IMMUNOLOGY & SEROLOGY

Discoverer Discovery
Edward Jenner Chinese practice of Insufflation/ Variolation (cowpox),
Smallpox vaccine, Cross immunity
Gregor Mendel Mendelian Inheritance
Louis Pasteur Live attenuated chicken cholera and anthrax vaccine
Ellie Metchnikoff Cellular Theory of immunity, Phagocytosis
Jules Bordet Complement
Paul Ehrlich Antibody Formation Theory
Almroth Wright Opsonins
Salk and Sabin Polio vaccine
Gerald Edelman and chemical structure of antibodies.
Rodney Porter
Georges Kohler & Monoclonal Antibodies
Cesar Milstein
Rosalyn Yallow Radioimmunoassay
Susumu Tonegawa Antibody Diversity
Frazer HPV vaccine
 Question #1

Who received a Nobel prize because of discovering phagocytosis?

A. Kohler & Milstein

B. Susumu Tonegawa
C. Edelman & Porter
D. Ellie Metchnikoff
 Question #2

Which of the following Nobel prize winners focused on the

research concerning production of Monoclonal Antibodies?

A. Jules Bordet
B. Susumu Tonegawa
C. George Kohler and Cesar Milstein
D. Paul Ehrlich
 Question #3

Genetic differences in the antibody (Antibody Diversity) is

credited to:

A. Ellie Metchnikoff
B. Susumu Tonegawa
C. Karl Landsteiner
D. Paul Ehrlich
 Question #4

Jenner’s work with cowpox, which provided immunity against

smallpox, demonstrates which phenomenon?

A. Natural immunity
B. Attenuation of vaccines
C. Phagocytosis
D. Cross-immunity
 Question #5

Which of the following can be attributed to Pasteur?

A. Discovery of opsonins
B. Research on haptens
C. First attenuated vaccines
D. Discovery of the ABO blood groups
What is Attenuation?
üAttenuation involves the use of bacteria or viruses that
have been weakened through exposure to modifying
conditions such as chemical treatment, elevated or cold
temperatures

üThese weakened microorganisms do not cause disease in

healthy individuals, but are able to stimulate the immune
response because they contain many of the same antigens
as their pathogenic counterpart.
 Question #6

Which two organs are considered the primary lymphoid organs

in which immunocompetent cells originate and mature?

A. Thyroid and Peyer’s patches

B. Thymus and bone marrow
C. Spleen and mucosal-associated lymphoid tissue (MALT)
D. Lymph nodes and thoracic duct
Sites of lymphoreticular tissue.
• Primary organs include the bone
marrow and the thymus.
• Secondary organs are distributed
throughout the body and include
the spleen, lymph nodes, and
mucosal-associated lymphoid tissue.
• The spleen filters antigens in the
blood, while the lymphatic
system filters fluid from the
tissues
 Question #7

T cells travel from the bone marrow to the thymus for

maturation. What is the correct order of the maturation sequence
for T cells in the thymus?

A. Bone marrow to the cortex; after thymic education, released

back to peripheral circulation
B. Maturation and selection occur in the cortex; migration to the
medulla; release of mature T cells to secondary lymphoid
organs
C. Storage in either the cortex or medulla; release of T cells into
the peripheral circulation
D. Activation and selection occur in the medulla; mature T cells
are stored in the cortex until activated by antigen
T LYMPHOCYTE SELECTION
• Goal: To produce T lymphocytes (T-cells) that won’t attack self-
antigens when released from the Thymus
• Pre-T cells (Double-Negative Thymocytes) produced from the
bone marrow will migrate to the Thymus for maturation.
• The process of Thymocytes maturation is divided into 2: Positive
Selection and Negative Selection.
• Positive Selection occurs in the Thymic cortex while
• Negative Selection occurs in the Thymic medulla.
• Before the start of Negative selection, Thymocytes first develop
TCR (T-cell receptor), and both CD4 and CD8 molecules.
• Thymocytes with both CD markers is known as Double-Positive
Thymocyte.
• After the development of TCR and CD markers, Positive selection
will start.
 Question #8

In the thymus, positive selection of immature T cells is based

upon recognition of which of the following?

