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SEROLOGY MTAP 1 > Harr’s Medical Laboratory Science Review PART 2 (CHAPTER REVIEW) > Flashcards

Harr’s Medical Laboratory Science Review PART 2 (CHAPTER REVIEW) Flashcards

1
Q
  1. 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 deletion of mutant cells
D. Manifestation of immunosuppression

A

B. Loss of tolerance to self-antigens

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2
Q
  1. An ANA test is performed on a specimen from a 55-year-old woman
    who has unexplained joint pain. The IFA result shows a titer of 40 and a homogeneous pattern. The appropriate follow-up for this patient is:

A. Anti-DNA assay
B. Extractable nuclear antigen (ENA) testing
C. Retest ANA in 3 to 6 months
D. CH50 complement assay

A

C. Retest ANA in 3 to 6 months

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3
Q
  1. Which disease is likely to show a rim (peripheral) pattern in an immunofluorescence (IF) microscopy test for ANA?

A. Mixed connective tissue disease (MCTD)
B. RA
C. SLE
D. Scleroderma

A

C. SLE

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4
Q
  1. What type of antibodies is represented by the homogeneous pattern in the IFA for ANAs?

A. Antihistone antibodies
B. Anticentromere antibodies
C. Anti-ENA (anti-Smith [anti-Sm] and anti-ribonucleoprotein
[anti-RNP]) antibodies
D. Anti-RNA antibodies

A

A. Antihistone antibodies

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4
Q
  1. A patient’s specimen is strongly positive in an ANA ELISA. Which of the following would not be an appropriate follow-up to this result?

A. IFA on human epithelial type 2 (HEp-2) cells
B. Specific ENA ELISA tests
C. Specific anti-DNA ELISA
D. Rheumatoid factor (RF) assay

A

D. Rheumatoid factor (RF) assay

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5
Q
  1. What disease is indicated by a high titer of anti-Sm antibody?

A MCTD
B. RA
C. SLE
D. Scleroderma

A

C. SLE

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6
Q
  1. Which disease is least likely when a nucleolar pattern occurs in an IFA for ANAs?

A. MCTD
B. Sjögren syndrome
C. SLE
D. Scleroderma

A

A. MCTD

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7
Q
  1. What antibodies are represented by the nucleolar pattern in the IFA for ANAs?

A. Antihistone antibodies
B. Anti-dsDNA antibodies
C. Anti-ENA (anti-Sm and anti-RNP) antibodies
D. Anti-RNA antibodies

A

A. Antihistone antibodies

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8
Q
  1. 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 substrate
C. Slide agglutination testing
D. Laboratory tests cannot distinguish between these
disorders

A

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

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9
Q
  1. 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. Antifibrillarin antibody
B. Anti–ribosomal P antibody
C. A serum with nucleolar and homogeneous patterns
D. Technical artifact

A

A. Antifibrillarin antibody

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10
Q
  1. Which immunofluorescence pattern indicates the need for ENA testing by multiplex, line blots, or ELISA assays?

A. Homogeneous or solid
B. Peripheral or rim
C. Speckled
D. Nucleolar

A

C. Speckled

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11
Q
  1. Which of the following is used in rapid slide tests for detection of RFs?

A. Whole IgM molecules
B. Fc portion of the IgG molecule
C. Fab portion of the IgG molecule
D. Fc portion of the IgM molecule

A

B. Fc portion of the IgG molecule

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12
Q
  1. Which of the following methods is least likely to give a definitive result for the diagnosis of RA?

A. Nephelometric measurement of anti-IgG
B. Agglutination testing for RF
C. Anti-CCP
D. IFA for ANAs

A

D. IFA for ANAs

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13
Q
  1. Which disease might be indicated by antibodies to smooth muscle?

A. Atrophic gastritis
B. Autoimmune hepatitis
C. Myasthenia gravis
D. Sjögren syndrome

A

B. Autoimmune hepatitis

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14
Q
  1. 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 disease

A

A. Graves disease and Hashimoto thyroiditis

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15
Q
  1. What is the main use of laboratory tests to detect antibodies 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 β-cells

A

D. To screen susceptible individuals prior to destruction of β-cells

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16
Q
  1. A patient presents with clinical 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 typing

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17
Q
  1. 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 a 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

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18
Q
  1. Which of the following is a description of a type I hypersensitivity
    reaction?

