Stevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 1 Introduction to Immunity and the Immune system 1. Which of the following €af be attributed to Pasteur? a. Discovery of opsonins b. Observation of phagocytosis 4. Theory of humoral immunity 2. Which WBC is capable of further differentiation in tissues? a. Neutrophil b. Eosinophil . Basophil 3. The cells that Metchnikoff first observed are associated with which phenomenon? b. Adaptive immunity ¢. Humoral immunity 4. Specific immunity 4, Where are all undifferentiated lymphocytes made? b. Spleen Thymus 4d. Lymph nodes 5. Which of the following statements is true of NK cells? a, They rely upon memory for antigen recognition. b. They have the same CD groups as B cells. c. They are found mainly in lymph nodes. | 6. Which cell is the most potent phagocytic cellin the tissue? a. Neutrophil . Eosinophil 4. Basophil 7. The ability of an individual to resist infection by means of normally present body functions is called b. humoral immunity. ¢. adaptive immunity. 4. cross-immunity. 8. A cell characterized bya nucleus with two to five lobes, a diameter of 10 to 15 um, and a large number of neutral staining granules is identified as a(n) a, eosinophil b. monocyte. «. basophil. 9. Which of the following is a primary lymphoid organ? a. Lymph node b. Spleen d. MALT 10. What type of cells would be found in 2 primary follicle? b. Germinal centers , Plasma cells d, Memory cells 111. Which of the following is a distinguishing feature of Bells? a. Act as helper cells c. Able to kill target cells without prior exposure d. Active in phagocytosis 12, Where do lymphocytes mainly come in contact with antigens? b. Bloodstream Bone marrow . Thymus 13, Which of the following is found on the T cell subset, known as helpers? a.cD19 ©. CDB 4, CD56 14, Which of the following statements best characterizes adaptive immunity? 1[PegeStevens — Immulogy and Serology Study Questions (4™ Edition) a. Relies on normally present body functions b. Response is similar for each exposure | d. Involves only cellular immunity 15. The main function of T cells in the immune response b. produce antibodies. c. participate actively in phagocytosis. d. respond to target cells without prior exposure, 16. Which of the following is a part of humoral immunity? a. Cells involved in phagocytosis ¢. Macrophages and mast cells in the tissue d. Tand B cells in lymph nodes 17. Immunity can be defined as a, the study of medicines used to treat diseases. b. a specific population at risk for 2 disease. d. the study of the noncellular portion of the blood. 18. Ablood cell that has reddish staining granules and is able to kill large parasites describes a, basophils. b. monocytes. c. neutrophils, 19. Which of the following statements best describes a lymph node? a. It is considered a primary lymphoid organ, b. It removes old RBCs. d. It is where B cells mature, jenic groups identified by different sets of antibodies reacting in a similar manner to certain stander¢ cell lines best describes a. cytokines. c. neutrophilic granules. 4. opsonins. 21 PageStevens — Immulogy and Serology Study Questions (4™ Edition) Chapter 2 Nature of Antigens and the Major Histocompatibility Complex Review Questions 1. All of the following are characteristics of an effective Immunogen except a. internal complexity, b. large molecular weight, c. the presence of numerous epitopes. 2. Which of the following best describes a hapten? a. Cannot react with antibody c. Has multiple determinant sites d. Alarge chemically complex molecule 3. Which would be the most effective immunogen? b. Nylon polymer with a molecular weight of 250,000 Polysaccharide with @ molecular weight of 220,000 d, Protein with a molecular weight of 175,000 4, Which of the following individuals would likely respond most strongly to a bacterial infection? a. An adult who is 75 years of age b. Amelnourished 40-year-old d. Anewborn baby 5. Which best describes an epitope? a. A peptide that must be at least 10,000 MW b. An area of an immunogen recognized only by T cells c. Asegment of sequential amino acids only 6. Adjuvants act by which of the following methods? b. Facilitates rapid escape from the tissues Limits the area of the immune response d. Decreases number of APCs 7. Aheterophile antigen is one that a. isa self-antigen c.has been used previously to stimulate antibody response, 4.is from the same species but is different from the host. 8, Which of the following is true of class II MHC (HLA) antigens? b. They are found on all nucleated cells. ¢. They all originate at one locus. 4d, They are coded for on chromosome 9. 9. Class ll MHC molecules are recognized by which of the following? b. CD8+ T cells ¢. Natural killer cells 4. Neutrophils 10. Which of the following best describes the role of TAP? a. They bind to class Il molecules to help block the antigen-binding site b. They bing to class | proteins in proteasomes. 4d. They help cleave peptides for transport to ‘endosomes. 111, What is the purpose of the invariant chain in antigen processing associated with class lI MHC molecules? a. Helps transport peptides to the binding site c. Binds to CD8+ T cells d. Cleaves peptides into the proper size for binding 12, An individual is recovering from a bacterial infection and tests positive for antibodies to 2 protein normally found in the cytoplasm of this bacterium. Which of the following statements is true of this situation? a. Class | molecules have presented bacterial antigen to CDB+ T cells. b, Class | molecules have presented bacterial antigen to CD4+ T cells | 4d. B cells have recognized bacterial antigen without help from T cells. 13. In relation to 2 human, alloantigens would need to. be considered in which of the following events? 3] PegeStevens — Immulogy and Serology Study Questions (4™ Edition) b. Vaccination with the polysaccharide coat of a bacterial cell ¢. Oral administration of a live but heat-Killed virus particle d. Grafting skin from one area of the body to another 14. Which is characteristic of class | MHC molecules? a. Consists of one a and one B chain c. Able to bind whole proteins d. Coded for by DR, DP, and DQ genes 415. Class | MHC antigens E and G serve which function? a. Enhance the response by macrophages b. Transport antigen for recognition by CD4+ T cells .Bind to A, B, and C antigens to protect the binding site 16. Which best explains the difference between immunogens and antigens? a. Only antigens are large enough to be recognized by Tells, b. Only immunogens can react with antibody. d. Only antigens are recognized as foreign. 17. When a child inherits one set of six HLA genes ‘together from one parent, this is called a(n) a. genotype. . phenotype. 4. allotype. 18. HLA molecules A, B, and C belong to which MHC class? b. Class Il . Class Ill d. Class IV 4|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 3 Innate Immunity 1. The term for enhancement of phagocytosis by coating of ae ae" with serum proteins is b. agglutination. . solubilization, 4. chemotaxis. 2. Which of the following plays an important role as an external defense mechanism? a, Phagocytosis: b. C-reactive protein 4. Complement 3. The process of inflammation is characterized by all of the following except a. increased blood supply to the area. ae of WBCs, 4d. appearance of acute-phase reactants. 4, Skin, lactic acid secretions, stomach acidity, and the motion of cilia represent which type of immunity? b. Cross c. Adaptive d. Auto 5. The structure formed by the fusion of engulfed material and enzymatic granules within the phagocytic cell iscalleda a. phagosome. b. lysosome. c. vacuole. 6. The presence of human microbiota (normal flora) acts as a defense mechanism by which of the following methods? a. Maintaining an acid environment . Keeping phagocytes in the area 4d. Coating mucosal surfaces 7, Measurement of CRP levels can be used for all of the following except ‘a. monitoring drug therapy with anti-inflammatory agents. b. tracking the progress of an organ transplant. © diagnosis ofa specific bacterial infection. d, determining active phases of rheumatoid arthritis. 8, Pathogen recognition receptors act by ‘a. recognizing molecules common to both host cells and pathogens. helping to spread infection because they are found ‘on pathogens. 4, all recognizing the same pathogens. 9, Which of the following are characteristics of acute-phase reactents? a, Rapid increase following infection b. Enhancement of phagocytosis . Nonspecific indicators of inflammation 10. Which is the most significant agent formed in the phagolysosome for the elimination of microorganisms? a. Proteolytic enzymes b, Hydrogen ions d. Superoxides 11, Which acute-phase reactant helps to prevent formation of peroxides and free radicals that may damage tissues? b. Fibrinogen. ¢.Ceruloplasmin Serum amyloid A 12, Which statement best describes Toll-like receptors (TLRs)? a. They protect adult flies from infection. b, They are found on all host cells. . They only play a role in adaptive immunity. 