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WorksheetsIS MIDTERM EXAM
Total questions: 100
Worksheet time: 1hrs 11mins
Rheumatoid factor is?
an antigen found in the serum of patients with rheumatoid arthritis
identical to the rheumatoid arthritis precipitin
IgM autoantibody
capable of forming circulating immune complexes only when IgM-type autoantibody is present
The presence of immune complexes indicates?
polyclonal hypergammaglobulinemia
inflammatory tissue injury
protection from complement-dependent neutrophil chemotaxis
normal host response to antigenic exposure
Immediate hypersensitivity is most commonly associated with?
transfusion reaction
contact dermatitis
anaphylactic reaction
bacterial septicemia
A transfusion reaction to erythrocyte antigens will activate which of the following immunopathologic mechanisms?
immediate hypersensitivity
delayed hypersensitivity
Arthus reaction
immune cytolysis
Delayed hypersensitivity is related to:
contact sensitivity to inorganic chemicals
transfusion reaction
anaphylactic reaction
bacterial septicemia
High titers of antimicrosomal antibodies are most often found in:
rheumatoid arthritis
chronic hepatitis
systemic lupus erythematosus
thyroid disease
Systemic lupus erythematosus patients often have which of the following test results?
high titers of DNA antibody
high titers of anti-smooth muscle antibodies
decreased serum immunoglobulin levels
high titers of antimitochondrial antibody
Anti-RNA antibodies are often present in individuals having an antinuclear antibody immunofluorescent pattern that is:
speckled
rim
diffuse
nucleolar
Which of the following terms describes a graft between genetically unidentical individuals belonging to the same species?
autograft
isograft
allograft
xenograft
In primary biliary cirrhosis, which of the following antibodies is seen in high titers?
antimitochondrial
anti-smooth muscle
anti-DNA
anti-parietal cell
In chronic active hepatitis, high titers of which of the following antibodies are seen?
antimitochondrial
anti-smooth muscle
anti-DNA
anti-parietal cell
In the indirect fluorescent antinuclear antibody test, a homogeneous pattern indicates the presence of antibody to:
RNP
Sm
RNA
DNA
In the indirect fluorescent antinuclear antibody test, a speckled pattern indicates the presence of antibody to:
RNP
Sm
RNA
DNA
Which of the following is used to detect allergen-specific IgE?
RIST
IEP
RAST
CRP
In skin tests, a wheal and flare development is indicative of:
immediate hypersensitivity
delayed hypersensitivity
anergy
Arthus reaction
Carcinoembryonic antigen (CEA) is most likely to be produced in a malignancy involving the
brain
testes
bone
colon
Which of the following is DECREASED in serum during the active stages of systemic lupus erythematosus?
antinuclear antibody
complement (C3)
immune complexes
anti-DNA
Rheumatoid factor in a patient's serum may cause a false:
positive test for the detection of IgM class antibodies
negative test for the detection of IgM class antibodies
positive test for the detection of IgG class antibodies
negative test for the detection of IgG class antibodies
Which of the following is an organ-specific autoimmune disease?
myasthenia gravis
Addison's disease
rheumatoid arthritis
progressive systemic sclerosis
Which immunologic mechanism is usually involved in bronchial asthma?
immediate hypersensitivity
immune complex
antibody-mediated cytotoxicity
delayed hypersensitivity
Antihistamines:
stimulate IgE antibody production b. stimulate IgG blocking antibodies
bind histamine
stimulate IgG blocking antibodies
block histamine receptors
Detection of which of the following substances is most useful to monitor the course of a patient with testicular cancer?
alpha-fetoprotein
prolactin
carcinoembryonic antigen
testosterone
Tumor markers found in the circulation are most frequently measured by
immunoassays
thin-layer chromatography
high-pressure liquid chrom atography
colorimetry
Avidity may be defined as the:
degree of hemolysis
titer of an antigen
dilution of an antibody
strength of a reacting antibody
Which of the following has been associated with patients who have homozygous C3 deficiency?
undetectable hemolytic complement activity in the serum
systemic lupus erythematosus
no detectable disease
a lifelong history of life-threatening infections
Immunologic surveillance of tumors is thought to be affected by:
B lymphocytes and T lymphocytes
B lymphocytes and macrophages
T lymphocytes and macrophages
macrophages and lymphokines
A benign monoclonal gammopathy:
usually is associated with a decrease in other immunoglobulins
occasionally is associated with radiographic bone lesions
occurs in approximately 10% of people over the age of 70
usually is of the IgM class
Incompatibility by which of the following procedures is an absolute contraindication to allotransplantation?