A. Ragweed antigen cross-links with IgE on the surface of mast cells, causing release of preformed mediators and
resulting in symptoms of an allergic reaction
B. Anti-Fya from a pregnant woman crosses the placenta and attaches to the Fya antigenpositive RBCs of the fetus,
destroying the RBCs
C. Immune complex deposition occurs on the glomerular basement membrane of the kidney, leading to renal failure
D. Exposure to poison ivy causes sensitized T cells to release lymphokines that cause a localized inflammatory
reaction

A

A. Ragweed antigen cross-links with IgE on the surface of mast cells, causing release of preformed mediators and
resulting in symptoms of an allergic reaction

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19
Q
  1. Why is skin testing the most widely used method to test for a type I
    hypersensitivity reaction?

A. It causes less trauma and is more cost effective than other methods
B. It has greater sensitivity than in vitro measurements
C. It is more likely to be positive for IgE-specific allergens compared with other methods
D. It may be used to predict the development of further allergen sensitivity

A

B. It has greater sensitivity than in vitro measurements

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20
Q
  1. Which in vitro test measures IgE levels against a specific allergen?

A. Histamine release assay
B. Radioimmunosorbent test (RIST)
C. Fluorescent allergosorbent test (FAST)
D. Precipitin radioimmunosorbent test (PRIST)

A

C. Fluorescent allergosorbent test (FAST)

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21
Q
  1. A patient who is blood group O is accidentally transfused with group A blood and develops a reaction during the transfusion. What antibody is involved in this type II reaction?

A. IgM
B. IgE
C. IgG and IgE
D. IgG

A

A. IgM

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22
Q
  1. Which test would measure the coating of RBCs by antibody as occurs in hemolytic transfusion reactions?

A. Indirect antiglobulin test (IAT)
B. Direct antiglobulin test (DAT)
C. ELISA
D. Hemagglutination

A

B. Direct antiglobulin test (DAT)

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23
Q
  1. Which of the following conditions will most likely result in a false-negative DAT test?

A. Insufficient washing of RBCs
B. Use of heavy chain–specific polyclonal anti-human Ig
C. Use of excessive centrifugal force
D. Use of a sample obtained by finger puncture

A

A. Insufficient washing of RBCs

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24
Q
  1. Which test detects antibodies that have attached to tissues, resulting in a type-II cytotoxic reaction?

A. Indirect immunofluorescence
B. Direct immunofluorescence (DIF)
C. Immunofixation electrophoresis (IFE)
D. Hemagglutination

A

B. Direct immunofluorescence (DIF)

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24
Q
  1. Which of the following tests will detect circulating immune complexes in the serum of some patients with systemic autoimmune diseases, such as RA?

A. Direct IFA
B. Enzyme immunoassay (EIA)
C. Assay of cryoglobulins
D. IAT

A

C. Assay of cryoglobulins

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25
Q
  1. A patient deficient in the C3 complement component would be
    expected to mount a normal:

A. Type I and IV hypersensitivity response
B. Type II and IV hypersensitivity response
C. Type I and III hypersensitivity response
D. Type II and III hypersensitivity response

A

A. Type I and IV hypersensitivity response

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25
Q
  1. Which of the following symptoms in a young child may indicate an immunodeficiency syndrome?

A. Anaphylactic reactions
B. Severe rashes and myalgia
C. Recurrent bacterial, fungal, and viral infections
D. Weight loss, rapid heartbeat, breathlessness

A

C. Recurrent bacterial, fungal, and viral infections

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26
Q
  1. What immune elements are involved in a positive skin test for tuberculosis?

A. IgE antibodies
B. T cells and macrophages
C. NK cells and IgG antibody
D. B cells and IgM antibody

A

B. T cells and macrophages

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26
Q
  1. A patient receives a transfusion of packed RBCs and fresh frozen plasma (FFP) and develops an anaphylactic, nonhemolytic reaction. She reports receiving a transfusion 20 years earlier. She had no reaction to the previous transfusion, but she did feel “poorly” a few weeks later. Which of the following transfused substances most likely
    elicited the reaction?

