final exam immunology review (multiple choice)
What is the titer in tube #6 if tube #1 is undiluted and the dilutions are doubled? a. 64 b. 128 c. 32 d. 16
a. 64
Positive selection of T cells selects for T cells that are a. Able to recognize MHC b. Able to differentiate self from non-self antigens c. T cells that are specific to a particular type of antigen d. None of the above
a. Able to recognize MHC
The strength with which an antibody binds to an antigen is termed the a. Affinity b. Avidity c. Valence d. Reactivity
a. Affinity avidity is the force that keeps the antigen-antibody complex together after initial binding
Active immunity differs from passive immunity because in active immunity a. Antibody is produced by the host b. Does not produce memory c. Occurs between mother and baby d. Antibody is synthetic
a. Antibody is produced by the host
In the direct fluorescent antibody-screening test for the diagnosis of syphilis, which of the following labeled antibody reagents is used? a. Antibody to T. pallidum b. Antibody to human immunoglobulin c. Antibody to lecithin d. Antibody to cardiolipin
a. Antibody to T. pallidum
1. What is a "hallmark" of the innate immune system? a. Available quickly b. Specific for the antigen c. It has memory d. It can discriminate
a. Available quickly
What is the function(s) of the Fab region of an IgG immunoglobulin molecule? a. Binds to antigen b. Fix complement c. Secrete antigen d. Present antigen to T cells
a. Binds to antigen
Which complement components are associated only with classical pathway activation? a. C1q, C1r, C1s b. C3 c. C5, C6, C7 d. C8, C9
a. C1q, C1r, C1s
The mechanism responsible for pathology in autoimmune disease is a. Circulating immune complexes b. The inability to activate B cells c. Lack of intracellular killing after neutrophil phagocytosis of bacteria d. Non-specifically activated T cells
a. Circulating immune complexes
VDJ recombination in B cells results in a. Functional antibodies with a unique specificity b. Opsonization c. T cell positive selection d. Complement activation
a. Functional antibodies with a unique specificity
What is the most common form of hepatitis? a. HAV b. HBV c. HCV d. HDV
a. HAV
Which hepatitis marker is found in some HBsAG positive patients and indicates a high level of infectivity? a. HBeAG b. Anti-HBe c. Anti-HBc d. Anti-HBs
a. HBeAG
A common cause of false-positive Rheumaton results is a. Heterophile antibodies b. Antinuclear antibodies c. Cardiolipin antibodies d. There are no false-positive reactions observed with this assay
a. Heterophile antibodies
A cytokine that is produced by CD 4+ T cells and stimulates B cells to proliferate and produce immunoglobulins a. IL6 b. IL2 c. TNF-alpha d. INF-gamma
a. IL6
The immunoglobulin class is principally found in body secretions (saliva, tears, colostrums, etc)? a. IgA b. IgE c. IgG d. IgM
a. IgA
Which immunoglobulin classes activate the classical complement pathway? a. IgG and IgM b. IgA and IgE c. IgM and IgD d. IgE and IgG
a. IgG and IgM
what is the predominant type of antibody found in the serum of neonates born after full term gestation? a. Maternal IgG b. Infant IgA c. Infant IgG d. Infant IgM
a. Maternal IgG
Placental transfer of antibody from mother to fetus is an example of a. Naturally acquired, passive immunity b. Naturally acquired, active immunity c. Artificially acquired, active immunity d. Artificially acquired, passive immunity
a. Naturally acquired, passive immunity
Antigens from another member of the host's species that may elicit an immune response are a. Autoantigens b. Alloantigens c. Heteroantigens d. Heterophile antigens
b. Alloantigens
Hypersensitivity is? a. A previous exposure to an antigen b. An exaggerated immune response that causes tissue damage to the host c. Systemic immediate reaction that may be life threatening d. Antigens that can elicit IgE antibody response in certain individuals
b. An exaggerated immune response that causes tissue damage to the host
What acute phase reactant is a sensitive indicator of inflammation and infection? a. Complement b. C-reactive protein c. Heterophile antibody d. Antinuclear antibody
