly in developing countries. Protein- tz tz tz tz
energy malnutrition impairs production of lymphocytes, immunoglobulins, and complement proteins, leaving in
tz tz tz tz tz tz tz tz tz tz tz
dividuals vulnerable to opportunistic and common infections.
tz tz tz tz tz tz
7. An example of a secondary immunodeficiency is:
tz tz tz tz tz tz tz
A. Job Syndrome. tz tz
B. Common Variable Immunodeficiency.
tz tz tz
C. Familial Mediterranean Fever.
tz tz tz
D. Pneumocystis Carinii pneumonia (PCP).
tz tz tz tz
✔ Answer: D. Pneumocystis Carinii pneumonia (PCP).
tz tz tz tz tz tz
📖 Rationale: Pneumocystis carinii (now jirovecii) pneumonia is an opportunistic infection that arises in indivi
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
duals with secondary (acquired) immunodeficiency, most notably AIDS (HIV infection). It is not a primary immu
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
nodeficiency itself but serves as an indicator disease of profound immune suppression. Job Syndrome and Co
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
mmon Variable Immunodeficiency are examples of primary immunodeficiencies.
tz tz tz tz tz tz tz
8. An example of a primary immunodeficiency is:
tz tz tz tz tz tz tz
A. Sinopulmonary infections due to HIV.
tz tz tz tz tz
B. Severe Combined Immunodeficiency (SCID).
tz tz tz tz
Page 3 of 31 tz tz tz
, C. Immunosuppression from corticosteroids.
tz tz tz
D. Lymphopenia secondary to chemotherapy.
tz tz tz tz
✔ Answer: B. Severe Combined Immunodeficiency (SCID).
tz tz tz tz tz tz
📖 Rationale: Severe Combined Immunodeficiency (SCID) is a primary immunodeficiency caused by inherite
tz tz tz tz tz tz tz tz tz tz tz tz
d genetic defects affecting both T and B lymphocyte development and function. It results in virtually absent ad
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
aptive immunity. Affected infants present with recurrent, severe infections early in life. SCID is sometimes call
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
ed 'bubble boy disease' because patients must be kept in sterile environments.
tz tz tz tz tz tz tz tz tz tz tz
9. Which type of hypersensitivity reaction is responsible for contact dermatitis caused by poison i
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
vy?
A. Type I - IgE-mediated tz tz tz tz
B. Type II - Cytotoxic tz tz tz tz
C. Type III - Immune complex-mediated
tz tz tz tz tz
D. Type IV - Delayed (cell-mediated)
tz tz tz tz tz
✔ Answer: D. Type IV - Delayed (cell-mediated)
tz tz tz tz tz tz tz
📖 Rationale: Contact dermatitis from poison ivy is a classic Type IV hypersensitivity reaction. Sensitized T ly
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
mphocytes recognize the hapten (urushiol) bound to skin proteins. On re-
tz tz tz tz tz tz tz tz tz tz
exposure, T cells release cytokines causing local inflammation 24–
tz tz tz tz tz tz tz tz
72 hours after contact. No antibodies or complement are involved.
tz tz tz tz tz tz tz tz tz
10. A patient is diagnosed with systemic lupus erythematosus (SLE). Which type of hypersensitiv
tz tz tz tz tz tz tz tz tz tz tz tz tz
ity reaction underlies the tissue damage in SLE?
tz tz tz tz tz tz tz
A. Type I tz tz
B. Type II tz tz
C. Type IIItz tz
D. Type IV tz tz
✔ Answer: C. Type III
tz tz tz tz
📖 Rationale: SLE is a Type III (immune complex-mediated) hypersensitivity reaction. Antigen-
tz tz tz tz tz tz tz tz tz tz tz
antibody complexes (anti- tz tz
dsDNA and other autoantibodies) deposit in tissues such as the glomeruli, blood vessels, and joints. These co
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
mplexes activate complement, causing inflammation and tissue injury characteristic of the disease.
tz tz tz tz tz tz tz tz tz tz tz
11. Which immunoglobulin is primarily responsible for mediating Type I hypersensitivity reaction
tz tz tz tz tz tz tz tz tz tz tz
s?
A. IgA tz
B. IgG tz
C. IgM tz
D. IgE tz
✔ Answer: D. IgE
tz tz tz
📖 Rationale: IgE is the primary antibody mediating Type I (immediate) hypersensitivity reactions. IgE binds t
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
o high-affinity Fc receptors on mast cells and basophils. When antigen cross-
tz tz tz tz tz tz tz tz tz tz tz
links adjacent IgE molecules, it triggers degranulation and release of histamine, prostaglandins, and leukotrien
tz tz tz tz tz tz tz tz tz tz tz tz tz
es, causing immediate allergic symptoms.
tz tz tz tz
Page 4 of 31 tz tz tz
MIDTERM EXAM
Advanced Pathophysiology
Chamberlain University
100 Exam-Style Practice Questions
Immunology, Hypersensitivity & Immunodeficiency
With Highlighted Answers & Detailed Rationales
✔ Correct answers are highlighted in green
📖 Rationales are highlighted in yellow
,1. Which of the following is the underlying pathology for hay fever?
