IMMUNOSEROLOGY LABORATORY: a. eosinophil. b. monocyte. c. basophil. d. neutrophil.

9. Which of the following is a primary lymphoid organ?

Chapter 1: Introduction to Immunity and a. Lymph node
the Immune System b. Spleen
c. Thymus
1. Which of the following can be attributed to Pasteur? d. MALT
a. Discovery of opsonins
b. Observation of phagocytosis 10. What type of cells would be found in a primary
c. First attenuated vaccines follicle?
d. Theory of humoral immunity a. Unstimulated B cells
b. Germinal centers
2. Which WBC is capable of further differentiation in c. Plasma cells
tissues? d. Memory cells
a. Neutrophil b. Eosinophil c. Basophil d. Monocyte
11. Which of the following is a distinguishing feature of
3. The cells that Metchnikoff first observed are B cells?
associated with which phenomenon? a. Act as helper cells
a. Innate immunity b. Presence of surface antibody
b. Adaptive immunity c. Able to kill target cells without prior exposure
c. Humoral immunity d. Active in phagocytosis
d. Specific immunity
12. Where do lymphocytes mainly come in contact with
4. Where are all undifferentiated lymphocytes made? antigens?
a. Bone marrow a. Secondary lymphoid organs
b. Spleen b. Bloodstream
c. Thymus c. Bone marrow
d. Lymph nodes d. Thymus

5. Which of the following statements is true of NK cells? 13. Which of the following is found on the T cell subset
a. They rely upon memory for antigen recognition. known as helpers?
b. They have the same CD groups as B cells. a. CD19 b. CD4 c. CD8 d. CD56
c. They are found mainly in lymph nodes.
d. They kill target cells without prior exposure to 14. Which of the following statements best
them. characterizes adaptive immunity?
a. Relies on normally present body functions
6. Which cell is the most potent phagocytic cell in the b. Response is similar for each exposure
tissue? c. Specificity for each individual pathogen
a. Neutrophil d. Involves only cellular immunity
b. Dendritic cell
c. Eosinophil 15. The main function of T cells in the immune response
d. Basophil is to
a. produce cytokines that regulate both innate and
7. The ability of an individual to resist infection by adaptive immunity.
means of normally present body functions is called b. produce antibodies.
a. innate immunity. c. participate actively in phagocytosis.
b. humoral immunity. d. respond to target cells without prior exposure.
c. adaptive immunity.
d. cross-immunity. 16. Which of the following is a part of humoral
immunity?
8. A cell characterized by a nucleus with two to five a. Cells involved in phagocytosis
lobes, a diameter of 10 to 15 μm, and a large number of b. Neutralization of toxins by serum
neutral staining granules is identified as a(n)
c. Macrophages and mast cells in the tissue d. T and B c. A weightlifter who is 35 years old
cells in lymph nodes d. A newborn baby

17. Immunity can be defined as 5. Which best describes an epitope?

a. the study of medicines used to treat diseases. a. A peptide that must be at least 10,000 MW
b. a specific population at risk for a disease. b. An area of an immunogen recognized only by T cells
c. the condition of being resistant to disease. c. A segment of sequential amino acids only
d. the study of the noncellular portion of the blood. d. A key portion of the immunogen

18. A blood cell that has reddish staining granules and is 6. Adjuvants act by which of the following methods?
able to kill large parasites describes a. Protects antigen from being degraded
a. basophils. b. monocytes. c.neutrophils. d.eosinophils. b. Facilitates rapid escape from the tissues
c. Limits the area of the immune response
19. Which of the following statements best describes a d. Decreases number of APCs
lymph node?
a. It is considered a primary lymphoid organ. b. It 7. A heterophile antigen is one that
removes old RBCs. a. is a self-antigen.
c. It collects fluid from the tissues. b. exists in unrelated plants or animals.
d. It is where B cells mature. c. has been used previously to stimulate antibody
response.
20. Antigenic groups identified by different sets of d. is from the same species but is different from
antibodies reacting in a similar manner to certain the host.
standard cell lines best describes
a. cytokines. 8. Which of the following is true of class II MHC (HLA)
b. clusters of differentiation (CD). antigens?
c. neutrophilic granules. a. They are found on B cells and macrophages.
d. opsonins. b. They are found on all nucleated cells.
c. They all originate at one locus.
Chapter 2: Nature of Antigens and the Major d. They are coded for on chromosome 9.
Histocompatibility Complex
All of the following are characteristics of an effective 9. Class II MHC molecules are recognized by which of
immunogen except: the following?
a. internal complexity. a. CD4+ T cells
b. large molecular weight. b. CD8+ T cells
c. the presence of numerous epitopes. c. Natural killer cells
d. found on host cells. d. Neutrophils

