1. Which of the following statements accurately describes
competitive binding assays?
a. Excess binding sites for the analyte are provided.
b. Labeled and unlabeled analyte are present in equal
amounts.
c. The concentration of patient analyte is inversely
proportional to bound radioactive label.
d. All the patient analyte is bound in the reaction.
2. How do heterogeneous assays differ from
homogeneous
assays?
a. Heterogeneous assays require a separation step.
b. Heterogeneous assays are easier to perform than
homogeneous assays.
c. The concentration of patient analyte is directly
proportional
to bound label in homogeneous assays.
d. Homogeneous assays are more sensitive than
heterogeneous ones.
3. In the following equation, what is the ratio of bound
radioactive antigen (Ag*) to bound patient antigen (Ag)?
12Ag * _ 4Ag _ 4Ab :___Ag * Ab _ ___AgAb _ Ag*
____Ag
a. 1:4
b. 1:3
c. 3:1
d. 8:4
4. Which of the following characterizes a capture or
sandwich
enzyme assay?
a. Less sensitive than competitive enzyme assays
b. Requires two wash steps
c. Best for small antigens with a single determinant
d. A limited number of antibody sites on solid phase
5. Advantages of EIA over RIA include all except which
one
of the following?
a. Decrease in hazardous waste
b. Shorter shelf life of kit
c. No need for expensive equipment
d. Ease of adaptation to automated techniques
6. Which of the following is characteristic of direct
fluorescent
assays?
a. The anti-immunoglobulin has the fluorescent tag.
b. Antibody is attached to a solid phase.
c. Microbial antigens can be rapidly identified by this
method.
d. The amount of color is in inverse proportion to the
amount of antigen present.
7. Which of the following is true of fluorescence
polarization
immunoassay?
a. Both antigen and antibody are labeled.
b. Large molecules polarize more light than smaller
molecules.
c. When binding occurs, there is quenching of the
fluorescent tag.
d. The amount of fluorescence is directly proportional
to concentration of the analyte.
8. All of the following are desirable characteristics of
antibodies
used in immunoassays except
a. high affinity.
b. high specificity.
c. high cross-reactivity.
d. not found in the patient sample.
9. In a noncompetitive enzyme immunoassay, if a negative
control shows the presence of color, which of the
following might be a possible explanation?
a. No reagent was added.
b. Washing steps were incomplete.
c. The enzyme was inactivated.
d. No substrate was present.
10. Which of the following best characterizes
chemiluminescent
assays?
a. Only the antigen can be labeled.
b. Tests can be read manually.
c. These are only homogeneous assays.
d. A chemical is oxidized to produce light.
11. Immunofluorescent assays may be difficult to interpret
for which reason?
a. Autofluorescence of substances in serum
b. Nonspecific binding to serum proteins
c. Subjectivity in reading results
d. Any of the above
12. Which statement best describes flow-through
immunoassays?
a. Results are quantitative.
b. Reagents must be added separately.
c. They are difficult to interpret.
d. They are designed for point-of-care testing.
REVIEW QUESTIONS
1. Which technique is based on probe amplification rather
than amplification of the target in question?
a. PCR
b. TMA
c. Dot-blot
d. Branched chain amplification
2. How are DNA and RNA different?
a. Only RNA contains uracil.
b. Only DNA contains cytosine.
c. DNA is less stable than RNA.
d. RNA is usually double-stranded.
3. All of the following are true of a nucleic acid probe
except
a. it is a short nucleic acid chain.
b. it can be made up of either DNA or RNA.
c. it is labeled with a marker for detection.
d. it attaches to double-stranded DNA.
4. Which of the following techniques uses restriction
enzymes, electrophoresis, and then transfer of DNA
fragments
onto a solid matrix, followed by probing with
labeled probes?
a. Dot-blot
b. Southern blot
c. Hybridization protection assay
d. LCR
5. All of the following would be advantages of nucleic acid
amplification techniques except
a. detection of nonviable organisms.
b. extreme sensitivity.
c. early detection of disease.
d. low cost.
6. Which best describes the principle of DNA chip
technology?
a. Chips contain multiple probes on their surface.
b. Chips contain multiple copies of one unique probe.
c. The sample is labeled with a fluorescent tag.
d. Hybridization is detected by the presence of
radioactivity.
7. A hybridization reaction involves which of the
following?
a. Binding of two complementary DNA strands
b. Cleaving of DNA into smaller segments
c. Separating DNA strands by heating d. CD4 only
d. Increasing the number of DNA copies 6. Which cell surface marker is termed the common acute
8. Which best describes the PCR? lymphoblastic leukemia marker?
a. Two probes are joined by a ligating enzyme. a. CD19
b. RNA copies of the original DNA are made. b. CD10
c. Extender probes are used to detect a positive reaction. c. CD23
d. Primers are used to make multiple DNA copies. d. CD21
9. During PCR, what happens in the annealing step? 7. All of the following are clinical applications for flow
a. The primers bind to the target DNA. cytometry except
b. Strands are separated by heating. a. fetal hemoglobin.
c. An RNA copy is made. b. immunophenotyping of lymphocyte subpopulations.
d. Protein is made from the DNA strands. c. HIV viral load analysis.
10. What is the function of restriction endonucleases? d. enumeration of stem cells in a peripheral blood
a. They splice short DNA pieces together. mononuclear cell product.
b. They cleave DNA at specific sites. 8. Which type of analyzer allows one to measure multiple
c. They make RNA copies of DNA. analytes from multiple samples, loaded at any time?
d. They make DNA copies from RNA. a. Batch analyzer
11. To what does in situ hybridization refer? b. Random access analyzers
a. Nucleic acid probes react with intact cells within c. Front-end loaded analyzers
tissues. d. Sequential access analyzers
b. Probes are protected from degradation if 9. All of the following are benefits of automation except
hybridized. a. greater accuracy.
c. RNA polymerase copies messenger RNA. b. increased turnaround time.
d. Hybridization takes place in solution. c. savings on controls.
12. What is PCR used for in clinical settings? d. less disposal of outdated reagents.
a. Detection of early HIV infection 10. If an analyzer gets different results each time the
b. Determination of specific HLA antigens same sample is tested, what type of problem does this
c. Measurement of cytokines represent?
d. All of the above a. Sensitivity
b. Specificity
1. Flow cytometry separates cells on the basis of which of c. Accuracy
the following? d. Precision
a. Forward and 90-degree side scatter of an interrupted
beam of light 1. Which of the following is a general characteristic of
b. Front-angle scatter only of an interrupted light hypersensitivity reactions?
beam a. Immune responsiveness is depressed.
c. Absorbance of light by different types of cells b. Antibody is involved in all reactions.
d. Transmittance of light by cells in solution c. Either self-antigen or heterologous antigen may be
2. Forward-angle light scatter is an indicator of cell involved.
a. granularity. d. The antigen triggering the reaction is a harmful
b. density. one.
c. size. 2. Which of the following is associated with an increase in
d. number. IgE production?
3. What is the single most important requirement for a. Transfusion reaction
samples b. Activation of Th1 cells
to be analyzed on a flow cytometer? c. Reaction to poison ivy
a. Whole blood is collected into a serum-separator d. HDN
tube. 3. Which of the following would cause a positive
b. Cells must be in a single-cell suspension. DAT test?
c. Samples must be fixed in formaldehyde prior to a. Presence of IgG on red cells
processing. b. Presence of C3b or C3d on red cells
d. Blood must be kept refrigerated while processing. c. A transfusion reaction due to preformed
4. Which represents the best explanation for a flow antibody
cytometers d. Any of the above
ability to detect several cell surface markers at the 4. All of the following are associated with type I
same time? hypersensitivity
a. The forward scatter can separate out cells on the except
basis of complexity. a. release of preformed mediators from mast cells.
b. One detector can be used to detect many different b. activation of complement.
wavelengths. c. cell-bound antibody bridged by antigen.
c. For each marker, a specific fluorochromeantibody d. an inherited tendency to respond to allergens.
combination is used. 5. Which newly synthesized mediator has a mode of action
d. Intrinsic parameters are separated out on the basis similar to that of histamine?
of amount of side scatter. a. LTB4
5. Which of the following cell surface markers would be b. Heparin
present on a population of T helper cells? c. ECF-A
a. CD3 and CD4 d. PGD2
b. CD3 and CD8 6. Which of the following is associated with anaphylaxis?
c. CD3 only a. Buildup of IgE on mast cells
b. Activation of complement b. molecular mimicry.
c. Increase in cytotoxic T cells c. new expression of class II MHC antigens.
d. Large amount of circulating IgG d. polyclonal activation of B cells.
7. To determine if a patient is allergic to rye grass, the best 2. Which of the following would be considered an
test to perform is organspecific
a. total IgE testing. autoimmune disease?
b. skin prick test. a. SLE
c. DAT. b. RA
d. complement fixation. c. Hashimotos thyroiditis
8. Which condition would result in HDN? d. Goodpastures syndrome
a. Buildup of IgE on mothers cells 3. SLE can be distinguished from RA on the basis of which
b. Sensitization of cytotoxic T cells of the following?
c. Exposure to antigen found on both mother and a. Joint pain
baby red cells b. Presence of antinuclear antibodies
d. Prior exposure to foreign red cell antigen c. Immune complex formation with activation of
9. What is the immune mechanism involved in type III complement
hypersensitivity reactions? d. Presence of anti-ds DNA antibodies
a. Cellular antigens are involved. 4. Which of the following would support a diagnosis of
b. Deposition of immune complexes occurs in antibody drug-induced lupus?
excess. a. Antihistone antibodies
c. Only heterologous antigens are involved. b. Antibodies to Smith antigen
d. Tissue damage results from exocytosis. c. Presence of RF
10. What is the immune phenomenon associated with the d. Antibodies to SS-A and SS-B antigens
Arthus reaction? 5. A homogeneous pattern of staining of the nucleus on IIF
a. Tissue destruction by cytotoxic T cells may be caused by which of the following antibodies?
b. Removal of antibody-coated red blood cells a. Anti-Sm antibody
c. Deposition of immune complexes in blood vessels b. Anti-SSA/Ro antibody
d. Release of histamine from mast cells c. Antihistone antibody
11. Contact dermatitis can be characterized by all of the d. Antidouble-stranded DNA
following except 6. Which of the following is characteristic of RA?
a. formation of antigenantibody complexes. a. Association with certain HLA-DR genes
b. generation of sensitized T cells. b. Joint involvement that is symmetric
c. Langerhans cells acting as antigen-presenting cells. c. Presence of antibody against IgG
d. complexing of a hapten to self-antigen. d. All of the above
12. Which of the following conclusions can be drawn 7. Which of the following best describes the slide
about agglutination
a patient whose total IgE level is determined to be test for RF?
150 IU/mL? a. It is specific for RA.
a. The patient definitely has allergic tendencies. b. A negative test rules out the possibility of RA.
b. The patient may be subject to anaphylactic shock. c. It is a sensitive screening tool.
c. Further antigen-specific testing should be done. d. It detects IgG made against IgM.
d. The patient will never have an allergic reaction. 8. Hashimotos thyroiditis can best be differentiated from
REVIEW QUESTIONS Graves disease on the basis of which of the following?
CHAPTER 13 Hypersensitivity 221 a. Decrease in thyroid hormone levels
13. Which of the following explains the difference between b. Presence of thyroid peroxidase antibodies
type II and type III hypersensitivity reactions? c. Enlargement of the thyroid
a. Type II involves cellular antigens. d. Presence of lymphocytes in the thyroid
b. Type III involves IgE. 9. Which of the following would be considered a
c. IgG is involved only in type III reactions. significant
d. Type II reactions involve no antibody. finding in Graves disease?
14. A 37-year-old woman received two units of packed red a. Increased TSH levels
blood cells following a surgical procedure. She had been b. Antibody to TSHR
transfused once before. Five days after surgery, she c. Decreased T3 and T4
experienced a slight fever and some hemoglobin in her d. Antithyroglobulin antibody
urine, indicating a delayed transfusion reaction. A DAT 10. Immunologic findings in type I diabetes mellitus
test on a blood sample was positive. Which of the include all of the following except
following a. presence of CD8 T cells in the islets of
statements best describes this reaction? Langerhans.
a. The patient had IgM antibody to the red cells b. antibody to colloid.
transfused. c. antibody to insulin.
b. The patients reaction was due to an amnestic d. antibody to GAD.
response. 11. Destruction of the myelin sheath of axons caused by
c. Only IgE was coating the transfused red blood cells. the
d. The antibody present reacted best at room presence of antibody is characteristic of which disease?
temperature. a. MS
b. MG
1. All of the following may contribute to autoimmunity c. Graves disease
except d. Goodpastures syndrome
a. clonal deletion of self-reactive T cells.