MLC
HLA typing
Rh typing
ABO grouping
Cells from a patient with hairy cell leukemia have immunologic and functional features of
mast cells and B lymphocytes
B lymphocytes and T lymphocytes
granulocytes and monocytes
B lymphocytes and monocytes
A 25-year-old woman is seen by a physician because of Raynaud's phenomenon, myalgias, arthralgias, and difficulty in swallowing. There is no evidence of renal disease. An ANA titer is 1:8000 with a speckled pattern. Which of the following are also likely to be found in this patient?
high-level nDNA antibody and a low CH,, level
high-level Sm antibody
high-titer rheumatoid factor
high-level ribonucleoprotein (RNP) antibody
What is a general definition for autoimmunity?
Increase of tolerance to self-antigens
Loss of tolerance to self-antigens
Increase in clonal deletion of mutant cells
Manifestation of immunosuppression
An antinuclear antibody test is performed on a specimen from a 55-year-old woman who has unexplained joint pain. The IFA result is a titer of 40 and a homogeneous pattern. The appropriate follow-up for this patient is:
Anti-DNA assay
Extractable nuclear antigen (ENA) testing
Retest ANA in 3–6 months
CH50 complement assay
Which disease is likely to show a rim (peripheral) pattern in an immunofluorescence (IF) microscopy test for ANA?
Mixed connective tissue disease (MCTD)
Rheumatoid arthritis
Systemic lupus erythematosus
Scleroderma
A patient’s specimen is strongly positive in an ANA ELISA. Which of the following would not be an appropriate follow up to this result?
Immunofluorescence test on HEp-2 cells
Specific ENA ELISA tests
Specific anti-DNA ELISA
Rheumatoid factor assay
What type of antibodies is represented by the solid or homogeneous pattern in the immunofluorescence test for antinuclear antibodies?
Antihistone antibodies
Anticentromere antibodies
Anti-ENA (anti-Sm and anti-RNP) antibodies
Anti-RNA antibodies
What disease is indicated by a high titer of anti-Sm (anti-Smith) antibody?
Mixed connective tissue disease (MCTD)
RA
SLE
Scleroderma
Which disease is least likely when a nucleolar pattern occurs in an immunofluorescence test for antinuclear antibodies?
MCTD
Sjögren’s syndrome
SLE
Scleroderma
What antibodies are represented by the nucleolar pattern in the immunofluorescence test for antinuclear antibodies?
Antihistone antibodies
Anti-dsDNA antibodies
Anti-ENA (anti-Sm and anti-RNP) antibodies
Anti-RNA antibodies
Which test would best distinguish between SLE and MCTD?
Multiplex or ELISA test for anti-SM and anti-RNP
Immunofluorescence testing using Crithidia as substrate
Slide agglutination testing
Laboratory tests cannot distinguish between these disorders
An ANA test on HEp-2 cells shows nucleolar staining in interphase cells and dense chromatin staining in mitotic cells. The most likely cause of this staining pattern is:
Antifibrillarin antibody
Antiribosomal p antibody
A serum with nucleolar and homogeneous patterns
Technical artifact
Which immunofluorescence pattern indicates the need for ENA testing by Ouchterlony immunodiffusion, Multiplex, or ELISA assays?
Homogeneous or solid
Peripheral or rim
Speckled
Nucleolar
Which of the following methods is least likely to give a definitive result for the diagnosis of RA?
Nephelometric measurement of anti-IgG
Agglutination testing for rheumatoid factor
Anti CCP
Immunofluorescence testing for antinuclear antibodies.
. Which disease might be indicated by antibodies to smooth muscle?
Atrophic gastritis
Autoimmune hepatitis
Myasthenia gravis
Sjögren’s syndrome
Antibodies to thyroid peroxidase can be detected by using agglutination assays. Which of the following diseases may show positive results with this type of assay?
