Essentials of Human Anatomy and Physiology, 11e (Marieb) Chapter 12 The Lymphatic System and Body Defenses 12.1 Multiple Choice Part I Questions Using Figure 12.1, identify the following: 1) A lymph capillary is indicated by. A) Label A B) Label B C) Label C D) Label D E) Label E Page Ref: 399 1
2) A lymph node is indicated by. A) Label A B) Label B C) Label C D) Label D E) Label E Page Ref: 399 3) The lymph duct is indicated by. A) Label A B) Label B C) Label C D) Label D E) Label E Page Ref: 399 4) Blood capillaries are indicated by. A) Label A B) Label B C) Label C D) Label D E) Label E Answer: E Page Ref: 399 5) Lymphatic collecting vessels are indicated by. A) Label A B) Label B C) Label C D) Label D E) Label E Page Ref: 399 2
Using Figure 12.2, identify the following: 6) The spleen is indicated by. A) Label A B) Label B C) Label C D) Label D 3
7) The tonsils are indicated by. A) Label A B) Label B C) Label C D) Label D 8) The thymus is indicated by. A) Label A B) Label B C) Label C D) Label D 9) The Peyer's patches are indicated by. A) Label A B) Label B C) Label C D) Label D 10) The lymphoid organ that destroys worn-out blood cells is indicated by. A) Label A B) Label B C) Label C D) Label D Bloom's: 2) Comprehension 11) The lymphoid tissues that trap and remove bacteria that enter the throat are indicated by. A) Label A B) Label B C) Label C D) Label D Bloom's: 2) Comprehension 4
12) Lymph fluid and some plasma proteins originate (escape) from the. A) intracellular fluid B) blood vascular system C) endocrine system D) respiratory system Page Ref: 399 13) Excess accumulation of fluid, which impairs the exchange of materials within the tissues, is called. A) stroke B) shock C) edema D) MALT (mucosa-associated lymphatic tissue) Page Ref: 399 14) The duct drains lymph from the right arm and the right side of the head and thorax. A) brachiocephalic B) subclavian C) thoracic D) right lymphatic Page Ref: 400 15) Bacteria and tumor cells are removed from lymph by. A) lymph nodes B) tonsils C) the spleen D) thymus Page Ref: 400 16) The role of the is to trap and remove bacteria or other foreign pathogens entering the throat. A) thymus B) spleen C) tonsils D) lymph node 5
17) Peyer's patches and the tonsils are part of the collection of small lymphoid tissues that protect the upper respiratory and digestive tracts from infection and are referred to as. A) lymph nodes B) MALT or mucosa-associated lymphatic tissue C) germinal centers D) lymphatics 18) Harmful or disease-causing microorganisms from which nonspecific defenses protect the body are called. A) macrophages B) antibodies C) pathogens D) allergens Page Ref: 405 19) Redness, heat, swelling, and pain are the four most common indicators of. A) fever B) dehydration C) edema D) acute inflammation Page Ref: 406 20) The third line of defense involves the adaptive response mediated by. A) lymphocytes B) antigens C) mucous membranes D) pathogens Page Ref: 404, 408, 410 6
21) The binding of complement proteins to certain sugar or proteins on a foreign cell's surface is called. A) cellular immunity (cellular-mediated immunity) B) complement fixation C) positive chemotaxis D) diapedesis Page Ref: 410 22) Small proteins known as are secreted by virus-infected cells to help defend cells that have not yet been infected. A) haptens B) pyrogens C) interferons D) antigens Page Ref: 410 23) A(n) is any substance capable of mobilizing our immune system and provoking an immune response. A) interferon B) antibody C) antigen D) pyrogen Page Ref: 410, 411 24) Troublesome small molecules or incomplete antigens that may mount an attack that is harmful rather than protective are called. A) haptens B) antibodies C) pyrogens D) interferons Page Ref: 412 7
25) T cells or B cells that are capable of responding to a specific antigen by binding to it with antigen-specific receptors that appear on the lymphocyte's surface are considered. A) clones B) complement C) self-tolerant D) immunocompetent Page Ref: 412 26) The major role of cells is to engulf antigens and present pieces of them to the cells that will deal with those fragments. A) helper T B) antigen-presenting C) cytotoxic T D) killer Page Ref: 414 27) Active immunity to tetanus, whooping cough, and polio can be artificially acquired when we receive. A) vaccines B) serum C) antivenom D) antitoxin Page Ref: 416 28) Antibodies provided by serum from an immune donor or an animal donor do not challenge the B cells and thus provide. A) cellular or cell-mediated immunity B) active immunity C) natural immunity D) passive immunity Page Ref: 416 8
