Type Iii Hypersensitivity

TYPE III HYPERSENSITIVITY

Q. 1

‘Arthus reaction’ is best explained by which of the following immune reaction?

 A

Localized immune complex

 B

Ag-Ab reaction

 C

Compliment mediated

 D

Ab mediated

Q. 1

‘Arthus reaction’ is best explained by which of the following immune reaction?

 A

Localized immune complex

 B

Ag-Ab reaction

 C

Compliment mediated

 D

Ab mediated

Ans. A

Explanation:

Arthus reaction involves the formation of antigen/antibody complexes in the body after the intradermal injection of an antigen.

It is a type III or immune complex mediated hypersensitivity reaction.

Type III hypersensitivity involves antigen-antibody complexes which may precipitate around blood vessels and cell membranes causing damage.

Ref: Pathologic Basis Of Disease, Robbins, 6th Edition, Page 201; Chandrasoma Taylor 3rd Edition, Page 112; Textbook of Microbiology, Ananthanarayan and Paniker, 7th Edition, Chapter 18, Page 165.

 


Q. 2

Acute poststreptococcal glomerulonephritis is characterised by which of the following hypersensitivity reactions?

 A

Type II: Hypersensitivity

 B

Type IV: Cell-Mediated Hypersensitivity

 C

Tuberculin-Type Hypersensitivity

 D

Type III: Immune Complex Hypersensitivity

Q. 2

Acute poststreptococcal glomerulonephritis is characterised by which of the following hypersensitivity reactions?

 A

Type II: Hypersensitivity

 B

Type IV: Cell-Mediated Hypersensitivity

 C

Tuberculin-Type Hypersensitivity

 D

Type III: Immune Complex Hypersensitivity

Ans. D

Explanation:

Acute poststreptococcal glomerulonephritis is a well-known immune complex disease.

Its onset occurs several weeks after a group A alpha hemolytic streptococcal infection, particularly of the skin, and often occurs with infection due to nephritogenic types of streptococci. 

The complement level is typically low, suggesting an antigen–antibody reaction with consumption of complement.
Lumpy deposits of immunoglobulin and complement component C3 are seen along glomerular basement membranes stained by immunofluorescence, suggesting antigen–antibody complexes.
It is likely that streptococcal antigen–antibody complexes are filtered out by glomeruli, fix complement, and attract neutrophils.
This series of events results in an inflammatory process that damages the kidney.
 
Ref: Brooks G.F. (2013). Chapter 8. Immunology. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg’s Medical Microbiology, 26e.

Q. 3

Which one of the following is False –

 A

Theobald – smith phenomenon is a type 1 hypersensitivity reaction

 B

Serum sickness is a type 11 hypersensitivity reaction

 C

Allograft rejection is a type IV hypersensitivity reaction

 D

Transfusion reaction is a type II hypersensitivity reaction

Q. 3

Which one of the following is False –

 A

Theobald – smith phenomenon is a type 1 hypersensitivity reaction

 B

Serum sickness is a type 11 hypersensitivity reaction

 C

Allograft rejection is a type IV hypersensitivity reaction

 D

Transfusion reaction is a type II hypersensitivity reaction

Ans. B

Explanation:

Ans. is ‘b’ i.e., Serum sickness is a type II reaction


Q. 4

The hypersensitivity reaction involved in the hyper acute rejection of renal transplant is

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Q. 4

The hypersensitivity reaction involved in the hyper acute rejection of renal transplant is

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Ans. C

Explanation:

Ans. is ‘c’ i.e., Type III

 Pre-existing antibody against donor graft antigens can cause hyperacute graft rejection.

. This form of rejection occurs within minutes or hours after transplantation

“The graft becomes engorged and purple coloured . These early lesions point to an antigen-antibody reaction at the level of vascular endothelium. The antigen-antibody reaction produces an Arthus-type (type-III) immune complex injury in the vessels of the transplant.”


Q. 5

Note a delayed type of hypersensitive reactions

 A

Arthus reaction

 B

Bronchial asthma

 C

Hemolytic anemia

 D

All

Q. 5

Note a delayed type of hypersensitive reactions

 A

Arthus reaction

 B

Bronchial asthma

 C

Hemolytic anemia

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., Arthus reaction; ‘b’ i.e., Bronchial asthma; ‘c’ i.e., Haemolytic anemia


Q. 6

Which is an example of type-HI hypersensitivity

 A

Contact dermatitis

 B

Hemolytic anemia

 C

Serum sickness

 D

Good pasture syndrome

Q. 6

Which is an example of type-HI hypersensitivity

 A

Contact dermatitis

 B

Hemolytic anemia

 C

Serum sickness

 D

Good pasture syndrome

Ans. C

Explanation:

Ans. is ‘c’ i.e., Serum sickness


Q. 7

Arthus phenomenon is an example of which hypersensitivity –

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Q. 7

Arthus phenomenon is an example of which hypersensitivity –

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Ans. C

Explanation:

