Download Klin immunology_1

1. A patient undergoing evaluation for possible infection with M. 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. 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
ANSWER: C
2. A 25-year-old woman presents with a history of recurrent expectoration of foulsmelling 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. corticosteroids
B. corticosteroids and an alkylating agent
C. monthly intravenous immunoglobulin
D. splenectomy
E. bone marrow transplantation
ANSWER: C
3. All of the following statements regarding the epidemiology of HIV infection are
correct EXCEPT
A. the risk of transmission following skin puncture from a needle contaminated with
blood from an HIV-infected patient is less than 0.5 percent
B. most cases of AIDS are now among I/V drug users
C. the risk of transmission from a single donor unit of blood is approximately 1/500,000
D. most pediatric cases of AIDS arise because of vertical transmission from an infected
mother
E. there is no convincing evidence that saliva can transmit HIV
ANSWER: B
4. 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
ANSWER:B
5. All the following statements concerning the ataxia-telangiectasia syndrome are correct
EXCEPT
A. it is inherited in an autosomal recessive manner
B. the cause is adenosine deaminase deficiency
C. malignancy is a common cause of death
D. bronchiectasis may occur
E. both humoral and cellular limbs of the immune system are affected
ANSWER: B
6. 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 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
ANSWER: A
7. 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
ANSWER: B
8. Which histologic subtype of lymphoma occurs most commonly in patients infected
with HIV?
A. Immunoblastic (large cell) lymphoma
B. Small, noncleaved (Burkitt's) lymphoma
C. Small, cleaved (follicular) lymphoma
D. Primary central nervous system lymphoma
E. Hodgkin's disease, mixed cellularity
ANSWER: A
9. A 68-year-old woman presents to her internist for a routine checkup. Her physical
examination is normal and routine laboratory evaluation is also normal except for an elevated
total protein of 90 g/L (9.0 g/dL). Further workup includes the following: serum protein
electrophoresis that reveals an M spike (proved to be IgG-K on immunoelectrophoresis) of 19
g/L (1.9 g/dL), an unremarkable urine protein electrophoresis, bone marrow aspirate and biopsy
that discloses normal hematopoesis and 3 percent bone marrow plasma cells, and a negative
skeletal survey. The proper course of action at this point is to
A. obtain quantitative immunoglobulin levels
B. obtain beta-microglobulin level
C. begin therapy with melphalan and prednisone
D. begin therapy with high-dose prednisone
E. reassure the patient; no additional action is required at this time
ANSWER: E
10. True statements about human T cells include which of the following?
A. They are the principal cells in the cortical "germinal centers" and medullary cords of
lymph nodes
B. They carry membrane-bound IgD on their surface
C. They constitute 70 to 80 percent of circulating blood lymphocytes
D. They arise from stem cells in the thymus
E. They are the main effectors of antibodydependent, cell-mediated cytotoxicity
ANSWER: C
11. Human immunoglobulin A (IgA) can be described by which of the following
statements?
A. It is the predominant immunoglobulin in plasma
B. It exists in four subclasses, of which IgA2 is predominant
C. It can prevent attachment of microorganisms to epithelial cell membranes
D. It is prominent early in the immune response and is the major class of antibody in cold
agglutinins
E. It has the shortest half-life of the five classes of immunoglobulin
ANSWER: C
12. Correct statements about isolated immunoglobulin A deficiency include which of the
following?
A. The incidence of atopic disease is high.
B. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA
levels.
C. Bone marrow transplantation is needed
D. Secretory IgA levels usually are normal.
E. Nothing above
ANSWER: A
13. Correct statements about isolated immunoglobulin A deficiency include which of the
following?
A. The risk of adverse reactions to transfusions is increased.
B. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA
levels.
C. Bone marrow transplantation is needed
D. Secretory IgA levels usually are normal.
E. Nothing above
ANSWER:A
14. Correct statements about isolated immunoglobulin A deficiency include which of the
following?
A. The incidence of autoimmune disese is increased.
B. The reduced number of IgA-bearing B cells accounts for the reduced serum IgA
levels.