A. IgA
B. Group A antigen
C. Rho (D) antigen
D. An antigen belonging to the Duffy system

A

A. IgA

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27
Q
  1. What screening test should be performed first in a young patient
    suspected of having an immune dysfunction disorder?

A. Complete blood count (CBC) and WBC differential
B. Chemotaxis assay
C. Complement levels
D. Bone marrow biopsy

A

A. Complete blood count (CBC) and WBC differential

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28
Q
  1. Which test should be performed when a patient has a reaction to transfused plasma products?

A. Ig levels
B. T-cell count
C. Hemoglobin levels
D. RBC enzymes

A

A. Ig levels

29
Q
  1. What is the “M” component in monoclonal gammopathies?

A. IgM produced in excess
B. Heavy chain produced in excess
C. Malignant proliferation of B cells
D. Monoclonal antibody or cell line

A

D. Monoclonal antibody or cell line

30
Q
  1. A child suspected of having an inherited humoral immunodeficiency
    disease is given diphtheria/tetanus vaccine. Two weeks after the immunization, his level of antibody to the specific antigens is measured. Which result is expected for this patient if he, indeed, has a humoral deficiency?

A. Increased levels of specific antibody
B. No change in the level of specific antibody
C. An increase in IgG-specific antibody but not IgM-specific antibody
D. Increased levels of nonspecific antibody

A

B. No change in the level of specific antibody

31
Q
  1. Which disease may be expected to show an IgM spike on an electrophoretic pattern?

A. Hypogammaglobulinemia
B. Multicystic kidney disease
C. Waldenström macroglobulinemia
D. Wiskott-Aldrich syndrome

A

C. Waldenström macroglobulinemia

32
Q
  1. Interpret the following description of an IFE assay of urine. Dense wide bands in both the κ- and λ-lanes. No bands present in the heavy-chain lanes.

A. Normal
B. Light-chain disease
C. Increased polyclonal Fab fragments
D. Multiple myeloma

A

C. Increased polyclonal Fab fragments

32
Q
  1. In testing for DiGeorge syndrome, what type of laboratory analysis would be most helpful in determining the number of mature T cells?

A. CBC
B. Dihydrorhodamine reduction (DHR) test
C. T-cell mitogen assays
D. Flow cytometry

A

D. Flow cytometry

33
Q
  1. Free monoclonal light chains are often present in the serum of patients with multiple myeloma and may be useful for disease monitoring. Which of the following assays would be recommended to detect the presence of free light chains in serum?

A. SPE
B. Urine immunofixation
C. Nephelometry
D. ELISA

A

C. Nephelometry

34
Q
  1. What is measured in the CH50 assay?

A. RBC quantity needed to agglutinate 50% of antibody
B. Complement needed to lyse 50% of RBCs
C. Complement needed to lyse 50% of antibody-sensitized RBCs
D. Antibody and complement needed to sensitize 50% of RBCs

A

C. Complement needed to lyse 50% of antibody-sensitized RBCs

35
Q
  1. All of the following tests measure phagocyte function except:

A. Leukocyte adhesion molecule analysis
B. DHR assay
C. Nitro blue tetrazolium (NBT) test
D. IL-2 assay

A

D. IL-2 assay

36
Q
  1. What type of disorders would show a decrease in C3, C4, and CH50?

A. Autoimmune disorders, such as SLE and RA
B. Immunodeficiency disorders, such as common variable immunodeficiency
C. Tumors
D. Bacterial, viral, fungal, or parasitic infections

A

A. Autoimmune disorders, such as SLE and RA

37
Q
  1. A patient had surgery for colorectal cancer, after which he received chemotherapy for 6 months. The test for carcinoembryonic antigen (CEA) was normal at this time. One year later, the bimonthly level of CEA was elevated (above 10 ng/mL). An examination and biopsy revealed recurrence of a small tumor. What was the value of the results
    provided by the CEA test in this clinical situation?

