Assessment IS Flashcards

Question

Which immunologic mechanism is usually involved in BRONCHIAL ASTHMA? a. Immediate hypersensitivity b. Immune complex c. Antibody mediated cytotoxicity d. Delayed hypersensitivity

Answer 1

a. Immediate hypersensitivity

Answer 2

b. Gerald Edelman, Rodney Porter

Answer 3

c. Susumu Tonegawa

Answer 4

d. They kill target cells without prior exposure to them

Answer 5

b. Dendritic cell

Answer 6

b. Chromosome 6

Answer 7

b. Clusters of differentiation (CD)

Answer 8

a. Ankylosing spondylitis

Answer 9

b. IgM and IgD

Answer 10

d. Synthesis of antibody

Answer 11

c. T cytotoxic

Answer 12

b. Effective against virally infected cells

Answer 13

b. Epitope

Answer 14

c. IgM and sIgA

Answer 15

c. IgG and IgM

Answer 16

d. Serum sickness

Answer 17

a. Rheumatoid arthritis

Answer 18

c. Primary biliary cirrhosis

Answer 19

b. Chronic active hepatitis

Answer 20

c. Hereditary angioedema

Answer 21

c. CRP and serum amyloid A

Answer 22

c. Systemic lupus erythematosus

Answer 23

b. Hinge region

Answer 24

b. Louis Pasteur ## Footnote STEVENS, TURGEON Louis Pasteur is generally considered to be the Father of Immunology.

Answer 25

a. Dendritic cell ## Footnote Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

Answer 26

c. Dendritic cell ## Footnote Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

Answer 27

c. Contain surface immunoglobulins ## Footnote B cells carry surface immunoglobulins that react to a specific antigen. The antigen can then be internalized processed and presented to an appropriate T helper cell. B cells are not phagocytic, nor do they participate in antibody-dependent cellular cytotoxicity (ADCC) reactions. Complement proteins are secreted by hepatocytes.

Answer 28

d. Maternal IgG ## Footnote Antibody production is immunogen induced. Because the fetus develops in a sequestered site, it makes very little immunoglobulin. Maternal IgG crosses the placenta and is the primary antibody found in infant's circulation.

Answer 29

c. IgG ## Footnote Immunoglobulin G is Ihe predominant class of immunoglobulin found in serum. It accounts for approximately 80% of the total serum immunoglobulin. The normal range is 800-1600 mg/dL.

Answer 30

d. IgM ## Footnote The IgM molecule is a pentamer that contains 10 binding sites. However, the actual valence falls to 5 with larger antigen molecules, probably because of steric restrictions. IgA, IgG, IgD, and IgE monomers each have two antigenic binding sites.

Answer 31

d. An immediate allergic reaction ## Footnote Type I hypersensitivity reactions occur immediately after second exposure to an allergen. On the first, or primary, exposure, IgE specific to the allergen is produced. The IgE binds to Fc receptors on the surface of basophils and mast cells. Immune complexes and complement are not involved in the response.

Answer 32

c. Immunodeficiency with decreased or dysfunctional T and B cells ## Footnote SCID is defined as a condition in which adaptive immune responses (i.e., cell-mediated and humoral-mediated immune responses) do not occur because of a lack of T and B cell activity. A number of genetic defects can lead to this condition. Children born with SCID need to live in a sterile environment, and they have a short life expectancy.

Answer 33

d. IgM ## Footnote The first B cells to respond to antigen differentiate into plasma cells that produce IgM antibody. Later in the immune response, stimulated B cells undergo a phenomenon called "class switching" and begin to produce antibodies of the IgG, IgA, and IgE classes. High concentration of IgM in patient serum is indicative of a recent infection.

Answer 34

c. Isograft ## Footnote Identical twins have the same genetic makeup. Grafts between them would be isografts or syngeneic grafts.

Answer 35

d .The absence of all immunoglobulins ## Footnote Bruton disease is a congenital form of agammaglobulinemia. It is a sex-linked phenomenon that affects males. Because B cells are not produced, affected males have levels of IgA, IgD, IgE, and IgM undetectable by routine assays. IgG may be absent or present at very low levels.

Answer 36

a. Artificial active ## Footnote Active immunity follows exposure to an antigen that stimulates the recipient to develop his or her own immune response. Vaccines are an example of artificial immunity in that the animal was exposed to the immunogen by the actions of a healthcare provider (unnatural).

Answer 37

c. Artificial passive ## Footnote Artificial passive immunity results following the injection of antibody synthesized by another individual or animal. This type of immunity is only temporary but may be very important in providing "instant" protection from an infectious agent before the recipient would have time to actively synthesize antibody.

Answer 38

d. Phagocytosis by polymorphonuclear cells ## Footnote Innate, or nonspecific, immunity refers to host defenses that are in general present at birth and do not require immunogen stimulation. Phagocytosis of bacteria by polymorphonuclear cells is an example. Cytotoxic T cell activity is part of the adaptive cell-mediated immune response, and antibody production is the mechanism of protection in the adaptive humoral-mediated immune response.

Answer 39

c. Nuclear antigen ## Footnote Antinuclear antibody (ANA) is the most consistent feature of systemic lupus erythematosus (SLE).

Answer 40

a. Type I hypersensitivity reactions ## Footnote Elevated IgE levels are found in type I hypersensitivity reactions. The antibody binds via the Fc portion of the molecule to Fc receptors on mast cells and basophils. When the attached antibody binds its specific allergen, the cell degranulates.

