Course Introduction
Clinical Immunology Practice Exam
Clinical Immunology explores the immune systems structure and function, focusing on its role in maintaining health and its involvement in disease processes. This course examines disorders of immune regulation, including immunodeficiencies, autoimmune diseases, hypersensitivities, and transplant immunology. Emphasis is placed on the underlying immunological mechanisms, current diagnostic approaches, and therapeutic strategies. Students will also discuss advances in immunological research and their clinical implications, preparing them for further study or careers in healthcare and biomedical sciences.
Recommended Textbook
Modern Blood Banking and Transfusion Practices 6th Edition by Denise M. Harmening
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27 Chapters
1413 Verified Questions
1413 Flashcards
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Page 2
Chapter 1: Red Blood Cells and Platelet Preservation:
Historical Perspectives and Current Trends
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44 Verified Questions
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Sample Questions
Q1) What is the average diameter of a platelet?
A) 5 to 10 µm
B) 2 to 4 µm
C) 1 to 2 µm
D) 4 to 6 µm
Answer: B
Q2) Which type of blood storage container is no longer available for use in the United States because it may limit the viability of RBCs?
A) Glass bottles
B) PVC plastic bags with DEHP
C) DEHP-free polyolefin containers
D) Latex-free plastic containers
Answer: A
Q3) The ABO blood groups were discovered in 1901 by whom?
A) Charles Drew
B) Karl Landsteiner
C) Loutit and Mollison
D) Edward Lindeman
Answer: B
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Chapter 2: Basic Genetics
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Sample Questions
Q1) Which type of genetic change (mutation) is incapable of reverting back to the original phenotype?
A) Duplication
B) Deletion
C) Recombination
D) Insertion
Answer: B
Q2) The diploid chromosome number in humans is:
A) 12
B) 23
C) 46
D) 92
Answer: C
Q3) A gene, such as the O gene, that produces no detectable product is called:
A) an amorph.
B) a trait.
C) an allele.
D) recessive.
Answer: A
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Page 4
Chapter 3: Fundamentals of Immunology
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Sample Questions
Q1) Opsonization is:
A) the coating of pathogens with factors that facilitate phagocytosis.
B) a major role of complement in immunity.
C) the binding of an opsonin, such as an antibody, to a receptor on the pathogen's cell membrane.
D) all of the above.
Answer: D
Q2) A person with the genotype MM shows a 3+ reaction when red blood cells are mixed with M antisera; whereas a person with the genotype MN shows a 1+ reaction. What phenomenon is occurring here?
A) Dosage
B) Prozone
C) Zeta potential
D) Hemolysis
Answer: A
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Chapter 4: Concepts in Molecular Biology
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Sample Questions
Q1) In the science of trans-blotting techniques, Southern is to DNA as Western is to:
A) carbohydrates.
B) enzymes.
C) lipids.
D) proteins.
Q2) Which of the following is representative of the lagging strand in DNA replication?
A) RNA polymerase catalyzes a primer that provides the 3'OH to which DNA polymerase III can add nucleotides.
B) DNA polymerase catalyzes a primer that provides the 5'OH to which RNA polymerase can add nucleotides.
C) DNA telomerase catalyzes a primer that provides the 3'OH to which RNA polymerase can add nucleotides.
D) DNA ligase catalyzes a primer that provides the 5'OH to which RNA polymerase can add nucleotides.
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Chapter 5: The Antiglobulin Test
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Sample Questions
Q1) The indirect antiglobulin test detects which antigen-antibody reactions?
A) In vivo
B) In vitro
C) Both in vivo and in vitro
D) None of the above
Q2) Which IgG antibodies are contained in polyspecific AHG?
A) High titer, high avidity
B) High titer, low avidity
C) Chemically modified
D) Those that are pentameric in structure
Q3) "Complete" agglutinins that agglutinate red blood cells in saline are of which immunoglobulin class?
A) IgG
B) IgM
C) IgA
D) IgE
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Chapter 6: The Abo Blood Group System
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Sample Questions
Q1) Where will the ABO discrepancy occur in cis-AB individuals?
