11.

A 3-year-old boy is seen by his physican because

of many recent bacterial infections. Flow
CALIBRATE REVIEW cytometery indicates normal levels of T and B
IMMUNOLOGY AND SEROLOGY cells. The nitroblue tetrazolium test for oxidative
September 2022 reduction is negative. The most likely cause is:
ANSWER KEY A. Wegener’s syndrome
B. Chronic granulomatous disease
1. Select the region of the antibody molecule C. Bruton’s agammaglobulinemia
responsible for imparting unique antibody D. Diabetes mellitus
specificity. 12. Which of the following is the receptor for the
A. Variable region fragment crystallizable portion, or nonspecific
B. Hinge region end, of the immunoglobulin molecule IgG to
C. Constant region Natural Killer Cell or Large Granular Lymphocyte?
D. Fc fragment A. CD16 C. CD21
2. In a serologic test, the term prozone is also B. CD56 D. CD96
known as: 13. Which treponemal test is the most specific for the
A. equivalence diagnosis of syphilis?
B. antibody excess A. HATTS
C. antigen excess B. TPI
D. serum-to-cell ratio C. MHA-TP
3. Which of the following is NOT true when D. FTA-ABS
comparing innate to adaptive immunity? 14. The ____ immune system uses ____ as well as
A. Innate responds quickly and adaptive responds molecules (e.g. complement components). The
slowly ____ immune system uses ____ as well as antigen
B. Innate has few pathogen (non-self) recognition recognition molecules.
mechanisms and adaptive has many A. Adaptive; Phagocytes; Innate; Lymphocytes
C. Innate has immunologic memory and adaptive B. Adaptive; Lymphocytes; Innate; Phagocytes
does not C. Innate; Phagocytes; Adaptive; Lymphocytes
D. Innate does not show response improvements D. Innate; Lymphocytes; Adaptive; Phagocytes
over time and adaptive does 15. Humoral immunity is mediated by antibodies from
4. T-lymphocytes respond to: ____ and is involved in the elimination of ____
A. Antigens presented on the surface of an antigen- pathogens. Cell mediated immunity is mediated
presenting cell by ____ and is involved in the elimination of ____
B. Antigens on microorganisms or other living cells pathogens.
C. Antigens floating in body fluids A. B-cells; Intracellular; T-cells; Extracellular
D. Native antigenic determinants of appropriate fit B. B-cells; Extracellular; T-cells; Intracellular
5. The Enzyme Linked Immunosorbent Assay (ELISA) C. T-cells; Intracellular; B-cells; Extracellular
technique for the detection of HbsAg: D. T-cells; Extracellular; B-cells; Intracellular
A. Requires radiolabeled C1q 16. What immunoglobulin variation is concerned with
B. Is quantitated by degree of fluorescence the variability at the constant region?
C. Uses Anti-HBS linked to horseradish peroxidase A. Isotypic
D. Uses beads coated with HBsAg B. Allotypic
6. SLE can be distinguished from RA on the basis of C. Idiotypic
which of the following? D. Heterotypic
A. Joint pain 17. . CEA is a tumor marker of?
B. Presence of antinuclear antibodies A. Colon
C. Immune complex formation with activation of B. breast
complement C. both
D. Presence of anti-ds DNA antibodies D. neither
7. Which statement is true regarding the radial 18. What density gradient solution is used to
immunodiffusion test? efficiently isolate lymphocytes from red blood
A. The area of the precipitin ring is directly cells?
proportional to the concentration of antigen in the A. Hank’s PBS
sample B. NaOH
B. The area of the precipitin ring is directly C. Ficoll Hypaque
proportional to the concentration of antibody in D. NSS
the sample 19. Anaphylaxis is characterized by all the following
C. The area of the precipitin ring is directly statements except:
proportional to the concentration antibody and A. It can cause death due to asphyxiation.
the antigen in the sample B. Massive release of histamine from mast cells and
D. The area of the precipitin ring indicates a partial basophils.
identity to the antibody in the sample C. Prior sensitization to an allergen.
