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BOC study (harr book) > chemistry rotation - immunology 3.3-3.4 > Flashcards

chemistry rotation - immunology 3.3-3.4 Flashcards

1
Q

which serum antibody response usually characterizes the primary (early) stage of syphilis
A. antibodies against syphilis are undetectable
B. detected 1-3 weeks after appearance of the primary chancre
C. detected in 50% of cases before the primary chancre disappears
D. detected within 2 weeks after infection

A

B.
- primary stage of syphilis antibodies are detectable after 1-3 weeks

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2
Q

what substance is detected in the sample by rapid plasma reagin (RPR) and VDRL tests for syphilis
A. cardiolipin
B. anticardiolipin
C. andti-treponemia pallidum antibody
D. T. pallidum

A

B.
- reagin is a nontreponemal that reacts with cardiolipin therefore it detects anti

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3
Q

what type of antigen is used in the RPR card test
A. live treponemal
B. killed suspension of treponemal organisms
C. cardiolipin
D. tanned sheep cells

A

C. cardiolipin

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4
Q

which of the following is the most sensitive test to detect congenital syphilis
A. VDRL
B. RPR
C. T pallidum partical agglutination (TP-PA)
D. PCR

A

D. PCR

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5
Q

a biological false pos reaction is least likely with which of test for syphilis
A. VDRL
B. TP-PA
C. RPR
D. all are equally likely

A

B. TP-PA
- more specific than other nontreponemal

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6
Q

a 12-yro girl has symptoms of fatigue and localized lymphadenopathy, lab test reveal peripheral blood lymphocytosis, positive RPR and positive spot test for IM. what test should be performed next
A. HIV screen
B, VDRL
C. EBV specific antigen test
D. TP-PA test

A

D. TP-PA
- symptoms are nonspecific but everything else points to IM

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7
Q

which test is most likely ot ne positive in the tertiary stage of syphilis
A. treponemal specific antibody
B. RPR
C. VDRL
D. reagin screen test

A

A. treponemal test more likely to be accurate than nontreponemal

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8
Q

what is the most likely interpretation of the following syphilus serological results serological results
- RPR: reactive
- TP-PA: non reactive

A. neurosyphilus
B. secondary syphilus
C. syphilis that has been successfully tested
D. biological false pos

A

D.
- pos with nontreponemal antigen and negative with treponemal = false pos

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9
Q

which specimen is the sample of choice to evaluate latent or tertiary syphilus
A, serum sample
B. chancre fluid
C, CSF
D. joint fluid

A

C. CSF
- neurosyphilis is present = CSF pos

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10
Q

interpret the following quantitative RPR test results
- RPR titer: weakly active 1-4, strongly active 1:8-1:64

A. excess antibody, prozone effect
B. excess antigen, postzone effect
C. equivalence of antigen and antibody
D. impossible to interpret = testing error

A

A. prozone

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11
Q

tests to identify infection with HIV fall into which three general classification types of tests
A. tissue culture, antigen and antibody tests
B. test for antigens, antibodies and nucleic acid
C. DNA probe, DNA amplification
D. ELISA, western blot and southern blot

A

B. fourth and fifth generation detect HIV antibody and p24 antigen

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12
Q

which tests are considered screening tests for HIV
A. ELISA, chemiluminescence, and rapid antibody test
B. IFA, western blot, radioimmunoprecipitation
C. culture, antigen capture assay, DNA amplification
D. reverse transcriptase messenger RNA assay (mRNA)

A

A. ELISA, chemiluminescence, and rapid antibody test

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13
Q

which tests are the recommended confirmatory test for HIV
A. ELISA and rapid antibody test
B. HIV 1-2 antibody differentiation assays and qualitative PCR test
C. culture, atnigen capture assay, quantitative PCR
D. reverse transcriptase and mRNA asasy

A

B. HIV 1-2 antibody differentiation assays and qualitative PCR test

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14
Q

how do 4th and 5th generation HIV tests reduce the time from infection to the test becoming positive
A. they are PCR tests detecting viral RNA
B. they detect p24 antigen in addition to HIV antibody
C. they detect proviral DNA
D. hey detect antibodies to more antiens than earlier generations of HIV test