C. Bone marrow transplantation is needed
D. Secretory IgA levels usually are normal.
E. Nothing above
ANSWER:A
15. Chemically induced tumors have tumor-associated transplantation antigens that
A. are always the same for a given carcinogen
B. are different for two tumors of different histologic type even if induced by the same
carcinogen
C. are very strong antigens
D. do not induce an immune response
E. None of above
ANSWER:B
16. After binding to its specific antigen, a B lymphocyte may switch its
A. immunoglobulin light-chain isotype
B. immunoglobulin heavy-chain class
C. variable region of the immunoglobulin heavy chain
constant region of the immunoglobulin light chain
Nothing above
ANSWER:B
17. Complement fixation refers to
A. the ingestion of C3b-coated bacteria by macrophages
B. the destruction of complement in serum by heating at 56 °C for 30 minutes
C. the binding of complement components by antigen-antibody complexes
D. the interaction of C3b with mast cells
E. none of above
ANSWER:C
18. Individuals with a genetic deficiency of C6 have decreased resistance to viral
infections
A.
increased hypersensitivity reactions
B.
increased frequency of cancer
C.
decreased resistance to Neisseria bacteremia
D.
none of above
ANSWER:C
19.
Natural killer cells are
A. B cells that can kill without complement
B. cytotoxic T cells
C. increased by immunization
D. able to kill virus-infected cells without prior sensitization
E. none of above
ANSWER:D
20. A primary immune response in an adult human requires approximately how much time
to produce detectable antibody levels in the blood?
A. 12 hours
B. 3 days
C. 1 week
D. 3 weeks
E. 6 weeks
ANSWER:C
21. The best method to demonstrate IgG on the glomerular basement membrane in a kidney
tissue section is the
A. precipitin test
B. complement fixation test
C. agglutination test
D. indirect fluorescent-antibody test
E. none of above
ANSWER:D
22.
Which one of the following substances is not released by activated helper T cells?
A. Alpha interferon
B. Gamma interferon
C. Interleukin-2
D. Interleukin-4
E. None of above
ANSWER:A
23. A delayed hypersensitivity reaction is characterized by
A. edema without a cellular infiltrate
B. an infiltrate composed of neutrophils
C. an infiltrate composed of helper T cells and macrophages
D. an infiltrate composed of eosinophils
E. None of above
ANSWER:C
24. An antigen found in relatively high concentration in the plasma of normal fetuses and a
high proportion of patients with progressive carcinoma of the colon is
A. viral antigen
B. carcinoembryonic antigen
C. alpha-fetoprotein
D. heterophil antigen
E. none of above
ANSWER:B
25. Antigen-presenting cells that activate helper T cells must express which one of the
following on their surfaces?
A. IgE
B. Gamma interferon
C. Class I MHC antigens
D. Class II MHC antigens
E. Nothing above
ANSWER:D
26. In setting up a complement fixation test for antibody, the reactants should be added in
what sequence? (Ag = antigen; Ab = antibody; C = complement; EA = antibody-coated indicator
erythrocytes.)
A.
Ag + EA + C/wait/ + patient's serum
B.
C + patient's serum + EA/wait/ + Ag
C.
Ag + patient's serum + EA/wait/+ C
D.
Ag + patient's serum + C/wait/+ EA
E.
No one in the list
ANSWER:D
27.
Which one of the following properties of antibodies is not dependent on the structure
of the heavy-chain constant region?
A.
Ability to cross the placenta
B.
Isotype (class)
C.
Ability to fix complement
D.
Affinity for antigen
E.
None of above
ANSWER:D
28.
The role of the macrophage during an antibody response is to
A. make antibody
B. lyse virus-infected target cells
C. activate cytotoxic T cells
D. process antigen and present it
E. none of above
ANSWER:D
29. The mother of a 4-year-old child notes that her child is sleeping poorly and scratching
his anal area. You suspect the child may have pinworms. Which one of the following is the
BEST method to make that diagnosis?
