Clinical Serology
Mock Exam
Course Introduction
Clinical Serology focuses on the study of serum and other body fluids to detect the presence of antibodies and antigens as indicators of disease. This course emphasizes the principles and laboratory techniques used in immunologic testing, including agglutination, precipitation, complement fixation, and enzyme-linked immunosorbent assays. Students explore the immune response to infectious agents, autoimmune disorders, transfusion compatibility, and the serological diagnosis of diseases. The curriculum integrates clinical case studies and hands-on laboratory experience to develop proficiency in interpreting serological results, understanding quality control measures, and applying serologic methods in healthcare settings.
Recommended Textbook
Clinical Immunology and Serology A Laboratory Perspective 3rd Edition by Christine Dorresteyn
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22 Chapters
562 Verified Questions
562 Flashcards
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Chapter 1: Introduction and Natural Immunity
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49 Verified Questions
49 Flashcards
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Sample Questions
Q1) Jenner's discovery that cowpox generated immunity against smallpox is based on the principle of:
A) attenuation of a harmful substance
B) natural immunity
C) passive immunity
D) cross-immunity
Answer: D
Q2) The function(s)of macrophages/monocytes in the host immune response is (are):
A) antigen presentation
B) phagocytosis
C) secretion of cytokines
D) all of these
Answer: D
Q3) Eosinophils are involved in the immune response against: A) viruses
B) intracellular bacteria
C) multicellular parasites
D) extracellular bacteria
Answer: C
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Page 3
Chapter 2: Lymphoid System
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Sample Questions
Q1) The difference in kinetics between a primary and secondary immune response is due to the presence of:
A) memory cells in the secondary response
B) suppressor cells in the primary response
C) macrophages in the secondary response
D) T cells in the primary response
Answer: A
Q2) T helper cells recognize which of the following?
A) exogenous peptide bound to class II
B) native extracellular viral proteins
C) endogenous peptides bound to class I
D) microbe-specific structures
Answer: A
Q3) An immature T cell differs from a mature T cell because an immature T cell:
A) expresses beta chains and pre-Ta
B) does not express T-cell receptor or CD3
C) co-expresses CD4 and CD8
D) is normally found in lymph nodes
Answer: C
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Page 4
Chapter 3: Nature of Antigens and 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) Which of the following molecules is the better immunogen?
A) protein
B) protein polysaccharide
C) nucleic acid
D) lipid
Answer: A
Q3) All of the following are characteristics of both MHC class I and class II molecules
EXCEPT:
A) expressed codominantly
B) involved in antigen recognition
C) members of the immunoglobulin superfamily
D) expressed constitutively on all nucleated cells
Answer: D
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Chapter 4: Antibody Structure and Function
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Sample Questions
Q1) All polymeric but not monomeric immunoglobulins are characterized by:
A) a secretory component
B) an extra H-chain domain
C) a J chain
D) high carbohydrate content
Q2) Where on an antibody molecule does combination with antigen take place?
A) variable region
B) constant region
C) hinge region
D) Fc region
Q3) Which best describes monoclonal antibody?
A) antibody made against multiple epitopes
B) antibody made by a variety of B cells
C) antibody made from a single antibody-producing cell
D) all antibody of any one particular class
Q4) Which antibody agglutinates and fixes complement best?
A) IgA
B) IgM
C) IgG
D) IgE
Page 6
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Chapter 5: Cytokines
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Sample Questions
Q1) IL-1,IL-6,and tumor necrosis factor-alpha function by:
A) increasing vascular permeability
B) increasing acute phase proteins
C) acting on the hypothalamus
D) promoting migration of inflammatory cells
E) all of these
Q2) Which cells produce interleukin-1?
A) T helper cells
B) cytotoxic T cells
C) B cells
D) macrophages
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 6: Complement System
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Sample Questions
Q1) Which factor must be associated with factor H to inactivate complement components?
A) C1INH
B) factor I
C) DAF
D) CR1
Q2) The recognition unit in the classical complement pathway consists of:
A) C4b2a3b
B) C5b6789
C) C1qrs
D) factor B
Q3) Which of the following can activate the alternative complement pathway?
A) IgG
B) mannose-binding lectin
C) C3b
D) C1q
Q4) What is cleaved by C3bBb?