Graves’ disease and Hashimoto’s thyroiditis
Myasthenia gravis
Granulomatous thyroid disease
Addison’s disease
What is the main use of laboratory tests to detect antibodies to islet cells and insulin in cases of insulin-dependent diabetes mellitus (IDDM)?
To regulate levels of injected insulin
To diagnose IDDM
To rule out the presence of other autoimmune diseases
To screen susceptible individuals prior to destruction of βcells
A patient present with clinical symptoms of celiac disease. Tests for anti-tissue transglutaminase and antigliadin antibodies are negative. Which of the following tests should be ordered?
IgG level
HLA DQ typing
HLA DR typing
IgM level
Which of the following is a description of a type I hypersensitivity reaction?
Ragweed antigen cross links with IgE on the surface of mast cells, causing release of preformed mediators and resulting in symptoms of an allergic reaction
Anti-Fya from a pregnant woman crosses the placenta and attaches to the Fya antigen-positive red cells of the fetus, destroying the red cells
Immune complex deposition occurs on the glomerular basement membrane of the kidney, leading to renal failure
Exposure to poison ivy causes sensitized T cells to release lymphokines that cause a localized inflammatory reaction
Why is skin testing the most widely used method to test for a type I hypersensitivity reaction
It causes less trauma and is more cost effective than other methods
It has greater sensitivity than in vitro measurements
It is more likely to be positive for IgE-specific allergens than other methods
It may be used to predict the development of further allergen sensitivity
Which in vitro test measures IgE levels against a specific allergen?
Histamine release assay
Radioimmunosorbent test (RIST)
Fluorescent allergosorbent test (FAST)
Precipitin radioimmunosorbent test (PRIST)
A patient who is blood group O is accidentally transfused with group A blood and develops a reaction during the transfusion. What antibody is involved in this type II reaction?
IgM
IgE
IgG and IgE
IgG
Which of the following symptoms in a young child may indicate an immunodeficiency syndrome?
Anaphylactic reactions
Severe rashes and myalgia
Recurrent bacterial, fungal, and viral infections
Weight loss, rapid heartbeat, breathlessness
What screening test should be performed first in a young patient suspected of having an immune dysfunction disorder?
Complete blood count (CBC) and white cell differential
Chemotaxis assay
Complement levels
Bone marrow biopsy
Which test should be performed when a patient has a reaction to transfused plasma products?
Immunoglobulin levels
T-cell count
Hemoglobin levels
Red cell enzymes
What is the “M” component in monoclonal gammopathies?
IgM produced in excess
μHeavy chain produced in excess
Malignant proliferation of B cells
Monoclonal antibody or cell line
What is measured in the CH50 assay?
RBC quantity needed to agglutinate 50% of antibody
Complement needed to lyse 50% of RBCs
Complement needed to lyse 50% of antibodysensitized RBCs
Antibody and complement needed to sensitize 50% of RBCs
What type of disorders would show a decrease in C3, C4, and CH50?
Autoimmune disorders such as SLE and RA
Immunodeficiency disorders such as common variable immunodeficiency
Tumors
Bacterial, viral, fungal, or parasitic infections
All of the following tests measure phagocyte function except:
Leukocyte adhesion molecule analysis
Di Hydro rhodamine reduction assay
NBT test
IL-2 (interleukin-2) assay
A patient had surgery for colorectal cancer, after which he received chemotherapy for 6 months. The test for carcinoembryonic antigen (CEA) was normal at this time. One year later, the bimonthly CEA was elevated (above 10 ng/mL). An examination and biopsy revealed the recurrence of a small tumor. What was the value of the results provided by the CEA test in this clinical situation?
Diagnostic information
Information for further treatment
Information on the immunologic response of the patient
No useful clinical information in this
A carbohydrate antigen 125 assay (CA-125) was performed on a woman with ovarian cancer. After treatment, the levels fell significantly. An examination performed later revealed the recurrence of the tumor, but the CA 125 levels remained low. How can this finding be explained?
Test error
CA-125 was the wrong laboratory test; α-fetoprotein (AFP) is a better test to monitor ovarian cancer
CA-125 may not be sensitive enough when used alone to monitor tumor development
CA-125 is not specific enough to detect only one type of tumor
What is the correct procedure upon receipt of a test request for human chorionic gonadotropin (hCG) on the serum from a 60-year-old man?
