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ISBB Flashcards

1
Q

From the following, identify a specific component of the adaptive immune system that is formed in response to antigenic stimulation:
A. Lysozyme
B. Complement
C. Commensal organisms
D. Immunoglobulin

A

D. Immunoglobulin

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2
Q

Which two organs are considered the primary lymphoid organs in which immunocompetent cells originate and mature?
A. Thyroid and Peyer’s patches
B. Thymus and bone marrow
C. Spleen and mucosal-associated lymphoid tissue (MALT)
D. Lymph nodes and thoracic duct

A

B. Thymus and bone marrow

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3
Q

What type of B cells are formed after antigen stimulation?
A. Plasma cells and memory B cells
B. Mature B cells
C. Antigen-dependent B cells
D. Receptor-activated B cells

A

A. Plasma cells and memory B cells

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4
Q

T cells travel from the bone marrow to the thymus for maturation. What is the correct order of the maturation sequence for T cells in the thymus?
A. Bone marrow to the cortex; after thymic education, released back to peripheral circulation
B. Maturation and selection occur in the cortex; migration to the medulla; release of mature T cells to secondary lymphoid organs
C. Storage in either the cortex or medulla; release of
T cells into the peripheral circulation
D. Activation and selection occur in the medulla; mature T cells are stored in the cortex until activated by antigen

A

B. Maturation and selection occur in the cortex; migration to the medulla; release of mature T cells to secondary lymphoid organs

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5
Q

Which cluster of differentiation (CD) marker appears during the first stage of T-cell development and remains present as an identifying marker for T cells?
A. CD1
B. CD2
C. CD3
D. CD4 or CD8

A

B. CD2

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6
Q

Which markers are found on mature, peripheral helper T cells?
A. CD1, CD2, CD4
B. CD2, CD3, CD8
C. CD1, CD3, CD4
D. CD2, CD3, CD4

A

D. CD2, CD3, CD4

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7
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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8
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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9
Q

What is the name of the process by which phagocytic cells are attracted to a substance such as a bacterial peptide?
A. Diapedesis
B. Degranulation
C. Chemotaxis
D. Phagotaxis

A

C. Chemotaxis

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10
Q

All of the following are immunologic functions of complement except:
A. Induction of an antiviral state
B. Opsonization
C. Chemotaxis
D. Anaphylatoxin formation

A

A. Induction of an antiviral state

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11
Q

Which complement component is found in both the classic and alternative pathways?
A. C1
B. C4
C. Factor D
D. C3

A

D. C3

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12
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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13
Q

How is complement activity destroyed in vitro?
A. Heating serum at 56°C for 30 min
B. Keeping serum at room temperature of 22°C for 1 hour
C. Heating serum at 37°C for 45 min
D. Freezing serum at 0°C for 24 hours

A

A. Heating serum at 56°C for 30 min

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14
Q

What is the purpose of C3a, C4a, and C5a, the split products of the complement cascade?
A. To bind with specific membrane receptors of lymphocytes and cause release of cytotoxic substances
B. To cause increased vascular permeability, contraction of smooth muscle, and release of histamine from basophils
C. To bind with membrane receptors of macrophages to facilitate phagocytosis and the removal of debris and foreign substances
D. To regulate and degrade membrane cofactor protein after activation by C3 convertase

A

B. To cause increased vascular permeability, contraction of smooth muscle, and release of histamine from basophils

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15
Q

Which region of the immunoglobulin molecule can bind antigen?
A. Fab
B. Fc
C. CL
D. CH

A

A. Fab

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16
Q

Which region determines whether an immunoglobulin molecule can fix complement?
A. VH
B. CH
C. VL
D. CL

A

B. CH

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17
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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18
Q

Which immunoglobulin appears first in the primary immune response?
A. IgG
B. IgM
C. IgA
D. IgE

A

B. IgM

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19
Q

Which immunoglobulin appears in highest titer in the secondary response?
A. IgG
B. IgM
C. IgA
D. IgE

A

A. IgG

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20
Q

Which immunoglobulin can cross the placenta?
A. IgG
B. IgM
C. IgA
D. IgE

A

A. IgG

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21
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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22
Q

All of the following are functions of
immunoglobulins except:
A. Neutralizing toxic substances
B. Facilitating phagocytosis through opsonization
C. Interacting with TC cells to lyse viruses
D. Combining with complement to destroy cellular antigens

A

C. Interacting with TC cells to lyse viruses

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23
Q

Which of the following cell surface molecules is classified as an MHC class II antigen?
A. HLA-A
B. HLA-B
C. HLA-C
D. HLA-DR