8. Immediately following a break in the skin, D. Associated with a significant increase in
phagocytes engulf bacteria within the wound. This eosinophils in the circulating blood.
is an example of a/an _________ immune response 20. During B cell development, when is there
which is __________ against a pathogen. rearrangement in the heavy (H) chain of the
A. Adaptive, Specific immunoblobulin gene started?
B. Innate, Nonspecific A. Pro-B cell stage
C. Innate, Specific B. Early pre-B cell stage
D. Adaptive, Nonspecific C. Late pre-B cell stage
9. A patient has the following hepatitis B serology: D. Immature cell stage
HBsAg: Negative 21. What is the lesion present during the latent stage
Anti-HBc: Positive of syphilis?
Anti-HBS: Positive A. Gummas
These results are consistent with which of the B. Condylomata Lata
following? C. Chancre
A. Acute hepatitis B D. None
B. Chronic hepatitis B 22. What color light is emitted when antigens are
C. Recovery from hepatitis B exposed to UV light after being treated with
D. Acute hepatitis A fluorescein isothiocyanate (FITC), such as in the
10. In an Ouchterlony immunodiffusion, the line of test for Treponema pallidum (syphilis)?
precipitation between the antibody and the A. Blue
antigen wells forms an X. This reaction would be B. Red
described as which of the following? C. Purple
A. Nonidentity D. Green
B. Partial identity 23. An ASO titer and a Streptozyme test are
C. Identity performed on a patient’s serum. The ASO titer was
D. None of the above negative, showing hemolysis in all patient tubes.
 The Streptozyme test is positive, and both the B. Congenital B-cell disorder
positive and negative controls react appropriately. C. Acquired T-cell disorder
What can you conclude from these test results? D. Acquired B-cell disorder
A. The patient has a high titer of ASO. 36. What can be done to make a hapten behave like an
B. The patient has an antibody to a streptococcal antigen?
exoenzyme other than streptolysin O. A. Denature the protein
C. The patient has not had a previous streptococcal B. Bind to protein
infection. C. Bind to lipid
D. The patient has scarlet fever. D. Bind to carbohydrate
24. Which of the following best describes the slide 37. Which immunoglobulin is associated with
agglutination test for RF? anaphylactic shock?
A. It is specific for RA. A. IgA
B. A negative test rules out the possibility of RA. B. IgD
C. It is a sensitive screening tool. C. IgE
D. It detects IgG made against IgM. D. IgG
25. A homogeneous pattern of staining of the nucleus 38. A kidney graft would have the BEST chance of
on IIF may be caused by which of the following survival post-transplantation if it were:
antibodies? A. HLA non-identical, mixed lymphocyte culture
A. Anti-Sm (+), ABO identical
B. Anti-histone B. HLA identical, mixed lymphocyte culture (+),
C. Anti-SSA/Ro ABO identical.
D. Anti–dsDNA C. HLA identical, mixed lymphocyte culture
26. Neutrophils and monocytes have receptors for (-), ABO identical.
which part of the immunoglobulin molecule? D. HLA identical, mixed lymphocyte culture (-),
A. Fc ABO non-identical.
B. Fab 39. Central Tolerance in the human immune defense
C. Hinge region system operates by:
D. Variable region A. Clonal deletion of T cells and clonal
27. What is the basic difference between the RPR and editing of B cells
VDRL tests? B. Cellular inactivation by weak signaling
A. The RPR detects antigen, whereas the VDRL without a co-stimulus
detects antibody C. Clearance of apototic bodies
B. The RPR test is read macroscopically, whereas the D. Antigen segregation
VDRL is read microscopically
C. The RPR test is a treponemal test, whereas the 40. The initial step in the process of phagocytosis is:
VDRL is nontreponemal A. Adherence
D. There is no difference because they are both B. Chemotaxis
specific tests for syphilis C. Engulfment, phagosome formation and
28. In which disease would you expect to see an IgM fusion
spike on electrophoresis? D. Digestion and destruction
A. Transient hypogammaglobulinemia of infancy 41. When a polyclonal gammopathy is compared to a
B. Wiskott-Aldrich syndrome monoclonal gammopathy, a patient with a
C. Leukocyte adhesion disease polyclonal gammopathy has:
D. WaldenstrÖm’s macroglobulinemia A. A single class and type of immunoglobulin.
29. The type of graft rejection that occurs within B. Elevated levels of several classes of immunoglobulin
minutes of a tissue transplant is ____________. molecules.
