Hematology and Immunology
Exam Answer Key
Course Introduction
This course explores the fundamental principles and clinical applications of hematology and immunology. Students will examine the structure and function of blood cells, mechanisms of hematopoiesis, hemostasis, and common hematological disorders. The immunology component focuses on the components and functions of the immune system, immune response mechanisms, and the role of immunity in disease prevention and pathogenesis. Emphasis is placed on diagnostic techniques, laboratory procedures, and current advances in the management of hematologic and immunologic diseases.
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) All of the following are commonly found within non-lymphoid tissues EXCEPT:
A) B cells.
B) macrophages.
C) mast cells.
D) dendritic cells.
Answer: A
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) T cells mature in the:
A) bone marrow.
B) thymus.
C) lymph nodes.
D) spleen.
Answer: B
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Chapter 2: Nature of Antigens and the Major
Histocompatibility Complex
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Sample Questions
Q1) The purpose of the invariant chain is to block the peptide-binding site of:
A) antibody molecules.
B) class II MHC molecules.
C) class I MHC molecules.
D) T-cell receptors.
Answer: B
Q2) Endogenous peptides binding to MHC-A,MHC-B,or MHC-C molecules on the surface of hepatocytes are critical for the response by:
A) B lymphocytes.
B) T helper cells.
C) cytotoxic T cells.
D) macrophages.
Answer: C
Q3) Which of the following molecules is the best immunogen?
A) Protein
B) Polysaccharide
C) Nucleic acid
D) Lipid
Answer: A
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Chapter 3: Innate Immunity
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Sample Questions
Q1) Which of the following binds to CD16 on the surface of natural killer cells?
A) MHC class I
B) Fc of IgG
C) T-cell receptor
D) Antigenic peptide
Answer: B
Q2) The killing mechanism of natural killer cells is regulated by:
A) inhibitory receptors.
B)activating receptors.
C)both inhibitory and activating receptors.
D)none of the above.
Answer: C
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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Sample Questions
Q1) How are cytotoxic T cells and natural killer cells similar?
A) Both require antibody to be bound to the target cell.
B) Both induce apoptosis in the target cell.
C) Both recognize peptide plus MHC class I.
D) Both kill target cells lacking MHC class I.
Q2) The cells that primarily function by secreting large amounts of cytokines are:
A) plasma cells.
B) B cells.
C) T helper cells.
D) cytotoxic T cells.
Q3) A cell that can recall previous contact with a particular antigen so that subsequent exposure leads to a more rapid and more effective immune response than the first encounter is which type of cell?
A) Memory lymphocyte
B) Effector lymphocyte
C) Plasma cell
D) Stem cell
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Chapter 5: Antibody Structure and Function
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Sample Questions
Q1) The ability of an antibody to opsonize is located in which region?
A) F(ab)<sub>2</sub>
B) Fc
C) VL + VC
D) Hypervariable
Q2) What is the main function of IgD?
A) It helps in class switching.
B) It is a primary response antibody.
C) It protects mucous membranes.
D) It offers protection to newborns.
Q3) Which antibody is found mainly as a dimer in mucosal secretions?
A) IgA
B) IgD
C) IgE
D) IgG
Q4) IgG subclasses differ from one another in the number and position of:
A) heavy chain domains.
B) antigen binding sites.
C) light chains.
D) disulfide bonds.
Page 7
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Chapter 6: Cytokines
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Sample Questions
Q1) IL-3,IL-7,and GM-CSF are all involved in:
A) hematopoiesis.
B) suppressing inflammation.
C) macrophage killing.
D) T-cell cytotoxicity.
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) The primary function of colony-stimulating factors (CSFs)is to promote:
A) apoptosis.
B) lysis.
C) diapedesis.
D) hematopoiesis.
Q4) Identify the main action of interferon-gamma.
A) Increases synthesis of acute-phase reactants
B) Stimulates cytotoxic T cells
C) Inhibits T-cell activity
D) Stimulates production of white blood cells
Page 8
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Chapter 7: Complement System
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Sample Questions
Q1) Which of the following activities is associated only with the alternative pathway of complement fixation?
A) Formation of a membrane attack unit
B) Factor B and C3b combination
C) Antigen-antibody combination
D) Lysis
Q2) 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
Q3) Which of the following immunoglobulins is able to activate complement?
