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Attaching to a poly-immunoglobulin receptor, secretory IgA finds its way into the lumens of glands via:
a. Transcytosis
b. Phagocytosis
c. Osmosis
d. Degranulation

a. Transcytosis

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True regarding Phosphorus:

a. Is normally unavailable in the diet

b. None of the given statements are true

c. Is excreted mainly in the proximal collecting tubules

d. Is mostly absorbed in the stomach by osmosis

c. Is excreted mainly in the proximal collecting tubules

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A man with a diagnosed parathyroid adenoma consults you concerning x-ray results. There seem to be lots of deposits of dense material in his lungs and soft tissues. Given his condition, these dense materials may likely be:
a. Due to very high calcium levels in the blood
b. Granulomas formed by an immunologic process
C. Metastatic cancer
d. Solidified mucus deposits

a. Due to very high calcium levels in the blood

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Which of the ff is true regarding Addison’s disease?
a. Due to a hypersecreting tumor
b. Can be due to autoimmune destruction (a majority is) but can also be due to other causes
c. Can not be related to other organ specific autoimmune disorders
d. NOTA

b. Can be due to autoimmune destruction (a majority is) but can also be due to other causes

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The physiologically active form of calcium:

a. Comprises around 10% of the total serum calcium in the body

b. Is bound to plasma proteins

c. Is bound to anions

d. Is the free or ionized form

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You do a skin prick test on a patient with a suspected allergy to hayseed. After a few minutes, a wheal and flare reaction appears on the skin. Which of the following is true?
a. If the reaction measures 1mm, this is considered positive
b. Measuring the wheal and flare increases reproducibility
c. This test must be conducted with a positive and negative control
d. Recording the exact reaction size is not necessary

c. This test must be conducted with a positive and negative control

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9
52 year old asian female consults at your clinic, with a chief complaint of diffuse bone pain over the past several years after menopause. Any weight-bearing activity causes her severe discomfort. She admits to eating a vitamin-poor diet. Lately the patient experiences severe back pain and inability to do simple chores such as lifting grocery bags and her grandchild without pain, PE shows guarding and tenderness in the cervical, thoracic, and lumbar spine with limited range of motion. There is also noticeable guarding with some limitation of movement at the cervical spine area. What is a defining characteristic of this illness?
a. PTH dysfunction
b. Paramyxovirus-related dysfunction of osteoclast
c. Microarchitectural deterioration of bone tissue
d. “softening” of the bones due to lack of mineralization

c. Microarchitectural deterioration of bone tissue

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Involved in the creation of protective barriers, the predominant immunoglobulin in secretion is:
a. IgA
b. IgG
c. IgM
d. IgE

a. IgA

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A patient is highly suspected to have an allergy, but his skin prick test is negative. What could be the cause of this?
a. The allergen concentration is too high
b. There are impurities that cause an allergic reaction
c. The patient may be taking drugs that blunt the immune response
d. There is nothing wrong, do serum IgE immediately

c. The patient may be taking drugs that blunt the immune response

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Cancellous bone has the following functions:
a. Houses the structures needed for the creation of blood elements
b. All of the given statements are true
c. Responsible for around half of bone turnover
d. Provides a large surface area for mineral exchange

b. All of the given statements are true

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In an intradermal test (IDT) for allergens:
a. None of the given choices are true
b. Can be prevented with 50% glycerine
c. The preparation has the same concentration as that used for skin tests
d. Allergen preparations can be stored at room temperatures

a. None of the given choices are true

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What is the action of calcitonin in the bone?
a. blocks osteoblasts > less bone buildup →> more calcium in serum
b. blocks osteoclasts -> less bone resorption -> less calcium in serum
c. blocks osteoblasts -> more bone buildup -> less calcium in serum
d. blocks osteoclasts > more bone resorption - > more calcium in serum

a. blocks osteoblasts > less bone buildup →> more calcium in serum

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The most abundant immunoglobulin in the serum:
a. IgE
b. IgM
c. IgG
d. IgA

c. IgG

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The reference method for calcium determination is
a. Atomic absorption spectrophotometry
b. Gas chromatography (non-tandem)
c. Indirect potentiometry
d. GC-MS (Gas chromatography- mass spectrophotometry)

a. Atomic absorption spectrophotometry

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Which of the following is true regarding organ specific autoimmune disease
a. AOTA
b. Damage to target cells is usually done via endotoxins
c. The target antigen is generalized in different organs, so there is usually a systemic response
d. Aside from destruction of target organ cells, antibodies can overstimulate target cells as well

d. Aside from destruction of target organ cells, antibodies can overstimulate target cells as well

