Biomedical Laboratory Diagnostics
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Course Introduction
Biomedical Laboratory Diagnostics explores the principles, techniques, and applications of laboratory procedures used in the diagnosis, monitoring, and treatment of diseases. The course covers essential topics such as specimen collection and processing, laboratory safety, quality assurance, and the use of advanced instrumentation in hematology, clinical chemistry, immunology, and microbiology. Students gain hands-on experience in the identification and analysis of biological samples, interpretation of results, and correlation with clinical findings. Emphasis is placed on the integration of laboratory data within the broader context of patient care and the critical role of laboratory professionals in the healthcare team.
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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Q1) Which of the following is a characteristic of opsonins?
A) They are carbohydrates that stimulate T cells.
B) They are molecules that coat bacteria, making them more susceptible to phagocytosis.
C) They are expressed on the surface of neutrophils.
D) They are produced by NK cells.
Answer: B
Q2) Pasteur's discovery that older bacterial cultures would not cause disease in chickens but would protect them from subsequent infection with more virulent strains is an example of:
A) attenuated vaccine.
B) natural immunity.
C) passive immunity.
D) cross-immunity.
Answer: A
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Page 3
Chapter 2: Nature of Antigens and the Major
Histocompatibility Complex
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Q1) MHC class I antigens are recognized by which of the following cells?
A) CD4+ T cells
B) CD8+ T cells
C) B cells
D) Macrophages
Answer: B
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) T cells are capable of recognizing:
A) conformational epitopes.
B) native (nondegraded) peptides.
C) degraded peptides.
D) haptens.
Answer: C
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Chapter 3: Innate Immunity
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Sample Questions
Q1) Which of the following is part of the external defense system?
A) Ceruloplasmin
B) Skin
C) Neutrophils
D) Complement
Answer: B
Q2) All of the following are characteristic of acute-phase reactants EXCEPT:
A) they are constituents that increase rapidly in response to infection.
B) they are used to diagnose a specific disease.
C) they enhance phagocytosis.
D) they limit destruction of host tissue.
Answer: B
Q3) 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
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5
Chapter 4: Adaptive Immunity
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Sample Questions
Q1) Identification of T-cell subsets is best accomplished with the use of:
A) antigen-induced proliferation assays.
B) cytotoxicity assays.
C) flow cytometry.
D) serum electrophoresis.
Q2) A T cell that is rarely found in secondary lymphoid organs and recognizes a limited number of native epitopes is known as:
A) a helper T cell.
B) a gamma-delta T cell.
C) a cytotoxic T cell.
D) an alpha-beta T cell.
Q3) Cytotoxic T cells are the primary immune response against which type of pathogen?
A) Viruses
B) Parasites
C) Bacteria
D) Fungi
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6
Chapter 5: Antibody Structure and Function
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Sample Questions
Q1) 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.
Q2) Bence-Jones proteins are identical to:
A) secretory IgA.
B) heavy chains.
C) light chains.
D) IgG molecules.
Q3) Which immunoglobulin activates the classical complement pathway?
A) IgD
B) IgM
C) IgA
D) IgE
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Chapter 6: Cytokines
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Q1) Which type of cytokine acts as the best defense against gram-negative bacteria?
A) TGF-beta
B) TNF
C) IL-2
D) IL-5
Q2) What is a main function of chemokines?
A) Inhibit the immune response
B) Enhance synthesis of acute-phase reactants
C) Establish a concentration gradient to guide cell movement
D) Protect cells from viral invasion
Q3) The actions of IL-1 and IL-10 are examples of:
A) redundancy.
B) antagonism.
C) synergy.
D) pleiotropy.
Q4) Identify the cytokine that is produced by Th2 cells and inhibits Th1.
A) IL-10
B) IL-5
C) IL-3
D) IFN-gamma
Page 8
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Chapter 7: Complement System
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Sample Questions
Q1) A system of serum proteins that interact to enhance the immune response by producing cytolytic,chemotactic,and other effects best describes:
A) complement.
B) fibrinogen.
C) haptoglobin.
D) CRP.
Q2) Identify the condition that would result from a deficiency in complement component C2.
A) Increased vascular permeability
B) Hereditary angioedema
C) Severe infections with encapsulated bacteria
D) Immune complex disease
Q3) Lack of the complement inhibitor C1INH results in which disease?
