Autoimmune Disease, Immunodeficiency, and Transplants Practice Questions

25 multiple-choice questions on Autoimmune disease, immunodeficiency, and transplants for paramedic and EMT students, from Chapter 26 (Immunologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Systemic lupus erythematosus (SLE) commonly causes:

   1. A. Joint pain, malar rash
   2. B. Bulging eyes and tremor
   3. C. Painless jaundice
   4. D. Spoon-shaped nails
   Show answer

   Answer: A. Joint pain, malar rash

   Lupus can affect skin, joints, kidneys, heart, lungs, and brain.

2. Lupus most commonly affects:

   1. A. Elderly men over age 70
   2. B. Infants and young toddlers
   3. C. Adolescent boys
   4. D. Women of childbearing age
   Show answer

   Answer: D. Women of childbearing age

   SLE is about nine times more common in women.

3. A lupus patient with chest pain that improves when leaning forward likely has:

   1. A. Pericarditis
   2. B. Pulmonary embolism
   3. C. Aortic dissection
   4. D. Pneumothorax
   Show answer

   Answer: A. Pericarditis

   Serositis, including pericarditis and pleurisy, is common in lupus.

4. Rheumatoid arthritis is an autoimmune disease that primarily affects:

   1. A. One large joint, often the knee
   2. B. Mainly the spine
   3. C. Small joints symmetrically
   4. D. Mainly the skin
   Show answer

   Answer: C. Small joints symmetrically

   RA commonly causes morning stiffness in the hands and wrists.

5. Patients with rheumatoid arthritis may have airway challenges due to:

   1. A. A large, swollen tongue at rest
   2. B. Cervical spine instability
   3. C. A short, receding jaw
   4. D. Narrowing of the trachea
   Show answer

   Answer: B. Cervical spine instability

   Atlantoaxial instability makes neck manipulation risky.

6. A patient taking adalimumab, a TNF-blocking drug for rheumatoid arthritis, has had 3 weeks of fever, night sweats, and cough. A key infection to consider is:

   1. A. Seasonal influenza
   2. B. Strep pharyngitis with fever
   3. C. Reactivated tuberculosis
   4. D. A lingering common cold
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   Answer: C. Reactivated tuberculosis

   TNF is key to walling off tuberculosis in granulomas. Blocking it can reactivate latent TB, and these drugs raise the risk of other serious infections too. Weeks of fever, night sweats, and cough call for an N95 and evaluation. Influenza, strep throat, and a cold are short illnesses that do not cause weeks of night sweats.

7. A woman with lupus has a flare of her disease after a sunny weekend at the beach. The most likely trigger is:

   1. A. Salt water on her skin
   2. B. Ultraviolet light exposure
   3. C. Dehydration from the outdoors
   4. D. An insect bite on her face
   Show answer

   Answer: B. Ultraviolet light exposure

   Sunlight (UV) is a well-known trigger of lupus skin and systemic flares, so patients are advised to use sun protection. Salt water, mild dehydration, and an insect bite are not recognized lupus triggers.

8. A patient with known IgA deficiency needs a blood transfusion. He is at special risk of:

   1. A. Hemolysis of the donor red cells
   2. B. Bleeding from IgA-deficient platelets
   3. C. Fluid overload from the plasma
   4. D. Anaphylaxis to IgA in donor plasma
   Show answer

   Answer: D. Anaphylaxis to IgA in donor plasma

   Some IgA-deficient patients make antibodies against IgA, so plasma-containing products from normal donors can trigger anaphylaxis. Hospitals may use washed or IgA-deficient products. Anti-IgA antibodies do not destroy donor red cells, and IgA has no role in platelet function. Fluid overload can happen to anyone and is not linked to IgA deficiency.

9. A patient with scleroderma has white, cold fingertips, and the finger pulse oximeter will not give a reading. You should:

   1. A. Try an earlobe or forehead sensor
   2. B. Assume her SpO2 is under 80%
   3. C. Rub the finger hard for 2 minutes
   4. D. Record the oxygen level as normal
   Show answer

   Answer: A. Try an earlobe or forehead sensor

   Raynaud phenomenon, common in scleroderma and lupus, causes spasm of the finger arteries, so finger probes often fail. Use an ear or forehead sensor and warm the hands. Do not guess a value.