Answer 41

a. Autoimmune disease ## Footnote The immune system recognizes host cells as self and is tolerant to antigens on those cells. The loss of tolerance will result in an autoimmune disease in which the immune system mounts an immune response against self cells. Graft-versus-host disease occurs when a bone marrow graft is incompatible with the host tissue and attacks the host.

Answer 42

a. Does not require previous exposure to an antigen ## Footnote The natural killer (NK) cells destroy target cells through an extracellular nonphagocytic mechanism. NK cells are part of the host's innate resistance and, therefore, do not need previous exposure to an antigen to be active.

Answer 43

d. Type 1 diabetes ## Footnote Destruction of the beta cells in the pancreas results in type 1 diabetes. An autoimmune response destroys the insulin-producing cells.

Answer 44

d. C5 ## Footnote The membrane attack complex forms following the binding of C5 to a biologic membrane. The complex is formed by the sequential addition of C6, C7, C8, and C9. When C5-C8 complex with C9, a tubule is formed that bridges the cell membrane.

Answer 45

c. Neutrophils ## Footnote The first response by the innate immune system consists of an influx of neutrophils into the tissue invaded by bacteria. Monocytes and macrophages, although they are phagocytic cells and part of the innate immune system, play only a minor role in the initial response to bacterial invasion.

Answer 46

b. Type II hypersensitivity reactions ## Footnote Incompatible blood transfusions are examples of a type II hypersensitivity reaction. These reactions are characterized as the antigen being a part of a cell. Antibody binds to the antigen, complement is activated, and the red blood cells are lysed.

Answer 47

d. Thyroid gland ## Footnote Hashimoto disease is a type of thyroiditis due to an autoimmune disease. Patients produce autoantibodies and T cells that respond to thyroid antigens. This results in inflammation and swelling of the thyroid gland (goiter). The autoantibody blocks the uptake of iodine, which results in a decrease in the production of thyroid hormones (hypothyroidism).

Answer 48

b. T lymphocytes ## Footnote Contact dermatitis is a delayed-type hypersensitivity reaction mediated by T cells.

Answer 49

a. Defective T lymphocyte production ## Footnote Congenital thymic hypoplasia (DiGeorge syndrome)

Answer 50

a. Dendritic cell ## Footnote Dendritic cells are considered the most effective APC in the body, as well as the most potent phagocytic cell.

Answer 51

a. Anti-CCP ## Footnote Antibodies to cyclic citrullinated peptide are often found in RF-negative patients with rheumatoid arthritis.

Answer 52

c. Nuclear matrix protein ## Footnote Nuclear matrix proteins (NMPs) are RNA-protein complexes. NMP-22 is shed into the urine in persons with bladder carcinoma and is about 25-fold higher than normal in this condition.

Answer 53

b. CA 15-3 ## Footnote CA 15-3 shares the same antigenic determinant as CA 27.29. The markers are used to monitor treatment and recurrence of breast cancer.

Answer 54

c. HER-2/neu ## Footnote Trastuzumab is an antibody to the HER-2/neu gene product, a tyrosine kinase receptor protein. HER- 2/neu is an oncogene that is overexpressed in some breast cancers. Overexpression is associated with a more aggressive clinical course but responds to treatment with trastuzumab, which blocks the attachment of growth factor to the receptor.

Answer 55

a. Hepatoma ## Footnote AFP is increased in all persons with yolk sac tumors and over 80% of those with hepatoma. Levels above 1000 ng/mL are diagnostic of hepatoma.

Answer 56

b. VH and VL ## Footnote Variations in the variable regions of the heavy and light chains of an immunoglobulin molecule define the idiotype.

Answer 57

c. C1q ## Footnote Mannose-binding lectin (MBL) of the lectin pathway of complement activation is found in circulation complexed with proteinases. It is considered to be similar in structure to C1q of the classical pathway. The MBL-proteinase complex does not require antibody for complement activation.

Answer 58

c. Antibody to thyroid-stimulating hormone receptor ## Footnote Autoantibody to the thyroid-stimulating hormone receptor ultimately causes release of thyroid hormones and a hyperthyroid condition.

Answer 59

d. Type IV ## Footnote Type IV hypersensitivity is the delayed-type hypersensitivity. Skin testing for tuberculosis causes a delayed-type hypersensitivity to intradermally injected antigens in individuals previously exposed to the organism.

Answer 60

b. Bruton’s agammaglobulinemia ## Footnote Bruton’s agammaglobulinemia is typically seen in infancy. These patients present with frequent recurring infections, especially after protective maternal antibody is gone and normal levels of circulating T cells. The syndrome is a genetic B cell enzyme deficiency in which the B cells fail to differentiate and mature to antibody-producing plasma cells.

Answer 61

d. C1 Inhibitor ## Footnote Hereditary angioedema is characterized by recurrent swelling. The condition is genetic or can be acquired and is the result of a deficiency of the complement protein C1 Inhibitor.

Answer 62

a. DiGeorge’s syndrome ## Footnote DiGeorge syndrome is the most likely cause. In this syndrome the thymus fails to develop before birth. These patients also show a marked decrease in T cells.

Answer 63

b. Chronic granulomatous disease ## Footnote Chronic granulomatous disease is an inherited disease that impairs the neutrophil’s ability to kill certain bacteria. The neutrophils lack the enzyme nicotinamide adenine dinucleotide phosphate oxidase, easily demonstrated by the failure to reduce nitroblue tetrazolium or produce a blue end result. These patients have normal levels of lymphocytes.