b. C-reactive protein
Severe recurrent infections are a sign of deficiency for which complement component? a. C1s b. C3 c. C7 d. C9
b. C3
A cytokine with chemotactic properties is a. Colony stimulating factor b. Chemokine c. TNF-alpha d. INF-gamma
b. Chemokine
A 3 y.o. female appeared to be developmentally slow. She had several facial anomalies, including a small jaw and ears that were set farther back than usual. She seemed prone to infections, especially yeast infections. Lab testing results were as follows: RBC counts normal; WBC counts indicated a decrease in lymphocytes. Flow cytometry results demonstrated the decrease in lymphocyte population was caused by low numbers of T cells. SPE showed a weak gamma band present. What immunodeficiency do you suspect? a. SCID b. DiGeorge anomaly c. PNP (Purine Nucleoside Phosphorylase) deficiency d. WAS (Wiskott-Aldrich Syndrome)
b. DiGeorge anomaly
Heterophile antibodies that agglutinate horse erythrocytes after absorption with guinea pig kidney antigen are found in infections with a. HIV b. Epstein-Barr Virus (EBV) c. Borreliaburgdorferii d. Cytomegalovirus (CMV)
b. Epstein-Barr Virus (EBV)
The Antistreptolysin O test is most useful to a. Diagnose Group A streptococcus (GAS) infections b. Identify patients at risk for ARF (rheumatic fever) or AGN (glomerulonephritis) c. Diagnose GAS endocarditis or septicemia d. Identify patient who have protective immunity to GAS
b. Identify patients at risk for ARF (rheumatic fever) or AGN (glomerulonephritis)
What immunoglobulin class is associated with hypersensitivity and allergic reactions? a. IgA b. IgE c. IgG d. IgM
b. IgE
A patient who is blood Group O is accidentally transfused with Group A blood. What antibodies are involved with this type II hypersensitivity reaction? a. IgM and IgE b. IgG and IgM c. IgG and IgE d. IgE and IgA
b. IgG and IgM
What is the end result of either complement pathway? a. Opsonin immune adherence b. Lysis c. Anaphylataxin d. Chemotaxin
b. Lysis (MAC complex)
What cells are associated with phagocytosis? a. Mast cells b. Macrophages, monocytes, and neutrophils c. Lymphocytes and mast cells d. Erythrocytes and neutrophils
b. Macrophages, monocytes, and neutrophils
Rheumatic heart diseased sometimes occurs after Group A streptococcal infections. In this condition, an autoimmune response attacks the tissues of the heart valves. This phenomenon is an example of: a. Epitope spreading b. Molecular mimicry - shared antigenic determinants c. Polyclonal B-cell activation d. Preferential activation of the thymus cells
b. Molecular mimicry - shared antigenic determinants
Autoantibodies to acetylcholine receptors are seen in which autoimmune disease? a. Multiple sclerosis b. Myasthenia gravis c. IDDM d. SLE
b. Myasthenia gravis
A common automated method for measuring immunoglobulins levels by precipitation reactions by detecting light scatter is a. Rocket electrophoresis b. Nephelometry c. Flow cytometry d. Western blot
b. Nephelometry
All of the following are true regarding IgA deficiency EXCEPT: a. Patients may be asymptomatic b. Patients are treated with IV Ig c. Patients have increased susceptibility to infections in the respiratory tract d. Patients have increased allergic disorders
b. Patients are treated with IV Ig
The LE cell found in lupus erythematosus is best described as which of the following a. A T cell that is enlarged and reactive b. A B cell that is enlarged and reactive c. A neutrophil that has engulfed the nucleus of another neutrophil d. A macrophage that has engulfed a T cell
c. A neutrophil that has engulfed the nucleus of another neutrophil
The term pleiotropy means a. Cytokine that acts as a local mediator b. Different cytokines with similar effects c. A single cytokine with many different actions d. None of the above
c. A single cytokine with many different actions
What antinuclear antibody is present in Sjogren's disease? a. Anti-histone b. Anti-Sm c. Anti- SSA d. Anti0Scl 70
c. Anti- SSA
Blood is drawn from a 25 year old woman with a clinical diagnosis of SLE. The ANA test is performed and a speckled pattern is detected. Which of the following auto-antibodies is most likely to be present? a. Anti-dsDNA b. Anti-histone c. Anti-Sm d. Anti-RNA
