CME QUESTIONS— AUTOIMMUNITY TO THE THYROID                    BACK
PREPARED BY ANTHONY WEETMAN, M.D.

Reading for this module should include Chapter 7 in Thyroid Disease Manager, or alternative sources. These could include chapters in Endocrinology, Edition III, comparable chapters in Endocrinology Edition IV , or appropriate chapters in "The Thyroid".

Anticipated study and testing time for this module is 3 hours. After reading the material, print out his page, complete the test, fill in required personal information, and send the page with payment to Center for Continuing Medical Education, 950 E 61st St., University of Chicago, Chicago, IL 60637., with payment of $45. After satisfactory completion of the examination, a certificate will be returned by mail.

1. Which of the following statements concerning T cells is true?
A. All T cells express a T cell receptor composed of an a and b chain
B. T cell receptor genes undergo somatic mutation to increase the diversity of antigens recognize
C. T cell receptors recognize antigenic peptides of around 25 amino acids in size
D. Specific V gene segments encoding the receptor rearrange with D and J segments to provide the unique recognition function of the receptor
E. All T cells require costimulatory signals from B7.1 or B7.2 to undergo activation

2. Which cytokine typifies a Th2 T cells?
A. IL-2
B. TNF
C. IL-4
D. g-IFN
E. IL-1

3. Which of the following statements concerning thyroglobulin as an autoantigen is true?
A. There are 4-6 major B cell epitopes
B. Thyroglobulin antibodies fix complement
C. Iodide content does not affect the antigenicity of thyroglobulin in animal models of thyroiditis
D. There is sequence homology with the TSH-receptor
E. It is a 670 kD molecule comprised of 4 identical subunits

4. Which of the following is not the target of the autoimmune response in patients with thyroid autoimmunity?
A. Na+/I- symporter
B. DNA
C. Acetylcholine receptor
D. Thyroid peroxidase
E. Megalin

5. Antibodies to the TSH receptor can display all but one of the following characteristics
A. Block the receptor
B. Displace 125I-TSH binding
C. Bind to conformational epitopes
D. Fix complement
E. Stimulate the receptor

6. Experimental autoimmune thyroiditis does not occur in which of the following?
A. BB/W rat
B. Immunization of mice with fibroblasts transfected with TSH-receptor
C. OS chicken
D. Genetic immunization of mice with TSH-receptor cDNA
E. NOD mouse

7. Antibodies to which of the following thyroid autoantigens causes neonatal disease after transplacental transfer?
A. Na+/I- symporter
B. T4
C. Thyroid peroxidase
D. TSH receptor
E. Thyroglobulin

8. Which of the following has not been associated with autoimmune thyroid disease in Caucasians?
A. HLA-DRB1*07
B. HLA-DQA*0501
C. HLA-DR4
D. HLA-DR3-linked haplotypes
E. CTLA-4

9. Which of the following is not associated with autoimmune thyroid disease?
A. Sjögren's syndrome
B. Celiac disease
C. Premature ovarian failure
D. Autoimmune polyglandular syndrome type 1
E. Psoriasis

10. Which of the following statements concerning T cells in Graves' disease is true?
A. HLA-DR-positive T cells increase in the circulation after methimazole treatment
B. CD4+ T cells infiltrate the thyroid
C. Changes in circulating T cell subsets are similar to those in other autoimmune diseases
D. CD8+ T cells infiltrate the thyroid

 

Answer Sheet
Enter "True" or "False" in the appropriate boxes.
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(True/False)
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