A) Hereditary angioedema
B) Paroxysmal nocturnal hemoglobinuria
C) Immune complex disease
D) Meningitis
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Chapter 8: Safety and Quality Management
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Sample Questions
Q1) What is the most appropriate laboratory safety wear?
A) Cloth laboratory coat worn unbuttoned
B) Fluid-resistant laboratory gown with wrist cuffs
C) A patient gown worn tied in the back
D) No laboratory coat unless you have to clean up a spill
Q2) A coworker says she has an allergy to latex.As her supervisor,what should you advise her to do?
A) Wear latex gloves but wash her hands often to stop the allergy.
B) Wear gloves made of an alternative material.
C) Do not wear gloves.
D) Wash the latex gloves before using.
Q3) A patient under isolation precautions is being transported to the x-ray department.He has no mask on and sneezes in the elevator.This scenario is an example of what type of hazard?
A) Chemical hazard
B) Sharps hazard
C) Chain-of-infection hazard
D) Physical hazard
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Chapter 9: Principles of Serological Testing
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Sample Questions
Q1) Which series of dilutions would be best in order to make a 1:3000 dilution?
A) 1:10, 1:3, 1:10
B) 1:5, 1:6, 1:100
C) 1:3, 1:100, 1:100
D) 1:30, 1:10, 1:100
Q2) Serology is the study of:
A) white blood cells.
B) red blood cells.
C) platelets.
D) the liquid components of the blood, especially antibodies.
Q3) A patient's serum must be added to a series of test tubes,but a different volume of serum must be added to each tube.If a single pipette is used,what kind is it?
A) Graduated
B) Volumetric
C) Analytic
D) Calibrated
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Chapter 10: Precipitation and Agglutination Reactions
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Q1) If antibody is uniformly distributed in a gel and antigen is added to a well cut into the gel,the process is called:
A) single diffusion.
B) double diffusion.
C) immunofixation.
D) retrodiffusion.
Q2) Based on the following equilibrium constants,which assay would have the best sensitivity?
A) K = 1
B) K = 2
C) K = 4
D) K = 9
Q3) Which of the following is true of a reverse agglutination test?
A) The antigen is a natural particle.
B) Antigen molecules are artificially bound to particles.
C) Antibody is attached to particles.
D) The antigen-antibody reaction is competitive (no agglutination indicates a positive result).
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12
Chapter 11: Labeled Immunoassays
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Sample Questions
Q1) Identify the characteristic associated with noncompetitive enzyme immunoassays.
A) They are less sensitive than agglutination reactions.
B) They are used when quantitation is necessary.
C) Antibody is bound to the solid phase.
D) Binding sites for patient antibody are limited.
Q2) 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.
Q3) A good enzyme for use in an immunoassay should have a:
A) rapid degradation rate.
B) high substrate conversion rate.
C) high cost.
D) toxic enzymatic product.
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13
Chapter 12: Molecular Diagnostic Techniques
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Sample Questions
Q1) In DNA sequencing,what is the purpose of the dideoxynucleotide bases?
A) To enhance synthesis of DNA
B) To stop growth of a DNA chain at a certain point
C) To make certain that only one strand of DNA is amplified
D) To create restriction fragment length polymorphisms
Q2) Which type of RNA is used to directly translate the DNA code into making functional proteins?
A) Transfer RNA
B) Ribosomal RNA
C) Messenger RNA
D) Probe RNA
Q3) Light is generated when nucleotides are added to a growing strand of DNA in the process of:
A) pyrosequencing.
B) ligase chain reaction.
C) strand displacement amplification.
D) branched DNA amplification.
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14
Chapter 13: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) In flow cytometry,the sheath fluid:
A) contains a dye required for cell identification.
B) draws the suspended cells into a laminar flow.
C) filters out extraneous wavelengths of light.
D) provides nutrients necessary to maintain cellular metabolism.
Q2) What is a disadvantage of automated testing in a clinical immunology laboratory?
A) Decreases potential for manual errors
B) Increases dependence on a single machine
C) Cannot be used within the preanalytical stage of testing
D) Cannot perform combined chemistry and immunoassay testing on a single platform
Q3) The ability to consistently reproduce the same result on repeated testing of the same sample is called:
A) accuracy.
B) precision.
C) analytic sensitivity.
D) analytic specificity.
Q4) In flow cytometry,fluorescence is usually used to determine:
A) intrinsic cell parameters.
B) extrinsic cell parameters.
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Chapter 14: Hypersensitivity
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Sample Questions
Q1) 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.
