Immunology Flashcards
1
Q
19 year old male presents to A&E with severe respiratory difficulty, light-headedness and a red itchy rash. On examination he has laryngeal oedema, bilateral wheezing across the lung fields and is hypotensive. He has recently been taking antibiotics for a chest infection.
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
A
E. Anaphylaxis
2
Q
A 3 year old girl is brought into A&E by her parents. She has had vomiting and diarrhoea since early yesterday evening when she was at a birthday party. On examination she has urticaria.
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
A
B. Food allergy
3
Q
A 40 year old man presents to his GP complaining of loss smell and nasal itching and discharge. On examination his nasal mucosa are swollen and have a bluish tinge. His symptoms improve with a corticosteroid spray
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
A
H. Allergic Rhinitis
4
Q
A 25 year old woman presents to her GP complaining of itchy, red wheals on her torso which have been present for 7 weeks. She can not remember how they started but has noticed they are worse in the heat and when she exercises.
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
A
C. Chronic Urticaria
5
Q
A 30 year old women presents to her GP with a red, itchy, oozing rash around her neck and fingers
All Answer Choices A. Acute Urticaria B. Food allergy C. Chronic Urticaria D. Allergic asthma E. Anaphylaxis F. Contact dermatitis G. Drug allergy H. Allergic Rhinitis I. Angioedema J. Allergic bronchopulmonary Aspergillosis
A
F. Contact dermatitis
6
Q
A 55 year old man with history of angina was advised to take a tablet before a long flight. After taking the pill, he suddenly finds that he has difficulty breathing, feels nauseous and is itching.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
A
I. Mast cell degranulation
Mast cell degranulation is not IgE mediated
7
Q
A 24 year old medical student develops worsening swelling of the hands and feet and abdominal pain before her final year medical exams. She says that similar milder episodes have occurred preciously.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
A
B. C1 inhibitor deficiency
The simple answer is that C1 inhibitor has a number of functions, in addition to inhibiting the activation of C1. For example,
it also inhibits activation of the kinin pathway, the clotting pathway and the fibrinolytic pathway. It does this through
inhibition of factor XII, activated factor XI, and kallikrein as well as C1.
It’s likely that activation of the kinin pathway and production of bradykinin mediates the angioedema associated with this
condition.
8
Q
A 50 year old Irish woman presents to her GP with episodes of diarrhoea, which is difficult to flush, abdominal pain, weight loss and fatigue. She also describes a blistering itchy rash on her knees.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
A
G. Coeliac disease
Coeliac disease is associated with a superficial, blistering skin rash ‘dermatitis herpetiformis’, which is intensely itchy
9
Q
A 26 year old male who has been suffering from ‘flu-like’ symptoms with fever presents to the GP after developing skin rash in the last few days.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
A
E. Acute urticaria
Acute urticaria is defined being present for less than 6 weeks, whereas chronic urticaria persists
for more than 6 weeks. In both cases the urticarial rash is intermittent, comes and goes and normally
persists in a single site for less than 24 hours.
10
Q
A 35 year old woman presents with persistent itchy wheels for the last 2 months. She noticed that when this is at its worst, she also has a fever and feels generally unwell. After an acute attack, she has bruising and post-inflammatory residual pigmentation at the site of the itching.
All Answer Choices A. Chronic urticaria B. C1 inhibitor deficiency C. Idiopathic angioedema D. Panic attack E. Acute urticaria F. IgE mediated anaphylaxis G. Coeliac disease H. Extrinsic allergic alveolitis I. Mast cell degranulation J. Allergic asthma K. Urticarial vasculitis
A
K. Urticarial vasculitis
Urticarial rashes that last more than 24 hours in a single site, resolve with bruising or skin depigmentation
may raise the possibility of an underlying vasculitis. In this instance a skin biopsy of the urticarial
lesion is useful to confirm/repute presence of a vasculitis
11
Q
A 19 year old male presents to A&E with increasing breathlessness. On examination his blood pressure is 90/55 mmHg and his respiratory rate is 28/min. He shows you a generalised red itchy skin rash, and examination of his chest reveals bilateral inspiratory and expiratory wheezes throughout.
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
A
D. Anaphylaxis
The combination of hypotension, respiratory distress, urticaria and bronchoconstriction is very suggestive of anaphylaxis
12
Q
A 35 year old woman presents with a two day history of a red itchy skin rash which started soon after her first scuba-diving lesson. She is otherwise well.
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
A
J. Acute urticaria
This rash is very suggestive of acute urticaria. The temporal association with scuba diving may indicate an allergy to latex (in wet suits).
