Question 1

A 10-year-old girl was brought in to her physician's office because she had been complaining that she was thirsty and had to go to the bathroom all the time.She had lost 15 pounds over the last 6 months and was more irritable than usual,especially after meals.The girl's fasting blood glucose was 575 mg/dL,her C-peptide was 0.5 ng/mL,and she had autoantibodies against glutamic acid decarboxylase and insulin.This girl has:

Accepted Answer

The symptoms described indicate a diagnosis of type 1 diabetes, including excessive thirst, frequent urination, unexplained weight loss, irritability, and high fasting blood glucose levels. The presence of autoantibodies against glutamic acid decarboxylase and insulin also support the diagnosis of type 1 diabetes. Hashimoto's thyroiditis, acute glomerulonephritis, and progressive systemic sclerosis are not related to the symptoms or laboratory values described.

Question 2

A 33-year-old female presents with red and irritated eyes for the last month.Discharge from the eyes is not apparent.She also has had recurrent low-grade fever and a rash on her chest and legs.Her joints have been achy for the last few months,and her mouth has been so dry it is often difficult to swallow food.Antinuclear antibody testing is performed,and a speckled pattern is observed on hep-2 cells.Follow-up testing reveals the presence of autoantibodies against SS-A and SS-B.This woman has:

Accepted Answer

The patient presents with symptoms consistent with Sjögren's syndrome, including dry eyes, dry mouth, joint pain, and autoantibodies against SS-A and SS-B. The rash on her chest and legs may be due to vasculitis, a common complication of Sjögren's syndrome. The speckled pattern on hep-2 cells is indicative of autoimmune disease, but the absence of other symptoms such as rash, oral ulcers, and joint pain make systemic lupus erythematosus less likely. Rheumatoid arthritis typically presents with joint swelling and tenderness, and Hashimoto's thyroiditis would not explain the patient's other symptoms.

Question 3

Systemic lupus erythematosus can be characterized by all of the following EXCEPT:

Accepted Answer

Systemic lupus erythematosus is characterized by a butterfly rash, joint pain, and the presence of circulating immune complexes. However, it is not characterized by the presence of reagin antibody, which is typically associated with syphilis.

Question 4

In the slide agglutination for lupus,which of the following is detected?

Accepted Answer

The slide agglutination test for lupus detects anti-DNP (deoxyribonucleoprotein) antibodies, which are associated with systemic lupus erythematosus (SLE).

Question 5

Which of the following would be an indicator of systemic lupus?

Accepted Answer

Anti-Sm antibody is a specific autoantibody that is commonly found in individuals with systemic lupus erythematosus (SLE). In fact, it is one of the diagnostic criteria for SLE. The other choices, anti-EB antibody, anti-myelin basic protein antibody, and anti-insulin antibody, are not specific to SLE and are associated with other conditions.

Question 6

A 45-year-old male presents to his physician complaining of achy joints,chronic runny nose,and coughing up blood.Chest x-ray shows pulmonary nodules.Cortisol is increased; ESR is slightly elevated.Tests for autoantibodies are positive for cytoplasmic antineutrophil cytoplasmic antibodies.This patient has:

Accepted Answer

The symptoms described are indicative of Wegener's granulomatosis, which is an autoimmune disease that causes inflammation of blood vessels in the nose, throat, and lungs. The presence of pulmonary nodules, high cortisol, and positive cytoplasmic antineutrophil cytoplasmic antibodies are all consistent with this diagnosis. Systemic lupus erythematosus and rheumatoid arthritis typically do not cause pulmonary nodules or coughing up blood. Chronic granulomatous disease is a genetic disorder that affects the immune system, but it does not present with the specific symptoms described.

Question 7

A 54-year-old woman presents to her optometrist complaining that she has been having difficulty focusing on objects,both near and far.Her vision problems are getting progressively worse.She also thinks that her eyelids are drooping and she is thinking of getting plastic surgery to "put them back up." The optometrist cannot find a good reason for her vision problems but is able to fit her with glasses and recommends that she see a rheumatologist.The rheumatologist sends the women's blood for autoantibody testing,and the laboratory professionals report that the woman has autoantibodies against the acetylcholine receptor.This woman has:

Accepted Answer

The presence of autoantibodies against the acetylcholine receptor is highly suggestive of myasthenia gravis, which is a neurological disorder that affects the transmission of nerve impulses to muscles, causing weakness and fatigue. The woman's complaints of difficulty focusing and drooping eyelids are consistent with myasthenia gravis, which commonly affects the muscles responsible for eye movements and facial expressions. The other options (Goodpasture's syndrome, Addison's disease, and multiple sclerosis) do not typically present with the same symptoms or laboratory findings as myasthenia gravis.

Question 8

Reasons for autoimmunity may include all of the following EXCEPT:

Accepted Answer

Normal antibody production is not a reason for autoimmunity. The other options (inheritance of certain HLA antigens, molecular mimicry, and polyclonal B cell activation) have been linked to the development of autoimmune disorders.

Question 9

A 40-year-old female patient has increased TSH and decreased rT3 and T4 levels with a normal T3 level.Antithyroglobulin is measured as 1:1280,and the antimicrosomal level is reportedly 1:6400.This patient most likely has:

Accepted Answer

The increased TSH and decreased T4 levels with a normal T3 level indicate hypothyroidism. The high levels of antithyroglobulin and antimicrosomal antibodies suggest Hashimoto's thyroiditis, which is a common cause of hypothyroidism. Neither type 1 diabetes nor systemic lupus erythematosus is typically associated with thyroid dysfunction. Graves' disease, on the other hand, is a cause of hyperthyroidism, not hypothyroidism, and would not be expected to have the same pattern of laboratory values seen in this patient.