12. Blood was drawn from a 25-year-old woman with
suspected
SLE. A FANA screen was performed, and a
speckled pattern resulted. Which of the following
actions should be taken next?
a. Report out as diagnostic for SLE
b. Report out as drug-induced lupus
c. Perform an antibody profile
d. Repeat the test1. How can normal cells become
malignant?
a. Overexpression of oncogenes
b. Underexpression of tumor-suppressing genes
c. Viral infection
d. All of the above
2. Which of the following best summarizes the concept of
tumor development via immunoediting?
a. Cytokines produced by tumor cells are toxic to
T cells expressing receptors for tumor-associated
antigens.
b. Cells that can escape the immune system have a
growth advantage over more immunogenic
tumor cells that are destroyed by T cells during
immunosurveillance.
c. T-cell activity causes an up-regulation of MHC
expression on tumor cells that allows them to escape
the immune system.
d. Expression of secreted tumor-associated antigen
saturates T-cell receptors and renders them
incapable of binding to the actual tumor cells.
3. A woman goes 3 days per week to a tanning bed for
20 minutes of UV exposure per visit. Which stage of
cancer is this?
a. Induction
b. In situ
c. Invasion
d. Dissemination
4. If a disease is present in 1 in every 10,000 individuals,
and a marker can detect this disease with 100 percent
sensitivity and 95 percent specificity, what would be the
number of false positives for each cancer found?
a. 5
b. 50
c. 500
d. 5000
5. Each of these markers may be elevated in multiple
myeloma except
a. CA-125.
b. -2 microglobulin.
c. monoclonal intact immunoglobulin molecules.
d. free monoclonal light chains from the immunoglobulin
molecule.
6. Both AFP and hCG exhibit serum elevations in
a. pregnancy.
b. ovarian germ cell carcinoma.
c. nonseminomatous testicular cancer.
d. all of the above.
7. Calcitonin and parathyroid hormone levels should not
be evaluated as indicating possible tumors without also
measuring serum
a. CEA.
b. calcium.
c. thyroglobulin antibodies.
d. thyroid hormones (TSH, T4).
8. Consensus guidelines indicate enough evidence to use
all of the following for cancer screening in the groups
indicated except
a. CA-125/women of reproductive age.
b. AFP/subjects at high risk for liver cancer.
c. fecal occult blood/people over 50 years of age.
d. PSA/men over 50 with at least 10 years of life
expectancy.
9. A 57-year-old man had a massive tumor removed from
his colon. His serum specimen had the following results
using an automated ELISA antibody sandwich assay for
CEA. The stated linearity of the test is 100 ug/L. What
should be done?
FINAL RESULT
TEST USING DILUTION
ABSORBANCE RESULT FACTOR
Undiluted 1.026 107.1 ug/L 107.1 ug/L
specimen
Specimen 1.269 125.7 ug/L 1257.0 ug/L
_ 10
Specimen 0.995 95.8 ug/L 9580.0 ug/L
_ 100
Specimen 0.101 9.6 ug/L 9600.0 ug/L
_ 1000
a. Retest all specimens using a different kit lot.
b. Retest the specimen at 1:10,000 and 1:100,000
dilutions.
c. Retest the specimen using heterophile antibody
blocking reagent.
d. Retest any specimen pipetted after the undiluted
specimen and report 9580.0 ug/L for this specimen.
REVIEW QUESTIONS
308 SECTION 3 Immune Disorders
10. A tumor found in the prostate does not stain with
antibody
to PSA. Is this proof that the tumor came from a
different organ?
a. Yes
b. No
11. In order to use a tumor marker to monitor the course
of the disease, which of the following must be true?
a. The laboratory measures the marker with the
same method over the entire course of the patients
treatment.
b. The marker must be released from the tumor or
because of the tumor into a body fluid that can be
obtained and tested.
c. The markers half-life is such that the marker
persists long enough to reflect tumor burden but
clears fast enough to identify successful therapy.
d. All of the above.
12. Which of the following markers could be elevated in
benign liver disease?
a. AFP
b. CEA
c. CA 15-3
d. CA 19-9
e. All of the above
13. Choose the incorrect statement.
a. Serum CA 19-9 levels should not be collected
from smokers.
b. Serum CA-125 specimen should not be collected
from women who are menstruating.
c. Feces for occult blood should not be collected
from subjects who recently ate peroxidasecontaining
foods.
d. Serum PSA specimens should be collected before
any manipulation of the prostate, including digital
rectal exam.
14. Immunotoxin antibodies used for cancer therapy are
humanized to prevent subjects from developing
a. graft-versus-host disease.
b. heterophile antibodies.
c. myelosuppression.
d. serum sickness.
15. Each marker below is correctly paired with a disease in
which it can be used for conditional monitoring except
a. CEA/choriocarcinoma.
b. CA-15.3/breast adenocarcinoma.
c. CA 125/ovarian adenocarcinoma.
d. CA-19.9/pancreatic adenocarcinoma.
1. All of the following are protective mechanisms against
bacteria except
a. production of fever.
b. phagocytosis.
c. activation of complement.
d. alteration of surface antigens.
2. All of the following are characteristics of streptococcal
M proteins except
a. it is the chief virulence factor of group A
streptococci.
b. it provokes an immune response.
c. antibodies to one serotype protect against other
serotypes.
d. it limits phagocytosis of the organism.
3. An ASO titer and a Streptozyme test are performed on
a patients serum. The ASO titer was negative, showing
hemolysis in all patient tubes. The Streptozyme test is
positive, and both the positive and negative controls react
appropriately. What can you conclude from these test
results?
a. The patient has a high titer of ASO.
b. The patient has an antibody to a streptococcal
exoenzyme other than streptolysin O.
c. The patient has not had a previous streptococcal
infection.
d. The patient has scarlet fever.
4. Which of the following applies to acute rheumatic fever?
a. Symptoms begin after either a throat or a skin
infection.
b. Antibodies to group A streptococci cross-react with
heart tissue.
c. Diagnosis is usually made by culture of the
organism.
d. All patients suffer permanent disability.
5. Which of the following indicates the presence of
anti-DNase B activity in serum?
a. Reduction of methyl green from green to colorless
b. Clot formation when acetic acid is added
c. Inhibition of red blood cell hemolysis
d. Lack of change in the color indicator
6. Which of the following is considered to be a
nonsuppurative
complication of streptococcal infection?
a. Acute rheumatic fever
b. Scarlet fever
c. Impetigo
d. Pharyngitis
7. All of the following are ways that bacteria can evade
host defenses except
a. presence of a capsule.
b. stimulation of chemotaxis.
c. production of toxins.
d. lack of adhesion to phagocytic cells.
8. Antibody testing for Rocky Mountain spotted fever may
not be helpful for which reason?
a. It is not specific.
b. It is too complicated to perform.
c. It is difficult to obtain a blood specimen.
d. Antibody production takes at least a week before
detection.
9. Which of the following enzymes is used to detect the
presence of H. pylori infections?
a. DNase
b. Hyaluronidase
c. Urease
d. Peptidase
10. Which of the following reasons make serological
identification
of a current infection with Helicobacter pylori
difficult?
a. No antibodies appear in the blood.
b. Only IgM is produced.
c. Antibodies remain after initial treatment.
d. No ELISA tests have been developed.
11. M. pneumoniae infections are associated with which
antibodies?
a. Cold agglutinins
b. Antibodies to ATPase
c. Antibodies to DNase
d. Antibodies to Proteus bacteria
12. Which of the following best describes the principle of
the IFA test for detection of antibodies produced in
Rocky Mountain spotted fever?
a. Proteus antigens are used to determine crossreactivity.
b. A light microscope is used to detect antigen
antibody combination.
c. Whole bacteria are used to detect antibodies.
d. Antibodies are detected by direct fluorescence.
1. Compared to a hosts response to the mumps virus,
overcoming
a parasitic infection is more difficult for the
host because of which of the following characteristics of
parasites?
a. Large size
b. Complex antigenic structures
c. Elaborate life cycle
d. All of the above
2. Most of the pathology associated with parasitic
infections
results from which of the following?
a. Symbiotic relationships with the host
b. Elaborate parasitic life cycles
c. Immune response to the offending organism
d. Innate defense mechanisms of the host
3. Parasites are able to evade host defenses by which of
the
following means?
a. Acquisition of host antigens
b. Changing surface antigens
c. Sequestering themselves within host cells
d. All of the above
4. The chronic nature of parasitic infections is due to the
hosts
a. inability to eliminate the infective agent.
b. type I hypersensitivity response to the infection.
c. ability to form a granuloma around the parasite.
d. tendency to form circulating immune complexes.
5. Clinical information provided by studying the immune
response to parasitic diseases
a. aids in correctly diagnosing the disease.
b. predicts the prognosis of the disease.
c. determines the possibility of reinfection by the
parasite.
d. All of the above
6. The presence of both IgM and IgG antibody in
toxoplasmosis infections suggests that the infection
a. occurred more than 2 years ago.
b. occurred less than 18 months ago.
c. is chronic.
d. has resolved itself.
7. IgE is an important component of the immune response b. immunodiffusion (ID) and
to infections caused by counterimmunoelectrophoresis
a. Toxoplasma gondii. (CIE).
b. Giardia lamblia. c. counterimmunoelectrophoresis (CIE) and
c. Cryptosporidium parvum. complement fixation (CF).
d. Schistosoma mansoni. d. enzyme immunoassay (EIA) and
8. Which of the following are factors that have enabled immunodiffusion (ID).
saprophytic fungi to cause infections in humans? 17. A 27-year-old man from Ohio, diagnosed with AIDS,
a. Their ability to survive the bodys cellular defenses developed chest pains and after a short period of time
b. Their traumatic introduction into body tissues also developed severe headaches with dizziness. His
c. Use of antibiotics and immunosuppressive agents hobby was raising messenger pigeons. His physician
d. All of the above ordered a sputum culture and spinal tap, and both were
9. In congenital toxoplasmosis, the newborn has elevated positive for a yeastlike fungus. These findings are most
levels of what class of immunoglobulin? consistent with infection by
a. IgA a. Candida albicans.
b. IgG b. Coccidioides immitis.
c. IgM c. Cryptococcus neoformans.
d. IgE d. Histoplasma capsulatum.
10. When a mycosis is suspected, patient information 18. Which of the following serological tests detects the
must polysaccharide capsule antigen in serum and CSF
be acquired for all of the following except of patients with suspected infection with Cryptococcus
a. symptoms and physical examination. neoformans?
b. occupation, residence, and travel. a. Complement fixation (CF)
c. medical treatment and medications. b. Hypersensitivity skin test
d. an exercise program. c. Latex agglutination (LA)
11. The most significant defense against fungal infections d. Hemagglutination test
is 19. What is the most widely used quantitative serological
a. cellular immunity. test for identification of antibodies in infection with
b. humoral immunity. Coccidioides immitis?
c. phagocytosis. a. Complement fixation (CF)
d. complement activation. b. Latex agglutination (LA)
12. Serodiagnosis is most important in making a rapid and c. Exoantigen test
presumptive diagnosis of fungal infections when d. Fluorescent antibody test
a. the patient is under 12 or over 50 years of age. 1. Treponema pallidum and Borrelia burgdorferi can be
b. the patient has an undiagnosed acute or chronic distinguished
respiratory infection. from each other on the basis of which of the
c. cultures of specimens are positive. following?
d. histological tissue slide preparations are positive. a. Only T. pallidum has axial filaments.
13. Because the stage of the mycosis is often not known, b. Only B. burgdorferi has an outer sheath.
what is the best way to proceed when initiating c. Only B. burgdorferi can be grown in the laboratory
serodiagnosis? on artificial media.
a. Use a skin test in an endemic area, because a positive d. Only T. pallidum stimulates IgM production to the
skin test is diagnostic. membrane proteins.
b. Use a combination of serological tests. 2. False-positive nontreponemal tests for syphilis may be
c. Serial testing is excessive; a single test is always due to which of the following?
diagnostic. a. Infectious mononucleosis
d. Use a single, specific antibody test. b. Systemic lupus
14. After infection has been established, serodiagnostic c. Pregnancy
tests d. All of the above
are most likely to be positive in which of the following 3. In the fluorescent treponemal antibody absorption
cases? (FTAABS)
a. The patient has developed a state of anergy. test, what is the purpose of absorption with Reiter
b. The patient is immunocompromised. treponemes?
c. The patient is immunocompetent. a. It removes reactivity with lupus antibody.
d. The tests were taken before antibodies had time to b. It prevents cross-reactivity with antibody to other
develop. T. pallidum subspecies.
REVIEW QUESTIONS c. It prevents cross-reactivity with antibody to
CHAPTER 20 Serological Response to Parasitic and nonpathogenic treponemes.
Fungal Infections 345 d. All of the above.