13. The action of CRP can be distinguished from that of SIPegeStevens — Immulogy and Serology Study Questions (4™ Edition) an antibody because b. only the antibody triggers the complement cascade. ¢.binding of the antibody is calcium-dependent. d. only CRP acts as an opsonin. 14. How does innate immunity differ from adaptive immunity? a, Innate immunity requires prior exposure to a pathogen. c. Innate immunity develops later than adaptive immunity, d. Innate immunity is more specific than adaptive immunity, 15. A40-year-old male who is a smoker develops symptoms of premature emphysema. The symptoms may bbe caused by a deficiency of which of the following, acute-phase reactants? a. Haptoglobin «Fibrinogen 4. Ceruloplasmin 16. Which statement best describes NK cells? a. Their response against pathogens is very specific. b. They only react when an abundance of MHC antigens is present. . They react when both an inhibitory and activating signal is triggered. 6lPeceStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 4 Adaptive Immunity 1. Which MHC molecule is necessary for antigen recognition by CD4+ T cells? a. Class | . Class Il d. No MHC molecule is necessary. 2. Which would be characteristic of a T-independent antigen? a. The IgG antibody is produced exclusively. b. A large number of memory cells are produced. c. Antigens bind only one receptor on 8 cells. 3, Humoral immunity refers to which of the following? b, Production of cytokines by T cells Elimination of virally infected cells by cytotoxic cells d. Downregulation of the immune response 4, Where does antigen-independent maturation of B lymphocytes take place? b. Thymus c.Spleen d. Lymph nodes 5. In the thymus, positive selection of immature T cells is based upon recognition of which of the following? a. Self-antigens b. Stress proteins d. chains 6. Which of these are found on a mature 8 cell? a. IgG and IgD c. Alpha and beta chains . CD3 7. How do cytotoxic T cells kill target cells? a. They produce antibodies that bind to the cell. b. They engulf the cell by phagocytosis. « a a aa a in the a cell. 8, Which of the following can be attributed to antigen-stimulated T cells? a, Humoral response b. Plasma cells d, Antibody 9. Which is a distinguishing feature of a pre-B cell? b. Complete IgM on the surface ¢. Presence of CD21 antigen d. Presence of CD25 antigen 10. When does genetic rearrangement for coding of antibody light chains take place during B-cell development? a. Before the pre-B cell stage ', As the cell becomes an immature B cell ¢. Not until the cell becomes a mature B cell d, When the B cell becomes a plasma cell 111. Which of the following antigens are found on the T-cell subset known as helper/inducers? a.CD3 ©. C08 coi 12, Where does the major portion of antibody production occur? a. Peripheral blood b. Bone marrow « a 13. Which of the following would represent a doublenegative thymocyte? a, CD2-CD3+CD4~CD8+ b. CD2-CD3-co4+cDs~ dd, CD2-CD3-CD4+CD8— 14, Which of the following best describes the T-cell 71 PageStevens — Immulogy and Serology Study Questions (4™ Edition) receptor for antigen? a, It consists of IgM and IgD molecules. b. itis the same for all T cells. C Itis present in the double-negative stage. 15. Acell flow cytometry pattern belonging to a 3- yearold patient showed the following: normal CD4+ T-cell count, normal CD19+ B-cell count, low CD8+ T-cell count. Which type of immunity would be affected? a, Production of antibody . Formation of plasme cells d. Downregulation of the immune response 16. Which of the following isa unique characteristic of adaptive immunity? a, Ability to fight infection c.A similar response to all pathogens encountered d. Process of phagocytosis to destroy a pathogen 17. Clonal deletion of T cells as they mature is important in which of the following processes? b. Positive selection of CD3/TCR receptors Allelic exclusion of chromosomes 4d. Elimination of cells unable to bind to MHC antigens 18. Where do germinal centers accur? a. In the thymus, b. In the bone marrow c.In peripheral blood BI PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 5 Antibody Structure and Function 1. Which of the following is characteristic of variable domains of immunoglobulins? b, They represent the complement-binding site. c. They are at the carboxy-terminal ends of the molecules. d. They are found only on H chains. 2. All of the following are true of IgM except that it b. fixes complement. has aJ chain d. is a primary response antibody. 3. How does the structure of ig€ differ from that of IgG? a. IgG has a secretory component and IgE does not. IgG has more antigen-binding sites than IgE. d. IgG has more light chains than IgE. 4, How many antigen-binding sites does a typical IgM molecule have? a2 ba 6 5, Bence Jones proteins are identical to which of the following? a. H chains c.lgM molecules d. lgG molecules 6. A Feb fragment consists of a, two H chains, b. two L chains. d. one L chain and an entire H chain, Which antibody best protects mucosal surfaces? bi leG clgD d.lgM 8 Which of the following pairs represents two different immunoglobulin allotypes? a. 1gM and IgG b. IgM1 and IgM2 ¢ Anti-human IgM and anti-human IgG 9. The structure of a typical immunoglobulin consists of which of the following? b. 4Land 2H chains dL and 4H chains 4. 2Land 4H chains 110. Which of the following are L chains of ar molecules? b. Gamma c. Mu d. Alpha 11. Ifthe results of serum protein electrophoresis show a significant decrease in the gemma band, which of the following isa likely possibility? a. Normal response to active infection b. air aa 4d, Monoclonal gammopathy 12. The subclasses of IgG differ mainly in a. the type of L chain. «. the ability to act as opsonins. 4, molecular weight. 13, Which best describes the role of the secretory b. A means of joining two IgA monomers together An aid to trapping antigen 4, Enhancement of complement fixation by the classical pathway 14, Which represents the main function of IgD? a. Protection of the mucous membranes b, Removal of antigens by complement fixation d. Destruction of parasitic worms gl PegeStevens — Immulogy and Serology Study Questions (4™ Edition) 15. Which antibody is best at agglutination and complement fixation? b.lgG c.leD 16. Which of the following can be attributed to the clonal selection hypothesis of antibody formation? a, Plasma cells make aa ma . Proteins can alter their shape to conform to antigen. 4. Cell receptors break off and become circulating antibody. 17. All of the following are true of IgE except that it a. fails to fix complement. C.attaches to tissue mast cel d. is found in the serum of allergic persons. 18. Which best describes coding for immunoglobulin molecules? a. All genes are located on the same chromosome. b. L chain rearrangement occurs before H chain rearrangement. | d. Lambda rearrangement occurs before kappa rearrangement. 19. What is the purpose of HAT medium in the preperation of monoclonal antibody? a, Fusion of the two cell types c. Restricting the growth of spleen cells. d. Restricting antibody production to the IgM class 20. Papain digestion of an IgG molecule results in which of the following? a. 2 Fab’ and 1 Fe’ fragment b. Flab')2 and 1 Fc’ fragment ©.2 Fab and 2 Fc fragments 21, Which antibody provides protection to the growing fetus because itis able to cross the placenta? b.leA IgM dtd 22, Which best characterizes the secondary response? 2. Equal amounts of igM and lgG are produced. b. There is an increase in IgM only. 4d. The lag phase is the same as in the primary response. 10|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 6 Cytokines 1. The ability of a single cytokine to alter the expression of several genesis called a at c. autocrine stimulation. d. endocrine effect. 