Immunology and Serology
Textbook Exam Questions
Course Introduction
This course provides an in-depth exploration of the immune system and the principles of immunology, focusing on the structure and function of immune cells, immune responses to pathogens, and the mechanisms underlying immunity. Students will learn about both innate and adaptive immunity, antigen-antibody interactions, and the development of immune memory. The course also introduces serological techniques used in laboratory diagnostics, such as ELISA, agglutination, and immunofluorescence, emphasizing their applications in detecting and analyzing diseases. Through lectures and hands-on laboratory work, students gain practical skills in performing and interpreting serological assays, fostering a comprehensive understanding of both theoretical concepts and clinical applications.
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 a characteristic of opsonins?
A) They are carbohydrates that stimulate T cells.
B) They are molecules that coat bacteria, making them more susceptible to phagocytosis.
C) They are expressed on the surface of neutrophils.
D) They are produced by NK cells.
Answer: B
Q2) The process by which leukocytes are attracted to a specific area by chemical messengers is called:
A) diapedesis.
B) degranulation.
C) chemotaxis.
D) opsonization.
Answer: C
Q3) Which of the following is characteristic of natural immunity?
A) It involves memory.
B) T lymphocytes play a major role.
C) It involves specificity.
D) Mechanisms are always present and fully functional.
Answer: D
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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 class I MHC molecules in the: A) nucleus.
B) endoplasmic reticulum.
C) endosomal compartment.
D) membrane surface.
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) T cells are capable of recognizing:
A) conformational epitopes.
B) native (nondegraded) peptides.
C) degraded peptides.
D) haptens.
Answer: C
Page 4
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Chapter 3: Innate Immunity
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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 is part of the external defense system?
A) Ceruloplasmin
B) Skin
C) Neutrophils
D) Complement
Answer: B
Q3) The phagosome of a macrophage is a membrane-bound vesicle that contains: A) enzymes.
B) reactive oxygen intermediates.
C) ingested pathogens.
D) perforin and granzymes.
Answer: C
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5
Chapter 4: Adaptive Immunity
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Q1) All of the following are found on the surface of a mature naïve B cell EXCEPT:
A) IgD
B) Lambda and mu chains
C) CD19
D) Surrogate light chains
Q2) Mutations causing deficiencies in CD40L expression lead to an inability of helper T cells to:
A) kill tumor cells, resulting in an increased risk of cancer.
B) activate macrophages, resulting in an inability to clear extracellular pathogens.
C) migrate to the site of an infection by chemotaxis, resulting in a slowed response.
D) promote class-switching, resulting in high IgM and low IgA and IgG concentrations.
Q3) 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
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6
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) In serum protein electrophoresis,which band contains the immunoglobulins?
A) Alpha-1
B) Alpha-2
C) Beta
D) Gamma
Q3) Identify the statement about monoclonal antibodies that is true.
A) They all recognize numerous antigens.
B) They arise from a single B cell.
C) They are used for testing only and not as therapeutic agents.
D) They are found only in cancerous states.
Q4) Kappa or lambda light chains:
A) are encoded on the same chromosome.
B) associate with only one type of heavy chain at a time.
C) can be expressed by the same B cell.
D) are expressed by a pre-B cell.
7
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Chapter 6: Cytokines
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Q1) Identify the cytokine that is produced by Th2 cells and inhibits Th1.
A) IL-10
B) IL-5
C) IL-3
D) IFN-gamma
Q2) The primary function of colony-stimulating factors (CSFs)is to promote:
A) apoptosis.
B) lysis.
C) diapedesis.
D) hematopoiesis.
Q3) Select the statement that best describes the action of IL-1.
A) Increases synthesis of acute-phase reactants
B) Increases proliferation of Th2 cells.
C) Increases production of IgE
D) Inhibits antigen presentation by macrophages
Q4) Erythropoietin regulates:
A) T-cell function.
B) bone marrow cell differentiation.
C) proinflammatory cytokine synthesis.
D) the acute-phase response.
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Chapter 7: Complement System
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Sample Questions
Q1) What is cleaved by C4b2a3b?
A) C3
B) C4
C) C5
D) C6
Q2) In the alternate pathway,factor B must bind to which of the following to initiate the cascade?
A) Factor I
B) C3b
C) C4b
D) Properdin
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
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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) Where should you dispose of blood-soaked gauze pads?
A) Regular garbage
B) Sharps container
C) Red biohazard bag
D) Laundry bag
Q3) 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) What is the sensitivity of the assay?
A)57%
B)75%
C)80%
D)90%
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) A blowout pipette would be labeled:
A) TD.
B) TC.
C) ML.
D) SD.
Q4) 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.
Page 11
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Chapter 10: Precipitation and Agglutination Reactions
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Q1) The particle-counting immunoassay method counts the number of:
A) agglutinated particles.
B) free antibody molecules.
C) free latex particles.
D) antigen-antibody bonds.
Q2) If an Ouchterlony immunodiffusion pattern shows an arc between antigens A and B with an extended line pointing to antigen B,this indicates that the antigens:
A) are identical.
B) are entirely different.
C) share a common epitope, with A being a more complex antigen.
D) share a common epitope, with B being a more complex antigen.
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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Q1) In which of the following testing situations is there a direct relationship between the amount of bound label and the amount of patient antigen present?
A) Competitive radioimmunoassay using labeled antigen
B) Competitive enzyme immunoassay using labeled antigen
C) Noncompetitive enzyme immunoassay using a second labeled antibody
D) Any of the above
Q2) Indirect immunofluorescence is similar to which type of enzyme immunoassay in terms of the performance of the assay?