2. Which of the following best describes a hapten? 10. Which of the following best describes the role of
a. Cannot react with antibody TAP?
b. Antigenic only when coupled to a carrier c. Has a. They bind to class II molecules to help block the
multiple determinant sites antigen-binding site.
d. A large chemically complex molecule b. They bind to class I proteins in proteasomes.
c. They transport peptides into the lumen of the
3. Which would be the most effective immunogen? endoplasmic reticulum.
a. Protein with a molecular weight of 200,000 d. They help cleave peptides for transport to
b. Nylon polymer with a molecular weight of 250,000 endosomes.
c. Polysaccharide with a molecular weight of 220,000
d. Protein with a molecular weight of 175,000 11. What is the purpose of the invariant chain in antigen
processing associated with class II MHC molecules?
4. Which of the following individuals would likely a. Helps transport peptides to the binding site
respond most strongly to a bacterial infection? b. Blocks binding of endogenous peptides
a. An adult who is 75 years of age c. Binds to CD8+ T cells
b. A malnourished 40-year-old d. Cleaves peptides into the proper size for binding
 Chapter 3 Innate Immunity
12. An individual is recovering from a bacterial infection 1. The term for enhancement of phagocytosis by coating
and tests positive for antibodies to a protein normally of foreign particles with serum proteins is
found in the cytoplasm of this bacterium. Which of the a. opsonization. b. agglutination. c. solubilization. d.
following statements is true of this situation? chemotaxis.
a. Class I molecules have presented bacterial antigen to
CD8+ T cells. 2. Which of the following plays an important role as an
b. Class I molecules have presented bacterial antigen to external defense mechanism?
CD4+ T cells. a. Phagocytosis
c. Class II molecules have presented bacterial antigen b. C-reactive protein c. Lysozyme
to CD4+ T cells. d. Complement
d. B cells have recognized bacterial antigen without help
from T cells. 3. The process of inflammation is characterized by all of
the following except
13. In relation to a human, alloantigens would need to a. increased blood supply to the area. b. migration of
be considered in which of the following events? WBCs.
a. Transplantation of a kidney from one individual to c. decreased capillary permeability.
another d. appearance of acute-phase reactants.
b. Vaccination with the polysaccharide coat of a
bacterial cell 4. Skin, lactic acid secretions, stomach acidity, and the
c. Oral administration of a live but heat-killed virus motion of cilia represent which type of immunity?
particle a. Innate b. Cross c. Adaptive d. Auto
d. Grafting skin from one area of the body to another
5. The structure formed by the fusion of engulfed mate-
14. Which is characteristic of class I MHC molecules? rial and enzymatic granules within the phagocytic cell is
a. Consists of one α and one β chain called a
b. Binds peptides made within the cell a. phagosome.
c. Able to bind whole proteins b. lysosome.
d. Coded for by DR, DP, and DQ genes c. vacuole.
d. phagolysosome
15. Class I MHC antigens E and G serve which function?
a. Enhance the response by macrophages 6. The presence of human microbiota (normal flora) acts
b. Transport antigen for recognition by CD4+ T cells as a defense mechanism by which of the following
c. Bind to A, B, and C antigens to protect the methods?
binding site a. Maintaining an acid environment
d. Protect fetal tissue from destruction by NK cells b. Competing with potential pathogens
c. Keeping phagocytes in the area
16. Which best explains the difference between d. Coating mucosal surfaces
immunogens and antigens?
a. Only antigens are large enough to be recognized by T 7. Measurement of CRP levels can be used for all of the
cells. following except
b. Only immunogens can react with antibody. a. monitoring drug therapy with anti-inflammatory
c. Only immunogens can trigger an immune response. agents.
d. Only antigens are recognized as foreign. b. tracking the progress of an organ transplant.
c. diagnosis of a specific bacterial infection.
17. When a child inherits one set of six HLA genes d. determining active phases of rheumatoid
together from one parent, this is called a(n) arthritis.
a. genotype. b. haplotype. c. phenotype. d. allotype.
8. Pathogen recognition receptors act by
18. HLA molecules A, B, and C belong to which MHC a. recognizing molecules common to both host cells and
class? pathogens.
a. Class I b. Class II c. Class III d. Class IV b. recognizing molecules that are unique to pathogens.
c. helping to spread infection because they are found
on pathogens. c. Fibrinogen
d. all recognizing the same pathogens. d. Ceruloplasmin

