Diagnostic Immunology Exam Review
Course Introduction
Diagnostic Immunology explores the principles and methodologies used to detect, analyze, and interpret immune responses in clinical settings. The course covers key topics such as immunoassay techniques, serological testing, immunophenotyping, and molecular diagnostics related to infectious, autoimmune, allergic, and immunodeficiency diseases. Students will learn how immune markers and immune system components serve as diagnostic tools for various pathological conditions, as well as gain practical skills in laboratory methods used in modern immunology diagnostics. Ethical considerations and the integration of diagnostic data into patient care will also be discussed.
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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Sample Questions
Q1) Opsonization
A)Elie Metchnikoff
B)Edward Jenner
C)Emil Von Behring
D)Almoth Wright
Answer: D
Q2) Phagocytosis
A)Elie Metchnikoff
B)Edward Jenner
C)Emil Von Behring
D)Almoth Wright
Answer: A
Q3) 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
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Chapter 2: Nature of Antigens and the Major
Histocompatibility Complex
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Sample Questions
Q1) MHC molecules containing beta-2-microglobulin:
A) contain alpha and beta transmembrane polypeptides.
B) participate in the activation of CD4 T cells.
C) are determined by MHC-A, MHC-B, and MHC-C genes.
D) are determined by MHC-DR genes.
Answer: C
Q2) Characteristics of heterophile antigens include which of the following?
A) Found in unrelated plants or animals but cross-react with the same antibody
B) One's own self-antigens
C) Any antigens used for immunization
D) All of the above
Answer: A
Q3) 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
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Chapter 3: Innate Immunity
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Sample Questions
Q1) The internal defense system includes which of the following?
A) Cilia
B) Mucous membranes
C) Acute-phase reactants
D) Acidity of the skin
Answer: C
Q2) C-reactive protein,complement components,and antibodies are all:
A) acute-phase reactants.
B) enzymes.
C) pathogen-recognition receptors.
D) opsonins.
Answer: D
Q3) For diapedesis to occur:
A) CD16 receptors must be bound.
B) microbes must be phagocytized.
C) endothelial cells must contract.
D) NADPH must be activated.
Answer: C
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Chapter 4: Adaptive Immunity
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Sample Questions
Q1) T cells that respond against self-antigens are inactivated by:
A) binding to immunoglobulin.
B) intermediate-strength binding to self MHC.
C) apoptosis.
D) positive selection.
Q2) Identification of T-cell subsets is best accomplished with the use of:
A) antigen-induced proliferation assays.
B) cytotoxicity assays.
C) flow cytometry.
D) serum electrophoresis.
Q3) Which type of leukocyte is identified by an ability to form rosettes with sheep red blood cells?
A) T cell
B) B cell
C) Natural killer cell
D) Plasma cell
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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) In serum electrophoresis conducted at pH 8.6,which protein group migrates the fastest?
A) Albumin
B) Alpha-1 globulin
C) Alpha-2 globulin
D) Gamma globulin
Q3) 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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Sample Questions
Q1) 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
Q2) The main target of IL-3 is:
A) antigen-activated B cells.
B) antigen-activated T cells.
C) macrophages.
D) stem cells.
Q3) Which option best describes the nature of IL-2?
A) Activates T helper cells
B) Is made by macrophages
C) Causes lysis of tumor cells
D) Downregulates the immune response
Q4) Identify the cytokine that is produced by Th2 cells and inhibits Th1.
A) IL-10
B) IL-5
C) IL-3
D) IFN-gamma
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Chapter 7: Complement System
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Sample Questions
Q1) Which complement component is found in both the classic and alternative pathways?
A) C1
B) C2
C) Factor B
D) C3
Q2) Which of the following is a characteristic of complement?
A) It is activated by IgE in the classical pathway.
B) It cannot be activated by molecules other than antigen-antibody complexes.
C) It plays a role in the lysis of target cells coated with specific antibodies.
D) It is enhanced by decay-accelerating factor.
Q3) Which of the following is referred to as C5 convertase?
A) C4b2a
B) MASP1
C) C4b2a3b
D) C1qrs
Q4) What is cleaved by C3bBb?
