Immunology 2

You answered the question correctly.
The primary purpose of neutrophil granules is to:
The correct answer is highlighted below
facilitate nuclear maturation.

help distinguish neutrophils from lymphocytes.
prepare cells for removal from circulation.
provide microbicidal action.
separate eosinophils and basophils from neutrophils.
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Neutrophil granules provide enzymes for hydrolytic substrate break-down, kill

ingested bacteria, and secrete their contents to regulate different physiological and
pathological processes, including inflammation.
Question Difficulty: Level 4
You answered the question incorrectly.
Which is the main limitation of standard PCR that is not a limitation of real-time
PCR?
Requirement of a large initial sample

Inability to quantitate DNA product due to endpoint analysis only
Ability to detect PCR product during the plateau stage
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The main limitation of standard PCR is the inability to quantitate the DNA product
due to reliance on endpoint analysis. The final yield of a product is not always equal
to the estimated exponential growth per cycle. Therefore, quantitation is not possible
with endpoint analysis. Real-time PCR overcame this limitation.
Which of the following is NOT true about real-time RT-PCR?
It is the most sensitive method for evaluating RNA

It requires the least amount of initial product
It does not require the use of reverse transcriptase
Can detect infection before antibodies appear
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PCR can be modified for the amplification of RNA with one additional step prior to
the PCR process - the addition of a retrovirus enzyme called reverse transcriptase. The
reverse transcriptase is used to create a copy of DNA using the original RNA
specimen. This method is used for many viruses, such as HIV, that have an RNA
genome. RT-PCR is extremely advantageous for many reasons. First, one can use a
blood sample of less than 1 mL which makes it available to test and monitor
neonates.Second, RT-PCR can detect infection in individuals before antibodies
appear. In addition to HIV, RT-PCR is the primary mode for the detection and
monitoring of hepatitis C.RT-PCR is also used for identifying Mycobacterium
tuberculosis and cytomegalovirus (CMV). RT-PCR is commonly combined with real
time PCR.
Which part of the immunoglobulin molecule is responsible for activating

complement?
Fc
Fab
heavy chains
light chains
Hinge regions
Feedback
The Fc portion of immunoglobulin can activate the classical complement pathway,

where the heavy chains, light chains, hinge regions and Fab portions cannot.
What is the first step of the PCR reaction?
Hybridization
Extension
Annealing
Denaturation
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The steps in the PCR process are:
Denaturation (Turning double stranded DNA into single strands.)
Annealing/Hybrization (Attachment of primers to the single DNA strands.)
Extension (Creating the complementary strand to produce new double

stranded DNA.)

If an antinuclear antibody indirect immunofluorescence test shows a positive,

speckled pattern, which would be the MOST appropriate additional test to perform?
Anti-mitochondrial antibody
Immunoglobulin quantitation
Screen for Sm and RNP antibodies
Anti-DNA antibody using C. lucillae
Mitochondrial antigen identification
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In systemic lupus erythematosis, a speckled ANA pattern is noted. To help confirm

this diagnosis, often anti-Sm and anti-RNP antibody tests are ordered; this detects
immune response against extractable nuclear antigens.
Which disease is MOST likely to show a homogenous pattern in an

immunofluorescence (IF) microscopy test for ANA?
Mixed connective tissue disease (MCTD)

CREST syndrome
SLE
Scleroderma
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In SLE, a homogeneous pattern is usually present, although SLE can also demonstrate
a speckled pattern. A nucleolar pattern is commonly seen in scleroderma. A
centromere pattern is common in CREST syndrome. Mixed connective tissue disease
(MCTD) is highly associated with a speckled ANA pattern.
The rheumatoid factor in rheumatoid arthritis is PRIMARILY which type of

immunoglobulin?
IgM
IgA
IgG
IgE
Incomplete
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Rheumatoid Factor (RF) is an antibody against the Fc portion of IgG molecules. It is

primarily, of the IgM class and can less commonly be IgG or IgA. These circulating
antibody complexes are found in the synovial tissue and synovial fluid and tend to
cause systemic problems. In the laboratory, routine latex agglutination test would
typically detect only IgM RF since most IgG and IgA antibodies are non-
agglutinating.
A decrease in which of the following in an AIDS patient are associated with increased
susceptibility to infection:

CD4+ cells
CD8+ cells
HIV antigens
HIV antibodies
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CD4 positive lymphocytes, or T-helper cells, are infected and destroyed by the HIV
virus.
A patient has the following test results:
ANA = positive 1:320

RA = positive
Complement = decreased
The above results would be seen in patients with:
rheumatic fever
rheumatoid arthritis
lupus erythematosus
glomerulonephritis
lyme disease
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The ANA test, or anti-nuclear anitbody, is a screening test used to detect lupus
erythematosus. In this case the ANA test was positive. The RA test, or rheumatoid
factor, screens for the presence of an antibody linked with rheumatoid arthritis and
other conditions such as lupus erythematosus. Again, in this case, the RA test was
positive. Finally, a decrease in complement proteins indicates that the classic pathway
may have been activated resulting in immune complexes, a clinically significant
symptom of lupus erythematosus.
Which of the following is not a feature of systemic lupus erythematosus (SLE):
Increased serum complement

Positive ANA
Circulating immune complexes
Decreased serum complement
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Complement is actually consumed during the immune reactions involved in SLE.

Therefore, a decrease in complement is expected. Circulating immune complexes and
a positive anti nuclear antibody (ANA) test are both usually present in patients with
SLE.
Multiplexing is the process of assaying several different genes within the same PCR
reaction.
True
False

A traveler is being evaluated at a local hospital for gastrointestinal pain, fever and
diarrhea. The patient has recently returned from a month-long visit to Southeast Asia.
The patient has no recent history of sexual activity or IV drug use but did describe
conditions of poor sanitation where they were visiting. If liver function test results
were elevated and bilirubinuria was noted, which of the following would be the next
logical test to order?
ELISA test for the Hepatitis B Surface Antigen (HBsAg)

Recombinant Immunoblot Assay (RIBA) test for Hepatitis C
Western Blot test for HIV
ELISA testing for Hepatitis A antigens in the stool
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The correct response is option D: ELISA testing for Hepatitis A antigens in the stool.
Hepatitis B, C and HIV are spread primarily through sexual contact or IV drug use
and needle sharing. While it is possible to contract these viruses through other means,
the patient history of visiting areas of low sanitation in Asia is more indicative of an
enterically (fecal-oral) transmitted organism like Hepatitis A. The earliest detectable
marker for Hepatitis A is the presence of viral antigens in the stool, which are most
often tested for using ELISA methodology.
What has happened in a titer, if tubes #5-7 show a stronger reaction than tubes #1-4?
poor technique
postzone reaction
prozone reaction
equivalence reaction
technical error
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By definition, prozone is a phenomena occur in immunological reactions when the

concentrations of antibody are so high that the optimum concentration for maximal
reaction with antigen is exceeded. Immunological phenomena in the prozone region
may show partial or total inhibition. Since this is the case in the question, there is a
partial inhibition in tubes 1-4 where the antibody is in higher concentrations causing
the prozone effect. In tubes 5-7, the antibody concentration is less, therefore there is
no prozone effect and a stronger reaction will then occur in these tubes.
If a cocktail that includes detergents, enzymes, and salts is used for DNA isolation,
which one of these ingredients will pull the DNA out from the sample?
Detergents
Salts
Enzymes
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If a cocktail that includes detergents, enzymes, and salts is used for DNA isolation, the
salts will pull the DNA out from the sample. The detergents break down the
membrane lipids and the enzymes remove the proteins.

