Serology Exam 2

Front 1

What is Central Tolerance?

Back 1

The positive and negative selection of body cells

Front 2

What is Peripheral tolerance?

Back 2

The system that down regulates potentially self-reactive body cells that passed through central tolerance.

Front 3

Do autoimmune disorders occur more frequently in men or woman? Explain your answer.

Back 3

Woman, because hormone levels contribute to self-reactivity.

Front 4

True or False?

Genetics such as HLA and Human Leukocyte Antigen (HLA) play an important role in susceptibility to autoimmune dz.?

Back 4

True

Front 5

What is the concept of immunological cross reactivity in regards to autoimmune dz?

Back 5

On cause of autoimmunity is that an Ab reacts to an Ag that is similar to the Ag that made the Ab. If the foreign epitope is similar enough to the original it can cause an immune response to self.

Front 6

What are the mechanisms of pathology in autoimmunity?

Back 6

1. Immune complex-mediated injury
2. Anti- tissue Ab
3. Cell-mediated immunity

Front 7

In what autoimmune Dz does the body produce Abs to TSH receptors to stimulate TSH? (Stimulating Ab)

Back 7

Grave's Dz, results in hyperthyroidism.

Front 8

In what autoimmune Dz does the body produce antibodies to acetylcholine receptors and inhibit neural pathways? (Blocking Ab)

Back 8

Myasthenia Gravis, results in improper muscle contractions. Can be seen in droopy eyelids b/c muscles are inhibited.

Front 9

What are ANAs?

Back 9

Antinuclear Anitbodies, they are antibodies that are formed against cell debris after apoptosis.

Front 10

What test is diagnostic of SLE?

Back 10

ANA using indirect immunofluorescence

Front 11

What ANA pattern is associated with these Ags:
- deoxyribonucleoprotein
- histones
- dsDNA

Back 11

Diffuse or Homogenous pattern

Front 12

What ANA pattern is solely indicative of SLE and is associated with the dsDNA Ag?

Back 12

Peripheral/Rim pattern

Front 13

True or False?

The main Ag for ANA speckled pattern is saline extractable Ag- Smith (Sm)?

Back 13

True, and it is indicative of SLE

Front 14

The nucleolar ANA pattern stains what parts of the cell?

Back 14

The nuclear RNA

Front 15

The centromere ANA pattern stains which part of the cell? And what Dz does it indicate?

Back 15

It stains the centromere region of the chromosome and indicates sclerosis.

Front 16

Anti-Smith Abs and anti-dsDNA Abs are exlusive to what Dz?

Back 16

SLE

Front 17

Antihistone Abs are linked to what subset of SLE? (Histones are the nuclear proteins that are the main component of chromatin)

Back 17

Drug induced SLE

Front 18

What are the Abs linked to Sjogren's syndrome?

Back 18

Anti-SS-A and Anti-SS-B

Front 19

What is the most specific ANA for SLE and what are the values seen in SLE Pts?

Back 19

Anti-dsDNA, >70% of SLE Pts have it and <1% of non-SLE don't have it.

Front 20

ds-DNA titers over what value are reliable to diagnose SLE?

Back 20

80

Front 21

Immunoflurescence assays for Anti-dsDNA rely on what protazoan and why?

Back 21

Crithidia luciliae, b/c it contains dsDNA in certain intracellular organelles. If the Pt has Anti-dsDNA, their IgG will bind to the dsDNA from the protazoan.

Front 22

True or False?

RA is usually diagnosed between the ages of 60-70?

Back 22

False, it is diagnosed between 30-50.

Front 23

True or False?

Men are 3x more likely to get RA than woman?

Back 23

False, woman are 3x more likely.

Front 24

True or False?

Manifestation of RA in the joints results in symmetrical joint swelling, stiffness, lethargy, and discomfort.

Back 24

True

Front 25

What cells does the pannus consist of in RA?

Back 25

Mainly macrophages, neutrophils, and lymphs.

Front 26

Which Ig is a common finding in RA?

Back 26

IgM, reacting with the Fc portion of IgG

Front 27

What is the term used for the anti-IgG Ab that forms in RA?

Back 27

Rheumatoid Factor (RF)

Front 28

True or False?

RF complexes in the joints lead to complement activation, and inflammatory damage

Back 28

True

Front 29

What Ab is diagnostic for RA?

Back 29

Anti-cyclic citrullinated peptides (Anti-CCP)

Front 30

True or False?

