Clinical Immunology
Solved Exam Questions
Course Introduction
Clinical Immunology explores the principles and functions of the immune system in relation to human health and disease. The course examines the mechanisms of immune responses, immune system disorders, and the clinical implications of immune dysfunction, including autoimmune diseases, immunodeficiencies, hypersensitivity reactions, and transplant immunology. It also covers diagnostic techniques and current approaches in immunotherapy, providing students with a strong foundation to understand the role of immunology in the diagnosis and treatment of clinical conditions.
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) All of the following are considered part of natural immunity EXCEPT:
A) eosinophils.
B) lymphocytes.
C) acute-phase reactants.
D) neutrophils.
Answer: B
Q2) Which best describes lymph nodes?
A) They line the interior of small blood vessels.
B) They are concentrated where appendages join the thorax of the body.
C) They are approximately 12 cm in size.
D) They are considered primary or central lymphoid organs.
Answer: B
Q3) "Cluster of differentiation" refers to:
A) a category of cell surface proteins used to identify cell types.
B) aggregates of differentiating stem cells.
C) groups of antigens that identify a cell as foreign.
D) the cells that congregate in germinal centers.
Answer: A
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Chapter 2: Nature of Antigens and the Major
Histocompatibility Complex
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Sample Questions
Q1) Which of the following would be the most effective immunogen?
A) One that is genetically foreign and has a single epitope
B) One with a molecular weight of less than 10,000 Da
C) One with multiple epitopes with many specificities
D) One with multiple epitopes with a single repeated specificity
Answer: C
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) An antigenic determinant is also called:
A) an immunogen.
B) an epitope.
C) an antibody.
D) a polysaccharide.
Answer: B
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Chapter 3: Innate Immunity
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Sample Questions
Q1) 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
Q2) Which of the following have the highest concentrations of Toll-like receptors?
A) B-cells
B) Monocytes
C) Natural killer cells
D) T cells
Answer: B
Q3) Which acute-phase reactant is an important clotting factor?
A) Haptoglobin
B) Ceruloplasmin
C) Fibrinogen
D) Alpha-2 macroglobulin
Answer: C
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Chapter 4: Adaptive Immunity
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Sample Questions
Q1) How are immunoglobulin and T-cell receptors similar?
A) Both have multiple gene segments encoding the variable region.
B) Both have an antigen-binding site that recognizes conformational epitopes.
C) Both are required for antigen presentation.
D) Both can capture numerous different antigens.
Q2) Antigen-independent differentiation of B cells occurs in the:
A) bone marrow.
B) spleen.
C) lymph node.
D) Peyer's patches.
Q3) T cells differ from B cells in which of the following ways?
A) T cells express surface immunoglobulin.
B) B cells express CD19 but not CD3.
C) T cells express CD19, CD3, and CD4.
D) B cells express surface immunoglobulin and CD3.
Q4) Immunoglobulin gene rearrangements occur in which stage of B-cell development?
A) Pro-B cell
B) Pre-B cell
C) Immature B cell
D) Mature B cell
Page 6
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Chapter 5: Antibody Structure and Function
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Sample Questions
Q1) Which immunoglobulin is found in only trace amounts in the serum?
A) IgM
B) IgG
C) IgD
D) IgA
Q2) Which is characteristic of IgG?
A) First class of antibody to appear
B) Found mainly in secretions
C) The least abundant antibody in serum
D) Provides immunity for the newborn
Q3) IgA in secretions has a valence of:
A) 1.
B) 2.
C) 4.
D) 10.
Q4) Which immunoglobulin can cross the placenta?
A) IgM
B) IgE
C) IgA
D) IgG
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Chapter 6: Cytokines
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Sample Questions
Q1) Erythropoietin regulates:
A) T-cell function.
B) bone marrow cell differentiation.
C) proinflammatory cytokine synthesis.
D) the acute-phase response.
Q2) 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.
Q3) Which cytokine is involved in natural immunity?
A) IL-2
B) IL-4
C) IL-5
D) IL-6
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8
Chapter 7: Complement System
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Sample Questions
Q1) The C5 convertase of the alternative pathway of complement activation is:
A) C4b.
B) C4b2a.
C) C4b2a3b.
D) C3bBb3bP.
Q2) Which complement receptor is involved in mediating phagocytosis?
A) CR1
B) CR2
C) CR3
D) CR4
Q3) The C5 convertase of the classical pathway of complement activation is:
A) C3bBbP.
B) C3bBb3bP.
C) C4b2a3b.
D) C4b2a.
Q4) Which complement protein is the key intermediate in all pathways?
