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CASSIE P a g e | 1
SUMMATIVE EXAM #1 9. Hypochlorite and hydroxyl ions damage
1. Skin pH that keeps most microorganisms irreversibly, occur in the oxygen-dependent phase of
from growing: phagocytosis.
A. 5.6 A. DNA
B. 6.5 B. Carbohydrate
C. 7.2 C. Lipid
D. 8.0 D. Protein
2. Primary function of the eosinophil: 10. Neutrophil phagocytosis and particle ingestion
A. Phagocytosis are associated with an increase in oxygen
B. Suppression of the inflammatory response utilization called respiratory burst. What are the
C. Reacting in acute, systemic hypersensitivity two most important products of this biochemical
reactions reaction?
D. Antigen recognition A. Hydrogen peroxide and superoxide anion
3. Interferons (IFN) have been demonstrated to act as: B. Lactoferrin and NADPH oxidase
A. Immunomodulators
C. Cytochrome b and collagenase
B. Antiviral agents- IFN are host/specific
D. Alkaline phosphatase and ascorbic acid
C. Antineoplastic agents
11. Which is the most significant agent formed in the
D. All of these
phagolysosome for the killing of microorganisms?
INTERFERONS ORIGIN PROMINENT BIOLOGICAL
(IFNS) ACTIVITIES A. Proteolytic enzymes
IFN-α Leukocytes Antiviral, increased MHC B. Hydroxyl radicals
class I expression. C. Hydrogen peroxide
IFN-β Fibroblasts, Antiviral, increased MHC D. Superoxides
epithelial cells class I expression 12. Which is the most significant agent formed in the
IFN-γ T cells Major macrophage phagolysosome for the elimination of
NK cells activator; induces MHC microorganisms?
class II molecules on many A. Proteolytic enzymes
cells and can synergize with B. Hydrogen ions
TNF; augments NK cell
C. Hypochlorite ions
activity; antagonist to IL-4.
D. Superoxides
4. The process of inflammation is characterized by all of
13. A DPT vaccination is an example of:
the following except:
A. Active humoral-mediated immunity
A. Increased blood supply to the area
B. Passive humeral-mediated immunity
B. Migration of white blood cells
C. Cell-mediated immunity
C. Decreased capillary permeability
D. Immediate hypersensitivity
D. Appearance of acute-phase reactants
14. Which of the following cell surface molecules is
5. Acute-phase reactants are produced primarily by:
classified as an MHC class II antigen?
A. Endothelial cells
A. HLA-A
B. Epithelial cells
B. HLA-B
C. Fibroblasts
C. HLA-C
D. Hepatocytes (liver parenchymal cells)
D. HLA-DR
6. The acute phase reactant that has the fastest
15. Antigen receptors on T lymphocytes bind HLA class II
response time and can rise 100x is:
molecules with the help of which accessory
A. Alpha-1 antitrypsin
molecule?
B. Haptoglobin
A. CD2
C. C-reactive protein- 100 to 1000x
B. CD3
D. Ceruloplasmin
C. CD4
7. Measurement of CRP levels can be used for all of the
D. CD8
following except:
16. What molecule on the surface of most T cells
A. Monitoring drug therapy with anti-inflammatory
recognizes antigen?
agents
A. IgT
B. Tracking the normal progress of surgery
B. MHC protein
C. Diagnosis of a specific bacterial infection
C. CD3
D. Determining active phases of rheumatoid arthritis
D. TcR
8. In plasma, this acute phase reactant is associated 17. The main function of T cells in the immune response is
with HDL cholesterol, and it is thought to play a role to:
in metabolism of cholesterol: A. Produce cytokines that regulate both innate
A. CRP and adaptive immunity
B. Ceruloplasmin B. Produce antibodies
C. Haptoglobin C. Participate actively in phagocytosis
D. Serum amyloid- elevated in bacterial inf D. Respond to target cells without prior exposure
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18. Which cluster of differentiation (CD) marker appears 27. An 18-month-old boy has recurrent sinopulmonary
during the first stage of T-cell development and infections and septicemia. Bruton’s X-linked
remains present as an identifying marker for T cells? immunodeficiency syndrome is suspected. Which
A. CD1 test result would be markedly decreased?
B. CD2 A. Serum IgG, IgA, and IgM
C. CCD3 B. Total T-cell count
D. CD4 or CD8 C. Both B- and T-cell counts
19. Which cluster of differentiation is MOST SPECIFIC D. Lymphocyte proliferation with phytohemagglutinin
identifying marker for mature T cells? stimulation
A. CD1 28. Macrophages produce which of the following
B. CD2 proteins during antigen processing?
C. CD3 A. IL-1 and IL-6- monokine
D. CD4 or CD8 B. γ-Interferon
20. Less expensive to perform and is of historic significance, C. IL-4, IL-5, and IL-10
because this represents the first means of T-cell D. Complement components C1 and C3
identification: 29. Which of the following best describes a HAPTEN?
