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Immunopathological processes
1. A 15 year old boy died of the heart failure. He had a history of rheumatic heart disease in his medical record. Histological investigation of the left auricle of the heart revealed the rheumatic granuloma (the Aschoff-Talalayev body) with a central fibrinous focus associated, with a perimeter plasma cells, macrophages and giant cells. Which of following best describe the type of immune response?
A. *Cell mediated (Type IV, delayed hyper sensitivity reaction)
B. Anaphylactic (Type I, immediate)
C. Cytolytic (Type II, immediate)
D. Immune complex (Type III, immediate)
E. Reaction of transplant rejection.
2. A 4-yers-old boy presents with multiple malformation of craniofacial bones. He died soon due to sepsis, resulted from bronchopneumonia. Blood test revealed the immunoglobulins within normal range. At autopsy the thymical aplasia was identified. Name the mane cause of death.
A. *Cellular immunodeficiency
B. Combined immunodeficiency
C. Secondary immunodeficiency
D. Acute leukemia
E. Chronic intoxication
3. A 48-year-old women with asthma presents with viral respiratory infection. The infection caused a status asthmaticus with a fatal outcome. Histological investigation of lung tissue revealed a contracted bronchus and a luminal plug containing mucus and cell debris. The submucosa was edematous and contained a mixed inflammatory infiltrate, including a lot of eosinophils and degranulated must cells. What is the mechanism of hypersensitivity presented in this case?
A. *Humoral immunity (Type I, anaphylactic reaction)
B. Inflammatory reaction
C. Autoimmune reaction
D. Immune complex reaction (Type III of reaction)
E. Cell-mediated immunity (Type IV of reaction)
4. A young man presents with the enlargement of the regional lymph nodes next to his inflamed wound. Histological investigation of the lymph node biopsy revealed the increased number of macrophages, lymphocytes and lymphoid follicules within cortex zone. Plasma cells number also increased. These alterations are most likely result of:
A. *Antigen stimulation
B. The acquired insufficiency of lymphoid tissue (secondary immunodeficiency state)
C. Hereditary immunodeficiency state
D. Neoplastic transformation
E. Hypersensitivity reaction
5. A newborn died after 3 days of life, as a result of a lethal outcome of intrauterine pneumonia. At autopsy a newborn is sound have a great reduction of his thymic weight and it’s sizes. Histological investigation of thymus revealed the unclear boundary between cortex and medulla zone as a result of lymphocytes amount reduction. A few Hassall corpuscles were found. They were focally keratinized and had concentric aggregated of epithelial cells. The gland was also exhibited lobe atrophy and sclerosis. What pattern of reaction did the thymus demonstrate?
A. *Accidental thymus transformation (involution)
B. Thymus atrophy
C. Thymus hypotrophy
D. Thymus aplasia (agenesis)
E. Thymus neoplasia
6. A 3-month-old child died because of sepsis. An autopsy revealed thymic hypoplasia, both sizes and mass of spleen reduction. Histologically, in spleen there was lack of the periarterial follicular T-zone and remarkable absence of cells at a red spleeny pulp. Lymph nodes investigation showed also absence of cells within paracortical (T-cells area). B-cells areas in immune system organs looked normal. What term best characterizes described above changes?
A. Di George’s syndrome
B. Combined immunodeficiency syndrome
C. Bruton’s disease (X-linked agammaglobulinemia)
D. Accidental thymus transformation
E. Acquired immunodeficiency syndrome (AIDS)
7. A morphological investigation of a kidney graft revealed a diffuse stromal infiltration by lymphocytes, plasmocytes, lymphoblasts, plasmablasts, and also a necrotic arteriitis. What pathology has developed in a graft?
A. *Immunological graft rejection
B. Glomerulonephritis
C. Ischemic kidney damage
D. Tubular necroses
E. Pyelonephritis
8. An 8-year-old girl, with a history of acute tonsillitis 3 weeks before the application, presented with nephrotic syndrome (proteinuria, haematuria and cylindruria). These testify the glomerular basal membrane’s lesion. What is the mechanism of the basal membrane pathology?
A. * Immune complex mechanism
B. Granulomatous mechanism
C. Antibody-mediated mechanism
D. Reagin-mediated mechanism
E. Cytotoxical mechanism
9. At 46-year-old patient with autoimmune gastritis a biopsy was taken. Histologically, there was an infiltration by lymphocytes and macrophages of a gastric mucous membrane. What type of hypersensitivity presented in that case?