15. Which best describes nonspecific cross-reactions that 4. Which test is recommended for testing cerebrospinal
occur in fungal serological tests? fluid for detection of neurosyphilis?
a. Occur as a result of crude unpurified antigens a. RPR
b. Occur with only one genus of fungi b. VDRL
c. Do not interfere with fungal identification c. FTA-ABS
d. Tend to remain at high titer as a mycosis develops d. Enzyme immunoassay
16. Two serological tests currently used for the diagnosis 5. Advantages of direct fluorescent antibody testing to T.
of aspergillosis and candidiasis are pallidum include all of the following except
a. complement fixation (CF) and enzyme a. reading is less subjective than with dark-field
immunoassay (EIA). testing.
b. monoclonal antibody makes the reaction very
specific.
c. slides can be prepared for later reading.
d. careful specimen collection is less important than in
dark-field testing.
6. Which of the following is true of reagin?
a. It can be detected in all patients with primary
syphilis.
b. It is antibody directed against cardiolipin.
c. Reagin tests remain positive after successful
treatment.
d. It is only found in patients with syphilis.
7. Which syphilis test detects specific treponemal
antibodies?
a. RPR
b. VDRL
c. FTA-ABS
d. Agglutination
8. Which of the following is true of treponemal tests for
syphilis?
a. They are usually negative in the primary stage.
b. Titers decrease with successful treatment.
c. In large-volume testing, they should be used as
screening tests.
d. They are subject to a greater number of false positives
than reagin tests.
9. An RPR test done on a 19-year-old woman as part of
a prenatal workup was negative but exhibited a rough
appearance. What should the technologist do next?
a. Report the result out as negative.
b. Do a VDRL test.
c. Send the sample for confirmatory testing.
d. Make serial dilutions and do a titer.
10. Treponemal EIA tests for syphilis are characterized by
all of the following except
a. they are adaptable to automation.
b. they are useful in diagnosing secondary or tertiary
syphilis.
c. subjectivity in reading is eliminated.
d. they can be used to distinguish between IgG and
IgM antibodies.
11. Which of the following tests is the most specific during
the early phase of Lyme disease?
a. IFA
b. EIA
c. Immunoblotting
d. Isolation of the spirochete
12. False-positive serological tests for Lyme disease may
be due to all of the following except
a. shared antigens between Borrelia groups.
b. cross-reactivity of antibodies.
c. resemblance of flagellar antigen to that of
Treponema organisms.
d. a patient in the early stage of the disease.
REVIEW QUESTIONS
366 SECTION 4 Serological Diagnosis of Infectious
Disease
13. Advantages of PCR testing for syphilis include all of
the following except
a. it is extremely specific.
b. many false positives are eliminated.
c. testing of serum is extremely sensitive.
d. it can be used on CSF.
14. A 24-year-old man who had just recovered from
infectious
mononucleosis had evidence of a genital lesion.
His RPR test was positive. What should the technologist
do next?
a. Report out as false positive.
b. Do a confirmatory treponemal test.
c. Do a VDRL.
d. Have the patient return in 2 weeks for a repeat test.
15. A 15-year-old girl returned from a camping trip.
Approximately a week after her return, she discovered
a small red area on her leg that had a larger red ring
around it. Her physician had her tested for Lyme disease,
but the serological test was negative. What is the
best explanation for these results?
a. She definitely does not have Lyme disease.
b. The test was not performed correctly.
c. Antibody response is often below the level of
detection in early stages.
d. Too much antibody was present, causing a false
negative.
16. Which of the following is a true statement about late
manifestations of Lyme disease?
a. Treatment cannot reverse complications.
b. Both central and peripheral nervous systems may
be affected.
c. Cardiac or neurological damage occurs in all cases.
d. Arthritis appears only in elderly patients.
17. Problems encountered in IFA testing for Lyme disease
include all of the following except
a. cross-reactivity with antibodies to syphilis.
b. false negatives in the later stages of disease.
c. false positives with rheumatoid factor.
d. subjectivity in the reading of fluorescent patterns.
1. An individual with hepatomegaly, jaundice, and elevated
liver enzymes has the following laboratory results: IgM
anti-HAV (negative), HBsAg (positive), IgM anti-HBc
(positive), and anti-HCV (negative). These findings support
a diagnosis of
a. hepatitis A.
b. acute hepatitis B.
c. chronic hepatitis B.
d. hepatitis C.
2. Which of the following hepatitis viruses is transmitted
by the fecal-oral route?
a. Hepatitis B
b. Hepatitis C
c. Hepatitis D
d. Hepatitis E
3. Quantitative tests for HCV RNA are used to
a. screen for hepatitis C.
b. determine the HCV genotype.
c. differentiate acute HCV infection from chronic
HCV infection.
d. monitor hepatitis C patients on antiviral therapy.
4. The serum of an individual who received all doses of the
hepatitis B vaccine should contain
a. anti-HBs.
b. anti-HBe.
c. anti-HBc.
d. all of the above.
5. A 12-year-old girl presented to her physician with a sore
throat, lymphadenopathy, and fatigue. Her laboratory
results were 5000 lymphocytes/_L with 10 percent
atypical lymphocytes, CMV antibody negative, and
heterophile
antibody screen negative. These laboratory
results
a. confirm a diagnosis of infectious mononucleosis.
b. indicate that the diagnosis is not infectious
mononucleosis, because the heterophile antibody
screen is negative.
c. suggest a diagnosis of infectious mononucleosis but
should be followed by a heterophile antibody titer
to strengthen the diagnosis.
d. suggest a diagnosis of infectious mononucleosis but
should be followed by a test for IgM anti-VCA to
strengthen the diagnosis.
6. In the laboratory, heterophile antibodies are routinely
detected by their reaction with
a. B lymphocytes.
b. bovine erythrocyte antigens.
c. sheep erythrocyte antigens.
d. Epstein-Barr virus antigens.
7. Presence of IgM anti-rubella antibodies in the serum
from an infant born with a rash suggests
a. a diagnosis of measles.
b. a diagnosis of German measles.
c. congenital infection with the rubella virus.
d. passive transfer of maternal antibodies to the
infants serum.
8. A pregnant woman is exposed to a child with a rubella
infection. She had no clinical symptoms but had a
rubella titer performed. Her antibody titer was 1:8.
Three weeks later, the test was repeated, and her titer
was 1:128. She still had no clinical symptoms. Was the
laboratory finding indicative of rubella infection?
a. No, the titer must be greater than 256 to be
significant.
b. No, the change in titer is not significant if no
clinical signs are present.
c. Yes, a greater than fourfold rise in titer indicates
early infection.
d. Yes, but clinical symptoms must also correlate
with laboratory findings.
9. The most common cause of congenital infections is
a. CMV.
b. rubella.
c. VZV.
d. HTLV-I.
10. A positive result on a screening test for HTLV-I
antibody
a. is highly specific for HTLV-I infection.
b. should be followed by PCR.
c. must be confirmed by Western blot.
d. must be confirmed by viral culture.
1. All of the following apply to HIV except
a. it possesses an outer envelope.
b. it contains an inner core with p24 antigen.
c. it contains DNA as its nucleic acid.
d. it is a member of the retrovirus family.
2. Which of the following genes is responsible for the
coding
of reverse transcriptase?
a. Env
b. Pol
c. Gag
d. Tat
3. HIV virions bind to host T cells through which
receptors?
a. CD4 and CD8
b. CD4 and the IL-2 receptor
c. CD4 and CXCR4
d. CD8 and CCR2
4. Antibodies to which of the following viral antigens are
usually the first to be detected in HIV infection?
a. gp120
b. gp160
c. gp41
d. p24
5. Which of the following is typical of the latent stage of
HIV infection?
a. Proviral DNA is attached to cellular DNA.
b. Large numbers of viral particles are synthesized.
c. A large amount of viral RNA is synthesized.
d. Viral particles with no envelope are produced.
6. The decrease in T-cell numbers in HIV-infected
individuals is due to
a. lysis of host T cells by replicating virus.
b. fusion of the T cells to form syncytia.
c. killing of the T cells by HIV-specific cytotoxic
T cells.
d. all of the above.
7. The most common means of HIV transmission
worldwide
is through
a. blood transfusions.
b. intimate sexual contact.
c. sharing of needles in intravenous drug use.
d. transplacental passage of the virus.
8. All of the following are likely immunologic
manifestations
of HIV infection except
a. decreased CD4 T-cell count.
b. increased CD8 T-cell count.
c. increased response to vaccine antigens.
d. increased serum immunoglobulins.
9. The drug zidovudine is an example of a
a. nucleoside analogue reverse transcriptase inhibitor.
b. nonnucleoside reverse transcriptase inhibitor.
c. protease inhibitor.
d. fusion inhibitor.
10. Which of the following methods is used in
thirdgeneration
ELISA tests for HIV antibody?
a. Binding of patient antibody to solid-phase recombinant
HIV antigens followed by addition of
enzyme-labeled antihuman immunoglobulin
b. Binding of patient antibody to solid-phase recombinant
HIV antigens, followed by addition of
enzyme-labeled HIV-specific antibodies
c. Binding of patient antibody to solid-phase recombinant
HIV antigens, followed by addition of
enzyme-labeled HIV antigens
d. Binding of patient antibody to a solid-phase coated
with antigens purified from HIV viral lysates, followed
by addition of enzyme-labeled antihuman
immunoglobulin
11. If a test has a high positive predictive value, which of
the following is true?
a. There will be no false negatives.
b. Most positives are true positives.
c. It is not a good screening test.
d. The number of true positives will vary with the
population.
12. False-negative test results in the ELISA test for HIV
antibody may occur because of
a. heat inactivation of the serum prior to testing.
b. collection of the test sample prior to seroconversion.
c. interference by autoantibodies.
d. recent exposure to certain vaccines.
13. Which of the following combinations of bands would
represent a positive Western blot for HIV antibody?
a. p24 and p55
b. p24 and p31
c. gp41 and gp120
d. p31 and p55
REVIEW QUESTIONS
CHAPTER 23 Laboratory Diagnosis of HIV Infection 423
14. Which of the following tests would give the least
reliable
results in a 2-month-old infant?
a. CD4 T-cell count
b. ELISA for HIV antibody b. Sample antigen binds to antibody fixed onto solid
c. RT-PCR for HIV nucleic acid phase; chemiluminescent-labeled antibody binds to
d. NASBA for HIV nucleic acid antigen-antibody complex.
15. The RT-PCR is a highly sensitive method that involves 4. Enzyme labels often used in indirect procedures are:
a. direct amplification of HIV RNA. a. Alkaline phosphatase
b. amplification of a label attached to HIV RNA. b. Horseradish peroxidase
c. amplification of a complementary DNA sequence c. Beta-galactosidase
to a portion of the HIV RNA. d. All of the above
d. DNA sequencing of a portion of HIV RNA. 5 and 6. Match the following:
CHAPTER 10 5. ____ Enzyme immunoassay (EIA)
Answers to Review Questions 6. ____ Immunofluorescent technique
1. c 2. a 3. c 4. b 5. b 6. c 7. b a. Uses a nonisotopic label
8. c 9. b 10. d 11. d 12. D b. Uses antibody labeled with fluorescein isothiocyanate
CHAPTER 11 (FITC)
Answers to Review Questions c. Uses colloidal particles consisting of a metal or
1. d 2. a 3. d 4. b 5. d 6. a 7. a insoluble metal compound
8. d 9. a 10. b 11. a 12. D 7-9. Match the assays and definitions.
CHAPTER 12 7. ____ Direct immunofluorescent assay
Answers to Review Questions 8. ____ Inhibition immunofluorescent assay
1. a 2. c 3. b 4. c 5. a 6. b 7. c 9. ____ Indirect immunofluorescent assay
8. b 9. b 10. C a. Based on antibodies acting as antigens and reacting
CHAPTER 13 with antiimmunoglobulins
Answers to Review Questions b. Uses conjugated antibody to detect antigen-antibody
1. c 2. b 3. d 4. b 5. d 6. a 7. b reactions
8. d 9. d 10. c 11. a 12. c 13. a 14. B c. Antigen first exposed to unlabeled antibody, then
CHAPTER 14 labeled antibody
Answers to Review Questions 10. For an enzyme to be used in an EIA, it must meet all
1. a 2. c 3. d 4. a 5. c 6. d 7. c the
8. a 9. b 10. b 11. a 12. C following criteria except:
CHAPTER 18 a. High amount of stability
Answers to Review Questions b. Extreme specificity
1. d 2. b 3. a 4. c 5. a 6. d 7. b c. Presence in antigen or antibody
8. a 9. d 10. b 11. d 12. e 13. a 14. b d. No alteration by inhibitor with the system
15. a 11. and 12. Fill in the blanks below, choosing from the
CHAPTER 19 answers for each.
Answers to Review Questions A fluorescent substance is one that while (11) __________
1. d 2. c 3. b 4. b 5. d 6. a 7. b light of one wavelength, (12) __________ light of
8. d 9. c 10. c 11. a 12. C another (longer) wavelength.
CHAPTER 20 11. 12.