tz tz tz tz tz tz tz tz tz tz tz
A. Formation of autoantibodies.
tz tz tz
B. Activation of complement.
tz tz tz
C. Destruction by T-cells.
tz tz tz
D. Mast cell degranulation.
tz tz tz
✔ Answer: D. Mast cell degranulation.
tz tz tz tz tz
📖 Rationale: Hay fever (allergic rhinitis) is a Type I (IgE-
tz tz tz tz tz tz tz tz tz tz
mediated) hypersensitivity reaction. Allergens cross-
tz tz tz tz
link IgE antibodies on mast cells, triggering degranulation and release of histamine and other mediators, causi
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
ng the classic symptoms of sneezing, itching, and nasal congestion.
tz tz tz tz tz tz tz tz tz
2. Which of the following assessment findings would be expected in a patient who presents with u
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
rticaria?
A. Eosinophilia.
tz
B. Decreased thyroid-stimulation hormone level.
tz tz tz tz
C. Thrombocytopenia.
tz
D. Leukopenia.
tz
✔ Answer: A. Eosinophilia.
tz tz tz
📖 Rationale: Urticaria (hives) is an allergic reaction involving IgE-
tz tz tz tz tz tz tz tz tz
mediated mast cell degranulation. Eosinophils are recruited to sites of allergic inflammation and are elevated i
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
n the blood (eosinophilia) during allergic reactions. Eosinophils help modulate the immune response by releasi
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
ng enzymes that inactivate mast cell mediators.
tz tz tz tz tz tz
3. The diagnosis for an individual who presents to the office with sudden swollen lips and eyes, s
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
hortness of breath, and throat tightness after a bee sting is:
tz tz tz tz tz tz tz tz tz tz
A. Anaphylaxis. tz
B. Asthma. tz
C. Angioedema. tz
D. Reactive airway disease. tz tz tz
✔ Answer: A. Anaphylaxis.
tz tz tz
📖 Rationale: Anaphylaxis is a severe, life-
tz tz tz tz tz tz
threatening systemic Type I hypersensitivity reaction triggered by allergens such as bee venom. It involves ma
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
ssive IgE- tz
mediated mast cell degranulation causing angioedema, bronchospasm (throat tightness/shortness of breath),
tz tz tz tz tz tz tz tz tz tz tz
and potentially circulatory collapse. Immediate epinephrine is the treatment of choice.
tz tz tz tz tz tz tz tz tz tz
4. Damage occurs with ABO incompatibility because:
tz tz tz tz tz tz
A. Mast cell degranulation. tz tz tz
B. Autoantibodies specific for thyroid tissue impair the receptors for TSH.
tz tz tz tz tz tz tz tz tz tz
C. Antigen/Antibody complexes attack the RBC.
tz tz tz tz tz
D. Complement damages RBC membrane causing cell lysis.
tz tz tz tz tz tz tz
Page 2 of 31 tz tz tz
,✔ Answer: D. Complement damages RBC membrane causing cell lysis.
tz tz tz tz tz tz tz tz tz
📖 Rationale: ABO incompatibility is a Type II (cytotoxic) hypersensitivity reaction. Preformed IgM antibodies
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
against incompatible ABO antigens activate the complement cascade, which damages and lyses the red bloo
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
d cell membrane, leading to intravascular hemolysis, hemoglobinuria, and potentially acute renal failure.
tz tz tz tz tz tz tz tz tz tz tz tz
5. Which of the following statements is true about a primary immunodeficiency?
tz tz tz tz tz tz tz tz tz tz tz
A. It is the result of a single gene defect.
tz tz tz tz tz tz tz tz tz
B. It appears primarily in older adults.
tz tz tz tz tz tz
C. It is usually inherited.
tz tz tz tz
D. It is the result of multiple gene defects.
tz tz tz tz tz tz tz tz
✔ Answer: C. It is usually inherited.
tz tz tz tz tz tz
📖 Rationale: Primary immunodeficiencies are disorders caused by intrinsic defects in the immune system,
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
most often due to genetic mutations inherited from one or both parents. They typically manifest in infancy or ea
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
rly childhood and may involve defects in B cells, T cells, complement, or phagocytes. While some are single-
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
gene defects, the defining feature is that they are usually inherited.
tz tz tz tz tz tz tz tz tz tz
6. ________________ is a predominant cause of secondary immune deficiencies worldwide.
tz tz tz tz tz tz tz tz tz tz
A. Malnutrition. tz
B. HIV infection. tz tz
C. Chemotherapy. tz
D. Autoimmune disease. tz tz
✔ Answer: A. Malnutrition.
