Immunology - Hypersensitivity/Disease States/ANA Quiz

All of the following are diagnostic clinical signs of RA except: -Subcutaneous nodules -Renal failure -Symmetrical arthritis -Swelling of fingers and joints

Renal failure

speckled, homogenous, rim

SLE

when do you see the peripheral rim pattern

SLE

Which of the following would support a diagnosis of drug-induced lupus? -Antibodies to SS-A and SS-B antigens -Presence of RF -Elevated levels of anti-histone antibodies -Antibodies to Smith antigen

SS-A and SS-B lupus, low sensitivity, highly prevalent in other AA diseases ds-DNA in active SLE

Nucleolar

Scleroderma

Which of the following explains the difference between type II and type III hypersensitivity reactions? -Type II reactions involve no antibody -IgG is involved only in type III reactions -Type II involves cellular antigens -Type III involves IgE

Type II involves cellular antigens

Arthus reaction

Type III

The predominant form of thyroid hormone in the circulation is: Thyroglobulin Triiodothyronine Thyroxine Diiodotyrosine

thryoxine

Hashimoto's / Graves

thyroid

What is the ASO (anti-Streptolysin O) test used for? to determine if a strep produces a hemolysin to determine if a strep has been lysogenized to demonstrate a serologic response to streptococcal antigen to demonstrate serologic response to Streptococcus pyogenes

to demonstrate serologic response to Streptococcus pyogenes

is the centromere stained in nucleolar ANA

variable

wegeners granulomatosis

vascular system

Which of the following is associated with an increase in IgE production? -Transfusion reaction -Activation of Th 2 cells -HDN -Reaction to poison ivy

-Activation of Th 2 cells

Which of the following would cause a positive DAT test? -Presence of IgG on red cells -Presence of C3b or C3d on red cells -A transfusion rection due to preformed antibodies -Any of the above

-Any of the above

In a serial dilution sequence, what is the titer in tube # 10, if tube # 1 is undiluted and the rest of the dilutions are doubled? 256 512 64 128

512

Rheumatoid arthritis can be best characterized as: -A chronic, symmetric, and erosive arthritis of the peripheral joints, that can also affect multiple organs. -A bothersome, painful manifestation of Type I hypersensitivity. -A self-limiting, acute inflammation of the peripheral joints. -A viral induced acute inflammatory process.

A chronic, symmetric, and erosive arthritis of the peripheral joints, that can also affect multiple organs.

Kidney allograft loss from intravascular thrombosis without cellular infiltration 5 days post-transplant may indicate which primary rejection mechanism? Hyperacute rejection Acute humoral rejection acute cellular rejection Accelerated humoral rejection

Accelerated humoral rejection

All of the following are associated with Type I hypersensitivity except: -Release of preformed mediators from cells -Activation of complement -Cell-bound antibody bridged by antigen -An inherited tendency to respond to allergens

Activation of complement

How can normal cells become malignant? Overexpression of oncogenes Underexpression of tumor-suppressing genes All of these answers are correct Viral infection

All of these answers are correct

Both AFP and hCG exhibit serum elevations in: nonseminomatous testicular cancer All of these answers are correct. ovarian germ cell tumors normal pregnancy

All of these answers are correct.

Immunologic findings in type 1 diabetes mellitus include all of the following except: -Presence of CD8 T cells in the islets of Langerhans -Antibody to colloid -Antibody to insulin -Antibody to GAD

Antibody to colloid

The first tumor marker was identified in urine in the 1850s. What was it? PSA Bence-Jones protein CA-125 CA 19-9

Bence-Jones protein

Which of the following is associated with Anaphylaxis? -Buildup of IgE on mast cells -Activation of complement -Increase in cytotoxic T cells -Large amount of circulating IgG

Buildup of IgE on mast cells

Which complement component is found in both the classic and alternative pathways? Factor D C1 C3 C4

C3

Each of these protein markers may be elevated in multiple myeloma except: monoclonal intact immunoglobulin molecules beta-2 microglobulin CA-125 free monoclonal light chains

CA-125

Centromere

CREST (scleroderma)

All of the following may contribute to autoimmunity except: -Polyclonal activation of B cells -Molecular mimicry -New expression of class II MHC antigens. -Clonal deletion of self-reactive T cells

Clonal deletion of self-reactive T cells You want clonal deletion, this means your bodies process of clearing abhorrent reactive t cells is functioning

What screening test(s) should be performed first in a young patient suspected of having an immune dysfunction disorder? Complement levels Bone marrow biopsy Complete blood count and white blood cell differential Chemotaxis assay

