From the following, identify a specific component in the adaptive immune system that is formed in response to antigenic stimulation:

A Lysozyme

B. Complement

C. Commensal organisms

D. Immunoglobulins

C. Commensal Organisms

Which two organisms are considered the primary lymphoid organs in which immunocompetent cell originate and mature?

A. Thyriod and Peryers Patches

B. Thymus and bone marrow

C. Spleen and mucosal-associated lymphoid tissue

D. Lymph duct and thoracic duct

What type of B cells are formed after antigen stimulation?

A. Plasma cells and memory B cells

B. Mature B cells

C. Antigen-dependent B cells

D. Receptor-activated B cells

T cells travel from the bone marrow to the thymus for maturation. What is the correct order of the maturation sequence for T cells in the thymus?

A. Bone marow to the cortex, after thymic education, released back to peripheral circulation.

B. Maturation and selection occur in the cortex, migration to the medulla, release of mature T cells to secondary lymph organs.

C. Storage in either the cortex or medulla, release of T cells into the peripheral circulation

D. Avtivation and selection occur in the medulla, mature T cells are stored in the cortex until activated by antigen.

Which CD narker appears during the first stage of T-cell development and remains present as an identifying marker for T cells.

A. CD1

B. CD2

C. CD3

D. CD4 or CD8

Which markers are found on mature, peripheral helper T cells?

A. CD1, CD2, CD4

B. CD2, CD3, CD8

C. CD1, CD3, CD4

D. CD2, CD3, CD4

Which T cell expresses the CD8 marker and acts specifically to kill tumors or virally infected cells?

A. Helper T

B.T supressor

C. T cytotoxic

D. T inducer/suppressor

How are cytotoxic T cells and natural killer cells similiar?

A. Require antigen to be present

B. Effective against virally infective cells

C. Recognize antigen in associationwith HLA class II markers

D. Do not bind to infected cells

What is the name of the phagocytic cells are attracted toa substance such as a bacterial peptide?

A. Diapedesis

B. Degranulation

C. Chemotaxic

D. Phagotaxis

All of the following are immunologic functions of complement  except:

A. Induction of an antiviral state

B. Opsonization

C. Chemotaxis

D. Anaphylatoxin formation

Which complement component is found in both the classic and alternative pathway ?

A. C1

B. C4

C. Fator D

D. C3

Which immunoglobulin(s) help(s) initialize the classic complement pathway ?

A. IgA and IgD

B. IgM only

C. IgG and IgM

D. IgG only

How is complement activity destroyed in vitro ?

A. Heating serum at 56° C for 30 min

B. Keeping serum at RT of 22°C for 1 hour

C. Heating serum at 37°C for 45 min

D. Freezing serum at 0°C for 24 hrs

What is the purpose of C3a, C4a, and C5a, the split products of the complement cascade?

A. To bind with specific membrane receptors of lymphocytes and cause release of cytotoxic substances.

B. To cause increased vascular permeability, contraction of smooth muscle, and release of histamine from basophils

C. To bind with membrane receptors of macrophages to facilitate phagocytosis and the removal of debris and foreign substances.

D. To regulate and degrade membrane cofactor protein after activation by C3 convertase

Which region if the immunoglobulin molecule can bind antigen ?

A. Fab

B. Fc

C. C_L

D. C_H

Which region determines

whether an immunoglobulin molecule can fix complement ?

A. V_H

B. C_H

C. V_L

D. C_L

Which immunoglobulin class(es) has/have a J chain?

A. IgM

B. IgE and IgD

C. IgM and sIgA

D. IgG3 and IgA

Which immunoglobulin appears first in the primary immune response ?

A. IgG

B. IgM

C. IgA

D. IgE

Which immunoglobulin appears in highest titer in the secondary response ?

A. IgG

B. IgM

C. IgA

D. IgE

Which immunoglobulins can cross the placenta?