Return the request; hCG is not performed on men
Perform a qualitative hCG test to see if hCG is present
Perform the test; hCG may be increased in testicular tumors
Perform the test but use different standards and controls
Would an hCG test using a monoclonal antibody against the β-subunit of hCG likely be affected by an increased level of follicle-stimulating hormone (FSH)?
Yes, the β-subunit of FSH is identical to that of hCG
No, the test would be specific for the β-subunit of hCG
Yes, a cross reaction would occur because of structural similarities
No, the structure of FSH and hCG are not at all similar I
Which of the following substances, sometimes used as a tumor marker, is increased two- or threefold in a normal pregnancy?
Alkaline phosphatase (ALP)
Adrenocortocotropic hormone (ACTH)
Calcitonin
Neuron-specific enolase
What is an advantage of performing a prostatespecific antigen (PSA) test for prostate cancer?
PSA is stable in serum and not affected by a digital-rectal examination
PSA is increased only in prostatic malignancy
A normal serum level rules out malignant prostatic disease
The percentage of free PSA is elevated in persons with malignant disease
Which method is the most sensitive for quantitation of AFP?
Double immunodiffusion
Electrophoresis
Enzyme immunoassay
Particle agglutination
Select the best donor for a man, blood type AB, in need of a kidney transplant.
His brother, type AB, HLA matched for class II antigens
His mother, type B, HLA matched for class I antigens
His cousin, type O, HLA matched for major class II antigens
Cadaver donor, type O, HLA matched for some class I and II antigens
Hereditary deficiency of early complement components (Cl, C4, and C2) is associated with:
pneumococcal septicemia
small bowel obstruction
systemic lupus erythematosus
gonococcemia
Which of the following findings is associated with a hereditary deficiency of C3?
pneumococcal septicemia
small bowel obstruction
systemic lupus erythematosus
gonococcemia
Hereditary deficiency of late complement components (C5, C6, C7, or C8) can be associated with which of the following conditions?
pneumococcal septicemia
small bowel obstruction
systemic lupus erythematosus
gonococcemia
Infantile X-linked agamrnaglobulinemia is referred to as:
Bruton'sagammaglobulinemia
. DiGeorge's syndrome
Swiss-type agamrnaglobulinemia
ataxia telangiectasia
Immunodeficiency with thrombocytopenia and eczema is often referred to as:
DiGeorge's syndrome
Bruton'sagamrnaglobulinemia
ataxia telangiectasia
Wiskott-Aldrich syndrome
The autosomal recessive form of severe combined immunodeficiency disease is also referred to as:
Bruton'sagammaglobulinemia
Swiss-type lymphopenicagammaglobulinemia
DiGeorge's syndrome
Wiskott-Aldrich syndrome
Combined immunodeficiency disease with loss of muscle coordination is referred to as
DiGeorge's syndrome
Bruton'sagamrnaglobulinemia
ataxia telangiectasia
Wiskott-Aldrich syndrome
HLA-B8 antigen has been associated with which of the following pairs of diseases?
ankylosing spondylitis and myasthenia gravis
celiac disease and ankylosing spondylitis
myasthenia gravis and celiac disease
Reiter's disease and multiple sclerosis
Systemic lupus erythematosus patients with active disease often have which of the following test results
high titers of antimicrosomal antibodies
high titers of anti-smooth muscle antibodies
marked decrease in serum CH50
decreased serum immunoglobulin levels
Anti-extractable nuclear antigens are most likely associated with which of the following antinuclear antibody immunofluorescent patterns?
speckled
rim
diffuse
nucleolar
Anti-glomerular basement membrane antibody is most often associated with this condition:
systemic lupus erythematosus
celiac disease
chronic active hepatitis
Goodpasture's disease
In pernicious anemia, which of the following antibodies is characteristically detected?
anti-mitochondria
anti-smooth muscle
anti-DNA
anti-parietal cell
HLA antibodies are generally obtained from which of the following?
multiparous women
. nonidentical siblings
sheep
rabbits
The ratio of kappa to lambda light chains in normal individuals is:
1:1
2.1
3.1
4:1
Which is a recognized theory of the origin of autoimmunity?
enhanced suppressor T-cell function
diminished helper T-cell activity
defects in the idiotype-anti-idiotype network
deficient B-cell activation
For which immunodeficiency syndrome should patients receive irradiated blood products to protect against the development of GvH disease?
