Stevens Is

IMMUNOLOGY & SEROLOGY - STEVENS (4th Edition)
Review Questions 8. A cell characterized by a nucleus with two to

Chapter 1 Introduction to Immunity and the five lobes, a diameter of 10 to 15 µm, and a large
Immune System number of neutral staining granules is identified
as a(n)
1. Which of the following can be attributed to a. eosinophil.
Pasteur? b. monocyte.
a. Discovery of opsonins c. basophil.
b. Observation of phagocytosis d. neutrophil.
c. First attenuated vaccines
d. Theory of humoral immunity 9. Which of the following is a primary lymphoid
organ?
2. Which WBC is capable of further differentiation a. Lymph node
in tissues? b. Spleen
a. Neutrophil c. Thymus
b. Eosinophil d. MALT
c. Basophil
d. Monocyte 10. What type of cells would be found in a primary
3. The cells that Metchnikoff first observed are follicle?
associated with which phenomenon? a. Unstimulated B cells
a. Innate immunity b. Germinal centers
b. Adaptive immunity c. Plasma cells
c. Humoral immunity d. Memory cells
d. Specific immunity
11. Which of the following is a distinguishing
4. Where are all undifferentiated lymphocytes feature of B cells?
made? a. Act as helper cells
a. Bone marrow b. Presence of surface antibody
b. Spleen c. Able to kill target cells without prior exposure
c. Thymus d. Active in phagocytosis
d. Lymph nodes
12. Where do lymphocytes mainly come in
5. Which of the following statements is true of NK contact with antigens?
cells? a. Secondary lymphoid organs
a. They rely upon memory for antigen recognition. b. Bloodstream
b. They have the same CD groups as B cells. c. Bone marrow
c. They are found mainly in lymph nodes. d. Thymus
d. They kill target cells without prior exposure to
them. 13. Which of the following is found on the T cell
subset known as helpers?
6. Which cell is the most potent phagocytic cell in a. CD19
the tissue? b. CD4
a. Neutrophil c. CD8
b. Dendritic cell d. CD56
c. Eosinophil
d. Basophil 14. Which of the following statements best
characterizes
7. The ability of an individual to resist infection by adaptive immunity?
means of normally present body functions is a. Relies on normally present body functions
called b. Response is similar for each exposure
a. innate immunity. c. Specificity for each individual pathogen
b. humoral immunity. d. Involves only cellular immunity
c. adaptive immunity.
d. cross-immunity.
mix
15. The main function of T cells in the immune 2. Which of the following best describes a hapten?
response is to a. Cannot react with antibody
a. produce cytokines that regulate both innate and b. Antigenic only when coupled to a carrier
adaptive immunity. c. Has multiple determinant sites
b. produce antibodies. d. A large chemically complex molecule
c. participate actively in phagocytosis.
d. respond to target cells without prior exposure. 3. Which would be the most effective
immunogen?
16. Which of the following is a part of humoral a. Protein with a molecular weight of 200,000
immunity? b. Nylon polymer with a molecular weight of
a. Cells involved in phagocytosis 250,000
b. Neutralization of toxins by serum c. Polysaccharide with a molecular weight of
c. Macrophages and mast cells in the tissue 220,000
d. T and B cells in lymph nodes d. Protein with a molecular weight of 175,000
17. Immunity can be defined as 4. Which of the following individuals would likely
a. the study of medicines used to treat diseases. respond most strongly to a bacterial infection?
b. a specific population at risk for a disease. a. An adult who is 75 years of age
c. the condition of being resistant to disease. b. A malnourished 40-year-old
d. the study of the noncellular portion of the c. A weightlifter who is 35 years old
blood. d. A newborn baby
18. A blood cell that has reddish staining granules 5. Which best describes an epitope?
and is able to kill large parasites describes a. A peptide that must be at least 10,000 MW
a. basophils. b. b. An area of an immunogen recognized only
b. monocytes. by T cells
c. neutrophils. c. A segment of sequential amino acids only
d. eosinophils. d. A key portion of the immunogen
19. Which of the following statements best 6. Adjuvants act by which of the following
describes a lymph node? methods?
a. It is considered a primary lymphoid organ. a. Protects antigen from being degraded
b. It removes old RBCs. b. Facilitates rapid escape from the tissues
c. It collects fluid from the tissues. c. Limits the area of the immune response
d. It is where B cells mature. d. Decreases number of APCs
20. Antigenic groups identified by different sets of 7. A heterophile antigen is one that
antibodies reacting in a similar manner to certain a. is a self-antigen.
standard cell lines best describes b. exists in unrelated plants or animals.
a. cytokines. c. has been used previously to stimulate antibody
b. clusters of differentiation (CD). response.
c. neutrophilic granules. d. is from the same species but is different from
d. opsonins. the host.
Chapter 2 Nature of Antigens and the Major 8. Which of the following is true of class II MHC
Histocompatibility Complex (HLA) antigens?
a. They are found on B cells and macrophages.
1. All of the following are characteristics of an b. They are found on all nucleated cells.
effective immunogen except c. They all originate at one locus.
a. internal complexity. d. They are coded for on chromosome 9.
b. large molecular weight.
c. the presence of numerous epitopes. 9. Class II MHC molecules are recognized by
d. found on host cells. which of the following?
a. CD4+ T cells
b. CD8+ T cells
c. Natural killer cells
d. Neutrophils
mix
10. Which of the following best describes the role 15. Class I MHC antigens E and G serve which
of TAP? function?
a. They bind to class II molecules to help block a. Enhance the response by macrophages
the antigen-binding site. b. Transport antigen for recognition by CD4+ T
b. They bind to class I proteins in proteasomes. cells
c. They transport peptides into the lumen of the c. Bind to A, B, and C antigens to protect the
endoplasmic reticulum. binding site
d. They help cleave peptides for transport to d. Protect fetal tissue from destruction by NK cells
endosomes.
16. Which best explains the difference between
11. What is the purpose of the invariant chain in immunogens and antigens?
antigen processing associated with class II MHC a. Only antigens are large enough to be
molecules? recognized by T cells.
a. Helps transport peptides to the binding site b. Only immunogens can react with antibody.
b. Blocks binding of endogenous peptides c. Only immunogens can trigger an immune
c. Binds to CD8+ T cells response.
d. Cleaves peptides into the proper size for d. Only antigens are recognized as foreign.
binding
17. When a child inherits one set of six HLA genes
12. An individual is recovering from a bacterial together from one parent, this is called a(n)
infection and tests positive for antibodies to a a. genotype.
protein normally found in the cytoplasm of this b. haplotype.
bacterium. Which of the following statements is c. phenotype.
true of this situation? d. allotype.
a. Class I molecules have presented bacterial
antigen 18. HLA molecules A, B, and C belong to which
to CD8+ T cells. MHC class?
b. Class I molecules have presented bacterial a. Class I
antigen b. Class II
to CD4+ T cells. c. Class III
c. Class II molecules have presented bacterial d. Class IV
antigen
to CD4+ T cells. Chapter 3 Innate Immunity
d. B cells have recognized bacterial antigen
without help from T cells. 1. The term for enhancement of phagocytosis by
coating of foreign particles with serum proteins is
13. In relation to a human, alloantigens would a. opsonization.
need to be considered in which of the following b. agglutination.
events? c. solubilization.
a. Transplantation of a kidney from one individual d. chemotaxis.
to another
b. Vaccination with the polysaccharide coat of a 2. Which of the following plays an important role
bacterial cell as an external defense mechanism?
c. Oral administration of a live but heat-killed virus a. Phagocytosis
particle b. C-reactive protein
d. Grafting skin from one area of the body to c. Lysozyme
another d. Complement
14. Which is characteristic of class I MHC 3. The process of inflammation is characterized by

molecules? all of the following except
a. Consists of one a and one ẞ chain a. increased blood supply to the area.
b. Binds peptides made within the cell b. migration of WBCs.
c. Able to bind whole proteins c. decreased capillary permeability.
d. Coded for by DR, DP, and DQ genes d. appearance of acute-phase reactants.
mix
4. Skin, lactic acid secretions, stomach acidity, 11. Which acute-phase reactant helps to prevent
and the motion of cilia represent which type of Formation of peroxides and free radicals that may
immunity? damage tissues?
a. Innate a. Haptoglobin
b. Cross b. Fibrinogen
c. Adaptive c. Ceruloplasmin
d. Auto d. Serum amyloid A
5. The structure formed by the fusion of engulfed 12. Which statement best describes Toll-like
material and enzymatic granules within the receptors (TLRs)?
phagocytic cell is called a a. They protect adult flies from infection.
a. phagosome. b. They are found on all host cells.
b. lysosome. c. They only play a role in adaptive immunity.
c. vacuole. d. They enhance phagocytosis.
d. phagolysosome
13. The action of CRP can be distinguished from
6. The presence of human microbiota (normal that of an antibody because
flora) acts as a defense mechanism by which of a. CRP acts before the antibody appears.
the following methods? b. only the antibody triggers the complement
a. Maintaining an acid environment cascade.
b. Competing with potential pathogens c. binding of the antibody is calcium-dependent.
c. Keeping phagocytes in the area d. only CRP acts as an opsonin.
d. Coating mucosal surfaces
14. How does innate immunity differ from adaptive
7. Measurement of CRP levels can be used for all immunity?
of the following except a. Innate immunity requires prior exposure to a
a. monitoring drug therapy with anti-inflammatory pathogen.
agents. b. Innate immunity depends upon normally
b. tracking the progress of an organ transplant. present body functions.
c. diagnosis of a specific bacterial infection. c. Innate immunity develops later than adaptive
d. determining active phases of rheumatoid immunity.
arthritis. d. Innate immunity is more specific than adaptive
immunity.
8. Pathogen recognition receptors act by
a. recognizing molecules common to both host 15. A 40-year-old male who is a smoker develops
cells and pathogens. symptoms of premature emphysema. The
b. recognizing molecules that are unique to symptoms may be caused by a deficiency of
pathogens. which of the following acute-phase reactants?
c. helping to spread infection because they are a. Haptoglobin
found on pathogens. b. Alpha1-antitrypsin
d. all recognizing the same pathogens. c. Fibrinogen
d. Ceruloplasmin
9. Which of the following are characteristics of
acute-phase reactants? 16. Which statement best describes NK cells?
a. Rapid increase following infection a. Their response against pathogens is very
b. Enhancement of phagocytosis specific.
c. Nonspecific indicators of inflammation b. They only react when an abundance of MHC
d. All of the above antigens is present.
c. They react when both an inhibitory and
10. Which is the most significant agent formed in activating signal is triggered.
the phagolysosome for the elimination of d. They are able to kill target cells without
microorganisms? previous exposure to them.
a. Proteolytic enzymes
b. Hydrogen ions
c. Hypochlorite ions
d. Superoxides
mix
Chapter 4 Adaptive Immunity 8. Which of the following can be attributed to