A. Diagnostic information
B. Information for further treatment
C. Information on the immunologic response of the patient
D. No useful clinical information in this case

A

B. Information for further treatment

38
Q
  1. A carbohydrate antigen 125 assay (CA-125) was performed on a woman with ovarian cancer. After treatment, the levels fell significantly. An examination performed later revealed recurrence of the tumor, but the CA-125 levels remained low. How can this finding be explained?

A. Test error
B. CA-125 was the wrong laboratory test; α-fetoprotein (AFP) is a better test to monitor ovarian cancer
C. CA-125 may not be sensitive enough when used alone to monitor tumor development
D. CA-125 is not specific enough to detect only one type of tumor

A

C. CA-125 may not be sensitive enough when used alone to monitor tumor development

39
Q
  1. What is the correct procedure upon receipt of a test request for human chorionic gonadotropin (hCG) on the serum of a 60-year-old man?

A. Return the request; hCG is not performed on men
B. Perform a qualitative hCG test to see if hCG is present
C. Perform the test; hCG may be increased in testicular tumors
D. Perform the test but use different standards and controls

A

C. Perform the test; hCG may be increased in testicular tumors

40
Q
  1. Would an hCG test using a monoclonal antibody against the
    β-subunit of hCG likely be affected by an increased level of follicle-stimulating hormone (FSH)?

A. Yes, the β-subunit of FSH is identical to that of hCG
B. No, the test would be specific for the β-subunit of hCG
C. Yes, a cross reaction would occur because of structural similarities
D. No, the structure of FSH and hCG are not at all similar

A

B. No, the test would be specific for the β-subunit of hCG

41
Q
  1. Which of the following substances, sometimes used as a tumor marker, is increased two or threefold in a normal pregnancy?

A. Alkaline phosphatase (ALP)
B. Calcitonin
C. Adrenocortocotropic hormone (ACTH)
D. Neuron-specific enolase

A

A. Alkaline phosphatase (ALP)

42
Q
  1. What is an advantage of performing a prostate-specific antigen (PSA) test for prostate cancer?

A. PSA is stable in serum and not affected by digital rectal examination
B. PSA is increased only in prostatic malignancy
C. A normal serum level rules out malignant prostatic disease
D. The percentage of free PSA is elevated in persons with malignant disease

A

A. PSA is stable in serum and not affected by digital rectal examination

43
Q
  1. Which method is the most sensitive for quantitation of AFP?

A. Double immunodiffusion
B. Electrophoresis
C. Enzyme immunoassay
D. Particle agglutination

A

C. Enzyme immunoassay

43
Q
  1. How is HLA typing used in the investigation of genetic diseases?

A. For prediction of the severity of the disease
B. For genetic linkage studies
C. For direct diagnosis of disease
D. Is not useful in this situation

A

B. For genetic linkage studies

44
Q
  1. Select the best donor for a man, blood type AB, in need of kidney transplantation.

A. His brother, type AB, HLA matched for class II antigens
B. His mother, type B, HLA matched for class I antigens
C. His cousin, type O, HLA matched for major class II antigens
D. Deceased donor, type O, HLA matched for some class I and II antigens

A

A. His brother, type AB, HLA matched for class II antigens

45
Q
  1. Interpret the following microcytotoxicity target cell results:

A9 and B12 cells = damaged;
A1 and Aw19 cells = intact.

A. Positive for A1 and Aw19; negative for A9 and B12
B. Negative for A1 and Aw19; positive for A9 and B12
C. Error in test system; retest
D. Impossible to determine

A

B. Negative for A1 and Aw19; positive for A9 and B12

46
Q
  1. Which method, classically used for HLA-D typing, is often used to determine the compatibility between a living organ donor and a recipient?

A. Flow cytometry
B. Mixed lymphocyte culture (MLC)
C. Primed lymphocyte test
D. Restriction fragment length polymorphism (RFLP)

A

B. Mixed lymphocyte culture (MLC)

47
Q
  1. SITUATION: Cells type negative for all HLA antigens in a complement-dependent cytotoxicity assay. What is the most likely cause?