A) C3
B) C5
C) C6
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Chapter 7: Safety and Specimen Preparation
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Sample Questions
Q1) Which series of dilutions would be best in order to make a 1:3000 dilution?
A) 1:10,1:3,1:10
B) 1:5,1:6,1:100
C) 1:3,1:100,1:100
D) 1:30,1:10,1:100
Q2) When a staphylococcal infection is passed between patients due to health-care workers not washing their hands,this represents an example of:
A) lack of chemical hygiene
B) a sharps hazard
C) the chain of infection
D) a specimen transport problem
Q3) Use of universal precautions is best explained by which of the following?
A) handling a urine specimen from a patient with a bacterial infection very carefully
B) wearing gloves in handling a serum specimen from a patient with HIV
C) taking gloves off in the lab to place a serum specimen in a chemistry analyzer
D) treating every specimen in the lab as if it were infectious
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9
Chapter 8: Precipitation Reactions
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Sample Questions
Q1) Affinity between individual antigen and antibody molecules depends on several types of bonds,such as ionic bonds,hydrophobic bonds,hydrogen bonds,and van der Waals forces.How is the strength of these attractions characterized?
A) specificity
B) avidity
C) reactivity
D) multivalency
Q2) Precipitation reactions involve combination of soluble antibody with:
A) soluble antigen
B) cellular antigens
C) red blood cells
D) radioactive antigen
Q3) The Western blot test used to confirm HIV is an example of which of the following?
A) immunofixation
B) immunoelectrophoresis
C) double diffusion
D) passive agglutination
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Chapter 9: Agglutination
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Sample Questions
Q1) 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
Q2) Which of the following would enhance an agglutination reaction?
A) polyethylene glycol (PEG)
B) high ionic strength saline
C) running the reaction at 4C
D) running the reaction at a high pH
Q3) What would be the best test to determine evidence of hemolytic disease of the newborn?
A) direct antiglobulin testing
B) passive agglutination
C) coagglutination testing
D) indirect antiglobulin testing
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Chapter 10: Labeled Immunoassays
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Sample Questions
Q1) An immunoassay is performed in the following manner to look for an Ag in the patient serum: Patient serum + labeled Ag + known Ab are added together and incubated.Unbound material is washed off.The amount of labeled Ag is then measured.What assay is performed?
A) homogeneous EIA
B) competitive EIA
C) sandwich EIA
D) ELISA
Q2) Pregnancy testing is based on an early increase in which hormone?
A) human chorionic gonadotropin
B) luteinizing hormone
C) thyroid-stimulating hormone
D) follicle-stimulating hormone
Q3) Which of the following best describes homogeneous assays?
A) A washing step is necessary.
B) Concentration of patient antigen is directly proportional to the label detected.
C) The reagent antibody has an enzyme tag.
D) Labeled and unlabeled analyte are present in equal amounts.
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Chapter 11: Molecular Techniques
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13 Flashcards
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Sample Questions
Q1) 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
Q2) What would be an advantage of using molecular diagnostic techniques in identification of specific HLA antigens instead of serological techniques?
A) less quality control needed
B) more specific
C) more rapid
D) all of the above
E) all except one of the above
Q3) Which of the following steps are included in a Southern blot?
A) ligation of DNA probes by a DNA ligase
B) gel electrophoresis followed by transfer of the pattern to a membrane
C) denaturation of DNA followed by annealing of primers and bases
D) creating a nick in a DNA strand followed by amplification
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13
Chapter 12: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) The expression of cell surface markers is determined in the flow cytometer by which of the following?
A) chemiluminescence
B) fluorescence
C) optical density
D) radioactivity
E) scatter
Q2) A mature cytotoxic T cell expresses which markers?
A) CD3,CD4,and CD8
B) CD4,CD3,and CD5
C) CD5,CD8,and CD3
D) CD8,CD3,and CD2
Q3) In most flow cytometers,labeled cells:
A) scatter the light and absorb fluorescence
B) absorb fluorescence and emit electronic impulses
C) scatter the light and emit fluorescence
D) absorb both fluorescence and light
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14
Chapter 13: Hypersensitivity
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Sample Questions
Q1) An example of a type III hypersensitivity is:
A) myasthenia gravis
B) allergic rhinitis
C) contact sensitivity
D) rheumatoid arthritis
Q2) Reasons for autoimmunity include all of the following EXCEPT:
A) antibody that cross-reacts with self-antigens
B) inheritance of certain MHC antigens
C) molecular mimicry
D) deletion of self-reactive lymphocytes during maturation
Q3) Anaphylaxis is characterized by which of the following?
