Immunology Final Exam
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Still working on it, needs flow cytometry, complement, scatter plots, primary and secondary lymp organs, and photos
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86 Terms
Q: A tumor that is classified as malignant is described as:
Unencapsulated, disorganized, metastasis
Q: What is the definition of a carcinoma?
Epithelial
Q: What is the definition of a sarcoma?
Muscle, fat, blood vessels and cartilage
Q: A tumor-specific antigen is:
Specific to the tumor.
Q: Which of the following is a clinical application for tumor markers?
Screen, Diagnosis, Prognosis, Monitor
Q: A woman who has a history of ovarian cancer in her family goes to her physician for a "cancer test." What is the test that is most likely to be positive if the woman has ovarian cancer?
CA-125
Q: A CA-125 assay was performed on a woman with ovarian cancer. After treatment, the levels xxxl significantly. How can this finding be explained?
Increase-treatment not working
Decrease-treatment is working
Q: A patient had surgery for colorectal cancer, after which he received chemotherapy for 6 months. The test for CEA was normal at the time. One year later, the bimonthly CEA was elevated (above 10ng/mL). An examination and biopsy revealed the recurrence of small tumor. What was the value of the results provided by the CEA test in the clinical situation?
Monitoring
Q: Which type of gene is required for cell growth and division but can cause malignant transformation when altered?
Proto-oncogenes
Q: Polyclonal gammopathies can be exhibited as a secondary manifestation of all the following EXCEPT:
Multiple Myeloma
Q: Which cytogenetic abnormality is associated with an excellent prognosis in children with B-cell acute lymphoblastic leukemia (ALL)?
Philadelphia, t(12;21)(p13;q22)
Q: Which marker is highly specific for hairy-cell leukemia?
CD103 TRAP
Q: Which of the following is not a characteristic in the identification of lymphoma of B-cell origin?
Presence of CD14 and CD15
Q: Which of the following findings is a diagnostic criterion for monoclonal gammopathy of undetermined significance?
Serum monoclonal protein (IgG or IgA) concentration is less than 3g/dL
Q: What is the correct order of protein migration, starting at the anode and moving to cathode, following serum protein electrophoresis?
Albumin, alpha1, alpha2, beta, gamma
Q: A patient’s immunofixation electrophoresis shows excessive amounts of free monoclonal light chains. These light chains are referred to as:
Bence Jones proteins
Q: A child suspected of having an inherited humoral immunodeficiency disease is given a 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
Q: Which is true of selective IgA deficiency?
Patients may develop Anti-A
The most common primary immunodeficiency disorder
Characterized by a lack of IgA (IgG and IgM are normal)
Most patients are asymptomatic
Increase in the incidence of autoimmune diseases
Q: A specific defect in innate immunity leading to bacterial infections could involve a deficiency in:
Toll-like receptors
Q: The most serious impairment of opsonization and antimicrobial defense is caused by a deficiency in complement component:
C3
Q: The most common complement component deficiency is:
C2
Q: The interaction between an individual antigen and antibody molecule depends upon several types of bonds such as ionic bonds, hydrogen bonds, hydrophilic bonds, and van der Waals forces. How is the strength of this attraction characterized?
Avidity. How well it fits into the fab region
Q: A laboratory is evaluating an ELISA test for detecting an antibody to CCP. The laboratory includes serum from healthy volunteers and patients with other connective tissue diseases in the evaluation. These specimens determine which factor of the assay?
Specificity
Q: The detection of precipitation reactions depends on the presence of optimal proportions of antigen and antibody. A patient’s sample contains a large amount of antibody, but the reaction in a test system containing antigen is negative. What has happened?
Pro-zone phenomenon
Q: Which mechanism is involved in peripheral tolerance to self-antigens?
Inhibition of co-stimulatory signals from antigen-presenting cells
Q: Central tolerance, in which lymphocytes learn to distinguish between self-antigens and foreign antigens, takes place in the thymus and:
Bone marrow
Q: Identify a specific component of the adaptive immune system that is formed in response to antigenic stimulation:
Immunoglobulins
Q: Which two organs are considered the primary lymphoid organs in which immunocompetent cells originate and mature?