A) IgA
B) IgD
C) IgE
D) IgM
Q4) What is cleaved by C3bBb?
A) C3
B) C5
C) C6
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Chapter 8: Safety and Quality Management
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Sample Questions
Q1) In performing routine quality control on a particular laboratory test,a high-quality control value is obtained that changes the mean.What type of change does this represent?
A) Trend
B) Standard deviation
C) Shift
D) Central tolerance
Q2) 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
Q3) 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
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Chapter 9: Principles of Serological Testing
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Sample Questions
Q1) 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.
Q2) A blowout pipette would be labeled:
A) TD.
B) TC.
C) ML.
D) SD.
Q3) What type of pipette must be blown out to deliver the exact volume of liquid?
A) Volumetric
B) Serological
C) Analytic
D) Multichannel
Q4) 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
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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 process by which particulate antigens such as cells aggregate to form larger complexes when specific antibody is present is called:
A) sensitization.
B) precipitation.
C) agglutination.
D) flocculation.
Q3) Coombs reagent is used for what purpose?
A) To link small antigens on patient red cells
B) To enhance agglutination with IgG-coated red blood cells
C) To enhance agglutination with IgM-coated red blood cells
D) To cause a precipitation reaction with small amounts of antibody
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Chapter 11: Labeled Immunoassays
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Sample Questions
Q1) Pregnancy testing can be performed at home using:
A) capture assay.
B) immunochromatography.
C) fluorescence polarization.
D) chemiluminescence.
Q2) Which of the following best describes competitive binding assays?
A) A limited number of binding sites are present.
B) The concentration of patient antigen is directly proportional to the label detected.
C) All patient antigen present is allowed to bind.
D) Labeled and unlabeled analyte are present in equal amounts.
Q3) Which statement about noncompetitive enzyme immunoassays is true?
A) Binding sites for patient antigen are limited.
B) Washing in between steps is not necessary.
C) All patient antigen is allowed to react with binding sites.
D) Color is indirectly proportional to the concentration.
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13
Chapter 12: Molecular Diagnostic Techniques
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Sample Questions
Q1) In a polymerase chain reaction,the threshold cycle represents:
A) the minimum amount of target that can be amplified.
B) an indication of the original amount of target in the sample.
C) the maximum number of cycles that can be carried out before the amplicons saturate the solution.
D) the degree of complementarity between the primers and the target.
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) What process confers specificity in molecular biology methods?
A) Amplification
B) Polymorphism
C) Strand cleavage
D) Hybridization
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Chapter 13: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) 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.
Q2) How close a measured value is to the actual (true)value is called:
A) accuracy.
B) precision.
C) analytic sensitivity.
D) analytic specificity.
Q3) The ability to consistently reproduce the same result on repeated testing of the same sample is called: A) accuracy.
B) precision.
C) analytic sensitivity.
D) analytic specificity.
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) Reaction to poison ivy is which type of hypersensitivity?
A) I
B) II
C) III
D) IV
Q2) Which newly synthesized mediator has a mode of action similar to that of histamine?
A) LTB4
B) Heparin
C) ECF-A
D) PGD?
Q3) Contact dermatitis can be characterized by:
A) formation of antigen-antibody complexes.
B) immediate sensitization of Th1 cells.
C) Langerhans cells acting as antigen-presenting cells.
D) decreased cytokine production.
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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) 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
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) Four candidate bone-marrow donors were tested for compatibility with a patient in need of a transplant.HLA typing was performed,and the serologic types and alleles of the patient and four potential donors are shown in the table.On the basis of these findings,which donor would be the best match for the patient?
A) Donor 1
B) Donor 2
C) Donor 3
D) Donor 4
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) 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
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Chapter 17: Tumor Immunology
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Sample Questions
Q1) In which of the following conditions would you not see an increase in alpha-fetoprotein?
A) Pregnancy
B) Hepatocellular carcinoma
C) Hepatitis
D) Hypercholesteremia
Q2) A proto-oncogene is a normal gene that has a positive influence on cell proliferation.
A)True
B)False
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) An example of a tumor-specific antigen is the BCR/ABL protein for chronic myelogenous leukemia.
