Immuno tb flashcards Unit 3



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Immuno TB Flashcards Unit 3

  1. A 10-year-old girl was brought in to her physician's office because she had been complaining that she was thirsty and had to go to the bathroom all the time. She had lost 15 pounds over the last 6 months and was more irritable than usual, especially after meals. The girl's fasting blood glucose was 575 mg/dL, her C-peptide was 0.5 ng/mL, and she had autoantibodies against glutamic acid decarboxylase and insulin. This girl has:

type 1 diabetes

  1. A 40-year-old woman presents with a lemon-yellow, waxy pallor and a red, beefy tongue. She is extremely fatigued and is having difficulty getting up in the morning and getting through the day. Antiparietal cell antibodies are found in her serum. This woman has:

pernicious anemia

  1. A 56-year-old woman presents to her physician complaining of weight gain and joint problems. She is increasingly having difficulty walking up stairs and manipulating her fingers. Fingers in both hands as well as knees on both legs are equally painful and stiff. The symptoms have been progressing over the last 6 months. Rheumatoid factor is elevated, and antinuclear antibodies are not detected. Complement levels in her joints are less than the levels in her serum. This woman has:

rheumatoid arthritis

  1. A 30-year-old clinical laboratory sciences student complains of being tired, yet not able to sleep. The woman also states that her hair has been breaking off and she has lost 20 pounds over the last 2 months without trying. The woman's pulse and blood pressure are both elevated and her eyes seem to be bulging. Her CBC is normal, thyroid-stimulating hormone is decreased, and T4 is increased. Antimicrosomal and antithyroglobulin antibodies are each 1:400. This woman has:

Graves' disease

  1. A 54-year-old woman presents to her optometrist complaining that she has been having difficulty focusing on objects, both near and far. Her vision problems are getting progressively worse. She also thinks that her eyelids are drooping and she is thinking of getting plastic surgery to “put them back up.” The optometrist cannot find a good reason for her vision problems but is able to fit her with glasses and recommends that she see a rheumatologist. The rheumatologist sends the women's blood for autoantibody testing, and the laboratory professionals report that the woman has autoantibodies against the acetylcholine receptor. This woman has:

myasthenia gravis

  1. A 33-year-old female presents with red and irritated eyes for the last month. Discharge from the eyes is not apparent. She also has had recurrent low-grade fever and a rash on her chest and legs. Her joints have been achy for the last few months, and her mouth has been so dry it is often difficult to swallow food. Antinuclear antibody testing is performed, and a speckled pattern is observed on hep-2 cells. Follow-up testing reveals the presence of autoantibodies against SS-A and SS-B. This woman has:

Sjögren's syndrome

  1. A 45-year-old male presents to his physician complaining of achy joints, chronic runny nose, and coughing up blood. Chest x-ray shows pulmonary nodules. Cortisol is increased; ESR is slightly elevated. Tests for autoantibodies are positive for cytoplasmic antineutrophil cytoplasmic antibodies. This patient has:

Wegener's granulomatosis

  1. The “CREST” variant of which disease is associated with the presence of an anticentromere antibody?

progressive systemic sclerosis (scleroderma)

  1. A 40-year-old female patient has increased TSH and decreased rT3 and T4 levels with a normal T3 level. Antithyroglobulin is measured as 1:1280, and the antimicrosomal level is reportedly 1:6400. This patient most likely has:

Hashimoto's thyroiditis

  1. What lab findings would be most likely to indicate multiple sclerosis?

several bands on electrophoresis of CSF

  1. Systemic lupus erythematosus can be characterized by all of the following EXCEPT:

A) butterfly rash

B) joint pain

C) presence of circulating immune complexes

D) presence of reagin antibody



D

  1. In the slide agglutination for lupus, what is detected?

anti-DNP

  1. An autoimmune disease characterized by pain and progressive destruction of the joints, weight loss, morning stiffness, and presence of an antibody directed against IgG best describes:

rheumatoid arthritis

  1. Reasons for autoimmunity may include all of the following EXCEPT:

A) inheritance of certain HLA antigens

B) molecular mimicry

C) polyclonal B cell activation

D) normal antibody production



D

  1. The characteristic ANA pattern produced by antibody to DNA-histone complex is:

homogeneous

  1. A disease characterized by hypoactivity of the thyroid with weight gain and a sluggish metabolism due to destruction of thyroglobulin best describes:

Hashimoto's thyroiditis

  1. In the RF test for rheumatoid arthritis, what is being detected?




IgM directed against IgG

  1. 18. What are characteristic of cold autoimmune hemolytic anemia?