Which one of the following statements concerning phagocytosis is FALSE?
Cells are only capable of phagocytizing bacteria.

Membrane reaches out and surrounds the material to be internalized.
Once internalized the material is surrounded by phagosomes.
Only specialized cells are capable of phagocytosis.
Whole pathogenic organisms can be ingested.
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Cells do not only phagocytize bacteria, the can phagocytize other cells, cellular
remnants, and other waste products as well.
A hapten can BEST be described as
A carrier molecule for an antigen that is not antigen alone

A determinant capable of stimulating an immune response only when bound to a
carrier protein
An immunoglobulin functional only in the presence of complement
Half of an immunoglobulin molecule
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A hapten is a low molecular weight molecule that can elicit an immune response only
when attached to a large carrier such as a protein.

For a substance to be immunogenic it must be:
A linear molecule
A lipid
Less than 5,000 molecular weight
Recognized as non-self
A haptene
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Only non-self antigens can be immunogenic. Self antigens are normally recognized by
the immune system as part of the host, so an immune response does not normally
occur. Non-self antigens are immunogenic since they have the potential to cause an
immune response.
Which of the following is/are NOT associated with immediate hypersensitivity?
The correct answers are highlighted below
Hay fever
Serum sickness
Arthus reaction
Anaphylactic shock
Tuberculin reaction
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The tuberculin reaction is a type of delayed hypersensitivity reaction that appears 48-
72 hours after antigen exposure, which is different from an immediate
hypersensitivity response, which generally appears within 12 minutes of an antigen
challenge. Arthus reactions and serum sickness are classified as a Type III
hypersensitivty reactions involving the formation of immune complexes. The other
choices above are all associated with immediate hypersensitivity reactions.
Which one of the following immunoglobulins is MOST likely to be elevated in

anaphylactic shock?
IgA
IgD
IgE
IgG
IgM
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"True" anaphylaxis is caused by degranulation of mast cells or basophils mediated by

IgE, and pseudo-anaphylaxis occurs without IgE mediation.

Match each letter in this image of a tissue cell that is used as a substrate in ANA
testing to the structure that it is indicating.
Your answers are on the left. The correct answers are on the right and highlighted.
Nucleus A
Nucleolus B
Cytoplasm C
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Generally we consider 2 compartments in the cell when detecting autoantibodies in

systemic rheumatic disease: the nucleus, indicated by letter A and cytoplasm,
indicated by letter C. Staining of the nucleus includes staining inside the nucleoli,
indicated by letter B.
Monoclonal antibodies are usually manufactured in vitro by using:

Cultured T cells
Human plasma cells
Hybridomas
Cytotoxic T cells
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Monoclonal antibodies are monospecific antibodies that are the same because they are
made by one type of immune cell which are all clones of a unique parent cell, also
called a hybrid cell line, which usually arise from a hybridoma. The fusion of a
specific antibody-producing lymphocyte with a myeloma cell will multiply to become
a source of pure monoclonal antibody. This is often used in the manufacturing process
for monoclonal antibody reagents.
The DNA strand ending with a phosphate group is the 5' end.
True
False
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The direction of a strand is determined by what is found at the end of a strand. A

strand ending with a phosphate is a 5' end and a strand ending with an OH group is a
3' end.

What type of follow-up testing is recommended for a Speckled ANA pattern?
None
Testing for antibodies to the extractable nuclear antigens (ENA)
Testing for antibodies to dsDNA
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Speckled ANA patterns are usually followed-up with testing for antibodies to the
extractable nuclear antigens (ENA). Frequently this includes: Sm (Smith), U1-RNP,
SSA/Ro, SSB/La, and Scl-70.
Testing for dsDNA antibodies is usually done on homogeneous ANA patterns.

However, some labs will suggest both dsDNA and ENA testing if the speckled pattern
is greater than 1:160.
Match terms with fragments resulting from papain digestion of an IgG molecule:
Fc fragment B
Fab fragment A
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A = Fab fragment
B = Fc fragment
Which one of the following is not descriptive of the different branches of the immune
system?
Cell-Mediated
Extrinsic
Humoral
Innate
Non-specific
Feedback
Cell mediated, humoral, innate, and non-specific are all branches of the immune
system. Extrinsic is a branch of the coagulation cascade.
Which of the following mediators is released during T-cell activation?
immunoglobulins
thymosin
serotonin
lymphokines
cytoplasmic granules
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T cells secrete lymphokines, which encourage cell growth, promote cell activation,
direct cellular traffic, destroy target cells, and initiate macrophages.
Which of the following antibody types is chiefly seen in the primary immune
response:
IgG
IgA
IgM
IgD
Feedback
IgM is the main immunoglobulin seen in the primary immune response. IgG is chiefly
seen in the secondary immune response. IgA is the predominant immunoglobulin in
body secretions. Finally, IgD is found in very small quantities and accounts for less
than 1% of the total immunoglobulin pool.

Which class of antibody is able to agglutinate RBCs after anti-human globulin is
added?
IgA
IgE
IgG
IgM
IgD
Feedback
Anti-human globulin (AHG) is created to bind with IgG antibodies at the Fc portion
of the antibodies. AHG will bind to both bound and unbound IgG antibodies. When
IgG is bound to RBCs, the AHG reagent will allow visible agglutination to occur.
Which of these is NOT a Systemic Autoimmune Rheumatic Disease (SARD)?
Systemic sclerosis
Lupus erythematosus
Rheumatoid arthritis
Multiple sclerosis
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While multiple sclerosis is an autoimmune disease it is not one of the SARDs.