A. Acute C. Bence Jones protein in the urine
B. Chronic D. M spike on serum protein electrophoresis
C. Hyperacute 42. The characteristics of an acute phase protein include
D. Accelerated the following EXCEPT:
30. Antibodies to which of the following A. An acute phase response is a non-specific
immunoglobulins are known to have produced indicator of an inflammatory response.
anaphylactic reactions following blood B. Acute phase proteins are synthesized slowly in
transfusion? response to tissue injury.
A. IgA C. C-reactive protein is an acute phase protein.
B. IgM D. Laboratory measurement of an acute phase can
C. IgE be used to monitor the progress of therapy in
D. IgG inflammatory diseases.
31. Which of the following is used to detect allergen- 43. Most disorders associated with a primary
specific IgE? immunodeficiency are _________ disorders
A. RIST A. T-cell disorders
B. IEP B. B-cell disorders
C. RAST C. Complement disorders
D. CRP D. Platelet disorders
32. In a complement fixation test, all reagent control 44. Representative assays in the category of
tubes give the expected reactions. Both the treponemal methods include the listed assays
unknown test and its serum control fail to except:
hemolyze. What is the most likely explanation? A. Chemiluminescent immunoassays
A. Old sheep red blood cells B. Enzyme-linked immunosorbent assays
B. Absence of antibody in the serum C. Venereal Disease Research Laboratory Test
C. Heat inactivated serum D. Fluorescent treponemal antibody absorption (FTA-
D. Anti-complementary serum ABS)
33. A false negative cold agglutinin test may result if: 45. Given the following results, what is the immune
A. The specimen is centrifuged at room temperature status of the patient?
B. The cold agglutinin demonstrates anti-I HBsAg: negative
specificity HBeAg: negative
C. The specimen is refrigerated prior to serum Anti-HBc: positive
separation Anti-HBs: positive
D. Adult human O red cells are used in the assay
34. Potent chemotactic activity is associated with A. Acute infection
which of the following components of the B. Chronic infection
complement system? C. Recovery
A. C1q D. Immunization
B. C5a 46. The term TITER (as it applies to the measurement
C. C3b of antibodies) is best defined as:
D. MBL A. The correct answer is highlighted below
35. Bruton’s agammaglobulinemia is a: B. Concentration of antibody in the serum
A. Congenital T-cell disorder C. Maximum reactive dilution X 100
 D. Maximum reactive dilution / 100 B. 1 only D. 3 and 4
E. Reciprocal of maximum reactive dilution 61. The test circle for the positive control for CRP
47. A major macrophage-activating cytokine is: determination should contain?
A. Interferon gamma A. CRP latex reagent + human serum
B. Interleukin 3 (IL-3) B. CRP latex reagent + positive control
C. Interleukin 4 (IL-4) C. positive control + human serum
D. Interleukin 5 (IL-5) D. CRP latex reagent + negative control
48. Which of the following is incorrectly matched 62. cathepsin G and defensins are involved in the
regarding Graft Rejection? process of?
a. Accelerated: 2-5 days c. Hyperacute: minutes A. positive chemotaxis
b. Acute: 7-21 days d. Chronic:<3 months B. initiating attachment of pathogens to toll like
49. Which of the following describes the receptors
pathophysiologic autoimmune mechanism C. creation of punches and holes to target cells to
responsible for Graves disease? facilitate entry of granzymes.
