www.rcpath.org The Royal College of Pathologists : Immunology Model Question Paper

[mariammal]

Part 1 examination
Immunology: Second paper

This paper is for medically qualified candidates only
Each part of a question is awarded equal marks unless otherwise stated in the question.
1 Using a short note format, describe the role of the immunology laboratory in the investigation of each of the following presentations. You should describe the immunological differential diagnosis, and discuss the clinical utility and limitations of each of your suggested tests.
a) Peripheral neuropathy.
b) Abnormal liver function tests.
c) Persistent rhinitis.

http://www.rcpath.org/index.asp?PageID=51
http://www.rcpath.org/resources/pdf/...candidates.pdf

2 Answer all parts of the question:
a) Describe the principles of DNA and RNA amplification and detection.
b) Using a short note format and illustrating your answer with relevant examples, describe how molecular biological techniques are applicable to the diagnosis and management of primary immunodeficiency disorders.
c) Write short notes on the detection (in the routine diagnostic laboratory) of autoantibodies to nucleic acid and other nuclear antigens in the diagnosis and management of autoimmune diseases.

3 You are telephoned for advice. For each of the following scenarios, describe what further information you would request, what immunology tests you would advise, and how the results would affect the patient’s diagnosis and clinical management.
a) A 42-year-old with total villous atrophy on intestinal biopsy and serum IgA <0.06 g/L.
b) A 25-year-old with itching, erythema and diarrhoea after eating seafood.
c) A 26-year-old with acute onset haemoptysis and shortness of breath.

4 Answer all parts of this question:
a) In a short notes format, compare and contrast the use of normal human immunoglobulin in the treatment of primary immunodeficiency and autoimmunity. Your answer should include immunoglobulin preparations, dosage regimes, side-effects, and give relevant examples.
b) Using short notes, outline the proposed mechanisms of action of high-dose immunoglobulin as an immunomodulatory agent.
c) You are asked to review the result of an IgG level of 42 g/L from the nephelometer. The patient is a 52-year-old male, and 18-months earlier the IgG level was 17.2 g/L. Describe what information you would request, what steps you would take to verify the result, and what the possible diagnostic associations might be.

5 You are contacted to discuss a 9-month-old male with recurrent chest infections and failure to thrive. He is the first child of Caucasian parents, born at full term. His immunoglobulin levels at 7 months and at 9 months are shown:
7-months-old 9-months-old Reference range
IgG 1.81 1.57 2.17 – 9.04 g/L
IgA 0.12 0.10 0.11 – 0.90 g/L
IgM 0.90 1.32 0.34 – 1.26 g/L

What further information would you request? Describe the differential diagnoses and the reasons for these, and what investigations you would suggest to clarify the diagnosis. Outline the principles of initial management of this patient.