Ans. is ‘c’ i.e., Type III


Q. 8

Delayed type of hypersensitivity is seen in following except –

 A

Arthus phenomenon

 B

Contact dermatitis

 C

Tuberculin test

 D

Graft vs host reaction

Q. 8

Delayed type of hypersensitivity is seen in following except –

 A

Arthus phenomenon

 B

Contact dermatitis

 C

Tuberculin test

 D

Graft vs host reaction

Ans. A

Explanation:

Ans. is ‘a’ i.e., Arthus Phenomenon


Q. 9

Arthus reaction is what type of hypersensitivity reaction –

 A

Localized immune complex

 B

Ag – Ab reaction

 C

Compliment mediated

 D

Ab mediated

Q. 9

Arthus reaction is what type of hypersensitivity reaction –

 A

Localized immune complex

 B

Ag – Ab reaction

 C

Compliment mediated

 D

Ab mediated

Ans. A

Explanation:

Ans. is ‘a’ i.e., Localized immune complex


Q. 10

Large antigen – antibody reaction is required to cause –

 A

Serum sickness

 B

Arthus reaction

 C

Urticaria

 D

Anaphylactic-reaction

Q. 10

Large antigen – antibody reaction is required to cause –

 A

Serum sickness

 B

Arthus reaction

 C

Urticaria

 D

Anaphylactic-reaction

Ans. B

Explanation:

Ans. is ‘b’ i.e., Arthus reaction


Q. 11

Which of the following type hypersensitivity reactions occurs in Farmer’s lungs –

 A

Type I

 B

Type II

 C

Type III

 D

a and b

Q. 11

Which of the following type hypersensitivity reactions occurs in Farmer’s lungs –

 A

Type I

 B

Type II

 C

Type III

 D

a and b

Ans. C

Explanation:

Ans. is ‘c’ i.e., Type III

Hypersensitivity pneumonitis (including farmer ‘s lung) is an immunologically mediated response to an extrinsic antigen that involves both immune complex (type III) and delayed type (type IV) hypersensitivity reactions.


Q. 12

Hypersensitivity Pneumonitis is classically described as a:

 A

Type I hypersensitivity reaction

 B

Tye II hypersensitivity reaction

 C

Type III (Immune complex) Hypersensitivity

 D

Type IV (Cell mediated) Hypersensitivity

Q. 12

Hypersensitivity Pneumonitis is classically described as a:

 A

Type I hypersensitivity reaction

 B

Tye II hypersensitivity reaction

 C

Type III (Immune complex) Hypersensitivity

 D

Type IV (Cell mediated) Hypersensitivity

Ans. C

Explanation:

Answer is C  (Immune complex)

Hypersensitivity pneumonitis is an immunologically mediated response to an extrinsic antigen that involves both immune complex (Type III) and cell mediated (Type IV) hypersensitivity reactions.

Classically however, Hypersensitivity pneumonitis was believed to be a immune complex (Type III) mediated hypersensitivity response which is therefore the better answer amongst the options provided.

However in strict terminology both option C and D should be correct.

Types of Hypersensitivity Reactions: Review

 

Type I Hypersensitivity (IgE)Q

Type II Hypersensitivity (IgG & IgM)Q Cytotoxic, complement mediated lysisQ

 

Includes.-

•   Local: Eczema, Hay fever, Asthma

(Atopy).Q

•   Systemic: Anaphylaxis.

Examples based on type 1.11S Q:




Includes:

•   Complement mediated lysisY

•   Antibody dependent cell mediated toxicity (formerly classified as type

•   Changes in cellular function (former type V).Q

– Increased function: Grave’s disease.Q

– Decreased function: M. Gravis.e

•   PhagocytosisY

Examples includes:

1).Q

 

•   Theoblad Smith phenomenon:Q This is

anaphylaxis in guinea pigs.

•   PK reaction (Prusnitz Kunster):Q

Demonstrate that IgE is homocytotropic

i.e. species specific.

•   Casoni’s test: Immediate type (IgE) H.S

•    Those with Ag on RBC.

