IMMUNOLOGY & SEROLOGY CPAP2 RATIONALE

Ma’am Agnes Guzman

1. The ___ immune system uses ___ as well as molecules (e.g. complement components). The ___ immune system uses ___ as
well as antigen recognition molecules.
A. Adaptive; Phagocytes; Innate; Lymphocytes
2. Which of the ff is NOT true when comparing innate to adaptive immunity?
A. Innate responds quickly and adaptive responds slowly
B. Innate has few pathogen (non-self) recognition mechanisms and adaptive has many
C. Innate has immunologic memory and adaptive does not
D. Innate does not show response improvements over time and adaptive does not.
3. Which of the following components of the innate immune system involved the release of histamine?
A. Tissue mast cell
B. Eosinophil
C. NK cell
D. Neutrophil
4. The coating of particulate antigen by antibody and/or complement components that allows them to be more phagocytized
readily is called:
A. Opsonization
B. Complement fixation
C. Immune adherence
D. Immune complex formation
5. Which of the following components of the adaptive immune system causes lysis of virally infected cells and the release of
cytokines?
A. CD4+ activated T cell and CD8+ cytotoxic T cell
B. Activated B cell
C. CD4+ activated T cell
D. NOTA
6. Humoral immunity is mediated by antibodies from ___ and is involved in the elimination of ___ pathogens. Cell mediated
immunity is mediated by ___ and is involved in the elimination of ___ pathogens.
A. B-cells; Extracellular; T cells; Intracellular
7. A process wherein cells are attracted to the site of inflammation by chemical substances
A. Chemotaxis
B. Phagocytosis
C. Sensitization
D. Diapedesis
8. Cell-mediated immunity is moderated by:
A. B lymphocytes
B. Monocyte-macrophage
C. B lymphocyte and T lymphocytes
D. T lymphocytes
9. Skin, lactic acid secretions, stomach acidity, and the motion of cilia represent which type of immunity?
A. Adaptive
B. Specific
C. Natural
D. Acquired
10. In the first line of nonspecific body defense, intact skin, is cut with a piece of glass contaminated with S. aureus, which cellular
component of the immune system quickly responds?
A. Neutrophils
B. T lymphocytes
C. B lymphocytes
D. Platelets
11. What is the source of undifferentiated T-lymphocytes?
A. Bone marrow
B. Liver and spleen
C. Thymus
D. Lymph nodes
12. Surface markers on lymphocytes can be used to
A. Classify leukemic cells
B. Monitor patients on immunotherapy
C. Identify and count CD4+ and CD8+ cells

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 13. Antigen presenting cells include macrophages and dendritic cells, which are found in lymphoid tissues and the ___. These are
critical in the uptake and presentation of antigen to T cells.
A. Skin
B. Liver
C. Kidney
D. Brain
14. Which of the ff is a primary lymphoid organ?
A. Thymus
B. Lymph node
C. MALT
D. Spleen
15. Where does the major portion of antibody production occur?
A. Lymph nodes
B. Peripheral blood
C. Thymus
D. Bone marrow
16. Center for antigen independent lymphopoiesis?
A. Bone Marrow – from CMP, CLP
B. Spleen
C. Thymus
D. Lymph nodes
17. This part of the LN contains differentiated cells and APCs
A. Medulla
B. Cortex – B cells; communication between lymphocytes and other cells
C. White pulp – lymphoid aggregation
D. Paracortex – mixture of immature and mature T-cells
18. What type of cells would be found in primary follicle?
A. Unstimulated B cells
B. Memory cells – record info about immune system
C. Germinal center – important in B cell humoral response
D. Plasma cells – B cell that secrete antibodies
19. What do you call determinant site of an antigen?
A. Epitope/Determinant site
B. Hapten – incomplete antigen
C. Paratope – antigen-binding site; part of Ab
D. Determinant site – recognize and bind to antigen
20. MHC class I presents antigen to what population of T-cells?
A. CD8+ T-cytotoxic cells
B. CD8+ T-helper cells
C. CD4- T-suppressor cells
D. CD4+ T-cytotoxic cells
21. Non-classical antigen of MHC Class II include?
A. HLA-DO, HLA-DM, HLA-DN
B. Non classical class I – E, F, G
22. Adjuvants act by which of the ff methods?
A. Complex to antigen to increase its size
B. Prevent rapid escape from the tissue
C. Increase processing
23. All the ff describe an epitope EXCEPT:
A. Consists of sequential amino acids only
B. Area of an immunogen recognized by T cells
C. Key portion of the immunogen
D. Same as an antigenic determinant site
24. Which of the ff is true of MHC Class II antigens?
A. They are found on B cells and macrophages
B. They all originate at one locus
C. They are coded for on chromosome 9
D. They are found on all nucleated cells
25. From the ff, identify a specific component of the adaptive immune system that is formed in response to antigenic stimulation
A. Immunoglobulin
B. Commensal organisms
C. Complement
D. Lysozyme