9. Which of the following are characteristics of acute- 16. Which statement best describes NK cells?
phase reactants? a. Their response against pathogens is very specific.
a. Rapid increase following infection b. They only react when an abundance of MHC
b. Enhancement of phagocytosis antigens is present.
c. Nonspecific indicators of inflammation c. They react when both an inhibitory and activating
d. All of the above signal is triggered.
d. They are able to kill target cells without previous
10. Which is the most significant agent formed in the exposure to them.
phagolysosome for the elimination of microorganisms?
a. Proteolytic enzymes b. Hydrogen ions Chapter 4 Adaptive Immunity
c. Hypochlorite ions d. Superoxides 1. Which MHC molecule is necessary for antigen recog-
nition by CD4+ T cells?
11. Which acute-phase reactant helps to prevent a. Class I
formation of peroxides and free radicals that may b. Class II
damage tissues? c. Class III
a. Haptoglobin d. No MHC molecule is necessary.
b. Fibrinogen
c. Ceruloplasmin d. Serum amyloid A 2. Which would be characteristic of a T-independent
antigen?
12. Which statement best describes Toll-like receptors a. The IgG antibody is produced exclusively.
(TLRs)? b. A large number of memory cells are produced.
a. They protect adult flies from infection. c. Antigens bind only one receptor on B cells.
b. They are found on all host cells. d. It consists of a limited number of repeating
c. They only play a role in adaptive immunity. determinants.
d. They enhance phagocytosis.
3. Humoral immunity refers to which of the following?
13. The action of CRP can be distinguished from that of a. Production of antibody by plasma cells b. Production
an antibody because of cytokines by T cells
a. CRP acts before the antibody appears. c. Elimination of virally infected cells by
b. only the antibody triggers the complement cascade. cytotoxic cells
c. binding of the antibody is calcium-dependent. d. Downregulation of the immune response
d. only CRP acts as an opsonin.
4. Where does antigen-independent maturation of B
14. How does innate immunity differ from adaptive lymphocytes take place?
immunity? a. Bone marrow b. Thymus
a. Innate immunity requires prior exposure to a c. Spleen d. Lymph nodes
pathogen.
b. Innate immunity depends upon normally present 5. In the thymus, positive selection of immature T cells
body functions. is based upon recognition of which of the following?
c. Innate immunity develops later than adaptive a. Self-antigens b. Stress proteins
immunity. c. MHC antigens d. μ chains
d. Innate immunity is more specific than adaptive
immunity. 6. Which of these are found on a mature B cell?
a. IgG and IgD
15. A 40-year-old male who is a smoker develops symp- b. IgM and IgD
toms of premature emphysema. The symptoms may be c. Alpha and beta chains
caused by a deficiency of which of the following acute- d. CD3
phase reactants?
a. Haptoglobin 7. How do cytotoxic T cells kill target cells?
b. Alpha1-antitrypsin a. They produce antibodies that bind to the cell.
b. They engulf the cell by phagocytosis. b. Formation of plasma cells
c. They stop protein synthesis in the target cell. c. Elimination of virally infected cells
d. They produce granzymes that stimulate apoptosis. d. Downregulation of the immune response

8. Which of the following can be attributed to antigen- 16. Which of the following is a unique characteristic of
stimulated T cells? adaptive immunity?
a. Humoral response b. Plasma cells a. Ability to fight infection
c. Cytokines b. Ability to remember a prior exposure to a pathogen
d. Antibody c. A similar response to all pathogens encountered
d. Process of phagocytosis to destroy a pathogen
9. Which is a distinguishing feature of a pre-B cell?
a. μ chains in the cytoplasm 17. Clonal deletion of T cells as they mature is important
b. Complete IgM on the surface c. Presence of CD21 in which of the following processes?
antigen a. Elimination of autoimmune responses
d. Presence of CD25 antigen b. Positive selection of CD3/TCR receptors
c. Allelic exclusion of chromosomes
10. When does genetic rearrangement for coding of d. Elimination of cells unable to bind to MHC
antibody light chains take place during B-cell antigens
development?
a. Before the pre-B cell stage 18. Where do germinal centers occur?
b. As the cell becomes an immature B cell a. In the thymus
c. Not until the cell becomes a mature B cell d. When b. In the bone marrow
the B cell becomes a plasma cell c. In peripheral blood
d. In lymph nodes
11. Which of the following antigens are found on the T-
cell subset known as helper/inducers? Chapter 5: Antibody Structure and Function
a. CD3 b. CD4 c. CD8 d. CD11 1. Which of the following is characteristic of variable
domains of immunoglobulins?
12. Where does the major portion of antibody a. They occur on both the H and L chains.
production occur? b. They represent the complement-binding site.
a. Peripheral blood b. Bone marrow c. They are at the carboxy-terminal ends of the
c. Thymus molecules.
d. Lymph nodes d. They are found only on H chains.

13. Which of the following would represent a double- 2. All of the following are true of IgM except that it
negative thymocyte? a. can cross the placenta.
a. CD2–CD3+CD4–CD8+ b. fixes complement.
b. CD2–CD3–CD4+CD8– c. has a J chain.
c. CD2+CD3+CD4–CD8– d. is a primary response antibody.
d. CD2–CD3–CD4+CD8–
3. How does the structure of IgE differ from that of IgG?
14. Which of the following best describes the T-cell a. IgG has a secretory component and IgE does not.
receptor for antigen? b. IgE has one more constant region than IgG.
a. It consists of IgM and IgD molecules. c. IgG has more antigen-binding sites than IgE.
b. It is the same for all T cells. d. IgG has more light chains than IgE.
c. It is present in the double-negative stage.
d. Alpha and beta chains are unique for each antigen. 4. How many antigen-binding sites does a typical IgM
molecule have?
15. A cell flow cytometry pattern belonging to a 3-year- a. 2 b.4 c.6 d. 10
old patient showed the following: normal CD4+ T-cell
count, normal CD19+ B-cell count, low CD8+ T-cell 5. Bence Jones proteins are identical to which of the
count. Which type of immunity would be affected? following?
a. Production of antibody a. H chains
b. L chains d. Enhancement of complement fixation by the
c. IgM molecules classical pathway
d. IgG molecules
14. Which represents the main function of IgD?
6. A Fab fragment consists of a. Protection of the mucous membranes
a. two H chains. b. Removal of antigens by complement fixation
b. two L chains. c. Enhancing proliferation of B cells
c. one L chain and one-half of an H chain. d. Destruction of parasitic worms
d. one L chain and an entire H chain.
15. Which antibody is best at agglutination and comple-
7. Which antibody best protects mucosal surfaces? ment fixation?
a. IgA b. IgG c. IgD d. IgM a. IgA b. IgG c. IgD d. IgM