Complete blood count and white blood cell differential

the substrate used in an indirect immunofluorescent assay looking for dsDNA

Crithidia luciella

One particularly sensitive assay for ds-DNA to help with diagnosis of SLE is an immunofluorescent test uses a hemoflagellate called _________ _________ as the substrate. -Escherichia coli -Clonorchis sinensis -Crithidia luciliae -Trichomonas vaginalis

Crithidia luciliae

Hashimoto's thyroiditis can best be differentiated from Graves' disease on the basis of which of the following? -Enlargement of the thyroid -Presence of thyroid peroxidase antibodies -Presence of lymphocytes in the thyroid -Decrease in thyroid hormone levels

Decrease in thyroid hormone levels

What is the immune phenomenon associated with the Arthus reaction? -Tissue destruction by cytotoxic T cells -Removal of antibody-coated RBCs -Deposition of immune complexes in blood vessels -Release of histamine from mast cells

Deposition of immune complexes in blood vessels

Contact dermatitis can be characterized by all of the following except: -Formation of antigen-antibody complexes -Generation of sensitized T cells -Langerhans cells acting as antigen-presenting cells -Complexing of a hapten to self-antigen

Formation of antigen-antibody complexes

Anti-basement membrane antibody to glomerular and/or alveolar tissues is characteristic of: -Graves' Disease -SLE -Goodpasture's Syndrome -MS

Goodpasture's Syndrome

The _________ system is the strongest immunologic barrier to successful allogenic organ and HSC (Hematopoietic stem cell) transplantation. mHAs GVHD HLA MCH

HLA

AFP

Hepatocellular carcinoma hepatoblastoma yolk sac (endodermal sinus) tumor mixed germ cell tumors

BHCG

Hydatidiform moles and choriocarcinomas (gestational trophoblastic disease), testicular cancer, mixed germ cell tumors

From the following, identify a specific component of the adaptive immune system that is formed in response to antigenic stimulation: Lysozyme Immunogens Immunoglobulin Complement

Immunoglobulin

All of the following are immunological functions of complement except: Chemotaxis Anaphylatoxin formation Induction of an antiviral state Opsonization

Induction of an antiviral state

rim or homogenous ANA pattern

Lupus

Which autoimmune disease demonstrates progressive muscle weakness due to antibody-mediated damage to the acetylcholine receptors in skeletal muscle? -MS -Goodpasture's Syndrome -Diabetes mellitus -MG

MG

Destruction of the myelin sheath of axons is caused by the presence of antibody is characteristic of which disease? -Goodpasture's Syndrome -Grave's Disease -MS -MG

MS

What is the "M" component in monoclonal gammopathies? Monoclonal antibody or cell line IgM produced in excess Waldenstrom's macroglobulinemia Malignant proliferation of B cells

Monoclonal antibody or cell line

A 40 yo patient has areas of punched out osseous destruction, osteoporosis, pathological fractures, no reactive sclerosis or expansion. He also has swelling, anemia, increased urinary calcium, Bence-Jones proteinuria, hyperglobulinemia (and uria), M spike on serum and urine ELP, and reversed AG ratio. What disease is described? Ewings Sarcoma Osteoblastoma Osteomalcia Multiple Myeloma

Multiple Myeloma

A child suspected of having an inherited humoral immunodeficiency disease is given a diphtheria/tetanus vaccine. Two weeks later, his level of antibody to the specific antigens is measured. If the working diagnosis is correct, what result is expected for this patient? Increased levels of specific antibody Increased levels of nonspecific antibody No change in the level of specific antibody An increase in IgG-specific antibody, but not IgM-specific antibody

No change in the level of specific antibody

Which condition would result in HDFN? -Buildup of IgE on mother's cells -Sensitization of cytotoxic T cells -Exposure to antigen found on both mother and baby red blood cells -Prior exposure to foreign red cell antigen

Prior exposure to foreign red cell antigen

Which statement best describes immunofixation electrophoresis (IFE)? Proteins are separated by electrophoresis followed by overlay of monospecific anti-immunoglobulins Serum is electrophoresed; the separated immunoglobulins diffuse against specific antisera placed into troughs Proteins react with monospecific antisera followed by electrophoresis Antisera are electrophoresed, then diffused against patient's serum

Proteins are separated by electrophoresis followed by overlay of monospecific anti-immunoglobulins

When performing a titer for a specific antibody, tube #s 5-7 show a stronger reaction than tube #s 1-4. This phenomenon exhibited by tubes 1-4 is referred to as: Prozone effect Poor technique Postzone effect Equivalence effect