A. Monoclonal antibodies A. Not able to react with antibody
B. Flow cytometry B. Antigenic only when coupled to a carrier
C. Rosette test- use sheep RBC C. Has multiple determinant sites
D. None of these D. A large chemically complex molecule
21. This T cell defect is a congenital anomaly that 30. Haptenic determinant will react with:
represents faulty embryogenesis, which results in A. Both T cells and antibody
aplasia of the parathyroid and thymus glands: B. T cells but not antibody
A. DiGeorge syndrome C. Neither T cells nor antibody
B. Ataxia telangiectasia D. Antibody but not T cells
C. Bruton agammaglobulinemia 31. A synonym for an ANTIGENIC DETERMINANT is:
D. Wiskott-Aldrich syndrome A. Immunogen
22. In testing for DiGeorge’s syndrome, what type of B. Epitope
laboratory analysis would be most helpful in C. Binding site
determining the number of mature T cells? D. Polysaccharide
A. Complete blood count 32. UNIQUE AMINO ACID SEQUENCE THAT IS COMMON
B. Nitroblue tetrazolium (NBT) test TO ALL IMMUNOGLOBULIN MOLECULES of a given
C. T-cell enzyme assays class in a given species:
D. Flow cytometry A. Isotype- 2 identical HC + 2 identical LC
23. A transplant patient began to show signs of rejection B. Allotype
8 days after receipt of the transplanted organ, and C. Idiotype
the organ was removed. What immune elements D. Any of these
ALLOTYPE Minor variations of these sequences that are
might be found in the rejected organ?
present in some individuals but not others
A. Antibody and complement
IDIOTYPE Variable portions of each chain unique to a
B. Primarily antibody specific antibody molecule,
C. Macrophages
33. Antibody class/isotype and antibody subclass are
D. T cells determined by major physiochemical differences and
24. Patients at risk for graft-versus-host disease (GVHD) antigenic variation found primarily in the:
include each of the following, EXCEPT recipients of: A. Constant region of heavy chain
A. Bone marrow transplants B. Constant region of light chain
B. Lung transplants C. Variable regions of heavy and light chains- idiotype
C. Liver transplants D. Constant regions of heavy and light chains- allotype
D. Irradiated leukocytes 34. Antibody allotype is determined by the:
25. Marginal B cells remain in the: A. Constant region of heavy chain
A. Bone marrow B. Constant region of light chain
B. Lymph nodes C. Variable regions of heavy and light chains
C. Spleen D. Constant regions of heavy and light chains
D. Thymus 35. Antibody idiotype is dictated by the:
MARGINAL B CELLS remain in the spleen in order to A. Constant region of heavy chain
respond quickly to any blood-borne pathogens they may B. Constant region of light chain
come into contact with. C. Variable regions of heavy and light chains
FOLLICULAR B CELLS migrate to lymph nodes and other D. Constant regions of heavy and light chains
secondary organs. 36. The ratio of kappa to lambda light chain-producing
26. Which of the following is the most common humoral cells in normal individuals is:
immune deficiency disease? A. 1:1
A. Bruton agammaglobulinemia B. 2:1
B. Selective IgA deficiency C. 3:1
C. IgG deficiency D. 4:1
D. Wiskott-Aldrich syndrome
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37. All of the following are functions of immunoglobulins 47. All of the following are immunologic functions of
except: complement except:
A. Neutralizing toxic substances A. Induction of an antiviral state
B. Facilitating phagocytosis through opsonization B. Opsonization
C. Interacting with TC cells to lyse viruses C. Chemotaxis
D. Combining with complement to destroy D. Anaphylatoxin formation
cellular antigens 48. Which region determines whether an
38. Treatment of IgG with papain results in how many immunoglobulin molecule can fix complement?
fragments from each immunoglobulin molecule? A. VH
A. 2 B. CH
B. 3 C. VL
C. 4 D. CL
D. 5 49. Which of the following statements is false about an
39. Which of the following immunoglobulins is present in anamnestic response versus a primary response?
the highest concentration in normal human serum? A. Has a shorter lag phase
A. IgM B. Has a longer plateau
B. IgG C. Antibodies decline more gradually
C. IgA D. IgM antibodies predominate
D. IgE 50. In a secondary (anamnestic) response, all the
40. The key structural difference that distinguishes following characteristics are correct except:
immunoglobulin subclasses is the: A. IgG is the predominant antibody type
A. Number of domains B. It has a shorter lag phase
B. Stereometry of the hypervariable region C. The antibody titer is lower
C. The sequence of the constant regions D. It has a more gradual decline in antibody response
D. Covalent linkage of the light chains 51. Most plasma complement proteins (beta) are
lmmunoglobulin subclasses differ from each other in synthesized in the LIVER with the exception of:
their Fe regions; this is the reason that the different A. C1 and Factor B
classes have different biological function. B. C1 and Factor D
41. The SUBCLASSES of IgG differ mainly in: C. C3 and Factor B
A. Type of L chain D. C3 and Factor D
B. Arrangement of disulfide bonds Most plasma complement proteins are synthesized in the liver
C. Ability to act as opsonins with the exception of C1 components; these are mainly
produced by 1ntestinal epithelial cells and Factor D, which
D. Molecular weight
is made in aDipose tissue.
42. Which lgG subclass is most efficient at crossing the
52. Which complement component is present in the
placenta?
greatest quantity in plasma?
A. lgG1
A. 2
B. lgG2
B. 3- convergence of pathway, key mediator
C. lgG3
D. lgG4 C. 4
43. Which antibody is best at agglutination and
D. 8
53. The three complement activation pathways converge
complement fixation?
A. IgA at the point of cleavage of complement component:
B. IgG A. C3
C. IgD B. C5
D. IgM>IgG3>1>2 C. C7
44. Which of the following statements about IgM is false?
D. C8
54. Which of the following releases histamine and other
A. Composed of five basic subunits
B. More efficient in the activation of the complement mediators from basophils?- anaphylatoxins
cascade and agglutination than IgG A. C3a
C. Predominant in an initial antibody response B. Properdin factor B
C. C1q
D. Predominant in a secondary (anamnestic) response
D. C4
45. Which best describes the role of the SC of IgA?
55. Which of the following complement components is a
A. A transport mechanism across endothelial cells
strong CHEMOTACTIC FACTOR as well as a strong
B. A means of joining two IgA monomers together
ANAPHYLATOXIN?
C. An aid to trapping antigen
A. C3a
D. Enhancement of complement fixation by the
B. C3b
classical pathway
C. C5a
46. Which represents the main function of IgD?
A. Protection of the mucous membranes D. C4a
56. Which of the following activities is associated with
B. Removal of antigens by complement fixation
C3b?
C. Enhancing proliferation of B cells
A. Opsonization
D. Destruction of parasitic worms
B. Anaphylaxis
C. Vasoconstriction
D. Chemotaxis
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57. Mannose-binding protein in the lectin pathway is 67. A patient with joint swelling and pain tested negative
most similar to which classical pathway component? for serum RF by both latex agglutination and ELISA
A. C3 methods. What other test would help establish a
B. C1rs diagnosis of RA in this patient?
C. C1q A. Anti-CCP
D. C4 B. ANA testing
58. Complement can be inactivated in human serum by C. Flow cytometry
heating to ° C. D. Complement levels
A. 25 68. A laboratory is evaluating an enzyme-linked
B. 37 immunosorbent assay (ELISA) for detecting an
C. 45 antibody to cyclic citrullinated peptide (CCP), which is
D. 56 a marker for rheumatoid arthritis.
Complement can be inactivated by heating to 56° C for  The laboratory includes serum from healthy
30 minutes or, after 4 hours, reinactivated by heating volunteers and patients with other connective
for 10 minutes. tissue diseases in the evaluation.
