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MT review > Assessment IS > Flashcards

Assessment IS Flashcards

1
Q

Cells known to be actively phagocytic include:

a. Neutrophils, monocytes, basophils
b. Monocytes, lymphocytes, neutrophils
c. Neutrophils, eosinophils, monocytes
d. Lymphocytes, eosinophils, monocytes

A

c. Neutrophils, eosinophils, monocytes

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2
Q

Which of the following can be attributed to IL-1?

a. Mediator of the innate immune response
b. Differentiation of stem cells
c. Halts growth of virally infected cells
d. Stimulation of mast cells

A

a. Mediator of the innate immune response

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3
Q

Interferons (IFN) have been demonstrated to act as:

a. Immunomodulators
b. Antiviral agents
c. Antineoplastic agents
d. All of these

A

d. All of these

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4
Q

Why might a COLONY STIMULATING FACTOR (CSF) be given to a cancer patient?

a. Stimulate activity of NK cells
b. Increase production of certain types of leukocytes
c. Decrease the production of TNF
d. Increase production of mast cells

A

b. Increase production of certain types of leukocytes

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5
Q

Acute-phase reactants are produced primarily by:

a. Endothelial cells
b. Epithelial cells
c. Fibroblasts
d. Hepatocytes (liver parenchymal cells)

A

d. Hepatocytes (liver parenchymal cells)

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6
Q

In plasma, this acute phase reactant is associated with HDL cholesterol, and it is thought to play a role in metabolism of cholesterol:

a. CRP
b. Ceruloplasmin
c. Haptoglobin
d. Serum amyloid

A

d. Serum amyloid

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7
Q

Of the circulating lymphocytes in peripheral blood, which are in the greatest percentages (60-80%)?

a. Natural killer cells
b. Null lymphocytes
c. B lymphocytes
d. T lymphocytes

A

d. T lymphocytes

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8
Q

Antigen receptors on T lymphocytes bind HLA class II molecules with the help of which accessory molecule?

a. CD2
b. CD3
c. CD4
d. CD8

A

c. CD4

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9
Q

The main function of T cells in the immune response is to:

a. Produce cytokines that regulate both innate and adaptive immunity
b. Produce antibodies
c. Participate actively in phagocytosis
d. Respond to target cells without prior exposure

A

a. Produce cytokines that regulate both innate and adaptive immunity

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10
Q

How do cytotoxic T cells kill target cells?

a. They produce antibodies that bind to the cell
b. They engulf the cell by phagocytosis
c. They stop protein synthesis in the target cell
d. They produce granzymes that stimulate apoptosis

A

d. They produce granzymes that stimulate apoptosis

CD8+ T cells are cytotoxic cells that are able to destroy cancer cells or virally infected host cells by producing PERFORINS and GRANZYMES.

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11
Q

Which of the following best describes a HAPTEN?

a. Not able to react with antibody
b. Antigenic only when coupled to a carrier
c. Has multiple determinant sites
d. A large chemically complex molecule

A

b. Antigenic only when coupled to a carrier

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12
Q

UNIQUE AMINO ACID SEQUENCE THAT IS COMMON TO ALL IMMUNOGLOBULIN MOLECULES of a given class in a given species:

a. Isotype
b. Allotype
c. Idiotype

A

a. Isotype

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13
Q

Antibody ALLOTYPE is determined by the:

a. Constant region of heavy chain
b. Variable regions of heavy and light chains
c. Constant region of light chain
d. Constant regions of heavy and light chains

A

d. Constant regions of heavy and light chains

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14
Q

Antibody IDIOTYPE is dictated by the:

a. Constant region of heavy chain
b. Variable regions of heavy and light chains
c. Constant region of light chain
d. Constant regions of heavy and light chains

A

b. Variable regions of heavy and light chains

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15
Q

Treatment of IgG with papain results in how many fragments from each immunoglobulin molecule

a. 2
b. 3
c. 4
d. 5

A

b. 3

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16
Q

Which of the following immunoglobulins is present in the highest concentration in normal human serum?

a. IgM
b. IgG
c. IgA
d. IgE

A

b. IgG

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17
Q

The SUBCLASSES of IgG differ mainly in:

a. Type of L chain
b. Arrangement of disulfide bonds
c. Ability to act as opsonins
d. Molecular weight

A

b. Arrangement of disulfide bonds

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18
Q

Which antibody is best at agglutination and complement fixation?

a. IgA
b. IgG
c. IgD
d. IgM

A

d. IgM

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19
Q

The immunoglobulin class typically found to be present in saliva, tears and other secretions is:

a. IgG
b. IgA
c. IgM
d. IgD

A

b. IgA

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20
Q

Measurement of serum levels of which of the following immunoglobulins can serve as a screening test for multiple allergies?

a. IgA
b. IgE
c. IgG
d. IgM

A

b. IgE

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21
Q

Which complement component is present in the greatest quantity in plasma?

a. C2
b. C3
c. C4
d. C8

A

b. C3

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22
Q

The three complement activation pathways converge at the point of cleavage of complement component _____.

a. C3
b. C5
c. C7
d. C8

A

a. C3

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23
Q

Which of the following complement components is a strong CHEMOTACTIC FACTOR as well as a strong ANAPHYLATOXIN?

a. C3a
b. C3b
c. C5a
d. C4a

A

c. C5a

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24
Q

Which of the following activities is associated with C3b?

a. Opsonization
b. Anaphylaxis
c. Vasoconstriction
d. Chemotaxis

A

a. Opsonization

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25
Q

Which immunologic mechanism is usually involved in BRONCHIAL ASTHMA?

a. Immediate hypersensitivity
b. Immune complex
c. Antibody mediated cytotoxicity
d. Delayed hypersensitivity

A

a. Immediate hypersensitivity

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26
Q

The BASIC STRUCTURE OF IMMUNOGLOBULINS was elucidated in the 1950s and 1960s by:

a. Georges Kohler and Cesar Milstein
b. Gerald Edelman, Rodney Porter
c. Susumu Tonegawa
d. Rosalyn Yalow

A

b. Gerald Edelman, Rodney Porter

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27
Q

Recipient of the Nobel Prize for Physiology or Medicine in 1987, for his discovery of the genetic mechanism that produces ANTIBODY
DIVERSITY:

a. Georges Kohler and Cesar Milstein
b. Gerald Edelman, Rodney Porter
c. Susumu Tonegawa
d. Rosalyn Yalow

A

c. Susumu Tonegawa

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28
Q

Which of the following is true of NK cells?

a. They rely upon memory for antigen recognition
b. They have the same CD groups as B cells
c. They are found mainly in lymph nodes
d. They kill target cells without prior exposure to them

A

d. They kill target cells without prior exposure to them

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29
Q

Which cell is the most potent phagocytic cell in tissue?

a. Neutrophil
b. Dendritic cell
c. Eosinophil
d. Basophil

A

b. Dendritic cell

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30
Q

The HLA complex is located primarily on:

a. Chromosome 3
b. Chromosome 6
c. Chromosome 9
d. Chromosome 17

A

b. Chromosome 6

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31
Q

Antigenic groups identified by different sets of antibodies reacting in a manner to certain standard cell lines best describes:

a. Cytokines
b. Clusters of differentiation (CD)
c. Neutrophilic granules
d. Opsonins

A

b. Clusters of differentiation (CD)

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32
Q

An HLA specimen is collected in a tube containing:

a. ACD
b. EDTA
c. Silica
d. Thrombin

A

a. ACD

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33
Q

Of the following diseases, which one has the HIGHEST RELATIVE RISK IN ASSOCIATION WITH AN HLA ANTIGEN?

a. Ankylosing spondylitis
b. Dermatitis herpetiformis
c. Juvenile diabetes
d. Rheumatoid arthritis

A

a. Ankylosing spondylitis

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34
Q

Which of these are found on a mature B cell?

a. IgG and IgD
b. IgM and IgD
c. Alpha and beta chains
d. CD 3

A

b. IgM and IgD

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35
Q

All the following are a function of T cells except:

a. Mediation of delayed-hypersensitivity reactions
b. Mediation of cytolytic reactions
c. Regulation of the immune response
d. Synthesis of antibody

A

d. Synthesis of antibody

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36
Q

Which T cell expresses the CD8 marker and acts specifically to kill tumors or virally infected cells?

a. Helper T
b. T suppressor
c. T cytotoxic
d. T inducer/suppressor

A

c. T cytotoxic

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37
Q

How are cytotoxic T cells (TC cells) and natural killer (NK) cells similar?

a. Require antibody to be present
b. Effective against virally infected cells
c. Recognize antigen in association with HLA class II markers
d. Do not bind to infected cells

A

b. Effective against virally infected cells

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38
Q

Select the term that describes the unique part of the antigen that is recognized by a corresponding antibody.

a. Immunogen
b. Epitope
c. Paratope
d. Clone

A

b. Epitope

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39
Q

Which immunoglobulin cross links mast cells to release histamine?

a. IgG
b. IgM
c. IgA
d. IgE

A

d. IgE

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40
Q

Which immunoglobulin class(es) has (have) a J chain?

a. IgM
b. IgE and IgD
c. IgM and sIgA
d. IgG3 and IgA

A

c. IgM and sIgA

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41
Q

Which immunoglobulin(s) help(s) initiate the classic complement pathway?

a. IgA and IgD
b. IgM only
c. IgG and IgM
d. IgG only

A

c. IgG and IgM

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42
Q

What is MOST SERIOUS complement deficiency?

a. C1
b. C2
c. C3
d. C4

A

c. C3

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43
Q

What is the MOST COMMON complement component deficiency?

a. C1
b. C2
c. C3
d. C4

A

b. C2

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44
Q

Type IV hypersensitivity reactions are responsible for all the following
EXCEPT:

a. Contact sensitivity
b. Elimination of tumor cells
c. Rejection of foreign tissue grafts
d. Serum sickness

A

d. Serum sickness

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45
Q

Anti-CCP (cyclic citrullinated proteins) is specifically associated with which autoimmune disease?

a. Rheumatoid arthritis
b. Myasthenia gravis
c. Autoimmune hepatitis
d. Goodpasture’s syndrome

A

a. Rheumatoid arthritis

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46
Q

Anti-mitochondrial antibodies are strongly associated with which disease?

a. Autoimmune hepatitis
b. Celiac disease
c. Primary biliary cirrhosis
d. Goodpasture’s syndrome

A

c. Primary biliary cirrhosis

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47
Q

Which disease might be indicated by antibodies to smooth muscle?

a. Atrophic gastritis
b. Chronic active hepatitis
c. Myasthenia gravis
d. Sjögren’s syndrome

A

b. Chronic active hepatitis

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48
Q

A lack of C1 INHIBITOR might result in which of the following conditions?

a. Paroxysmal nocturnal hemoglobinuria
b. Hemolytic uremic syndrome
c. Hereditary angioedema
d. Increased bacterial infections

A

c. Hereditary angioedema

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49
Q

Increased up to 1000x in inflammation:

a. Alpha1-antitrypsin and CRP
b. Ceruloplasmin and C3
c. CRP and serum amyloid A
d. Fibrinogen and haptoglobin

A

c. CRP and serum amyloid A

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50
Q

Anti-dsDNA antibodies are associated with which of the following?

a. Syphilis
b. CMV infection
c. Systemic lupus erythematosus
d. Hemolytic anemia

A

c. Systemic lupus erythematosus

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51
Q

The flexible portion of the heavy chain of an immunoglobulin molecule that is located between the first and second constant regions.

a. Heavy chain
b. Hinge region
c. Light chain
d. Disulfide bonds

A

b. Hinge region

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52
Q

Father of Immunology:

a. Edward Jenner
b. Louis Pasteur
c. Gerald Edelman
d. Paul Ehrlich

A

b. Louis Pasteur

STEVENS, TURGEON
Louis Pasteur is generally considered to be the Father of Immunology.

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53
Q

Most potent phagocytic cell:

a. Dendritic cell
b. Eosinophil
c. Macrophage
d. Neutrophil

A

a. Dendritic cell

Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

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54
Q

Most efficient antigen-presenting cell (APC):

a. B cell
b. T cell
c. Dendritic cell
d. Macrophage

A

c. Dendritic cell

Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

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55
Q

Which of the following is characteristic of B cells?

a. Phagocytic
b. Participate in antibody-dependent cellular cytotoxicity (ADCC) reactions
c. Contain surface immunoglobulins
d. Secrete the C5 component of complement

A

c. Contain surface immunoglobulins

B cells carry surface immunoglobulins that react to a specific antigen. The antigen can then be internalized processed and presented to an appropriate T helper cell. B cells are not phagocytic, nor do they participate in antibody-dependent cellular cytotoxicity (ADCC)
reactions. Complement proteins are secreted by hepatocytes.