What sero-marker is the first marker to become positive in Hepatitis B and is

associated with the infective stage?
HBc antibody
HBc total
HBs antigen
Hbs antibody
Hbe antigen
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Hepatitis B surface antigen, or HBs, is a protein that is present on the surface of the
virus. The protein will be present via laboratory testing in the blood with acute and
chronic HBV infections
What is the most common combination of ANA patterns?
Homogeneous and centromere

Speckled and nucleolar
Speckled and SSA/Ro
Homogeneous and speckled
Feedback
Homogeneous and speckled is correct. In some labs this combination of patterns is the
most frequent of all positive ANAs.
Remember, however, any combination is possible and the other combinations listed
above are not uncommon.
What is the half-life of IgG?
2.3 days
2.8 days
5 - 6 days
18 - 23 days
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The half-life of IgG is 18 - 23 days.
The half life of IgM and IgA are approximately 5-6 days. The half life of IgD and IgE
are 2.8 and 2.3 days, respectively.
The reaction that occurs when a soluble antigen is mixed with its specific antibody is
termed:
Precipitation
Agglutination
Sensitization
Fixation
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The reaction that occurs when a soluble antigen is mixed with its specific antibody is
termed precipitation. The visible precipitate is composed of large aggregates of
antigen crosslinked by antibodies.
Which T cell expresses the CD8 marker and acts specifically to kill tumor or virally
infected cells?
Helper T
T suppressor
T inducer/suppressor
T cytotoxic
Natural killer
Feedback
T-cells with the CD8 marker (also known as cytotoxic T cells) belong to a sub-group
of T lymphocytes that are capable of inducing the death of infected somatic or tumor
cells. Cytoxic T cells kill other cells that are infected with viruses or organisms as
well as other damaged or dysfunctional cells.
The antibody MOST frequently present in systemic lupus erythematosus (SLE) is

directed against:
Myelin
Nuclear antigen
Surface antigens of bone marrow stem cells
Surface antigens of renal cells
Cytoplasmic processes
Feedback
The anti-nulear antigen test, or ANA test, is a test used to screen for autoimmune
diseases, especially systemic lupus erythematosus. It determines whether auto-
antibodies to cell nuclei are present. In 97% of cases diagnosed as SLE, patients have
a positive ANA test.
The vast MAJORITY of would-be invaders are killed or inactivated primarily by

which part of the immune system?
Cell Mediated
Specific
Humoral
Innate
Feedback
The innate immunity system is inherent and nonspecific; meaning that all pathogens
are attacked similarly. The skin, mucus in respiratory tracts, acid pH, and others are
all examples of the innate immunity system that the body has to prevent infection
upon first exposure.

The part of the immunoglobulin molecule that may be kappa or lambda chains is:
Fc
Fab
heavy chains
light chains
Hinge regions
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Light chains must always be either the kappa or lambda types in the formation of an
antibody.
You are performing a manual antibody titer in a clinical laboratory. You have made
serial dilutions of a patients plasma sample and you are looking for anti-streptolysin
O antibodies. The first tube contains pure patient plasma. The second tube contains a
1:2 dilution of the first tube. The third tube contains a 1:2 dilution of the second tube
and so on. The patients antibodies no longer give visible reaction in tube 5, indicating
their titer is tube 4 (or the last tube where there is a positive result). What is the
concentration of antibodies in tube 4 compared to the concentration in tube 1?
The concentration of antibodies in tube 4 is the same as the concentration of

antibodies in tube 1
The concentration of antibodies in tube 4 is about 1/4 the concentration of
The concentration of antibodies in tube 4 is 1/8 the concentration of antibodies in
tube 1
The concentration of antibodies in tube 4 is 4 times the concentration of
Feedback
The correct response is option C: The concentration of antibodies in tube 4 is about

1/8 the concentration of antibodies in tube 1. If a serial dilution is made where each
sample tube contains a 1:2 dilution based upon the sample before it in the series, then
the pattern for dilution is 1:1, 1;2, 1:4, 1:8, 1:16 and so on. The dilution factor for
each tube is multiplied by a factor of 2 as it proceeds through a series. In the example
above, the first tube would contain only plasma. The second tube would be a 1:2
dilution, the third tube would be a 1:4 dilution and the fourth tube would contain a 1:8
dilution. Therefore the concentration of antibodies in tube 4 is 1/8 of the concentration
found in the first tube (pure patient plasma)
Twelve weeks after onset of the disease, patients with uncomplicated acute hepatitis B
usually will demonstrate which of the following in their serum?
HBsAg
Anti-HTLV
Anti-HBe
Anti-HIV
Feedback
The Hepatitis B e-antigen, or HBeAg is a viral protein associated with HBV

infections. Unlike the surface antigen, the e-antigen is found in the blood only when
there are viruses also present. Anti-HBe is an antibody produced in response to the
Hepatitis B e antigen. In those who have recovered from acute hepatitis B infection,
anti-HBe will be present along with anti-HBc and anti-HBs.

Jane Doe is a 39-year-old female who felt tired for several months, had pain in the
joints of her fingers, and recently developed a dermatitis following exposure to the
sun. The following test results were obtained on a blood sample drawn during the
initial evaluation:
Total Protein = 8.4 gm/dL (N = 6.0-8.0 gm/dL)

ANA >1:2560; speckled pattern
CRP = positive
C3 = 40 mg/dL (N = 80-180 mg/dL)
C4 = 5 mg/dL (N = 15-45 mg/dL)
Based on the clinical and laboratory findings, what disease should be suspected?
SLE
Sjogren's syndrome
Scleroderma
Feedback
The ANA titer is usually less than 1:160 in diseases other than SLE, so that the
possibility of SLE is increased in patients with higher titers. A speckled pattern is
commonly found in patients with SLE indicating binding to a variety of nonhistone,
small ribonucleoprotein (RNP) particles. A high crp level indicates that inflammation
is occuring, as in SLE for example, but does not indicate the location or cause of the
inflammation. Decreased complement levels also are associated with autoimmune
diseases. Both C3 and C4 levels are typically depressed in SLE
A 2 month old infant presented with history of chronic diarrhea and failure to thrive.
The child's mother also revealed that the baby has suffered from thrush (Candida
infections) since birth. Preliminary findings showed lymphopenia (<2,000),
hypogammaglobulinemia, and physical findings showed a small thymus, no tonsils or
lymph nodes. Which of the following immune deficiencies DOES the patient present?
T-cell activation deficiency