59. A specimen should be reinactivated when more than These specimens determine which factor of the assay?
hour(s) has (have) elapsed since inactivation. A. Sensitivity
A. 1 B. Precision
B. 2 C. Bias
C. 4 D. Specificity
D. 8 69. In PRIMARY BILIARY CIRRHOSIS, which of the
60. Which outcome indicates a negative result in a following antibodies is seen in high titers?
complement fixation test? (+)- nohemolysis A. Antimitochondrial
A. Hemagglutination B. Anti-smooth muscle
B. Absence of hemagglutination C. Anti-DNA
C. Hemolysis D. Anti-parietal cell
D. Absence of hemolysis 70. Which disease might be indicated by antibodies to
61. What is a general definition for autoimmunity? smooth muscle?
A. Increase of tolerance to self-antigens A. Atrophic gastritis
B. Loss of tolerance to self-antigens B. Autoimmune hepatitis
C. Increase in clonal deletion of mutant cells C. Myasthenia gravis
D. Manifestation of immunosuppression D. Sjögren’s syndrome
62. Laboratory features of SLE include: 71. Antibodies to thyroid peroxidase can be detected by
A. The presence of ANAs using agglutination assays. Which of the following
B. Circulating anticoagulant and immune complexes diseases may show positive results with this type of
C. Decreased levels of complement- C1, c2, c4 assay?
D. All of the above A. Graves’ disease and Hashimoto’s thyroiditis
63. What disease is indicated by a high titer of anti-Sm B. Myasthenia gravis
(anti-Smith) antibody? C. Granulomatous thyroid disease
A. Mixed connective tissue disease (MCTD) D. Addison’s disease
B. RA 72. In Grave’s disease, one of the main autoantibodies is:
C. SLE A. Anti-CCP
D. Scleroderma B. Antibody to islet cells of pancreas
64. Which immunofluorescence pattern indicates the C. Antibody to thyroid-stimulating hormone receptor
need for ENA testing by Ouchterlony D. Anti-dsDNA
immunodiffusion, Multiplex, or ELISA assays? 73. HLA-B8 ANTIGEN has been associated with which of
A. Homogeneous or solid the following pairs of diseases?
B. Peripheral or rim A. Ankylosing spondylitis and myasthenia gravis
C. Speckled- Anti Sm, Anti RNP B. Myasthenia gravis and celiac disease
D. Nucleolar C. Celiac disease and akylosing spondylitis
65. Rheumatoid factor is most often of which of the D. Reiter disease and multiple sclerosis
following classes: 74. Which immunologic mechanism is usually involved in
A. IgE BRONCHIAL ASTHMA?
B. IgA A. Immediate hypersensitivity
C. IgM B. Immune complex
D. IgG C. Antibody mediated cytotoxicity
66. Rheumatoid factor consists of antibodies that bind D. Delayed hypersensitivity
the: 75. After a PENICILLIN injection, a patient rapidly
A. Fc portion of IgG molecule- heavy chain develops respiratory distress, vomiting and hives.
B. Fab portion of IgG molecule This reaction is primarily mediated by:
C. Fc portion of IgM molecule A. IgG
D. Fab portion of IgM molecule B. IgA
C. IgM
D. IgE
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76. In skin tests, WHEAL AND FLARE development is
indicative: Antihistamine
A. Immediate hypersensitivity
B. Anergy
C. Delayed hypersensitivity
D. Arthus reaction
77. Which test would measure the coating of red cells by
antibody as occurs in hemolytic transfusion
reactions?
A. Indirect antiglobulin test (IAT)
B. Direct antiglobulin test (DAT)- HDN, HTR, AIHA,
drug induced HA
C. ELISA
D. Hemagglutination
78. Which of the following conditions will most likely
result in a false-negative DAT test?
A. Insufficient washing of RBCs
B. Use of heavy chain–specific polyclonal anti-human
Ig
C. Use of excessive centrifugal force
D. Use of a sample obtained by finger puncture
79. Type III reactions are exemplified by all the following
except:
A. Arthus reaction
B. Serum sickness
C. Glomerulonephritis
D. Shingles- immune complex
80. Which test is used to evaluate the cellular immune
system in a patient?
A. Skin test for commonly encountered antigens
B. Determination of isohemagglutinin titer
C. Immunoelectrophoresis of serum
D. Lymphocyte proliferation to mitogen/antigen
81. What immune elements are involved in a positive
skin test for tuberculosis?
A. IgE antibodies
B. T cells and macrophages
C. NK cells and IgG antibody
D. B cells and IgM antibody
82. How can interfering cold agglutinins be removed
from a test sample?
A. Centrifuge the serum and remove the top layer
B. Incubate the clot at 1 to 4°C for several hours,
then remove serum
C. Incubate the serum at 56°C in a water bath for 30
minutes
D. Use an anticoagulated sample
83. All positive cold agglutinin tubes remain positive
after 37°C incubation except the positive control.
What is the most likely explanation for this situation?
A. High titer cold agglutinins
B. Contamination of the test system
C. Antibody other than cold agglutinins
D. Faulty water bath
84. What is the “M” component in monoclonal
gammopathies?
A. IgM produced in excess
B. μ Heavy chain produced in excess
C. Malignant proliferation of B cells
D. Monoclonal antibody or cell line
85. The most common application of IEP of serum is for the:
A. Diagnosis of monoclonal gammopathy
B. Diagnosis of polyclonal gammopathy
C. Diagnosis of autoimmune hemolysis
D. Demonstration of Bence Jones (BJ) protein
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86. The most important application of IEP of urine is: a.
