Immune stimulation and immunosuppression MCQs With Answer are essential for B. Pharm students preparing for clinical pharmacology and therapeutics. This concise, keyword-rich introduction covers mechanisms, immunomodulators, biologics, vaccines, cytokines, and immunosuppressants like corticosteroids, calcineurin inhibitors, and anti‑TNF agents. Questions emphasize drug actions, clinical indications, adverse effects, monitoring, and interactions to build strong foundations in immunotherapy, transplant pharmacology, autoimmunity, and infectious disease management. Clear, focused MCQs help reinforce learning and prepare students for exams and practical prescribing. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which drug primarily stimulates neutrophil recovery after chemotherapy?
- Interferon-alpha
- Granulocyte colony-stimulating factor (G-CSF)
- Cyclosporine
- Rituximab
Correct Answer: Granulocyte colony-stimulating factor (G-CSF)
Q2. Which cytokine is most important for activating macrophages and promoting Th1 responses?
- Interleukin-4 (IL-4)
- Interferon-gamma (IFN-γ)
- Interleukin-10 (IL-10)
- Transforming growth factor-beta (TGF-β)
Correct Answer: Interferon-gamma (IFN-γ)
Q3. Which immunosuppressant inhibits calcineurin to block IL-2 transcription?
- Sirolimus
- Mycophenolate mofetil
- Ciclosporin (Cyclosporine)
- Azathioprine
Correct Answer: Ciclosporin (Cyclosporine)
Q4. Which agent is a fusion protein that blocks T-cell costimulation by binding CD80/86?
- Basiliximab
- Belatacept
- Infliximab
- Etanercept
Correct Answer: Belatacept
Q5. Which adverse effect is classically associated with long-term corticosteroid therapy?
- Agranulocytosis
- Osteoporosis and adrenal suppression
- Pancreatitis
- Peripheral neuropathy
Correct Answer: Osteoporosis and adrenal suppression
Q6. Which drug selectively inhibits mTOR leading to blockade of T-cell proliferation?
- Sirolimus (Rapamycin)
- Tacrolimus
- Prednisone
- Methotrexate
Correct Answer: Sirolimus (Rapamycin)
Q7. Which immunosuppressive prodrug is metabolized to 6-mercaptopurine and risks myelosuppression?
- Azathioprine
- Cyclophosphamide
- Tacrolimus
- Cyclosporine
Correct Answer: Azathioprine
Q8. Which monoclonal antibody targets CD20 on B cells and is used in autoimmune disease and lymphoma?
- Rituximab
- Adalimumab
- Tocilizumab
- Natalizumab
Correct Answer: Rituximab
Q9. Anti-TNF agents increase risk of reactivation of which infection?
- Hepatitis C
- Tuberculosis
- Varicella zoster only
- Urinary tract infections exclusively
Correct Answer: Tuberculosis
Q10. Which laboratory test best monitors the immunosuppressive effect of calcineurin inhibitors?
- Serum creatinine and drug trough levels
- Serum IgG levels
- ESR only
- Anti-nuclear antibody titer
Correct Answer: Serum creatinine and drug trough levels
Q11. Which drug alkylates DNA and is used for severe autoimmune disease and as an immunosuppressant?
- Cyclophosphamide
- Mycophenolate mofetil
- Azathioprine
- Rituximab
Correct Answer: Cyclophosphamide
Q12. Which vaccine type is contraindicated in most patients on strong immunosuppression?
- Inactivated influenza vaccine
- mRNA COVID-19 vaccine
- Live attenuated vaccines
- Subunit vaccines
Correct Answer: Live attenuated vaccines
Q13. Which drug inhibits inosine monophosphate dehydrogenase (IMPDH) reducing guanosine synthesis in lymphocytes?
- Mycophenolate mofetil
- Sirolimus
- Azathioprine
- Prednisone
Correct Answer: Mycophenolate mofetil
Q14. Which immune checkpoint inhibitor blocks PD-1 and enhances anti-tumor T-cell activity?
- Ipilimumab
- Nivolumab
- Infliximab
- Belatacept
Correct Answer: Nivolumab
Q15. Which cytokine therapy is used for chronic hepatitis C and some malignancies, but causes flu-like symptoms?
- Interferon-alpha
- Interleukin-2
- Interleukin-10
- Granulocyte-macrophage colony-stimulating factor (GM-CSF)
Correct Answer: Interferon-alpha
Q16. Which agent blocks IL-6 receptor and is used in rheumatoid arthritis and cytokine release syndrome?