A. Too much supravital dye was added
B. Rabbit complement is inactivated
C. All leukocytes are dead
D. Antisera is too concentrated

A

B. Rabbit complement is inactivated

48
Q
  1. What method may be used for tissue typing instead of serological HLA typing?

A. PCR
B. Southern blotting
C. RFLP
D. All of these options

A

D. All of these options

49
Q
  1. Which of the following serial dilutions contains an incorrect factor?

A. 1:4, 1:8, 1:16
B. 1:1, 1:2, 1:4
C. 1:5, 1:15, 1:45
D. 1:2, 1:6, 1:12

A

D. 1:2, 1:6, 1:12

50
Q
  1. A patient was tested for syphilis by the RPR method and was reactive. A TP-PA test was performed and the result was negative. Subsequent testing showed the patient to have a high titer of ACAs by the ELISA method. Which routine laboratory test is most likely to be abnormal for this patient?

A. Activated partial thromboplastin time (APTT)
B. Anti–smooth muscle antibodies
C. Aspartate aminotransferase (AST)
D. C3 assay by immunonephelometry

A

A. Activated partial thromboplastin time (APTT)

51
Q
  1. Inflammation involves a variety of biochemical and cellular mediators. Which of the following may be increased within 72 hours after an initial infection?

A. Neutrophils, macrophages, antibody, complement, α1-antitrypsin
B. Macrophages, T cells, antibody, haptoglobin, fibrinogen
C. Neutrophils, macrophages, complement, fibrinogen, C-reactive protein
D. Macrophages, T cells, B cells, ceruloplasmin, complement

A

C. Neutrophils, macrophages, complement, fibrinogen, C-reactive protein

52
Q
  1. An 18-month-old boy has recurrent sinopulmonary infections and septicemia. Bruton thymidine kinase deficiency is suspected. Which test result would be markedly decreased?

A. Serum IgG, IgA, and IgM
B. Total T-cell count
C. Both B- and T-cell counts
D. Lymphocyte proliferation with phytohemagglutinin stimulation

A

A. Serum IgG, IgA, and IgM

53
Q
  1. A patient received 5 units of FFP and developed a severe anaphylactic reaction. He has a history of respiratory and gastrointestinal infections. Post-transfusion studies showed all 5 units
    to be ABO compatible. What immunologic test would help to determine the cause of this transfusion reaction?

A. Complement levels, particularly C3 and C4
B. Flow cytometry for T-cell counts
C. Measurement of Igs
D. NBT test for phagocytic function

A

C. Measurement of Igs

54
Q
  1. IFE revealed excessive amounts of polyclonal IgM and low concentrations of IgG and IgA. What is the most likely explanation of these findings and the best course of action?

A. Proper amounts of antisera were not added; repeat both tests
B. Test specimen was not added properly; repeat both procedures
C. Patient has common variable immunodeficiency; perform B-cell count
D. Patient has immunodeficiency with hyper-M; perform CD40 ligand (CD154) analysis

A

D. Patient has immunodeficiency with hyper-M; perform CD40 ligand (CD154) analysis

55
Q
  1. SITUATION: A 54-year-old man was admitted to the hospital after having a seizure. Many laboratory tests were performed, including an RPR, but none of the results was positive. The physician suspects a case of late (tertiary) syphilis. Which test should be performed next?

A. Repeat RPR, followed by VDRL
B. Treponemal test, such as TP-PA on serum
C. VDRL on CSF
D. No laboratory test is positive for late (tertiary) syphilis

A

B. Treponemal test, such as TP-PA on serum

56
Q
  1. A patient came to his physician complaining of a rash, severe headaches, stiff neck, and sleep problems. Laboratory tests of
    significance were an elevated sedimentation rate (ESR) and slightly
    increased liver enzymes. Further questioning of the patient revealed
    that he had returned from a hunting trip in upstate New York 4 weeks ago. His physician ordered a serological test for Lyme disease, and the assay was negative. What is the most likely explanation of these results?

A. The antibody response is not sufficient to be detected at this stage
B. The clinical symptoms and laboratory results are not characteristic of Lyme disease
C. The patient likely has early-stage HBV infection
D. Laboratory error has caused a false-negative result

A

A. The antibody response is not sufficient to be detected at this stage

57
Q
  1. A 19-year-old girl came to her physician complaining of a sore throat
    and fatigue. Upon physical examination, lymphadenopathy was noted. Reactive lymphocytes were noted on the differential, but a rapid test for antibodies to IM was negative. Liver enzymes were only slightly elevated. What test(s) should be ordered next?