13
Q
A 22 year old woman presents with an intermittently itchy and desquamating skin rash on her abdomen which is unresponsive to antihistamines
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
A
G. Contact hypersensitivity
This rash is typical of contact hypersensitivity. The distribution of the rash suggests that the specific agent is nickel, which used to be a component of the studs of jeans and is commonly found in the metal used in belts
14
Q
A 40 year old man complains of loss of smell with nasal itching and discharge over 4 weeks. He also describes morning sneezing. He is otherwise in good health. On examination his nasal mucosa are swollen and hyperaemic.
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
A
C. Allergic rhinitis
The combination of sneezing, rhinorrhea and loss of smell is very suggestive of allergic rhinitis
15
Q
This 45 year old woman presents to A&E with tongue swelling and acute respiratory tract obstruction. She has longstanding hypertension and received a renal transplant two years previously. She has no history of allergic disease. On examination her blood pressure is stable, and examination of her lung fields reveal normal breath sounds. Her current medication includes cyclosporine, azathioprine, captopril and nifedipine.
All Answer Choices A. Hereditary angioedema B. Allergic bronchopulmonary aspergillosis C. Allergic rhinitis D. Anaphylaxis E. Acute angioedema F. Allergic conjunctivitis G. Contact hypersensitivity H. Chronic urticaria I. Allergic asthma J. Acute urticaria
A
E. Acute angioedema
This woman has angioedema of the tongue, without symptoms suggestive of a generalised allergic reaction. Isolated angioedema may be allergic in origin, but 94% of cases angioedema presenting to A&E are drug induced and the majority of these are associated with ACE inhibitors (eg captopril).
16
Q
A 19 year old male presents to A&E with increasing breathlessness. On examination his blood pressure is 90/55 mmHg and his respiratory rate is 28/min. He shows you a generalised red itchy skin rash, and examination of his chest reveals bilateral inspiratory and expiratory wheezes throughout.
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
A
D. IM adrenaline 1mL of 1:1000
The most important treatment of anaphylaxis is adrenaline, which should be given intramuscularly. (Note for final year pharm: 1:1000 means 1mg/mL; 1:10000 means 0.1mg/mL ; 1% means 1g/dL)
17
Q
A 35 year old woman presents with a two day history of a red itchy skin rash which started soon after her first scuba-diving lesson. She is otherwise well.
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
A
H. PO antihistamines
- Severe acute urticaria is effectively treated with a short course of oral anti-histamines
18
Q
A 22 year old woman is presents with this intermittently itchy and desquamating skin rash which is unresponsive to antihistamines
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
A
J. None of the above
Contact hypersensitivity should be treated by avoidance of the sensitising agent, in this case nickel
19
Q
This 45 year old woman presents to A&E with tongue swelling and acute respiratory tract obstruction. She has longstanding hypertension and received a renal transplant two years previously. She has no history of allergic disease. On examination her blood pressure is stable, and examination of her lung fields reveal normal breath sounds. Her current medication includes cyclosporine, azathioprine, captopril and nifedipine.
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
A
IM adrenaline 0.5 mL of 1:1000
20
Q
A 40 year old man complains of loss of smell with nasal itching and discharge over 4 weeks. He also describes morning sneezing. He is otherwise in good health. On examination his nasal mucosa are swollen and hyperaemic.
A. IV adrenaline 0.3mL of 1:1000 B. IM adrenaline 1mL of 1:10000 C. Inhaled antihistamines D. IM adrenaline 1mL of 1:1000 E. Intraarticular corticosteroids F. Venom immunotherapy G. IM adrenaline 0.5 mL of 1:1000 H. PO antihistamines I. Inhaled corticosteroids J. None of the above K. Intranasal antihistamines L. IV antihistamines M. Intracardiac adrenaline
A
PO antihistamines
Oral antihistamines and intranasal corticosteroids are the mainstay of treatment of mild allergic rhinitis. (As intranasal corticosteroid is not an option available, the “single best” answer here is oral antihistamines.)