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56
Q

What is the predominant type of antibody found in the serum of neonates born after full-term gestation?

a. Infant IgA
b. Infant IgG
c. Infant IgM
d. Maternal IgG

A

d. Maternal IgG

Antibody production is immunogen induced. Because the fetus develops in a sequestered site, it makes very little immunoglobulin. Maternal IgG crosses the placenta and is the primary antibody found in infant’s circulation.

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57
Q

The major class of immunoglobulin found in adult human serum is:

a. IgA
b. IgE
c. IgG
d. IgM

A

c. IgG

Immunoglobulin G is Ihe predominant class of immunoglobulin found in serum. It accounts for approximately 80% of the total serum immunoglobulin. The normal range is 800-1600 mg/dL.

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58
Q

Which class of immunoglobulin possesses 10 antigenic binding sites?

a. IgA
b. IgD
c. IgG
d. IgM

A

d. IgM

The IgM molecule is a pentamer that contains 10 binding sites. However, the actual valence falls to 5 with larger antigen molecules, probably because of steric restrictions. IgA, IgG, IgD, and IgE monomers each have two antigenic binding sites.

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59
Q

Type I hypersensitivity is:

a. Associated with complement-mediated cell lysis
b. Due to immune complex deposition
c. Mediated by activated macrophages
d. An immediate allergic reaction

A

d. An immediate allergic reaction

Type I hypersensitivity reactions occur immediately after second exposure to an allergen. On the first, or primary, exposure, IgE specific to the allergen is produced. The IgE binds to Fc receptors on the surface of basophils and mast cells. Immune complexes and complement are not involved in the response.

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60
Q

Severe combined immunodeficiency(SCID) is an:

a. Immunodeficiency with decreased B cells and neutrophils
b. Immunodeficiency with lymphocytopenia and eosinophilia
c. Immunodeficiency with decreased or dysfunctional T and B cells
d. Immunodeficiency with decreased lymphocytes and decreased complement
concentration

A

c. Immunodeficiency with decreased or dysfunctional T and B cells

SCID is defined as a condition in which adaptive immune responses (i.e., cell-mediated and humoral-mediated immune responses) do not occur because of a lack of T and B cell activity. A number of genetic defects can lead to this condition. Children born with SCID need to live in a sterile environment, and they have a short life expectancy.

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61
Q

After exposure to antigen, the first antibodies that can be detected belong to the class:

a. IgA
b. IgE
c. IgG
d. IgM

A

d. IgM

The first B cells to respond to antigen differentiate into plasma cells that produce IgM antibody. Later in the immune response, stimulated B cells undergo a phenomenon called “class switching” and begin to produce antibodies of the IgG, IgA, and IgE classes. High concentration of IgM in patient serum is indicative of a recent infection.

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62
Q

A kidney transplant from one identical twin to another is an example of a(n):

a. Allograft
b. Autograft
c. Isograft
d. Xenograft

A

c. Isograft

Identical twins have the same genetic makeup. Grafts between them would be isografts or syngeneic grafts.

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63
Q

In Bruton disease, measurement of serum immunoglobulins would show:

a. Elevated levels of IgE
b. Elevated levels of IgG
c. Normal levels of IgG and IgM but reduced levels of IgA
d .The absence of all immunoglobulins

A

d .The absence of all immunoglobulins

Bruton disease is a congenital form of agammaglobulinemia. It is a sex-linked phenomenon that affects males. Because B cells are not produced, affected males have levels of IgA, IgD, IgE, and IgM undetectable by routine assays. IgG may be absent or
present at very low levels.

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64
Q

The type of immunity that follows the injection of an immunogen is termed:

a. Artificial active
b. Natural active
c. Artificial passive
d .Innate

A

a. Artificial active

Active immunity follows exposure to an antigen that stimulates the recipient to develop his or her own immune response. Vaccines are an example of artificial immunity in that the animal was exposed to the immunogen by the actions of a healthcare provider (unnatural).

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65
Q

The type of immunity that follows the injection of antibodies synthesized by another individual or animal is termed:

a. Artificial active
b. Natural adaptive
c. Artificial passive
d. Natural passive

A

c. Artificial passive

Artificial passive immunity results following the injection of antibody synthesized by another individual or animal. This type of immunity is only temporary but may be very important in providing “instant” protection from an infectious agent before the recipient would have time to actively synthesize antibody.

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66
Q

Innate immunity includes:

a. Anamnestic response
b. Antibody production
c. Cytotoxic T cell activity
d. Phagocytosis by polymorphonuclear cells

A

d. Phagocytosis by polymorphonuclear cells

Innate, or nonspecific, immunity refers to host defenses that are in general present at birth and do not require immunogen stimulation. Phagocytosis of bacteria by polymorphonuclear cells is an example.
Cytotoxic T cell activity is part of the adaptive cell-mediated immune response, and antibody production is the mechanism of protection in the adaptive humoral-mediated immune response.

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67
Q

The antibody most frequently present in systemic lupus erythematosus is directed against:

a. Surface antigens of bone marrow stem cells
b. Surface antigens of renal cells
c. Nuclear antigen
d. Myelin

A

c. Nuclear antigen

Antinuclear antibody (ANA) is the most consistent feature of systemic lupus erythematosus (SLE).

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68
Q

Elevated IgE levels are typically found in:

a. Type I hypersensitivity reactions
b. Type II hypersensitivity reactions
c. Type III hypersensitivity reactions
d. Type IV hypersensitivity reactions

A

a. Type I hypersensitivity reactions

Elevated IgE levels are found in type I hypersensitivity reactions. The antibody binds via the Fc portion of the molecule to Fc receptors on mast cells and basophils. When the attached antibody binds its specific allergen, the cell degranulates.

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69
Q

Loss of self-tolerance results in:

a. Autoimmune disease
b. Graft-versus-host disease
c. Immunodeficiency
d. Tumors

A

a. Autoimmune disease

The immune system recognizes host cells as self and is tolerant to antigens on those cells. The loss of tolerance will result in an autoimmune disease in which the immune system mounts an immune response against self cells.
Graft-versus-host disease occurs when a bone marrow graft is incompatible with the host tissue and attacks the host.

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70
Q

The activity of natural killer (NK) cells:

a. Does not require previous exposure to an antigen
b. Involves phagocytosis and killing of bacteria
c. Requires interaction with cytotoxic T cells
d. Requires interaction with B cells

A

a. Does not require previous exposure to an antigen

The natural killer (NK) cells destroy target cells through an extracellular nonphagocytic mechanism. NK cells are part of the host’s innate resistance and, therefore, do not need previous exposure to an antigen to be active.

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71
Q

An autoimmune disease causing destruction of pancreatic cells can result in:

a. Hashimoto disease
b. Multiple sclerosis
c. Myasthenia gravis
d. Type 1 diabetes

A

d. Type 1 diabetes

Destruction of the beta cells in the pancreas results in type 1 diabetes. An autoimmune response destroys the insulin-producing cells.

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72
Q

Which of the following complement proteins is part of the membrane attack complex (MAC)?

a. Cl
b. C3
c. C4
d. C5

A

d. C5

The membrane attack complex forms following the binding of C5 to a biologic membrane.
The complex is formed by the sequential addition of C6, C7, C8, and C9. When C5-C8 complex with C9, a tubule is formed that bridges the cell membrane.

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73
Q

A cut on a person’s finger becomes contaminated with the bacterium Staphylococcus aureus. The first response by the immune system consists of activity of:

a. B cells
b. Monocytes
c. Neutrophils
d. T cells

A

c. Neutrophils

The first response by the innate immune system consists of an influx of neutrophils into the tissue invaded by bacteria. Monocytes and macrophages, although they are phagocytic cells and part of the innate immune system, play only a minor role in the initial response to bacterial invasion.

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74
Q

Incompatible blood transfusions are examples of:

a. Type I hypersensitivity reactions
b. Type II hypersensitivity reactions
c. Type III hypersensitivity reactions
d. Type IV hypersensitivity reactions

A

b. Type II hypersensitivity reactions

Incompatible blood transfusions are examples of a type II hypersensitivity reaction. These reactions are characterized as the antigen being a part of a cell. Antibody binds to the antigen, complement is activated, and the red blood cells are lysed.

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75
Q

Hashimoto disease is an autoimmune disease primarily involving the:

a. Kidneys
b. Liver
c. Lungs
d. Thyroid gland

A

d. Thyroid gland

Hashimoto disease is a type of thyroiditis due to an autoimmune disease. Patients produce autoantibodies and T cells that respond to thyroid antigens. This results in inflammation and swelling of the thyroid gland (goiter). The autoantibody blocks the uptake of iodine, which results in a decrease in the production of thyroid hormones
(hypothyroidism).

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76
Q

Contact dermatitis is mediated by:

a. B lymphocytes
b. T lymphocytes
c. Macrophages
d. Polymorphonuclear cells

A

b. T lymphocytes

Contact dermatitis is a delayed-type hypersensitivity reaction mediated by T cells.

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77
Q

Which of the following is characteristic of DiGeorge syndrome?

a. Defective T lymphocyte production
b. Depressed B cell development
c. Suppressed intracellular killing by polymorphonuclear cells
d. Suppressed complement levels

A

a. Defective T lymphocyte production

Congenital thymic hypoplasia (DiGeorge syndrome)

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78
Q

Which of the following frequently functions as an antigen-presenting cell?

a. Dendritic cell
b. Cytotoxic T lymphocyte
c. Natural killer cell
d. T helper cell

A

a. Dendritic cell

Dendritic cells are considered the most effective APC in the body, as well as the most potent phagocytic cell.

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79
Q

A patient with joint swelling and pain tested negative for serum RF by both latex agglutination and ELISA methods. What other test would help establish a diagnosis of RA in this patient?

a. Anti-CCP
b. ANA testing
c. Flow cytometry
d. Complement levels

A

a. Anti-CCP

Antibodies to cyclic citrullinated peptide are often found in RF-negative patients with rheumatoid arthritis.

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80
Q

Which of the following is the best analyte to monitor for recurrence of ovarian cancer?

a. CA 15-3
b. CA 19-9
c. CA 125
d. CEA

A

c. CA 125

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81
Q

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

A

c. Nuclear matrix protein

Nuclear matrix proteins (NMPs) are RNA-protein complexes. NMP-22 is shed into the urine in persons with bladder carcinoma and is about 25-fold higher than normal in this condition.

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82
Q

Which of the following tumor markers is used to monitor persons with breast cancer for RECURRENCE of disease?

a. Cathepsin-D
b. CA 15-3
c. Retinoblastoma gene
d. Estrogen receptor (ER)

A

b. CA 15-3

CA 15-3 shares the same antigenic determinant as CA 27.29. The markers are used to monitor treatment and recurrence of breast cancer.

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83
Q

Which tumor marker is used to determine the usefulness of trastuzumab (Herceptin) therapy for breast cancer?

a. PR
b. CEA
c. HER-2/neu
d. Myc

A

c. HER-2/neu

Trastuzumab is an antibody to the HER-2/neu gene product, a tyrosine kinase receptor protein. HER- 2/neu is an oncogene that is overexpressed in some breast cancers.
Overexpression is associated with a more aggressive clinical course but responds to treatment with trastuzumab, which blocks the attachment of growth factor to the receptor.

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84
Q

Which type of cancer is associated with the highest level of AFP?

a. Hepatoma
b. Ovarian cancer
c. Testicular cancer
d. Breast cancer

A

a. Hepatoma

AFP is increased in all persons with yolk sac tumors and over 80% of those with hepatoma. Levels above 1000 ng/mL are diagnostic of hepatoma.

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85
Q

Immunoglobulin IDIOTYPES are antibodies with variations in the domains of which of the following?

a. CH1 and CH2
b. VH and VL
c. VH and CL
d. CH1, CH2 and CH3

A

b. VH and VL

Variations in the variable regions of the heavy and light chains of an immunoglobulin molecule define the idiotype.