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 26. Which MHC class of molecules is necessary for antigen recognition by CD4+ T-cells
A. Class II – found on limited cells (B cells)
B. Class I
C. Class III
27. Neutrophil arise from what progenitor cells
A. Common myeloid progenitor
B. Erythroid progenitors
C. Common lymphoid progenitors
D. Macrophage progenitor
28. A heterophile antigen is one that
A. Exists in unrelated plants or animals
29. Which of the ff is a chemoattractant that attracts neutrophils to the site of infection?
A. IL-6
B. IL-12 – produced by monocytes, macrophages and EBV
C. IL-1 – regulation of immune and inflammatory response; modulator for inflammation
D. TNF
30. A lack of IL 4 might result in which of the ff?
A. Decreased eosinophil count – IL4 is produced by mast cells, T cell, Basophil and Eosinophil
31. Which of the ff is also known as the T cell GF
A. IL-2 – T-cell GF
B. IL- 7 – hematopoietic GF; secreted by stromal cells
C. IFN-γ
D. IL-12
32. High concentrations of these cytokines may lead to metabolic alterations and shock
A. TNF – regulation of immune cells, able to induce fever, apoptotic cell death
B. IL-10 – anti-inflammatory
C. IFN-y – protein made and released by host in response to viruses
D. IFN-a – anti-tumor and anti-viral
33. A px in septic shock caused by gram-neg bacterial infection exhibits the ff symptoms: high fever, very low BP, and DIC. Which
cytokine is the most likely contributor to these symptoms?
A. TNF
B. IL-10
C. IFN-y
D. IFN-a
34. What cytokine stimulate hematopoietic progenitor cells to form colonies?
A. Colony-stimulating factors
B. Stromal cell factor
C. TGF
D. Stem cell factor
35. Which of the FF can be attributed to antigen stimulated T-cells
A. Cytokines
B. Plasma cells
C. Humoral response
D. Antibody
36. Which IL trigger cells to go to different cell lineage during hematopoiesis?
A. IL-3
B. IL-1
C. IL-2
D. IL-4
E. IL-5
37. Which would be the best assay to measure a specific cytokine?
A. ELISA Testing
B. Measurement of leukocyte chemotaxis
C. T-cell proliferation
D. Blast formation
38. Kapp light chain is coded on what gene?
A. Chromosome 2
B. Chromosome 22
C. Chromosome 6
D. Chromosome 14
E. Chromosome 9

