Antibody quiz

An autoimmune disease-causing destruction of pancreatic cells can result in

Type 1 diabetes

Tissue injury in systemic rheumatic disorders such as systemic lupus erythematosus is thought to be caused by:

deposits of immune complexes

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

Myasthenia gravis

A 33-year-old female presents with eyes that have been red and irritated for the past month. Discharge from the eyes is not apparent. She also has a recurrent low-grade fever and a rash on her chest and legs. Her joints have been achy for the past 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. Which follow-up test result would you expect for this patient?

Presence of anti-SS-A or anti-SS-B

Which of the following is correct regarding C-reactive protein (CRP)?

Is usually elevated in pediatric bacterial infections

In the latex agglutination assay for rheumatoid factor, the antigen coated on the latex beads is

IgG

The IIF staining patter on ethanol-fixed leukocytes slides shows a perinuclear or nuclear staining pattern. This pattern is typically due to:

P-ANCA

Antibody-mediated destruction of the acetylcholine receptor at the postsynaptic membrane of the neuromuscular junction occurs in which of the following diseases?

Myasthenia gravis

Which laboratory finding is associated with multiple sclerosis?

Several bands on electrophoresis of cerebrospinal fluid

Antinuclear antibody tests are performed to help diagnose:

Lupus erythematosus

In the anti-double-stranded DNA procedure, the antigen most commonly utilized is:

Crithida lucilia

Dry eyes and mouth are symptoms of which of the following diseases?

Sjögren's syndrome

Anti-extractable nuclear antigens are most likely associated with which of the following anti-nuclear antibody immunofluorescent patterns?

speckled

Raynaud's phenomenon is associated with a deficiency/dysfunction of the complement fraction

C7

A 40-year-old female patient has increased thyroid-stimulating hormone (TSH) and decreased 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.

Rheumatoid factors are defined as:

autoantibodies with specificity for the Fc portion of the immunoglobulin (IgG) molecule

Antibody to cyclic citrullinated peptide (CCP) is diagnostic for

rheumatoid arthritis

The "CREST" variant of which disease is associated with the presence of an anticentromere antibody?

Progressive systemic sclerosis (scleroderma)

A speckled nuclear pattern in an antinuclear antibody test indicates:

antibody to an extractable nuclear antigen.

The specificity of the ANA test for SLE is

low; other people have this antibody

A 54-year-old woman presents to her optometrist complaining that she has been having difficulty focusing on objects 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 mentions she has a neuromuscular disease in which the nerve muscles do not function normally. What autoantibody would you recommend be tested for in this patient?

Antibody to the acetylcholine receptor

Although some patients with other types of SLE have antibody to this nuclear antigen, the fact that 95% of patients with drug-induced Lupus have antibody to this particular antigen can be helpful if drug-induced lupus is suspected. The antigen is

histones

Which of the following is diagnostic for systemic lupus erythematosus?

Anti-Sm antibody

In the indirect fluorescent anti-nuclear antibody test, a speckled pattern may indicate the presence of antibody to:

Sm

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 laboratory 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 disease is the most likely cause of the symptoms?

Goodpasture's syndrome

Autoimmunity

1. involves genetics

2. can sometimes be gender associated

3. can be hormone associated

4. B and C

5. all of the above

All of the above

A patient comes into the clinic with dry eyes and dry mouth but no joint pain. What diagnosis would you expect?

Sjögren’s syndrome

The lymphocyte subtype that controls autoimmunity in the peripheral blood is:

Treg

Which of the following is used in rapid slide tests for detection of rheumatoid factors?

Fc portion of the IgG molecule

Antibodies to cyclic citrullinated peptides

1. recognize antigens that contain an arginyl converted to a cyclic citrullyl

2. have a high specificity for the diagnosis of SLE

3. have a high specificity for the diagnosis of autoimmune hepatitis

4. have a high specificity for the diagnosis of rheumatoid arthritis

5. A and D

A and D

Autoimmunity can be

1. infection associated because of a cross-reactive epitope

2. environmentally associated

3. trauma associated

4. A and B

5. all of the above

All of the above

Which of the following is decreased in serum during the active stages of systemic lupus erythematosus?

complement (C3)

A disease characterized by hypoactivity of the thyroid with weight gain and a sluggish metabolism as a result of destruction of thyroglobulin best describes:

Hashimoto's thyroiditis.

Which disease is likely to show a rim (peripheral) pattern in an immunofluorescence (IF) microscopy test for ANA?

Systemic lupus erythematosus

The characteristic antinuclear antibody pattern produced by antibody to DNA-histone complexes is:

homogeneous.

Systemic lupus erythematosus is characterized by:

presence of dsDNA antibodies

Which of the following methods is least likely to give a definitive result for the diagnosis of RA?

Immunofluorescence testing for antinuclear antibodies

IgA autoantibodies against gliadin, tissue transglutaminase, and endomysium are found in patients which of the following diseases?

celiac

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 infiltrates. Cortisol is increased; erythrocyte sedimentation rate (ESR) is slightly elevated. Tests for autoantibodies are positive for antineutrophil cytoplasmic antibodies. On the basis of these findings, a likely diagnosis for this patient is:

Wegener's granulomatosis (Granulomatosis with polyangiitis-GPA)

Another student has an odd-looking blistery rash and has been losing weight. You and she are good friends, but must she tell you about her bowel symptoms? She has diarrhea and cramping. What do you think she might have?

Celiac disease

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.

Hashimoto disease is an autoimmune disease primarily involving the

thyroid gland

Anti-glomerular basement membrane antibody is most often associated with this condition:

Goodpasture syndrome

Autoimmune hemolytic anemia targets which cells or tissues?

