Clinical Immunology
Midterm Exam
Course Introduction
Clinical Immunology explores the mechanisms by which the immune system protects the body from disease, focusing on the diagnosis, management, and treatment of immune-related disorders. The course examines the structure and function of the immune system, immune deficiencies, hypersensitivity reactions, autoimmune diseases, transplantation immunology, and immunotherapeutic strategies. Emphasis is placed on laboratory techniques for immunological testing and their clinical applications, as well as the interpretation of case studies to understand immune pathologies and current approaches to patient care.
Recommended Textbook
Clinical Immunology and Serology A Laboratory Perspective 4th Edition by Christine Dorresteyn
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Page 2
Chapter 1: Introduction to Immunity and the Immune System
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Sample Questions
Q1) The ability to resist infection through normally present body functions best characterizes:
A) autoimmunity.
B) natural immunity.
C) acquired immunity.
D) alloimmunity.
Answer: B
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) Which of the following are components of both innate and adaptive immune responses?
A) Immunoglobulins
B) T helper cells
C) Macrophages
D) B cells.
Answer: C
Page 3
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Chapter 2: Nature of Antigens and the Major
Histocompatibility Complex
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Sample Questions
Q1) Class II molecules bind to what kind of peptides?
A) Native peptides
B) Processed exogenous
C) Processed endogenous
D) Any of the above
Answer: B
Q2) A 50-kDa protein from a bacterial cell that has numerous different epitopes would be called:
A) a hapten but not an antigen.
B) a hapten and an antigen.
C) an antigen but not an immunogen.
D) an immunogen and an antigen.
Answer: D
Q3) Endogenous peptides binding to MHC-A,MHC-B,or MHC-C molecules on the surface of hepatocytes are critical for the response by:
A) B lymphocytes.
B) T helper cells.
C) cytotoxic T cells.
D) macrophages.
Answer: C
Page 4
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Chapter 3: Innate Immunity
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Q1) Which of the following binds to CD16 on the surface of natural killer cells?
A) MHC class I
B) Fc of IgG
C) T-cell receptor
D) Antigenic peptide
Answer: B
Q2) The phagosome of a macrophage is a membrane-bound vesicle that contains:
A) enzymes.
B) reactive oxygen intermediates.
C) ingested pathogens.
D) perforin and granzymes.
Answer: C
Q3) Macrophages recognize target cells using which of the following?
A) MHC class I molecules
B) Toll-like receptors
C) Antigen-specific receptors
D) Killer cell inhibitory receptors
Answer: B
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5
Chapter 4: Adaptive Immunity
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Sample Questions
Q1) A T-independent antibody response:
A) involves memory cells.
B) results in the secretion of primarily IgM.
C) is usually triggered by haptens.
D) requires antigen binding to surface IgD.
Q2) Which marker would be found on pre-B cells?
A) CD3
B) Mu heavy chains
C) CD16
D) IgD
Q3) T lymphocytes undergo antigen-independent maturation in the:
A) thymus.
B) bone marrow.
C) lymph node.
D) spleen.
Q4) 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.
Page 6
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Chapter 5: Antibody Structure and Function
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Sample Questions
Q1) Which immunoglobulin activates the classical complement pathway?
A) IgD
B) IgM
C) IgA
D) IgE
Q2) Which immunoglobulin appears first in the primary response?
A) IgG
B) IgM
C) IgA
D) IgE
Q3) Immunoglobulins IgG,IgM,IgA,and IgD represent:
A) isotypes.
B) allotypes.
C) idiotypes.
D) heterotypes.
Q4) Which antibody is found mainly as a dimer in mucosal secretions?
A) IgA
B) IgD
C) IgE
D) IgG
Page 7
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Chapter 6: Cytokines
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Sample Questions
Q1) 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.
Q2) Characteristic of cytokines include which of the following?
A) They are directly cytotoxic to bacteria.
B) They are produced primarily by the liver.
C) They are chemical messengers that regulate the immune system.
D) They are polysaccharides.
Q3) Cytokines exhibit pleiotropy,which refers to:
A) multiple cytokines affecting the same cell.
B) one cytokine inhibiting the activity of another cytokine.
C) one cytokine affecting multiple cells.
D) cytokines acting together to affect a cell.
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Chapter 7: Complement System
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Sample Questions
Q1) Binding of a lectin to a sugar found in bacteria and fungi occurs in which complement pathway?
A) Alternative pathway
B) Classical pathway
C) MBL pathway
D) All of the above
Q2) The recognition unit in the classical complement pathway consists of:
A) C4b2a3b.
B) C5b6789.
C) C1qrs.