21
Q
Cytokines exerting an anti-viral effect
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
A
E. Interferons
22
Q
Immunoglobulin dimer
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
A
D. IgA
23
Q
MHC associated with Th1 cells
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
A
F. Major histocompatability complex class 2
24
Q
Acts on hepatocytes to induce synthesis of acute phase proteins in response to bacterial infection
A. Alternative complement pathway B. Natural Killer cells C. IgM D. IgA E. Interferons F. Major histocompatability complex class 2 G. Major histocompatability complex class 1 H. Classical complement pathway I. IgG J. IL6 K. IgE L. Innate immune system M. CD8+
A
J. IL6
25
Arise in the first few days after infection and are important in defence against viruses and tumors
```
A. Alternative complement pathway
B. Natural Killer cells
C. IgM
D. IgA
E. Interferons
F. Major histocompatability complex class 2
G. Major histocompatability complex class 1
H. Classical complement pathway
I. IgG
J. IL6
K. IgE
L. Innate immune system
M. CD8+
```
B. Natural Killer cells
26
MHC associated with Th2 cells
```
A. Alternative complement pathway
B. Natural Killer cells
C. IgM
D. IgA
E. Interferons
F. Major histocompatability complex class 2
G. Major histocompatability complex class 1
H. Classical complement pathway
I. IgG
J. IL6
K. IgE
L. Innate immune system
M. CD8+
```
F. Major histocompatability complex class 2
27
MHC associated with cytotoxic T cells
```
A. Alternative complement pathway
B. Natural Killer cells
C. IgM
D. IgA
E. Interferons
F. Major histocompatability complex class 2
G. Major histocompatability complex class 1
H. Classical complement pathway
I. IgG
J. IL6
K. IgE
L. Innate immune system
M. CD8+
```
G. Major histocompatability complex class 1
28
Along with IgD, is one of the first immunoglobulins expressed on B cells before they undergo antibody class switching
```
A. Alternative complement pathway
B. Natural Killer cells
C. IgM
D. IgA
E. Interferons
F. Major histocompatability complex class 2
G. Major histocompatability complex class 1
H. Classical complement pathway
I. IgG
J. IL6
K. IgE
L. Innate immune system
M. CD8+
```
C. IgM
29
The most abundant (in terms of g/L) immunoglobulin in normal plasma
```
A. Alternative complement pathway
B. Natural Killer cells
C. IgM
D. IgA
E. Interferons
F. Major histocompatability complex class 2
G. Major histocompatability complex class 1
H. Classical complement pathway
I. IgG
J. IL6
K. IgE
L. Innate immune system
M. CD8+
```
I. IgG
30
Deficiencies in this predispose to SLE
```
A. Alternative complement pathway
B. Natural Killer cells
C. IgM
D. IgA
E. Interferons
F. Major histocompatability complex class 2
G. Major histocompatability complex class 1
H. Classical complement pathway
I. IgG
J. IL6
K. IgE
L. Innate immune system
M. CD8+
```
H. Classical complement pathway
31
Kostmanns syndrome is a congenital deficiency of which component of the immune system?
```
All Answer Choices
A. Bacterial
B. B lymphocyte
C. MHC Class I
D. T lymphocyte
E. Neutrophil
F. MHC Class II
G. Fungal
H. Complement
I. Viral
J. Mast cell
K. Parasitic
```
E. Neutrophil
32
Which component of the innate immune system is usually one of the first to respond to infection through a cut?
```
All Answer Choices
A. Bacterial
B. B lymphocyte
C. MHC Class I
D. T lymphocyte
E. Neutrophil
F. MHC Class II
G. Fungal
H. Complement
I. Viral
J. Mast cell
K. Parasitic
```
E. Neutrophil
33
Which infection is most common as a consequence of B cell deficiency?
```
All Answer Choices
A. Bacterial
B. B lymphocyte
C. MHC Class I
D. T lymphocyte
E. Neutrophil
F. MHC Class II
G. Fungal
H. Complement
I. Viral
J. Mast cell
K. Parasitic
```
A. Bacterial
34
Meningococcal infections are quite common as a result of which deficiency of the component of the immune system?
```
All Answer Choices
A. Bacterial
B. B lymphocyte
C. MHC Class I
D. T lymphocyte
E. Neutrophil
F. MHC Class II
G. Fungal
H. Complement
I. Viral
J. Mast cell
K. Parasitic
```
H. Complement
35
Produced by the liver, when triggered, enzymatically activate other proteins in a biological cascade and are important in innate and antibody mediated immune response?
```
All Answer Choices
A. Bacterial
B. B lymphocyte
C. MHC Class I
D. T lymphocyte
E. Neutrophil
F. MHC Class II
G. Fungal
H. Complement
I. Viral
J. Mast cell
K. Parasitic
```
H. Complement
36
A complete deficiency in this molecule is associated with recurrent respiratory and gastrointestinal infections.
```
All Answer Choices
A. C3a
B. Macrophages
C. AP50
D. IgM
E. IgG
F. NADPH oxidoase
G. CH50
H. Myeloperoxidase
I. MAC
J. C3b
K. IgA
L. C1
M. Neutrophils
```
K. IgA
37
Leukocyte Adhesion Deficiency is characterised by a very high count in which ?
```
All Answer Choices
A. C3a
B. Macrophages
C. AP50
D. IgM
E. IgG
F. NADPH oxidoase
G. CH50
H. Myeloperoxidase
I. MAC
J. C3b
K. IgA
L. C1
M. Neutrophils
```
M. Neutrophils
38
Which crucial enzyme is vital for the oxidative killing of intracellular micro-organisms?
