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