A)True
B)False
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Chapter 18: Immunoproliferative Diseases
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Q1) 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
Q2) Which statement regarding myelogenous leukemias is true?
A) They originate from a common colony-forming cell line.
B) They originate from a common myeloid precursor cell.
C) They originate from a common erythroid precursor cell.
D) They originate from a common megakaryocytic precursor cell.
Q3) 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
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Chapter 19: Immunodeficiency Diseases
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Sample Questions
Q1) A child suspected of having an inherited humoral immunodeficiency disease is given a diphtheria/tetanus vaccine.Two weeks after the immunization,his level of antibody to the specific antigens is measured.Which result is expected for this patient if he does have this deficiency?
A) Increased levels of specific antibody
B) No change in the level of specific antibody
C) An increase in IgG-specific antibody but not IgM-specific antibody
D) Increased levels of nonspecific antibody
Q2) Delayed-type hypersensitivity skin tests are used to screen for:
A) humoral immunodeficiencies.
B) cell-mediated immunodeficiencies.
C) phagocyte immunodeficiencies.
D) complement deficiencies.
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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Chapter 20: Serological and Molecular Detection of Bacterial Infections
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Q1) Antibodies against streptolysin O,hyaluronidase,and DNase B are measured in the diagnosis of which disease?
A) Streptococcal pharyngitis
B) Acute rheumatic fever
C) Rheumatoid arthritis
D) Systemic lupus erythematosus
Q2) Which statement regarding exotoxins and endotoxins is true?
A) Endotoxins and exotoxins are highly immunogenic, allowing for the development of protective antibodies and vaccines.
B) Endotoxin has targeted activity, whereas exotoxins have systemic effects when released.
C) Endotoxin is released from the cell wall of dead bacteria, whereas exotoxin is released from live bacteria.
D) Endotoxins and exotoxins bind to specific receptors on a bacterial cell, leading to the pathological events associated with the toxins.
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Chapter 21: Spirochete Diseases
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Q1) Treponema pallidum and Borrelia burgdorferi can be distinguished from each other on the basis of which of the following?
A) Only T pallidum has axial filaments.
B) Only B burgdorferi has an outer sheath.
C) Only B burgdorferi can be grown in the laboratory on artificial media.
D) Only T pallidum stimulates IgM production against the membrane proteins.
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
Q3) At which stage of syphilis is the RPR the most sensitive?
A) Primary
B) Secondary
C) Tertiary
D) Latent
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Chapter 22: Serological and Molecular Diagnosis of
Parasitic and Fungal
Infections
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Q1) 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
Q2) A patient who has recently traveled to Africa presents to the physician with a possible parasitic infection.The physician orders serological testing.Which of the following conditions is best detected via serological testing?
A) Ascariasis
B) Lyme disease
C) Malaria
D) Toxoplasmosis
Q3) Serology assays are useful in the diagnosis of Aspergillus infections from bronchial lavage samples in immunocompromised patients.
A)True
B)False
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Chapter 23: Serology and Molecular Detection of Viral Infections
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Q1) A patient with infectious mononucleosis would have what outstanding feature in the hematology evaluation?
A) Decreased total white blood cells
B) Presence of atypical lymphocytes
C) Increased percentage of eosinophils
D) Absence of neutrophils
Q2) Which test is most specific for infectious mononucleosis?
A) Monospot
B) CBC with differential
C) Anti-EBV titers
D) Paul-Bunnell test
Q3) A patient has the following hepatitis profile: anti-HAV IgM = not detected; HBsAg = not detected; anti-HBc IgM = not detected; anti-HBc total = not detected; anti-HBs = 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
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Chapter 24: Laboratory Diagnosis of HIV Infection
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Q1) 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
Q2) 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.
Q3) In the Western blot test for HIV antibody,a positive test result is indicated by the bands p24 and p55.
A)True
B)False
Q4) 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
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Chapter 25: Immunization and Vaccines
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Q1) Hematopoietic stem cell transplantation is an example of adoptive immunity.
A)True
B)False
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) An inactivated vaccine is used clinically to prevent:
A) chickenpox.
B) measles.
C) mumps.
D) influenza.
Q4) Passive immunity involves the activation of IgD.
A)True
B)False
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