Clinical Immunology
Chapter Exam Questions
Course Introduction
Clinical Immunology explores the complexities of the human immune system in health and disease, focusing on the mechanisms underlying immune responses, disorders, and interventions. The course covers topics such as innate and adaptive immunity, immunopathology, hypersensitivity reactions, autoimmunity, immunodeficiencies, and the immune aspects of transplantation and oncology. Emphasis is placed on the clinical application of immunological principles in diagnosis, prevention, and treatment of diseases, including laboratory techniques and current advances in immunotherapy. Through case studies and practical sessions, students gain insight into the pivotal role of immunology in patient care and modern medicine.
Recommended Textbook
Clinical Immunology and Serology A Laboratory Perspective 3rd Edition by Christine Dorresteyn
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Page 2
Chapter 1: Introduction and Natural Immunity
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Sample Questions
Q1) Which substance best inactivates bacterial proteins?
A) NADP
B) oxygen
C) OCl<sup>-</sup>
D) lactic acid
Answer: C
Q2) All of the following are considered part of natural immunity EXCEPT:
A) eosinophils
B) lymphocytes
C) acute phase reactants
D) neutrophils
Answer: B
Q3) Acquired (adaptive)immunity can be characterized by which of the following?
A) nonspecific
B) immediate response
C) depends on neutrophils and macrophages
D) involves memory
Answer: D
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3
Chapter 2: Lymphoid System
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Sample Questions
Q1) A cell that can recall previous contact with a particular antigen so that subsequent exposure leads to a more rapid and more effective immune response than the first encounter is by definition which type of cell?
A) memory lymphocyte
B) effector lymphocyte
C) plasma cell
D) stem cell
Answer: A
Q2) Which cell is capable of producing antibody?
A) plasma cell
B) CD4+ T cell
C) macrophage
D) neutrophil
Answer: A
Q3) The cells that primarily function by secreting large amounts of cytokines are:
A) plasma cells
B) B cells
C) T helper cells
D) cytotoxic T cells
Answer: C
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Chapter 3: Nature of Antigens and Major Histocompatibility Complex
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Sample Questions
Q1) Naturally occurring anti-A and anti-B antibodies are thought to be due to exposure to which of the following?
A) heterophile antigens
B) haptens
C) alloantigens
D) autoantigens
Answer: A
Q2) Which of the following is true of HLA (MHC)class I antigens?
A) They are recognized by helper T cells.
B) They are found on all nucleated cells.
C) They combine with exogenous antigen.
D) They are coded for on chromosome 9.
Answer: B
Q3) HLA (MHC)class I protein is found on:
A) RBCs
B) all nucleated cells
C) B cells and macrophages
D) stem cells only
Answer: B
Page 5
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Chapter 4: Antibody Structure and Function
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Sample Questions
Q1) Which immunoglobulin appears first in the primary response?
A) IgG
B) IgM
C) IgA
D) IgE
Q2) IgA in the secretions has a valence of:
A) one
B) two
C) four
D) ten
Q3) Which region of the immunoglobulin molecule can bind antigen?
A) Fab
B) CL
C) CH
Q4) An immunoglobulin that contains a peptide that is not synthesized by a B cell is:
A) IgM in serum
B) IgA in secretions
C) IgG in secretions
D) IgD on a B cell membrane
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Chapter 5: Cytokines
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Sample Questions
Q1) Erythropoietin is classified as which of the following?
A) T-cell regulator
B) colony-stimulating factor
C) proinflammatory cytokine
D) regulator of the acute phase response
Q2) What is the main function of chemokines?
A) inhibit the immune response
B) enhance synthesis of acute phase reactants
C) enhance migration of white blood cells
D) protect cells from viral invasion.
Q3) IFN-gamma is produced by:
A) B cells
B) TH1 cells
C) TH2 cells
D) macrophages
Q4) What is one of the main activities of interleukin-4 (IL-4)?
A) downregulation of the immune response
B) increased production of neutrophils
C) generation of TH2 cells
D) protecting cells from viral invasion
Page 7
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Chapter 6: Complement System
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Q1) Which of the following are important functions of the complement system?