A) C3
B) C5
C) C6
Page 9
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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) A blood spill occurs in the immunology laboratory.What should you do?
A) Call housekeeping to wash the area.
B) Make a 1:10 solution of bleach and wash the area.
C) Wipe up the spill with paper towels.
D) Wipe the area with concentrated bleach.
Q3) 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
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Chapter 9: Principles of Serological Testing
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Sample Questions
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) When 0.5 mL of serum is added to 1.5 mL of diluent,what dilution does this represent?
A) 1:3
B) 1:4
C) 1:5
D) 3:1
Q3) A blood sample is processed,and the resulting serum is pink.This indicates: A) a normal serum sample.
B) a hemolyzed serum sample, but hemolysis is common and can be ignored.
C) a hemolyzed serum sample, which may adversely affect testing.
D) definite evidence of bacterial contamination.
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Chapter 10: Precipitation and Agglutination Reactions
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Sample Questions
Q1) If the concentration of free antibody (Ab)= 3 mol/L,the concentration of free antigen (Ag)= 2 mol/L,and the concentration of antigen-antibody complex = 6 mol/L,then the equilibrium constant K equals:
A) 1.
B) 2.
C) 4.
D) 9.
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) In a capture assay to determine the presence of a viral antigen in a patient sample,which of the following would be on solid phase?
A) Antigen
B) Labeled antibody
C) Unlabeled antibody
D) Antihuman immunoglobulin
Q2) The standard method for detecting antinuclear antibodies (in certain autoimmune diseases)is:
A) direct immunofluorescence.
B) indirect immunofluorescence.
C) fluorescence polarization.
D) autofluorescence.
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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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) Light is generated when nucleotides are added to a growing strand of DNA in the process of:
A) pyrosequencing.
B) ligase chain reaction.
C) strand displacement amplification.
D) branched DNA amplification.
Q3) In which technique is the signal amplified instead of the target DNA?
A) Branched DNA amplification
B) Polymerase chain reaction
C) Transcription-mediated amplification
D) Solution hybridization
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Chapter 13: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) 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.
Q2) 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
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.
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Chapter 14: Hypersensitivity
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Sample Questions
Q1) The normal activity of a type I hypersensitivity response is protection primarily against which of the following?
A) Parasites
B) Viruses
C) Bacteria
D) Fungi
Q2) T cell-dependent hypersensitivity occurs:
A) 24 to 72 hours after exposure to the antigen.
B) immediately after exposure to the antigen.
C) 5 to 7 days after contact with antigen.
D) 1 to 4 hours after contact with antigen.
Q3) Preformed mediators that are released during the activation phase of a type I hypersensitivity response include which of the following?
A) Histamine
B) Cyclooxygenase
C) Leukotriene
D) Prostaglandin
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Chapter 15: Autoimmunity
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Sample Questions
Q1) 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.
Q2) A 45-year-old male presents to his physician complaining of achy joints,chronic runny nose,and coughing up blood.Chest x-ray shows pulmonary infiltrates.Cortisol is increased; erythrocyte sedimentation rate (ESR)is slightly elevated.Tests for autoantibodies are positive for antineutrophil cytoplasmic antibodies.On the basis of these findings,a likely diagnosis for this patient is:
A) systemic lupus erythematosus.
B) rheumatoid arthritis.
C) chronic granulomatous disease.
D) Wegener's granulomatosis.
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Page 17
Chapter 16: Transplantation Immunology
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Sample Questions
Q1) 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.
Q2) In direct allorecognition,the recipient T cells bind and respond directly to foreign HLA proteins.
A)True
B)False
Q3) 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
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Chapter 17: Tumor Immunology
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Sample Questions
Q1) HER-2
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
Q2) Carcinoembryonic antigen
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
Q3) 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
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Chapter 18: Immunoproliferative Diseases
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Sample Questions
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 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) 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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Sample Questions
Q1) 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
Q2) An autosomal-recessive disease characterized by the presence of abnormally large granules primarily affecting the function of lysosomes is known as:
A) Chédiak-Higashi syndrome.
B) X-linked lymphoproliferative disease.
C) leukocyte adhesion deficiency.
D) common variable immunodeficiency.