Answers to Review Questions a. Emitting a. Emits
1. d 2. c 3. d 4. a 5. a 6. b 7. d b. Absorbing b. Absorbs
8. d 9. c 10. d 11. a 12. b 13. b 14. c c. Generating bright c. Reduces
15. a 16. b 17. c 18. c 19. A d. Generating dull d. Increases
CHAPTER 21 13-16. Match the following.
Answers to Review Questions 13. ____ Quantum dots (Q dots)
1. c 2. d 3. d 4. b 5. d 6. b 7. c 14. ____ SQUID technology
8. c 9. d 10. b 11. b 12. d 13. c 14. b 15. ____ Luminescent oxygen-channeling immunoassay
15. c 16. b 17. B (LOCI)
CHAPTER 22 16. ____ Fluorescent in situ hybridization (FISH)
Answers to Review Questions a. Semiconductor nanocrystals
1. b 2. d 3. d 4. a 5. d 6. b 7. c b. Method of tagging antibodies with superparamagnetic
8. c 9. a 10. C particles
CHAPTER 23 c. Technology based on two different 200-nm latex
Answers to Review Questions particles
1. c 2. b 3. c 4. d 5. a 6. d 7. b d. Molecular cytogenetic technique
8. c 9. a 10. c 11. b 12. b 13. c 14. b 1. Nephelometry measures the light scatter of:
15. c a. Ions
1. Chemiluminescence: b. Macromolecules
a. Has excellent sensitivity and dynamic range c. Antibodies
b. Does not require sample radiation d. Soluble antigens
c. Uses unstable chemiluminescent reagents and 2. Nephelometry can be used to assay all the following
conjugates except:
d. Both a and b a. IgM
2 and 3. Match the descriptions (a and b) to the assays. b. IgG
2. ____ Competitive immunoassay c. IgD
3. ____ Sandwich immunoassay d. IgA
a. Fixed amount of labeled antigen competes with 3. Cryoglobulins are proteins that precipitate or gel when
unlabeled antigen from patient specimen for a cooled to:
limited number of antibody-binding sites. a. 18 C (0.4 F)
b. 0 C (32 F) b. TMA
c. 4 C (39 F) c. NASBA
d. 18 C (64 F) d. RT-PCR
4-6. Match the following types of cryoglobulin with their 12. Which of the following nucleic acid amplification
respective descriptions. techniques does not require the use of a thermocycler?
4. ____ Type I a. PCR
5. ____ Type II b. SDA
6. ____ Type III c. NASBA
a. Contains two classes of immunoglobulins, at least d. TMA
one of which is monoclonal 1. Factors that influence the development of an infectious
b. Mixed, no monoclonal protein found disease include all the following except the:
c. Monoclonal IgG, IgA, or IgM a. Immune status of the individual
7. Cryoglobulin analysis can be useful in the diagnosis of: b. Incidence of an organism in the population
a. Hypothermia c. Pathogenicity of the agent
b. Raynauds phenomenon d. Sole presence of the agent or microorganism
c. Hepatitis C 2-5. Match the appropriate immunologic defense
d. Rheumatoid arthritis mechanism
8. Laser is an acronym for: (a-d) with the class of microorganism.
a. Light amplification by stimulated emission of radiation 2. ____ Bacteria
b. Light augmentation by stimulated emitted radiation 3. ____ Yeast
c. Light amplified by stimulated energy radiation 4. ____ Viruses
d. Large angle stimulation by emitted radiation 5. ____ Parasites
9. All the following are descriptive characteristics of laser a. Interferon
light except: b. Lysozymes and phagocytosis
a. Intensity c. Immunoglobulins, complement, antibody-dependent
b. Stability cell-mediated cytotoxicity, and cellular defenses
c. Polychromaticity d. Possibly the activation of complement
d. Monochromaticity 6. The detection of _________ can be of diagnostic
10. A photon is a: significance during the first exposure of a patient to an
a. Basic unit of light infectious agent.
b. Basic unit of all radiation a. IgM
c. Component of an atom b. IgG
d. Component of laser light c. IgA
11. The major application of flow cell technology is: d. IgD
a. Identification of cells 7. Serologic procedures for the diagnosis of recent
b. Cell sorting before further analysis infection
c. Diagnosis of autoimmune disease should include:
d. Both a and b a. Only an acute specimen
12. Four-color immunofluorescence typically uses: b. Only a convalescent specimen
a. Fluorescein isothiocyanate (FITC) c. Acute and convalescent specimens
b. Phycoerythrin (PE) d. Acute, convalescent, and 6-month postinfection
c. Peridinin chlorophyll protein (PerCP) specimens
d. All of the above 8. An important factor affecting microbial disease
chapter 14 development
3. The traditional PCR technique: is the:
a. Extends the length of the genomic DNA a. Ability of some microorganisms to multiply in an
b. Alters the original DNA nucleotide sequence intracellular habitat
c. Copies the target region of DNA b. Display of antigen variation
d. Amplifies the target region of RNA c. Presence of a related microorganism
4. For the PCR reaction to occur, the clinician must d. Both a and b
provide 9. For an infectious disease to develop in a host, the
which of the following? organism must initially:
a. Oligonucleotide primers a. Survive phagocytosis
b. Individual deoxynucleotides b. Be in the log phase of multiplication
c. Thermostable DNA polymerase c. Penetrate the skin or mucous membrane barrier
d. All of the above d. Be present in the host for 7 to 10 days
5. The enzyme reverse transcriptase converts: 10-12. Match each type of infectious disease to the
a. mRNA to cDNA appropriate
b. tRNA to DNTP description.
c. dsDNA to ssDNA 10. ____ Bacterial disease
d. Mitochondrial to nuclear DNA 11. ____ Viral disease
6. DNA polymerase catalyzes: 12. ____ Parasitic disease
a. Primer annealing a. Affected by immune responses such as
b. Primer extension immunoglobulin,
c. Hybridization of DNA complement, and antibody-dependent
d. Hybridization of RNA cell-mediated cytotoxicity
11. Which of the following techniques uses signal b. Inhibited by antibiotics, lysozymes, and
amplification? phagocytosis
a. bDNA c. Stimulates production of, and is in turn inhibited by,
interferon (4) Q fever
13. The first type of antibody that may be apparent in the a. 1, 2, 3
immune response to an infectious disease is: b. 1, 2, 4
a. IgM c. 2, 3, 4
b. IgG d. 1, 3, 4
c. IgD 3. Vaccines can be divided into _________ vaccines.
d. IgA a. Live, attenuated
14. A distinguishing characteristic of the herpesviruses is b. Nonreplicating
that: c. Naked DNA
a. They are cell-associated viruses. d. Both a and b
b. They are enveloped RNA. 4. To meet FDA requirements, a vaccine must:
c. Human beings are the only known reservoir of a. Produce protective immunity with only minimal side
infection. effects.
d. Both a and c b. Be immunogenic enough to produce a strong and
15. Up to _________ of infants develop antibody to HHV-6 measurable immune response.
by 10 to 11 months of age. c. Be stable during its shelf life.
a. 25% d. All of the above.
b. 50% 5. The earliest host response to vaccination is a(n):
c. 75% a. Innate immune response
d. 95% b. Memory response
16. Varicella-zoster virus causes: c. Anamnestic response
a. Chickenpox d. Both a and b
b. Shingles 6 and 7. Match the following:
c. Measles 6. ___ Preventive HIV vaccine
d. Both a and b 7. ___ Therapeutic HIV vaccine
17. Varicella-zoster virus can be reactivated in: a. Given to HIV-negative individuals
a. AIDS patients b. For HIV-positive patients to improve their immune
b. Older adults system to prevent progression to AIDS
c. Immunocompromised persons 8-12. Match the following (use an answer only once):
d. All of the above 8. ___ Anthrax vaccine
18. Rapid preliminary diagnosis of varicella-zoster virus 9. ___ Cytomegalovirus CMV vaccine
can 10. ___ Hay fever vaccine
be done in the laboratory by: 11. ___ Human papillomavirus (HPV) vaccine
a. Direct immunofluorescence 12. ___ Influenza vaccine
b. Viral isolation a. Protection against bioterrorism
c. ELISA method b. Protection against cervical cancer
d. Complement fixation c. Not available for preventing congenital infection
19. Histoplasmosis is caused by a: d. DNA-based vaccine
a. Bacterium e. Annual vaccination required
b. Parasite 13-15. Match the following:
c. Fungus 13. ___ Leukemia vaccine
d. Virus 14. ___ Polio vaccine
20. Aspergillosis is: 15. ___ Smallpox vaccine
a. An opportunistic organism a. Has reduced disease by 99%
b. Caused by a parasite b. Successful in cats
c. A cause of skin infections c. Given to high-risk individuals
d. A relatively mild disease 1. S. pyogenes is the most common causative agent of all
21. The first test to be positive in coccidioidomycosis is: the
a. Fluorescent antibody following disorders and complications except:
b. Hypersensitivity testing a. Pharyngitis
c. Complement fixation b. Gastroenteritis
d. Culture of the organism c. Scarlet fever
22-24. Match the following. d. Impetigo
22. ____ Blastomycosis 2. All the following characteristics are descriptive of M
23. ____ Sporotrichosis protein except:
24. ____ Cryptococcosis a. No known biological role
a. Subcutaneous lymphatic mycosis b. Found in association with the hyaluronic capsule
b. Vector in infected pigeons c. Inhibits phagocytosis
c. Chronic fungal disease d. Antibody against M protein provides type-specific
1. The Center for Biologics Evaluation and Research immunity
CBER regulates: 3. Substances produced by S. pyogenes include all the
a. Laboratory safety following except:
b. Vaccine products a. Hyaluronidase
c. Personnel qualifications b. DNAses (A, B, C, D)
d. Research grants c. Erythrogenic toxin
2. Pathogens adapted for biological warfare include: d. Interferon
(1) Smallpox 4. Laboratory diagnosis of S. pyogenes can be made by all
(2) Bacillus anthracis the
(3) Chickenpox following except:
a. Culturing of throat or nasal specimens b. Not a current infection, but indicates a past infection
b. Febrile agglutinins c. Trend toward recovery
c. ASO procedure d. No clinical significance
d. AntiDNase B 18. If a streptococcal infection is suspected, but the ASO
5. False ASO results may be caused by all the following titer does not exceed the reference range, a(n)
except: _________________ should be performed.
a. Room temperature reagents and specimens at the a. Repeat titer
time of testing b. AntiDNAse B test
b. The presence of beta-lipoprotein c. Anti-NADase test
c. Bacterial contamination of the serum specimen d. Throat culture
d. Oxidation of ASO reagent caused by shaking or 19. The classic tests to demonstrate the presence of
aeration of the reagent vial streptococcal
6. Members of the S. pyogenes species are almost always infection are:
_____ hemolytic. a. ASO and anti-NADase
a. Alphab. b. ASO and antiDNAse B
Betac. c. Anti-NADase and anti-DNAse
gammad. d. Both a and b
Alpha- or beta- 20. The highest reported levels of sensitivity testing for
7. Long-term complications of S. pyogenes infection can group
include: A streptococci are in:
a. Acute rheumatic fever a. ASO titers
b. Poststreptococcal glomerulonephritis b. Direct latex agglutination tests
c. Rheumatoid arthritis c. Surface (optical) immunoassay
d. Both a and b d. Both a and b, which are equivalent
8. Particularly virulent serotypes of S. pyogenes produce 1-4. Match the Treponema-associated diseases (a-d) with
proteolytic enzymes that cause __________________ in the
a wound or lesion on an extremity. respective causative organism.
a. Necrotizing fasciitis 1. ____ T. pallidum
b. Bone degeneration 2. ____ T. pallidum (variant)
c. Burning and itching 3. ____ T. pertenue
d. Severe inflammation 4. ____ T. carateum
9-11. Match the substances produced by group A a. Yaws
streptococci b. Syphilis
with the appropriate description. c. Pinta
9. ____ Hyaluronidase d. Bejel
10. ____ Streptokinase 5-8. Match the following stages of syphilis with the
11. ____ Erythrogenic toxin appropriate
a. Degrades DNA signs and symptoms.
