Lab Exam 1 Flashcards
Which do you drain and blow out?
Serological or volumetric?
Serological pipette (two frosted bands near the mouthpiece) 
Semi quantitative method of measuring concentration of antibody and serum
Titration
- result is expressed as the reciprocal of the highest dilution at which microscopic agglutination is observed
What is the endpoint of a serial dilution? 
The highest dilution showing the desired positive reaction with the antigen such as a color change or one plus agglutination
Expressed as a dilution ratio or is the reciprocal of the dilution (ex: 1:640 , or 640)
What are serial dilutions used for in the clinical lab? 
-prepare working solutions from stock solutions
-To qualify control antisera
-Demonstrate changing amounts of antibody during pregnancy or disease states
Titration:
An accurate dilution should have the last _____ tubes Containing diluted serum negative.
Two
Relative amount of antibody That can tell you how severe the infection is
Titer 
What produces hCG?
Placenta
Trophoblast of or the developing embryo
In a normal pregnancy, hCG can be detected in serum as early as seven days following conception, and the concentration ___________ every 1.3 to 2 days.
Doubles
HCG reaches a peak of approximately ____________ At the end of the first trimester. 
2000,000 mIU/mL
What type of test is used for at home pregnancy tests?
Immunochromatography
In Enzyme immunoassay determination of human chorionic gonadotropin, the test band region is pre-coated with ________ hCG antibody which is complex to colloidal gold particles. This complex is trapped by anti-alpha hCG and forms a color complex in the test region.
Anti-beta
The control region of a immuno chromatography pregnancy test contains a second antibody directed against the _________ hCG antibody. 
Anti-beta
 _______ of pregnancies end in abortion. 
Half
A positive Immunochromatography pregnancy test results if there is a minimum of ______ mIU/mL present.
25
What can cause false positive pregnancy tests?
Islet cell tumors and germ cell tumors
___________ phase serum proteins increase when there is inflamation.
Acute
Serum protease inhibitor; Partially inhibits proteolytic enzymes released from phagocytic cells in damaged tissues, controls tissue damage
Alpha-2 macroglobulin
-50% increase
Copper transport to cytochrome C, essential in aerobic energy production, increased in phagocytosis and wound healing, protects against oxidative damage, decreased in Wilson’s disease 
Ceruloplasmin
-50% increase
What disease causes golden bands in the eyes and other organs?
Wilson’s disease
(Ceruloplasmin)
Complement cascade targets pathogens, synthesized in liver
Complement component
C3- 50% increase (C3 pokes holes in cell)
Serum protease inhibitor; main component of alpha band, targets Proteases released for proteolytic Leukocytes such as elastases and degrade collagen and elastin, increased in pulmonary infections 
Alpha- 1- antitrypsin
2-4 X increase
Causes formation of fibrin clot at wound site, fibrinogen cleaves by thrombin to form fibrin
Fibrinogen
2-4 X increase
Glycoprotein; 100 kD, Scavenges free hemoglobin released by intravascular hemolysis
-keeps it from depositing in kidneys
Haptoglobin
2-4 X increase 
Named for a precipitate of C- polysaccharide extract of pneumococcus, associated with inflammatory diseases
Popular test for general inflammation 
CRP (C reactive protein)
100x’s
Good acute phase serum test that is non-specific and is used as a baseline
CRP
Acute phase serum protein:
Major serum protein
Albumin
-deceased 
a lipoprotein
Serum Amyloid A
100 X- 1000 X increase
Epstein-Barr virus is also known as human herpesvirus _____
4
Epstein-Barr virus is a __________ herpes that causes infectious mononucleosis. This causes patients to produce heterophile antibodies
Gamma
The ______________ differential test distinguished between Forssman, serum sickness and IM antibodies by absorbing the serum with guinea pig kidney and beef erythrocytosis prior to the reaction with horse erythrocytes. 
Davidson
______ may also cause nasopharyngeal carcinoma in susceptible populations
EBV
The Sure Vue mono test has pure antigen the only reacts with ___________ in the serum. This test only confirms IM antibodies and does not confirm the EBV causative agent therefore additional testing may be warranted when diagnosis is problematic
IM antibody
What three antibody tests can healthcare providers perform for EBV associated antigens?
-viral capsid antigen (VCA) -Acute phase testing
-Early antigen (EA) -Acute phase testing (undetectable after 3-6 months)
-EBV nuclear antigen (EBNA) -later test (present for the rest of the patients life)
When testing for EBV….
If someone has positive VCA-IgG and EA-D IgG tests, then it is likely that the person….
Has a current or recent EBV infection
EBV testing:
If the VCA-IgM is negative but VCA-IgG and EBNA antibody are positive, the it is likely that the person….
Had a pervious infection
What is the advantage and disadvantage of Davidson differential?