A. IgG

B. IgM

C. IgA

D. IgE

Which immunoglobulin cross-links mast cells to release histamine?

A. IgG

B. IgM

C. IgA

d. IgE

All of the following are the functions of immunoglobulins except:

A. Neutralizing toxic substances

B. Facilitating phagocytosis through opsonization

C. Interacting with T_C cells to lyse virus

D. Combining with complement to destroy cellular antigens

Which of the following antigens is classified as an MHC class II antigen?

A. HLA-A

B. HLA-B

C. HLA-C

D. HLA-DR

Which MHC class of antigens is necessary for antigen recognition by CD4 positive T cells?

A. Class I

B. Class II

C. Class III

D. No MHC molecule is necessary for antigen recognition

Which of the following are products of HLA class III genes?

A. T cell immune receptors

B. HLA-D antigens on immune cells

C. Complement proteins C2,C4, and Factor B

D. Immunoglobulin V1 regions

What molecule is on the surface of most T cells recognizes antigen?

A. IgT,a four chain molecule that includes tau heavy chain

B. MHC protein, a two chain molecule encoded by the HLA region.

C. CD3, consisting of six different chains

D. TcR, consisting of two chains: alpha and beta

The T cell antigen receptor is similiar to immunoglobulin molecule in that it:

A. Remains bound to the cell surface and is never secreted

B. Contains V and C regions on each of its chains

C. Binds complement

D. Can cross the placenta and provide protection to the fetus

Toll like receptors are found on which cells?

A. T cells

B. Dendritic cells

C. B cells

D. Large granular lymphocytes

Macrophages produce which of the following proteins during antigen processing?

A. IL-1 and IL-6

B. gamma interferon

C. IL-4,IL-5, and IL-10

D. Complement compents C1 and C3

A superantigen, such as toxic shock syndrome toxin-1(TSST1) bypasses the normal antigen processing stage by binding to and cross linking ?

A. A portion of an immunoglobulin molecule and complement component C1

B. Toll like receptors and an MHC class I molecule

C. A portion of an immunoglobulin and a portion of a T cell receptor

D. A portion of a T cell receptor and a MHC class II molecule

The interaction between an individual antigen and antibody molecule depends upon several types of bonds such as ionic,hydrogen,hydrophobic,van der Waals.How is the strength of this attraction characterized ?

A. Avidity

B. Affinity

C. Reactivity

D. Valency

Lab is evaluating an ELISA for detecting and antibody to CCP. Lab includes both healthy patients and those with connective tissue disorders. These specimens determine:

A. Sensitivity

B. Precision

C. Bias

D. Specificity

The detection of precipitation reactions depends on the presence of maximal proportions of antibody and antigen. Patients sample contains large amount of antibody, but the reaction in the test system is negative. ???

A. Performanence error

B. Low specificity

C. Shift in the zone if equivalence

D. Prozone phenomenon

Which part of the RID -radial immunodiffusion test system contains the antisera ?

A. Center wells

B. Outer wells

C. Gel

D. Antisera may be added to any well

What is the interpretation when an Ouchterlony plate shows crossed lines between wells 1 and 2 ( antigen is placed in the center well and antisera in wells 1 and 2)

A. No reaction between wells 1 and 2

B. Partial identity between wells 1 and 2

C. Nonidentity between cells 1 and 2

D. Identity between wells 1 and 2

Why is RIA or EIA the method of choice for detection of certain analytes,such as hormones, normally found in low concentrations ?

A. Because of low cross reactivity

B. Because of high specificity

C. Because of high sensitivity

D. Because test systems cannot be designes as both competitive and noncompetitive assays

What comprisis the indicator system in ans ELISA for detecting antibody?

A. Enzyme-conjugate antibody + chromogenic substrate

B. Antigen-substrate + chromogenic substrate

C. Enzyme + antigen

D. Substrate + antigen

A. Enzyme-conjugate antibody + chromogenic substrate

What outcome results from improper washing of a tube or well after adding the enzyme-antibody conjugate in an

ELISA system ?

