Immunology- Tumor Testing and Transplantation

Question 1

1. A patient had surgery for colorectal cancer, after
   which he received chemotherapy for 6 months.
   The test for carcinoembryonic antigen (CEA)
   was normal at this time. One year later, the
   bimonthly CEA was elevated (above 10 ng/mL).
   An examination and biopsy revealed the recurrence
   of a small tumor. What was the value of the
   results provided by the CEA test in this clinical
   situation?
   A. Diagnostic information
   B. Information for further treatment
   C. Information on the immunologic response of
   the patient
   D. No useful clinical information in this case

Answer 1

B. Information for further treatment

Question 2

2. A carbohydrate antigen 125 assay (CA-125)
   was performed on a woman with ovarian cancer.
   After treatment, the levels fell significantly.
   An examination performed later revealed the
   recurrence of the tumor, but the CA 125 levels
   remained low. How can this finding be explained?
   A. Test error
   B. CA-125 was the wrong laboratory test;
   α-fetoprotein (AFP) is a better test to monitor
   ovarian cancer
   C. CA-125 may not be sensitive enough when used
   alone to monitor tumor development
   D. CA-125 is not specific enough to detect only one
   type of tumor

Answer 2

C. CA-125 may not be sensitive enough when used
alone to monitor tumor development

Question 3

3. What is the correct procedure upon receipt of a
   test request for human chorionic gonadotropin
   (hCG) on the serum from a 60-year-old man?
   A. Return the request; hCG is not performed
   on men
   B. Perform a qualitative hCG test to see if hCG is
   present
   C. Perform the test; hCG may be increased in
   testicular tumors
   D. Perform the test but use different standards and
   controls

Answer 3

C. Perform the test; hCG may be increased in
testicular tumors

Question 4

4. Would an hCG test using a monoclonal antibody
   against the β-subunit of hCG likely be affected
   by an increased level of follicle-stimulating
   hormone (FSH)?
   A. Yes, the β-subunit of FSH is identical to that
   of hCG
   B. No, the test would be specific for the β-subunit
   of hCG
   C. Yes, a cross reaction would occur because of
   structural similarities
   D. No, the structure of FSH and hCG are not at
   all similar

Answer 4

B. No, the test would be specific for the β-subunit
of hCG

Question 5

5. Which of the following substances, sometimes
   used as a tumor marker, is increased two- or
   threefold in a normal pregnancy?
   A. Alkaline phosphatase (ALP)
   B. Calcitonin
   C. Adrenocortocotropic hormone (ACTH)
   D. Neuron-specific enolase

Answer 5

A. Alkaline phosphatase (ALP)

Question 6

6. What is an advantage of performing a prostatespecific antigen (PSA) test for prostate cancer?
   A. PSA is stable in serum and not affected by a
   digital-rectal examination
   B. PSA is increased only in prostatic malignancy
   C. A normal serum level rules out malignant
   prostatic disease
   D. The percentage of free PSA is elevated in persons
   with malignant disease

Answer 6

A. PSA is stable in serum and not affected by a
digital-rectal examination

Question 7

7. Which method is the most sensitive for
   quantitation of AFP?
   A. Double immunodiffusion
   B. Electrophoresis
   C. Enzyme immunoassay
   D. Particle agglutination

Answer 7

C. Enzyme immunoassay

Question 8

8. How is HLA typing used in the investigation of
   genetic diseases?
   A. For prediction of the severity of the disease
   B. For genetic linkage studies
   C. For direct diagnosis of disease
   D. Is not useful in this situation

Answer 8

B. For genetic linkage studies

Question 9

9. Select the best donor for a man, blood type AB, in
   need of a kidney transplant.
   A. His brother, type AB, HLA matched for class II
   antigens
   B. His mother, type B, HLA matched for class I
   antigens
   C. His cousin, type O, HLA matched for major
   class II antigens
   D. Cadaver donor, type O, HLA matched for some
   class I and II antigens

Answer 9

A. His brother, type AB, HLA matched for class II
antigens

Question 10

10. Interpret the following microcytotoxicity results:

A9 and B12 cells damaged; A1 and Aw19 cells intact.

A. Positive for A1 and Aw19; negative for A9
and B12
B. Negative for A1 and Aw19; positive for A9
and B12
C. Error in test system; retest
D. Impossible to determine

Answer 10

B. Negative for A1 and Aw19; positive for A9
and B12

Question 11

11. Which method, classically used for HLA-D typing,
    is often used to determine the compatibility
    between a living organ donor and recipient?
    A. Flow cytometry
    B. Mixed lymphocyte culture (MLC)
    C. Primed lymphocyte test (PLT)
    D. Restriction fragment length polymorphism
    (RFLP)

Answer 11

B. Mixed lymphocyte culture (MLC)

Question 12

12. SITUATION: Cells type negative for all HLA
    antigens in a complement-dependent cytotoxicity
    assay. What is the most likely cause?
    A. Too much supravital dye was added
    B. Rabbit complement is inactivated
    C. All leukocytes are dead
    D. Antisera is too concentrated

Answer 12

B. Rabbit complement is inactivated

Question 13

13. What method may be used for tissue typing
    instead of serological HLA typing?
    A. PCR
    B. Southern blotting
    C. RFLP
    D. All of these options

Answer 13

D. All of these options