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When measuring for serum calcium, aside from a serum separator or lithium tube, one can use this type of vial for blood extraction:
a. Red Top

b. Blue Top

c. Gray Top

d. Violet Top

a. Red Top

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The nasal provocation test:
a. None of the given choices are true
b. Should be done as a first line test for all allergic patients
c. Is non-invasive
d. Is an example of an In Vitro test

c. Is non-invasive

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Antibodies are made up of:
a. 3 heavy chains and 1 light chain
b. 2 light chains, a hinge region, one medium chain, and one heavy chain
c. 2 light chains and 2 heavy chains
d. 4 light chains

c. 2 light chains and 2 heavy chains

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The specific term for Hypercortisolism due to an ACTH-secreting pituitary adenoma is
a. Cushing’s Disease
b. Cushing’s Syndrome
c. Conn Syndrome
d. MENZA

a. Cushing’s Disease

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What can be expected in a patient with adrenal crisis?

a. vomiting and/or diarrhea

b. Confusion

c. All of the above

d. Severe weakness

c. All of the above

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True regarding Autoimmune Hemolytic Anemia:
a. All of the above
b. May be induced by drugs
c. Autoantibodies against RBCs are formed
d. Leads to lysis of RBCs

a. All of the above

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True regarding Hashimoto Thyroiditis

a. Occurs more in women

b. Characterized by a delayed type hypersensitivity response

c. Ultimately leads to decreased thyroid function

d. All of the above

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A patient taking lithium for symptoms of bipolar type I can develop what?

a. Hypercortisolism

b. SIADH

c. Hypothyroidism

d. Hyperprolactinemia

c. Hypothyroidism

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Goodpasture syndrome involves which of the following? (select all the correct answers)
a. Anti - glomerular basement membrane
b. Pulmonary hemorrhage
c. Low amounts of urea in the serum
d. Rapidly progressive glomerulonephritis

b. Pulmonary hemorrhage

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35. Which of the following is true regarding Grave’s Disease? a. All of the above b. Mediated by destruction and loss of function of thyrocytes c. Patient’s present with heat intolerance among other symptoms d. Granuloma formation is mandatory for the diagnosis

c. Patient’s present with heat intolerance among other symptoms

36. Of the IgG types, ____ is the most effective complement activator a. IgG4 b. IgG2 c. IgG3 d. IgG1

c. IgG3

38. Which of the following statements correctly describe the action of PTH? a. PTH acts on the bone to decrease serum calcium concentration b. PTH acts on the liver to create enzymes that cleave protein-bound calcium c. In the context of a low serum calcium, PTH acts on the kidney to increase calcium reabsorption d. In the context of a high serum calcium, PTH stimulates RANKL to increase bone resorption

c. In the context of a low serum calcium, PTH acts on the kidney to increase calcium reabsorption

39. An X-linked receptor defect is one of the most common congenital causes of Nephrogenic Diabetes Insipidus. a. True b. False

a. True

40. In what conditions can conventional Calcium measurements be inaccurate, necessitating a correction? a. Nephrotic Syndrome b. Liver Disease c. All of the above d. Chronic Lymphocytic Leukemia

c. All of the above

41. Which of the following is NOT used to measure phosphorus? a. Reacting phosphorus to create a picrate solution b. Indirect Potentiometry c. Reacting phosphorus to create a phosphomolybdate complex d. Atomic Absorption Spectrophotometry

a. Reacting phosphorus to create a picrate solution

42. True regarding Pernicious Anemia a. Low RBC count due to autoimmune lysis of RBCs b. Can be due to an autoimmune attack of gastric epithelium c. Due to a deficiency of Thiamine d. All of the above

b. Can be due to an autoimmune attack of gastric epithelium

43. The resorption of bone is primarily due to the action of osteoclasts. What is the expected serum calcium level in conditions with extremely high osteoclast activity? a. High b. Normal C. Low

a. High

44. When a person is first infected with something, the primary Immunoglobulin in this initial response is: a. IgG b. IgM с. IgA d. IgE

