BOC Immunology
d
66. In a positive anti-streptolysin O enzyme inhibition test, the patient's: a) streptolysin "O" enzyme in the patient serum neutralizes the anti-streptolysin "O" reagent, resulting in no hemolysis b) red blood cells are hemolyzed by the streptolysin"O" enzyme in the reagent c) anti-streptolysin "O" neutralizes the streptomycin "O" reagent, resulting in hemolysis d) anti-streptolysin "O" inhibits the reagent streptolysin "O's" resulting in no hemolysis
d
67. Blood is drawn from a patient for serological tests for a viral disease at the time of onset and again 4 weeks later. The results of the test are considered diagnostic if the: a) first antibody titer is 2x the second b) first and second antibody titers are equal c) first antibody is 4x the second d) second antibody titer is at least 4x the first
b
68. Which of the following is most useful in establishing a diagnosis in the convalescence phase of a viral infection? a) slide culture b) serological techniques c) shell vial d) culture on Mccoy media
d
69. The best method to detect infections due to rubella, Epstein-Barr, and human immunodefiency viruses is: a) antigen detection by EIA b) cell culture c) antigen detection by Western blot d) antibody detection by EIA
a
7) The result of an anti-nuclear antibody test was a titer of 1:320 with a peripheral pattern. Which of the following sets of results best correlate with these results? a) anti-dsDNA titer 1:80, and a high titer of antibodies to Sm b) antimitochondrial antibody titer 1:160, and antibodies to RNP c) anti-Scl-70, and antibodies to single-stranded DNA d) high titers of anti-SS-A and anti-SS-B
a
71. A DPT vaccination is an example of: a) active humoral-mediated immunity b) passive humoral-mediated immunity c) cell-mediated immunity d) immediate hypersensitivity
b
72. Cells known to be actively phagocytic include: a) neutrophils, monocytes, basophils b) neutrophils, eosinophils, monocytes c) monocytes, lymphocytes, neutrophils d) lymphocytes, eosinophils, monocytes
a
73. The presence of HbsAg, anti-HBc and often HbeAg is characteristic of: a) early acute phase HBV hepatitis b) early convalescent phase HBV hepatitis c) recovery phase of acute HBV hepatitis d) past HBV infection
b
77. When testing a patient for HIV antibody, which of the following is used to confirm a positive screening test? a) radioimmunoassay b) Western blot c) immunofluorescence d) Elisa
a
8) Systemic lupus erythematosus patients often have which of the following test results? a) high titers of DNA antibody b) decreased serum immunoglobulin levels c) high titers of anti-smooth muscle antibodies d) high titers of antimitochondrial antibody
a
80. What kind of antigen-antibody reaction would be expected if soluble antigen is added to homologous antibody? a) precipitation b) agglutination c) complement fixation d) hemagglutination
a
81. The rapid plasma reagin test: a) is useful in screening for syphilis b) is useful in diagnosing syphilis c) does not give false-positives d) uses heated plasma
a
82. Flocculation tests for syphilis detect the presence of: a) reagin antibody b) antigen c) hemolysin d) Forssman antigen
a
83. In the cold agglutination test, the tubes containing the serum and erythrocytes are allowed to stand overnight in the fridge, and results are read next morning. If a disk of the erythrocytes floats up from the bottom of the tube with only the flick of a finger, this is read as a: a) 4+ reaction b) 2+ reaction c) 1+ reaction d) negative reaction
c
84. Flocculation tests for syphilis use antigen composed of: a) Treponema pallidum b) reagin c) cardiolipin and lecithin d) charcoal
d
86. A VDRL serum sample is heat inactivated, then placed in a fridge for overnight storage. Before being tested, the serum must be: a) kept colder than 10° C b) allowed to equilibrate to room temperature c) warmed to 37°C d) reheated to 56°C for 10 minutes
b
87. Substances that are antigenic only when coupled to a protein carrier are: a) opsonins b) haptens c) adjuvants d) allergens
b