A) Forward grouping with anti-A
B) Reverse grouping with B cells
C) Forward grouping with anti-AB
D) Reverse grouping with A<sub>1</sub> cells
Q2) If a group O mother gives birth to a group A baby, which of the following antibodies is usually responsible for crossing the placenta and causing hemolytic disease of the newborn (HDN)?
A) Anti-AB
B) Anti-B
C) Anti-A
D) Anti-H
Q3) What percentage of the type-A population are A<sub>1</sub>?
A) 80%
B) 50%
C) 20%
D) 10%
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Chapter 7: The RH Blood Group System
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Sample Questions
Q1) What is the principle of the Rh-Hr (Weiner) terminology?
A) The Rh gene produces at least three factors within an agglutinogen.
B) Each gene (D, C, c, E, e) produces one product or antigen.
C) The Rh gene produces at least three factors within an agglutinin.
D) Each gene is independent of the others.
Q2) What does hr' refer to in the Weiner nomenclature?
A) c
B) e
C) C
D) E
Q3) In the black population, a mosaic form of which antigen may be found?
A) c
B) E
C) e
D) C
Q4) Which of the following statements regarding anti-LW is true?
A) Anti-LW reacts poorly with cord cells.
B) Anti-LW reacts stronger with Rh-positive cells than with Rh-negative cells.
C) Rh-null individuals lack the LW gene.
D) The gene coding for LW is located on the same chromosome as the Rh genes.
Page 9
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Chapter 8: Blood Group Terminology and the Other Blood Groups
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Sample Questions
Q1) All of the following are characteristics of Duffy antibodies except:
A) they are IgG in nature.
B) they may or may not show dosage.
C) they are destroyed by enzymes.
D) they are not implicated in HDN.
Q2) Which blood group system is not based on carbohydrates?
A) Lewis
B) Rh
C) P
D) ABO
Q3) A patient presented in the emergency room needing to be transfused ASAP. According to the computer, the patient had a Kell antibody five years ago. The antibody screen is negative now. Of the following, the best procedure to obtain suitable blood for transfusion is:
A) to use immediate spin crossmatch compatible blood.
B) to take the time to crossmatch the units of blood through the AHG phase.
C) to antigen type the units for Kell and completely crossmatch the negative ones.
D) to assume the electronic crossmatch is acceptable.
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Chapter 9: Detection and Identification of Antibodies
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Sample Questions
Q1) What is tested in an antibody screen?
A) Patient red blood cells are tested against group O reagent screening cells.
B) Patient serum is tested against group AB reagent screening cells.
C) Patient serum is tested against group O reagent screening cells.
D) Patient serum is tested against group A reagent screening cells.
Q2) Tests with which AHG reagents can determine if IgG, complement, or both are coating red blood cells?
A) Monospecific
B) Polyspecific
C) Standardized
D) Irradiated
Q3) Which of the following statements concerning acid eluates is false?
A) Citric acid is an example of an acid eluate
B) The pH is reduced to 3 or less to disrupt the antigen-antibody complex
C) The pH of the eluate remains at 3 before testing against a panel
D) None of the above
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Chapter 10: Pre-Transfusion Testing
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Sample Questions
Q1) What may be added to samples from patients taking heparin to induce clotting?
A) Protamine sulfate
B) Antithrombin III
C) Reptilase
D) Fibrinogen
Q2) What is an "electronic" crossmatch?
A) A database compiled by the American Red Cross for rare phenotype accessibility
B) Comparison of donor and patient ABO groups and serologic data from a computer file
C) A crossmatch performed in microtiter plates and read by a spectrophotometer
D) All of the above
Q3) A patient with anti-K and anti-Jk<sup>a</sup> needs two units of RBCs for surgery. How many group-specific units would need to be screened to find two that are compatible?
A) 6
B) 10
C) 20
D) 36
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12
Chapter 11: Overview of the Routine Blood Bank Laboratory
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Sample Questions
Q1) A STAT type and screen comes from surgery. Your institution uses a blood bank band ID bracelet system. The nurse who obtained specimens did not label them with the blood bank number before she handed them to transport to take to the laboratory. What would be the most appropriate action to take?
A) Call surgery and have the nurse come down and properly label the specimens.
B) Accept the specimen as is.
C) Reject the specimen and have it re-collected.
D) Label the specimen yourself and continue with testing.
Q2) What additive is used to freeze blood for long-term storage at -65°C?
