Bone Graft Immunology — MCQs

10 questions

The graft with the maximum osteogenic potential is:

A researcher is studying the interactions between foreign antigens and human immune cells. She has isolated a line of lymphocytes that is known to bind antigen-presenting cells. From this cell line, she has isolated a cell surface protein that binds to class I major histocompatibility complex molecules. The continued activation, proliferation and survival of this specific cell line requires which of the following signaling molecules?

All of the following factors affect osseointegration EXCEPT:

The hypersensitivity reaction involved in the hyperacute rejection of a renal transplant is:

What is the consequence of preformed antibodies in organ transplantation?

An autograft of a burn victim is best described by which one of the following?

Compression osteosynthesis may be used in all these areas except?

All are true about aneurysmal bone cyst except -

Which of the following is the POOREST recipient bed for a skin graft?

Q10

The ideal synthetic material used for femoropopliteal bypass when autologous vein is unavailable is:

Bone Graft Immunology Indian Medical PG Practice Questions and MCQs

Question 1: The graft with the maximum osteogenic potential is:

A. Allograft
B. xenograft
C. Autocortical
D. autocancellus (Correct Answer)

Explanation: ***autocancellus*** - **Autocancellous** bone grafts are considered the gold standard due to their high osteogenic potential as they contain **viable osteoblasts** and **bone marrow stromal cells**. - The porous structure of cancellous bone also provides a **scaffold** for new bone formation and excellent revascularization. *Allograft* - **Allografts** are grafts transferred between genetically dissimilar individuals of the same species and are **osteoconductive** and **osteoinductive** but lack viable cells and thus have lower osteogenic potential than autografts. - They undergo sterilization processes that can further reduce their osteoinductive properties and may elicit an **immune response** from the recipient. *xenograft* - **Xenografts** are grafts transferred between different species and primarily serve as an **osteoconductive scaffold**. - They lack live osteogenic cells and have the **lowest osteogenic potential** due to significant immunological barriers and species-specific biochemical differences. *Autocortical* - **Autocortical** grafts are structural and provide mechanical support, but their **osteogenic potential is lower** than cancellous bone. - Cortical bone has a denser structure with fewer viable cells and a slower revascularization rate compared to cancellous bone.

Question 2: A researcher is studying the interactions between foreign antigens and human immune cells. She has isolated a line of lymphocytes that is known to bind antigen-presenting cells. From this cell line, she has isolated a cell surface protein that binds to class I major histocompatibility complex molecules. The continued activation, proliferation and survival of this specific cell line requires which of the following signaling molecules?

A. Interleukin 1
B. Interleukin 4
C. Interleukin 2 (Correct Answer)
D. Interleukin 8
E. Interleukin 6

Explanation: ***Interleukin 2*** - The description of the lymphocyte binding the **constant portion of MHC class I** and requiring a signaling molecule for activation, proliferation, and survival points to a **T cell**. - **Interleukin-2 (IL-2)** is a crucial cytokine for the proliferation, differentiation, and survival of T lymphocytes, acting in an autocrine or paracrine fashion after T cell activation. *Interleukin 1* - **Interleukin-1 (IL-1)** is primarily involved in inflammation and fever, produced by macrophages and other innate immune cells. - While it can act as a costimulator for T cells, it is not the primary cytokine required for their sustained proliferation and survival after initial activation. *Interleukin 4* - **Interleukin-4 (IL-4)** is a key cytokine in humoral immunity, promoting B cell proliferation and differentiation, and inducing IgE class switching. - It also plays a role in the differentiation of naive T cells into **Th2 cells**, but it is not the main cytokine for general T cell proliferation and survival. *Interleukin 8* - **Interleukin-8 (IL-8)**, also known as CXCL8, is a chemokine primarily responsible for attracting and activating neutrophils to sites of infection or inflammation. - It does not have a direct role in the sustained proliferation and survival of activated lymphocytes. *Interleukin 6* - **Interleukin-6 (IL-6)** is a pleiotropic cytokine involved in acute phase reactions, hematopoiesis, and the immune response, particularly B cell differentiation and antibody production. - Although it can influence T cell responses, it is not the primary growth factor for activated T lymphocytes as IL-2 is.

Question 3: All of the following factors affect osseointegration EXCEPT:

A. Biocompatibility of implant material.
B. Implant design.
C. Patient's blood type (Correct Answer)
D. Status of the host bed.