A) lysis of foreign cells
B) increase in vascular permeability
C) clearance of antigen-antibody complexes
D) all of the above
E) all except one of the above
Q2) Which factors are found in all three pathways?
A) factors B and D
B) C4,C2,C3
C) C5-C9
D) C1qrs,C3,C5
Q3) Chemotactic and anaphylactic factors are produced by proteolytic cleavage of:
A) C1q,C1r,C1s
B) C4,C2
C) C5,C3
D) C5,C6,C7,C8
Q4) What is cleaved by C3bBb?
A) C3
B) C5
C) C6
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Chapter 7: Safety and Specimen Preparation
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Q1) 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
Q2) Which of the following should be part of a chemical hygiene plan?
A) appropriate work practices
B) engineering controls such as fume hoods
C) employee training
D) all of the above
Q3) 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
Q4) Which of the following applies to recapping of needles?
A) It can be done carefully as long as gloves are worn.
B) A sheath can be placed back on the needle with the other hand.
C) Transport needles back to the lab for disposal.
D) Never manually recap a needle.
Page 9
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Chapter 8: Precipitation Reactions
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Sample Questions
Q1) In radial immunodiffusion,the diameter of the precipitin ring correlates with the:
A) concentration of antibody
B) size of antigen
C) length of time the antigen and antibody are bound
D) concentration of antigen
Q2) Radial immunodiffusion combined with electrophoresis best describes which of the following?
A) immunofixation electrophoresis
B) immunoelectrophoresis
C) Ouchterlony diffusion
D) rocket immunoelectrophoresis
Q3) An Ouchterlony immunodiffusion assay is set up and a line of precipitation is seen forming between the antigen and antibody wells.The lines of precipitation formed by two adjacent antigen wells cross each other,forming an X.The reaction described is called:
A) identity
B) non-identity
C) partial identity
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Chapter 9: Agglutination
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Q1) When a patient's red blood cells combine with anti-A typing serum to produce a positive result,this reaction is known as:
A) passive agglutination
B) reverse passive agglutination
C) hemagglutination
D) flocculation
Q2) A serological reaction is set up in which the antigen is bound to a large carrier,the antibody is soluble,and they bind and form an insoluble complex that is detected macroscopically.What type of assay is described?
A) precipitation
B) agglutination
C) flocculation
D) neutralization
Q3) If a Coombs' test is positive,which of the following is true?
A) Antibody has coated patient red blood cells in vitro.
B) Antigen is reacting with patient antibody.
C) Antibody has coated patient red blood cells in vivo.
D) Antigen has coated patient red blood cells in vivo.
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Chapter 10: Labeled Immunoassays
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Q1) In an indirect fluorescent immunoassay such as the FTA confirmatory test for syphilis,all of the following are true EXCEPT:
A) A labeled antigen is used.
B) Washing is an important step.
C) Patient antibody is detected.
D) Antihuman globulin has a fluorescent tag.
Q2) In the following equation,what is the ratio of bound radioactive antigen to bound patient antigen? 8ag* + 4ag + 6ab ---> ag*ab + agab + ag* + ag
A) 1:6
B) 1:3
C) 2:1
D) 8:6
Q3) In the following equation,10 Ag* + 5 Ag + 3 Ab ---> Ag*Ab + Ag Ab + Ag* + Ag,the ratio of bound radioactive antigen to bound patient antigen is:
A) 2:1
B) 1:2
C) 3:1
D) 5:1
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Chapter 11: Molecular Techniques
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Sample Questions
Q1) Restriction fragment length polymorphisms are characterized by all of the following EXCEPT:
A) Their DNA base sequences are the same.
B) Different DNA bases result in cleavage at different places.
C) They are detected by gel electrophoresis.
D) Different patterns can be used for identification purposes.
Q2) What would be an advantage of using molecular diagnostic techniques in identification of specific HLA antigens instead of serological techniques?
A) less quality control needed
B) more specific
C) more rapid
D) all of the above
E) all except one of the above
Q3) In order for a probe to hybridize to the target,which condition must be met?
