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BOC study (harr book) > chemistry externship - immunology 3.5-3.6 > Flashcards

chemistry externship - immunology 3.5-3.6 Flashcards

1
Q

which of the following is a description of a type 1 hypersensitivity reaction
A. Ragweed antigen cross-linked with IgE on the surface of mast cells, causing release of preformed mediators and resulting in symptoms of an allergic reaction
B. anti-Fya from a pregnant woman crosses the placenta and attaches to the Fya antigen pos RCs of the features, destorying the RBCs
C. immune complex deposition occurs on the glomerular basement membrane of he kidney, leading to renal failure
D. exposure to poison ivy causes sensitized T cells to realse lymphokines that cause a localized inflammatory reaction

A

A.
- type 1 = anaphylactic characterized by IgE binding to mast cells

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2
Q

why is skin testing the most widely used method to test for a type 1 hypersensitivity reaction
A. it causes less trauma and is more cost effective than other methods
B. it has greater sensitivity than in vitro measurements
C. it is more likely to be pos for IgE specific allergens compared with other methods
D. it may be used to predict the development of further allergen sensitivity

A

B. greater sensitivity than in vitro
- testing on the body is more accurate in activating IgE than in vitro methods

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3
Q

which in vitro test measures IgE levels against a specific allergen
A. histamine release assay
B. RIST
C. FAST
D. PRIST

A

C. fluorescent allergosorbent test (FAST)
- measures specific IgE
- RIST and PRIST measure total IgE

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4
Q

a patient who is blood group O is accidentally transfused with group A blood and develops a reaction during the transfusion. what antibody is involved in this type II reaction
A. IgM
B. IgE
C. IgG and IgE
D. IgG

A

A. IgM
- IgG and IgM are antibodies involved in type II cytotoxic reactions but naturally occurring IgM is related to ABO incompatibility

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5
Q

which test would measure the coating of RBCs by antibody as occurs in hemolytic transfusion reactions
A. indirect antiglobulin test
B. direct antiglobulin
C. ELISA
D. hemagglutination

A

B. DAT
- measures antibody coating in vivo

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6
Q

which test detects antibodies that have attached to tissues, resulting in type II cytotoxic reactions
A. indirect immunofluorescence
B. direct immunofluorescence (DIF)
C. immunofixation electrophoresis (IFE)
D. hemagglutination

A

B. direct immunofluorescence (DIF)

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7
Q

which of the following conditions will most likely result in false neg DAT
A. insufficient washing of RBCs
B. use of heavy chain specific polyclonal anti-human Ig
C. use of excessive centrifugal force
D. use of a sample obtained by finger puncture

A

A. insufficient washing of RBCs
- incomplete removal of unbound Igs and other proteins which neutralize antiglobulin reagent = no agglutination

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8
Q

which of the following tests will detect circulating immune complexes in the serum of some patient with systemic autoimmune disease, such as RA
A. direct IFA
B. enzyme immunoassay (EIA)
C. assay of cryoglobulins
D. IAT

A

C. assay of cryoglobulins
- autoimmune Ag-Ab complexes forming insoluble clots at 4C = detectable through clot formation and serum testing

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9
Q

what immune elements are involved in a pos skin test for TB
A. IgE antibodies
B. T cell and macrophages
C. NK cells and IgG
D. B cells and IgM antibody

A

B. T cells and macrophages
- cells responsible for a pos TB test

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10
Q

a patient receives a transfusion of packed RBCs and FFP and develops an anaphylactic, nonhemolytic rxn. she reports receiving a transfusion 20 yrs earlier. she had no rxn to the previous transfuion but she did feel ‘poorly’ few weeks later. which of the following transfused substances most likely elected this reaction
A. IgA
B. group A antigen
C. Rho (D) antigen
D. an antigen belonging to the duffy system

A

A. IgA
- nonhemolytic = nonRBC antigen
- asymptomatic IgA deficiency making antibody against alpha chain if exposed to IgA in transfusion

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11
Q

a patient deficient in the C3 complement component would be expected to mount a normal:
A. type I and IV hypersensitivity response
B. type II and IV
C. type I and III
D. type II and III

A

A. type I and IV
- complement is involved in type II and III hypersensitivity but would have no effect on IgE (type I) or cell mediated (type II)