antigen-stimulated T cells?
1. Which MHC molecule is necessary for antigen a. Humoral response
recognition by CD4+ T cells? b. Plasma cells
a. Class I c. Cytokines
b. Class II d. Antibody
c. Class III
d. No MHC molecule is necessary. 9. Which is a distinguishing feature of a pre-B
cell?
2. Which would be characteristic of a T- a. µ chains in the cytoplasm
independent antigen? b. Complete IgM on the surface
a. The IgG antibody is produced exclusively. c. Presence of CD21 antigen
b. A large number of memory cells are produced. d. Presence of CD25 antigen
c. Antigens bind only one receptor on B cells.
d. It consists of a limited number of repeating 10. When does genetic rearrangement for coding
determinants. of antibody light chains take place during B-cell
development?
3. Humoral immunity refers to which of the a. Before the pre-B cell stage
following? b. As the cell becomes an immature B cell
a. Production of antibody by plasma cells c. Not until the cell becomes a mature B cell
b. Production of cytokines by T cells d. When the B cell becomes a plasma cell
c. Elimination of virally infected cells by cytotoxic
cells 11. Which of the following antigens are found on
d. Downregulation of the immune response the T-cell subset known as helper/inducers?
a. CD3
4. Where does antigen-independent maturation of b. CD4
B lymphocytes take place? c. CD8
a. Bone marrow d. CD11
b. Thymus
c. Spleen 12. Where does the major portion of antibody
d. Lymph nodes Production occur?
a. Peripheral blood
5. In the thymus, positive selection of immature T b. Bone marrow
cells is based upon recognition of which of the c. Thymus
following? d. Lymph nodes
a. Self-antigens
b. Stress proteins 13. Which of the following would represent a
c. MHC antigens Double negative thymocyte?
d. µ chains a. CD2-CD3+CD4-CD8+
b. CD2-CD3-CD4+CD8-
6. Which of these are found on a mature B cell? c. CD2+CD3+CD4-CD8-
a. IgG and IgD d. CD2-CD3-CD4+CD8-
b. IgM and IgD
c. Alpha and beta chains 14. Which of the following best describes the T-
d. CD3 cell receptor for antigen?
a. It consists of IgM and IgD molecules.
7. How do cytotoxic T cells kill target cells? b. It is the same for all T cells.
a. They produce antibodies that bind to the cell. c. It is present in the double-negative stage.
b. They engulf the cell by phagocytosis. d. Alpha and beta chains are unique for each
c. They stop protein synthesis in the target cell. antigen.
d. They produce granzymes that stimulate
apoptosis.
mix
15. A cell flow cytometry pattern belonging to a 3- 4. How many antigen-binding sites does a typical
yearold patient showed the following: normal IgM molecule have?
CD4+ T-cell count, normal CD19+ B-cell count, a. 2
low CD8+ T-cell count. Which type of immunity b. 4
would be affected? с. 6
a. Production of antibody d. 10
b. Formation of plasma cells
c. Elimination of virally infected cells 5. Bence Jones proteins are identical to which of
d. Downregulation of the immune response the following?
a. H chains
16. Which of the following is a unique b. L chains
characteristic of adaptive immunity? c. IgM molecules
a. Ability to fight infection d. IgG molecules
b. Ability to remember a prior exposure to a
pathogen 6. A Fab fragment consists of
c. A similar response to all pathogens a. two H chains.
encountered b. two L chains.
d. Process of phagocytosis to destroy a pathogen c. one L chain and one-half of an H chain.
d. one L chain and an entire H chain.
17. Clonal deletion of T cells as they mature is
important in which of the following processes? 7. Which antibody best protects mucosal
a. Elimination of autoimmune responses surfaces?
b. Positive selection of CD3/TCR receptors a. IgA
c. Allelic exclusion of chromosomes b. IgG
d. Elimination of cells unable to bind to MHC c. IgD
antigens d. IgM
18. Where do germinal centers occur? 8. Which of the following pairs represents two
a. In the thymus different immunoglobulin allotypes?
b. In the bone marrow a. IgM and IgG
c. In peripheral blood b. IgM1 and IgM2
d. In lymph nodes c. Anti-human IgM and anti-human IgG
d. IgG1m3 and IgG1m17
Chapter 5 Antibody Structure and Function
9. The structure of a typical immunoglobulin
1. Which of the following is characteristic of consists of which of the following?
variable domains of immunoglobulins? a. 2L and 2H chains
a. They occur on both the H and L chains. b. 4L and 2H chains
b. They represent the complement-binding site. c. 4L and 4H chains
c. They are at the carboxy-terminal ends of the d. 2L and 4 H chains
molecules.
d. They are found only on H chains. 10. Which of the following are L chains of antibody
molecules?
2. All of the following are true of IgM except that it a. Kappa
a. can cross the placenta. b. Gamma
b. fixes complement. c. Mu
c. has a J chain. d. Alpha
d. is a primary response antibody.
11. If the results of serum protein electrophoresis
3. How does the structure of IgE differ from that of show a significant decrease in the gamma band,
IgG? which of the following is a likely possibility?
a. IgG has a secretory component and IgE does a. Normal response to active infection
not. b. Multiple myeloma
b. IgE has one more constant region than IgG. c. Immunodeficiency disorder
c. IgG has more antigen-binding sites than IgE. d. Monoclonal gammopathy
d. IgG has more light chains than IgE.
mix
12. The subclasses of IgG differ mainly in 19. What is the purpose of HAT medium in the
a. the type of L chain. preparation of monoclonal antibody?
b. the arrangement of disulfide bonds. a. Fusion of the two cell types
c. the ability to act as opsonins. b. Restricting the growth of myeloma cells
d. molecular weight. c. Restricting the growth of spleen cells
d. Restricting antibody production to the IgM class
13. Which best describes the role of the secretory
component of IgA? 20. Papain digestion of an IgG molecule results in
a. A transport mechanism across endothelial cells which of the following?
b. A means of joining two IgA monomers together a. 2 Fab' and 1 Fc' fragment
c. An aid to trapping antigen b. F(ab')2 and 1 Fc' fragment
d. Enhancement of complement fixation by the d. 2 Fab and 1 Fc fragment
classical pathway c. 2 Fab and 2 Fc fragments
14. Which represents the main function of IgD? 21. Which antibody provides protection to the
a. Protection of the mucous membranes growing fetus because it is able to cross the
b. Removal of antigens by complement fixation placenta?
c. Enhancing proliferation of B cells a. IgG
d. Destruction of parasitic worms b. IgA
c. IgM
15. Which antibody is best at agglutination and d. IgD
complement fixation?
a. IgA 22. Which best characterizes the secondary
b. IgG response?
c. IgD a. Equal amounts of IgM and IgG are produced.
d. IgM b. There is an increase in IgM only.
c. There is a large increase in IgG but not IgM.
16. Which of the following can be attributed to the d. The lag phase is the same as in the primary
clonal selection hypothesis of antibody formation? response.
a. Plasma cells make generalized antibody.
b. B cells are preprogrammed for specific Chapter 6 Cytokines
antibody synthesis.
c. Proteins can alter their shape to conform to 1. The ability of a single cytokine to alter the
antigen. expression of several genes is called
d. Cell receptors break off and become circulating a. redundancy.
antibody. b. pleiotropy.
c. autocrine stimulation.
17. All of the following are true of IgE except that it d. endocrine effect.
a. fails to fix complement. 2. Which of the following effects can be attributed
b. is heat stable. to IL- 1?
c. attaches to tissue mast cells. a. Mediation of the innate immune response
d. is found in the serum of allergic persons. b. Differentiation of stem cells
c. Halted growth of virally infected cells
18. Which best describes coding for d. Stimulation of mast cells
immunoglobulin molecules? 3. Which of the following precursors are target
a. All genes are located on the same cells for IL-3?
chromosome. a. Myeloid precursors
b. L chain rearrangement occurs before H chain b. Lymphoid precursors
rearrangement. c. Erythroid precursors
c. Four different regions are involved in coding of d. All of the above
H chains. 4. A lack of IL-4 may result in which of the
d. Lambda rearrangement occurs before kappa following effects?
rearrangement. a. Inability to fight off viral infections
b. Increased risk of tumors
c. Lack of IgM
d. Decreased eosinophil count
mix
5. Which of the following cytokines is also known 11. Selective destruction of Th cells by the human
as the T-cell growth factor? immunodeficiency virus contributes to immune
a. IFN-y suppression by which means?
b. IL-12 a. Decrease in IL-1
c. IL-2 b. Decrease in IL-2
d. IL-10 c. Decrease in IL-8
d. Decrease in IL-10
6. Which of the following represents an autocrine
effect of IL-2? 12. Why might a colony stimulating factor be
a. Increased IL-2 receptor expression by the Th given to a cancer patient?
cell producing it a. Stimulate activity of NK cells
b. Macrophages signaled to the area of antigen b. Increase production of certain types of
stimulation leukocytes
c. Proliferation of antigen-stimulated B cells c. Decrease the production of TNF
d. Increased synthesis of acute-phase proteins d. Increase production of mast cells
throughout the body
13. Which of the following would result from a lack
7. IFN-a and IFN-ẞ differ in which way from of TNF?
IFN-gamma? a. Decreased ability to fight gram-negative
a. IFN-a and IFN-ẞ are called immune interferons, bacterial infections
b. Increased expression of class II MHC molecules
and IFN-gamma is not.
c. Decreased survival of cancer cells
b. IFN-a and IFN-ẞ primarily activate
d. Increased risk of septic shock
macrophages, whereas IFN-gamma halts viral
activity. 14. Which cytokine acts to promote differentiation
c. IFN-a and IFN-ẞ are made primarily by activated of T cells to the Th1 subclass?
T cells, whereas IFN-gamma is made by a. IL-4
fibroblasts. b. IFN-a
d. IFN-a and IFN-ẞ inhibit cell proliferation, c. IL-12
whereas IFN-gamma stimulates antigen d. IL-10
presentation by class II MHC molecules.
15. What is the major function of T regulatory
8. A patient in septic shock caused by a gram- cells?
negative bacterial infection exhibits the following a. Suppression of the immune response by
symptoms: high fever, very low blood pressure, producing TNF
and disseminated intravascular coagulation. b. Suppression of the immune response by
Which cytokine is the most likely contributor to inducing IL-10
these symptoms? c. Proliferation of the immune response by
a. IL-2 producing IL-2
b. TNF d. Proliferation of the immune response by
c. IL-12 inducing IL-4
d. IL-7
16. Th17 cells affect the innate immune response
9. IL-10 acts as an antagonist to what cytokine? by inducing production of which cytokines?
a. IL-4 a. IFN-y and IL-2
b. TNF-α b. IL-4 and IL-10
c. IFN-gamma c. IL-2 and IL-4
d. TGF-B d. TNF-a and IL-6
10. Which would be the best assay to measure a Chapter 7 Complement System
specific cytokine?
a. Blast formation 1. The classical complement pathway is activated
b. T-cell proliferation by
c. Measurement of leukocyte chemotaxis a. most viruses.
d. ELISA testing b. antigen-antibody complexes.
c. fungal cell walls.
d. mannose in bacterial cell walls.
mix
2. Which of the following is characteristic of 9. Which of the following is true of the