10. A patient with scleroderma suddenly has a severe headache, a BP of 210/120, and very little urine output. You should suspect:

    1. A. A simple tension headache
    2. B. Dehydration from poor intake
    3. C. Scleroderma renal crisis
    4. D. An allergic reaction to food
    Show answer

    Answer: C. Scleroderma renal crisis

    Scleroderma can suddenly damage the small kidney arteries, causing malignant hypertension and acute kidney failure. It is an emergency treated in the hospital, usually with ACE inhibitors. Dehydration lowers rather than raises the BP.

11. A patient with HIV who has an undetectable viral load on treatment needs care after a fall. The correct infection control approach is:

    1. A. Standard precautions, as for anyone
    2. B. Airborne isolation with an N95
    3. C. Gown and double gloves for any contact
    4. D. Avoiding skin-to-skin contact
    Show answer

    Answer: A. Standard precautions, as for anyone

    HIV spreads through blood and certain body fluids, not by air or casual contact. Standard precautions, with gloves for blood and body fluids, apply to every patient regardless of HIV status. Treatment that keeps the virus undetectable lowers transmission risk even further.

12. AIDS is diagnosed when the CD4 count falls below:

    1. A. 2,000 cells/µL
    2. B. 1,000 cells/µL
    3. C. 800 cells/µL
    4. D. 200 cells/µL
    Show answer

    Answer: D. 200 cells/µL

    Or when an AIDS-defining illness occurs.

13. A 34-year-old who has lost weight has thick white plaques in the mouth that scrape off. He takes no antibiotics or inhaled steroids. This finding suggests:

    1. A. Normal mouth flora for adults
    2. B. Weakened immunity, such as HIV
    3. C. Severe vitamin C deficiency (scurvy)
    4. D. An allergy to his toothpaste
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    Answer: B. Weakened immunity, such as HIV

    Oral thrush is a Candida infection. In an adult without antibiotics, inhaled steroids, dentures, or diabetes, it suggests weakened cell-mediated immunity, and with weight loss HIV is a leading concern. Scurvy causes bleeding gums, not plaques.

14. A kidney transplant recipient has vomited all morning and could not keep down her anti-rejection pills. This matters because:

    1. A. Missed doses can trigger rejection
    2. B. The pills are causing the vomiting
    3. C. Missed doses cause drug toxicity
    4. D. Her kidney can no longer filter fluid
    Show answer

    Answer: A. Missed doses can trigger rejection

    Anti-rejection drugs must be taken on schedule to keep blood levels steady. Missed doses from vomiting can lead to rejection, and dehydration can also harm the graft. She needs hospital evaluation, possibly with IV medication and fluids. Missing doses lowers drug levels, so it cannot cause toxicity, and one morning of vomiting does not mean the kidney has failed.

15. A heart transplant recipient has new shortness of breath and fatigue but no chest pain. Coronary disease in a transplanted heart often lacks angina because the heart:

    1. A. Cannot develop coronary plaque
    2. B. Has a larger blood supply
    3. C. Lacks nerve connections
    4. D. Is protected by steroids
    Show answer

    Answer: C. Lacks nerve connections

    Transplantation cuts the nerves to the heart, including pain fibers, so coronary disease in the graft often presents as dyspnea, fatigue, heart failure, or dysrhythmia rather than chest pain. Plaque does develop in transplanted hearts and is a major long-term problem. Get a 12-lead ECG and transport.

16. Signs of kidney transplant rejection include:

    1. A. An increase in appetite and energy levels
    2. B. Bradycardia with a slow, regular pulse
    3. C. Excess hair growth on the face and arms
    4. D. Low urine output, graft tenderness
    Show answer

    Answer: D. Low urine output, graft tenderness

    Fever, weight gain, and rising creatinine are also seen.

17. You have a mild cold and are assigned to transport a patient who had a stem cell transplant last month. The best approach is to:

    1. A. Proceed as usual; colds are minor
    2. B. Wear a mask; swap if you can
    3. C. Ask the patient to wear gloves
    4. D. Take an antibiotic before the call
    Show answer

    Answer: B. Wear a mask; swap if you can

    A virus that causes a mild cold in you can cause serious pneumonia in a profoundly immunosuppressed patient. Wear a mask, use strict hand hygiene, and let a healthy partner do the close care if possible. Antibiotics do not treat colds.

