Deck 15: Autoimmunity

Question 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:

A) rheumatoid arthritis.
B) lupus.
C) hemolytic disease of the newborn.
D) hemolytic anemia.

Answer 1

rheumatoid arthritis.

Question 2

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:

A) type 1 diabetes.
B) Graves disease.
C) Hashimoto's thyroiditis.
D) systemic lupus erythematosus.

Answer 2

Hashimoto's thyroiditis.

Question 3

Autoimmune hemolytic anemia targets which cells or tissues?

A) Liver
B) Platelets
C) Red blood cells
D) Connective tissues

Answer 3

Red blood cells

Question 4

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

A) Graves disease.
B) Hashimoto's thyroiditis.
C) myasthenia gravis.
D) rheumatoid arthritis.

Question 5

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?

A) Positive ANCA
B) Presence of anti-SS-A or anti-SS-B
C) Decreased rheumatoid factor
D) Presence of antibody to dsDNA

Question 6

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

A) Systemic lupus erythematosus
B) Goodpasture's disease
C) Autoimmune hemolytic anemia
D) Myasthenia gravis

Question 7

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 most likely has:

A) Graves disease.
B) pernicious anemia.
C) ulcerative colitis.
D) type 1 diabetes.

Question 8

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:

A) Hashimoto's thyroiditis.
B) acute glomerulonephritis.
C) type 1 diabetes.
D) progressive systemic sclerosis.

Question 9

Which of the following is diagnostic for systemic lupus erythematosus?

A) Anti-Sm antibody
B) Anti-EB antibody
C) Anti-myelin basic protein antibody
D) Anti-insulin antibody

Question 10

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:

A) systemic lupus erythematosus.
B) rheumatoid arthritis.
C) chronic granulomatous disease.
D) Wegener's granulomatosis.

Question 11

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

A) homogeneous.
B) peripheral.
C) speckled.
D) nucleolar.

Question 12

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

A) Progressive systemic sclerosis (scleroderma)
B) Rheumatoid arthritis
C) Systemic lupus erythematosus
D) Mixed connective tissue disease

Question 13

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:

A) systemic lupus erythematosus.
B) Wegener's granulomatosis.
C) Hashimoto's thyroiditis.
D) rheumatoid arthritis.

Question 14

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:

A) Addison's disease.
B) Graves disease.
C) Hashimoto's thyroiditis.
D) type 1 diabetes.

Question 15

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

A) Competitive immunoassay
B) Immunofixation
C) Indirect fluorescence testing
D) Direct fluorescence testing

Question 16

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.What autoantibody would you recommend be tested for in this patient?

A) Antibody to the acetylcholine receptor
B) Antibody to myelin basic protein
C) Antibody to basement membrane antigens
D) Anti-neutrophil cytoplasmic antibodies (ANCAs)

Question 17

Which laboratory finding is associated with multiple sclerosis?

A) Several bands on electrophoresis of cerebrospinal fluid
B) Antibody to thyroglobulin
C) Antibody to acetylcholine receptors
D) Presence of antinuclear antibodies

Question 18

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

A) Decrease in thyroid hormone levels
B) Presence of thyroid peroxidase antibodies
C) Enlargement of the thyroid
D) Presence of lymphocytes in the thyroid

Question 19

Systemic lupus erythematosus is characterized by:

A) HLA-DR antigens expressed on thyroid epithelial cells.
B) increase in cells lining the synovial membrane.
C) absence of immune complexes.
D) presence of dsDNA antibodies.

Question 20

In the rheumatoid factor test,what is being detected?

A) antinuclear antibody
B) antithyroglobulin antibody
C) IgM directed against IgG
D) IgG directed against IgM

Question 21

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

A) type 1 diabetes mellitus.
B) celiac disease.
C) rheumatoid arthritis.
D) biliary cirrhosis.

Question 22

Citrullinated proteins:

A) are modified by carbohydrate side chains.
B) contain modified (atypical) amino acids.
C) are denatured nucleic acids.
D) are microbial toxins.

Question 23

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

A) Joint pain
B) Presence of inflammation
C) Deposition of immune complexes in the kidneys
D) Antibody to acetylcholine receptors

Question 24

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

A) immunodiffusion followed by indirect immunofluorescence.
B) indirect immunofluorescence followed by enzyme immunoassay.
C) direct immunofluorescence followed by serum protein electrophoresis.
D) immunofixation electrophoresis followed by direct immunofluorescence.

Question 25

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?

A) Autoimmune hemolytic anemia
B) Rheumatoid arthritis
C) Mononucleosis
D) Syphilis

Question 26

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

A) Myasthenia gravis
B) Multiple sclerosis
C) Hashimoto's thyroiditis
D) Contact dermatitis

Question 27

Central tolerance,in which lymphocytes learn to distinguish between self-antigens and foreign antigens,takes place in the thymus and:

A) spleen.
B) lymph nodes.
C) bone marrow.
D) liver.

Question 28

Which of the following is considered a systemic autoimmune disease?

A) Multiple sclerosis
B) Graves disease
C) Myasthenia gravis
D) Systemic lupus erythematosus

Question 29

A perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA)staining pattern consists of:

A) diffuse, granular staining at the outer edges of the cell cytoplasm.
B) a continuous fluorescent ring (rim) in the cytoplasm, close to the plasma membrane.
C) fluorescence surrounding the lobes of the nuclei.
D) dense staining of neutrophilic granules.

Question 30

In antinuclear antibody testing,HEp-2 cells:

A) are the source of the antigen.
B) are the source of the antibody.
C) are fluorescently labeled.
D) fluoresce spontaneously.

Question 31

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?

A) Goodpasture's syndrome
B) Multiple myeloma
C) Graves disease
D) Multiple sclerosis

Question 32

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?

A) Systemic lupus erythematosus
B) Goodpasture's syndrome
C) Multiple sclerosis
D) Rheumatoid arthritis

Question 33

Which mechanism is involved in peripheral tolerance to self-antigens?

A) Negative selection
B) Receptor editing
C) Inhibition of co-stimulatory signals from antigen-presenting cells
D) All of the above

Question 34

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

A) anti-RNA antibody.
B) antibody to DNA-histone complexes.
C) anticentromere antibody.
D) antibody to extractable nuclear antigens.

Question 35

A speckled nuclear pattern in an antinuclear antibody test indicates:

A) anti-RNA antibody.
B) antibody to DNA-histone complex.
C) anticentromere antibody.
D) antibody to an extractable nuclear antigen.