A

B.
- detection of p24 antigen allows for diagnosis app 1 week after infection

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15
Q

a woman who has had 5 pregnancies subsequently tested positive for HIV on a 4th generation assay and is negative on HIV1-2 differentiation assay and a follow up molecular assay. the initial reactivity may be caused by
A. possible cross reaction with herpes or EBV antibodies
B interference from medication
C, cross reacting antibodies elected during pregnancy
D, possible technical error repeat specimen should be requested

A

C. antibodies during pregnancy

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16
Q

interpret the following results for HIV testing
- 4th generation ELISA: pos
- repeat ELISA: pos
- hiv 1-2 antibody differentiation: negative
- qualitative HIV RNA rtPCR: pos

A. false pos 4th gen
B. false neg antibody differentiation
C. indeterminate; further testing needed
D. HIV p24 antigendetected on forth generation ELISA

A

D. HIV p24 antigendetected on forth generation ELISA

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17
Q

what is the most likely explanation when antibody tests for HIC are neg but the PCR test is pos
A. probably not HIV infection
B. pt is in the window phase
C. tests were perofmred incorrectly
D. clinical signs were misinterpreted

A

B. window period

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18
Q

what criteria consititue the classification system for HIV infection
A. cd4 pos T cell count and clinical symptoms
B. clinical symptoms condition duration and strength of reactivity on fourth generation test
C. presence or absence of lymphadenopathy
D. strong fourth gen HIV test reactivity with cd8 pos t cell count

A

A. cd4 pos T cell count and clinical symptoms

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19
Q

What is the main difficulty associated with the development of an HIV vaccine
A. difficult to culture; antigen extracting and concentration are extremely laborious
B. human trials cannot be performed
C. different strains of the virus are genetically diverse
D. anti-idiotype antibodies cannot be developed

A

C. genetically diverse

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20
Q

which cd4:cd8 ratio is most likely in patient with AIDS
A. 2;1
B. 3;1
C. 2;3
D. 1;3

A

D. inverted 4;8 ratio

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21
Q

what is the advantage of fourth gen rapid HIV tests over earlier rapid test
A. they use recombinant antigens
B. they detect multiple strains of HIV
C. they detect p24 antigens
D. they are quantitative

A

C. they detect p24 antigens

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22
Q

which method is used to test for HIV infections in infants who are born to HIV pos mothers
A. ELISA
B. western blot
C. PCr
D. viral culture

A

C. PCR

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23
Q

what is the most likely cause when a fourth gen HIV assay is pos fr all controls and samples
A. improper pipetting
B. improper washing
C. improper addition of sample
D. improper reading

A

C.

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24
Q

what constitutes a diagnosis of viral hepatitis
A, abnormal test results for liver enzymes
B. clinical signs and symptoms
C. pos results for hep markers
D. all of these

A

D. all of these

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25
Q

which of the following statements regarding infection with hep D virus is true
A. occurs in pt with HIV infection
B. does not progress to chronic hep
C. occurs in patients with hep b infection
D. is not spread through blood or sexual contact

A

C. super infection
- b d budies

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26
Q

all of the following hep viruses are spread through blood or blood products
A. HAV
B. HBV
C. HCV
D. HDV

A

A. HAV

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27
Q

which hep B marker is the best indicator of early acute infection
A. HBsAg
B. HBeAg
C. anti-Hbc
D. anti-Hbs

A

A. HBsAg
- first marker to appear usually within 4 weeks but antiHBc-IgM is the first antibody

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28
Q

which is the first antibody detected in serum after infection with HBV
A. anti-HBs
B. anti- HBc IgM
C. anti-HBe
D. all are detectable at the same time

A

B. anti-HBc IgM
- first antibody persisitng for years after infection

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29
Q

which antibody persists in low level carriers of HBV
A. IgM anti HBc
B. IgG anti HBc
C. IgM anti HBe
D. IgG anti HBs

A

B. IgG anti-HBc

30
Q

what is the most likely explanation when a patient has clinical signs of viral hep but test neg for HAV IgM, HBsAg, and HCV
A. tests were performed improperly
B. the patient does not have hep
C. the patient is in the core window period
D. clinical eval was performed improperly

A

C. core window
- when boh surface antigen and antibody are undetectable but still infected

31
Q

which hep B marker should be performed on blood products
A. HBsaAg and anti-HBc
B. anti-HBs and anti-HBc
C.HBeAg and HBcAg
D. anti-HBs and HBeAg

A

A. HBsaAg and anti-HBc
- HBsAg = early infection detection
- anti-HBc = marker past infection and still considered infectious