2. Which of the following effects can be attributed to IL- R b. Differentiation of stem cells c. Halted growth of virally infected cells d. Stimulation of mast cells 3. Which of the following precursors are target cells for IL-3? a. Myeloid precursors b. Lymphoid precursors c. ca aa 4. A lack of IL-4 may result in which of the following effects? a. Inability to fight off viral infections b. Increased risk of tumors . Lack of IgM 5. Which of the following cytokines is also known as the T-cell growth factor? a. IFNy b.IL42 d.iL-10 6. Which of the following represents an autocrine effect of IL-2? eee bb. Macrophages signaled to the area of antigen stimulation . Proliferation of antigen-stimulated B cells d. Increased synthesis of acute-phase proteins throughout the body 7. IFN-a and IEN-B differ in which way from IFN-gamma? a IFN-atand IFN-B are called immune interferons, and |FN-gamma is not. b. IFN-aand IFN-8 primarily activate macrophages, whereas IFN-gamma halts viral activity. .IFN-a and IFN-B are made primarily by activated T cells, whereas IFN-gamma is made by fibroblasts, 8. A patient in septic shock caused by a gram-negative bacterial infection exhibits the following symptoms: high fever, very low blood pressure, and disseminated intravascular coagulation. Which cytokine is the most likely contributor to these symptoms? It cia iL? 9. IL-10 acts as an antagonist to what cytokine? alla b. TNF-a 4. TGF-B 10. Which would be the best assay to measure a specific cytokine? a. Blast formation b, T-cell proliferation c. Measurement of leukocyte chemotaxis 11. Selective destruction of Th cells by the human immunodeficiency virus contributes to immune suppression by which means? ‘a. Decrease in IL-1 ¢. Decrease in IL-8 d. Decrease in IL-10 12. Why might 2 colony stimulating factor be given to a ‘cancer patient? a, Stimulate activity of NK cells . Decrease the production of TNF d, Increase production of mast cells M|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) 13. Which of the following would result from lack of TNF? eee b. Increased expression of class I MHC molecules c. Decreased survival of cancer cells d. Increased risk of septic shock 14. Which cytokine acts to promote differentiation of T cells to the Th subclass? alls bIFN-a d.IL-10 15, What is the major function of T regulatory cells? a, Suppression of the immune response by producing TNF = ¢. Proliferation of the immune response by producing IL-2 d. Proliferation of the immune response by inducing IL-4 16. Th17 cells affect the innate immune response by inducing production of which cytokines? a, IFN-y and IL-2 b. IL-4 and IL-10 clL-2and IL-4 12/PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 7 Complement System 1. The classical complement pathway is activated by a, most viruses, . fungal cell walls. dd. mannose in bacterial cell walls. 2. Which of the following is characteristic of complement components? . Mainly synthesized by B cells c. Present as active enzymes d. Heat stable 3. All of the following are true of the recognition unit except a. it consists of Cig, Cir, and Cis. b. the subunits require calcium for binding together. c. binding occurs at the FC region of antibody molecules. 4. Which of the following is referred to as C3 convertase? a. Clgrs 36D d. CabSa 5. Mannose-binding protein in the lectin pathway is ‘most similar to which classical pathway component? a3 b.Cirs 0.4 6. Which of the following describes the role of properdi in the alternative pathway? b. Conversion of B to Bb . Inhibition of C3 convertase formation d. Binding and cleavage of Factor 8 7. Which best characterizes the membrane attack complex (MAC)? a. Each pathway uses different factors to form it. b. CS through C9 are not added in any particular order, ¢. One MAC unit is sufficient to iyse any type of cell | 8. All of the following represent functions of the ‘complement system except b. lysis of foreign cells. . increase in vascular permeability. 4. migration of neutrophils to the tissues. ‘9, Which of the following is true of the amplifica loop in complement activation? a. Itis only found in the alternative pathway. b. The membrane attack unit is amplified. d, Increasing amounts of Clars are produced. 10. Factor H acts by competing with which of the following for the same binding site? 11, A lack of CR1 receptors on RBCs would result in which of the following? 1a. Decreased binding of C3b to RBCS | c. Decreased breakdown of Clars d, Decreased binding of Factor H 12, Which best describes the role of CR2 on cell membranes? ‘a. Binds Cigrs to inactivate it ¢. Increases clearance of immune complexes d. Binds particles opsonized with C3b 13. Which of the following best characterizes hemolytic uremic syndrome? a. It is a rare cause of renal failure in children 1B] PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Cc. The major cause is lack of DAF on RBCs. 4d. itis associated with antibody-to-C3 convertase. 14. The CHSO test measures which of the following? b. Functioning of both the classical and alternative pathways c. Genetic deficiencies of any of the complement components 4. Functioning of the lectin pathway only 15. Which of the following would be most effective in preventing bystander lysis of RBCs? a. CL-INH b. Factor B d. Factor H 16. A decreased CHS0 level and 2 normal AHSO level indicate which deficiency? a, Decrease in components in the lectin pathway only b. Decrease in components in the alternative pathway only c. Decrease in components of both classical and alternative amie 17. Which best describes the role of an anaphylatoxin? a. Coats cells to increase phagocytosis b. Attracts WBCs to the area of antigen concentration «. Increases production of interleukin-1 18. Which best describes the role of Factor H? a. Acts with DAF to break down C3b . Binds to the CSCBC7 complex d. Binds to Cig to shut down the classical pathway 19. Alack of C1-INH might result in which of the following conditions? a, Paroxysmal nocturnal hemoglobinuria b. Hemolytic uremic syndrome d. Increased bacterial infections 20. Which would be most effective in measuring an individual complement component? a aa ¢. AHSO assay d. Lytic assay with liposome 14|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 8 Safety and Quality Management 1. Atechnologist who observes a red rash on her hands after removing her gloves a, should apply antimicrobial lotion to the hands. bb, may be washing the hands too frequently. d. should not create friction when washing the hands. 2. In the chain of infection, a contaminated work area would serve as which of the following? b. Means of transmission c. Portal of entry d. Portal of exit 3. The only biological waste that does not have to be arded in a container with a biohazard symbol is b. serum, feces. d. serum tubes. 4, Patient specimens transported by the Department of Transportation must be labeled as @ a. diagnostic specimen, b. clinical specimen, d. laboratory specimen. 5. A technician places tightly capped noninfectious serum tubes in a rack and places the rack and the specimen data in a labeled leakproof metal courier box. Is there anything wrong with this scenario? a. Yes, DOT requirements are not met. bb. No, the tubes are placed in a rack d. No, the box contains the specimen data, 6. The Occupational Exposure to Bloodborne Pathogens Standard developed by OSHA requires employers to provide all of the following except a, hepatitis 8 immunization. b. safety training. d, laundry facilities for nondisposable lab coats. 7. An employee who receives an accidental needlestick should immediately a iia sodium a tothe area. receive HIV prophylaxis. d. receive a hepatitis B booster shot. £8 The first thing to do when acidis spilled on the skin is to 2. notify a supervisor. b. neutralize the area with 2 bese. apply burn ointment. 9. When combining acid and water, b. water is added to acid. c. water is slowly added to acic. d. both solutions are combined simultaneously. 10. To determine the chemical characteristics of sodium azide, an employee would consult the a. Chemical Hygiene Plan. b. Merck manual. d, NRC guidelines. 11. A technician who is pregnant should avoid working with a. organic chemicals. ¢. HIV-positive serum, d. needles and lancets. 12. Which of the following laboratory regulatory agencies, classifies laboratory tests by their complexity? a. OSHA b.cAP TIC 13. Which of the following organizations publishes guidelines that are considered the standard of care for laboratory procedures? b. CLs TIC 15|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) . CAP 14. Quality managment refers to a. performance of two levels of testing controls. b. reliable control results. c. increased a 15, When external quality control is run, what information must be documented? a. The lot number ». Expiration date of the control c. The test results 4. Allof the above 16. What steps are taken when the results of the quality control testing are outside of the stated confidence b. Run anew control ¢. Open anew control bottle 4. All of the above 17. When a new bottle of OC material is opened, what information is placed on the label? a. The time the bottle was opened b. The supervisor's initials c. The lot number 18. What is the primary goal of TOM? a, Precise test results b. Increased laboratory productivity d. Reproducible test results 19. Would a control sample that has accidentally become diluted produce a trend or a shift in the Levey-Jennings plot? a. Trend Fill in the Blank 20. Indicate whether each of the following would be considered 2 (1) preexamination, (2) examination, or (3) postexamination variable by placing the appropriate number in the space. Reagent expiration date Rejection of a hemolyzed specimen Construction of a Levey-lennings chart Telephoning a critical result to the nurse Calibrating the centrifuge Pipetting the diluent 16 |PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 9 Principles of Serological Testing 1. If serum is not tested immediately, how should it be treated? a, Itcan be left at room en for 24 hours. c.Itcan be stored in the refrigerator for up to 48 hours. d. It needs to be frozen immedictely, 2. 4.1:750 dilution of serum is needed to perform a serological test. Which of the following series of ns would be correct to use in this situation? a. 15, 1:15, 1:10 b. 45, 1:10, 15 61:15, 1:10, 1:3 4:15, 1:3, 15 3. How much diluent needs to be added to 0.2 mL of serum to make a 1:20 dilution? a. 19.8 mL. 4omt 4. 