Bone marrow and Thymus
Q: Which region determines whether an immunoglobulin molecule can fix complement?
Fc region
Q: Which MHC class of molecule is necessary for antigen recognition by CD4-positive cells?
MHC Class II
Q: Which of the following cell surface molecules is classified as an MHC class II antigen
HLA-DP, HLA-DR, HLA-DQ
Q: An initial titer of 4 followed by a subsequent titer of 16 for the same patient, drawn 2 weeks later, is indicative of which of the following?
Active infection
Q: Which of the following are components of both innate and adaptive immune responses?
Monocytes, macrophages, and dendritic cells
Q: What is the purpose of C3a, C4a, and C5a?
Anaphylatoxic factors
Q: Where does the specific immune response to a foreign antigen mainly occur?
Fab region
Q: The most primitive component of the immune response found even in some of the simplest forms of life is the ability to:
Recognize self from non-self
Q: A man opens up an old loaf of bread and inhales Penicillium spores from the organism growing inside. Inside the man’s lungs, phagocytes engulf and digest the spores. The man never gets sick. This is an example of:
Innate immunity
Q: Thymocytes start as:
Double negatives to double positives to single positive
Q: All of the following are characteristic of acute-phase reactants EXCEPT:
They are used to diagnose specific diseases
Q: Class II molecules bind to what kind of peptides?
Exogenous peptides
Q: A patient with a viral infection to the ABC virus is found to have a high antibody titer to the ABC virus’s RNA, or anti-ABCr. Which of the following is true?
MHC Class I presented antigen to CD8+ T cells
Q: What is measured in the CH50 assay?
Complement needed to lyse 50% of antibody sensitized RBC
Q: If complement CH50 is decreased and complement AH50 is normal in a specimen, the specimen may be deficient in factor(s):
C1, C2, or C4
Q: Complement components are completely destroyed if a specimen is:
Heated 56°C for 30 minutes
Q: The C5 convertase of the classical pathway of complement activation is:
C4b2a3b
Q: A cytokine “storm” is a:
Dysregulation of cytokines
Q: A Fab fragment consists of:
One light chain and one half of a heavy chain
Q: The combination of a plasma cell fused to a myeloma cell is called a:
Hybridoma
Q: Select the statement about secondary response to an antigen that is true.
Increase from 100 fold to 1000 fold for IgG
Q: Identify the true statement about the anamnestic response versus the primary response.
The primary response involves a rapid increase in antibody titer, whereas the amnestic response involves a rapid decrease in antibody titer
Q: A patient has a PSA level of XXX the day before surgery to remove a localized prostate tumor. One week following surgery, the serum PSA was determined to be XXXX by the same method. What is the most likely cause of these results?
Increase- treatment not working
Decrease- treatment working
Q: A pregnant woman came to her physician with a maculopapular rash on her face and neck. What positive test(s) would reveal a diagnosis of congenital rubella syndrome in her baby after birth?
Rubella-specific IgM
Q: A 57-year-old male is found to have increased levels of small lymphocytes incidentally on a peripheral smear completed during routine microscopic examination of blood work. This is suggestive of which of the following?
CLL
Q: A 67-year-old male is found to have bruising and purpura and complaints of bone pain. This patient may be experiencing symptoms associated with which of the following?
Multiple Myeloma
Q: A highly sensitive and specific assay that is used to identify the type of monoclonal protein present in a sample is:
Immunofixation electrophoresis
Q: Hodgkin’s lymphoma has an infectious etiology with possible association with:
Epstein-Barr
Q: Laboratory evaluation of a patient suspected of having an immunoproliferative disorder begins with performance of a(n):
CBC w/ diff
Serum Ig levels
Iso hemagglutinins and antibody response after vaccination,
delayed hypersensitivity-type skin reactions
CH50 assay
DHR assay
Q: Malignancies of the plasma cells often involve which of the following?