29) The region of the antibody that varies from antibody to antibody is called the region. A) regional or R B) variable or V C) constant or C D) stable or S Page Ref: 417 30) Large antigen-antibody complexes can become insoluble and settle out of solution, a reaction called. A) neutralization B) complement fixation C) precipitation D) agglutination Page Ref: 420 31) Killer T cells, which kill virus-invaded body cells, are also called. A) cytotoxic T cells B) regulatory T cells C) antigen-presenting cells D) helper T cells Page Ref: 421 32) Tissue grafts harvested from a different animal species are known as. A) xenografts B) autografts C) allografts D) isografts Page Ref: 425 33) Systemic (body-wide) acute allergic response caused by allergens that directly enter the blood, as with certain bee stings or spider bites, is called. A) myasthenia gravis B) rheumatic fever C) anaphylactic shock D) delayed hypersensitivity Page Ref: 426 9
34) AIDS cripples the immune system by interfering with the activity of cells called. A) antigen-presenting cells B) plasma cells C) memory cells D) helper T cells Page Ref: 428-429 35) A tropical disease that results when parasitic worms clog the lymphatic vessels is called. A) glomerulonephritis B) elephantiasis C) appendicitis D) allergic contact dermatitis Page Ref: 431 12.2 Multiple Choice Part II Questions 1) Lymph is largely composed of water that has escaped from. A) cytosol B) cerebrospinal fluid C) saliva D) tears E) blood Answer: E Page Ref: 399 2) The right lymphatic duct collects lymph from the. A) right arm B) right leg C) left leg D) left side of the head E) right and left legs Page Ref: 400 10
3) Lymph from the left arm returns to the heart through the. A) inferior vena cava B) left subclavian vein C) left external jugular vein D) left subclavian artery E) aorta Page Ref: 400 Bloom's: 3) Application 4) Which one of the following is NOT a mechanism that aids lymph return to the heart? A) milking action of skeletal muscles B) pressure changes within the thorax C) the pumping action of the heart D) smooth muscle contractions within the lymphatic vessels E) presence of valves within the larger lymph vessels Page Ref: 399-400 5) What structure carries lymph into a lymph node? A) trabeculae B) afferent lymphatic vessel C) follicles D) efferent lymphatic vessel E) germinal center Page Ref: 402 6) Which lymphatic organ's major job is to destroy worn-out red blood cells and return some of the products to the liver? A) tonsils B) spleen C) thymus gland D) appendix E) Peyer's patches 11
7) Which lymphoid tissues trap and remove bacteria entering the throat? A) axillary lymph nodes B) cervical lymph nodes C) tonsils D) Peyer's patches E) thymus gland 8) The thymus is most active during. A) infancy B) adolescence C) middle age D) old age E) the entire lifetime 9) What lymphoid organ stores platelets and acts as a blood reservoir? A) thymus B) spleen C) appendix D) tonsils E) Peyer's patches 10) The lymph tissues found within the walls of the small intestine are called. A) tonsils B) appendix C) Peyer's patches D) thymus tissues E) intestinal nodes 12
11) Where is the thymus located? A) pharynx B) beneath sternum overlying heart C) armpits, groin, and neck D) small intestine E) left side of abdominopelvic cavity 12) Mucosa-associated lymphatic tissue (MALT) includes the. A) spleen B) thymus C) tonsils only D) tonsils, the appendix, and Peyer's patches E) tonsils and spleen 13) The body's first line of defense against the invasion of disease-causing microorganisms is. A) phagocytes B) natural killer cells C) skin and mucous membranes D) inflammatory response E) fever Page Ref: 404, 405, 406 14) The adaptive (specific) defense system. A) is an innate defense B) issues an attack specific to particular foreign substances C) includes the skin and mucous membranes D) is the body's first line of defense against invading pathogens E) provides mechanical barriers to the body Page Ref: 404 13
