immuno exam (Immunoproliferative, SLE, RA review questions)
Worldwide the incidence of rheumatoid arthritis is: a. 1% to 2% b. 2%to4% c. 5% to 10% d. More than 10%
1% to 2%
Arrange the steps in the pathogenesis of rheumatoid arthritis in the proper order.
1) the primary etiologic factor initiates synovitis., 2)Immunologic events perpetuate the initial inflammatory reaction. 3)An inflammatory reaction in the synovium develops into a proliferative destructive process of tissue.
Light-chain disease represents about ________ of monoclonal gammopathies. a. 5% to 10% b. 10% to 15% c. 15% to 25% d. 25% to 50%
10 to 15
Bence-Jones proteins are soluble at room temperature, form a precipitate near_______, and then dissolve (resolubilize) at _______.
60*C, 100*C
SLE is more common in: a. Female infants b. Male infants c. Adolescent through middle-aged women d. Adolescent through middle-aged men
Adolescent through middle-aged women
What is the most consistent immunologic feature of multiple myeloma? a. Synthesis of dysfunctional single monoclonal proteins b. Synthesis of Ig chains or fragments c. Presence of M protein in serum and/or urine d. All of the above
All of the above
Diffused or homogeneous pattern
Anti-DNA-nucleoprotein antibody
The primary mechanism responsible for pathology in systemic lupus erythematosus is a. Allergic reaction to foreign molecules b. Antibodies directed against self antigens c. Polyclonal activation of cytotoxic T cells d. Lack of intracellular killing after neutrophil phagocytosis of bacteria
Antibodies directed against self antigens
Rheumatoid factor is de ned as: a. Antigens with specificity for antibody determinants on the Fc fragment of human or certain animal IgG b. Antibodies with specificity for antigen determinants on the Fc fragment of human or certain animal IgG c. Antigens with specificity for antibody determinants on the Fc fragment of human or certain animal IgD d. Antibodies with specificity for antigen determinants on the Fc fragment of human or certain animal IgD
Antibodies with specificity for antigen determinants on the Fc fragment of human or certain animal IgG
speckled pattern
Antibody to any extractable nuclear antigen devoid of DNA or histone
The principle of the rapid agglutination test is based on the reaction of patient (5) _______ and (6)_______ derived from gamma globulin. a. Antigen b. Antibody c. Complement levels d. Leukocytes
Antibody, Antigen
All the following characteristics are common to organ- specific and organ-nonspecific disorders except: a. Autoantibody tests are of diagnostic value. b. Antibodies may appear in each of the main immunoglobulin classes. c. Antigens are available to lymphoid system in low concentrations. d. Circulatory autoantibodies react with normal body constituents.
Antigens are available to lymphoid system in low concentrations.
A 38-year-old woman visited her physician because of fatigue, fever, and joint pain (proximal interphalangeal, wrist, and knee joints). She also noticed sensitivity to the sun and reported having a rash following recent exposure. The physician noted a rash over her nose and cheeks. Laboratory results included white blood cell count 5.5 X 109/L (reference range 4.8-10.8 X 109/L) and red blood cell count 4.5 X 1012/L (reference range 4.0-5.4 X 1012/L). Urinalysis results were within reference ranges, except for 4+ protein and 1+ RBCs, 0-3 hyaline casts/lpf and 0-1 RBC cast/lpf on microscopic examination. Which of the following tests would be most helpful in diagnosing this patient's condition? a. Anti-nuclear antibody b. a-Fetoprotein c. Anti-streptolysin O d. Hepatitis profile
Antinuclear antibody
Most immunologically mediated renal diseases fall into one of the following categories, except for: a. Association with circulating immune complexes b. Association with circulating antigen c. Association with anti-glomerular basement membrane antibody d. Membranoproliferative glomerulonephritis
Association with circulating antigen
Patients with multiple myeloma have defects in: a. Cellular immunity b. Humoral immunity c. Synthesis of normal immunoglobulins d. Both b and c
B + c
The cellular aberrations in SLE include: a. B cell depletion b. De ciency of suppressor T cell function c. Hyperproduction of helper T cells d. Bothbandc
B cell depletion, hyperproduction of helper t cells