complement components? amplification loop in complement activation?
a. Normally present in serum a. It is only found in the alternative pathway.
b. Mainly synthesized by B cells b. The membrane attack unit is amplified.
c. Present as active enzymes c. C3b is the product that is increased.
d. Heat stable d. Increasing amounts of C1qrs are produced.
3. All of the following are true of the recognition 10. Factor H acts by competing with which of the
unit except following for the same binding site?
a. it consists of C1q, C1r, and C1s. a. Factor B
b. the subunits require calcium for binding b. Factor D
together. c. C3B
c. binding occurs at the FC region of antibody d. Factor I
molecules.
d. C1q becomes an active esterase. 11. A lack of CR1 receptors on RBCs would result
in which of the following?
4. Which of the following is referred to as C3 a. Decreased binding of C3b to RBCs
convertase? b. Decreased clearance of immune complexes by
a. C1qrs the spleen
b. C3bD c. Decreased breakdown of C1qrs
c. C3bBb d. Decreased binding of Factor H
d. C4b5a
12. Which best describes the role of CR2 on cell
5. Mannose-binding protein in the lectin pathway membranes?
is most similar to which classical pathway a. Binds C1qrs to inactivate it
component? b. Acts as co-receptor on B cells for antigen
a. C3 c. Increases clearance of immune complexes d.
b. C1rs Binds particles opsonized with C3b
c. C1q
d. C4 13. Which of the following best characterizes
hemolytic uremic syndrome?
6. Which of the following describes the role of a. It is a rare cause of renal failure in children.
properdin in the alternative pathway? b. It can be associated with deficiencies in Factor
a. Stabilization of C3/C5 convertase H.
b. Conversion of B to Bb c. The major cause is lack of DAF on RBCs.
c. Inhibition of C3 convertase formation d. It is associated with antibody-to-C3 convertase.
d. Binding and cleavage of Factor B
14. The CH50 test measures which of the
7. Which best characterizes the membrane attack following?
complex (MAC)? a. Patient serum required to lyse 50% of
a. Each pathway uses different factors to form it. sensitized sheep RBCs
b. C5 through C9 are not added in any particular b. Functioning of both the classical and alternative
order. pathways
c. One MAC unit is sufficient to lyse any type of c. Genetic deficiencies of any of the complement
cell. components
d. C9 polymerizes to form the transmembrane d. Functioning of the lectin pathway only
channel.
15. Which of the following would be most effective
8. All of the following represent functions of the in preventing bystander lysis of RBCs?
complement system except a. C1-INH
a. decreased clearance of antigen-antibody b. Factor B
complexes. c. DAF
b. lysis of foreign cells. d. Factor H
c. increase in vascular permeability.
d. migration of neutrophils to the tissues.
mix
16. A decreased CH50 level and a normal AH50 3. The only biological waste that does not have to
level indicate which deficiency? be discarded in a container with a biohazard
a. Decrease in components in the lectin pathway symbol is
only a. urine.
b. Decrease in components in the alternative b. serum.
pathway only c. feces.
c. Decrease in components of both classical and d. serum tubes.
alternative pathways
d. Decrease in components of the classical 4. Patient specimens transported by the
pathway only Department of Transportation must be labeled as
a. diagnostic specimen.
17. Which best describes the role of an b. clinical specimen.
anaphylatoxin? c. biological specimen, category b.
a. Coats cells to increase phagocytosis d. laboratory specimen.
b. Attracts WBCs to the area of antigen
concentration 5. A technician places tightly capped
c. Increases production of interleukin-1 noninfectious serum tubes in a rack and places
d. Increases permeability of blood vessels the rack and the specimen data in a labeled
leakproof metal courier box. Is there anything
18. Which best describes the role of Factor H? wrong with this scenario?
a. Acts with DAF to break down C3b a. Yes, DOT requirements are not met.
b. Prevents binding of Factor B to C3b b. No, the tubes are placed in a rack.
c. Binds to the C5C6C7 complex c. Yes, absorbent material is missing.
d. Binds to C1q to shut down the classical d. No, the box contains the specimen data.
pathway
6. The Occupational Exposure to Bloodborne
19. A lack of C1-INH might result in which of the Pathogens Standard developed by OSHA requires
following conditions? employers to provide all of the following except
a. Paroxysmal nocturnal hemoglobinuria a. hepatitis B immunization.
b. Hemolytic uremic syndrome b. safety training.
c. Hereditary angioedema c. hepatitis C immunization.
d. Increased bacterial infections d. laundry facilities for nondisposable lab coats.
20. Which would be most effective in measuring 7. An employee who receives an accidental
an individual complement component? needlestick should immediately
a. CH50 assay a. apply sodium hypochlorite to the area.
b. Radial immunodiffusion b. notify a supervisor.
c. AH50 assay c. receive HIV prophylaxis.
d. Lytic assay with liposome d. receive a hepatitis B booster shot.
Chapter 8 Safety and Quality Management 8. The first thing to do when acid is spilled on the
skin is to
1. A technologist who observes a red rash on her a. notify a supervisor.
hands after removing her gloves b. neutralize the area with a base.
a. should apply antimicrobial lotion to the hands. c. apply burn ointment.
b. may be washing the hands too frequently. d. flush the area with water.
c. may have developed a latex allergy.
d. should not create friction when washing the 9. When combining acid and water,
hands. a. acid is added to water.
b. water is added to acid.
2. In the chain of infection, a contaminated work c. water is slowly added to acid.
area would serve as which of the following? d. both solutions are combined simultaneously.
a. Reservoir
b. Means of transmission
c. Portal of entry
d. Portal of exit
mix
10. To determine the chemical characteristics of 17. When a new bottle of QC material is opened,
sodium azide, an employee would consult the what information is placed on the label?
a. Chemical Hygiene Plan. a. The time the bottle was opened
b. Merck manual. b. The supervisor's initials
c. SDS. c. The lot number
d. NRC guidelines. d. The date and the laboratory worker's initials
11. A technician who is pregnant should avoid 18. What is the primary goal of TQM?
working with a. Precise test results
a. organic chemicals. b. Increased laboratory productivity
b. radioisotopes. c. Improved patient outcomes
c. HIV-positive serum. d. Reproducible test results
d. needles and lancets.
19. Would a control sample that has accidentally
12. Which of the following laboratory regulatory become diluted produce a trend or a shift in the
Agencies classifies laboratory tests by their Levey-Jennings plot?
complexity? a. Trend
a. OSHA b. Shift
b. CAP
c. TJC Fill in the Blank
d. CMS 20. Indicate whether each of the following would
be considered a (1) preexamination, (2)
13. Which of the following organizations publishes examination, or (3) postexamination variable by
Guidelines that are considered the standard of placing the appropriate number in the space.
care for laboratory _2_ Reagent expiration date
procedures? _1_ Rejection of a hemolyzed specimen
a. CLIA _2_ Construction of a Levey-Jennings chart
b. CLSI _3_Telephoning a critical result to the nurse
c. c. TJC _2_ Calibrating the centrifuge
d. CAP _2_ Pipetting the diluent
14. Quality managment refers to Chapter 9 Principles of Serological Testing

a. performance of two levels of testing controls.
b. reliable control results. 1. If serum is not tested immediately, how should it
c. increased productivity. be treated?
d. quality of specimens and patient care. a. It can be left at room temperature for 24 hours.
b. It can be stored in the refrigerator for up to 72
15. When external quality control is run, what hours.
information must be documented? c. It can be stored in the refrigerator for up to 48
a. The lot number hours.
b. Expiration date of the control d. It needs to be frozen immediately.
c. The test results
d. All of the above 7. If 0.02 mL of serum is diluted with 0.08 mL of
diluent, what dilution of serum does this
16. What steps are taken when the results of the represent?
quality control testing are outside of the stated a. 1:4
confidence limits? b. 1:5
a. Check the expiration date of the control c. 1:10
material d. 1:20
b. Run a new control
c. Open a new control bottle
d. All of the above
mix
8. A tube containing a 1:40 dilution is accidently 15. What is the final dilution of serum obtained
dropped. A 1:2 dilution of the specimen is still from the following serial dilutions: 1:4, 1:4, 1:4,
available. A volume of 4 mL is needed to run the 1:4, 1:4, 1:4?
test. How much of the 1:2 dilution is needed to a. 1:24
remake 4 mL of a 1:40 dilution? b. 1:256
a. 0.2 mL c. 1:1,024
b. 0.4 mL d. 1:4,096
c. 0.5 mL
d. 1.0 mL 16. A new laboratory assay gave the following
results: number of patients tested = 100; number
9. If 0.4 mL of serum is mixed with 15.6 mL of of true positives = 54, number of true negatives =
diluent, what dilution of serum does this 42; number of false positives = 2; number of false
represent? negatives = 2. What is the specificity of this assay
a. 1:4 in whole numbers?
b. 1:40 a. 75%
c. 2:70 b. 85%
d. 1:80 c. 95%
d. 98%
10. How much diluent needs to be added to 0.1
mL of serum to make a 1:15 dilution? 17. What is the sensitivity of the assay in Question
a. 1.4 mL 16?
b. 1.5 mL a. 84%
c. 5.0 mL b. 90%
d. 15 mL с. 92%
d. 96%
11. Which of the following choices would be
considered a serial dilution? 18. A screening test gave the following results:
a. 1:5, 1:15, 1:20 number of patients tested = 150; number of true
b. 1:2, 1:10, 1:25 positives = 50; number of true negatives = 85;
c. 1:15, 1:30, 1:40 number of false positives = 5; number of false
d. 1:5, 1:15, 1:45 negatives = 10. What is the positive predictive
value rounded off to a whole number for a patient
12. The following dilutions were set up to titer an whose test is positive?
antibody. The following results were obtained: 1:4 a. 91%
+,1:8+, 1:16+, 1:32 +, 1:64-. How should the titer b. 83%
be reported out? c. 89%
a. 4 d. 56%
b. 16
c. 32
d. 64
13. If a serological test is positive for an individual

who does not have a particular disease, the result
was caused by a problem with
a. sensitivity.
b. specificity.
c. accuracy.
d. poor pipetting.
14. Which of the following would be the correct

way to make a 5% solution of hydrochloric acid
from concentrated hydrochloric acid?
a. 0.5 mL of acid and 9.5 mL of water
b. 0.5 mL of acid and 95 mL of water
c. 0.1 mL of acid and 9.9 mL of water
d. 0.1 mL of acid and 4.9 mL of water
mix
Chapter 10 Precipitation and Agglutination 7. How does measurement of turbidity differ from
Reactions nephelometry?
a. Turbidity measures the increase in light after it
1. In a precipitation reaction, how can the ideal passes through a solution.
Antibody be characterized? b. Nephelometry measures light that is scattered
a. Low affinity and low avidity at an angle.
b. High affinity and low avidity c. Turbidity deals with univalent antigens only.
c. High affinity and high avidity d. Nephelometry is not affected by large particles
d. Low affinity and high avidity falling out of solution.
2. Precipitation differs from agglutination in which 8. Which of the following refers to the force of
way? attraction between an antibody and a single
a. Precipitation can only be measured by an antigenic determinant?
automated instrument. a. Affinity
b. Precipitation occurs with univalent antigen, b. Avidity
whereas agglutination requires multivalent c. Van der Waals attraction
antigen. d. Covalence
c. Precipitation does not readily occur because
few antibodies can form aggregates with antigen. 9. Immunofixation electrophoresis differs from
d. Precipitation involves a soluble antigen, immunoelectrophoresis in which way?
whereas agglutination involves a particulate a. Electrophoresis takes place after diffusion has
antigen. occurred in immunofixation electrophoresis.
b. Better separation of proteins with the same
3. When soluble antigens diffuse in a gel that electrophoretic mobilities is obtained in
contains antibody, in which zone does optimum immunoelectrophoresis.
precipitation occur? c. In immunofixation electrophoresis, antibody is
a. Prozone directly applied to the gel instead of being placed
b. Zone of equivalence in a trough.
c. Postzone d. Immunoelectrophoresis is a much faster
d. Prezone procedure.
4. Which of the following statements apply to rate 10. If crossed lines result in an Ouchterlony
nephelometry? immunodiffusion reaction with antigens 1 and 2,
a. Readings are taken before equivalence is what does this indicate?
reached. a. Antigens 1 and 2 are identical.
b. It is more sensitive than turbidity. b. Antigen 2 is simpler than antigen 1.
c. Measurements are time dependent. c. Antigen 2 is more complex than antigen 1.
d. All of the above. d. The two antigens are unrelated
5. Which of the following is characteristic of the 11. Which technique represents a single-diffusion
end-point method of RID? reaction?
a. Readings are taken before equivalence. a. Radial immunodiffusion
b. Concentration is directly in proportion to the b. Ouchterlony diffusion
square of the diameter. c. Immunoelectrophoresis
c. The diameter is plotted against the log of the d. Immunofixation electrophoresis
concentration.
d. It is primarily a qualitative rather than a 12. Which best describes the law of mass action?
quantitative method. a. Once antigen-antibody binding takes place, it is
irreversible.
6. In which zone might an antibody-screening test b. The equilibrium constant depends only on the
be false negative? forward reaction.
a. Prozone c. The equilibrium constant is related to strength
b. Zone of equivalence of antigen-antibody binding.
c. Postzone d. If an antibody has a high avidity, it will
d. None of the above dissociate from antigen easily.
mix
13. Agglutination of dyed bacterial cells 20. In a particle-counting immunoassay using