A very specific and sensitive diagnostic test for RA is Anti-dsDNA assay?

Back 30

False, it is Anti-CCP assay.

Front 31

What some treatments of RA?

Back 31

Physical therapy, anti-inflammatory drugs, diseae-modifying anti-rheumatic drugs

Front 32

What is the auto Ab present in Hashimoto's Tyroiditis?

Back 32

Anti-thyroglobulin, TSH-binding inhibitory Ab, and Anti-thyroid peroxidase

Front 33

True or False?

Hashimoto's thyroiditis is characterized by hypothyroidism, and elevated TSH?

Back 33

False, hyperthyroidism and elevated TSH

Front 34

Hyperthyroidism, low thyroxine, and decreased TSH are all signs of what AID?

Back 34

Grave's Dz,

Front 35

True or False?

Thyroxine functions to increase the production of TSH?

Back 35

False, thyroxine (T3 and T4) function to downregulate TSH production.

Front 36

In this AID, Thyroid Stimulating Immunoglobulin (TSI) binds to TSH receptor and stimulates thyroid hormone release with out TSH present.

Back 36

Grave's Dz

Front 37

Addison's disease results in the inability to produce _________ under stress.

Back 37

Cortisol

Front 38

This Dz is caused by autoimmune destruction of the adrenal cortex.

Back 38

Addison's Dz

Front 39

Diagnostic signs of this Dz are elevated ACTH, renin, and ACTH.

Back 39

Addison's Dz

Front 40

True or False?

The first stage of autoimmune testicular failure is destruction of the Sertoli cells followed by second stage with the destruction of Leydig cells.

Back 40

False, first stage is Leydig cells and second stage is sertoli cells.

Front 41

Patients with Celiac Dz develop an intolerance to what?

Back 41

Gluten.

Front 42

What occurs in the intestines of people with Celiac Dz after they have eaten gluten?

Back 42

IgA autoantibodies react with the lining of the smooth muscle of the small intestine.

Front 43

Pernicious anemia results from a deficiency of ________.

Back 43

Vitamin B12

Front 44

The levels of what stomach protein are a good diagnostic test for Pernicious anemia?

Back 44

Intrinsic factor

Front 45

What is the treatment for Pernicious anemia?

Back 45

Monthly intramuscular vit B12 injections

Front 46

What is the difference in pathophysiology of ulcerative colitis and Chron's Dz.

Back 46

UC usually affects the large intestine and does not affect the anus. Chron's Dz can affect the entire digestive system, including the mouth an anus.

Front 47

What are skip lesions?

Back 47

-they are in the rectum and large intestine
- normal intestine adjacent to friable cobblestone mucosa

Front 48

What is the key identifying mark of Chron's Dz?

Back 48

Granulomas

Front 49

What is a granuloma? (Chron's Dz)

Back 49

Collections of macrophages and monocytes in any layer of the intestinal wall.

Front 50

Jaundice, elevated liver enzymes, clotting disorders, and chronic lecrotic inflammation in liver biopsy are all evidence of what?

Back 50

Hepatic disease/ Liver failure

Front 51

True or False?

Type I Hepatic Dz is characterized by Anti-liver/kidney microsomes and anti-liver cytosol Ag.

Back 51

False, Type I is characterized by ANAs and Anti-smooth muscle Ab.

Front 52

Exlusion of viral hepatitis and alcoholism, the presence of autoantibodies, elevated IgG levels, and liver histology is a signs for diagnosis of ___________.

Back 52

Hepatic Dz

Front 53

Treatment of Hepatic Dz includes ___________

Back 53

Glucocorticoids

Front 54

Inflammation of the bile ducts in the liver is diagnostic of _______________

Back 54

Primary biliary Cirrhosis (PBC)

Front 55

In this AID, overtime scarring and destruction of the biliary network causes blockage of the bile from the liver, called cholestasis.

Back 55

Primary biliary Cirrhosis

Front 56

As scarring in PBC progresses, what symptoms occur?

Back 56

- Abdominal pain in upper right quadrant (Liver)
- dry mouth and eyes
- joint pain
- hepatosplenomegaly

Front 57

What is the Ab in PBC?

Back 57

Anti-mitochondria, very specific(>95%) and sensitive.

Front 58

True or False?

Pemphigus vulgaris has blisters within the epithelial layer and can have both cutaneous and mucosal lesions?

