Deck 27: Immunoproliferative Disorders

Question 1

MATCHING
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

Answer 1

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

Question 2

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 k light chains.The second form is polyclonal IgG,which reacts with the monoclonal IgM rheumatoid factor.

Answer 2

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.

Question 3

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 k light chains.The second form is polyclonal IgG,which reacts with the monoclonal IgM rheumatoid factor.

Answer 3

Cryoglobulins consist of two forms.The monoclonal form always has rheumatoid factor activity and usually is an IgM with k light chains.The second form is polyclonal IgG,which reacts with the monoclonal IgM rheumatoid factor.

Question 4

Bence Jones proteinuria is often associated with:

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

Question 5

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 6

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 7

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 8

Cryoglobulins are proteins that precipitate at:

A) -18° C.
B) -4° C.
C) 0° C.
D) 4° C.

Question 9

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

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

Question 10

An automated nephelometric assay allows for the quantitation of:

A) k free light chains.
B) l free light chains.
C) light chains on automated instruments.
D) all of the above.

Question 11

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 12

DNA hybridization or blotting is the newest technology available and can be used to detect:

A) abnormal gene arrangements.
B) mutations in cellular oncogenes.
C) increased protein synthesis.
D) both a and b

Question 13

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 14

MATCHING
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 15

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 16

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 17

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 18

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

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

Question 19

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

A) b2-microglobulin level
B) IgG serum concentration
C) IgM serum concentration
D) IgA serum concentration

Question 20

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

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

Question 21

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 22

Fill in the blanks,choosing the correct temperature.
Bence Jones (BJ)proteins are soluble at room temperature,become insoluble near (1)_______,and then resolubilize (dissolve)at (2)________.

A)37° C
B)50° C
C)60° C
D)100° C

Question 23

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 24

Multiple myeloma is the most common form of dysproteinemia.It accounts for (1)_______% of all types of malignant diseases and (2)_______% of hematologic malignancies.

A)1
B)10
C)15
D)25

Question 25

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 k light chains.The second form is polyclonal IgG,which reacts with the monoclonal IgM rheumatoid factor.