A. Diagnosis of monoclonal gammopathy
B. Diagnosis of polyclonal gammopathy
C. Diagnosis of autoimmune hemolysis
D. Demonstration of Bence Jones (BJ) protein
87. Patients with Waldenström’s macroglobulinemia
exhibit abnormally large amounts of:
A. IgM
B. IgG
C. IgE
D. IgA
88. The interaction between an individual antigen and
antibody molecule depends upon several types of
bonds such as ionic bonds, hydrogen bonds,
hydrophobic bonds, and van der Waals forces. How
is the strength of this attraction characterized?
A. Avidity
B. Affinity
C. Reactivity
D. Valency
89. Which of the following type(s) of bonding is (are)
involved in antigen-antibody reactions?
A. Hydrophobic
B. Hydrogen
C. Van der Waals
D. All of the above
90. Bonding of antigen to antibody exists exclusively as:
A. Hydrogen bonding
B. Van der Waals forces
C. Electrostatic forces
D. Noncovalent bonding
The four types of noncovalent bonds involved in antigen-
antibody reactions are:
1. Hydrophobic bonds
2. Hydrogen bonds
3. Van der Waals forces
4. Electrostatic forces
THE BONDING OF ANTIGEN TO ANTIBODY
IS EXCLUSIVELY NONCOVALENT.
91. 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 postzone
92. When soluble antigens diffuse in a gel that contains
antibody, in which zone does optimum precipitation
occur?
A. Prozone- do serum dilution
B. Zone of equivalence
C. Postzone- repeat after a week
D. Prezone
93. A soluble antigen and soluble antibody reacting to
form an insoluble product describes
A. Agglutination reactions
B. Heterophile reactions
C. Labeled reactions
D. Precipitation reactions
94. Which of the following is the most common
application of IMMUNOELECTROPHORESIS (IEP)?
A. Identification of the absence of a normal serum
protein
B. Structural abnormalities of proteins
C. Screening for circulating immune complexes
D. Diagnosis of monoclonal gammopathies
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95. In FPIA, labeled antigens compete with unlabeled 103. Direct examination of the treponemes:
antigen in the patient sample for a limited number of A. Light microscopy
antibody binding sites. The MORE antigen that is B. Darkfield microscopy- primary and secondary
present in the patient sample: Ag+ Fp- inverse C. VDRL testing
A. Less fluorescence D. RPR testing
B. Greater fluorescence 104. Which serum antibody response usually characterizes
C. Less fluorescence polarization the primary (early) stage of syphilis?
D. Greater fluorescence polarization A. Antibodies against syphilis are undetectable
96. MAJOR SYSTEMS IN A FLOW CYTOMETER include all B. Detected 1 to 3 weeks after appearance of
of the primary chancre
the following except: TURGEON C. Detected in 50% of cases before the primary
A. Fluidics chancre disappears
B. Optics D. Detected within 2 weeks after infection
C. Computerized electronics 105. What substance is detected by the rapid plasma
D. Gating reagin (RPR) and Venereal Disease Research
Laboratory (VDRL) tests for syphilis?
HYDRODYNAMIC Cells in suspension move through
FOCUSING sheath fluid in a SINGLE-FILE LINE, A. Cardiolipin
allowing each to individually pass B. Anticardiolipin antibody
through a laser light C. Anti-T. pallidum antibody
GATING Electronic boundaries created to D. Treponema pallidum
separate a specific population of 106. What type of antigen is used in the RPR card test?
interest A. Live treponemal organisms
FLUORESCENTLY Used to determine cell lineage and aid B. Killed suspension of treponemal organisms
