immunology-Autoimmune Diseases

Question 1

1. What is a general definition for autoimmunity?
   A. Increase of tolerance to self-antigens
   B. Loss of tolerance to self-antigens
   C. Increase in clonal deletion of mutant cells
   D. Manifestation of immunosuppression
   Immunology/Apply knowledge of fundamental

Answer 1

B. Loss of tolerance to self-antigens

Question 2

2. An antinuclear antibody test is performed on a
   specimen from a 55-year-old woman who has
   unexplained joint pain. The IFA result is a titer of
   40 and a homogeneous pattern. The appropriate
   follow-up for this patient is:
   A. Anti-DNA assay
   B. Extractable nuclear antigen (ENA) testing
   C. Retest ANA in 3–6 months
   D. CH50 complement assay

Answer 2

C. Retest ANA in 3–6 months

Question 3

3. Which disease is likely to show a rim (peripheral)
   pattern in an immunofluorescence (IF) microscopy
   test for ANA?
   A. Mixed connective tissue disease (MCTD)
   B. Rheumatoid arthritis
   C. Systemic lupus erythematosus
   D. Scleroderma

Answer 3

C. Systemic lupus erythematosus

Question 4

4. A patient’s specimen is strongly positive in an
   ANA ELISA. Which of the following would not be
   an appropriate follow up to this result?
   A. Immunofluorescence test on HEp-2 cells
   B. Specific ENA ELISA tests
   C. Specific anti-DNA ELISA
   D. Rheumatoid factor assay

Answer 4

D. Rheumatoid factor assay

Question 5

5. What type of antibodies is represented by the solid
   or homogeneous pattern in the immunofluorescence
   test for antinuclear antibodies?
   A. Antihistone antibodies
   B. Anticentromere antibodies
   C. Anti-ENA (anti-Sm and anti-RNP) antibodies
   D. Anti-RNA antibodies

Answer 5

A. Antihistone antibodies

Question 6

6. What disease is indicated by a high titer of
   anti-Sm (anti-Smith) antibody?
   A. Mixed connective tissue disease (MCTD)
   B. RA
   C. SLE
   D. Scleroderma

Answer 6

C. SLE

Question 7

7. Which disease is least likely when a nucleolar
   pattern occurs in an immunofluorescence test for
   antinuclear antibodies?
   A. MCTD
   B. Sjögren’s syndrome
   C. SLE
   D. Scleroderma

Answer 7

A. MCTD

Question 8

8. What antibodies are represented by the nucleolar
   pattern in the immunofluorescence test for
   antinuclear antibodies?
   A. Antihistone antibodies
   B. Anti-dsDNA antibodies
   C. Anti-ENA (anti-Sm and anti-RNP) antibodies
   D. Anti-RNA antibodies

Answer 8

D. Anti-RNA antibodies

Question 9

9. Which test would best distinguish between SLE
   and MCTD?
   A. Multiplex or ELISA test for anti-SM and
   anti-RNP
   B. Immunofluorescence testing using Crithidia as
   substrate
   C. Slide agglutination testing
   D. Laboratory tests cannot distinguish between
   these disorders

Answer 9

A. Multiplex or ELISA test for anti-SM and
anti-RNP

Question 10

10. An ANA test on HEp-2 cells shows nucleolar
    staining in interphase cells and dense chromatin
    staining in mitotic cells. The most likely cause of
    this staining pattern is:
    A. Antifibrillarin antibody
    B. Antiribosomal p antibody
    C. A serum with nucleolar and homogeneous
    patterns
    D. Technical artifact

Answer 10

A. Antifibrillarin antibody

Question 11

11. Which immunofluorescence pattern indicates
    the need for ENA testing by Ouchterlony
    immunodiffusion, Multiplex, or ELISA assays?
    A. Homogeneous or solid
    B. Peripheral or rim
    C. Speckled
    D. Nucleolar

Answer 11

C. Speckled

Question 12

12. Which of the following is used in rapid slide tests
    for detection of rheumatoid factors?
    A. Whole IgM molecules
    B. Fc portion of the IgG molecule
    C. Fab portion of the IgG molecule
    D. Fc portion of the IgM molecule

Answer 12

B. Fc portion of the IgG molecule

Question 13

13. Which of the following methods is least likely to
    give a definitive result for the diagnosis of RA?
    A. Nephelometric measurement of anti-IgG
    B. Agglutination testing for rheumatoid factor
    C. Anti CCP
    D. Immunofluorescence testing for antinuclear
    antibodies

Answer 13

D. Immunofluorescence testing for antinuclear
antibodies

Question 14

14. Which disease might be indicated by antibodies to
    smooth muscle?
    A. Atrophic gastritis
    B. Autoimmune hepatitis
    C. Myasthenia gravis
    D. Sjögren’s syndrome

Answer 14

B. Autoimmune hepatitis

Question 15

15. Antibodies to thyroid peroxidase can be detected
    by using agglutination assays. Which of the
    following diseases may show positive results
    with this type of assay?
    A. Graves’ disease and Hashimoto’s thyroiditis
    B. Myasthenia gravis
    C. Granulomatous thyroid disease
    D. Addison’s disease

Answer 15

A. Graves’ disease and Hashimoto’s thyroiditis

Question 16

16. What is the main use of laboratory tests to detect
    antibodies to islet cells and insulin in cases of
    insulin-dependent diabetes mellitus (IDDM)?
    A. To regulate levels of injected insulin
    B. To diagnose IDDM
    C. To rule out the presence of other autoimmune
    diseases
    D. To screen susceptible individuals prior to
    destruction of β cells

Answer 16

D. To screen susceptible individuals prior to
destruction of β cells

Question 17

17. A patient presents with clinical symptoms of celiac
    disease. Tests for anti-tissue transglutaminase and
    antigliadin antibodies are negative. Which of the
    following tests should be ordered?
    A. IgG level
    B. HLA DQ typing
    C. HLA DR typing
    D. IgM level

Answer 17

B. HLA DQ typing

Question 18

18. A specimen appears to have a perinuclear staining
    pattern in an antineutrophil cytoplasmic antibody
    (ANCA) immunofluorescent assay using ethanolfixed neutrophils, suggesting the possibility of a
    pANCA. On which of the following substrates
    would this specimen display cytoplasmic
    speckling?
    A. Formalin-fixed neutrophils
    B. Unfixed neutrophils
    C. HEp-2 cells
    D. Rabbit kidney tissue

Answer 18

A. Formalin-fixed neutrophils