A. Resilt will be falsely decreased

B. Result will be fasely increased

C. Result will be unaffected

D. Result is impossible to determine

B. Result will be fasely increased

What would happen if the color reaction phase is prolonged in one tube or well of an ELISA test?

A. Result would be falsely decreased

B. Result will be fasely increased

C. Result would be unaffected

D. mImpossible to determine

The absorbance of a sample measured by ELISA is greater than the highest standard. What corrective action should be taken?

A. Extrapolate an estimated result from the highest reading

B. Repeat the test using a standard of higher concentration

C. Repeat the assay using one half the volume of the sample.

D. Dilute the test sample

A patient was supected of having a lymphoproliferative disorder. After several lab tests were completed, the patient was found to have IgM kappa paraprotein. In what sequence sould the lab tests leading to this diagnosis should have been done?

A. SPE and UPE followed by immunofixation electrophoresis on the positives

B. Immunoelectrophoresis of serum followed by immunofixation of serum if positive.

C. Immunoelectrophoresis of serum followed by protein electrophoresis of serum if positive.

D. Either SPE or IEP could have led to the final conclusion. Only a single test shouls have been performed.

A. SPE and UPE followed by immunofixation electrophoresis on the positives

An IFE performed on a serum sample showed a narrow dark band in the lanes containg anti-gamma γ and anti- lambda λ. How shoud this be interpreted ?

A. Abnormally decreased IgG concentration

B. Abnormal test result demonstrating monoclonal IgG lambda.

C. Normal test result

D. Impossible to determine without densitometric quantitation

WHich type of nephelometry is used to measure immune complex formation almost immediately after reagent has been added?

A. Rate ( kinetic )

B. Endpoint

C. Continous

D. One dimensional

An immunofluorescense microscopy assay(IFA) was performed and a significant antibody titer was reported. Positive and negative controls were ok. Clinical eval of patient was not consistent with positive result. Most likely explanation.

A. Clinical condition of the patient changed since the sample was tested.

B. Pattern of fluorescence was misinterpreted

C. The control results were misinterpreted

D. The wrong cell line was used for the test

What corrective action should be taken when an indeterminate patern occurs in an indirect IFA ?

A. Repeat the test using a larger volume of sample

B. Call the physician

C. Have another person read the slide

D. Dilute the sample and retest

Which statement best describes passive agglutination reactions used for serodiagnosis ?

A. Such agglutination reactions are more rapid bacause they are a single step process

B. Reactions require the addition of a second antibody

C. Passive agglutination reactions require biphasis incubation

D. Carrier particles for antigen such as latex particles are used.

What has happened in a titer, if tubes 5-7 show a stronger reaction than tubes 1-4 ?

A. Prozone reaction

B. Postzone reaction

C. Equivalence reaction

D. Poor technique

A. Prozone reaction

What is the titer in tube #8 if tube #1 is undiluted and dilutions are doubled ?

A. 64

B. 128

C. 256

D. 512

Which outcome indicates a negative resilt in a complement fixation test ?

A. Hemagglutination

B. Absence of agglutination

C. Hemolysis

D. Absence of hemolysis

What effect does selecting the wrong gate have on the results when cells are counted by flow cytometry ?

A. No effect

B. Failure to count the desired cell population

C. Falsely elevated results

D. Impossible to determine

Which statement best describes basic immunophenotyping ?

A. Lineage determination by detecting antigens on the surface of the gated cells using fluorescent antibodies

B. Identification of cell maturity using antibodies to detect antigens within the nucleus

C. Identification and sorting of cells by front and side scater of light from laser

D. Analysis of cells collected by flow cytometry using traditional agglutination reactions

A flow cytometry scattergram of a bone marrow sample shows a dense population of cells located inbetween normal lymphoid and normal myeloid cells. What is most likely explanation ?

