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Quiz for Practitioners
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1

Of the following, which is expressed earliest in B cell development?
A)Surface IgD
B)Surface IgG
C)Surface IgM
D)Cytoplasmic chains
E)Fc receptors
2

A 29-year-old man with episodic abdominal pain and stress-induced edema of the lips, tongue, and occasionally larynx is likely to have low functional or absolute levels of which of the following proteins?
A)C5A (complement cascade)
B)IgE
C)T cell receptor, chain
D)Cyclooxygenase
E)C1 esterase inhibitor
3

A 35-year-old woman comes to the local health clinic because for the past 6 months she has had recurrent urticarial lesions, which occasionally leave a residual discoloration. She also has had arthralgias. Sedimentation rate obtained now is 85 mm/h. The procedure most likely to yield the correct diagnosis in the case would be
A)a battery of wheal-and-flare allergy skin tests
B)measurement of total serum IgE concentration
C)measurement of C1 esterase inhibitor activity
D)skin biopsy
E)patch testing
4

A 23-year-old man seeks medical attention for perennial nasal congestion and postnasal discharge. He states he does not have asthma, eczema, conjunctivitis, or a family history of allergic disease. His nasal secretions are rich in eosinophils. The test most likely to yield a specific diagnosis in this setting is
A)serum IgE level (competitive radioimmunosorbent technique)
B)serum IgE level (radiodiffusion technique)
C)elimination diet test
D)skin testing
E)sinus x-rays
5

A patient undergoing evaluation for possible infection with Mycobacterium tuberculosis develops a skin wheal 48 h after intradermal placement of TB purified- protein derivative (PPD). Which of the following cellular events accounts for these findings?
A)Interleukin (IL)-7-induced B cell activation and secretion of antibodies
B)IL-3-mediated B cell activation and induction of help for T cell activation
C)Monocyte-derived IL-6 activation of T cells
D)Complement-mediated endothelial cell damage
E)CD44-mediated monocyte adhesion to endothelial cells
6

A fifty-year-old patient with a 3-year history of asthma and a long history of seasonal coryza recently was noted to have developed an erythematous rash on his lower extremities. Biopsy of the rash revealed small-vessel vasculitis with necrotizing granulomatosis inflammation. Chest x-ray disclosed nonspecific bilateral interstitial infiltrates. An antineutrophil cytoplasmic autoantibody was noted in the patient's serum. Which of the following laboratory findings is most likely in this situation?
A)Blood culture positive for M. tuberculosis
B)Elevated serum rheumatoid factor
C)Elevated eosinophil count
D)Positive cold agglutinin titre
E)Elevated serum cryoglobulins
7

A 47-year-old man has had fever, weight loss, arthralgias, pleuritic chest pain, and midabdominal pain for the past 2 months. One week ago he noticed difficulty dorsiflexing his right great toe. Blood pressure is 150/95 mmHg (he has always been normotensive), and laboratory studies reveal anemia of chronic disease, high erythrocyte sedimentation rate, and polymorphonuclear leukocytosis. The chest x-ray is clear. The most likely diagnosis is
A)giant cell arteritis
B)allergic granulomatosis
C)Wegener's granulomatosis
D)polyarteritis nodosa
E)hypersensitivity vasculitis
8

Which of the following statements regarding the renal involvement associated with systemic lupus erythematosus (SLE) is true?
A)Clinically apparent renal disease occurs in 90% of affected persons
B)Interstitial nephritis is a rare finding on renal biopsy
C)Renal biopsy is not initially necessary in patients with deteriorating renal function and active urine sediment
D)Renal disease is uncommon in patients with high- titer anti-double-stranded DNA antibodies
E)Urinalysis in affected persons usually reveals proteinuria but little sediment and no red blood cells
9

A 25-year-old woman presents with a history of recurrent expectoration of foul-smelling sputum and intermittent fevers. Chest x-ray discloses characteristic "tram- tracking" bronchial thickening. Physical examination reveals coarse rhonchi in the right chest and splenomegaly. Blood test results are normal except for low levels of serum IgG and IgA. Her past medical history is remarkable for frequent upper respiratory infections and for a history of diarrhea 3 years ago due to Giardia lamblia infection. The most appropriate therapy would be
A)glucocorticoids
B)glucocorticoids and an alkylating agent
C)monthly intravenous immunoglobulin
D)splenectomy
E)bone marrow transplantation
10

Patients with SLE often develop renal failure. Which of the following represents a known mechanism for the development of kidney damage in patients with SLE?
A)Prerenal azotemia
B)Hypercalcemia causing renal tubular damage
C)Trapping of antibody-double-stranded DNA complexes in glomeruli
D)Renal artery occlusion
E)Precipitation of antibody-double-stranded DNA complexes in renal tubules producing interstitial nephropathy
11