A) Glycerol
B) Glycine
C) Glutamic acid
D) Dextran
Q3) Granulocyte concentrates follow the same compatibility protocol as packed red blood cells.
A)True
B)False
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13
Chapter 12: Other Technologies and Automation
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Sample Questions
Q1) The indicator cells used to detect antibodies in a solid phase technology are:
A) anti-D coated RBCs.
B) AHG-coated RBCs.
C) plain RBC suspension.
D) antibody screen cell I.
Q2) Using the affinity column technique, a serologic reaction that forms a fine red blood cell band at the top of the gel column and a red blood cell button at the bottom of the gel column is interpreted as:
A) mixed-field
B) weak positive
C) strong positive
D) negative
Q3) A layer of red blood cells agglutinates at the top of the gel media, and a pellet of unagglutinated red blood cells forms at the bottom. These findings are comparable to which of the following reactions in the test tube?
A) Negative
B) Weak positive
C) Mixed-field
D) Invalid
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Chapter 13: Donor Screening and Component Preparation
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Sample Questions
Q1) How many times can a person meeting all the optimal criteria donate an apheresis unit of platelets per year?
A) 56 times
B) 112 times
C) 24 times
D) 48 times
Q2) A whole blood donor who has taken Tegison should be:
A) accepted.
B) deferred for 3 months.
C) permanently deferred.
D) deferred for 6 months.
Q3) A patient has a baseline platelet count of 30,000/µL. Upon receiving a platelet pool of 4 random platelets, what would you expect the post-transfusion platelet count to be?
A) 35,000/µL
B) 50,000/µL
C) 80,000/µL
D) 100,000/µL
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Chapter 14: Apheresis
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Sample Questions
Q1) Photopheresis is effective against what malignant disorder?
A) Hairy cell leukemia
B) Cutaneous T-cell lymphoma
C) Hodgkin's lymphoma
D) Acute lymphocytic leukemia
Q2) What is the definition of apheresis?
A) The process of freezing RBCs in liquid nitrogen
B) Separation or removal of a blood component from whole blood
C) The addition of EPO to red blood cells to increase 2,3 DPG levels
D) The extraction of plasma from a whole blood unit
Q3) Plasma exchange is most effective when_____ is considered the pathological substance.
A) IgG
B) IgM
C) IgA
D) IgE
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Chapter 15: Transfusion Therapy
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Sample Questions
Q1) What is used to anticoagulate the shed blood obtained from intraoperative salvage?
A) EDTA
B) Citrate
C) Heparin
D) Citrate and heparin
Q2) How would the hematocrit of a patient with chronic anemia be affected by transfusion of 2 units of whole blood versus transfusion with 3 units of packed RBCs?
A) Patient's hematocrit would be equally affected.
B) The packed RBCs would increase the hematocrit more than the whole blood.
C) The whole blood would increase the hematocrit more than the packed RBCs.
D) The hematocrit would not change at all with the whole blood because of the plasma in the unit.
Q3) What disease state may require exogenous fibrinogen replacement?
A) Disseminated intravascular coagulation
B) Liver failure
C) Congenital fibrinogen deficiency
D) All of the above
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Page 17
Chapter 17: Cellular Therapy
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Sample Questions
Q1) Which mechanism may play a role in fever development in an FNHTR?
A) Release of pyrogens from transfused white blood cells
B) The production of interleukin-6 by the complement system
C) Synthesis of prostaglandins (PGE±) in hypothalamic cells by interleukin-6
D) None of the above
Q2) What test is indicated for the detection of HLA antibodies?
A) Direct Coombs'
B) Antibody screen
C) Lymphocyte panels
D) Cold antibody panel
Q3) Which of the following may be a factor in a nonimmune transfusion reaction?
A) Post-transfusion purpura
B) Circulatory overload
C) Allergic reaction
D) Immediate hemolytic transfusion reaction
Q4) All of the following are immediate nonhemolytic transfusion reactions, except:
A) being febrile.
B) PTP.
C) anaphylaxis.
D) an allergic response.
Page 18
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Chapter 18: Transfusion-Transmitted Diseases
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Sample Questions
Q1) Which of the following is indicated when a recipient of blood or blood components develops a viral disease?
