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Select the ONE answer that is BEST in each case.
A 29-year-old woman is being treated with penicillin for “strep throat.” She develops arthralgia, lymphadenopathy, urticaria, and an active urine sediment 6 days after starting the antibiotics. Which of the following is the most likely mechanism of this drug reaction?
Drug hypersensitivity is the most common cause of serum sickness. It is believed that the drug acts as a hapten binding to a plasma protein. The resultant drug-protein complex induces an immune response. Common signs and symptoms include fever, skin rash (urticarial or morbilliform), arthralgias, lymphadenopathy, and albuminuria. Arthritis, nephritis, neuropathy, and vasculitis are less common. Primary sensitization requires 1–3 weeks, but symptoms can occur rapidly on reexposure
See all quizzes of the Immunology and Allergy at here:
1. A 29-year-old woman is being treated with penicillin for “strep throat.” She develops arthralgia, lymphadenopathy, urticaria, and an
active urine sediment 6 days after starting the antibiotics. Which of the following is the most likely mechanism of this drug reaction?
(A) immunoglobulin E (IgE) release
(B) mast cell degranulation
(C) immediate-type hypersensitivity
(D) macrophage-endothelial cell interaction
(E) circulating immune complexes
2. A 24-year-old man is diagnosed with disseminated histoplasmosis after developing symptoms of fever, lymphadenopathy, hepatosplenomegaly, and pancytopenia. Which of the following is the body’s major immunologic defense against histoplasmosis?
(A) immunoglobulin G (IgG) antibodies
(B) mononuclear leukocytes
(D) immunoglobulin M (IgM) antibody
3. Which of the following are large, granular lymphoid cells that are mediators of antibodydependent cellular cytotoxicity?
(B) natural killer (NK) cells
(C) T lymphocytes, suppressor subset
(D) B lymphocytes
4. A 9-year-old boy presents with sneezing, runny nose, and nasal congestion. The symptoms are seasonal and worse in the spring time. He is diagnosed with hay fever (allergic rhinitis). Which of the following statements about hay fever is correct?
(A) sufferers may develop asthma
(B) symptoms are not improved by moving to different locations
(C) sufferers are less prone to develop upper respiratory infections (URIs)
(D) sufferers are severely disturbed emotionally
(E) hay fever can be improved symptomatically only with steroids
5. A 19-year-old man has recurrent attacks of gastrointestinal colic and swelling of his face and legs. There is no relationship of the attacks to any foods or activity. His father has a similar syndrome. Which of the following is the most likely cause of death in this disease?
(A) an unrelated condition
(B) an anaphylactic shock reaction
(C) edema of the glottis
(E) a reaction
6. A 34-year-old woman with human immunodeficiency virus (HIV) has a routine complete blood count performed. She was diagnosed
2 years ago, and is currently doing well with no symptoms and not on any antiretroviral therapy. Which of the following changes is most
likely seen on her peripheral blood cell counts?
(C) increased helper T cells
(E) decreased NK cells
7. A 30-year-old woman with myasthenia gravis is found to have an autoimmune hemolytic anemia. The chest x-ray (CXR) reveals an anterior mediastinal mass. Which of the following is the most likely diagnosis?
(B) nodular sclerosing Hodgkin’s disease
(C) small cleaved cell non-Hodgkin’s lymphoma
(E) bronchogenic carcinoma, small cell undifferentiated type
8. A 19-year-old man presents with coughing up blood and decreased urine output. On examination, he has normal air entry, and heart
sounds. There is no skin rash or lymph nodes and his abdomen is normal. CXR reveals patchy infiltrates in both lower lobes and his
creatinine is elevated. Urinalysis is positive for red cells and protein. A renal biopsy reveals autoantibodies to basement membranes. Which of the following is the most likely diagnosis?
(B) myasthenia gravis
(C) Goodpasture’s syndrome
(E) hemolytic anemia
9. A 25-year-old woman presents with decreased urine output, new leg edema, and facial swelling. She was previously well with no past
medical history. Laboratory investigations reveal acute renal failure and a renal biopsy is performed. Immunofluorescence of the biopsy
specimen reveals a granular pattern of immune complex-mediated glomerulonephritis. Which of the following conditions is most likely to
cause this pattern of renal injury?
(A) acute tubular necrosis (ATN)
(B) Wegener’s granulomatosis
(C) postinfectious glomerulonephritis
(D) hemolytic uremic syndrome (HUS)
(E) Goodpasture’s syndrome
10. A 25-year-old woman has been getting desensitization shots for an allergy for 1 year. Today she developed diffuse urticaria 5 minutes after the injection. Which of the following is the most appropriate next step in management?
