Immunomodulators

23 Questions | By Chachelly | Updated: Mar 21, 2022 | Attempts: 776

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1.

A 28-year-old woman was admitted to the hospital with fever, a malar butterfly erythema, arthralgia, intermittent pleuritic pain and oral ulcers. Her lab tests revealed the following: serum creatinine 5.2 mg/dL, BUN 35 mg/dL, and high serum level of antinuclear antibodies. Which of the following drugs was most likely included in the therapeutic management of this patient?
- A.
  
  Infliximab
- B.
  
  Prednisone
- C.
  
  BCG vaccine
- D.
  
  Interferon-beta-1b
- E.
  
  Aldesleukin
2.

A 32-year-old woman, who has been suffering from myasthenia gravis for four years, developed progressive dyspnea several days after an upper respiratory tract infection. Physical examination disclosed bilateral ptosis, bilateral facial weakness an diminished upper and lower motor strength. An IV edrophonium injection improved muscle strength. A serum assay for anti-acetylcholine receptor antibody was 4.8 (normal < 0.5). The appropriate treatment, promptly instituted, included a parenteral injection of prednisone. Which of the following statements best explains the most likely mechanism of action of the drug in this case?
- A.
  
  Inhibition of plasma cholinesterase
- B.
  
  Activation of Nm receptors
- C.
  
  Stimulation of synthesis of interleukin 2
- D.
  
  Inhibition of T cell activation and proliferation
- E.
  
  Stimulation of synthesis of interleukin 1
3.

A 35-year-old man, who was scheduled for a heart transplant, received a triple immunosuppressive therapy just before surgery. Which of the following three drug combinations were most likely administered?
- A.
  
  Azathioprine, prednisone, aldesleukin
- B.
  
  Cyclosporine, azathioprine, prednisone
- C.
  
  Prednisone, triamcinolone, cyclosporine
- D.
  
  Aldesleukin, infliximab, etanercept
- E.
  
  Infliximab, etanercept, triamcinolone
4.

A 42-year-old man came to the clinic complaining of an extensive rash, white plaque-like lesions in his mouth, dry eyes, hyperpigmentation of the tissues surrounding the eyes, and diarrhea. Three months before the man, who was suffering from chronic myelogenous leukemia, underwent an allogeneic bone marrow transplantation from his sister and was successfully treated for his acute graft versus host disease. The patient had had no major health problems after that disease. Which of the following pairs of drugs were most likely included in the therapeutic treatment of this patient?
- A.
  
  Prednisone and cyclosporine
- B.
  
  Cyclosporine and erythromycin
- C.
  
  Cyclophosphamide and doxorubicin
- D.
  
  Vinblastine and prednisone
- E.
  
  Doxorubicin and vinblastine
5.

A 32-year-old man suffering from extensive psoriasis resistant to topical agents and photochemotherapy, started an immunosuppressive treatment with oral cyclosporine. Which of the following cells represent the main site of action of the drug?
- A.
  
  Macrophages
- B.
  
  Dendritic cells
- C.
  
  T-helper cells
- D.
  
  Plasma cells
- E.
  
  Natural killer cells
6.

A 45-year-old man, who had received an heart transplant one month ago, was in the hospital and scheduled for endomyocardial biopsy. The patients complained of a tingling sensation in his hands and peripheral edema. Significant blood test results were: potassium 6.1 mEq/L, creatinine 3.8 mg/dL, BUN 42 mg/dL Current medications included cyclosporine, prednisone, azathioprine, theophylline, diltiazem and famotidine. Biopsy results indicated no acute rejection. If the lab results were drug related, which of the following was the most likely causative agent?
- A.
  
  Prednisone
- B.
  
  Cyclosporine
- C.
  
  Azathioprine
- D.
  
  Theophylline
- E.
  
  Diltiazem
7.

A 33-year old man with an end stage renal disease underwent a kidney transplant. The therapeutic management of the patient included an IV injection of azathioprine just before surgery. Which of the following statements best explains the most likely mechanism of action of the drug in this case?
- A.
  
  Blockade of receptors of TNF-alpha
- B.
  
  Inhibition of clonal expansion of T and B lymphocytes
- C.
  
  Inhibition of antigen presentation by dendritic cells
- D.
  
  Stimulation of genetic expression of interleukin 2
- E.
  
  Stimulation of macrophage phagocytic activity
8.