A) The target must be double-stranded.
B) The target can only be RNA.
C) The target must have the same bases.
D) The target must have complementary bases.
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13
Chapter 12: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) In most flow cytometers,labeled cells:
A) scatter the light and absorb fluorescence
B) absorb fluorescence and emit electronic impulses
C) scatter the light and emit fluorescence
D) absorb both fluorescence and light
Q2) What is meant by "gating" in flow cytometry?
A) the chromatic arrangement of cellular populations
B) process by which one cell population adheres to another population
C) an electronic window separating subpopulations of cells
D) an electronic device measuring all populations of cells
Q3) The expression of cell surface markers is determined in the flow cytometer by which of the following?
A) chemiluminescence
B) fluorescence
C) optical density
D) radioactivity
E) scatter
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14
Chapter 13: Hypersensitivity
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Q1) Immune injury resulting from the localization of immune complexes in blood vessels and tissues describes which hypersensitivity reaction?
A) I
B) II
C) III
D) IV
Q2) Anaphylaxis is characterized by all of the following EXCEPT:
A) IgE-coated mast cells
B) massive release of histamine
C) bronchoconstriction
D) circulating immune complexes
Q3) Which isotype of immunoglobulin is involved in a type I hypersensitivity?
A) IgE
B) IgA
C) IgG
D) IgM
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Chapter 14: Autoimmunity
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Sample Questions
Q1) 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
Q2) A 40-year-old woman presents with a lemon-yellow,waxy pallor and a red,beefy tongue.She is extremely fatigued and is having difficulty getting up in the morning and getting through the day.Antiparietal cell antibodies are found in her serum.This woman has:
A) Graves' disease
B) pernicious anemia
C) ulcerative colitis
D) type 1 diabetes
Q3) The "CREST" variant of which disease is associated with the presence of an anticentromere antibody?
A) progressive systemic sclerosis (scleroderma)
B) rheumatoid arthritis
C) systemic lupus erythematosus
D) mixed connective tissue disease
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Chapter 15: Immunoproliferative Diseases
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Q1) A 55-year-old male presents with symptoms that include weakness,loss of appetite,and anemia.Immunofixation electrophoresis reveals a heavy IgM band.Which of the following is the most likely diagnosis?
A) SCID
B) multiple myeloma
C) Waldenström's macroglobulinemia
D) DiGeorge syndrome
Q2) Which immunoproliferative disorder is a cancer of the plasma cells and results in secretion of light chains into the urine?
A) multiple myeloma
B) Waldenström's macroglobulinemia
C) alpha heavy chain disease
D) DiGeorge syndrome
Q3) What is the main difference between leukemias and lymphomas?
A) In leukemias,malignant cells are mainly located in the tissues.
B) Lymphomas are present mainly in peripheral blood.
C) Lymphomas arise due to a lack of response to stimulating antigens.
D) Lymphomas arise mainly in lymph nodes,the spleen,or other lymphoid tissue.
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Chapter 16: Immunodeficiency Disease
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Sample Questions
Q1) A 9-month-old infant is seen by a physician due to a persistent skin infection.His white and red blood cell counts are normal.However,immunofixation electrophoresis indicates a low level of IgG.When the infant returns to the physician for a follow-up visit in a month,his IgG level has increased.What condition do these results indicate?
A) SCID
B) transient hypogammaglobulinemia
C) common variable immunodeficiency
D) DiGeorge anomaly
Q2) Which of the following statements about severe combined immunodeficiency (SCID)are true?
A) may be associated with a signal transduction defect
B) is accompanied by hypergammaglobulinemia
C) patients can be vaccinated with live virus
D) occurs only in males
Q3) Which of the following best describes common variable immunodeficiency disease?
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 and/or IgG.
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Page 18
Chapter 17: Transplantation Immunology
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Q1) Graft-versus-host disease results under which conditions?