A. Self-antigens
B. Stress proteins
C. MHC antigens
D. μ chains
POSITIVE SELECTION (CORTEX)
• How to survive: Survival depends on
the ability of the Thymocytes to bind
to MHC molecule.
NEGATIVE SELETION (MEDULLA)
• How to survive: Survival depends on the
ability of the Thymocytes to not recognize
self-antigens
 Question #9

Which of the following would represent a double negative

thymocyte?

A. CD2–CD3+CD4–CD8+
B. CD2+CD3–CD4–CD8–
C. CD2–CD3+CD4+CD8–
D. CD2+CD3+CD4+CD8–
 Question #10

Where are all undifferentiated lymphocytes made?

A. Bone marrow
B. Thymus
C. Spleen
D. Lymph nodes
 Question #11

Which of the following organs is NOT part of the immune

system?

A. Thyroid
B. Thymus
C. Spleen
D. Peyer’s patches
 Question #12

Which phagocytic cells are found in the skin, in the linings of

the body's lumen and in those parts that come directly in
contact and with the environment?

A. Dendritic cells
B. Neutrophil
C. Kupffer cells
D. Monocyte
Phagocytic Cells
1. Neutrophil (Segmented neutrophils, Segs, Microphage)
• Principal phagocyte
• 1st WBC to go to the site of infection (Segmented neutrophils are able
to gather quickly at the site of injury because they are actively motile)
• Increased in bacterial and fungal infections
2. Eosinophil
• Regulates the immune response, indirect phagocytosis, increased in
allergic reaction and parasitic infection (makes holes in parasites)
3. Monocyte/ Macrophage
• Largest cell in the peripheral blood
• Slow motility, microbial killing, phagocytosis, secretion of cell mediators
4. Dendritic cells
• Most potent phagocyte, most effective APC
Macrophages according to location in the body

Lungs – aka dust cells

Placenta – Hoffbauer cells
Spleen – Littoral cells
Skin – Langerhans cells
Synovium – Type A lining
cells
 Question #13

Toll-like receptors are found on which cells?

A. T cells
B. Dendritic cells
C. B cells
D. Large granular lymphocytes
• Toll-like receptors (TLR) are the primary antigen recognition
protein of the innate immune system.
• They are found on antigen-presenting cells such as dendritic
cells and macrophages.
• Eleven TLRs have been described.
• TLRs recognize certain structural motifs common to infecting
organisms.
• TLR 4, for example, recognizes bacterial lipopolysaccharide
(LPS).
• Its target organisms are gram negative bacteria
• The name comes from their similarity to the Toll protein
in Drosophila.
Toll-like receptors are found on which cells? Question #13

A. T cells
B. Dendritic cells
C. B cells
D. Large granular lymphocytes
• aka NK cells aka Kiss of death
• First line of defense against cells that are:
ü Virally infected
ü Infected with intracellular pathogen
ü Tumor cells
• They have the ability to recognize damaged cells, and eliminate such
cells without prior exposure
• Markers: CD16 and CD56
• Stimulated by: IL-12, INF-alpha, INF-beta
• Serve as the link between innate and adaptive immunity
 Question #14

Innate immunity includes

A. Anamnestic response
B. Antibody production
C. Cytotoxic T cell activity
D. Phagocytosis by polymorphonuclear cells
 INNATE IMMUNITY ADAPTIVE IMMUNITY
Characteristics Non-specific Specific, Diverse, with
Natural response memory, stimulated
response
Cells Phagocytes, N, E, B, Lymphocytes (B cells, T
Macrophage, Mast cells, cells, NK cells)
Dendritic cells
Response time immediate Slow, delayed (3-5 days)
Memory Little or no memory of With memory of prior
prior antigenic exposure antigenic exposure
Processes Phagocytosis, Antigen T cell and B cell
presentation activation
Specificity Non specific, Broad Specific, Very Narrow
(recognize related (recognize a specific
structures) epitope)
Span Short term Long term
Pathogen TLRs Memory cells
recognition
 Question #15

The presence of human microbiota (normal flora) acts as a

defense mechanism by which of the following methods?

