Immunopathology Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Immunopathology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Immunopathology Indian Medical PG Question 1: Given the immunologic abnormalities of normal serum IgG, normal serum IgA, normal serum IgM, decreased T-cell function, and decreased parathyroid function, which clinical presentation is most likely?
- A. A 1-year-old boy with severe eczema, recurrent middle-ear infections, lymphopenia, and thrombocytopenia
- B. A 9-year-old boy with an eczema-like rash and recurrent severe staphylococcal infections
- C. A 5-year-old boy who, after 3 months of age, developed recurrent otitis media, pneumonia, diarrhea, and sinusitis, often with simultaneous infections at two or more disparate sites
- D. A distinctive-appearing 8-month-old boy with an interrupted aortic arch, hypocalcemia, and cleft palate (Correct Answer)
Immunopathology Explanation: ***A distinctive-appearing 8-month-old boy with an interrupted aortic arch, hypocalcemia, and cleft palate***
- This presentation is highly suggestive of **DiGeorge syndrome**, characterized by **thymic hypoplasia** (leading to decreased T-cell function) and **parathyroid hypoplasia** (causing hypocalcemia).
- **Cardiac defects** (like an interrupted aortic arch) and **facial anomalies** (including cleft palate) are also classic features of this disorder, which involves a deletion on chromosome 22q11.2.
*A 1-year-old boy with severe eczema, recurrent middle-ear infections, lymphopenia, and thrombocytopenia*
- This clinical picture describes **Wiskott-Aldrich syndrome**, an X-linked disorder characterized by the triad of eczema, thrombocytopenia (with small platelets), and immunodeficiency leading to recurrent infections.
- While it involves immunodeficiency and lymphopenia, it does not typically present with decreased parathyroid function.
*A 9-year-old boy with an eczema-like rash and recurrent severe staphylococcal infections*
- This presentation is characteristic of **hyper-IgE syndrome** (Job's syndrome), an immunodeficiency characterized by extremely elevated IgE levels, recurrent staphylococcal skin infections, and eczema.
- The immunologic abnormalities described in the stem (normal Ig levels, decreased T-cell function, decreased parathyroid function) do not match the key features of hyper-IgE syndrome.
*A 5-year-old boy who, after 3 months of age, developed recurrent otitis media, pneumonia, diarrhea, and sinusitis, often with simultaneous infections at two or more disparate sites*
- This description is consistent with **X-linked agammaglobulinemia (XLA)**, where B-cell maturation is blocked, leading to a profound deficiency of all immunoglobulin classes.
- The stem mentions normal serum IgG, IgA, and IgM, which rules out XLA.
Immunopathology Indian Medical PG Question 2: In primary immune deficiency, the following plasma protein fraction can be reduced:
- A. Alpha2 globulin
- B. Gamma globulin (Correct Answer)
- C. Alpha1 globulin
- D. Beta globulin
Immunopathology Explanation: ***Gamma globulin***
- In primary immune deficiency, there is a significant reduction in **gamma globulin**, resulting from impaired antibody production [1].
- This protein fraction primarily contains **immunoglobulins**, which are crucial for the immune response [1][2].
*Alpha1 globulin*
- Typically associated with **protease inhibitors** and **transport proteins**, its levels are not directly impacted in primary immune deficiency.
- This fraction does not primarily play a role in the **immune response** like gamma globulins do.
*Alpha2 globulin*
- Contains **haptoglobin** and **ceruloplasmin**, which often remain stable in immunodeficiencies.
- Its reduction is not characteristic of primary immune deficiency, as it does not directly relate to **antibody function**.
*Beta globulin*
- Includes fractions such as **transferrin** and **complement proteins**, generally unaffected by primary immune deficiencies.
- While important, these proteins do not primarily comprise **antibodies** and do not show a decrease in these conditions.
Immunopathology Indian Medical PG Question 3: Which of the following is not a first-line drug for the management of a patient with rheumatoid arthritis?
