Advanced Immunology Review
Questions
Course Introduction
Advanced Immunology delves into the complex mechanisms of the immune system, exploring both innate and adaptive immunity at the molecular and cellular levels. The course covers topics such as antigen recognition, immune cell signaling, cytokine networks, immune tolerance, and the molecular basis of immunological disorders. Students will examine contemporary research on autoimmunity, hypersensitivity, immunodeficiency, and tumor immunology, as well as novel advances in immunotherapies and vaccine development. Emphasis is placed on critical analysis of scientific literature and experimental approaches used in immunological research.
Recommended Textbook
Clinical Immunology and Serology A Laboratory Perspective 4th Edition by Christine Dorresteyn
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Chapter 1: Introduction to Immunity and the Immune System
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Sample Questions
Q1) Contact with antigen and activation of B cells normally occurs in the:
A) peripheral blood.
B) connective tissue.
C) thymus.
D) lymph nodes.
Answer: D
Q2) T cells are mainly concentrated in which region of the lymph nodes?
A) Primary follicles
B) Secondary follicles
C) Paracortex
D) Medulla
Answer: C
Q3) Acquired (adaptive)immunity can be characterized as:
A) nonspecifically activated.
B) immediately responsive.
C) neutrophil dependent.
D) involving memory.
Answer: D
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Chapter 2: Nature of Antigens and the Major
Histocompatibility Complex
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Sample Questions
Q1) A processed antigen first encounters and binds to MHC class II molecules in the: A) nucleus.
B) endoplasmic reticulum.
C) endosomal compartment.
D) membrane surface.
Answer: C
Q2) A determinant site on an antigen that is produced by the folding of the primary chain is known as a:
A) conformational epitope.
B) linear epitope.
C) hapten.
D) monovalent epitope.
Answer: A
Q3) The term "human leukocyte antigen" is synonymous with: A) allele.
B) haplotype.
C) major histocompatibility complex.
D) chromosome.
Answer: C
4
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Chapter 3: Innate Immunity
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Sample Questions
Q1) Which of the following is directly used in oxidative killing of target cells?
A) Hydrogen peroxide
B) Lysozyme
C) Defensin
D) TNF-alpha
Answer: A
Q2) All of the following are part of the process of phagocytosis EXCEPT:
A) formation of a phagosome.
B) creation of hypochlorite radicals.
C) diapedesis.
D) fusion of lysosome with phagosome.
Answer: C
Q3) Which of the following occurs during the oxidative burst?
A) A decrease in oxygen consumption
B) Pseudopodia extending around a particle
C) The release of granules from a cell
D) Increased release of carbon dioxide
Answer: B
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5
Chapter 4: Adaptive Immunity
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Sample Questions
Q1) The purpose or end result of negative selection of the T cell is to ensure:
A) MHC restriction.
B) self-tolerance.
C) T-cell receptor expression.
D) expression of CD3.
Q2) Which cells are responsible for killing virally infected host cells and tumor cells?
A) CD4 T cells
B) CD8 T cells
C) B cells
D) Plasma cells
Q3) A lymphocyte exhibits the following markers: CD19,IgM,IgD.What is its likely identity?
A) Double-negative T cell
B) Immature B cell
C) Double-positive T cell
D) Mature B cell
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6
Chapter 5: Antibody Structure and Function
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Sample Questions
Q1) In serum protein electrophoresis,which band contains the immunoglobulins?
A) Alpha-1
B) Alpha-2
C) Beta
D) Gamma
Q2) The theory that lymphocytes are preprogrammed to respond to a particular type of antigen best describes:
A) the clonal selection theory.
B) Ehrlich's side-chain theory.
C) the spontaneous generation theory.
D) Edelman's antibody-formation theory.
Q3) Which is characteristic of IgG?
A) First class of antibody to appear
B) Found mainly in secretions
C) The least abundant antibody in serum
D) Provides immunity for the newborn
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Chapter 6: Cytokines
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Sample Questions
Q1) IFN-gamma is produced by:
A) B cells.
B) Th1 cells.
C) Th2 cells.
D) macrophages.
Q2) Select the assay format that is particularly advantageous for analyzing cytokines that act in networks or induce cascades of downstream cytokines.
A) ELISpot
B) Polymerase chain reaction
C) Agglutination
D) Multiplexed ELISA
Q3) The primary function of colony-stimulating factors (CSFs)is to promote:
A) apoptosis.
B) lysis.
C) diapedesis.
D) hematopoiesis.
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Page 8
Chapter 7: Complement System
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Sample Questions
Q1) In the alternate pathway,factor B must bind to which of the following to initiate the cascade?
A) Factor I
B) C3b
C) C4b
D) Properdin
Q2) The C3 convertase of the alternative pathway of complement activation is:
A) C3bBbP.