Back 58

True

Front 59

What is the Ab in the Pemphigus vulgaris?

Back 59

Anti-Desmoglein

Front 60

True or False?

Bullous pemphigoid causes blisters within the epithelial layer?

Back 60

False, it causes blisters below the dermis, at the dermal/epidermal junction.

Front 61

What is the Ab in Bullous pemphigoid?

Back 61

Anti-bullous pemphigoid (BP)

Front 62

What Integumentary AID is characterized by small blisters on an erythamatous base?

Back 62

Dermatitis herpetiformis

Front 63

This AID attacks the bodies ACH receptors and causes problems with motor function.

Back 63

Myasthenia Gravis

Front 64

What test is used for Dx of Myasthenia Gravis?

Back 64

Anti-ACH receptor assay,
Very specific (>80%)

Front 65

Why are ACH-ase inhibitors and immunosuppressive drugs used in Myasthenia Gravis?

Back 65

- ASH-ase inhibitors b/c we are trying to increase the conc. of ACH in the neuromuscular junction.
- IM drugs to try and shut down the autoimmunity

Front 66

What Ab is present in Dermatitis herpetiformis?

Back 66

Anti-tissue transglutaminase

Front 67

A carcinoma is a tumor of ___________

Back 67

Epithelial tissue

Front 68

An adenocarcinoma is a tumor of _____________.

Back 68

Epithelial cells that form glandular structures.

Front 69

A sarcoma is a tumor of __________________.

Back 69

Supportive/ connective tissue (muscle, bone, cartilage, fat, blood vessels)

Front 70

Leukemia, Lymphoma, and myeloma, are tumors involved with ____________

Back 70

White blood cells

Front 71

CNS malignancies have tumors involving ___________.

Back 71

The brain and spinal cord

Front 72

True or False?

The scale for grading a tumor based upon differentiation goes from T0-T4 with the least differentiation at T4?

Back 72

False, differentiation is graded by G1-G4, G4 being the least differentiated. (Worst prognosis)

Front 73

What is the grading scale for tumor size?

Back 73

T0=no evidence of tumor
T1-T4= increasingly larger tumor

Front 74

What is the grading scale for measuring the nodal involvement of a cancerous tumor?

Back 74

N0= no nodes involved
N1-N3= increasing nodal involvement
Nx= unable to define nodal involvement

Front 75

What is the grading scale to measure the amount of metastasis from a cancerous tumor?

Back 75

M0= no distant metastasis
M1= distant metastasis is found
Mx= metastatic involvement cannot be setermined

Front 76

What term is used to describe the substances that can be measured in the blood and on cell surfaces caused by differentiation and growth controls?

Back 76

Tumor associated Ags (TAA)

Front 77

True or False?

Because TAAs can sometimes present in small amount on normal cells, the body may tolerate them in tumor cells as well instead of destroying them?

Back 77

True

Front 78

What are TAAs good for measuring/monitoring?

Back 78

1. Diagnosis/staging of tumor
2. monitoring/localization of metastasis
3. evaluation of biopsies
4. Immunotherapy

Front 79

What are some non-serologic cancer screening tests?

Back 79

1. Self examination
2. fecal occult blood
3. digital rectal scan for prostate cancer
4. colonoscopy

Front 80

True or False?

When using TAAs as a diagnostic tool, there are high false-negs and false-pos?

Back 80

False, TAAs are very specific to whether Dz is present or not.

Front 81

True or False?

TAA test is a stand-alone Dx for cancer and does not need to be performed with other tests?

Back 81

False, TAA testing is a confirmatory test when a screening is positive.

Front 82

What tests enhance the ability to see tumor cells?

Back 82

1. Flow cytometry
2. FISH test
3. qPCR

Front 83

What proteins are diagnostic of MM and are found in the urine?

Back 83

Bence-Jones Proteins

Front 84

What are Bence-Jones proteins?

Back 84

- Light chain Ig
- found in urine of MM Pts

Front 85

True or False?

Beta-2 microglobulin is a component of anucleated cells and is used to diagnose AML, CML, and MMM?

Back 85

False, Beta-2 macroglobulin is a component of Nucleated cells and is used to diagnose MM, CLL, and some lymphomas

Front 86

True or False?

Alpha 1-Fetoprotein (AFP) is a tumor marker used to Dx breast cancer?

Back 86

False,

It is used to Dx testicular cancer and hepatoma

Front 87

True or False?