D) factor B
Q3) What is cleaved by C3bBb?
A) C3
B) C5
C) C6
Q4) Which of the following immunoglobulins is able to activate complement?
A) IgA
B) IgD
C) IgE
D) IgM
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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) What is the best procedure for removing gloves when leaving the laboratory?
A) Take gloves off last and leave.
B) Take gloves off and wash hands.
C) Leave gloves on and remove them outside of the laboratory.
D) Leave gloves on, rinse gloves with water, and then remove them outside of the laboratory.
Q3) 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
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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) If you want to make 4 mL of a 1:20 dilution,how much serum would be needed?
A) 0.2 mL
B) 2 mL
C) 0.5 mL
D) 1 mL
Q3) The probability that a person with a positive screening test actually has the disease screened for is called:
A) sensitivity.
B) specificity.
C) positive predictive value.
D) negative predictive value.
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11
Chapter 10: Precipitation and Agglutination Reactions
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Sample Questions
Q1) The particle-counting immunoassay method counts the number of:
A) agglutinated particles.
B) free antibody molecules.
C) free latex particles.
D) antigen-antibody bonds.
Q2) Which best characterizes agglutination inhibition reactions?
A) The antigen is naturally expressed on particles.
B) Antigen molecules are artificially bound to particles.
C) Antibody is attached to particles.
D) No agglutination indicates a positive result.
Q3) Agglutination reactions run at room temperature are appropriate for antigen-antibody reactions involving:
A) IgA.
B) IgE.
C) IgG.
D) IgM.
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Chapter 11: Labeled Immunoassays
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Sample Questions
Q1) Indirect immunofluorescence is similar to which type of enzyme immunoassay in terms of the performance of the assay?
A) Competitive
B) Capture
C) ELISA
D) Homogeneous
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) An antigen is fixed to a microscope slide,then incubated with patient serum.After washing,fluorescently labeled anti-human immunoglobulin is applied.After an additional wash,the slide is inspected with a fluorescent microscope.This technique is called:
A) direct immunofluorescence.
B) indirect immunofluorescence.
C) fluorescence polarization.
D) autofluorescence.
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13
Chapter 12: Molecular Diagnostic Techniques
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Sample Questions
Q1) Which process can be combined with a bead array format enabling detection of 100 different targets in one sample?
A) Branched DNA amplification
B) Transcription-mediated amplification
C) Ligase chain reaction
D) Strand displacement amplification
Q2) In the process of translation,the addition of a particular amino acid to a growing protein may be specified by:
A) one specific mRNA nucleotide.
B) only one specific combination of three mRNA nucleotides.
C) one of several specific combinations of three mRNA nucleotides.
Q3) The common characteristic of transcription-mediated amplification and reverse-transcriptase polymerase chain reaction is that both:
A) are isothermal processes.
B) start with an RNA target.
C) use DNA polymerase.
D) generate RNA as the primary product.
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Chapter 13: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) 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
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) 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) Reactions to antigens in natural rubber (latex)can trigger:
A) type I and type II hypersensitivity.
B) type II and type III hypersensitivity.
C) type III and type IV hypersensitivity.
D) type I and type IV hypersensitivity.
Q2) An exaggerated reaction directed against an antigen that is harmless is called:
A) atopy.
B) hypersensitivity.
C) immune complex disease.
D) passive cutaneous anaphylaxis.
Q3) Type I hypersensitivity involves:
A) IgE binding to mast cells and basophils.
B) phagocytic cell degranulation and proteolytic enzyme activity.
C) a kidney membrane antigen and specific antibody.
D) natural killer cell activation.
Q4) Compared with percutaneous (prick)tests,intradermal skin tests:
A) are more sensitive.
B) require less antigen.
C) carry less risk.
D) are better for diagnosing food allergies.
Page 16
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Chapter 15: Autoimmunity
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Sample Questions
Q1) An autoimmune disease characterized by pain and progressive destruction of the joints,weight loss,morning stiffness,and presence of an antibody directed against IgG best describes:
A) rheumatoid arthritis.
B) lupus.
C) hemolytic disease of the newborn.
D) hemolytic anemia.
Q2) Which of the following is considered a systemic autoimmune disease?
A) Multiple sclerosis
B) Graves disease
C) Myasthenia gravis
D) Systemic lupus erythematosus
Q3) 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 most likely has:
A) Graves disease.
B) pernicious anemia.
C) ulcerative colitis.
D) type 1 diabetes.
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Chapter 16: Transplantation Immunology
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Sample Questions
Q1) To determine a patient's HLA type using the complement-dependent cytotoxicity test,which of the following must be used?