(A) discontinuation of subsequent injections for 3 weeks
(B) application of a tourniquet distal to the injection site
(C) administration of steroids prior to the next injection
(D) administration of aminophylline subcutaneously
(E) administration of epinephrine (1:1000) subcutaneously
11. A 23-year-old man treated for strep throat with penicillin develops arthralgia, urticaria, and lymphadenopathy. Urinalysis reveals red cell
casts. Which of the following is characteristic of the syndrome?
(A) it usually requires corticosteroids
(B) symptoms last several months
(C) it may recur after apparent recovery
(D) it may be transferred by leukocyte infusions
(E) most patients are children
12. A22-year-old woman has recurrent fungal infections and is suspected of having immunodeficiency secondary to impaired T-cell function. Which of the following is the most cost-effective screening test of cellular immunity?
(A) quantification of serum immunoglobulin A (IgA)
(B) lymphocyte enumeration on a cell sorter
(C) lymphocyte responses to mitogens
(D) nitroblue tetrazolium assay
(E) intradermal skin test with Candida albicans
13. A 19-year-old female university student unwittingly eats shrimp in the dormitory dining room. Over the next 20 minutes, acute skin
lesions consisting of erythematous, elevated wheals appear. Which of the following is most characteristic of these lesions?
(A) are most common on the palms and soles
(B) are rarely itchy
(C) do not blanch on pressure
(D) are caused by a localized vasculitis
(E) are caused by an ongoing, immediate, hypersensitivity reaction
14. A 27-year-old man develops small (several millimeters) pruritic wheals when he goes jogging and when he takes very hot showers. Which of the following is most appropriate in the management of this condition?
(A) discontinuation of all vigorous exercises
(B) counseling regarding recognition and
treatment of anaphylactic reactions
(C) treatment with anticholinergic medications
(D) treatment with hydroxyzine
(E) cool baths rather than hot showers
15. A 42-year-old man has an allergy to penicillin. He is given cephalexin for a skin infection on his finger after a cut became infected. He now develops angioedema after drug exposure. Which of the following physical findings is characteristic of this syndrome?
(A) invariably severe itching
(B) prolonged nature of the edema
(C) fluid extravasation from subcutaneous and intradermal postcapillary venules
(D) involvement of lips, tongue, eyelids, genitalia, and dorsum of hands or feet
(E) fluid accumulation in the most dependent areas of the body
16. A 47-year-old woman, with Type I diabetes of 30 years’ duration, is in the hospital for assessment of atypical chest pain. While in the hospital, she develops a true anaphylactic reaction. Which of the following is the most likely cause for the reaction?
(A) radiographic contrast media
(D) folic acid supplement
(E) exposure to nuts
17. A 27-year-old long-time intravenous (IV) drug user has recurrent infections and a low CD4+ count. Which factor is true concerning this
(A) qualitative defects in T lymphocytes follow quantitative problems
(B) the low CD4 count in advanced disease is secondary to the direct cytotoxic effects of virus infection
(C) B-lymphocyte abnormalities do not occur early in the disease
(D) macrophages are important in viral dissemination
(E) circulating immune complexes are rarely present
18. A 24-year-old man with known HIV infection presents with a right hemiparesis that developed over several days. Cognitive examination reveals global impairment, and a computed tomography (CT) scan reveals multiple cortical lesions that are spherical and ring enhancing. Which of the following is the most likely diagnosis?
(A) glioblastoma multiforme
(D) progressive multifocal leukoencephalopathy
(E) cytomegalovirus (CMV)
19. A 23-year-old woman has had several episodes of severe wheezing over the past 3 years. She is a nonsmoker and feels well in between
episodes. She has no personal or family history of atopy. The wheezing episodes are most likely to occur in spring. Which of the following is the most likely mechanism of wheezing in this woman?
(A) elevated IgE levels
(B) mast cell instability
(C) nonspecific hyperirritability of the
(D) disordered immediate hypersensitivity
(E) disordered delayed hypersensitivity
20. A 45-year-old man with severe asthma is doing well after a recent exacerbation requiring hospital admission. He is interested in avoiding any potential agents that might trigger his asthma. Which of the following foods is most likely to precipitate an asthmatic reaction in this man?
(A) red meat
(B) egg whites
(C) green salad