b. Also called spreading factor 5. ____ Primary syphilis
c. Responsible for characteristic scarlet fever rash 6. ____ Secondary syphilis
d. Dissolves clots by converting plasminogen to plasmin 7. ____ Latent syphilis
12. All the following characteristics of S. pyogenes are 8. ____ Late (tertiary) syphilis
correct a. Diagnosis only by serologic methods
except: b. Presence of gummas
a. It is an uncommon pathogen. c. Development of a chancre
b. It occurs most frequently in school-age children. d. Hutchinsonian triad
c. It is spread by contact with large droplets produced e. Generalized illness followed by macular lesions in
in the upper respiratory tract. most patients
d. It has been known to cause foodborne and 9. Which of the following is a term for nontreponemal
milkborne epidemics. antibodies produced by an infected patient against
13. The clinical manifestations of S. pyogenesassociated components of their own or other mammalian cells?
upper respiratory infection are: a. Autoagglutinins
a. Mild and usually unnoticeable b. Reagin antibodies
b. Age dependent c. Alloantibodies
c. Associated with cold sores d. Nonsyphilis antibodies
d. Difficult to detect 10-12. Match the following:
14. The most reliable immunologic test for recent S. 10. ____ FTA-ABS test
pyogenes 11. ____ TP-PA test
skin infection is: 12. ____ RPR test
a. ASO a. Treponemal method
b. AntiDNAse B b. Nontreponemal method
c. Anti-NADase 13. In the RPR procedure, a false-positive reaction can
d. Antibody to erythrogenic toxin result
15-17. Match each ASO titer situation to the appropriate from all the following except:
description. (An answer may be used twice.) a. Infectious mononucleosis
15. ____ Rising titer b. Leprosy
16. ____ Declining titer c. Rheumatoid arthritis
17. ____ Constant (low) titer d. Streptococcal pharyngitis
a. Increase in severity of infection 14. The first diagnostic blood test for syphilis was the:
a. VDRL a. 1%
b. Wassermann b. 3%
c. RPR c. 5%
d. Colloidal gold d. 10%
15. Syphilis was initially treated with: 6. Erythema migrans:
a. Fullers earth a. Occurs in all patients
b. Heavy metals (e.g., arsenic) b. Harbors B. burgdorferi in the advancing edge
c. Sulfonamides (e.g., triple sulfa) c. Is easily distinguished from other erythemas
d. Antibiotics (e.g., penicillin) d. Is more common in the winter months
16. Direct examination of the treponemes is most often 7. The predominant symptoms of Lyme meningitis are:
performed by: a. Severe headache and mild neck stiffness
a. Light microscopy b. Aseptic meningitis and double vision
b. Darkfield microscopy c. Cranial nerve palsies and blurred vision
c. VDRL testing d. Peripheral radiculoneuritis and peripheral
d. RPR testing neuropathy
17. Pathogenic treponemes _______________ cultivatable 8. Cardiac involvement in Lyme disease may include:
with consistency in artificial laboratory media. a. Murmurs
a. Are b. Conduction abnormalities
b. Are not c. Congestive heart failure
18. In infected blood, T. pallidum does not appear to d. Vasculitis
survive 9. Ocular involvement in Lyme disease includes all the
at 4 C (39 F) for longer than: following except:
a. 1 day a. Cranial nerve palsies
b. 2 days b. Conjunctivitis
c. 3 days c. Panophthalmitis with loss of vision
d. 5 days d. Choroiditis with retinal detachment
19. The primary incubation period for syphilis (T. pallidum) 10. Pregnancy in Lyme disease:
is usually about: a. Does not result in high fetal mortality
a. 1 week b. Has been associated with transplacental
b. 2 weeks infection
c. 3 weeks c. Should be terminated because of maternal risk
d. 4 weeks d. Is not associated with congenital abnormalities
20. The stage of syphilis that can be diagnosed only by 11. The most useful test for distinguishing between
serologic (laboratory) methods is the: truepositive
a. Incubation phase and false-positive serologic test results is:
b. Primary phase a. Enzyme-linked immunosorbent assay
c. Secondary phase b. Immunofluorescence assay
d. Latent phase c. Polymerase chain reaction
21. Immunocompetent patients infected with T. pallidum d. T cell assay
produce: 12. Preventive methods include all the following except:
a. Specific antibodies against T. pallidum a. Wearing light-colored clothes
b. Nonspecific antibodies against the protein antigen b. Tucking pants into socks
group common to pathogenic spirochetes c. Applying insect repellent to skin and clothes
c. Reagin antibodies d. All of the above
d. All of the above 13. Lyme disease, the most common tickborne disease in
1. Common vectors of Lyme disease include all the the
following except: United States, is a major health hazard for:
a. I. pacificus a. Dogs
b. I. scapularis b. Horses and cattle
c. I. ricinus c. Humans
d. D. variabilis d. All of the above
2. The only continent without Lyme disease is: 14. Lyme disease is a ________ type of infection.
a. Asia a. Bacterial
b. Europe b. Parasitic
c. Africa c. Viral
d. Antarctica d. Fungal
3. The primary reservoir in nature for B. burgdorferi is the: 15. The first Native American case of what would later be
a. White-tailed deer called Lyme disease occurred in:
b. White-footed mouse a. Connecticut
c. Lizard b. Wisconsin
d. Meadowlark c. Florida
4. The first B. burgdorferi antigen to elicit an antibody d. New York
response is: 16-19. Fill in the blanks in the chart below, choosing from
a. Outer surface protein A the following answers.
b. Outer surface protein B Possible answers for
c. Flagellar 41-kDa polypeptide question 16:
d. 60-kDa polypeptide Possible answers for
5. On average, the incidence of infection following an question 17:
I. scapularis tick bite in an endemic area is: a. 3 days a. Neurologic
b. 1 week b. Rheumatoid d. Nausea
c. 4 weeks 26. Definitive diagnosis of ehrlichiosis requires:
d. 3 months a. A complete blood count
c. Cutaneous b. Detection of the presence of lymphocytopenia
(e.g., erythema c. Acute and convalescent serum antibody titers
migrans) d. Direct microscopic observation of inclusions in
d. Cardiac leukocytes
Possible answers for 27. In human granulocytic ehrlichiosis (anaplasmosis), the
question 18: diagnosis is confirmed by seroconversion or by a single
Possible answers for serologic titer of _____ in patients with a supporting
question 19: history and clinical symptoms.
a. Hours to weeks a. Arthritis a. 1:2
b. Days to weeks b. Lyme carditis b. 1:16
c. Weeks to months c. 1:80
d. Weeks to years d. 1:160
c. Transplacental 28. In the eastern United States, babesiosis is caused by:
transmission a. B. microti
d. Lymphocytoma b. B. canis
16-19. Fill in the blanks: Clinical features of Lyme disease c. B. bovis
Stage Length of Time d. B. equi
Common Signs and 29. Babesiosis is characterized by:
Symptoms a. Fever
I 16. ________ (median) 17. ________ manifestation b. Fatigue
after infection c. Hemolytic anemia
II Follows a variable d. All of the above
latent period 30. Babesia organisms can be found in:
Target organs and a. Peripheral blood
systems can manifest b. Sputum
abnormalities. c. Synovial fluid
III 18. ________ after d. Various exudates
infection 31. West Nile virus causes:
19. _______, late neurologic a. Encephalitis
complications b. Polio
20. Unlike some procedures, the polymerase chain c. Measles
reaction d. Arthritis
(PCR) assay can be used to detect Lyme diseasecausing 32. West Nile virus is transmitted by:
organisms in: a. Dogs
a. Urine b. Cats
b. Cerebrospinal fluid c. Rats
c. Synovial fluid d. Mosquitoes
d. Blood 1. Toxoplasmosis is a ________ infection.
21 and 22. Fill in the blanks, choosing from the possible a. Bacterial
answers (a-d). b. Mycotic
Antigen detection systems in Lyme disease testing screen c. Parasitic
for _______ (21) rather than for _______ (22) associated d. Viral
with the infection. 2. The definitive host of T. gondii is the:
a. Antibody a. Horse
b. Microorganisms b. Pig
c. Antigenic products c. Dog
d. An infected tick d. Domestic cat
23. A patient who has a specific Lyme diseaseassociated 3. All the following are specific methods for preventing
manifestation may be treated with: congenital toxoplasmosis except:
a. Vaccination a. Avoid touching mucous membranes while handling
b. Interferon raw meat.
c. Antibiotic b. Wash hands thoroughly after handling raw meat.
d. Analgesic c. Eliminate food contamination by flies, cockroaches,
24. Ehrlichia spp. belong to the same family as the and other insects.
organism d. Dispose of fecally contaminated cat litter into plastic
that causes: garbage bags.
a. Lyme disease 4. The presence of IgM antibodies to T. gondii in an adult
b. Rocky Mountain spotted fever is
c. Toxoplasmosis indicative of a(an):
d. Infectious mononucleosis a. Carrier state
25. One of the most common physical findings in adults b. Active infection
with c. Chronic infection
ehrlichiosis is: d. Latent disease
a. Hives 5. All the following characteristics are correct regarding
b. Fever toxoplasmosis except:
c. Erythema migrans a. It is recognized as a tissue coccidian.
b. Domestic dogs are a source of the disease. associated with:
c. It can be transmitted by infected blood. a. Primary active infection
d. It can be transmitted transplacentally. b. Reactivated active infection
6. Toxoplasmosis is a serious health threat to: c. Latent infection
a. AIDS patients d. Either a or b
b. Adults 12-14. Match the following:
c. Children older than 2 years 12. _____ Primary infection
d. Older patients 13. _____ Reactivation of latent infection in seropositive
7. Congenital toxoplasmosis can cause: IgG patient
a. Congenital heart disease 14. _____ Reinfection with strain of CMV different from
b. Central nervous system malformation original strain
c. Urinary tract infections a. IgG, but IgM response unknown
d. Muscular disorders b. Specific IgM antibody response
8. Antibodies to T. gondii are demonstrable _______ after c. IgG (no detectable IgM)
infection. 15. All the herpesviruses share the feature of being:
a. 3 to 5 days a. RNA viruses
b. Within 10 days b. Small viruses
c. Within 2 weeks c. Cell-associated viruses
d. Within 4 weeks d. Nonenveloped viruses
9. The method of choice for detecting IgM antibodies in 16. A most likely mode of CMV acquisition is:
toxoplasmosis is: a. Irradiated blood products
a. Enzyme-linked immunosorbent assay (ELISA) b. Non-irradiated blood transfusions containing viable
b. Indirect fluorescent antibody (IFA) leukocytes
c. Indirect hemagglutination (IHA) d. All of the above
d. Complement fixation (CF) 17. Which of the following appears to be the only
1. All the following describe CMV except: immunosuppressed
a. Herpes family virus group at significant risk of acquiring CMV
b. DNA virus infection?
c. Cell-associated virus a. Transplant patients
d. Epidemic worldwide b. Seronegative patients
2. Because CMV can persist latently, an active infection c. Seropositive patients
may develop as a result of all the following conditions d. Health care workers
except: 18. All the following are methods for the prevention of
a. Pregnancy CMV except:
b. Immunosuppressive therapy a. Irradiated blood products
c. Organ or bone marrow transplantation b. Leukocyte-depleted blood products
d. Transfusion of leukocyte-poor blood c. Immune globulin with CMV antibodies
3. CMV is recognized as the cause of congenital viral d. Transfusion of fresh blood
infection in what percentage of all live births? 19-22. Indicate true statements with the letter A and false
a. 0.1% to 0.4% statements with the letter B.
b. 0.4 to 2.5% 19. _____ Primary and recurrent maternal CMV infections
c. 2.5% to 4.9% can be transmitted in utero.
d. 4.9% to 9.9% 20. _____ CMV is the most common intrauterine
4. Transfusion-acquired CMV infection can cause: infection.
a. Mononucleosis-like syndrome 21. _____ Few CMV-infected newborns are asymptomatic.
b. Hepatitis 22. _____ Normal adults and children usually experience
c. Rejection of a transplanted organ CMV infection without serious complications.
d. All of the above 1. The Epstein-Barr virus can cause all the following
5-7. Match the three types of CMV infection with their except:
appropriate description. a. Infectious mononucleosis
5. _____ Primary infection b. Burkitts lymphoma
6. _____ Reactivated infection c. Nasopharyngeal carcinoma
7. _____ Reinfection d. Neoplasms of the bone marrow
a. Significant antibody response and viral shedding are 2. The primary mode of EBV transmission is:
caused by different strain of virus. a. Exposure to blood
b. Seronegative recipient is transfused with blood from b. Exposure to oral-pharyngeal secretions
actively or latently infected donor. c. Congenital transmission
c. Seropositive recipient is transfused with blood from d. Fecal contamination of drinking water
a CMV antibodypositive or negative donor. 3. Infants infected with EBV are more likely to experience
8-10. Match the following serologic markers of CMV symptomatic infection than EBV-infected adolescents.
infection: a. True
8. _____ Early antigens b. False
9. _____ Immediate-early antigens 4. IgM heterophile antibody is characterized by all the
10. _____ Late antigens following features except:
a. Appear 72 hours after infection or at the end of the a. Reacts with horse, ox, and sheep RBCs
viral replication cycle b. Absorbed by beef erythrocytes
b. Appear within 1 hour of cellular infection c. Absorbed by guinea pig kidney cells
c. Present within 24 hours d. Does not react with EBV-specific antigens
11. Antibodies to immediate-early and early antigens are 5. Characteristics of EBV-infected lymphocytes include all
the following except: b. Detects heterophile antibodies and uses horse
a. B type erythrocytes
b. Expression of viral capsid antigen c. Detects heterophile antibodies and uses sheep
c. Expression of early antigen erythrocytes
d. Expression of EBV genome 1-4. Match the following forms of hepatitis with the
6. Which of the following stages of infectious appropriate
mononucleosis description (a-d), using each answer only once.