A

D. HLA-DR

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24
Q

Which MHC class of molecule is necessary for antigen recognition by CD4-positive T cells?
A. Class I
B. Class II
C. Class III
D. No MHC molecule is necessary for antigen recognition

A

B. Class II

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25
Q

Which of the following are products of HLA class III genes?
A. T-cell immune receptors
B. HLA-D antigens on immune cells
C. Complement proteins C2, C4, and Factor B
D. Immunoglobulin VL regions

A

C. Complement proteins C2, C4, and Factor B

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26
Q

What molecule on the surface of most T cells recognizes antigen?
A. IgT, a four-chain molecule that includes the tau heavy chain
B. MHC protein, a two-chain molecule encoded by the HLA region
C. CD3, consisting of six different chains
D. TcR, consisting of two chains, alpha and beta

A

D. TcR, consisting of two chains, alpha and beta

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27
Q

The T-cell antigen receptor is similar to immunoglobulin molecules in that it:
A. Remains bound to the cell surface and is never secreted
B. Contains V and C regions on each of its chains
C. Binds complement
D. Can cross the placenta and provide protection to a fetus

A

B. Contains V and C regions on each of its chains

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28
Q

Toll-like receptors are found on which cells?
A. T cells
B. Dendritic cells
C. B cells
D. Large granular lymphocytes

A

B. Dendritic cells

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29
Q

Macrophages produce which of the following proteins during antigen processing?
A. IL-1 and IL-6
B. γ-Interferon
C. IL-4, IL-5, and IL-10
D. Complement components C1 and C3

A

A. IL-1 and IL-6

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30
Q

A superantigen, such as toxic shock syndrome toxin-1 (TSST-1), bypasses the normal antigen processing stage by binding to and cross linking:
A. A portion of an immunoglobulin molecule and complement component C1
B. Toll-like receptors and an MHC class 1 molecule
C. A portion of an immunoglobulin and a portion of a T-cell receptor
D. A portion of a T-cell receptor and an MHC class II molecule

A

D. A portion of a T-cell receptor and an MHC class II molecule

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31
Q

T regulator cells, responsible for controlling autoimmune antibody production, express which of the following phenotypes?
A. CD3, CD4, CD8
B. CD3, CD8, CD25
C. CD3, CD4, CD25
D. CD8, CD25, CD56

A

C. CD3, CD4, CD25

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32
Q

The interaction between an individual antigen and antibody molecule depends upon several
types of bonds such as ionic bonds, hydrogen bonds, hydrophobic bonds, and van der Waals forces. How is the strength of this attraction
characterized?
A. Avidity
B. Affinity
C. Reactivity
D. Valency

A

B. Affinity

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33
Q

A laboratory is evaluating an enzyme-linked immunosorbent assay (ELISA) for detecting an antibody to cyclic citrullinated peptide (CCP), which is a marker for rheumatoid arthritis. The laboratory includes serum from healthy volunteers
and patients with other connective tissue diseases in the evaluation. These specimens determine which factor of the assay?
A. Sensitivity
B. Precision
C. Bias
D. Specificity

A

D. Specificity

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34
Q

The detection of precipitation reactions depends on the presence of optimal proportions of antigen
and antibody. A patient’s sample contains a large amount of antibody, but the reaction in a test system
containing antigen is negative. What has happened?
A. Performance error
B. Low specificity
C. A shift in the zone of equivalence
D. Prozone phenomenon

A

D. Prozone phenomenon

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35
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

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36
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

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37
Q

Why is a chemiluminescent immunoassay (CIA) or enzyme immunoassay (EIA) the method of choice for detection of certain analytes, such as hormones, normally found in low concentrations?
A. Because of low cross reactivity
B. Because of high specificity
C. Because of high sensitivity
D. Because test systems may be designed as both competitive and noncompetitive assays

A

C. Because of high sensitivity

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38
Q

What comprises the indicator system in an indirect ELISA for detecting antibody?
A. Enzyme-conjugated antibody + chromogenic substrate
B. Enzyme conjugated antigen + chromogenic substrate
C. Enzyme + antigen
D. Substrate + antigen

A

A. Enzyme-conjugated antibody + chromogenic substrate

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39
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

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40
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

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41
Q

The absorbance of a sample measured by ELISA is greater than the highest standard. What corrective action should be taken?
A. Extrapolate an estimated value from the highest reading
B. Repeat the test using a standard of higher concentration
C. Repeat the assay using one half the volume of the sample
D. Dilute the test sample