A. The sample was improperly collected

B. An abnormal cell population is present

C. The laser optics are out of alignment

D. The cells are most likely not leukocytes

Which serum antibody response usually characterizes the primary (early) stage of syphilis ?

A. Antibodies against spyhilis are undectectable.

B. Detected 1-3 weeks after appearance of first primary chancre.

C. Detected in 50% of cases before the primary chancre disappears

D. Detected within 2 weeks after infection

What substance is detected by the RPR and VDRL tests ?

A. Cardiolipin

B. Reagin

C. Specific antibody

D. Treponema pallidum

What type of antigen is used in the RPR card test ?

A. Live treponemal organisms

B. Killed suspension of treponemal organisms

C. Cardiolipin

D. Tanned sheep cells

Which of the following is the most sensitive to detect congenital syphillis ?

A. VDRL

B. RPR

C. Microhemagglutinin test for T pallidium (MHA-TP)

D. PCR

A biological false-positive reaction is LEAST likely with which test for syphilis ?

A. VDRL

B. Fluorescent T pallidium antibody absorbtion test

C. RPR

D. All are equally likely to detect a false positive result

A 12 year old girl has symptoms of fatigue and a localized lymphadenopathy. Lab tests reveal peripheral lymphocytosis, positive RPR and a positive monospot. What test should be done next ?

A. HIV test by ELISA

B. VDRL

C. Epstein Barr virus specific antigen test

D. MHA-TP

Which test is most likely to be positive in the tertiary stage of syphilis ?

A. FTA-ABS

B. RPR
C. VDRL

D. Reagin screen test (RST)

What is the most likely interpretation of the following syphilis serology results ?

RPR: reactive VDRL:reactive MHA-TP:nonreactive

A. Neurosyphilis

B. Secondary syphilis

C. Syphilis that has been succesfully treated

D. Biological false-positive

Which specimen is the sample of choice to evaluate latent or tertiary syphilis ?

A. Serum

B. Chancre fluid

C. CSF

D. Joint fluid

Interpret the following quantitative RPR test results ?

RPR titer :weakly  positive x8,reactive x16-x64

A. Excess antibody: prozone effect

B. Excess antigen,postzone effect

C. Equivalence of antigen and antibody

D. Impossible to interpret,testing error

Tests to id infection with HIV fall into which three general classification types of test?

A. Tissue culture,antigen,and antibody tests

B. Tests for antigens,antibodies and nucleic acid

C. DNA probe,DNA amplification,Western Blot tests

D. ELISA,Western blot and Southern blot

Which tests are considered screening tests for HIV ?

A. ELISA and rapid-antibody tests

B. Immunoflouresence,Western blot,radioimmunoassay precipitation assay

C. Culture,antigen capture asay, DNA amplification

D. Reverse transcriptase and messenger RNA assay

Which tests are considered confirmatory tests for HIV ?

A. ELISA and rapid antibody tests

B. Immunofluorescense assay(IFA), Western blot test, and PCR

C. Culture,antigen capture assay,polymerase chain reaction

D. Reverse transcriptase and mRNA assay

B. Immunofluorescense assay(IFA), Western blot test, and PCR

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

A woman had 5 pregnancies and subsequently tested positive for HIV by Western blot. What is the most likely reason for this result ?

A. Possible cross reaction with herpes or EBV antibodies

B. Interference from meds

C. Cross reaction with HLA antigens in the antigen preparation

D. Possibel technical error

Interpret the following results for HIV infections:

ELISA: positive, repeat ELISA:neg, Western Blot:no bands

A. Positive for HIV

B. Negative for HIV

C. Indeterminate

D. Further testing needed

B. Negative for HIV

Interpret the following results for HIV infection.

ELISA: positive,repeat ELISA:negative,Western blot: no bands

A. Positive for HIV

B. Negative for HIV

C. Indeterminate

D. Further testing needed

Interpret the followign results for HIV infection.