A. Hepatitis testing
B. EBV serological panel
C. HIV confirmatory testing
D. Bone marrow biopsy

A

B. EBV serological panel

58
Q
  1. A patient received 2 units of RBCs following surgery. Two weeks after the surgery, the patient was seen by his physician and was found to have mild jaundice and slightly elevated liver enzymes. Hepatitis testing, however, was negative. What should be done next?

A. Nothing until more severe or definitive clinical signs develop
B. Repeat hepatitis testing immediately
C. Repeat hepatitis testing in a few weeks
D. Check blood bank donor records and contact donor(s) of transfused unit

A

C. Repeat hepatitis testing in a few weeks

59
Q
  1. A hospital employee received the final dose of the hepatitis B vaccine 3 weeks ago. She wants to donate blood. Which of the following results are expected from the hepatitis screen, and will she be allowed to donate blood?

A. HBsAg, positive; anti-HBc, negative—she may donate
B. HBsAg, negative; anti-HBc, positive—she may not donate
C. HBsAg, positive; anti-HBc, positive—she may not donate
D. HBsAg, negative; anti-HBc, negative—she may donate

A

D. HBsAg, negative; anti-HBc, negative—she may donate

60
Q
  1. A pregnant woman came to her physician with a maculopapular rash on her face and neck. Her temperature was 37.7°C. Rubella tests for both IgG and IgM antibody were positive. What positive test(s) would reveal a diagnosis of congenital rubella syndrome in her baby after birth?

A. Positive rubella tests for both IgG and IgM antibody
B. Positive rubella test for IgM
C. Positive rubella test for IgG
D. No positive test is revealed in congenital rubella syndrome

A

B. Positive rubella test for IgM

61
Q
  1. SITUATION: A patient with RA has acute pneumonia but a negative result on throat culture. The physician suspects an infection with Mycoplasma pneumoniae and requests an IgM-specific antibody test. The test is performed directly on serial dilutions of serum less than 4 hours old. The result is positive, giving a titer of 1:32. However, the test is repeated 3 weeks later, and the titer remains at 1:32. What test should be performed to determine if the patient is truly infected with M.
    pneumoniae?

A. IgG anti-M. pneumoniae
B. Cold agglutinins
C. M. pneumoniae PCR or other molecular assay
D. Respiratory culture

A

C. M. pneumoniae PCR or other molecular assay

62
Q
  1. A patient had a PSA level of 60 ng/mL the day before surgery to remove a localized prostate tumor. One week after surgery, serum PSA was determined to be 8 ng/mL by the same method. What is the most likely cause of these results?

A. Incomplete removal of the malignancy
B. Cross reactivity of the antibody with another tumor antigen
C. Testing too soon after surgery
D. Hook effect with the PSA assay

A

C. Testing too soon after surgery

63
Q
  1. A patient with symptoms associated with SLE and scleroderma was evaluated by immunofluorescence microscopy for ANAs by using the HEp-2 cell line as substrate. The cell line displayed a mixed pattern of fluorescence that could not be separated by serial dilutions of the serum. Which procedure would be most helpful in determining the antibody profile of this patient?

A. Use of a different tissue substrate
B. Absorption of the serum using the appropriate tissue extract
C. Requesting a new specimen
D. ELISA tests for specific antibodies

A

D. ELISA tests for specific antibodies

64
Q
  1. 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

65
Q
  1. What is the main advantage of the recovery and reinfusion of autologous stem cells?

A. It slows the rate of rejection of transplanted cells
B. It prevents graft-versus-host disease
C. No HLA testing is required
D. Engraftment occurs in a more efficient sequence

A

B. It prevents graft-versus-host disease

66
Q
  1. A transplant recipient began to show signs of rejection 8 days after transplantation, and the organ was removed. What immune elements
    might be found in the rejected organ?

