Immunology Exam 2: Hypersensitivity/Autoimmune/Immunodeficiency
IgD
Recurrent, periodic fevers may be associated with increased production of which immunoglobulin?
presence of anti-dsDNA antibodies
SLE can be distinguished from RA on the basis of which of the following?
newly synthesized, preformed
Secondary mediators during the activation phase of an allergic reaction are _____ while primary mediators are _____.
anaphylactic, short
Type I hypersensitivity is also known as ______ hypersensitivity. There is a ____ lag time between exposure and onset of clinical symptoms.
antibody-mediated cytotoxic antigen (IgM, IgG, self-antigen)
Type II hypersensitivity is also known as _______ hypersensitivity. It is triggered by an _________ found on cell surfaces.
complex-mediated directed against a soluble antigen
Type III hypersensitivity is also known as ______ hypersensitivity. The key components are IgM and IgG ________. Antigen-antibody complexes precipitate out and deposit in tissue, complement binds, vasodilation and vasopermability increase, macrophages release granules causing tissue damage.
defective neutrophil function
What clinical manifestation would be seen in a patient with myeloperoxidase deficiency?
deposition of immune complexes occurs in antibody excess
What is the immune mechanism involved in type III hypersensitivity reactions?
IgE Mast cells Basophils Eosinophils
Key components of Type I Hypersensitivity
all of the above
Reactions to latex are caused by type I hypersensitivity type IV hypersensitivity skin irritation
anti-tTG
A 20-year-old woman made an appointment to see her physician because she was experiencing intermittent diarrhea. Laboratory testing revealed that she also had an iron deficiency anemia. To determine if the patient has celiac disease, her doctor should order which of teh following laboratory test?
Wiskott-Aldrich syndrome
A 3-year-old boy is hospitalized because of recurrent bouts of pneumonia. Laboratory tests are run and the following findings are noted: prolonged bleeding time, decreased platelet count, increased level of serum alpha-fetoprotein, and a deficiency of naturally occuring isohemagllutinins. Based on these results which is the most likely diagnosis?
DHR reduction
A 4-year-old boy presents with recurrent would and soft-tissue infections. Which of the following assays should be considered for diagnosing his presumed PID?
T regulatory cells
A FoxP3 gene mutation may lead to a deficiency of what cell type?
hypersensitivity
A heightened state of immune responsiveness. Exaggerated immune response to a typically harmless antigen. Results in tissue damage.
recurrent Neisserial infections
A patient with a deficiency in complement component C7 would likely present with
anti-dsDNA
A peripheral pattern of staining of the nucleus on IIF is caused by which of the following antibodies?
Noncompetitive solid phase immunoassay
Current test that replaces RIST that is a screening tool for diagnosis of allergies, rhinitis, asthma, ect.
T cell positive, B cell positive
A renal transplant candidate was crossmatched with a donor that was mismatched for only the HLA-B35 antigen. The candidate was known to have an antibody specific for HLA-B35. Which of the following combinations of T- and B-cell flow cytometric crossmatch results would be expected?
all of the above
A technologist performs an IIF test for ANCAs and observes that there is an intense fluorescent staining of the nulcear lobes of the neutrophils. How can this type of staining be differentiated from a peripheral ANA pattern? Perform the test on formalin-fixed leukocytes Perform IIF with HEp-2 cells Perform an ELISA for ANCAs
passive immunotherapy
A woman with breast cancer is treated with a monoclonal antibody to HER2. This is an example of:
an inflammatory response induced by cytokines released from Th1 cells
A young woman developed red, itchy papules on her wrist 2 days after wearing a new bracelet. This reaction was caused by
sensitization phase
APCs process allergens and present them to helper T cells. Helper T cells induce production of allergen-specific IgE IgE binds to high-affinity receptors on mast cells and basophils
activation of complement
All of the following are associated with type 1 hypersensitivity except Release of preformed mediators from mast cells Activation of complement Cell-bound antibody bridged by antigen An inherited tendency to respond to allergens
CA 125/women of reproductive age
All of the following are recommended for cancer screening in the groups indicated except CA 125/women of reproductive age AFP/subjects at high risk for liver cancer PSA/men over 50 with at least 10 years of life expectancy none of the above
clonal deletion of self-reactive T cells
All of the following may contribute to autoimmunity except clonal deletion of self-reactive T cells Molecular mimicry Increased expression of class II MHC antigens Polyclonal activation of B cells
Activation phase
Allergen cross-links adjacent cell-bound IgE's. Mast cells and basophils degranulate Chemical mediators are released and bind to target organs Allergy symptoms are produced.
RA
Anti-CCP is specifically associated with which autoimmune disease?