tz tz tz
📖 Rationale: Malnutrition is the most common cause of secondary (acquired) immunodeficiency worldwide,
tz tz tz tz tz tz tz tz tz tz tz tz tz
particularly in developing countries. Protein- tz tz tz tz
energy malnutrition impairs production of lymphocytes, immunoglobulins, and complement proteins, leaving in
tz tz tz tz tz tz tz tz tz tz tz
dividuals vulnerable to opportunistic and common infections.
tz tz tz tz tz tz
7. An example of a secondary immunodeficiency is:
tz tz tz tz tz tz tz
A. Job Syndrome. tz tz
B. Common Variable Immunodeficiency.
tz tz tz
C. Familial Mediterranean Fever.
tz tz tz
D. Pneumocystis Carinii pneumonia (PCP).
tz tz tz tz
✔ Answer: D. Pneumocystis Carinii pneumonia (PCP).
tz tz tz tz tz tz
📖 Rationale: Pneumocystis carinii (now jirovecii) pneumonia is an opportunistic infection that arises in indivi
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
duals with secondary (acquired) immunodeficiency, most notably AIDS (HIV infection). It is not a primary immu
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
nodeficiency itself but serves as an indicator disease of profound immune suppression. Job Syndrome and Co
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
mmon Variable Immunodeficiency are examples of primary immunodeficiencies.
tz tz tz tz tz tz tz
8. An example of a primary immunodeficiency is:
tz tz tz tz tz tz tz
A. Sinopulmonary infections due to HIV.
tz tz tz tz tz
B. Severe Combined Immunodeficiency (SCID).
tz tz tz tz
Page 3 of 31 tz tz tz
, C. Immunosuppression from corticosteroids.
tz tz tz
D. Lymphopenia secondary to chemotherapy.
tz tz tz tz
✔ Answer: B. Severe Combined Immunodeficiency (SCID).
tz tz tz tz tz tz
📖 Rationale: Severe Combined Immunodeficiency (SCID) is a primary immunodeficiency caused by inherite
tz tz tz tz tz tz tz tz tz tz tz tz
d genetic defects affecting both T and B lymphocyte development and function. It results in virtually absent ad
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
aptive immunity. Affected infants present with recurrent, severe infections early in life. SCID is sometimes call
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
ed 'bubble boy disease' because patients must be kept in sterile environments.
tz tz tz tz tz tz tz tz tz tz tz
9. Which type of hypersensitivity reaction is responsible for contact dermatitis caused by poison i
tz tz tz tz tz tz tz tz tz tz tz tz tz tz
vy?
A. Type I - IgE-mediated tz tz tz tz
B. Type II - Cytotoxic tz tz tz tz
C. Type III - Immune complex-mediated
tz tz tz tz tz
D. Type IV - Delayed (cell-mediated)
tz tz tz tz tz
✔ Answer: D. Type IV - Delayed (cell-mediated)
tz tz tz tz tz tz tz
📖 Rationale: Contact dermatitis from poison ivy is a classic Type IV hypersensitivity reaction. Sensitized T ly
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
mphocytes recognize the hapten (urushiol) bound to skin proteins. On re-
tz tz tz tz tz tz tz tz tz tz
exposure, T cells release cytokines causing local inflammation 24–
tz tz tz tz tz tz tz tz
72 hours after contact. No antibodies or complement are involved.
tz tz tz tz tz tz tz tz tz
10. A patient is diagnosed with systemic lupus erythematosus (SLE). Which type of hypersensitiv
tz tz tz tz tz tz tz tz tz tz tz tz tz
ity reaction underlies the tissue damage in SLE?
tz tz tz tz tz tz tz
A. Type I tz tz
B. Type II tz tz
C. Type IIItz tz
D. Type IV tz tz
✔ Answer: C. Type III
tz tz tz tz
📖 Rationale: SLE is a Type III (immune complex-mediated) hypersensitivity reaction. Antigen-
tz tz tz tz tz tz tz tz tz tz tz
antibody complexes (anti- tz tz
dsDNA and other autoantibodies) deposit in tissues such as the glomeruli, blood vessels, and joints. These co
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
mplexes activate complement, causing inflammation and tissue injury characteristic of the disease.
tz tz tz tz tz tz tz tz tz tz tz
11. Which immunoglobulin is primarily responsible for mediating Type I hypersensitivity reaction
tz tz tz tz tz tz tz tz tz tz tz
s?
A. IgA tz
B. IgG tz
C. IgM tz
D. IgE tz
✔ Answer: D. IgE
tz tz tz
📖 Rationale: IgE is the primary antibody mediating Type I (immediate) hypersensitivity reactions. IgE binds t
tz tz tz tz tz tz tz tz tz tz tz tz tz tz tz
o high-affinity Fc receptors on mast cells and basophils. When antigen cross-
tz tz tz tz tz tz tz tz tz tz tz
links adjacent IgE molecules, it triggers degranulation and release of histamine, prostaglandins, and leukotrien
tz tz tz tz tz tz tz tz tz tz tz tz tz
es, causing immediate allergic symptoms.
tz tz tz tz
Page 4 of 31 tz tz tz
