Clinical Laboratory Science
Chapter Exam Questions
Course Introduction
Clinical Laboratory Science is a multidisciplinary field focused on the analysis of blood, body fluids, and tissues to aid in the diagnosis, treatment, and prevention of disease. This course covers principles and techniques in areas such as hematology, clinical chemistry, immunology, microbiology, and molecular diagnostics. Students will gain both theoretical knowledge and practical laboratory skills required for the accurate performance of diagnostic tests, understanding of quality control procedures, laboratory safety, and interpretation of laboratory data. Through lectures, hands-on laboratory experiences, and case studies, learners will develop competencies essential for roles in medical laboratories and broader clinical 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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Q1) Which of the following is NOT a characteristic of neutrophils?
A) Congregate in the marginating pool in blood vessels
B) Capable of diapedesis
C) Granules that become bright orange with Wright stain
D) Segmented nucleus
Answer: C
Q2) Which of the following best describes diapedesis?
A) Movement toward increasing concentrations of a cytokine
B) Attachment of immunoglobulin to target cells
C) Movement through blood vessel walls as cells exit the circulation
D) Engulfment of target cells
Answer: C
Q3) Primary lymphoid organs include which of the following?
A) Spleen
B) Tonsils
C) Thymus
D) Lymph nodes
Answer: C
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Chapter 2: Nature of Antigens and the Major
Histocompatibility Complex
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Q1) A processed antigen first encounters and binds to MHC class II molecules in the: A) nucleus.
B) endoplasmic reticulum.
C) endosomal compartment.
D) membrane surface.
Answer: C
Q2) Which of the following is a low-molecular-weight molecule that has one binding site for an antibody?
A) Antigen
B) Hapten
C) Immunogen
D) Adjuvant
Answer: B
Q3) A determinant site on an antigen that is produced by the folding of the primary chain is known as a:
A) conformational epitope.
B) linear epitope.
C) hapten.
D) monovalent epitope.
Answer: A
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Chapter 3: Innate Immunity
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Q1) Which of the following is directly used in oxidative killing of target cells?
A) Hydrogen peroxide
B) Lysozyme
C) Defensin
D) TNF-alpha
Answer: A
Q2) Acute-phase reactants are elevated in a patient's serum.What does this result,on its own,indicate about the patient?
A) Inflammation of an unknown cause is present.
B) The patient has a leukemia but not a lymphoma.
C) The patient has a bacterial infection.
D) There is a parasitic infection and not a viral infection.
Answer: A
Q3) Which substance best inactivates bacterial proteins?
A) Nicotinamide adenine dinucleotide phosphate
B) Oxygen
C) Hypochlorite
D) Lactic acid
Answer: C
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Chapter 4: Adaptive Immunity
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Q1) Helper T cells that promote a humoral immune response include which of the following?
A) Th1
B) Th2
C) Th17
D) All of the above
Q2) Which marker is found on the group of T cells that assists B cells in making antibody?
A) CD2
B) CD19
C) CD4
D) CD5
Q3) Which type of helper T cell promotes cytotoxic activity?
A) Th1
B) Th2
C) Treg
D) Th9
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Chapter 5: Antibody Structure and Function
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Q1) Identify the characteristic that best describes IgE.
A) Fixes complement
B) Binds to mast cells
C) Found on mucosal surfaces
D) Participates in agglutination reactions
Q2) The receptor for antigen on a mature B cell is:
A) MHC class I.
B) IgG.
C) IgM.
D) MHC class II.
Q3) Bence-Jones proteins are identical to:
A) secretory IgA.
B) heavy chains.
C) light chains.
D) IgG molecules.
Q4) The region of an antibody molecule that exhibits the greatest variability from antibody to antibody is known as the:
A) hypervariable region.
B) constant region.
C) Fc region.
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Chapter 6: Cytokines
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Q1) What is the function of TGF-beta?
A) Promotes cell-mediated immunity
B) Regulates cell growth and differentiation
C) Inhibits IL-2
D) Acts as an endogenous pyrogen
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) What is one of the main activities of IL-4?
A) Downregulates the immune response
B) Increases production of neutrophils
C) Generates Th2 cells
D) Protects cells from viral invasion
Q4) Which cytokine might be given therapeutically to a patient with severe anemia?
A) IL-4
B) Erythropoietin
C) TGF-beta
D) Interferon-alpha
Page 8
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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 protein is the key intermediate in all pathways?
A) C4
B) C2
C) C3
D) C1
Q3) Which of the following is an important function of the complement system?
A) Stimulation of growth of T cells
B) Decrease in vascular permeability
C) Clearance of antigen-antibody complexes
D) Increased production of antibody
Q4) What reagent is present in a CH50 assay and absent in an AH50 assay?
A) Calcium
B) Red blood cells
C) Ethylene glycol
D) Magnesium
Page 9
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Chapter 8: Safety and Quality Management
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Sample Questions
Q1) 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
Q2) Which option is considered the primary goal of a Six Sigma program?