represents which type of reaction? reagent antibody attached to latex particles, if the
a. Direct agglutination particle count in solution is very low, what does
b. Passive agglutination this mean about the presence of patient antigen?
c. Reverse passive agglutination a. The patient has no antigen present.
d. Agglutination inhibition b. The patient has a very small amount of antigen.
c. The patient has a large amount of antigen
14. If a single IgM molecule can bind many more present.
antigens than a molecule of IgG, which of the d. The test is invalid.
following is higher?
a. Affinity Chapter 11 Labeled Immunoassays
b. Initial force of attraction
c. Avidity 1. Which of the following statements accurately
d. Initial sensitization describes competitive binding assays?
a. Excess binding sites for the analyte are
15. Agglutination inhibition could best be used for provided.
which of the following types of antigens? b. Labeled and unlabeled analyte are present in
a. Large cellular antigens such as erythrocytes equal amounts.
b. Soluble haptens c. The concentration of patient analyte is inversely
c. Bacterial cells proportional to bound label.
d. Coated latex particles d. All the patient analyte is bound in the reaction.
16. Which of the following correctly describes 2. How do heterogeneous assays differ from
reverse passive agglutination? homogeneous assays?
a. It is a negative test. a. Heterogeneous assays require a separation
b. It can be used to detect autoantibodies. step.
c. It is used for identification of antigens. b. Heterogeneous assays are easier to perform
d. It is used to detect sensitization of red blood than homogeneous assays.
cells. c. The concentration of patient analyte is indirectly
proportional to bound label in heterogeneous
17. Reactions involving IgG may need to be assays.
enhanced for which reason? d. Homogeneous assays are more sensitive than
a. It is only active at 25°C. heterogeneous ones.
b. It may be too small to produce lattice formation.
c. It has only one antigen-binding site. 3. In the following equation, what is the ratio of
d. It is only able to produce visible precipitation bound radioactive antigen (Ag*) to bound patient
reactions. antigen (Ag)?
12Ag*+4Ag+4Ab: Ag*
18. For which of the following tests is a lack of Ab + AgAb + Ag* +Ag
agglutination a positive reaction? a. 1:4
a. Hemagglutination b. 1:3
b. Passive agglutination c. 3:1
c. Reverse passive agglutination d. 8:4
d. Agglutination inhibition
4. Which of the following responses characterizes
19. Typing of RBCs with reagent antiserum a capture or sandwich enzyme assay?
represents which type of reaction? a. Less sensitive than competitive enzyme assays
a. Direct hemagglutination b. Requires two wash steps
b. Passive hemagglutination c. Best for small antigens with a single
c. Hemagglutination inhibition determinant
d. Reverse passive hemagglutination d. A limited number of antibody sites on solid
phase
mix
5. Which of the following is an advantage of 11. Immunofluorescent assays may be difficult to

enzyme immunoassay over RIA? Interpret for which reason?
a. Decrease in hazardous waste a. Autofluorescence of substances in serum
b. Shorter shelf life of kit b. Nonspecific binding to serum proteins
c. Natural inhibitors do not affect results c. Subjectivity in reading results
d. Needs to be read manually d. Any of the above
6. Which of the following is characteristic of direct 12. Which statement best describes flow-through
fluorescent assays? immunoassays?
a. The anti-immunoglobulin has the fluorescent a. Results are quantitative.
tag. b. They are designed for point-of-care testing.
b. Antibody is attached to a solid phase. c. Reagents must be added separately.
c. Microbial antigens can be rapidly identified by d. They are difficult to interpret.
this method.
d. The amount of color is in inverse proportion to 13. Which of the following is characteristic of an
the amount of antigen present. indirect enzyme immunoassay?
a. The first antibody has the enzyme label.
7. Which of the following is true of fluorescence b. All reagents are added together.
polarization immunoassay? c. Color is directly proportional to the amount of
a. Both antigen and antibody are labeled. patient antigen present.
b. Large molecules polarize more light than d. Enzyme specificity is not essential.
smaller molecules.
c. When binding occurs, there is quenching of the 14. In a homogeneous enzyme immunoassay,
fluorescent tag. which best describes the enzyme?
d. The amount of fluorescence is directly a. Enzyme activity is altered when binding to
proportional to concentration of the analyte. antibody occurs.
b. The enzyme label is on the antibody..
8. A fluorescent substance is best described as c. Enzyme activity is directly proportional to the
one in which amount of patient antigen present.
a. light energy is absorbed and converted to a d. Most enzymes can be used in this type of
longer wavelength. assay.
b. the emitted wavelength can be seen under
normal white light. 15. In an indirect immunofluorescent assay, what
c. there is a long time between the absorption and would be the outcome of an improper wash after
emission of light. the antibody-enzyme conjugate is added?
d. it spontaneously decays and emits light. a. Results will be falsely decreased.
b. Results will be falsely increased.
9. In a noncompetitive enzyme immunoassay, if a c. Results will be unaffected.
Negative control shows the presence of color, d. It would be difficult to determine the effect.
which of the following might be a possible
explanation? 16. In a heterogeneous enzyme immunoassay, if
a. No reagent was added. the patient sample produces more color than the
b. Washing steps were incomplete. highest positive control, what action should be
c. The enzyme was inactivated. taken?
d. No substrate was present. a. Report the results out as determined.
b. Dilute the patient sample.
10. Which of the following best characterizes c. Repeat the assay using one-half the volume of
Chemiluminescent assays? the patient sample.
a. Only the antigen can be labeled. d. Report the results as falsely positive.
b. Tests can be read manually.
c. These are only homogeneous assays.
d. A chemical is oxidized to produce light.
mix
Chapter 12 Molecular Diagnostic Techniques 8. Which best describes the PCR?

a. Two probes are joined by a ligating enzyme.
1. What holds two single strands of DNA together b. RNA copies of the original DNA are made.
in a double helix? c. Extender probes are used to create a visible
a. 2' carbon of deoxyribose attached to a hydroxyl product.
group d. Primers are used to make multiple DNA copies.
b. Hydrogen bonds between A and T and C and G
c. Ribose 3' carbon hydroxyl attached to ribose 9. What takes place during in situ hybridization?
a. Two probes are joined by a ligating enzyme. a. RNA polymerase copies messenger RNA.
5' carbon phosphate b. Hybridization takes place in solution.
d. Phosphorylation of nitrogen bases c. Nucleic acid probes react with intact cells in
tissues.
2. What is the complement to the following DNA d. Probes are protected from degradation if
sequence? hybridized.
5'-GATCGATTCG-3'
a. 3'-CTAGCTAAGC-5' 10. What determines the specificity for PCR?
b. 3'-CGAATCGATC-5' a. Nucleotide mix ratios and concentrations
c. 3'-GCTTAGCTAG-5' b. Mono- and divalent cation concentrations.
d. 3'-GATCGATTCG-5' c. Primers and their annealing temperature
d. DNA polymerase
3. How are DNA and RNA different?
a. Only RNA contains uracil.
11. An antibody test for HIV within 3 months of
b. Only DNA contains cytosine.
Exposure is negative. Does this guarantee a
c. DNA is usually single stranded.
negative PCR test?
d. DNA is less stable than RNA.
a. Yes, because if no antibodies are present, no
4. What is the function of restriction virus is present.
endonucleases? b. No, PCR-detectable virus may be present
a. They splice short pieces of DNA together. before generation of detectable antibodies.
b. They cleave DNA at specific sites. c. Yes, it has been 3 months since exposure.
c. They make RNA copies of DNA. d. No, but the PCR test will be less sensitive than
d. They make DNA copies from RNA. the antibody test.
5. What is the purpose of somatic hypermutation 12. How do PCR and qPCR differ?
in genes that code for antibodies? a. In qPCR, the results can be seen at the end of
a. To increase diversity of the immunoglobulin each cycle.
repertoire. b. SYBR Green is only used in PCR.
b. To prevent further antibody formation c. PCR is an isothermal process and qPCR is not.
c. To switch antibodies from IgM to IgG d. Internal amplification controls are not necessary
d. To prevent further VDJ recombination in qPCR.
6. What characteristic distinguishes restriction 13. Which method is a signal amplification