Patients with SLE characteristically manifest: a. Butterfly rash over the bridge of the nose b. Skin lesions on the arms and legs c. Ulcerations on the trunk d. Photophobia
Butterfly rash over the bridge of the nose
Multiple myeloma is a a. Lymphoproliferative disease of T cells b. Cancer of plasma cells characterized by increased antibody concentration c. Lymphoproliferative disease resulting in a decrease in antibody production d. Cancer of monocytes characterized by increased kappa and lambda chain synthesis
Cancer of plasma cells characterized by increased antibody concentration
Anticentromere antibody
Demonstrated in most patients with CREST syndrome
Mi-I
Dermatomyositis
In rapid testing for rheumatoid factor, biological false- positive results can be caused by a variety of disorders including: a. Infectious mononucleosis b. Hepatitis c. Systemic lupus erythematosus d. Either b or c
Either b or c
One of the mechanisms believed to induce self-tolerance is: a. Induction of responsiveness in immunocompetent cells b. Elimination of clone programmed to react with antigen c. Decreased suppressor cell activity d. Stimulation of clones of immunocompetent cells
Elimination of clone programmed to react with antigen
All the following are criteria for rheumatoid arthritis except: a. Morning stiffness b. Evening stiffness c. Rheumatoid nodules d. Radiographic changes
Evening stiffness
InRA,vascular and parenchymal lesions suggest that lesions result from injury induced by immune complexes, especially those containing antibodies to: a. IgM b. IgG c. IgE d. IgD
IgG
Patients with Waldenström's macroglobulinemia exhibit abnormally large amounts of: a. IgM b. IgG c. IgE d. IgA
IgM
The sites of immune complex deposition in SLE are in uenced by all the following factors except: a. Molecular size b. Molecular configuration c. Immune complex specificity d. Immunoglobulin class
Immune complex specificity
The immunologic manifestations of multiple sclerosis include all the following except: a. Antimyelin antibodies b. An oligoclonal increase in CSF immunoglobulin c. In vitro antibody-mediated immunity d. An increase in certain HLA and Ia antigens
In vitro antibody-mediated immunity
Rheumatoid arthritis most frequently develops in: a. Adolescent females b. Adolescent males c. Middle-aged women d. Middle-aged men
Middle-aged women
Polyclonal gammopathies can be exhibited as a secondary manifestation of all the following except: a. Chronic infection b. Chronic liver disease c. Multiple myeloma d. Rheumatoid connective disease
Multiple myeloma
Serum complement levels are usually _______ in patients with rheumatoid arthritis. a. Normal b. Decreased c. Increased d. a or b
Normal
Jo-1
Polymyositis
Anticardiolipin antibody
Present in SLE and associated with arterial and venous thrombosis
One of the most potent inducers of abnormalities and clinical manifestations of SLE is: a. Chloramphenicol b. Procainamide hydrochloride c. Isoniazid d. Penicillin
Procainamide hydrochloride
RANA
Progressive systemic sclerosis
Anti SS-A
Sjogren's syndrome
Anti-glomerular basement membrane antibodies
Suggestive of Goodpasture's disease
SS-B/La
Systemic lupus erythematosus
RF correlates with all the following except: a. the severity of the disease in general b. the presence of nodules c. Other organ system involvement (i.e., vasculitis) d. the age of the patient
The age of the patient
Women are _______ likely than men to develop rheumatoid arthritis. a. Less b. Equally c. Two to three times more d. 10 to 20 times more
Two to three times more
Anti-DNA antibodies
Useful in monitoring the activity and exacerbations of SLE
Antibody expression in the development of autoimmunity is regulated by all the following factors except: a. Genetic predisposition b. Increasing age c. Environmental factors (e.g., ultraviolet [UV ] radiation) d. Active infectious disease
active infectious disease
Laboratory features of SLE include: a. e presence of ANAs b. Circulating anticoagulant and immune complexes c. Decreased levels of complement d. All of the above
all of the above
Laboratory procedures that are helpful in assessing renal disease include: a. Antibody to double-stranded DNA b. Levels of C3 and C4 c. Cryoglobulin assay d. All of the above
all of the above
Monoclonal gammopathy involves elevated levels of a single class and type of immunoglobulin referred to as: a. Monoclonal protein b. M protein c. Paraprotein d. All of the above
all of the above