MCH deficiency
Deficiency in immunoglobulin production
Severe combined immunodeficiency syndrome
Inborn error of metabolism
Feedback
Severe combined immunodeficiency syndrome, or SCID is a very serious human

immunodeficiency disorder. It is actually a group of congenital disorders in which
both the humoral and cell-mediated portions of a patient's immune system are
dysfunctional. Children with SCID are vulnerable to recurrent severe infections,
retarded growth, and early death.
Which of the following diseases is NOT associated with autoantibodies?
acquired hemolytic anemia

chronic thyroiditis
Lupus erythematosus
Hemolytic disease of the newborn
Feedback
HDN is associated with alloantibodies from the mother's bloodstream directed against
the baby's red cell antigens.
For the ANA test to be positive what must be present in the nucleus of the interphase
cell?
Strong staining
Centromeres
dsDNA
A clearly discernible pattern
Feedback
A clearly discernible pattern is correct.
The strength of the reaction doesn't matter, only that it is clearly discernible.
Centromere and dsDNA are just some of the many different antigens, however,
without the corresponding (cognate) antibodies from the patient sample there is no
ANA pattern. Remember, to be ANA positive there must be a clearly discernible
pattern in the nucleus of the interphase cells.
Which of the following would you expect to find in the serum of a patient who has
recovered from Hepatitis B infection within 6 months after infection?
Anti-HBs
Anti-HBe
HBe
HBsAg
Feedback
The anti-Hbs antibody is produced in response to HBV surface antigen. The anti-Hbs
levels in the blood of patient who are infected with hepatitis B will rise during the
recovery phase. This test in the laboratory is used to detect previous exposure to HBV,
but can also be used to detect successful vaccination. This test is performed mainly to
determine whether or not vaccination is necessary or to determine if a person has
recovered from a hepatitis B infection and is immune.
The serum hemolytic complement level (CH50):
Is a measure of total complement activity

Provides the same information as a serum factor B level
Is detectable when any component of the classical system is congenitally absent
Can be calculated from the serum concentrations of the individual components
Is part of the non-hemolytic Alternate complement cascade
Feedback
Total hemolytic complement, or CH50, is an assay used to evaluate the complete

complement sequence. CH50 is often decreased in SLE, glomerulonephritis and other
immune complex diseases. A normal CH50 level indicates that all the components, C1
through C9, are present.

A phlebotomist at a local hospital recently had an accidental needle stick while

drawing blood from a patient being treated for acute hepatitis B. Which serological
marker from the patient would be of most value to the physician evaluating the
phlebotomist's possible infection status?
Hepatitis B surface Antigen (HBsAg)

Hepatitis B e Antigen (HBeAg)
Hepatitis B core Antigen (HBcAg)
Anti-Hepatitis B e (anti-HBe) IgM
Anti-Hepatitis B core (anti-HBc) IgG
Feedback
The correct response is option B: The Hepatitis B "e" Antigen (HBeAg). This antigen
indicates the virus is actively replicating and therefore the patient is very infectious.
The hepatitis B e antigen is present when the virus is actively replicating. In cases
of unintentional needlesticks, infectivity is of highest concern. The risk for infection is
greatest during phases of increased HBeAg serology. The Hepatitis B surface antigen
is the first detectable marker, but if the patient is known to have Hepatitis B already, it
would be relatively unhelpful to confirm the condition with another HBsAG test. The
core antigen is not detectable because it is covered by the nuclear envelope. Antibody
response patterns would not be very helpful either as the patient has already been
diagnosed with acute Hepatitis B. IgG antibodies would indicate recovery, which is
not the case for this patient and IgM antibodies indicating a recent or acute infection
would only confirm what is already known. Recall, in cases of unintentional
needlesticks, infectivity is of highest concern.
What is the MOST likely cause when clinical signs indicate HIV infection, but
antibody tests are negative?
probably not HIV infection

patient is in the "window phase" before antibody production
tests were performed incorrectly
Feedback
When clinical signs indicate HIV infection, but antibody tests are negative, a patient
can be in the "window phase" before antibody production. This means that the HIV
viral antigens have yet not produced an immune response great enough for laboratory
studies to detect anti-HIV antibodies. This window period can last up to 6 months
after infection.
Diseases associated with dysfunctions of polymorphonuclear neutrophils (PMNs)

include all of the following EXCEPT:
Chediak-Higashi syndrome (CH)

Chronic granulomatous disease (CGD)
Gaucher 's Disease
Myeloperoxidase deficiency (MPO)
Feedback
Chediak-Higashi, chronic granulomatous disease, and myeloperoxidase deficiency are

all dysfunctional neutrophil disorders. Gaucher's disease the most common lysosomal
storage disease caused by insufficient activity of the lysosomal enzyme
glucocerebrosidase that leads to the deposition of glucocerebroside in cells of the
macrophage-monocyte system.

The term TITER ( as it applies to the measurement of antibodies) is best defined as:
Concentration of antibody in the serum

Maximum reactive dilution X 100
Maximum reactive dilution / 100
Reciprocal of maximum reactive dilution
Feedback
A specimen with a last reacting tube containing a 1:100 dilution, would be said to
have a titer of 100.
Which two stages of cell division are the most important for reading ANAs?
Prophase and metaphase

Interphase and anaphase
Anaphase and telophase
Interphase and metaphase
Feedback
Interphase and Metaphase is the correct answer.
While it is necessary to recognize all stages of cell division, the two most important
are interphase and metaphase. In order for the ANA to be positive there must be a
clearly discernible pattern in the nucleus of the interphase cells. Metaphase mitotic
cells are used to assist in identification of the ANA pattern.

The antinuclear antibody (ANA) test pattern that is seen in this image, viewed using
fluorescent microscopy, is characterized by smooth staining in the nuclei of the
interphase cells (a) and smooth staining in the chromosomal areas of the metaphase
mitotic cells (b). Which pattern is this?
Note: (a) points to the nuclei of two interphase cells. the nucleus of the interphase cell
is the primary consideration for discerning the ANA pattern. (b) indicates a metaphase
mitotic cell. Observing the chromosomal area and cytoplasm of the metaphase cell
may assist in identification of the ANA pattern.
Speckled
Centromere
SSA/Ro
Homogeneous
Feedback
Homogeneous is correct.
This pattern is characterized by smooth staining in the nuclei of the interphase cells
(a). The nucleoli may or may not stain. Notice the smooth staining in the
chromosomal areas of the metaphase mitotic cells (b).
In order for the ANA to be positive there must be a clearly discernible pattern in the
nuclei of the interphase cells. Metaphase mitotic cells are used to assist in
identification of the ANA pattern.
A kidney graft would have the BEST chance of survival post-transplantation if it

were:
HLA non-identical, mixed lymphocyte culture (+), ABO identical.