10.0 mL 4. If glacial acetic acid needs to be diluted with water to make a 10% solution, what does the glacial acetic acid represent? b. Diluent c.Titer 4. Serial dilution 5. A pipette that has markings all the way down to its tip iscalleda a. volumetric pipette. serial pipette. d. micropipette, 6.A serological test requires 5 mL of a 1:50 dilution. How much serum is required to make this, dilution? 2.0.5 mL. b.0.01 mL c10mt 7. If 0.02 ml of serum is diluted with 0.08 mL of diluent, what dilution of serum does this represent? ald 1:10 1:20 8. A tube containing 2 1:40 dilution is accidently, dropped. A 1:2 dilution of the specimen is still available. A volume of 4 ml is needed to run the test. How much of the 1:2 dilution is needed to remake 4 ml of @ 1:40 dilution? b.0.4 mt. .0Smb d.LOmL 9. IF 0.4 mL of serum is mixed with 15.6 mL of diluent, what dilution of serum does this represent? aid ©.2:70 d. 1:80 10. How much diluent needs to be added to 0.1 mL of serum to make a 1:15 dilution? bs mt 5.0 mL 4.15 mt LL. Which of the following choices would be considered a serial dilution? a1, 1:15, 1:20 b. 1:2, 1:10, 1:25 ¢. 1:15, 1:30, 1:40 12. The following dilutions were set up to titer an antibody. The following results were obtained: 1:4 +, 1:8 +, 1:16 4, 1:32 +, 1:64 -, How should the titer, be reported out? ad b. 16 4.64 13, Ifa serological testis positive for an individual who 7 |PegeStevens — Immulogy and Serology Study Questions (4™ Edition) does not have a particular disease, the result was caused by a problem with a ne c. accuracy. 4. poor pipetting. 14. Which of the following would be the correct way to make a 5% solution of hydrochloric acid from concentrated hydrochloric acid? b.0.5 mL of acid and 95 mL of water €.0.1 mL of acid and 9.9 mL of water 4.0.1 mL of acid and 4.9 mL of water 15, What is the final dilution of serum obtained from the following serial dilutions: 1:4, 1:4, 1:4, 1:4, 1:4, 1:4? a 24 b.1:256 11,024 16. Anew laboratory assay gave the following results: ‘number of patients tested = 100; number of true positives = 54, number of true negatives = 42; number of false positives = 2; number of false negatives = 2, What is the specificity ofthis assay in whole numbers? a. 75% b. 85% 6. 98% 17. What is the sensitivity of the assay in Question 16? a. 8496 b. 90% ©. 92% 18, Ascreening test gave the following results: number of patients tested = 150; number of true positives = 50; number of true negatives = 85; number of false positives = 5; number of false negatives = 10. What is the positive predictive value rounded off to a whole number for a patient whose test is positive? b. 83% 89% 4, 56% 18|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 10 Precipitation and Agglutintion Reactions 1. Ina precipitation reaction, how can the ideal antibody be characterized? a. Low affinity and low avidity b. High affinity and low avidity 4d. Low affinity and high avidity 2. Precipitation differs from agglutination in which way? a. Precipitation can only be measured by an automated instrument b. Precipitation occurs with univalent antigen, whereas agglutination requires multivalent antigen. Cc Precipitation does not readily occur because few antibodies can form aggregates with antigen, 3. When soluble antigens diffuse in a gel that contains antibody, in which zone does optimum precipitation occur? a, Prozone c. Postzone d. Prezone 4. Which of the following statements apply to rate nephelometry? a. Readings are taken before equivalence is reached. b. It is more sensitive than turbidity. c. Measurements are time dependent. 5. Which of the following is characteristic of the end-point method of RID? a, Readings are taken before equivalence. c. The diemeter is plotted against the log of the concentration. 4. Its primarily a qualitative rather than 3 quantitative method. 6. In which zone might an antibody-screening test be false a? b. Zone of equivalence ¢. Postzone 4d, None of the above 7. How does measurement of turbidity differ from nephelometry? a. Turbidity measures the increase in light after it passes through a solution, Turbidity deals with univalent antigens only. d. Nephelometry is not affected by large particles falling out of solution 8, Which of the following refers to the force of attraction between an antibody and a single antigenic determinant? b. avidity . Van der Waals attraction d, Covalence 9. Immunofixation electrophoresis differs from immunoelectrophoresis in which way? a. Electrophoresis takes place after diffusion has ‘occurred in immunofixation electraphoresis. b. Better separation of proteins with the same electrophoretic mobilities is obtained in immunoelectrophoresis. d, Immunoelectrophoresis is a much faster procedure 10. If crossed lines result in an Ouchterlony immunodiffusion reaction with antigens 1 and 2, what does this indicate? a. Antigens 1 and 2 are identical, b. Antigen 2 is simpler than antigen 2. . Antigen 2 is more complex than antigen 1. 19|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) 11. Which technique represents a single-diffusion reaction? b. Ouchterlony diffusion c. Immunoelectrophoresis d. Immunofixation electrophoresis 12. Which best describes the law of mass action? aa, Once antigen-antibody binding takes place, itis irreversible. b. The equilibrium constant depends only on the forwerd reaction. d. If an antibody has a high avisity, from antigen easily. will dissociate 13. Agglutination of dyed bacterial cells represents which oe of reaction? b. Passive agglutination c. Reverse passive agglutination d. Agglutination inhibition 14. Ifa single IgM molecule can bind many more antigens than a molecule of IgG, which of the following is higher? a. Affinity b. Initial force of attraction 4. Initial sensitization 15, Agglutination inhibition could best be used for which of the following types of antigens? a. Large cellular antigens such as erythrocytes . Bacterial cells 4. Coated latex particles 16. Which of the following correctly describes reverse passive agglutination? a. Itis 2 negative test b. It cen be used to detect autoantibodies d. It is used to detect sensitization of red blood cells 17. Reactions involving IgG may need to be enhanced for which reason? a. Itis only active at 25°C , It has only one antigen-binding site. d. Itis only able to produce visible precipitation reactions. 18. For which of the following tests is @ lack of agglutination a positive reaction? a. Hemagglutination b. Passive agglutination c. Reverse passive agglutination 19. Typing of RBCs with reagent antiserum represents which type of reaction? b. Passive hemagglutination ¢ Hemnagglutination inhibition 4, Reverse passive hemagglutination 20, In a particle-counting immunoassay using reagent antibody attached to latex particles, if the particle count in solution is very low, what does this mean about the presence of patient antigen? a. The patient has no antigen present. b. The patient has a very small amount of antigen. d. The testis invalid. 20|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 11 Labeled immunoassays 1. Which of the following statements accurately describes competitive binding assays? a, Excess binding sites for the analyte are provided b. Labeled and unlabeled analyte are present in equal amounts. 4. All the patient analyte is bound in the reaction, 2, How do heterogeneous assays differ from homogeneous assays? ‘a Heterogeneous assays require a separation step. b. Heterogeneous assays are easier to perform than homogeneous assays. c. The concentration of patient analyte is indirectly proportional to bound label in heterogeneous assays. d, Homogeneous assays are more sensitive than heterogeneous ones. 3. In the following equation, what is the ratio of bound radioactive antigen (Ag*) to bound patient antigen (Ag)? 12Ag* + 4Ag+4Ab > _Agt Ab+__AgAb+Ag*+ Ag 4, Which of the following responses characterizes a capture or sandwich enzyme assay? a. Less sensitive than competitive enzyme assays . Best for small antigens with a single determinant d. Alimited number of antibody sites on solid phase 5. Which of the following is an advantage of enzyme immunoassay over RIA? b. Shorter shelf life of kit c. Natural inhibitors do not affect results d. Needs to be read manuelly 6. Which of the following is characteristic of direct fluorescent assays? a, The anti-immunoglobulin has the fluorescent tag. b. Antibody is attached to a solid phase. | 4d. The amount of color isin inverse proportion to the amount of antigen present. 7. Which of the following is true of fluorescence Polarization immunoassay? a. Both antigen and antibody are labeled. | When binging occurs, there is quenching of the fluorescent tag d. The amount of fluorescence is directly propor to concentration of the analyte. nal 8.A fluorescent substance is best described as one in which | b. the emitted wavelength can be seen under normal white light. . there is a long time between the absorption and. ‘emission of light. 