Q2) Which isotype of immunoglobulin is involved in a type I hypersensitivity?
A) IgE
B) IgA
C) IgG
D) IgM
Q3) What immune phenomenon is responsible for the muscle weakness associated with myasthenia gravis?
A) Binding of antibody to a receptor on muscle cells
B) Muscle cell destruction by cytotoxic T cells
C) Deposition of immune complexes in the muscles
D) Release of histamine from mast cells in the muscles
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Chapter 15: Autoimmunity
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Q1) A 30-year-old clinical laboratory science student complains of being tired but is not able to sleep.The woman also states that her hair has been breaking off,and she has lost 20 pounds over the past 2 months without trying.The woman's pulse and blood pressure are elevated,and her eyes seem to be bulging.Her complete blood count (CBC)is normal,thyroid-stimulating hormone is decreased,and T4 is increased.Antimicrosomal and antithyroglobulin antibodies are each 1:400.This woman most likely has:
A) Addison's disease.
B) Graves disease.
C) Hashimoto's thyroiditis.
D) type 1 diabetes.
Q2) Antibodies directed against thyroglobulin represent a significant finding in which of the following autoimmune diseases?
A) Myasthenia gravis
B) Multiple sclerosis
C) Hashimoto's thyroiditis
D) Contact dermatitis
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Chapter 16: Transplantation Immunology
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Q1) Suppose a mother and her child possess the following HLA haplotypes:?Mother: ?A28 B17 Cw4 Dw3?A30 B21 Cw2 Dw10?Child: ?A3 B8 Cw6 Dw7?A28 B17 Cw4 Dw3 Paternity testing was performed.Three potential fathers were HLA typed and found to contain the following haplotypes:?Father 1: ?A30 B21 Cw2 Dw10?A1 B2 Cw5 Dw9?Father 2: ?A3 B8 Cw6 Dw7?A8 B9 Cw1 Dw8?Father 3: ?A3 B8 Cw5 Dw4?A2 B1 Cw6 Dw7??Which of the following statements is true?
A) The true father may be Father 1 only.
B) The true father may be Father 2 only.
C) The true father may be Father 1 or Father 2.
D) The true father may be Father 2 or Father 3.
Q2) A transplantation patient suffers an organ rejection within hours after the procedure.What type of rejection occurred?
A) Hyperacute
B) Acute
C) Chronic
D) Graft-versus-host disease
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Chapter 17: Tumor Immunology
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Q1) A proto-oncogene is a normal gene that has a positive influence on cell proliferation.
A)True
B)False
Q2) Which of the following is a clinical application for tumor markers?
A) Screening
B) Diagnosis
C) Monitoring
D) All of the above
Q3) A tumor that is classified as malignant is described as:
A) a disorganized mass that is not encapsulated and can invade nearby organs.
B) a slow-growing, organized mass of encapsulated cells.
C) usually confined to the skin.
D) an area of swelling that shows no abnormal growth of cells.
Q4) Cancer antigen 19-9
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
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Chapter 18: Immunoproliferative Diseases
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Q1) Which marker is highly specific for hairy-cell leukemia?
A) CD19
B) CD20
C) CD25
D) CD103
Q2) 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
Q3) Which of the following is not a characteristic in the identification of lymphoma of B-cell origin?
A) Surface immunoglobulins
B) Cell-surface proteins CD19 and CD20
C) Rearrangement of immunoglobulin genes
D) Presence of CD14 and CD15
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20
Chapter 19: Immunodeficiency Diseases
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Q1) A nitroblue tetrazolium test shows little color in cells observed under a microscope.What disease does this finding correlate with?
A) Chronic granulomatous disease
B) Ataxia telangiectasia
C) Wiskott-Aldrich syndrome
D) Transient hypogammaglobulinemia
Q2) An inflammatory syndrome involving recurrent fevers is
A) ataxia telangiectasia.
B) Wiskott-Aldrich.
C) autoimmune lymphoproliferative.
D) hyper IgD.
Q3) A defective kinase needed for DNA repair and cell cycle control leads to involuntary muscle movements and dermal capillary swelling in which syndrome?
A) Ataxia telangiectasia
B) Wiskott-Aldrich
C) Autoimmune lymphoproliferative
D) Chediak-Higashi
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Chapter 20: Serological and Molecular Detection of Bacterial Infections
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Q1) Which of the following bacterial enzymes causes the release of lysosomal contents into the cytoplasm of the phagocytic cell,leading to the death of the cell?