A. Maintaining an acid environment

B. Competing with potential pathogens
C. Keeping phagocytes in the area
D. Coating mucosal surfaces
Normal Flora
• One example is the Lactobacillus species that colonizes the
epithelial surfaces of the vaginal canal.
• The human host provides conditions (temperature,
atmosphere, nutrients) that allow the bacteria to grow and
multiply; in exchange, the bacteria produce lactic acid, which
prevents the colonization of bacteria and yeast that may
cause disease.
• Mechanisms:
1. Microbial competition for the nutrients and for adherence
to the vaginal epithelium;
2. Reduction of the vaginal pH by the production of organic
acids, especially lactic acid
 Question #16

Which of the following peripheral blood cells plays a key role in

killing of parasites?
Granule contents:
A. Neutrophils
• Catalase,
B. Monocytes • lysozyme,
C. Lymphocytes • Cationic proteins,
D. Eosinophils • histaminase, and
• Major basic protein (which puts
holes in the parasite)
 Question #17

Which is the principal type of leukocyte in the process of

phagocytosis?

A. Neutrophil
B. Basophil
C. Monocyte
D. Eosinophil
Phagocytic Cells
1. Neutrophil (Segmented neutrophils, Segs, Microphage)
• Principal phagocyte
• 1st WBC to go to the site of infection (Segmented neutrophils are
able to gather quickly at the site of injury because they are
actively motile)
• Increased in bacterial and fungal infections
2. Eosinophil
• Regulates the immune response, indirect phagocytosis, increased
in allergic reaction and parasitic infection (makes holes in
parasites)
3. Monocyte/ Macrophage
• Largest cell in the peripheral blood
• Slow motility, microbial killing, phagocytosis, secretion of cell
mediators
4. Dendritic cells
• Most potent phagocyte, most effective APC
 Question #18

Enhancement of phagocytosis by coating of foreign particles

with serum proteins is called

A. Opsonization.
B. Agglutination.
C. Solubilization.
D. Chemotaxis.
This coating of the organisms by molecules that speed up
phagocytosis is termed opsonization; the Fc portions of
antibody and C3 are called opsonins.

The steps in opsonization are as follows:

1. Antibody attached to the surface of a bacterium minimally
binds the Fc phagocyte receptor.
2. Complement C3b is attached to the surface of the bacterium
and binds loosely to the phagocyte C3b receptor.
3. Both antibody and C3b are attached to the surface of the
bacterium and bound tightly to the phagocyte, allowing
greater opportunity for the phagocyte to engulf the
bacterium
 Question #19

This refers to the movement of granulocytes from the

circulating pool to the peripheral tissues

A. Chemotaxis
B. Diapedesis
C. Pseudopodia
D. Brownian Movement
 Question #20

What is the name of the process by which phagocytic cells are

attracted to a substance such as a bacterial peptide?

A. Diapedesis • The recruitment of immune cells to the site of

B. Degranulation infection
C. Chemotaxis • Chemical messengers that aid in WBC movements:
D. Phagotaxis Chemotaxins/ Chemoattractants
• Ex. C5a, C3a, CRP, IL-8
• Without this process, WBC movement would be
random
 Question #21

All of the following are characteristics of an effective

immunogen except:

A. Internal complexity.
B. Large molecular weight.
C. The presence of numerous epitopes.
D. Found on host cells.
Characteristics of an Immunogen
1) Macromolecular size
• ≥10 kDa to 100 kDa
• The greater the MW, the greater the immunogenicity
2) Foreignness
• Must be recognized by the body as "non-self"
3) Chemical composition and molecular complexity
• Proteins and Polysaccharides are the most immunogenic due to their
complex structure
• Lipids and DNA (Nucleic Acids) are less immunogenic due to their
simple structure and instability.
• In order: Pro Pol Li NA
4) The ability to be processed (Degradability) and presented with MHC
molecules.
5) Route of Entry and Dosage
• IV and intraperitoneal are effective
6) Large stretches which are NOT composed of long repeating polymers/
units
 Question #22

Which would be the most effective immunogen?

