Ch. 8 Specific Diagnostic Modalities

Question 1

polymorphism in which chemokine are associated with serum total IgE?

Answer 1

CCL-11 (eotaxin) - increased in blacks, decreased in whites

Question 2

venom IDTs are performed up to what concentration?

Answer 2

1 ug/mL

Question 3

nasal responsiveness to capsaicin is increased in what condition?

Answer 3

allergic rhinitis (not in non-allergic)

Question 4

both histamine and methacholine induce a secretory response, but unlike histamine, methacholine does not induce?

Answer 4

nasal reflexes

Question 5

what is the most reproducible measurement in pulmonary function test?

Answer 5

FEV1

Question 6

what is the primary outcome measure in most FDA phase III asthma drug trials?

Answer 6

FEV1

Question 7

what is considered a significant response to bronchodilator?

Answer 7

increase of FEV1 of 12% AND increase of 200mL

Question 8

T or F, severity of airway hyper responsiveness does not correlate with severity of asthma

Answer 8

TRUE

Question 9

what is the difference between selective and non-selective bronchoprovacation?

Answer 9

selective testing looks at specific triggers, non selective testing produces bronchoconstriction in all asthmatic

Question 10

is methacholine a direct or indirect bronchonconstrictor?

Answer 10

direct

Question 11

what PC20 concentration is considered positive?

Answer 11

PC20 < or equal to 8mg/ml

Question 12

T or F, a negative methacholine challenge in the winter excludes seasonal pollen induced asthma?

Answer 12

FALSE

Question 13

what are the indirect bronchoconstrictors?

Answer 13

exercise, hypertonic saline, cold, mannitol, adenosine, allergen

Question 14

which bronchoprovocation test is highly sensitive? specific?

Answer 14

sensitive: methacholine
specific: mannitol, exercise

Question 15

mucus is increased in asthmatic, which gene is expressed more in asthmatics compared to normal controls?

Answer 15

mucin gene (MUC5AC)

Question 16

who gets more airway infections, primary ciliary dyskinesia patients or CF?

Answer 16

CF - suggests that altered mucus plays larger role in disease progression than ciliary movement

Question 17

what method is used to quantify IgG, IgA, IgM, and inflammatory markers?

Answer 17

nephelometry

Question 18

what method to determine the presence of allergen specific IgE, BNP, complement, toxins, histamine, leukotriene C4, and tumor markers?

Answer 18

ELISA

Question 19

western blot procedure?

Answer 19

separate proteins on gel, transfer to a membrane, then add specific antibody followed by a secondary antibody conjugated to an enzyme, measure the colorimetric reaction

Question 20

What diseases are confirmed by Western blot?

Answer 20

HIV and Hep B

Question 21

what is the process of immunofixation electrophoresis

Answer 21

separate serum proteins on gel, expose to specific anti-sera and the immunoprecipitate is visualized with a protein stain

Question 22

immunoCAP uses what method to detect allergen specific IgE?

Answer 22

ELISA – sandwich assay

Question 23

allergen IgE determined from Immunocap, Turbo MP and Immulite 200 are NOT comparable. Studies determining predictive values of specific IgE for food is determined by which one?

Answer 23

immunocap

Question 24

immunofixation electrophoresis is used for?

Answer 24

identification and quantification of monoclonal paraproteins seen on SPEP, and determine which light chain is present

Question 25

zone of equivalence results in small or large immune complexes?

Answer 25

large

Question 26

zone of antigen excess or antibody excess produces small or large immune complexes?

Answer 26

small

Question 27

descending order of complement activation by immunoglobulin?

Answer 27

IgM > IgG3 > IgG1 > IgG2

Question 28

excessive immune complex formation results in complement consumption, so what levels can be used to monitor disease activity?

Answer 28

C3, C4 (e.g. in SLE)

Question 29

what assays are used to measure cytokines and mediators?

Answer 29

ELISA or RIA assays

Question 30

forward scatter on flow cytometry measures?

Answer 30

size

Question 31

side scatter on flow cytometr measures?

Answer 31

granularity and complexity

Question 32

what monoclonal antibody is used in the treatment of solid organ transplant rejection and acute T cell ALL?