Explanation: ***Patient's blood type*** - A patient's **blood type** (e.g., A, B, AB, O) is determined by antigens present on red blood cells and plays no direct role in the biological processes of bone healing or the integration of a dental implant with bone. - While systemic factors can influence osseointegration, blood type itself does not affect the cellular and molecular mechanisms required for direct bone-to-implant contact. *Biocompatibility of implant material* - The **biocompatibility** of the implant material (e.g., **titanium**) is crucial for osseointegration, as it must not elicit adverse reactions and must permit host bone growth on its surface. - Materials that are cytotoxic or inflammatory will prevent bone apposition and lead to fibrous encapsulation rather than direct bone contact. *Implant design* - **Implant design**, including features like **surface roughness**, thread pitch, and macro-geometry, significantly influences the initial stability and long-term success of osseointegration. - A greater surface area and appropriate surface treatments can enhance bone cell attachment and differentiation, promoting faster and stronger bone integration. *Status of the host bed* - The **status of the host bone bed** refers to its quality and quantity (e.g., bone density, vascularity), which are critical for the biological processes of osseointegration. - Adequate bone volume and good bone quality provide a stable foundation and sufficient blood supply for bone regeneration around the implant.

Question 4: The hypersensitivity reaction involved in the hyperacute rejection of a renal transplant is:

A. Type I
B. Type III
C. Type IV
D. Type II (Correct Answer)

Explanation: ***Type II*** - Hyperacute rejection is primarily mediated by **antibody-mediated mechanisms**, indicative of Type II hypersensitivity [2]. - It involves pre-existing **IgG antibodies** that react against donor renal graft antigen, leading to rapid graft destruction [1]. *Type I* - Type I hypersensitivity is associated with **allergic reactions** involving **IgE antibodies**, not relevant to transplant rejection [2]. - Typically involves conditions like **anaphylaxis** or **asthma**, which are unrelated to hyperacute rejection scenarios. *Type IV* - Type IV hypersensitivity is cell-mediated and typically manifests as **delayed-type hypersensitivity**, not acute rejection. - It involves **T cells** and does not play a role in the immediate immune response seen in hyperacute rejection. *Type III* - Type III hypersensitivity involves the formation of immune complexes, leading to conditions like **serum sickness**, not hyperacute rejection. - This type of reaction is usually more relevant in **chronic inflammatory conditions** rather than immediate transplant rejections. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 241-242. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 208-210.

Question 5: What is the consequence of preformed antibodies in organ transplantation?

A. Delayed T-cell mediated rejection
B. Long-term graft dysfunction due to chronic inflammation
C. Post-transplant antibody-mediated rejection
D. Immediate graft failure due to preformed antibodies (Correct Answer)

Explanation: ***Hyperacute rejection*** - This occurs immediately after transplant due to **preformed antibodies** reacting against donor antigens, leading to rapid allograft failure [1]. - It is typically associated with **complement activation** and often results in thrombosis of the graft vessels [1]. *Acute rejection* - Primarily mediated by **T cells** rather than preformed antibodies, occurring days to months after transplantation [2]. - Involves a **cellular immune response**, unlike hyperacute rejection which is antibody-mediated [2]. *Acute humoral rejection* - Also involves antibodies but develops **days to weeks** post-transplant rather than immediately like hyperacute rejection. - This type is characterized by a **specific antibody response** and complement activation, but is not due to preformed antibodies. *Chronic rejection* - A long-term process that develops over months to years due to **persistent immune-mediated injury** to the graft, leading to gradual loss of function. - Involves mechanisms such as **tissue fibrosis and vascular changes**, differing from the immediate action of preformed antibodies in hyperacute rejection. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 241-242. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 242.

Question 6: An autograft of a burn victim is best described by which one of the following?

A. Transplant from one person to another person
B. Transplant from one person to a genetically identical person
C. Transplant from one species to another species
D. Transplant from one region of a person to another region (Correct Answer)

Explanation: ***Transplant from one region of a person to another region*** - An **autograft** involves transferring tissue from one site to another within the **same individual**. - This type of graft is immunologically optimal as it avoids **immune rejection**. *Transplant from one person to another person* - This describes an **allograft**, where tissue is transplanted between genetically distinct individuals of the **same species**. - **Allografts** carry a risk of rejection and require immunosuppression. *Transplant from one person to a genetically identical person* - This is an **isograft** (or syngraft), occurring between **monozygotic twins** or highly inbred animals. - While genetically identical, it is a specific type of **allograft** and not an autograft. *Transplant from one species to another species* - This describes a **xenograft**, where tissue is transferred between individuals of **different species**. - **Xenografts** face significant immune rejection and ethical considerations, making them less common in standard practice.

Question 7: Compression osteosynthesis may be used in all these areas except?