TAGGED in characterizing patient C. Cardiolipin
ANTIBODIES immunophenotype D. Tanned sheep cells
97. Flow cytometry characterizes cells on the basis of 107. Speed and time of rotation for serum VDRL test:
which of the following? A. 100 rpm for 4 minutes
A. Forward and 90-degree side scatter of B. 100 rpm for 8 minutes
an interrupted beam of light C. 180 rpm for 4 minutes
B. Front-angle scatter only of an interrupted light beam D. 180 rpm for 8 minutes
C. Absorbance of light by different types of cells 108. Speed and time of rotation for CSF VDRL test:
D. Transmittance of light by cells in solution A. 100 rpm for 4 minutes
98. What effect does selecting the wrong gate have on B. 100 rpm for 8 minutes
the results when cells are counted by flow C. 180 rpm for 4 minutes
cytometry? D. 180 rpm for 8 minutes
A. No effect 109. Speed and time of rotation for RPR:
B. Failure to count the desired cell population A. 100 rpm for 4 minutes
C. Falsely elevated results B. 100 rpm for 8 minutes
D. Impossible to determine C. 180 rpm for 4 minutes
99. What is the immunologic method utilized in the FLOW D. 180 rpm for 8 minutes
CYTOMETER? 110. In the RPR test, what is the gauge of the needle for
A. Latex agglutination antigen delivery?
B. Immunofluorescence A. 16
C. Enzyme linked immunoassay B. 18
D. Radioimmunoassay C. 20
100. What temperature is used to achieve DNA D. 21
denaturation to a single strand? 111. A widely used HEMAGGLUTINATION test for
A. 74 °C detecting antibody to Treponema pallidum is:
B. 92 °C A. MHA-TP test (microhemagglutination test)
C. 94 °C B. FTA-ABS test
D. 102 °C C. VDRL test
DENATURATION 94 oC D. TPI test
ANNEALING 50° to 58°C or higher 112. Which test is recommended for testing cerebrospinal
EXTENSION 72°C fluid for detection of neurosyphilis?
101. What is the lowest level of hormone for which most A. RPR
current serum hCG tests can give a positive result? B. VDRL
A. 25 mIU/mL C. FTA-ABS
B. 50 mIU/mL D. Enzyme immunoassay
C. 100 mIU/mL 113. Which specimen is the sample of choice to evaluate
D. 200 mIU/mL latent or tertiary syphilis?
102. In the card pregnancy test, if the test band appears A. Serum sample
very faint, it is recommended that it is: B. Chancre fluid
A. Reported as positive C. CSF
B. Reported as negative D. Joint fluid
C. Test is considered invalid
D. New sample collected 48 hours later and tested
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114. Which test is most likely to be positive in the tertiary 124. The first serologic marker to appear in patients with
stage of syphilis? acute hepatitis B virus infection is
A. FTA-ABS A. Anti-HBs
B. RPR B. Anti-HBc HBV DNA- 1st marker not sero
C. VDRL C. Anti-HBe
D. Reagin screen test (RST) D. HBsAg/Australia ag
115. A biological false-positive reaction is least likely with 125. Which hepatitis B marker is the best indicator of
which test for syphilis? early acute infection?
A. VDRL A. HBsAg
B. FTA-ABS B. HBeAg
C. RPR C. Anti-HBc
D. All are equally likely to detect a false-positive result D. Anti-HBs
116. Which of the following is the most sensitive test 126. Which surface marker is a reliable marker for the
to detect congenital syphilis? presence of high levels of hepatitis B virus (HBV) and
A. VDRL a high degree of infectivity?
B. RPR A. HBe Ag
C. Microhemagglutination test for T. pallidum B. HBs Ag
C. HBc Ag
(MHA-TP)
D. Anti-HBsAg
D. Polymerase chain reaction (PCR)
127. Which is the first antibody detected in serum after
117. Which control shows the correct result for a valid
infection with hepatitis B virus (HBV)?
ASO test? RBC con: no hemo, SLO con: complete
A. Anti-HBs
A. SLO control, no hemolysis
B. Anti-HBc IgM- only marker (+) in window period
B. Red cell control, no hemolysis
C. Anti-HBe
C. Positive control, hemolysis in all tubes
D. All are detectable at the same time
D. Hemolysis in both SLO and red cell control
128. Which antibody persists in low-level carriers of
118. Interpret the following ASO results:
hepatitis B virus?
 Tube Nos. 1–4 (Todd unit 125): no hemolysis (+)
A. IgM anti-HBc
 Tube No. 5 (Todd unit 166): hemolysis (-)
B. IgG anti-HBc- lifelong marker of HBV
A. Positive Todd unit 125
C. IgM anti-HBe
B. Positive Todd unit 166
D. IgG anti-HBs
C. No antistreptolysin O present
129. What assay would confirm the immune status of the
D. Impossible to interpret
hepatitis B virus?
119. A single ASO titer is considered to be moderately
A. HBsAg
elevated if the titer is at least Todd units in
B. Anti-HBs
an adult.
C. IgM anti-HBcAg
A. 200 Todd units
D. Hepatitis C Ag
B. 240 Todd units
130. A hospital employee received the final dose of the
C. 320 Todd units
hepatitis B vaccine 3 weeks ago. She wants to donate
D. 340 Todd units
blood. Which of the following results are expected
120. A single ASO titer is considered to be moderately
from the hepatitis screen, and will she be allowed to
elevated if the titer is at least Todd units in
donate blood?
a child.
A. HBsAg, positive; anti-HBc, negative; she may
A. 200 Todd units
donate
B. 240 Todd units
B. HBsAg, negative; anti-HBc, positive; she may not
C. 320 Todd units
donate
D. 340 Todd units
C. HBsAg, positive; anti-HBc, positive; she may not
121. What is the endpoint for the antistreptolysin O (ASO)
donate
latex agglutination assay? Significant>200 IU/mL
D. HBsAg, negative; anti-HBc, negative; she
A. Highest serum dilution that shows no agglutination
may donate
B. Highest serum dilution that shows agglutination
131. If only anti-HBs is positive, which of the following can
C. Lowest serum dilution that shows agglutination
be ruled out?
