Clinical Immunology
Midterm Exam
Course Introduction
Clinical Immunology explores the principles and applications of immunological concepts in the diagnosis, treatment, and management of human diseases. The course covers the structure and function of the immune system, mechanisms of immune responses, and the pathogenesis of immunological disorders, including hypersensitivities, autoimmune diseases, and immunodeficiencies. Students will examine diagnostic techniques, laboratory methods, and emerging therapies, as well as the role of immunology in transplantation, cancer, infectious diseases, and allergies. Emphasis is placed on case studies and current clinical practices to prepare students for problem-solving in medical and laboratory settings.
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) Which of the following is a characteristic of natural killer cells?
A) They mature in the thymus.
B) They are smaller than B and T cells.
C) They are a type of lymphocyte.
D) They are part of the adaptive immune system.
Answer: C
Q2) Which of the following is characteristic of natural immunity?
A) It involves memory.
B) T lymphocytes play a major role.
C) It involves specificity.
D) Mechanisms are always present and fully functional.
Answer: D
Q3) Macrophages that migrate to the liver are called:
A) alveolar macrophages.
B) histiocytes.
C) microglial cells.
D) Kupffer cells.
Answer: D
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Chapter 2: Nature of Antigens and the Major
Histocompatibility Complex
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Q1) Characteristics of MHC class II molecules include which of the following?
A) Interact with CD8+ T cells
B) Have an alpha chain and beta-2 microglobulin
C) Have alpha and beta chains of approximately equal size
D) Combine with antigen made inside the cell
Answer: C
Q2) A processed antigen first encounters and binds to class I MHC molecules in the:
A) nucleus.
B) endoplasmic reticulum.
C) endosomal compartment.
D) membrane surface.
Answer: B
Q3) 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
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Chapter 3: Innate Immunity
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Sample Questions
Q1) 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
Q2) Natural killer cells recognize and kill abnormal host cells that are:
A) opsonized with IgE.
B) lacking expression of MHC class I.
C) expressing MHC class I.
D) presenting antigen bound to MHC class II.
Answer: B
Q3) 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
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5
Chapter 4: Adaptive Immunity
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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) Mutations causing deficiencies in CD40L expression lead to an inability of helper T cells to:
A) kill tumor cells, resulting in an increased risk of cancer.
B) activate macrophages, resulting in an inability to clear extracellular pathogens.
C) migrate to the site of an infection by chemotaxis, resulting in a slowed response.
D) promote class-switching, resulting in high IgM and low IgA and IgG concentrations.
Q3) Which statement best describes the specific antigen receptor that is a part of CD3 found on T cells?
A) It appears in the double-negative stage.
B) Alpha and beta chains bind antigen.
C) It is found only on T helper cells.
D) All eight chains are specific for antigen.
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Chapter 5: Antibody Structure and Function
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Q1) The ability of an antibody to opsonize is located in which region?
A) F(ab)<sub>2</sub>
B) Fc
C) VL + VC
D) Hypervariable
Q2) Identify the true statement about the anamnestic response versus the primary response.
A) The primary response has a long lag phase; the anamnestic response has a short lag phase.
B) The primary response has a short lag phase; the anamnestic response has a long lag phase.
C) the primary response involves a rapid increase in antibody titer, whereas the anamnestic response involves a rapid decrease in antibody titer.
D) The primary response involves predominantly an increase in IgG antibodies, whereas the anamnestic response involves predominantly an increase in IgM antibodies.
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Chapter 6: Cytokines
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Sample Questions
Q1) A cytokine "storm" is a:
A) systemic transfer of reactive macrophages induced by cytokines.
B) cytokine-mediated invasion of an infected wound by leukocytes.
C) massive, pathological overproduction of cytokines that contributes to pathogenesis.
D) psychological response to cytokines that bind hypothalamic receptors.
Q2) The primary function of colony-stimulating factors (CSFs)is to promote:
A) apoptosis.
B) lysis.
C) diapedesis.
D) hematopoiesis.
Q3) IL-2 is produced by one cell,and the same IL-2 stimulates that same cell.This type of cytokine activity is called:
A) autocrine.
B) paracrine.
C) endocrine.
D) pleotropic.
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Chapter 7: Complement System
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Sample Questions
Q1) Which complement factor polymerizes to cause lysis of a foreign cell?
A) C5
B) C6
C) C8
D) C9
Q2) Which of the following is referred to as C5 convertase?
A) C4b2a
B) MASP1
C) C4b2a3b
D) C1qrs
Q3) Which factors are found in all three pathways?
A) Factors B and D
B) C4, C2, and C3
C) C5 through C9
D) C1qrs, C3, and C5
Q4) Lack of the complement components C5 through C9 may result in which condition?