B) C3bB.
C) C4b2a3b.
D) C4b2a.
Q3) Which of the following complement components has chemotactic activity?
A) C3b
B) C3a
C) C1qrs
D) C5b6789
Q4) What is cleaved by C3bBb?
A) C3
B) C5
C) C6
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Chapter 8: Safety and Quality Management
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Sample Questions
Q1) A laboratory technologist receives blood samples via the pneumatic tube system.One of the tubes breaks in the carrier.To break the chain of infection,what should the laboratory technologist do?
A) Wear gloves before handling the broken sample.
B) Open the bag in the tube station without gloves.
C) Pour the blood that spilled out into a new tube.
D) Send the sample back to the sending station as is.
Q2) Where should you dispose of blood-soaked gauze pads?
A) Regular garbage
B) Sharps container
C) Red biohazard bag
D) Laundry bag
Q3) Which option is considered the primary goal of a Six Sigma program?
A) To increase laboratory productivity
B) To cut laboratory costs
C) To decrease the amount of reagent used
D) To reduce variables and decrease errors
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Chapter 9: Principles of Serological Testing
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Sample Questions
Q1) The concentration of a solution is reduced by adding:
A) solute.
B) particles.
C) diluent.
D) osmoles.
Q2) If 0.9 mL of saline is added to 0.1 mL of serum,what does the 0.9 mL represent?
A) The final dilution
B) The diluent
C) The solute
D) The total solution
Q3) Calculate the positive predictive value of the assay.
A)57%
B)75%
C)80%
D)90%
Q4) Serology is the study of:
A) white blood cells.
B) red blood cells.
C) platelets.
D) the liquid components of the blood, especially antibodies.
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Chapter 10: Precipitation and Agglutination Reactions
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Sample Questions
Q1) In an agglutination reaction,the antibody isotype that most effectively overcomes the electrostatic repulsion between particles is:
A) IgA.
B) IgE.
C) IgG.
D) IgM.
Q2) Which antibody class may require the use of an enhancement technique to visualize the reaction?
A) IgM
B) IgG
C) IgA
D) IgE
Q3) The AFFINITY of antigen-antibody binding is influenced by which of the following?
A) How well the antigen fits into the binding site on Fab
B) The number of Fab sites on the immunoglobulin
C) The number of antigens in the reaction
D) The charge distribution on Fc
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Chapter 11: Labeled Immunoassays
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Sample Questions
Q1) The standard method for detecting antinuclear antibodies (in certain autoimmune diseases)is:
A) direct immunofluorescence.
B) indirect immunofluorescence.
C) fluorescence polarization.
D) autofluorescence.
Q2) Which of the following best describes competitive binding assays?
A) A limited number of binding sites are present.
B) The concentration of patient antigen is directly proportional to the label detected.
C) All patient antigen present is allowed to bind.
D) Labeled and unlabeled analyte are present in equal amounts.
Q3) Compared with a capture assay,a radioimmunoassay is likely to be more advantageous in terms of:
A) use in diverse, nonlaboratory settings.
B) cost of equipment.
C) detecting small molecules.
D) cost of reagents.
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13
Chapter 12: Molecular Diagnostic Techniques
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Sample Questions
Q1) What is meant by semiconservative replication of DNA?
A) Only part of the molecule is reproduced at one time.
B) Each strand is the template for another strand.
C) One copy is the same, and another copy is different.
D) DNA uses RNA to make new copies.
Q2) Strand displacement amplification shares which characteristic with polymerase chain reaction?
A) Both are isothermal amplification processes.
B) Both involve an endonuclease.
C) Both involve DNA polymerase.
D) Both result in probe amplification.
Q3) Select the strand of RNA that is complementary to this single strand of DNA: A T T A G
C C G T A T
A) T A A T C G G C A T A
B) U A A U C G G C U A U
C) T U U T C G G C A U A
D) T A A T U G G U A T A
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Page 14
Chapter 13: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) Flow cytometry is commonly used to:
A) measure serum protein concentrations.
B) identify microbes.
C) determine the stage of leukocyte differentiation.
D) measure complement activation.
Q2) Fluorescently labeled antibodies are used in flow cytometry to determine:
A) the size of a cell.
B) the granularity of a cell.
C) proteins associated with a cell.
D) the shape of the nucleus.
Q3) In flow cytometry,it is possible to detect the expression of 10 different cell membrane proteins simultaneously by:
A) using 10 different lasers that produce light at different wavelengths.
B) measuring the amount of light scattered at 10 different angles.
C) staining the cells with 10 different labeled probes that fluoresce at different wavelengths.
D) measuring mass as well as fluorescent intensity.
Q4) In flow cytometry,fluorescence is usually used to determine:
A) intrinsic cell parameters.
B) extrinsic cell parameters.