A. Comminuted fractures of the mandible (Correct Answer)
B. FZ suture (provides anatomical support)
C. Bone graft fixation (promotes healing)
D. Root of zygomatic arch (maintains structural integrity)

Explanation: ***Comminuted fractures of the mandible*** - **Compression osteosynthesis** is generally **contraindicated** in comminuted fractures because the application of compression can further **displace or fragment** the multiple bone pieces. - Such fractures often require **tension band plating** or **reconstruction plates** to stabilize the fragments without causing additional compression or displacement. *FZ suture (provides anatomical support)* - The **frontozygomatic (FZ) suture** is an area where compression osteosynthesis can be effectively used to achieve **stable fixation** and **anatomical reduction**. - Compression helps to **stabilize the bone segments** at the suture line, leading to better healing and restoration of orbital rim integrity. *Bone graft fixation (promotes healing)* - Compression osteosynthesis is often employed in **bone graft fixation** to promote **intimate contact** between the graft and the host bone, which is crucial for successful **graft incorporation and healing**. - This compression enhances **vascularization** and reduces movement, creating a more favorable environment for **osteogenesis**. *Root of zygomatic arch (maintains structural integrity)* - Compression osteosynthesis can be effectively used at the **root of the zygomatic arch** to maintain **structural integrity** and achieve stable fixation of fractures in this region. - Applying compression helps to **reduce fracture gaps** and provides stability, which is essential for restoring the contour and function of the midface.

Question 8: All are true about aneurysmal bone cyst except -

A. Eccentric
B. Expansile & lytic
C. Treated by simple curettage (Correct Answer)
D. Metaphysis of long bones

Explanation: ***Treated by simple curettage*** - Aneurysmal bone cysts (ABCs) often require more aggressive treatment than simple curettage due to their **high recurrence rate** and the risk of incomplete removal. - **Sclerotherapy**, **embolization**, or **en bloc resection** may be necessary, especially for larger or recurrent lesions, as simple curettage alone is often insufficient. *Eccentric* - Aneurysmal bone cysts are indeed **eccentric lesions**, meaning they are located off-center within the bone. - This eccentric location is a characteristic feature often observed on **radiological imaging**. *Expansile & lytic* - ABCs are typically **expansile** (causing bone expansion) and **lytic** (destructive to bone tissue) lesions. - This combination of features contributes to the characteristic **"blow-out" appearance** on imaging. *Metaphysis of long bones* - The **metaphysis of long bones** is a common site for aneurysmal bone cysts, particularly in younger individuals. - Other frequently affected sites include the **spine** and **flat bones**.

Question 9: Which of the following is the POOREST recipient bed for a skin graft?

A. Fat (Correct Answer)
B. Muscle
C. Deep fascia
D. Skull bone

Explanation: ***Fat*** - **Fat** is a poor recipient for a skin graft due to its **limited vascularity**, which hinders the necessary process of revascularization for graft survival. - The high metabolic demand of a graft cannot be adequately met by the relatively avascular subcutaneous fat, leading to graft failure. *Muscle* - **Muscle tissue** is an excellent recipient bed for skin grafts due to its **rich blood supply**. - Its robust vascularity effectively supports the revascularization and survival of the grafted tissue. *Deep fascia* - **Deep fascia** provides a good vascularized bed for skin grafts, as it has a reasonable blood supply from underlying muscles and surrounding tissues. - This vascularization is sufficient to nourish and ensure the take of a skin graft. *Skull bone* - **Skull bone** (specifically the periosteum covering it) can serve as an adequate graft bed due to its vascular supply. - If the **periosteum** is intact and healthy, it offers sufficient blood flow for graft survival.

Question 10: The ideal synthetic material used for femoropopliteal bypass when autologous vein is unavailable is:

A. Dacron
B. Xenograft
C. Saphenous vein
D. PTFE (non-expanded)
E. Cryopreserved vein graft
F. ePTFE (Correct Answer)
. Polyethylene terephthalate (PET)
. Allograft

Explanation: ***ePTFE (Expanded Polytetrafluoroethylene)*** - **ePTFE** is the preferred synthetic graft for femoropopliteal bypass when autologous vein is unavailable - Offers good **biocompatibility** and relative resistance to **thrombosis** - Provides superior patency rates in above-knee femoropopliteal bypasses compared to other synthetic materials (5-year patency ~50-60%) - The expanded structure allows tissue ingrowth and better integration *Dacron (Polyethylene terephthalate)* - Generally used for **larger diameter vessels** (e.g., aortoiliac grafts) - Has **inferior patency rates** in smaller diameter femoropopliteal position compared to ePTFE - More prone to kinking and associated with higher rates of intimal hyperplasia in peripheral circulation *Saphenous vein* - The autologous saphenous vein is the **gold standard** for femoropopliteal bypass with superior long-term patency (5-year patency ~70-80%) - However, this question specifically asks for synthetic material when vein is unavailable or unsuitable - Not always available or of adequate quality in all patients *PTFE (non-expanded)* - **Non-expanded PTFE** lacks the porous structure of ePTFE - Not used for vascular grafts due to absence of tissue ingrowth capability - The **expanded** form is specifically engineered for vascular applications

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free