HLA identical, mixed lymphocyte culture (+), ABO identical.
HLA identical, mixed lymphocyte culture (-), ABO identical.
HLA identical, mixed lymphocyte culture (-), ABO non-identical.
Feedback
A graft which is matched based on HLA and ABO typing is ideal. The mixed
lymphocyte culture, or MLC, should be negative also to prevent graft vs. host disease
in transplant procedures.
Which branch of the immune system has an immediate response on first exposure to a
foreign antigenic stimulus?
Cell Mediated
Specific
Humoral
Innate
Feedback
are attacked similarly. The skin, mucus in respiratory tracts, acid pH, and others are
all examples of the innate immunity system that the body has to prevent infection
upon first exposure.
Which is NOT a benefit of automated isolation and extraction equipment?
Cheaper and more practical

Requires less manipulation
Considered moderate complexity
Consistent results
Feedback
Though automated extraction machines have many benefits over manual methods the
costs are high and generally require a high throughput of samples in order to justify
the costs.
Automated extraction has many benefits over the traditional manual methods. The
most important benefit is that the nucleic acid isolated is constantly consistent. There
is a reduced amount of manipulation with dramatically decreases the chance of cross
contamination. Also, automated extraction machines are considered moderate
complexity and can be performed by a wider variety of laboratory professionals.
Which of the following is the activation unit in the classical complement pathway?
C1
C2
C4, C2, C3
C5, C6, C7, C8, C9
C1, C2, C9
Feedback
The combination of complement C4, C2 and C3 that binds to the antigen-antibody

complex in the initial reaction step in the classical pathway of complement activation
is called the activation unit.
Determining viral load is how one determines a positive diagnosis for HIV infection.
True
False
Feedback
Determining viral load is a way to monitor already infected individuals with HIV and
other viral diseases. The viral load can show how well treatments are working, show
potential medication resistance, and also indicate relapses.
Contact dermatitis is mediated by:
B lymphocytes
Macrophages
Polymorphonuclear cells
T lymphocytes
Chemokines
Feedback
When an antigen comes in contact with the skin, the antigen is processed by cells in
the epidermis and come in contact with T lymphocytes. T lymphocytes recognize the
antigen as foreign and circulate through the bloodstream back to the epidermis and
produce an inflammatory response to eliminate the antigen, but this immune response
can produce a characteristic rash in the skin called contact dermititis.
Which one of the following would not be considered an anatomic barrier of the innate
immune system?
Tears and Saliva

Epidermis
Low pH
Mucous membranes
T lymphocytes
Feedback
are attacked similarly. The skin (dermis and epidermis), mucus membranes, acid (low)
pH, tears, saliva, cilia, mucous and others are all examples of the anatomic barriers of
the innate immune system which the body uses as its first line of defense. T
lymphocytes play a main role in the adaptive immune system and are not anatomical
barriers of the innate immune system.
The lymphokine most important for increased natural killer cell activity and decreased
viral replication in cells is:
Interferon gamma
Interleukin 3
Interleukin 4
Interleukin 5
Feedback
Interferon gamma serves various purposes in immunologic response, including the

promotion of natural killer cell activity as well as decreased viral replication by using
enzymes to decrease protein replication, both viral or host, inside of the cell.

The greatest risk for the manifestation of anomalies in maternal rubella infection
during gestation is the:
first trimester
second trimester
third trimester
delivery
eighth month
Feedback
Infection early in the pregnancy is the most dangerous time period for the
manifestation of anomalies due to rubella. In fact, defects are rare when infection
occurs after 20 weeks gestation.
Match each characteristic listed below to either standard or real-time PCR.
Real-time PCR Measures PCR product at the exponential stage

Standard PCR Measures PCR product at the plateau stage
Standard PCR Is followed by agarose gel electrophoresis
Real-time PCR All cycles, including detection, can be completed in the same tube

Which immunoglobulin class is able to cross the placenta from the mother to the
fetus?
IgA
IgD
IgE
IgG
IgM
Feedback
Immunoglobulins of the IgG class are able to cross the placenta since they circulate as
monomers; thus they are small in size. The other types of immunoglobulins are too
large to cross the placental barrier, for example, IgM is a pentamer.
The mediator cells that bind MOST to IgE antibodies are:
Basophils
Eosinophils
Polymorphonuclear neutrophils
Macrophages
Feedback
Allergen-specific IgE, synthesized in response to allergens, becomes fixed to

receptors on cellular membranes, especially those of basophils. If these receptor-
bound IgE molecules are aggregated on re-exposure to specific allergen, both mast
cells and basophils produce mediators that result in the allergic response. IgE-antigen
interaction at the cell surface causes degranulation of cells and release of substances
including: histamine, SRS-A, platelet activator, a kallikrein, and an eosinophil chemotactic
factor. Basophils are the principal cells that bind IgE antibody while their number of receptor
sites is proportional to serum IgE levels. Eosinophils are drawn to the site by the basophil
chemotaxis mechanism, but are not the main cell which binds the IgE antibody.
The mechanism responsible for pathology in autoimmune diseases is:
Circulating immune complexes

Lack of intracellular killing after neutrophil phagocytosis of bacteria
Non-specifically activated T cells
The inability to activate B cells
Major Histocompatibility complex
Feedback
Immune complexes are formed from the binding of an antibody to an antigen.

Immune complexes may themselves cause disease when they are deposited in organs,
e.g. in certain forms of vasculitis. Immune complex deposition is an associated feature
of several autoimmune diseases, including systemic lupus erythematosus,
cryoglobulinemia, rheumatoid arthritis, scleroderma and Sjgren's syndrome.

Match terms to IgG molecule illustration:
Heavy chain A
Light chain B
Antigen binding occurs here C
Variable region D
Feedback
A = Heavy chain
B = Light chain
C = Antigen binding occurs here
D = Variable region
Patient 1234 has a positive antinuclear antibody (ANA) test with a centromere pattern
at a 1:1280 titer.
Surprised by the result, the clinician calls and says the patient is only having mild
stiffness of her fingers and asks your opinion of the result. Which is your best reply?
You point out that centromere antibodies have been known to occur years prior
to the onset of the disease and the patient should be carefully examined and
monitored for the development of other symptoms.
You comment that it's common to over-read ANA results and since the ANA
testing is not diagnostic and prone to false results it's unlikely the results are of
any concern.
You state that the ANA results alone are diagnostic of systemic sclerosis and
since there is no cure for this disease the clinician is powerless to do anything.
Feedback
Centromere antibodies can precede the diagnosis by 10 to 15 years. While the ANA
alone is not diagnostic this patient is having clinical symptoms of stiff fingers that fits
nicely with the centromere ANA pattern. Early diagnosis and early treatment are
important to improve quality of life for the patient.
Prozone is usually found in:
those tubes of titration which contain the least concentration of antibody

the serum of a patient who has more than one antibody
a patient sample in which the serum contains a high titer of antibody
a patient sample in which the serum has been inactivated before titering
the presence of ionic clouds
Feedback
Prozone is a phenomenon in which titers of specific antigen and antibody do not

agglutinate or precipitate visibly because of an excess in antibody. Therefore the
correct answer is "a patient sample in which the serum contains a high titer of
antibody".
Match antibody group with corresponding descriptor:
IgG - IgM Fixes complement via classical pathway