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 39. Cytokine produced by fibroblast
A. IFN-β – produced by innate cells
B. TNF-α
C. IFN-α
D. TNF-β
40. What cytokine modulate inflammation and immunity by regulating growth, mobility, and differentiation of lymphoid cells?
A. Interleukin
B. Chemokine – secreted by cells that stimulate movement of cells of the immune system
C. Lymphokine – subset of cytokine secreted by immune cells
D. GSF
41. Which 2 organs are considered the primary lymphoid organs in which immunocompetent cells originate and mature?
A. Thymus and Bone Marrow
B. Lymph nodes and thoracic duct
C. Spleen and MALT
D. Thyroid and Peyer’s patches
42. What type of B cells are formed after antigen stimulation?
A. Plasma cells and Memory B cells
B. Mature B cells
C. Receptor-activated B cells
D. Antigen-dependent B cells
43. Which CD appear during the first stage of T cell development and remains present as an identifying marker for T cells
A. CD2
B. CD1 – chromosome 1
C. CD4 or CD8
D. CD3
44. Which of the ff B cell CD marker appears all throughout the maturation and differentiation stage?
A. CD 19
B. CD 25
C. CD 23
D. CD 21
45. The action of CRP can be distinguished from that of an antibody in which of the ff ways?
A. CRP acts before antibody appears
46. Animal bite victim receives an immune globulin, this form of immunization is
A. Artificially acquired passive immunity
B. Artificially acquired active immunity
C. Naturally acquired passive immunity
D. Naturally acquired active immunity
47. During MHC Class II antigen presentation if binding occurs with a T cell receptor on a CD4 T cell, the T helper cell recruits and
triggers what lymphocytes?
A. B cells
B. NK cells
C. T cells
D. Plasma cells
48. HLA typing is done in what situations?
A. Tissue/organ donation
B. Disease association
C. Paternity testing
D. Studies of racial ancestry and migration
49. The strength of the attraction between an epitope and the antigen combining site of the antibody
A. Affinity
B. Complexity
C. Avidity
D. Antigenicity
50. Periarteriolar lymphoid sheath is located on what region?
A. White pulp
B. Paracortex
C. Red pulp
D. Cortex
51. Widal test is a serological test used to assess
A. Typhoid fever
B. Rickettsial infection – Weil Felix test
C. Tuberculosis – special culture
D. Diptheria – throat and nose swab

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 52. What is the strain used in sorbent FTA-ABS test?
A. Reiter’s strain of T. pallidum – FTA-ABS  most commonly used confirmatory test
B. Nichol’s strain of T. pallidum – Indirect Fluorescence
53. Enzymes that detect presence of H. pylori
A. Urease
B. Hyaluronidase
C. DNase
D. Peptidase
54. Specific treponemal test
A. MHA-TP – other specific test: FTA-ABS
B. Non-treponemal test – VDRL & RPR
C. Widal test
55. Serological identity as shown by appearance of smooth curved line is seen on what precipitation reaction?
A. Ouchterlony double diffusion
B. RIA – measures diameter of precipitation
C. Laurell technique – high apex of rocket
D. IE – ex. bence jones protein
56. Antibody response in syphilis
A. Cardiolipin – Antigen (VDRL & RPR)
B. Reagin – Antibody to cardiolipin
C. Complement
D. Hemolysin
57. Flaviridae
A. Hepa C
B. Hepa A – Picornavirus
C. Hepa B – Hepadnaviridae
D. Hepa E
58. Rickettsia spp. found only in Africa
A. R. felis – N & S America, Europe, Africa
B. R. rickettsii – Western hemisphere
C. R. japonica – Japan
D. R. akari – US, Ukraine, Croatia, Kore
59. Rickettsia spp. That exhibit Rocky Mountain Spotted fever through tick bite?
A. R. rickettsii
B. R. japonica – Japanese spotted fever; tick bite
C. R. felis – Flea-borne spotted fever
D. R. akari – Rickettsial pox
60. M. pneumonia associated with
A. Cold agglutinins
B. Antibody to Proteus bacteria
C. Antibodies to DNase
D. Antibodies to ATPase
61. Laboratory diagnosis of S. pyogenes can be made by all the following EXCEPT:
A. Febrile agglutinins
B. Culturing of throuat and nasal specimens
C. ASO procedure
D. Anti-DNase B
62. What type of antigen is used in the RPR card test?
A. Cardiolipin
B. Killed suspension of treponemal organisms
C. Reagin
D. Tanned sheep cells
63. A biological false-positive reaction is LEAST LIKELY with which test for syphilis?
A. FTA-ABS
B. VDRL
C. RPR
64. Rickettsia spp. found in Western Hemisphere
A. R. rickettsii
B. R. japonica – Japan
C. R. akari – US, Ukraine, Croatia, Korea
D. R. felis – N & S America, Europe, Africa