8. Which of the following pairs represents two different 16.Which of the following can be attributed to the
immunoglobulin allotypes? clonal selection hypothesis of antibody formation?
a. IgM and IgG a. Plasma cells make generalized antibody.
b. IgM1 and IgM2 b. B cells are preprogrammed for specific antibody
c. Anti-human IgM and anti-human IgG synthesis.
d. IgG1m3 and IgG1m17 c. Proteins can alter their shape to conform to antigen.
d. Cell receptors break off and become circulating
9. The structure of a typical immunoglobulin consists of antibody.
which of the following?
a. 2L and 2H chains 17. All of the following are true of IgE except that it
b. 4L and 2H chains a. fails to fix complement.
c. 4L and 4H chains b. is heat stable.
d.2Land4Hchains c. attaches to tissue mast cells.
d. is found in the serum of allergic persons.
10. Which of the following are L chains of antibody
molecules? 18. Which best describes coding for immunoglobulin
a. Kappa molecules?
b. Gamma a. All genes are located on the same chromosome.
c. Mu b. L chain rearrangement occurs before H chain
d. Alpha rearrangement.
c. Four different regions are involved in coding of
11. If the results of serum protein electrophoresis show H chains.
a significant decrease in the gamma band, which of the d. Lambda rearrangement occurs before kappa
following is a likely possibility? rearrangement.
a. Normal response to active infection
b. Multiple myeloma 19. What is the purpose of HAT medium in the prepara-
c. Immunodeficiency disorder tion of monoclonal antibody?
d. Monoclonal gammopathy a. Fusion of the two cell types
b. Restricting the growth of myeloma cells
12. The subclasses of IgG differ mainly in c. Restricting the growth of spleen cells
a. the type of L chain. d. Restricting antibody production to the IgM class
b. the arrangement of disulfide bonds.
c. the ability to act as opsonins. 20. Papain digestion of an IgG molecule results in which
d. molecular weight. of the following?
a. 2 Fab' and 1 Fc' fragment
13. Which best describes the role of the secretory b. F(ab')2 and 1 Fc' fragment c. 2 Fab and 2 Fc fragments
compo- nent of IgA? d. 2 Fab and 1 Fc fragment
a. A transport mechanism across endothelial cells
b. A means of joining two IgA monomers together 21. Which antibody provides protection to the growing
c. An aid to trapping antigen fetus because it is able to cross the placenta?
a. IgG b. IgA c. IgM d. IgD b. IFN-α and IFN-β primarily activate macrophages,
whereas IFN-gamma halts viral activity.
22. Which best characterizes the secondary response? c. IFN-α and IFN-β are made primarily by activated T
a. Equal amounts of IgM and IgG are produced. b. There cells, whereas IFN-gamma is made by fibroblasts.
is an increase in IgM only. d. IFN-α and IFN-β inhibit cell proliferation, whereas
c. There is a large increase in IgG but not IgM. IFN-gamma stimulates antigen presentation by class II
d. The lag phase is the same as in the primary MHC molecules.
response.
8. A patient in septic shock caused by a gram-negative
Chapter 6: Cytokines bacterial infection exhibits the following symptoms:
1. The ability of a single cytokine to alter the expression high fever, very low blood pressure, and disseminated
of several genes is called intravascular coagulation. Which cytokine is the most
a. redundancy. likely contributor to these symptoms?
b. pleiotropy. a. IL-2 b. TNF c. IL-12 d. IL-7
c. autocrine stimulation.
D. endocrine effect. 9. IL-10 acts as an antagonist to what cytokine?
a. IL-4
2. Which of the following effects can be attributed to IL- b. TNF-α
1? c. IFN-gamma
a. Mediation of the innate immune response d. TGF-β
b. Differentiation of stem cells
c. Halted growth of virally infected cells 10. Which would be the best assay to measure a specific
d. Stimulation of mast cells cytokine?
a. Blast formation
3. Which of the following precursors are target cells for b. T-cell proliferation
IL-3? c. Measurement of leukocyte chemotaxis
a. Myeloid precursors b. Lymphoid precursors d. ELISA testing
c. Erythroid precursors d. All of the above
11. Selective destruction of Th cells by the human
4. A lack of IL-4 may result in which of the following immunodeficiency virus contributes to immune
effects? suppression by which means?
a. Inability to fight off viral infections b. Increased risk of a. Decrease in IL-1
tumors b. Decrease in IL-2
c. Lack of IgM c. Decrease in IL-8
d. Decreased eosinophil count d. Decrease in IL-10

5. Which of the following cytokines is also known as the 12. Why might a colony stimulating factor be given to a
T-cell growth factor? cancer patient?
a. IFN-γ b. IL-12 c. IL-2 d. IL-10 a. Stimulate activity of NK cells
b. Increase production of certain types of leukocytes
6. Which of the following represents an autocrine effect c. Decrease the production of TNF
of IL-2? d. Increase production of mast cells
a. Increased IL-2 receptor expression by the Th cell
producing it
b. Macrophages signaled to the area of antigen 13. Which of the following would result from a lack of
stimulation TNF?
c. Proliferation of antigen-stimulated B cells a. Decreased ability to fight gram-negative bacterial
d. Increased synthesis of acute-phase proteins infections
throughout the body b. Increased expression of class II MHC molecules
c. Decreased survival of cancer cells
7. IFN-α and IFN-β differ in which way from IFN-gamma? d. Increased risk of septic shock
a. IFN-α and IFN-β are called immune interferons, and
IFN-gamma is not.
14. Which cytokine acts to promote differentiation of T b. Conversion of B to Bb
cells to the Th1 subclass? c. Inhibition of C3 convertase formation d. Binding and
a. IL-4 b. IFN-α c. IL-12 d. IL-10 cleavage of Factor B

