Deck 14: Autoimmunity

Question 1

A 10-year-old girl was brought in to her physician's office because she had been complaining that she was thirsty and had to go to the bathroom all the time.She had lost 15 pounds over the last 6 months and was more irritable than usual,especially after meals.The girl's fasting blood glucose was 575 mg/dL,her C-peptide was 0.5 ng/mL,and she had autoantibodies against glutamic acid decarboxylase and insulin.This girl has:

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

Answer 1

type 1 diabetes

Question 2

A 33-year-old female presents with red and irritated eyes for the last month.Discharge from the eyes is not apparent.She also has had recurrent low-grade fever and a rash on her chest and legs.Her joints have been achy for the last 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.Follow-up testing reveals the presence of autoantibodies against SS-A and SS-B.This woman has:

A) systemic lupus erythematosus
B) Sjögren's syndrome
C) rheumatoid arthritis
D) Hashimoto's thyroiditis

Answer 2

Sjögren's syndrome

Question 3

Systemic lupus erythematosus can be characterized by all of the following EXCEPT:

A) butterfly rash
B) joint pain
C) presence of circulating immune complexes
D) presence of reagin antibody

Answer 3

presence of reagin antibody

Question 4

In the slide agglutination for lupus,which of the following is detected?

A) anti-DNP
B) anti-IgG
C) anti-RNA
D) anti-HCG

Question 5

Which of the following would be an indicator of systemic lupus?

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

Question 6

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 nodules.Cortisol is increased; ESR is slightly elevated.Tests for autoantibodies are positive for cytoplasmic antineutrophil cytoplasmic antibodies.This patient has:

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

Question 7

A 54-year-old woman presents to her optometrist complaining that she has been having difficulty focusing on objects,both 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 sends the women's blood for autoantibody testing,and the laboratory professionals report that the woman has autoantibodies against the acetylcholine receptor.This woman has:

A) myasthenia gravis
B) Goodpasture's syndrome
C) Addison's disease
D) multiple sclerosis

Question 8

Reasons for autoimmunity may include all of the following EXCEPT:

A) inheritance of certain HLA antigens
B) molecular mimicry
C) polyclonal B cell activation
D) normal antibody production

Question 9

A 40-year-old female patient has increased TSH and decreased rT3 and 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

Question 10

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

A) competitive immunoassay
B) immunofixation
C) indirect fluorescent testing
D) direct fluorescent testing

Question 11

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 12

Which of the following are characteristic of cold autoimmune hemolytic anemia?

A) It is usually found in children.
B) It is seen when the patient warms up.
C) The antibody reacts as an anti-I.
D) The antibody reacts as an anti-D.

Question 13

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

A) Addison's disease
B) Graves' disease
C) Hashimoto's thyroiditis
D) type 1 diabetes
E) rheumatoid arthritis

Question 14

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 progressing over the last 6 months.Rheumatoid factor is elevated,and antinuclear antibodies are not detected.Complement levels in her joints are less than the levels in her serum.This woman has:

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

Question 15

The characteristic ANA pattern produced by antibody to DNA-histone complex is:

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

Question 16

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

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

Question 17

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

Question 18

Which of the following lab findings would be most likely to indicate multiple sclerosis?

A) several bands on electrophoresis of CSF
B) antibody to thyroglobulin
C) antibody to acetylcholine receptors
D) presence of antinuclear antibodies

Question 19

In the RF test for rheumatoid arthritis,what is being detected?

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

Question 20

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 has:

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

Question 21

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

A) systemic lupus
B) Goodpasture's disease
C) autoimmune hemolytic anemia
D) myasthenia gravis

Question 22

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 23

Which of the following would be an indicator of systemic lupus?

A) anti-deoxynucleoprotein antibody
B) anti-EB antibody
C) anti-myelin basic protein antibody
D) anti-insulin antibody

Question 24

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 lab 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 is the most likely cause of the symptoms?

A) lupus
B) Goodpasture's syndrome
C) multiple sclerosis
D) rheumatoid arthritis

Question 25

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 an 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 26

A 25-year-old female sees her physician because of swelling in the joints of her hands and generally feeling tired and run down.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) mono
D) syphilis

Question 27

All of the following findings would be useful in the diagnosis of Graves' disease EXCEPT:

A) presence of antibodies to thyroid-stimulating hormone receptors
B) hyperthyroidism
C) symptoms of nervousness and weight loss
D) increase in allergic IgE

Question 28

Homogeneous staining of the nucleus in an ANA test indicates:

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

Question 29

Lupus 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 kidney
D) antibody to acetylcholine receptors