- A. Hydroxychloroquine
- B. Sulfasalazine
- C. Azathioprine (Correct Answer)
- D. Methotrexate
Immunopathology Explanation: ***Azathioprine***
- While an **immunosuppressant**, azathioprine is generally reserved for patients with **refractory rheumatoid arthritis (RA)** or those who cannot tolerate or have failed first-line DMARDs.
- Its use often comes with a higher risk of side effects, making it less suitable as an initial agent compared to other conventional synthetic DMARDs.
*Hydroxychloroquine*
- This is a **first-line DMARD** for RA, particularly in patients with **mild disease**, due to its relatively favorable safety profile.
- It is often used in combination with other DMARDs like methotrexate.
*Sulfasalazine*
- Sulfasalazine is a common **first-line conventional synthetic DMARD** for RA, especially effective in patients with peripheral arthritis.
- It is frequently used when methotrexate is contraindicated or not tolerated, or as part of combination therapy.
*Methotrexate*
- **Methotrexate is considered the cornerstone** and **first-line treatment** for most patients with rheumatoid arthritis due to its efficacy and tolerability [1].
- It is recommended for early initiation in newly diagnosed patients to prevent joint damage and improve outcomes [2].
Immunopathology Indian Medical PG Question 4: Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)?
1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria.
2. It is same as bacteraemia.
3. It results in Multiple Organ Dysfunction Syndrome (MODS).
4. White cell counts of more than 12 × 10^9/litre are present. Select the answer using the code given below.
- A. 2, 3 and 4
- B. 1, 2 and 3
- C. 1, 3 and 4 (Correct Answer)
- D. 1, 2 and 4
Immunopathology Explanation: ***1, 3 and 4***
- **SIRS** can be caused by the release of **lipopolysaccharide endotoxin** from the cell wall of dying **Gram-negative bacteria** like *E. coli*, triggering a systemic inflammatory response [1].
- One of the major complications of **SIRS** is the progression to **Multiple Organ Dysfunction Syndrome (MODS)**, where organs begin to fail due to uncontrolled inflammation [1].
- A component of the **SIRS criteria** is a white blood cell count greater than 12 x 10^9/L or less than 4 x 10^9/L, or the presence of more than 10% immature band forms [1].
*2, 3 and 4*
- **Bacteremia** refers specifically to the presence of **viable bacteria** in the bloodstream, while **SIRS** is a broader inflammatory response that can be triggered by various causes (infectious or non-infectious).
- While bacteremia can lead to SIRS, SIRS can also occur without bacteremia (e.g., pancreatitis, trauma).
*1, 2 and 3*
- **Bacteremia** is not the same as SIRS; bacteremia is a potential cause of SIRS, but SIRS can arise from non-infectious conditions as well.
- The presence of bacteria in the blood (bacteremia) is a specific finding, whereas SIRS describes a *syndrome* of systemic inflammation.
*1, 2 and 4*
- This option incorrectly states that **SIRS is the same as bacteremia**, which it is not.
- Also, while bacteremia can lead to SIRS, **MODS** is a crucial and often fatal consequence of advanced SIRS, which is omitted in this option.
Immunopathology Indian Medical PG Question 5: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split.
Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Immunopathology Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1***
**Analysis of Statement 1:**
- A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris**
- The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid
- The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic
- **Statement 1 is CORRECT** ✓
**Analysis of Statement 2:**
- The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris
- This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis
- The intact basal cells standing upright resemble a row of tombstones
- **Statement 2 is CORRECT** ✓
**Does Statement 2 explain Statement 1?**
- Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split
- However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split
- The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis**
- Therefore, **Statement 2 does NOT explain Statement 1** ✗
*Incorrect: Statement 2 is the correct explanation for Statement 1*
- While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism
*Incorrect: Statements 1 and 2 are incorrect*
- Both statements are medically accurate descriptions of Pemphigus vulgaris features
*Incorrect: Statement 1 is incorrect*
- Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
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