A. Examine the stool for the presence of cysts
B. Examine the stool for the presence of trophozoites
C. Examine a blood smear for the presence of microfilaria
D. Determine the titer of IgE antibody
E. Nothing above
ANSWER:D
30.
A 22-year-old woman had fever to 100 °F and anorexia for the past 2 days, and this
morning she appears jaundiced. On examination, her liver is enlarged and tender. She has a
total bilirubin of 5 mg/dL (normal < 1) and elevated transaminases. She received the complete
course of the hepatitis B vaccine 2 years ago but has not had the hepatitis A vaccine. The results of
her hepatitis serologies are as follows: HAV-IgM-negative, HAV-IgG-positive, HBsAg-negative,
HBsAb-positive, HBcAb-negative, HCV-Ab-positive. Of the following, which one is the
MOST accurate?
A. She probably has hepatitis A now, probably has not been infected with HBV, and
probably had hepatitis C in the past
B. She probably has hepatitis A now, probably has been infected with HBV in the past,
and probably had hepatitis C in the past
C. She has been infected with HAV in the past, probably has not been infected with
HBV, and probably has hepatitis C now
D. She has been infected with HAV in the past, probably has hepatitis B now, and
probably had hepatitis C in the past
E. None of above
ANSWER:C
31. Regarding the function of the different classes of antibodies, which one of the following
statements is the MOST accurate?
A. IgA acts as an antigen receptor on the surface of B cells
B. IgG activates the alternative pathway of complement, resulting in the production of C3a
that degrades the bacterial cell wall
C. IgG binds to the bacterial surface and makes the bacteria more easily ingested by
phagocytes
D. IgM defends against worm parasites, such as hookworms
E. IgE blocks the binding of viruses to the gut mucosa
ANSWER:C
32. Regarding the primary and secondary anamnestic immune responses, which one of the
following statements is MOST accurate?
A. The IgM made in the primary response is made primarily by memory B cells
B. The lag phase is shorter in the primary response than in the secondary response
C. In the primary response, memory B cells are produced, but memory T cells are not
D. Antigen must be processed and presented in the primary response but not in the
secondary response
E. The amount of IgG made in the secondary response is greater than the amount made in the
primary response
ANSWER:E
33. Which of the following statements about IgM is true?
A.
It is a reagenic antibody
B.
It is important in the first few days of the primary immune response
C.
It increases in serum concentration after IgG has reached its peak serum
concentration
D.
It is the smallest of the immunoglobulin molecules
E.
It is involved in the allergic reaction
ANSWER:B
34. Actively acquired immunity can be coused by all of the following except?
A. The specific disese
B. Exposure to subclinical doses of the disease-causing organism
C. Vaccination with the appropriate antigen
D. Injection with immune serum containing appropriate antibody
E. The specific disese Vaccination with the appropriate antigen
ANSWER:D
35. All of the following are characteristics of the human immunodeficiency virus except?
A. it binds to the CD4 molecule preferentially
B. it contains gp120 and gp41 envelope proteins
C. it is the causative agent of AIDS
D. it contains DNA within its core
E. it contains a reverse transcriptase within its core
ANSWER:D
36. Which of the following components determines the class-specific antigenicity of
immunoglobulines?
A. J chain
B. T chain
C. Light chain
D. Heavy chain
E. Secretory components
ANSWER:D
37. Which one of the following substances may be passively transferred from the mother
to the fetus during the third trimester of the pregnancy?
