Immunology Practice Questions PDF

49 TLrnor Markers CANCER TuMoR MARKER ASSOCI...

49 TLrnor Markers CANCER TuMoR MARKER ASSOCIATED CANCER TUMOR MARKERS Alpha Fetoprotcin (AFP) liver, ova1·y, t est es 1. Substances synthesized and released by (tetrablastoma) a tumor or produced by host in Carcinoembryonic antigen colon, brea s t , lun g response to a tumor (CEA) 2. Found in circulation, body cavity CA 15-1 , BR 17.29 , breast fluids, cell membranes or B.R 27.29 cytoplasm/nucleus of a cell CA 125 ovary 3. Absent or only trace amounts in normal CA 19-9 pancreas population 4,. Used in diagnosing, determining disease Estrogen/ Progesterone bre a st progression, choosing therapeutic receptors drugs, monitoring response to therapy, HER2/neu breas t - use of Hen:eptin and detecting recurrence a. Most common use is monitoring for Prostate specific antigen prostate tumor recurrence (PSA) 5. Testing commonly performed by ELISA IMMUNOLOGY PRACTICE QUESTIONS 1. A specimen is tested for antibodies to varicella 3. An immunofluorescence procedure is resulting in a titer of 320. Two weeks later performed to test for specific antibodies to another specimen is drawn from the patient Epstein Barr Virus. The following antibodies and the resulting titer is 640. A third test is were found: done on a specimen drawn 4 weeks after the first specimen and the titer is 320. What is the anti-VCA anti-EA disease status of the patient? anti-EBNA A. Antibody levels are increased but titers indicate a past infection with How would these results be interpreted? chicken pox. A. Early infection B. Antibody levels are within normal B. Recent infection reference limits. C. Current infection C. Elevated antibody levels indicate a D. Past infection current chicken pox infection. D. The second titer indicates a current 4. ANA fluorescent techniques were performed infection with chicken pox. and a speckled pattern appeared with a titer of 640. What would you do next? 2. A patient is immunized for rubella. What type A. Repeat the procedure. of immunity does this patient have? B. Test for extractable nuclear A. Active antibodies. B. Passive C. Look for fluorescent mitotic cells. C. Adoptive D. Test for DNA (Use Crithidia luciliae D. Natural substrate). 50 5. Multiple, homogeneous, narrow bands are 11. To test for antibodies to specific allergens, the present in the gamma zone on electrophoresis following procedure would be performed: of a patient's CSF on agarous gel. A. RPR lmmunofixation indicates that the bands are B. CRP primarily lgG. This may indicate which of the C. RIST following diseases: D. RAST A. Addison's disease E. VDRL B. Myasthenia gravis C. Multiple sclerosis 12. A patient suspected of having syphilis had D. Multiple myeloma various tests performed with the following results: 6. Assess the disease state of the patient with the Rapid plasma reagin (RPR) - reactive following results: FTA-ABS - nonreactive HBsAg positive VDRL (CSF) - nonreactive HBeAg positive anti-HBC positive These test results best reflect which of the anti-HBe negative following? anti-HBsAg negative A. neurosyphilis B. biologic false positive A. Incubation period for Hepatitis B C. primary stage syphilis infection D. secondary stage syphilis B. Very early infection with Hepatitis E. te rtiary stage syphilis B C. Highly infectious stage of Hepatitis 13. An agglutination procedure is performed with B infection the following results: D. Immunity to Hepatitis B 7. After exposure to measles, a patient is tested and has a 1:20 titer. This indicates: A. Current infection B. Immunity C. Immunization The reportable titer for this test is: D. Test should be repeated in 10 days to 2 weeks. A. 40 B. 160 C. 320 8. The best method for screening cerebrospinal D. Results are inconsistent. Procedure fluid for syphilis is: should he repeated. A. VDRL B. RPR C. FTA-abs 14. Listed below are the results for a patient who D. darkfield microscopy had a positive ANA on initial testing. 9. A patient has a T helper:T regulatory ratio of 1:2. What disease state might you expect? nt i-Sm nt i-SSA A. infectious mononucleosis B. rheumatoid arthritis nti-SSB C. AIDS n t i-Scl-7 0 D. systemic lupus erythematosus nti-RANA 10. Multiple myeloma most commonly involves The disease most closely associated with the following class of immunoglobulin: these results is: A. IgA B. IgD A. SLE C. IgG B. mixed connective tissue disease D. IgM C. scleroderma D. Sjogren1s syndrome  51 15. The tumor marker associated with cancer of 18. Laboratory assays are performed on a the pancreas is: patient with suspected thyroid disease. Listed below are the results: A. CEA B. CA 19-9 Test Result C. CA 125 D. CA 15-3 Anti-TPO (TPO Ab) elevated TSHRAb elevated 16. The most sensitive assay for all stages of syphilis is: TSI elevated A. FTA-Ahs Anti-Tg (Tg AB) normal B. MTA-TP C.RPR These results are consistent with which of the D.VDRL following? A. Hashimoto' s thyroiditis 17. The following test is the most accurate B. Graves disease indication of