15) Which one of the following is NOT one of the nonspecific body defenses? A) intact skin B) antibody production C) the inflammatory response D) fever E) natural killer cells Page Ref: 404 16) The process by which neutrophils are squeezed through the capillary walls during the inflammatory process is called. A) agglutination B) chemotaxis C) diapedesis D) coagulation E) antibody production Page Ref: 408 17) Which of the following is NOT one of the four most common indicators of the inflammatory response? A) redness B) heat C) swelling D) chills E) pain Page Ref: 406, 407 18) Chemotaxis is best described as. A) the movement of neutrophils through capillary walls B) the movement of cells along a chemical gradient C) the dilation of blood vessels D) the release of a lytic chemical by perforins E) the accumulation of excess fluids in tissue space Page Ref: 406 14
19) The inflammatory process begins with release of chemicals, which do all of the following EXCEPT. A) dilate blood vessels B) attract phagocytes to the area C) stimulate release of lysozyme D) cause capillaries to become leaky E) activate pain receptors Page Ref: 406-407 20) Membrane attack complexes (MAC) form holes in attacked cells causing them to burst; this is a result of. A) interferon B) complement fixation C) natural killer cells D) keratin E) phagocytes Page Ref: 410 21) What does fever accomplish? A) Fever inhibits bacteria reproduction and speeds the repair process. B) Fever promotes cell lysis by direct cell attack. C) Fever enables macrophages to attack microorganisms. D) Fever prevents the spread of pathogens to adjacent tissues. E) Fever prevents the formation of complement fixation. Page Ref: 410 Bloom's: 2) Comprehension 22) What inhibits viruses from entering and attacking healthy cells? A) membrane-attack complexes (MAC) B) keratin C) interferons D) pyrogens E) complement Page Ref: 410 15
23) The study of immunity is called. A) histology B) anatomy C) pathology D) immunology E) microbiology Page Ref: 411 24) Which of the following substances is NOT likely to trigger the immune response? A) pollen grains B) bacteria C) self-antigens D) fungi E) virus particles Page Ref: 412 25) Humoral immunity is provided by. A) pyrogens B) skin and mucous membranes C) interferon D) antibodies E) complement fixation Page Ref: 412 26) Regardless of whether it matures into a B cell or a T cell, a lymphocyte that is capable of responding to a specific antigen by binding to it is said to be. A) clonal B) incompetent C) immune D) immunocompetent E) complemented Page Ref: 412 16
27) The specific foreign substances that an individual's immune system has the ability to recognize and resist are determined by. A) individual exposure to the specific foreign substance B) individual genetic makeup C) the total number of lymphocytes present at a given time D) the total number of macrophages at a given time E) the total number of self-antigens at a given time Page Ref: 414 28) Lymphocytes are trained to be self-tolerant of. A) fungi B) foreign blood cells C) the body's own cells D) viruses E) bacteria Page Ref: 413 29) B cells develop immunocompetence in the. A) thymus gland B) bone marrow C) spleen D) thyroid gland E) lymph nodes Page Ref: 413 30) Antigen-presenting cells behave as. A) interferons B) pyrogens C) macrophages D) natural killer cells E) complement Page Ref: 414 17
31) How do plasma cells assist with humoral immunity? A) Plasma cells reproduce rapidly to crowd pathogens out of the blood. B) Plasma cells bind to viruses and bacteria to immobilize them. C) Plasma cells produce interferons. D) Plasma cells secrete highly-specific antibodies. E) Plasma cells secrete pyrogens. Page Ref: 415-416 Bloom's: 2) Comprehension 32) Vaccines are NOT for. A) pneumonia B) tetanus C) measles D) snake bites E) polio Page Ref: 417 33) Due to a recent respiratory illness from a viral infection, Jennifer has now developed. A) naturally acquired active immunity B) artificially acquired active immunity C) naturally acquired passive immunity D) artificially acquired passive immunity E) passively acquired natural immunity Page Ref: 416-417 Bloom's: 2) Comprehension 34) Which portion of the antibody's structure determines the antibody's class? A) variable region B) heavy chain C) constant region D) disulfide bonds E) light chain Page Ref: 417 18
