HOLY ANGEL UNIVERSITY

School of Nursing and Allied Medical Sciences

Department of Medical Technology

IMMUNOLOGY AND SEROLOGY RATIONALE

Question 80
The heterophil antibody test is reported as which of the following?

1. Highest dilution that shows hemolysis

2. Highest dilution that shows agglutination
3. Lowest dilution that shows hemolysis
4. Lowest dilution that shows agglutination

Rationale: Heterophil antibody test is reported as the highest dilution that shows
agglutination because having a dilution that shows hemolysis is considered to be an error.
It may not be used since erroneous results might be released. Agglutination in the lowest
dilution on the other hand is not also correct because the classic heterophil antibody titer
is reported as the highest serum dilution wherein the erythrocytes agglutinate after the
absorption of the test serum.

Question 81
In the heterophil test, when serum is adsorbed with beef cells:

1. There is a decrease in the titer of infectious mononucleosis antibodies

2. There is an increase in the titer of Guinea pig kidney antibodies
3. Serum sickness antibodies are not adsorbed
4. Forssman antibodies are adsorbed

Rationale: According to some references. It was stated that absorption of beef

erythrocytes will remove heterophil antibodies such as infection mononucleosis
antibodies and serum sickness antibodies. Hence, choice 1 is incorrect since it only
shows decrease of titer. Choice 3 is correct since serum sickness antibodies are not
absorbed at all. Forssman antibodies are absorbed by guinea pig kidney cells and not
beef cells. Hence, choice 4 is wrong. There is also no proof that increase in the titer of
guinea pig kidney antibodies occur. Hence, it is wrong too.

Question 82
The Weil-Felix test is used for the detection of which type of antibodies?

1. Salmonella
2. Mycoplasma
3. Rickettsial
4. Viral

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Rationale: Widal test is used to measure antibodies against O and H antigens of
Salmonella. For mycoplasma, ELISA is utilized. A blood test that tests the antibodies of
mycoplasma pneumonia is used and the results usually take 2-6 days long. For viral
diseases, there are specific viral tests that are done per virus. Lastly, the correct answer
is Weil-Felix test because it is useful for identifying several rickettsial diseases such as
murine typhus and Q fever.

Question 83
The Widal and Weil-Felix reactions are examples of technics used to detect:

1. Heterophile antibodies
2. Reagin
3. Febrile agglutinins
4. Forssman antigen

Rationale: The 1st choice is incorrect because the Monospot test, also known as
Heterophile antibody test, is the one the detects these antibodies. Monospot test is used
to confirm a diagnosis of infectious mononucleosis. For Reagin the test used is the Rapid
plasma reagin test. For Forrsman antigen detection, the Davidsohn differential test is
used. All choices except the 3rd choice is incorrect. Hence, febrile agglutinins is the
answer. Widal test and Weil-Felix involves the search for agglutinin sin the patient’s
serum.

Question 84
OX 19 and OX 2 refers to:

1. Strains of Proteus vulgaris

2. Antigens of Rickettsia prowazeki
3. Serotypes of Brucella abortus
4. Antibodies of Salmonella typhi

Rationale: Antigens of Rickettsia prowazeki are not in that form. They are usually named
like “lipopolysaccharide antigens.” The different serotypes of Brucella abortus does not
include OX 19 and OX 2. Serotypes of b. abortus include serotype A, M, and more.
Antibodies of Salmonella typhi include Anti-BH, Anti-TH, and more. It does not have OX
19 and OX 2 so it is not an answer. Hence, the answer is the 1st choice. OX 19 and OX 2
are considered strains of Proteus vulgaris. Proteus OX2, OX19 & OXK antigen
suspensions employed in the Weil-Felix test are used for diagnosis of Rickettsial
infection.

Question 85
In the Widal test, an elevated titers O titer indicates:

1. Current infection
2. Increase agglutinins to S. typhi
3. Recent vaccination

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 4. A cross reaction

Rationale: The Widal test is positive if TO antigen titer is more than 1:160 in an active
infection, or if TH antigen titer is more than 1:160 in past infection or in immunized
persons. A patient suspected of having Typhoid Fever has a titer of 1:160 with Typhoid
O antigen, and a rise in titer in a subsequent titer. This indicates current infection.
However, if there is really a huge elevation in the O titer, this indicate that there is increase
agglutinins to S. typhi. Recent vaccination would be indicated if there is an increase of H
titer. Widal test may occur early in the course of illness, and a false-positive Widal test
may result from past infection or from previous exposure to cross-reactive antigens or
vaccination. Hence, the correct answer is the 2nd choice.

Question 86
Serological cross reactions are usually:

1. Indicative of infection with an unrelated organism

2. In lower titers than are specific reactions
3. Detected only later than are specific reactions
4. Of a different type than are specific reactions

Rationale: An antibody has a specific amino acid sequence (the Fab region) that dictates
its affinity for a specific antigen. Cross-reactivity between antigens occurs when an
antibody raised against one specific antigen has a competing high affinity toward a
different antigen. This is often the case when two antigens have similar structural regions
that the antibody recognizes. According to references, serological cross reactions are
usually in lower titers. Hence, the correct answer is the 2nd choice.

Question 87
Brucella abortus will cross-react with antibodies of which of the following bacteria?

1. Salmonella typhi
2. Proteus vulgaris
3. Streptococcus pneumoniae
4. Franciscella tularensis

Rationale: The major Brucella antigens that are useful for diagnosing human brucellosis
are the smooth (S) lipopolysaccharide (LPS) of the outer cell membrane and the internal
(cytosolic) proteins. As in the case of other Gram-negative bacteria in the S-phase, the
surface of Brucella is an outer membrane containing SLPS which is exposed to the
environment. The LPS is the immunodominant antigen but is also the molecule carrying
the epitopes that may cross-react with other Gram-negative bacteria including Yersinia
enterocolitica O:9, Escherichia coli O:157, Francisella tularensis, Salmonella urbana
O:30, Vibrio cholerae, and others. Hence, the correct answer is the 4th choice.

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