infection is characterized by antibody to Epstein-Barr 1. ______ Acute hepatitis
nuclear antigen (EBNA)? 2. ______ Fulminant acute hepatitis
a. Recent (acute) infection 3. ______ Subclinical hepatitis without jaundice
b. Past infection (convalescent) period 4. ______ Chronic hepatitis
c. Reactivation of latent infection a. This rare form is associated with hepatic failure.
d. Both b and c b. Typical form of hepatitis with associated jaundice
7. Which of the following stages of infectious c. Probably accounts for persons with serum antibodies
mononucleosis but no history of hepatitis
infection is (are) characterized by heterophile antibody? d. Accompanied by hepatic inflammation and necrosis
a. Recent (acute) infection 5-8. Match the following (use an answer only once).
b. Past infection (convalescent) period 5. ______ Hepatitis A
c. Reactivation of latent infection 6. ______ Hepatitis B
d. Both a and c 7. ______ Hepatitis D
8. What percentage of the worlds population is exposed to 8. ______ Hepatitis C
EBV? a. Intact virus is the Dane particle
a. 25% b. Transmission by both parenteral and nonparenteral
b. 50% routes
c. 75% c. Requires HBV as a helper
d. 95% d. Most common form of hepatitis
9. Infectious mononucleosis postperfusion syndrome is a 9-12. Match the following (use an answer only once).
primary infection resulting from a blood transfusion from 9. ______ Hepatitis A
a(n) _______ to a(n) _______ recipient. 10. ______ Hepatitis B
a. Immune; nonimmune 11. ______ Delta agent
b. Nonimmune; immune 12. ______ Hepatitis C
c. Infected; nonimmune a. Should receive immune globulin intramuscularly
d. Infected; immune after exposure
10. In infectious mononucleosis, there is no: b. Defective or incomplete RNA virus
a. Acute state c. Has an epidemiology similar to that of HAV
b. Latent state d. Previously called Australia antigen
c. Carrier state 13-17. Match the following serologic markers with the
d. Reactivation appropriate description.
11. The incubation period of infectious mononucleosis is: 13. ______ HBsAg
a. 2 to 4 days 14. ______ HBeAg
b. 10 to 15 days 15. ______ Anti-HBc
c. 10 to 50 days 16. ______ Anti-HBe
d. 51 to 90 days 17. ______ Anti-HBs
12. The use of horse erythrocytes in rapid slide tests for a. Indicator of recent HBV infection may be only
infectious mononucleosis increases their: serologic marker during the window phase
a. Cost b. Found in the serum of some patients who are
b. Sensitivity HBsAg positive; marker for level of virus, infectivity
c. Specificity c. A serologic marker of recovery and immunity
d. Both b and c d. Initial detectable marker found in serum during
13. EBV-infected B lymphocytes express all the following incubation period of HBV infection
new antigens except: e. In the case of acute hepatitis, the first serologic
a. Viral capsid antigen VCA evidence of the convalescent phase
b. Early antigen EA 18. Of patients in the United States with chronic hepatitis
c. Cytoplasmic antigen (CA) B,
d. Nuclear antigen NA _______ of them acquired the virus in childhood.
14. Anti-EBNA IgG does not appear until a patient has a. Less than 20%
entered the: b. 20% to 30%
a. Initial phase of infection c. 30% to 40%
b. Primary infection phase d. More than 40%
c. Convalescent period 19. The rate of posttransfusion hepatitis C decreased to
d. Reactivation of infectious stage _______ after the introduction of serologic testing in the
15-17. Match each procedure to the appropriate screening of blood donors.
description. a. Less than 1%
15. ______ Paul-Bunnell screening test b. 5%
16. ______ Davidsohn differential test c. 10%
17. ______ MonoSlide agglutination test d. 15%
a. Distinguishes between heterophile antibodies; uses 20-22. Match the following forms of hepatitis with the
beef erythrocytes, guinea pig kidney cells, and sheep correct average incubation time.
erythrocytes 20. ______ Hepatitis A
21. ______ Hepatitis B d. Anti-HCV
22. ______ Hepatitis C 33. The earliest detectable serologic marker of acute
a. 5 days hepatitis
b. 25 days C is:
c. 50 days a. Anti-HCV
d. 75 days b. Anti-HBc and liver serum enzyme abnormalities
e. 150 days c. HCV-RNA
23. Which form of hepatitis does not have a chronic form d. Anti-HBs and anti-HBc
of 34. Primary hepatitis viruses are given this name because
the disease? they primarily attack:
a. Hepatitis A a. A variety of body systems
b. Hepatitis B b. The liver
c. Hepatitis C c. The skin
24. Another name for hepatitis B infection is: d. The nervous system
a. Infectious hepatitis 35. Hepatitis A has all the following characteristics except:
b. Long incubation hepatitis a. DNA virus
c. Australia antigen b. Short-incubation hepatitis
d. Dane particle c. Crowded, unsanitary conditions as a risk factor
25. The most frequent clinical response to hepatitis B d. Rare occurrence of transfusion acquisition
virus is: 36. The Australia antigen is now called:
a. Jaundice within 75 days a. Dane particle
b. Asymptomatic infection b. Long-incubation hepatitis
c. Subclinical infection c. Hepatitis B surface antigen (HBsAg)
d. Both b and c d. Hepatitis B core antigen (HBcAg)
26. The first laboratory screening test of donor blood was 37-42. Fill in the following table, using a, b, or c, as
for indicated.
the detection of: a. Positive (+)
a. HBc b. Negative ()
b. HBsAg c. Questionable ()
c. HBe Serologic Markers for Hepatitis B Virus Infection
d. Anti-HBe Early (Asymptomatic) Acute or Chronic Low-Level Carrier
27. Which surface marker is a reliable marker for the Immunity With HBsAg
presence of high levels of hepatitis B virus (HBV) and a HbsAg 37. ________ 38. ________ Negative () Negative ()
high degree of infectivity? Anti-HBs Negative () Questionable () Negative ()
a. HBeAg Positive (+)
b. HBsAg Anti-HBc Negative () 39. ________ 40. ________ 41.
c. HBcAg ________
d. Anti-HBsAg Anti-HBc (IgM) Negative () Positive (+) Negative () 42.
28. The only serologic marker during the anti-core window ________
period of hepatitis B (the time between disappearance of 43. Which category has the highest incidence of acute
detectable HBsAg and appearance of detectable anti- hepatitis C?
HBs) may be: a. Low socioeconomic status
a. Anti-HBs b. Dialysis
b. Anti-HBc c. Transfusion
c. Anti-HBe d. Illegal drug use
d. HBsAg 44. Which category has the lowest incidence of acute
29. Which of the following is a characteristic of the delta hepatitis C?
agent? a. Sexual, household
a. Is a DNA virus b. Dialysis
b. Usually replicates only in HBV-infected hosts c. Drug abuse
c. Infects patients who are HBcAg positive d. Transfusion
d. Is frequently found in the United States 45-48. Match each form of hepatitis to the appropriate
30. Which of the following viruses is rarely implicated in mode
transfusion-associated hepatitis? of transmission. (You may use an answer more than
a. Hepatitis A once.)
b. Hepatitis B 45. ______ Hepatitis A
c. Hepatitis C 46. ______ Hepatitis B
d. Cytomegalovirus 47. ______ Hepatitis C
31. In health care workers, the risk of contracting hepatitis 48. ______ Hepatitis E
C a. Fecal-oral
is _______the risk of contracting AIDS. b. Parenteral
a. Lower than c. Parenteral and nonparenteral
b. Higher than 1. All the following groups of individuals should receive
c. The same as rubella vaccinations except:
d. Not something to worry about compared to a. School-age children
32. The specific diagnostic test for hepatitis C is: b. Women of childbearing age
a. Absence of anti-HAV and anti-HBsAg c. Pregnant women
b. Increase in liver serum enzyme levels d. Health care personnel
c. Detection of non-A, non-B antibodies 2. The greatest risk of the manifestation of anomalies in
maternal rubella is _________________ of gestation. b. CD4
a. During the first month c. p24
b. During the first trimester d. p26
c. During the third month 3. HIV can infect all of the following cells except:
d. During the fourth or fifth month a. CD4+ subset of lymphocytes
3. In a patient with primary rubella infection, the b. Macrophages
appearance c. Monocytes
of _______ antibodies is associated with the clinical d. Polymorphonuclear leukocytes
signs and symptoms, when present. 4. The most rapidly growing segment of the HIV-infected
a. IgG population is:
b. IgM a. Homosexual males
c. IgD b. Lesbians
d. Both a and b c. Health care workers
4. Testing for _______ antibody is invaluable for the d. IV drug users and their sexual partners
diagnosis of congenital rubella syndrome. 5. In HIV infections, a window period of seronegativity
a. IgM extends from the time of initial infection up to:
b. IgG a. 2 weeks
c. IgD b. 2 to 6 weeks or longer
d. IgE c. 6 to 12 weeks or longer
5. Before the licensing of rubella vaccine in the United d. 4 to 8 months or longer
States in 1969, epidemics occurred at _______year 6 and 7. HIV antibodies are usually detected by (6)
intervals. ___________ and confirmed by (7) ___________.
a. 2- to 3- Possible answers for question 6:
b. 5- to 7- a. Latex agglutination
c. 6- to 9- b. Enzyme immunoassay
d. 10- to 20- c. Enzyme inhibition
6. Acute rubella infection lasts from _______ days. d. Radioimmunoassay
a. 1 to 2 Possible answers for question 7:
b. 2 to 4 a. Southern blot
c. 3 to 5 b. Northern blot
d. 7 to 10 c. Western blot
7. IgM antibodies to rubella virus reach peak levels at d. DNA hybridization
_______ days. 8. The AIDS-causing virus HIV has also been referred to
a. 2 to 4 as:
b. 3 to 5 a. Human T-lymphotropic virus type III
c. 5 to 7 b. HTLV-III
d. 7 to 10 c. Lymphadenopathy-associated virus (LAV)
8. IgG antibodies to rubella virus increase rapidly for d. All of the above
_______ days after the acquisition of infection. 9. HTLV-III was unique when it was isolated because it:
a. 2 to 8 a. Is a bovine infectious retrovirus
b. 3 to 10 b. Is a canine infectious retrovirus
c. 5 to 15 c. Was identified as the cause of AIDS
d. 7 to 21 d. Is a DNA containing virus
9. Which percentage of serologically confirmed cases of 10-12. Fill in the blanks in the following table with the
maternal infection occur before 11 weeks of gestation? correct letter, choosing from the following answers:
a. 11% a. Codes for p24 and for proteins such as p17, p9, and
b. 24% p7
c. 33% b. Codes for two glycoproteins, gp41 and gp120
d. 90% c. Produces DNA polymerase; produces endonuclease
10. German measles and measles are caused by the same Viral Genome Structural Components
virus. Component Product
a. True pol 10. _______
b. False gag 11. _______
11. Laboratory confirmation of rubeola antibody is done env 12. _______
by: 13-17. Arrange the HIV-1 life cycle events in proper order.
a. Detection of IgM antibodies in serum 13. ______ a. Reverse transcriptase converts viral
b. Detection of measles virus RNA by nucleic acid RNA into proviral DNA.
amplification in a clinical specimen 14. ______ b. New virus particles are produced as the
c. Isolation of rubella virus result of normal cellular activities of
d. Either a or b transcription and translation.
1. The major structural protein (core) of the HIV-1 virus is: 15. ______ c. New particles bud from the cell
a. gp41 membrane.
b. p24 16. ______ d. Virus attaches to CD4 membrane
c. gp34 receptor and sheds its protein coat,
d. gp140 exposing its RNA core.
2. The infectious process of AIDS begins when the gp120 17. ______ e. Proviral DNA is integrated into the
protein on the viral envelope bends to the protein genome (genetic complement of cell).
receptor, _______, on the surface of a target cell. 18. The criteria for HIV infection for persons 13 years of
a. CD8 age
or older include: except:
a. Repeatedly reactive screening test for HIV antibody a. Arthus reaction
b. Specific HIV antibody identified by use of supplemental b. Serum sickness
tests c. Glomerulonephritis
c. Direct identification of the virus d. Shingles
d. All of the above 7. Type IV reactions are responsible for all the following
19. After the early period of primary HIV infection, the except:
patient enters a period of clinical latency that lasts a a. Contact sensitivity
median of _______ years. b. Delayed hypersensitivity
a. 5 c. Elimination of tumor cells bearing neoantigens
b. 10 d. Hemolysis of red blood cells
c. 15 8. Type I hypersensitivity reactions can be associated
d. 20 with:
20. As AIDS progresses, the quantity of _______ a. Food allergies
diminishes b. Hay fever
and the risk of opportunistic infection increases. c. Asthma
a. HIV antigen d. All of the above
b. HIV antibody 9. The most common agents that cause anaphylactic
c. CD4+ T lymphocytes reactions are:
d. CD8+ T lymphocytes a. Drugs and food
21. The clinical symptoms of the later phase of AIDS are: b. Drugs and insect stings
a. Weight loss and decreased polymorphonuclear c. Poison ivy and insect stings
leukocyte (PMN) cells d. Food and insect stings
b. Extreme weight loss and fever 10-12. Arrange the sequence of events in anaphylaxis in
c. Multiple secondary (opportunistic) infections the
d. Both b and c proper sequence.