A. IgG
B. Anti-Rh antibody
C. Natural isohemagglutinins
D. IgM
E. None of above
ANSWER:A
38. Which one of the following statements best describes the rheumatoid factor?
A. It is the antigen initiating the rheumatoid inflammatory process
B. It is an antibody against cellular DNA
C. It consists primarily of DNA
D. It is an antibody against immunoglobulin
E. None of above
ANSWER:D
39. Which of the following tests is the most sensitive type of serologic test?
A. Virus neutralization
B. ELISA
C. Nucleic acid hybridization
D. Hemadsorption
E. Nothing
ANSWER:B
40. The human immunodeficiency virus (HIV)-1 has been shown to be transmitted by all
of the following mechanisms except
A. sexual contact
B. perinatal infection
C. shared needles
D. mosquitoes
E. blood transfusion
ANSWER:D
41. Which one of the following is a typical immune complex disease?
A. Klippel-Feil syndrome
B. Urticaria pigmentosa
C. SLE
D. Gastric ulcer
E. Osteoarthritis
ANSWER:C
42. High titer of rheumatoid factor are found in what percentage of patients with RA?
A. 5 %
B. 70 %
C. 25 %
D. 50 %
E. 100 %
ANSWER:B
43. Which of the following is the most common site of immune complexes?
A. both ureters
B. cardiac septum
C. capillaries in the renal glomerulus
D. posterior lobe of the pituitary gland
E. musculs
ANSWER:C
44. A woman of 36 years is on the 12-th week of the first pregnancy. We know from the
history that she was treated for infertility. She visited friends and contacted with child who
developed rubella in 2 days after meeting. Woman doesn’t know if she has ever been infected
with rubella. What is the adequate tactics?
A. Monitory of the specific Ig G and Ig M with the ELISA
B. Interruption of the pregnancy
C. Immune globulin injection
D. Cyclovin administration
E. Interferon administration
ANSWER:A
45. True statements regarding immune-complex disease include which of the following?
A. Normally, most immune complexes are removed by the reticuloendothelial system
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
ANSWER:A
46. Right statements regarding immune-complex disease include which of the following?
A. Signs and symptoms stem from the deposition of immune complexes in tissues other
than those of the reticuloendothelial system
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
ANSWER:A
47. Regarding immune-complex disease true statements include which of the following?
A. Persistence of immune complexes in the circulation seems to be a requirement for the
development of renal manifestations
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
ANSWER:A
48. True statements regarding immune-complex disease include which of the following?
A. Renal lesions depend on antigen-antibody combinations in which antigen is in slight
excess
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
ANSWER:A
49. True statements regarding immune-complex disease include which of the following?
A. The rash of cutaneous necrotizing vasculitis may be an example of immune-complex
disease
B. Symptoms of the disease are very specific
C. Renal manifestation are not frequent
D. Skin rash is the first symptom
E. Treatment is unknown
ANSWER:A
50. Which of the following statements about IgM is true?
A. It is a reagenic antibody
B. It is important in the first few days of the primary immune response
C. It increases in serum concentration after IgG has reached its peak serum concentration
D. It is the smallest of the immunoglobulin molecules
E. It is involved in the allergic reaction
ANSWER:A
51. All the medicines could be useful in case of anaphylactic reactions except:
A.
epinephrine
B.
diphenhydramine
C.
zaditen
D.
dobutamine
E.
betametason
ANSWER: C
52.
AIDS is caused by a human retrovirus that kills
A.
B lymphocytes
B.
lymphocyte stem cells
C.
CD4-positive T lymphocytes
D.
CD8-positive T lymphocytes
E.
None of above
ANSWER: C
53. Hyperacute graft rejection occurs due to:
A. preexisting antibodies
B. T-cytotoxic lymphocytes
C. NK-cells
D. T-suppressors
E. None of above
ANSWER: A
54. Acute graft rejection occurs due to:
A. preexisting antibodies
B. antibodies produced after transplantation
C. NK-cells
D. T-suppressors
E. None of above
ANSWER: B
55.Chronic graft rejection occurs due to:
A. preexisting antibodies
B. T-cytotoxic lymphocytes
C. antibodies produced after transplantation
D. T-suppressors
E. None of above
ANSWER: B
56. What type of drugs are not usefull for graft rejection prevention:
A. corticosteroids
B. cytotoxics
C. antilymphocyte globulin
D. non-steroid anti-inflammatory drugs
E. antilymphocyte serum
E. IgD
ANSWER: D
57. The most selective immunosuppressive drug is:
A. azathiprine
B. cyclosporin
C. metotrexat
D. mercaptopurine
E. cyclophosphamidum
ANSWER: B
58. GVHD (graft versus host reaction) occurs due to incorrect selection of:
A. heart
B. kidney
C. bone marrow
D. lymphatic node
E. lung
ANSWER: C
59. GVHD (graft versus host reaction) occurs due to incorrect selection of:
A. bones
B. kidney
C. intestine
D. lymphatic node
E. lung
ANSWER: C
60. Large granular lymphocytes which can kill virus-infected cells as part of innate
immunity are called:
A.