Monoclonal gammopathy of undetermined significance (MGUS) represents a: a. Monoclonal protein in patients with no features of multiple myeloma or related malignant disorders b. Disorder that can evolve into a malignant monoclonal gammopathy c. Serum monoclonal protein concentration less than 3 g/dL d. All of the above
all of the above
Multiple myeloma is also referred to as: a. Plasma cell myeloma b. Kahler's disease c. Myelomatosis d. All of the above
all of the above
Renal disease secondary to SLE can be assessed by: a. Antibody to native dsDNA b. Levels of C3 and C4 c. Levels of ANA d. All of the above
all of the above
SLE is a classic model of autoimmune disease and is a(n): a. Abnormality of the joints b. Systemic rheumatoid disorder c. Abnormality of connective tissue d. All of the above
all of the above
The overall incidence of SLE has an increased frequency among: a. Blacks b. Native Americans c. Puerto Ricans d. All of the above
all of the above
The term autoimmune disorder is used when: a. Demonstrable immunoglobulins display specificity for self antigens. b. Cytotoxic T cells display specificity for self antigens. c. Cytotoxic T cells contribute to the pathogenesis of the disease. d. All of the above
all of the above
Characteristic of untreated systemic lupus erythematosus
antinuclear antibody (ANA)
Antimyelin antibody
associated with multiple myeloma
Loss of self-tolerance results in a. Autoimmune disease b. Graft-versus-host disease c. Immunodeficiency d. Tumors
autoimmune disease
Most patients with multiple myeloma manifest: a. Bone pain b. Acute renal failure c. No symptoms d. Hepatomegaly and splenomegaly
bone pain
The mechanism responsible for autoimmune disorder is: a. Circulating immune complexes b. Antigen excess c. Antibody excess d. Antigen deficiency
circulating immune complexes
Antinuclear antibodies (ANAs) are always indicative of SLE. a. True b. False
false
True or False: In organ-specific disorders, lesions are caused by deposition of antigen-antibody complexes.
false
Acetylcholine receptor-blocking antibodies (anti-AchR)
found in 1/3 of patients with myasthenia gravis
In the RF agglutination procedure, a false-positive result may be observed in a serum specimen because of: a. Complement interference b. High levels of C-reactive protein (CRP) c. Antigen excess d. Hemolysis
hemolysis
Histone-reactive antinuclear antibody
highly suggestive of drug induced lupus
In light-chain disease, only ________ or _______ monoclonal light chains are synthesized by a one-cell clone.
kappa, lambda
M-proteins are associated with all the following malignant conditions except: a. Multiple myeloma b. Plasmacytoma c. Malignant lymphoproliferative diseases d. Lymphoma
lymphoma
Presence of at least 2 or more oligoclonal bands in electrophoresis from a CSF sample indicates what disease?
multiple sclerosis
The antibody most frequently present in systemic lupus erythematosus is directed against a. Surface antigens of bone marrow stem cells b. Surface antigens of renal cells c. Nuclear antigen d. Myelin
nuclear antigen
The principal demonstrable antibody in SLE is antibody to: a. Nuclear antigen b. Cell surface antigens of hematopoietic cells c. Cell surface antigens to neuronal cells d. Lymphocytic leukocytes
nuclear antigen
The most common form of juvenile idiopathic arthritis is: a. Systemic b. Oligoarthritis c. Psoriatic d. Enthesitis-related
oligoroarthritis
MGUS is characterized by all the following except: a. Fewer than 10% plasma cells in the bone marrow b. Presence of lytic bone lesions c. Anemia d. Hypercalcemia
presence of lytic bone lesions
Hashimoto disease is an autoimmune disease primarily involving the a. Kidneys b. Liver c. Lungs d. Thyroid gland
thyroid gland
True or False: In organ-specific disorders, antigens are only available to the lymphoid system in low concentrations.
true
True or False: In organ-specific disorders, there is a tendency to develop cancer.
true
True or False: The presence of autoantibodies are only associated with autoimmune disease.
true
True or False: There is a familial tendency to develop organ-specific disorders.
true
An autoimmune disease causing destruction of pancreatic cells can result in a. Hashimoto disease b. Multiple sclerosis c. Myasthenia gravis d. Type 1 diabetes
type 1 diabetes
Cryoglobulins are proteins that precipitate or gel at: a. −18° C b. −4° C c. 0°C d. 4°C
0