15. What is the major function of T regulatory cells? 7. Which best characterizes the membrane attack
a. Suppression of the immune response by producing complex (MAC)?
TNF a. Each pathway uses different factors to form it.
b. Suppression of the immune response by inducing IL- b. C5 through C9 are not added in any particular
10 order.
c. Proliferation of the immune response by producing IL- c. One MAC unit is sufficient to lyse any type
2 of cell.
d. Proliferation of the immune response by inducing IL-4 d. C9 polymerizes to form the transmembrane
channel.
16. Th17 cells affect the innate immune response by
inducing production of which cytokines? 8. All of the following represent functions of the
a. IFN-γ and IL-2 complement system except
b. IL-4 and IL-10 a. decreased clearance of antigen–antibody
c. IL-2 and IL-4 complexes.
d. TNF-α and IL- b. lysis of foreign cells.
c. increase in vascular permeability.
Chapter 7 – Complement System d. migration of neutrophils to the tissues.
1. The classical complement pathway is activated by
a. most viruses. 9. Which of the following is true of the amplification
b. antigen–antibody complexes. loop in complement activation?
c. fungal cell walls. a. It is only found in the alternative pathway.
d. mannose in bacterial cell walls. b. The membrane attack unit is amplified.
c. C3b is the product that is increased.
2. Which of the following is characteristic of d. Increasing amounts of C1qrs are produced.
complement components?
a. Normally present in serum 10. Factor H acts by competing with which of the
b. Mainly synthesized by B cells following for the same binding site?
c. Present as active enzymes a. Factor B b. Factor D c. C3B d. Factor I
d. Heat stable
11. A lack of CR1 receptors on RBCs would result in
3. All of the following are true of the recognition unit which of the following?
except a. Decreased binding of C3b to RBCs
a. it consists of C1q, C1r, and C1s. b. Decreased clearance of immune complexes by the
b. the subunits require calcium for binding together. spleen
c. binding occurs at the FC region of antibody c. Decreased breakdown of C1qrs
molecules. d. Decreased binding of Factor H
d. C1q becomes an active esterase.
12. Which best describes the role of CR2 on cell
4. Which of the following is referred to as C3 membranes?
convertase? a. Binds C1qrs to inactivate it
a. C1qrs b. C3bD c. C3bBb d. C4b5a b. Acts as co-receptor on B cells for antigen c. Increases
clearance of immune complexes
5. Mannose-binding protein in the lectin pathway is d. Binds particles opsonized with C3b
most similar to which classical pathway component?
a. C3 b. C1rs c. C1q d. C4 13. Which of the following best characterizes hemolytic
uremic syndrome?
6. Which of the following describes the role of a. It is a rare cause of renal failure in children.
properdin in the alternative pathway? b. It can be associated with deficiencies in Factor H.
a. Stabilization of C3/C5 convertase c. The major cause is lack of DAF on RBCs.
d. It is associated with antibody-to-C3 convertase. Chapter 8 Safety and Quality Management
1. A technologist who observes a red rash on her hands
14. The CH50 test measures which of the following? after removing her gloves
a. Patient serum required to lyse 50% of sensitized a. should apply antimicrobial lotion to the hands.
sheep RBCs b. may be washing the hands too frequently.
b. Functioning of both the classical and alternative c. may have developed a latex allergy.
pathways d. should not create friction when washing the hands.
c. Genetic deficiencies of any of the complement
components 2. In the chain of infection, a contaminated work area
d. Functioning of the lectin pathway only would serve as which of the following?
a. Reservoir
15. Which of the following would be most effective in b. Means of transmission c. Portal of entry
preventing bystander lysis of RBCs? d. Portal of exit
a. C1-INH b. Factor B c. DAF d. Factor H
3. The only biological waste that does not have to be
16. A decreased CH50 level and a normal AH50 level dis- carded in a container with a biohazard symbol is
indicate which deficiency? a. urine.
a. Decrease in components in the lectin pathway only b. serum.
b. Decrease in components in the alternative pathway c. feces.
only d. serum tubes.
c. Decrease in components of both classical and
alternative pathways 4. Patient specimens transported by the Department of
d. Decrease in components of the classical pathway Transportation must be labeled as a
only a. diagnostic specimen.
b. clinical specimen.
17. Which best describes the role of an anaphylatoxin? c. biological specimen, category b.
a. Coats cells to increase phagocytosis d. laboratory specimen.
b. Attracts WBCs to the area of antigen concentration
c. Increases production of interleukin-1 5. A technician places tightly capped noninfectious
d. Increases permeability of blood vessels serum tubes in a rack and places the rack and the
specimen data in a labeled leakproof metal courier box.
18. Which best describes the role of Factor H? Is there anything wrong with this scenario?
a. Acts with DAF to break down C3b a. Yes, DOT requirements are not met.
b. Prevents binding of Factor B to C3b b. No, the tubes are placed in a rack.
c. Binds to the C5C6C7 complex c. Yes, absorbent material is missing.
d. Binds to C1q to shut down the classical pathway d. No, the box contains the specimen data.