ELISA:positive,Western Blot:indeterminate, RIPA: negative

A. Positive for HIV-1

B. Positive for HIV-2

C. Cross-reaction: biological false positive result

D. Impossible to determine

What is the most likely explanation when antibody tests for HIV are negative but a PCR reaction test performed 1 week later is positive ?

A. Probable not HIV infection

B. Patient is in the 'window phase" before antibody production

C. Tests were performed incorrectly

D. Clinical signs may be misinterpreted

B. Patient is in the 'window phase" before antibody production

What criteria constitute the classification system for HIV infection?

A. CD4 positive t-cell count and clinical symptoms

B. Clinical symptoms,condition,duration and number of positive bands on Western blot.

C. Presence or absence of lymphadenopathy

D. Positive bands on Westerm blot and CD8 positive T-cell count

What is the main difficulty associated with the development of an HIV vaccinne ?

A. Virus has been difficult to culture,antigen extraction and concentration are laborious.

B. Human trials cannot be performed

C. Different strains of the virus are genetically diverse

D. Anti-idiotyped antibodies cannot be developed

Which T-helper to T-suppressor ratio is most likely in a patient with AIDS ?

A. 2:1

B. 3:1

C. 2:3

D. 1:2

What is a disadvantage of using a culture technique for diagnosis of HIV infection?

A. Time consuming

B. Large amounts of sample required

C. Difficult to grow

D. Difficult to measure growth

Which method is used to test for HIV infection in infants who are born to HIV positive moms?

A. ELISA
B. Western blot test

C. Polymerase chain reaction

D. Viral culture

C. Polymerase chain reaction

What is the most likely cause when a Western blot or ELISA is positive for all controls and samples?

A. Improper pipetting

B. Improper washing

C. Improper addition of sample

D. Improper reading

What constitutes a diagnosis of viral hepatitis ?

A. Abnormal test results for liver enzymes

B. Clinical sign and symptoms

C. Positive results for hepatitis markers

D. All of the above

Which of the following statements regarding infection with hepatitis D virus is true?

A. Occurs in patients with HIV infection

B. Does not progress to chronic hepatitis

C. Occurs in patients with Hep B

D. Is not spread through blood or sexual contact

All of the following heps viruses are spread through blood or blood products except:

A. Hep A

B. Hep B

C. Hep C

d. Hep D

Which hep B marker is the best indicator of early acute infection?

A. HBsAg

B. HBeAg

C. Anti-HBc

D. Anti-HBs

A. HBsAg

First marker,detected within 4 weeks of exposure

Which is the first antibody detected in serum after infection with hepatitis B virus?

A. Anti-HBs

B. Anti-Hbc

C. Anti-HBe

D. All are detectable at the same time

Which antibody persists in low level carriers of hep B virus ?

A. IgM anti-HBc

B. IgG anti-HBc

C. IgM anti-HBe

D. IgG anti-HBs

What is the most likely explanation when a patient has clinical signs of viral hepatitis but tests negative for hep A IgM,hep B surface antigen,and hep C Ab ?

A. Tests were performed improperly

B. The patients does not have hepatitis

C. The patient may be in the 'core window"

D. Clinical evaluation was performed improperly

Which hep B markers should be performed on blood products ?

A. HBsAg and anti-HBc

B. Anti-HBs and anti-HBc

C. HBeAg and HBcAg

D. Anti-HBs and HBeAg

Which hep antibody confers immunity against reinfection with hep B virus ?

A. Anti -HBc IgM

B. Anti-HBc IgG

C. Anti-HBe

D. Anti-HBs

Which test, other that seriological markers, is most consistently elevated in viral hepatitis ?

A. Anti nuclear antibodies

B. ALT

C. Absolute lymph count

D. LDH

If only anti-Hbs is positive, which of the following can be ruled out ?