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 65. Most sensitive test for congenital syphilis
A. PCR
B. VDRL
C. RPR
D. MHTP
66. Most common congenital infection
A. CMV
B. Congenital syphilis – Chronic infection caused by T. pallidum
C. Rubella – German measles
D. Herpes virus infection
67. In the exoantigen test for H. capsulatum, which bands are present in a positive result?
A. H and/or M
B. A – Blastomyces
C. 1,2,3 – Paracoccidiodes
D. HS, HL, F
68. 1st marker to appear in HBV infection
A. HBsAg
B. IgM anti-HBc – recent infection
C. Anti-HBs – antibody produced against surface antigen
D. Anti-HBe – antibody produced against envelope antigen
69. Type of IFA that is a blocking test wherein the Ag is first exposed to unlabeled Ab then to labeled Ab
A. Inhibition
B. Direct
C. Indirect
70. HIV Ab detected and confirmed by
A. Enzyme immunoassay, western blot
B. Latex agglutination, southern blot
C. Enzyme inhibition, northern blot
D. RIA, DNA hybridization
71. Syphilis stage that can be diagnosed by serological method
A. Latent phase
B. Incubation phase
C. Primary phase
D. Secondary phase
72. Test to measure the total IgE
A. RIST
B. RAST – measures antigen-specific immunoglobulins by using a solid-phase antigen to capture patient antibodies
C. ELISA
D. Western blot
73. Which of the following was used as the first generation for HBsAg detection?
A. Ouchterlony
B. ELISA – 3rd generation
C. Counterelectrophoresis – 3rd generation
D. RIA
74. He was credited for the discovery of HIV
A. Luc Montaigner
B. Edward Jenner – Father of Immunology
C. Edwin Southern – Southern Blot
D. W. Neal Burnette – Western Blot
75. CEA is a marker for what cancer?
A. Gastrointestinal
B. Ovarian – CA 125
C. Breast – CA 15-3, CA 27.29
76. Clinically significant value of Widal’s test
A. >1:160
B. >1:240 – ABSO of S. pyogenes
C. >1:320 – Weil felix
D. >1:512
77. Dane particles is associated with
A. HBV
B. HAV
C. HCV
D. HDV

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 78. It is designated as the National Reference Lab for HIV/AIDS, Hepatitis and STDs
A. SACCL (STD, AIDS Cooperative Central Laboratory)
B. NKTI – NRL for Hematology, IMH and Automated Urinalysis
C. EAMC – NRL for toxicology & drug testing
D. RITM – confirmatory testing for blood donors
79. Immunodiffusion technique wherein both antibody and antigen diffuses in the gel
A. Ouchterlony
B. RID – antibodies is in gel
C. CIE
D. Rocket Electrophoresis – antibody is in agar
80. Serum VDRL
A. 180 rpm, 4 mins
B. 100 rpm, 4 mins
C. 100 rpm, 8 mins
D. 180 rpm, 8 mins
81. The presence IgM antibodies to T. gondii in adult is indicative of a(an)
A. Active infection
B. Carrier state
C. Chronic infection
D. Latent disease
82. 1st serological test for syphilis
A. Wasserman – uses complement fixation
B. VDRL
C. RPR
83. Which of the following viruses is rarely implicated in transfusion-associated hepatitis
A. HAV
B. HAB
C. HAC
D. CMV
84. The most frequent clinical response in HBV
A. Asymptomatic infection
B. Jaundice within 75 days
85. Which form of hepatitis does not have a chronic form of the disease?
A. HAV
B. HBV
C. HCV
86. Initial detectable marker found in serum during incubation period of HBV infection
A. HBsAg
B. HBeAg – found in serum of patients who are HBsAG positive; infectivity
C. Anti-HBc – recent infection
D. Anti-HBe – acute infection: 1st serological evidence of convalescent phase
87. In the case of acute hepatitis, the first serologic evidence of convalescent phase
A. Anti-HBe
B. HBsAg
C. HBeAg
D. Anti-HBc
88. Detects heterophile antibodies and uses sheep erythrocytes
A. Paul-Bunnell screening test
B. Davidsohn differential test – distinguishes between heterophile antibodies; uses beef erythrocyte, guinea pig kidneys
and sheep erythrocyte
C. MonoSlide agglutination test – detects heterophile antibodies; uses horse erythrocyte
89. 166 Todd units in ASO titer means
A. NOTA
B. Elevated
C. Moderately elevated - >240 Todd units
D. Not elevated
90. A most likely mode of CMV acquisition is
A. Non-irradiated blood transfusions containing viable leukocytes
B. Irradiated blood products
C. Venereal route