enzymes from one another? system?
a. Diverse binding and cutting sites a. bDNA
b. Ability to quickly digest DNA b. qPCR
c. RNA degradation capability c. PCR
d. Ability of one enzyme to recognize several d. Digital PCR
different binding sites
14. Which of the following amplifications is
7. Which of the following is used in a Southern isothermal?
blot procedure? a. PCR
a. A ligase joins two adjacent probes. b. qPCR
b. Radiolabeled nucleotides are used to c. NASBA
synthesize DNA. d. LCR
c. DNA is cleaved by enzymes and
electrophoresed.
d. Many probes are placed on a small piece of
glass.
mix
15. Consider the following results for a qPCR test 20. A hybridization reaction involves which of the
for the presence of herpes virus: following?
Sample Ct/Sample Ct/Amp Control a. Separating DNA strands by heating
A 22.10 21.06 b. Binding of two complementary DNA strands
B 35.02. 20.99 c. Increasing the number of DNA copies
d. Cleaving DNA into smaller segments
Which of the following statements is true?
a. The HSV viral load in sample A is greater than 21. What is the difference between a
in sample B. polymorphism and
b. The HSV viral load in sample B is greater than a mutation?
in sample A. a. Mutations only affect A and T bases.
c. The HSV viral load in sample A is about the b. Mutations are more frequently present in a
same as in sample B. population.
d. The absolute number of viral particles in c. Polymorphisms are more frequently present in
sample B is greater than in sample A. a population.
d. Polymorphisms are easier to detect than
16. Which terminates chains when added to a mutations.
DNA replication reaction?
a. dNTPs Chapter 13 Flow Cytometry and Laboratory
b. ddNTPs Automation
c. Sequencing primer
1. Flow cytometry characterizes cells on the basis
d. DNA polymerase
of which of the following?
a. Forward and 90-degree side scatter of an
17. Which technique involves probe amplification
interrupted beam of light
rather than target amplification?
b. Front-angle scatter only of an interrupted light
a. Southern blot
beam
b. PCR
c. Absorbance of light by different types of cells
c. Transcription-mediated amplification
d. Transmittance of light by cells in solution
d. Ligase chain reaction
2. Forward-angle light scatter is an indicator of
18. How does next generation sequencing (NGS) cell
technology differ from the original Sanger chain a. granularity.
displacement sequencing? b. density.
a. NGS is more expensive to conduct than chain c. size.
displacement sequencing. d. number.
b. NGS can sequence thousands of DNA pieces
faster than Sanger sequencing. 3. What is the single most important requirement
c. Sanger sequencing involves ligation and NGS for samples to be analyzed on a flow cytometer?
does not. a. Whole blood is collected into a serum-separator
d. Only Sanger sequencing has direct clinical tube.
applications. b. Cells must be in a single-cell suspension.
c. Samples must be fixed in formaldehyde before
19. Which of the following methods best describes processing.
a nucleic acid probe? d. Blood must be kept refrigerated while
a. It attaches to double-stranded DNA. processing.
b. It is used in transcription-mediated
amplification. 4. Which statement represents the best
c. It is used to detect specific single-stranded explanation for a flow cytometer's ability to detect
DNA sequences. several cell surface markers at the same time?
d. It plays a key role in DNA chain termination a. The forward scatter can separate out cells on
sequencing. the basis of complexity.
b. One detector can be used to detect many
different wavelengths.
c. For each marker, a specific fluorochrome-
antibody combination is used.
mix
d. Intrinsic parameters are separated out on the 11. Many flow cytometry laboratories now use the
basis. of the amount of side scatter. CD45 marker in combination with SSC in
differentiating various populations of WBCs to
5. Which of the following cell surface markers replace which of the following combinations?
would be present on a population of T helper (Th) a. CD4 + SSC
cells? b. CD4 + FSC
a. CD3 and CD4 c. FSC + SSC
b. CD3 and CD8 d. FSC + CD45
c. CD3 only
d. CD4 only 12. Which cell surface marker is present on cells
seen in hairy cell leukemia?
6. If an analyzer consistently indicates a positive a. CD138
test when the analyte in question is not present, b. CD33
this represents a problem with c. CD103
a. sensitivity. d. CD34
b. specificity.
c. reportable range. 13. CD45 is a pan-leukocyte marker expressed on
d. precision. WBCS in varying levels or amounts of expression,
based on
7. All of the following are clinical applications for a. size of a cell.
flow cytometry except b. granularity of a cell.
a. fetal hemoglobin. c. maturity and lineage of a cell.
b. immunophenotyping of lymphocyte d. malignancy of a cell.
subpopulations.
c. HIV viral load analysis. 14. Which of the following statements best
d. enumeration of stem cells in a peripheral blood describes a single-parameter histogram?
mononuclear cell product. a. Each event is represented by a dot.
b. Data is distributed in four quadrants.
8. The various signals generated by cells c. Positive and negative events are plotted on the
intersecting with a flow cytometry laser are x and y axis.
captured by d. A chosen parameter is plotted versus the
a. bandwidth waves. number of events.
b. wave channels.
c. photomultiplier tubes. 15. How many fluorochromes (colors) are current
d. flow cells. clinical flow cytometers capable of detecting?
a. 2
9. Analysis of flow cytometer data of cells can be b. 6
filtered in many ways by using a method of c. 8
a. "gating" in a dot plot. d. 10
b. banding of a histogram.
c. single-parameter histogram monitoring. 16. Which type of analyzer allows one to measure
d. automatic sampling. multiple analytes from numerous samples, loaded
at any time?
10. A newer flow cytometry technology that has a. Batch analyzer
the potential to detect over 500 analytes from one b. Random access analyzer
sample of blood is called a/an c. Front-end loaded analyzer
a. RBC fragmentation assay. d. Sequential access analyzer
b. Dihydrorhodamine 123.
c. sucrose test. 17. Operational considerations when selecting
d. cytometric bead array. automated analyzers for your laboratory include
all of the following except
a. reagent stability.
b. test menu.
c. STAT capability.
d. purchase cost.
mix
18. Analyzers use different methods for mixing, 5. Which of the following is associated with
including used, it is imperative that anaphylaxis?
a, reagents always be kept refrigerated. a. Buildup of IgE on mast cells
b. there is no splashing or carry-over between b. Activation of complement
samples. c. Increase in cytotoxic T cells
c. samples are kept at room temperature. d. Large amount of circulating IgG
d. multiple methods are not used simultaneously.
6. To determine if a patient is allergic to rye grass,
19. All of the following are benefits of automation the best test to perform is the
except a. total IgE test.
a. greater accuracy. b. skin prick test.
c. savings on controls. c. DAT.
d. less disposal of outdated reagents. d. complement fixation.
20. If an analyzer gets different results each time 7. Which condition would result in HDN?
the same sample is tested, what type of problem a. Buildup of IgE on mother's cells
does this represent? b. Sensitization of cytotoxic T cells
a. Sensitivity c. Exposure to antigen found on both mother and
b. Specificity baby RBCs
c. Accuracy d. Prior exposure to foreign RBC antigen
d. Precision
8. What is the immune mechanism involved in
Chapter 14 Hypersensitivity type III hypersensitivity reactions?
a. Cellular antigens are involved.
1. Which of the following is a general b. Deposition of immune complexes occurs in
characteristic of hypersensitivity reactions? antibody excess.
a. The immune responsiveness is depressed. c. Only heterologous antigens are involved.
b. Antibodies are involved in all reactions. d. Tissue damage results from exocytosis.
c. An exaggerated immune response to an
antigen occurs. 9. What is the immune phenomenon associated
d. The antigen triggering the reaction is a harmful with the Arthus reaction?
one. a. Tissue destruction by cytotoxic T cells
b. Removal of antibody-coated RBCs
2. Which of the following is associated with an c. Deposition of immune complexes in blood
increase in IgE production? vessels
a. Transfusion reaction d. Release of histamine from mast cells
b. Activation of Th2 cells
c. Reaction to poison ivy 10. Which of the following conclusions can be
d. HDN drawn about a patient whose total IgE level was
determined to be 150 IU/mL?
3. Which of the following would cause a positive a. The patient definitely has allergic tendencies.
DAT test? b. The patient may be subject to anaphylactic
a. Presence of IgG on RBCs shock.
b. Presence of C3b or C3d on RBCs c. Antigen-specific testing should be done.
c. A transfusion reaction caused by preformed d. The patient will never have an allergic reaction.
antibody
d. Any of the above 11. Which of the following explains the difference
Between type II and type III hypersensitivity
4. All of the following are associated with type I reactions?
hypersensitivity except a. Type II involves cellular antigens.
a. release of preformed mediators from mast cells. b. Type III involves IgE.
b. activation of complement. c. IgG is involved only in type III reactions.
c. cell-bound antibody bridged by antigen. d. Type II reactions involve no antibody.
d. an inherited tendency to respond to allergens.
mix
12. Two days after administration of the PPD test, 3. SLE can be distinguished from RA on the basis
a female health-care worker developed an area of of which of the following?
redness and induration 12 mm in size at the a. Joint pain
injection site. This result means that she has b. Presence of antinuclear antibodies
a. an active case of tuberculosis. c. Immune complex formation with activation of
b. been exposed to M tuberculosis. complement
c. developed protective immunity against d. Presence of anti-dsDNA antibodies
tuberculosis
d. a result in the normal range for her risk group.. 4. Which of the following would support a
diagnosis of drug-induced lupus?
13. A young woman developed red, itchy papules a. Antihistone antibodies
on her wrist 2 days after wearing a new bracelet. b. Antibodies to Smith antigen
This reaction was caused by c. Presence of RF
a. IgE-sensitized mast cells in the skin. d. Antibodies to SS-A and SS-B antigens
b. antigen-antibody complexes in the skin.
c. damage to the skin cells by antibodies and 5. A peripheral pattern of staining of the nucleus
complement. on IIF is caused by which of the following
d. an inflammatory response induced by cytokines antibodies?
released from Th1 cells. a. Anti-Sm antibody
14. Reactions to latex are caused by b. Anti-SSA/Ro antibody
a. type I hypersensitivity. c. Centromere antibody
b. type IV hypersensitivity. d. Anti-dsDNA
c. skin irritation.
d. all of the above. 6. Which of the following would be considered a
significant finding in Graves disease?
15. To determine a cold agglutinin titer a. Increased TSH levels
a. patient serum should be separated from whole b. Antibody to TSHR
blood at 4°C and tested at 4°C. c. Decreased T3 and T4
b. patient serum should be separated from whole d. Antithyroglobulin antibody
blood at 4°C and tested at 37°C.
c. patient serum should be separated from whole 7. Destruction of the myelin sheath of axons
blood at 37°C and tested at 4°C. caused by the presence of antibody is
d. patient serum should be separated from whole characteristic of which disease?
blood at 37°C and tested at 37°C a. MS
b. MG
Chapter 15 Autoimmunity c. Graves disease
d. Goodpasture's syndrome
1. All of the following may contribute to
autoimmunity except 8. Blood was drawn from a 25-year-old woman
a. clonal deletion of self-reactive T cells. with suspected SLE. A FANA screen was
b. molecular mimicry. performed and a speckled pattern resulted. Which
c. increased expression of class II MHC antigens. of the following actions should be taken next?
d. polyclonal activation of B cells. a. Report out as diagnostic for SLE
b. Report out as drug-induced lupus
2. Which of the following would be considered an c. Perform an assay for specific ANAS
organ-specific autoimmune disease? d. Repeat the test
a. SLE
b. RA 9. Which of the following is a mechanism used to
c. GPA achieve peripheral tolerance?
d. Hashimoto's thyroiditis a. Negative selection of autoreactive T cells in the
thymus
b. Apoptosis of autoreactive B cells in the bone
marrow
c. Editing of B-cell receptors that weakly
recognize self-antigens in the bone marrow
d. Lack of a costimulatory signal to autoreactive
T cells in the lymph nodes
mix
10. Epitope spreading refers to Chapter 16 Transplantation Immunology