35) Which one of the following is NOT true of the constant (C) regions of antibodies? A) The constant regions are the same or nearly the same on all antibodies. B) The constant regions form the "stem" of an antibody. C) The constant regions determine the specific type of antibody class formed. D) The constant regions form an antigen-binding site. E) The constant regions determine how an antibody class will carry out its immune role. Page Ref: 417 Bloom's: 2) Comprehension 36) Which one of the following is NOT one of the antibody classes? A) IgA B) IgB C) IgD D) IgG E) IgE Page Ref: 418-419 37) IgE. A) is mainly found in mucus and secretions such as tears and saliva B) is passed from mother to fetus during pregnancy C) is the most abundant antibody in blood plasma D) can fix complement E) is involved in allergies Answer: E Page Ref: 418-419 38) What is the chief way the body responds to antigens? A) agglutination B) chemotaxis C) complement fixation D) neutralization E) precipitation Page Ref: 410, 419 19
39) Which antibody-antigen interaction results when a foreign blood type is transfused and clumped? A) opsonization B) agglutination C) neutralization D) precipitation E) phagocytosis Page Ref: 419 40) The process by which antibodies bind to specific sites on bacterial exotoxins (toxic chemicals secreted by bacteria) to block their harmful effects is called. A) agglutination B) chemotaxis C) complement fixation D) neutralization E) precipitation Page Ref: 419 41) Antigen presentation is essential for the activation and clonal selection of. A) T cells B) B cells C) plasma cells D) antigen-presenting cells E) antibodies Page Ref: 420-421 42) What type of T cell releases cytokines to indirectly rid the body of antigens? A) helper T cells B) cytotoxic T cells C) regulatory T cells D) killer T cells E) suppressor T cells Page Ref: 421 20
43) What is the best graft to have so as to avoid rejection of a transplanted tissue? A) an autograft B) a graft from a recently deceased individuals C) a graft from another primate D) a xenograft E) an allograft Page Ref: 425 Bloom's: 4) Analysis 44) Which of the following is often used to treat allergies? A) corticosteroids B) antihistamines C) blood transfusions D) bone marrow transplants E) immunosuppressor drugs Page Ref: 426 45) Allergic contact dermatitis following skin contact with poison ivy would normally lead to. A) immediate hypersensitivity B) acute hypersensitivity C) delayed hypersensitivity D) anaphylactic shock E) immunodeficiency Page Ref: 427 46) Hannah has an auto-immune disease in which the beta cells of the pancreas are destroyed. As a result, she does not make enough insulin. What disease does she have? A) multiple sclerosis B) Graves' disease C) myasthenia gravis D) type I diabetes mellitus E) systemic lupus erythematosis Page Ref: 426 Bloom's: 3) Application 21
47) Which one of the following is NOT an autoimmune disease? A) AIDS B) multiple sclerosis C) Graves' disease D) type I diabetes mellitus E) rheumatoid arthritis Page Ref: 426 12.3 True/False Questions 1) The two main structures of the lymphatic system are the lymphatic vessels and the blood vessels. Answer: FALSE Page Ref: 398 2) All lymph rejoins the bloodstream via the subclavian veins. Answer: TRUE Page Ref: 399 3) The lymph nodes filter bacteria, viruses, and tumor cells from blood on its way back to the heart. Answer: FALSE Page Ref: 400 4) The role of the spleen in the lymphatic system is to provide a site for lymphocyte proliferation and immune surveillance. Answer: TRUE Page Ref: 402 5) The most important function of the thymus gland is to destroy worn-out red blood cells and return some of the products to the liver. Answer: FALSE 6) The innate (nonspecific) defense system and adaptive (specific) defense system make up the immune system. Answer: TRUE Page Ref: 404 22
7) Injured cells release chemicals such as histamine and kinins that dilate vessels, attract phagocytes and activate pain receptors. Answer: TRUE Page Ref: 406 8) The final disposal of cell debris as inflammation subsides is performed by neutrophils. Answer: FALSE Page Ref: 407-408 9) The nonspecific defense by which complement proteins attach to sugars or proteins on the surface of foreign cells is called complement fixation. Answer: TRUE Page Ref: 410 10) Chemicals secreted by white blood cells and macrophages exposed to foreign substances that can increase body temperature are called pyrogens. Answer: TRUE Page Ref: 410 11) The study of immunity and the immune system is called endocrinology. Answer: FALSE Page Ref: 411 12) Like all blood cells, lymphocytes originate from hemocytoblasts contained within red bone marrow. Answer: TRUE Page Ref: 412 13) B cells become immunocompetent in the thymus. Answer: FALSE Page Ref: 413 14) Antigen-presenting cells (APCs) engulf antigens and present them to cells that will deal with them. Answer: TRUE Page Ref: 414 23