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 91. Which type of nephelometry is used to measure immune complex formation almost immediately after reagent has been
added?
A. Rate – measure small immune complexes formed under condition of antibody excess
B. Endpoint
C. Continuous
D. One dimensional
92. Which statement best describes passive agglutination reactions used for serodiagnosis?
A. Reactions require the addition of a second antibody
B. Such agglutination reactions are more rapid because they are a single-step process
C. Passive agglutination reactions require biphasic incubation
D. Carrier particles for antigen such as latex particles are used
93. Which outcome indicates a negative result in a complement fixation test?
A. Hemolysis
B. Hemagglutination
C. Absence of hemagglutination
D. Absence of hemolysis – CF is fixed in a Ag-Ab reaction therefore Ag-Ab complex is present in the patient serum
94. What is the advantage of the 4th-generation rapid HIV test over earlier rapid HIV tests?
A. They detect p24 antigen – uses solid phase antibodies to detect p24 antigens
B. They use recombinant antigens
C. They detect multiple strains of HIV
D. They are quantitative
Match the following:
95. Most common form of hepatitis – Hepatitis A
96. Intact virus is the Dane Particle – Hepatitis B
97. Requires HBV as a helper – Hepatitis D
98. Transmission by both parenteral and non-parenteral routes – Hepatitis C
99. The specific diagnostic test for Hepatitis C is
A. Anti-HCV
B. Absence of anti-HAV and anti-HBsAg
C. Increase in liver serum enzyme levels
D. Detection of non-A, non-B antibodies
[Link] infectious process of AIDS begins when the gp120 protein on the viral envelope bends to the protein receptor, on the
surface of a target cell
A. CD4
B. CD8
C. P24
D. P26
[Link]-felix test is a serological test used to assess?
A. Rickettsial infection
B. Diptheria
C. Typhoid fever
D. Tuberculosis
[Link] active hepatitis is associated with
A. Anti-smooth muscle antibody
B. Anti-DNP
C. Anti-mitochondrial antibody
D. Anti-myelin sheath antibody
[Link] spp. flea borne spotted fever
A. R. felis
B. R. rickettsii
C. R. japonica
D. R. akari
[Link] identity, measures the diameter of precipitation
A. RIA
B. Ouchterlony double diffusion
C. Laurell technique
D. Immunoelectrophoresis
[Link] spp. Japanese spotted fever and tick bite
A. R. japonica
B. R. rickettsii
C. R. felis
D. R. akari

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 106.A patient should be positive in what test and by how many to be reported as having HIV?
A. 2 ELISA and 1 Western Blot
B. 2 Western Blot and 1 ELISA
C. 2 ELISA and 2 Western Blot
D. 1 ELISA and 1 Western/Southern blot
[Link] line merge with spur formation in Ouchterlony technique means
A. Patial identity
B. Identity
C. Non-identity
[Link] spp. found only in Europe
A. R. felis
B. R. rickettsii
C. R. japonica
D. R. akari
[Link] the exoantigen test for Paracoccidiodes, which bands are present in a positive result?
A. 1,2,3
B. H and/or M
C. A
D. HS, HL, F
[Link] is used to measure the antigen specific IgE
A. RAST
B. RIST
C. ELISA
D. Western blot
[Link] was credited for the discovery of Western Blot
A. W. Neal Burnette
B. Luc Montaigner
C. Edward Jenner
D. Edwin Southern
[Link]-neutrophilic cytoplasmic antibodies are seen in cases of
A. Wegener’s granulomatosis
B. Rheumatoid arthritis
C. Myasthenia gravis
D. Multiple sclerosis
[Link] is designated as the NRL for confirmatory testing of blood donors
A. RITM
B. SACCL
C. NKTI
D. EAMC
[Link] technique wherein antibody is in gel
A. RID
B. CIE
C. Ouchterlony
D. Rocket Electrophoresis
[Link] of the ff serves as the screening test for Ebola virus?
A. ELISA
B. Western blot
C. IgM and IgG testing
D. Immunohistochemistry testing
[Link] of recent HBV infection may be only serologic marker during the window phase
A. Anti-HBc
B. HBsAg
C. HBeAg
D. Anti-HBe
117.A titer of 80 in RF latex test means
A. Positive
B. Weakly positive
C. Negative
D. Cannot be determined
[Link] between heterophile antibodies; uses beef erythrocyte, guinea pig kidneys and sheep erythrocytes
A. Davidsohn differential test
B. Paul-Bunell screening test