A. Protein with a molecular weight of 200,000

B. Lipid with a molecular weight of 250,000
C. Polysaccharide with a molecular weight of 220,000
D. DNA with a molecular weight of 175,000

Pro Pol Li NA
 Question #23

A hapten is:

A. Half of an immunoglobulin molecule

B. A earner molecule for an antigen that is not antigenic alone
C. An immunoglobulin functional only in the presence of
complement
D. A determinant capable of stimulating an immune response
only when bound to a carrier
 Question #24

The process of inflammation is characterized by all of the

following except

A. increased blood supply to the area.

B. migration of WBCs.
C. decreased capillary permeability.
D. increase of acute-phase reactants.
The inflammatory response involves the following three major stages:
1. Dilation of capillaries to increase blood flow
2. Microvascular structural changes and escape of plasma proteins
from the bloodstream
3. Leukocyte transmigration through endothelium and accumulation
at the site of injury
1. Increased blood supply to the affected area. Dilation of the blood vessels
caused by the release of chemical mediators such as histamine from
injured mast cells
2. Increased capillary permeability caused by contraction of the endothelial
cells lining the vessels. The increased permeability of the vessels allows
fluids in the plasma to leak into the tissues
3. Migration of WBCs, mainly neutrophils, from the capillaries to the
surrounding tissue in a process called diapedesis.
4. Migration of macrophages to the injured area
5. Macrophages, neutrophils, and dendritic cells all attempt to clear the
area through phagocytosis
5 CARDINAL SIGNS OF INFLAMMATION
Calor Heat
Rubor Redness
Tumor Swelling/ Edema
Dolor Pain
Functio laesa Loss of Function
 Question #25

Which of the following statements about the test for C-reactive

protein (CRP) is true?

A. It correlates with neutrophil phagocytic function.

B. It is an indicator of ongoing inflammation.
C. It is diagnostic for rheumatic fever.
D. Levels decrease during heart disease.
 Question #26

The activity of natural killer (NK) cells

A. Does not require previous exposure to an antigen

B. Involves phagocytosis and killing of bacteria
C. Requires interaction with cytotoxic T cells
D. Requires interaction with B cells

• First line of defense against cells that are:

ü Virally infected
ü Infected with intracellular pathogen
ü Tumor cells
• They have the ability to recognize damaged and target cells, and
eliminate such cells without prior exposure
 Question #27

Which of the following is the correct arrangement of steps

during phagocytosis?

A. Physical contact, outflowing of cytoplasm, formation of

phagosome, formation of phagolysosome, digestion, excretion
B. Formation of phagosome, outflowing of cytoplasm, Physical
contact, formation of phagolysosome, digestion, excretion
C. Outflowing of cytoplasm, physical contact, formation of
phagosome, formation of phagolysosome, digestion, excretion
D. Physical contact, formation of phagosome, outflowing of
cytoplasm, formation of phagolysosome, digestion, excretion
Steps involved in phagocytosis
a) Adherence: physical contact between the phagocytic cell and the
microorganism occurs, aided by opsonins.
b) Outflowing of cytoplasm to surround the microorganism.
c) Formation of phagosome: microorganism is completely
surrounded by a part of the cell membrane.
d) Formation of the phagolysome: cytoplasmic granules fuse with
membrane of phagosome, emptying contents into this membrane
bound space.
e) Digestion of the microorganism by hydrolytic enzymes.
f) Excretion of contents of phagolysosome to the outside by
exocytosis
 Question #28

How does the secondary humoral immune response differ from

the primary response?