Which of the following statements concerning the HLA-D region on the sixth human chromosome is correct?
A)It is located outside the major histocompatibility gene complex (MHC)
B)It encodes proteins involved in the mixed lymphocyte response
C)It encodes ubiquitously expressed proteins
D)Siblings matched for HLA-A, -B, and -C antigens will usually be matched at the D region
E)It is located close to genes encoding for cytokines such as granulocyte-macrophage colony stimulating factor, IL-3, and platelet-derived growth factor
12

Which of the following statements best describes the role of polymerase chain reaction (PCR) in the diagnosis of HIV infection?
A)It should be used if the western blot is indeterminate
B)It is a useful screening test
C)It should be used if two consecutive serologic tests (ELISA) are positive
D)It should be used if the initial serologic test is positive, but the second is negative
E)It has no real role
13

Which of the following statements regarding central nervous system disease in patients with HIV infection is correct?
A)The most common cause of central nervous system (CNS) disease is the AIDS dementia complex
B)The most common cause of seizures is cryptococcal meningoencephalitis
C)Antiretroviral agents have no role
D)The most common finding on MRI is multiple white matter lesions
E)Actual histologic evidence of direct HIV involvement is rare
14

A 50-year-old woman with severe adult-onset diabetes mellitus who requires insulin for glucose control gradually develops shortness of breath over the period of a few months. Chest x-ray reveals bilateral interstitial infiltrates. An open-lung biopsy discloses infiltration with eosinophils compatible with Loeffler's pneumonia. Given the patient's diabetes, an alternative to steroids would be advisable. Which of the following would be most appropriate in this clinical situation?
A)IL-2
B)Trimethoprim-sulfamethoxazole
C)Acyclovir
D)Mebendazole
E)Zafirlukast
15

A 30-year-old Turkish sailor reports several occurrences of painful oral ulcers in the tongue and the inner aspect of the cheek over the past year. He currently presents with several painful skin lesions, including an ulcer on the left side of his scrotum and painful red nodules on both shins. He also reports occasional bilateral knee and wrist pain. Which of the following tests would be compatible with the patient's diagnosis?
A)Elevated level of serum IgE levels
B)Biopsy of the skin lesion showing infiltration with neutrophils
C)Positive syphilis fluorescent antibody test from material obtained from the scrotal lesion
D)Positive herpes simplex virus culture from the genital lesion
E)The formation of a red nodule 2 days after a sterile needle is pricked into the patient's forearm
16

Dendritic cells are critical components of the immune system because they
A)produce antibodies that bind to specific microorganisms
B)are capable of directly recognizing specific antigens on the surface of pathogens
C)present antigens to lymphocytes in the context of the MHC and co-stimulatory molecules present on their cell surface
D)engulf microorganisms and kill them by secreting toxic substances such as superoxides, hydroxyl radicals, and lysozyme
E)provide critical help to activate B cells so that specific antimicrobial antibodies can be secreted
17

Which of the following is the LEAST common immunologic manifestation of HIV infection?
A)Cutaneous reactions to drugs
B)Anaphylactic reactions to drugs
C)Anticardiolipin antibodies
D)Oligoarticular arthritis
E)Fibromyalgia
18

A woman who has rheumatoid arthritis suddenly develops pain and swelling in the right calf. The most likely diagnosis is
A)ruptured plantaris tendon
B)pes anserinus bursitis
C)ruptured popliteal cyst
D)thrombophlebitis
E)Achilles tendonitis
19

A 70-year-old woman presents with blurring of vision in the left eye since waking earlier in the morning. She reports 2 months of fevers, sweats, anorexia, and a 4.5-kg (10-lb) weight loss. She also reports increasingly severe left temporal headaches over the same time period. Her physical examination reveals scalp tenderness over the left temporal region. Her laboratories reveal a normochromic, normocytic anemia, mildly elevated alkaline phosphatase, and an erythrocyte sedimentation rate of 92. Appropriate action includes
A)obtaining an emergent MRI/MRA of her head
B)referring the patient for a biopsy of her temporal artery, but abstaining from initiating therapy until the biopsy results are available
C)initiating high-dose glucocorticoid therapy and referring the patient for a temporal artery biopsy
D)obtaining a head CT to rule out metastatic disease and scheduling a colonoscopy
E)performing a lumbar puncture to rule out meningitis
20

A 65-year-old obese man complains of progressive pain in both knees, exacerbated by walking. Past medical history is unremarkable. Physical examination discloses normal pulses and circulation and no joint effusions. Bony crepitus is evident upon movement of either knee joint. Routine laboratory studies, including an ESR, are normal. Radiographs of the knees reveal joint space narrowing. What is the most important pathophysiologic feature in this situation?
A)Deposition of calcium pyrophosphate crystals
B)Deposition of urate crystals
C)Lymphocytic infiltration of synovium
D)Neutrophilic infiltration of synovium
E)Loss of articular cartilage







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