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86
Q

Mannose-binding lectin is similar to which component of the classical pathway?

a. C3
b. C2
c. C1q
d. C5a

A

c. C1q

Mannose-binding lectin (MBL) of the lectin pathway of complement activation is found in circulation complexed with proteinases. It is considered to be similar in structure to C1q of the classical pathway. The MBL-proteinase complex does not require antibody for complement activation.

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87
Q

In Grave’s disease, one of the main autoantibodies is:

a. Anti-CCP
b. Antibody to islet cells of pancreas
c. Antibody to thyroid-stimulating hormone receptor
d. Anti-dsDNA

A

c. Antibody to thyroid-stimulating hormone receptor

Autoantibody to the thyroid-stimulating hormone receptor ultimately causes release of thyroid hormones and a hyperthyroid condition.

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88
Q

Skin testing for exposure to tuberculosis is an example of which type of hypersensitivity?

a. Type I
b. Type II
c. Type III
d. Type IV

A

d. Type IV

Type IV hypersensitivity is the delayed-type hypersensitivity. Skin testing for tuberculosis causes a delayed-type hypersensitivity to intradermally injected antigens in individuals previously exposed to the organism.

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89
Q

A 1-year-old boy is seen for having many recurrent infections with Streptococcus pneumoniae. Laboratory tests revealed a normal quantity of T cells, but no B cells and no immunoglobulins were seen on electrophoresis. Which of the following would most likely be the cause?

a. Chronic granulotomatous disease
b. Bruton’s agammaglobulinemia
c. DiGeorge’s syndrome
d. Wiskott-Aldrich syndrome

A

b. Bruton’s agammaglobulinemia

Bruton’s agammaglobulinemia is typically seen in infancy. These patients present with frequent recurring infections, especially after protective maternal antibody is gone and normal levels of circulating T cells. The syndrome is a genetic B cell enzyme deficiency in which the B cells fail to differentiate and mature to antibody-producing plasma cells.

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90
Q

A patient with hereditary angiodema has which of the following deficiencies?

a. C5-9
b. Phagocytic cell function
c. Mature B cells
d. C1 Inhibitor

A

d. C1 Inhibitor

Hereditary angioedema is characterized by recurrent swelling. The condition is genetic or can be acquired and is the result of a deficiency of the complement protein C1 Inhibitor.

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91
Q

A radiograph of a 1-year-old boy indicates the lack of a thymus. Complete blood count and flow cytometry confirm a below-normal lymphocyte count and a lack of T cells. Which of the following would most likely be the cause?

a. DiGeorge’s syndrome
b. Wiskott-Aldrich syndrome
c. Bare lymphocyte syndrome
d. Bruton’s agammaglobulinemia

A

a. DiGeorge’s syndrome

DiGeorge syndrome is the most likely cause. In this syndrome the thymus fails to develop before birth. These patients also show a marked decrease in T cells.

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92
Q

A 3-year-old boy is seen by his physician because of many recent bacterial infections. Flow cytometery indicates normal levels of T and B cells. The nitroblue tetrazolium test for oxidative reduction is negative. The most likely cause is:

a. Wegener’s syndrome
b. Chronic granulomatous disease
c. Bruton’s agammaglobulinemia
d. Diabetes mellitus

A

b. Chronic granulomatous disease

Chronic granulomatous disease is an inherited disease that impairs the neutrophil’s ability to kill certain bacteria. The neutrophils lack the enzyme nicotinamide adenine dinucleotide phosphate oxidase, easily demonstrated by the failure to reduce nitroblue tetrazolium or
produce a blue end result. These patients have normal levels of lymphocytes.

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93
Q

The type of graft rejection that occurs within minutes of a tissue transplant is ____________.

a. Acute
b. Chronic
c. Hyperacute
d. Accelerated

A

c. Hyperacute

The hyperacute tissue graft reject occurs within minutes to hours of a transplant and is typically associated with transplantation across ABO blood groups and anti-ABO antibodies.

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94
Q

A biomarker that exhibits greater specificity than other proinflammatory markers in identifying patients with sepsis and can be used in the DIAGNOSIS OF BACTERIAL INFECTIONS:

a. Ceruloplasmin
b. Cytokines
c. CEA
d. Procalcitonin

A

d. Procalcitonin

Procalcitonin (PCT) is a biomarker that exhibits greater specificity than other proinflammatory markers (e.g., cytokines) in identifying patients with sepsis and can be used in the diagnosis of bacterial infections.

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95
Q

Macrophages have specific names according to their tissue location. Macrophages in the liver are:

a. Alveolar macrophages
b. Microglial cells
c. Kupffer cells
d. Histiocytes

A

c. Kupffer cells

MACROPHAGES NOMENCLATURE IN DIFFERENTTISSUES
CNS - Microglial cells
Kidney - Mesangial cells
Liver - Kupffer cells
Lung - Alveolar macrophage
Lymph node - Lymph node macrophage
Spleen - Splenic macrophage

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96
Q

Skin pH keeps most microorganisms from growing:

a. pH 5.6
b. pH 6.5
c. pH 7.2
d. pH 8.0

A

a. pH 5.6

Lactic acid in sweat, for instance, and fatty acids from sebaceous glands maintain the skin at a pH of approximately 5.6. This acidic pH keeps most microorganisms from growing.

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97
Q

C1 consists of three subunits: C1q, C1r and C1s, which are bound together by:

a. Magnesium
b. Calcium
c. Iron
d. Chloride

A

b. Calcium

C1 forms the recognition unit of the complement pathway. It consists of three subunits stabilized by calcium.

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98
Q

High titers of antimicrosomal antibodies are most often found in:

a. RA
b. SLE
c. Chronic active hepatitis
d. Hashimoto’s thyroiditis

A

d. Hashimoto’s thyroiditis

Hashimoto’s thyroiditis is an autoimmune disorder that results in hypothyroidism. More than 80% of the patients with the disease have serum anti-thyroglobulin and anti-microsomal antibodies

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99
Q

Which autoantibodies are strongly associated with granulomatosis with polyangiitis (Wegener’s granulomatosis)?

a. ANA
b. ANCA
c. AMA
d. ASMA

A

b. ANCA

ANCA: ANTINEUTROPHILIC CYTOPLASMIC ANTIBODY

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100
Q

The immunoglobulin classes most commonly found on the surface of circulating B lymphocytes in the peripheral blood of normal persons are:

a. IgM, IgA
b. IgM, IgG
c. IgM, IgD
d. IgM, IgE

A

c. IgM, IgD

IgM and IgD are the classes of immunoglobulin that are found on most circulating B cells. They are in effect the B cell receptor.

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101
Q

Immunodeficiency with thrombocytopenia and eczema is often referred to as:

a. DiGeorge syndrome
b. Bruton agammaglobulinemia
c. Ataxia telangiectasia
d. Wiskott-Aldrich syndrome

A

d. Wiskott-Aldrich syndrome

Wiskott Aldrich syndrome is an X-linked recessive defect that exhibits immunodeficiency, eczema and thrombocytopenia.

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102
Q

The prozone phenomenon can result in a (an):

a. False-positive reaction
b. False-negative reaction
c. Enhanced agglutination
d. Diminished antigen response

A

b. False-negative reaction

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103
Q

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

A

d. Diagnosis of monoclonal gammopathies

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104
Q

In a ____ immunofluorescent assay, ANTIBODY THAT IS CONJUGATED WITH A FLUORESCENT TAG is added directly to unknown antigen that is fixed to a microscope slide:

a. Direct immunofluorescent assay
b. Indirect immunofluorescent assay
c. Inhibition immunofluorescent assay

A

a. Direct immunofluorescent assay

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105
Q

A substrate is first exposed to a patient’s serum, then after washing, ANTI-HUMAN IMMUNOGLOBULIN LABELED WITH A FLUOROCHROME is added. The procedure described is:

a. Fluorescent quenching
b. Indirect fluorescence
c. Direct fluorescence
d. Fluorescence inhibition

A

b. Indirect fluorescence

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106
Q

BLOCKING TEST in which an antigen is first exposed to unlabeled antibody and then to labeled antibody, and is finally washed and examined:

a. Direct immunofluorescent assay
b. Indirect immunofluorescent assay
c. Inhibition immunofluorescent assay

A

c. Inhibition immunofluorescent assay

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107
Q

In FLUORESCENCE POLARIZATION IMMUNOASSAY (FPIA), the degree of fluorescence polarization is ____ proportional to concentration of the analyte.

a. Direct
b. Inverse
c. Variable
d. No effect

A

b. Inverse

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108
Q

In FLUORESCENCE POLARIZATION IMMUNOASSAY (FPIA), labeled antigens compete with unlabeled antigen in the patient sample for a limited number of antibody binding sites. The MORE antigen that is present in the patient sample:

a. Less fluorescence
b. Greater fluorescence
c. Less fluorescence polarization
d. Greater fluorescence polarization

A

c. Less fluorescence polarization

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109
Q

The polymerase chain reaction (PCR) involves three processes. Select the order in which these occur.

a. Extension→Annealing→Denaturation
b. Annealing→Denaturation→Extension
c. Denaturation→Annealing→Extension
d. Denaturation→Extension→Annealing

A

c. Denaturation→Annealing→Extension

The PCR process results in identical copies of a piece of double-stranded DNA. The process involves three steps that are repeated to double the number of copies produced with each cycle.

The first step is denaturation to separate the complementary strands.

Annealing occurs when a primer binds upstream to the segment of interest on each strand, called the template.

Extension involves the enzymatic addition of nucleotides to the primer to complete the new strand.

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110
Q

In the PCR cycle, how is denaturation accomplished?

a. Heat
b. Alkali treatment
c. Addition of sulfonylurea
d. Formamide

A

a. Heat

In PCR, the separation of dsDNA occurs by heating the sample. This breaks the double bonds between the base pairs and is reversible by lowering the temperature.

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111
Q

What temperature is used to achieve DNA denaturation to a single strand?

a. 74 °C
b. 92 °C
c. 94 °C
d. 102 °C

A

c. 94 °C

DENATURATION: 94C
ANNEALING: 50 to 58C or higher
EXTENSION: 72C

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112
Q

The Australia antigen is now called:

a. Dane particle
b. Long-incubation hepatitis
c. Hepatitis B surface antigen (HBsAg)
d. Hepatitis B core antigen (HBcAg)

A

c. Hepatitis B surface antigen (HBsAg)

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113
Q

The FIRST SEROLOGIC MARKER to appear in patients with acute hepatitis B virus infection is:

a. Anti-HBs
b. Anti-HBc
c. Anti-HBe
d. HBsAg

A

d. HBsAg

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114
Q

Which surface marker is a reliable marker for the presence of high levels of hepatitis B virus (HBV) and a high degree of infectivity?

a. HBeAg
b. HBsAg
c. HBcAg
d. Anti-HBsAg

A

a. HBeAg

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115
Q

Which of the following tests is positive during the WINDOW PERIOD of infection with hepatitis B?

a. Hepatitis B surface antigen
b. Hepatitis B surface antibody
c. Hepatitis B core antibody
d. Hepatitis C antibody

A

c. Hepatitis B core antibody

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116
Q

Which hepatitis antibody confers immunity against reinfection with hepatitis B virus?

a. Anti-HBc IgM
b. Anti-HBc IgG
c. Anti-HBe
d. Anti-HBs

A

d. Anti-HBs

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117
Q

If only anti-HBs is positive, which of the following can be ruled out?

a. Hepatitis B virus vaccination
b. Distant past infection with hepatitis B virus
c. Hepatitis B immune globulin (HBIG) injection
d. Chronic hepatitis B virus infection

A

d. Chronic hepatitis B virus infection

Persons with chronic HBV infection show a positive test result for anti-HBc (IgG or total) and HBsAg but not anti-HBs. Patients with active chronic hepatitis have not become immune to the virus.

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118
Q

Risk factors for hepatitis C virus (HCV) include:

a. Illegal IV drug use
b. Occupational exposure
c. Multiple sexual partners
d. All of the above

A

d. All of the above

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119
Q

The specific diagnostic test for hepatitis C is:

a. Absence of anti-HAV and anti-HBsAg
b. Increase in liver serum enzyme levels
c. Detection of non-A, non-B antibodies
d. Anti-HCV

A

d. Anti-HCV

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120
Q

As AIDS progresses, the quantity of _______ diminishes and the risk of opportunistic infection increases.

a. HIV antigen
b. HIV antibody
c. CD4+ T lymphocytes
d. CD8+ T lymphocytes

A

c. CD4+ T lymphocytes

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121
Q

The most frequent malignancy observed in AIDS patients is:

a. Pneumocystis jiroveci (P. carinii)
b. Kaposi’s sarcoma
c. Toxoplasmosis
d. Non-Hodgkin’s lymphoma

A

b. Kaposi’s sarcoma

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122
Q

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

A

d. p24

In HIV-1 infection, antibodies to the gag proteins p24 and p55 appear relatively early after exposure to the virus, but tend to decrease or become undetectable as clinical symptoms of AIDS appear.