Prozone effect

A patient presented with clinical signs and symptoms of a lymphoproliferative disorder. Several blood draws and laboratory tests later, the patient was found to have an IgM kappa paraprotein. What sequence of tests should have been performed to come up with a more timely, and less painful diagnosis? IEP of serum followed by protein elctrophoresis if positive. Immunoelectrophoresis (IEP) of serum followed by IFE of serum if positive. Either serum protein electrophoresis or IEP could have led to the final diagnosis. Serum and urine protein electrophoresis followed by immunofixation electrophoresis (IFE) on the positives

Serum and urine protein electrophoresis followed by immunofixation electrophoresis (IFE) on the positives

A laboratory is evaluating an ELISA assay for detecting an antibody to cyclic citrullinated peptide, a marker for rheumatoid arthritis. Included in the population sampled are serums from healthy people (students, no doubt) and patients with other connective tissue diseases. These specimens are included to help determine which factor of the assay? Bias Precision Sensitivity Specificity

Specificity

The three levels of dysfunction that may be evaluated in a patient with an endocrine problem are primary, secondary, and tertiary. The possible defective sites that correspond to these primary, secondary, and tertiary levels of dysfunction are, respectively: Pituitary, target gland, hypothalamus Hypothalamus, target gland, pituitary Target gland, pituitary, hypothalamus Pituitary, hypothalamus, target gland

Target gland, pituitary, hypothalamus

Autoantibodies that bind to TSH receptor sites on thyroid cell membranes preventing thyroid-stimulating hormone from binding are: Thyroid-stimulating immunoglobulins Antithyroglobulins Thyroxine-binding globulins Antimicrosomal antibodies

Thyroid-stimulating immunoglobulins

What is the immune mechanism involed in type III hypersensitivty reactions? -Cellular antigens are involved. -Deposition of immune complexes occurs in antibody excess -Only heterologous antigens are involved. -Tissue damage results from exocytosis.

Tissue damage results from exocytosis.

Which of the following is the best description of the sequence of events for thyroid hormone synthesis? Trapping of iodine, organification, activation of iodine, coupling of iodotyrosyl residues, and proteolysis of thyroglobulin with release of T3 and T4 Trapping of iodine, activation of iodine, couplinf of iodotyrosyl residues, proteolysis of thryoglobulin with release of T3 and T4, and organification Trapping of iodine, activation of iodine, organification, coupling of iodotyrosyl residues, and proteolysis of thyroblobulin with release of T3 and T4 Activation of iodine, trapping of iodine, coupling of iodotyrosyl residues, organification, and proteolysis of thyroglobulin with release of T3 and T4

Trapping of iodine, activation of iodine, organification, coupling of iodotyrosyl residues, and proteolysis of thyroblobulin with release of T3 and T4

Anti-streptolysin O titer is a test based on the neutralization of the hemolytic activity of streptolysin O. True False

True

Myasthenia gravis

acetylcholine receptors at neuromuscular junction

A DPT or DTaP vaccination is an example of: cell-mediated immunity active humoral-mediated immunity immediate hypersensitivity passive humoral-mediated immunity

active humoral-mediated immunity

addison's

adrenal

Measurement of Alkaline Phosphatase (ALP) in serum can be beneficial in the following diseases: Seminoma Paget's Disease Metastases in the bone of liver All of the above

all of the above

TSH is secreted by the: thyroid gland hypothalalamus posterior pituitary anterior pituitary

anterior pituitary

Rheumatoid factors are defined as: -antigens found in the sera of patients with rheumatoid arthritis -identical to rheumatoid arthritis precipitin -auto-antibodies with specificity for the Fc portion of the immunoglobulin (IgG) molecule -capable of forming circulating immune complexes only when IgM-type autoantibody is present

auto-antibodies with specificity for the Fc portion of the immunoglobulin (IgG) molecule

CA 14-3 CA27-29

breast cancer

CA15-3/BR 27-29

breast cancer

In pregnant women, those who take oral contraceptives, and newborn infants, the total thyroxine (T4) levels can be altered because of: The presence of iodotyrosines in the serum Changes in tissue use Inappropriate iodine metabolism Changes in binding capacity of thyroid hormone carrier proteins

changes in binding capacity of thyroid hormone carrier proteins

In terms of patient population, gangliogliomas mainly affect _________ and __________?

children and young adults

Carcinoembryonic antigen (CEA) is most likely to be produced in a malignancy involving the: testes brain colon bone

colon

CEA

colon, breast, lung cancer

Multiple sclerosis

destruction of myelin sheath

In a patient with suspected primary hyperthyroidism associated with Graves' disease, one would expect the following laboratory serum results: _______________ free T4 and/or free T3, and ________________ TSH. Thyroid-stimulating immunoglobulins (TSIs) are ususally ___________________ in this condition. normal, elevated, positive elevated, elevated, positive elevated, undetecable, positive elevated, undetectable, negative

elevated, undetecable, positive

Prostate Specific Antigen is a highly specific and sensitive marker for prostate cancer and is always diagnostic of underlying malignant disease. True False

false PSA is notoriously non-specific and because of this must be carefully evaluated in light of the other lab values, imagery, clinical symptoms, and previous history.