c. Anti-Sm
The reciprocal of the highest dilution of a patient sample in which antibody is detectable in a serial dilution is the a. Endpoint b. Postzone c. Antibody titer d. Zone of equivalence
c. Antibody titer
The equivalence zone is a (an) a. Area of false negativity b. Area of false positivity c. Area of maximum reactivity in a serological test d. Technical problem due to improper specimen handling
c. Area of maximum reactivity in a serological test
A positive PPD is an example of a. Immediate hypersensitivity reaction b. Immune complex disorder c. Delayed hypersensitivity reaction d. Cytotoxic reaction
c. Delayed hypersensitivity reaction
What is the cause of the facial anomalies in the patient with DiGeorge anomaly a. Abnormal gene codes for a protein chain called gamma chain that is common to receptors for interleukins. b. Affects an enzyme involved in metabolism of purines, producing a moderate to severe defect in cell mediated immunity with normal or only mildly impaired humoral immunity c. Developmental abnormality of the 3rd and 4th pharyngeal pouches that affect thymic development d. Lack circulation mature B cells
c. Developmental abnormality of the 3rd and 4th pharyngeal pouches that affect thymic development
Double negative thymocytes a. Express both CD4 and CD8 on their surface b. Express two CD4 markers on their surface c. Express neither CD8 or CD4 on their surface d. Express neither MHC I or MHC II on their surface
c. Express neither CD8 or CD4 on their surface
Which hepatitis markers are important in testing blood products? a. Anti-HAV and anti-HBs b. Anti-D, anti-HAV, and anti-HBsAG c. HBsAG, anti-HBc (core) and anti-HCV d. Anti-HAV and anti-HEV
c. HBsAG, anti-HBc (core) and anti-HCV
Which hepatitis is the major cause of about 90% of all transfusion-related hepatitis? a. HAV b. HBV c. HCV d. HDV
c. HCV
A 39-year-old woman presented with a large, painless swelling in her neck. The enlargement had been a gradual process over 2 years. She had puffy eyelids, dry hair, and felt increasingly tired. On examination, her thyroid was diffusively enlarged and had a rubbery consistency. There were no signs of thyroid failure. Lab tests confirmed high titer antibodies to thyroid peroxidase and thyroglobulin. The patient likely has a. Grave's Disease b. Goodpasture's syndrome c. Hashimoto's Thyroiditis d. Multiple Sclerosis
c. Hashimoto's Thyroiditis
Antigens from an unrelated species that are so closely related or identical that antibody to one will cross-react with the antigen of another is a. Autoantigen b. Alloantigen c. Heterophile d. Epitope
c. Heterophile
The most common immunodeficiency is a. Total IgG deficiency b. IgG subclass 2 deficiency c. IgA deficiency d. IgM deficiency
c. IgA deficiency
What is the site of fluorescence which indicates a positive result for anti-dsDNA in the Crithidia assay? a. Polar body staining b. Nuclear staining c. Kinetoplast staining d. Peripheral nuclear staining
c. Kinetoplast staining
All are characteristics of an antigen except a. Foreignness b. Chemical complexity c. Low molecular weight d. Ability to be degraded
c. Low molecular weight
The lectin pathway of complement is initiated by a. IgG antibodies b. C1 c. MBL binding mannose and other sugars found in microorganisms d. Factors B and D
c. MBL binding mannose and other sugars found in microorganisms
Serum proteins that attach to a foreign substance and help prepare it for phagocytosis are a. Acute phase reactants b. Chemokines c. Opsonins d. Interferons
c. Opsonins
What is necessary to determine if an individual has had a recent infection? a. Acute sample only b. Convalescent sample only c. Paired sera- acute and convalescent tested in parallel d. Single serum sample only
c. Paired sera- acute and convalescent tested in parallel
Antibodies are secreted by: a. Marrow stem cells b. T-lymphocytes c. Plasma cells d. Natural killer cells
c. Plasma cells
An assay to measure antigen-specific IgE is: a. Arthus reaction b. RIST c. RAST d. Schilling test
c. RAST