15) Artificially acquired passive immunity is conferred when one receives immune serum for poisonous snake bites. Answer: TRUE Page Ref: 417 Bloom's: 3) Application 16) Antibodies are also referred to as immunoglobulins. Answer: TRUE Page Ref: 417 17) The constant region of the antibody joins heavy and light chains to form an antigen-binding site specifically made to fit an antigen. Answer: FALSE Page Ref: 417 18) The antibody a mother passes to her fetus is IgM. Answer: FALSE Page Ref: 418, 419 19) The process that occurs when antibodies clump foreign cells is called agglutination. Answer: TRUE Page Ref: 419 20) Cytotoxic T cells release perforins to creates pores in the target cell's membrane to kill the cell. Answer: TRUE Page Ref: 421 21) Antigen presentation is essential for the activation of clonal selection of T cells. Answer: TRUE Page Ref: 421 22) Xenografts are ideal donor organs or tissues since they rarely cause rejection. Answer: FALSE Page Ref: 425 24
23) Autoimmune disease arises when the immune system is no longer tolerant of self-antigens and antibodies are produced to attack the body's own tissues. Answer: TRUE Page Ref: 425-426 24) Allergies, or hypersensitivities, are normal immune responses. Answer: FALSE Page Ref: 426 25) Anaphylactic shock, an acute systemic allergic response, causes vasodilation and difficulty breathing. Answer: TRUE Page Ref: 426 26) As people age, they become more resistant to the development of autoimmune and immunodeficiency diseases. Answer: FALSE Page Ref: 431 25
12.4 Matching Questions Match the following descriptions with the appropriate lymphoid organ or tissue: A) thymus gland B) Peyer's patches C) tonsils D) spleen 1) Located on the left side of the abdominal cavity Page Ref: 402 2) Trap and remove bacteria and pathogens entering the throat 3) Located overlying the heart 4) Filters and cleanses the blood of bacteria, viruses, and other debris Page Ref: 402-403 5) Located in the wall of the small intestines 6) Located in the pharynx (throat) Answers: 1) D 2) C 3) A 4) D 5) B 6) C 26
Match the following terms with the correct description: A) pyrogen B) antigen C) cytokines D) mucus E) antibody F) interferon G) perforins 7) Any substance capable of provoking an immune response Page Ref: 412 8) Small protein that binds with receptors on healthy cells to promote protein synthesis and prevent viruses from binding Page Ref: 410 9) Chemical secreted by white blood cells and macrophages to raise the body's temperature Page Ref: 410 10) Chemical released by natural killer cells to cause cell lysis Page Ref: 421 11) Chemical released by macrophages and dendritic cells to activate many other immune cells Page Ref: 421 12) Protein secreted by activated B cells in response to an antigen Page Ref: 402, 412 13) Sticky substance in the respiratory and digestive passageways that trap microorganisms Page Ref: 405, 406 Answers: 7) B 8) F 9) A 10) G 11) C 12) E 13) D 27
Match the following biological function with its antibody class: A) Antigen-presenting cell (APC) B) Memory cell C) B cell D) Regulatory T cell E) Cytotoxic T cell F) Helper T cell G) Plasma cell 14) May exist in the body for years and enable a quick response to subsequent meetings with the same antigen Page Ref: 424 15) Slows or stops B and T cell activity once infection has been conquered Page Ref: 424 16) Cell that produces huge numbers of the same antibody (immunoglobulin) Page Ref: 424 17) Kills virus-infected cells, cancerous cells, and is involved in graft rejection Page Ref: 424 18) Engulfs and presents parts of antigens on the membrane for recognition by T cells bearing receptors for the same antigen Page Ref: 424 19) Progeny (clone members) of this cell form plasma cells and memory cells Page Ref: 424 20) Binds with a specific antigen presented by an antigen-presenting cell (APC) Page Ref: 424 Answers: 14) B 15) D 16) G 17) E 18) A 19) C 20) F 28