A

D. Dilute the test sample

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42
Q

A patient was suspected of having a
lymphoproliferative disorder. After several laboratory tests were completed, the patient was found to have an IgMκ paraprotein. In what
sequence should the laboratory tests leading to this diagnosis have been performed?
A. Serum protein electrophoresis (SPE) followed by immunofixation electrophoresis (IFE)
B. Immunoglobulin levels followed by SPE
C. Total lymphocyte count followed by immunoglobulin levels
D. Immunoglobulin levels followed by urine protein electrophoresis

A

A. Serum protein electrophoresis (SPE) followed by immunofixation electrophoresis (IFE)

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43
Q

An IFE performed on a serum sample showed a narrow dark band in the lanes containing anti-γ and anti-λ. How should this result be interpreted?
A. Abnormally decreased IgG concentration
B. Abnormal test result demonstrating monoclonal IgGλ
C. Normal test result
D. Impossible to determine without densitometric quantitation

A

B. Abnormal test result demonstrating monoclonal IgGλ

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44
Q

Which type of nephelometry is used to measure immune complex formation almost immediately
after reagent has been added?
A. Rate
B. Endpoint
C. Continuous
D. One dimensional

A

A. Rate

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45
Q

An immunofluorescence microscopy assay (IFA) was performed, and a significant antibody titer was
reported. Positive and negative controls performed as expected. However, the clinical evaluation of the patient was not consistent with a positive finding. What is the most likely explanation of this situation?
A. The clinical condition of the patient changed since the sample was tested
B. The pattern of fluorescence was misinterpreted
C. The control results were misinterpreted
D. The wrong cell line was used for the test

A

B. The pattern of fluorescence was misinterpreted

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46
Q

What corrective action should be taken when an indeterminate pattern occurs in an indirect IFA?
A. Repeat the test using a larger volume of sample
B. Call the physician
C. Have another medical laboratory scientist read the slide
D. Dilute the sample and retest

A

D. Dilute the sample and retest

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47
Q

Which statement best describes passive agglutination reactions used for serodiagnosis?
A. Such agglutination reactions are more rapid because they are a single-step process
B. Reactions require the addition of a second antibody
C. Passive agglutination reactions require biphasic incubation
D. Carrier particles for antigen such as latex particles are used

A

D. Carrier particles for antigen such as latex particles are used

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48
Q

The directions for a slide agglutination testminstruct 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

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49
Q

What effect does selecting the wrong gate have on the results when cells are counted by flow cytometry?
A. No effect
B. Failure to count the desired cell population
C. Falsely elevated results
D. Impossible to determine

A

B. Failure to count the desired cell population

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50
Q

Which statement best describes
immunophenotyping?
A. Lineage determination by detecting antigens on the surface of the gated cells using fluorescent
antibodies
B. Identification of cell maturity using antibodies to detect antigens within the nucleus
C. Identification and sorting of cells by front and side-scatter of light from a laser
D. Analysis of cells collected by flow cytometry using traditional agglutination reactions

A

A. Lineage determination by detecting antigens on the surface of the gated cells using fluorescent
antibodies

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51
Q

A flow cytometry scattergram of a bone marrow sample shows a dense population of cells located in-between normal lymphoid and normal myeloid cells. What is the most likely explanation?
A. The sample was improperly collected
B. An abnormal cell population is present
C. The laser optics are out of alignment
D. The cells are most likely not leukocytes

A

B. An abnormal cell population is present

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52
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. Detected 1–3 weeks after appearance of the primary chancre

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53
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

A. Cardiolipin

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54
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

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55
Q

Which of the following is the most sensitive test to detect congenital syphilis?
A. VDRL
B. RPR
C. Microhemagglutinin test for T. pallidum (MHA-TP)
D. Polymerase chain reaction (PCR)

A

D. Polymerase chain reaction (PCR)

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56
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)

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57
Q

A 12-year old girl has symptoms of fatigue and a localized lymphadenopathy. Laboratory tests reveal a peripheral blood lymphocytosis, a positive RPR,
and a positive spot test for IM. What test should be performed next?
A. HIV test by ELISA
B. VDRL
C. Epstein–Barr virus (EBV) specific antigen test
D. Treponema pallidum particle agglutination (TP-PA) test

A

D. Treponema pallidum particle agglutination (TP-PA) test

58
Q

Which test is most likely to be positive in the tertiary stage of syphilis?
A. FTA-ABS
B. RPR
C. VDRL
D. Reagin screen test (RST)

A

A. FTA-ABS

59
Q

What is the most likely interpretation of the following syphilis serological
results?
RPR: reactive; VDRL: reactive; MHA-TP: nonreactive
A. Neurosyphilis
B. Secondary syphilis
C. Syphilis that has been successfully treated
D. Biological false positive