4d. it spontaneously decays and emits light. 9. In a noncompetitive enzyme immunoassay, if 2 negative control shows the presence of color, which of the following might be a possible explanation? ‘a. No reagent was added. . The enzyme was inactivated. d. No substrate was present. 10. Which of the following best characterizes chemiluminescent assays? a. Only the antigen can be labeled. b. Tests can be read menually. . These are only homogeneous assays. 11, Immunofluorescent assays may be difficult to interpret for which reason? 21|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) a. Autofluorescence of substances in serum b. Nonspecific binding to serum proteins ©. Subj ma in reading results 12. Which statement best describes flow-through immunoassays? a, Results are quantitative. c. Reagents must be added separately. 4. They are difficult to interpret. 13. Which of the following is characteristic of an indirect enzyme immunoassay? a. The first antibody has the enzyme label. b. All reagents are added together. d. Enzyme specificity is not essential. 14. In a homogeneous enzyme immunoassay, which best describes the enzyme? a. Enzyme activity is altered when binding to antibody occurs. b.The et label is on the ee d. Most enzymes can be used in this type of assay, 15. In an indirect immunofluorescent assay, what would be the outcome of an improper wash after the antibody-enzyme conjugate is adéed? a, Results will be falsely decreased >, Results will be falsely increased. «. Results will be unaffected, 4, It would be difficult to determine the effect. 16. In a heterogeneous enzyme immunoassay, if the patient sample produces more color than the highest positive control, what action should be taken? a. Report the results out as determined, b, Dilute the patient sample. c. Repeat the assay using one-half the volume of the patient sample. d. Report the results as falsely positive. 22|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 12 Molecular Diagnostic Techniques 11, What holds two single strands of DNA together in a double helix? a. 2' carbon of deoxyribose attached to 2 hydroxyl group _ eee . Ribose 3" carbon hydroxyl attached to ribose 5’ carbon phosphate d. Phosphorylation of nitrogen bases 2. What is the complement to the following DNA sequence? S/-GATCGATTCG-3" a. SUCTAGCTAAGC-S CGAATCGATC-5' GCTTAGCTAG-5 GATCGATTCG-5! | 3. How are DNA and RNA different? b. Only DNA contains cytosine c. DNAis usually single stranded. d. DNA is less stable than RNA. 4, What is the function of restriction endonucleases? a. They splice short pieces of DNA together. They make RNA copies of DNA. d. They make DNA copies from RNA. 5. What is the purpose of somatic hypermutation genes that code for antibodies? b. To prevent further antibody formation c. To switch antibodies from IgM to IgG d. To prevent further VDJ recombination 6. What characteristic distinguishes restriction enzymes from one another? 42, Diverse binding and cutting sites b. Ability to quickly digest DNA c. RNA degradation capability 4. Ability of one enzyme to recognize several different binding sites 7. Which of the following is used in a Southern blot procedure? 2. A ligase joins two adjacent probes. b, Radiolabeled nucleotides are used to synthesize g 2 5 d. Many probes are placed on a small piece of glass. 8, Which best describes the PCR? ‘a. Two probes are joined by a ligating enzyme. b. RNA copies of the original DNA are mace. c. Extender probes are used to create a visible product, copies. ‘9, What takes place during in situ hybridization? ‘a, RNA polymerase copies messenger RNA. b. Hybridization takes place in solution. d. Probes are protected from degradation if hybridized. 10. What determines the specificity for PCR? a, Nucleotide mix ratios end concentrations b. Mono- and divalent cation concentrations 4d. DNA polymerase 11. An antibody test for HIV within 3 months of exposure is negative. Does this guarantee a negative PCR test? 1. Yes, because if no antibodies are present, no virus is present, . Yes, it has been 3 months since exposure, 4d. No, but the PCR test will be less sensitive than the antibody test. 12, How do PCR and qPCR differ? 2 9 8 3 ¢. PCRis an isothermal process and qPCR is not. d. Internal amplification controls are not necessary in gPCR. 23/PegeStevens — Immulogy and Serology Study Questions (4™ Edition) 13. Which method is a signal amplification system? 14. Which of the following amplifications is isothermal? a, PCR b. qPCR NASBA 15. Consider the following results for a GPCR test for the presence of herpes virus: Sample Ct/Semple Ct/Amp Control 22.10 21.06 8 35,02. 20.99, Which of the following statements is true? a. The HSV viral load in sample Ais greater than in sample 8, b. The HSV viral load in sample Bis greater than in sample A. ¢. The HSV viral load in sample A is about the same as in sample B. 16. Which terminates chains when added to a DNA. replication reaction? a. dNTPs: c. Sequencing primer 4d. DNA polymerase 17. Which technique involves prabe amplification rather than target amplification? a, Southern blot b.PCR c. Transcription-mediated amplification 18. How does next generation sequencing (NGS) technology differ from the original Sanger chain displacement sequencing? a. NGS is more expensive to conduct than chain displacement sequencing, . Sanger sequencing involves ligation and NGS does not. 4d, Only Sanger sequencing has direct clinical applications. 19. Which of the fall nucleic acid probe? a. Itattaches to double-stranded DNA. b. Itis used in transcription-mediated amplification. 1g methods best describes a d. It plays a key role in DNA chain termination sequencing. 20. A hybridization reaction involves which of the following? ‘a. Separating DNA strands by heating . Increasing the number of DNA copies d. Cleaving DNA into smaller segments 21 What is the difference between a polymorphism and ‘a mutation? a, Mutations only affect A and T bases. b, Mutations are more frequently present in a population 4d. Polymorphisms are easier to detect than mutations. 24| PageStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 13 Flow Cytometry and Laboratory Automation 1. Flow cytometry characterizes cells on the basis of which of the following? ee b. Front-angle scatter only of an interrupted light beam c. Absorbance of light by different types of cells 4. Transmittance of light by cells in solution 2. Forward-angle light scatter is an indicator of cell a. granularity. b. density. d. number, 3. What is the single most important requirement for samples to be analyzed on a flow cytometer? a, Whole blood is collected into a serum-separator tube. c. Samples must be fixed in formaldehyde before processing. d. Blood must be kept refrigerated while processing. 4. Which statement represents the best explanation for a flow cytometer’s ability to detect several cell surface markers at the same time? a. The forward scatter can separate out cells on the basis of complexity. b. One detector can be used to detect many different wavelengths. | d. Intrinsic parameters are separated out on the basis of the amount of side scatter. 5. Which of the following cell surface markers would be present ona ggriston of T helper (Th) cells? b. CD3 and COB ©.CD3 only, d. CD4 only 6. If an analyzer consistently indicates a positive test when the analyte in question is not present, this represents a problem with a ee ¢ reportable range. d. precision. 7. Allof the following are clinical applications for flow cytometry except a. fetal hemoglobin. b, immunophenotyping of lymphocyte subpopulations. ¢. HIV viral load analysis. 8, The various signals generated by cells intersecting with a flow cytometry laser are captured by a. bandwidth waves. b. wave channels, d. flow cells. 9. Analysis of flow cytometer data of cells can be filtered in many ways by using a method of b. banding of a histogram. . single-parameter histogram monitoring, automatic sampling, 10, A newer flow cytometry technology that has the potential to detect over 500 analytes fram one sample of blood is called a/an ‘a. RBC fragmentation assay. b, Dinydrorhodamine 123, c. sucrose test. 11, Many flow cytometry laboratories now use the cpas marker in combination with SSC in differentiating various populations of WBCs to replace which of the following combinations? a. CD4 + SSC b. Coa + FSC . FSC + CD45 12. Which cell surface marker is present on cells seen in, hairy cell leukemia? 25|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) a. CD138 b. CD33 . CD34 13, CD45 isa pan-leukacyte marker expressed on WBCs in varying levels or amounts of expression, based on a. size of a cell b. aaa of a cell. d. malignancy of a cell 14. Which of the following statements best describes a single-parameter histogram? a, Each event is represented by a dot. b. Data is distributed in four quadrants. . Positive and negative events are plotted on the xand y axis. 15. How many fluorochromes (colors) are current clinical fiow cytometers capable of detecting? 