A) Transfusion-reaction investigation
B) Donor look-back
C) Incident report
D) Type and screen
Q2) What treatment is recommended for chronic liver disease due to hepatitis C virus infection?
A) Gamma globulin
B) Prednisone
C) Alpha interferon
D) Gamma interferon
Q3) Which of the following viral infections poses a severe threat to chronically transfused individuals who carry the hepatitis B virus (HBV)?
A) Superinfection by hepatitis C virus (HCV)
B) Infection with hepatitis G virus (HGV)
C) Superinfection by hepatitis D virus (HDV)
D) Non-A, non-B, non-C virus (NANBNC virus)
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Chapter 19: Hemolytic Disease of the Fetus and Newborn
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Sample Questions
Q1) Which red blood cell morphology is most characteristic in ABO HDFN and absent in Rh HDFN?
A) Target cells
B) Teardrop cells
C) Microspherocytes
D) Burr cells
Q2) All Rh-negative recipients who are transfused with as little as 1 mL of Rh-positive cells will develop anti-D.
A)True
B)False
Q3) Cannulation of the umbilical vein under ultrasound guidance is known as:
A) cordocentesis.
B) amniocentesis.
C) apheresis.
D) pericardiocentesis.
Q4) Which prenatal serologic tests are recommended during the first trimester?
A) ABO
B) Rh
C) Antibody screen
D) All of the above
Page 20
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Chapter 20: Autoimmune Hemolytic Anemias
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Sample Questions
Q1) Which cells contain the most i antigen?
A) Lymphocytes
B) Cord blood
C) Adult red blood cells
D) Platelets
Q2) What is one indication a positive DAT might be due to alloantibody coating donor red blood cells?
A) Positive eluate
B) Positive rosette test
C) Microscopic mixed-field appearance
D) Panagglutinin reaction in panel studies
Q3) Most cases of warm autoimmune hemolytic anemia will be DAT-positive with which of the following?
A) Anti-IgG only
B) Anti-C3d only
C) Both anti-IgG and Anti-C3d
D) None of the above
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21
Chapter 21: The Hla System
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Sample Questions
Q1) In HLA testing, what is the purpose of mineral oil contained in the testing well?
A) To prevent evaporation of antisera during incubation
B) To create a viscous microenvironment
C) To act as an antigen-antibody complex potentiator
D) To provide height to the testing well
Q2) What is the linkage disequilibrium in reference to the HLA antigens?
A) Occurrence of HLA genes more frequently in the same haplotype than would be expected by chance alone
B) Displacement of HLA genes on different chromosomes
C) Occurrence of HLA genes less frequently in the same haplotype than would be expected by chance alone
D) Crossover of HLA genes
Q3) What is the definition of total ischemic time in heart transplantation?
A) The amount of time there is not blood flow through the organ
B) The time it takes to perform the transplant
C) The time it takes for PO<sub>2</sub> levels to normalize after transplant
D) The time it takes for CO<sub>2</sub> levels to normalize after transplant
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Page 22
Chapter 22: Relationship Testing
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Sample Questions
Q1) What is the statistical basis of the Hardy-Weinberg principle?
A) Selection of mates is dependent on blood types and therefore is random.
B) Selection of mates is dependent on blood types and therefore is biased.
C) Selection of mates is independent of blood types and therefore is random.
D) Selection of mates is independent of blood types and therefore is biased.
Q2) The inclusionary calculations are deemed invalid if which of the following possible subjects is to be ruled out as the alleged father of the child?
A) Brother
B) Uncle
C) Father
D) All of the above
Q3) In HLA serologic testing, how are cytotoxic effects of antigen-antibody interactions detected?
A) There is visible agglutination, or clumping.
B) The cells remain clear.
C) Trypan blue or eosin stains the cells because of loss of membrane integrity.
D) There is hemolysis.
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Chapter 23: Quality Management
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Sample Questions
Q1) Employee training takes place:
A) before procedures are validated.
B) after competence assessments.
C) before flowcharting the process.
D) after hiring and after implementing new procedures.
Q2) Which of the following might lead to unacceptable quality control results?
A) A technician who has not worked in the area for several months
B) A deteriorated "Anti-A"
C) An uncalibrated serofuge
D) All of the above
Q3) Which of the following is not regarded as an instrument?