The antibody reacts as an anti-I.

  1. The fluorescent antinuclear antibody test for lupus is an example of what?

indirect fluorescent testing

  1. What would be an indicator of systemic lupus?

anti-Sm antibody

  1. In which one of the following autoimmune diseases are antibodies to acetylcholine receptors produced, thereby blocking the signal to muscles?

myasthenia gravis

  1. Lupus can be distinguished from rheumatoid arthritis on the basis of what?

deposition of immune complexes in the kidney

  1. A 25-year-old female sees her physician because of swelling in the joints of her hands and generally feeling tired and run down. A slide agglutination test for antibody directed against IgG is positive. What is the most likely cause of her symptoms?

rheumatoid arthritis

  1. Antibodies directed against thyroglobulin represent a significant finding in what autoimmune diseases?

Hashimoto's thyroiditis

  1. What would be an indicator of systemic lupus?

anti-deoxynucleoprotein antibody

  1. A 35-year-old female experiences difficulty in walking, and her hands and feet are numb from time to time. Suspecting a disease involving the central nervous system, her physician orders an MRI. The MRI reveals lesions on the myelin sheath. What is the most likely disease?

multiple sclerosis

  1. All of the following findings would be useful in the diagnosis of Graves' disease EXCEPT:

A) presence of antibodies to thyroid-stimulating hormone receptors

B) hyperthyroidism

C) symptoms of nervousness and weight loss

D) increase in allergic IgE



D

  1. Homogeneous staining of the nucleus in an ANA test indicates:




antibody to DNA-histone complex

  1. A 16-year-old male goes to his physician for an annual checkup. A routine urinalysis indicates the presence of blood, an increase in protein, and an increase in urea. The young man reports that he has been feeling tired and has a persistent cough. The doctor orders additional lab testing, including a serum test for rheumatoid factor, antinuclear antibody testing, anti-streptolysin O testing, and testing for the presence of anti-basement membrane antibodies. Only the latter test was positive. What is the most likely cause of the symptoms?

Goodpasture's syndrome

  1. A CBC, differential, and flow cytometry were performed on a patient with the following results (normal values): WBC = 8.0 th/uL (5.0–10.0 th/uL), diff = 90% lymphs (20–40%), CD3 = 5% (60–80%), CD5 = 95% (60–80%), CD19 = 95% (5–20%), CD10 = 0% (0%), surface Ig = pos (positive), and cytoplasmic Ig = neg (negative). What disease does this patient have?

B-cell chronic leukemia

  1. What is the interpretation of the following patient results? (normal values) WBC = 90.0 th/uL (5.0–10.0 th/uL,), with 89% lymphs (20–40%); CD3 = 90% (60–80%); CD5 = 87% (60–80%); CD10 = 0% (< 1%); CD4 = 88% (30–65%); CD20 = 12% (5–20%); CD34 = 0% (< 1%); CD8 = 3% (10–40%); kappa = 10% (3–15%); lambda = 5% (2–10%); CD19 = 15% (5–20%).

T-cell chronic leukemia


  1. What is the interpretation of the following patient results? (normal values) WBC = 25.0 th/uL (5.0–10.0 th/uL), with 78% blasts; CD3 = 83% (60–80%); CD5 = 90% (60–80%); CD10 = 2% (< 1%); CD4 = 85% (30–65%); CD20 = 1% (5–20%); CD34 = 0% (< 1%); CD8 = 87% (10–40%); kappa = 1% (3–15%); lambda = 0% (2–10%); CD19 = 2% (5–20%).

T-cell acute leukemia

  1. What is the interpretation of the following patient results? (normal values) WBC = 7.0 th/uL (5.0–10.0 th/uL), with 89% blasts; CD3 = 10% (60–80%); CD5 = 9% (60–80%); CD10 = 89% (< 1%); CD4 = 6% (30–65%); CD20 = 0% (5–20%); CD34 = 94% (< 1%); CD8 = 3% (10–40%); kappa = 0% (3–15%); lambda = 0% (2–10%); CD19 = 90% (5–20%).