IgM Largest antibody, pentamer
IgG Crosses placental barrier
IgE Immediate hypersensitivity
Feedback
Both IgG and IgM can activate complement. IgM is the largest immunoglobulin, as it
is a pentamer. IgG immunoglobulins have the ability to cross the placental barrier.
Finally, immediate hypersensitivity reactions are associated with IgE
immunoglobulins.
During which stage in real-time PCR can the fluorescent signal start to be recorded?
Plateau stage
Exponential stage
Leveling stage
Feedback
In real-time PCR the fluorescent signal is generally too low to detect until after the
first couple of cycles. However, detection usually occurs before the end of the
exponential stage.
The immunoglobulin molecule is made up of both heavy and light chains - the light
chains can be comprised of which of the following:
Alpha or beta
Alpha or lambda
Kappa or beta
Kappa or lambda
Feedback
Only kappa or lambda chains can compose the light chains of an immunoglobulin
molecule.
When are data collected in a real-time PCR procedure?
Prior to addition of fluorescent dyes or probes

At a single endpoint
During nucleic acid amplification
Feedback
In real-time PCR, data are collected during nucleic acid amplification rather than at a
single endpoint.
A cause of FALSE-POSITIVE results in the rapid plasma reagin (RPR) test for
syphilis is:
Gastroenteritis
Gonococcal urethritis
Infectious monocucleosis
Streptococcal pharyngitis
Feedback
The RPR test can show false positive results in the absence of syphilis if infectious
mononucleosis, SLE, antiphospholipid antibody syndrome, hepatitis A, leprosy, or
malaria are present.
Which antinuclear antibody (ANA) testing pattern shown below is homogeneous?
Note: (a) points to the nucleus (nuclei) of the interphase cell(s), the primary
consideration for discerning the ANA pattern and (b) indicates the metaphase mitotic
cells. Observing the chromosomal area and cytoplasm of the metaphase cell may
assist in identification of the ANA pattern.
Pattern A
Pattern B
Pattern C
Feedback
In order for the ANA test to be positive there must be a clearly discernible pattern in
the nucleus of the interphase cells. Metaphase mitotic cells are used to assist in
identification of the ANA pattern.
Pattern A is homogeneous. This pattern is characterized by smooth staining in the

nucleus of the interphase cells (a). The nucleoli may or may not stain. Notice the
smooth staining in the chromosomal area of the metaphase mitotic cells (b).
Pattern B is nuclear membrane. This pattern is characterized by smooth staining in the

nucleus of the interphase cells (a). The nucleoli may or may not stain. Notice however
the chromosomal area of the metaphase mitotic cells is negative (b).
Pattern C has no clearly discernable pattern in the nucleus of the interphase cells (a).
However, there is a discernable pattern staining in the cytoplasm (b). This pattern is
characteristic of anti-golgi antibodies.
Which of the following are useful serological tests to document antecedent

Streptococcal infections:
ASO
anti-DNAse
M-antigen
Hemolysin
Feedback
ASO (antistreptolysin O titer) and DNAse (antideoxyribonuclease-B titer) are tests

that can be used to detect antecedent streptococcal infections. The ASO is usually
utilized to determine whether a previous group A Streptococcus infection has caused a
poststreptococcal disease, such as rheumatic fever, scarlet fever, or
glomerulonephritis. The anti-DNase test is utilized to determine whether a previous
infection of group A beta-hemolytic Streptococcus has occured.
Phagocytosis by reticuloendothelial cells is greatly enhanced by:
hemolysins
opsonins
specific antitoxins
protective (neutralizing) antibodies
chemokines
Feedback
Opsonins, through a process of opsonization, mark cells, particles, or microbes for

phagocytosis by reticuloendothelial cells.

Which method remains the gold standard for ANA detection?
Radioimmunoassay (RIA)
Lateral Flow Immunoassay
Enzyme Immunoasay (ELISA)
Slide-based immunofluorescent assay (IFA) or Colorzyme
Feedback
Slide-based ANA tests using HEp-2 or HEp-2000 cells are the gold standard.
Dozens of different antibodies can be detected using slide-based assays. Solid phase
assays such as bead and ELISA assays lack sensitivity, resulting in an unacceptable
number of false negative results.
RIAand Lateral flow are not methods used for ANA testing.
How does the secondary immune response differ from the primary immune response?
IgG is the predominant antibody class produced in the secondary immune

response
The antibody levels produced are higher in the secondary immune response
The lag phase (the time between exposure to antigen and production of antibody)
is shorter in the secondary
The primary immune response typically does not involve specific IgG antibody
All of the above
Feedback
All of the above choices are correct when differentiating the secondary immune
response differ from the primary immune response. In the secondary immune
response:
IgG is the predominant antibody class produced in the secondary immune

response
The antibody levels produced are higher in the secondary immune response
The lag phase (the time between exposure to antigen and production of
antibody) is shorter in the secondary
The primary immune response typically does not involve specific IgG
antibody
The prozone effect can be described by all of the following EXCEPT:
Results in a false negative reaction

The result of antibody excess
Dilution of antibody can help prevent its occurrence
Results in a false positive reaction
Feedback
The only statement that is not true of prozone is the last answer choice.
The remaining answers all describe the prozone effect. Prozone is the result of
antibody excess; it appears as a false negative, which becomes positive as the patient's
serum is diluted.

What temperature is considered optimal for Taq polymerase activity?
20oC
72oC
95oC
Feedback
Taq polymerase has optimal activity at 72C but can survive up to 95C.
Which immune elements are involved in a POSITIVE TB skin test?
IgE
T cells and macrophages
Nkcells and IgG antibodies
B cells and IgM antibodies
Epithelial skin cells
Feedback
When the tuberculosis (TB) skin test is performed, the T-lymphocyte cells with
receptor sites for tuberculosis antigens will produce a positive test result. The T-
lymphocytes secrete cytokines which attract macrophages to the site of the skin test.
Together these cells cause the swelling pattern to occur in the characteristic positive
skin test.
B lymphocytes and T lymphocytes are derived from:
Hematopoietic stem cells