Answer 64

c. Hyperacute ## Footnote The hyperacute tissue graft reject occurs within minutes to hours of a transplant and is typically associated with transplantation across ABO blood groups and anti-ABO antibodies.

Answer 65

d. Procalcitonin ## Footnote Procalcitonin (PCT) is a biomarker that exhibits greater specificity than other proinflammatory markers (e.g., cytokines) in identifying patients with sepsis and can be used in the diagnosis of bacterial infections.

Answer 66

c. Kupffer cells ## Footnote MACROPHAGES NOMENCLATURE IN DIFFERENTTISSUES CNS - Microglial cells Kidney - Mesangial cells Liver - Kupffer cells Lung - Alveolar macrophage Lymph node - Lymph node macrophage Spleen - Splenic macrophage

Answer 67

a. pH 5.6 ## Footnote Lactic acid in sweat, for instance, and fatty acids from sebaceous glands maintain the skin at a pH of approximately 5.6. This acidic pH keeps most microorganisms from growing.

Answer 68

b. Calcium ## Footnote C1 forms the recognition unit of the complement pathway. It consists of three subunits stabilized by calcium.

Answer 69

d. Hashimoto's thyroiditis ## Footnote Hashimoto’s thyroiditis is an autoimmune disorder that results in hypothyroidism. More than 80% of the patients with the disease have serum anti-thyroglobulin and anti-microsomal antibodies

Answer 70

b. ANCA ## Footnote ANCA: ANTINEUTROPHILIC CYTOPLASMIC ANTIBODY

Answer 71

c. IgM, IgD ## Footnote IgM and IgD are the classes of immunoglobulin that are found on most circulating B cells. They are in effect the B cell receptor.

Answer 72

d. Wiskott-Aldrich syndrome ## Footnote Wiskott Aldrich syndrome is an X-linked recessive defect that exhibits immunodeficiency, eczema and thrombocytopenia.

Answer 73

b. False-negative reaction

Answer 74

d. Diagnosis of monoclonal gammopathies

Answer 75

a. Direct immunofluorescent assay

Answer 76

b. Indirect fluorescence

Answer 77

c. Inhibition immunofluorescent assay

Answer 78

b. Inverse

Answer 79

c. Less fluorescence polarization

Answer 80

c. Denaturation→Annealing→Extension ## Footnote The PCR process results in identical copies of a piece of double-stranded DNA. The process involves three steps that are repeated to double the number of copies produced with each cycle. The first step is denaturation to separate the complementary strands. Annealing occurs when a primer binds upstream to the segment of interest on each strand, called the template. Extension involves the enzymatic addition of nucleotides to the primer to complete the new strand.

Answer 81

a. Heat ## Footnote In PCR, the separation of dsDNA occurs by heating the sample. This breaks the double bonds between the base pairs and is reversible by lowering the temperature.

Answer 82

c. 94 °C ## Footnote DENATURATION: 94C ANNEALING: 50 to 58C or higher EXTENSION: 72C

Answer 83

c. Hepatitis B surface antigen (HBsAg)

Answer 84

c. Hepatitis B core antibody

Answer 85

d. Anti-HBs

Answer 86

d. Chronic hepatitis B virus infection ## Footnote Persons with chronic HBV infection show a positive test result for anti-HBc (IgG or total) and HBsAg but not anti-HBs. Patients with active chronic hepatitis have not become immune to the virus.

Answer 87

d. All of the above

Answer 88

d. Anti-HCV

Answer 89

c. CD4+ T lymphocytes

Answer 90

b. Kaposi’s sarcoma

Answer 91

d. p24 ## Footnote In HIV-1 infection, antibodies to the gag proteins p24 and p55 appear relatively early after exposure to the virus, but tend to decrease or become undetectable as clinical symptoms of AIDS appear. Antibodies to the envelope proteins gp41, gp120, and gp160 appear slightly later but remain throughout all disease stages in an HIV-infected individual, making them a more reliable indicator of the presence of HIV.

Answer 92

d. HIV-1 and HIV-2 antibodies and p24 antigen ## Footnote FIRST GENERATION Solid-phase, indirect Anti-HIV1 SECOND GENERATION Indirect binding Anti-HIV1, anti-HIV2 THIRD GENERATION Sandwich technique Anti-HIV1, anti-HIV2 Simultaneously detecting HIV antibodies of different immunoglobulin classes, including IgM FOURTH GENERATION Detects anti-HIV1, anti-HIV2 and p24

Answer 93

d. Bands at p24 and gp120 ## Footnote Criteria for determining a positive test result have been published by the Association of State and Territorial Public Health Laboratory Directors and CDC, the Consortium for Retrovirus Serology Standardization, the American Red Cross, and the FDA. According to these criteria, a result should be reported as positive if at least two of the following three bands are present: p24, gp41, and gp120/gp160.

Answer 94

c. Gel ## Footnote In an RID test system, for example, one measuring hemopexin concentration, the gel would contain the antihemopexin. A standardized volume of serum containing the antigen is added to each well. Antigen diffuses from the well into the gel and forms a precipitin ring by reaction with antibody. At equivalence, the area of the ring is proportional to antigen concentration.

Answer 95

c. Nonidentity between wells 1 and 2 ## Footnote Crossed lines indicate nonidentity between wells 1 and 2. The antibody from well 1 recognizes a different antigenic determinant than the antibody from well 2.

Answer 96

b. Result will be falsely increased ## Footnote If unbound enzyme-conjugated anti-immunoglobulin is not washed away, it will catalyze conversion of substrate to colored product, yielding a falsely elevated result.

