Clinical immunology

Question 1

Which is NOT a side-effect of chronic steroid therapy?
A) Hypertension
B) Myopathy
C) Hyperpotassemia
D) Cataract
E) Glaucoma

Answer 1

C) Hyperpotassemia

Question 2

Which autoantibody is NOT specific for poly-dermatomyositis?
A) Anti-Ku
B) Anti-Mi2
C) Anti-SRP
D) Anti-Sm
E) Anti-Jo1

Answer 2

D) Anti-Sm

Question 3

Which immunosuppressive agent MAY NOT be used for SLE therapy?
A) Cyclophosphamide
B) Methotrexate
C) Belimumab
D) Adalimumab
E) Azathioprine

Answer 3

D) Adalimumab

Question 4

Which is NOT a complication of systemic sclerosis?
A) Diffuse pulmonary fibrosis
B) Honeydew melon stomach
C) Esophageal stricture
D) Pulmonary hypertension
E) Fingertip-ulcer

Answer 4

B) Honeydew melon stomach

Question 5

Which is NOT an ANCA-associated vasculitis?
A) Polyarteritis nodosa
B) Churg-Strauss syndrome
C) Granulomatous vasculitis
D) Microscopic polyangiitis
E) Wegener granulomatosis

Answer 5

A) Polyarteritis nodosa

Question 6

Which antibody is specific for Antiphospholipid syndrome?
A) Anti-apexin V.
B) Anti-beta2-microglobulin I.
C) Anti-beta2-glycoprotein I
D) Anti-cardiotliptin
E) Anti-lupus anticoagulant

Answer 6

C) Anti-beta2-glycoprotein I

Question 7

Which autoantibody is specific for MCTD?
A) Anti-PM-Scl
B) Anti-U1 RNP
C) ANCA
D) Anti-SS-A
E) Anti-dsDNA

Answer 7

B) Anti-U1 RNP

Question 8

Which is true about immunofluorescent staining of antinuclear antibody?
A) The staining is nucleolar in SLE
B) The staining is homogenous in MCTD
C) The staining is nucleolar in systemic sclerosis
D) The staining is homogenous in RA
E) The staining is against centromer in myositis

Answer 8

C) The staining is nucleolar in systemic sclerosis

Question 9

Which is NOT a polysystemic autoimmune disease?
A) Polymyositis
B) Systemic sclerosis
C) Sclerosis multiplex
D) Sjögren’s syndrome
E) MCTD

Answer 9

C) Sclerosis multiplex

Question 10

Which statement is NOT typical in systemic autoimmune diseases?
A) Familiar aggregation
B) Sometimes medicines or chemicals can trigger them
C) Antinuclear autoantibodies are frequent
D) Males are affected mainly
E) The disease can worsen or improve during pregnancy

Answer 10

D) Males are affected mainly

Question 11

Which genetic constellation is typical in autoimmune diseases?
A) HLA-DQ2-DR4
B) HLA-A1-B8-DR3
C) HLA-A8-B27-DR4
D) HLA-B7-B27-DR3
E) HLA-A1-B7-DR4

Answer 11

B) HLA-A1-B8-DR3

Question 12

Which of the following is the most frequently occurring systemic autoimmune disease?
A) SLE
B) Polymyositis
C) Systemic sclerosis
D) MCTD
E) Sjögren’s syndrome

Answer 12

E) Sjögren’s syndrome

Question 13

Which autoimmune disease is NOT commonly associated with B-cell lymphoma?
A) SLE
B) Systemic sclerosis
C) Rheumatoid arthritis
D) Polymyositis
E) Sjögren’s syndrome

Answer 13

D) Polymyositis

Question 14

Which is NOT a symptom of antiphospholipid syndrome?
A) Habitual abortion
B) Frequent migraine
C) Thrombocytosis
D) Increased risk of thromboembolism
E) Livedo reticularis

Answer 14

C) Thrombocytosis

Question 15

Which medicine DO NOT causes SLE?
A) Etanercept
B) Procainamide
C) Infliximab
D) Hydralazine
E) Rituximab

Answer 15

E) Rituximab

Question 16

In what percent of patients with undifferentiated autoimmune diseases (NDC) develops definitive autoimmune disease?
A) 5-10 %
B) 15-20 %
C) 30-40 %
D) 50-60 %
E) 70-80 %