A 32-year-old man, who underwent renal transplant, showed signs of acute allograft rejection which was resistant to corticosteroid treatment. He was treated with muromonab CD3 that was able to reverse the rejection. Which of the following statements best explains the molecular mechanism of action of the drug in this case?
- A.
  
  It inhibits antibody formation by plasma cells
- B.
  
  It inhibits several enzymes involved in purine metabolism
- C.
  
  It inhibits calcineurin enzyme in T cell cytoplasm
- D.
  
  It stimulates the synthesis of interleukin-1 in T cells
- E.
  
  It neutralize a surface protein receptor complex in T cells
9.

A 27-year-old primipara delivered a baby boy at term. The woman was Rho(D) negative and her husband was Rho(D) positive. The woman received an IV injection of Rho(D) immune globulin just after the delivery. Which of the following statements best explains the mechanism of action of the Rho(D) immune globulin?
- A.
  
  It prevents placental crossing of Rho(D) positive erythrocytes in subsequent pregnancies
- B.
  
  It blocks the production of maternal antibodies against Rho(D) positive erythrocytes
- C.
  
  It prevents the hemolytic disease of the mother in subsequent pregnancies
- D.
  
  It blocks the production of fetal Rho(D) positive erythrocytes in subsequent pregnancies
- E.
  
  It prevents the placental crossing of fetal Rho(D) antibodies in subsequent pregnancies
10.

A 42-year-old woman undergoing heart transplant received mycophenolate mofetil, cyclosporine and prednisone before surgery. Which of the following statements best explains why mycophenolate mofetil is currently substituted for azathioprine to prevent rejection in solid organ transplantation ?
- A.
  
  Its immunosuppressant activity is definitely superior to that of azathioprine
- B.
  
  It has significantly less adverse effects than azathioprine
- C.
  
  It has drastically reduced the risk of graft versus host disease
- D.
  
  It selectively inhibits macrophage-mediated production of several interleukins
- E.
  
  It selectively inhibits antigen recognition by antigen presenting cells
11.

A 46-year-old man came to his doctor complaining that his joints were very painful. He had been taking NSAIDs and then glucocorticosteroids for 2 -3 years, and they were no longer working. Investigations showed that he had a high erythrocyte sedimentation rate and a low hematocrit, synovial leukocytosis, and progressive loss of joint mobility and function. He was prescribed a two drug treatment. One drug was a biological agent which targeted an inflammatory cytokine, produced by activated macrophages and T-cells in inflamed joints. The second drug has anti-inflammatory activity independent of its cytotoxic actions. It is often given with a folate supplement. It is known to slow joint erosion, and remains efficacious longer than other Disease-Modifying Antirheumatic Drugs. Which of the following pairs of drugs fulfill the criteria for the drug regimen recommended for this patient?
- A.
  
  Aldesleukin and cyclophosphamide
- B.
  
  Interferon alpha and cyclosporine
- C.
  
  Infliximab and methotrexate
- D.
  
  Rituxumab and methotrexate
12.

A patient who received a renal transplant six months previously, is being maintained on methylprednisolone, sirolimus, and mycophenolate mofetil. A week ago he was brought to the ER with a fever, pain over the graft, and he reported a significant decrease in urine volume. A panel of tests and a renal biopsy were ordered. The results of tests on his blood revealed creatinine levels of 3.8/dL (normal 0.5-1.2mg/dL), BUN 56mg/dL,(normal 5-20) ; the BUN /creatinine ration is 14/1(normal 10/1). Which of the following, best reflects the most appropriate modification to the current course of therapy for this patient?
- A.
  
  Add muromonab CD3
- B.
  
  Add a diuretic
- C.
  
  Add etanercept
- D.
  
  Substitute cyclosporine for sirolimus
- E.
  
  Add azathioprine
13.

The diagram below illustrates the importance of purine synthesis in the cell cycle. What is the best explanation of the immunosuppressive actions of mycophenolate in the prevention of renal graft rejection?
- A.
  
  Renal tubular epithelial cells are targeted and sent into G0 phase where they are protected from immune attack
- B.
  
  Grafted cells are prevented from producing cell surface antigens as their metabolism slows down
- C.
  
  B cells cannot produce antibodies so the graft is protected from attack
- D.
  
  Purine metabolism in mature T&B cell is targeted, T-cell proliferation is prevented and the rejection process is stopped
14.

Cancer chemotherapy, bone marrow transplantation, and HIV, cause profound depression of cell numbers in the bone marrow . Which cell counts increase as a result of the actions of Filgrastim and Sargramostim?
- A.
  