A. Antibody-dependent cellular cytotoxicity D. oxygen-independent phagocytosis
B. Complement-activating autoantibody E. oxidative burst
C. Inactivating autoantibody 63. Which cluster of differentiation (CD) marker appears
D. Stimulating autoantibody during the first stage of T-cell development and remains
E. T-cell–mediated cellular cytotoxicity present as an identifying marker for T cells?
50. How are cytotoxic T cells (TC cells) and natural killer A. CD1
(NK) cells similar? B. CD2
A. Require antibody to be present. C. CD3
B. Effective against virally infected cells. D. CD4 or CD8
C. Recognize antigen in association with HLA class II 64. Macrophages produce which of the following
D. Do not bind to infected cells. proteins during antigen processing?
51. All of the following are functions of A. IL-1 and IL-6
immunoglobulins, Except: B. g-Interferon
A. Neutralizing toxic substances. C. IL-4, IL-5, and IL-10
B. Facilitating phagocytosis through Opsonization. D. Complement components C1 and C3
C. Interacting with Tc cells to lyse viruses. 65. The interaction between an individual antigen
D. Combining with complement to destroy cellular and antibody molecule depends upon several types of
antigens. bonds such as ionic bonds, hydrogen bonds,
52. The T-cell antigen receptor is similar to hydrophobic bonds, and van der Waals forces. How is
immunoglobulin molecules in that it: the strength of this attraction characterized?
A. Remains bound to the cell surface and is never A. Avidity
secreted. B. Affinity
B. Contains V and C regions on each of its chains. C. Reactivity
C. Binds complement. D. Valency
D. Can cross the placenta and provide protection to a 66. Which part of the radial immunodiffusion (RID)
fetus. test system contains the antisera?
53. Which region determines whether an A. Center well
immunoglobulin molecule can fix complement? B. Outer wells
A. Variable Heavy Chain C. Constant Heavy Chain C. Gel
B. Variable Light Chain D. Constant Light Chain D. Antisera may be added to any well
54. Result of Papain Cleavage: 67. What comprises the indicator system in an
A. 2 Fab, 2 Fc C. F(ab)’ 2, 2 Fc indirect ELISA for detecting antibody?
B. 1 Fab, 2 Fc D. 2 Fab, 1 Fc A. Enzyme-conjugated antibody + chromogenic substrate
55. Which statement concerning non-Forssman B. Enzyme conjugated antigen + chromogenic substrate
heterophile antibody is true? C. Enzyme + antigen
A. It is not absorbed by guinea pig antigen D. Substrate + antigen
B. It is absorbed by guinea pig antigen 68. What outcome results from improper washing of
C. It does not agglutinate horse RBCs a tube or well after adding the enzyme–antibody
D. It does not agglutinate sheep RBCs conjugate in an ELISA system?
56. What is the most likely explanation when antibody A. Result will be falsely decreased
tests for HIV are negative but a polymerase chain B. Result will be falsely increased
reaction test performed 1 week later is positive? C. Result will be unaffected
A. Probably not HIV infection. D. Result is impossible to determine
B. Patient is in the “window phase” before antibody 69. Which statement best describes passive
production. agglutination reactions used for serodiagnosis?