b. IgM

45. Most of the calcium in the human body is contained in the: a. Skeleton b. Liver C. Serum d. Skin

a. Skeleton

46. This IgG type CANNOT cross the placenta: a. IgG4 b. IgG2 c. IgG3 d. IgG1

b. IgG2

47. When and under what circumstances is it best to measure phosphorus in a patient? a. During the afternoon, before dinner b. In the evening, after dinner c. Any time of the day is optimal d. During a fasting specimen in the morning

a. During the afternoon, before dinner

48. You are consulted by a young patient diagnosed with Type 1 Diabetes Mellitus. Which of the following applies to her condition? a. None of the above b. Patients with her condition are always obese c. People with her condition usually present at an elderly age d. All of the above e. Infiltration of the pancreas by massive amounts of primarily B lymphocytes

e. Infiltration of the pancreas by massive amounts of primarily B lymphocytes

49. In Myasthenia Gravis which of the following is true? a. The disease can be treated in a number of different ways b. AOTA c. Mediated by antibodies blocking acetylcholine receptors d. Manifests as progressive weakness

c. Mediated by antibodies blocking acetylcholine receptors

50. After eating a meal, a man develops hives all over the body, and has difficulty breathing. The mechanism behind this particular reaction is mediated by: a. IgG b. IgE c. IgM d. IgA

b. IgE

50. The following statements about diabetes are true A. After testing for FBS, no further confirmatory test is needed B. Wildly varying random glucose levels throughout the day is a worrisome issue C. DKA is not an emergency and most cases are managed at home D. Hypoglycemic symptoms with a plasma glucose level of ≤ 50 mg/dL (2.8 mmol/L) in an individual who is not receiving medications for diabetes is not a concern.

B. Wildly varying random glucose levels throughout the day is a worrisome issue

51.Which of the following is a non-organ specific autoimmune disease? A. Pemphigus Vulgaris B. Pernicious Anemia C. Scleroderma D. Hashimotos Thyroiditis

C. Scleroderma

52. Which of the following laboratory test will NOT evaluate autoimmunity A. Carcinoembryonic antigen B. Indirect immunofluorescence C. Enzyme-linked immunosorbent assay D. Western Blot

A. Carcinoembryonic antigen

53.Histologic hallmark of the pemphigus group and responsible for the clinical presentation of flaccid blisters and erosions A. Intraepidermal acantholysis B. Subepidermal blister formation C. Hyperkeratosis D. Parakeratosis

A. Intraepidermal acantholysis

54. This is the most common variant of pemphigus A. pemphigus vulgaris B. pemphigus foliaceus C. paraneoplastic pemphigus D. igA pemphigus

A. pemphigus vulgaris

55. Which of the following finding is associated with autoimmune disease A. Presence of humoral or cell mediated immunity B. Ability to transfer the disease with antibodies C. Disease recurrence with organ transplantation in the absence of immunosuppression D. AOTA

D. AOTA

56.Which of the following is associated with antibodies against the dermal-epidermal junction (BMZ) A. Bullous pemphigoid B. Pemphigus foliaceus C. Paraneoplastic pemphigus D. IgA pemphigus

A. Bullous pemphigoid

57.Which of the following variant of pemphigus will not show IgG deposition and C3 in Direct immunofluorescence A. Pemphigus vulgaris B. IgA pemphigus C. Pemphigus foliaceus D. Paraneoplastic pemphigus

B. IgA pemphigus

58.Which of the following immunologic feature will differentiate Bullous Pemphigoid from Dermatitis Herpetiformis A. Granular IgA deposition in the dermal papilla B. Circulating anti-BMZ autoantibodies C. Serum IgA autoantibodies directed against endomysium can be detected D. Serum IgA autoantibodies tTG and eTG can be detected

A. Granular IgA deposition in the dermal papilla

59.This blister disorder is associated with Celiac disease A. Bullous pemphigoid B. Pemphigoid gestationis C. Mucous membrane pemphigoid D. Dermatitis Herpetiformis

D. Dermatitis Herpetiformis

60.Which of the following is least associated with Autoimmune Gastritis A. Known consequence is vitamin B12 deficiency B. Leads to mucosal atrophy and achlorhydria C. Presents with very high serum gastrin concentrations D. Precedes with gastric hypertrophy