A. * Type IY (cell-mediated hypersensitivity)
B. Type II (reagin type)
C. Type II (antibody-mediated cytotoxicity)
D. Type III (immune complex cytotoxicity)
E. Type V (granulomatous)
10. Histological investigation of a lymph node revealed a considerable quantity of the enlarged lymphoid follicles with big germinal centers, and plenty of mitotic figures. What pathology these changes are characteristic for?
A. *Antigen stimulation with follicle hyperplasia
B. Atrophy of lymphoid tissue
C. Lymphosarcoma
D. Lymphogranulomatosis
E. Lympholeukemia
11. A child had a subcutaneous injection of tuberculin for a testing. Twenty-four hours later a physical examination revealed the expressed hyperemia and induration of tissues in the place of injection. What was the mechanism of these changes?
A. *Cellular cytotoxicity
B. Reagin cytotoxicity
C. Antibody cytotoxicity
D. Granulomas formation
E. Immune complex
12. A 6-year-old child had the Mantoux test. In 3 days there was an inflammatory induration and a reddening of a skin 15 mm in diameter. That was considered as the positive test. What type of hypersensitivity reaction presented in that case?
A. *Hypersensitivity of slow type
B. Immune complex hypersensitivity
C. Complement-mediated cytotoxicity
D. Hypersensitivity immediate type
E.
13. Physical examination of a pregnant woman with an Rh-negative blood revealed a high level of antierythrocyte antibodies. The cutaneous flap of her Rh-positive husband applied for depression of antibodies. In 2 weeks a flap was rejected. Microscopical investigation showed a disturbance of blood circulation, edema and cellular infiltration mainly by lymphocytes, neutrophils and macrophages. What is the most probable pathology?
A. *Transplantation immunity
B. Hypersensitivity reaction immediate type
C. Hypersensitivity reaction slow type
D. Granulomatous inflammation
E. Interstitial inflammation
14. A 3-year-old child died of an acute destructive staphylococcal pneumonia. Macroscopically, thymus mass reduced to 3,0 gr. Microscopical investigation of thymus showed reduction of lobules, considerable decline of lymphocytes quantity, stromal collapse, and inversion of layers with cystic enlargement of the Hassall’s bodies. What is the most likely diagnosis?
A. *Accidental thymus involution
B. Thymomegaly
C. Thymus hypoplasia
D. Thymus dysplasia
E. Thymus agnenesia
15. The experiment animal with a history of previous sensibilization received the next subcutaneous dose of antigen. In the place of injection a fibrinous inflammation with alteration of vessels walls, matrix and fiber structures of connective tissue (mucoid and fibrinoid swelling) and fibrinoid necrosis developed. What immunological reaction takes place?
A. * Hypersensitivity reaction immediate type
B. Hypersensitivity reaction slow type
C. Reaction of transplantation immunity
D. Normergic reaction
E. Granulomatosis
16. A man with a history of bronchial asthma died of asphyxia. Microscopical investigation of lungs revealed excess of mucus with lots of eosinophils in the bronchial lumen, sclerosis of interalveolar septas and alveoli dilatation. What mechanism of hypersensitivity reaction presented in that case?
A. *Reagin reaction
B. Cytotoxic reaction
C. Immune complex reaction
D. Cytolysis, conditioned by lymphocytes
E. Granulomatosis
17. The infiltration anesthesia by ultracain with adrenaline solution has been done to a young man. Then redness, edema of the skin with itchy blisters suddenly developed. What type of hypersensitivity took place?
A. * Anaphylaxis
B. Cytotoxicity
C. Immune complex damage
D. Hypersensitivity slow type
E. Granulomatosis
18. A 33-year-old patient with a history of acute tonsillitis presented with the urinary syndrome (haematuria, proteinuria and leukocyturia). Kidneys biopsy revealed an intracapillary proliferative glomerulonephritis. Electronic microscopy determined large subepithelial deposits. What is the pathogenesis of this disease?