How does the secondary immune response differ from the primary response? a. The antibody levels produced are higher in the secondary immune response b. IgG is the predominant antibody class produced in the secondary immune response c. The lag phase is shorter in the secondary immune response d. All of the above
d. All of the above
Various factors to consider when interpreting serologic tests include: a. Cross-reactivity b. Age and immunocompetence of the patient c. Sensitivity and specificity of the test method d. All of the above
d. All of the above
What is a general definition for Rheumatoid factor? a. Increase in clonal deletion of mutant cells b. Inability to discriminate between self and non-self c. Receive products of an immunological response of another individual d. An antibody directed against the Fc portion of an IgG molecule
d. An antibody directed against the Fc portion of an IgG molecule
In the antinuclear antibody (ANA) IFA test, which of the following antibody is associated with systemic lupus erythematosus? a. Anti-RNP b. Anti-SSB c. Anti-RNA d. Anti-DNA
d. Anti-DNA
What test provides the first serological evidence of convalescence during an HBV infection? a. HBsAG b. Anti-HBs c. Anti-HBc d. Anti-HBe
d. Anti-HBe
A homogenous pattern of nuclear staining in the ANA test may be due to the presence of which of the following antibodies? a. Anti-Sm b. Anti-SSA c. Anti-ENA d. Anti-dsDNA
d. Anti-dsDNA
The portion of the immunoglobulin molecule that determines the class of that molecule is a. Light chain b. Heavy chain c. Variable region d. Constant region
d. Constant region
False positive HIV serologies can occur with a. Lack of sufficient antibody concentration b. B-cell dysfunction c. Prozone d. Cross reacting HLA antigens or women who have had multiple pregnancies
d. Cross reacting HLA antigens or women who have had multiple pregnancies
MHC Class I antigens present: a. Exogenous antigens to CD4+ T cells b. Exogenous antigens to CD8+ T cells c. Endogenous antigens to CD 4+ T cells d. Endogenous antigens to CD 8+ T cells
d. Endogenous antigens to CD 8+ T cells
The portion of the immunoglobulin molecule that binds to the antigen is a. Variable region of the light chain b. Constant region of the heavy chain c. Fc receptor d. F(ab) region
d. F(ab) region
The most common fluorochrome is a. Calcoflour white b. Alkaline phosphate c. Horseradish peroxidase d. Fluorescein isothiocyanate
d. Fluorescein isothiocyanate
A disease characterized by glomerulonephritis, pulmonary symptoms, and anti-basement membrane antibodies that is most common in young males is a. Grave's Disease b. Pernicious anemia c. Systemic lupus erythematosus d. Goodpasture's syndrome
d. Goodpasture's syndrome
A cytokine with anti-viral properties: a. IL1 b. IL2 c. TNF d. IFN
d. IFN
Characteristics of MHC include all of the following EXCEPT : a. found on all nucleated cells b. inherited as a haplotype c. play a role in cellular immunity development d. Immature B cell
d. Immature B cell
A general definition for autoimmunity is a. An antibody directed against the Fc portion of an IgG molecule b. Receive products of an immunological response of another individual c. Increase in clonal deletion of mutant cells d. Inability to discriminate between self and non-self
d. Inability to discriminate between self and non-self
The mechanism most frequently present in systemic lupus erythematosus is directed against a. Myelin b. Surface antigens of bone marrow stem cells c. Surface antigens of renal cells d. Nuclear antigen
d. Nuclear antigen
Interpret the following EBV serology panel: Anti-VCA IgM (-); anti-VCA IgG (+); EA (+); EBNA (+) a. Acute primary infection b. Recent primary infection c. Remote primary infection d. Reactivation
d. Reactivation
Functions of antibodies include all of the following EXCEPT a. Opsonization b. Killing microorganisms c. Fixing complement d. Secreting cytokines
d. Secreting cytokines
Both B lymphocytes and T lymphocytes are derived from? a. Macrophages and monocytes b. Mucosal-associated lymphoid tissue (MALT) c. Fetal liver d. Stem cells
d. Stem cells
What condition is characterized by the presence of Anti-Scl 70? a. SLE b. Rheumatoid arthritis c. Polymyositis scleroderma d. Systemic sclerosis