A

D. Biological false positive

60
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

61
Q

Interpret the following quantitative RPR test results.
RPR titer: weakly reactive 1:8; reactive 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. Excess antibody, prozone effect

62
Q

Tests to identify infection with HIV fall into which three general classification types of tests?
A. Tissue culture, antigen, and antibody tests
B. Tests for antigens, antibodies, and nucleic acid
C. DNA probe, DNA amplification, and Western blot tests
D. ELISA, Western blot, and Southern blot tests

A

B. Tests for antigens, antibodies, and nucleic acid

63
Q

Which tests are considered screening tests for HIV?
A. ELISA, 4th generation, and rapid antibody tests
B. Immunofluorescence, Western blot, radioimmuno-precipitation assay
C. Culture, antigen capture assay, DNA amplification
D. Reverse transcriptase and messenger RNA (mRNA) assay

A

A. ELISA, 4th generation, and rapid antibody tests

64
Q

Which tests are considered confirmatory tests for HIV?
A. ELISA and rapid antibody tests
B. Western blot test, HIC-1,2 differentiation assays, and polymerase chain reaction
C. Culture, antigen capture assay, polymerase chain reaction
D. Reverse transcriptase and mRNA assay

A

B. Western blot test, HIC-1,2 differentiation assays, and polymerase chain reaction

65
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

66
Q

A woman who has had five pregnancies subsequently tests positive for HIV by Western blot. What is the most likely reason for this result?
A. Possible cross-reaction with herpes or EBV antibodies
B. Interference from medication
C. Cross-reaction with HLA antigens in the antigen preparation
D. Possible technical error

A

C. Cross-reaction with HLA antigens in the antigen preparation

67
Q

Interpret the following results for HIV infection.
ELISA: positive; repeat ELISA: negative; Western blot: no bands
A. Positive for HIV
B. Negative for HIV
C. Indeterminate
D. Further testing needed

A

B. Negative for HIV

68
Q

Interpret the following results for HIV infection.
HIV 1,2 ELISA: positive; HIV-1 Western blot: indeterminate; HIV-1 p24 antigen: negative
A. Positive for antibodies to human
immunodeficiency virus, HIV-1
B. Positive for antibodies to human
immunodeficiency virus, HIV-2
C. Cross reaction; biological false-positive result
D. Additional testing required

A

D. Additional testing required

69
Q

What is the most likely explanation when antibody tests for HIV are negative but a polymerase chain
reaction test performed 1 week later is positive?
A. Probably not HIV infection
B. Patient is in the “window phase” before antibody production
C. Tests were performed incorrectly
D. Clinical signs may be misinterpreted

A

B. Patient is in the “window phase” before antibody production

70
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

71
Q

What is the main difficulty associated with the development of an HIV vaccine?
A. The virus has been difficult to culture; antigen extraction 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. Different strains of the virus are genetically diverse

72
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

73
Q

What is the advantage of 4th-generation rapid HIV tests over earlier rapid HIV tests?
A. They use recombinant antigens
B. They detect multiple strains of HIV
C. They detect p24 antigen
D. They are quantitative

A

C. They detect p24 antigen

74
Q

Which method is used to test for HIV infection in infants who are born to HIV-positive mothers?
A. ELISA
B. Western blot test
C. Polymerase chain reaction
D. Viral culture

A

C. Polymerase chain reaction

75
Q

What is the most likely cause when a Western blot or ELISA is positive for all controls and samples?
A. Improper pipetting
B. Improper washing
C. Improper addition of sample
D. Improper reading

A

B. Improper washing

76
Q

What constitutes a diagnosis of viral hepatitis?
A. Abnormal test results for liver enzymes
B. Clinical signs and symptoms
C. Positive results for hepatitis markers
D. All of these options

A

D. All of these options

77
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

78
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

79
Q

What type of serological testing does the blood bank technologist perform when determining the blood group of a patient?
A. Genotyping
B. Phenotyping
C. Both genotyping and phenotyping
D. Polymerase chain reaction

A

B. Phenotyping

80
Q

If anti-K reacts 3+ with a donor cell with a
genotype KK and 2+ with a Kk cell, the antibody is demonstrating:
A. Dosage
B. Linkage disequilibrium
C. Homozygosity
D. Heterozygosity

A

A. Dosage

81
Q

Carla expresses the blood group antigens Fya, Fyb, and Xga. James shows expressions of none of these antigens. What factor(s) may account for the absence of these antigens in James?
A. Gender
B. Race
C. Gender and race
D. Medication