Page 15
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Chapter 14: Hypersensitivity
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Sample Questions
Q1) The normal activity of a type I hypersensitivity response is protection primarily against which of the following?
A) Parasites
B) Viruses
C) Bacteria
D) Fungi
Q2) Type I hypersensitivity can be treated by injecting a specific recombinant humanized IgG called omalizumab.This antibody:
A) binds allergens, preventing them from binding patient IgE.
B) occupies Fc receptors on mast cells, preventing binding by patient IgE.
C) binds to a heavy-chain domain on patient IgE, preventing the IgE from binding to mast cells.
D) inhibits Th2 cells that would otherwise promote excess IgE production.
Q3) Preformed mediators that are released during the activation phase of a type I hypersensitivity response include which of the following?
A) Histamine
B) Cyclooxygenase
C) Leukotriene
D) Prostaglandin
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Page 16
Chapter 15: Autoimmunity
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Sample Questions
Q1) A 10-year-old girl visits her physician's office because she has been complaining about being thirsty and having to go to the bathroom all the time.She has lost 15 pounds over the past 6 months and has been more irritable than usual,especially after meals.The girl's fasting blood glucose is 575 mg/dL (reference range,< 100 mg/dL),her C-peptide is 0.5 ng/mL (reference range,0.8-3.1 ng/mL),and she has autoantibodies against glutamic acid decarboxylase and insulin.On the basis of these findings,a likely diagnosis for this girl is:
A) Hashimoto's thyroiditis.
B) acute glomerulonephritis.
C) type 1 diabetes.
D) progressive systemic sclerosis.
Q2) In the rheumatoid factor test,what is being detected?
A) antinuclear antibody
B) antithyroglobulin antibody
C) IgM directed against IgG
D) IgG directed against IgM
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Chapter 16: Transplantation Immunology
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Sample Questions
Q1) A transplant patient on a follow-up visit to his physician is noted to have progressive fibrosis and scarring with narrowing of the vessels leading to the transplanted organ.What type of rejection is occurring?
A) Hyperacute
B) Acute
C) Chronic
D) Accelerated
Q2) To determine whether a patient can accept a solid organ transplant from a nonrelated donor,which of the following tests would be used to verify compatibility after an HLA match is determined?
A) ABO blood typing
B) CDC assay
C) HLA antibody screen
D) RAST test
Q3) To correctly read a complement-dependent cytotoxicity test,the technologist should record the number of viable cells.
A)True
B)False
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Chapter 17: Tumor Immunology
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Sample Questions
Q1) Which of the following is a clinical application for tumor markers?
A) Screening
B) Diagnosis
C) Monitoring
D) All of the above
Q2) What is the definition of a sarcoma?
A) A cancer that is derived from skin or epithelial linings of internal organs or glands
B) A cancer that is derived from muscle, bone, fat or soft tissues
C) A cancer that is derived from blood and lymphatic systems
D) A cancer that is derived from brain and spinal tissue
Q3) HER-2
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
Q4) Tumor-associated antigens are expressed only in tumor cells.
A)True
B)False
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Chapter 18: Immunoproliferative Diseases
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Sample Questions
Q1) A patient's immunofixation electrophoresis shows excessive amounts of free monoclonal light chains.These light chains are referred to as:
A) Bence Jones proteins.
B) precipitated immunoglobulin A
C) albumin.
D) alpha-1 antitrypsin.
Q2) Malignant plasma cells exhibiting CD38,CD56,and CD138 are found in:
A) Waldenström macroglobulinemia.
B) chronic myeloid leukemia.
C) multiple myeloma.
D) monoclonal gammopathy of undetermined significance.
Q3) A patient whose malignant clone is positive for the CD markers CD15 and CD30 is most likely to have what clinical disease?
A) Non-Hodgkin lymphoma
B) Hodgkin lymphoma
C) Acute lymphocytic leukemia
D) Hairy-cell leukemia
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Chapter 19: Immunodeficiency Diseases
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Sample Questions
Q1) A 9-month-old boy is suspected of having an immune deficiency because he had many recurrent infections with Streptococcus pneumoniae.Laboratory tests reveal a normal percentage of T cells and T-cell subsets but a lack of mature B cells and immunoglobulins.This boy most likely has:
A) Wiskott-Aldrich syndrome.
B) DiGeorge anomaly.
C) X-linked agammaglobulinemia.
D) chronic granulomatous disease.
Q2) Which of the following statements best describes common variable immunodeficiency?
A) Symptoms appear in infancy.
B) It is inherited as an X-linked recessive.
C) It is invariably fatal for the patient.
D) There is a deficiency of IgA, IgG, or both.
Q3) Which of the following is associated with DiGeorge syndrome?