Advantage- When properly performed, this test is specific for infectious mononucleosis and false positives are rare
Disadvantage- very time-consuming and burdensome
-Uses purified Paul Bunnell antigen attached to latex particles and detects heterophile antibodies in Patient serum
-passive agglutination principle
MonoDiff test
Symptoms of infectious mononucleosis
Fever, sore throat, tender lymphadenopathy, anorexia, Mellis, headache and myalgia  and splenomegaly and splenomegaly in most patients
Complications of infectious mononucleosis?
Bacterial Pharyngitis, splenic rupture and a variety of autoimmune complications including hemolytic anemia, thrombocytopenia and myocarditis
May include meningoencephalitis
What is the immune response to infectious mononucleosis?
Heterophile antibodies-antibodies, not directed to the organism***
Anti-Epstein Barr antibodies (anti-EBV)
describe the principle for a positive Davison differential test for IM 
Patient serum Is added to guinea pig kidney cells. These antibodies are not absorbed by the kidney cells. The anybody’s then react with beef (Ox) Red blood cells which caused agglutination and positive for IM 
What type of test is the Mono Sure-Vue test? 
One step rapid latex particle agglutination test for qualitative and semi quantitative determination of infectious mononucleosis heterophile antibodies in serum or plasma
(Passive agglutination test)
Describe the principle for a negative Davison differential test for IM
The patients serum containing Foresman antibodies are added to guinea pig kidney cells. Antibodies are absorbed by the kidney cells. These antibodies are then allowed to react with beef red blood cells which does NOT cause agglutination = negative for IM, positive for Forssman antibodies. 
The principle behind the Paul-Bunnell-Davidson test is that the two types of sheep agglutinins are distinguished by ____________ them before and after absorption with guinea pig kidney and ox cells. 
Titrating
In the Davison differential test, to be considered absorb there must be a greater than _________ tube difference between the presumptive titer and the differential titer.
Three
________________ pneumonia is a member of a group of degenerate bacteria lacking a cell wall.
Mycoplasma
M. Pneumonia was the first human pathogen identified in the group and causes up to _______ % of all cases of pneumonia
20
M. Pneumonia infection is termed an ______________ pneumonia.
Atypical
What is the typical presentation of M. pneumonia infection? 
Flu like symptoms, but unlike most viral and bacterial pneumonia‘s, it is more gradual in presentation and recovery
What are the unique characteristics of bacteria lacking cell walls?
-intracellular
-Flexible
-Resistant to cell wall antibiotics like penicillin
-Can exchange DNA via plasmids 
 typical bacterial pneumonia‘s can easily be cultured on standard media or scene on Gram stain, unlike ____________ Pneumonia. 
Atypical
What test was used in lab to detect M. pneumonia IgM.
Enzyme immunoassay (EIA)
What bacteria causes syphilis? How is it best seen?
Treponoma pallidum
With silver staining or dark field microscopy (characteristic corkscrew coil shape, gram-negative but may stain irregularly) 
What are the stages of syphilis?
-primary-genital manifestation typically
-secondary
-Latent
-Tertiary 
What are the two testing methods for syphilis? 
-Reagin Testing
-Treponemal testing
Which hepatitis virus is a co-infection with another hepatitis virus?
Hepatitis D (Can only get this with hepatitis B)
Which two hepatitis viruses are a fecal oral route transmission?
Hepatitis A and E
(Hepatitis type)
- non-enveloped RNA virus
-Fecal oral transmission
-Usually self-limited illness
-no carrier state
-In rare cases, fulminant hepatic necrosis
Hepatitis A 
(Diagnosis of hepatitis A)
What indicates acute infection and what indicates exposure and immunity? 
Acute- IgM anti-HAV
Exposure/immunity- IgG anti-HAV
What is the transmission in hepatitis B virus? 
-parental
-Sexual
-Vertical
Incubation period of 1 to 6 months
(hepatitis B)
_____% chronic carriers, _____% Acute hepatitis
10, 25
What is the first specific marker in hepatitis B?
HBsAg
-detectable during incubation, peaks in acute stage
-Declines upon recovery
-Elevated in carriers
(hepatitis B)
Disappear shortly after HBsAg and parallels HBsAg
Present during active replication of virus (Most infectious phase) 
HBeAg
First detectable antibody in hepatitis B
Anti-HBc
_________ present in the interval between disappearance of HBsAg and appearance of Anti-HBs (core window)
Anti-HBc IgM
(Hepatitis B)
_______ produced during convalescence period and persists for life
IgG
(Hepatitis B)
- appears after disappearance of HBeAg
-Indicates resolution
Anti-HBe
(Hepatitis B)
-appears during recovery and lasts for years
- indicates immunity (Also produced from vaccination) 
Anti-HBs
Sure-Vue CRP test principle
Rapid test for the qualitative and semi-quantitative determination of C-reactive proteins in serum by agglutination of latex particles on slide. Measurement of C-reactive protein aids in the evaluation of the amount of injury to body tissues.