Blood transfusion reaction.Q

Hemolytic anemia e.g. with I.M. and mycoplasma.Q

•    Those with Ag on Neutrophils: Agranulocytosis.Q

•    Those with Ag on platelets: e.g. 1TP.Q

•    Those with Ag on basement membrane: Goodpasture’sQ

 

Type III Immune complex (IgM & IgG)

Type IV Delayed hypersensitivity (cellular immunity)

 

 

Includes:

•   Local: Arthus reactionY

•   Systemic: Serum sickness.Q

Examples:

Includes:

 

 

•   Tuberculin test.Q

•  Lepromin test.Q

•    Contact dermatitis.Q

•   Jones-Mote reaction (cutaneous basophilic hypersensitivity).Q

•    Graft rejection (chronic).Q

 

•   Shick’s test.Q

•   Post streptococcal G.N.Q

•   Detected by RAJ1 Assay.Q

 

Hyprsensitivity Pneumonitis is associated with both Type III and Type IV Hypersensitivity

 

 

 


Q. 13

SLE is which type of hypersensitivity reaction:

March 2005

 A

Type I hypersensitivity

 B

Type II hypersensitivity

 C

Type III hypersensitivity

 D

Type IV hypersensitivity

Q. 13

SLE is which type of hypersensitivity reaction:

March 2005

 A

Type I hypersensitivity

 B

Type II hypersensitivity

 C

Type III hypersensitivity

 D

Type IV hypersensitivity

Ans. C

Explanation:

Ans. C: Type III hypersensitivity

Type III hypersensitivity response (Immune-complex mediated response) Examples are:

  • Some form of glomerulonephritis
  • Serum sickness
  • Arthus reaction
  • SLE

Antinuclear antibody (ANA) testing and anti-extractable nuclear antigen (anti-EN A) form the mainstay of serologic testing for SLE.

Several techniques are used to detect ANAs. Clinically the most widely used method is indirect immunofluorescence. The pattern of fluorescence suggests the type of antibody present in the patient’s serum.

ANA screening yields positive results in many connective tissue disorders and other autoimmune diseases, and may occur in normal individuals.

Subtypes of antinuclear antibodies include anti-Smith and anti-double stranded DNA (dsDNA) antibodies (which are linked to SLE) and anti-histone antibodies (which are linked to drug-induced lupus).

Anti-dsDNA antibodies are highly specific for SLE; they are present in 70% of cases, whereas they appear in only 0.5% of people without SLE.

The anti-dsDNA antibody titers also tend to reflect disease activity, although not in all cases.


Q. 14

Cell mediated immunity is NOT responsible for:

September 2004

 A

Arthus reaction

 B

Contact dermatitis

 C

Graft rejection

 D

Tumor rejection

Q. 14

Cell mediated immunity is NOT responsible for:

September 2004

 A

Arthus reaction

 B

Contact dermatitis

 C

Graft rejection

 D

Tumor rejection

Ans. A

Explanation:

Ans. A i.e. Arthus reaction

Type III reactions (Arthus reaction etc.) are immune complex diseases/ Type III reactions


Q. 15

NOT an immune complex hypersensitivity reaction:

September 2012

 A

Good pasture syndrome

 B

SLE

 C

Arthus reaction

 D

Post-streptococcal glomerulonephritis

Q. 15

NOT an immune complex hypersensitivity reaction:

September 2012

 A

Good pasture syndrome

 B

SLE

 C

Arthus reaction

 D

Post-streptococcal glomerulonephritis

Ans. A

Explanation:

Ans. A i.e. Goodpasture syndrome

Goodpasture’s syndrome is a type II hypersensitivity-like reaction


Q. 16

Which of the following is type III hypersensitivity reaction:         

September 2006

 A

Prausnitz-kustner reaction

 B

Contact dermatitis

 C

Arthus reaction

 D

Rh incompatibility

Q. 16

Which of the following is type III hypersensitivity reaction:         

September 2006

 A

Prausnitz-kustner reaction

 B

Contact dermatitis

 C

Arthus reaction

 D

Rh incompatibility

Ans. C

Explanation:

Ans. C: Arthus reaction


Q. 17

Serum sickness is which type of hypersensitivity reaction:    

September 2011

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Q. 17

Serum sickness is which type of hypersensitivity reaction:    

September 2011

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Ans. C

Explanation:

Ans. C: Type III

Serum sickness is a systemic form of type III hypersensitivity


Q. 18

A study of skin biopsy of SLE patient using RTC labeled human IgG antiserum shows deposition of irregular particles at dermoepidermal junction. This means there is presence of

 A

Anti-nuclear antibody

 B

Anti-collagen antibody

 C

Anti-epithelial antibody

 D

Immune complex deposits

Q. 18

A study of skin biopsy of SLE patient using RTC labeled human IgG antiserum shows deposition of irregular particles at dermoepidermal junction. This means there is presence of

 A

Anti-nuclear antibody

 B

Anti-collagen antibody

 C

Anti-epithelial antibody

 D

Immune complex deposits

Ans. D

Explanation:

Ans. d. Immune complex deposits


Q. 19

Antinuclear antibody specific for SLE is ‑

 A

Anti ds DNA

 B

Anti nuclear antibodies

 C

Anti centromere antibody

 D

Anti histone Ab

Q. 19

Antinuclear antibody specific for SLE is ‑

 A

Anti ds DNA

 B

Anti nuclear antibodies

 C

Anti centromere antibody

 D

Anti histone Ab

Ans. A

Explanation:

Ans. is ‘a’ i.e., Anti ds DNA 



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