16. Which type of analyzer allows one to measure multiple analytes from numerous samples, loaded at any time? a. Batch analyzer . Front-end loaded analyzer 4d. Sequential access analyzer 17. Operational considerations when selecting automated analyzers for your laboratory include all of the following except a. reagent stability. b. test menu, STAT. cant 18. Analyzers use different methods for mixing, including magnetic stirring, rotation paddles, forceful dispensing, and vigorous lateral shaking, Whichever method. used, itis imperative that a. reagents always be kept refrigerated. ¢. samples are kept at room temperature. 4d, multiple methods are not used simultaneously. 19, All of the following are benefits of automation except a. greater accuracy. «, savings on controls. d. less disposal of outdated reagents. 20. If an analyzer gets different results each time the ‘same sample is tested, what type of problem does this represent? a. Sensitivity b. Specificity Accuracy 26|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 14 Hypersensitivity 1. Which of the following is a general characteristic of hypersensitivity reactions? a. The immune responsiveness is depressed. b. Antibodies are involved in all reections. 4d. The antigen triggering the reaction is a harmful one. 2. Which of the following is associated with an increase in IgE production? a. Transfusion reaction . Reaction to poison ivy d. HDN 3. Which of the following would cause a positive DAT test? a. Presence of IgG on RBCs b, Presence of C3b or C3d on RBCs -A transfusion reaction caused by preformed antibody 4, All of the following are associated with type | hypersensitivity except a, release of preformed mediators from mast cells. c.cell-bound antibody bridged by antigen. d. an inherited tendency to respond to allergens. 5. Which of the following is associated with anaphylaxis? b. Activation of complement c. Increase in cytotoxic T cells d, Large amount of circulating IgG 6. To determine if @ patient is allergic to rye grass, the best test to perform is the a. total IgE test. ©. DAT. 4. complement fixation. 7. Which condition would result in HON? a, Buildup of IgE on mother’s cells, b. Sensitization of cytotoxic T cells . Exposure to antigen found on both mother and aby RBCS | 8, What is the immune mechanism involved in type III hypersensitivity reactions? a. Cellular antigens are involved. | . Only heterologous antigens are involved. d. Tissue damage results from exocytosis. ‘9. What is the immune phenomenon associated with the ‘Arthus reaction? a. Tissue destruction by cytotoxic T cells b, Removal of antibody-coated RBCs 4d. Release of histamine from mast cells, 10. Which of the following conclusions can be drawn about a patient whose total IgE level was determined to be 150 IU/ml? a. The patient definitely has allergic tendencies b. The patient may be subject to anaphylactic shock. d. The patient will never have an allergic reaction. 11, Which of the following exolains the difference between type I and type Ill hypersensitivity reactions? b. Type Ill involves IgE. . IgG is involved only in type Ill reactions 4d. Type Il reactions involve no antibody. 12. Two days after admi female health-care worker developed an area of redness and induration 12 mm in size atthe injection site. This result means that she has a. an active case of tuberculosi b. been exposed to M tuberculosis. ¢. developed protective immunity against tuberculosis 4d. a result in the normal range for her risk group. istration of the PPD test, a 13, A young women developed red, itchy papules on her wrist 2 days after wearing a new bracelet. This WI|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) reaction was caused by a. Ig€-sensitized mast cells in the skin. b. antigen-antibody complexes in the skin. c. damage to the skin cells by antibodies and complement. 14. Reactions to latex are caused by a. type | hypersensitivity. b. type IV hypersensitivity. c. skin irritation. 15, To determine a cold agglutinin titer a. patient serum should be separated from whole blood at 4°C and tested at 4°C. b. patient serum should be separated from whole blood at 4°C and tested at 37°C. d. patient serum should be separated from whole blood at 37°C and tested at 37°C. 28|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 15 Autoimmunity 1. All of the following may contribute to autoimmunity except b. molecular mimicry. . increased expression of class Il MHC antigens. 4. polyclonal activation of B cells. 2. Which of the following would be considered an organ-specific autoimmune disease? a. SLE b.RA GPA 3, SLE can be distinguished from RA on the basis of which of the following? a. Joint pain b. Presence of antinuclear antibodies c. Immune complex formation with activation of complement 4, Which of the following would support a diagnosis of drug-induced lupus? b. Antibodies to Smith antigen c. Presence of RF d. Antibodies to $S-A and $S-8 antigens 5. A peripheral pattern of staining of the nucleus on IIF is caused by which of the following antibodies? a. Anti-Sm antibody b. Anti-SSA/Ro antibody c. Centromere antibody 6. Which of the following would be considered a significant finding in Graves disease? a. Increased TSH levels c. Decreased T3 and T4 d. Antithyroglobulin antibody 7. Destruction of the myelin sheath of axons caused by the -_ of antibody is characteristic of which disease? b. MG c. Graves disease 4d. Goodpasture’s syndrome 8, Blood was drawn from a 25-year-old woman with suspected SLE. A FANA screen was performed and a speckled pattern resulted. Which of the following actions should be taken next? ‘a. Report out as diagnostic for SLE b. Report out as drug-induced lupus d., Repeat the test ‘9, Which of the following is a mechanism used to achieve peripheral tolerance? a. Negative selection of autoreactive T cells in the thymus b. Apoptosis of autoreactive 8 cells in the bone marrow Editing of B-cell receptors that weakly recognize self-antigens in the bone marrow 10. Epitope spreading refers to a. post-translational modifications to self-antigens. b. modifications in gene expression that are not caused by changes in DNA sequence. d, cross-reaction of the immune response to 2 pathogen with a similar self-antigen. 11. Anti-CCP (cyclic citrullinated proteins) is specifically associated with which autoimmune disease? b. MG ¢. Autoimmune hepatitis d, Goodpasture’s syndrome 12. Which autoantibodies are strongly associated with granulomatosis with polyangiitis (Wegener's granulomatosis)? a. ANA AMA 29 | PenceStevens — Immulogy and Serology Study Questions (4™ Edition) d. SMA 13. Atechnologist performs an IIF test for ANCAs and observes that there is an intense fluorescent staining of the nuclear lobes of the neutrophils. How can this type of staining be differentiated from a peripheral ANA pattern? a, Perform the test on formalin-fixed leukocytes b. Perform IF with HEp-2 cells Perform an ELISA for ANCAS 14. A20-year-old woman made an appointment to see her physician because she was experiencing intermittent diarrhea. Laboratory testing revealed that she also had an iron deficiency anemia, To determine if the patient has celiac disease, her doctor should order which of the following laboratory tests? b. Antigliadin c. Antigluten 4. All of the above 15, Antimitochondrial antibodies are strongly associated with which disease? a, Autoimmune hepatitis celiac disease d. Goodpasture’s syndrome Review Questions Chapter 16 Transplantation Immunology 1. Which of the following responses is the type of allograft rejection associated with vascular and parenchymal injury with lymphocyte infiltrates? a. Hyperacute rejection c. Acute humoral rejection d. Chronic rejection 2. Antigen receptors on T lymphocytes bind HLA class I! + peptide complexes with the help of which accessory molecule? a. co2 b.cD3 4. C08 3. Patients who have received the following types of grafts are at risk for graft-versus-host disease (GVHD) except for recipients of ‘a, bone marrow transplants. b. lung transplants, «liver transplants. 4, Which of the following properties are not exhibited by HLA molecules? 1a. They belong to the immunoglobulin superfamily. b. They are heterodimeric. ¢. They are integral cell membrane glycoproteins. 5. Kidney allograft loss from intravascular thrombosis without cellular infitration 5 days post-transplant may indicate which primary rejection mechanism? 