19. A lack of C1-INH might result in which of the 6. The Occupational Exposure to Bloodborne Pathogens
following conditions? Standard developed by OSHA requires employers to
a. Paroxysmal nocturnal hemoglobinuria b. Hemolytic provide all of the following except
uremic syndrome a. hepatitis B immunization.
c. Hereditary angioedema b. safety training.
d. Increased bacterial infections c. hepatitis C immunization.
d. laundry facilities for nondisposable lab coats
20. Which would be most effective in measuring an
individual complement component? 7. An employee who receives an accidental needlestick
a. CH50 assay should immediately
b. Radial immunodiffusion a. apply sodium hypochlorite to the area.
c. AH50 assay b. notify a supervisor.
d. Lytic assay with liposome c. receive HIV prophylaxis.
d. receive a hepatitis B booster shot.
8. The first thing to do when acid is spilled on the skin is 17. When a new bottle of QC material is opened, what
to in- formation is placed on the label?
a. notify a supervisor. a. The time the bottle was opened
b. neutralize the area with a base. c. apply burn b. The supervisor’s initials
ointment. c. The lot number
d. flush the area with water d. The date and the laboratory worker’s initials

9. When combining acid and water, 18. What is the primary goal of TQM?
a. acid is added to water. a. Precise test results
b. water is added to acid. b. Increased laboratory productivity
c. water is slowly added to acid. c. Improved patient outcomes
d. both solutions are combined simultaneously. d. Reproducible test results

10. To determine the chemical characteristics of sodium 19. Would a control sample that has accidentally
azide, an employee would consult the become diluted produce a trend or a shift in the Levey-
a. Chemical Hygiene Plan. b. Merck manual. Jennings plot?
c. SDS. a. Trend b. Shift
d. NRC guidelines.
Chapter 9: Principles of Serological Testing
11. A technician who is pregnant should avoid working 1. If serum is not tested immediately, how should it be
with treated?
a. organic chemicals. b. radioisotopes. a. It can be left at room temperature for 24 hours.
c. HIV-positive serum. d. needles and lancets. b. It can be stored in the refrigerator for up to
72 hours.
12. Which of the following laboratory regulatory c. It can be stored in the refrigerator for up to
agencies classifies laboratory tests by their complexity? 48 hours.
a. OSHA b. CAP c. TJC d. CMS d. It needs to be frozen immediately.

13. Which of the following organizations publishes 2. A 1:750 dilution of serum is needed to perform a
guide- lines that are considered the standard of care for serological test. Which of the following series of
labo- ratory procedures? dilutions would be correct to use in this situation?
a. CLIA b. CLSI c. TJC d. CAP a. 1:5, 1:15, 1:10
b. 1:5, 1:10, 1:5 c. 1:15, 1:10, 1:3
14. Quality managment refers to d. 1:15, 1:3, 1:5
a. performance of two levels of testing controls. b.
reliable control results. 3. How much diluent needs to be added to 0.2 mL of
c. increased productivity. serum to make a 1:20 dilution?
d. quality of specimens and patient care. a. 19.8 mL b. 4.0 mL c. 3.8 mL d. 10.0 mL