d. Systemic sclerosis
Which group of cells has a specific regulatory population? a. neutrophils b. macrophages c. B cells d. T cells
d. T cells
Contact dermatitis from position ivy is mediated by a. B lymphocytes b. Monocytes c. Polymorphonuclear cells d. T lymphocytes
d. T lymphocytes
While playing tennis on a warm day, a young man felt a wasp on his arm and brushed it off, but still received a mild sting, which he ignored. Ten minutes later he felt dizzy and began to itch under his arms and on his scalp. When he broke out in hives and felt tightness in his chest, he headed for the hospital. On the way he felt cold and clammy and collapsed on the seat of the taxi. In the emergency unit his pulse was barely detectable. What type of hypersensitivity reaction did he have? a. Type I b. Type II c. Type III d. Type IV
a. Type I
In general, a myeloma secreting which type of paraprotein is most likely to cause renal failure? a. IgG a. Қ light chains b. IgM c. μ heavy chains
a. Қ light chains
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. Additional lab tests show decreased Vitamin B12 levels and decreased RBCs. This woman has a. Myasthenia gravis b. Pernicious anemia c. Multiple Sclerosis d. Grave's Disease
b. Pernicious anemia
What is an acute phase protein? a. Substances that enhance phaogcytosis by increasing the rate and quality of uptake of a particle b. Plasma protein whose concentration increases or decreases during inflammation c. Produces mediator substances that destroy cells d. Responsible for the cellular immune response
b. Plasma protein whose concentration increases or decreases during inflammation
Antigen excess occurs in a. Prozone reactions b. Postzone reactions c. Equivalence reactions d. Poor technique
b. Postzone reactions
The visible serologic reaction between soluble antigen and its specific antibody is? a. Sensitization b. Precipitation c. Agglutination d. Opsonization
b. Precipitation
The formation of an insoluble complex made up of soluble antigen and soluble antibody is a. Sensitization b. Precipitation c. Agglutination d. Opsonization
b. Precipitation agglutination is when particulate antigens (ie cells) bind together in order to form a larger complex in the presence of antibody (AB)
Interpret the following EBV serology panel: Anti-VCA IgM (+); anti-VCA IgG (+); EA (+); EBNA (-) a. Acute primary infection b. Recent primary infection c. Remote primary infection d. Reactivation
b. Recent primary infection
In the classical pathway, there are 3 main sequences of events. They are: a. Activation, recognition, attack b. Recognition, activation, attack c. Attack, recognition, activation d. None of the above
b. Recognition, activation, attack
Hepatitis D is a a. Satellite virus that infects with hepatitis E b. Satellite virus that infects with hepatitis B c. Satellite virus that infects with hepatitis A d. Satellite virus that infects with hepatitis C
b. Satellite virus that infects with hepatitis B
An adjuvant is a substance added to a vaccine to increase the immunizing potential of the antigen. Select one way this is accomplished from those listed below a. Increases the protein content of the fluid b. Slows the release of the antigen thereby increasing the exposure time c. Increased the degradation of the antigen d. Promotes phagocytosis
b. Slows the release of the antigen thereby increasing the exposure time
A 28-year old male is seen in the ED with a wet ulcerated lesion of the penis. The ED physician orders an RPR. The result is reported as "non-reactive." The ED physician questions this result and requests an RPR titer. The RPR titer is reported as "non-reactive." Which of the options listed below would describe your recommendation to the physician who wants to help with the diagnosis of this case? a. Suggest that no further testing is necessary since the patient probably does not have syphilis b. Suggest the physician refer the patient to the Health Department for a "darkfield microscopy" or "direct FA" to rule out syphilis c. Suggest that an MHA-TP be performed to confirm the diagnosis d. Suggest the patient be retested in 7-10 days with the FTA-ABS test