A) Protein H
B) Leukocidin
C) M protein
D) IgA protease
Q2) A symbiotic relationship in which both the microorganism and the host benefit is called:
A) commensal.
B) mutualistic.
C) parasitic.
D) virulent.
Q3) The advantage of microscopic visualization in bacterial diagnosis is that the method is:
A) very sensitive.
B) easy to perform.
C) easy to interpret.
D) able to identify all clinically relevant microbes.
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Chapter 21: Spirochete Diseases
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Q1) The Centers for Disease Control and Prevention recommends which two-tiered testing procedure for Lyme disease?
A) Screening by IFA or EIA with positive or borderline result followed by Western blot for confirmation
B) Screening by IFA followed by EIA for confirmation
C) Screening by Western blot followed by PCR for confirmation
D) Screening by EIA followed by PCR for confirmation
Q2) The antibody known as reagin is:
A) only present in the disease syphilis.
B) tested for using charcoal sensitized with cardiolipin.
C) found in all patients with primary syphilis.
D) antibody directed against IgG.
Q3) The VDRL test on cerebrospinal fluid for neurosyphilis:
A) is very specific.
B) is very sensitive.
C) does not require the use of a microscope.
D) uses a higher antigen volume than the serum test.
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Chapter 22: Serological and Molecular Diagnosis of
Parasitic and Fungal
Infections
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Q1) 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.
Q2) A 27-year-old female patient who is pregnant is undergoing serological testing as a precaution because of a recent food poisoning episode in which she ate undercooked pork at a picnic.The laboratory tests revealed positive IgG antibodies and negative IgM antibodies to toxoplasmosis.What do these test results indicate?
A) She has an active infection, and there is risk of transmission to the fetus.
B) She does not have an active infection, and there is no risk to the fetus.
C) She has a chronic infection, and there is minimal risk to the fetus.
D) She has an active infection, and there is no risk to the fetus.
Q3) An example of a fungal organism that commonly causes systemic infections is:
A) Malassezia furfur.
B) Trichophyton species.
C) Cryptococcus neoformans.
D) Candida albicans.
Page 24
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Chapter 23: Serology and Molecular Detection of Viral Infections
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Q1) Serology is performed on a patient with a rash and fever.Results are: rubella IgM = positive; rubella IgG = positive; measles IgM = negative; measles IgG = positive; varicella-zoster IgM = negative; varicella-zoster IgG = negative.What is the interpretation of these results?
A) Acute infection with rubella virus
B) Acute infection with measles virus
C) Not immune to measles or rubella viruses
D) Immune to varicella-zoster virus only
Q2) Swollen parotid glands are key diagnostic indicators of:
A) measles.
B) mumps.
C) varicella.
D) rubella.
Q3) A newborn infant tests positive for anti-HBc IgG.This result is evidence that:
A) the infant is infected with hepatitis B
B) the mother was infected with hepatitis B.
C) both mother and infant are infected with hepatitis B.
D) Both mother and infant are immune to hepatitis B.
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Chapter 24: Laboratory Diagnosis of HIV Infection
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Q1) gp41
A) Component of reverse transcriptase enzyme
B) Transmembrane protein
C) Envelope protein that binds to CD4 on T cells
D) Core coat for nucleic acids
Q2) When HIV replicates,the DNA in the viral genome is transcribed into RNA.
A)True
B)False
Q3) Which HIV group is responsible for a majority of the HIV infections worldwide?
A) Group M
B) Group O
C) Group N
D) Group P
Q4) Which of the following is considered the best indicator of immune function in HIV-infected individuals?
A) HIV-1 viral load
B) Presence of HIV-2 antibodies
C) CD4 T-cell count
D) Absolute lymphocyte count
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Chapter 25: Immunization and Vaccines
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Q1) A mother provides immunity to her unborn child in the womb via which process?
A) Active immunity
B) Passive immunity
C) Adoptive immunity
D) Adoptive immunotherapy
Q2) An adverse reaction to a vaccine can involve hypersensitivity or an allergic reaction.
A)True
B)False
Q3) Inactivated vaccine
A) Vaccine produced by incorporating a gene from a pathogenic microorganism into the genome of nonpathogenic bacteria, yeast, or other cells
B) Vaccine in which intact, killed viruses or bacteria retain antigenic properties to induce a predominantly humoral immune response
C) The use of bacteria or viruses that have been weakened
D) Chemically inactivated bacterial exotoxins that induce the production of antibodies
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