Answer 97

b. Result will be falsely increased ## Footnote If the color reaction is not stopped within the time limits specified by the procedure, the enzyme will continue to act on the substrate, producing a falsely elevated test result.

Answer 98

a. Possible false-positive result ## Footnote Failure to follow directions, as in this case where the reaction was allowed to proceed beyond the recommended time, may result in a false-positive reading. Drying on the slide may lead to a possible erroneous positive reading.

Answer 99

a. Decreased numbers of CD4 T cells.

Answer 100

d. 1:2 ## Footnote An inverted CD4:CD8 ratio (less than 1.0) is a common finding in an AIDS patient. The Centers for Disease Control and Prevention requires a CD4-positive (helper T) cell count of less than 200/μL or 14% in the absence of an AIDS-defining illness (e.g., Pneumocystis carinii pneumonia) in the case surveillance definition of AIDS.

Answer 101

a. Hepatitis A ## Footnote Hepatitis A is spread through the fecal–oral route and is the cause of infectious hepatitis. Hepatitis A virus has a shorter incubation period (2–7 weeks) than hepatitis B virus (1–6 months). Epidemics of hepatitis A virus can occur, especially when food and water become contaminated with raw sewage. Hepatitis E virus is also spread via the oral–fecal route and, like hepatitis A virus, has a short incubation period.

Answer 102

a. HBsAg ## Footnote Hepatitis B surface antigen (HBsAg) is the first marker to appear in hepatitis B virus infection. It is usually detected within 4 weeks of exposure (prior to the rise in transaminases) and persists for about 3 months after serum enzyme levels return to normal.

Answer 103

b. Anti-HBc IgM ## Footnote Antibody to the hepatitis B core antigen (anti-HBc) is the first detectable hepatitis B antibody. It persists in the serum for 1–2 years post-infection and is found in the serum of asymptomatic carriers of HBV.

Answer 104

b. Alanine aminotransferase (ALT) ## Footnote ALT is a liver enzyme and may be increased in hepatic disease. Highest levels occur in acute viral hepatitis, reaching 20–50 times the upper limit of normal.

Answer 105

c. HIV viral load ## Footnote The HIV viral load will rise or fall in response to treatment more quickly than any of the other listed parameters. The absolute CD4 count is also an indicator of treatment effectiveness and is used in resource-poor areas that might not have facilities for molecular testing available. Note that the absolute CD4 count is not one of the choices, however.

Answer 106

b. Zone of equivalence

Answer 107

a. Radial immunodiffusion

Answer 108

b. It may be too small to produce lattice formation.

Answer 109

d. Agglutination inhibition

Answer 110

a. Direct hemagglutination

Answer 111

a. Anti-HBs

Answer 112

b. Intimate sexual contact.

Answer 113

b. Collection of the test sample before seroconversion.

Answer 114

b. Agglutination occurs when the antigen is particulate ## Footnote Precipitation reactions occur between soluble antigen and soluble antibody that produce a visible end result typically in the form of a visible line of precipitate. Agglutination reactions occur when the antigen is particulate or coated on a particulate such as latex beads.

Answer 115

c. Excess antigen in test ## Footnote PROZONE Antibody excess, false negative Remedy: serum dilution POSTZONE Antigen excess, false negative Remedy: repeat test after a week to give time for antibody production

Answer 116

c. Acute hepatitis B ## Footnote The most likely answer is acute hepatitis B because of the presence of IgM anti-HBc in combination with the hepatitis surface antigen. Typically the presence of IgM indicates the presence of an acute phase of a disease.

Answer 117

d. Nephlometry measures light scattered in a solution, and turbidimetry measures light transmitted through a solution ## Footnote Nepholometry measures light at angles. The light source used for detection is placed at an angle from the detection device. Turbidometry detection devices are placed directly across from the light source and measures the intensity of the light as it passes through solution.

Answer 118

d. Polymorphonuclear leukocytes ## Footnote In addition to T lymphocytes, macrophages, peripheral blood monocytes, and cells in the lymph nodes, skin, and other organs also express measurable amounts of CD4 and can be infected by HIV-1.

Answer 119

c. Staphylococcal protein A ## Footnote Protein A, found in the cell walls of Staphylococcus aureus bacteria, has high affinity for the Fc region of IgG and can be used to bind IgG in some laboratory assays.

Answer 120

b. RAST ## Footnote RIST - measures TOTAL IgE RAST - measures SPECIFIC IgE

Answer 121

a. Affinity

Answer 122

b. Avidity

Answer 123

a. Soluble

Answer 124

a. Destruction of complement

Answer 125

c. Solid phase ## Footnote A variety of solid-phase supports are used, including microtiter plates, nitrocellulose membranes, and magnetic latex beads.

Answer 126

c. Antigen and antibody

Answer 127

d. Enzyme-conjugated

Answer 128

c. Charcoal particles

Answer 129

b. 100 RPM for 8 minutes

Answer 130

a. Treponemal antibody

Answer 131

d. Todd or International Units

Answer 132

c. Rickettsial

Answer 133

d. IFA and micro-IF ## Footnote IFA - indirect fluorescent assays Micro-IF - microimmunofluorescent assay The IFA test and the micro-IF are currently considered the gold standard for detecting rickettsial antibodies.

Answer 134

a. Strains of Proteus vulgaris

Answer 135

a. Inflammation

Answer 136

b. Mycoplasma pneumoniae

Answer 137

b. CREST syndrome ## Footnote Most patients with CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) demonstrate anti-centromere antibody.