A) To increase laboratory productivity
B) To cut laboratory costs
C) To decrease the amount of reagent used
D) To reduce variables and decrease errors
Q3) What is the most appropriate laboratory safety wear?
A) Cloth laboratory coat worn unbuttoned
B) Fluid-resistant laboratory gown with wrist cuffs
C) A patient gown worn tied in the back
D) No laboratory coat unless you have to clean up a spill
Q4) How should you wash your hands after removing gloves?
A) Rinse only your fingers with water for 20 seconds.
B) Wash your hands without soap for 10 seconds.
C) Wash your hands with soap for at least 20 seconds.
D) Run water over your hands and then apply hand sanitizer.
Page 10
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Chapter 9: Principles of Serological Testing
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Q1) On a serial dilution with the following tubes set up,1:2,1:4,1:8,1:16,1:32,and 1:64,there is no visible agglutination in the 1:64 tube.What is the titer of the antibody?
A) 32
B) 16
C) 64
D) Cannot be determined
Q2) If complement interferes with test results,the serum sample should be:
A) treated with an anticoagulant.
B) frozen and thawed before testing.
C) heated to 56°C for 30 minutes.
D) centrifuged at 3,000 g for 30 minutes.
Q3) A patient's serum must be added to a series of test tubes,but a different volume of serum must be added to each tube.If a single pipette is used,what kind is it?
A) Graduated
B) Volumetric
C) Analytic
D) Calibrated
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Chapter 10: Precipitation and Agglutination Reactions
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Q1) 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.
Q2) 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.
Q3) Which best describes hemagglutination tests?
A) Patient antibody reacts with hemoglobin.
B) The reaction involves red blood cells.
C) Patient antibody is always involved.
D) Hemoglobin binds to antigen.
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Chapter 11: Labeled Immunoassays
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Q1) 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.
Q2) A tissue section is fixed to a microscope slide,then incubated with a fluorescently labeled antibody that binds to an antigen expressed by cells in that tissue.The preparation is then washed and inspected with a fluorescent microscope.This technique is called:
A) direct immunofluorescence.
B) indirect immunofluorescence.
C) fluorescence polarization.
D) autofluorescence.
Q3) Point-of-care testing is performed most easily using:
A) homogeneous enzyme immunoassay.
B) immunofixation assay.
C) immunochromatographic assay.
D) capture ELISA.
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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) 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.
Q3) Which type of RNA is used to directly translate the DNA code into making functional proteins?
A) Transfer RNA
B) Ribosomal RNA
C) Messenger RNA
D) Probe RNA
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Chapter 13: Flow Cytometry and Laboratory Automation
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Q1) In flow cytometry,if there are two light detectors,what does the amount of side scatter indicate?
A) Size of the cell
B) Granularity of the cell
C) Surface markers
D) Shape of the cell
Q2) What is meant by "gating" in flow cytometry?
A) The chromatic arrangement of cellular populations
B) The 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) A fluorescent signal in flow cytometry is generated by:
A) light reflected off cells passing through a laser beam.
B) light scattered by fluorochromes.
C) fluorochromes that absorb energy from a laser beam and then release the energy as longer-wavelength light.
D) cell metabolism.
Q4) In flow cytometry,fluorescence is usually used to determine:
A) intrinsic cell parameters.
B) extrinsic cell parameters.
Page 15
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Chapter 14: Hypersensitivity
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Q1) 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.
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) Hypersensitivities to poison ivy and nickel are:
A) mediated by IgG and IgM antibodies.
B) immunodeficiency diseases.
C) IgE responses to a hapten.
D) macrophage and T-cell responses to a hapten.
Q4) 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.
Page 16
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Chapter 15: Autoimmunity
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Q1) 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
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 35-year-old female experiences difficulty in walking,and her hands and feet are numb from time to time.Suspecting a disease involving the central nervous system,her physician orders magnetic resonance imaging (MRI).The MRI reveals lesions on the myelin sheath.What is the most likely disease?
A) Goodpasture's syndrome
B) Multiple myeloma
C) Graves disease
D) Multiple sclerosis
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Chapter 16: Transplantation Immunology
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Q1) A transplant patient has been prescribed corticosteroids as part of his post-transplant medication regimen.What class of drug is the patient taking?
A) Hormone
B) Immunosuppressive
C) Anti-metabolite
D) Calcineurin inhibitor
Q2) In indirect allorecognition,the host's T helper cells recognize foreign protein and uptake,process,and present it to recipient antigen-presenting cells (APCs).
A)True
B)False
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) A woman who has a history of ovarian cancer in her family goes to her physician for a "cancer test." What is the test that is most likely to be positive if the woman has ovarian cancer?
A) Carcinoembryonic antigen
B) Alpha-fetoprotein
C) Cancer antigen 125
D) Human chorionic gonadotropin
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) Alpha-fetoprotein
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
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Chapter 18: Immunoproliferative Diseases
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Q1) Which marker is highly specific for hairy-cell leukemia?