AFP is elevated in 60% of nonseminomatous testicular cancer and 50-70% with hepatoma?

Back 87

True

Front 88

This tumor marker is Dx for pregnancy and a sensitive indicator of:
- non-seminomatous testicular cancer
-used w/ AFP to reduce false-negs
- gestational trophoblastic
- Germ cell tumors

Back 88

Human Chorionic Gonadotropin (hCG)

Front 89

True or False?

CA 15-3 and CA 27-29 are both tumor markers used to monitor the course of breast cancer and are not used for screening of the cancer?

Back 89

True

Front 90

CA 19-9 tumor marker is used to monitor what cancers?

Back 90

Pancreatic and hepatobiliary (also for stomach and colorectal cancers.

Front 91

True or False?

CA 19-9 is recommended to be used for staging of pancreatic/ hepatobiliary cancer?

Back 91

False, only to be used as a monitoring test.

Front 92

CA 125 is used to monitor and screen for which cancer?

Back 92

Ovarian cancer

Front 93

What other diagnostics can be used with CA 215 to Dx ovarian cancer?

Back 93

- symptoms, familial risk
- pelvic masses
- it is not recommended to be used as a screening test b/c it has high incidence of false-pos b/c of endometriosis, pelvic inflam. Dz, and menstruation.

Front 94

What tumor marker is an oncofetal Ag present in and used for STAGING of colorectal, breast, lung, pancreatic, stomach and ovarian cancers?

Back 94

Carcinoembryonic Ag

Front 95

True or False?

The concentration of Prostate specific Ag increases as the size of the prostate increases?

Back 95

True

Front 96

What are things that would cause a false negative PSA?

Back 96

- taking drugs for a UTI (lower PSA by 50%)
- herbal supplements

Front 97

What are some things that can cause a false pos for PSA?

Back 97

Prostatitis, PSA goes down when prostatitis is treated with antibiotics. If infection is a possibility, treat Pt with antibiotics then retest PSA.

Front 98

True or False?

-2 out of 3 times when PSA is increased, Pt does not have prostate cancer
- 1 out of 7 with prostate cancer do not have elevated PSA

Back 98

True

Front 99

What are the recommended peramiters to be tested for prostate cancer?

Back 99

- If PSA is >1.0 ng/mL then get tested annually. If DRE is positive, biopsy is required.
- If PSA <1.0 ng/mL then analyze in 5 years, at age 45. If still neg, test annually starting at age 50.

Front 100

What would the clinician need to do if patient has a PSA increase of 0.52 ng/mL from their last annual examination? (>0.35 ng/mL per yr is the standard)

Back 100

Perform a biopsy

Front 101

What is the concept of the free to total PSA test?

Back 101

- PSA exists in a complex form in cancer more that free from.
- free to total ratio of <25%, biopsy should be performed

Front 102

Carcinomas (breast, lung, prostate, thyroid, gastrointestinal, endocrine and liver) are detected by immunohistochemical analysis of ____________.

Back 102

Cytokeratins

Front 103

Mesenchymal tumors (melanocyte, muscle fibers, endothelium, nerve, paraganglioma, synovium, or cartilage) are detected by immunohistchemical analysis of _____________________.

Back 103

Vimentin

Front 104

Hepatopoietic tumors (leukemias, lymphomas, myelomas) are detected by immunohistochemical analysis of _____________________.

Back 104

CD 45

Front 105

What tumor marker is measured to determine the tumors susceptibility to Herceptin (anti-HER-2)?

Back 105

HER-2

Front 106

True or False?

Tumors with high HER-2 are likely to respond to anthracycline (chemotherapy)?

Back 106

True!

Front 107

True or False?

The concentration of tumor cells circulating in the blood is indicative of a tumors ability metastasize?

Back 107

True

Front 108

What is the name and method of the only FDA approved test to detect circulating tumor cells?

Back 108

Anti-EpCAM
- react with carcinoma
- bound to ferric particles to enrich tumor cells from blood.
- separated by magnet
- stained w/ anti-cytokeratin/ tumor specific marker
- negative for anti-CD45 labeling

Front 109

What are the 3 monoclonal Abs used in radiolocalization?

Back 109

Prostascint, Bexxar, Zevalin

Front 110

What monoclonal Ab is prostate-specific membrane Ag and is used post-prostatectomy to look for metastasis?

Back 110

Prostscint