Answer 138

c. Crithidia luciliae ## Footnote One particularly sensitive assay for ds-DNA is an immunofluorescent test using Crithidia luciliae, a hemoflagellate, as the substrate. This trypanosome has circular ds-DNA in the kinetoplast. A positive test is indicated by a brightly stained KINETOPLAST with patient serum and an antibody conjugate.

Answer 139

d. Fc portion of IgG

Answer 140

b. Anticardiolipin antibody ## Footnote Reagin is the name for a nontreponemal antibody that appears in the serum of syphilis-infected persons and is detected by the RPR and VDRL assays. Reagin reacts with cardiolipin, a lipid-rich extract of beef heart and other animal tissues.

Answer 141

c. Cardiolipin ## Footnote Cardiolipin is extracted from animal tissues, such as beef hearts, and attached to carbon particles. In the presence of reagin, the particles will agglutinate.

Answer 142

b. Fluorescent T. pallidum antibody absorption test (FTA-ABS) ## Footnote The FTA-ABS test is more specific for T. pallidum than nontreponemal tests such as the VDRL and RPR and would be least likely to detect a biological false-positive result. The FTA-ABS test uses heat-inactivated serum that has been absorbed with the Reiter strain of T. pallidum to remove nonspecific antibodies.

Answer 143

c. CSF ## Footnote If neurosyphilis is present, cerebrospinal fluid serology will be positive and the CSF will display increased protein and pleocytosis characteristic of central nervous system infection.

Answer 144

a. CD4-positive T-cell count and clinical symptoms ## Footnote The classification system for HIV infection is based upon a combination of CD4-positive T-cell count (helper T cells) and various categories of clinical symptoms. Classification is important in determining treatment options and the progression of the disease.

Answer 145

c. Occurs in patients with hepatitis B ## Footnote Hepatitis D virus is an RNA virus that requires the surface antigen or envelope of the hepatitis B virus for entry into the hepatocyte. Consequently, hepatitis D virus can infect only patients who are coinfected with hepatitis B.

Answer 146

b. Only IgM antibodies positive ## Footnote If only IgM antibodies are positive, this result indicates a recent vaccination or an early primary infection.

Answer 147

d. IgM ## Footnote Rheumatoid factor (RF) is an immunoglobulin that reacts with antigenic determinants on an IgG molecule. Although they may be of several types, the one that is easily serologically detectable is IgM. This is because of the agglutination activity of the molecule. RF tests are commonly used in the diagnosis of rheumatoid arthritis.

Answer 148

b. Anti-DNase B ## Footnote The serological diagnosis of group A streptococcal infection can be made by demonstrating anti-DNase B. The antistreptolysin O (ASO) assay can also be used; however, ASO response is poor in skin infections.

Answer 149

c. IgG ## Footnote Staphylococcal protein A binds only the IgG class (subclasses IgG1, IgG2, and IgG4) of immunoglobulin. Binding occurs via the Fc portion of the antibody molecule, leaving the Fab portion available to bind antigen in an immunologic assay.

Answer 150

c. Complexed with charcoal ## Footnote The rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests use a cardiolipin antigen. However, in the RPR test, charcoal particles are included with the antigen. When antibody in the patient sample combines with the antigen, the charcoal is trapped in the immune complex, allowing the reaction to be read macroscopically.

Answer 151

b. Flocculation reaction ## Footnote The cardiolipin antigen is particulate, not soluble, in the VDRL test. However, the particles are too small to make macroscopic agglutinates when combined with antibody. This type of reaction is called a flocculation reaction and needs to be read with low-power microscopy.

Answer 152

d. Systemic lupus erythematosus ## Footnote Patients with connective tissue disorders such as systemic lupus erythematosus may show a false positive reaction in the VDRL test. Other causes of false positives include rheumatic fever, infectious mononucleosis, malaria, and pregnancy.

Answer 153

b. Antinuclear antibody (ANA) ## Footnote Testing for antinuclear antibodies (ANAs) is commonly performed by the immunofluorescence method—using fluorescein-conjugated antihuman antibody to detect patient antibody bound to nuclear components of test cells.

Answer 154

b. It is an indicator of ongoing inflammation. ## Footnote CRP is an acute-phase reactant. Although it is elevated in inflammation, its presence is not diagnostic for any one disease, such as rheumatic fever. It does not correlate with antibody levels or with neutrophil phagocytic function. CRP levels are sometimes elevated during heart disease.

Answer 155

d. Precipitation reactions ## Footnote Precipitation reactions involve both soluble antigens and antibodies. With agglutination reactions, one of the reactants is soluble and the other is insoluble. A reactant is made insoluble by combining with a carrier particle such as latex beads.

Answer 156

d. FTA-ABS ## Footnote The fluorescent treponemal antibody absorbance (FTA-ABS) test is often used as a confirmatory test for syphilis. Treponema pallidum subsp. pallidum, the causative agent of syphilis, is the source of the antigen. The rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) are diagnostic tests for syphilis that use nontreponemal antigen.

Answer 157

c. Lyme disease ## Footnote IMPORTANT! IgM antibody to OspC is an important early marker in the diagnosis of Lyme disease.

Answer 158

d. Epstein-Barr virus ## Footnote INFECTIOUS MONONUCLEOSIS (EBV) The Davidsohn differential test can be used to detect heterophile antibodies produced during infectious mononucleosis. These antibodies are not adsorbed by guinea pig antigens. Therefore, the antibodies are available to agglutinate horse red blood cells.