a. post-translational modifications to self-antigens.
b. modifications in gene expression that are not 1. Which of the following responses is the type of
caused by changes in DNA sequence. allograft rejection associated with vascular and
c. expansion of the immune response to unrelated parenchymal injury with lymphocyte infiltrates?
antigens. a. Hyperacute rejection
d. cross-reaction of the immune response to a b. Acute cellular rejection
pathogen with a similar self-antigen. c. Acute humoral rejection
d. Chronic rejection
11. Anti-CCP (cyclic citrullinated proteins) is
specifically associated with which autoimmune 2. Antigen receptors on T lymphocytes bind HLA
disease? class II + peptide complexes with the help of
a. RA which accessory molecule?
b. MG a. CD2
c. Autoimmune hepatitis b. CD3
d. Goodpasture's syndrome c. CD4
d. CD8
12. Which autoantibodies are strongly associated
with granulomatosis with polyangiitis (Wegener's 3. Patients who have received the following types
granulomatosis)? of grafts are at risk for graft-versus-host disease
a. ANA (GVHD) except for recipients of
b. ANCA a. bone marrow transplants.
c. AMA b. lung transplants.
d. SMA c. liver transplants.
d. irradiated leukocytes.
13. A technologist performs an IIF test for ANCAs
and observes that there is an intense fluorescent 4. Which of the following properties are not
staining of the nuclear lobes of the neutrophils. exhibited by HLA molecules?
How can this type of staining be differentiated a. They belong to the immunoglobulin superfamily.
from a peripheral ANA pattern? b. They are heterodimeric.
a. Perform the test on formalin-fixed leukocytes c. They are integral cell membrane glycoproteins.
b. Perform IIF with HEp-2 cells d. They are monomorphic.
c. Perform an ELISA for ANCAS
d. All of the above 5. Kidney allograft loss from intravascular
thrombosis without cellular infiltration 5 days post-
14. A 20-year-old woman made an appointment to transplant may indicate which primary rejection
see her physician because she was experiencing mechanism?
intermittent diarrhea. Laboratory testing revealed a. Hyperacute rejection
that she also had an iron deficiency anemia. To b. Accelerated humoral rejection
determine if the patient has celiac disease, her c. Acute humoral rejection
doctor should order which of the following d. Acute cellular rejection
laboratory tests?
a. Anti-tTG 6. Which reagents would be used in a direct
b. Antigliadin (forward) donor-recipient crossmatch test? a.
c. Antigluten Donor serum and recipient lymphocytes + rabbit
d. All of the above serum complement
b. Recipient serum and donor lymphocytes +
15. Antimitochondrial antibodies are strongly rabbit serum complement
associated with which disease? c. Donor stimulator cells + recipient responder
a. Autoimmune hepatitis cells + complete culture medium
b. Celiac disease d. Recipient stimulator cells + donor responder
c. Primary biliary cirrhosis cells + complete culture medium
d. Goodpasture's syndrome
mix
7. The indirect allorecognition pathway involves 12. Which one of the following donors would be
which one of the following mechanisms? expected to elicit a positive mixed lymphocyte
a. Processed peptides from polymorphic donor response in lymphocytes from a patient who has
proteins restricted by recipient HLA class II the HLA-DRB1*01:01, 01:03 alleles?
molecules a. DRB1*01:01, 01:03
b. Processed peptides from polymorphic recipient b. DRB1*01:01, 01:01
proteins restricted by donor HLA class I c. DRB1*01:03, 01:03
molecules d. DRB1*01:01, 01:05
c. Intact polymorphic donor protein molecules
recognized by recipient HLA class I molecules 13. Which of the following donors would be the
d. Intact polymorphic donor protein molecules most appropriate, based on ABO compatibility, for
recognized by recipient HLA class II molecules a renal transplant candidate with the ABO type =
O?
8. Which immunosuppressive agent selectively a. O
inhibits IL-2 receptor-mediated activation of T b. A
cells and causes clearance of activated T cells c. B
from the circulation? d. AB
a. Mycophenolate mofetil
b. Cyclosporine mofetil 14. Which of the following HLA antigens would be
c. Corticosteroids expected to elicit an HLA antibody response in a
d. Daclizumab kidney transplant recipient with the following HLA
type: HLA-A*01,03; B*07,14; C*01,04N;
9. Phenotyping for HLA class II antigens requires DRB1*16,07?
B lymphocytes because a. HLA-A*01
a. B lymphocytes express HLA class II antigens. b. HLA-B*14
b. B lymphocytes do not express HLA class I c. HLA-C*04
antigens. d. HLA-DRB1*16
c. B lymphocytes are exquisitely sensitive to
complement-mediated lysis. 15. Suppose a 30-year-old man was found to be a
d. B lymphocytes represent the majority of suitable donor for a kidney transplant to his
lymphocytes in the peripheral blood. younger sister. This transplant would be an
example of a(an)
10. A renal transplant candidate was a. autograft.
crossmatched with a donor that was mismatched b. allograft.
for only the HLA-B35 antigen. The candidate was c. isograft.
known to have an antibody specific for HLA-B35. d. xenograft
Which of the following combinations of T- and B-
cell flow cytometric crossmatch results would be Chapter 17 Tumor Immunology
expected?
a. T cell negative, B cell negative 1. How can normal cells become malignant?
b. T cell positive, B cell positive a. Overexpression of oncogenes
c. T cell negative, B cell positive b. Underexpression of tumor suppressor genes
d. T cell positive, B cell negative c. Viral infection
d. All of the above
11. Which of the following HLA alleles differs from
A*02:01:02 by a synonymous nucleotide 2. Which of the following best summarizes the
substitution? concept of tumor development via immunoediting?
a. A*01:01:01:01 a. Tumor cells produce cytokines that are toxic to
b. A*02:01:03 T cells.
c. A*02:02 b. Tumor cells that can escape the immune
d. A*02:03:01 system have a growth advantage over tumor cells
that are destroyed during immunosurveillance.
c. T-cell activity causes an increase in MHC
expression on tumor cells that allows them to
escape the immune system.
mix
d. Secreted tumor-associated antigen saturates T- 8. The best use of serum tumor markers is
cell receptors and makes T cells incapable of considered to be in
binding to tumor cells. a. screening for cancer.
b. initial diagnosis of cancer.
3. Which of the following is an example of a c. monitoring patients undergoing cancer
tumorspecific antigen? treatment.
a. BCR/ABL fusion protein d. determining patient prognosis.
b. CEA
c. CA 125 9. In order to use a tumor marker to monitor the
d. PSA course of the disease, which of the following must
be true?
4. Most tumor markers are not used to screen the a. The laboratory measures the marker with the
General population because they same
a. cannot be inexpensively quantified. method over the entire course of the patient's
b. do not rise to high enough levels in the treatment.
presence of cancer. b. The marker must be released from the tumor
c. can also be elevated in conditions other than or, because of the tumor, into a body fluid that can
the cancer. be obtained and tested.
d. vary too much between patients belonging to c. The marker's half-life is such that the marker
different ethnic populations. persists long enough to reflect tumor burden but
clears fast enough to identify successful therapy.
5. Both AFP and hCG exhibit serum elevations in d. All of the above.
a. pregnancy.
b. ovarian germ cell carcinoma. 10. Which of the following markers could be
c. nonseminomatous testicular cancer. elevated in nonmalignant liver disease?
d. all of the above. a. AFP
b. CEA
6. Suppose a patient with ovarian cancer had a c. CA 15-3
serum CA 125 level of 50 kU/L at initial diagnosis. d. All of the above
After her tumor was surgically removed, her CA
125 level declined to 25 kU/L. She received 11. Each of the following markers is correctly
chemotherapy drug #1; after 1 year, her CA 125 paired with a disease in which it can be used for
level was 40 kU/L. She was then given patient monitoring except
chemotherapy drug #2 and her CA 125 level rose a. CEA/choriocarcinoma.
to 60 kU/L. These results indicate that b. CA 15-3/breast adenocarcinoma.
a. surgery was effective in removing the patient's c. CA 125/ovarian adenocarcinoma.
tumor. d. CA 19-9/pancreatic adenocarcinoma.
b. chemotherapy drug #1 was more effective than
chemotherapy drug #2. 12. Which of the following is a marker used in
c. both chemotherapy drug #1 and chemotherapy immunohistochemical staining to identify tumors
drug #2 were effective. of epithelial origin?
d. neither chemotherapy drug #1 nor a. Cytokeratins
chemotherapy drug #2 were effective. b. Vimentin
c. CD45
7. All of the following are recommended for d. CD10
cancer screening in the groups indicated except
a. CA 125/women of reproductive age. 13. Which of the following assays would you
b. AFP/subjects at high risk for liver cancer. recommend to test for chromosomal
c. PSA/men over 50 with at least 10 years of life rearrangements such as the BCR/ABL
expectancy. translocation seen in CML?
d. none of the above. a. PCR
b. FISH
c. Microarray
d. Next generation sequencing
mix
14. Innate immune responses thought to be 7. Which of the following is characteristic of

involved in defense against tumors include heavy- chain diseases?
a. NK cell-mediated apoptosis. a. Usually of B-cell origin
b. MHC I-restricted T-cell-mediated destruction. b. Rare lymphomas
c. ADCC. c. Production of abnormal Ig heavy chains
d. all of the above. d. All of the above
15. A woman with breast cancer is treated with a 8. Flow cytometry results on a patient reveal a
monoclonal antibody to HER2. This is an example decrease of cells with CD2 and CD3. What does
of this indicate?
a. a cancer vaccine. a. Lack of B cells
b. an immunotoxin. b. Lack of T cells
c. passive immunotherapy. c. Lack of monocytes
d. active immunotherapy. d. Lack of natural killer cells
Chapter 18 Immunoproliferative Diseases 9. Which of the following is true of Waldenström

1. Bence Jones proteins consist of macroglobulinemia but not multiple myeloma?
a. monoclonal IgG. a. Hyperviscosity syndrome is often present.
b. IgG-IgM complexes. b. A single protein-producing clone is elevated.
c. free к or a light chains. c. The cancerous cell is a preplasma cell.
d. free u heavy chains. d. Bence Jones proteins are present in the urine.
2. Which of the following would be the best 10. The presence of anemia, bone pain,
indicator of a malignant clone of cells? thrombocytopenia, and lytic bone lesions is
a. Overall increase in antibody production suggestive of
b. Increase in IgG and IgM only a. Hodgkin lymphoma.
c. Increase in antibody directed against a specific b. hairy cell leukemia.
epitope c. chronic lymphocytic leukemia.
d. Decrease in overall antibody production d. multiple myeloma.
3. All of the following are features of malignancy 11. The presence of an M protein on
except immunofixation electrophoresis (IFE) is indicated
a. excess apoptosis. by
b. rapid proliferation. a. broad, diffuse banding.
c. clonal proliferation. b. a narrow, discrete band.
d. chromosomal mutations. c. a few well-defined bands in the IgG lane.
d. a single band at the point of application in all
4. All of the following features are commonly used of the lanes.
to classify lymphoid neoplasms except
a. cell of origin. 12. Surface immunoglobulin on a leukemic cell
b. presence of gene translocations. indicates a(n)
c. exposure of the patient to carcinogens. a. B cell.
d. morphology or cytology of the malignant cells. b. T cell.
c. macrophage.
5. Hodgkin lymphoma is characterized by d. autoimmune disease.
a. proliferation of T cells.
b. excess immunoglobulin production. 13. Which of the following is not a requirement for
c. an incurable, rapidly progressive course. Urine testing by IFE?
d. the presence of Reed-Sternberg cells in lymph a. Collection of a 24-hour sample
nodes. b. Concentration of the sample
c. Dilution of the sample
6. Chronic leukemias are characterized as d. Removal of sediment
a. usually being of B-cell origin.
b. being curable with chemotherapy.
c. usually occurring in children.
d. following a rapidly progressive course.
mix
14. Multiple myeloma is characteristically 5. Which of the following statements applies to

