Deck 4: Diseases of the Immune System

Question 1

Deposition of AL amyloid in the kidneys of patients with multiple myeloma usually results in

A) acute renal failure
B) tubular necrosis
C) nephrotic syndrome
D) chronic pyelonephritis
E) nephrocalcinosis

Answer 1

nephrotic syndrome

Question 2

A 40-year-old man presents with hemoptysis and renal failure. A kidney biopsy specimen revealed linear deposits of IgG in glomerular basement membranes and crescents between the glomerular capillary loops and the Bowman capsule. The antibodies causing these pathologic changes react with

A) laminin
B) fibronectin
C) collagen type I
D) collagen type IV
E) podocytes of glomerular epithelial cells

Answer 2

collagen type IV

Question 3

The most common fungal pathogen infecting the mouth and the esophagus of patients with AIDS is

A) Candida albicans
B) Cryptococcus neoformans
C) Aspergillus fumigatus
D) Histoplasma capsulatum
E) Cryptosporidium

Answer 3

Candida albicans

Question 4

A 10-year-old girl presented with lilac or heliotrope discoloration of the upper eyelids, muscle weakness, and dusky red patches over the knuckles, elbows, and knees. Which antibody was most likely found in this patient's blood?

A) Anti-histidyl-t-RNA synthetase
B) Anti-double-stranded DNA
C) Anti-single-stranded DNA
D) Anti-topoisomerase
E) Anti-ribonucleoprotein antibody SS-A (Ro)

Question 5

Mutation of the gene encoding the enzyme that is essential for the maturation of pre-B cells to mature B lymphocytes is the cause of

A) common variable immunodeficiency
B) isolated IgA deficiency
C) DiGeorge syndrome
D) severe combined immunodeficiency
E) X-linked agammaglobulinemia

Question 6

Which antibody can most effectively activate complement by the alternate pathway, even without prior forming an antigen-antibody complex?

A) IgA
B) IgD
C) IgE
D) IgG
E) IgM

Question 7

Antigen-antibody reaction in polyarteritis nodosa is characterized by which form of necrosis of the arterial wall?

A) Coagulative necrosis
B) Fibrinoid necrosis
C) Liquefactive necrosis
D) Fat necrosis
E) Caseous necrosis

Question 8

In addition to T-helper lymphocytes, which other cells serve as a major reservoir for the human immunodeficiency virus in lymph nodes?

A) B lymphocytes
B) Pre-B and pre-T lymphocytes
C) Cytotoxic T lymphocytes
D) Follicular dendritic cells
E) Plasma cells

Question 9

The formation of vesicles in contact dermatitis caused by poison ivy is primarily mediated by

A) T_H1 lymphocytes
B) T_H2 lymphocytes
C) CD8 lymphocytes
D) B cells
E) macrophages

Question 10

Which molecule on the surface of lymphocytes serves as the receptor for the human immunodeficiency virus (HIV)?

A) CD3
B) CD4
C) CD8
D) CD15
E) CD20

Question 11

Which of the following is the most abundant bronchospasm-inducing arachidonic acid derivative generated by cyclooxygenase in the mast cells?

A) Leukotriene B₄
B) Prostacyclin
C) Prostaglandin D₂
D) Thromboxane
E) Lipoxin

Question 12

Generic antinuclear antibodies are found in more than 95% of patients with systemic lupus erythematosus. Which pattern of staining seen on tissue culture cells in the indirect antibody immunofluorescence microscopy test signifies the presence of these antibodies?

A) Nucleolar pattern
B) Speckled nuclear pattern
C) Diffuse nuclear pattern
D) Rim nuclear pattern
E) Granular cytoplasmic pattern

Question 13

Amyloid deposited in the tissue of patients who are on dialysis for chronic renal failure is most often biochemically related to which precursor protein?

A) Light chain of immunoglobulin G
B) Serum amyloid associated (SAA) protein
C) Transthyretin
D) ß2-microglobulin
E) Calcitonin

Question 14

Which of the following blood studies is the best evidence of microvascular endothelial cell injury that typically occurs in systemic sclerosis (scleroderma)?

A) Hyperbilirubinemia
B) Hypoalbuminemia
C) Increased levels of von Willebrand factor
D) Increased levels of IgG
E) Increased levels of fibrinogen

Question 15

Which of the following is the predominant and most common cardiovascular manifestation of systemic lupus erythematosus?

A) Mural endocarditis
B) Valvular endocarditis of mitral valve
C) Myocarditis
D) Pericarditis
E) Conduction system injury with arrhythmia

Question 16

The most common and the most serious form of renal disease encountered in systemic lupus erythematosus (SLE) is classified as x. Most of the lesions found in SLE are mediated by the deposition of immune complexes (type III hypersensitivity reaction). Which pathologic reaction is due to type II hypersensitivity (cytotoxic) reaction?

A) Class I (minimal changes)
B) Class II (mesangial)
C) Class III (focal proliferative)
D) Class IV (diffuse proliferative)
E) Class IV (membranous)

Question 17

Antibodies to centromere are found in patients who have

A) systemic sclerosis
B) CREST syndrome
C) Sjögren syndrome
D) polymyositis
E) dermatomyositis

Question 18

Autoantibodies to IgA are found in approximately 40% of patients who have

A) common variable immunodeficiency
B) isolated IgA deficiency
C) DiGeorge syndrome
D) severe combined immunodeficiency
E) X-linked agammaglobulinemia

Question 19

Which antibodies are considered to be markers of Sjögren syndrome?

A) Antinuclear antibody
B) Anti-double-stranded DNA
C) Anti-single-stranded DNA
D) Anti-topoisomerase
E) Anti-ribonucleoprotein antibody SS-A (Ro)

Question 20

A 23-year-old woman was given an intradermal injection of purified protein derivative of tubercle bacilli (PPD) as part of the yearly testing for tuberculosis. A positive reaction was elicited. Which cells secrete the cytokines needed for the formation of granulomas at the site of injection?

A) Keratinocytes
B) Melanocytes
C) B lymphocytes
D) T_H1 cells
E) T_H2 cells