```
All Answer Choices
A. C3a
B. Macrophages
C. AP50
D. IgM
E. IgG
F. NADPH oxidoase
G. CH50
H. Myeloperoxidase
I. MAC
J. C3b
K. IgA
L. C1
M. Neutrophils
```
F. NADPH oxidoase
39
Which complement factor is an important chemotaxic agent?
```
All Answer Choices
A. C3a
B. Macrophages
C. AP50
D. IgM
E. IgG
F. NADPH oxidoase
G. CH50
H. Myeloperoxidase
I. MAC
J. C3b
K. IgA
L. C1
M. Neutrophils
```
A. C3a
40
What is the functional complement test used to investigate the classical pathway?
```
All Answer Choices
A. C3a
B. Macrophages
C. AP50
D. IgM
E. IgG
F. NADPH oxidoase
G. CH50
H. Myeloperoxidase
I. MAC
J. C3b
K. IgA
L. C1
M. Neutrophils
```
G. CH50
41
What is the functional complement test used to investigate the classical pathway?
```
All Answer Choices
A. C3a
B. Macrophages
C. AP50
D. IgM
E. IgG
F. NADPH oxidoase
G. CH50
H. Myeloperoxidase
I. MAC
J. C3b
K. IgA
L. C1
M. Neutrophils
```
G. CH50
42
Graves Disease
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
E. Type II – Antibody mediated
43
SLE
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
G. Type III – Immune complex mediated
44
Rheumatoid arthritis
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
B. Type IV – T-cell mediated
45
Asthma
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
H. Not an autoimmune disease
46
Type 1 diabetes
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
B. Type IV – T-cell mediated
47
Immune thrombocytopaenic purpura
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
E. Type II – Antibody mediated
48
ABO hemolytic transfusion reaction
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
E. Type II – Antibody mediated
49
Hepatitis C associated membranoproliferative glomerulonephritis type I
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
G. Type III – Immune complex mediated
50
Goodpasture's syndrome
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
E. Type II – Antibody mediated
51
Myaesthenia gravis
```
A. Type III – complement mediated
B. Type IV – T-cell mediated
C. Type II – Antigen mediated
D. Type III – T-cell mediated
E. Type II – Antibody mediated
F. Type IV – Complement mediated
G. Type III – Immune complex mediated
H. Not an autoimmune disease
```
E. Type II – Antibody mediated
52
Systemic lupus erythematous
```
A. Rheumatoid factor
B. Anti-cardiolipin antibody
C. Anti-GAD antibody
D. Anti-centromere antibody
E. Coomb's test
F. Anti-CCP antibody
G. p-ANCA
H. Anti-mitochondrial antibody
I. Anti-nuclear antibody
J. c-ANCA
K. Anti-DNA antibody
```
K. Anti-DNA antibody
The rationale for the answer for SLE being anti-DNA antibody rather than ANA is that whilst ANA is very sensitive for SLE, it is not specific. Anti-DNA, in contrast, is highly specific to SLE (~95%).
53
Wegener's granulomatosis
```
A. Rheumatoid factor
B. Anti-cardiolipin antibody
C. Anti-GAD antibody
D. Anti-centromere antibody
E. Coomb's test
F. Anti-CCP antibody
G. p-ANCA
H. Anti-mitochondrial antibody
I. Anti-nuclear antibody
J. c-ANCA
K. Anti-DNA antibody
```
J. c-ANCA
c-ANCA matches with Wegener's Granulomatosis, whilst p-ANCA would match with polyarteritis nodosa
54
Rheumatoid arthritis
```
A. Rheumatoid factor
B. Anti-cardiolipin antibody
C. Anti-GAD antibody
D. Anti-centromere antibody
E. Coomb's test
F. Anti-CCP antibody
G. p-ANCA
H. Anti-mitochondrial antibody
I. Anti-nuclear antibody
J. c-ANCA
K. Anti-DNA antibody
```
F. Anti-CCP antibody
Rheumatoid factor is not specific or sensitive to rheumatoid arthritis and is common in the elderly. Anti-CCP is a more specific test for rheumatoid arthritis and a better predictor of an aggressive course.
55
Auto-immune haemolytic anaemia
```
A. Rheumatoid factor
B. Anti-cardiolipin antibody
C. Anti-GAD antibody
D. Anti-centromere antibody
E. Coomb's test
F. Anti-CCP antibody
G. p-ANCA
H. Anti-mitochondrial antibody
I. Anti-nuclear antibody
J. c-ANCA
K. Anti-DNA antibody
```
E. Coomb's test
56
Primary biliary cirrhosis
```
A. Rheumatoid factor
B. Anti-cardiolipin antibody
C. Anti-GAD antibody
D. Anti-centromere antibody
E. Coomb's test
F. Anti-CCP antibody
G. p-ANCA
H. Anti-mitochondrial antibody
I. Anti-nuclear antibody
J. c-ANCA
K. Anti-DNA antibody
```
H. Anti-mitochondrial antibody
57
Primary biliary cirrhosis
```
A. Rheumatoid factor
B. Anti-cardiolipin antibody
C. Anti-GAD antibody
D. Anti-centromere antibody
E. Coomb's test
F. Anti-CCP antibody
G. p-ANCA
H. Anti-mitochondrial antibody
I. Anti-nuclear antibody
J. c-ANCA
K. Anti-DNA antibody
```
H. Anti-mitochondrial antibody
58
What is the specific auto-antigen that is the target of the immune system?