CD4
Antigen receptors on T lymphocytes bind HLA class II + peptide complexes with the help of which accessory molecule?
primary biliary cirrhosis
Antimitochondrial antibodies are strongly associated with which disease?
perform an assay for specific ANAs
Blood was drawn from a 25 year old woman with suspected SLE. A FANA screen was performed and a speckled pattern resulted. Which of the following actions should not be taken next?
all of the above
Both AFP and hCG exhibit serum elevations in pregnancy ovarian germ cell carcinoma nonseminomatous testicular cancer
I, II, III, IV
Categories of hypersensitivity
innate immunity deficiency
Chronic mucocutaneous candidiasis, a PID that was previously thought to be a cell-mediated deficiency, is now classified as which type of PID?
Indirect Antiglobulin Test (IAT)
Coomb's test. Tests patient serum for antibodies to RBC antigens. Incubate reagent RBCs with patient serum at 37*C, wash, add anti-human globulin. Positive = agglutination
cell-mediated immunity
Defects in which branch of the immune system are most commonly associated with severe illness after administration of live virus vaccines?
IV
Delayed hypersensitivity reactions include categories _____.
MS
Destruction of the myelin sheath of axons caused by the presence of antibody is characteristic of which disease?
Direct Antiglobulin Test (DAT)
Detects RBCs coated with complement components or IgG antibody by incubation with a polyspecific anti-human Ig directed against IgG and C'. If positive then test is repeated with mono-specific anti-IgG, anti-C3b, and anti-C3d
autosomal recessive inheritance
DiGeorge anomaly may be characterized by all of the following except autosomal recessive inheritance cardiac abnormalities parathyroid hypoplasia decreased number of mature T cells
CEA/choriocarcinoma
Each of the following markers is correctly paired with a disease in which it can be used for patient monitoring except CEA/choriocarcinoma CA 15-3/breast adenocarcinoma CA 125/ovarian adenocarcinoma CA 19-9/pancreatic adenocarcinoma
expansion of the immune response to unrelated antigens
Epitope spreading refers to
Transfusion reactions Hemolytic disease of the newborn Autoimmune hemolytic anemia (warm reactive antibodies, cold agglutins, paroxysmal cold hemoglobinuria) Goodpasture's syndrome Hashimoto's disease
Examples of Type II Hypersensitivity
Serum sickness
Generalized type III hypersensitivity reaction caused by passive immunization of humans with animal serum. Causes headache, fever, nausea, joint pain, rashes, lymphadenopathy. Secondary exposure can cause cardiovascular collapse.
all of the above
How can normal cells become malignant? Overexpression of oncogenes Underexpression of tumor suppressor genes Viral infection
I, II, III
Immediate hypersensitivity reactions include categories _____.
all of the above
In order to use a tumor marker to monitor the course of the disease, which of the following must be true? The laboratory measures the marker with the same method over the entire course of the patient's treatment The marker must be released from the tumor or, because of the tumor, into a body fluid that can be obtained and tested. The marker's half-life is such that the marker persists long enough to reflect tumor burden but clears fast enough to identify successful therapy.
atopy
Inherited tendency to respond to naturally occurring inhaled and ingested allergens with continued production of IgE
NK cell-mediated apoptosis
Innate immune responses thought to be involved in defense against tumors include
accelerated humoral rejection
Kidney allograft loss from intravascular thrombosis without cellular infiltration 5 days post-transplant may indicate which primary rejection mechanism?
can also be elevated in conditions other than the cancer
Most tumor markers are not used to screen the general population because they
RAST
Noncompetitive solid phase immunoassay using radiolabeled anti-IgE to detect allergen SPECIFIC IgE in patient serum.
irradiated leukocytes
Patients who have received the following types of grafts are at risk for graft-versus-host disease (GVHD) except for recipients of bone marrow transplants lung transplants liver transplants irradiated leukocytes
SCID
Patients with which immunodeficiency syndrome should receive irradiated blood products to protect against the development of GVHD?
B lymphocytes express HLA class II antigens
Phenotyping for HLA class II antigens requires B lymphocytes because
TRECS
Prenatal screening for SCID involves detecting
Histamine Heparin ECF-A Neutrophil chemotactic factor Proteases
Primary mediators during the activation phase of allergic reaction
RIST
Radiolabeled IgE competes with patient IgE for binding to anti-IgE coated onto solid phase
arthus reaction
Skin reaction caused by type III hypersensitivity. Localized inflammation characterized by redness, swelling, and edema. Peaks at 3-8 hours. Followed by hemorrhagic, necrotic lesion that may ulcerate
allograft
Suppose a 30 year old man was found to be a suitable donor for a kidney transplant to his younger sister. This transplant would be an example of a
neither chemotherapy drug #1 nor chemotherapy drug #2 were effective
Suppose a patient with ovarian cancer had a serum CA125 level of 50 kU/L at initial diagnosis. After her tumor was surgically removed, her CA 125 level declined to 25 kU/L. She received chemotherapy drug #1; after 1 year, her CA 125 level was 40kU/L. She was then given chemotherapy drug #2 and her CA 125 level rose to 60 kU/L. These results indicate that
rhinitis asthma food allergies urticaria eczema systemic anaphylaxis
Symptoms and clinical manifestations of Type I Hypersensitivity
SCID
T-cell subset enumeration by flow cytometry would be most useful in making the diagnosis of which disorder?