32
Q

wihc hep antibody confers immunity against reinfection with HBV
A. anti-HBc IgM
B. anti-HBc IgG
C. anti-HBe
D. anti-HBs

A

D. anti-HBs
- appears later in infection compared to HBc and is marker of immunity rather than diagnosis

33
Q

which test, other than serological markers, is most consistently elevated in viral hep
A. antinuclear antibodies
B. ALT
C. absolute lymph count
D. lactate dehydrogenase

A

B. ALT
- liver enzyme marker -> hep = inflammation of liver = markers for liver elevated

34
Q

if only anti-HBs is pos. which of the following can be ruled out
A. HBV vaccinating
B. distant past infection
C. hep B immune globulin injection (HBIG)
D. chronic HBV

A

D. chronic HBV
- would be ois for anti-HBc - IgG or total - and HBsAg but not anti-HBs

35
Q

interpret the following results for EBV infection:
- IgG and IgM antibodies to viral capsid: Positive

A. infection in the past
B. infection with a mutual enhancer virus, such as HIV
C. current infection
D. impossible to interpret

A

C. currect infection
- IgG may persist for life but IgM will dissipate with time

36
Q

rapid mono test use latex particles coated with which of the following
A. guinea pig antigen
B. beef proteins
C. horse proteins
D. sheep proteins

A

B. beef
- detect heterophile antibodies against beef protein

37
Q

blood products are tested for which virus before being transfused into newborns
A. EBV
B. HTLV-II
C. CMV
D. HDV

A

C. CMV

38
Q

what is the endpoint for the ASO latex agglutination assay
A. highest serum dilution that shows no agglutination
B. highest serum dilution that shows agglutination
C. lowest serum dilution that shows agglutination
D. lowers serum dilution that shows no agglutination

A

B. highest serum dilution that shows agglutination
- serial dilutions until endpoint is reached

39
Q

a streptoenzyme test was performed, but the result was negative, even though the patient showed clinical signs of strep throat. what should be done next
A. either ASo or anti-deoxyribonuclease B test
B. another streptozyme test using diluted serum
C. antihyulronidase test
D. wait 3-5 days and repeat the test

A

A. either ASo or anti-deoxyribonuclease B test
- single test is not enough to rule out infection, ASO and anti-DNase B are more specific

40
Q

rapid assays for influenza that utilize specimens obtained from nasopharyngeal swabs detect:
A. IgM anti-influenza
B. IgA anti-influenza
C. IgA- influenza antigen immune complexes
D. influenza nucleoprotein antigens

A

D. influenza nucleoprotein antigens
- antigen detection methods prior to antibody formation

41
Q

how can interfering cold agglutinins be removed from a test sample
A. centrifuge the serum and remove the top layer
B. incubate the clot at 1C to 4 C for several hours then remove the serum
C. incubate the serum at 56 C in a water bath for 30 minutes
D. use an anticoagulated sample

A

B. incubate the clot at 1C to 4C for several hoirs and then remove the serum
- allows agglutinins to attach autologous RBCs and the serum to be free of agglutinins

42
Q

all tubes (dilutions) except the negative control are pos for cold agglutinins. this indicates:
A. contaminated RBCs
B. a rare antibody against RBC antigens
C. the sample was stored at 4C prior to separating serum and cells
D. further serial dilution is necessary

A

D. further dilutions, endopoint not yet reached

43
Q

all positive cold agglutinin tubes remain pos after 37C incubation except the pos control what is the most likely explanation for this situation
A. high titer cold agglutinins
B. contamination of the test system
C. antibody other than cold agglutinins
D. faulty water bath

A

C. antibody other than cold agglutinins
- cold agglutinins would not react at that temperature anyway

44
Q

which increase in antibody titer (dilution) best indicates an acute infection
A. from 1;2 to 1;8
B. from 1;4 to 1;16
C. from 1’16 to 1;256
D. from 1;64 to 1;128

A

C. 1;16 to 1;256 four fold increase/two tube increase

45
Q

which of the following pos antibody test may be an indication of recent vaccination or early primary infection for rubella in a pt with no clinical symptoms
A. only IgG antibodies positive
B. only IgM antibodies pos
C. both IgG and IgM positive
D. fourfold rise in titer of IgG antibodies