```
A. Lung
B. Ciclosporin
C. Type II collagen
D. Prednisolone
E. Anti-neutrophil cytoplasmic antibodies
F. Lumpy-bumpy pattern
G. Plasmapheresis
H. Smooth linear pattern
I. Type II Hypersentivity
J. Glomerular basement membrane
K. Type IV collagen
L. Mesangium
M. Skin
N. Blood vessels
```
K. Type IV collagen
59
The pattern of the antibody deposition in the glomerular basement membrane is typically described as what?
```
A. Lung
B. Ciclosporin
C. Type II collagen
D. Prednisolone
E. Anti-neutrophil cytoplasmic antibodies
F. Lumpy-bumpy pattern
G. Plasmapheresis
H. Smooth linear pattern
I. Type II Hypersentivity
J. Glomerular basement membrane
K. Type IV collagen
L. Mesangium
M. Skin
N. Blood vessels
```
H. Smooth linear pattern
60
Name the drug most likely to be used in the treatment of this disease.
```
A. Lung
B. Ciclosporin
C. Type II collagen
D. Prednisolone
E. Anti-neutrophil cytoplasmic antibodies
F. Lumpy-bumpy pattern
G. Plasmapheresis
H. Smooth linear pattern
I. Type II Hypersentivity
J. Glomerular basement membrane
K. Type IV collagen
L. Mesangium
M. Skin
N. Blood vessels
```
D. Prednisolone
61
Immune damage may be associated with the kidney and commonly which other tissue?
```
A. Lung
B. Ciclosporin
C. Type II collagen
D. Prednisolone
E. Anti-neutrophil cytoplasmic antibodies
F. Lumpy-bumpy pattern
G. Plasmapheresis
H. Smooth linear pattern
I. Type II Hypersentivity
J. Glomerular basement membrane
K. Type IV collagen
L. Mesangium
M. Skin
N. Blood vessels
```
A. Lung
62
X-Linked Agammaglobulinaemia
```
A. CD3 mutation
B. IL-2 receptor
C. Bruton’s tyrosine kinase (Btk) gene
D. MHC Class II
E. WASP gene
F. IFN Receptor 1 gene
G. Chromosome 22q11
H. IL12 gene
I. CD40 Ligand gene
```
C. Bruton’s tyrosine kinase (Btk) gene
63
DiGeorge’s Syndrome
```
A. CD3 mutation
B. IL-2 receptor
C. Bruton’s tyrosine kinase (Btk) gene
D. MHC Class II
E. WASP gene
F. IFN Receptor 1 gene
G. Chromosome 22q11
H. IL12 gene
I. CD40 Ligand gene
```
G. Chromosome 22q11
Di George syndrome. The thymus is affected but not the bone marrow, where B cell production and maturation take place. Hence there is
no reduction in B cell numbers. B cells require T cell help (CD4+ cells) for activation and production of normal quantities of immunoglobulins.
Without this help, B cell activity is reduced.
64
Severe Combined Immunodeficiency
```
A. CD3 mutation
B. IL-2 receptor
C. Bruton’s tyrosine kinase (Btk) gene
D. MHC Class II
E. WASP gene
F. IFN Receptor 1 gene
G. Chromosome 22q11
H. IL12 gene
I. CD40 Ligand gene
```
B. IL-2 receptor
65
Wiskott-Aldrich Syndrome
```
A. CD3 mutation
B. IL-2 receptor
C. Bruton’s tyrosine kinase (Btk) gene
D. MHC Class II
E. WASP gene
F. IFN Receptor 1 gene
G. Chromosome 22q11
H. IL12 gene
I. CD40 Ligand gene
```
E. WASP gene
66
Bare lymphocyte syndrome
```
A. CD3 mutation
B. IL-2 receptor
C. Bruton’s tyrosine kinase (Btk) gene
D. MHC Class II
E. WASP gene
F. IFN Receptor 1 gene
G. Chromosome 22q11
H. IL12 gene
I. CD40 Ligand gene
```
D. MHC Class II
67
X-Linked Agammaglobulinaemia
```
A. CD40 Ligand gene
B. WASP gene
C. CD3 mutation
D. Bruton’s tyrosine kinase (Btk) gene
E. IL12 gene
F. MHC Class III
G. IL-2 receptor
H. Chromosome 22q11
I. IFN Receptor 1 gene
J. Adenosine Deaminase (ADA) gene
```
D. Bruton’s tyrosine kinase (Btk) gene
68
DiGeorge’s Syndrome
```
A. CD40 Ligand gene
B. WASP gene
C. CD3 mutation
D. Bruton’s tyrosine kinase (Btk) gene
E. IL12 gene
F. MHC Class III
G. IL-2 receptor
H. Chromosome 22q11
I. IFN Receptor 1 gene
J. Adenosine Deaminase (ADA) gene
```
H. Chromosome 22q11
Di George syndrome. The thymus is affected but not the bone marrow, where B cell production and maturation take place. Hence there is
no reduction in B cell numbers. B cells require T cell help (CD4+ cells) for activation and production of normal quantities of immunoglobulins.