- Tocilizumab
- Etanercept
- Rituximab
- Basiliximab
Correct Answer: Tocilizumab
Q17. Which monitoring parameter is critical for azathioprine to reduce risk of severe myelosuppression?
- Serum potassium
- Thiopurine methyltransferase (TPMT) activity or genotype
- Serum calcium
- Urinalysis only
Correct Answer: Thiopurine methyltransferase (TPMT) activity or genotype
Q18. Which drug class predisposes to hypertension, nephrotoxicity, and neurotoxicity as major side effects?
- Corticosteroids
- Calcineurin inhibitors (e.g., tacrolimus, cyclosporine)
- Biologic anti-TNF agents
- Colony-stimulating factors
Correct Answer: Calcineurin inhibitors (e.g., tacrolimus, cyclosporine)
Q19. Which immunostimulatory adjuvant is commonly used in vaccines to enhance antigen presentation?
- Aluminum salts (alum)
- Ciclosporin
- Sirolimus
- Azathioprine
Correct Answer: Aluminum salts (alum)
Q20. Which condition is most likely an indication for anti-CD25 monoclonal antibody basiliximab?
- Induction therapy in organ transplantation to prevent acute rejection
- Treatment of bacterial sepsis
- Long-term management of osteoporosis
- Chronic hepatitis B antiviral therapy
Correct Answer: Induction therapy in organ transplantation to prevent acute rejection
Q21. Which lab abnormality is commonly seen with mycophenolate mofetil therapy?
- Hyperglycemia
- Leukopenia
- Hypocalcemia
- Hyperkalemia
Correct Answer: Leukopenia
Q22. Which mechanism explains how immune checkpoint inhibitors cause autoimmune-like adverse events?
- Direct cytotoxicity to B cells only
- Disinhibition of T cells leading to loss of self-tolerance
- Direct inhibition of cytokine synthesis
- Increased clearance of autoantibodies
Correct Answer: Disinhibition of T cells leading to loss of self-tolerance
Q23. Which oral small-molecule drug inhibits JAK enzymes and is used in rheumatoid arthritis?
- Tofacitinib
- Tacrolimus
- Etanercept
- Rituximab
Correct Answer: Tofacitinib
Q24. Which therapy is indicated to treat neutropenia-induced infection risk in oncology patients?
- Granulocyte colony-stimulating factor (G-CSF)
- Azathioprine
- Anti-TNF agents
- Cyclosporine
Correct Answer: Granulocyte colony-stimulating factor (G-CSF)
Q25. Which immunomodulator interferes with DNA synthesis by inhibiting dihydrofolate reductase and is used in autoimmune disease?
- Methotrexate
- Mycophenolate mofetil
- Ciclosporin
- Etanercept
Correct Answer: Methotrexate
Q26. Which clinical situation most commonly requires monitoring of viral load when using immunosuppressants?
- Monitoring hepatitis B or CMV reactivation after transplantation
- Routine LDL cholesterol monitoring
- Monitoring thyroid function tests
- Measuring blood glucose only
Correct Answer: Monitoring hepatitis B or CMV reactivation after transplantation
Q27. Which statement best describes immune stimulation by IL-2 therapy?
- IL-2 suppresses NK and T-cell proliferation
- High-dose IL-2 can expand cytotoxic T cells and NK cells for cancer therapy
- IL-2 is used to induce tolerance in transplantation
- IL-2 primarily reduces antibody production by B cells
Correct Answer: High-dose IL-2 can expand cytotoxic T cells and NK cells for cancer therapy
Q28. Which adverse effect is especially associated with sirolimus therapy?
- Hyperprolactinemia
- Hyperlipidemia and impaired wound healing
- Severe hypokalemia
- Delayed hypersensitivity type I only
Correct Answer: Hyperlipidemia and impaired wound healing
Q29. Which mechanism is central to methotrexate’s anti-inflammatory effect at low doses in rheumatology?
- Inhibition of TNF-alpha directly
- Increased extracellular adenosine leading to anti-inflammatory effects
- Activation of complement cascade
- Direct blockade of CD20 on B cells
Correct Answer: Increased extracellular adenosine leading to anti-inflammatory effects
Q30. In transplantation, which immune process is mainly targeted to prevent acute cellular rejection?
- Antibody-mediated complement activation only
- T-cell activation and proliferation
- Neutrophil degranulation exclusively
- Platelet aggregation
Correct Answer: T-cell activation and proliferation
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