  Lymphocytes
- B.
  
  Neutrophils
- C.
  
  Stem cells
- D.
  
  Dendritic cells
- E.
  
  Macrophages
15.

A 28 year old male patient is given cyclosporine and prednisone prior to receiving a kidney transplant.Which immunocompetant cells are prevented from mounting an immune response?
- A.
  
  B lymphocytes
- B.
  
  Cytotoxic B lymphocytes
- C.
  
  Dendritic cells
- D.
  
  Th2 lymphocytes
- E.
  
  Th1 lymphocytes
16.

Rapidly dividing B&T-lymphocytes cannot utilise the salvage pathway for purine synthesis. Which immunosuppressive drug prolongs graft survival by specifically inhibiting the synthesis of a precursor of nucleic acid synthesis?
- A.
  
  Azathioprine
- B.
  
  Mycophenolate mofetil
- C.
  
  Cyclosporine
- D.
  
  Muromonab CD3
- E.
  
  Sirolimus
17.

A hospitalised patient developed anorexia, acute abdominal discomfort, and severe headache. The previous week she had received a liver transplant together with appropriate immunosuppressants . Her laboratory results showed an increase in serum transaminases and bilirubin, confirming a diagnosis of moderate graft rejection. Her medications were switched to IV methyl prednisolone and a drug which disrupts both activated and non-activated T lymphocyte functions. Which of the following drugs has this profile?
- A.
  
  Sirolimus
- B.
  
  Azathioprine
- C.
  
  Mycophenolate mofetil
- D.
  
  Muromonab CD3
- E.
  
  Methotrexate
18.

A hospitalised patient, who developed serious hypotension, was diagnosed with capillary leak syndrome and pulmonary edema. He was receiving antimalignant chemotherapy, and adjunctively, a recombinant form of an endogenous cytokine, as treatment for his metastatic renal cell carcinoma .Which of the following drugs most likely caused his current problems?
- A.
  
  Oprelvekin
- B.
  
  Aldesleukin
- C.
  
  Interferon- alpha2A
- D.
  
  Interleukin-1
- E.
  
  Sargramostim
19.

A 47-year- old woman with choriocarcinoma is treated with very high doses of methotrexate (MTX).Which of following drugs is given to limit the toxic effects of this regimen on normal host cells?
- A.
  
  Deferoxamine
- B.
  
  Leucovorin
- C.
  
  N-acetyl cysteine
- D.
  
  Penicillamine
20.

A 35 year old man has been receiving mycophenolate mofetil prophylactically for renal transplant rejection. This drugs acts by inhibiting:
- A.
  
  The induction of proinflammatory cytokines such as IL-2.
- B.
  
  The enzyme mammalian kinase in the G1- S phase.
- C.
  
  Inosine monophosphate dehydrogenase in the guanosine nucleotide pathway
- D.
  
  The binding of TNF alfa to its receptors.
21.

Levamisole as adjunctive therapy. This drug acts as follows.
- A.
  
  It stimulates maturation/proliferation of T cells
- B.
  
  It stimulates committed erythroid precursors
- C.
  
  It is a non-lineage- specific hematopoietic agent
- D.
  
  It inhibits TNF alpha production
22.

A 38 year old woman on treatment with methotrexate for severe chronic arthritis was give leucovorin as a rescue agent for her anemia. With regard to the mechanism of action of leucovorin, which of the following is the most correct statement?
- A.
  
  Inside the cell the drug is metabolized to other reduced folate cofactors such as methyl-THF and methylene-THF which assist recovery of the blood cells
- B.
  
  Inside the cell the drug is metabolized to dihydrofolate which assists recovery of the blood cells
- C.
  
  It is a folate analog and can thus substitute for folate, which assists in recovery of the blood cells
- D.
  
  It is a precursor of tetrahydrofolate and can thus increase folate levels leading to recovery of the blood cells
23.

A 60 year old woman is diagnosed with a malignant lymphoma. Ten years ago, she was diagnosed with a disease that caused her eyes and mouth to be dry. Physical examination reveals a woman in no acute distress with lymphadenopathy. Laboratory data is significant for a positive antinuclear antibody test. Which of the following antibodies is most likely positive in this case?
- A.
  
  Anti-double stranded DNA
- B.
  
  Anti –Scl-70
- C.
  
  Anti-centromere
- D.
  
  Anti-nuclear RNP