Without this help, B cell activity is reduced.
69
Severe Combined Immunodeficiency
```
A. CD40 Ligand gene
B. WASP gene
C. CD3 mutation
D. Bruton’s tyrosine kinase (Btk) gene
E. IL12 gene
F. MHC Class III
G. IL-2 receptor
H. Chromosome 22q11
I. IFN Receptor 1 gene
J. Adenosine Deaminase (ADA) gene
```
G. IL-2 receptor
70
Wiskott-Aldrich Syndrome
```
A. CD40 Ligand gene
B. WASP gene
C. CD3 mutation
D. Bruton’s tyrosine kinase (Btk) gene
E. IL12 gene
F. MHC Class III
G. IL-2 receptor
H. Chromosome 22q11
I. IFN Receptor 1 gene
J. Adenosine Deaminase (ADA) gene
```
B. WASP gene
Wiskott-Aldrich syndrome is an X-linked recessive disease characterised by: thrombocytopenia lymphopenia and depressed cellular immunity immunosuppression eczema malignant lymphoma
71
This region encodes C2, C4 and factor B
```
A. CD40 Ligand gene
B. WASP gene
C. CD3 mutation
D. Bruton’s tyrosine kinase (Btk) gene
E. IL12 gene
F. MHC Class III
G. IL-2 receptor
H. Chromosome 22q11
I. IFN Receptor 1 gene
J. Adenosine Deaminase (ADA) gene
```
F. MHC Class III
72
Hyper IgM syndrome
```
A. CD40 Ligand gene
B. WASP gene
C. CD3 mutation
D. Bruton’s tyrosine kinase (Btk) gene
E. IL12 gene
F. MHC Class III
G. IL-2 receptor
H. Chromosome 22q11
I. IFN Receptor 1 gene
J. Adenosine Deaminase (ADA) gene
```
A. CD40 Ligand gene
73
A 25 year old woman comes to her GP about family planning. She is worried because she had an older brother who died before she was born and her grandmother lost two children which she things were both boys. Her GO thinks there may be a genetic disorder in her family affecting the IL-2 receptor.
If correct she has a 50% of inheriting the trait from her mother and being a carrier herself. And there would be a 50% chance of passing it to her children. If inherited, her daughters would be carriers and her sons would require treatment which is usually a bone marrow transplant but gene therapy is sometimes used.
```
A. Bare lymphocyte syndrome
B. DiGeorge syndrome
C. Reticular dysgenesis
D. TAP deficiency
E. Hyper IgM syndrome
F. Common variable immune deficiency
G. Severe combined immunodeficiency (SCID)
H. Bruton's X linked hypogammaglobulinaemia
I. Selective IgA deficency
```
G. Severe combined immunodeficiency (SCID)
74
A jaundiced 8 month old child presents with failure to thrive, and a history of recurrent infections (viral, bacterial and fungal). On examination there is hepatomegally and blood tests show a raised alk phos and low CD4 count. A defect is found in the proteins that regulate MHC Class II transcription.
```
A. Bare lymphocyte syndrome
B. DiGeorge syndrome
C. Reticular dysgenesis
D. TAP deficiency
E. Hyper IgM syndrome
F. Common variable immune deficiency
G. Severe combined immunodeficiency (SCID)
H. Bruton's X linked hypogammaglobulinaemia
I. Selective IgA deficency
```
A. Bare lymphocyte syndrome
75
Patient X’s GP writes inquiring about whether to vaccinate. The patient suffers from recurrent respiratory tract infections and has been diagnosed with one of the B-cell maturation defects.
For which one is immunisation still effective?
```
A. Bare lymphocyte syndrome
B. DiGeorge syndrome
C. Reticular dysgenesis
D. TAP deficiency
E. Hyper IgM syndrome
F. Common variable immune deficiency
G. Severe combined immunodeficiency (SCID)
H. Bruton's X linked hypogammaglobulinaemia
I. Selective IgA deficency
```
I. Selective IgA deficiency
76
For which disorder would a bone marrow transplant be unhelpful but a thymic transplant may provide a cure?