A

B. IgM only

46
Q

why is lab diagnosis difficult in cases of Lyme disease
A. clinical response may not be apparent upon initial infection; IgM antibody may not be detected until 3 - 6 weeks after infection
B lab tests may be designed to detect whole Borrelia burgodorferi, not flagellar antigens found early in infection
C. most lab test are technically demanding and lack specificity
D. antibodies formed initially to B. burgdorferi may cross react in antigen test for autoimmune diseases

A

A. clinical response may not be apparent upon initial infection; IgM antibody may not be detected until 3 - 6 weeks after infection

47
Q

serological test for which disease may gice a false pos result if the pt has Lyme disease
A. HIV
B. syphilus
C. EBV
D. hep c

A

B. syphilus
- both caused by a spirochete therefore some treponemal false pos

48
Q

in monitoring a pt with HIV infection, which parameter may be expected to be the most sensitive indicator of the effectiveness of antiretroviral treatment
A. HIV antibody titer
B. CD4:CD8 ration
C. HIV viral load
D. absolute total T cell count

A

C. viral load
- will rise and fall more quickly than other listed parameters

49
Q

a renal transplant recip is found to have a rising creatinine level and reduced urine output. the physician orders a urine PCR assay. when you call to find out what organism the physician wants you to ID you are told:
A. HCV
B, legionella pneumophilia
C. EBV
D. BK virus

A

D. BK virus
- a polyoma virus causes renal and UTI and usually found in kidney transplant recipients

50
Q

which of the following fungal organisms is best diagnosed by an antigen detection test as opposed to an antibody detection assay
A. histoplasma
B. cryptococcus
C. candidia
D. aspergillus

A

B. cyrptococcus
- antibody detection is not reliable in this one, need antigen detection from serum or CSF
- histoplasma = urine measurements
- aspergillus = serum galactomann assay
- no antigen detectable for candida = need antibody detection

51
Q

your cytology lab refers a Papanicolaou smear specimen to you for an assay designed to detect the presence of virus associated with cervical cancer you perform
A. ELISA for anti-HSV-2
B. molecular assay for HSV-2
C. ELISA for PHV
D. molecular assay for HPV

A

D. molecular HPV
- cervical cancer assocaited closely with HPV and molecular is most specific

52
Q

an immunosuppressed patient has unexplained anemai. the physician suspects parvovirus B19 infection . the parvo IgM test result is neg. The next course of action is
A. pt does not have parvo
B. convalescent specimen is recommended in 4 weeks to determine if a fourfold rise in titer has occurred
C. a parvovirus PCR is recomenneded
D. a recent transfusion for the pt anemia may have resulted in false neg result and the pt should be retested in 4 weeks

A

C. PCR

53
Q

a newborn is to be tersted for vertically transmitted HIV infection. which of the following test is most useful
A. HIV PCR
B. CD4 count
C. rapid HIV antibody test
D. HIB IgM antibody test

A

A. HIV PCR

54
Q

what is a general definition for autoimmunity A. increase of tolerance to self antigens
B. loss of tolerance to self antigens
C. increase in clonal detection of mutant cells
D. manifestation of immunosuppression

A

B. loss of tolerance to self antigens

55
Q

an ANA test is performed on a specimen from a 55 yro woman who has unexplained joint pain. The IFA result shows a titer of 40 and a homogenous pattern. the appropriate follow up for the patient is
A. anti-DNA assay
B. ENA testing
C. retest ANA in 3-6 months
D. CH50 complement assay

A

C. retest in 3-6 months
- abt 25% of woman in this age have low titer pos for ANA but no disease

56
Q

which disease is likely to show a rim (peripheral) pattern in an immunofluorescence (IF) microscope test for ANA
A. mixed connective tissue disease (MCTD)
B. RA
C. SLE
D. Scleroderma

A

C. SLE
- rim = SLE related to anti-dsDNA

57
Q

a patients specimen is strongle pos in an ANA ELISA which of the following would not be an appropriate follow up to this result
A. IFA on human epithelia type 2 (HEp-2) cells
B. specific ENA ELISA test
C. specific anti-DNA ELISA
D. Rheumatoid factor assay

A

D. RF assay
- ANA ELISA is a screening assay = needs to be followed up with a more specific assay
- does not screen for RF

58
Q

what type of antibodies is represented by the homogenous pattern in the IFA for ANAs
A. anti-histone antibodies
B. anticentromere ab
C. anti-ENA antibodies
D. anti-RNA