Question 10

The fluorescent antinuclear antibody test for lupus is an example of which of the following?

Accepted Answer

The fluorescent antinuclear antibody test for lupus is an example of indirect fluorescent testing, as it involves identifying the binding of fluorescent antibodies to specific antigens in the patient's serum.

Question 11

The "CREST" variant of which disease is associated with the presence of an anticentromere antibody?

Accepted Answer

The CREST variant of progressive systemic sclerosis (scleroderma) is associated with the presence of an anticentromere antibody. CREST stands for Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia, which are characteristic features of this variant. The presence of anticentromere antibody is a diagnostic feature of CREST syndrome.

Question 12

Which of the following are characteristic of cold autoimmune hemolytic anemia?

Accepted Answer

Cold autoimmune hemolytic anemia is characterized by the presence of cold agglutinins, which are typically IgM antibodies that react with the I antigen on red blood cells.

Question 13

A 30-year-old clinical laboratory sciences student complains of being tired,yet not able to sleep.The woman also states that her hair has been breaking off and she has lost 20 pounds over the last 2 months without trying.The woman's pulse and blood pressure are both elevated and her eyes seem to be bulging.Her CBC is normal,thyroid-stimulating hormone is decreased,and T4 is increased.Antimicrosomal and antithyroglobulin antibodies are each 1:400.This woman has:

Accepted Answer

The symptoms described are consistent with hyperthyroidism and the presence of antithyroid antibodies supports the diagnosis of Graves' disease. Addison's disease is a disorder of the adrenal glands and would present with different symptoms, like fatigue, weight loss, and low blood pressure. Hashimoto's thyroiditis is a type of autoimmune hypothyroidism and would present with opposite lab results, like an increased TSH and a decreased T4. Type 1 diabetes and rheumatoid arthritis are not associated with the symptoms described.

Question 14

A 56-year-old woman presents to her physician complaining of weight gain and joint problems.She is increasingly having difficulty walking up stairs and manipulating her fingers.Fingers in both hands as well as knees on both legs are equally painful and stiff.The symptoms have been progressing over the last 6 months.Rheumatoid factor is elevated,and antinuclear antibodies are not detected.Complement levels in her joints are less than the levels in her serum.This woman has:

Accepted Answer

The patient's symptoms of joint pain and stiffness, along with an elevated rheumatoid factor and normal antinuclear antibodies, are consistent with a diagnosis of rheumatoid arthritis. The presence of complement levels in joints being less than serum is also a characteristic feature of rheumatoid arthritis. Systemic lupus erythematosus and Wegener's granulomatosis can also cause joint problems, but the absence of antinuclear antibodies and other symptoms make these less likely diagnoses. Hashimoto's thyroiditis is an autoimmune disorder affecting the thyroid gland and does not typically involve joint symptoms.

Question 15

The characteristic ANA pattern produced by antibody to DNA-histone complex is:

Accepted Answer

The answer of The characteristic ANA pattern produced by antibody...

Question 16

A disease characterized by hypoactivity of the thyroid with weight gain and a sluggish metabolism due to destruction of thyroglobulin best describes:

Accepted Answer

Hashimoto's thyroiditis is an autoimmune disorder in which the body's immune system attacks the thyroid gland, resulting in reduced production of thyroid hormones. This leads to symptoms such as weight gain, sluggish metabolism, and fatigue. Graves' disease, on the other hand, is characterized by hyperactivity of the thyroid gland, resulting in symptoms such as weight loss, increased heart rate, and anxiety. Myasthenia gravis is a neuromuscular disorder that causes muscle weakness and fatigue, while rheumatoid arthritis is an autoimmune disorder that primarily affects the joints. Neither of these conditions are directly related to thyroid function.

Question 17

An autoimmune disease characterized by pain and progressive destruction of the joints,weight loss,morning stiffness,and presence of an antibody directed against IgG best describes:

Accepted Answer

Rheumatoid arthritis is an autoimmune disease that primarily affects the joints, causing pain and destruction over time. Weight loss and morning stiffness are also common symptoms. A hallmark of rheumatoid arthritis is the presence of an antibody directed against IgG, known as rheumatoid factor. Lupus may also involve joint pain and autoimmune activity but is not typically characterized by the destruction seen in rheumatoid arthritis. Hemolytic disease of the newborn and hemolytic anemia involve destruction of red blood cells, not joint pain or autoimmunity.

Question 18

Which of the following lab findings would be most likely to indicate multiple sclerosis?

Accepted Answer

Several bands on electrophoresis of CSF is a characteristic finding in multiple sclerosis, indicating the presence of oligoclonal bands. The other options are not specific for multiple sclerosis.

Question 19

In the RF test for rheumatoid arthritis,what is being detected?

Accepted Answer

The RF test detects IgM antibodies directed against IgG. This is a common finding in patients with rheumatoid arthritis. A positive RF test can help confirm the diagnosis of rheumatoid arthritis.

Question 20

A 40-year-old woman presents with a lemon-yellow,waxy pallor and a red,beefy tongue.She is extremely fatigued and is having difficulty getting up in the morning and getting through the day.Antiparietal cell antibodies are found in her serum.This woman has:

Accepted Answer

The lemon-yellow, waxy pallor and red, beefy tongue indicate a B12 deficiency which is commonly seen in pernicious anemia. Antiparietal cell antibodies are also associated with pernicious anemia. Graves' disease and type 1 diabetes do not typically present with these symptoms. Ulcerative colitis may cause anemia, but it does not typically cause the characteristic waxy pallor and red, beefy tongue seen in B12 deficiency.

Quiz 14: Autoimmunity