b. Suggest the physician refer the patient to the Health Department for a "darkfield microscopy" or "direct FA" to rule out syphilis
Systemic lupus erythematosus is an example of a. Organ specific disease b. Systemic autoimmune disease c. Intermediate autoimmune disease d. None of the above
b. Systemic autoimmune disease
A 9-year-old female is taken to the ER with hives covering her entire body. The physician discusses the possibility of an allergy. He asks if the child has been taking any medications and asks what the child had for dinner. She did not think the clams should be causing any problems since the child had eaten the fried clams only last month for the first time and had not experienced any hives at that time. The physician prescribes an injection of Benadryl and anti-histamine, and within a short time the symptoms diminished. The doctor tells the mother that it looks like the child does have a food allergy to fried clams since shellfish commonly causes that type of condition and recommends that the child not be allowed to eat shellfish in the future. What type of hypersensitivity does this case study depict? a. Type II b. Type I c. Type III d. Type IV
b. Type I (Anaphylatic hypersensitivity) type II (Antibody mediated cytotoxic hypersensitivity) III (Complex mediated hypersensitivity) IV (Cell mediated hypersensitivity)
The process by which neutrophils travel through the intact capillary is: a. opsonization b. diapedesis c. chemotaxis d. phagocytosis
b. diapedesis
The innate immune response's first line of defense is a. granulocytes b. intact skin and mucus membranes c. phagocytosis d. natural killer cell
b. intact skin and mucus membranes
A baby is born to a mother who has latent syphilis. The baby exhibits no symptoms of disease at birth, but a cord blood RPR is "reactive." How should these results be handled? a. Report as reactive only, no further testing is indicated. b. Ignore results, as syphilis cannot be transmitted during the latent stage c. Repeat test in several week and look for a change in titer d. Report the results as being caused by transplacental passage of mother's antibodies.
c. Repeat test in several week and look for a change in titer
A pro-inflammatory cytokine that is a major mediator of the immune response to gram negative bacteria is a. IL1 b. IL2 c. TNF d. IFN
c. TNF
What is the most likely explanation when a patient has clinical signs of viral hepatitis but tests negative for hepatitis A IgM, hepatitis B surface antigen and hepatitis C antibody? a. Tests were performed improperly b. The patient does not have hepatitis c. The patient may be in the "core window" d. Clinical evaluation was performed improperly
c. The patient may be in the "core window"
Which two organs are considered the primary lymphoid organs where immunocompetent cells originate and mature? a. Lymph nodes and thoracic duct b. Thyroid and Peyer's patches c. Thymus and bone marrow d. Spleen and mucosal-associated lymphoid tissue (MALT)
c. Thymus and bone marrow
A 38-year-old man presented with a 3-month history of intermittent swelling of his ankles and puffiness of his face. There were no urinary symptoms and no family history of renal disease. Antinuclear antibodies and hepatitis B surface antigen were not detected, and the antistreptolysin O titer was not raised. There were no free light chains in his urine. A renal biopsy was done to find the cause of his nephrotic syndrome; this showed no obvious increase in cellularity. However, the basement membrane of all glomeruli showed marked but uniform thickening with numerous subepithelial 'spikes'. Immunofluorescent examination showed granular deposits of IgG and C3 along all the glomerular capillary walls. The biopsy appearances were typical of membranous glomerulonephritis. What type of hypersensitivity reaction did he have? a. Type I b. Type II c. Type III d. Type IV
c. Type III
Which assay is used to diagnose neurosyphilis? a. RPR b. Darkfield c. VDRL d. FTA-ABS
c. VDRL
Which of the following molecules is the better immunogen? a. nucleic acid b. polysaccharide c. protein d. lipid
c. protein