A) degranulation of mast cells
B) production of IgG
C) T-cell mediators
D) all of the above
Q4) Complement is responsible for tissue damage in which of the following reactions?
A) immediate hypersensitivity
B) type III hypersensitivity
C) delayed hypersensitivity
D) anaphylaxis
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Chapter 14: Autoimmunity
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Sample Questions
Q1) A disease characterized by hypoactivity of the thyroid with weight gain and a sluggish metabolism due to destruction of thyroglobulin best describes:
A) Graves' disease
B) Hashimoto's thyroiditis
C) myasthenia gravis
D) rheumatoid arthritis
Q2) Antibodies directed against thyroglobulin represent a significant finding in which of the following autoimmune diseases?
A) myasthenia gravis
B) multiple sclerosis
C) Hashimoto's thyroiditis
D) contact dermatitis
Q3) The fluorescent antinuclear antibody test for lupus is an example of which of the following?
A) competitive immunoassay
B) immunofixation
C) indirect fluorescent testing
D) direct fluorescent testing
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16
Chapter 15: Immunoproliferative Diseases
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Sample Questions
Q1) What is the interpretation of the following patient results? (normal values)WBC = 7.0 th/uL (5.0-10.0 th/uL),with 89% blasts; CD3 = 10% (60-80%); CD5 = 9% (60-80%); CD10 = 89% (< 1%); CD4 = 6% (30-65%); CD20 = 0% (5-20%); CD34 = 94% (< 1%); CD8 = 3% (10-40%); kappa = 0% (3-15%); lambda = 0% (2-10%); CD19 = 90% (5-20%).
A) normal
B) B-cell acute leukemia
C) T-cell acute leukemia
D) B-cell chronic leukemia
E) T-cell chronic leukemia
Q2) What is the main difference between leukemias and lymphomas?
A) In leukemias,malignant cells are mainly located in the tissues.
B) Lymphomas are present mainly in peripheral blood.
C) Lymphomas arise due to a lack of response to stimulating antigens.
D) Lymphomas arise mainly in lymph nodes,the spleen,or other lymphoid tissue.
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Chapter 16: Immunodeficiency Disease
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Sample Questions
Q1) A 9-month-old boy was suspected of having an immune deficiency because he had many recurrent infections with Streptococcus pneumoniae.Laboratory tests revealed a normal percentage of T cells and T-cell subsets but a lack of mature B cells and immunoglobulins.This boy most likely has:
A) Wiskott-Aldrich syndrome
B) DiGeorge syndrome
C) X-linked agammaglobulinemia
D) chronic granulomatous disease
Q2) A patient with hereditary angioedema will present with swelling in the tissues and has which of the following deficiencies?
A) C5,C6,C7,C8
B) phagocytic cell function
C) mature B cells
D) C1 inhibitor
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 18
Chapter 17: Transplantation Immunology
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Sample Questions
Q1) Graft-versus-host disease results under which conditions?
A) when immunocompetent cells are placed in an immunocompromised host
B) when immunodeficient cells are placed in an immunocompetent host
C) any time tissue is not exactly matched in a transplant
D) only when adult cells are transplanted into a baby
Q2) A 25- year-old female is in kidney failure and needs a transplant.She is A positive and HLA A1A3/B5B7/C2C9/DR4DR8.Which of the following donors would be the best match?