neutrophils
B.
natural killer cells
C.
monocytes
D.
lymphocytes
E.
mast cells
ANSWER: B
61. Interferon action is:
A.
primarily antiviral
B.
to disrupt cytoplasmic membranes
C.
to protect primary infected cells
D.
found in high levels in phagocytic granules
E.
kill cells infected by viruses
ANSWER: A
62. Primary lymphoid organes are:
A.
thymus
B.
bursa of Fabricius.
C.
bone marrow.
D.
all of the above are correct
E.
all of the above are false
ANSWER: D
63. Natural killer cells are involved in:
A.
allograft rejection.
B.
tumour rejection.
C.
non-specific killing of virus transformed target cells.
D.
type II of allergy
E.
all of the above.
ANSWER: E
64. C3 is cleaved to form C3a and C3b by C3-convertase. C3b is involved in all of the
following EXCEPT:
A.
altering vascular permeability
B.
promoting phagocytosis
C.
forming alternative-pathway C3 convertase
D.
forming C5 convertase.
E. can bind to macrophages
ANSWER: A
65. CD3 surface antigen is expressed only by:
A.
T cells.
B.
В cells.
C.
monocytes.
D.
granulocytes.
E.
mast cells
ANSWER: A
66. A T helper lymphocyte recognizes an antigen presented by an antigen-presenting-cell
(APC) if the antigen is associated with:
A.
HLA class I antigen.
B.
Surface immunoglobulin.
C.
HLA class II antigen.
D.
CD 8 antigen.
E.
All of the above.
ANSWER: C
67. T-killer cells are important in controlling
A.
virus infections
B.
allergy
C.
autoimmunity
D.
antibodies synthesis
E.
all of these
ANSWER: A
68. Which one of the following substances is released by activated helper Th1 cells?
A.
Alpha interferon
B.
Gamma interferon
C.
Interleukin-5
D.
Interleukin-6
E.
Bradikidin
ANSWER: B
69. All of the following are organs of immune system, except:
A.
GALT
B.
spleen
C.
lymph nodes
D.
thyroid gland
E.
tonsil gland
ANSWER: D
70. An example of a nonspecific chemical barrier to infection is:
A. NK cells
B. unbroken skin
C. cilia in trachea
D. lysozyme in saliva
E. all of these
ANSWER: D
71. Which of the following is the end product of the complement system?
A.
properdin
B.
membrane attack complex
C.
cascade reaction
D.
complement factor C1
E.
complement factor C9
ANSWER: E
72. Why does lysozyme destroy bacteria cells?
A.
because inhibits protein synthesis
B.
because activates lysosome’s enzymes
C.
because inhibits mRNA
D.
because attacks of peptidoglycan
E.
because stimulates proteolytic enzymes
ANSWER: D
73. Which of the following pairs is mismatched
A.
vagina --- lactobacilli
B.
eye --- lysozyme
C.
oropharynx --- anaerobes
D.
mucus --- lactoferrin
E.
skin --- Gram negative
ANSWER: E
74. Primary defense mechanisms of the gastrointestinal tract include all except:
A.
lysozyme
B.
secretory IgA
C.
mucus
D.
bile
E.
acidity in stomach
ANSWER: A
75. Lysozyme:
A.
aggregates bacteria
B.
captures free iron
C.
breaks down the bacterial cell wall
D.
enhances phagocytosis
E.
is antiviral
ANSWER: C
76. Stem cells arise from:
A.
yolk sac.
B.
foetal liver.
C.
bone marrow.
D.
all of the above.
E.
all of the above are wrong
ANSWER: D
77. Which do T cells assist in the functions of certain B cells and other T cells.
A. Sensitized
B. Cytotoxic
C. Helper
D. Natural killer
E. K cells
ANSWER: C
78. Each of the following statements concerning class II MHC proteins is correct
EXCEPT:
A.