A) CD19
B) CD20
C) CD25
D) CD103
Q2) A patient whose malignant clone is positive for the CD markers CD15 and CD30 is most likely to have what clinical disease?
A) Non-Hodgkin lymphoma
B) Hodgkin lymphoma
C) Acute lymphocytic leukemia
D) Hairy-cell leukemia
Q3) 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
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Chapter 19: Immunodeficiency Diseases
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Q1) Decreased CD3-positive lymphocytes and a lack of responsiveness to phytohemagglutinin in the circulation are typically associated with:
A) inflammation.
B) transient hypogammaglobulinemia.
C) DiGeorge anomaly.
D) chronic granulomatous disease.
Q2) The most serious impairment of opsonization and antimicrobial defense is caused by a deficiency in complement component:
A) C1q.
B) factor B.
C) C3.
D) C5.
Q3) Which syndrome is characterized by defective apoptosis,leading to survival of lymphocytes that can react with self antigens?
A) Ataxia telangiectasia
B) Wiskott-Aldrich
C) Autoimmune lymphoproliferative
D) Chediak-Higashi
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Chapter 20: Serological and Molecular Detection of Bacterial Infections
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Q1) Which of the following is the first reaction in a lateral flow immunochromatographic assay?
A) Antigen reacts with a labeled antibody.
B) Antigen is captured by antibody immobilized at a specific location on a membrane.
C) Labeled antibody is captured by membrane-immobilized antibody.
D) Antibody reacts with a labeled antigen.
Q2) Acute glomerulonephritis can be a sequela of infection by:
A) Streptococcus pyogenes.
B) Mycoplasma pneumoniae.
C) Rickettsia rickettsii.
D) Helicobacter pylori.
Q3) The advantage of molecular assays in bacterial diagnosis is:
A) many methods approved by the Food and Drug Administration are available.
B) the instrumentation is not expensive.
C) the reagents and disposables are not expensive.
D) the methods are very sensitive.
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Chapter 21: Spirochete Diseases
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Q1) The Centers for Disease Control and Prevention recommends which two-tiered testing procedure for Lyme disease?
A) Screening by IFA or EIA with positive or borderline result followed by Western blot for confirmation
B) Screening by IFA followed by EIA for confirmation
C) Screening by Western blot followed by PCR for confirmation
D) Screening by EIA followed by PCR for confirmation
Q2) Patient serum is mixed with gel particles that have been sensitized with Treponema pallidum antigens as well as with unsensitized gel particles in a separate well.Agglutination was observed in the well with sensitized gel particles but not in the well with unsensitized gel particles.What is the interpretation of these results?
A) Positive for anti-T pallidum antibodies
B) Positive for heterophile antibodies
C) Negative for anti-T pallidum antibodies
D) Negative for anticardiolipin antibodies
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Chapter 22: Serological and Molecular Diagnosis of
Parasitic and Fungal
Infections
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Q1) A patient is diagnosed with coccidioidomycosis.This infection can be classified as:
A) subcutaneous.
B) systemic.
C) opportunistic.
D) superficial.
Q2) A patient has been diagnosed with tapeworm.Identify the type of parasitic organism involved.
A) Protozoa
B) Helminth
C) Ectoparasite
D) Host
Q3) A patient with candidiasis is considered to have which type of mycotic infection?
A) Subcutaneous
B) Systemic
C) Opportunistic
D) Superficial
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Chapter 23: Serology and Molecular Detection of Viral Infections
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Q1) 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.
Q2) A physician suspects that his patient has infectious mononucleosis.Heterophile antibody tests are negative.Serological testing for Epstein-Barr virus (EBV)was performed,with the following results obtained: EBV VCA IgM = neg; EBV VCA IgG = neg; EBV-EA = neg; EBV-NA = neg.What is this person's status with regard to EBV?
A) Acute EBV
B) Convalescent EBV
C) Never infected with EBV
D) Past exposure to EBV
Q3) A patient has detectable levels of IgG and IgM against the viral capsid antigens of Epstein-Barr virus (EBV).This patient has:
A) been infected with EBV in the past.
B) an infection with HIV, too.
C) a current infection with EBV.
D) never had EBV.
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Chapter 24: Laboratory Diagnosis of HIV Infection
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Q1) p24
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
Q2) The Southern blot test is the specific confirmatory test for HIV infection.
A)True
B)False
Q3) p66
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
Q4) CD4 T cells play a central role in the immune response system by regulating the activities of B and T lymphocytes.
A)True
B)False
Q5) 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) Trastuzumab,an antibody used in the treatment of breast cancer with an overexpression of the HER2 marker,is an example of a
A) mouse monoclonal antibody.
B) chimeric antibody.
C) humanized antibody.
D) fully human antibody.
Q2) Inactivated vaccine
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) Passive immunity involves the activation of IgD.
A)True
B)False
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