A) her brother,who is B positive and HLA A1A3/B7B5/C2C9/DR8DR4
B) her sister,who is A positive and HLA A3A4/B7B9/C2C3/DR4DR7
C) her mother,who is AB positive and HLA A1A4/B9B5/C9C3/DR8DR7
D) an unrelated donor who is A positive and HLA A6A3/B5B7/C3C10/DR2DR9
Q3) Transplantation of an individual's skin from one place to another is an example of a(n):
A) autograft
B) allograft
C) xenograft
D) heterograft
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19
Chapter 19: Tumor Immunology
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Sample Questions
Q1) Acute glomerulonephritis is due to:
A) deposition of immune complexes in the kidney
B) destruction of glomeruli by Streptolysin O
C) formation of cross-reacting antibodies
D) invasion of the kidney by Streptococcus pyogenes
Q2) Which of the following bacterial enzymes causes the release of lysosomal contents into the cytoplasm of the phagocytic cell,leading to the death of the cell?
A) protein H
B) leukocidin
C) M protein
D) IgA protease
Q3) Antibodies detected by reacting rickettsial antigens with specific antibody followed by use of an anti-immunoglobulin with a fluorescent tag could be used to diagnose:
A) Rocky Mountain spotted fever
B) Mycoplasma pneumonia
C) stomach ulcers
D) rheumatic fever
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Chapter 20: Serologic and Molecular Detection of Bacterial
Infections
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Sample Questions
Q1) A 25-year-old pregnant female has serologic testing to determine if she has a toxoplasmosis infection.A low level of both IgM and IgG is found.On repeat testing 2 weeks later,the results are the same.What can be concluded from these results?
A) She has an active infection.
B) The baby will have serious central nervous system damage.
C) She was exposed to toxoplasmosis at some time in the past.
D) She has never been exposed to toxoplasmosis.
Q2) Why is testing for Cryptococcal antigen preferred over testing for antibodies?
A) This is usually not a humoral response to infection.
B) Immunocompromised patients do not produce antibody.
C) Subclinical infection can be detected.
D) all of the above
Q3) Which statement best describes antigenic variation seen in parasites?
A) The host immune system can respond more quickly.
B) Different parasites have different antigens.
C) Parasites can periodically change their surface antigens.
D) Parasites become sequestered in host cells.
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Page 21
Chapter 21: Serologic and Molecular Detection of Bacterial
Infections
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Sample Questions
Q1) Which of the following may characterize the disease process in syphilis?
A) generalized rash
B) period of latency
C) localized chancre
D) all of the above
E) all except one of the above
Q2) RPR stands for
A) reagin plasma reactive
B) reactive phosphate reagent
C) rapid plasma reagin
D) random positive reagin
Q3) The RPR and VDRL are similar in which of the following ways? RPR and VDRL are both:
A) read macroscopically
B) flocculation reactions
C) specific assays for syphilis
D) antigen detection assays
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Chapter 22: Serology of Parasitic and Fungal Infections
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Sample Questions
Q1) A 36-year-old African American male presents to a free clinic with symptoms of anorexia,malaise,vomiting,abdominal pain,and mild jaundice.The patient is a known IV drug abuser.The physician orders liver function tests and an acute hepatitis serum panel.The laboratory reports the following results: anti-HAV IgM = not detected; HBsAg = not detected; anti-HBc IgM = not detected; anti-HBc total = detected; anti-HBs = detected; anti-HCV = detected.This man has:
A) acute hepatitis B
B) chronic hepatitis B
C) acute hepatitis A
D) acute hepatitis C
Q2) A physician suspects that his patient has infectious mononucleosis.Heterophile antibody tests are negative.Serological testing for Epstein-Barr virus 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 regards to EBV?
A) acute EBV
B) convalescent EBV
C) never infected with EBV
D) past exposure to EBV
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Chapter 23: Spirochete Diseases
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Sample Questions
Q1) A 25-year-old male presents to the public health clinic complaining of flu-like symptoms.The man has been an IV drug user and prostitute for the last 5 years.HIV antibody screening is positive.Subsequently,antibodies are found to have specificity for p24,gp120,p31,and gp41.This patient has:
A) current HIV infection
B) indeterminate HIV infection
C) lack of HIV infection
D) infection with some other virus
Q2) Which is most likely a positive Western blot result for infection with HIV?
A) band at p24
B) band at gp60
C) bands at p24 and p31
D) bands at p24 and gp120
Q3) What is the main mechanism of action of nucleoside analogue drugs such as zidovudine?
A) inhibiting the action of reverse transcriptase
B) blocking entry of HIV into host cells
C) acting as protease inhibitors
D) preventing release of HIV particles
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Page 24