Answer 16

D) 50-60 %

Question 17

In which case can be NDC diagnosed?
A) In the presence of three typical clinical symptoms
B) In the presence of one typical clinical symptom and two autoantibody positivity’s
C) In the presence of two clinical symptoms and two autoantibodies
D) In the presence of two clinical symptoms and one autoantibody
E) In the presence of one clinical symptom and three typical autoantibodies

Answer 17

D) In the presence of two clinical symptoms and one autoantibody

Question 18

Which process is NOT typical in the pathogenesis of SLE?
A) DNA repair disorder
B) DNA methylation
C) Tissue citrullination
D) Increased B-cell activity
E) Decreased regulatory T-cell activity

Answer 18

C) Tissue citrullination

Question 19

Which biological therapy is appropriate for the therapy of SLE?
A) Etanercept
B) Infliximab
C) Belimumab
D) Adalimumab
E) Tocilizumab

Answer 19

C) Belimumab

Question 20

Accelerated atherosclerosis and increased cardiovascular mortality are NOT typical in which disease?
A) Rheumatoid arthritis
B) SLE
C) Sjögren’s syndrome
D) Antiphospholipid syndrome
E) Systemic sclerosis

Answer 20

C) Sjögren’s syndrome

Question 21

Which is NOT a real histological type of lupus nephritis?
A) Diffuse lupus nephritis
B) Sclerotizing glomerulonephritis
C) Membranous lupus nephritis
D) Mesangial proliferative lupus nephritis
E) Focal minimal lupus nephritis

Answer 21

E) Focal minimal lupus nephritis

Question 22

Which is NOT a typical cause of death in SLE?
A) Cardiovascular disease
B) Kidney failure
C) Central nervous system lupus
D) Pulmonary fibrosis
E) Secondary tumors

Answer 22

D) Pulmonary fibrosis

Question 23

Which pathogenetic process DOES NOT plays a role in the development of systemic sclerosis?
A) Microvascular disorders
B) Immunopathological disorders
C) Tissue citrullination
D) Collagen deposition in the organs
E) Macrovascular disorders

Answer 23

C) Tissue citrullination

Question 24

Against which antigen is oriented Anti-Scl70 in scleroderma?
A) RNA polymerase I
B) DNA polymerase I
C) DNA topoisomerase III
D) RNA polymerase III
E) DNA topoisomerase I

Answer 24

E) DNA topoisomerase I

Question 25

Which is NOT a diagnostic criterion of systemic sclerosis?
A) Sclerodactylia
B) Paroxysmal scleroderma
C) Star-shaped scars on the fingertips
D) Bibasilar pulmonary fibrosis
E) Esophageal dismotility

Answer 25

E) Esophageal dismotility

Question 26

Which medicine is NOT appropriate for treating the vascular symptoms of systemic sclerosis?
A) Nitroglycerin
B) Calcium antagonists
C) Angiotensin II receptor antagonists
D) Beta receptor blockers
E) Sildenafil

Answer 26

D) Beta receptor blockers

Question 27

Which is NOT among the clinic pathological subtypes of inflammatory muscle diseases?
A) Adult polymyositis
B) Tumor-associated myositis
C) Juvenile poly-dermatomyositis
D) Inclusion body myositis
E) Ossification myositis

Answer 27

E) Ossification myositis

Question 28

Which is NOT among the diagnostic criteria of inflammatory muscular diseases according to Bohan and Peter?
A) Elevated levels of CK and LDH enzymes
B) Intensifying weakness of distal muscles
C) Positive muscle biopsy with inflammation, necrosis
D) EMG disorders
E) Skin symptoms specific for dermatomyositis

Answer 28

B) Intensifying weakness of distal muscles

Question 29

Which is NOT among the American-European Consensus Criteria for Sjögren’s syndrome?
A) Anti-fodrin antibody
B) Anti-SS-A and/or anti-SS-B antibody
C) Positive Rose-Bengal test
D) Schirmer-test <5 mm/5 min
E) Positive salivary gland scintigraphy

Answer 29

A) Anti-fodrin antibody

Question 30

Which agent is NOT appropriate for treating glandular symptoms of Sjögren’s syndrome?
A) N-acetylcysteine
B) Tear point occlusion
C) Methylcellulose containing artificial tear
D) Infliximab
E) Pilocarpine

Answer 30

D) Infliximab

Question 31

Which disease is NOT an element of MCTD?
A) Rheumatoid arthritis
B) NDC
C) Polymyositis
D) SLE
E) Systemic sclerosis