A) Competitive
B) Capture
C) ELISA
D) Homogeneous
Q3) Which of the following best describes homogeneous assays?
A) A washing step is not necessary.
B) The concentration of patient antigen is always 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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13
Chapter 12: Molecular Diagnostic Techniques
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Sample Questions
Q1) The individual nucleotides along a single strand of DNA are held together by:
A) phosphodiester bonds.
B) disulfide bonds.
C) hydrogen bonds.
D) peptide bonds.
Q2) A short strand of DNA or RNA used to detect an unknown nucleic acid in a patient specimen best describes a:
A) nucleic acid probe.
B) restriction enzyme.
C) primer.
D) restriction fragment length polymorphism.
Q3) 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.
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Chapter 13: Flow Cytometry and Laboratory Automation
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Q1) Which light signal in flow cytometry could be used to provide information about the expression of a protein on the outer surface of a cell membrane?
A) Forward-angle light scatter
B) Red light emitted by phycoerythrin
C) Polarized light
D) Right-angle light 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) 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.
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Chapter 14: Hypersensitivity
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Q1) The precipitation of immune complexes in small blood vessels under the skin that occurs when antigen is injected in an animal with large amounts of circulating antibody describes which of the following?
A) Serum sickness
B) Arthus reaction
C) Anaphylaxis
D) Delayed hypersensitivity
Q2) Which of the following diseases is an example of a type II hypersensitivity?
A) Anaphylaxis
B) Myasthenia gravis
C) Post-streptococcal glomerulonephritis
D) Bruton's agammaglobulinemia
Q3) What immune phenomenon is responsible for the muscle weakness associated with myasthenia gravis?
A) Binding of antibody to a receptor on muscle cells
B) Muscle cell destruction by cytotoxic T cells
C) Deposition of immune complexes in the muscles
D) Release of histamine from mast cells in the muscles
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16
Chapter 15: Autoimmunity
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Q1) A perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA)staining pattern consists of:
A) diffuse, granular staining at the outer edges of the cell cytoplasm.
B) a continuous fluorescent ring (rim) in the cytoplasm, close to the plasma membrane.
C) fluorescence surrounding the lobes of the nuclei.
D) dense staining of neutrophilic granules.
Q2) An autoimmune disease characterized by pain and progressive destruction of the joints,weight loss,morning stiffness,and presence of an antibody directed against IgG best describes:
A) rheumatoid arthritis.
B) lupus.
C) hemolytic disease of the newborn.
D) hemolytic anemia.
Q3) Homogeneous staining of the nucleus in an antinuclear antibody test indicates:
A) anti-RNA antibody.
B) antibody to DNA-histone complexes.
C) anticentromere antibody.
D) antibody to extractable nuclear antigens.
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Chapter 16: Transplantation Immunology
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Q1) 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
Q2) 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
Q3) The percent (%)panel reactive antibody (%PRA)is the proportion of lymphocytes in the panel killed by the patient's serum and complement.
A)True
B)False
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Chapter 17: Tumor Immunology
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Q1) Cancer antigen 19-9
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
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 carcinoma?
A) A cancer that is derived from skin or epithelial linings of internal organs or glands
B) A cancer that is derived from muscle, fat, and 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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19
Chapter 18: Immunoproliferative Diseases
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Q1) 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
Q2) 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
Q3) 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.
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Chapter 19: Immunodeficiency Diseases
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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) The most common complement component deficiency is:
A) C1q.
B) factor B.
C) MASP.
D) C2.
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) The pathogenesis of poststreptococcal glomerulonephritis involves:
A) deposition of immune complexes in the kidneys.
B) destruction of glomeruli by streptolysin O.
C) bacterial-induced dehydration.
D) invasion of the kidneys by Streptococcus pyogenes.
Q2) What is the main reason testing for cold agglutinins is no longer recommended to diagnose infection with Mycoplasma pneumonia?
A) It is difficult to perform.
B) False positives may be caused by certain viruses.
C) Very few people develop anti-I antibodies.
D) It requires expensive instrumentation.
Q3) 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.
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Page 22
Chapter 21: Spirochete Diseases
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Q1) The antibody known as reagin is:
A) only present in the disease syphilis.
B) tested for using charcoal sensitized with cardiolipin.
C) found in all patients with primary syphilis.
D) antibody directed against IgG.
Q2) 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
Q3) Laboratory results for a patient indicated a positive RPR and a negative FTA.The patient had no obvious sore,rash,or other symptoms.What is the most likely cause of these results?
A) Primary syphilis
B) Secondary syphilis
C) Tertiary syphilis
D) Another disease, such as mononucleosis
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Chapter 22: Serological and Molecular Diagnosis of Parasitic
and Fungal
Infections
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Q1) 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.
Q2) Suppose a parasite invades a patient and causes disease.The patient develops an immune response and has some resistance to the parasite but is not cured.This outcome is considered what type of host-parasite interaction?
A) Symbiosis
B) Commensalism
C) Sterilizing immunity
D) Concomitant immunity
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Page 24
Chapter 23: Serology and Molecular Detection of Viral Infections
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Q1) 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.
Q2) Swollen parotid glands are key diagnostic indicators of:
A) measles.
B) mumps.
C) varicella.
D) rubella.
Q3) 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.
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Chapter 24: Laboratory Diagnosis of HIV Infection
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Q1) Of the designated subtypes of HIV,which is the most common in the United States?
A) Subtype B
B) Subtype C
C) Subtype A
D) Subtype K
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) Which HIV group is responsible for a majority of the HIV infections worldwide?
A) Group M
B) Group O
C) Group N
D) Group P
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
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Chapter 25: Immunization and Vaccines
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Q1) 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
Q2) Toxoid 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
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