A. The lag phase (the time between exposure to immunogen

and production of antibody) is longer in the secondary
immune response.
B. IgM is the predominant antibody class produced in the
secondary immune response.
C. The antibody levels produced are higher in the secondary
immune response.
D. Cytotoxic T lymphocytes play an important role in the
secondary response.
Lag phase —no antibody is detectable.
Log phase —the antibody titer increases logarithmically.
Plateau phase —the antibody titer stabilizes.
Decline phase —the antibody is catabolized.
An Anamnestic/Secondary immune response differs from a primary
response based on:
1. Time
• A secondary response has a shorter lag phase, longer plateau,
and more gradual decline.
2. Type of antibody
• IgM antibodies are the principal class formed in the primary
response. Although some IgM antibody is formed in a
secondary response, the IgG class is the predominant type
formed.
3. Antibody titer
• In a secondary response, antibody levels attain a higher titer.
The plateau levels in a secondary response are typically 10-
fold or greater than the plateau levels in the primary response
 Question #29

Which of the following statements best characterizes adaptive

immunity?

A. Relies on normally present body functions

B. Response is similar for each exposure
C. Specificity for each individual pathogen
D. Involves only cellular immunity
 INNATE IMMUNITY ADAPTIVE IMMUNITY
Characteristics Non-specific Specific, Diverse, with
Natural response memory, stimulated
response
Cells Phagocytes, N, E, B, Lymphocytes (B cells, T
Macrophage, Mast cells, cells, NK cells)
Dendritic cells
Response time immediate Slow, delayed (3-5 days)
Memory Little or no memory of With memory of prior
prior antigenic exposure antigenic exposure
Similar response for each Increased immune
exposure response upon repeated
exposure
Processes Phagocytosis, Antigen T cell and B cell
presentation activation
Specificity Non specific, Broad Specific, Very Narrow
(recognize related (recognize a specific
structures) epitope)
Span Short term Long term
 Question #30

Which of the following is a characteristic of T cells?

A. Synthesize antibody
B. Mature in the thymus
C. Able to bind unprocessed antigen
D. Primarily protect against extracellular parasites
 Question #31

How are cytotoxic T cells (TC cells) and natural killer (NK) cells
similar?

A. Require an antibody to be present

B. Effective against virally infected cells
C. Recognize antigen in association with HLA class II markers
D. Do not bind to infected cells
 Question #32

Cell-mediated immunity is primarily mediated by

A. B cells
B. T helper cells
C. Plasma cells
D. Dendritic cells
 Question #33

How do cytotoxic T cells kill target cells?

A. They produce antibodies that bind to the cell.

B. They engulf the cell by phagocytosis.
C. They stop protein synthesis in the target cell.
D. They produce granzymes that stimulate apoptosis.
Action of Cytotoxic T Cells
Cytotoxic T cells can kill target cells in two major ways.
1. Once antigen recognition occurs, the cytotoxic T cells either
release the contents of granules that damage the cell or
2. They bind to the host cell and, using intracellular signaling,
induce apoptosis.

Granules within cytotoxic T cells contain two different types of

toxins:
1. Granzymes are a class of enzymes called serine proteases and
2. Perforins are pore-forming proteins that insert themselves into
the target cell membrane.
 Question #34

Cells that can act as antigen-presenting cells for exogenous

antigens include

A. All nucleated cells

B. Endothelial cells
C. B lymphocytes
D. T lymphocytes
 Question #35

Which of the following cytokines is also known as the T-cell

growth factor?

A. IFN-γ
B. IL-12
C. IL-2
D. IL-10
E X C E L L E R O N L I N E
 E X C E L L E R O N L I N E

Question #1

Practices used in the laboratory to ensure the quality of the

testing process and the accuracy and precision of the results:

A. Quality patient care

B. Method evaluation
C. Quality assurance
D. Quality control
E X C E L L E R O N L I N E
 Question #36

Which of the following cytokines can mediate release of acute

phase proteins from the liver?