B-cell acute leukemia

  1. Which immunoproliferative disorder is a cancer of the plasma cells and results in secretion of light chains into the urine?

multiple myeloma

  1. A 55-year-old male presents with symptoms that include weakness, loss of appetite, and anemia. Immunofixation electrophoresis reveals a heavy IgM band. What is the most likely diagnosis?

Waldenström's macroglobulinemia


  1. What is the main difference between leukemias and lymphomas?




Lymphomas arise mainly in lymph nodes, the spleen, or other lymphoid tissue.

  1. What best describes the difference between chronic and acute lymphocytic leukemias?




Acute lymphocytic leukemias have a high response rate to chemotherapy.

  1. Decreased CD3-positive lymphocytes and a lack of responsiveness to phytohemagglutinin (PHA) in the circulation would typically be associated with:

DiGeorge syndrome

  1. What statements about severe combined immunodeficiency (SCID) are true?




may be associated with a signal transduction defect

  1. A 9-month-old boy was suspected of having an immune deficiency because he had many recurrent infections with Streptococcus pneumoniae. Laboratory tests revealed a normal percentage of T cells and T-cell subsets but a lack of mature B cells and immunoglobulins. This boy most likely has:

X-linked agammaglobulinemia

  1. A patient with hereditary angioedema will present with swelling in the tissues and has what deficiencies?

C1 inhibitor

  1. A 7-month-old boy is seen by a specialist because of hypocalcemia, viral pneumonia, a history significant for recurrent diarrhea, and oral candidiasis. An x-ray reveals the lack of a thymic shadow. This boy most likely has:

DiGeorge syndrome

  1. An autosomal recessive disease characterized by the presence of abnormally large granules primarily affecting the function of lysosomes is known as:

Chédiak-Higashi syndrome

  1. A child suspected of having an inherited humoral immunodeficiency disease is given diphtheria/tetanus vaccine. Two weeks after the immunization, his level of antibody to the specific antigens is measured. Which result is expected for this patient if he does have this deficiency?

no change in the level of specific antibody

  1. Which disease may be expected to show an IgM spike on an electrophoretic pattern?

Waldenström's macroglobulinemia

  1. What diseases results in an acquired or secondary immunodeficiency?

HIV infection

  1. A 1-year-old boy is evaluated for a suspected immune deficiency. He has a history since birth of eczema, recurrent rashes, and diarrhea. (Normal values are given in parentheses.) His WBC count is 6.75/uL (5.0–10.8 × 103 uL) with a normal differential. Platelet count is 35,000 (150,000–350,000/uL) and the platelets are small. His IgG is 750 mg/dL (600–1,500 mg/dL), IgM is 30 mg/dL (75–150 mg/d :), IgA is 475 mg/dL (50–125 mg/dL), and IgE is 750 mg/dL (10–50 mg/dL). The boy's blood is typed as O-positive, and he does not have anti-A or anti-B antibodies. Flow cytometry performed on his blood shows 11% (5–20%) CD19 and 50% (60–80%) CD3 cells with a normal ratio of CD4:CD8. T-cell function tests are abnormal. This boy most likely has:

Wiskott-Aldrich syndrome

  1. A 2-week-old girl is evaluated by a specialist because her physical appearance is abnormal. She has been hospitalized since birth. (Normal values are given in parentheses.) Her CD3 level is reported as 15% (60–80%), CD4 = 10% (30–65%), CD8 = 5% (10–40%), and CD19 = 84% (5–20%). Serum immunoglobulin levels are normal. Karyotyping reveals a deletion on chromosome 22. This girl has:

DiGeorge syndrome

  1. A 9-month-old infant is seen by a physician due to a persistent skin infection. His white and red blood cell counts are normal. However, immunofixation electrophoresis indicates a low level of IgG. When the infant returns to the physician for a follow-up visit in a month, his IgG level has increased. What condition do these results indicate?

transient hypogammaglobulinemia


  1. A 6-month-old baby has suffered from recurrent bacterial infections. Flow cytometry results indicate a lack of B cells but presence of normally functioning T cells. Which is the most likely diagnosis?

Bruton's agammaglobulinemia

  1. Which is true of selective IgA deficiency?




Patients may develop an anti-IgA antibody.