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 C. MonoSlide agglutination test
[Link] antigen is seen in
A. HBV
B. HAV
C. HCV
D. HDV
[Link] was credited for the discovery of Southern Blot
A. Edwin Southern
B. W. Neal Burnette
C. Luc Montaigner
D. Edward Jenner
121.OX2 and OX19 antigen derived from ___ and used in ___
A. Proteus vulgaris, Weil Felix test
B. Proteus vulgaris, widal test
C. Proteus mirabilis, weil felix test
D. Proteus mirabilis, weil felix
[Link] spp. that are found only in Korea
A. R. akari
B. R. rickettsii
C. R. japonica
D. R. felis
[Link] test for HCV
A. ALT and anti-HBc
B. AST and anti-HBc
C. AST and anti-HCV
D. ALT and anti-HCV
[Link] test include all the ff EXCEPT
A. Rubeola
B. Toxoplasmosis
C. CMV
D. HSV
[Link] CIE, antigens migrate towards ___ and antibodies migrate towards ___?
A. Anode; Cathode
B. Cathode; Anode
C. Both anode
D. Both cathode
[Link] pattern of anti-SM in IFA:
A. Speckled
B. Peripheral
C. Nucleolar
D. Homogenous
[Link] significant value of Weil-Felix test
A. >1:320
B. >1:160
C. >1:240
D. >1:512
[Link]
A. HBV
B. HAV
C. HCV
D. HEV
[Link] technique antigen and antibody is oppose sequence
A. CIE
B. RID
C. Ouchterlony
D. Rocket electrophoresis
[Link] carrier of Ebola virus
A. Fruit bats
B. Monkeys
C. Humans
D. Fishes

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 [Link]-parietal cell antibodies and anti-intrinsic factor antibodies are seen in what autoimmune disease?
A. Pernicious anemia
B. SLE
C. Grave’s disease
D. Hashimoto’s disease
[Link] ff was used as 3rd generation for HBsAg detection EXCEPT
A. Ouchterlony
B. ELISA
C. RIA
D. CIE
[Link] antigen is attached to the carrier particle. Agglutination occurred when corresponding antibody is present. What is the
process described?
A. Passive agglutination
B. Direct
C. Reverse passive
D. Coagglutination
[Link] of the ff is the most common congenital immunodeficiency?
A. Selective IgA deficiency
B. X-linked Brutons agammaglobulinemia
C. DiGeorge anomaly
D. Ataxia telangiectasia
[Link] against Scrub typhus agglutinates
A. OX-K
B. OX-19
C. OX-2
[Link] method of choice for detecting IgM antibodies in Toxoplasmosis
A. ELISA
B. IFA
C. IHA
D. CF
[Link] CF, a negative result is manifested by
A. Lysis of sheep RBC
B. Agglutinate sheep RBC
C. No hemolysis
D. Increased CRP
[Link] in the serum of some patients who are HBsAg positive, marker for level of virus, infectivity
A. HBsAg
B. HBeAg
C. Anti-HBc
D. Anti-HBe
139.240 Todd units in ASO titer means
A. Moderately elevated
B. Elevated
C. Not elevated
[Link] infectious mononucleosis, there is no
A. Carrier state
B. Acute state
C. Latent state
D. Reactivation
[Link] heterophile antibodies using horse erythrocytes
A. MonoSlide agglutination test
B. Davidsohn differential test
C. Paul-Bunell screening test
[Link] is transmitted most frequently by
A. Sexual activity
B. Unknown
C. Blood transfusions
D. Needle sharing among IV drug users
[Link] of the ff blood-borne pathogens is destroyed under prolonged cold temperature storage?
A. T. pallidum
B. B. microti
C. T. cruzi

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 D. P. falciparum
144.A device used to measure radioactivity in RIA
A. Scintillation counter
B. Spectrophotometer
C. Fluorometer
[Link]
A. HAV
B. HBV
C. HCV
D. HEV

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