A) Neisseria infection
B) Paroxysmal nocturnal hemoglobinuria
C) Atherosclerosis
D) Meningitis
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Chapter 8: Safety and Quality Management
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Sample Questions
Q1) 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
Q2) What does the acronym RACE stand for?
A) Run, active, call, escape
B) Rescue, alarm, contain, extinguish
C) Recall, alarm, call, exit
D) Run, alarm, code, extinguish
Q3) 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.
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10
Chapter 9: Principles of Serological Testing
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Sample Questions
Q1) If the assay was used to test a different population consisting of 240 infected patients and 50 healthy controls,which assay parameter would increase?
A)Sensitivity
B)Specificity
C)Positive predictive value
D)Negative predictive value
Q2) An antibody titer is defined as the reciprocal of the:
A) last serial dilution tube in which a positive reaction is still visible.
B) first serial dilution tube in which a negative reaction is achieved.
C) diluent divided by the solvent.
Q3) 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
Q4) Calculate the assay's specificity.
A)57%
B)75%
C)80%
D)90%
11
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Chapter 10: Precipitation and Agglutination Reactions
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Q1) The production of insoluble complexes that absorb or scatter light but are too small to see directly is called:
A) precipitation.
B) agglutination.
C) equivalence.
D) sensitization.
Q2) The law of mass action states that:
A) any free reactants will rapidly bind together.
B) the number of antibody binding sites must equal the number of antigen binding sites.
C) free reactants are in equilibrium with bound reactants.
D) the rate of binding equals the rate of dissociation.
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) Select the technique that would most likely be used to determine the concentration of a therapeutic drug.
A) Radioimmunoassay
B) Chemiluminescent assay
C) Fluorescence polarization immunoassay
D) Enzyme immunoassay
Q2) Which assay poses the greatest risk of exposure to biohazards?
A) Radioimmunoassay
B) Enzyme immunoassay
C) Fluorescence polarization
D) Chemiluminescent immunoassays
Q3) 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.
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Chapter 12: Molecular Diagnostic Techniques
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Sample Questions
Q1) Next-generation sequencing involves:
A) generating many short sequences from an intact, continuous DNA sequence.
B) generating many short sequences from fragmented DNA.
C) splicing together DNA fragments.
D) adding multiple probes to fragmented DNA.
Q2) Use of microarrays consisting of either DNA or RNA to identify an unknown nucleic acid best describes:
A) in situ hybridization.
B) polymerase chain reaction.
C) DNA chip technology.
D) strand displacement amplification.
Q3) 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.
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Chapter 13: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) In flow cytometry,forward scatter provides a measure of:
A) cell size.
B) cell granularity.
C) membrane receptor expression.
Q2) The reference interval is determined by:
A) using a standardized reagent to establish the highest and lowest concentrations that can be measured by an instrument or test system.
B) measuring an analyte in samples from a large number of healthy people, using the same instrument or test system.
C) the period of time between the acquisition and testing of a sample.
D) the difference in concentration between the highest and lowest standards used in the standard curve.
Q3) 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.
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15
Chapter 14: Hypersensitivity
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Sample Questions
Q1) Which of the following occurs in hemolytic disease of the newborn?
A) IgE builds up on the mother's cells.
B) The Rh- mother is exposed to Rh+ baby cells.
C) The Rh+ mother is exposed to Rh- baby cells.
D) The baby must be Rh-.
Q2) To determine if a patient is allergic to peanuts,the best test to perform is:
A) allergen-specific IgE.
B) total serum IgE.
C) serum protein electrophoresis.
D) RID to measure IgG.
Q3) The principal difference between type II and type III hypersensitivity reactions is:
A) the isotype of the antibody involved.
B) complement-mediated lysis of host cells.
C) whether the antigen is cellular or soluble.
D) involvement of helper T cells and macrophages.
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Chapter 15: Autoimmunity
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Sample Questions
Q1) A speckled nuclear pattern in an antinuclear antibody test indicates:
A) anti-RNA antibody.
B) antibody to DNA-histone complex.
C) anticentromere antibody.
D) antibody to an extractable nuclear antigen.
Q2) 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.
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Chapter 16: Transplantation Immunology
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Sample Questions
Q1) 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
Q2) Four candidate bone-marrow donors were tested for compatibility with a patient in need of a transplant.HLA typing was performed,and the serologic types and alleles of the patient and four potential donors are shown in the table.On the basis of these findings,which donor would be the best match for the patient?
A) Donor 1
B) Donor 2
C) Donor 3
D) Donor 4
Q3) Which histocompatibility system activates gamma or delta T-cell receptors?
A) ABO blood group antigen
B) Killer immunoglobulin-like receptors
C) MHC class-I related chain A (MICA) antigen
D) Minor histocompatibility antigens
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Chapter 17: Tumor Immunology
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Q1) Carcinoembryonic antigen
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
Q2) In which of the following conditions would you not see an increase in alpha-fetoprotein?