2. Hyperacute rejection . Acute humoral rejection d. Acute cellular rejection 6, Which reagents would be used in a direct (forward) donor-recipient crossmatch test? ‘a. Donor serum and recipient lymphocytes + rabbit serum complement —— ¢. Donor stimulator cells + recipient responder cells + complete culture medium d. Recipient stimulator cells + donor responder cells + complete culture medium 7. The indirect allorecognition pathway involves which ‘one of the following mechanisms? b, Processed peptides from polymorphic recipient proteins restricted by donor HLA class | molecules , Intact polymorphic donor protein molecules recognized by recipient HLA class | molecules d. Intact polymorphic donor protein molecules recognized by recipient HLA class Il molecules 30|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) 8. Which immunosuppressive agent selectively inhibits IL-2 receptor-mediated activation of T cells and causes clearance of activated T cells from the circulation? a. Mycophenolate mofetil b. Cyclosporine mofetil c. Corticosteroids 9. Phenotyping for HLA class ll antigens requires B lymphocytes because b. 8 lymphocytes do not express HLA class | antigens. c. Blymphocytes are exquisitely sensitive to complement-mediated lysis. d. B lymphocytes represent the majority of lymphocytes in the peripheral blood, 10. Arenal transplant candidate was crossmatched with a donor that was mismatched for only the HLA-B35, antigen. The candidate was known to have en antibody specific for HLA-835. Which of the following combinations of T- and B-cell flow cytometric. crossmatch results would be expected? a. T cell negative, B cell negative c.T cell negative, 8 cell positive 4. T cell positive, B cell negative 11. Which of the following HLA alleles differs from A*02:01:02 by a synonymous nucleotide substitution? a, A°01:01:01:01 b. A*02:01:03 .A*02:02 d. A*02:03:01 12. Which one of the following donors would be expected to elicit a positive mixed lymphocyte response in lymphocytes from a patient who has the HLA-DRB1*01:01, 01:03 alleles? a, DRB1*01:01, 01:03 b, DRB1*01:01, 01:01 d, DRB1*01:01, 01:05 13. Which of the following donors would be the most appropriate, based on ABO compatibility, for a renal transplant candidate with the ABO type = 0? ba cB AB 14, Which of the following HLA antigens would be expected to elicit an HLA antibody response in a kidney transplant recipient with the following HLA type: HLA-A*01,03; B*07,14; C*01,04N; DRB1*16,07? , HLA-DRB1*16 15. Suppose a 30-year-old man was found to be a suitable donor for a kidney transplant to his younger sister. This transplant would be an example of alan) a. autograft. «.Isograft. 4. xenograft. 31] PengeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 17 Tumor immunology 1. How can normal cells become malignant? a. Overexpression of oncogenes b, Underexpression of tumor suppressor genes «Viral infection 2. Which of the following best summarizes the concept of tumor development via immunoediting? ‘a, Tumor cells produce cytokines that are toxic to T cells. c. T-cell activity causes an increase in MHC expression on tumor cells that allows them to escape the immune system. d. Secreted tumor-associated antigen saturates T-cell receptors and makes T cells incapable of binding to tumor cells. 3. Which of the following is an exemple of a tumorspecific mia b.CEA ©.CA125, 6. PSA 4, Most tumor markers are not used to screen the general Population because they a. cannot be inexpensively quantified, bb. do not rise to high enough levels in the presence of cancer. ae d. vary too much between patients belonging to different ethnic populations. 5. Both AFP and hCG exhibit serum elevations in a. pregnancy. b. ovarian germ cell carcinoma. c. nonseminomatous testicular cancer. 6. Suppose a patient with ovarian cancer had a serum CA125 level of SO KU/Lat initial diagnosis. After her ‘tumor was surgically removed, her CA 125 level declined to 25 KU/L. She received chemotherapy drug #1; after 1 year, her CA 125 level was 40 KU/L. She was then given chemotherapy drug #2 and her CA 125 level rose to 60 KU/L. These results indicate that a. surgery was effective in removing the patient's tumor. b. chemotherapy drug #1 was more effective than chemotherapy drug #2 ¢. both chemotherapy drug #1 and chemotherapy drug #2 were effective, 7. All of the following are recommended for cancer screening in the groups indicated except b, AFP/subjects at high risk for liver cancer. . PSA/men over 50 with at least 10 years of life expectancy. d. none of the above. 8, The best use of serum tumor markers is considered tobe in a. screening for cencer. b. initial diagnosis of cancer. 4d. determining patient prognosis. 9. In order to use a tumor marker to monitor the course of the disease, which of the following must be true? a. The laboratory measures the marker with the same method over the entire course of the patient's treatment, b. The marker must be released from the tumor or, because of the tumor, into a body fluid that can be obtained and tested. The marker's half-life is such that the marker persists long enough to reflect tumor burden but clears fast a to identify successful therapy. 10. Which of the following markers could be elevated in nonmalignant liver disease? a. AFP. b.CEA ©. CA1S-3 32|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) 11. Each of the following markers is correctly paired. with @ disease in which it can be used for patient monitoring except, b. CA 15-3/breast adenocarcinoma. ©. CA 125/ovarian adenocarcinoma. 4d. CA 19-9/pancreatic adenocarcinoma 12. Which of the following is a marker used in immunohistochemical staining to identify tumors of epithelial origin? b. Vimentin CD45 4. CD10 13. Which of the following assays would you recommend to test for chromosomal rearrangements such as the BCR/ABL translocation seen in CML? a. PCR ¢. Microarray d. Next generation sequencing 14. Innate immune responses thought to be involved in defense against tumors include b. MHC [-restricted T-cell-mediated destruction. ©. ADCC, 4d. all of the above. 15. Awoman with breast cancer is treated with a monocional antibody to HER2, This is an example of a. a cancer vaccine. b. an immunotoxin. 4. active immunotherapy. 33] PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 18 Immunoproliferative Diseases 1. Bence Jones proteins consist of 2, monoclonal IgG b. a aaa d. free heavy chains. 2. Which of the following would be the best indicator of a malignant clone of cells? a. Overall increase in antibody production b. Increase in IgG and IgM only _ eee d. Decrease in overall antibody production 3. All of the following are features of malignancy except b. rapid proliferation. c.clonal proliferation. d. chromosomal mutations. 4. All of the following features are commonly used to classify lymphoid neoplasms except a. cell of origin. b. presence of gene translocations. 4d. morphology or cytology of the malignant cells. 5. Hodgkin lymphoma is characterized by a. proliferation of T cells. excess immunoglobulin production. c.an incurable, rapidly progressive course. 6. Chronic leukemias are characterized as b. being curable with chemotherapy. c. usually occurring in children. d. following 2 rapidly progressive course. 7. Which of the following is characteristic of heavy- a. Usually of B-cell origin bb. Rare lymphomas . Production of abnormal Ig heavy chains 8, Flow cytometry results on a patient reveal 2 decrease of cells with CD2 and CD3. What does this indicate? a. Lack of B cells ¢. Lack of monocytes 4d. Lack of natural killer cells ‘9. Which of the following is true of Waldenstrom. macroglobulinemia but not multiple myeloma? b. A single protein-producing clone is elevated. . The cancerous cell is 2 preplasme cell d. Bence Jones proteins are present in the urine, 10. The presence of anemia, bone pain, thrombocytope and lytic bone lesions is suggestive of a. Hodgkin lymphoma. b. hairy cell leukemia. . chronic lymphacytic leukemia 11, The presence of an M protein on immunofixation electrophoresis (IFE) is indicated by 2. broad, diffuse banding c.a few well-defined bands in the IgG lene. d. a single band et the point of application in all of the lanes. 12, Surface immunoglobulin on a leukemic cell indicates a(n) b. Tell. , macrophage. d. autoimmune disease. 13. Which of the following is not 2 requirement for urine testing by IFE? a. Collection of a 24-hour sample b. Concentration of the sample d, Removal of sediment 14, Multiple myeloma is characteristically preceded by a. chronic hypogammegiobulinemia. 34] PegeStevens — Immulogy and Serology Study Questions (4™ Edition) b. Helicobacter pylori infection. c. va aaa 15. Which serum free light chain (sFLC) assay result indicates presence of a malignant plasma cell clone? b. A decrease in x and A concentrations c. A decrease in IgG, IgA, and IgM concentrations d. An increase in immunoglobulin concentrations over a 24-hour period 35 PengeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 19 Immunodeficiency Diseases 1. Patients with which immunodeficiency syndrome should receive irradiated blood products to protect against the development of GVHD? a, Bruton’s thymidine kinase (Btk) deficiency b, Selective IgA deficiency CGD 2. T-cell subset enumeration by flow cytometry would be ‘most useful in making the diagnosis of which disorder? a. Bruton’s thymidine kinase (Btk) deficiency b. Selective IgA deficiency 4d. Multiple myeloma 3. What clinical manifestation would be seen in a patient with myeloperoxidase deficiency? a, Defective T-cell function b. Inability to produce IgG c. Defective NK cell function 4, Defects in which branch of the immune system are ‘most commonly associated with severe illness after administration of live virus vaccines? b. Humoral immunity c. Complement 4. Phagocytic cells 5. Which of the following statements applies to Bruton’s thymidine kinase (Btk) deficiency? a. It typically appears in females. c.Teells are abnormal d. There isa lack of pre-B cells in the bone marrow. 