A) when immunocompetent cells are placed in an immunocompromised host
B) when immunodeficient cells are placed in an immunocompetent host
C) any time tissue is not exactly matched in a transplant
D) only when adult cells are transplanted into a baby
Q2) When foreign HLA antigens are presented by antigen-presenting cells to T cells,this is known as:
A) direct allorecognition
B) indirect allorecognition
C) minor histocompatibility recognition
D) acute rejection
Q3) Transplantation of an individual's skin from one place to another is an example of a(n):
A) autograft
B) allograft
C) xenograft
D) heterograft
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19
Chapter 19: Tumor Immunology
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Sample Questions
Q1) Acute glomerulonephritis is due to:
A) deposition of immune complexes in the kidney
B) destruction of glomeruli by Streptolysin O
C) formation of cross-reacting antibodies
D) invasion of the kidney by Streptococcus pyogenes
Q2) Antibodies detected by reacting rickettsial antigens with specific antibody followed by use of 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
Q3) Organisms that are short rods or coccobacilli and obligate intracellular bacteria best describes:
A) Streptococcus pyogenes
B) Helicobacter pylori
C) Rickettsia prowazekii
D) Mycoplasma pneumonia
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20
Chapter 20: Serologic and Molecular Detection of Bacterial
Infections
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Q1) Why is testing for Cryptococcal antigen preferred over testing for antibodies?
A) This is usually not a humoral response to infection.
B) Immunocompromised patients do not produce antibody.
C) Subclinical infection can be detected.
D) all of the above
Q2) A 30-year-old male patient with AIDS exhibits pulmonary symptoms that include coughing and some difficulty breathing.The patient reported that he had previously worked in a bakery.His white blood cell count was normal,indicating that the infection is not bacterial in nature.Tests for the presence of fungal antigens were performed with the following results: ouchterlony immunodiffusion negative for antibodies to Aspergillus; negative latex agglutination test for Candida antigen,and positive EIA test for the galactomannan antigen of Aspergillus.What conclusion can be reached from these results?
A) The galactomannan is a false-positive result.
B) The infection is likely caused by Aspergillus.
C) The Candida antigen test is a false-negative
D) An Aspergillus infection is ruled out due to negative antibody testing.
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Page 21
Chapter 21: Serologic and Molecular Detection of Bacterial
Infections
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Q1) At which stage of syphilis is the RPR specific for syphilis?
A) primary
B) secondary
C) tertiary
D) latent
E) none of these
Q2) RPR stands for
A) reagin plasma reactive
B) reactive phosphate reagent
C) rapid plasma reagin
D) random positive reagin
Q3) At which stage of syphilis is the RPR the most sensitive?
A) primary
B) secondary
C) tertiary
D) latent
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Page 22
Chapter 22: Serology of Parasitic and Fungal Infections
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Q1) A patient has the following hepatitis profile: anti-HAV IgM = not detected; HBsAg = detected; anti-HBc IgM = detected; anti-HBc total = detected; anti-HBs = not detected; anti-HCV = not detected.What is his diagnosis?
A) acute hepatitis A
B) acute hepatitis B
C) acute hepatitis C
D) chronic hepatitis B
E) immune to hepatitis B
Q2) A 14-year-old boy presents to the physician complaining of sore throat,fatigue,and fever for the last week.A monotest was performed and was reported as positive.This boy has:
A) infectious mononucleosis
B) streptococcal pharyngitis
C) acute glomerulonephritis
D) common cold
Q3) The causative agent of infectious mononucleosis is
A) Streptococcus pyogenes
B) Staphylococcus aureus
C) Epstein-Barr virus
D) HIV
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Chapter 23: Spirochete Diseases
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Q1) All of the following conditions would indicate AIDS EXCEPT:
A) a CD4+ count of less than 200 cells/\(\mu\)L
B) Kaposi's sarcoma
C) esophageal candidiasis
D) infectious mononucleosis
Q2) Which is most likely a positive Western blot result for infection with HIV?
A) band at p24
B) band at gp60
C) bands at p24 and p31
D) bands at p24 and gp120
Q3) The Western blot test used to confirm HIV is an example of which of the following?
A) immunofixation
B) immunoelectrophoresis
C) double diffusion
D) passive agglutination
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