Chapters 26-30

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1

Cytotoxic Reaction

Type II Hypersensitivity

2

Cell-mediated Reaction

Type IV Hypersensitivity

3

Immune Complex Reaction

Type III Hypersensitivity

4

Anaphylactic Reaction

Type I Hypersensitivity

5

With which cell type are anaphylactic reactions associated?

Mast cells

6

Type III reactions are exemplified by all of the following except:

a. arthus reaction

b. serum sickness

c. glomerulonephritis

d. shingles

d. shingles

7

Type IV reactions are responsible for all the following except:

a. contact sensitivity

b. delayed hypersensitivity

c. elimination of tumor cells bearing neoantigens

d. hemolysis of red blood cells

d. hemolysis of red blood cells

8

Type I hypersensitivity reactions can be associated with

food allergies, hay fever, and asthma

9

The most common agents that cause anaphylactic reactions are:

drugs and insect stings

10

Place in Order

A. The effects of mediator release produce vascular changes, activation of platelets, eosinophils, and neutrophils, and activation of the coagulation cascade.

B. The offending antigen attaches to the IgE antibody fixed to the surface membrane of mast cells and basophils.

C. Activated mast cells and basophils release various mediators.

B, C, and A

11

Increases vascular permeability and promotes contraction of smooth muscle

Histamine

12

Enhances the effects of histamine on target organs

Leukotriennes

13

Contracts smooth muscle

Serotonin

14

Enhances release of histamine and serotonin

Platelet activating factor

15

Attracts cells to area of activity; these cells release secondary mediators that may limit the effects of primary mediators

Eosinophil chemotactic factors of anaphylaxis

16

Affects smooth muscle tone and vascular permeability

Prostaglandins

17

In vitro evaluation of type I hypersensitivity reactions can include

RIST

18

Cytotoxic reactions are characterized by the interaction of:

IgM or IgG to cell-bound antigen

19

An example of delayed non hemolytic (type II hypersensitivity) reaction is

Graft-vs-host disease

20

Under normal conditions, immune complexes protect the host because they:

Facilitate the clearance of various antigens and invading microorganisms

21

Immune complexes can

Suppress or augment immune response by interacting with T and B cells, inhibit tumor cell destruction, and be deposited in blood vessel walls

22

The general anatomic sites of antigen-antibody interaction are:

Tissues with a large filtration area, interstitial fluids, and cell surface membranes or fixed intercellular structures

23

Type IV hypersensitivity reactions are responsible for all the following except:

A. contact sensitivity

B. Elimination of tumor cells

C. Rejection of foreign tissue grafts

D. Serum sickness

D. Serum sickness

24

Polyclonal gammopathies can be exhibited as a secondary manifestation of all the following except:

Chronic infection

Chronic liver disease

Multiple myeloma

Rheumatoid connective tissue

Multiple myeloma

25

What is the most frequent cause of death in a patient with multiple myeloma?

Infectious disease

26

Patients with multiple myeloma have defects in:

Humoral immunity and synthesis of normal immunoglobulins

27

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

MM All of the above

28

Bence-Jones proteins are soluble at room temperature, form a precipitate near ____, and then dissolve (resolubilize) at ___.

60 Celsius, 100 Celsius

29

M proteins are associated with all the following malignant conditions except:

A. Multiple myeloma

B. Plasmacytoma

C. Malignant lymphoproliferative diseases

D. Lymphoma

D. Lymphoma

30

Cryoglobulins are proteins that precipitate or gel at:

0 Celsius

31

Monoclonal gammopathy involves elevated levels of a single class and type of immunoglobulin referred to as

Monoclonal (M) protein or paraprotein

32

In light chain disease, only _____ or _____ monoclonal light chains are synthesized by a one-cell clone.

kappa; lambda

33

Multiple myeloma is also referred to as:

Plasma cell myeloma, Kahler's disease and Myelomatosis

34

Most patients with multiple myeloma manifest

bone pain

35

Patients with Waldenstrom;s macroglobulinemia exhibit abnormally large amounts of

IgM

36

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

MG All of the above

37

Monoclonal gammopathy of undetermined significance (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

B. Presence of lytic bone lesions

38

Light chain disease represents about ___ of monoclonal gammopathies.

10-15%

39

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

C. Antigens are available to lymphoid system in low concentrations

40

Antibody expression in the development of autoimmunity is regulated by all the following factors except:

A. Genetic predisposition

B. Increasing age

C. Environmental factors

D. Active infectious disease

D. Active infectious disease

41

The mechanism responsible for autoimmune disorder is:

Circulating immune complexes

42

One of the mechanisms believed to induce self-tolerance is

elimination of clone programmed to react with antigen

43

Found in one third of patients with myasthenia gravis

Acetylcholine receptor-blocking antibodies

44

Present in SLE and associated with arterial and venous thrombosis

Anticardiolipin antibody

45

Useful in monitoring the activity and exacerbations of SLE

Anti-DNA antibodies

46

Suggestive of Goodpasture's disease

Anti-glomerular basement membrane

47

Characteristic of mixed connective tissue disease

Antinuclear ribonucleoprotein

48

Antibody to basic nonhistone nuclear protein, diagnostic of systemic sclerosis

Anti-Scl

49

Presence of antibody confirms diagnosis of SLE

Anti-Sm

50

Seen in viral disorders

Anti-smooth muscle

51

Demonstrable in Sjogren's syndrome---sicca complex

Anti SS-A

52

Highly suggestive of drug-induced lupus erythematosus

Histone-reactive antinuclear antibody

53

Found in most patients with polymyositis

PM-I antibody

54

The term autoimmune disorder is used when:

A. Demonstrable immunoglobulins display specificity for self antigens

B. Cytotoxic T cells display specificity for self antigens and contribute to the pathogenesis of the disease.

C. Both A and B

Both A and B

55

T/F The presence of autoantibodies are only associated with autoimmune disease.

False

56

T/F In organ-specific disorders, antigens are only available to the lymphoid system in low concentrations.

True

57

There is a familial tendency to develop organ-specific disorders.

True

58

In organ-specific disorders, lesions are caused by deposition of antigen-antibody complexes.

False

59

In organ-specific disorders, there is a tendency to develop cancer

True

60

Self-recognition (tolerance) is induced by:

A. Burnet's clonal selection theory

B. Elimination of the small clone of immunocompetent cells programmed to react with the antigen

C. Induction of unresponsiveness in the immunocompetent cells through excessive antigen binding

D. All of the above

SR All of the above

61

Useful in the diagnosis of myasthenia gravis

Acetylcholine receptor binding antibody (AChR)

62

Demonstrated in most patients with CREST syndrome

Anticentromere antibody

63

Found in 60% of patients with pernicious anemia

Antiintrinsic factor antibody

64

Strongly suggestive, in high titer, of primary biliary binding antibody cirrhosis

Antimitochondrial antibody

65

Associated with multiple myeloma

Antimyelin antibody

66

Diagnostic of Dressler's syndrome or rheumatic fever

Antimyocardial antibody

67

Marker for Wegener's granulomatosis

Cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA)

68

Characteristic of untreated systemic lupus erythematosus

Antinuclear antibody (ANA)

69

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

C. In vitro antibody-mediated immunity

70

Most immunologically mediated renal diseases fall into one of the following categories, except for association with:

A. Circulating immune complexes

B. Circulating antigen

C. Anti-glomerular basement membrane antibody

D. Membranoproliferative glomerulonephritis

B. Circulating antigen

71

Polymyositis and dermatomyositis are the most common expressions of:

Skeletal muscle disorders

72

Autoimmune pancreatitis is more common in women than in men

False

73

Autoimmune pancreatitis patients are younger than 50 years at diagnosis.

False

74

The number of reported cases of autoimmune pancreatitis has been decreasing over the last decade.

False

75

The immunologic abnormality associated with autoimmune pancreatitis in the Japanese population is

HLA halotype

76

SLE is more common in:

Adolescent through middle-aged women

77

One of the most potent inducers of abnormalities and clinical manifestations of SLE is

Procainamide hydrochloride

78

The cellular aberrations in SLE include

Deficiency fo suppressor T cell function and hyper production of helper T cells

79

The principle demonstrable antibody in SLE is antibody to

nuclear antigen

80

The sites of immune complex deposition in SLE are influenced by all the following except:

A. Molecular size

B. Molecular configuration

C. Immune complex specificity

D. Immunoglobulin class

C. Immune complex specificity

81

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

SLE All of the above

82

The overall incidence of SLE has an increased frequency among

Blacks, Native Americans, and Puerto Ricans

83

Patients with SLE characteristically manifest:

Butterfly rash over the bridge of the nose

84

Laboratory features of SLE include:

A. The presence of ANAs

B. Circulating anticoagulant and immune complexes

C. Decreased levels of complement

D. All of the above

Lab features of SLE All of the above

85

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

Lab procedures of SLE All of the above

86

T/F: Antinuclear antibodies ANAs are always indicative of SLE.

ANAs False

87

Jo-1

Polymyositis

88

Mi-I

Dermatomyositis

89

SS-B/La

Systemic lupus erythematosus

90

RANA

Progressive systemic sclerosis

91

Anti-DNA-nucleoprotein antibody

Diffused or homogenous pattern

92

Antibody to any extractable nuclear antigen devoid of DNA or histone

Speckled pattern

93

Rheumatoid arthritis most frequently develops in:

Middle aged women

94

Worldwide the incidence of rheumatoid arthritis is

1-2%

95

Women are _____ likely than men to develop rheumatoid arthritis.

two to three times more

96

Antibodies with specificity for antigen determinants on the Fc fragment of human or certain animal IgG

Rheumatoid factor

97

The principle of the rapid agglutination test is based on the reaction of patient _____ and _____ derived from gamma globulin.