Macrophages or Monocytes
Mucosa-associated lymphoid tissue (MALT)
The fetal liver
Bone marrow
Feedback
All lymphocytes originate, and are therefore derived from, hematopoietic stem cells
via hematopoiesis. The stem cells eventually mature into common lymphoid
progenitor cells. The progenitor cells then differentiate into their distinct lymphocyte
types. B cells mature into B lymphocytes in the bone marrow, while T cells migrate to
and mature in the thymus.
The prozone effect ( when performing a screening titer) is most likely to result in:
False positive
False negative
No reaction at all
Mixed field reaction
Feedback
Prozone effect (due to antibody excess) will result in an initial false negative in spite
of the large amount of antibody in the serum, followed by a positive result as the
specimen is diluted.
This antinuclear antibody (ANA) test is viewed using fluorescent microscopy. The
pattern is characterized by staining of the nucleoli in the nuclei of the interphase cells
(a). Which pattern is this?
Note: (a) points to the nuclei of the interphase cells, the primary consideration for
discerning the ANA pattern and (b) indicates a metaphase mitotic cell. Observing the
chromosomal area and cytoplasm of the metaphase cell may assist in identification of
the ANA pattern.
Nuclear lamins
SSA/Ro
Nucleolar
Large speckled
Feedback
Nucleolar is correct.
This pattern is characterized by staining in the nucleoli of the interphase cells (a). The
nucleolar staining can display subtle variations in staining inside the nucleoli
including smooth, speckled and clumpy. All are reported as ANA positive, Nucleolar.
In this sample staining is present in the chromosomal area of the metaphase mitotic
cells (b) along with some staining in the area outside of the chromosomal area. The
staining of the mitotics can be different with different anti-nucleolar antibodies.
Remember the ANA pattern is determined by staining in the interphase cells and the
mitotics are used to assist in interpretation.
The most common rapid slide test (MONOSPOT) for infectious mononucleosis
employs:
Horse erythrocytes
Sheep erythrocytes
Intact beef erythrocytes
None of the above
Feedback
A positive spot test shows agglutination of horse erythrocytes when added to patient
serum previously absorbed with guinea pig kidney, but not when added to patient
serum previously absorbed with beef erythrocyte stroma. The test is generally simple,
sensitive, and specific, but false negative are common in young children with
mononucleosis.

A patient has the following test results:
ANA = positive 1:320

RA = positive
Complement = decreased
The above results would be seen in patients with:
rheumatic fever
rheumatoid arthritis
lupus erythematosus
glomerulonephritis
lyme disease
Feedback
The ANA test, or anti-nuclear anitbody, is a screening test used to detect lupus
erythematosus. In this case the ANA test was positive. The RA test, or rheumatoid
factor, screens for the presence of an antibody linked with rheumatoid arthritis and
other conditions such as lupus erythematosus. Again, in this case, the RA test was
positive. Finally, a decrease in complement proteins indicates that the classic pathway
may have been activated resulting in immune complexes, a clinically significant
symptom of lupus erythematosus.
Which of the following is responsible for humoral response:

Neutrophils
Basophils
B lymphocytes
Monocytes
Feedback
In the humoral response, B-lymphocytes are stimulated to when an antigen binds to its
surface receptors. This sensitizes or primes the B cell and it undergoes clonal
selection, where it reproduces asexually by mitosis. Most of the family of clones
become plasma cells. These cells produce antibodies while other B cells become long-
lived memory cells.
The part of the molecule responsible for differences among immunoglobulin classes
is:
Fc
Fab
heavy chains
light chains
Hinge regions
Feedback
Antibodies are differentiated based on their heavy chains; different heavy chains
create different isotypes. Humans have five different isotypes of immunoglobulins.

Which complement component is found in both classical and alternative pathways?
C1
C4
factor D
C3
Factor B
Feedback
C3 activates both classical and alternative complement activation pathways.

Individuals with C3 deficiency are susceptible to bacteria infection as they will not be
able to mount a complement response against the bacteria.
In real-time PCR procedures, fluorescence resonance energy transfer (FRET) is the

process that allows for probes to emit fluorescence only after hybridization.
True
False

The best way to evaluate single nucleotide polymorphism (SNP) is by melting curve
analysis
True
False
Feedback
The use of real-time PCR can detect differences as small as one base pair in a DNA
segment.
Corneal tissue may be transplanted successfully from one patient to another because:
Anti-corneal antibodies are easily suppressed

Corneal antigens do not activate T cells
The cornea is non-antigenic
The cornea occupies a privileged site not usually seen by the immune system
The cornea has the same DNA in everyone.
Feedback
No HLA matching is performed for corneal tissue transplants as the cornea occupies a
privileged site not usually seen by the immune system. This term has been coined
"immune privileged".

The strength with which a multivalent antibody binds a multivalent antigen is termed
the:
Affinity
Avidity
Reactivity
Valence
Feedback
Avidity is a measure of the overall strength of binding of an antigen with many

antigenic determinants and multivalent antibodies. Avidity is influenced by both the
valence of the antibody and the valence of the antigen.
In terms of immunology, which one of the following statements is TRUE?
Acute phase proteins help to deactivate the complement process.

Fibronectin opsonizes bacteria and promotes their rapid phagocytosis.
Thiocyanate is a secretory molecule found in skin secretions.
Tumor Necrosis Factor reduces phagocytosis at the site of infection.
Feedback
Fibronectin opsonizes bacteria and promotes their rapid phagocytosis. The remaining
choices are incorrect, as acute phase proteins NOT help to deactivate the complement
process, thiocyanate is NOT a secretory molecule found in skin secretions, and tumor
necrosis factor does NOT reduce phagocytosis at the site of an infection.
Which of the following immunoglobulin classes is chiefly responsible for the

degranulation of mast cells and basophils:
IgG
IgA
IgM
IgE
Feedback
IgE levels are often increased in patients with allergic disease. IgE binds to the
membranes of mast cells and basophils, and if specific antigen is present to react with
the IgE molecule, degranulation of these cells occurs, releasing histamines, and other
substances into the blood or tissues.
=================
Patients with Waldenstrom's macroglobulinemia demonstrate excessively increased

concentrations of which of the following?
IgG
IgM
IgA
IgD
IgE
Feedback
Waldenstrom's macroglobulinemia is the result of lymphoplasmacytic lymphoma

typically characterized by the production of a large amount of monoclonal IgM
antibody.
The hepatitis B virus vaccine was administered to MLS students during

Orientation.Which type of immunity is expected to develop and provide long-term
protection?
active
passive
adoptive
innate
inactive
Feedback
The hepatitis B vaccine is a series of immunizations consisting of three injections of

the hepatitis B antigen. The antigen causes the recipient of the injection to make
antibodies against the antigen, hence why this is an example of active immunity.

Patients with antibody to the following antigen are immune to Hepatitis B:
Core antigen
Surface antigen
e antigen
Delta antigen
Feedback
Patients who have antibodies directed against the hepatitis B surface antigen, or anti-
HBs, have an immunity to hepatitis B. This is the principle behind hepatitis B
vaccinations as proteins associated with the hepatitis B surface antigen are
administered to an individual, who then produces an immune response against the
surface antigen. The antibodies produced through this process allows for the
immunization against the hepatitis B virus.