15. When external quality control is run, what informa- 4. If glacial acetic acid needs to be diluted with water to
tion must be documented? make a 10% solution, what does the glacial acetic acid
a. The lot number represent?
b. Expiration date of the control c. The test results a. Solute. b. Diluent. c. Titer. d. Serial dilution
d. All of the above
5. A pipette that has markings all the way down to its tip
16. What steps are taken when the results of the quality is called a
control testing are outside of the stated confidence a. volumetric pipette. b. serial pipette.
limits? c. graduated pipette. d. micropipette.
a. Check the expiration date of the control material
b. Run a new control 6. A serological test requires 5 mL of a 1:50 dilution.
c. Open a new control bottle How much serum is required to make this dilution?
d. All of the above a. 0.5 mL. b. 0.01 mL. c. 1.0 mL d. 0.1 mL
7. If 0.02 mL of serum is diluted with 0.08 mL of diluent, d. 1:4,096
what dilution of serum does this represent?
a. 1:4 b. 1:5. c. 1:10 d. 1:20 16. A new laboratory assay gave the following results:
number of patients tested = 100; number of true
8. A tube containing a 1:40 dilution is accidently positives = 54, number of true negatives = 42; number
dropped. A 1:2 dilution of the specimen is still available. of false positives = 2; number of false negatives = 2.
A volume of 4 mL is needed to run the test. How much
of the 1:2 dilution is needed to remake 4 mL of a 1:40 What is the specificity of this assay in whole numbers?
dilution? a. 75% b. 85% c. 95% d. 98%
a. 0.2 mL b. 0.4 mL c. 0.5 mL d. 1.0 mL
17.What is the sensitivity of the assay in Question 16?
9. If 0.4 mL of serum is mixed with 15.6 mL of diluent, a. 84% b. 90% c. 92% d. 96%
what dilution of serum does this represent?
a. 1:4 b. 1:40 c. 2:70 d. 1:80 18.A screening test gave the following results: number
of patients tested = 150; number of true positives = 50;
10. How much diluent needs to be added to 0.1 mL of number of true negatives = 85; number of false
serum to make a 1:15 dilution? positives = 5; number of false negatives = 10. What
a. 1.4 mL b. 1.5 mL c. 5.0 mL d.15mL is the positive predictive value rounded off to a whole
number for a patient whose test is positive?
11. Which of the following choices would be considered a. 91% b. 83% c. 89% d. 56%
a serial dilution?
a. 1:5, 1:15, 1:20
b. 1:2, 1:10, 1:25 Chapter 10 Precipitation and Agglutination Reactions
c. 1:15, 1:30, 1:40 1. In a precipitation reaction, how can the ideal
d. 1:5, 1:15, 1:45 antibody be characterized?
a. Low affinity and low avidity
12. The following dilutions were set up to titer an b. High affinity and low avidity
antibody. The following results were obtained: 1:4 +, 1:8 c. High affinity and high avidity
+, 1:16 +, 1:32 +, 1:64 –. How should the titer be d. Low affinity and high avidity
reported out?
a.4 b. 16 c. 32 d. 64 2. Precipitation differs from agglutination in which way?
a. Precipitation can only be measured by an automated
13. If a serological test is positive for an individual who instrument.
does not have a particular disease, the result was b. Precipitation occurs with univalent antigen, whereas
caused by a problem with agglutination requires multivalent antigen.
a. sensitivity. c. Precipitation does not readily occur because few
b. specificity. antibodies can form aggregates with antigen.
c. accuracy. d. Precipitation involves a soluble antigen, whereas
d. poor pipetting. agglutination involves a particulate antigen.

14. Which of the following would be the correct way to 3. When soluble antigens diffuse in a gel that contains
make a 5% solution of hydrochloric acid from antibody, in which zone does optimum precipitation
concentrated hydrochloric acid? occur?
a. 0.5 mL of acid and 9.5 mL of water a. Prozone
b.0.5mLofacidand95mLofwater b. Zone of equivalence
c. 0.1 mL of acid and 9.9 mL of water c. Postzone
d. 0.1 mL of acid and 4.9 mL of water d. Prezone