  1. What best describes common variable immunodeficiency disease?




There is a deficiency of IgA and/or IgG.

  1. A male baby who has suffered from persistent Candida fungal infections and several bouts of pneumonia all before the age of 6 months is found to have some developmental problems as well as low-set ears. Lab testing reveals an absence of T cells. What is the most likely diagnosis?

DiGeorge syndrome

  1. What is associated with DiGeorge syndrome?




small or missing thymus

  1. The disease SCID is characterized by what?

diagnosed in infancy, short life span, no antibody production

  1. A nitro-blue tetrazolium (NBT) test indicates little color in cells observed under a microscope. What disease does this most likely indicate?

chronic granulomatous disease

  1. Which term applies to the type of graft rejection that begins within a few weeks or months after transplantation of an organ and is due to CD8 reactive T cells?

chronic rejection

  1. Which antigens are most important in matching for tissue transplants?




HLA A and B, blood group antigens A or B, and HLA DR1 and DQ1

  1. A 25- year-old female is in kidney failure and needs a transplant. She is A positive and HLA A1A3/B5B7/C2C9/DR4DR8. What donors would be the best match?

A) her brother, who is B positive and HLA A1A3/B7B5/C2C9/DR8DR4

B) her sister, who is A positive and HLA A3A4/B7B9/C2C3/DR4DR7

C) her mother, who is AB positive and HLA 1A4/B9B5/C9C3/DR8DR7

D) an unrelated donor who is A positive and HLA

A6A3/B5B7/C3C10/DR2DR9


B

  1. The type of rejection that occurs within minutes to hours due to preformed antibody is known as:

hyperacute rejection

  1. Graft-versus-host disease results under which conditions?




when immunocompetent cells are placed in an immunocompromised host

  1. Transplantation of an individual's skin from one place to another is an example of a(n):

autograft


  1. When foreign HLA antigens are presented by antigen-presenting cells to T cells, this is known as:

indirect allorecognition

  1. When a complement-dependent cytotoxicity test was performed using standard antibodies to HLA A1, A3, B2, and B11, the following microscopic results were obtained: a majority of blue cells were seen with anti-A1, A3, and B11. Based on these results, what is the phenotype of the donor cells?

HLA A1, A3, B11



  1. Which test would be best to determine the actual genotype in an HLA matching?

polymerase chain reaction

  1. How can normal cells become malignant?




Overexpression of oncogenes, Underexpression of tumor-suppressing genes, Viral infection

  1. 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

  1. If a disease is present in 1 in every 10,000 ndividuals, and a marker can detect this disease with 100% sensitivity and 95% specificity, what would be the number of false positives for each cancer found?

5

  1. A tumor found in the prostate does not sstain with antibody to PSA. Is this proof that the tumor came from a different organ?

No

  1. Antibodies against streptolysin O, hyaluronidase, and DNase B are measured in the diagnosis of which disease?

rheumatic fever

  1. Acute glomerulonephritis is due to:




deposition of immune complexes in the kidney

  1. What bacterial enzymes causes the release of lysosomal contents into the cytoplasm of the phagocytic cell, leading to the death of the cell?

leukocidin

  1. An ASO test was performed on the serum from a 10-year-old female patient with the following results: no hemolysis in the 1:10, 1:20, 1:40, and 1:80 tubes; and hemolysis in the 1:160, 1:320, and 1:640 tubes. What conclusion can you draw from these results?

The titer is 1:80, and the patient is normal.

  1. What statements best describes Helicobacter pylori?




It is a gram-negative spiral that causes ulcers.

  1. All of the following are tests used to identify Helicobacter pylori EXCEPT:

A) polymerase chain reaction

B) urease

C) enzyme immunoassay

D) DNase


D

  1. What is the main reason testing for cold agglutinins is no longer recommended to diagnose infection with Mycoplasma pneumonia?

False-positives may be caused by certain viruses.

  1. Organisms that are short rods or coccobacilli and obligate intracellular bacteria best describes:




Rickettsia prowazekii

  1. How does complement help in defense against bacterial invasion?




It promotes phagocytosis.

  1. Antibodies detected by reacting rickettsial antigens with specific antibody followed by use of an anti-immunoglobulin with a fluorescent tag could be used to diagnose:

Rocky Mountain spotted fever






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