Antibodies to the envelope proteins gp41, gp120, and gp160 appear slightly later but remain throughout all disease stages in an HIV-infected individual, making them a more reliable indicator of the presence of HIV.

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123
Q

The fourth-generation ELISA tests for HIV detect:

a. HIV-1 and HIV-2 antigens
b. HIV-1 and HIV-2 antibodies
c. p24 antigen
d. HIV-1 and HIV-2 antibodies and p24 antigen

A

d. HIV-1 and HIV-2 antibodies and p24 antigen

FIRST GENERATION
Solid-phase, indirect
Anti-HIV1

SECOND GENERATION
Indirect binding
Anti-HIV1, anti-HIV2

THIRD GENERATION
Sandwich technique
Anti-HIV1, anti-HIV2
Simultaneously detecting HIV antibodies of different immunoglobulin classes, including IgM

FOURTH GENERATION
Detects anti-HIV1, anti-HIV2 and p24

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124
Q

Which is most likely a positive Western blot result for infection with HIV?

a. Band at p24
b. Band at gp60
c. Bands at p24 and p31
d. Bands at p24 and gp120

A

d. Bands at p24 and gp120

Criteria for determining a positive test result have been published by the Association of State and Territorial Public Health Laboratory Directors and CDC, the Consortium for Retrovirus Serology Standardization, the American Red Cross, and the FDA.

According to these criteria, a result should be reported as positive if at least two of the following three bands are present: p24, gp41, and gp120/gp160.

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125
Q

Which part of the radial immunodiffusion (RID) test system contains the antisera?

a. Center well
b. Outer wells
c. Gel
d. Antisera may be added to any well

A

c. Gel

In an RID test system, for example, one measuring hemopexin concentration, the gel would contain the antihemopexin. A standardized volume of serum containing the antigen is added to each well. Antigen diffuses from the well into the gel and forms a precipitin ring by reaction with antibody. At equivalence, the area of the ring is proportional to antigen concentration.

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126
Q

What is the interpretation when an Ouchterlony plate shows crossed lines between wells 1 and 2(antigen is placed in the center well and antisera in wells 1 and 2)?

a. No reaction between wells 1 and 2
b. Partial identity between wells 1 and 2
c. Nonidentity between wells 1 and 2
d. Identity between wells 1 and 2

A

c. Nonidentity between wells 1 and 2

Crossed lines indicate nonidentity between wells 1 and 2. The antibody from well 1 recognizes a different antigenic determinant than the antibody from well 2.

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127
Q

What outcome results from improper washing of a tube or well after adding the enzyme–antibody conjugate in an ELISA system?

a. Result will be falsely decreased
b. Result will be falsely increased
c. Result will be unaffected
d. Result is impossible to determine

A

b. Result will be falsely increased

If unbound enzyme-conjugated anti-immunoglobulin is not washed away, it will catalyze conversion of substrate to colored product, yielding a falsely elevated result.

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128
Q

What would happen if the color reaction phase is prolonged in one tube or well of an ELISA test?

a. Result will be falsely decreased
b. Result will be falsely increased
c. Result will be unaffected
d. Impossible to determine

A

b. Result will be falsely increased

If the color reaction is not stopped within the time limits specified by the procedure, the enzyme will continue to act on the substrate, producing a falsely elevated test result.

129
Q

The directions for a slide agglutination test instruct that after mixing the patient’s serum and latex particles, the slide must be rotated for 2 minutes. What would happen if the slide were rotated for 10 minutes?

a. Possible false-positive result
b. Possible false-negative result
c. No effect
d. Depends on the amount of antibody present in the sample

A

a. Possible false-positive result

Failure to follow directions, as in this case where the reaction was allowed to proceed beyond the recommended time, may result in a false-positive reading. Drying on the slide may lead to a possible erroneous positive reading.

130
Q

The characteristic laboratory finding in HIV infection is:

a. Decreased numbers of CD4 T cells.
b. Decreased numbers of CD8 T cells.
c. Decreased numbers of CD20 B cells.
d. Decreased immunoglobulins.

A

a. Decreased numbers of CD4 T cells.

131
Q

Which CD4:CD8 ratio is most likely in a patient with acquired immunodeficiency syndrome (AIDS)?

a. 2:1
b. 3:1
c. 2:3
d. 1:2

A

d. 1:2

An inverted CD4:CD8 ratio (less than 1.0) is a common finding in an AIDS patient. The Centers for Disease Control and Prevention requires a CD4-positive (helper T) cell count of less than 200/μL or 14% in the absence of an AIDS-defining illness (e.g., Pneumocystis carinii pneumonia) in the case surveillance definition of AIDS.

132
Q

All of the following hepatitis viruses are spread through blood or blood products except:

a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D

A

a. Hepatitis A

Hepatitis A is spread through the fecal–oral route and is the cause of infectious hepatitis. Hepatitis A virus has a shorter incubation period (2–7 weeks) than hepatitis B virus (1–6 months). Epidemics of hepatitis A virus can occur, especially when food and water become contaminated with raw sewage.

Hepatitis E virus is also spread via the oral–fecal route and, like hepatitis A virus, has a short incubation period.

133
Q

Which hepatitis B marker is the best indicator of early acute infection?

a. HBsAg
b. HBeAg
c. Anti-HBc
d. Anti-HBs

A

a. HBsAg

Hepatitis B surface antigen (HBsAg) is the first marker to appear in hepatitis B virus infection. It is usually detected within 4 weeks of exposure (prior to the rise in transaminases) and persists for about 3 months after serum enzyme levels return to normal.

134
Q

Which is the first antibody detected in serum after infection with hepatitis B virus (HBV)?

a. Anti-HBs
b. Anti-HBc IgM
c. Anti-HBe
d. All are detectable at the same time

A

b. Anti-HBc IgM

Antibody to the hepatitis B core antigen (anti-HBc) is the first detectable hepatitis B antibody. It persists in the serum for 1–2 years post-infection and is found in the serum of asymptomatic carriers of HBV.

135
Q

Which test, other than serological markers, is most consistently elevated in viral hepatitis?

a. Antinuclear antibodies
b. Alanine aminotransferase (ALT)
c. Absolute lymphocyte count
d. Lactate dehydrogenase

A

b. Alanine aminotransferase (ALT)

ALT is a liver enzyme and may be increased in hepatic disease. Highest levels occur in acute viral hepatitis, reaching 20–50 times the upper limit of normal.

136
Q

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
d. Absolute total T-cell count

A

c. HIV viral load

The HIV viral load will rise or fall in response to treatment more quickly than any of the other listed parameters. The absolute CD4 count is also an indicator of treatment effectiveness and is used in resource-poor areas that might not have facilities for molecular testing available. Note that the absolute CD4 count is not one of the choices, however.

137
Q

When soluble antigens diffuse in a gel that contains antibody, in which zone does OPTIMUM precipitation occur?

a. Prozone
b. Zone of equivalence
c. Postzone
d. Prezone

A

b. Zone of equivalence

138
Q

Which technique represents a SINGLE-diffusion reaction?

a. Radial immunodiffusion
b. Ouchterlony diffusion
c. Immunoelectrophoresis
d. Immunofixation electrophoresis

A

a. Radial immunodiffusion

139
Q

Reactions involving IgG may need to be enhanced for which reason?

a. It is only active at 25°C.
b. It may be too small to produce lattice formation.
c. It has only one antigen-binding site.
d. It is only able to produce visible precipitation reactions.

A

b. It may be too small to produce lattice formation.

140
Q

For which of the following tests is a lack of agglutination a positive reaction?

a. Hemagglutination
b. Passive agglutination
c. Reverse passive agglutination
d. Agglutination inhibition

A

d. Agglutination inhibition

141
Q

Typing of RBCs with reagent antiserum represents which type of reaction?

a. Direct hemagglutination
b. Passive hemagglutination
c. Hemagglutination inhibition
d. Reverse passive hemagglutination

A

a. Direct hemagglutination

142
Q

The serum of an individual who received all doses of the hepatitis B vaccine should contain:

a. Anti-HBs
b. Anti-HBe
c. Anti-HBc
d. All of the above

A

a. Anti-HBs

143
Q

The most common means of HIV transmission worldwide is through:

a. Blood transfusions
b. Intimate sexual contact.
c. Sharing of needles in intravenous drug use.
d. Transplacental passage of the virus.

A

b. Intimate sexual contact.

144
Q

False-negative test results in a laboratory test for HIV antibody may occur because of:

a. Heat inactivation of the serum before testing.
b. Collection of the test sample before seroconversion.
c. Interference by autoantibodies.
d. Recent exposure to certain vaccines.

A

b. Collection of the test sample before seroconversion.

145
Q

What is the main difference between agglutination and precipitation reactions?

a. Agglutination occurs between a soluble antigen and antibody
b. Agglutination occurs when the antigen is particulate
c. Precipitation occurs when the antigen is particulate
d. Precipitation occurs when both antigen and antibody are particulate

A

b. Agglutination occurs when the antigen is particulate

Precipitation reactions occur between soluble antigen and soluble antibody that produce a visible end result typically in the form of a visible line of precipitate.

Agglutination reactions occur when the antigen is particulate or coated on a particulate such as latex beads.

146
Q

Postzone causes false-negative reactions in antibody titers as a result of which of the following?

a. Too much diluent added to test
b. Excess antibody in test
c. Excess antigen in test
d. Incorrect diluent added to test

A

c. Excess antigen in test

PROZONE
Antibody excess, false negative
Remedy: serum dilution

POSTZONE
Antigen excess, false negative
Remedy: repeat test after a week to give time for antibody production

147
Q

Serum tested positive for HBsAg and anti-HBc IgM. The patient most likely has which of the following?

a. Acute hepatitis C
b. Chronic hepatitis B
c. Acute hepatitis B
d. Acute hepatitis A

A

c. Acute hepatitis B

The most likely answer is acute hepatitis B because of the presence of IgM anti-HBc in combination with the hepatitis surface antigen. Typically the presence of IgM indicates the presence of an acute phase of a disease.

148
Q

What is the difference between nephelometry and turbidimetry?

a. There is no difference between the two assays, only in name
b. Nephlometry is a newer example of turbidimetry
c. Nephlometry measures light transmitted through a solution, and turbidimetry measures light scattered in a solution
d. Nephlometry measures light scattered in a solution, and turbidimetry measures light transmitted through a solution

A

d. Nephlometry measures light scattered in a solution, and turbidimetry measures light transmitted through a solution

Nepholometry measures light at angles. The light source used for detection is placed at an angle from the detection device.

Turbidometry detection devices are placed directly across from the light source and measures the intensity of the light as it passes through solution.

149
Q

HIV can infect all of the following cells except:

a. CD4+ subset of lymphocytes
b. Macrophages
c. Monocytes
d. Polymorphonuclear leukocytes

A

d. Polymorphonuclear leukocytes

In addition to T lymphocytes, macrophages, peripheral blood monocytes, and cells in the lymph nodes, skin, and other organs also express measurable amounts of CD4 and can be infected by HIV-1.

150
Q

A bacterial protein used to bind human immunoglobulins is:

a. HAV antibody, IgA type
b. Escherichia coli protein C
c. Staphylococcal protein A
d. HAV antibody, IgG type

A

c. Staphylococcal protein A

Protein A, found in the cell walls of Staphylococcus aureus bacteria, has high affinity for the Fc region of IgG and can be used to bind IgG in some laboratory assays.

