2016 Interventional Immunology Post-Test

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* 1. A 35 year-old female is seen for bloody bowel movements (4/day) and lower abdominal pain. She undergoes colonoscopy and is found to have redness and superficial ulceration from the anorectal junction to the descending colon. The remainder of the colon and the ileum are unremarkable. What is the diagnosis?

Ulcerative colitis

Crohn’s disease

Irritable bowel syndrome

Diverticulitis

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* 2. A 24 year-old male presents with right lower quadrant abdominal pain and watery stools. On colonoscopy, he is found to have focal ulcerations in the ascending colon and terminal ileum. What is the diagnosis?

Ulcerative colitis

Crohn’s disease

Irritable bowel syndrome

Diverticulitis

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* 3. C.D. is a 32 year-old male recently diagnosed with ileal Crohn’s disease. He presented with abdominal pain, diarrhea, iron-deficiency anemia, and weight loss and has been characterized as having moderate-severe disease. Which treatment regimen has been associated with the greatest response rate in patients such as C.D.?

Mesalamine (5-ASA)

Azathioprine (thiopurine)

Infliximab (anti-TNF)

Infliximab and azathioprine

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* 4. Why targeting kinases was not considered a feasible therapeutic approach?

There are only few kinases in the genome.

There are too many kinases in the genome.

Kinases utilize ATP and this is also used in many other biochemical events.

The ATP binding pocket of kinases is not easily accessible.

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* 5. Which other kinases, besides the JAKs, are currently under investigation for immunosuppressive therapy

Among the most actively researched targets Syk and the PI3Kinase pathway appear to be the most promising.

Drugs targeting MAP kinases such as p38 are no longer being investigated for the treatment of autoimmune diseases.

The B cell receptor pathway and the tyrosine kinase BTK are currently investigated as target for the development of immunosuppressants.

Several other kinases, not only tyrosine kinases, are being pursued.

All of the above

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* 6. Why is targeting RORt has the potential to be efficacious in the treatment of inflammatory diseases?

Because this transcription factor is activated by IL-17

Because RORt is critical for the development of Th17 cells

Because is downstream of the T cells receptor?

Because is critical for the development of Th1 cells

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* 7. Which of the following is a limitation of CAR T cells as therapy for cancer?

CAR constructs must be HLA-matched

CARs require the target antigen to be expressed on the tumor cell surface

Target antigen must be expressed at high levels

Need for frequent or continuous dosing

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* 8. What are some of the factors that have made immunotherapy successful recently?

Antibodies that block inhibitory checkpoints

Technology improvements to engineer T cells

Treatment of patients with advanced disease

Exclusion of patients who have low blood counts

A and B

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* 9. Which of the following scenarios is most likely to result in immediate cytokine release syndrome?

70 year old male with chronic lymphocytic leukemia with bulky lymphadenopathy and no lymphocytosis receiving a CD19-directed CAR T cell

10 year old male with relapsed acute lymphoblastic leukemia with 80% blasts in the marrow receiving a CD19-directed CAR T cell

52 year female with ovarian cancer with extensive metastatic deposits receiving a mesothelin-directed CAR T cell

28 year old female with relapsed acute lymphoblastic leukemia with minimal residual disease.

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* 10. Which of the following designs allow use of data from neighboring dose levels

3+3

Continual Reassessment Method

Two-stage

Futility

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* 11. Which one of the following is true about subgroup analysis?

It is not subject to type 1 error problems

It is not subject to type 2 error problems

You can make strong causal statements when not prespecified

Is appropriate when pre-specified and there is sufficient power

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* 12. When would using a biomarker NOT be appropriate?

To obtain an early read on efficacy

To select patients likely to respond

To get a higher response rate by biomarker compared to the clinical outcome

To exclude patients unlikely to respond