A

C. Gender and race

82
Q

Which of the following statements is true?
A. An individual with the BO genotype is
homozygous for B antigen
B. An individual with the BB genotype is
homozygous for B antigen
C. An individual with the OO genotype is
heterozygous for O antigen
D. An individual with the AB phenotype is
homozygous for A and B antigens

A

B. An individual with the BB genotype is
homozygous for B antigen

83
Q

Which genotype is heterozygous for C?
A. DCe/dce
B. DCE/DCE
C. Dce/dce
D. DCE/dCe

A

A. DCe/dce

84
Q

Which genotype(s) will give rise to the Bombay phenotype?
A. HH only
B. HH and Hh
C. Hh and hh
D. hh only

A

D. hh only

85
Q

Meiosis in cell division is limited to the ova and sperm producing four gametes containing what complement of DNA?
A. 1N
B. 2N
C. 3N
D. 4N

A

A. 1N

86
Q

A cell that is not actively dividing is said to be in:
A. Interphase
B. Prophase
C. Anaphase
D. Telophase

A

A. Interphase

87
Q

Which of the following describes the expression of most blood group antigens?
A. Dominant
B. Recessive
C. Codominant
D. Corecessive

A

C. Codominant

88
Q

What blood type is not possible for an offspring of an AO and BO mating?
A. AB
B. A or B
C. O
D. All are possible

A

D. All are possible

89
Q

The alleged father of a child in a disputed case of paternity is blood group AB. The mother is group O and the child is group O. What type of exclusion is this?
A. Direct/primary/first order
B. Probability
C. Random
D. Indirect/secondary/second order

A

D. Indirect/secondary/second order

90
Q

If the frequency of gene Y is 0.4 and the frequency of gene Z is 0.5, one would expect that they should occur together 0.2 (20%) of the time. In actuality, they are found together 32% of the time. This is an example of:
A. Crossing over
B. Linkage disequilibrium
C. Polymorphism
D. Chimerism

A

B. Linkage disequilibrium

91
Q

In the Hardy–Weinberg formula, p2 represents:
A. The heterozygous population of one allele
B. The homozygous population of one allele
C. The recessive allele
D. The dominant allele

A

B. The homozygous population of one allele

92
Q

In this type of inheritance, the father carries the trait on his X chromosome. He has no sons with the trait because he passed his Y chromosome to his sons; however, all his daughters will express the trait.
A. Autosomal dominant
B. Autosomal recessive
C. X-linked dominant
D. X-linked recessive

A

C. X-linked dominant

93
Q

Why do IgM antibodies, such as those formed against the ABO antigens, have the ability to directly agglutinate red blood cells (RBCs) and cause visible agglutination?
A. IgM antibodies are larger molecules and have the ability to bind more antigen
B. IgM antibodies tend to clump together more readily to bind more antigen
C. IgM antibodies are found in greater
concentrations than IgG antibodies
D. IgM antibodies are not limited by subclass specificity

A

A. IgM antibodies are larger molecules and have the ability to bind more antigen

94
Q

Which of the following enhancement mediums decreases the zeta potential, allowing antibody and
antigen to come closer together?
A. LISS
B. Polyethylene glycol
C. Polybrene
D. ZZAP

A

A. LISS

95
Q

This type of antibody response is analogous to an anamnestic antibody reaction.
A. Primary
B. Secondary
C. Tertiary
D. Anaphylactic

A

B. Secondary

96
Q

Which antibodies to a component of complement are contained in the rabbit polyspecific antihuman globulin reagent for detection of in vivo sensitization?
A. Anti-IgG and anti-C3a
B. Anti-IgG and anti-C3d
C. Anti-IgG and anti-IgM
D. All of these options

A

B. Anti-IgG and anti-C3d

97
Q

Which of the following distinguishes A1 from A2 blood groups?
A. A2 antigen will not react with anti-A, A1 will react strongly (4+)
B. An A2 person may form anti-A1; an A1 person will not form anti-A1
C. An A1 person may form anti-A2, an A2 person will not form anti-A1
D. A2 antigen will not react with anti-A from a nonimmunized donor; A1 will react with any anti-A

A

B. An A2 person may form anti-A1; an A1 person will not form anti-A1

98
Q

A patient’s serum is incompatible with O cells. The patient RBCs give a negative reaction to anti-H lectin. What is the most likely cause of these results?
A. The patient may be a subgroup of A
B. The patient may have an immunodeficiency
C. The patient may be a Bombay
D. The patient may have developed alloantibodies