Answer 32

OKT3 - monoclonal anti-CD3 | leads to activation then apoptosis of T cells causing immunosuppression

Question 33

what is the proposed mechanism of IVIG?

Answer 33

binding of FcyRIIb

Question 34

increased number of B cells with low levels of this CD marker are associated with CVID?

Answer 34

high levels of CD-21 low B cells

Question 35

what CD markers are measured after an abnormal newborn screen for TRECs?

Answer 35

CD45RO and CD45RA, there are low levels of CD45RA in SCID

Question 36

CD4 expression is down regulated by which HIV protein?

Answer 36

Nef

Question 37

HIV binds to what CD marker as a correceptor for entry into T cells?

Answer 37

CD4

Question 38

where does omalizumab bind on free IgE?

Answer 38

CH3 domain of free IgE, specifically at the FcERI binding site

Question 39

what is the most potent complement receptor?

Answer 39

CR3 which binds iC3b

Question 40

hereditary C3 deficiency presents with?

Answer 40

autoimmune disease and recurrent infections

Question 41

which chemokine receptors are co-receptors for HIV entry?

Answer 41

CCR5, CXCR4

Question 42

how does the DHR test work?

Answer 42

DHR is taken up by phagocytes and oxidized to a green fluorescent compound by products of the NADPH oxidase system, fluorescence is measured by flow cytometry

Question 43

AH50 measures lysis of alternative pathway by lysing what RBCs?

Answer 43

unsensitized rabbit RBCs

Question 44

CH50 measures lysis of complement pathway by lysing what RBCs?

Answer 44

sheep RBCs sensitized with rabbit IgM

Question 45

the most common cause of low complement level?

Answer 45

poorly handled specimen, always repeat abnormal test

Question 46

hybridomas are made of what two cells?

Answer 46

spleen cells from an immunized mouse fused with myeloma cells that lack Ab production and HGPRT

Question 47

ximab means?

Answer 47

chimeric -mouse and human

Question 48

umab

Answer 48

human

Question 49

zumab

Answer 49

humanized

Question 50

omab

Answer 50

mouse

Question 51

what method should be used in patients with antibody deficiencies to detect infections?

Answer 51

PCR

Question 52

Besides SCID, what other conditions can have low TREC levels in newborns?

Answer 52

HIV, Down syndrome, and 22q11 deletion

Question 53

what can nex-gen sequencing be used for?

Answer 53

whole exome sequencing, screening panels of disease-related genes, transcription factor binding sites, DNA methylation patterns, and metagenomics (studies microbial DNA populations)

Question 54

southern blot detects?

Answer 54

DNA

Question 55

western blot detects?

Answer 55

protein

Question 56

northern blot detects?

Answer 56

RNA

Question 57

what can be diagnosed using FISH

Answer 57

22q11.2 deletion, Prader Willi, Angelman, Cri--du-chat, Down syndrome, ALL

Question 58

microarray use what substrate and rely on what luminescence for detection?

Answer 58

substrate: glass, silicone, or polystyrene beads | use fluorescence for detection

Question 59

microarrays can be used to detect?

Answer 59

gene expression patterns, SNPs, chromosomal abnormalities, genotype mutations

Question 60

how do microarrays work?

Answer 60

known cDNA probes are present on microarray chip, RNA from patient is reverse transcribed to cDNA, which is amplified by PCR and labeled, the cDNA then hybridizes to microarray cDNA probes and the intensity of the fluorescence is measured to determine gene expression

Question 61

what alleles are matched for SCT?

Answer 61

HLA-A, B, C, DRB1, and DQB1

Question 62

what alleles are matched for solid organ?

Answer 62

HLA-A, B, DR

Question 63

what solid organs are usually NOT matched for HLA type?

Answer 63

heart, liver, lung and pancreatic grafts

Question 64

xray and CT finding in chronic eosinophilic pneumonia?

Answer 64

"photonegative" pulmonary edema | peripheral, non segmental opacities in middle and upper lung zones

Question 65

CT findings in GPA?

Answer 65

peripheral wedge shaped consolidations, multiple nodules, some with cavitation

Question 66

a pneumatocele on CT should make you think of what condition?

Answer 66

STAT 3 hyper IgE syndrome

Question 67

absent thymic shadow indicates?

Answer 67

complete Digeorge