A.*Immune complex mechanism
B. Atopy
C. Cytotoxic, cytolytic action of antibodies
D. Cellularally caused cytolysis
E. Granulomatosis
19. A 10-month-old child has developed pneumonia. Clinical and laboratory tests revealed absence of mature B-lymphocytes in peripheral blood and in B-zones of lymph nodes, acute reduction of immunoglobulins in serum. In peripheral blood a total quantity of lymphocytes was normal. What kind of an immunodeficiency developed in that case?
A. *Brutone sindrome
B. Neselof syndrome
C. Severe combined immunodeficiency
D. Di-George syndrome
E. Viskotta-Oldrich syndrome
20. A patient with a history of serious radioactive irradiation had bone marrow transplantation. In 2 months a rush on the skin and diarrhea developed. Clinical and laboratory tests showed hepatic insufficiency, local necrosis of the skin’s epithelial cells, intestinal crypts and liver parenchymal cells. What was the reason for symptoms aggravation?
A. * ”Graft against the owner” disease
B. Sepsis development
C. An acute graft rejection
D. A chronic graft rejection
E. An exacerbation of a chronic hepatitis
21. A 7-month-old child died of severe pneumonia complicated by sepsis. A post-mortem revealed an absence of thymus. In lymph nodes there were no lymphoid follicles and cortical substance, in a spleen follicles were markedly reduced, germinal centers were absent. What is the most likely diagnosis?
A. *Thymus agenesia
B. Thymus aplasia
C. Thymus atrophy
D. Thymus hypoplasia
E. Acidental thymus involution
22. A 1-year-old child died of a relapsing pneumonia. A post-mortem revealed hypoplasia of a thymus and peripheral lymphoid tissue, atrophy of cerebellum cortex, angiotelectasis of bulbar conjunctiva. Immunohistochemistry revealed decreased level of immunoglobulins. What is the most likely disease?
A. * Louis-Bar’s syndrome
B. Di-George syndrome
C. Nezelof syndrome
D.West’s syndrome
E. Brutone syndrome
23. A 20-year-old woman died of postnatal sepsis. A post-mortem revealed enlarged congested spleen with abundant curettage from a cut section. Microscopical investigation showed hyperplasia and infiltration by plasmocytes of the red pulp and spleen’s follicles. The red pulp was also rich with macrophages. What pathology resulted in spleen’s alteration?
A. * Antigenic stimulation of an organism
B. Hereditary insufficiency of a peripheric lymphoid tissue
C. Reaction of hypersensitivity of immediate type
D. Reaction of hypersensitivity of the slowed type
E. Autoimmunization
24. Microscopical investigation of arterioles showed plasmatic saturation, mucoid and fibrinoid swelling, fibrinoid necrosis of walls, diffuse infiltration by lymphocytes, plasmocytes and monocytes. In addition, the focal proliferation of hystiocytes, endotheliocytes and pericytes were determined. The final diagnosis was the “periarteritis nodosa”. What type of inflammation took place in arterioles?
A. * Acute immune inflammation
B. Acute not immune inflammation
C. Focal exudative inflammation
D. Diffusive exudative inflammation
E. Fibrinous inflammation
25. During operation of kidney transplantation in 15 minutes after vascular anastomoses application, transplant became flabby, cyanotic and spotty; the pulsation was absent. Microscopical investigation of a kidney specimen revealed periendothelial accumulation of neutrophils in glomeruli vessels. In addition there were also a thrombosis and necrosis of some glomeruli. Specify the type of graft rejection.
A. *Hyperacute rejection
B. Accelerated rejection
C. Acute intersticial rejection
D. Acute vascular rejection
E. Chronic rejection
26. A 30 year old woman has applied a lipstick with a fluorescent substance for a long time. Then she got a limited erythema and slight peeling on her lip border, later there appeared transversal striae and cracks. Special methods of microscopic examination of the affected area helped to reveal sensibilized lymphocytes and macrophages in the connective tissue; cytolysis. What type of immunological hypersensitivity was developed?
A. *IV type (cellular cytotoxicity)
B. I type (reaginic)
C. III type (immune complex cytotoxicity)
D. II type (antibody cytotoxicity)
E. Granulomatosis
27. 48 hours after tuberculine test (Mantoux test) a child had a papule 10 mm in diameter on the spot of tuberculine injection. What hypersensitivity mechanism underlies these changes?
A. *Cellular cytotoxicity
B. Granulomatosis
C. Antibody-dependent cytotoxicity
D. Anaphylaxy
E. Immunocomplex cytotoxicity