D. Lowest serum dilution that shows no agglutination
A. Hepatitis B virus vaccination
122. Which test, other than serological markers, is most
B. Distant past infection with hepatitis B virus
consistently elevated in viral hepatitis?
C. Hepatitis B immune globulin (HBIG) injection
A. Antinuclear antibodies
D. Chronic hepatitis B virus infection
B. Alanine aminotransferase (ALT)
132. What is the main difficulty associated with the
C. Absolute lymphocyte count
development of an HIV vaccine?
D. Lactate dehydrogenase
A. The virus has been difficult to culture; antigen
123. Which of the following was a surrogate test for
extraction and concentration are extremely
hepatitis that is no longer required?
laborious
A. ALT
A and B Surrogate for HCV B. Human trials cannot be performed
B. Anti-HBc
Sp. for HCV: AntiHCV, ELISA, C. Different strains of the virus are genetically diverse
C. CMV
RIBA (radioimmunoblot) D. Anti-idiotype antibodies cannot be developed
D. HBsAg
CONTENTS ARE PROTECTED AND MAY NOT BE UPLOADED OR DISTRIBUTED.
133. Tests to identify infection with HIV fall into
which three general classification types of tests?
A. Tissue culture, antigen, and antibody tests
B. Tests for antigens, antibodies, and nucleic
acid
C. DNA probe, DNA amplification, and Western
blot tests
D. ELISA, Western blot, and Southern blot tests
134. What is the advantage of 4th-generation rapid HIV
tests over earlier rapid HIV tests?
A. They use recombinant antigens
B. They detect multiple strains of HIV
C. They detect p24 antigen
D. D. They are quantitative
135. Antibodies to which of the following viral antigens
are usually the first to be detected in HIV infection?
A. gp120
B. gp160
C. gp41
D. p24
136. Which of the following combinations of bands would
represent a positive Western blot for HIV antibody?
A. p24 and p55- inconclusive
B. p24 and p31- inconclusive
C. gp41 and gp120
D. p31 and p55
Result should be reported as positive if at least two of
the following three bands are present: p24, gp41, and
gp120/gp160.
The Western blot, which was used for many years to
confirm positive HIV antibody screening test results,
detects antibody specificities to individual HIV antigens.
It is no longer recommended for diagnosis of HIV
because it is labor intensive, relatively insensitive, and
has a long result turnaround time.
137. 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
138. A woman who has had five pregnancies subsequently
tests 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 medication
C. Cross-reaction with HLA antigens in the
antigen preparation
D. Possible technical error
139. Which of the following tests is CURRENTLY
RECOMMENDED BY THE CDC to confirm a positive
screening test result for HIV infection?
A. Rapid test for HIV-1 and HIV-2 antibodies
B. Western blot
C. Molecular testing for HIV RNA
D. HIV viral culture
140. Which method is used to test for HIV infection in
infants who are born to HIV-positive mothers?
A. ELISA
B. Western blot test
C. Polymerase chain reaction
D. Viral culture
CASSIE P a g e | 8
141. A newborn is to be tested for a vertically transmitted
HIV infection. Which of the following tests is most
useful?
A. HIV PCR
B. CD4 count
C. Rapid HIV antibody test
D. HIV IgM antibody test
142. In monitoring an HIV-infected patient, which
parameter may be expected to be the most sensitive
indicator of the effectiveness of antiretroviral
treatment?
A. HIV antibody titer
B. CD4:CD8 ratio
C. HIV viral load- quantify HIV RNA
D. Absolute total T-cell count
143. HTLV-I and HTLV-II can be transmitted by:
A. Bloodborne (transfusion, IV drug abuse)
B. Sexual contact (commonly from men to women)
C. Mother-to-child (mainly through breastfeeding)
D. All of these
These viruses have RNA as their nucleic acid and the
enzyme, REVERSE TRANSCRIPTASE, whose function is
to transcribe the viral RNA into DNA.
HTLV-I transforms CD4+ T lymphocytes into malignant
cells in a small percentage of individuals through
mechanisms mediated by the TAX PROTEIN, which result
in increased cell proliferation and accumulation of
harmful genetic mutations.
The tests MOST COMMONLY USED FOR SCREENING ARE
ELISA or CLIA methods that incorporate recombinant
antigens or synthetic peptides from both HTLV-I and
HTLV-II. Commercially available Western blot assays are
most commonly used for confirmation; line
immunoassays (LIA) andIFA tests have also been
developed.