Answer 31

B) NDC

Question 32

Which disease constitutes diagnostic criteria for MCTD according to Alarcon-Segovia?
A) Pulmonary fibrosis
B) Swelling of the back of the hand
C) Pulmonary arterial hypertension
D) Esophageal dismotility
E) Swelling of the fingers

Answer 32

B) Swelling of the back of the hand

Question 33

Which systemic vasculitis affects the medium-sized vessels?
A) Churg-Strauss syndrome
B) Takayasu arteritis
C) Kawasaki disease
D) Cryoglobulinemic vasculitis
E) Polymyalgia rheumatica

Answer 33

C) Kawasaki disease

Question 34

Histopathological forms of lupus nephritis:
1) Focal lupus nephritis
2) Membranous lupus nephritis
3) Sclerotizing glomerulonephritis
4) Minimal mesangial nephritis
5) Diffuse lupus nephritis

A) 1. and 3. are correct
B) 2. and 4. are correct
C) only 5. is correct
D) 1., 3. and 5. are correct
E) all answers are correct

Answer 34

E) all answers are correct

Question 35

Classification criteria of SLE:
1) Iron deficiency anemia
2) ANA positivity
3) Anti-ENA antibody
4) Leukopenia <4G/l
5) Lymphocytosis

A) answers 1 and 3 are correct
B) answers 2 and 4 are correct
C) only answer 5 is correct
D) answers 1, 3 and 5 are correct
E) all of the answers are correct

Answer 35

B) answers 2 and 4 are correct

Question 36

Diagnostic criteria of Sjögren’s syndrome according to the American-European Consensus system:
1) Recurrent foreign body sensation in the eyes
2) Positive ultrasound of salivary glands
3) Dry eyes for more than 3 months
4) Schirmer-test <3mm/3min
5) Positive sialography

A) 1. and 3. answers are correct
B) 2. and 4. answers are correct
C) only 5. answer is correct
D) 1., 3. and 5. answers are correct
E) all of the answers are correct

Answer 36

D) 1., 3. and 5. answers are correct

Question 37

B-cell inhibitor appropriate for therapy of SLE:
1) Rituximab
2) Tocilizumab
3) Certolizumab pegol
4) Infliximab
5) Belimumab

A) 1. and 3. are correct
B) 2. and 4. are correct
C) only 5. is correct
D) 1., 3. and 5. are correct
E) all answers are correct

Answer 37

C) only 5. is correct

Question 38

Classification criteria of Henoch-Schönlein purpura:
1) Palpable purpura
2) ANCA positivity
3) Abdominal angina
4) Lymphocytes in the wall of small vessels
5) Age <21 years at the beginning of the disease

A) 1. and 3. are correct
B) 2. and 4. are correct
C) only 5. is correct
D) 1., 3. and 5. are correct
E) all answers are correct

Answer 38

D) 1., 3. and 5. are correct

Question 39

Which is true?
1) Wegener-granulomatosis is a vasculitis affecting the small vessels
2) Polyarteritis nodosa is an ANCA-associated vasculitis
3) Microscopic polyangiitis is an ANCA-associated vasculitis
4) Takayasu-arteritis affects the medium-sized vessels
5) Churg-Strauss syndrome is not ANCA-associated

A) 1. and 3. are correct
B) 2. and 4. are correct
C) only 5. is correct
D) 1., 3. and 5. are correct
E) all answers are correct

Answer 39

A) 1. and 3. are correct

Question 40

Appropriate medicines for therapy of ANCA-associated vasculitides:
1) Cyclophosphamide
2) Azathioprine
3) Sulfamethoxazole
4) Methotrexate
5) Rituximab

A) 1. and 3. are correct
B) 2. and 4. are correct
C) only 5. is correct
D) 1., 3. and 5. are correct
E) all answers are correct

Answer 40

E) all answers are correct

Question 41

Organ symptoms of systemic sclerosis:
1) Pulmonary arterial hypertension
2) Apical pulmonary fibrosis
3) Watermelon-stomach
4) Discoid skin symptoms
5) Subcutaneous calcinosis

A) 1. and 3. are correct
B) 2. and 4. are correct
C) only 5. is correct
D) 1., 3. and 5. are correct
E) all answers are correct

Answer 41

D) 1., 3. and 5. are correct