Given the following results, what is the immune status of the patient?
HbsAg - neg
HbeAg - neg
Anti-Hbc - neg
anti-HBs - pos
anti-HBe - neg
acute infection
chronic infection
immunization
susceptible
Feedback
Anti-HBs is expected to be positive post-vaccination. Since there are no other
antigens or corresponding antibodies present in the patient sample, it is likely that
patient has been immunized to hepatitis B and is no longer susceptible.

HbsAg - neg
HbeAg - neg
Anti-Hbc - neg
anti-HBs - pos
anti-HBe - neg
acute infection
chronic infection
immunization
susceptible
Feedback
Anti-HBs is expected to be positive post-vaccination. Since there are no other

antigens or corresponding antibodies present in the patient sample, it is likely that
patient has been immunized to hepatitis B and is no longer susceptible.
HbsAg: positive
HbeAg: positive
Anti-HBc IgM: positive
Anti-HBs: negative
acute infection
chronic infection
immunization
susceptible
Feedback
HbsAg is positive in acute and chronic Hepatitis B infections, since the antigen is
found on the actual surface of the virus. HbeAg is present in the blood when the
hepatitis B viruses are replicating, indicating an active infection. Anti-Hbc IgM is
present due to the immune response to the presence of the hepatitis core antigen and
indicates an acute infection. Anti-HBs is generally interpreted as indicating recovery
and immunity from hepatitis B virus infection, according to the CDC.
The Western Blot Assay is used as a confirmatory test for which of the following:
HBsAg
CMV Antibody
Anti-HCV
Anti-HIV-1
Feedback
Western blot testing is the gold standard for anti-HIV-1 confirmation.

Which of these may contribute to the development of an autoimmune disease?

(Choose all that apply)
Genetic predisposition
Exposure to a triggering event
Low birth weight
Gender
Feedback
Genetic predisposition may make some individuals more susceptible to development

of an autoimmune disease. An event that triggers the body to perceive antigens as
foreign may also lead to the development of an autoimmune disease. Another factor is
gender; women are more likely to develop an autoimmune disease.
There is no evidence that low birth weight would lead to development of an

autoimmune disorder.
Which is not an application of real-time PCR?
Diagnosis of infectious diseases

Measurement of gene transcription
Drug therapy efficacy
Amplification of DNA for northern blot
Feedback
The amplification of DNA for northern blot is not an application of real-time PCR.
However, real-time PCR can be used to: diagnose infectious diseases, measure gene
transcription, measure drug therapy efficacy, and more. In contrast to regular reverse
transcriptase-PCR and analysis by agarose gels, real-time PCR gives quantitative
results. An additional advantage of real-time PCR is the relative ease and convenience
of use compared to some older methodologies.
There are two patterns present in this microscopic field from an antinuclear antibody
ANA test. The test is viewed using fluorescent microscopy. One pattern can be seen in
the interphase cells (a) and the area outside of the chromosomal area of the mitotics
(b). The other pattern is recognizable in the chromosomal area of the metaphase
mitotic cells (c). What are these two patterns?

Centromere
Homogeneous
Speckled
Nucleolar
Feedback
This is an example of a mix of homogeneous and speckled ANA patterns.
In this sample notice the speckled ANA is the dominant pattern in the interphase cells
(a) and some speckling in the area outside of the chromosomal area of the mitotics
(b).
Also notice the smooth staining of the chromosomal area of the metaphase mitotic
cells (c). This represents the presence of a homogeneous ANA pattern.

The image on the right represents the result of a fluorescent antinuclear antibody
(ANA) test. What pattern should be reported?
Note: (a) points to the nuclei of several interphase cells, the primary consideration for
discerning the ANA pattern and (b) indicates a metaphase mitotic cell. Observing the
chromosomal area and cytoplasm of the metaphase cell may assist in identification of
the ANA pattern.
Homogeneous
Speckled
Nucleolar
Centromere
Feedback
Centromere. This pattern is characterized by staining of discrete speckles in the

nucleus of the interphase cells. This is staining of the centromere. There are usually
46 speckles one for each set of chromosomes. Notice the discrete speckling is also
seen in the chromosomal area of the metaphase mitotics.
The Homogeneous ANA pattern is characterized by smooth staining in the nucleus of

the interphase cells. The nucleoli may or may not stain. Notice the smooth staining in
the chromosomal area of the metaphase mitotic cells.
The Speckled ANA pattern is characterized by granular/speckled staining in the
nucleus of the interphase cells and an absence of staining in the chromosomal area of
the metaphase mitotic cells.
The Nucleolar ANA pattern is characterized by staining in the nucleoli of the

interphase cells.

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You answered the question correctly.

The primary purpose of neutrophil granules is to:

The correct answer is highlighted below

facilitate nuclear maturation.

Neutrophil granules provide enzymes for hydrolytic substrate break-down, kill

Question Difficulty: Level 4

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The correct answer is highlighted below

Requirement of a large initial sample

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Which of the following is NOT true about real-time RT-PCR?

The correct answer is highlighted below

It is the most sensitive method for evaluating RNA

Question Difficulty: Level 6

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Which part of the immunoglobulin molecule is responsible for activating

The correct answer is highlighted below

The Fc portion of immunoglobulin can activate the classical complement pathway,

Question Difficulty: Level 6

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What is the first step of the PCR reaction?

The correct answer is highlighted below

The steps in the PCR process are:

Denaturation (Turning double stranded DNA into single strands.)

Annealing/Hybrization (Attachment of primers to the single DNA strands.)

Extension (Creating the complementary strand to produce new double

Question Difficulty: Level 4

If an antinuclear antibody indirect immunofluorescence test shows a positive,

The correct answer is highlighted below

In systemic lupus erythematosis, a speckled ANA pattern is noted. To help confirm

Question Difficulty: Level 6

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Which disease is MOST likely to show a homogenous pattern in an

The correct answer is highlighted below

Mixed connective tissue disease (MCTD)

Question Difficulty: Level 4

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The rheumatoid factor in rheumatoid arthritis is PRIMARILY which type of

The correct answer is highlighted below

Rheumatoid Factor (RF) is an antibody against the Fc portion of IgG molecules. It is

Question Difficulty: Level 7

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The correct answer is highlighted below

Question Difficulty: Level 3

You answered the question correctly.

A patient has the following test results:

ANA = positive 1:320

The above results would be seen in patients with:

The correct answer is highlighted below

You answered the question correctly.

Which of the following is not a feature of systemic lupus erythematosus (SLE):

The correct answer is highlighted below

Increased serum complement

Complement is actually consumed during the immune reactions involved in SLE.

Question Difficulty: Level 6

You answered the question correctly.

The correct answer is highlighted below

Question Difficulty: Level 3

The correct answer is highlighted below

ELISA test for the Hepatitis B Surface Antigen (HBsAg)

Question Difficulty: Level 6

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The correct answer is highlighted below

By definition, prozone is a phenomena occur in immunological reactions when the