A

C. The patient may be a Bombay

99
Q

What antibodies are formed by a Bombay individual?
A. Anti-A and anti-B
B. Anti-H
C. Anti-A,B
D. Anti-A, B, and H

A

D. Anti-A, B, and H

100
Q

Acquired B antigens have been found in:
A. Bombay individuals
B. Group O persons
C. All blood groups
D. Group A persons

A

D. Group A persons

101
Q

Blood is crossmatched on an A positive person with a negative antibody screen. The patient received a transfusion of A positive RBCs 3 years ago. The donors chosen for crossmatch were A positive. The crossmatch was run on the Ortho Provue and yielded 3+ incompatibility. How can these results be explained?
A. The patient has an antibody to a low-frequency
antigen
B. The patient has an antibody to a high-frequency
antigen
C. The patient is an A2 with anti-A1
D. The patient is an A1 with anti-A2

A

C. The patient is an A2 with anti-A1

102
Q

A patient’s red cells forward as group O, serum agglutinates B cells (4+) only. Your next step would be:
A. Extend reverse typing for 15 minutes
B. Perform an antibody screen including a room-temperature incubation
C. Incubate washed red cells with anti-A1 and anti-A,B for 30 minutes at room temperature
D. Test patient’s red cells with Dolichos biflorus

A

C. Incubate washed red cells with anti-A1 and anti-A,B for 30 minutes at room temperature

103
Q

Which typing results are most likely to occur when a patient has an acquired B antigen?
A. Anti-A 4+, anti-B-3+, A1 cells neg, B cells neg
B. Anti-A 3+, anti-B neg, A1 cells neg, B cells neg
C. Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+
D. Anti-A 4+, anti-B 4+, A1 cells 2+, B cells neg

A

C. Anti-A 4+, anti-B 1+, A1 cells neg, B cells 4+

104
Q

Which blood group has the least amount of H antigen?
A. A1B
B. A2
C. B
D. A1

A

A. A1B

105
Q

What type RBCs can be transfused to an A2 person with anti-A1?
A. A only
B. A or O
C. B
D. AB

A

B. A or O

106
Q

What should be done if all forward and reverse ABO results as well as the autocontrol are positive?
A. Wash the cells with warm saline, autoadsorb the serum at 4°C
B. Retype the sample using a different lot number of reagents
C. Use polyclonal typing reagents
D. Report the sample as group AB

A

A. Wash the cells with warm saline, autoadsorb the serum at 4°C

107
Q

What should be done if all forward and reverse ABO results are negative?
A. Perform additional testing such as typing with anti-A1 lectin and anti-A,B
B. Incubate at 22°C or 4°C to enhance weak expression
C. Repeat the test with new reagents
D. Run an antibody identification panel

A

B. Incubate at 22°C or 4°C to enhance weak expression

108
Q

N-acetyl-D-galactosamine is the immunodominant carbohydrate that reacts with:
A. Arachis hypogaea
B. Salvia sclarea
C. Dolichos biflorus
D. Ulex europeaus

A

C. Dolichos biflorus

109
Q

A stem cell transplant patient was retyped when she was transferred from another hospital. What is the most likely cause of the following results?
Patient cells: Anti-A, neg Anti-B, 4+
Patient serum: A1 cells, neg B cells, neg
A. Viral infection
B. Alloantibodies
C. Immunodeficiency
D. Autoimmune hemolytic anemia

A

C. Immunodeficiency

110
Q

What reaction would be the same for an A1 and an A2 person?
A. Positive reaction with anti-A1 lectin
B. Positive reaction with A1 cells
C. Equal reaction with anti-H
D. Positive reaction with anti-A,B

A

D. Positive reaction with anti-A,B

111
Q

A female patient at 28 weeks’ gestation yields the following results:
Patient cells: — Anti-A, 3+ Anti-B, 4+
Patient serum: A1 cells, neg B cells, 1+ O cells, 1+
Which of the following could be causing the ABO discrepancy?
A. Hypogammaglobulinemia
B. Alloantibody in patient serum
C. Acquired B
D. Weak subgroup

A

B. Alloantibody in patient serum

112
Q

A 61-year-old male with a history of multiple myeloma had a stem cell transplant 3 years ago. The donor was O positive and the recipient was
B positive. He is admitted to a community hospital for fatigue and nausea. Typing results reveal the following:
Anti-A = 0
Anti-B =0
Anti-A,B = 0
Anti-D = 4+
A1 cells = 4+
B cells = 0
How would you report this type?
A. O positive
B. B positive
C. A positive
D. Undetermined