Answer 159

a. A sibling (brother or sister) ## Footnote Because the human leukocyte antigen (HLA) system is extremely polymorphic, the odds are greatly against finding an HLA-compatible donor in unrelated individuals. The genes coding for HLA antigens are inherited from one's parents and are expressed co-dominantly. Between an offspring and either parent, there is, statistically, a 25% chance of an HLA match. Between siblings, there is a 50% chance of an HLA match.

Answer 160

c. Latex agglutination

Answer 161

b. Immunofluorescence

Answer 162

b. Syphilis

Answer 163

a. Acute rheumatic fever

Answer 164

a. MHA-TP test

Answer 165

d. All of these

Answer 166

d. HSV1 and HSV2

Answer 167

d. Past infection, reactivation of latent infection ## Footnote VCA - VIRAL CAPSID ANTIGEN EBNA - EBV NUCLEAR ANTIGEN EA - EARLY ANTIGEN CHARACTERISTICS DIAGNOSTIC PROFILE OF EBV SUSCEPTIBILITY If the patient is seronegative (lacks antibody to VCA) PRIMARY INFECTION Antibody (IgM) to VCA is present; EBNA is absent. PAST INFECTION Antibodies to VCA and EBNA are present. REACTIVATION If antibody to EBNA and increased antibodies to EA are present, patient may be experiencing reactivation.

Answer 168

a. 72 hours ## Footnote IgM antibodies become detectable 3 to 4 days after appearance of symptoms and persist for 8 to 12 weeks.

Answer 169

a. ELISA ## Footnote Varicella-Zoster virus (VZV) Antibodies ELISA - most common, easiest Automated, provides objective results, and does not require viral culture FAMA - reference method Considered to be the reference method for VZV antibody, it requires live, virus-infected cells and is not suitable for large-scale routine testing FAMA (fluorescent antibody to membrane antigen)

Answer 170

b. IgM anti-HAV

Answer 171

a. Southern blot ## Footnote SNOW DROP S - Southern Blot = D - DNA N - Northern Blot = R - RNA W - Western Blot = P - PROTEINS

Answer 172

a. Plasmodium falciparum ## Footnote HRP-II: Plasmodium falciparum pLDH AND ALDOLASE TESTS: All four Plasmodium spp.

Answer 173

Inverted phase contrast microscopes ## Footnote Trays are usually read on inverted phase contrast microscopes. In the properly adjusted phase, cells that have not been injured appear small, bright, and refractile. Injured cells that have taken up eosin-Y or trypan blue owing to antibody and complement-mediated damage will flatten and appear large, dark, and nonrefractile.

Answer 174

Mouse spleen ## Footnote The production of hybridomas begins by immunizing a mouse with a certain antigen. After a time, the mouse’s spleen cells are harvested. Spleen cells are combined with myeloma cells in the presence of polyethylene glycol (PEG), a surfactant. The PEG brings about fusion of plasma cells with myeloma cells, producing a hybridoma.

Answer 175

Mouse kidney ## Footnote In fluorescent antinuclear antibody (FANA) testing, mouse kidney or human epithelial HEp-2 cells are fixed to a slide and allowed to react with patient serum.

Answer 176

Sheep RBCs ## Footnote The Streptozyme test is a slide agglutination screening test for the detection of antibodies to several streptococcal antigens. Sheep red blood cells are coated with streptolysin, streptokinase, hyaluronidase, DNase, and NADase so that antibodies to any of the streptococcal antigens can be detected.

Answer 177

Spleen ## Footnote In the spleen, immature B cells develop into mature cells known as marginal zone B cells. These B cells remain in the spleen in order to respond quickly to any blood-borne pathogens they may come into contact with. Other immature B cells become follicular B cells, which are found in lymph nodes and other secondary organs.

Answer 178

IgG ## Footnote Most serological tests in clinical use detect H. pylori–specific antibodies of the IgG class. Although IgM antibody is produced in H. pylori infections, testing for its presence lacks clinical value, since most infections have become chronic before diagnosis. Thus, IgG is the primary antibody found. IgA testing has a lower sensitivity and specificity than IgG testing, but it may increase sensitivity of detection when used in conjunction with IgG testing.

Answer 179

Type IV hypersensitivity reaction

Answer 180

Diapedesis

Answer 181

Chemotaxis

Answer 182

Serum amyloid A

Answer 183

Bacterial infections ## Footnote SERUM AMYLOID A It has been found to increase significantly more in bacterial infections than in viral infections.

Answer 184

NK cells ## Footnote Two subsets of NK cells exist—those that have a high level of CD56 and low or no CD16, and those with some CD56 and high levels of CD16.

Answer 185

180 rpm for 4 minutes ## Footnote SERUM VDRL The slide is rotated for 4 minutes on a rotator at 180 rpm. It is read microscopically to determine the presence of flocculation, or small clumps. The results are recorded as reactive (medium to large clumps), weakly reactive (small clumps), or nonreactive (no clumps or slight roughness).

Answer 186

100 rpm for 8 minutes

Answer 187

Basophils and mast cells ## Footnote IgE is best known for its very low concentration in serum and the fact that it has the ability to activate mast cells and basophils.

Answer 188

Eosinophils and neutrophils ## Footnote IgE appears to be a nuisance antibody; however, it may serve a protective role by triggering an acute inflammatory reaction that recruits neutrophils and eosinophils to the area to help destroy invading antigens that have penetrated IgA defenses.

