Page 1249 - Clinical Immunology_ Principles and Practice ( PDFDrive )

CHaPTEr 89 Biological Modifiers of Inflammatory Diseases 1210.e1

MULTIPLE-CHOICE QUESTIONS

1. A patient has symmetrical inflammatory arthritis and pho- the following biologicals would be MOST appropriate to
tosensitive skin rashes. The serological profile is notable for prescribe?
positive rheumatoid factor (RF), positive anti–citrullinated A. Secukinumab
peptide (CCP) antibody, and positive antinuclear antibody B. Tocilizumab
(ANA) (titer 1 : 640). She is diagnosed with rheumatoid arthritis C. Etanercept
(RA) and systemic lupus erythematosus (SLE) overlap. Treat- D. Natalizumab
ment with weekly dosing with methotrexate and treatment E. Vedolizumab
with an antimalarial (hydroxychloroquine) fails to achieve 4. A 23-year-old patient has a history of asthma, for which an
resolution of the joint inflammation. Which of the following inhaled corticosteroid preparation and a beta-agonist have
biological treatments would be most appropriate to treat the been prescribed, and recurrent urticaria, for which daily doses
ongoing joint inflammation? of an antihistamine (loratadine) and a leukotriene receptor
A. Etanercept antagonist (montelukast) have been prescribed. Although
B. Adalimumab occasional use of a rescue inhaler is required, the asthma is
C. Certolizumab felt to be reasonably well controlled; however, there are recur-
D. Rituximab ring episodes of urticaria and angioedema. Laboratory studies
E. Belimumab
3
are notable for a peripheral eosinophil count of 210/mm
2. A patient with congestive heart failure, chronic kidney disease, and serum immunoglobulin E (IgE) of 110 IU/mL. Comple-
and diabetes is hospitalized with manifestation of volume ment level C4 is 12 mg/dL (normal >14), complement C3 is
overload and fever. Escherichia coli bacteremia from urinary normal, and CH50 is normal. Tests for antinuclear antibodies
sepsis is confirmed. Appropriate parenteral antimicrobial (ANAs) and antineutrophil cytoplasmic antibodies (ANCAs)
therapy and diuresis are initiated, resulting in clinical improve- are negative. Addition of which of the following would be
ment. But on the third hospital day, the patient develops pain, MOST useful in managing this disorder?
swelling, and tenderness in the left great toe, midfoot, and A. Omalizumab
ankle. An ankle arthrocentesis is performed, and it demon- B. Rituximab
strates of urate crystals in the joint fluid; gram staining is C. Mepolizumab
negative for bacterial organisms. Given the reluctance to D. Reslizumab
prescribe nonsteroidal antiinflammatory drugs (NSAIDs) or E. Eculizumab
corticosteroids to manage the acute polyarticular gout because
of this patient’s comorbidities, which of the following bio- 5. A patient with an undifferentiated autoimmune connective
logicals would be MOST appropriate to use in this setting? tissue disease has ongoing severe inflammatory manifestations
A. Canakinumab affecting the central nervous system, lungs, joints, and kidneys
B. Anakinra despite use of standard therapy, prompting consideration of
C. Infliximab more aggressive cell-depleting immunosuppressive therapy.
D. Abatacept Use of which of the following is MOST likely to be associated
E. Mepolizumab with the reemergence of autoimmune manifestations following
immune reconstitution?
3. A patient with inflammatory bowel disease (IBD) has increased A. Rituximab followed by belimumab
weight loss in association with ongoing abdominal pain and B. Obinutuzumab followed by belimumab
diarrhea despite use of adalimumab. Abdominal imaging C. Alemtuzumab
confirms evidence of significant bowel inflammation involving D. Brentuximab vedotin
multiple segments of the ileum. Which of the following of E. Cyclophosphamide followed by low-dose IL-2