A

D. Undetermined

113
Q

A complete Rh typing for antigens C, c, D, E, and e revealed negative results for C, D, and E. How is the individual designated?
A. Rh positive
B. Rh negative
C. Positive for c and e
D. Impossible to determine

A

B. Rh negative

114
Q

How is an individual with genotype Dce/dce classified?
A. Rh positive
B. Rh negative
C. Rhnull
D. Total Rh

A

A. Rh positive

115
Q

If a patient has a positive direct antiglobulin test, should you perform a weak D test on the cells?
A. No, the cells are already coated with antibody
B. No, the cells are Rhnull
C. Yes, the immunoglobulin will not interfere with the test
D. Yes, Rh reagents are enhanced in protein media

A

A. No, the cells are already coated with antibody

116
Q

Which donor unit is selected for a recipient with anti-c?
A. r ́r
B. R0R1
C. R2r ́
D. r ́ry

A

D. r ́ry

117
Q

Which genotype usually shows the strongest reaction with anti-D?
A. DCE/DCE
B. Dce/dCe
C. D–/D–
D. -CE/-ce

A

C. D–/D–

118
Q

Testing reveals a weak D that reacts 1+ after indirect antiglobulin testing (IAT). How is this result classified?
A. Rh-positive
B. Rh-negative, Du positive
C. Rh-negative
D. Rh-positive, Du positive

A

A. Rh-positive

119
Q

What is one possible genotype for a patient who develops anti-C antibody?
A. R1r
B. R1R1
C. r ́r
D. rr

A

D. rr

120
Q

A patient developed a combination of Rh antibodies: anti-C, anti-E, and anti-D. Can compatible blood be found for this patient?
A. It is almost impossible to find blood lacking the C, E, and D antigens
B. rr blood could be used without causing a problem
C. R0R0 may be used because it lacks all three antigens
D. Although rare, ryr blood may be obtained from close relatives of the patient

A

B. rr blood could be used without causing a problem

121
Q

A patient tests positive for weak D but also appears to have anti-D in his serum. What may be the problem?
A. Mixup of samples or testing error
B. Most weak D individuals make anti-D
C. The problem could be due to a disease state
D. A D mosaic may make antibodies to missing antigen parts

A

D. A D mosaic may make antibodies to missing antigen parts

122
Q

Which offspring is not possible from a mother who is R1R2 and a father who is R1r?
A. DcE/DcE
B. Dce/DCe
C. DcE/DCe
D. Dce/dce

A

A. DcE/DcE

123
Q

Why is testing a pregnant woman for weak D not
required?
A. An Rh-negative fetus may yield false positive results in a fetal maternal bleed
B. An Rh-positive fetus may yield false positive results in a fetal maternal bleed
C. D antigen strength decreases during pregnancy
D. D antigen strength increases during pregnancy

A

B. An Rh-positive fetus may yield false positive results in a fetal maternal bleed

124
Q

What antibodies could an R1R1 make if exposed to R2R2 blood?
A. Anti-e and anti-C
B. Anti-E and anti-c
C. Anti-E and anti-C
D. Anti-e and anti-c

A

B. Anti-E and anti-c

125
Q

What does the genotype —/— represent in the
Rh system?
A. Rh negative
B. D mosaic
C. Rhnull
D. Total Rh

A

C. Rhnull

126
Q

What techniques are necessary for weak D testing?
A. Saline + 22°C incubation
B. Albumin or LISS + 37°C incubation
C. Saline + 37°C incubation
D. 37°C incubation + IAT

A

D. 37°C incubation + IAT

127
Q

A patient types as AB and appears to be Rh positive on slide typing. What additional tests should be performed for tube typing?
A. Rh negative control
B. Direct antiglobulin test (DAT)
C. Low-protein Rh antisera
D. No additional testing is needed

A

A. Rh negative control

128
Q

According to the Wiener nomenclature and/or genetic theory of Rh inheritance:
A. There are three closely linked loci, each with a primary set of allelic genes
B. The alleles are named R1, R2, R0, r, r ́, r ̋, Rz, and ry
C. There are multiple alleles at a single complex locus that determine each Rh antigen
D. The antigens are named D, C, E, c, and e

A

C. There are multiple alleles at a single complex locus that determine each Rh antigen

129
Q

The Wiener nomenclature for the E antigen is:
A. hr ́
B. hrv ́
C. rh ̋
D. Rh0

A

C. rh ̋

130
Q

A physician orders 2 units of leukocyte-reduced red blood cells. The patient is a 55-year-old male
with anemia. He types as an AB negative, and his antibody screen is negative. There is only 1 unit of AB negative in inventory. What is the next blood type that should be given?
A. AB positive (patient is male)
B. A negative
C. B negative
D. O negative