15. What is the final dilution of serum obtained from 4. Which of the following statements apply to rate
the following serial dilutions: 1:4, 1:4, 1:4, 1:4, 1:4, 1:4? nephelometry?
a. 1:24 a. Readings are taken before equivalence is reached.
b. 1:256 b. It is more sensitive than turbidity.
c. 1:1,024 c. Measurements are time dependent.
d. All of the above. b. Antigen 2 is simpler than antigen 1.
c. Antigen 2 is more complex than antigen 1.
5. Which of the following is characteristic of the end- d. The two antigens are unrelated.
point method of RID?
a. Readings are taken before equivalence. 11. Which technique represents a single-diffusion
b. Concentration is directly in proportion to the reaction?
square of the diameter. a. Radial immunodiffusion
c. The diameter is plotted against the log of the b. Ouchterlony diffusion
concentration. c. Immunoelectrophoresis
d. It is primarily a qualitative rather than a d. Immunofixation electrophoresis
quantitative method.
12. Which best describes the law of mass action?
6. In which zone might an antibody-screening test be a. Once antigen–antibody binding takes place, it is
false negative? irreversible.
a. Prozone b. The equilibrium constant depends only on the
b. Zone of equivalence forward reaction.
c. Postzone c. The equilibrium constant is related to strength of
d. None of the above antigen–antibody binding.
d. If an antibody has a high avidity, it will dissociate
7. How does measurement of turbidity differ from from antigen easily.
nephelometry?
a. Turbidity measures the increase in light after it passes 13.Agglutination of dyed bacterial cells represents
through a solution. which type of reaction?
b. Nephelometry measures light that is scattered at an a. Direct agglutination
angle. b. Passive agglutination
c. Turbidity deals with univalent antigens only. d. c. Reverse passive agglutination
Nephelometry is not affected by large particles d. Agglutination inhibition
falling out of solution.
14. If a single IgM molecule can bind many more
8. Which of the following refers to the force of antigens than a molecule of IgG, which of the following
attraction between an antibody and a single antigenic is higher?
determinant? a. Affinity
a. Affinity b. Initial force of attraction
b. Avidity c. Avidity
c. Van der Waals attraction d. Initial sensitization
d. Covalence
15. Agglutination inhibition could best be used for
9. Immunofixation electrophoresis differs from which of the following types of antigens?
immunoelectrophoresis in which way? a. Large cellular antigens such as erythrocytes
a. Electrophoresis takes place after diffusion has b. Soluble haptens
occurred in immunofixation electrophoresis. c. Bacterial cells
b. Better separation of proteins with the same d. Coated latex particles
electrophoretic mobilities is obtained in
immunoelectrophoresis. 16. Which of the following correctly describes reverse
c. In immunofixation electrophoresis, antibody is passive agglutination?
directly applied to the gel instead of being placed in a a. It is a negative test.
trough. b. It can be used to detect autoantibodies.
d. Immunoelectrophoresis is a much faster procedure. c. It is used for identification of antigens.
d. It is used to detect sensitization of red blood
10. If crossed lines result in an Ouchterlony cells.
immunodiffu- sion reaction with antigens 1 and 2, what
does this indicate?
a. Antigens 1 and 2 are identical.
17. Reactions involving IgG may need to be enhanced 3. In the following equation, what is the ratio of bound
for which reason? radioactive antigen (Ag*) to bound patient antigen (Ag)?
a. It is only active at 25°C. 12Ag* + 4Ag + 4Ab → :___Ag*
b. It may be too small to produce lattice formation. Ab + ___AgAb + Ag* +___Ag
c. It has only one antigen-binding site.
d. It is only able to produce visible precipitation a. 1:4 b. 1:3 c. 3:1 d. 8:4
reactions.
4. Which of the following responses characterizes a
18. For which of the following tests is a lack of capture or sandwich enzyme assay?
agglutination a positive reaction? a. Less sensitive than competitive enzyme assays
a. Hemagglutination b. Requires two wash steps
b. Passive agglutination c. Best for small antigens with a single determinant
c. Reverse passive agglutination d. A limited number of antibody sites on solid phase
d. Agglutination inhibition
5. Which of the following is an advantage of enzyme
19. Typing of RBCs with reagent antiserum represents immunoassay over RIA?
which type of reaction? a. Decrease in hazardous waste
a. Direct hemagglutination b. Shorter shelf life of kit
b. Passive hemagglutination c. Natural inhibitors do not affect results d. Needs to be
c. Hemagglutination inhibition read manually
d. Reverse passive hemagglutination
6. Which of the following is characteristic of direct
20. In a particle-counting immunoassay using reagent fluorescent assays?
antibody attached to latex particles, if the particle count a. The anti-immunoglobulin has the fluorescent tag.
in solution is very low, what does this mean about the b. Antibody is attached to a solid phase.
presence of patient antigen? c. Microbial antigens can be rapidly identified by
a. The patient has no antigen present. this method.
b. The patient has a very small amount of antigen. d. The amount of color is in inverse proportion to the
c. The patient has a large amount of antigen present. amount of antigen present.
d. The test is invalid.
7. Which of the following is true of fluorescence polar-
Chapter 11: Labeled Immunoassays ization immunoassay?
1. Which of the following statements accurately a. Both antigen and antibody are labeled.
describes competitive binding assays? b. Large molecules polarize more light than smaller
a. Excess binding sites for the analyte are provided. molecules.
b. Labeled and unlabeled analyte are present in equal c. When binding occurs, there is quenching of the
amounts. fluorescent tag.
c. The concentration of patient analyte is inversely d. The amount of fluorescence is directly proportional
proportional to bound label. to concentration of the analyte.
d. All the patient analyte is bound in the reaction.
8. A fluorescent substance is best described as one in
2. How do heterogeneous assays differ from which
homogeneous assays? a. light energy is absorbed and converted to a longer
a. Heterogeneous assays require a separation step. wavelength.
b. Heterogeneous assays are easier to perform than b. the emitted wavelength can be seen under normal
homogeneous assays. white light.
c. The concentration of patient analyte is indirectly c. there is a long time between the absorption and
proportional to bound label in heterogeneous assays. emission of light.
d. Homogeneous assays are more sensitive than d. it spontaneously decays and emits light.
heterogeneous ones.
9. In a noncompetitive enzyme immunoassay, if a nega-
tive control shows the presence of color, which of the
following might be a possible explanation?
a. No reagent was added. 16. In a heterogeneous enzyme immunoassay, if the
b. Washing steps were incomplete. c. The enzyme was patient sample produces more color than the highest
inactivated. positive control, what action should be taken?
d. No substrate was present. a. Report the results out as determined.
b. Dilute the patient sample.
10. Which of the following best characterizes c. Repeat the assay using one-half the volume of the
chemilumi- nescent assays? patient sample.
a. Only the antigen can be labeled. d. Report the results as falsely positive.
b. Tests can be read manually.
c. These are only homogeneous assays.
d. A chemical is oxidized to produce light.

11. Immunofluorescent assays may be difficult to

interpret for which reason?
a. Autofluorescence of substances in serum b.
Nonspecific binding to serum proteins c. Subjectivity in
reading results
d. Any of the above

12. Which statement best describes flow-through

immunoassays?
a. Results are quantitative.
b. They are designed for point-of-care testing.
c. Reagents must be added separately.
d. They are difficult to interpret.

13. Which of the following is characteristic of an indirect

enzyme immunoassay?
a. The first antibody has the enzyme label.
b. All reagents are added together.
c. Color is directly proportional to the amount of
patient antigen present.
d. Enzyme specificity is not essential.

14. In a homogeneous enzyme immunoassay, which

best describes the enzyme?
a. Enzyme activity is altered when binding to antibody
occurs.
b. The enzyme label is on the antibody.
c. Enzyme activity is directly proportional to the
amount of patient antigen present.
d. Most enzymes can be used in this type of assay.

15. In an indirect immunofluorescent assay, what would

be the outcome of an improper wash after the
antibody-enzyme conjugate is added?
a. Results will be falsely decreased.
b. Results will be falsely increased.
c. Results will be unaffected.
d. It would be difficult to determine the effect.