Answer 189

Antigen–antibody complexes

Answer 190

Bacterial cell walls, especially those containing lipopolysaccharide; fungal cell walls; yeast; viruses; virally infected cells; tumor cell lines; and some parasites, especially trypanosomes ## Footnote Triggering substances for the alternative pathway include bacterial cell walls, especially those containing lipopolysaccharide; fungal cell walls; yeast; viruses; virally infected cells; tumor cell lines; and some parasites, especially trypanosomes. All of these can serve as sites for binding the complex C3bBb, one of the end products of this pathway.

Answer 191

Interferons

Answer 192

Down syndrome ## Footnote Causes of increased maternal serum alpha fetoprotein levels? 1. Open neural tube defects such as spina bifida and anencephaly can typically increase MSAFP by double or more. 2. Twins or multiple pregnancies can also increase the result. Cause of decreased maternal serum alpha fetoprotein levels: Down syndrome (trisomy 21) and Edwards syndrome (trisomy 18) can cause as much as a 25% decrease in MSAFP.

Answer 193

Hyperglobulinemia ## Footnote Hypergammaglobulinemia such as polyclonal increase is associated with autoimmune disorders. Hypergammaglobulinemia such as monoclonal increase is associated with such disease states as multiple myeloma, lymphomas, etc.

Answer 194

5.6 ## Footnote Skin at a pH of approximately 5.6 This acidic pH keeps most microorganisms from growing.

Answer 195

Cardiolipin

Answer 196

Fluorescent microscope

Answer 197

Anti-dsDNA ## Footnote Antibodies to dsDNA are present in 70% of patients with lupus and are highly specific for the disease.

Answer 198

Toxoplasmosis

Answer 199

Proteins ## Footnote Formation of hypochlorite and hydroxyl ions damage PROTEINS irreversibly.

Answer 200

Abs to DNA, abs to nucleolar antigens, abs to histone and abs to nonhistone proteins ## Footnote ANAs can be divided into four groups to provide a systematic classification: antibodies to DNA, antibodies to histone, antibodies to nonhistone proteins, and antibodies to nucleolar antigens.

Answer 201

B cells ## Footnote SECOND LINE OF DEFENSE: Cellular 1. Mast cells 2. Neutrophils 3. Macrophages Humoral 1. Complement 2. Lysozyme 3. Interferon

Answer 202

Phagolysosome

Answer 203

IFN-alpha ## Footnote IFN-α has been used to treat hepatitis C and Kaposi’s sarcoma, as well as certain leukemias and lymphomas.

Answer 204

IFN-beta ## Footnote IFN-β is efficacious in treating multiple sclerosis, although the exact mechanism of action remains unclear.

Answer 205

240 ## Footnote A single ASO titer is considered to be moderately elevated if the titer is at least 240 Todd units in an adult and 320 Todd units in a child.

Answer 206

320 ## Footnote A single ASO titer is considered to be moderately elevated if the titer is at least 240 Todd units in an adult and 320 Todd units in a child.

Answer 207

Candida ## Footnote Current recommendations include the combined detection of mannan and anti-mannan antibodies for the specific identification of Candida species in serum samples.

Answer 208

FAMA ## Footnote The most sensitive and reliable method of detecting VZV antibody is a fluorescent test called FAMA (fluorescent antibody to membrane antigen) that detects antibody to the envelope glycoproteins of the virus. While FAMA is considered to be the reference method for VZV antibody, it requires live, virus-infected cells and is not suitable for large-scale routine testing.

Answer 209

ELISA ## Footnote The most commonly used method to detect VZV antibodies in the clinical laboratory is the ELISA because it is automated, provides objective results, and does not require viral culture.

Answer 210

Cytomegalovirus ## Footnote CMV is also the most common cause of congenital infections, occurring in approximately 1 percent of all neonates

Answer 211

EIA ## Footnote Enzyme immunoassays (EIA) for IgM, IgG, or IgA and indirect fluorescent antibody (IFA) assays for IgG are available and should be performed when congenital toxoplasmosis is suspected. IFA testing has been widely used, but EIA is the method of choice, as it is more sensitive, less difficult to perform, and easier to interpret.

Answer 212

PCR ## Footnote Prenatal congenital toxoplasmosis can be diagnosed by performing polymerase chain reaction (PCR) technology on amniotic fluid to detect T. gondii DNA.

Answer 213

PCR ## Footnote Currently, there are no useful serological procedures for diagnosing CNS infection in immunocompromised patients. These individuals often do not produce detectable levels of specific antibody against the parasite, and procedures to detect circulating antigen appear to lack sensitivity. PCR is, therefore, the method of choice to detect T. gondii DNA in CSF.

Answer 214

Innate immunity

Answer 215

They kill target cells without prior exposure to them.

Answer 216

Dendritic cell

Answer 217

Neutrophil

Answer 218

Secondary lymphoid organs

Answer 219

Specificity for each individual pathogen

Answer 220

Produce cytokines that regulate both innate and adaptive immunity

Answer 221

Clusters of differentiation (CD)

Answer 222

Found on host cells

Answer 223

Only immunogens can trigger an immune response

Answer 224

Opsonization

Answer 225

They produce granzymes that stimulate apoptosis.

Answer 226

μ chains in the cytoplasm

Answer 227

Lymph node

Answer 228

Elimination of virally infected cells

Answer 229

Ability to remember a prior exposure to a pathogen

Answer 230

Susumu Tonegawa

Answer 231

They occur on both the H and L chains

Answer 232

Arrangement of disulfide bonds

Answer 233

Heat stable ## Footnote IgE is the most heat-labile of all immunoglobulins; heating to 56°C for between 30 minutes and 3 hours results in conformational changes and loss of ability to bind to target cells.