C. Tests were performed incorrectly. A. Such agglutination reactions are more rapid because
D. Clinical signs may be misinterpreted they are a single-step process
57. Which of the following best describes the slide B. Reactions require the addition of a second antibody
agglutination test for RF? C. Passive agglutination reactions require biphasic
I. It is specific for SLE. Incubation
II. A negative test rules out the possibility of RA. D. Carrier particles for antigen such as latex particles
III. It is a sensitive screening tool. are used
IV. It detects IgM made against IgG. 70. A flow cytometry scattergram of a bone marrow
A. I, II, III C. I, III sample shows a dense population of cells located in-
B. III, IV D. I, II between normal lymphoid and normal myeloid cells.
58. Which of the following is true of macrophages? What is the most likely explanation?
A. smaller than monocytes A. The sample was improperly collected
B. has no peroxidases B. An abnormal cell population is present
C. short life span C. The laser optics are out of alignment
D. all of the above D. The cells are most likely not leukocytes
59. What is the main purpose of incorporating latex in 71. A patient with joint swelling and pain tested
the CRP reagent? negative for serum RF by both latex agglutination
A. to facilitate better visualization under the microscope. and ELISA methods. What other test would help
B. to make the antibody insoluble and particulate. establish a diagnosis of RA in this patient?
C. will serve as the antigen carrier A. Anti CCP
D. to have a color contrast. B. ANA testing
60. In the experiment for CRP determination, which of C. Flow cytometry
the ff is NOT true about the latex? D. Complement levels
I. coated in the surface of latex are antibodies to CRP. 72. A 12-year old girl has symptoms of fatigue and a
II. latex are biologically inert particles. localized lymphadenopathy. Laboratory tests reveal a
III. latex is attached to CRP antigens. peripheral blood lymphocytosis, a positive RPR, and
IV. the use of white test cards is recommended in these a positive spot test for IM. What test should be
types of experiment. performed next?
A. 1 and 2 C. 1, 3 and 4 A. HIV test by ELISA
B. VDRL phytohemagglutinin stimulation
C. Epstein–Barr virus (EBV) specific antigen test 85. Which statement concerning non-Forssman
D. Treponema pallidum particle agglutination (TP-PA) test heterophile antibody is true?
73. Interpret the following quantitative RPR test A. It is not absorbed by guinea pig antigen
results. B. It is absorbed by guinea pig antigen
RPR titer: weakly reactive 1:8; reactive 1:8–1:64 C. It does not agglutinate horse RBCs
A. Excess antibody, prozone effect D. It does not agglutinate sheep RBCs
B. Excess antigen, postzone effect 86. Which control shows the correct result for a valid
C. Equivalence of antigen and antibody ASO test?
D. Impossible to interpret; testing error A. SLO control, no hemolysis
74. A transplant patient began to show signs of B. Red cell control, no hemolysis
rejection 8 days after receipt of the transplanted C. Positive control, hemolysis in all tubes
organ, and the organ was removed. What immune D. Hemolysis in both SLO and red cell control
elements might be found in the rejected organ? 87. What type of antibodies is represented by the
A. Antibody and complement solid or homogeneous pattern in the
B. Primarily antibody immunofluorescence test for antinuclear antibodies?
C. Macrophages A. Antihistone antibodies
D. T cells B. Anticentromere antibodies
75. Interpret the following results for HIV infection. C. Anti-ENA (anti-Sm and anti-RNP) antibodies
HIV 1,2 ELISA: positive; HIV-1 Western blot: D. Anti-RNA antibodies
indeterminate; HIV-1 p24 antigen: negative 88. Which of the following is used in rapid slide tests
A. Positive for antibodies to human for detection of rheumatoid factors?
immunodeficiency virus, HIV-1 A. Whole IgM molecules
B. Positive for antibodies to human B. Fc portion of the IgG molecule
immunodeficiency virus, HIV-2 C. Fab portion of the IgG molecule
C. Cross reaction; biological false-positive result D. Fc portion of the IgM molecule
D. Additional testing required 89. Which disease might be indicated by antibodies
76. All of the following hepatitis viruses are spread to smooth muscle?
through blood or blood products except: A. Atrophic gastritis
A. Hepatitis A B. Autoimmune hepatitis
B. Hepatitis B C. Myasthenia gravis
C. Hepatitis C D. Sjögren’s syndrome
D. Hepatitis D 90. Antibodies to thyroid peroxidase can be detected
77. Which is the first antibody detected in serum by using agglutination assays. Which of the following
after infection with hepatitis B virus (HBV)? diseases may show positive results with this type of
A. Anti-HBs assay?
B. Anti-HBc IgM A. Graves’ disease and Hashimoto’s thyroiditis
C. Anti-HBe B. Myasthenia gravis
D. All are detectable at the same time C. Granulomatous thyroid disease
78. What is the most likely explanation when a D. Addison’s disease
patient has clinical signs of viral hepatitis but tests 91. The autoantibody _______is against the ______ , a
negative for hepatitis A IgM, hepatitis B surface characteristic finding of RA?
antigen, and hepatitis C Ab? A. IgM; Fab portion of IgG
A. Tests were performed improperly B. IgG; Fab portion of IgM
B. The patient does not have hepatitis C. IgM; Fc portion of IgG
C. The patient may be in the “core window” D. IgE; Fc portion of IgM
D. Clinical evaluation was performed improperly
79. Which of the following is incorrectly matched 92. Which of the ff is decreased in serum during the
regarding Graft Rejection? active stages of SLE?