151
Q

Which of the following is used to detect allergen specific IgE?

a. RIST
b. RAST
c. IEP
d. CRP

A

b. RAST

RIST - measures TOTAL IgE
RAST - measures SPECIFIC IgE

152
Q

Initial force of attraction that exists between A SINGLE FAB SITE ON AN ANTIBODY MOLECULE AND A SINGLE EPITOPE OR DETERMINANT SITE on the corresponding antigen:

a. Affinity
b. Avidity

A

a. Affinity

153
Q

It represents the sum of all the attractive forces between an antigen and an antibody:

a. Affinity
b. Avidity

A

b. Avidity

154
Q

The antigen used in the precipitation test is:

a. Soluble
b. Insoluble
c. Particulate
d. Cellular

A

a. Soluble

155
Q

Inactivation of sera for serological tests is performed for what purpose?

a. Destruction of complement
b. Increasing sensitivity of test
c. Removal of particulate matter
d. Restoration of refrigerated sera to appropriate temperature for testing

A

a. Destruction of complement

156
Q

In ELISA, either antigen or antibody may be bound to ____ phase.

a. Liquid phase
b. Semi-solid phase
c. Solid phase

A

c. Solid phase

A variety of solid-phase supports are used, including microtiter plates, nitrocellulose membranes, and magnetic latex beads.

157
Q

In the enzyme-linked immunosorbent assay (ELISA), which of the following can be attached to a solid-phase support (e.g. polystyrene)?

a. Antigen anzyme
b. Antibody and albumin
c. Antigen and antibody
d. Antigen and albumin

A

c. Antigen and antibody

158
Q

In the enzyme-linked immunosorbent assay (ELISA), the antihuman globulin is:

a. Fluorochrome-conjugated
b. Auramine-conjugated
c. Hormone-conjugated
d. Enzyme-conjugated

A

d. Enzyme-conjugated

159
Q

Rapid plasma reagin (RPR) antigen contain cardiolipin with:

a. 10% saline
b. Lipoteichoic acid
c. Charcoal particles
d. Fluorescein isothiocyanate

A

c. Charcoal particles

160
Q

The rapid plasma reagin (RPR) test is rotated at what speed for which length of time?

a. 200 RPM for 10 minutes
b. 100 RPM for 8 minutes
c. 180 RPM for 4 minutes
d. 125 RPM for 2 minutes

A

b. 100 RPM for 8 minutes

161
Q

FTA-ABS is used to identify which of the following in the patient’s serum?

a. Treponemal antibody
b. Treponemes
c. Reagin
d. Cardiolipin

A

a. Treponemal antibody

162
Q

The serum titer in the ASO tube test is reported in:

a. Highest dilution that gives a positive result
b. Lowest dilution that gives a negative result
c. ASO units
d. Todd or International Units

A

d. Todd or International Units

163
Q

The Weil-Felix test is used for the detection of which type of antibodies:

a. Salmonella
b. Mycoplasma
c. Rickettsial
d. Viral

A

c. Rickettsial

164
Q

God standard for detecting rickettsial antibodies:

a. Weil-Felix test
b. ELISA
c. Immunoblot
d. IFA and micro-IF

A

d. IFA and micro-IF

IFA - indirect fluorescent assays
Micro-IF - microimmunofluorescent assay
The IFA test and the micro-IF are currently considered the gold standard for detecting rickettsial antibodies.

165
Q

OX-19 and OX-2 refer to:

a. Strains of Proteus vulgaris
b. Antigens of Rickettsia prowazeki
c. Serotypes of Brucella abortus
d. Antibodies to Salmonella typhi

A

a. Strains of Proteus vulgaris

166
Q

The presence of C-reactive protein in a patient’s serum indicates:

a. Inflammation
b. Pneumococcal pneumonia
c. Group A Strep infection
d. Typhoid or paratyphoid

A

a. Inflammation

167
Q

Cold agglutinins may develop after infection with:

a. Klebsiella pneumoniae
b. Mycoplasma pneumoniae
c. Streptococcus pneumoniae
d. Haemophilus influenzae

A

b. Mycoplasma pneumoniae

168
Q

A positive ANA with the pattern of ANTI-CENTROMERE ANTIBODIES is most frequently seen in patients with:

a. Rheumatoid arthritis
b. CREST syndrome
c. Systemic lupus erythematosus
d. Sjogren syndrome

A

b. CREST syndrome

Most patients with CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) demonstrate anti-centromere antibody.

169
Q

In the anti-dsDNA procedure, the antigen most commonly utilized is:

a Rat stomach liver
b. Mouse kidney tissue
c. Crithidia luciliae
d. Toxoplasma gondii

A

c. Crithidia luciliae

One particularly sensitive assay for ds-DNA is an immunofluorescent test using Crithidia luciliae, a hemoflagellate, as the substrate. This trypanosome has circular ds-DNA in the kinetoplast. A positive test is indicated by a brightly stained KINETOPLAST with patient serum and an antibody conjugate.

170
Q

Rheumatoid factor is typically an IgM autoantibody with specificity for which of the following?

a. SS-B
b. Double-stranded DNA
c. Ribonucleoprotein
d. Fc portion of IgG

A

d. Fc portion of IgG

171
Q

What substance is detected by the rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests for syphilis?

a. Cardiolipin
b. Anticardiolipin antibody
c. Anti-T. pallidum antibody
d. Treponema pallidum

A

b. Anticardiolipin antibody

Reagin is the name for a nontreponemal antibody that appears in the serum of syphilis-infected persons and is detected by the RPR and VDRL assays. Reagin reacts with cardiolipin, a lipid-rich extract of beef heart and other animal tissues.

172
Q

What type of antigen is used in the RPR card test?

a. Live treponemal organisms
b. Killed suspension of treponemal organisms
c. Cardiolipin
d. Tanned sheep cells

A

c. Cardiolipin

Cardiolipin is extracted from animal tissues, such as beef hearts, and attached to carbon particles. In the presence of reagin, the particles will agglutinate.

173
Q

A biological false-positive reaction is LEAST likely with which test for syphilis?

a. VDRL
b. Fluorescent T. pallidum antibody absorption test (FTA-ABS)
c. RPR
d. All are equally likely to detect a false-positive result

A

b. Fluorescent T. pallidum antibody absorption test (FTA-ABS)

The FTA-ABS test is more specific for T. pallidum than nontreponemal tests such as the VDRL and RPR and would be least likely to detect a biological false-positive result.

The FTA-ABS test uses heat-inactivated serum that has been absorbed with the Reiter strain of T. pallidum to remove nonspecific antibodies.

174
Q

Which specimen is the sample of choice to evaluate latent or tertiary syphilis?

a. Serum sample
b. Chancre fluid
c. CSF
d. Joint fluid

A

c. CSF

If neurosyphilis is present, cerebrospinal fluid serology will be positive and the CSF will display increased protein and pleocytosis characteristic of central nervous system infection.

175
Q

What criteria constitute the classification system for HIV infection?

a. CD4-positive T-cell count and clinical symptoms
b. Clinical symptoms, condition, duration, and number of positive bands on Western blot
c. Presence or absence of lymphadenopathy
d. Positive bands on Western blot and CD8-positive T-cell count

A

a. CD4-positive T-cell count and clinical symptoms

The classification system for HIV infection is based upon a combination of CD4-positive T-cell count (helper T cells) and various categories of clinical symptoms. Classification is important in determining treatment options and the progression of the disease.

176
Q

Which of the following statements regarding infection with hepatitis D virus is true?

a. Occurs in patients with HIV infection
b. Does not progress to chronic hepatitis
c. Occurs in patients with hepatitis B
d. Is not spread through blood or sexual contact

A

c. Occurs in patients with hepatitis B

Hepatitis D virus is an RNA virus that requires the surface antigen or envelope of the hepatitis B virus for entry into the hepatocyte. Consequently, hepatitis D virus can infect only patients who are coinfected with hepatitis B.

177
Q

Which of the following positive antibody tests may be an indication of recent vaccination or early primary infection for rubella in a patient with no clinical symptoms?

a. Only IgG antibodies positive
b. Only IgM antibodies positive
c. Both IgG and IgM antibodies positive
d. Fourfold rise in titer for IgG antibodies

A

b. Only IgM antibodies positive

If only IgM antibodies are positive, this result indicates a recent vaccination or an early primary infection.

178
Q

The serologically detectable antibody produced in rheumatoid arthritis (RA) is primarily of the class:

a. IgA
b. IgE
c. IgG
d. IgM

A

d. IgM

Rheumatoid factor (RF) is an immunoglobulin that reacts with antigenic determinants on an IgG molecule.

Although they may be of several types, the one that is easily serologically detectable is IgM. This is because of the agglutination activity of the molecule.

RF tests are commonly used in the diagnosis of rheumatoid arthritis.

179
Q

Diagnosis of group A streptococci (Streptococcus pyogenes) infection is indicated by the presence of:

a. Anti-protein A
b. Anti-DNase B
c. Anti-beta-toxin
d. C-reactive protein

A

b. Anti-DNase B

The serological diagnosis of group A streptococcal infection can be made by demonstrating anti-DNase B.

The antistreptolysin O (ASO) assay can also be used; however, ASO response is poor in skin infections.

180
Q

Diagnostic reagents useful for detecting antigen by the COAGGLUTINATION reaction may be prepared by binding antibody to killed staphylococcal cells via the Fc receptor of staphylococcal protein A. The class of antibody bound by this protein is:

a. IgA
b. IgD
c. IgG
d. IgM

A

c. IgG

Staphylococcal protein A binds only the IgG class (subclasses IgG1, IgG2, and IgG4) of immunoglobulin.

Binding occurs via the Fc portion of the antibody molecule, leaving the Fab portion available to bind antigen in an immunologic assay.

181
Q

The rapid plasma reagin assay for syphilis does not need to be read microscopically because the antigen is:

a. Cardiolipin
b. Complexed with latex
c. Complexed with charcoal
d. Inactivated bacterial cells

A

c. Complexed with charcoal

The rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests use a cardiolipin antigen.

However, in the RPR test, charcoal particles are included with the antigen. When antibody in the patient sample combines with the antigen, the charcoal is trapped in the immune complex, allowing the reaction to be read macroscopically.

182
Q

The Venereal Disease Research Laboratory (VDRL) test for syphilis is classified as a(n):

a. Agglutination reaction
b. Flocculation reaction
c. Hemagglutination reaction
d. Precipitation reaction

A

b. Flocculation reaction

The cardiolipin antigen is particulate, not soluble, in the VDRL test. However, the particles are too small to make macroscopic agglutinates when combined with antibody.

This type of reaction is called a flocculation reaction and needs to be read with low-power microscopy.

183
Q

One cause of a FALSE-POSITIVE VDRL test is:

a. Brucellosis
b. Treponema pallidum infection
c. Rocky Mountain spotted fever
d. Systemic lupus erythematosus

A

d. Systemic lupus erythematosus

Patients with connective tissue disorders such as systemic lupus erythematosus may show a false positive reaction in the VDRL test.

Other causes of false positives include rheumatic fever, infectious mononucleosis, malaria, and pregnancy.

184
Q

Which of the following serologic tests is commonly performed by an immunofluorescence method?

a. Anti-HBs
b. Antinuclear antibody (ANA)
c. Antistreptolysin O (ASO)
d. C-reactive protein (CRP)

A

b. Antinuclear antibody (ANA)

Testing for antinuclear antibodies (ANAs) is commonly performed by the immunofluorescence method—using fluorescein-conjugated antihuman antibody to detect patient antibody bound to nuclear components of test cells.

185
Q

Which of the following statements about the test for C-reactive protein (CRP) is true?

a. It correlates with neutrophil phagocytic function.
b. It is an indicator of ongoing inflammation.
c. It is diagnostic for rheumatic fever.
d. Levels decrease during heart disease.

A

b. It is an indicator of ongoing inflammation.

CRP is an acute-phase reactant. Although it is elevated in inflammation, its presence is not diagnostic for any one disease, such as rheumatic fever. It does not correlate with antibody levels or with neutrophil phagocytic function. CRP levels are sometimes elevated during heart disease.

186
Q

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

A

d. Precipitation reactions

Precipitation reactions involve both soluble antigens and antibodies.

With agglutination reactions, one of the reactants is soluble and the other is insoluble. A reactant is made insoluble by combining with a carrier particle such as latex beads.

187
Q

Which of the following is an example of a TREPONEMAL antigen test used for the diagnosis of syphilis?

a. CRP
b. RPR
c. VDRL
d. FTA-ABS

A

d. FTA-ABS

The fluorescent treponemal antibody absorbance (FTA-ABS) test is often used as a confirmatory test for syphilis. Treponema pallidum subsp. pallidum, the causative agent of syphilis, is the source of the antigen.

The rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) are diagnostic tests for syphilis that use nontreponemal antigen.

188
Q

A patient report states the presence of serum antibodies to OspC. What disease does the patient most likely have? - IMPORTANT

a. Syphilis
b. Strep throat
c. Lyme disease
d. Rubella

A

c. Lyme disease

IMPORTANT!
IgM antibody to OspC is an important early marker in the diagnosis of Lyme disease.

189
Q

Patient serum is mixed with a suspension of guinea pig antigen. When the sample is then mixed with horse red blood cells, agglutination occurs. This is suggestive of an infection caused by:

a. Borrelia burgdorferi
b. Hepatitis B virus
c. Hepatitis C virus
d. Epstein-Barr virus

A

d. Epstein-Barr virus

INFECTIOUS MONONUCLEOSIS (EBV)
The Davidsohn differential test can be used to detect heterophile antibodies produced during infectious mononucleosis. These antibodies are not adsorbed by guinea pig antigens. Therefore, the antibodies are available to agglutinate horse red blood cells.

190
Q

A living donor is being sought for a child who requires a kidney transplant. The best odds of finding an MHC-compatible donor occur between the child and:

a. A sibling (brother or sister)
b. An unrelated individual
c. The child’s father
d. The child’s mother

A

a. A sibling (brother or sister)

Because the human leukocyte antigen (HLA) system is extremely polymorphic, the odds are greatly against finding an HLA-compatible donor in unrelated individuals. The genes coding for HLA antigens are inherited from one’s parents and are expressed co-dominantly. Between an offspring and either parent, there is, statistically, a 25% chance of an HLA match. Between siblings, there is a 50% chance of an HLA match.

191
Q

Which of the following serologic tests detects the polysaccharide capsule ANTIGEN in serum and CSF of patients with suspected infection with Cryptococcus neoformans?

a. Complement fixation
b. India ink test
c. Latex agglutination
d. Hemagglutination test

A

c. Latex agglutination

192
Q

What is the immunologic method utilized in the FLOW CYTOMETER?

a. Latex agglutination
b. Immunofluorescence
c. Enzyme linked immunoassay
d. Radioimmunoassay

A

b. Immunofluorescence

193
Q

This disease was endemic in Haiti and was subsequently contracted and CARRIED TO EUROPE by COLUMBUS CREW:

a. Gonorrhea
b. Syphilis
c. Typhoid
d. Hepatitis

A

b. Syphilis

194
Q

Which of the following is considered to be nonsuppurative complication of streptococcal infection?

a. Acute rheumatic fever
b. Scarlet fever
c. Impetigo
d. Pharyngitis

A

a. Acute rheumatic fever

195
Q

A widely used HEMAGGLUTINATION test for detecting antibody to Treponema pallidum is:

a. MHA-TP test
b. FTA-ABS test
c. VDRL test
d. RPR test

A

a. MHA-TP test

196
Q

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

A

d. All of these

197
Q

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

A

d. HSV1 and HSV2

198
Q

Which of the following stages of infectious mononucleosis infection is characterized by ANTIBODY TO EPSTEIN-BARR NUCLEAR ANTIGEN (EBNA)?

a. Recent (acute) infection
b. Past infection (convalescent) period
c. Reactivation of latent infection
d. Past infection, reactivation of latent infection

A

d. Past infection, reactivation of latent infection

VCA - VIRAL CAPSID ANTIGEN
EBNA - EBV NUCLEAR ANTIGEN
EA - EARLY ANTIGEN

CHARACTERISTICS DIAGNOSTIC PROFILE OF EBV

SUSCEPTIBILITY
If the patient is seronegative (lacks antibody to VCA)

PRIMARY INFECTION
Antibody (IgM) to VCA is present; EBNA is absent.

PAST INFECTION
Antibodies to VCA and EBNA are present.

REACTIVATION
If antibody to EBNA and increased antibodies to EA are present, patient may be experiencing reactivation.

199
Q

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

A

a. 72 hours

IgM antibodies become detectable 3 to 4 days after appearance of symptoms and persist for 8 to 12 weeks.

200
Q

The most commonly used method to detect VZV antibodies in the clinical laboratory is:

a. ELISA
b. PCR
c. FAMA
d. All of these

A

a. ELISA

Varicella-Zoster virus (VZV) Antibodies

ELISA - most common, easiest
Automated, provides objective results, and does not require viral culture

FAMA - reference method
Considered to be the reference method for VZV antibody, it requires live, virus-infected cells and is not suitable for large-scale routine testing

FAMA (fluorescent antibody to membrane antigen)

201
Q

ACUTE HEPATITIS A is routinely diagnosed in symptomatic patients by demonstrating the:

a. HAV antigen
b. IgM anti-HAV
c. IgG anti-HAV

A

b. IgM anti-HAV

202
Q

Which technique is used to detect DNA containing a specific base sequence by applying a labeled probe to DNA bands immobilized onto nitrocellulose paper following electrophoresis?

a. Southern blot
b. Northern blot
c. Western blot

A

a. Southern blot

SNOW DROP
S - Southern Blot = D - DNA
N - Northern Blot = R - RNA
W - Western Blot = P - PROTEINS

203
Q

Rapid antigen detection for HISTIDINE-RICH PROTEIN II (HRP-II) is specific for:

a. Plasmodium falciparum
b. Plasmodium malariae
c. Plasmodium ovale
d. Plasmodium vivax

A

a. Plasmodium falciparum

HRP-II: Plasmodium falciparum

pLDH AND ALDOLASE TESTS: All four Plasmodium spp.

204
Q

Serologic HLA testing uses a form of complement- dependent microlymphocytotoxicity (CDC) performed in 60-well or 72-well microtiter trays. Trays are usually read on:

Brightfield microscopes
Darkfield microscopes
Polarizing microscopes
Inverted phase contrast microscopes

A

Inverted phase contrast microscopes

Trays are usually read on inverted phase contrast microscopes. In the properly adjusted phase, cells that have not been injured appear small, bright, and refractile. Injured cells that have taken up eosin-Y or trypan blue owing to antibody and complement-mediated damage will flatten and appear large, dark, and nonrefractile.

205
Q

In the production of hybridoma, plasma cells are harvested from:

Rabbit kidney
Rabbit spleen
Mouse liver
Mouse spleen

A

Mouse spleen

The production of hybridomas begins by immunizing a mouse with a certain antigen. After a time, the mouse’s spleen cells are harvested. Spleen cells are combined with myeloma cells in the presence of polyethylene glycol (PEG), a surfactant. The PEG brings about fusion of plasma cells with myeloma cells, producing a hybridoma.

206
Q

In fluorescent antinuclear antibody testing, _______ or human epithelial HEp-2 cells are fixed to a slide and allowed to react with patient serum.

Rabbit kidney
Rabbit spleen
Mouse kidney
Mouse spleen

A

Mouse kidney

In fluorescent antinuclear antibody (FANA) testing, mouse kidney or human epithelial HEp-2 cells are fixed to a slide and allowed to react with patient serum.

207
Q

Which receptor on T cells is responsible for rosetting with sheep red blood cells?

CD2
CD3
CD4
CD8

A

CD2

208
Q

Carrier particles to which antigens are attached in Streptozyme testing:

Bentonite
Charcoal
Horse RBCs
Sheep RBCs

A

Sheep RBCs

The Streptozyme test is a slide agglutination screening test for the detection of antibodies to several streptococcal antigens. Sheep red blood cells are coated with streptolysin, streptokinase, hyaluronidase, DNase, and NADase so that antibodies to any of the streptococcal antigens can be detected.

209
Q

Marginal B cells remain in the:

Bone marrow
Lymph nodes
Spleen
Peyer’s patches

A

Spleen

In the spleen, immature B cells develop into mature cells known as marginal zone B cells. These B cells remain in the spleen in order to respond quickly to any blood-borne pathogens they may come into contact with.

Other immature B cells become follicular B cells, which are found in lymph nodes and other secondary organs.

210
Q

Primary antibody found in Helicobacter pylori infection:

IgA
IgD
IgG
IgM

A

IgG

Most serological tests in clinical use detect H. pylori–specific antibodies of the IgG class. Although IgM antibody is produced in H. pylori infections, testing for its presence lacks clinical value, since most infections have become chronic before diagnosis. Thus, IgG is the primary antibody found.

IgA testing has a lower sensitivity and specificity than IgG testing, but it may increase sensitivity of detection when used in conjunction with IgG testing.

211
Q

Mantoux tuberculin test:

Type I hypersensitivity reaction
Type II hypersensitivity reaction
Type III hypersensitivity reaction
Type IV hypersensitivity reaction

A

Type IV hypersensitivity reaction

212
Q

The process by which cells are capable of moving from the circulating blood to the tissues by squeezing through the wall of a blood vessel:

Chemotaxis
Diapedesis
Endosmosis
Phagocytosis

A

Diapedesis

213
Q

The migration of cells in the direction of a chemical messenger:

Chemotaxis
Diapedesis
Endosmosis
Phagocytosis

A

Chemotaxis

214
Q

In plasma, it is associated with HDL cholesterol, and it is thought to play a role in metabolism of cholesterol:

Alpha1-antitrypsin
Fibrinogen
Mannose-binding lectin
Serum amyloid A

A

Serum amyloid A

215
Q

Serum amyloid A has been found to increase significantly more in:

Bacterial infections
Fungal infections
Parasitic infections
Viral infections

A

Bacterial infections

SERUM AMYLOID A
It has been found to increase significantly more in bacterial infections than in viral infections.

216
Q

Cells that express CD56 and/or CD16:

B cells
T cells
NK cells
All of the above

A

NK cells

Two subsets of NK cells exist—those that have a high level of CD56 and low or no CD16, and those with some CD56 and high levels of CD16.

217
Q

For serum VDRL, the slide is rotated at:

100 rpm for 4 minutes
100 rpm for 8 minutes
180 rpm for 4 minutes
180 rpm for 6 minute

A

180 rpm for 4 minutes

SERUM VDRL
The slide is rotated for 4 minutes on a rotator at 180 rpm. It is read microscopically to determine the presence of flocculation, or small clumps. The results are recorded as reactive (medium to large clumps), weakly reactive (small clumps), or nonreactive (no clumps or slight roughness).

218
Q

For RPR, the card is rotated at:

100 rpm for 4 minutes
100 rpm for 8 minutes
180 rpm for 4 minutes
180 rpm for 8 minutes

A

100 rpm for 8 minutes

219
Q

Most heat-labile of all immunoglobulins:

IgA
IgD
IgE
IgM

A

IgE

220
Q

IgE has the ability to activate:

B cells
B cells and T cells
Basophils and mast cells
Eosinophils and neutrophils

A

Basophils and mast cells

IgE is best known for its very low concentration in serum and the fact that it has the ability to activate mast cells and basophils.

221
Q

IgE recruits _____________ to the area to help destroy invading antigens that have penetrated IgA defenses:

B cells
B cells and T cells
Basophils and mast cells
Eosinophils and neutrophils

A

Eosinophils and neutrophils

IgE appears to be a nuisance antibody; however, it may serve a protective role by triggering an acute inflammatory reaction that recruits neutrophils and eosinophils to the area to help destroy invading antigens that have penetrated IgA defenses.

222
Q

The classical complement pathway is activated by:

Most viruses
Antigen–antibody complexes
Fungal cell walls
All of the above

A

Antigen–antibody complexes

223
Q

Triggering substances for the alternative pathway:

-Antigen-antibody complex
-Bacterial cell walls, especially those containing lipopolysaccharide; fungal cell walls; yeast; viruses; virally infected cells; tumor cell lines; and some parasites, especially trypanosomes
-Microorganisms with mannose or similar sugars in their cell wall
-All of the above

A

Bacterial cell walls, especially those containing lipopolysaccharide; fungal cell walls; yeast; viruses; virally infected cells; tumor cell lines; and some parasites, especially trypanosomes

Triggering substances for the alternative pathway include bacterial cell walls, especially those containing lipopolysaccharide; fungal cell walls; yeast; viruses; virally infected cells; tumor cell lines; and some parasites, especially trypanosomes. All of these can serve as sites for binding the complex C3bBb, one of the end products of this pathway.

224
Q

Mannose-binding protein in the lectin pathway is most similar to which classical pathway component?