89. A serological test for syphilis that depends upon the detection of cardiolipin-lecithin-cholesterol antigen is: a) FTA-ABS b) RPR c) MHA-TP d) TPI
b
91. The serological test for syphilis recommended for detecting antibody in Cerebrospinal fluid is: a) nontreponemal antibody b) CSF-VDRL c) FTA-ABS d) MHA-TP
b
96. What assay would confirm the immune status of hepatitis B virus? a) HBsAg b) anti-HBs c) IgM anti-HBcAg d) hepatitis C Ag
d
97. The following procedure has been routinely used for detection of hepatitis B surface antigen (HBsAg) because of its high level of sensitivity: a) hemagglutination b) counterimmunoelectrophoresis c) radial immunodiffusion d) ELISA
a
98. In an indirect ELISA method desiged to detect antibody to the rubella virus in patient serum, the conjugate used should be: a) anti-human IgG conjugated to an enzyme b) anti-rubella antibody conjugated to an enzyme c) rubella antigen conjugated to an enzyme d) anti-rubella antibody conjugated to a substrate
b
1) Antinuclear antibody tests are performed to help diagnose? a) acute leukemia b) lupus erythematosus c) hemolytic anemia d) Crohn disease
b
101. Which of the following is the best indicator of an acute infection with the hepatitis A virus? a) the presence of IgG antibodies to hepatitis a virus b) the presence of IgM antibodies to hepatitis a virus c) a sharp decline in the level of IgG antibodies to hepatitis a virus d) a rise in both IgM and IgG levels of antibody to hepatitis a virus
a
102. Biological false-positive VDRL reactions are frequently encountered in patients with: a) lupus erythematosus b) acquired immune defficiency syndrome (AIDS) c) gonorrhea d) tertiary syphilis
c
103. Which serological marker of HBV infection indicates recovery and immunity? a) viral DNA polymerase b) HBe antigen c) anti-HBs d) HBsAg
c
105. For diagnosis of late latent or tertiary syphilis, the most appropriate assay is: a) RPR b) VDRL c) FTA-ABS d) FTA-ABS IgM
b
106. A 26-year old nurse developed fatigue, a low-grade fever, polyarthrist and urticaria. Two months earlier she had cared for a patient with hepatitis. Which of the following findings are likely to be observed in this nurse? a) a negative hepatitis B surface antigen test b) elevated AST and ALT levels c) a positive rheumatoid factor d) a positive Monospot test
a
107. The classic antibody response pattern following infection with hepatitis A is: a) increase in IgM antibody; decrease in IgM antibody; increase in IgG antibody b) detectable presence of IgG antibody only c) detectable presence of IgM antibody only d) decrease in IgM antibody; increase in IgG antibody of the the IgG3 subtype
a
108) Refer to the following illustration of the hepatitis B virus: Select the corresponding lettered component indicated on the diagram for the surface antigen. a. A b. B c. C d. D
d
109) Refer to the following illustration of the hepatitis B virus: Select the corresponding lettered component indicated on the diagram for e antigen. a. A b. B c. C d. D
c
110) Refer to the following illustration of the hepatitis B virus: Select the corresponding lettered component indicated on the diagram for core antigen. a. A b. B c. C d. D
b
111) Refer to the following illustration of the hepatitis B virus: Select the corresponding lettered component indicated on the diagram for viral DNA. a. A b. B c. C d. D
c
113. The enzyme-linked immunosorbent assay (ELISA) technique for the detection of HBsAg: a) requires radiolabeled C1q b) is quantitated by degree of fluorescence c) uses anti-HBs linked to horseradish peroxidase d) uses beads coated with HBsAg
b
114. The antigen marker most closely associated with transmissibility of HBV infection is: a) HBsAg b) HBeAg c) HBcAg d) HBV
b
115. Chronic carriers of HBV: a) have chronic symptoms of hepatitis b) continue to carry HBV c) do not transmit infection d) carry HBV but are not infectious
c
117. The initial immune response following fetal infection with rubella is the production of which class(es) antibodies? a) IgG b) IgA c) IgM d) both IgG and IgA
a