```
A. Bare lymphocyte syndrome
B. DiGeorge syndrome
C. Reticular dysgenesis
D. TAP deficiency
E. Hyper IgM syndrome
F. Common variable immune deficiency
G. Severe combined immunodeficiency (SCID)
H. Bruton's X linked hypogammaglobulinaemia
I. Selective IgA deficency
```
B. DiGeorge syndrome
77
In acute rejection, release of this substance from CD8+ lymphocytes helps kill target cells
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
K. Granzyme B
78
In acute rejection, these are produced as a result of the activation of neutrophils and macrophages
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
T. Free radicals
79
A difference in this between host and recipient is the main cause of transplant rejection
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
J. HLA type
80
Along with anti-HLA antibodies, the most important screen to ensure a match before transplantation
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
I. ABO blood type
81
Risk factor for chronic allograft rejection
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
P. Hypertension
82
Transplanting an ABO incompatible kidney will result in ___ rejection
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
G. Hyperacute
83
Treatment of acute antibody mediated rejection
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
F. IV Immunoglobulins and Plasmapheresis
84
Treatment of acute cell mediated rejection
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
Q. High dose corticosteroids
85
The 3 most important HLA types to screen for in renal transplantation when matching donor and recipient, in order of importance
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
L. HLA DR > B > A
86
Lymphocyte that responds to foreign HLA DR types
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
D. CD4+ T cells
87
Lymphocyte that responds to foreign HLA A types
```
A. Interferon gamma
B. HLA DR > A > B
C. HLA A > B > DR
D. CD4+ T cells
E. CD17+ T cells
F. IV Immunoglobulins and Plasmapheresis
G. Hyperacute
H. Diabetes
I. ABO blood type
J. HLA type
K. Granzyme B
L. HLA DR > B > A
M. CD8+ T cells
N. Hypotension
O. Diuretics
P. Hypertension
Q. High dose corticosteroids
R. Amino acids
S. Antibiotics
T. Free radicals
```
M. CD8+ T cells
88
Prevents DNA replication especially of T cells
```
A. Ribavirin
B. Immunoglobulins
C. Gentamicin
D. Perindopril
E. Cyclophosamide
F. Chloramphenicol
G. Cyproterone acetate
H. Metolazone
I. Ciclosporin
J. Infliximab
K. Thyroxine
L. Dobutamine
M. Prednisolone
N. Mycophenolate mofetil
```
N. Mycophenolate mofetil
Both mycophenolate mofetil and cyclophosphamide prevent lymphocyte proliferation by inhibiting DNA replication. However, mycophenolate mofetil is more selective for T cells, whereas cycophosphamide affects B cells more than T cells
89
Causes a transient increase in neutrophil count
```
A. Ribavirin
B. Immunoglobulins
C. Gentamicin
D. Perindopril
E. Cyclophosamide
F. Chloramphenicol
G. Cyproterone acetate
H. Metolazone
I. Ciclosporin
J. Infliximab
K. Thyroxine
L. Dobutamine
M. Prednisolone
N. Mycophenolate mofetil
```
M. Prednisolone
90
Monoclonal antibodies inhibiting the actions of cytokines
```
A. Ribavirin
B. Immunoglobulins
C. Gentamicin
D. Perindopril
E. Cyclophosamide
F. Chloramphenicol
G. Cyproterone acetate
H. Metolazone
I. Ciclosporin
J. Infliximab
K. Thyroxine
L. Dobutamine
M. Prednisolone
N. Mycophenolate mofetil
```
J. Infliximab
91
Can cause gingival hypertrophy as a side effect
```
A. Ribavirin
B. Immunoglobulins
C. Gentamicin
D. Perindopril
E. Cyclophosamide
F. Chloramphenicol
G. Cyproterone acetate
H. Metolazone
I. Ciclosporin
J. Infliximab
K. Thyroxine
L. Dobutamine
M. Prednisolone
N. Mycophenolate mofetil
```
I. Ciclosporin
92
Administration of this may boost the immune system
```
A. Ribavirin
B. Immunoglobulins
C. Gentamicin
D. Perindopril
E. Cyclophosamide
F. Chloramphenicol
G. Cyproterone acetate
H. Metolazone
I. Ciclosporin
J. Infliximab
K. Thyroxine
L. Dobutamine
M. Prednisolone
N. Mycophenolate mofetil
```
B. Immunoglobulins
93
Corticosteroids, as well as being directly lymphotoxic in high doses, inhibit T-cell function via which other mechanism?