a. Accelerated: 2-5 days c. Hyperacute: minutes A. Complement
b. Acute: 7-21 days d. Chronic:<3 months B. Anti-nuclear antibody
80. If only anti-HBs is positive, which of the C. Complement
following can be ruled out? D. Anti-DNA
A. Hepatitis B virus vaccination 93. Tissue injury in systemic rheumatic disorders such
B. Distant past infection with hepatitis B virus as SLE is thought to caused by?
C. Hepatitis B immune globulin (HBIG) injection A. Cytotoxic T cells
D. Chronic hepatitis B virus infection B. IgE activity
81. What is the main use of laboratory tests to detect C. Enzymes released by phagocytes
antibodies to islet cells and insulin in cases of D. Cytolytic antibodies
insulin-dependent diabetes mellitus (IDDM)? 94. Incompatibility by which of the following procedures
is an absolute contraindication to allotransplantation?
A. To regulate levels of injected insulin A. HLA typing
B. To diagnose IDDM B. MLC
C. To rule out the presence of other autoimmune C. ABO grouping
diseases D. Rh typing
D. To screen susceptible individuals prior to 95. In a positive ASO enzyme inhibition test, the patient
destruction of b cells is:
82. A patient deficient in the C3 complement A. streptolysin O enzyme in the patient serum
component would be expected to mount a normal: neutralizes the ASO reagent
A. Type I and IV hypersensitivity response B. red blood cells are hemolysed by the
B. Type II and IV hypersensitivity response streptolysin O enzyme reagent
C. Type I and III hypersensitivity response C. anti-streptolysin O neutralizes the
D. Type II and III hypersensitivity response streptolysin O reagent, resulting in hemolysis
83. In testing for DiGeorge’s syndrome, what type of D. anti-streptolysin O inhibits the reagent
laboratory analysis would be most helpful in streptolysin “O”s, resulting in no hemolysis
determining the number of mature T cells? 96. A 1:5 dilution of patient serum is necessary to run
A. Complete blood count serologic test. There is 0.1mL of serum that can be used.
B. Nitroblue tetrazolium (NBT) test What amount of diluent is necessary to make this
C. T-cell enzyme assays dilution using all of the serum
D. Flow cytometry A. 0.4ml
84. An 18-month-old boy has recurrent B. 0.5ml
sinopulmonary infections and septicemia. Bruton’s C. 0.1ml
X-linked immunodeficiency syndrome is suspected. D. 5.1ml
Which test result would be markedly decreased?
A. Serum IgG, IgA, and IgM 97. Which of the following is incorrectly matched
B. Total T-cell count regarding Graft Rejection?
C. Both B- and T-cell counts a. Allograft: different nonidentical individual but same
D. Lymphocyte proliferation with specie
b. heterograft: from different specie
c. autograft: from the same individual
d. xenograft: from the same spp, but different
individual
98. CDC has used CD4 cell counts to classify patients
into various stages of HIV infection, patients with this
CD4 T cells count are classified as having AIDS.
a. >200/uL c. <500 cells/uL
b. <200/uL d. >500 cells/uL
99. What is the dilution in tube 4 of a twofold serial
dilution, if tube 1 is undiluted?
A. 1:4
B. 1:8
C. 1:10
D. 1:16
100. A pregnant woman is exposed to a child with a
rubella infection. She had no clinical symptoms but
had a rubella titer performed. Her antibody titer was
1:8. Three weeks later, the test was repeated and
her titer was 1:32. She still had no clinical
symptoms. Was the laboratory finding indicative of
rubella infection?
a. No, the titer must be greater than 128 to be
significant.
b. No, the change in titer is not significant if no clinical
signs are present.
c. Yes, a greater than four-fold rise in titer indicates
early infection.
d. Yes, but clinical symptoms must also correlate

===========END OF EXAM===========

Prepared by: Carl Renzo Ambray, RMT