A. IL-6
B. IL-8
C. IL-12
D. IL-10
Acute Phase Reactants
• Glycoproteins in nature
• Increase rapidly during infection, inflammation, injury, and tissue
trauma
• Functions:
1. Promote phagocytosis
2. Limit tissue destruction by proteolytic enzymes
• Produced from: liver (hepatocytes) within 12 to 24 hrs in
response to increased cytokines
• Initiated and Sustained by: IL-1, IL-6, TNF-alpha
 Question #37

Macrophages produce which of the following proteins during

antigen processing?

A. IL-1 and IL-6

B. γ-Interferon
C. IL-4, IL-5, and IL-10
D. Complement components C1 and C3
 Question #38

Which best characterizes the secondary response?

A. Equal amounts of IgM and IgG are produced.

B. There is an increase in IgM, IgG, and IgE.
C. There is a large increase in IgG but not IgM.
D. The lag phase is the same as in the primary response.
An Anamnestic/Secondary immune response differs from a primary
response based on:
1. Time
• A secondary response has a shorter lag phase, longer plateau,
and more gradual decline.
2. Type of antibody
• IgM antibodies are the principal class formed in the primary
response. Although some IgM antibody is formed in a
secondary response, the IgG class is the predominant type
formed.
3. Antibody titer
• In a secondary response, antibody levels attain a higher titer.
The plateau levels in a secondary response are typically 10-
fold or greater than the plateau levels in the primary response
 Question #39

Humoral components of the adaptive immune system include:

A. T lymphocytes
B. B lymphocytes
C. Antibodies
D. Saliva
 Question #40

B cells that produce and release large amounts of antibody are

called:

A. Plasma Cells
B. Neutrophils
C. Memory cells
D. Basophils
 Question #41

Which of these is/are found on a mature B cell?

A. IgG and IgD STAGES IN B-CELL DIFFERENTIATION

B. IgM and IgD Pro-B Cell Rearrangement of genes
coding for heavy and light
C. IgD and IgE
chain of Ab
D. α and β chains Pre-B Cell Synthesis of heavy-chain,
mu chain
Immature B Presence of complete IgM
Cell MatureD
Mature B Cell IgM + IgD
 Question #42

Which of the following is characteristic of B cells?

A. Phagocytic
B. Participate in antibody-dependent cellular cytotoxicity
(ADCC) reactions
C. Contain surface immunoglobulins
D. Secrete the C5 component of complement
 Question #43

Where does the major portion of antibody production occur?

A. Peripheral blood
B. Bone marrow
C. Thymus
D. Lymph nodes
 Question #44

A lymphokine is:

A. A soluble mediator produced by granulocytes and affecting

lymphocytes
B. A soluble mediator produced by lymphocytes
C. A soluble mediator produced by plasma cells
D. An antibody that reacts with lymphocytes
 E X C E L L E R O N L I N E

Question #45

Antigenic groups identified by different sets of antibodies

reacting in a similar manner to certain standard cell lines best
describes

A. cytokines.
B. clusters of differentiation (CD)
C. neutrophilic granules
D. opsonins
 Question #46

T regulator cells, responsible for controlling autoimmune

antibody production, express which of the following phenotypes?

A. CD3, CD4, CD8

B. CD3, CD8, CD25
C. CD3, CD4, CD25
D. CD8, CD25, CD56
 Question #47

Which markers are found on mature, peripheral helper T cells?

A. CD1, CD2, CD4

B. CD2, CD3, CD8
C. CD1, CD3, CD4
D. CD2, CD3, CD4
 Question #48

Which correctly describes coding for immunoglobulin molecules?