They are found on the surface of both B and T cells
B.
They have a high degree of polymorphism
C.
They are involved in the presentation of antigen by macrophages
D.
They have a binding site for CD4 proteins
E.
They are main in succefull transplantation
ANSWER: A
79. Find the correct statements concernin haptens:
A. A hapten can combine with an antibody
B. A hapten cannot induce an antibody by itself; rather, it must be bound to a
carrier protein to be able to induce antibody
C. Haptens are big molecules of protein
D. Haptens must be processed by CD8 cells to become immunogenic
E. Haptens must be processed by MHC II to become immunogenic
ANSWER: A
80. Humoral factor of a nonspecific resistance to infection is
A.
NK cells
B.
unbroken skin
C.
lysozyme in saliva
D.
cilia in trachea
E.
all of these
ANSWER: C
81. C3a and C5a can cause
A.
A bacterial lysis
B.
B vascular permeability
C.
C phagocytosis of IgE coated bacteria
D.
D aggregation of C4 and C2
E.
E activate protein synthesis
ANSWER: B
82. The most common type of circulating white cell is the:
A.
neutrophil
B.
lymphocyte
C.
basophil
D.
eosinophil
E.
monocyte
ANSWER: A
83. The following is not part of the defense mechanisms of the neutrophil:
A.
lactoferrin
B.
superoxide anion
C.
lysozyme
D.
free radicals
E.
hydrogen peroxide
ANSWER: C
84. Interferon action is:
A.
primarily antiviral
B.
to disrupt cytoplasmic membranes
C.
to protect primary infected cells
D.
found in high levels in phagocytic granules
E.
kill virus direct
ANSWER: A
85. The earliest stages of B cell differentiation
A.
Occur in the embryonic thymus
B.
Require the presence of antigen
C.
Involve rearrangement of K chain gene segments
D.
Involve rearrangement of surrogate light chain gene rearrangement
E.
Involve rearrangement of heavy chain gene segments
ANSWER: E
86. Each of the following agents has been demonstrated to alter the course of rheumatoid
arthritis EXCEPT
A. gold
B. omega-3 fatty acids
C. methotrexate
D. D-penicillamine
E. hydroxychloroquine
ANSWER: B
87. 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
ANSWER: C
88. Which of the following systemic manifestations is LEAST characteristic of early
adult rheumatoid arthritis?
A. High fever
B. Weight loss
C. Muscle wasting
D. Vague musculoskeletal symptoms
E. Fatigue
ANSWER: A
89. Which of the following conditions is LEAST likely to occur in late extraarticular
seropositive rheumatoid arthritis?
A. Neutropenia
B. Dry eyes
C. Leg ulcers
D. Sensorimotor polyneuropathy
E. Hepatitis
ANSWER: E
90. Arthritis associated with psoriasis can be manifest in several different ways. Each of
the following is characteristic of psoriatic arthritis EXCEPT
A. asymmetric oligoarticular arthritis
B. rheumatoid factor-positive symmetric polyarthritis
C. arthritis of distal interphalangeal joints
D. severe destructive polyarthritis (arthritis mutilans)
E. spondylitis and sacroiliitis with or without peripheral arthritis
ANSWER: B
91. In which of the following clinical situations would a diagnosis of ankylosing
spondylitis most likely be correct?