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12
Q

which of the following symptoms is a young child may indicate an immunodeficiency syndrome
A. anaphylactic rxns
B. severe rash and myalgia
C. recurrent bacterial, fungal, and viral infections
D. weight loss, rapid heart beat, and breathlessness

A

C. recurrent bacterial, fungal, and viral infections
- occurring after disappearance of maternal IgG

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13
Q

what screening test should be performed first in a young patient suspected of having an immune dysfunction disorder
A. CBC and WBC diff
B. chemotaxis assay
C. complement levels
D. BM biopsy

A

A. CBC and WBC with diff
- WBCs would be decreased or abnormal which would indicate further testing necessary

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14
Q

which test should be performed when a patient has a reaction to transfused plasma products
A. Ig levels
B. T cell count
C. hemoglobin levels
D. RBC enzymes

A

A. Ig levels
- rxn common in IgA deficient ppl who have formed anti-IgA antibodies

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15
Q

what is the ‘M’ component in monoclonal gammopathies
A. IgM produced in excess
B. heavy chain produced in excess
C. malignant proliferation of B cells
D. monoclonal antibodies or cell line

A

D. monoclonal antibody or cell line

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16
Q

a child suspected of having an inherited humoral immunodeficiency disease is given diptheria/tetnus vaccine. Two weeks after, his level of Ab to the spp antigens is measured. Which result is expected for this pt if he has humoral deficiency
A. increased levels of spp antibody
B. no change in level of spp antibody
C. an increase in IgG specific antibody but no IgM specific antibody
D. increased levels of nonspecific antibody

A

B. no change

17
Q

which disease may be expected to show an IgM spike on an electrophoretic pattern
A. hypogammaglobulinemia
B. multicystic kidney disease
C. waldenstrom macroglobulinemia
D. wiskott-aldrich syndrome

A

C. waldenstrom macroglobulinemia
- malignancy of plasma/plasmacytoid lymphs

18
Q

in testing for DiGeorge syndrome, what type of lab analysis would be most helpful in determining the number of mature T cells
A. CBC
B. Hihydrorhodamine reduction (DHR) test
C. T cell mitogen asasy
D. flow cytometry

A

D. flow
- caused by developmental failure/hypoplasia of thymus leading to efficiency of T cells so flow helps ID subpopulations of T cells

19
Q

interpret the following desription of an IFE assay of urine
- dense wide bands in both kappa and lambda lanes
- no bands present in heavy-chain lanes

A. normal
B. light chain disease
C. increased polyclonal Fab fragments
D. multiple myeloma

A

C. increased polyclonal Fab fragment
- indicates excessive polyclonal light chain excretion as Fab fragments

20
Q

free monoclonal light chains are often present in the serum of patients with MM and may be useful for disease monitoring. which of the following assays would be recommended to detect the presence of free light chains in serum
A. SPE
B. urine immunofixation
C. nephelometry
D. ELISA

A

C. nephelometry
- usually not present in sufficient quantity to show band on protein electrophoresis gel
- serum Ig heavy and light chains are most commonly measured by using rate or endpoint nephelometry

21
Q

what is measured in the CH50 assay
A. RBC quantity needed to agglutinate 50% of antibody
B. complement needed to lyse 50% of RBCs
C. complement needed to lyse 50% of antibody-sensitized RBCs
D. antibody and complement needed to sensitize 50% of RBCs

A

C. complement needed to lyse 50% of antibody-sensitized RBCs
- low levels associated with deficiency of some complement components

22
Q

what tye of disorders would show a decease in C3, C4 and CH50
A. autoimmune disorders such as SLE and RA
B. immunodeficiency disorders such as common variable immunodeficiency
C. tumors
D. bacterial, viral, fungal or parasitic infections

A

A. autoimmune disorders such as SLE and RA
- pattern of decrease indicates classic pathway activation (use of factors)

23
Q

all of the following tests measure phagocyte function except
A. leukocyte adhesion molecule analysis
B. DHR assay
C. nitro blue tetrazolium (NBT) test
D. IL-2 assay

A

D. IL-2 assay
- DHR and older NBT used to diagnose chronic granulomatous disease (failure of respiratory burst)
- leukocyte adhesion deficiency associated with defect in integrin on surface
- IL-2 is a cytokine that causes B cell proliferation and increased production of antibody, interferon and other cytokines = detects transplant rejection

BOC study (harr book) (16 decks)

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