Bruton’sagammaglobulinemia
. Severe IgA deficiency
SCID
CGD
T-cell subset enumeration by flow cytometry would be most useful in making the diagnosis of which disorder?
Bruton’sagammaglobulinemia
Severe IgA deficiency
SCID
Multiple myeloma
What clinical manifestations would be seen in a patient with myeloperoxidase deficiency?
Defective T-cell function
Inability to produce IgG
Defective NK cell function
Defective neutrophil function
Defects in which arm of the immune system are most commonly associated with severe illness after administration of live virus vaccines?
Cell-mediated immunity
Humoral immunity
Complement
Phagocytic cells
Which of the following statements applies to Bruton’s X-linked agammaglobulinemia?
It typically appears in females.
There is a lack of circulating CD19 positive B cells.
T cells are abnormal
There is a lack of pre-B cells in the bone marrow.
DiGeorge anomaly may be characterized by all of the following except
autosomal recessive inheritance
cardiac abnormalities
parathyroid hypoplasia
decreased number of mature T cells
. 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 alphafetoprotein, and a deficiency of naturally occurring isohemagglutinins. Based on these results, which is the most likely diagnosis?
PNP deficiency
Selective IgA deficiency
SCID
WAS
Which of the following is associated with AT?
Inherited as an autosomal recessive
Defect in both cellular and humoral immunity
Chromosomal breaks in lymphocytes
All of the above
The type of allograft rejection associated with vascular and parenchymal injury with lymphocyte infiltrates is which of the following?
Hyperacute rejection
Acute cellular rejection
Antigen receptors on T lymphocytes bind HLA class II molecules with the help of which accessory molecule?
CD2
CD3
CD4
CD8
Patients at risk for graft-versus-host disease (GVHD) include each of the following, except recipients of
bone marrow transplants
lung transplants
liver transplants.
irradiated leukocytes.
HLA molecules exhibit all of the following properties, except that they
belong to the immunoglobulin superfamily
are heterodimeric
are integral cell membrane glycoproteins
are monomorphic.
Kidney allograft loss from intravascular thrombosis without cellular infiltration 5 days post-transplant raises the suspicion level about which primary rejection mechanism?
Hyperacute rejection
Accelerated humoral rejection
Acute humoral rejection
Acute cellular rejection
Which reagents would be used in a direct (forward) donor–recipient crossmatch test?
Donor serum and recipient lymphocytes + rabbit serum complement
Recipient serum and donor lymphocytes + rabbit serum complement
Donor stimulator cells + recipient responder cells + complete culture medium
Recipient stimulator cells + donor responder cells complete culture medium
The indirect allorecognition pathway involves which one of the following mechanisms?
Processed peptides from polymorphic donor proteins restricted by recipient HLA class II molecules
Processed peptides from polymorphic recipient proteins restricted by donor HLA class I molecules
Intact polymorphic donor protein molecules recognized by recipient HLA class I molecules
Which immunosuppressive agent selectively inhibits IL-2 receptor-mediated activation of T cells and causes clearance of activated T cells from the circulation?
Mycophenolatemofetil
Cyclosporine mofetil
Corticosteroids
Daclizumab
How can normal cells become malignant?
Overexpression of oncogenes
Underexpression of tumor-suppressing genes
Viral infection
All of the above
Which of the following best summarizes the concept of tumor development via immunoediting?
Cytokines produced by tumor cells are toxic to T cells expressing receptors for tumor-associated antigens.
Cells that can escape the immune system have a growth advantage over more immunogenic tumor cells that are destroyed by T cells during immunosurveillance
T-cell activity causes an up-regulation of MHC expression on tumor cells that allows them to escape the immune system
Expression of secreted tumor-associated antigen saturates T-cell receptors and renders them incapable of binding to the actual tumor cells.
A woman goes 3 days per week to a tanning bed for 20 minutes of UV exposure per visit. Which stage of cancer is this?
Induction
In situ
Invasion
Dissemination
Each of these markers may be elevated in multiple myeloma except
CA-125.
β-2 microglobulin.
monoclonal intact immunoglobulin molecules
free monoclonal light chains from the immunoglobulin molecule.