Infectious mononucleosis is an acute viral infection caused by the _________________ virus, a member of the Human herpesvirus family
Epstein Barr 
Which herpes simplex virus typically causes symptoms above the waist and which one below the waist? 
herpes simplex virus 1: Above the waist, cold sores, common in immunotherapy
Herpes simplex virus 2: Below the waist, genital lesions
- neonatal herpes simplex virus infection and herpes Symplex virus encephalitis also occur
What are the clinical manifestations of parental transmission of herpes Symplex viruses? 
-encephalitis (Can also cause encephalitis in adults if not well managed)
-Mental retardation
-Eye infections
What is the cellular response to herpes Symplex viruses? 
TH-1
Interferon and humoral, mucosal, and cellular immunity or important defenses. 
Herpes Symplex viruses replicate initially in _____________ cells, Producing a characteristic vessel on an ______________ base.  then ascends sensory nerves to the dorsal root ganglia, where after an initial period of replication, it establishes latency.
Epithelial, erythematous 
A human herpesvirus,
Atypical lymphocytes they get really big (reactive) ?
Syncytium (blending of nuclei)
 cytomegalovirus (CMV) 
What are the three clinical syndromes of cytomegalovirus?
- Congenital cytomegalovirus infection, Causes hepatosplenomegaly, retinitis (blindness), And central nervous system involvement
- In about 10% of older children and adults, primary cytomegalovirus infection causes a mononucleosis syndrome with fever, malaise, atypical lymphocytosis, and pharyngitis
- Immunocompromise host may develop life-threatening disseminated disease involving the lungs, G.I. tract, liver, retina, and central nervous system
Where does cytomegalovirus mainly replicate? And how is that shed?
Salivary glands and kidneys
Shed in saliva and urine
Replication is slow and the virus induces characteristic giant cells with intranuclear inclusions
Among the most prevalent viral infections worldwide. Not a big deal for adults but can be very bad for babies or immunocompromise adults.
Cytomegalovirus 
In some families, Epstein-Barr virus causes ____________ Syndrome that is a X-linked lymphoproliferative disease.
Duncan’s
Epstein-Barr virus can cause Nasopharyngeal cancer in what population?
Chinese 
Epstein-Barr virus replicates in epithelial cells of the ______________ and ____ Lymphocytes. 
Oropharynx, B
Human herpesvirus six and seven are associated with….
Exanthem subitem (roseola) and with rejection of transplanted kidneys
- Antibodies to this virus are present in almost everyone by age 5 
Human herpesvirus eight has been found associated with _______________ in AIDS Patients as well as intra-abdominal solid tumors.
Kaposi’s sarcoma (blood blisters) 
What are all the herpes viruses discussed in lab?
-herpes Symplex virus type 1
-Herpes simplex virus type 2
-Varicella-zoster virus
-Cytomegalovirus
-Epstein-Barr virus
-Human herpesvirus 6
-Human herpesvirus 7
-kaposi’s Sarcoma

Describe the test used for Mycoplasma
key points
-rapid enzyme immunoassay for detection of IGM to Mycoplasma pneumonia
-thin layer chromatography
- reaction ports (top two): WASH that gets rid of unbound substrate for enzyme, Sandwich reaction, and SUBSTRATE is added
-sample ports (bottom two): serum and conjugate (Alkaline phosphatase) added.
- timing is very important for this test
What percentage of people with rheumatoid arthritis have antibodies to rheumatoid factor (RF)
-also common in lupus patients and other autoimmune diseases
70%
What is the principle of rheumatoid factor test? 
And immunologic reaction between RF as antibodies and the corresponding antigen which is heat denatured IgG coded on a latex particle
*latex particle is coated with RF IgG antigen (Passive agglutination). Agglutination occurs if the patient serum has RF antibodies 
What is the main concern with rubella infections? 
Infection in pregnant women, especially during the first trimester can cause serious birth defects. Otherwise The infection is fairly mild in children and adults
Antibodies that recognize antigen on RBCs at low temperatures in cause agglutination 
Cold agglutinins
(reacts with erythrocyte somatic receptors, anti I antibody*)
What is the primary disease process causing a cold agglutinin titer?
Mycoplasma pneumonia/Atypical pneumonia (Only serological test for the specific disease)
-Surrogate test

-other diseases include hemolytic anemia, mononucleosis, lymphoma or leukemia
Called agglutinins are typically ______ antibodies. 
IgM
A significant tighter for cold agglutinin is _______.
In less than four is normal
32
HBsAg
Active hepatitis B infection
HBeAg
Current or past HBV infection
Anti-HBc (total)
Recovery phase of hepatitis B
Anti-HBe
Past infection - evidence of immunity
Anti-HBs
Various manifestations of HBV
Name two non-treponemal tests. And what do they stand for?
VDRL (venereal Disease research laboratory)
RPR (rapid plasma antigen)
Why is VDRL temperature dependent?
Heat required to unactivate/destroy compliment
How is VDRL read?
Microscopically
How is RPR read?
Macroscopically