Red blood cells

What percentage of the SLE patients is positive for antinuclear antibodies

95

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:

Retest ANA in 3–6 months

Which laboratory assay is a highly specific indicator and the most sensitive assay for a diagnosis of rheumatoid arthritis?

Cyclic citrullinated peptide

Antibodies to cyclic citrullinated proteins (anti-CCP) are specific diagnostic indicators for:

rheumatoid arthritis.

Hashimoto’s thyroiditis can best be differentiated from Graves disease on the basis of which of the following?

Decrease in thyroid hormone levels

Screening and confirmation tests for antinuclear antibodies are typically performed by:

indirect immunofluorescence followed by enzyme immunoassay.

High titers of antimicrosomal antibodies are most often found in:

thyroid disease

Rheumatoid factors in a patient’s serum may cause a false:

positive for the detection of IgM class antibodies

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

Rheumatoid arthritis

A positive ANA with the pattern of anticentromere antibodies is most frequently seen in patients with:

CREST syndrome

Which of the following is considered a systemic autoimmune disease?

Systemic lupus erythematosus

What disease is indicated by a high titer of anti-Sm (anti-Smith) antibody?

SLE

Homogeneous staining of the nucleus in an antinuclear antibody test indicates:

antibody to DNA-histone complexes.

In an anti-nuclear antibody indirect immunofluorescence test, a sample of patient serum shows a positive, speckled pattern. Which would be the most appropriate additional test to perform?

screen for Sm and RNP antibodies

Antibodies directed at native DNA are most frequently associated with which pattern of fluorescence in the IFA-ANA test?

rim

In the rheumatoid factor test, what is being detected?

IgM directed against IgG

What type of antibodies is represented by the solid or homogeneous pattern in the immunofluorescence test for antinuclear antibodies?

Anti-histone antibodies

A patient comes into the clinic with dry eyes and dry mouth but no joint pain. Which pattern of ANA staining would you expect?

speckled

SLE is associated with

decreased clearance of dead and dying cells

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

Graves disease.

In antinuclear antibody testing, HEp-2 cells:

are the source of the antigen.

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

ANCA is found in

Wegener's granulomatosis

Systemic lupus erythematosus can be distinguished from rheumatoid arthritis on the basis of which of the following?

Deposition of immune complexes in the kidneys

Citrullinated proteins:

contain modified (atypical) amino acids.

Sera to be tested for IFA-ANA 6 days after drawing is best stored at?

5°C +/- 2°

Anti-RNA antibodies are often present in individuals having an anti-nuclear antibody immunofluorescent pattern that is:

nucleolar

What is a general definition for autoimmunity?

Loss of tolerance to self-antigens

The characteristics of an acute phase protein include the following EXCEPT:

Acute phase proteins are synthesized slowly in response to tissue injury.

Rheumatoid factor reacts with:

gamma globulin-coated particles

In the indirect fluorescent anti-nuclear antibody test, a homogenous pattern indicates the presence of antibody to:

DNA

Antibodies directed against thyroglobulin represent a significant finding in which of the following autoimmune diseases?

Hashimoto's thyroiditis

Monoclonal antibodies are used in the treatment of some autoimmune diseases including Crohn's and rheumatoid arthritis. This therapeutic antibody reacts with

TNF-alpha

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 getting progressively worse over the past 6 months. Rheumatoid factor is elevated, and antinuclear antibodies are not detected. Complement levels in her joints are decreased. This woman most likely has:

rheumatoid arthritis.

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 magnetic resonance imaging (MRI). The MRI reveals lesions on the myelin sheath. What is the most likely disease?

Multiple sclerosis

ANCA:

1. stands for antinuclear and cytoplasmic antibodies

2. stands for antineutrophil and cytoplasmic antigens

3. aids in the diagnosis of vasculitic diseases

4. A and C

5. B and C

A and C

Rheumatoid factors are immunoglobulins with specificity for allotypic determinants located on the

Fc fragment of IgG

SLE is

1. related to a single gene mutation

2. made worse by exposure to sunlight

3. due to inflammation caused by circulating immune complexes

4. B and C

5. all of the above

B and C

Which of the following is used for testing the specificity of the antibody in a patient suspected of having SLE?

1. ANA testing on HEP-2 cells

2. ELISA testing

3. testing on Crithidia luciliae

4. all of the above

5. A and B

All of the above

A student in the class always is complaining that she's cold, she's tired, she's been gaining weight but says she just doesn't care about anything anymore. The semester has been tough, and although you feel guilty, at first you ignore her, but just now as you looked up, her neck appears to be enlarged in the front and her skin and hair look dry. What do you think she might have?

Hashimoto's disease

Serum from CREST subset of systemic sclerosis in ANA testing shows

centromere staining

Antibody to which of the following cytokines can be used to treat rheumatoid arthritis.

TNF-alpha

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?

Rheumatoid factor assay

A 10-year-old girl visits her physician's office because she has been complaining about being thirsty and having to go to the bathroom all the time. She has lost 15 pounds over the past 6 months and has been more irritable than usual, especially after meals. The girl's fasting blood glucose is 575 mg/dL (reference range, < 100 mg/dL), her C-peptide is 0.5 ng/mL (reference range, 0.8–3.1 ng/mL), and she has autoantibodies against glutamic acid decarboxylase and insulin. On the basis of these findings, a likely diagnosis for this girl is:

type 1 diabetes.

Hashimoto disease is an autoimmune disease primarily involving the:

Thyroid gland

Anti-CCP antibodies

are seen in about 70% of cases of rheumatoid arthritis and are rarely seen in others

The fluorescent antinuclear antibody test for lupus is an example of which of the following?

Indirect fluorescence testing

Which immunofluorescence pattern indicates the need for ENA testing by Ouchterlony immunodiffusion, Multiplex, or ELISA assays?

Speckled