Immunology Review Corner

Immunology Review Corner: Chapter 66 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Drs. Eric Chenworth, Mayo Clinic; Karla R. Davis, Walter Reed Medical Center; Anne K. Ellis, McMaster University.

Chapter 66: Asthma Pathogenesis

1. Which cells are resident cells of the airways, rather than recruited from the circulation to the lungs?

A. Eosinophils
B. Mast cells
C. T-lymphocytes
D. Neutrophils

2. A 47-year-old man presents at the request of his employee-health physician for evaluation of possible occupational asthma. Which of the following statements regarding occupational asthma is most correct?

A. Occupational asthma is universally a progressive condition.
B. Occupational asthma is potentially curable with early removal of the worker from exposure to the sensitizing agent.
C. Occupational asthma is invariably due to a usual aeroallergen exposure.
D. Occupational asthma always occurs due to a hapten-induced specific IgE response.

3. After a documented case of Respiratory Syncytial Virus (RSV) bronchiolitis, approximately which percentage of patients will demonstrate persistent wheezing after 5 years?

A. 10%
B. 40%
C. 60%
D. 75%

4. Curschmann’s spirals are found within mucus plugs in asthmatic airways. Which cell type is often arranged in a spiral pattern, composing Curschmann’s spirals?

A. Dendritic cells
B. Eosinophils
C. Macrophages
D. Neutrophils

5. Which cells are considered to be the predominant and most characteristic cells in asthma?

A. Dendritic cells
B. Eosinophils
C. Macrophages
D. Neutrophils

6. Which of the following is the predominant cell found during virus-induced exacerbations of asthma?

A. Eosinophil
B. Mast cell
C. Lymphocyte
D. Neutrophil

7. Which of the following cytokines is thought to have regulatory functions, and contributes to fibroblast generation of extracellular matrix (ECM) proteins in asthma?

A. IL-1
B. IL-6
C. IFN-alpha
D. IL-11

8. Which of the following cytokines enhances the synthesis of collagens I and III, fibronectins, tenascin, and proteoglycans?

A. Insulin-like growth factor (IGF)
B. Platelet-derived growth factor (PDGF)
C. Transforming growth factor beta (TGF-beta)
D. Tumor necrosis factor (TNF)

9. You are asked by a concerned parent about a possible association of wheezing with allergy and viral airway infection. Which of the following is most correct?
A. Evidence of allergy in combination with the presence of virus in nasal secretions synergistically increases the odds ratio for wheezing.
B. It is unlikely that there is any increased risk for wheezing in allergic patients with viral airway infection versus non-allergic patients.
C. Common viral infections have no impact on lower airway function and wheezing.
D. Allergy alone accounts for virtually all cases of wheezing.

10. Neonatal T cells produce relatively low levels of which of the following cytokines?

A. IL-4
B. IL-5
C. IL-10
D. IFN-gamma

11. For low-molecular-weight chemicals implicated in occupational asthma, specific IgE or IgG antibodies have generally not been clearly implicated. For which of the following low-molecular-weight chemicals is an increased role of CD8+T cells in the absence of IgE suspected in occupational sensitization?

A. Acid anhydrides
B. Ethanolamines
C. Toluene isocynate
D. Plicatic acid

12. Eosinophil secondary granules contain four principal basic proteins. Which protein is believed to function as a parasitic toxin, may produce many of the deleterious effects on the airway tissue seen in asthma, and has been found in high concentrations near areas of desquamated epithelium in asthmatic airways?

A. Major basic protein (MBP)
B. Eosinophil cationic protein (ECP)
C. Eosinophil peroxidase (EPO)
D. Eosinophil-derived neurotoxin (EDN)

13. Which of the following prostanoids has bronchodilator and anti-inflammatory activity?

A. PGD 2
B. PGF 2 alpha
C. PGE 2
D. Thromboxane A2

14. Nonallergic asthma patients have a cytokine profile that includes predominant increased expression of which of the following cytokines?
A. IL-3
B. IL-4
C. IL-5
D. GM-CSF

15. A potential role for Chlamydia pneumoniae has been described in the pathogenesis of asthma and asthma exacerbations in some patients. With regard to these associations, which of the following statements is most correct?
A. C. pneumoniae induces a profound and universal Th2-type response in all patients regardless of HLA phenotype.
B. Intracellular bacteria such as C. pneumoniae down-regulate all cytokine production.
C. C. pneumoniae may stimulate Th2-type cytokines when presented in the context of HLA-DR15, while it may stimulate Th1-type cytokines when presented by cells expressing HLA-DR4.
D. An association between C. pneumoniae antibody titers and wheezing has not been demonstrated.

Answers
1. B, page 1178
2. B, page 1189
3. B, page 1183
4. C, page 1177
5. B, page 1178
6. D, page 1193
7. D, page 1189
8. C, page 1180
9. A, page 1187
10. D, page 1182
11. C, page 1189
12. A, page 1192
13. C, page 1194
14. C, page 1195
15. C, page 1188