D. Precedes with gastric hypertrophy

61.Characteristic histologic finding of Celiac Disease include: A. Increased intraepithelial CD8 T lymphocytes (>25/100 enterocytes) B. Villous hyperplasia C. Hypoplastic crypts D. All of the above

A. Increased intraepithelial CD8 T lymphocytes (>25/100 enterocytes)

62.Confirmatory test for Celiac Disease A.Traditional antigliadin antibody tests B.IgA endomysial autoantibodies (anti-EMA) C.IgG antideamidated gliadin peptide (DGP) D.IgA antitissue transglutaminase autoantibodies (anti-tTG)

D.IgA antitissue transglutaminase autoantibodies (anti-tTG)

63. Which of the following is mostly associated with Ulcerative colitis A. Characterized by discontinuous transmural ulcerations B. Found throughout the digestive tract C. p-ANCA is present in 40% to 80% of patients D. Highly associated with anti–Saccharomyces cerevisiae mannan antibodies (ASCA)

C. p-ANCA is present in 40% to 80% of patients

64. Laboratory assessment for Autoimmune Hepatitis includes all of the following EXCEPT: A. Alanine(ALT), Aspartate (AST) aminotransferases B. Alkaline phosphatase (ALP) C. Albumin D. IgM

B. Alkaline phosphatase (ALP)

65. Which of the following is NOT a hallmark of Autoimmune Hepatitis A.Serum ALT greater than five times the upper limit of the reference interval B.Positive SMA C.Histologic features of interface hepatitis D.Positive AMA

D.Positive AMA

66.What is the serologic hallmark of Primary Biliary Cholangitis A. ALP (Alkaline phosphatase) B. AMA (Antimitochondrial autoantibodies) C. ANA (Antinuclear autoantibody) D. SMA (Anti–smooth muscle autoantibody)

A. ALP (Alkaline phosphatase)

67.Common cause of the nephrotic syndrome in adults A. Membranous Nephropathy B. Membranous Glomerulonephritis C. Membranous Glomerulopathy D. All of the above

D. All of the above

68.This glomerular disease is characterized by capillary wall thickening on LM, prominent granular (“lumpy-bumpy”) capillary wall staining for IgG and C3 on IF, and subepithelial deposits on EM A. Membranoproliferative glomerulonephritis (MPGN) B. IgA nephropathy C. Membranous nephropathy D. Anti-GBM disease

C. Membranous nephropathy

69 Which of the following is NOT associated with IgA Nephropathy? A. the most common primary glomerulonephritis in the world B. Pathogenesis involves abnormal IgA glycosylation C. EM confirms the presence of subendothelial deposits D. IgAN is essentially an IF diagnosis

C. EM confirms the presence of subendothelial deposits

70. Hashimoto's Thyroiditis will most likely show... A. Elevated TSH B. Presence of thyroperoxidase antibody C. Elevated thyroglobulin autoantibodies D. All of the above

D. All of the above

71 Which of the following laboratory findings is least likely associated with the diagnosis of Graves disease? A. Autoantibodies to the TSH receptor B. Elevated TSH C. thyroid-stimulating immunoglobulins (TSI) positive D. Thyrotropin-Binding Inhibitor Immunoglobulins positive

D. Thyrotropin-Binding Inhibitor Immunoglobulins positive

72. Which of the following laboratory findings will distinguish Graves disease from Atrophic Thyroiditis A. Presence of Thyrotropin-Binding Inhibitor Immunoglobulins B. Negative for thyroid-stimulating immunoglobulins (TSI) C. Both D. None of the above

D. None of the above

73.This disease is caused by autoantibodies directed against the nicotinic acetyl choline (Ach) receptor (AChR) A. Myasthenia Gravis B. Lamber-eaton Myasthenia Syndrome C. Multiple sclerosis D. Stiff-person syndrome

A. Myasthenia Gravis

74. Which immunofluorescence pattern is associated with CREST? a. Homogenous pattern b. Speckled pattern c. Nucleolar pattern d. Centromere/Peripheral pattern

d. Centromere/Peripheral pattern

75.This autoimmune disease will show autoantibodies to desmoglein 3 and 1 a. Dermatitis Herpetiformis b. Pemphigus c. Pemphigoid d. Epidermolysis bulls acquisita

b. Pemphigus

26. Most prevalent cation in the human body A. Calcium B. Magnesium C. Chloride D. Sodium

A. Calcium

27. Which of the following is NOT a form of serum calcium? A. Free or ionized calcium B. Complexed calcium C. Plasma protein-bound calcium D. Elmental calcium