Answer 234

2 Fab and 1 Fc fragment ## Footnote Papain digestion yields two Fab fragments and an Fc portion. Pepsin digestion yields an F(ab’)2 fragment with all the antibody activity, as well as an Fc′ portion.

Answer 235

There is a large increase in IgG but not IgM

Answer 236

TNF ## Footnote Tumor necrosis factor (TNF) secreted in response to gram-negative bacterial infections, causing a decrease in blood pressure, reduced tissue perfusion, and disseminated intravascular coagulation. The latter may lead to uncontrolled bleeding.

Answer 237

Increase production of certain types of leukocytes

Answer 238

Hereditary angioedema

Answer 239

Radial immunodiffusion ## Footnote The methods most frequently used to measure individual components include radial immunodiffusion (RID) and nephelometry.

Answer 240

Radial immunodiffusion

Answer 241

W+ ## Footnote 0 No agglutination or hemolysis W+ Tiny agglutinates, turbid background 1+ Small agglutinates, turbid background 2+ Medium-sized agglutinates, clear background 3+ Several large agglutinates, clear background 4+ One solid agglutinate

Answer 242

Mixed-field ## Footnote Grading Agglutination Reactions Negative No aggregates Mixed-field A few isolated aggregates; mostly free-floating cells; supernatant appears red Weak (±) Tiny aggregates barely visible macroscopically; many free erythrocytes; turbid and reddish supernatant 1+ A few small aggregates just visible macroscopically; many free erythrocytes; turbid and reddish supernatant 2+ Medium-sized aggregates; some free erythrocytes; clear supernatant 3+ Several large aggregates; some free erythrocytes; clear supernatant 4+ All erythrocytes are combined into one solid aggregate; clear supernatant

Answer 243

3+ ## Footnote Negative: No aggregates Mixed field: A few isolated aggregates; mostly free-floating cells; supernatant appears red Weak (±) Tiny aggregates barely visible macroscopically; many free erythrocytes; turbid and reddish supernatant 1+ A few small aggregates just visible macroscopically; many free erythrocytes; turbid and reddish supernatant 2+ Medium-sized aggregates; some free erythrocytes; clear supernatant 3+ Several large aggregates; some free erythrocytes; clear supernatant 4+ All erythrocytes are combined into one solid aggregate; clear supernatant.

Answer 244

Ligase chain reaction

Answer 245

Size ## Footnote Scattered light in a forward direction is a measure of cell size, whereas the side scatter determines a cell’s internal complexity, or granularity.

Answer 246

Patch test ## Footnote The patch test is considered the gold standard in testing for contact dermatitis.

Answer 247

Antibody to TSH receptors

Answer 248

Anti-tTG ## Footnote CELIAC DISEAS: ANTIBODIES TO TISSUE TRANSGLUTAMINASE (tTG) Currently, detection of IgA antibodies to tTG is the serological method of choice for initial testing.

Answer 249

Primary biliary cirrhosis

Answer 250

ABO ## Footnote The ABO system is the only blood group system that affects clinical transplantation.

Answer 251

Monitoring patients undergoing cancer treatment ## Footnote Tumor markers are best used to monitor patient response to therapy by performing serial measurements over time. If therapy is effective, the amount of tumor marker will decrease. Ineffective therapy and recurrence of cancer is indicated by an increase in the tumor marker level. Ideally, these increases would precede other signs of disease recurrence by several months.

Answer 252

Passive immunotherapy

Answer 253

Defective neutrophil function

Answer 254

Recurrent Neisserial infections

Answer 255

IgD ## Footnote Hyper IgD syndrome, also referred to as periodic fever syndrome, and Muckle-Wells syndrome. Hyper IgD is caused by a deficiency of mevalonate kinase, an enzyme involved in a sterol synthesis pathway. The syndrome has been seen primarily in northern European populations.

Answer 256

It is an important mechanism for protecting a bacterium against ingestion by PMNs ## Footnote One of the most important features of a capsule is its role in blocking phagocytosis by WBCs.

Answer 257

All of these

Answer 258

VDRL ## Footnote A positive VDRL test on spinal fluid is diagnostic of neurosyphilis because false positives are extremely rare.

Answer 259

Make serial dilutions and do a titer. ## Footnote Testing of sera from patients in the secondary stage is subject to false negatives because of the prozone phenomenon (antibody excess). In this case, a nonreactive pattern that is typically granular or rough in appearance is seen. If a prozone is suspected, serial twofold dilutions of the patient’s sera should be made to obtain a titer.

Answer 260

Active immunity

Answer 261

Edward Jenner

Answer 262

Use of attenuated microorganisms in vaccines ## Footnote Louis Pasteur used the principle of attenuation, or weakened microorganisms, to produce vaccines against chicken cholera, anthrax, and rabies.

Answer 263

Recombinant antigen ## Footnote Hepatitis A vaccine - inactivated vaccine Hepatitis B vaccine - recombinant antigen

Answer 264

Haptoglobin

Answer 265

Fibrinogen

Answer 266

Alpha1-antitrypsin

Answer 267

CRP and serum amyloid

Answer 268

Liver ## Footnote Produced by the liver under the control of IL-6, CRP is a parameter of inflammatory activity.

Answer 269

Dendritic cells ## Footnote Dendritic cells, however, are considered the most effective APC in the body, as well as the most potent phagocytic cell.

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