A) Pregnancy
B) Hepatocellular carcinoma
C) Hepatitis
D) Hypercholesteremia
Q3) A proto-oncogene is a normal gene that has a positive influence on cell proliferation.
A)True
B)False
Q4) An example of a tumor-specific antigen is the BCR/ABL protein for chronic myelogenous leukemia.
A)True
B)False
Page 19
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Chapter 18: Immunoproliferative Diseases
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Q1) 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
Q2) Which of the following findings is a diagnostic criterion for monoclonal gammopathy of undetermined significance?
A) Serum monoclonal protein greater than 3 g/dL
B) Plasma cell count lower than 10% of total cells in bone marrow
C) Increased calcium in the blood
D) Presence of CRAB features
Q3) 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.
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Chapter 19: Immunodeficiency Diseases
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Q1) Which of the following diseases results in an acquired or secondary immunodeficiency?
A) HIV infection
B) Bruton's tyrosine kinase deficiency
C) Leukocyte adhesion deficiency
D) Wiskott-Aldrich syndrome
Q2) A child suspected of having an inherited humoral immunodeficiency disease is given a diphtheria/tetanus vaccine.Two weeks after the immunization,his level of antibody to the specific antigens is measured.Which result is expected for this patient if he does have this deficiency?
A) Increased levels of specific antibody
B) No change in the level of specific antibody
C) An increase in IgG-specific antibody but not IgM-specific antibody
D) Increased levels of nonspecific antibody
Q3) Which is true of selective IgA deficiency?
A) It is invariably fatal.
B) It is very rare.
C) It mainly occurs in older adults.
D) Patients may develop an anti-IgA antibody.
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Page 21
Chapter 20: Serological and Molecular Detection of Bacterial Infections
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Q1) Which bacterium does not cause fever?
A) Streptococcus pyogenes
B) Mycoplasma pneumoniae
C) Rickettsia rickettsii
D) Helicobacter pylori
Q2) The gold standard for diagnosing Rickettsia rickettsii infection is:
A) culture.
B) molecular methods.
C) microscopy.
D) indirect immunofluorescence.
Q3) Identify the true statement about exotoxins.
A) They are structural proteins on the exterior surface of bacteria.
B) They nonspecifically activate host complement and coagulation cascades.
C) They bind to specific receptors on host cells.
D) They promote bacterial adhesion.
Q4) The ability of an organism to cause disease is known as its:
A) virulence.
B) infectivity.
C) resistance.
D) pathogenicity.
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Chapter 21: Spirochete Diseases
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Q1) 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.
Q2) A patient is diagnosed with syphilis.Which of the following laboratory tests can be used to monitor the effectiveness of therapy in this patient?
A) RPR
B) TP-PA
C) C-reactive protein
D) Monospot test
Q3) Which of the following is a cause of a biological false-positive in the nontreponemal assays for syphilis?
A) Prozone
B) Reagents too cold
C) Sera dried on card
D) Autoimmune disease
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Chapter 22: Serological and Molecular Diagnosis of Parasitic
and Fungal
Infections
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Q1) A complement fixation test for Histoplasma antibodies shows a 1:32 titer.This means the patient is negative for Histoplasma infection.
A)True
B)False
Q2) Which statement best describes antigenic variation of a parasite?
A) Parasites can change their antigens or create novel antigens.
B) Parasites do not have any surface antigens.
C) Parasites are ingested by macrophages, and antigens are denatured.
D) Parasites have similar host antigens.
Q3) 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.
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Chapter 23: Serology and Molecular Detection of Viral Infections
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Q1) 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.
Q2) A patient has the following Epstein-Barr virus (EBV)antibody profile: EB-VCA IgM = neg; EB-VCA IgG = pos; EBV-EA-R IgG = pos; EBV-EBNA IgG = pos.Which of the following is the correct interpretation of these data?
A) Never infected with EBV
B) Acute infection with EBV
C) Recent convalescence from EBV
D) Reactivation of past infection with EBV
Q3) Which test is most specific for infectious mononucleosis?
A) Monospot
B) CBC with differential
C) Anti-EBV titers
D) Paul-Bunnell test
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Chapter 24: Laboratory Diagnosis of HIV Infection
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Q1) Which of the following genes is responsible for the coding of reverse transcriptase?
A) env
B) pol
C) gag
D) tat
Q2) 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
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) When HIV replicates,the DNA in the viral genome is transcribed into RNA.
A)True
B)False
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Chapter 25: Immunization and Vaccines
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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) Why is alum incorporated into many of the vaccines used today?
A) It induces the release of proinflammatory cytokines at the injection site.
B) It reduces the chance for hypersensitivity to occur after exposure to the vaccine.
C) It reduces interference by maternal antibodies.
D) It allows for the combination of multiple vaccines into a single injection.
Q4) Passive 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
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