D. Elmental calcium

28.Which of the following statement is true of calcium? A. absorbed in the duodenum and upper jejunum B. calcium absorption increased in children, pregnancy, and during lactation. C. It decreases with advancing age D. All statements are correct

D. All statements are correct

29.Which of the following ion is an important constituent of nuclei acid? A. Calcium B. Phosphorus C. Magnesium D. Chloride

B. Phosphorus

30.This is the second most prevalent intracellular cation A. Calcium B. Magnesium C. Chloride D. Sodium

B. Magnesium

31.Which of the following is least associated with Magnesium? A. Essential for the function of more than 300 cellular enzymes B. Required for cellular energy metabolism and has an important role in membrane stabilization, C. Required in nerve conduction, ion transport, and calcium channel activity D. It forms high-energy compounds (ATP) and cofactors

D. It forms high-energy compounds (ATP) and cofactors

32.Which of the following hormones regulate Mineral metabolism? A. Parathyroid hormone (PTH) B. 1,25-dihydroxyvitamin D3 (1,25[OH]2D3) C. Calcitonin D. All of the above

D. All of the above

33.Which of the following statement is least associated with Parathyroid hormone? A.Synthesized and secreted by the chief cells of the parathyroid gland. B.Inhibits osteoclastic bone resorption by directly binding to osteoclasts C.Ionized magnesium has also been shown to influence the secretion of PTH. D.The primary physiologic function of PTH is to maintain the concentration of ionized calcium in the ECF

B.Inhibits osteoclastic bone resorption by directly binding to osteoclasts

34.This is the most important regulator of calcitonin secretion A. Ionized calcium concentration B. Plasma protein bound calcium C. Complexed calcium D. None of the above

A. Ionized calcium concentration

36. Which of the following statement is associated with Vitamin D metabolism? A.The steroid hormone 1,25(OH)2D3 is the major biologically active metabolite of the vitamin D sterol family. B. May be ingested in the diet or synthesized in the skin from 7- dehydrocholesterol (provitamin D3) through exposure to sunlight C. Activation of Vitamin D takes place in the liver and kidney. D. All of the above

D. All of the above

35. Which of the following is a physiologic role of calcitonin? A. Inhibits osteoclastic bone resorption by directly binding to osteoclasts. B. Causes increased clearance of calcium and phosphate in the kidney. C. Inhibits the action of PTH and vitamin D D. All of the above

D. All of the above

37.What role does vitamin D measurement play in the management of osteoporosis? A. Vitamin D deficiency must be demonstrated to establish the diagnosis B. Vitamin D is consistently elevated in osteoporosis C. A normal vitamin D level rules out osteoporosis D. Vitamin D deficiency is a risk factor for developing osteoporosis

D. Vitamin D deficiency is a risk factor for developing osteoporosis

38.Which of the following is a Parathyroid Hormone mediated cause of Hypercalcemia? A. Malignancy associated B. Primary hyperparathyroidism C. Vitamin D mediated D. Vitamin D intoxication

B. Primary hyperparathyroidism

39. Which of the following is least likely to cause hypocalcemia? A. Chronic renal failure B. Hypomagnesemia C. MEN 1 D. Vitamin D deficiency

C. MEN 1

40. Which of the following statement is associated with hypophosphatemia? A. Most common cause is a shift of phosphorus from extracellular fluid into cells B. Caused by decreased renal excretion in acute and chronic renal failure C. Increased intake with excessive oral, rectal, or intravenous administration D. Increased extracellular load due to a transcellular shift in acidosis

A. Most common cause is a shift of phosphorus from extracellular fluid into cells

41. Patients with Hypermagnesemia will usually present with: A. Hypotension B. Bradycardia C. Respiratory depression D. All of the above

D. All of the above

42. Loss of magnesium in the GI tract is due to: A. Acute and chronic diarrhea B. Malabsorption C.Steatorrhea after extensive bowel resection D. All of the above

D. All of the above

43. Which of the following will cause elevated Phosphate levels A. Hypoparathyroidism and pseudohypoparathyroidism B. Alcohol abuse C. Primary hyperparathyroidism D. Acute respiratory alkalosis