22. The most frequent malignancy observed in AIDS 10. _______
patients is: 11. _______
a. Pneumocystis jiroveci (P. carinii) 12. _______
b. Kaposis sarcoma a. The effects of mediator release produce vascular
c. Toxoplasmosis changes, activation of platelets, eosinophils, and
d. Non-Hodgkins lymphoma neutrophils, and activation of the coagulation
23. Sources of error in the Western blot test include: cascade.
a. Concentration of HIV antigen b. The offending antigen attaches to the IgE antibody fixed
b. Presence of other infectious agents to the surface membrane of mast cells and basophils.
c. Technical skill and experience of the technologist c. Activated mast cells and basophils release various
performing the test mediators.
d. Age of the blood specimen 13-18. Complete the table, choosing from the possible
24. All the following methods have been developed to answers provided.
detect Mediators of Anaphylaxis
HIV-1 antigen except: Mediator Primary Action
a. Transcriptase method Histamine 13. ________
b. Synthetic peptide approach Leukotrienes 14. ________
c. Immunofluorescence assay Serotonin 15. ________
d. Immunohistochemical staining Platelet-activating factor 16. ________
25. All the following methods have been developed to Eosinophil chemotactic factors
detect of anaphylaxis
the presence of HIV-1 viral gene except: 17. ________
a. Radioimmunoassay Prostaglandins 18. ________
b. In situ hybridization Possible answers
c. Southern blot analysis to questions 13-15:
d. DNA amplification Possible answers
Match the following types of hypersensitivity with their to questions 16-18:
respective type of reaction. a. Enhances the effects of
1. _____ Type I hypersensitivity histamine on target organs
2. _____ Type II hypersensitivity b. Increases vascular
3. _____ Type III hypersensitivity permeability and
4. _____ Type IV hypersensitivity promotes contraction
a. Cytotoxic reaction of smooth muscle
b. Cell-mediated reaction c. Generates kinins
c. Immune complex reaction d. Contracts smooth
d. Anaphylactic reaction muscle
5. With which cell type are anaphylactic reactions a. Affects smooth muscle tone
associated? and vascular permeability
a. T lymphocyte b. Enhances the release of
b. B lymphocyte histamine and serotonin
c. Monocyte c. Attracts cells to area of
d. Mast activity; these cells release
6. Type III reactions are exemplified by all the following secondary mediators that
may limit the effects of 3. The mechanism responsible for autoimmune disorder
primary mediators. is:
d. Alters bronchial smooth a. Circulating immune complexes
muscle b. Antigen excess
19. In vitro evaluation of type I hypersensitivity reactions c. Antibody excess
can d. Antigen deficiency
include: 4. One of the mechanisms believed to induce self-
a. RIST tolerance is:
b. Skin testing a. Induction of responsiveness in immunocompetent
c. Neither a nor b cells
d. Both a and b b. Elimination of clone programmed to react with
20. Cytotoxic reactions are characterized by the antigen
interaction of: c. Decreased suppressor cell activity
a. IgG to soluble antigen d. Stimulation of clones of immunocompetent cells
b. IgG to cell-bound antigen 5-8. Match the following (use an answer only once).
c. IgM to soluble antigen 5. _______ Acetylcholine receptorblocking antibodies
d. IgM or IgG to cell-bound antigen 6. _______ Anticardiolipin antibody
21. An example of a delayed nonhemolytic (type II 7. _______ Anti-DNA antibodies
hypersensitivity) reaction is: 8. _______ Antiglomerular basement membrane
a. Febrile reaction antibodies
b. Graft-versus-host disease a. Helpful in monitoring Addisons disease
c. Urticaria b. Found in one third of patients with myasthenia
d. Congestive heart failure gravis
22. Under normal conditions, immune complexes protect c. Useful in monitoring the activity and exacerbations
the of SLE
host because they: d. Suggestive of Goodpastures disease
a. Facilitate the clearance of various antigens e. Present in SLE and associated with arterial and
b. Facilitate the clearance of invading microorganisms venous thrombosis
c. Interact with complement 9-12. Match the following:
d. Both a and b 9. _______ Antinuclear ribonucleoprotein
23. Immune complexes can: 10. _______ Anti-Scl
a. Suppress or augment the immune response by 11. _______ Anti-Sm
interacting with T and B cells 12. _______ Antismooth muscle
b. Inhibit tumor cell destruction a. Antibody to basic nonhistone nuclear protein,
c. Be deposited in blood vessel walls diagnostic of systemic sclerosis
d. All of the above b. Present in bullous pemphigoid
24. The general anatomic sites of antigen-antibody c. Presence of antibody confirms diagnosis of SLE
interaction are: d. Seen in viral disorders
a. Tissues with a large filtration area e. Characteristic of mixed connective tissue disease
b. Interstitial fluids 13-15. Match the following:
c. Cell surface membranes or fixed intercellular 13. _______ Anti SS-A
structures 14. _______ Histone-reactive antinuclear antibody
d. All of the above 15. _______ PM-I antibody
25. Type IV hypersensitivity reactions are responsible for a. Detectable in patients with myasthenia gravis
all b. Demonstrable in Sjgrens syndromesicca complex
the following except: c. Highly suggestive of drug-induced lupus
a. Contact sensitivity erythematosus
b. Elimination of tumor cells d. Found in one third of patients with uncomplicated
c. Rejection of foreign tissue grafts polymyositis and some patients with
d. Serum sickness dermatomyositis
1. All the following characteristics are common to e. Found in most patients with polymyositis
organspecific 16. The term autoimmune disorder is used when:
and organ-nonspecific disorders except: a. Demonstrable immunoglobulins display specificity
a. Autoantibody tests are of diagnostic value. for self antigens.
b. Antibodies may appear in each of the main b. Cytotoxic T cells display specificity for self antigens.
immunoglobulin c. Cytotoxic T cells contribute to the pathogenesis of
classes. the disease.
c. Antigens are available to lymphoid system in low d. All of the above
concentrations. 17-21. Indicate true statements (A) and false statements
d. Circulatory autoantibodies react with normal body with (B).
constituents. 17. _______ The presence of autoantibodies are only
2. Antibody expression in the development of associated
autoimmunity with autoimmune disease.
is regulated by all the following factors except: 18. _______ In organ-specific disorders, antigens are only
a. Genetic predisposition available to the lymphoid system in low concentrations.
b. Increasing age 19. _______ There is a familial tendency to develop
c. Environmental factors (e.g., ultraviolet [UV] organspecific
radiation) disorders.
d. Active infectious disease
20. _______ In organ-specific disorders, lesions are a. Autoantibodies against carbonic anhydrase
caused by b. HLA haplotype
deposition of antigen-antibody complexes. c. Hypogammaglobulinemia
21. _______ In organ-specific disorders, there is a d. Elevated serum IgE levels
tendency 1. SLE is more common in:
to develop cancer. a. Female infants
22. Self-recognition (tolerance) is induced by: b. Male infants
a. Burnets clonal selection theory c. Adolescent through middle-aged women
b. Elimination of the small clone of immunocompetent d. Adolescent through middle-aged men
cells programmed to react with the antigen 2. One of the most potent inducers of abnormalities and
c. Induction of unresponsiveness in the clinical manifestations of SLE is:
immunocompetent a. Chloramphenicol
cells through excessive antigen binding b. Procainamide hydrochloride
d. All of the above c. Isoniazid
23-26. Match each term with the correct description. d. Penicillin
23. _______ Acetylcholine receptor binding antibody 3. The cellular aberrations in SLE include:
(AChR) a. B cell depletion
24. _______ Anticentromere antibody b. Deficiency of suppressor T cell function
25. _______ Antiintrinsic factor antibody c. Hyperproduction of helper T cells
26. _______ Antimitochondrial antibody d. Both b and c
a. Strongly suggestive, in a high titer, of primary biliary 4. The principal demonstrable antibody in SLE is
binding antibody cirrhosis antibody to:
b. Useful in the diagnosis of myasthenia gravis a. Nuclear antigen
c. Demonstrated in most patients with CREST b. Cell surface antigens of hematopoietic cells
syndrome c. Cell surface antigens to neuronal cells
d. Found in 60% of patients with pernicious anemia d. Lymphocytic leukocytes
27-30. Match each term below with the correct description. 5. The sites of immune complex deposition in SLE are
27. _______ Antimyelin antibody influenced by all the following factors except:
28. _______ Antimyocardial antibody a. Molecular size
29. _______ Cytoplasmic antineutrophil cytoplasmic b. Molecular configuration
antibody (c-ANCA) c. Immune complex specificity
30. _______ Antinuclear antibody (ANA) d. Immunoglobulin class
a. Associated with multiple myeloma 6. Renal disease secondary to SLE can be assessed by:
b. Marker for Wegeners granulomatosis a. Antibody to native dsDNA
c. Characteristic of untreated systemic lupus b. Levels of C3 and C4
erythematosus c. Levels of ANA
d. Diagnostic of Dresslers syndrome or rheumatic fever d. All of the above
35. The immunologic manifestations of multiple sclerosis 7. SLE is a classic model of autoimmune disease and
include all the following except: is a(n):
a. Antimyelin antibodies a. Abnormality of the joints
b. An oligoclonal increase in CSF immunoglobulin b. Systemic rheumatoid disorder
c. In vitro antibody-mediated immunity c. Abnormality of connective tissue
d. An increase in certain HLA and Ia antigens d. All of the above
36. Most immunologically mediated renal diseases fall into 8. The overall incidence of SLE has an increased
one of the following categories, except for: frequency
a. Association with circulating immune complexes among:
b. Association with circulating antigen a. Blacks
c. Association with antiglomerular basement membrane b. Native Americans
antibody c. Puerto Ricans
d. Membranoproliferative glomerulonephritis d. All of the above
37. Polymyositis and dermatomyositis are the most 9. Patients with SLE characteristically manifest:
common a. Butterfly rash over the bridge of the nose
expressions of: b. Skin lesions on the arms and legs
a. Rheumatoid heart disease c. Ulcerations on the trunk
b. Skeletal muscle disorders d. Photophobia
c. Rheumatoid arthritis 10. Laboratory features of SLE include:
d. Either a or b a. The presence of ANAs
38-40. Indicate whether each of the following statements is b. Circulating anticoagulant and immune complexes
true (A) or false (B) regarding the epidemiology of c. Decreased levels of complement
autoimmune pancreatitis. d. All of the above
38. ______ It is more common in women than men. 11. Laboratory procedures that are helpful in assessing
39. ______ Most patients are younger than 50 years at renal
diagnosis. disease include:
40. ______ The number of reported cases has been a. Antibody to double-stranded DNA
decreasing b. Levels of C3 and C4
over the last decade. c. Cryoglobulin assay
41. The immunologic abnormality associated with d. All of the above
autoimmune 12. Antinuclear antibodies (ANAs) are always indicative
pancreatitis in the Japanese population is: of SLE.
a. True d. Radiographic changes
b. False 11. RF correlates with all the following except:
13-16. Match the appropriate antibody and disease. a. The severity of the disease in general
13. ______ Jo-1 b. The presence of nodules
14. ______ Mi-I c. Other organ system involvement (i.e., vasculitis)
15. ______ SS-B/La d. The age of the patient
16. ______ RANA 12. In RA, vascular and parenchymal lesions suggest that
a. Systemic lupus erythematosus lesions result from injury induced by immune complexes,
b. Dermatomyositis especially those containing antibodies to:
c. Progressive systemic sclerosis a. IgM
d. Polymyositis b. IgG
17 and 18. Match the interpretation of the ANA staining c. IgE
pattern to its respective antibody. d. IgD
17. ______ Diffused or homogeneous pattern 13. Serum complement levels are usually _______ in
18. ______ Speckled pattern patients
a. AntiDNA-nucleoprotein antibody with rheumatoid arthritis.
b. Antibody to nucleolar RNA a. Normal
c. Antibody to any extractable nuclear antigen devoid b. Decreased
of DNA or histone c. Increased
d. Anticentromere antibody d. a or b
1. Rheumatoid arthritis most frequently develops in: 14. The most common form of juvenile idiopathic arthritis
a. Adolescent females is:
b. Adolescent males a. Systemic
c. Middle-aged women b. Oligoarthritis
d. Middle-aged men c. Psoriatic
2. Worldwide the incidence of rheumatoid arthritis is: d. Enthesitis-related
a. 1% to 2% 15. In the RF agglutination procedure, a false-positive
b. 2% to 4% result
c. 5% to 10% may be observed in a serum specimen because of:
d. More than 10% a. Complement interference
3. Women are _______ likely than men to develop b. High levels of C-reactive protein (CRP)
rheumatoid c. Antigen excess
arthritis. d. Hemolysis
a. Less 16. In rapid testing for rheumatoid factor, biological
b. Equally falsepositive
c. Two to three times more results can be caused by a variety of disorders
d. 10 to 20 times more including:
4. Rheumatoid factor is defined as: a. Infectious mononucleosis
a. Antigens with specificity for antibody determinants b. Hepatitis
on the Fc fragment of human or certain animal IgG c. Systemic lupus erythematosus
b. Antibodies with specificity for antigen determinants d. Either b or c
on the Fc fragment of human or certain animal IgG 1. Benign tumors are characterized as:
c. Antigens with specificity for antibody determinants a. Growing slowly
on the Fc fragment of human or certain animal IgD b. Resembling the parent tissue
d. Antibodies with specificity for antigen determinants c. Usually invading tissues (metastasizing)
on the Fc fragment of human or certain animal IgD d. Both a and b
5 and 6. The principle of the rapid agglutination test is 2-5. Match the following.
based 2. _______ Benign tumor arising from glands
on the reaction of patient (5) _______ and (6)_______ 3. _______ Benign tumor arising from epithelial surfaces
derived from gamma globulin. 4. _______ Malignant tumor of connective tissue
a. Antigen 5. _______ Malignant tumor of glandular epithelium
b. Antibody (e.g., colon)
c. Complement levels a. Sarcoma
d. Leukocytes b. Adenoma
7-9. Arrange the steps in the pathogenesis of rheumatoid c. Adenocarcinoma
arthritis in the proper order. d. Papillomas
7. ______ 6. Which of the following factors is not a risk factor in the
8. ______ development of cancer?