preceded by Bruton's thymidine kinase (Btk) deficiency?
a. chronic hypogammaglobulinemia. a. It typically appears in females.
b. Helicobacter pylori infection. b. There is a lack of circulating CD19+ B cells.
c. non-Hodgkin lymphoma. c. T cells are abnormal.
d. monoclonal gammopathy of undetermined d. There is a lack of pre-B cells in the bone
significance. marrow.
15. Which serum free light chain (sFLC) assay 6. DiGeorge anomaly may be characterized by all
result indicates presence of a malignant plasma of the following except
cell clone? a. autosomal recessive inheritance.
a. An abnormal κ:λ ratio b. cardiac abnormalities.
b. A decrease in K and A concentrations c. parathyroid hypoplasia.
c. A decrease in IgG, IgA, and IgM concentrations d. decreased number of mature T cells.
d. An increase in immunoglobulin concentrations
over a 24-hour period 7. A 3-year-old boy is hospitalized because of
recurrent bouts of pneumonia. Laboratory tests
Chapter 19 Immunodeficiency Diseases are run and the following findings are noted:
prolonged bleeding time, decreased platelet
1. Patients with which immunodeficiency count, increased level of serum alpha-fetoprotein,
syndrome should receive irradiated blood and a deficiency of naturally occurring
products to protect against the development of isohemagglutinins. Based on these results, which
GVHD? is the most likely diagnosis?
a. Bruton's thymidine kinase (Btk) deficiency a. PNP deficiency
b. Selective IgA deficiency b. Selective IgA deficiency
c. SCID c. SCID
d. CGD d. Wiskott-Aldrich syndrome
2. T-cell subset enumeration by flow cytometry 8. Which of the following is (are) associated with
would be most useful in making the diagnosis of ataxia-telangiectasia?
which disorder? a. Inherited as an autosomal recessive
a. Bruton's thymidine kinase (Btk) deficiency b. Defect in both cellular and humoral immunity
b. Selective IgA deficiency c. Chromosomal breaks in lymphocytes
c. SCID d. All of the above
d. Multiple myeloma
9. A 4-year-old boy presents with recurrent wound
3. What clinical manifestation would be seen in a and soft-tissue infections. Which of the following
patient with myeloperoxidase deficiency? assays should be considered for diagnosing his
a. Defective T-cell function presumed PID?
b. Inability to produce IgG a. DHR reduction
c. Defective NK cell function b. CD4 quantitation
d. Defective neutrophil function c. CD19 quantitation
d. CD56 quantitation
4. Defects in which branch of the immune system
are most commonly associated with severe illness 10. A patient with a deficiency in complement
after administration of live virus vaccines? Component C7 would likely present with
a. Cell-mediated immunity a. recurrent Staphylococcal infections.
b. Humoral immunity b. recurrent Neisserial infections.
c. Complement c. recurrent E coli infections.
d. Phagocytic cells d. recurrent Nocardia infections.
mix
11. A FoxP3 gene mutation may lead to a 3. An ASO titer and a streptozyme test are
deficiency of what cell type? performed on a patient's serum. The ASO titer is
a. T helper cells negative, the streptozyme test is positive, and
b. T cytotoxic cells both the positive and negative controls react
c. B cells appropriately. What can you conclude from these
d. T regulatory cells test results?
a. The ASO is falsely negative.
12. The Cylex ImmunoKnow assay is useful in b. The patient has an antibody to a streptococcal
Determining functional capabilities of which cell exoenzyme other than streptolysin O.
type? c. The patient has not had a previous
a. T cells streptococcal infection.
b. B cells d. The patient has scarlet fever.
c. NK cells
d. Neutrophils 4. Which of the following applies to acute
rheumatic fever?
13. Recurrent, periodic fevers may be associated a. Symptoms begin after S. pyogenes infection of
with increased production of which the throat or the skin.
immunoglobulin? b. Antibodies to Group A streptococci are
a. IgG believed to cross-react with heart tissue.
b. IgM c. Diagnosis is usually made by culture of the
c. IgD organism.
d. IgE d. All patients suffer permanent disability.
14. Chronic mucocutaneous candidiasis, a PID 5. Which of the following indicates the presence of
that was previously thought to be a cell-mediated anti- DNase B activity in serum?
deficiency, is now classified as which type of PID? a. Reduction of methyl green from green to
a. Autoinflammatory disorder colorless
b. Complement deficiency b. Clot formation when acetic acid is added
c. Predominantly antibody deficiency c. Inhibition of red blood cell hemolysis
d. Innate immunity deficiency d. Lack of change in the color indicator
15. Prenatal screening for SCID involves detecting 6. Which of the following is considered to be a
a. Tregs Nonsuppurative complication of streptococcal
b. TRECS infection?
c. THELPS a. Acute rheumatic fever
d. TCYTOS b. Scarlet fever
c. Impetigo
Chapter 20 Serological and Molecular d. Pharyngitis
Detection of Bacterial Infections 369
7. All of the following are ways that bacteria can
1. All of the following are protective mechanisms evade host defenses except
against bacteria except a. presence of a capsule.
a. production of antimicrobial defense peptides. b. stimulation of chemotaxis.
b. phagocytosis. c. production of toxins.
c. activation of complement. d. lack of adhesion to phagocytic cells.
d. release of lipid A from the bacterial cell.
8. Antibody testing for Rocky Mountain spotted
2. All of the following are characteristics of fever may not be helpful for which reason?
streptococcal M proteins except a. It is not specific.
a. it is the chief virulence factor of Group A b. It is too complicated to perform.
streptococci. c. It is difficult to obtain a blood specimen.
b. it provokes an immune response. d. Antibody production takes at least a week
c. antibodies to one serotype protect against other before detection.
serotypes.
d. it limits phagocytosis of the organism.
mix
9. Which of the following enzymes is used to 13. Which of the following is true regarding
detect the presence of H pylori infections? exotoxins and endotoxins?
a. DNase a. Both endotoxin and exotoxins are highly
b. Hyaluronidase immunogenic allowing for the development of
c. Urease protective antibodies and vaccines.
d. Peptidase b. Endotoxin has targeted activity whereas
exotoxins have systemic effects when released.
10. Which of the following reasons make c. Endotoxin is released from the cell wall of dead
serological identification of a current infection with bacteria, whereas exotoxin is released from live
Helicobacter pylori difficult? bacteria.
a. No antibodies appear in the blood. d. Both endotoxin and exotoxins bind to specific
b. Only IgM is produced. receptors on a bacterial cell leading to cell lysis.
c. Antibodies remain after initial treatment.
d. No ELISA tests have been developed. 14. Characteristics of a bacterial capsule include
which of the following?
11. M pneumoniae infections are associated with a. It cannot be used for vaccine development.
the production of which antibodies? b. It is composed of peptidoglycan.
a. Cold agglutinins c. It is an important mechanism for protecting a
b. Antibodies to ATPase bacterium against ingestion by PMNs.
c. Antibodies to DNase d. It is what causes bacteria to stain as gram-
d. Antibodies to Proteus bacteria negative.
12. Which of the following best describes the 15. Which of the following statements regarding
principle of the IFA test for detection of antibodies Helicobacter pylori is not true?
produced in Rocky Mountain spotted fever? a. It is associated with an increased risk of gastric
a. Patient serum is applied to a microtiter plate carcinoma.
coated with a monoclonal antibody directed b. It is the cause of most cases of acute food
against the target antigen. A detection antibody poisoning in the United States.
labeled with biotin and directed against the target c. It is a major cause of peptic ulcers in the United
antigen is added. After addition of a substrate, a States.
color reaction develops indicating presence of the d. It is positive for urease.
antigen.
b. Specific antibodies in the serum sample attach Chapter 21 Spirochete Diseases
to the antigens fixed to a microscope slide. In a
1. False-positive nontreponemal tests for syphilis
second step, the attached antibodies are stained
may occur because of which of the following?
with fluorescein-labeled anti-human
a. Infectious mononucleosis
immunoglobulin and visualized with the
b. Systemic lupus
fluorescence microscope.
c. Pregnancy
c. The serum sample is treated chemically to link
d. All of the above
the target antibodies to a fluorophore. The labeled
sample is applied to a microscope slide to which
2. In the fluorescent treponemal antibody
the antigen has been attached. Following a wash
absorption (FTA-ABS) test, what is the purpose of
step, the slide is examined for fluorescence.
absorption with Reiter treponemes?
d. Patient serum is applied to a slide to which a
a. It removes reactivity with lupus antibody.
specific antigen is bound. Following a wash step, a
b. It prevents cross-reactivity with antibody to
chromogenic dye is applied that binds to the Fc
other T pallidum subspecies.
region of IgG and IgM antibodies. After a second
c. It prevents cross-reactivity with antibody to
wash step, the slide is examined for fluorescence.
nonpathogenic treponemes.
d. All of the above.
3. Which test is recommended for testing

cerebrospinal fluid for detection of neurosyphilis?
a. RPR
b. VDRL
c. FTA-ABS
d. Enzyme immunoassay
mix
4. Advantages of direct fluorescent antibody 10. Which of the following tests is the most
testing to T pallidum include all of the following specific during the early phase of Lyme disease?
except a. IFA
a. reading is less subjective than with dark-field b. EIA
testing. c. Immunoblotting
b. monoclonal antibody makes the reaction very d. detection of B burgdorferi DNA by PCR
specific.
c. slides can be prepared for later reading. 11. False-positive serological tests for Lyme
d. careful specimen collection is less important disease may be caused by all of the following
than in dark-field testing. except
a. shared antigens between Borrelia groups.
5. Which of the following is true of nontreponemal b. cross-reactivity of antibodies.
antibodies? c. resemblance of flagellar antigen to that of
a. They can be detected in all patients with Treponema organisms.
primary syphilis. d. a patient in the early stage of the disease.
b. These antibodies are directed against
cardiolipin. 12. A 24-year-old man who had just recovered
c. Nontreponemal tests remain positive after from infectious mononucleosis had evidence of a
successful treatment. genital lesion. His RPR test was positive. What
d. The antibodies are only found in patients with should the technologist do next?
syphilis. a. Report out as false positive.
b. Do a confirmatory treponemal test.
6. Which syphilis test detects specific treponemal c. Do a VDRL.
antibodies? d. Have the patient return in 2 weeks for a repeat
a. RPR test.
b. VDRL
13. A 15-year-old girl returned from a camping
c. FTA-ABS
trip. Approximately a week after her return, she
d. Agglutination
discovered a small red area on her leg that had a
larger red ring around it. Her physician had her
7. Which of the following is true of treponemal
tested for Lyme disease, but the serological test
tests for syphilis?
was negative. What is the best explanation for
a. They are usually negative in the primary stage.
these results?
b. Titers decrease with successful treatment.
a. She definitely does not have Lyme disease.
c. In large-volume testing, they are often used as
b. The test was not performed correctly.
screening tests.
c. Antibody response is often below the level of
d. They are subject to a greater number of false
detection in early stages.
positives than nontreponemal tests.
d. Too much antibody was present, causing a false
negative.
8. An RPR test done on a 19-year-old woman as
part of a prenatal workup was negative but 14. The reverse screening algorithm for syphilis
exhibited a rough appearance. What should the testing
technologist do next? a. is the CDC preferred algorithm.
a. Report the result out as negative. b. is more labor intensive than the "traditional"
b. Do a VDRL test. method.
c. Send the sample for confirmatory testing. c. has a high number of false positives that must
d. Make serial dilutions and do a titer. be resolved by doing a TP-PA test.
d. is more prone to transcription errors in
9. Treponemal EIA tests for syphilis are reporting.
characterized by all of the following except
a. they are adaptable to automation. 15. Borrelia miyamotoi infection.
b. they are useful in monitoring antibody titers in a. may explain some cases of supposed Lyme
syphilis patients undergoing therapy. disease where no rash was found.
c. subjectivity in reading is eliminated. b. is a new lethal tick-borne disease.
d. they can be used to distinguish between IgG c. is carried by the common dog tick.
and IgM antibodies. d. is another name for Southern Tick Associated
Illness (STARI).
mix
Chapter 22 Serological and Molecular 8. The most significant defense against fungal
Diagnosis of Parasitic and Fungal Infections infections is
a. cellular immunity.
1. Compared with a host's response to the mumps b. humoral immunity.
virus, overcoming a parasitic infection is more c. phagocytosis.
difficult for the host because of which of the d. complement activation.
following characteristics of parasites?
a. Large size 9. Clinical manifestations of fungal-related illness.
b. Complex antigenic structures include
c. Elaborate life cycle a. hypersensitivity caused by fungal spores.
d. All of the above b. poisoning caused by ingestion of mycotoxins.
c. growth of fungi in or on tissue.
2. Which of the following is indicative of a recent d. all of the above.
infection with Toxoplasma gondii?
a. Anti-Toxoplasma IgM 10. Which of the following assay formats are
b. Anti-Toxoplasma IgE increasingly being adopted by clinical laboratories
c. High avidity anti-Toxoplasma IgG for serological detection of fungal infections
d. Low avidity anti-Toxoplasma IgG because of their ease of use?
a. ELISA assays
3. Parasites are able to evade host defenses by b. Lateral flow assays
which of the following means? c. Radial immunodiffusion assays
a. Production of antigens similar to host antigens d. Indirect immunofluorescence assays
b. Changing surface antigens
c. Sequestering themselves within host cells 11. The presence of anti-H antibodies indicates
d. All of the above which of the following?
a. A previous infection with Coccidioides immitis
4. The chronic nature of parasitic infections is b. A previous exposure to Histoplasma
caused by the host's capsulatum
a. inability to eliminate the infective agent. c. An active infection with Cryptococcus
b. type I hypersensitivity response to the infection. neoformans
c. ability to form a granuloma around the d. An active infection with Histoplasma
parasite. capsulatum
d. tendency to form circulating immune
complexes. 12. A limiting factor in reliably being able to detect
Antifungal antibodies in an acute infection is
5. The presence of both IgM and IgG antibody in a. the lack of humoral response to fungal agents
toxoplasmosis infections suggests that the caused by immunosuppression.
infection b. current assays lack specificity.
a. occurred more than 2 years ago. c. antibodies are not normally formed against
b. occurred more recently than 18 months ago. most fungi.
c. is chronic. d. antibodies tend to remain at low titer as a
d. has resolved itself. mycosis develops.
6. Which of the following is indicative of a parasitic 13. False positives may be observed in latex
infection? agglutination tests for the capsular antigen of
a. Increased IgA levels Cryptococcus neoformans because of
b. Increased IgE levels a. the use of serum instead of CSF.
c. Increased IgG levels b. the presence of rheumatoid factor in the
d. Increased IgM levels specimen.
c. cross-reactivity with other fungal antigens.
7. In congenital toxoplasmosis, which class of d. the low specificity of the assay.
antibodies is the most sensitive in detecting
infection?
a. IgA
b. IgG
c. IgM
d. IgE
mix
14. A 27-year-old man from Ohio, diagnosed with 4. A newborn suspected of having a congenital
AIDS, developed chest pains. After a short period viral infection should be tested for virus-specific
of time he also developed severe headaches with antibodies of which class(es)?
dizziness. In his free time, his hobby was exploring a. IgM
caves (a spelunker). His physician ordered a b. IgG
sputum culture and spinal tap and both were c. IgA
positive for a yeastlike fungus. These findings are d. All of the above classes
most consistent with infection by
a. Candida albicans. 5. Which of the following hepatitis viruses is
b. Coccidioides immitis. transmitted by the fecal-oral route?
c. Cryptococcus neoformans. a. Hepatitis B
d. Histoplasma capsulatum. b. Hepatitis C
c. Hepatitis D
15. Which of the following serological tests d. Hepatitis E
detects the polysaccharide capsule antigen in
serum and CSF of patients with suspected 6. An individual with hepatomegaly, jaundice, and
infection with Cryptococcus neoformans? elevated liver enzymes has the following
a. Complement fixation (CF) laboratory results: IgM anti-HAV (negative),
b. India ink test HBsAg (positive), IgM anti-HBc (positive), and
c. Latex agglutination (LA) anti-HCV (negative).
d. Hemagglutination test These findings support a diagnosis of
a. hepatitis A.
16. Which of the following is a nondimorphic b. acute hepatitis B.
fungus that is found in concentrated bird c. chronic hepatitis B.
droppings and can readily cause meningitis in d. hepatitis C.
immunocompromised individuals?
a. Coccidioides immitis 7. The serum of an individual who received all
b. Candida albicans doses of the hepatitis B vaccine should contain
c. Cryptococcus neoformans a. anti-HBs.
d. Histoplasma capsulatum b. anti-HBe.
c. anti-HBc.
Chapter 23 Serology and Molecular Detection d. all of the above.
of Viral Infections
8. Quantitative tests for HCV RNA are used to
1. The role of CTLs in immune responses against a. screen for hepatitis C.
viruses is to b. determine the HCV genotype.
a. neutralize viral activity. c. differentiate acute HCV infection from chronic
b. promote destruction of viruses by ADCC. HCV infection.
c. destroy virus-infected host cells. d. monitor hepatitis C patients on antiviral therapy.
d. attack free virions.
9. In the laboratory, heterophile antibodies are
2. Viruses can escape immune defenses by routinely detected by their reaction with
a. undergoing frequent genetic mutations. a. B lymphocytes.
b. suppressing the immune system. b. bovine erythrocyte antigens.
c. integrating their nucleic acid into the host c. sheep erythrocyte antigens.
genome. d. Epstein-Barr virus antigens.
d. all of the above.
10. The presence of IgM anti-rubella antibodies in
3. A patient who has developed immunity to a viral the serum from an infant born with a rash
infection would be expected to have which of the suggests
following serology results? a. a diagnosis of measles.
a. IgM+, IgG- b. a diagnosis of German measles.
b. IgM-, IgG+ c. congenital infection with the rubella virus.
c. IgM+, IgG+ d. passive transfer of maternal antibodies to the
d. IgM-, IgG- infant's serum.
mix
11. A pregnant woman is exposed to a child with a 2. HIV virions bind to host T cells through which
rubella infection. She had no clinical symptoms receptors?
but had a rubella titer performed. Her antibody a. CD4 and CD8
titer was 1:8. Three weeks later, the test was b. CD4 and the IL-2 receptor
repeated and her titer was 1:128. She still had no c. CD4 and CCR5
clinical symptoms. d. CD8 and CCR2
Was the laboratory finding indicative of rubella
infection? 3. Antibodies to which of the following viral
a. No, the titer must be greater than 256 to be antigens are usually the first to be detected in HIV
significant. infection?
b. No, the change in titer is not significant if no a. gp120
clinical signs are present. b. gp160
c. Yes, a greater than four-fold rise in titer c. gp41
indicates early infection. d. p24
d. Yes, but clinical symptoms must also correlate
with laboratory findings. 4. Which of the following is typical of the latent
stage of HIV infection?
12. The cause of shingles is the a. Proviral DNA is attached to cellular DNA.
a. cytomegalovirus b. Large numbers of viral particles are
b. rubella virus synthesized.
c. varicella-zoster virus c. A large amount of viral RNA is synthesized.
d. HTLV-I d. Viral particles with no envelope are produced.
13. The method of choice for detecting VZV 5. The decrease in T-cell numbers in HIV-infected
infection in immunocompromised hosts is individuals is caused by
a. serology to detect virus-specific IgM antibodies. a. lysis of host T cells by replicating virus.
b. serology to detect virus-specific IgG antibodies. b. fusion of the T cells to form syncytia.
c. viral culture c. killing of the T cells by HIV-specific cytotoxic T
d. real-time PCR cells.
d. all of the above.
14. Which of the following is true regarding
laboratory testing for mumps? 6. The most common means of HIV transmission
a. RT-PCR is recommended as the primary worldwide is through
diagnostic test. a. blood transfusions.
b. Serology is necessary for confirmation of a b. intimate sexual contact.
suspected clinical case. c. sharing of needles in intravenous drug use.
c. IgM tests for mumps are highly specific. d. transplacental passage of the virus
d. An acute infection must be confirmed by a four-
fold rise in IgG titer. 7. The drug zidovudine is an example of a
a. nucleoside analogue reverse-transcriptase
15. A positive result on a screening test for HTLV-I inhibitor.
antibody should be b. nonnucleoside reverse-transcriptase inhibitor.
a. considered highly specific for HTLV-I infection. c. protease inhibitor.
b. followed by PCR. d. fusion inhibitor.
c. confirmed by Western blot.
d. validated by viral culture. 8. False-negative test results in a laboratory test
for HIV antibody may occur because of
Chapter 24 Laboratory Diagnosis of HIV a. heat inactivation of the serum before testing.
Infection b. collection of the test sample before
seroconversion.
1. All of the following describe HIV except a, it c. interference by autoantibodies.
possesses an outer envelope. d. recent exposure to certain vaccines.
b. it contains an inner core with p24 antigen.
c. it contains DNA as its nucleic acid.
d. it is a member of the retrovirus family.
mix
9. Which of the following combinations of bands Chapter 25 Immunization and Vaccines