A. Hypoparathyroidism and pseudohypoparathyroidism

4.Most common metabolic disease of bone A.Osteopetrosis B.Osteomalacia C.Osteoporosis D.Osteogenesis Imperfecta

C.Osteoporosis

45. Which of the following condition is a Primary Osteoporosis? a. Idiopathic b. Calcium deficiency c. Thyrotoxicosis d. Immobilization

a. Idiopathic

46.Failure to mineralize newly formed organic matrix (osteoid) in the mature skeleton a. Osteitis deformans b. Osteogenesis Imperfecta c. Osteomalacia d. Renal osteodystrophy

c. Osteomalacia

47. This is characterized by the uncoupling of osteoclast and osteoblast function A. Pagets disease of bone B. Osteitis deformans C. Osteogenesis Imperfecta D. Both Pagets and Osteitis deformans

D. Both Pagets and Osteitis deformans

48.Which of the following diseases will produce osteomalacia or rickets? A. Vitamin D deficiency states B. Phosphate depletion C. Systemic acidosis D. All of the above

D. All of the above

49.Which of the following statement is correct of Renal Osteodystrophy? A. Affects both bone quality and quantity through metabolic and hormonal disturbances B. Refers to the spectrum of bone abnormalities that occur in patients with ARF C. Radiographs may show focal osteosclerosis D. Renal transplantation may progress disease condition

A. Affects both bone quality and quantity through metabolic and hormonal disturbances

50. Tunneling resorption refers to A. Manner in which osteoclast gain access to mineralized bone B. Osteoclast dig cutting cones through mineralized surfaces into the mineralized cores of trabeculae C. Both statement refers to tunneling resorption D. Both statement is not associated with tunneling resorption

A. Manner in which osteoclast gain access to mineralized bone

51. Antibodies are made up of: A. 2 light chains and 2 heavy chains B. 3 heavy chains and 1 light chain C. 4 light chains D. 2 light chains, a hinge region, one medium chain, and one heavy chain

A. 2 light chains and 2 heavy chains

52. of the IgG types, ______ is the most effective complement activator A. IgG1 B. IgG2 C. IgG3 D. IgG4

C. IgG3

53.After eating a meal, a man develops hives all over the body, and has difficulty breathing. The mechanism behind this particular reaction is mediated by: A. IgA B. IgM C. IgG D. IgE

D. IgE

54.The Nasal Provocation test: A. Should be done as a first line test for all allergic patients B. Is non-invasive C. Is an example of an In Vitro test D. None of the given choices are true

B. Is non-invasive

55. In an intradermal test for allergens: A. Allergen preparations can be stored at room temperature B. The preparation has the same concentration as that used for skin tests. C. Can be preserved with 50% glycerine D. None of the given choices are true

D. None of the given choices are true

56.You do a skin prick test on a patient with a suspected allergy to hayseed. After a few minutes, a wheal and flare reaction appears on the skin. Which of the following is true? A. If the reaction measures 1mm, this is considered positive B. Measuring the wheal and flare increases reproducibility C. This test must be conducted with a positive and negative control D. Recording the exact reaction size is not necessary

C. This test must be conducted with a positive and negative control

57.A patient is highly suspected to have an allergy, but his skin prick test is negative. What could be the cause of this? A. There is nothing wrong, do a serum IgE immediately B. The allergen concentration is too high C. There are impurities that cause an allergenic reaction D. The patient may be taking drugs that blunt the immune response

D. The patient may be taking drugs that blunt the immune response

58.Attaching to a poly-immunoglobulin receptor, secretory IgA finds its way into the lumens of glands via: A Phagocytosis B Transcytosis C Degranulation D Osmosis

B Transcytosis

59 Involved in the creation of protective barriers, the predominant Immunoglobulin in secretions is: A. IgA B. IgM C. IgG D. IgE

A. IgA

60. when a person is first infected with something, the primary immunoglobin in this initial response is a. IgA B. IgM C. IgG D. IgE

B. IgM

61. This IgG type CANNOT easily cross the placenta: A. IgG1 B. IgG2 C. IgG3 D. IgG4

B. IgG2

62.The most abundant immunoglobulin in the serum: A. IgA B. IgM C. IgG D. IgE

C. IgG