Deck 26: Immunoproliferative Disorders

Question 1

Cryoglobulins are proteins that precipitate at

A)-18° C
B)-4° C
C)0° C
D)4° C

Answer 1

0° C

Question 2

Patients with Waldenström's macroglobulinemia (WM) exhibit abnormally large amounts of

A)IgM.
B)IgG.
C)IgE.
D)IgA.

Answer 2

IgM.

Question 3

Bence Jones proteinuria is often associated with

A)intrarenal obstruction.
B)direct tubular-cell injury.
C)renal failure.
D)All of the above.

Answer 3

All of the above.

Question 4

The diagnosis of multiple myeloma (MM) depends on

A)more than 10% plasma cells in the bone marrow.
B)a decreased concentration of B lymphocytes.
C)excretion of Bence Jones protein.
D)increased albumin concentration in serum protein.

Question 5

An automated nephelometric assay allows for the quantitation of:

A)( $\kappa$ free light chains.)
B)( $\lambda$ free light chains.)
C)light chains on automated instruments.
D)All of the above.

Question 6

Match the terms with the appropriate definition.
Monoclonal gammopathy

A)Benign or malignant condition that results from a single clone of lymphoid-plasma cells producing elevated levels of a single class and type of immunoglobulin
B)Condition characterized by the elevation of two or more immunoglobulins by several clones of plasma cells

Question 7

Which laboratory assay has been adopted as a prognostic indicator in multiple myeloma?

A)( $\beta$ ₂-microglobulin level)
B)IgG serum concentration
C)IgM serum concentration
D)IgA serum concentration

Question 8

The difference in antibody class between multiple myeloma (MM) and Waldenström's macroglobulinemia (WM) is that the most common form of MM displays _________, but WM displays ____________.

A)IgG; IgM
B)IgG; IgD
C)IgM; IgG
D)IgA; IgM

Question 9

The major growth factor for multiple myeloma (MM) cells is

A)IL-2.
B)IL-6.
C)IL-20.
D)IL-22.

Question 10

Fluorescent in situ hybridization (FISH) testing of a bone marrow aspirate in patients with multiple myeloma should include the following:

A)t(4;14)(p16;q32)
B)t(14;16)(q32;q23)
C)17p13 deletions
D)A, B and C

Question 11

More than one-third of patients with Waldenström's macroglobulinemia (WM) display

A)hepatomegaly and splenomegaly.
B)lymphadenopathy.
C)Raynaud's phenomenon.
D)all of the above.

Question 12

The most consistent immunologic feature of multiple myeloma (MM) is

A)constant synthesis of a dysfunctional single monoclonal protein.
B)incessant synthesis of immunoglobulin chains of fragments.
C)suppression of the synthesis of normal functional antibody.
D)All of the above.

Question 13

Monoclonal gammopathy of undetermined significance (MGUS) represents (a)

A)monoclonal protein in patients with no features of multiple myeloma (MM) 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.

Question 14

What is the M component in a monoclonal gammopathy?

A)Excessive IgM antibody
B)Monoclonal antibody or cell line
C)Excessive number of macrophages
D)Proliferation of malignant cells

Question 15

Patients with multiple myeloma (MM) have defects in ______________ but not in _____________.

A)cellular immunity; humoral immunity
B)humoral immunity; cellular immunity
C)blood cell multiplication; protein synthesis
D)complement; the structure of other protein molecules

Question 16

Mortality exceeds 50% in patients with multiple myeloma (MM) because of

A)sepsis.
B)renal insufficiency.
C)aplastic anemia.
D)bone fractures.

Question 17

When an M spike is observed on serum protein electrophoresis, the suggested sequence of testing includes testing by

A)immunoelectrophoresis.
B)immunofixation.
C)flow cytometry.
D)Both A and B.

Question 18

If an IgG spike is observed on a serum electrophoretic pattern, what diagnosis does this suggest?

A)Multiple myeloma (MM)
B)Waldenström's macroglobulinemia (WM)
C)Acute lymphoblastic leukemia (ALL)
D)Hypogammaglobulinemia

Question 19

Patients with multiple myeloma that exhibit increased Serum free light chains may be efficiently demonstrated to have these abnormal free serum light chains by which of the following techniques?

A)Serum protein electrophoresis
B)Serum free light chain immunoassay
C)Repeated bone marrow biopsies
D)Whole-body scans

Question 20

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.

Question 21

Match the terms with the appropriate definition.
Polyclonal gammopathy

A)Benign or malignant condition that results from a single clone of lymphoid-plasma cells producing elevated levels of a single class and type of immunoglobulin
B)Condition characterized by the elevation of two or more immunoglobulins by several clones of plasma cells

Question 22

Match the types of cryoglobulin with the correct description.

-Type II

A)Mixed cryoglobulins in which both constituent immunoglobulins are polyclonal. More than 90% contain IgM rheumatoid factor and IgG. These cryoglobulins are seen in a variety of autoimmune, systemic rheumatic diseases and persistent infections with immune complexes (e.g., bacterial endocarditis).
B)Cryoglobulins composed of a single class; IgM and IgG classes most common; IgA or light-chain, single cryoglobulins seen less frequently. This type constitutes about 25% of cryoglobulins and is generally associated with multiple myeloma, macroglobulinemia, and other, rarer neoplastic proliferations of plasma cells and lymphocytes.
C)Cryoglobulins consist of two forms. The monoclonal form always has rheumatoid factor activity and usually is an IgM with $\kappa$ light chains. The second form is polyclonal IgG, which reacts with the monoclonal IgM rheumatoid factor.

Question 23

Match the types of cryoglobulin with the correct description.

-Type I

A)Mixed cryoglobulins in which both constituent immunoglobulins are polyclonal. More than 90% contain IgM rheumatoid factor and IgG. These cryoglobulins are seen in a variety of autoimmune, systemic rheumatic diseases and persistent infections with immune complexes (e.g., bacterial endocarditis).
B)Cryoglobulins composed of a single class; IgM and IgG classes most common; IgA or light-chain, single cryoglobulins seen less frequently. This type constitutes about 25% of cryoglobulins and is generally associated with multiple myeloma, macroglobulinemia, and other, rarer neoplastic proliferations of plasma cells and lymphocytes.
C)Cryoglobulins consist of two forms. The monoclonal form always has rheumatoid factor activity and usually is an IgM with $\kappa$ light chains. The second form is polyclonal IgG, which reacts with the monoclonal IgM rheumatoid factor.

Question 24

Match the types of cryoglobulin with the correct description.

-Type III

A)Mixed cryoglobulins in which both constituent immunoglobulins are polyclonal. More than 90% contain IgM rheumatoid factor and IgG. These cryoglobulins are seen in a variety of autoimmune, systemic rheumatic diseases and persistent infections with immune complexes (e.g., bacterial endocarditis).
B)Cryoglobulins composed of a single class; IgM and IgG classes most common; IgA or light-chain, single cryoglobulins seen less frequently. This type constitutes about 25% of cryoglobulins and is generally associated with multiple myeloma, macroglobulinemia, and other, rarer neoplastic proliferations of plasma cells and lymphocytes.
C)Cryoglobulins consist of two forms. The monoclonal form always has rheumatoid factor activity and usually is an IgM with $\kappa$ light chains. The second form is polyclonal IgG, which reacts with the monoclonal IgM rheumatoid factor.