```
A. Goodpasture’s syndrome
B. Blocking cytokine synthesis
C. Mycophenolate mofetil
D. Atopic dermatitis
E. Plasmapheresis
F. Bee/wasp venom allergy
G. Infliximab
H. Bone marrow suppression
I. Inhibition of DNA synthesis
J. Polio vaccine
K. Influenza type B vaccine
L. Diptheria, Tetanus, Pertussis vaccine
M. Tacrolimus
```
B. Blocking cytokine synthesis
94
The antiproliferative drug cyclophosphamide inhibits lymphocyte proliferation by which mechanism?
```
A. Goodpasture’s syndrome
B. Blocking cytokine synthesis
C. Mycophenolate mofetil
D. Atopic dermatitis
E. Plasmapheresis
F. Bee/wasp venom allergy
G. Infliximab
H. Bone marrow suppression
I. Inhibition of DNA synthesis
J. Polio vaccine
K. Influenza type B vaccine
L. Diptheria, Tetanus, Pertussis vaccine
M. Tacrolimus
```
I. Inhibition of DNA synthesis
95
Plasmapheresis may be indicated in which condition?
```
A. Goodpasture’s syndrome
B. Blocking cytokine synthesis
C. Mycophenolate mofetil
D. Atopic dermatitis
E. Plasmapheresis
F. Bee/wasp venom allergy
G. Infliximab
H. Bone marrow suppression
I. Inhibition of DNA synthesis
J. Polio vaccine
K. Influenza type B vaccine
L. Diptheria, Tetanus, Pertussis vaccine
M. Tacrolimus
```
A. Goodpasture’s syndrome
96
Example of a vaccine that should NOT be given to a severely immunocompromised patient.
```
A. Goodpasture’s syndrome
B. Blocking cytokine synthesis
C. Mycophenolate mofetil
D. Atopic dermatitis
E. Plasmapheresis
F. Bee/wasp venom allergy
G. Infliximab
H. Bone marrow suppression
I. Inhibition of DNA synthesis
J. Polio vaccine
K. Influenza type B vaccine
L. Diptheria, Tetanus, Pertussis vaccine
M. Tacrolimus
```
J. Polio vaccine
97
A condition where antigen desensitization therapy may be indicated.
```
A. Goodpasture’s syndrome
B. Blocking cytokine synthesis
C. Mycophenolate mofetil
D. Atopic dermatitis
E. Plasmapheresis
F. Bee/wasp venom allergy
G. Infliximab
H. Bone marrow suppression
I. Inhibition of DNA synthesis
J. Polio vaccine
K. Influenza type B vaccine
L. Diptheria, Tetanus, Pertussis vaccine
M. Tacrolimus
```
F. Bee/wasp venom allergy
98
Prednisolone
```
A. Anorexia
B. Pneumonitis, pulmonary fibrosis and cirrhosis
C. Hypertension
D. Hair loss
E. Dysrhythmias
F. Bone marrow depression
G. Lethargy
H. Hypertension and reduced GFR
I. Ototoxicity
J. Anaphylaxis
```
C. Hypertension
99
Ciclosporin
```
A. Anorexia
B. Pneumonitis, pulmonary fibrosis and cirrhosis
C. Hypertension
D. Hair loss
E. Dysrhythmias
F. Bone marrow depression
G. Lethargy
H. Hypertension and reduced GFR
I. Ototoxicity
J. Anaphylaxis
```
H. Hypertension and reduced GFR
100
Azathioprine
```
A. Anorexia
B. Pneumonitis, pulmonary fibrosis and cirrhosis
C. Hypertension
D. Hair loss
E. Dysrhythmias
F. Bone marrow depression
G. Lethargy
H. Hypertension and reduced GFR
I. Ototoxicity
J. Anaphylaxis
```
F. Bone marrow depression
101
Methotrexate
```
A. Anorexia
B. Pneumonitis, pulmonary fibrosis and cirrhosis
C. Hypertension
D. Hair loss
E. Dysrhythmias
F. Bone marrow depression
G. Lethargy
H. Hypertension and reduced GFR
I. Ototoxicity
J. Anaphylaxis
```
B. Pneumonitis, pulmonary fibrosis and cirrhosis
For methotrexate (MTX) induced cirrhosis monitor serum procollagen III rather than doing liver biopsy. MTX is given once WEEKLY as maintenance therapy in autoimmune disease; more often and you're looking at anti-tumour regimens. Remember to replace folate.
102
Immunoglobulin
```
A. Anorexia
B. Pneumonitis, pulmonary fibrosis and cirrhosis
C. Hypertension
D. Hair loss
E. Dysrhythmias
F. Bone marrow depression
G. Lethargy
H. Hypertension and reduced GFR
I. Ototoxicity
J. Anaphylaxis
```
J. Anaphylaxis