A) C4
B) C2
C) C3
D) C1
Page 9
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Chapter 8: Safety and Quality Management
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Sample Questions
Q1) The Centers for Disease Control and Prevention developed standard precautions using the assumption that:
A) outpatients are generally healthy enough, so no precautions need to be taken.
B) all patients are potentially infected or carriers of transmittable organisms, so appropriate precautions need to be followed.
C) only patients with coughs are potentially infected or carriers of transmittable organisms, so appropriate precautions are recommended only for these patients.
D) all hospitalized patients are considered healthy until blood culture results are available; precautions are recommended for those with positive results.
Q2) What does the acronym PASS stand for?
A) Pull, aim, squeeze, sweep
B) Pass, activate, sweep, scram
C) Pull, alarm, squeeze, sweep
D) Pass, activate, scram, scream
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Chapter 9: Principles of Serological Testing
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Sample Questions
Q1) To prepare 70 ml of a 10% solution of acetic acid,how much acetic acid is needed?
A) 0.7 mL
B) 7 mL
C) 10 mL
D) 1.4 mL
Q2) 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
Q3) Serology is the study of:
A) white blood cells.
B) red blood cells.
C) platelets.
D) the liquid components of the blood, especially antibodies.
Q4) 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.
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Chapter 10: Precipitation and Agglutination Reactions
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Sample Questions
Q1) 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
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 end-point radial immunodiffusion assay:
A) is read after antigen-antibody equivalence is reached.
B) is the most rapid immunodiffusion method.
C) requires only a negative control for interpretation.
D) can be converted to a kinetic method by application of electrical current.
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Chapter 11: Labeled Immunoassays
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Sample Questions
Q1) Which assay poses the greatest risk of exposure to biohazards?
A) Radioimmunoassay
B) Enzyme immunoassay
C) Fluorescence polarization
D) Chemiluminescent immunoassays
Q2) Which compound would be an appropriate label in a chemiluminescent assay?
A) Horseradish peroxidase
B) Iodine-125
C) Fluorescein
D) Ruthenium derivative
Q3) Extremely high analyte concentrations can cause false-negative results (hook effect)in which type of assay?
A) Homogeneous competitive
B) Heterogeneous competitive
C) Homogeneous noncompetitive
D) Heterogeneous noncompetitive
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13
Chapter 12: Molecular Diagnostic Techniques
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Sample Questions
Q1) The best method for detecting multiple genotypes of the same virus is:
A) pyrosequencing.
B) ligase chain reaction.
C) strand displacement amplification.
D) branched DNA amplification.
Q2) Select the reaction characterized by amplification of a specific region of a DNA strand through denaturing and annealing.
A) Signal amplification
B) Polymerase chain reaction
C) Solution hybridization
D) Ligase chain reaction
Q3) 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.
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14
Chapter 13: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) A single cell parameter acquired by flow cytometry is presented graphically as a: A) histogram.
B) dot plot.
C) vector plot.
D) quadrant analysis.
Q2) In flow cytometry,fluorescence is usually used to determine:
A) intrinsic cell parameters.
B) extrinsic cell parameters.
Q3) How close a measured value is to the actual (true)value is called:
A) accuracy.
B) precision.
C) analytic sensitivity.
D) analytic specificity.
Q4) As measured in flow cytometry,cells that are the smallest and have the least granules would be identified as:
A) lymphocytes.
B) granulocytes.
C) monocytes.
D) erythrocytes.
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Chapter 14: Hypersensitivity
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Sample Questions
Q1) An exaggerated reaction directed against an antigen that is harmless is called:
A) atopy.
B) hypersensitivity.
C) immune complex disease.
D) passive cutaneous anaphylaxis.
Q2) Which of the following is characteristic of autoimmune hemolytic anemia caused by cold agglutinins?
A) It is a type I hypersensitivity reaction.
B) It is the most common cause of autoimmune hemolytic anemia.
C) The IgM antibodies are specific to Ii blood groups.
D) The reaction is irreversible.
Q3) 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.
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Chapter 15: Autoimmunity
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Sample Questions
Q1) Which laboratory finding is associated with multiple sclerosis?
A) Several bands on electrophoresis of cerebrospinal fluid
B) Antibody to thyroglobulin
C) Antibody to acetylcholine receptors
D) Presence of antinuclear antibodies
Q2) Autoimmune hemolytic anemia targets which cells or tissues?
A) Liver
B) Platelets
C) Red blood cells
D) Connective tissues
Q3) Hashimoto's thyroiditis can best be differentiated from Graves disease on the basis of which of the following?