A) Viable lymphocytes
B) Purified T cells
C) A single antiserum from a commercial source
D) Complement from patient serum
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) Which of the following is characteristic of an acute graft-versus-host disease episode?
A) The reaction occurs within 100 days of the transplant.
B) The reaction involves the skin, gastrointestinal (GI) tract, and liver.
C) The reaction produces a fibrous condition of the mouth and eyes.
D) The reaction involves the recipient's bone marrow.
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Page 18
Chapter 17: Tumor Immunology
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Sample Questions
Q1) An example of a tumor-specific antigen is the BCR/ABL protein for chronic myelogenous leukemia.
A)True
B)False
Q2) Carcinogenesis is thought to be initiated by the exposure of the host to factors such as bacteria.
A)True
B)False
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) Alpha-fetoprotein
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
Page 19
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Chapter 18: Immunoproliferative Diseases
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Q1) What is the correct order of protein migration,starting at the cathode and moving to anode,following serum protein electrophoresis?
A) Albumin, gamma, alpha 1, alpha 2, beta
B) Albumin, alpha 1, alpha 2, beta, and gamma
C) Gamma, beta, alpha 2, alpha 1, albumin
D) Beta, gamma, alpha 2, and alpha 1, albumin
Q2) Which marker is highly specific for hairy-cell leukemia?
A) CD19
B) CD20
C) CD25
D) CD103
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) 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
Q2) 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
Q3) The most common complement component deficiency is:
A) C1q.
B) factor B.
C) MASP.
D) C2.
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Page 21
Chapter 20: Serological and Molecular Detection of Bacterial Infections
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Q1) The current standard method for diagnosing Rocky Mountain spotted fever is often unhelpful to the patient because:
A) it lacks sensitivity.
B) the diagnosis is obtained after the period in which treatment must begin.
C) the sampling procedure is very invasive.
D) it lacks specificity.
Q2) The M protein of group A streptococci inhibits:
A) antibody binding.
B) phagocytosis.
C) T-cell apoptosis.
D) lymphocyte proliferation.
Q3) What is the main reason testing for cold agglutinins is no longer recommended to diagnose infection with Mycoplasma pneumonia?
A) It is difficult to perform.
B) False positives may be caused by certain viruses.
C) Very few people develop anti-I antibodies.
D) It requires expensive instrumentation.
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Page 22
Chapter 21: Spirochete Diseases
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Q1) A laboratory test that is used to confirm syphilis and detects specific treponemal antibodies is:
A) VDRL.
B) TP-PA.
C) RPR.
D) monospot.
Q2) 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
Q3) 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.
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Chapter 22: Serological and Molecular Diagnosis of
Parasitic and Fungal
Infections
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Q1) What approach can be used to decrease the chance of a false-positive result when performing latex agglutination to identify Cryptococcus infections?
A) Mixing the specimen with India ink
B) Pretreating the specimen with heat and pronase
C) Freezing the specimen
D) Waiting for the patient to be symptomatic before testing
Q2) Serology assays are useful in the diagnosis of Aspergillus infections from bronchial lavage samples in immunocompromised patients.
A)True
B)False
Q3) 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
Q4) To correctly determine an infection with toxoplasmosis within the last 12 months,both IgG and IgM should be negative.
A)True
B)False
Page 24
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Chapter 23: Serology and Molecular Detection of Viral Infections
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Sample Questions
Q1) The most common cause of congenital infections is:
A) cytomegalovirus.
B)rubella.
C) varicella-zoster virus.
D) human T-cell lymphotropic virus type I
Q2) A 14-year-old boy presents to the physician complaining of sore throat,fatigue,and fever for the past week.A monotest is performed and is reported as positive.It is likely that this boy has:
A) infectious mononucleosis.
B) streptococcal pharyngitis.
C) acute glomerulonephritis.
D) a common cold.
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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Page 25
Chapter 24: Laboratory Diagnosis of HIV Infection
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Q1) Which antigen can be routinely detected in the blood of a person who has recently been infected with HIV?
A) p14
B) p19
C) p23
D) p24
Q2) gp120
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 of the following genes is responsible for the coding of reverse transcriptase?
A) env
B) pol
C) gag
D) tat
Q4) The Southern blot test is the specific confirmatory test for HIV infection.
A)True
B)False
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Chapter 25: Immunization and Vaccines
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Q1) Attenuation
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
Q2) A patient with leukemia is scheduled for a bone marrow transplant.Which type of immunity is provided via this procedure?
A) Passive immunity
B) Active immunity
C) Adoptive immunity
D) Active disease
Q3) 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
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