118. A maternal serum rubella titer that is equal to or greater than 1:8 indicates: a) probable immunity to rubella b) evidence of acute rubella infection c) susceptibility to rubella infection d) absence of acute rubella
c
120. Which of the following is a treponemal test? a) RST b) RPR c) FTA-ABS d) VDRL
b
121. The air temperature throughout the serology laboratory is 20°C. How will this affect VDRL and RPR results? a) no effect -the acceptable test range is 20°C-24°C b) weaken reactions so that false negatives occur c) strengthen reactions so that positive titers appear elevated d) increase the number of false positives from spontaneous clumping
a
122. Which laboratory technique is most frequently used to diagnose and follow the course of therapy of a patient with secondary syphilis? a) flocculation b) precipitation c) complement fixation d) indirect immunofluorescence
a
124. The most commonly used serological indicator of recent streptococcal infection is the antibody to: a) streptolysin O b) hyaluronidase c) NADase d) DNA
c
125. Antibodies composed of IgG immunoglobulin: a) occur during the primary response to antigen b) are larger molecules than IgM antibodies c) can cross the placenta from mother to fetus d) can be detected in saline crossmatches
b
126. Measurement of serum levels of which of the following immmunoglobulins can serve as a screening test for multiple allergies? a) IgA b) IgE c) IgG d) IgM
b
127. Cells that are precursors of plasma cells and also produce immunoglobulins are: a) macrophages b) B lymphocytes c) T lymphocytes d) monocytes
d
128. IgM antibodes are frequently hemolytic because of: a) their dimeric structure b) the molecule's 5 antigen binding sites c) their sedimentation coefficient of 7-15 S d) their efficient ability to fix complement
c
129. To which of the following classes do the antibodies that cause hemolytic disease of the newborn belong? a) IgA b) IgE c) IgG d) IgD
b
130. It is important to note that when an infant is born, levels of specific antibody of the following class are used to indicate neonatal infection: a) IgA b) IgG c) IgM d) IgD
d
132. Antibodies are produced by: a) killer cells b) marrow stem cells c) mast cells d) B cells
a
133. Antibody class and antibody subclass are determined by major physiochemical differences and antigenic variation found primary in the: a) constant region of heavy chain b) constant region of light chain c) variable regions of heavy and light chains d) constant regions of heavy and light chains
a
135. Which of the following immunoglobulin classes is associated with a secretory component (transport piece)? a) IgA b) IgD c) IgE d) IgG
b
136. The immunoglobulin class typically found to be present in saliva, tears and other secretions is: a) IgG b) IgA c) IgM d) IgD
b
137. Treatment of IgG with papain results in how many fragments from each immunoglubulin molecule? a) 2 b) 3 c) 4 d) 5
d
138. The immunoglubulin class associated with immediate hypersensitivity or atopic reactions is: a) IgA b) IgM c) IgD d) IgE
c
139. Which of the following immunoglubulins is the most efficient at agglutination? a) IgG b) IgA c) IgM d) IgE
c
14) A patient has the following test results: The above results could be seen in patients with: a) rheumatic fever b) rheumatoid arthritis c) lupus erythematosus d) glomerulonephritis
c
142. The key structural difference that distinguishes immunoglubulin subclasses is the: a) number of domains b) stereometry of the hypervariable region c) the sequence of the constant regions d) covalent linkage of the light chains
d
146. The IgM molecule is a: a) dimer b) trimer c) tetramer d) pentamer
b
147. Which of the following immunoglubulin is present in the highest concentration in normal human serum? a) IgM b) IgG c) IgA d) IgE
a
16) Which of the following is the most sensitive and appropriate method for the detection of rheumatoid factor? a) nephelometry b) immunofixation electrophoresis c) immunofluorescence d) manual latex agglutination
d
17) Rheumatoid factor reacts with: a) inert substances such as latex b) Rh-pos erythrocytes c) kinetoplasts of Crithidia luciliae d) gamma globulin-coated particles
a