A. For the last 10 years, a 28-year-old man has had low back pain and stiffness, worse at
night and relieved with activity
B. For the last 5 years, a 32-year-old man has had low back pain made worse with
activity but improved with bed rest
C. For the last 10 years, a 34-year-old man has had intermittent bouts of mild low back
pain; now, however, he suddenly is unable to dorsiflex his right great toe
D. For the last 10 years, a 65-year-old man has had low back pain radiating down both
posterior thighs to the knees
E. For the last 15 years, a 72-year-old man has had progressive low back pain made
worse with walking but improved with rest and leaning forward
ANSWER: A
92. A 26-year-old woman with systemic lupus erythematosus (SLE) is noted to have a
prolonged partial thromboplastin time. This abnormality is associated with
A. leukopenia
B. drug-induced lupus
C. central nervous system vasculitis
D. central nervous system hemorrhage
E. deep venous thrombosis
ANSWER: E
93. A patient with diffuse cutaneous scleroderma (systemic sclerosis) who had been
stable for several years is recently noted to have hypertension. This patient is at significant risk
of dying from
A. thrombotic stroke
B. central nervous system hemorrhage
C. renal failure
D. pulmonary hypertension
E. pulmonary fibrosis
ANSWER: C
94. A 27-year-old woman with systemic lupus erythematosus is in remission; current
treatment is azathioprine, 75 mg/d, and prednisone, 5 mg/d. Last year she had a life-threatening
exacerbation of her disease. She now strongly desires to become pregnant. Which of the
following is the LEAST appropriate action?
A. Advise her that the risk of spontaneous abortion is high
B. Warn her that exacerbations can occur in the first trimester and in the postpartum
period
C. Tell her it is unlikely a newborn will have lupus
D. Advise that fetal loss rates are higher if anticardiolipin antibodies are detected in her
serum
E. Stop the prednisone just before she attempts to become pregnant
ANSWER: C
95. Which of the following is LEAST likely to be seen in Sjogren's syndrome?
A. Dental caries
B. Corneal ulceration
C. Renal tubular acidosis
D. Lymphoma
E. Cardiac fibrosis
ANSWER: E
96. Drug-induced systemic lupus erythematosus (SLE) can be characterized by which of
the following statements?
A. Twenty percent of patients receiving procainamide develop drug-induced lupus
B. Nephritis is a frequent consequence of hydralazine-induced lupus
C. Most patients on hydralazine develop a positive antinuclear antibody (ANA) test;
however, only 10 percent suffer from lupuslike symptoms
D. There are males prevalens in the structure of drug-induced systemic lupus
erythematosus
E. Treatment is unknown
ANSWER: A
97. Correct statements concerning the use of nonsteroidal anti-inflammatory drugs
(NSAIDs) in the treatment of rheumatoid arthritis include which of the following?
A. The mechanism of action of NSAIDs is the blockade of 5-lipoxygenase
B. The newer NSAIDs are more efficacious than aspirin
C. The newer NSAIDs induce platelet dysfunction
D. NSAIDs can not exacerbate allergic rhinitis and asthma
E. The mechanism of NSAID-induced azotemia is unrelated to these drugs' ability to
disrupt arachidonic acid metabolism
ANSWER: C
98. True statements concerning the use of nonsteroidal anti-inflammatory drugs
(NSAIDs) in the treatment of rheumatoid arthritis include which of the following?
A. The mechanism of action of NSAIDs is the blockade of 5-lipoxygenase
B. The newer NSAIDs are more efficacious than aspirin
C. It is necessary to increase dose every day (D) NSAIDs can exacerbate allergic rhinitis
and asthma
D. The mechanism of NSAID-induced azotemia is unrelated to these drugs' ability to
disrupt arachidonic acid metabolism
E. None of above
ANSWER: C
99. Accurate statements about rheumatoid factors include which of the following?
A. They are antibodies to the Fc fragment of immunoglobulin G
B. They are associated with multiple sclerosis
C. Their presence in the serum of persons with rheumatoid arthritis does not correlates
with a worse prognosis than that for persons with seronegative disease
D. Their presence correlates with articular manifestations of rheumatoid arthritis
E. They frequently do not appear in the serum of persons with rheumatoid arthritis until
late in the course of the illness
ANSWER: A
100. Accurate statements about rheumatoid factors include which of the following?
A. They are associated with multiple sclerosis
B. They are associated with several conditions in which there is chronic antigenic
stimulation
C. Their presence in the serum of persons with rheumatoid arthritis does not correlates
with a worse prognosis than that for persons with seronegative disease D. Their presence
correlates with articular manifestations of rheumatoid arthritis
E. They frequently do not appear in the serum of persons with rheumatoid arthritis until
late in the course of the illness
ANSWER: B