144. Individuals exposed to EBV maintain an
asymptomatic latent infection in:
A. B cells
B. T cells
C. All lymphocytes
D. Monocytes
145. 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 information
146. Two cross-reacting antigen types of herpes simplex
virus have been identified:
A. EBV and CMV
B. HHV6 and HHV7
C. VZV and CMV
D. HSV1 and HSV2
147. Cross-reactions in the complement fixation test for
Histoplasma capsulatum occur in patients with ;
but titers appear to be lower.
A. Aspergillosis
B. Blastomycosis
C. Aspergillosis, blastomycosis
D. Blastomycosis, aspergillosis, coccidiomycosis
 CONTENTS ARE PROTECTED AND MAY NOT BE UPLOADED OR DISTRIBUTED.
148. Which of the following fungal organisms is best
diagnosed by an antigen detection test as
opposed to an antibody detection assay?
A. Histoplasma
B. Cryptococcus
C. Candida
D. Aspergillus
149. LATEX AGGLUTINATION for cryptococcal is
now recommended test for Cryptococcus
neoformans.
A. Polysaccharide capsule
B. Antigen
C. Antibody
D. Nucleic acids
Cross-reactions may occasionally occur due to RF or
circulating antibodies that bind with nonreactive
polysaccharide in immune complexes.
1. Treating the serum or CSF specimens with a protease
that destroys RF and cleaves antibodies in the
immune complexes eliminates these reactions.
2. Extraction of RF and circulating antibodies in serum
can also be accomplished by treatment with EDTA
and boiling for 5 minutes.
FALSE-POSITIVE RESULTS IN SPINAL FLUID CAN BE
ELIMINATED SIMPLY BY HEATING THE SPECIMEN IN A
BOILING WATER BATH.
150. Serological testing provides the most practical and
reliable means of confirming a measles diagnosis.
Samples collected before may yield false-negative
results, and repeat testing on a later sample is
recommended in that situation.
A. 72 hours
B. 5 days
C. 6 days
D. 9 days
IgM antibodies become detectable 3 to 4 days after
appearance of symptoms and persist for 8 to 12 weeks.
151. Blood products are tested for which virus before
being transfused to newborns?
A. EBV
B. Human T-lymphotropic virus II (HTLV-II)
C. Cytomegalovirus (CMV)- CMV-, HbS-
D. Hepatitis D virus
152. 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 information
153. In general, in which of the following situations is the
analysis of a tumor marker most useful?
A. Testing for recurrence or Monitoring
B. Prognosis
C. Screening
D. Diagnosis
Common Mtd for analysis of tumor marker- immunoassay
CASSIE P a g e | 9
154. What is the primary clinical utility of measuring CEA?
A. Diagnosis of liver cancer
B. Diagnosis of colorectal cancer
C. Screening for cancers of endodermal origin
D. Monitoring for recurrence of cancer
155. Which type of cancer is associated with the highest
level of AFP?
A. Hepatoma
B. Ovarian cancer
C. Testicular cancer
D. Breast cancer
156. Which tumor marker is associated with cancer of the
urinary bladder?
A. CA-19-9
B. CA-72-4
C. Nuclear matrix protein
D. Cathepsin-D
157. A 55-year-old male with early stage prostate cancer
diagnosed by biopsy had his prostate gland removed
(simple prostatectomy). His PSA prior to surgery
was
10.0 ng/mL. If the surgery was successful in
completely removing the tumor cells, what would
the PSA result be 1 month after surgery?
A. Undetectable
B. 1 to 3 ng/mL
C. Less than 4 ng/mL
D. Less than 10 ng/mL
158. A patient has a prostate-specific antigen level of 60
ng/mL the day before surgery to remove a localized
prostate tumor. One week following surgery, the
serum PSA was determined to be 8 ng/mL by the
same method. What is the most likely cause of these
results?
A. Incomplete removal of the malignancy
B. Cross reactivity of the antibody with another tumor
antigen
C. Testing too soon after surgery- should be 3-4 wks
D. Hook effect with the PSA assay
159. Which of the following statements regarding the
Philadelphia chromosome is true?
A. It is seen exclusively in chronic myelogenous
leukemia
B. It results from a translocation
C. It appears as a short-arm deletion of chromosome
21
D. It is associated with a poor prognosis
160. A major advantage of POCT is:
A. Faster turnaround time
B. Lower cost
C. Better quality than traditional testing
D. Both A and C
Major advantage of POCT is the rapidity of assay results; the
major drawback is cost.
END OF EXAM.