18) A consistently and repeatedly negative IFA-ANA is: a) strong evidence against untreated SLE b) associated with active SLE c) characteristic of SLE with renal involvement d) associated with lupus inhibitor
a
19) Positive rheumatoid factor is generally associated with: a) hyperglobulinemia b) anemia c) decreased erythrocyte sedimentation rate d) azotemia
a
20) The following results are from rubella titer performed on acute and convalescent sera using 2-fold serial dilution: Date tested: 1/23/04 Acute serum titer: 1:8 Convalescent serum titer: 1:32 After evaluating the above results, best interpretation is: a) results are consistent with active infection with rubella b) variation in the acute serum titers invalidates these results c) test should be repeated by a different technologist d) patient was not infected with rubella
a
21) Rheumatoid factors are immunoglobulins with specificitiy for allotypic determinants located on the: a) Fc fragment of IgG b) Fab fragment of IgG c) J chain of IgM d) secretory of component of IgA
a
22) Rheumatoid factor in patients serum may cause a false: a) positive test for the detection of IgM class antibodies b) negative test for the detection of IgM class antibodies c) positive test for the detection of IgG class antibodies d) negative test for the detection of IgG class antibodies
c
23) Rheumatoid factors are defined as: a) antigens found in the sera of patients with rheumatoid arthritis b) identical to the rheumatoid arthritis precipitin c) autoantibodies with specificity for the Fc portion of the immunoglobulin (IgG) molecule d) capable of forming circulating immune complexes only when IgM-type autoantibody is present
d
27) High titers of antimicrosomal antibodies are most often found in: a) rheumatoid arthritis b) systemic lupus erythematosus c) chronic hepatitis d) thyroid disease
b
29) In chronic active hepatitis, high titers of which of the following antibodies are seen? a) antimitochondrial b) anti-smooth muscle c) anti-DNA d) anti-parietal cell
c
3) Which of the ANA patterns shown above would be associated with high titers of antibodies to the Sm antigen? a) diagram A b) diagram B c) diagram C d) diagram D
d
31) Anti-RNA antibodies are often present in individuals having an anti-nuclear antibody immunoflurorescent pattern that is: a) speckled b) rim c) diffuse d) nucleolar
a
32) Anti-extractable nuclear antigens are most likely associated with which of the following anti-nuclear antibody immunofluorescent patterns? a) speckled b) rim c) diffuse d) nucleolar
c
33) In an anti-nuclear antibody indirect immunofluorescent test, a sample of patient serum shows a postive, speckled pattern. Which would be the most appropriate additional test to perform? a) antimitochondrial antibody b) immunoglobulin quantitation c) screen for Sm and RNP antibodies d) anti-DNA antibody using C luciliae
b
4) Sera to be tested for IFA-ANA 6 days after drawing is best stored at? a) room temperature b) 5°C +/- 2° c) -70°C in a constant temperature freezer d) -20°C in a frost-free self-defrosting freezer
c
41. In the indirect immunofluorescence method of antibody detection in patient serum, the labeled antibody is: a) human anti-goat immunoglobulin b) rheumatoid factor c) goat anti-human immunoglobulin d) complement
a
42. Which of the following describes an antigen-antibody reaction? a) the reaction is reversible b) the reaction is the same as a chemical reaction c) a lattice is formed at prozone d) a lattice is formed at postpone
c
43. The most common label in direct fluorescent antibody technique (DFA) is: a) alkaline phosphatase b) horseradish peroxidase c) fluorescein isothiocyanate d) calcofluor white
c
44. A substrate if first exposed to a patients serum, then after washing, anti-human immunoglobulin labeled with a fluorochrome is added. The procedure described is: a) fluorescent quenching b) direct fluorescence c) indirect fluorescence d) fluorescence inhibition
d
45. Avidity may be defined as the: a) degree of hemolysis b) titer of an antigen c) dilution of an antibody d) strength of a reacting antibody
b