the presence of inflammation: C. Thyroid cancer A. ESR D. Hypothyroidism B. CRP C. ANA D. RPR ANSWERS AND RATIONALE 1. A 4. B To properly assess an infection as current, Speckled patterns are confirmed using there must be a 4-fold rise in the antibody double irnmunodiffusion, radial titer. If the first titer was 320, subsequent immunodiffusion, indirect tests should give a titer of at least 1280 if im:munofluorescence or enzyme immunoassay infection is current. to test for antibodies to specific saline extractable nuclear antigens (anti-Sm , anti-ds 2. A DNA, anti-Scl-70, etc.) Option A is incorrect Active immunity occurs after patient is because repeating the test is unnecessary. presented with an antigen (infectious organism Option C is incorrect since mitotic cells are not or immunizatio11) and the patient produces positive in speckled patterns. Option D is antibodies. incorrect because Critbidia substrate is used to confirm a homogeneous pattern. Option B is incorrect since passive 5. C immunity occurs when antibody is produced by another person or animal and the In multiple sclerosis, IgG oligoclonal bands antibodies are transferred to the patient giving are often seen in CSF. Option A is inconect the patient temporary immunity. (The because 40 - 70% of patients manifest patient does not produce the antibodies.) antibodies against elements of the adrenal Option C, adoptive immunity, occurs when cortex and adrenal cell surfaces. Option Bis immunocompetent cells are transferred to the incorrect since patients with myasthenia gravis patient. Option D, natural immunity, refers to demonstrate acetylcholine receptor blocking the nonspecific mechanisms involved in antibodies. (IgG, C3 and C9 can he fighting infection. It does not result in demonstrnted at the neuromuscular junctions). antibody formation. Option D is incorrect because multiple 3. D myeloma (plasma cell myeloma) is characterized by neoplastic proliferation of a single clone The presence of antibody to Epstein Barr (monoclonal) of plasma cells that produce a Virus nuclear antigen indicates a past specific type of immunoglobulin (usually IgG). infection. Anti-VCA is probably lgG rather than IgM. 52 6. C 13. B When HBeAg is present, the patient is The initial tube indicates that prozone has considered highly infectious. Option A is occurred. Therefore, the last tube showing incorrect because all antigen and antibody agglutination is 1:160. The titer of 160 is the results would be negative during the reciprocal of the dilution of the last tube incubation period. Option Bis incorrect displaying agglutination. because anti-HBc would be negative in a very 14. D early infection. Option Dis incorrect because an immune individual would be positive for If an ANA pattern is speckled, follow up anti-HBsAg. testing is performed for antibodies directed 7. D against extractable nuclear antigens to confirm the test and aid in determining the The patient's titer is not definitive. He/she autoimmune disease present. Anti-SSA and could have antibodies from a past infection or anti-SSB are often positive in patients with from immunization. To determine if the Sjogrens syndrome. Patients with anti-Sm infection is current, the test should be often have SLE. Anti-Sci 70 is associated with repeated in about two weeks with the r esults scleroderma and anti-RANA is associate d with demonstrating a titer of at least 80 (4--fold rheumatoid arthritis. increase). 15. B 8. A CA 19-9 is often elevated in patients with VDRL is the test of choice for testing CSF. pancreatic cancer. CEA is elevated in many cancers including breast cancer and colon 9. C cancer. CA125 is a marker u sed in ovarian cancer. CA15-3 is used in patients with breast Due to reduced numbers of T cells in cancer. acquired immunodeficiency disease, there is a decrease in the T helper/ T regulator ratio. 16. A 10. C FTA-Abs remains positive after treatment. on-treponemal tests are not positive after the Proliferation of a monoclonal antibody in patient is treated. multiple myeloma is usually of the lgG class. 17. B 11. D CRP is the most sensitive measure of the Radioallergosorbent testing (RAST) is used rise and fall of inflammation. Concentrations to measure lgE antibodies to specific of CRP increase within 4-6 hours of the onset allergens. Specific allergen assays may also be of inflammation and decrease rapidly when performed using ELISA techniques. inflammation subsides. ESR indicates 12. B inflammation but. does not rapidly r eflect changes in inflammatory status. FTA-ABS (fluorescent treponemal antibody 18. B abso1ption) is u sed to confirm positive screening tests (RPR, VDRL) for syphilis. TPO Ab, TSHR Ab and TSI are eleva1ted Many diseases other than syphilis such as in Graves Disease and hyperthyroidism. Tg Ab SLE, infectious mononucleosis , hepatitis, and may also be elevated in thyroid cancer. malaria give false positive r esults for screening tests. Since the FTA-ABS is negative, this is probably a biologic false positive.