A

B. A negative

131
Q

Which technology may report an Rh-weak D positive as Rh negative?
A. Gel System
B. Solid Phase
C. Tube Testing
D. None of these options

A

A. Gel System

132
Q

A patient has the Lewis phenotype Le(a−b−). An antibody panel reveals the presence of anti-Lea. Another patient with the phenotype Le(a−b+) has a positive antibody screen; however, a panel reveals no conclusive antibody. Should anti-Lea be considered as a possibility for the patient with the Le(a−b+) phenotype?
A. Anti-Lea should be considered as a possible antibody
B. Anti-Lea may be a possible antibody, but further studies are needed
C. Anti-Lea is not a likely antibody because even Leb individuals secrete some Lea
D. Anti-Lea may be found in saliva but not detectable in serum

A

C. Anti-Lea is not a likely antibody because even Leb individuals secrete some Lea

133
Q

A technologist is having great difficulty resolving an antibody mixture. One of the antibodies is anti-
Lea. This antibody is not clinically significant in this situation, but it needs to be removed to reveal the possible presence of an underlying antibody of clinical significance. What can be done?
A. Perform an enzyme panel
B. Neutralize the serum with saliva
C. Neutralize the serum with hydatid cyst fluid
D. Use DTT (dithiothreitol) to treat the panel cells

A

B. Neutralize the serum with saliva

134
Q

What type of blood should be given to an individual who has an anti-Leb that reacts 1+ at the IAT phase?
A. Blood that is negative for the Leb antigen
B. Blood that is negative for both the Lea and Leb antigens
C. Blood that is positive for the Leb antigen
D. Lewis antibodies are not clinically significant, so any type of blood may be given

A

A. Blood that is negative for the Leb antigen

135
Q

Which of the following statements is true concerning the MN genotype?
A. Antigens are destroyed using bleach-treated cells
B. Dosage effect may be seen for both M and N antigens
C. Both M and N antigens are impossible to detect because of cross-interference
D. MN is a rare phenotype seldom found in routine antigen typing

A

B. Dosage effect may be seen for both M and N antigens

136
Q

Anti-M is sometimes found with reactivity detected at the immediate spin (IS) phase that persists in strength to the IAT phase. What is the
main testing problem with a strong anti-M?
A. Anti-M may not allow detection of a clinically significant antibody
B. Compatible blood may not be found for the patient with a strongly reacting anti-M
C. The anti-M cannot be removed from the serum
D. The anti-M may react with the patient’s own cells, causing a positive autocontrol

A

A. Anti-M may not allow detection of a clinically significant antibody

137
Q

A patient is suspected of having paroxysmal cold hemoglobinuria (PCH). Which pattern of reactivity is characteristic of the Donath-Landsteiner antibody, which causes this condition?
A. The antibody attaches to RBCs at 4°C and causes hemolysis at 37°C
B. The antibody attaches to RBCs at 37°C and causes agglutination at the IAT phase
C. The antibody attaches to RBCs at 22°C and causes hemolysis at 37°C
D. The antibody attaches to RBCs and causes agglutination at the IAT phase

A

A. The antibody attaches to RBCs at 4°C and causes hemolysis at 37°C

138
Q

How can interfering anti-P1 antibody be removed from a mixture of antibodies?
A. Neutralization with saliva
B. Agglutination with human milk
C. Combination with urine
D. Neutralization with hydatid cyst fluid

A

D. Neutralization with hydatid cyst fluid

139
Q

Which antibody is frequently seen in patients with warm autoimmune hemolytic anemia?
A. Anti-Jka
B. Anti-e
C. Anti-K
D. Anti-Fyb

A

B. Anti-e

140
Q

An antibody shows strong reactions in all test phases. All screen and panel cells are positive. The serum is then tested with a cord cell and the reaction is negative. What antibody is suspected?
A. Anti-I
B. Anti-i
C. Anti-H
D. Anti-p

A

A. Anti-I

141
Q

Which group of antibodies is commonly found as cold agglutinins?
A. Anti-K, anti-k, anti-Jsb
B. Anti-D, anti-e, anti-C
C. Anti-M, anti-N
D. Anti-Fya, anti-Fyb

A

C. Anti-M, anti-N

142
Q

Which of the following antibodies
characteristically gives a refractile mixed-field appearance?
A. Anti-K
B. Anti-Dia
C. Anti-Sda
D. Anti-s

A

C. Anti-Sda

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