C3b
C1rs
C1q
C4

A

C1q

225
Q

An antigen that triggers a type I hypersensitivity response:

Hapten
Histamine
Allergen
Oncogene

A

Allergen

226
Q

Cytokines produced by T cells and other cell lines that inhibit viral synthesis or act as immune regulators:

Integrins
Interferons
Complement
Antibodies

A

Interferons

227
Q

Decreased maternal alpha fetoprotein levels are associated with:

Anencephaly
Down syndrome
Twins or multiple pregnancies
Spina bifida

A

Down syndrome

Causes of increased maternal serum alpha fetoprotein levels?
1. Open neural tube defects such as spina bifida and anencephaly can typically increase MSAFP by double or more.
2. Twins or multiple pregnancies can also increase the result.

Cause of decreased maternal serum alpha fetoprotein levels:
Down syndrome (trisomy 21) and Edwards syndrome (trisomy 18) can cause as much as a 25% decrease in MSAFP.

228
Q

Positive rheumatoid factor is generally associated with:

Anemia
Azotemia
Decreased ESR
Hyperglobulinemia

A

Hyperglobulinemia

Hypergammaglobulinemia such as polyclonal increase is associated with autoimmune disorders. Hypergammaglobulinemia such as monoclonal increase is associated with such disease states as multiple myeloma, lymphomas, etc.

229
Q

Skin pH keeps most microorganisms from growing:

5.6
6.5
7.2
8.0

A

5.6

Skin at a pH of approximately 5.6
This acidic pH keeps most microorganisms from growing.

230
Q

Antigen in the RPR test:

Anti-cardiolipin
Cardiolipin
Charcoal
Reagin

A

Cardiolipin

231
Q

Microscope used for the Quantitative Buffy Coat (QBC) method for diagnosis of malaria:

Darkfield microscope
Fluorescent microscope
Phase contrast microscope
Polarizing microscope

A

Fluorescent microscope

232
Q

Color of the AHG reagent:

Red
Yellow
Blue
Green

A

Green

233
Q

Anticoagulant for the direct AHG test (DAT):

ACD
EDTA
Heparin
Oxalate

A

EDTA

234
Q

Present in 70% of patients with lupus and are highly specific for the disease:

Anti-DNP
Anti-RNP
Anti-dsDNA
Anti-CCP

A

Anti-dsDNA

Antibodies to dsDNA are present in 70% of patients with lupus and are highly specific for the disease.

235
Q

T in TORCH or STORCH stands for:

Trichinellosis
Trichuriasis
Toxoplasmosis
None of the above

A

Toxoplasmosis

236
Q

In the chain of infection, a contaminated work area would serve as which of the following:

Source
Method of transmission
Host
All of the above

A

Source

237
Q

In the process of phagocytosis, formation of hypochlorite and hydroxyl ions damage _______ irreversibly.

DNA
RNA
Carbohydrates
Proteins

A

Proteins

Formation of hypochlorite and hydroxyl ions damage PROTEINS irreversibly.

238
Q

Which tumor marker is used to monitor patients with breast cancer for recurrence of disease?

CA 15-3
Estrogen receptor (ER)
Cathepsin-D
CA 50

A

CA 15-3

239
Q

Antinuclear antibodies (ANA) include:

-Abs to DNA
-Abs to DNA, abs to nucleolar antigens
-Abs to DNA, abs to nucleolar antigens and abs to histone
-Abs to DNA, abs to nucleolar antigens, abs to histone and abs to nonhistone proteins

A

Abs to DNA, abs to nucleolar antigens, abs to histone and abs to nonhistone proteins

ANAs can be divided into four groups to provide a systematic classification: antibodies to DNA, antibodies to histone, antibodies to nonhistone proteins, and antibodies to nucleolar antigens.

240
Q

All are components of the second line of defense, except:

Macrophages
Mast cells
Neutrophils
B cells

A

B cells

SECOND LINE OF DEFENSE:
Cellular
1. Mast cells
2. Neutrophils
3. Macrophages

Humoral
1. Complement
2. Lysozyme
3. Interferon

241
Q

A vacuole formed within a phagocytic cell as pseudopodia surround a particle during the process of phagocytosis:

Neutrophil
Monocyte
Phagosome
Phagolysosome

A

Phagosome

242
Q

The structure formed by the fusion of cytoplasmic granules and the phagocytic vacuole during the process of phagocytosis:

Neutrophil
Monocyte
Phagosome
Phagolysosome

A

Phagolysosome

243
Q

It has been used to treat hepatitis C and Kaposi’s sarcoma, as well as certain leukemias and lymphomas:

TGF-alpha
TGF-beta
IFN-alpha
IFN-beta

A

IFN-alpha

IFN-α has been used to treat hepatitis C and Kaposi’s sarcoma, as well as certain leukemias and lymphomas.

244
Q

Efficacious in treating multiple sclerosis, although the exact mechanism of action remains unclear:

TGF-alpha
TGF-beta
IFN-alpha
IFN-beta

A

IFN-beta

IFN-β is efficacious in treating multiple sclerosis, although the exact mechanism of action remains unclear.

245
Q

A single ASO titer is considered to be moderately elevated if the titer is at least ______ Todd units in an adult:

160
200
240
320

A

240

A single ASO titer is considered to be moderately elevated if the titer is at least 240 Todd units in an adult and 320 Todd units in a child.

246
Q

A single ASO titer is considered to be moderately elevated if the titer is at least ______ Todd units in a child.

160
200
240
320

A

320

A single ASO titer is considered to be moderately elevated if the titer is at least 240 Todd units in an adult and 320 Todd units in a child.

247
Q

Current recommendations include the combined detection of mannan and anti-mannan antibodies for the specific identification of ______ species in serum samples.

Bordetella
Mycobacterium
Candida
Cryptococcus

A

Candida

Current recommendations include the combined detection of mannan and anti-mannan antibodies for the specific identification of Candida species in serum samples.

248
Q

Antibodies to which of the following viral antigens are usually the first to be detected in HIV infection?

gp120
gp160
gp41
p24

A

p24

249
Q

Most sensitive and reliable; reference method for VZV antibody:

Latex agglutination
ELISA
FAMA
PCR

A

FAMA

The most sensitive and reliable method of detecting VZV antibody is a fluorescent test called FAMA (fluorescent antibody to membrane antigen) that detects antibody to the envelope glycoproteins of the virus.

While FAMA is considered to be the reference method for VZV antibody, it requires live, virus-infected cells and is not suitable for large-scale routine testing.

250
Q

The most commonly used method to detect VZV antibodies in the clinical laboratory:

Latex agglutination
ELISA
FAMA
PCR

A

ELISA

The most commonly used method to detect VZV antibodies in the clinical laboratory is the ELISA because it is automated, provides objective results, and does not require viral culture.

251
Q

Most common cause of congenital infections:

Cytomegalovirus
Rubella
Syphilis
Toxoplasmosis

A

Cytomegalovirus

CMV is also the most common cause of congenital infections, occurring in approximately 1 percent of all neonates

252
Q

Method of choice for diagnosis of congenital toxoplasmosis:

EIA
IFA
FAMA
PCR

A

EIA

Enzyme immunoassays (EIA) for IgM, IgG, or IgA and indirect fluorescent antibody (IFA) assays for IgG are available and should be performed when congenital toxoplasmosis is suspected.

IFA testing has been widely used, but EIA is the method of choice, as it is more sensitive, less difficult to perform, and easier to interpret.

253
Q

Prenatal congenital toxoplasmosis can be diagnosed by performing ______ on amniotic fluid to detect T. gondii DNA.

EIA
IFA
FAMA
PCR

A

PCR

Prenatal congenital toxoplasmosis can be diagnosed by performing polymerase chain reaction (PCR) technology on amniotic fluid to detect T. gondii DNA.

254
Q

Method of choice to detect T. gondii DNA in CSF:

EIA
IFA
FAMA
PCR

A

PCR

Currently, there are no useful serological procedures for diagnosing CNS infection in immunocompromised patients. These individuals often do not produce detectable levels of specific antibody against the parasite, and procedures to detect circulating antigen appear to lack sensitivity. PCR is, therefore, the method of choice to detect T. gondii DNA in CSF.

255
Q

The cells that Metchnikoff first observed are associated with which phenomenon?

Innate immunity
Adaptive immunity
Humoral immunity
Specific immunity

A

Innate immunity

256
Q

Which of the following statements is true of NK cells?

They rely upon memory for antigen recognition.
They have the same CD groups as B cells.
They are found mainly in lymph nodes.
They kill target cells without prior exposure to them.

A

They kill target cells without prior exposure to them.

257
Q

Which cell is the most potent phagocytic cell in the tissue?

Neutrophil
Dendritic cell
Eosinophil
Basophil

A

Dendritic cell

258
Q

A cell characterized by a nucleus with two to five lobes, a diameter of 10 to 15 μm, and a large number of neutral staining granules is identified as a(n):

Eosinophil
Monocyte
Basophil
Neutrophil

A

Neutrophil

259
Q

Where do lymphocytes mainly come in contact with antigens?

Secondary lymphoid organs
Bloodstream
Bone marrow
Thymus

A

Secondary lymphoid organs

260
Q

Which of the following statements best characterizes adaptive immunity?

Relies on normally present body functions
Response is similar for each exposure
Specificity for each individual pathogen
Involves only cellular immunity

A

Specificity for each individual pathogen

261
Q

The main function of T cells in the immune response is to:

Produce cytokines that regulate both innate and adaptive immunity
Produce antibodies
Participate actively in phagocytosis
Respond to target cells without prior exposure

A

Produce cytokines that regulate both innate and adaptive immunity

262
Q

Antigenic groups identified by different sets of antibodies reacting in a similar manner to certain standard cell lines best describes:

Cytokines
Clusters of differentiation (CD)
Neutrophilic granules
Opsonins

A

Clusters of differentiation (CD)

263
Q

All of the following are characteristics of an effective immunogen except:

Internal complexity
Large molecular weight
Presence of numerous epitopes
Found on host cells

A

Found on host cells

264
Q

HLA molecules A, B, and C belong to which MHC class?

Class I
Class II
Class III
Class IV

A

Class I

265
Q

Which best explains the difference between immunogens and antigens?

Only antigens are large enough to be recognized by T cells
Only immunogens can react with antibody
Only immunogens can trigger an immune response
Only antigens are recognized as foreign.

A

Only immunogens can trigger an immune response

266
Q

The term for enhancement of phagocytosis by coating of foreign particles with serum proteins is

Opsonization
Agglutination
Solubilization
Chemotaxis

A

Opsonization

267
Q

How do cytotoxic T cells kill target cells?

They produce antibodies that bind to the cell.
They engulf the cell by phagocytosis.
They stop protein synthesis in the target cell.
They produce granzymes that stimulate apoptosis.

A

They produce granzymes that stimulate apoptosis.

268
Q

Which is a distinguishing feature of a pre-B cell?

μ chains in the cytoplasm
Complete IgM on the surface
Presence of CD21 antigen
Presence of CD25 antigen

A

μ chains in the cytoplasm

269
Q

Where does the major portion of antibody production occur?

Peripheral blood
Bone marrow
Thymus
Lymph node

A

Lymph node

270
Q

A cell flow cytometry pattern belonging to a 3-year old patient showed the following: normal CD4+ T-cell count, normal CD19+ B-cell count, low CD8+ T-cell count. Which type of immunity would be affected?

Production of antibody
Formation of plasma cells
Elimination of virally infected cells
Downregulation of the immune response

A

Elimination of virally infected cells

271
Q

Which of the following is a unique characteristic of adaptive immunity?

Ability to fight infection
Ability to remember a prior exposure to a pathogen
A similar response to all pathogens encountered
Process of phagocytosis to destroy a pathogen

A

Ability to remember a prior exposure to a pathogen

272
Q

Discovery of genetic principles underlying the generation of antibodies with different specificities:

Edward Jenner
Ellie Metchnikoff
Emil von Behring
Susumu Tonegawa

A

Susumu Tonegawa

273
Q

Which of the following is characteristic of variable domains of immunoglobulins?

They occur on both the H and L chains
They represent the complement-binding site
They are at the carboxy-terminal ends of the molecules
They are found only on H chains

A

They occur on both the H and L chains

274
Q

Which antibody best protects mucosal surfaces?

