Immunopoliferative Disorders

Question 1

1. Polyclonal gammopathies can be exhibited as a secondary
   manifestation of all the following except:
   a. Chronic infection
   b. Chronic liver disease
   c. Multiple myeloma
   d. Rheumatoid connective disease

Answer 1

c. Multiple myeloma

Question 2

2. What is the most frequent cause of death in a patient
   with multiple myeloma?
   a. Skeletal destruction
   b. Chronic renal failure
   c. Neurologic disorders
   d. Infectious disease

Answer 2

d. Infectious disease

Question 3

3. Patients with multiple myeloma have defects in:
   a. Cellular immunity
   b. Humoral immunity
   c. Synthesis of normal immunoglobulins
   d. Both b and c

Answer 3

d. Both b and c

Question 4

4. What is the most consistent immunologic feature of
   multiple myeloma?
   a. Synthesis of dysfunctional single monoclonal
   proteins
   b. Synthesis of Ig chains or fragments
   c. Presence of M protein in serum and/or urine
   d. All of the above

Answer 4

d. All of the above

Question 5

Bence-Jones proteins are soluble at room temperature, form a
precipitate near (5) _______, and then dissolve (resolubilize)
at (6) ________.
a. 37° C
b. 50° C
c. 60° C
d. 100° C

Answer 5

5. c
6. d

Question 6

7. M proteins are associated with all the following malignant
   conditions except:
   a. Multiple myeloma
   b. Plasmacytoma
   c. Malignant lymphoproliferative diseases
   d. Lymphoma

Answer 6

d. Lymphoma

Question 7

8. Cryoglobulins are proteins that precipitate or gel at:
   a. −18° C
   b. −4° C
   c. 0° C
   d. 4° C

Answer 7

c. 0° C

Question 8

9. Monoclonal gammopathy involves elevated levels
   of a single class and type of immunoglobulin referred
   to as:
   a. Monoclonal protein
   b. M protein
   c. Paraprotein
   d. All of the above

Answer 8

d. All of the above

Question 9

In light-chain disease, only (10) ________ or (11)
________ monoclonal light chains are synthesized by a
one-cell clone.

Possible answers to question 10:
a. beta
b. gamma
c. kappa
d. alpha

Possible answers to question 11:
a. lambda
b. alpha
c. beta
d. gamma

Answer 9

10. c
11. a

Question 10

12. Multiple myeloma is also referred to as:
    a. Plasma cell myeloma
    b. Kahler’s disease
    c. Myelomatosis
    d. All of the above

Answer 10

d. All of the above

Question 11

13. Most patients with multiple myeloma manifest:
    a. Bone pain
    b. Acute renal failure
    c. No symptoms
    d. Hepatomegaly and splenomegaly

Answer 11

a. Bone pain

Question 12

(I can’t insert the image. it’s on the slide labeled Serum Electrophoretic Pattern on Laurie’s slides, on the right.)

14. The figure above represents the serum electrophoresis of a
    patient with:
    a. Waldenström’s macroglobulinemia
    b. Multiple myeloma
    c. No protein abnormality
    d. Polyclonal gammopathy

Answer 12

b. Multiple myeloma

Question 13

15. Patients with Waldenström’s macroglobulinemia exhibit
    abnormally large amounts of:
    a. IgM
    b. IgG
    c. IgE
    d. IgA

Answer 13

a. IgM

Question 14

16. Monoclonal gammopathy of undetermined significance
    (MGUS) represents a:
    a. Monoclonal protein in patients with no features of
    multiple myeloma or related malignant disorders
    b. Disorder that can evolve into a malignant monoclonal
    gammopathy
    c. Serum monoclonal protein concentration less than
    3 g/dL
    d. All of the above

Answer 14

d. All of the above

Question 15

17. MGUS is characterized by all the following except:
    a. Fewer than 10% plasma cells in the bone marrow
    b. Presence of lytic bone lesions
    c. Anemia
    d. Hypercalcemia

Answer 15

b. Presence of lytic bone lesions

Question 16

18. Light-chain disease represents about ________ of
    monoclonal gammopathies.
    a. 5% to 10%
    b. 10% to 15%
    c. 15% to 25%
    d. 25% to 50%

Answer 16

b. 10% to 15%