A. Antibody and complement
B. Primarily antibody
C. Macrophages
D. T cells

A

D. T cells

67
Q
  1. A patient with ovarian cancer who has been treated with chemotherapy is being monitored for recurrence by using serum CA-125, CA-50, and CA 15–3. Six months after treatment the CA 15–3
    is elevated, but the CA-125 and CA-50 remain low. What is the most likely explanation of these findings?

A. Ovarian malignancy has recurred
B. CA 15–3 is specific for breast cancer and indicates metastatic breast cancer
C. Testing error occurred in the measurement of CA 15–3 caused by poor analytical specificity
D. The CA 15–3 elevation is spurious and probably benign

A

A. Ovarian malignancy has recurred

68
Q
  1. An initial and repeat fourth generation HIV screening test are both
    positive. The antibody differentiation assay is negative, as is the qualitative RNA PCR test. The patient shows no clinical signs of HIV infection, and the patient’s CD4 T-cell count is normal. Based on these results, which conclusion is correct?

A. Patient is diagnosed as HIV-1 positive
B. Patient is diagnosed as HIV-2 positive
C. Results are inconclusive
D. Patient is diagnosed as HIV-1 negative

A

D. Patient is diagnosed as HIV-1 negative

69
Q
  1. A woman who has been pregnant for 12 weeks is tested for toxoplasmosis. Her IgM ELISA titer is 2.6 (reference range less than 1.6), and her IgG ELISA value is 66 (reference range less than 8). The physician asks you if these results indicated an infection during the past 12 weeks. Which of the following tests would you recommend to determine if the woman was infected during her pregnancy?

A. Toxoplasmosis PCR on amniotic fluid
B. Toxoplasmosis IgM on amniotic fluid
C. Toxoplasmosis IgG avidity
D. Amniotic fluid culture

A

C. Toxoplasmosis IgG avidity

70
Q
  1. On January 4, an SPE on a specimen obtained at your hospital in North Dakota from a 58-year-old patient shows a band at the β—γ junction. The specimen was also positive for RF. You recommend that an immunofixation test be performed to determine if the band
    represents a monoclonal Ig. Another specimen is obtained 2 weeks later by the physician in his office 30 miles away, and whole blood is submitted to you for IFE. The courier placed the whole blood specimen in an ice chest for transport. In this specimen, no β-γ band is seen in
    the serum protein lane, and the IgM lane is very faint. The RF on this specimen was negative. The physician wants to know what went wrong in your laboratory. Your response is

A. Nothing went wrong in our laboratory; the patient had an infection 2 weeks ago, and it had cleared up
B. Something went wrong in our laboratory—we likely mislabeled one of the specimens; please resubmit a new
specimen, and we will test it at no charge
C. We will run a second specimen after 2-mercaptoethanol treatment, which will eliminate IgM aggregates and allow for
more sensitive monoclonal IgM detection
D. Please redraw another specimen from the patient, and this time, separate the serum from the clot in your office
before placing the specimen on ice and sending it to us by courier

A

D. Please redraw another specimen from the patient, and this time, separate the serum from the clot in your office
before placing the specimen on ice and sending it to us by courie

71
Q
  1. A patient undergoing dialysis is positive for both HBsAg and anti-HBs. The physician suspects a laboratory error. Do you agree?

A. Yes; the patient should not test positive for both HBsAg and anti-HBs
B. No; incomplete dialysis of a patient in the core window phase of HBV infection will yield this result
C. No; it is likely the patient has recently received a hepatitis B booster vaccination within the past week, and this could have caused these results
D. Perhaps; a new specimen should be submitted to clear up the confusion

A

C. No; it is likely the patient has recently received a hepatitis B booster vaccination within the past week, and this could have caused these results

72
Q
  1. You are evaluating an ELISA assay as a replacement for your IFA ANA test. You test 50 specimens in duplicate on each assay. The ELISA assay uses a HEp-2 extract as its antigen source. The correlation between the ELISA and IFA tests is only 60% (30 of 50 specimens agree). Which of the following is the next best course of action?

A. Test another 50 specimens
B. Perform a competency check on the medical laboratory scientists who performed the tests
C. Order a new lot of both kits and then retest on the new lots
D. Refer the discrepant specimens for testing by another method

A

D. Refer the discrepant specimens for testing by another method

SEROLOGY MTAP 1 (8 decks)

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