would represent a positive Western blot for HIV
antibody? 1. Suppose an individual develops antibodies in
a. p24 and p55 response to a streptococcal pharyngitis infection.
b. p24 and p31 This is an example of
c. gp41 and gp120 a. active immunity.
d. p31 and p55 b. passive immunity.
c. adoptive immunity.
10. The fourth-generation ELISA tests for HIV d. immunoprophylaxis.
detect
a. HIV-1 and HIV-2 antigens. 2. Which of the following illustrates passive
b. HIV-1 and HIV-2 antibodies. immunity?
c. p24 antigen. a. Development of high antibody titers in a
d. HIV-1 antibodies, HIV-2 antibodies, and p24 healthy person after receipt of the hepatitis B
antigen. vaccine
b. Recovery of a patient from a hepatitis A
11. The conjugate used in the fourth-generation infection
ELISA tests for HIV consists of enzyme-labeled c. Passage of IgG antibodies through the placenta
a. anti-human immunoglobulin. of a pregnant woman to her fetus
b. HIV-1- and HIV-2-specific antibodies. d. Transfer of tumor-infiltrating lymphocytes to a
c. HIV-1- and HIV-2-specific antigens. cancer patient
d. HIV-1- and HIV-2-specific antigens plus
antibody to p24. 3. Which of the following is not a characteristic of
passive immunity?
12. The characteristic laboratory finding in HIV a. Transfer of antibodies
infection is b. Occurs naturally or as a result of therapy
a. decreased numbers of CD4 T cells. c. Provision of immediate protection
b. decreased numbers of CD8 T cells. d. Development of long-term memory
c. decreased numbers of CD20 B cells.
d. decreased immunoglobulins. 4. What was one of the major contributions of
Louis Pasteur to vaccine development?
13. Which of the following tests is currently a. Development of the smallpox vaccine
Recommended by the CDC to confirm a positive b. Use of attenuated microorganisms in vaccines
screening test result for HIV infection? c. Inactivation of bacterial toxins for vaccines
a. Rapid test for HIV-1 and HIV-2 antibodies d. Discovery of recombinant vaccine antigens
b. Western blot
c. Molecular testing for HIV RNA 5. The antigenic component of the hepatitis B
d. HIV viral culture vaccine differs from those of many of the
conventional vaccines in that it consists of a
14. Which of the following tests would give the a. live, attenuated virus.
least reliable results in a 2-month-old infant? b. inactivated virus.
a. CD4 T-cell count c. cryptic antigen.
b. ELISA for HIV antibody d. recombinant antigen
c. PCR for HIV proviral DNA
d. p24 antigen 6. Which of the following describes the properties
of a toxoid?
15. Which of the following measurements are a. Both pathogenic and immunogenic
routinely used to monitor patients with HIV b. Pathogenic but not immunogenic
infection who are undergoing antiretroviral c. Not pathogenic but immunogenic
therapy? d. Neither pathogenic nor immunogenic
a. HIV antibody titer
b. p24 antigen levels
c. CD4 T-cell and CDB T-cell counts
d. CD4 T-cell count and HIV RNA copy number
mix
7. Suppose a vaccine was available in two forms: 13. HAMA are

attenuated and inactivated. What is an advantage a. mouse-derived antibodies that have been used
of the attenuated form? for therapy.
a. It can be used in immunocompromised b. monoclonal antibodies with therapeutic
patients. benefits.
b. It induces both humoral and cell-mediated c. human antibodies that are produced against
immunity. mouse proteins.
c. There is no interference of the immune d. antitoxins that can provide immediate immunity.
response in infants by maternal antibodies.
d. It does not require special handling and storage 14. What is a major characteristic of adoptive
to maintain its effectiveness. immunotherapy?
a. It involves the transfer of cells to deliver
8. What factor(s) influence the effectiveness of a immunity.
person's immune response to a vaccine? b. It involves the transfer of cytokines to deliver
a. Age of the recipient immunity.
b. The individual's immune status c. It can only occur in the presence of autologous
c. The nature of the vaccine cells.
d. All of the above d. Its purpose is to increase the humoral immune
response.
9. An oral vaccine may be advantageous over an
injectable vaccine for a pathogen because it 15. Infusion of TILs into a cancer patient is an
a. reduces the risk of transmitting bloodborne example of
pathogens in developing areas of the world. a. active immunity.
b. avoids the pain associated with injections. b. adoptive immunity.
c. induces mucosal immunity. c. passive immunity.
d. all of the above. d. natural immunity
10. When one individual becomes immunized by

Receiving a series of vaccine injections according
to schedule, the resulting protection extends to
that individual's nearby contacts. This concept is
known as
a. immunologic memory.
b. neighborhood immunity.
c. herd immunity.
d. contagious immunity.
11. Which preparation would you recommend for

treatment of a patient with an antibody
deficiency?
a. Monoclonal antibody
b. Specific human immune serum globulin
c. Standard human immune serum globulin
d. Animal serum antitoxins
12. Immunoglobulins consisting of a mouse-

derived variable region combined with a human-
derived constant region are known as
a. monoclonal antibodies.
b. chimeric antibodies.
c. humanized antibodies.
d. fully human antibodies.
mix

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IMMUNOLOGY & SEROLOGY - STEVENS (4th Edition)

Review Questions 8. A cell characterized by a nucleus with two to

14. Which is characteristic of class I MHC 3. The process of inflammation is characterized by

Chapter 4 Adaptive Immunity 8. Which of the following can be attributed to

2. Which of the following is characteristic of 9. Which of the following is true of the

14. Quality managment refers to Chapter 9 Principles of Serological Testing

13. If a serological test is positive for an individual

14. Which of the following would be the correct

13. Agglutination of dyed bacterial cells 20. In a particle-counting immunoassay using

5. Which of the following is an advantage of 11. Immunofluorescent assays may be difficult to

Chapter 12 Molecular Diagnostic Techniques 8. Which best describes the PCR?

6. What characteristic distinguishes restriction 13. Which method is a signal amplification

10. Epitope spreading refers to Chapter 16 Transplantation Immunology

14. Innate immune responses thought to be 7. Which of the following is characteristic of

Chapter 18 Immunoproliferative Diseases 9. Which of the following is true of Waldenström

14. Multiple myeloma is characteristically 5. Which of the following statements applies to

3. Which test is recommended for testing

9. Which of the following combinations of bands Chapter 25 Immunization and Vaccines

7. Suppose a vaccine was available in two forms: 13. HAMA are

10. When one individual becomes immunized by

11. Which preparation would you recommend for

12. Immunoglobulins consisting of a mouse-

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