46. In the interpretation of aggutination tests for febrile diseases, which of the following is of the greatest diagnostic importance? a) anamnestic reactions caused by the heterologous antigens b) rise in titer of the patient's serum c) history of previous vaccination d) naturally occurring antibodies prevalent where the disease is endemic
d
47. Cholesterol is added to the antigen used in flocculation tests for syphilis to: a) destroy tissue impurities present in the alcoholic beef heart extract b) sensitize the sheep RBCs c) decrease specificity of the antigen d) increase sensitivity of the antigen
c
48. The strength of a visible reaction is known as: a) prozone reaction b) absorption c) avidity d) elution
a
49. Which of the following describes an antigen-antibody precipitation reaction of non-indentity? a) precipitin lines cross, forming double spurs b) precipitin lines fuse, forming single spur c) no precipitin lines are formed d) precipitin lines fuse, forming a single arc
a
5) Antibodies directed at native DNA are most frequently associated with which pattern of fluorescence in the IFA-ANA test? a) rim b) diffuse c) speckled d) centromere
c
50. Which test has the greatest sensitivity for antigen detection? a) precipitin b) agglutination c) ELISA d) complement fixation
d
51. Excess antigen in precipitation gel reactions will: a) have no effect on the precipitate reaction b) not dissolve precipitate after formation c) enhance the precipitate reaction d) dissolve the precipitate after formation
b
52. Soluble immune complexes are formed under the condition of: a) antigen deficiency b) antigen excess c) antibody excess d) complement
b
53. The visible serological reaction between soluble antigen and its specific antibody is: a) sensitization b) precipitation c) agglutination d) opsonization
c
54) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area on the curve for equivalence precipitate is: a. A b. B c. C d. D
b
55) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area on the curve where no precipitate formed due to antigen is: a. A b. B c. C d. D
a
56) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area on the curve for prozone is: a. A b. B c. C d. D
d
57) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area on the curve where soluble antigen-antibody complexes have begun to form is: a. A b. B c. C d. D
b
58) The curve below obtained by adding increasing amounts of a soluble antigen to fixed volumes of monospecific antisera: The area in which the addition of more antibody would result in the information of additional precipitate is: a. A b. B c. C d. D
a
59) Which of the above figures demonstrates a reaction pattern of identity? a. Figure #1 b. Figure #2 c. Figure #3 d. Figure #4
b
6) The technologist observes apparent homogenous staining of the nucleus of interphase cells while performing an IFA-ANA, as well as staining of the chromosomes in mitotic cells. This result is: a) indicative of 2 antibodies, which should be separately reported after titration b) expected for anti-DNA antibodies c) inconsistent; the test should be reported with new reagent d) expected for anti-centromere antibodies
b
60) Which of the above figures demonstrates a reaction pattern of nonidentity? a. Figure #1 b. Figure #2 c. Figure #3 d. Figure #4
c
61) Which of the above figures demonstrates a reaction pattern showing 2 different antigenic molecular species? a. Figure #1 b. Figure #2 c. Figure #3 d. Figure #4
c
64. The enzyme control tube in an ASO hemolytic assay exhibits no cell lysis. What is the most likely explanation for this? a) incorrect ph of buffer b) low ionic strength buffer c) oxidation of the enzyme d) reduction of the enzyme
c
65. The following pattern of aggultination was observed in an antibody titration: This set of reactions most likely resulted from: a) faulty pipetting technique b) postzoning c) prozoning d) the presence of a high-titer, low-avidity antibody
a
The following cold agglutinin titer results are observed: The best interpretation is: a. positive, 1:128 b. negative c. invalid because 37°C reading is negative d. repeat the 4°C readings