A. Hepatitis B virus vaccination

B. Distant past infection with Hep B virus

C. Hep B immune globulin (HBIG)injection

D. Chronic hep B virus infection

Interpret the following results for EBV infection: IgG and IgM antibodies to viral capsid antigen(VCA) are positive.

A. Infection in the past

B. Infection with a mutual enhancer virus such as HIV

C. Current infection

D. Impossible to interpret,need more info

Interpret the following results for EBV infection: IgG ans IgM antibodies to viral capsid antigen are positive.

A. Infection in the past

B. Infection with a mutual enhancer virus such as HIV

C. Current infection

D. Impossible to interpret,need more information

Which statement concerning non-Forseman antibody is true?

A. It is not absorbed by guinea pig antigen

B. It is absorbed by guinea pig antigen

C. It does not agglitinate horse RBCs

D. It does not agglutinate sheep RBCs

Given a heterophile antibody titer or 224, which of the results below indicate IM ?

Absorbtion w/GPKidney            Absorbtion w/beef cells

A. 2 tube titer reduction         5 tube titer reduction

B. No titer reduction               no titer reduction

C. 5 tube titer reduction            5 tube titer reduction

D. 5 tube titer reduction                no titer reduction

The directions for a slide agglutination test instruction that after mixing the patient's serum and latex particle, the slide must be rotated for 2 minutes. What would happen of the slide were rotated for 10 minutes ?

A. Possible false positive

B. Possible false negative

C. No effect

D. DEpends on the amount of antibody present in the sample

A. Possible false positive

 Given a heterophile antibody titer of 224, which of the results below indicate serum sickness ?

Absorbtion w/GPKidney            Absorbtion w/beef cells

A. 2 tube titer reduction         5 tube titer reduction

B. No titer reduction               no titer reduction

C. 5 tube titer reduction            5 tube titer reduction

D. 5 tube titer reduction                no titer reduction

Given a herophile antibody titer of 224, which of the results below indicate an error in testing ?

Absorbtion w/GPKidney            Absorbtion w/beef cells

A. 2 tube titer reduction         5 tube titer reduction

B. No titer reduction               no titer reduction

C. 5 tube titer reduction            5 tube titer reduction

D. 5 tube titer reduction                no titer reduction

What is the endpoint for the ASO latex agglutination assay ?

A. highest dilution that shows no agglutination

B. highest dilution that shows agglutination

C. Lowest dilution that shown afflutination

D. Lowest dilution that shows no dilution

Interpret the following antistreptolysin O (ASO) results ?

Tube # 1-4(Todd unit 125)  no hemoysis,

Tube 5(Todd unit 166) hemolysis

A. Postive Todd unit : 125

B. Positive Todd unit : 166

C. Negative

D. Impossible to interpret

A. Postive Todd unit : 125

Which control shows the correct result for a valid ASO test ?

A.  SLO control, no hemolysis

B. Red cell control, no hemolysis

C. Negative

D. Impossible to interpret

A streptozyme test was performed, but the result was negative, even though the patient showed clinical signs of a streptoccal throut infection. What should be done next ?

A. Either ASO or anti-deoxyribonuclease B(anti-DNase B) testing

B. another streptozyme test using diluted serum

C. antihyaluronidase testing

D. wait 3-5 days and repeat the streptozyme test

A. Either ASO or anti-deoxyribonuclease B(anti-DNase B) testing

Rapid assays for influenza that utilize specimens obtained from nasopharyngeal swabs detect ?

A. IgM anti-influenza

B. IgA anti-influenza

C. IgA-influenza AG immune complexes

D. Influenza antigen

How can interfering cold agglutinins be removed from the test sample ?

Incubate the clot at 1-4 degrees for several hours, and then remove serum 

All tubes (dilutions) except the negative control are positive for cold agglutinins. This idicates :

Further serial dilutions are necessary