Direct antiglobulin test (DAT) Indirect antiglobulin test (IAT)
Tests for Type II Hypersensitivity
T cells
The Cylex ImmunoKnow assay is useful in determining functional capabilities of which cell type?
monitoring patients undergoing cancer treatment
The best use of serum tumor markers is considered to be in
processed peptides from polymorphic donor proteins restricted by recipient HLA class II molecules
The indirect allorecognition pathway involves which one of the following mechanisms?
patient serum should be separated from whole blood at 37*C and tested at 4*C
To determine a cold agglutinin titer
skin prick test
To determine if a patient is allergic to rye grass, the best test to perform is the
Avoidance of allergen Drug therapy Monocloncal anti-IgE antibody Allergy immunotherapy
Treatments for Type I hypersensitivity
been exposed to M tuberculosis
Two days after administration of the PPD test, a female health-care worker developed an area of redness and induration 12 mm in size at the injection site. This result means that she has
In vivo skin test Total IgE (RIST, RAST)
Two types of testing for Type I Hypersensitivity
deposition of immune complexes in blood vessels
What is the immune phenomenon associated with the Arthus reaction?
ANCA
Which autoantibodies are strongly associated with granulomatosis with polyangitis (Wegener's granulomatosis)?
prior exposure to foreign RBC antigen
Which condition would result in HDN?
daclizumab
Which immunosuppressive agent selectively inhibits IL-2 receptor-mediated activation of T cells and causes clearance of activated T cells from the circulation?
A*02:01:03
Which of the following HLA alleles differs from A*02:01:02 by a synonymous nucleotide substitution?
HLA-C*04
Which of the following HLA antigens would be expected to elicit an HLA antibody response in a kidney transplant recipient with the following HLA type: HLA-A*01, 03; B*07, 14; C*01, 04N; DRB1*16,07?
FISH
Which of the following assays would you recommend to test for chromosomal rearrangments such as the BCR/ABL translocation seen in CML?
tumor cells that can escape the immune system have a growth advantage over tumor cells that are destroyed during immunosurveillance
Which of the following best summarizes the concept of tumor development via immunoediting?
antigen-specific testing should be done
Which of the following conclusions can be drawn about a patient whose total IgE level was determined to be 150 IU/mL?
O
Which of the following donors would be the most appropriate, based on ABO compatibility, for a renal transplant candidate with the ABO type = O?
Type II involves cellular antigens
Which of the following explains the difference between type II and type III hypersensitivity reactions?
an exaggerated immune response to an antigen occurs
Which of the following is a general characteristic of hypersensitivity reactions?
cytokeratins
Which of the following is a marker used in immunohistochemical staining to identify tumors of epithelial origin?
lack of a costimulatory signal to autoreactive T cells in the lymph nodes
Which of the following is a mechanism used to achieve peripheral tolerance?
BCR/ABL fusion protein
Which of the following is an example of a tumor-specific antigen?
activation of Th2 cells
Which of the following is associated with an increase in IgE production?
buildup of IgE on mast cells
Which of the following is associated with anaphylaxis?
all of the above
Which of the following is associated with ataxia-telangiectasia? Inherited as an autosomal recessive Defect in both cellular and humoral immunity Chromosomal breaks in lymphocytes
all of the above
Which of the following markers could be elevated in nonmalignant liver disease? AFP CEA CA 15-3
they are monomorphic
Which of the following properties are not exhibited by HLA molecules? They belong in the immunoglobulin superfamily They are heterodimeric They are intergral cell membrane glycoproteins They are monomorphic
acute cellular rejection
Which of the following responses is the type of allograft rejection associated with vascular and parenchymal injury with lymphocyte infiltrates?
there is a lack of circulating CD19+ B cells
Which of the following statements applies to Bruton's thymidine kinase (Btk) deficiency?
antibody to TSHR
Which of the following would be considered a significant finding in Graves disease?
Hashimoto's thyroiditis
Which of the following would be considered an organ-specific autoimmune disease?
all of the above
Which of the following would cause a positive DAT test? Presence of IgG on RBCs Presence of C3b or C3d on RBCs A transfusion reaction caused by preformed antibody
antihistone antibodies
Which of the following would support a diagnosis of drug-induced lupus?
DRB1*01:03, 01:03
Which one of the following donors would be expected to elicit a positive mixed lymphocyte response in lymphocytes from a patient who has the HLA-DRB1*01:01, 01:03 alleles?
recipient serum and donor lymphocytes + rabbit serum complment
Which reagents would be used in a direct (forward) donor-recipient crossmatch test?