9. ______ a. Smoking
a. Immunologic events perpetuate the initial inflammatory b. Low-fat diet
reaction. c. Obesity
b. The primary etiologic factor initiates synovitis. d. Sedentary lifestyle
c. An inflammatory reaction in the synovium develops 7. Risk factors associated with breast cancer include:
into a proliferative destructive process of tissue. a. First-degree family history of breast cancer
10. All the following are criteria for rheumatoid arthritis b. Pregnancy after 30 years of age
except: c. Use of estrogen (oral contraceptives or hormone
a. Morning stiffness replacement)
b. Evening stiffness d. All of the above
c. Rheumatoid nodules 8-10. Indicate true statements with the letter A and false
statements with the letter B. c. To determine the degree of tumor burden
8. ______ Antibodies dominate body defenses against d. All of the above
cancer. 22-24. Match the following.
9. ______ Tumors express antigens that can be recognized 22. ______ Tumor-specific antigens
as foreign by the immune system of the tumor-bearing 23. ______ Tumor-associated antigens
host. 24. ______ Carcinofetal antigens
10. ______ The normal immune response frequently fails a. Cell surface molecules coded for by tumorigenic
to viruses
prevent the growth of tumors. b. Gene products resulting from gene derepression
11. The cells involved in the immune response to tumors c. Antigens uniquely related to each tumor
are: d. Probably do not produce unique antigens
a. T lymphocytes, B lymphocytes, and macrophages 25. Carcinoembryonic antigen is:
b. Cytotoxic T lymphocytes, NK cells, and a. An oncofetal protein, elevated in some types of
macrophages cancer, that is found on normal fetal endocrine tissue
c. Neutrophils, lymphocytes, and monocytes in the second trimester of gestation
d. CD8+ lymphocytes, monocytes, and basophils b. An elevated oncofetal protein, strongly correlated
12. Which of the following is not an environmental factor with various malignancies, that is found on normal
associated with carcinogenesis? fetal endocrine tissue in the second trimester of
a. Ultraviolet light gestation
b. Organically grown herbs c. Used clinically to monitor tumor progress in some
c. Benzene types of patients, persistently elevated even in
d. Asbestos residual disease or poor therapeutic response
13. The risk factor associated with the development of d. Both b & c
basal 26. Alpha-fetoprotein (AFP):
cell carcinoma or malignant melanoma is: a. Is synthesized by the fetal liver and yolk sac
a. Infrared light b. Can be elevated in some nonneoplastic conditions
b. Sunless tanning lotions c. Is a very reliable marker for monitoring a patients
c. Ultraviolet light response to chemotherapy and radiation therapy
d. Strobe lights d. All of the above
14. Patients with Down syndrome have a higher incidence 27. -hCG is not:
of: a. Elevated in normal pregnancy
a. Leukemia b. A sensitive tumor marker
b. Breast cancer c. Elevated in squamous cell carcinoma of the lung
c. Prostate cancer d. Elevated in teratocarcinoma and choriocarcinoma
d. Teratomas 28. Prostate-specific antigen is:
15. Tumor cells typically carry _______ genetic change(s). a. Prostate tissuespecific
a. One b. Prostate cancerspecific
b. Two c. Not useful for monitoring response to therapy in
c. Three to six patients with prostate cancer
d. Multiple d. Not directly proportional to tumor volume in
16. Cancer-predisposing genes may: prostate malignancies
a. Affect a hosts ability to repair damage to DNA 29-33. Match the following tumor markers and
b. Increase cell cohesiveness applications.
c. Decrease cell motility 29. ______ CEA
d. Enhance the hosts immune ability to recognize and 30. ______ AFP
eradicate incipient tumors 31. ______ CA 125
17. Oncogenes are: 32. ______ CA 19-9
a. Genetic targets of carcinogens 33. ______ CA 27-29
b. Altered versions of normal genes a. Frequently elevated in endometrially derived
c. Detectable in 15% to 20% of a variety of human tumors gastrointestinal neoplasms
d. All of the above b. Most useful in ovarian and endometrial carcinomas
18 and 19. Match the following definitions. c. Increased levels may indicate recurrent breast
18. ______ Mutation or overexpression of oncogenes carcinoma.
19. ______ Mutation or overexpression of tumor d. May be elevated in patients with gastrointestinal
suppressor malignancies
genes e. Should be quantitated with -hCG initially in all
a. Results in the production of nonfunctional proteins patients with teratocarcinoma
that can no longer control cell proliferation 34. Which tumor marker is used to monitor patients with
b. Produces proteins that can stimulate uncontrolled breast cancer for recurrence of disease?
cell growth a. CA 15-3
20. Which of the following is used to determine the risk of b. Estrogen receptor (ER)
developing cancer? c. Cathepsin-D
a. p53 gene d. CA 50
b. c-erbB-2 gene 35-38. Match an example of a therapeutic intervention with
c. Squamous cell carcinoma antigen the appropriate mode of action (an answer may be used
d. Epidermal growth factor receptor (EGFR) more than once).
21. A tumor marker assay is most useful: 35. ______ 6-Mercaptopurine
a. To screen patients for malignancies 36. ______ Corticosteroids
b. To monitor a cancer patient for disease recurrence 37. ______ Alkylating agents
38. ______ Vinca alkaloids 13. a
a. Cell cycle active, phase-specific 14. d
b. Cell cycle active, phase-nonspecific 15. c
c. Noncell cycle active 16. d
d. b or c 17. d
39. Tamoxifen acts as a(an) _______ pharmaceutical agent. 18. a
a. Cell cycle active, phase-specific 19. c
b. Noncell cycle active 20. a
c. Estrogen receptorblocking 21. b
d. Both b and c 22. c
40. Active host immunotherapy responses may be 23. a
achieved by: 24. b
a. Transferring immune cells into host. CHAPTER 16: A PRIMER ON VACCINES
b. Vaccination with killed tumor cells. 1. b
c. Administration of tumor-specific MAbs. 2. b
d. Administration of IFN-. 3. d
41-45. Match the environmental factors and associated 4. d
cancers. 5. a
41. _______ Benzene a. Endometrial cancer 6. a
42. _______ Estrogen b. Hepatocellular carcinoma 7. b
43. _______ Epstein-Barr virus c. Burkitts lymphoma virus 8. a
44. _______ Hepatitis B d. Leukemia 9. c
45. _______ Asbestos e. Mesothelioma 10. d
CHAPTER 12: LABELING TECHNIQUES 11. b
IN IMMUNOASSAY 12. e
1. d 13. b
2. a 14. a
3. b 15. c
4. d CHAPTER 17: STREPTOCOCCAL INFECTIONS
5. a 1. b
6. b 2. a
7. b 3. d
8. c 4. b
9. a 5. a
10. c 6. b
11. b 7. d
12. a 8. a
13. a 9. b
14. b 10. d
15. c 11. c
16. d 12. a
CHAPTER 13: AUTOMATED PROCEDURES 13. b
1. b 14. b
2. c 15. a
3. b 16. c
4. c 17. b
5. a 18. b
6. b 19. b
7. b 20. c
8. a CHAPTER 18: SYPHILIS
9. c CHAPTER 19: VECTOR-BORNE DISEASES
10. b 1. d
11. d 2. d
12. d 3. b
CHAPTER 14: MOLECULAR TECHNIQUES 4. c
CHAPTER 15: THE IMMUNE RESPONSE 5. b
IN INFECTIOUS DISEASES 6. b
1. d 7. a
2. b 8. b
3. d 9. b
4. a 10. b
5. c 11. c
6. a 12. d
7. c 13. d
8. d 14. a
9. c 15. b
10. b 16. c
11. c 17. c
12. a 18. d
19. a 4. d
20. c 5. d
21. c 6. a
22. a 7. c
23. c 8. b
24. b 9. a
25. b 10. d
26. c 11. b
27. c 12. c
28. a 13. d
29. d 14. b
30. a 15. a
31. a 16. e
32. d 17. c
CHAPTER 20: TOXOPLASMOSIS 18. b
1. c 19. d
2. d 20. b
3. d 21. d
4. b 22. c
5. b 23. a
6. a 24. b
7. b 25. d
8. c 26. b
9. a 27. a
CHAPTER 21: CYTOMEGALOVIRUS 28. b
1. d 29. b
2. d 30. a
3. b 31. b
4. d 32. d
5. b 33. c
6. c 34. b
7. a 35. a
8. c 36. c
9. b 37. a
10. a 38. a
11. d 39. a
12. b 40. a
13. c 41. b
14. a 42. b
15. c 43. d
16. b 44. d
17. b 45. a
18. d 46. b
19. a 47. c
20. a 48. a
21. b CHAPTER 24: RUBELLA INFECTION
22. a 1. c
CHAPTER 22: INFECTIOUS MONONUCLEOSIS 2. b
1. d 3. d
2. b 4. a
3. b 5. c
4. c 6. c
5. d 7. c
6. d 8. d
7. d 9. d
8. d 10. b
9. a 11. d
10. c CHAPTER 25: ACQUIRED IMMUNODEFICIENCY
11. c SYNDROME
12. d 1. b
13. c 2. b
14. c 3. d
15. c 4. d
16. a 5. c
17. b 6. b
CHAPTER 23: VIRAL HEPATITIS 7. c
1. b 8. d
2. a 9. c
3. c 10. c
11. a 28. d
12. b 29. b
13. d 30. c
14. a 31. c
15. e 32. d
16. b 33. c
17. c 34. c
18. d 35. c
19. b 36. b
20. c 37. b
21. d 38. b
22. b 39. b
23. c 40. b
24. b 41. b
25. a CHAPTER 29: SYSTEMIC LUPUS
CHAPTER 26: HYPERSENSITIVITY REACTIONS ERYTHEMATOSUS
1. d 1. c
2. a 2. b
3. c 3. d
4. b 4. a
5. d 5. c
6. d 6. d
7. d 7. d
8. d 8. d
9. b 9. a
10. b 10. d
11. c 11. d
12. a 12. b
13. b 13. d
14. a 14. b
15. d 15. a
16. b 16. c
17. c 17. a
18. a 18. c
19. a CHAPTER 30: RHEUMATOID ARTHRITIS
20. d 1. c
21. b 2. a
22. d 3. c
23. d 4. b
24. d 5. b
25. d 6. a
CHAPTER 28: AUTOIMMUNE DISORDERS 7. b
1. c 8. a
2. d 9. c
3. a 10. b
4. b 11. d
5. b 12. b
6. e 13. a
7. c 14. b
8. d 15. d
9. e 16. d
10. a CHAPTER 33: TUMOR IMMUNOLOGY
11. c 1. d
12. d 2. b
13. b 3. d
14. c 4. a
15. e 5. c
16. d 6. b
17. b 7. d
18. a 8. b
19. a 9. a
20. b 10. a
21. a 11. b
22. d 12. b
23. b 13. c
24. c 14. a
25. d 15. d
26. a 16. a
27. a 17. d
18. a 32. d
19. b 33. c
20. a 34. a
21. d 35. a
22. c 36. c
23. a 37. d
24. b 38. a
25. d 39. d
26. d 40. b
27. c 41. d
28. a 42. a
29. a 43. c
30. e 44. b
31. b 45. e