A

A. anti-histone
- aka anti-DNA abs seen in SLE, RA, MCTD and Sjogren

59
Q

what disease is indicated by a high titer of anti-Sm antibody
A. MCTD
B. RA
C. SLE
D. Scleroderma

A

C. SLE
- anitbody against saline ENAs causing speckled pattern

60
Q

which disease is least likely when a nucleolar pattern occurs in IFA for ANAs
A. MCTD
B. Sjogrens
C. SLE
D. Scleroderma

A

A. MCTD
- all except MCTD may have nucleolar app which is caused by anti-RNA ab

61
Q

what antibodies are represented by the nucleolar pattern in the IFA for ANAs
A. antihistone
B. anti-dsDNA
C. anti-ENA ab
D. anti-RNA

A

D. anti-RNA
- esp common with scleroderma but present in most autoimmune diseases

62
Q

which test would best distinguish between SLE and MCTD
A. multiplex or ELISA test for anti-Sm and anti-RNP
B. IFA using Crithidia as a substrate
C. slide agglutination testing
D. lab tests cannot distinguish between these two

A

A. multiplex or ELISA test for anti-Sm and anti-RNP

63
Q

an ANA test on HEp-2 cells shows nucleolar staining in interphase cells and dense chromatin staining in mitotic cells. the most likely cause of this staining pattern is:
A. anti fibrillarin antibody
B. anti-ribosomal P antibody
C. a serum with nucleolar and homogenous patterns
D. technical artifact

A

A. anti fibrillarin antibody
- background homogenous and cytoplasmis stain as well as nucleolar staining
-combo nucleolar/homogenous specimen shows homogenous in interphase cellsw

64
Q

which immunofluorescence pattern indicates the need for ENA testing by multiplex. line blots or ELISA assays
A homogenous
B. peripheral or rim
C. speckled
D. nucleolar

A

C. speckled
- caused by ab to ENAs such as Sm , RNP, SSA and SSB

65
Q

which of the following methods is least likely to give a definitive result for the diagnosis of RA
A. nephelometric measurements of anti-IgG
B. agglutination testing for RF
C. anti-CCP
D. IFA for ANAs

A

D. IFA for ANAs
- RA is usually homogenous pattern when ANA tested like many other autoimmune diseases making IFA not helpful

66
Q

which disease might be indicated by antibodies to smooth muscle
A. atrophic gastritis
B. autoimmune hep
C. myasthenia gravis
D. Sjogren syndrome

A

B. autoimmue hep
- found in 70% of chronic hep and 50% of primary biliary cirrohisis

67
Q

antibodies to thyroid peroxidase may appear in which of the following diseases
A. graves disease and Hashimoto thyroiditis
B. myasthenia gravis
C. granulomatous thyroid disease
D. addison diseases

A

A. graves or hashimotos

68
Q

what is the main use of lab tests to detect Ab to islet cells and insulin in cases of insulin dependent diabetes mellitus (IDDM)
A. to regulate levels of injected insulin
B. to diagnose IDDM
C. to rule out the presence of other autoimmune diseases
D. to screen susceptible individuals prior to destruction of beta-cells

A

D. to screen susceptible individuals prior to destruction of beta cells (those responsible for secreting insulin)
- fasting hyperglycemia and hgb A1c are findings to diagnose IDDM but antibody detection is used to monitor and start early treatment

69
Q

a pt presents with clincial symptoms of celiac disease. tests for anti-tissue transglutaminase and antigliadin antibodies are negative. which of the following tests should be ordered
A. IgG level
B. HLA DQ2 and DQ8 typing
C. HLA DR3 and DR7 typing
D. IgM level

A

B. HLA DQ2 and DQ8
- celiac disease is almost exclusively associated with presence of HLA DQ2 and or HLA DQ8 they are not diagnostic but are helpful

70
Q

a specimen appears to have a perinuclear staining pattern in an antineutrophil cytoplasmic antibody (ANCA) immunofluorescent assay using ethanol fixed neutrophils, suggesting the possibility of perinuclear ANCA (pANCA). on which of the following substrates would this specimen display cytoplasmic speckling
A. formalin-fixed neutrophils
B, unfixed neutrophils
C. HEp-2 cells
D. rabbit kidney tissue

A

A. formalin fixed neutrophils
- Ab to neutrophil cytoplasmic antigen demonstrating a perinuclear pattern of fluorescence indicates diagnosis of vasculitis

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