A) Decrease in thyroid hormone levels
B) Presence of thyroid peroxidase antibodies
C) Enlargement of the thyroid
D) Presence of lymphocytes in the thyroid
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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) The type of allograft rejection associated with fibrosis and scarring of vessel lumens is:
A) a hyperacute rejection.
B) an acute antibody-mediated rejection.
C) an acute cellular rejection.
D) a chronic rejection.
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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Sample Questions
Q1) Cancer antigen 125
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
Q2) A tumor-specific antigen is:
A) a general marker for all known human tumors.
B) a specific marker for leukemias.
C) unique to the tumor of an individual patient.
D) nonspecific to all patient populations.
Q3) What is the definition of a sarcoma?
A) A cancer that is derived from skin or epithelial linings of internal organs or glands
B) A cancer that is derived from muscle, bone, fat or soft tissues
C) A cancer that is derived from blood and lymphatic systems
D) A cancer that is derived from brain and spinal tissue
Q4) Tumor-associated antigens are expressed only in tumor cells.
A)True
B)False
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Chapter 18: Immunoproliferative Diseases
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Sample Questions
Q1) Which cytogenetic abnormality is associated with an excellent prognosis in children with B-cell acute lymphoblastic leukemia (ALL)?
A) t(12:21)(p13;q22)
B) t(14:18)(p13;q22)
C) t(9;22)
D) Hypodiploidy
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) 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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Chapter 19: Immunodeficiency Diseases
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Sample Questions
Q1) The buildup of toxic purine metabolites that impair B- and T-cell proliferation is the result of a mutation in the gene coding for:
A) recombinase activating gene 1 or 2.
B) JAK3 kinase.
C) mevalonate kinase.
D) adenosine deaminase.
Q2) The most common form of severe combined immunodeficiency disease results from an X-linked mutation in the gene that codes for:
A) interleukin-2.
B) a receptor subunit involved in signaling for interleukins-2, -4, -7, and -9.
C) a common subunit involved in signaling for the B-cell receptor and T-cell receptor complexes.
D) a sequence common to CD3 and CD19.
Q3) Which of the following statements best describes common variable immunodeficiency?
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, IgG, or both.
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Page 21
Chapter 20: Serological and Molecular Detection of Bacterial Infections
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Sample Questions
Q1) 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.
Q2) The pathogenesis of Rocky Mountain spotted fever involves:
A) systemic release of cytokines, leading to toxic shock.
B) endothelial cell damage, leading to increased vascular permeability.
C) release of potent exotoxins that destroy vascular endothelium.
D) invasion of the organism into the cardiac muscle.
Q3) Acute glomerulonephritis can be a sequela of infection by:
A) Streptococcus pyogenes.
B) Mycoplasma pneumoniae.
C) Rickettsia rickettsii.
D) Helicobacter pylori.
Q4) Which of the following is an endotoxin,not an exotoxin?
A) Streptolysin O
B) Lipid A
C) Streptokinase
D) Hyaluronidase
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Chapter 21: Spirochete Diseases
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Sample Questions
Q1) Syphilis is spread by:
A) rodent vectors.
B) insect vectors.
C) sexual transmission.
D) aerosolized respiratory droplets.
Q2) A patient presents with personality changes,altered mental state,and delusions of grandeur.The patient is then diagnosed as having syphilis.The patient is most likely in which stage of syphilis?
A) Primary
B) Secondary
C) Latent
D) Tertiary
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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23
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) 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.
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Page 24
Chapter 23: Serology and Molecular Detection of Viral Infections
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Sample Questions
Q1) 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.
Q2) 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) Chronic hepatitis B
D) Immune to hepatitis B
Q3) Interferons alpha and beta help the host in defense against viral infections by:
A) enhancing antibody production.
B) stimulating cytotoxic T cells.
C) activating Toll-like receptors.
D) inhibiting viral replication.
Page 25
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Chapter 24: Laboratory Diagnosis of HIV Infection
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Q1) The Southern blot test is the specific confirmatory test for HIV infection.
A)True
B)False
Q2) In the Western blot test for HIV antibody,a positive test result is indicated by the bands p24 and p55.
A)True
B)False
Q3) Which of the following peripheral blood measurements is used to determine the stage of HIV infection?
A) The number of CD4 T cells
B) The number of CD8 T cells
C) The number of HIV RNA copies
D) The HIV antibody titer
Q4) 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
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26
Chapter 25: Immunization and Vaccines
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Q1) Active 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
Q2) 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
Q3) Hematopoietic stem cell transplantation is an example of adoptive immunity.
A)True
B)False
Q4) Passive immunity involves the activation of IgD.
A)True
B)False
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