A) Small or missing thymus
B) Missing B-cell precursors
C) Inherited as X-linked recessive
D) M spike in the gamma region
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Page 21
Chapter 20: Serological and Molecular Detection of Bacterial Infections
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Sample Questions
Q1) Antibodies detected by reacting patient serum with rickettsial antigens,followed by incubation with an anti-immunoglobulin with a fluorescent tag,could be used to diagnose:
A) Rocky Mountain spotted fever.
B) Mycoplasma pneumonia.
C) stomach ulcers.
D) rheumatic fever.
Q2) The genetic determinants for the structural features of bacteria are encoded in: A) single-stranded DNA.
B) plasmids.
C) double-stranded RNA.
D) chromosomal DNA.
Q3) Which of the following is an endotoxin,not an exotoxin?
A) Streptolysin O
B) Lipid A
C) Streptokinase
D) Hyaluronidase
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Page 22
Chapter 21: Spirochete Diseases
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Sample Questions
Q1) Which statement about late manifestations of Lyme disease is true?
A) Treatment cannot reverse complications.
B) Both central and peripheral nervous systems may be affected.
C) Cardiac or neurological damage occurs in all cases.
D) Arthritis appears only in elderly patients.
Q2) Using the reverse algorithm method for syphilis diagnosis,a positive initial test and a negative follow-up test could be interpreted as:
A) a false negative in the treponemal test.
B) a false positive in the nontreponemal test.
C) past syphilis infection with subsequent decline in nontreponemal antibody titers.
D) current syphilis, likely in the secondary stage.
Q3) Lyme disease is caused by:
A) Treponema pallidum.
B) Borrelia recurrentis.
C) Leptospira autumnalis.
D) Borrelia burgdorferi.
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Chapter 22: Serological and Molecular Diagnosis of Parasitic
and Fungal
Infections
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Sample Questions
Q1) Suppose a parasite invades a patient and causes disease.The patient develops an immune response and has some resistance to the parasite but is not cured.This outcome is considered what type of host-parasite interaction?
A) Symbiosis
B) Commensalism
C) Sterilizing immunity
D) Concomitant immunity
Q2) A parasite accesses a target cell in a host,thus hiding its antigens from the host's immune system.This survival strategy is known as:
A) antigenic mimicry.
B) immunologic subversion.
C) antigenic concealment.
D) shedding.
Q3) A patient is diagnosed with coccidioidomycosis.This infection can be classified as:
A) subcutaneous.
B) systemic.
C) opportunistic.
D) superficial.
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Chapter 23: Serology and Molecular Detection of Viral Infections
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Sample Questions
Q1) A physician suspects that his patient has infectious mononucleosis.Heterophile antibody tests are negative.Serological testing for Epstein-Barr virus (EBV)was performed,with the following results obtained: EBV VCA IgM = neg; EBV VCA IgG = neg; EBV-EA = neg; EBV-NA = neg.What is this person's status with regard to EBV?
A) Acute EBV
B) Convalescent EBV
C) Never infected with EBV
D) Past exposure to EBV
Q2) Which of the following positive antibody tests may be an indication of recent rubella vaccination or early primary rubella infection in a patient with no clinical symptoms?
A) Only IgG positive
B) Only IgM positive
C) Both IgG and IgA antibodies positive
D) Fourfold rise in titer for IgG
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Chapter 24: Laboratory Diagnosis of HIV Infection
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Sample Questions
Q1) The most commonly used HIV drug-resistance assays are based on:
A) culture of HIV in the presence of antiretroviral drugs.
B) detection of genetic mutations in HIV.
C) ability of HIV antibodies to react with drug-resistant viral strains.
D) typing for the HLA-B27 allele.
Q2) Histoplasmosis (disseminated or extrapulmonary)is an opportunistic infection of stage 3 HIV infection.
A)True
B)False
Q3) Of the designated subtypes of HIV,which is the most common in the United States?
A) Subtype B
B) Subtype C
C) Subtype A
D) Subtype K
Q4) The RT-PCR is a highly sensitive method that involves:
A) direct amplification of HIV RNA.
B) amplification of a label attached to HIV RNA.
C) amplification of a complementary DNA sequence to a portion of the HIV RNA.
D) DNA sequencing of a portion of HIV RNA.
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Chapter 25: Immunization and Vaccines
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Sample Questions
Q1) An effective method of acquiring immunity is through the method of community immunity.
A)True
B)False
Q2) Hematopoietic stem cell transplantation is an example of adoptive immunity.
A)True
B)False
Q3) Human immune serum globulin is made from the pooled serum of thousands of donors.
A)True
B)False
Q4) Adoptive immunity
A) Immunization with a specific antigen
B) Transfer of antibodies from immunized host to nonimmune host
C) Transfer of cells, usually lymphocytes, from an immune host to a nonimmune host
Q5) Passive immunity involves the activation of IgD.
A)True
B)False
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