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WorksheetsMechanism of Rituximab in B-cell ALL
Total questions: 15
Worksheet time: 8mins
A 42-year-old woman diagnosed with B-cell acute lymphoblastic leukemia (ALL) undergoes immunophenotyping laboratory examination. The result reveals that her leukemic blasts express CD20 in addition to CD19 and CD10. Given her CD20 positivity, her oncologist considers adding rituximab, a monoclonal antibody targeting CD20, to her chemotherapy regimen. What is the most appropriate primary mechanism of the addition of a drug?
An antibody-dependent B-cell cytotoxicity against the membrane immune receptor
Direct inhibition of BCR-ABL tyrosine kinase activity
Blocking the cell interaction to prevent B-cell proliferation
Stimulating T-cell mediated immunity by acting as a vaccine adjuvant
Promoting differentiation of B-cell leukemic blasts into mature plasma cells
A 9-year-old girl presents with symptoms of fatigue and easy bruising. Bone marrow examination reveals a high percentage of lymphoblasts. Immunophenotyping reveals that the blasts express CD19, CD34, and TdT, and lack surface immunoglobulin. Which stage of B-cell development is most consistent?
Pre-B cell stage
Mature B-cell stage
Pro-B cell stage
Plasma cell stage
T-cell precursor stage
A 60-year-old patient with systemic lupus erythematosus (SLE) presents with nephritis. Kidney biopsy reveals immune complex deposition. Serology shows high titers of autoantibodies. What is the most appropriate role of antigen-antibody complexes in the pathogenesis of this patient’s renal disease?
Causing inflammation and tissue injury
Protect renal tissue from damage
Neutralize circulating pathogens preventing infection
Suppress immune responses in the kidney
Causing Systemic Lupus Eritematosus
A patient with severe respiratory distress due to SARS-CoV-2 infection is considered for monoclonal antibody therapy. However, viral sequencing reveals a spike protein mutation known to reduce the affinity of antibodies. What is the most critical consideration before initiating monoclonal antibody therapy in this patient?
The mutation may render the therapy ineffective.
Monoclonal antibodies will still work regardless of viral mutations.
The mutation enhances antibody binding, improving therapy efficacy.
Therapy should be delayed until the antibody titers naturally rise.
The mutation affects only T-cell responses, not antibody therapy.
A clinician must make decisions based on evidence received from the patients. Evidence resulting from laboratory results will have objective data. Related to antigen and antibody interaction, the use of an antigen detection test or an antibody detection test for diagnosing a suspected acute infection in a patient presenting within 48 hours of symptom onset is recommended. Which test is more appropriate and why?
Antigen test, because it detects current infection early
Antibody test, because antibodies appear immediately after infection
Antigen test, because it detects past infections better
Antibody test, because it is more sensitive in early infection
Neither test is useful in early infection
A 25-year-old woman presents with symptoms of fatigue, joint pain, and a malar rash. Laboratory tests reveal the presence of antinuclear antibodies (ANA) and elevated inflammatory markers. A biopsy of her lymphoid tissue shows defective elimination of autoreactive T cells in the thymic medulla. Which process of T cell development is most appropriate in this case?
Negative selection
Positive selection
T cell receptor (TCR) gene rearrangement
Migration of mature T cells
Activation of naïve T cells
A 6-year-old child with T-ALL presents with mediastinal mass and respiratory distress. What is the most clinical urgency to be the cause?
Compression of vital structures by thymic mass
Tumor lysis syndrome
Autoimmune hemolytic anemia
Opportunistic infections due to T cell depletion
Cytokine storm from leukemic cells
A patient’s blood sample is tested for antibodies against a recent viral infection to determine if they have been previously exposed. Which is the most correct statement regarding the infection process?
Past exposure or infection and possible immunity
Current active infection only
The patient is not infected
The infection is bacterial
The patient is vaccinated but not infected
A 25-year-old woman suddenly develops generalized urticaria, facial swelling, difficulty breathing, and hypotension shortly after eating shellfish at a restaurant. She is confused and struggling to articulate her thoughts. What is the most urgent next step in managing this patient?
Give intramuscular epinephrine
Administer oral antihistamines
Start intravenous corticosteroids
Provide supplemental oxygen
Observe for 30 minutes
A 45-year-old woman presents to the emergency department with the sudden onset of unilateral leg swelling, pain, and erythema. Doppler ultrasound confirms the presence of deep vein thrombosis (DVT). She has a history of recent long-haul flights and oral contraceptive use. Which coagulation pathway is primarily activated?
Extrinsic pathway
Intrinsic pathway
Common pathway
Fibrinolytic pathway
Platelet aggregation pathway
A 45-year-old woman presents to the emergency department with the sudden onset of unilateral leg swelling, pain, and erythema. Doppler ultrasound confirms the presence of deep vein thrombosis (DVT). She has a history of recent long-haul flights and oral contraceptive use. What is the most urgent clinical implication of risk?
risk of pulmonary embolism (PE)
risk of disseminated intravascular coagulation (DIC)
risk of hemorrhagic stroke
risk of bleeding
risk of thrombocytopenia
A 30-year-old man with hemophilia A presents with spontaneous joint bleeding and prolonged bleeding after minor trauma. Laboratory tests show prolonged activated partial thromboplastin time (aPTT) and normal prothrombin time (PT). Which is the most likely coagulation factor deficiency that explains this presentation?
Factor VIII
Factor IX deficiency
Factor V deficiency
Factor VII deficiency
Factor X deficiency
A 30-year-old man with hemophilia A presents with spontaneous joint bleeding and prolonged bleeding after minor trauma. Laboratory tests reveal a prolonged activated partial thromboplastin time (aPTT) and a normal prothrombin time (PT). What is the most correct immediate treatment?
factor VIII concentrate
fresh frozen plasma
vitamin K
platelet transfusion
antifibrinolytic agents
A 25-year-old woman presents with petechiae, mucosal bleeding, and a platelet count of 15,000/μL. Coagulation studies are normal. She recently had a viral infection. What is the most likely diagnosis?
Immune thrombocytopenic purpura (ITP)
Disseminated intravascular coagulation (DIC)
Hemophilia B
Vitamin K deficiency
Thrombotic thrombocytopenic purpura (TTP)
A 50-year-old man with sepsis develops bleeding from multiple sites, hypotension, and laboratory findings show prolonged PT, aPTT, low fibrinogen, and elevated D-dimer. What is the most correct diagnosis?
Disseminated intravascular coagulation (DIC)
Vitamin K deficiency
Hemophilia A
Thrombotic thrombocytopenic purpura (TTP)
Heparin-induced thrombocytopenia (HIT)