A) Automated analyzer
B) Pipette
C) Washer
D) Cuvette
Q4) What is a function of the quality committee or quality council?
A) To provide solutions to recurring clerical errors
B) To provide counseling for departmental downsizing
C) To set priorities for quality improvements
D) To focus on computer upgrades and software implementation
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Chapter 24: Transfusion Safety and Federal Regulatory Requirements
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Sample Questions
Q1) Which of the following would constitute short supply and an exemption from licensure?
A) RBCs used in the manufacturing of check cells
B) Recovered plasma used in the making of platelets
C) Recovered plasma used in the manufacturing of factor VIII
D) Whole blood used in the manufacturing of hemoglobin substitute
Q2) Which of the following prevents interstate shipment of biological products by an establishment?
A) an FDA warning letter
B) an FDA suspension
C) FDA form 483
D) short supply
Q3) Why is the Center for Biologics Evaluation and Research (CBER) notified in the case of a transfusion-related fatality?
A) To recall all banked units
B) To disclose the name of the deceased
C) To determine if appropriate corrective action has been taken to prevent recurrence
D) To report all reagent lot numbers used in typing deceased patient
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Chapter 24: Utilization Management
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Sample Questions
Q1) An example of direct behavior influence when implementing intervention strategies would be:
A) discussion with a physician about his ordering practice.
B) an e-mail to the nursing staff about their roles in transfusing.
C) a communication tree to all med techs about new protocols of issuing a product.
D) All of the above
Q2) Which statement is false?
A) There is zero inherent risk of transfusing blood if all protocols are followed.
B) Following quality assurance guidelines for transfusion increases the safety to the patient.
C) You must follow a physician's order no matter what.
D) All of the above statements are true.
Q3) Which of the following is not part of a blood utilization review?
A) Retrospective review
B) Concurrent review
C) Interpreted review
D) Prospective review
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Chapter 25: Laboratory Information Systems
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Q1) Software ________is the establishment of documented evidence that provides a high degree of assurance that the information system will consistently function as expected.
A) regulation
B) application
C) validation
D) maintenance
Q2) Which of the following best describes software?
A) Physical pieces of equipment that can be seen and touched
B) The "core" of the information system
C) Programmed instructions that tell computer how to operate and manipulate the data
D) A mechanism for connecting one computer system to another through a telephone line
Q3) Standard operating procedures must include computer functions that are part of the blood bank's technical procedures, such as the issuance of blood components.
A)True
B)False
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Chapter 26: Medicolegal and Ethical Aspects of Providing
Blood Collection and Transfusion Services
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Q1) A blood bank technologist working in an army medical center discovers that a colleague from boot camp who donated blood is HIV-positive. While at a nightclub on base, the technologist discloses this information to his sergeant. Within 24 hours the donor's commander confronts the donor with this rumor. By law the donor can file suit against the donor center for ________.
A) battery
B) negligence
C) tort
D) loss of privacy
Q2) Plaintiffs have prevailed in TTAIDS multimillion-dollar medical malpractice suits against physicians for which of the following arguments?
A) There is a lack of standard protocol for implementing new HIV test kits.
B) The patient did not need a transfusion based on clinical data.
C) The patient did not give informed consent.
D) The patient was health illiterate and therefore could not comprehend the need for transfusion.
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Chapter 27: Tissue Banking: A New Role for the Transfusion Service
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Q1) At a minimum, all but which of the following must be included on the tissue receipt records?
A) Tissue Identification Number (TIN)
B) Expiration date (if applicable)
C) Condition of the tissue and who received it/inspected it upon arrival
D) Donor's birth date
Q2) Which statement about autologous is true?
A) Autologous tissue has a different outdate than aoolgeneic tissue.
B) Autologous tissue is not regulated by the AATB.
C) The medical director can have autologous tissue reassigned to an allogeneic donor if it is not used by the autologous donor.
D) Autologous tissue should have the same shelf-life as allogeneic tissue under the same storage.
Q3) If your facility is a member of and accredited by the Eye Bank Associates of America, there is no need to be monitored by the FDA.
Multiple Choice
Identify the choice that best completes the statement or answers the question.
A)True
B)False
Page 29
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