6. DiGeorge anomaly may be characterized by all of the following except b. cardiac abnormalities. ©. parathyroid hypoplasia. d. decreased number of mature T cells. 7. 3-year-old boy is hospitalized because of recurrent bouts of pneumonia. Laboratory tests are run and the following findings are noted: prolonged bleeding time, decreased platelet count, increased level of serum alpha-fetoprotein, end a deficiency of naturally occurring isohemagglutinins. Based on these results, which is the most likely diagnosis? a, PNP deficiency b, Selective IgA deficiency SCID ‘8, Which of the following is (are) associated with ataxia-telangiectasia? a. Inherited as an autosomal recessive b. Defect in both cellular nd humoral immunity . Chromosomal breaks in lymphocytes 9, A4-year-old boy presents with recurrent wound and soft-tissue infections. Which of the following assays should be considered for diagnosing his presumed PID? b. CD4 quantitation . CD19 quantitation 4. CDS6 quantitation 10. A patient with a deficiency in complement ‘component C7 would likely present with ‘a. recurrent Staphylococcal infections. . recurrent E coll infections. d. recurrent Nocardia infections. 11. A FoxP3 gene mutation may lead to 2 deficiency of what cell type? a. Thelper cells, b. Teytotoxic cells Bells 12, The Cylex immunoknow assay is useful in determining functional capabilities of which cell type? b. Bells 36|PegeStevens — Immulogy and Serology Study Questions (4™ Edition) c. NKells 4. Neutrophils 13. Recurrent, periodic fevers may be associated with increased production of which immunoglobulin? a. IgG b.igm 6. IgE 14. Chronic mucocutaneous candidiasis, a PID that was previously thought to be a cell-mediated deficiency, is now classified as which type of PID? a. Autoinflammatory disorder b. Complement deficiency c. Predominantly antibody deficiency 15, Prenatal screening for SCID involves detecting a. Tregs. c. THELPS, 4. TCYTOS. 37 |PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 20 Serological and Molecular Detection of Bacterial Infections 369 1 All of the following are protective mechanisms against bacteria except a, production of antimicrobial defense peptides. b. phagocytosis ¢.activation of complement. 2. All of the following are characteristics of streptococcal M proteins except a. itis the chief virulence factor of Group A streptococci b. it provokes an immune response. | . it limits phagocytosis of the organism. 3. An ASO titer and a streptozyme test are performed on a patient's serum. The ASO titer is negative, the streptozyme test is positive, and both the positive and negative controls react appropriately. What can you conclude from these test results? a. The ASO is falsely negative c. The patient has not had a previous streptococcal infection. d. The patient has scarlet fever. 4, Which of the following applies to acute rheumatic fever? a. Symptoms begin after S. pyogenes infection of the throat or the skin . Diagnosis is usually made by culture of the organism. 4. All patients suffer permanent disability. 5. Which of the following indicates the presence of anti- DNase B activity in serum? b. Clot formation when acetic acid is added ¢ Inhibition of red blood cell hemolysis 4d, Lack of change in the color indicator 6. Which of the following is considered to be a nonsuppurative ‘complication of streptococcal infection? b, Scarlet fever ¢. Impetigo 4. Pharyngitis 7. All of the following are ways that bacteria can evade host defenses except a. presence of a capsule. ¢. production of toxins d. lack of adhesion to phagocytic cells. 8 Antibody testing for Rocky Mountain spotted fever may not be helpful for which reason? a. Itis not specific. b. It is too complicated to perform, .Itis difficult to obtain 2 blood specimen. ee 9, Which of the following enzymes is used to detect the presence of H pylori infections? a. DNase b. Hyaluronidase d. Peptidase 10. Which of the following reasons make serological identification of a current infection with Helicobacter pylori difficult? a. No antibodies appear in the blooe. b. Only IgM is produced. 4d. No ELISA tests have been developed. 111. M pneumoniae infections are associated with the production of which antibodies? b. Antibodies to ATPase c. Antibodies to DNase d. Antibodies to Proteus bacteria 38|PogeStevens — Immulogy and Serology Study Questions (4™ Edition) 12. Which of the following best describes the principle of the IFA test for detection of antibodies produced in Rocky Mountain spotted fever? a. Patient serum is applied to a microtiter plate coated with 2 monoclonal antibody directed against the target antigen. A detection antibody labeled with biotin and directed against the target antigen is added. After addition of a substrate, a color reaction develops indicating presence of the antigen. c. The serum sample is treated chemically to link the target antibodies to a fluorophore. The labeled sample is applied to a microscope slide to which the antigen has been attached. Following a wash step, the slide is examined for fluorescence. d. Patient serum is applied to a slide to which a specific antigen is bound. Following a wash step, a chromogenic dye is applied that binds to the Fe region of IgG and IgM antibodies. After a second wash step, the slide is examined for fluorescence. 13. Which of the following is true regarding exotoxins and endotoxins? a, Both endotoxin and exotoxins are highly immunogenic allowing for the development of protective antibodies and vaccines. bb. Endotoxin has targeted activity whereas exotoxins have systemic effects when released. d. Both endotoxin and exotoxins bind to specific receptors on a bacterial cell leading to cell lysis. 14. Characteristics of a bacterial capsule include which of the following? a. It cannot be used for vaccine development. b. itis composed of peptidoglycan. d. It is what causes bacteria to stain as gram-negative. 15. Which of the following statements regarding Helicobacter pyloriis not true? a. Itis associated with an increased risk of gastric carcinoma, | . Itis. a major cause of peptic ulcers in the United States. 4d. It is positive for urease. 39 PegeStevens — Immulogy and Serology Study Questions (4™ Edition) Review Questions Chapter 21 Spirochete Diseases 1 False-positive nontreponema| tests for syphilis may occur because of which of the following? a. Infectious mononucleosis b. Systemic lupus «. Pregnancy 2. In the fluorescent treponemal antibody absorption (FTA-ABS) test, what is the purpose of absorption with Reiter treponemes? a, It removes reactivity with lupus antibody. b. It prevents cross-reactivity with antibody to other T pallidum subspecies. d. All of the above. 3. Which test is recommenced for testing cerebrospinal fiuid for detection of neurosyphilis? a. RPR c. FTA-ABS 4. Enzyme immunoassay 4, Advantages of direct fluorescent antibody testing to T pallidum include all of the following except a, reading is less subjective than with dark-field testing. b. monoclonal antibody makes the reaction very specific, «.slides can be prepared for later reading. 5. Which of the following is true of nontreponemal antibodies? a. They can be detected in all patients with primary syphili bb These antibodies are directed against cardiolipin. c. Nontreponemal tests remain positive after successful treatment. 4. The antibodies are only found in patients with syphilis. 6. Which syphilis test detects specific treponemal antibodies? a. RPR b. VORL d. Agglutination 7. Which of the following is true of treponemal tests for syphilis? a. They are usually negative in the primary stage b. Titers decrease with successful treatment. | d, They are subject to a greater number of false positives than nontreponemal tests. 8. An RPR test done on a 19-year-old woman as part of a prenatal workup was negative but exhibited 2 rough appearance, What should the technologist do next? a. Report the result out as negative. b. Do a VDRL test. Send the sample for confirmatory testing. 9, Treponemal EIA tests for syphilis are characterized by all of the following except a as are adaptable to automation. syphilis patients undergoing therapy. c. subjectivity in reading is eliminated, d. they can be used to distinguish between IgG and IgM antibodies. 10, Which of the following tests is the most specific during the early phase of Lyme disease? a IFA b. EIA c Immunoblotting 11. False-positive serological tests for Lyme disease may be caused by all of the following except a. shared antigens between Borrelia groups. b. cross-reactivity of antibodies. ¢. resemblance of flagellar antigen to that of Treponema organisms. 12. A 24-year-old man who had just recovered from, infectious mononucleosis had evidence of @ genital 40|Pege