Excess plasma cells in the bone marrow, a monoclonal immunoglobulin component in the plasma and/or urine, and lytic bones
Q: Malignancies that originate from hematopoietic cells in the bone marrow are:
Leukemia
Q: What do multiple myeloma and Waldenström macroglobulinemia have in common?
Monoclonal gammopathy, hyperviscosity, and Bence Jones proteins
Q: Which is the correct description of IFE migration?
Immunofixation Electrophoresis
Q: Which of the following is not a result of malignant transformation?
Organized and encapsulated
Q: Which of the following is true about non-Hodgkin lymphoma?
B-cell lymphomas represent about 85% to 90% of all NHL cases
Survival without treatment averages greater than 5 years
Disease is usually advanced at diagnosis
Multiagent chemotherapy can prolong survival
Usually express B-cell phenotype.
Q: Which statement best describes chronic leukemias?
They are characterized by accumulation of small mature B lymphocytes
Q: A person steps on a rusty nail, which punctures her skin and activates resident macrophages to secrete IL1 beta. The fever that develops is an example of what type of cytokine signaling?
Endocrine
Q: A 2-week-old baby is seen for a possible infection with CMV. Which of the following statements is false?
An initial titer of anti-CMV IgG would need to be established
Q: Which of the following is not a characteristic in the identification of lymphoma of B-cell origin?
Presence of CD14 and CD15
Q: A patient with hereditary angioedema has which of the following deficiencies?
C1-INH
Q: A 3-year-old boy is seen by his physician because of many recent bacterial infections. Flow cytometry indicates normal levels of T and B cells. The nitroblue tetrazolium test for oxidative burst reduction is negative. The most likely cause is:
Chronic granulomatous disease
Q: A defective kinase needed for DNA repair and cell cycle control leads to involuntary muscle movements and dermal capillary swelling in which syndrome?
Ataxia telangiectasia
Q: Leukocyte adhesion deficiency is caused by a defect in:
CD18
Q: An autosomal-recessive form of severe combined immunodeficiency can be caused by a deficiency in:
JAK3
Adenosine deaminase
Q: A male baby who has suffered from persistent Candida fungal infections and several bouts of pneumonia before the age of 6 months is found to have some developmental problems as well as low-set ears. Laboratory testing reveals an absence of T cells. What is the most likely diagnosis?
DiGeorge
Q: Which of the following statements best describes common variable immunodeficiency?
There is a deficiency of IgA and/or IgG
Q: Which of the following is characteristic of an acute graft-versus-host disease episode?
Most notably the skin, GI tract, and liver
Q: In a patient who is exhibiting signs of graft-versus-host disease, which cell type is most likely responsible for the reaction?
T cells
Q: In which of the following conditions would you not see an increase in alpha-fetoprotein?
Hypercholesterolemia
Q: A patient whose malignant clone is positive for the CD markers CD15 and CD30 is most likely to have what clinical disease?
Hodgkins Lymphoma
Q: A 6-month-old baby has suffered from recurrent bacterial infections. Flow cytometry results indicate a lack of B cells but the presence of normally functioning T cells. What is the most likely diagnosis?
X-linked agammaglobulinemia
Burton tyrosine kinase deficiency
Q: Which of the following diseases results in an acquired or secondary immunodeficiency?
HIV
Q: A 9-month-old infant is seen by a physician because of 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
Q: Which test should be performed when a patient has a reaction to transfused plasma product?
Direct antiglobulin testing (Coombs)
Q: A patient’s total IgG is in the normal range, but he suffers from recurrent infections with encapsulated bacteria such as Streptococcus pneumoniae and Haemophilus influenzae. T-cell functions are all normal. What is the most likely cause of the infections?
IgG subclass deficiency (G2)
Q: The buildup of toxic purine metabolites that impair B- and T-cell proliferation is the result of a mutation in the gene coding for:
Adenosine deaminase
PNP deficiency
Q: Mutations causing deficiencies in CD40L expression lead to an inability of helper T cells to:
Class switching
Q: The accumulation of immune complexes in renal glomeruli or joints (lupus-like syndromes) can be caused by a deficiency in the complement component:
C2