Improper washing of a tube, well, or bead (the solid phase) after adding enzyme-antibody conjugate in an ELISA system would cause the results to be: impossible to determine falsely decreased unaffected falsely increased

falsely increased

Pernicious anemia

gastric parietal cells that secrete intrinsic factor

Increased concentrations of Alpha-fetoprotein (AFP) in adults are most characteristically associated with: hepatocellular carcinoma multiple myeloma chronic active hepatitis prostatic carcinoma

hepatocellular carcinoma

A tumor normally grows... with a decrease in metabolic rate when compared to normal cells from 1 cell to a billion cells in 1 year independent of normal growth signals and controls from a group of 10 different cells, so it is polyclonal in origin

independent of normal growth signals and controls

A woman goes 3 days per week to a tanning bed for 29 minutes of UV exposure per visit. What stage of carcinogenesis is this? dissemination invasion in situ induction

induction

The action of Sirolimus as an immunosuppressive drug is to: increase T-cell activity inhibit T-lymphocyte activation and proliferation by mTOR inhibition stimulate T cell proliferation block B cell function

inhibit T-lymphocyte activation and proliferation by mTOR inhibition

celiac disease

intestinal intolerance to glutens

Patients who have received the following types of grafts are at risk for graft-versus-host disease (GVHD) except for recipients of: lung transplants liver transplants bone marrow transplants irradiated leukocytes

irradiated leukocytes

what is stained with crithidia luciella

kinetoplast

AFP

liver, ovary, nonseminomatous testicular cancer

Elevated serum levels of the hormone calcitonin are usually associated with: trophoblastic tumors congenital adrenal hyperplasia small cell lung carcinoma medullary carcinoma of the thyroid

medullary carcinoma of the thyroid

calcitonin

medullary thyroid carcinoma

Chromogranin

neuroendocrine tumors / carcinoid

HCG

nonseminomatous testicular cancer

Carbohydrate antigen 125 (CA 125) is a tumor marker associated with: brain cancer ovarian and endometrial cancer benign prostatic hyperplasia bone cancer

ovarian and endometrial cancer

CA125

ovarian cancer

CA 125/HE4

ovarian cancer (peritoneal inflammation)

Type I diabetes mellitus

pancreas

CA 19-9

pancreatic cancer

beta-2-microglobulin

part of class I MHC, elevated lymphoid disorder

Idiopathic thrombocytopenia purpura

plts

PSA

prostate

goodpasteurs

renal basement membrane

sjogrens

salivary and lacrimal

Blood is drawn from a patient for serological tests for a viral disease at the time of onset and again 2-4 weeks later. The results are considered diagnostic if the: second antibody titer is at least 4X the first first antibody titer is 4X the second first antibody titer is 2X the second first and seond antibody titers are equal

second antibody titer is at least 4X the first

Which of the following would be considered a systemic autoimmune disease? -Gene coding for a specific MHC molecule -Molecular mimicry -Polyclonal B-cell activation -Self-tolerance

self-tolerance LOSS of self tolerance induces AI diseases

Acquired or adaptive immunity is also referred to as ___________________ immunity. innate nonspecific specific natural

specific

In addition to carcinoma of the prostate, elevated prostate-specific antigen (PSA) can occur due to all of the following except: benign prostatic hyperplasia statin therapy (cholesterol lowing drug) sexual intercourse prior to blood draw digital rectal exam prior to blood draw

statin therapy (cholesterol lowing drug)

The term avidity is used to describe the: strength with which a multivalent antibody binds a multivalent antigen. initial force of attraction that exists between an Fab site on an antibody and one epitope site on the corresponding antigen. phenomenon that occurs when an antibody reacts with an antigen that is structurally similar to the original antigen that induced antibody production. point in an antigen-antibody reaction at which the number of multivalent sites of antigen and antibody are approximately equal.

strength with which a multivalent antibody binds a multivalent antigen