Immuno Pathology SBAs Flashcards
A 65 year-old male with a history of steroid dependent asthma, hypertension, Type 2 Diabetes Mellitus and osteoporosis presents with recurrent chest, sinus, and skin infections. Past medical history of chemotherapy for follicular lymphoma and he has recently completed a 2 year maintenance therapy of 3 monthly rituximab. Current oral medication includes Prednisolone 5mg OD, Losartan 50mg OD, metformin500mg BD, alendronic acid 70mg weekly.
Serum immunoglobulins are as follows
IgG – 3.9g/L (ref interval 6.4-16.0g/L)
IgA – 0.9g/L (ref interval 0.8-3.4g/L)
IgM – 0.1g/L (ref interval 0.5-2.0g/L)
IgE 200IU/ml (reference interval 3-120IU/ml)
Which of the following medication are most likely to have cause antibody deficiency
A) Metformin
B) Losartan
C) Prednisolone
D) Alendronic Acid
E) Rituximab
rituximab
A 57-year-old male is referred to the Chest clinic with recurrent chest infections, requiring antibiotic therapy. Past medical history reveal lichen planus and a history of surgery for an anterior mediastinal mass 4 year previously. Physical examination show nail candidiasis, sternotomy scar and bi-basal crepitations. A HRCT chest scan shows extensive bronchiectasis.
Immune investigation are as follows
IgG – 3.1g/L (ref interval 6.4-16.0g/L)
IgA – 0.4g/L (ref interval 0.8-3.4g/L)
IgM – 0.2g/L (ref interval 0.5-2.0g/L)
IgE 500IU/ml (reference interval 3-120IU/ml)
B cell count 10cell/ul ( ref interval 100-500)
What is the most likely diagnosis?
A) Partial antibody deficiency syndrome
B) Common variable immune deficiency
C) High grade B cell Mediastinal Lymphoma
D) Thymoma with antibody deficiency/Good’s syndrome
E) Hyper IgE syndrome
D
Which of the following condition are more likely to present in patients with a CD4 T cell counts of more than 350cells/ul
A) CMV retinitis, Toxoplasma encephalitis, visceral Kaposi sarcoma
B) Herpes zoster, Pulmonary Tuberculosis, Pneumococcal pneumonia
C) Pneumocystis jirovecci pneumonia, disseminated MAC, ITP
D) EBV CNS lymphoma, oral candida, cryptococcal meningitis
E) Cutaneous Kaposi sarcoma, disseminated MAC, HSV infection
B
Which of the following statements are true about HIV-1 infection
A) Reverse transcription is associated with few errors in copying HIV-1 RNA template
B) Preferred option to commence ART in the UK is dual combination therapy containing an integrase inhibitor and NRTI
C) HLA-B*5701 blood test is used to prevent hypersensitivity reaction with protease inhibitors
D) Residual immune activation is commonly seen in patients on suppressive ART regimens
E) HIV-1 serology point care tests have similar diagnostic performance to 4th generation combined p24antigen/antibody tests
D) Residual immune activation is commonly seen in patients on suppressive ART regimens