Q3) An inflammatory syndrome involving recurrent fevers is A) ataxia telangiectasia.
B) Wiskott-Aldrich.
C) autoimmune lymphoproliferative.
D) hyper IgD.
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21
Chapter 20: Serological and Molecular Detection of Bacterial Infections
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Q1) Antibodies detected by reacting patient serum with rickettsial antigens,followed by incubation with 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.
Q2) Helicobacter pylori secretes urease to:
A) protect itself from a harsh environment. B) breach the mucosal barriers of the host.
C) inactivate neutrophils.
D) increase its virulence.
Q3) Acute glomerulonephritis can be a sequela of infection by: A) Streptococcus pyogenes.
B) Mycoplasma pneumoniae.
C) Rickettsia rickettsii.
D) Helicobacter pylori.
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Chapter 21: Spirochete Diseases
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Sample Questions
Q1) Select the characteristic associated with Borrelia miyamotoi.
A) Usually causes a ring-shaped rash
B) Does not induce antibodies in patients that cross-react in Lyme disease assays
C) Causes relapsing fevers
D) Can be easily cultured in diagnostic procedures
Q2) The RPR and VDRL tests differ from each other in which of the following ways?
A) Method for reading or visualizing the reaction
B) Specificity of antibody detected
C) Specificity of antigen detected
D) Principle for detecting antigen-antibody complexes
Q3) What type of test identifies the presence of the reagin antibody that forms against cardiolipin?
A) Treponemal test
B) Nontreponemal test
C) Fluorescent antibody testing
D) Dark-field microscopy
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23
Chapter 22: Serological and Molecular Diagnosis of Parasitic
and Fungal
Infections
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Q1) An example of a fungal organism that commonly causes systemic infections is:
A) Malassezia furfur.
B) Trichophyton species.
C) Cryptococcus neoformans.
D) Candida albicans.
Q2) Suppose a parasite invades a patient and causes disease.The patient develops immunity and is ultimately cured.This outcome is considered what type of host-parasite interaction?
A) Symbiosis
B) Commensalism
C) Sterilizing immunity
D) Concomitant immunity
Q3) A parasite that causes the immune system to increase protein production to distract the immune system is using which survival strategy?
A) Antigen shedding
B) Antigenic mimicry
C) Immunologic subversion
D) Immunologic diversion
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Chapter 23: Serology and Molecular Detection of Viral Infections
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Q1) Serology is performed on a patient with a rash and fever.Results are: rubella IgM = positive; rubella IgG = positive; measles IgM = negative; measles IgG = positive; varicella-zoster IgM = negative; varicella-zoster IgG = negative.What is the interpretation of these results?
A) Acute infection with rubella virus
B) Acute infection with measles virus
C) Not immune to measles or rubella viruses
D) Immune to varicella-zoster virus only
Q2) Viruses can evade host defenses by:
A) maintaining a stable genetic identity.
B) inducing increased expression of MHC class I.
C) inducing increased expression of MHC class II.
D) hiding from the immune system in a latent state.
Q3) Swollen parotid glands are key diagnostic indicators of:
A) measles.
B) mumps.
C) varicella.
D) rubella.
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Chapter 24: Laboratory Diagnosis of HIV Infection
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Q1) The RT-PCR is a highly sensitive method that involves:
A) direct amplification of HIV RNA.
B) amplification of a label attached to HIV RNA.
C) amplification of a complementary DNA sequence to a portion of the HIV RNA.
D) DNA sequencing of a portion of HIV RNA.
Q2) gp41
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) In the Western blot test for HIV antibody,a positive test result is indicated by the bands p24 and p55.
A)True
B)False
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Chapter 25: Immunization and Vaccines
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Q1) An effective method of acquiring immunity is through the method of community immunity.
A)True
B)False
Q2) Human immune serum globulin is made from the pooled serum of thousands of donors.
A)True
B)False
Q3) Why is alum incorporated into many of the vaccines used today?
A) It induces the release of proinflammatory cytokines at the injection site.
B) It reduces the chance for hypersensitivity to occur after exposure to the vaccine.
C) It reduces interference by maternal antibodies.
D) It allows for the combination of multiple vaccines into a single injection.
Q4) Passive 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
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