18. A woman taking weekly methotrexate for rheumatoid arthritis has mouth sores, fever, and bruising after mistakenly taking it every day. You should suspect:

    1. A. A flare of her rheumatoid arthritis
    2. B. A viral cold sore outbreak
    3. C. Methotrexate marrow toxicity
    4. D. Low vitamin K from her diet
    Show answer

    Answer: C. Methotrexate marrow toxicity

    Methotrexate is dosed once weekly for arthritis, and taking it daily by mistake is a classic error that suppresses the bone marrow and damages mucosa. Low white cells (infection), low platelets (bruising), and mouth ulcers follow. She needs urgent hospital care, including the antidote leucovorin.

19. A kidney transplant recipient with a sprained ankle asks whether ibuprofen is safe. The main concern with NSAIDs is:

    1. A. Harm to the transplanted kidney
    2. B. Triggering rejection of the kidney
    3. C. Bleeding into the transplanted kidney
    4. D. Lowering anti-rejection drug levels
    Show answer

    Answer: A. Harm to the transplanted kidney

    NSAIDs reduce blood flow within the kidney, and together with calcineurin inhibitors such as tacrolimus they can cause acute injury to a transplanted kidney. Acetaminophen is usually preferred. NSAIDs do not trigger rejection or lower anti-rejection drug levels.

20. Severe combined immunodeficiency (SCID) is:

    1. A. An acquired viral infection in older adults
    2. B. Inherited loss of B and T cell function
    3. C. An allergy to routine vaccines
    4. D. An autoimmune attack on the thymus
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    Answer: B. Inherited loss of B and T cell function

    Infants with SCID have repeated severe infections.

21. A patient with myasthenia gravis was started on ciprofloxacin 2 days ago and now has worsening weakness and trouble swallowing. The likely link is:

    1. A. A new drug allergy causing throat swelling
    2. B. A stroke caused by the antibiotic
    3. C. Normal fatigue from the infection
    4. D. The antibiotic worsening her myasthenia
    Show answer

    Answer: D. The antibiotic worsening her myasthenia

    Several drugs, including fluoroquinolones, aminoglycosides, and magnesium, impair neuromuscular transmission and can trigger a myasthenic crisis. Bulbar weakness (swallowing, speech) can precede respiratory failure, so monitor ventilation closely.

22. A patient with multiple sclerosis has worse leg weakness and blurred vision after a hot bath, which improve as she cools down. This is best explained by:

    1. A. A new stroke from the hot water
    2. B. Heat-sensitive damaged nerves
    3. C. Low blood sugar after bathing
    4. D. A sudden new MS relapse
    Show answer

    Answer: B. Heat-sensitive damaged nerves

    Demyelinated nerves conduct poorly when warm, so heat from baths, fever, or exercise temporarily worsens MS symptoms (Uhthoff phenomenon). Symptoms that resolve with cooling suggest this rather than a relapse or stroke, but a fever trigger should prompt a search for infection.

23. Scleroderma may complicate airway management because of:

    1. A. A large tongue and short neck
    2. B. Neck hypermobility and laxity
    3. C. Tight skin, small mouth opening
    4. D. Excess saliva and drooling
    Show answer

    Answer: C. Tight skin, small mouth opening

    Thickened skin limits mouth opening.

24. A lupus patient with fever, confusion, and seizures may have:

    1. A. CNS lupus or infection
    2. B. A simple migraine headache
    3. C. Heat exhaustion
    4. D. Hypothyroidism
    Show answer

    Answer: A. CNS lupus or infection

    Lupus and its treatments both increase infection risk.

25. A patient who received CAR-T cell therapy for lymphoma 5 days ago has a fever of 39.4 °C (103 °F), a heart rate of 128, and a BP of 84/50. You should suspect:

    1. A. Tumor lysis syndrome
    2. B. Graft-versus-host disease
    3. C. Simple dehydration from heat
    4. D. Cytokine release syndrome
    Show answer

    Answer: D. Cytokine release syndrome

    CAR-T cells are engineered immune cells that can trigger a massive cytokine release, usually in the first 1 to 2 weeks, causing fever, hypotension, and hypoxia. Sepsis can look the same in these immunosuppressed patients. Treat the shock, mention the therapy at handoff, and transport to the treating center if possible; new confusion may signal related neurotoxicity. Tumor lysis causes electrolyte and kidney problems, not high fever with shock. CAR-T cells are the patient's own cells, so graft-versus-host disease is not expected.