IgA
IgD
IgG
IgM

A

IgA

275
Q

The subclasses of IgG differ mainly in:

Type of light chain
Arrangement of disulfide bonds
Ability to act as opsonin
Molecular weight

A

Arrangement of disulfide bonds

276
Q

Which antibody is best at agglutination and complement fixation?

IgA
IgG
IgD
IgM

A

IgM

277
Q

All of the following are true of IgE EXCEPT that it:

Fail to fix complement
Heat stable
Attaches to tissue mast cells
Found in the serum of allergic persons

A

Heat stable

IgE is the most heat-labile of all immunoglobulins; heating to 56°C for between 30 minutes and 3 hours results in conformational changes and loss of ability to bind to target cells.

278
Q

Papain digestion of an IgG molecule results in which of the following?

2 Fab’ and 1 Fc’ fragment
F(ab’)2 and 1 Fc’ fragment
2 Fab and 2 Fc fragments
2 Fab and 1 Fc fragment

A

2 Fab and 1 Fc fragment

Papain digestion yields two Fab fragments and an Fc portion.

Pepsin digestion yields an F(ab’)2 fragment with all the antibody activity, as well as an Fc′ portion.

279
Q

Which best characterizes the secondary response?

Equal amounts of IgM and IgG are produced
There is an increase in IgM only
There is a large increase in IgG but not IgM
The lag phase is the same as in the primary response

A

There is a large increase in IgG but not IgM

280
Q

A patient in septic shock caused by a gram-negative bacterial infection exhibits the following symptoms: high fever, very low blood pressure, and disseminated intravascular coagulation. Which cytokine is the most likely contributor to these symptoms?

IL-2
TNF
IL-12
IL-7

A

TNF

Tumor necrosis factor (TNF) secreted in response to gram-negative bacterial infections, causing a decrease in blood pressure, reduced tissue perfusion, and disseminated intravascular coagulation. The latter may lead to uncontrolled bleeding.

281
Q

Why might a colony stimulating factor be given to a cancer patient?

Stimulate activity of NK cells
Increase production of certain types of leukocytes
Decrease the production of TNF
Increase production of mast cells

A

Increase production of certain types of leukocytes

282
Q

A lack of C1-INH might result in which of the following conditions?

Paroxysmal nocturnal hemoglobinuria
Hemolytic uremic syndrome
Hereditary angioedema
Increased bacterial infections

A

Hereditary angioedema

283
Q

Which would be most effective in measuring an individual complement component?

CH50 assay
Radial immunodiffusion
AH50 assay
Lytic assay with liposome

A

Radial immunodiffusion

The methods most frequently used to measure individual components include radial immunodiffusion (RID) and nephelometry.

284
Q

Which technique represents a single-diffusion reaction?

Radial immunodiffusion
Ouchterlony diffusion
Immunoelectrophoresis
Immunofixation electrophoresis

A

Radial immunodiffusion

285
Q

Tiny agglutinates turbid background:

0
W+
1+
2+
3+
4+

A

W+

0 No agglutination or hemolysis
W+ Tiny agglutinates, turbid background
1+ Small agglutinates, turbid background
2+ Medium-sized agglutinates, clear background
3+ Several large agglutinates, clear background
4+ One solid agglutinate

286
Q

A few isolated aggregates; mostly free-floating cells; supernatant appears red:

Negative
Mixed-field
Weak
1+

A

Mixed-field

Grading Agglutination Reactions
Negative No aggregates
Mixed-field A few isolated aggregates; mostly free-floating cells; supernatant appears red
Weak (±) Tiny aggregates barely visible macroscopically; many free erythrocytes; turbid and reddish supernatant
1+ A few small aggregates just visible macroscopically; many free erythrocytes; turbid and reddish supernatant
2+ Medium-sized aggregates; some free erythrocytes; clear supernatant
3+ Several large aggregates; some free erythrocytes; clear supernatant
4+ All erythrocytes are combined into one solid aggregate; clear supernatant

287
Q

Several large aggregates; some free erythrocytes; clear supernatant:

1+
2+
3+
4+

A

3+

Negative: No aggregates

Mixed field: A few isolated aggregates; mostly free-floating cells; supernatant appears red

Weak (±) Tiny aggregates barely visible macroscopically; many free erythrocytes; turbid and reddish supernatant

1+ A few small aggregates just visible macroscopically; many free erythrocytes; turbid and reddish supernatant

2+ Medium-sized aggregates; some free erythrocytes; clear supernatant

3+ Several large aggregates; some free erythrocytes; clear supernatant

4+ All erythrocytes are combined into one solid aggregate; clear supernatant.

288
Q

An HLA specimen is collected in a tube containing:

ACD
EDTA
Silica
Thrombin

A

ACD

289
Q

Which technique involves probe amplification rather than target amplification?

Southern blot
PCR
Transcription-mediated amplification
Ligase chain reaction

A

Ligase chain reaction

290
Q

Forward-angle light scatter is an indicator of cell:

Granularity
Density
Size
Number

A

Size

Scattered light in a forward direction is a measure of cell size, whereas the side scatter determines a cell’s internal complexity, or granularity.

291
Q

If an analyzer gets different results each time the same sample is tested, what type of problem does this represent?

Sensitivity
Specificity
Accuracy
Precision

A

Precision

292
Q

It is considered the gold standard in testing for contact dermatitis:

RIST
RAST
Tuberculin test
Patch test

A

Patch test

The patch test is considered the gold standard in testing for contact dermatitis.

293
Q

Which of the following would be considered a significant finding in Graves disease?

Increased TSH levels
Antibody to TSH receptors
Decreased T3 and T4
Antithyroglobulin antibody

A

Antibody to TSH receptors

294
Q

A 20-year-old woman made an appointment to see her physician because she was experiencing intermittent diarrhea. Laboratory testing revealed that she also had an iron deficiency anemia. To determine if the patient has CELIAC DISEASE, her doctor should order which of the following laboratory tests?

Anti-tTG
Antigliadin
Antigluten
All of the above

A

Anti-tTG

CELIAC DISEAS: ANTIBODIES TO TISSUE TRANSGLUTAMINASE (tTG)
Currently, detection of IgA antibodies to tTG is the serological method of
choice for initial testing.

295
Q

Antimitochondrial antibodies are strongly associated with which disease?

Autoimmune hepatitis
Celiac disease
Primary biliary cirrhosis
Goodpasture’s syndrome

A

Primary biliary cirrhosis

296
Q

Antigen receptors on T lymphocytes bind HLA class II+ peptide complexes with the help of which accessory molecule?

CD2
CD3
CD4
CD8

A

CD4

297
Q

The only blood group system that affects clinical transplantation:

ABO
Rh
Kell
Duffy

A

ABO

The ABO system is the only blood group system that affects clinical transplantation.

298
Q

The best use of serum tumor markers is considered to be in:

Screening for cancer
Initial diagnosis of cancer
Monitoring patients undergoing cancer treatment
Determining patient prognosis

A

Monitoring patients undergoing cancer treatment

Tumor markers are best used to monitor patient response to therapy by performing serial measurements over time.

If therapy is effective, the amount of tumor marker will decrease. Ineffective therapy and recurrence of cancer is indicated by an increase in the tumor marker level. Ideally, these increases would precede other signs of disease recurrence by several months.

299
Q

A woman with breast cancer is treated with a monoclonal antibody to HER2. This is an example of:

A cancer vaccine
An immunotoxin
Passive immunotherapy
Active immunotherapy

A

Passive immunotherapy

300
Q

What clinical manifestation would be seen in a patient with myeloperoxidase deficiency?

Defective T-cell function
Inability to produce IgG
Defective NK cell function
Defective neutrophil function

A

Defective neutrophil function

301
Q

A patient with a deficiency in complement component C7 would likely present with:

Recurrent Staphylococcal infections
Recurrent Neisserial infections
Recurrent Escherichia coli infections
Recurrent Nocardia infections

A

Recurrent Neisserial infections

302
Q

Recurrent, periodic fevers may be associated with increased production of which immunoglobulin?

IgG
IgM
IgD
IgE

A

IgD

Hyper IgD syndrome, also referred to as periodic fever syndrome, and Muckle-Wells syndrome.

Hyper IgD is caused by a deficiency of mevalonate kinase, an enzyme involved in a sterol synthesis pathway. The syndrome has been seen primarily in northern European populations.

303
Q

Characteristics of a bacterial capsule include which of the following?

It cannot be used for vaccine development
It is composed of peptidoglycan
It is an important mechanism for protecting a bacterium against ingestion by PMNs
It is what causes bacteria to stain as gram-negative

A

It is an important mechanism for protecting a bacterium against ingestion by PMNs

One of the most important features of a capsule is its role in blocking phagocytosis by WBCs.

304
Q

False-positive nontreponemal tests for syphilis may occur because of which of the following?

Infectious mononucleosis
Systemic lupus erythematosus
Pregnancy
All of these

A

All of these

305
Q

Which test is recommended for testing cerebrospinal fluid for detection of neurosyphilis?

RPR
VDRL
FTA-ABS
Enzyme immunoassay

A

VDRL

A positive VDRL test on spinal fluid is diagnostic of neurosyphilis because false positives are extremely rare.

306
Q

An RPR test done on a 19-year-old woman as part of a prenatal workup was negative but exhibited a rough appearance. What should the technologist do next?

Report the result out as negative.
Do a VDRL test
Send the sample for confirmatory testing.
Make serial dilutions and do a titer.

A

Make serial dilutions and do a titer.

Testing of sera from patients in the secondary stage is subject to false negatives because of the prozone phenomenon (antibody excess). In this case, a nonreactive pattern that is typically granular or rough in appearance is seen.

If a prozone is suspected, serial twofold dilutions of the patient’s sera should be made to obtain a titer.

307
Q

Suppose an individual develops antibodies in response to a streptococcal pharyngitis infection. This is an example of:

Active immunity
Passive immunity
Adoptive immunity
Immunoprophylaxis

A

Active immunity

308
Q

Protection from smallpox could be generated by the transfer of pustular material from cowpox lesion instead of the more hazardous smallpox lesion:

Edward Jenner
Louis Pasteur
Jules Bordet
Robert Kaus

A

Edward Jenner

309
Q

What was one of the major contributions of Louis Pasteur to vaccine development?

Development of the smallpox vaccine
Use of attenuated microorganisms in vaccines
Inactivation of bacterial toxins for vaccines
Discovery of recombinant vaccine antigens

A

Use of attenuated microorganisms in vaccines

Louis Pasteur used the principle of attenuation, or weakened microorganisms, to produce vaccines against chicken cholera, anthrax, and rabies.

310
Q

The antigenic component of the hepatitis B vaccine differs from those of many of the conventional vaccines in that it consists of a:

Live, attenuated virus
Inactivated virus
Cryptic antigen
Recombinant antigen

A

Recombinant antigen

Hepatitis A vaccine - inactivated vaccine
Hepatitis B vaccine - recombinant antigen

311
Q

Plays an important role in protecting the kidney from damage and in preventing the loss of iron by urinary excretion:

Alpha1-antitrypsin
Ceruloplasmin
Haptoglobin
Fibrinogen

A

Haptoglobin

312
Q

Serves to promote aggregation of red blood cells, and increased levels contribute to an increased risk for developing coronary artery disease, especially in women:

Alpha1-antitrypsin
Ceruloplasmin
Haptoglobin
Fibrinogen

A

Fibrinogen

313
Q

A deficiency can result in premature emphysema, especially in individuals who smoke or who are exposed to a noxious occupational environment:

Alpha1-antitrypsin
Ceruloplasmin
Haptoglobin
Fibrinogen

A

Alpha1-antitrypsin

314
Q

Acute phase reactants elevated up to 1000x in inflammation:

CRP and ceruloplasmin
CRP and serum amyloid
Ceruloplasmin and fibrinogen
Ceruloplasmin and haptoglobin

A

CRP and serum amyloid

315
Q

CRP is produced by the:

Kidney
Liver
Bone marrow
Thymus

A

Liver

Produced by the liver under the control of IL-6, CRP is a parameter of inflammatory activity.

316
Q

All tissue macrophages arise from:

B lymphocytes
Basophils
Neutrophils
Monocytes

A

Monocytes

317
Q

Considered the most effective antigen-presenting cells (APCs):

T cells
Macrophages
Neutrophils
Dendritic cells

A

Dendritic cells

Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

318
Q

Tissue mast cells resemble:

Basophil
Eosinophil
Monocyte
Neutrophil

A

Basophil

MT review (26 decks)

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