12.5 Essay Questions 1) Explain the origin and pathway of lymph. Answer: Lymph fluid arises from blood plasma that has been forced out of the capillary beds by osmotic and hydrostatic pressures. The fluid left behind is called interstitial fluid. The interstitial fluid is then picked up by lymph capillaries, after which it is called lymph. Lymph is routed up the lymphatic vessels until it is finally returned to the venous system through either the right lymphatic duct or the thoracic duct. Page Ref: 399-400 Bloom's: 2) Comprehension 2) Describe how the lymphatic and cardiovascular systems are similar in structure and function. Answer: Structurally, lymphatic vessels and the veins of the cardiovascular system are both thin-walled and operate under low-pressure. Some of the larger vessels in each system have valves. Functionally, both systems return fluids back to the heart. The lymphatic system is assisted by the same techniques as the cardiovascular system to return lymph (and venous blood) back to the heart: milking action of skeletal muscles, pressure changes in the thorax during breathing, and smooth muscles in the walls of the vessels. Page Ref: 400 Bloom's: 4) Analysis 3) Explain how the innate and adaptive immune systems differ in their responses to foreign substances. Answer: The innate immune system is the system we have when we're born. This system includes the skin and mucous membranes, the inflammatory response, and proteins already present in our cells. This system is the first one to come into contact with a foreign substance and thus is always prepared to defend the body. Therefore, we think of the innate system as the nonspecific body defense and the first line of defense to protection from invaders. The adaptive immune system is the second line of defense which defends us from specific invaders. This system consists of molecules like pyrogens and immune cells such as lymphocytes and macrophages. This system differs from the innate system since it must be exposed to the invader before it can form a response. Page Ref: 404 Bloom's: 4) Analysis 4) Identify the four most common indicators and major symptoms of an acute inflammatory response and explain their origins. Answer: The four most common indicators of the inflammatory response are redness, heat, swelling, and pain. Redness and heat are a result of dilation of blood vessels that increase blood flow to the injured area. Swelling occurs when increased permeability of the capillaries allows plasma to leak from the bloodstream into the tissue spaces. The excess fluid, or edema, triggers the activation of pain receptors in the area, accounting for the pain associated with an injury. Page Ref: 406 Bloom's: 2) Comprehension 29
5) List and describe the cells and chemicals the body uses as its second line of defense. Answer: 1. Phagocytes, such as neutrophils or macrophages, engulf foreign particles. These cells are in nearly every body organ and confront pathogens that make it through the surface membrane barriers. 2. Natural killer cells, found in blood and lymph, are lymphocytes. They can lyse and kill cancer cells and virus-infected body cells. 3. The inflammatory response is a nonspecific response that occurs when body tissues are injured. Page Ref: 406, 407 Bloom's: 2) Comprehension 6) Contrast the primary humoral response with the secondary humoral response. Answer: The primary humoral response occurs during the first encounter with an antigen. An antigen binds to a specific receptor on a specific B cell. The activated B cells proliferate to form a clone. While most of the B cell clone members become plasma cells that will secrete antibody molecules, B cells that do not become plasma cells will become memory cells. Memory cells exist for years and are capable of responding to the same antigen at a later meeting (immunological memory). Secondary humoral responses are the later immune responses that are faster, more prolonged, and more effective than the primary humoral response because preparations for this attack have already been made. Page Ref: 415-416 Bloom's: 4) Analysis 7) Let's suppose scientists have discovered a new disease that arises when antigen-presenting cells (APCs) are not made by the body. How do you think our immune response will be impacted? ntigen-presenting cells (APCs) engulf an antigen and present part of it on the membrane in combination with one of the APCs' own glycoproteins. T cells require the presentation of the antigen for activation and clonal selection. Without the presentation of antigens by APCs, the immune process would be severely impaired. T cell clone classes provide for cell-mediated immunity and include helper T cells, cytotoxic T cells, regulatory T cells, and memory cells. Page Ref: 414, 421 Bloom's: 3) Application 30