Antibody; antigen

98

Arrange Rheumatoid Arthritis Pathogenesis in order:

A. Immunologic events perpetuate the initial inflammatory reaction

B. The primary etiologic factor initiates synovitis

C. An inflammatory reaction in the synovium develops into a proliferative destructive process of tissue

B, A, C

99

All the following are criteria for rheumatoid arthritis except:

A. Morning stiffness

B. Evening stiffness

C. Rheumatoid nodules

D. Radiographic changes

Evening stiffness

100

Rheumatoid factor correlates with all the following except:

The severity of the disease in general

The presence of nodules

Other organ system involvement

The age of the patient

Age of patient

101

In RA, vascular and parenchymal lesions suggest that lesions result from injury induced by immune complexes, especially those containing antibodies to:

IgG

102

Serum complement levels are usually ____ in patients with rheumatoid arthritis.

Normal

103

The most common form of juvenile idiopathic arthritis is:

Oligoarthritis

104

In the RF agglutination procedure, a false-positive result may be observed in a serum specimen because of

hemolysis

105

In rapid testing for rheumatoid factor, biological false-positive results can be caused by a variety of disorders including:

Hepatitis or systemic lupus erythematosus

106

Type I hypersensitivity reactions are characterized by:

a. activation of complement.

b. antigen cross-links with IgE on mast cells.

c. being potentially fatal.

d. both b and c.

Type I hypersensitivity Both b and c

107

Cell-mediated immunity (Type IV) is responsible for:

a. contact sensitivity.

b. elimination of tumor cells bearing neoantigens.

c. rejection of foreign tissue graft.

d. all of the above.

Type IV All of the above

108

Antibody mediated hypersensitivity

Immediate hypersensitivity

109

Cell mediated hypersensitivity

Delayed hypersensitivity

110

Dependent on the host's response to a subsequent exposure of antigen

Immunization or sensitization

111

Not mediated by antigen-antibody interacton

Anaphylactoid reaction

112

The major growth factor for multiple myeloma cells is:

IL-6

113

Which laboratory assay has been adopted as a prognostic indicator in multiple myeloma?

B2-microglobulin

114

Patients with multiple myeloma have defects in _____ but not in _____.

humoral immunity cellular immunity

115

The diagnosis of MM depends on:

more than 10% plasma cells in the bone marrow

116

A decreased tolerance to self antigens

Autoimmunity

117

A disorder considered to be organ-nonspecific

Systemic lupus erythematosus

118

An individual may develop an autoimmune response to:

a. antigens that do not normally circulate in the blood.

b. altered antigens.

c. loss of immunoregulatory function by lymphocyte subsets.

d. all of the above.

Autoimmune response All of the above

119

The cause of insulin-dependent diabetes mellitus is:

immune destruction of B lymphocytes in pancreatic islets

120

Pernicious anemia is characterized by:

a. deficiency of vitamin B12.

b. presence of antiparietal antibodies.

c. presence of IF-blocking antibodies.

d. all the above.

P. anemia All of the above

121

A condition called the ________________ syndrome can be secondary to lupus and may complicate pregnancy.

antiphospholipid

122

A major cellular immunologic feature of SLE is:

a. lack of generalized suppressor T cell function.

b. reduction of generalized suppressor T cell function.

c. hyperproduction of helper T cells.

d. all of the above.

SLE All of the above

123

The site of deposition of immune complexes in systemic lupus erythematosus (SLE) is determined by:

a. molecular configuration.

b. immunoglobulin class.

c. complement-fixing ability.

d. all of the above.

Immune complexes All of the above

124

Many of the clinical manifestations of systemic lupus erythematosus are a consequence of:

tissue damage mediated by immune complexes

125

Always limited to the skin

discoid

126

can affect the skin, joints, and almost any organ or body system, including lungs, kidneys, heart, and brain

systemic

127

can be caused by procainamide

drug-induced

128

T/F: Immunologic features of rheumatoid arthritis may include anti-cyclic citrullinated peptide

True

129

Immunologic features of rheumatoid arthritis may include immune complexes

True

130

Immunologic features of rheumatoid arthritis may include antinuclear antibodies

True

131

Rheumatoid arthritis most frequently develops in middle-aged men.

False women

132

Pathogenic mechanisms hypothesized for rheumatoid arthritis include

a. an infective agent or other stimulus that binds to receptors on dendritic cells

b. activated T lymphocytes that proliferate and migrate into the joint

c. complement activation

d. both a and b

RA both a and b

133

In RA, stimulated macrophages and fibroblasts release cytokines. One that is particularly important is _____.

TNF-a

134

Which molecular component is used in rheumatoid factor rapid slide assays?

Fc region of IgG

135

Highly specific lab assay for RA

Cyclic citrullinated peptide (CCP) antibodies

136

Nonspecific lab assay for RA

Antinuclear antibodies (ANAs)

137

A biological false-positive rheumatoid factor (RF) assay result can be manifested by patients with:

a. systemic lupus erythematosus

b. hepatitis

c. syphilis

d. All of the above

RF Fasle Positive All of the above