A. All genes are located on the same chromosome.

B. Light-chain gene rearrangement occurs before heavy-chain
gene rearrangement.
C. Four different regions are involved in coding for heavy chains.
D. Lambda gene rearrangement occurs before kappa gene
rearrangement
 CODING FOR IMMUNOGLOBULIN MOLECULES

Rearrangement of
Heavy-Chain Genes
Four separate regions on chromosome 14
code for H chains:
• V
• D
• J
• Constant Region
 CODING FOR IMMUNOGLOBULIN MOLECULES

Light Chain Rearrangement

ü L chain rearrangement occurs only after μ chains appear
ü Lacks D region
ü Recombination of segments on chromosome 2,
coding for κ (kappa) chains, occurs before that on
chromosome 22, which codes for λ (lambda) chains
 Question #49

The portion of an antigen that binds to an antibody or T cell

receptor is called a(n)

A. Allergin
B. Avidin
C. Epitope
D. Valence
 Question #50

An Antibody determinant is also known as:

A. Paratope
B. Epitope
C. Fc region
D. Kininogen
 Question #51

Monocytes and macrophages play a major role in the

mononuclear phagocytic system. For an antibody-coated
antigen to be phagocytized, what part of the antibody molecule
fits into a receptor on the phagocytic cell?

A. Fc region
B. Fab region
C. Hinge region
D. Variable region
 Question #52

Which region of the immunoglobulin molecule can bind antigen?

A. Fc region
B. Fab region
C. Hinge region
D. Variable region
 Question #53

A Fab fragment consists of

A. two H chains.
B. two L chains.
C. one L chain and one-half of an H chain.
D. one L chain and an entire H chain.
 Question #54

Identify the specific component of the adaptive immune system

that is formed in response to antigenic stimulation:

A. Lysozyme
B. Complement
C. Commensal organisms
D. Immunoglobulin
 Question #55

All of the following are functions of immunoglobulins except:

A. Neutralizing toxic substances

B. Facilitating phagocytosis through opsonization
C. Interacting with Cytotoxic T cells to lyse viruses
D. Combining with complement to destroy cellular antigens
 Question #56

Which immunoglobulin appears first in the primary immune

response?

A. IgG
B. IgM
C. IgA
D. IgE
 Question #57

Which immunoglobulin appears with the highest titer in the

secondary response?

A. IgG
B. IgM
C. IgA
D. IgE
 Question #58

Which immunoglobulin can cross the placenta?

A. IgG
B. IgM
C. IgA
D. IgE
 Question #59

Which immunoglobulin cross links mast cells to release

histamine?

A. IgG
B. IgM
C. IgA
D. IgE
 Question #60

Which immunoglobulin class(es) has (have) a J chain?

A. IgM
B. IgE and IgD
C. IgM and sIgA
D. IgG3 and IgA
 Question #61

Which immunoglobulin(s) help(s) initiate the classical

complement pathway?

A. IgA and IgD

B. IgM only
C. IgG and IgM
D. IgG only
 Question #62

Which antibody is best at agglutination and complement

fixation?

A. IgA
B. IgG
C. IgD
D. IgM
 Question #63

Which class of immunoglobulin possesses delta heavy chains?

A. IgA 1. IgG - Gamma heavy chains

B. IgD 2. IgM - Mu heavy chains
C. IgE 3. IgA - Alpha heavy chains
D. IgG 4. IgD - Delta heavy chains
5. IgE - Epsilon heavy chains
 Question #64

Which represents the main function of IgD?

A. Protection of the mucous membranes

B. Removal of antigens by complement fixation
C. Enhancing proliferation of B cells
D. Destruction of parasitic worms
 Question #65

After exposure to antigen, the first antibodies that can be

detected belong to the class

A. IgA
B. IgE
C. IgG
D. IgM
 Question #66

Which class of immunoglobulin possesses 10 antigenic binding

sites?

A. IgA
B. IgD
C. IgG
D. IgM
 Question #67

What is the predominant type of antibody found in the serum

of neonates born after full-term gestation?

A. Maternal IgM
B. Infant IgG
C. Infant IgM
D. Maternal IgG
 Question #68

The subclasses of IgG differ mainly in

A. the type of light chain.

B. the arrangement of disulfide bonds.
C. the ability to act as opsonins.
D. molecular weight.
ü IgG3 has the largest hinge region and the largest number of interchain
disulfide bonds; therefore, it is the most efficient at binding complement,
followed by IgG1.
 Question #69

The Fab portion of an antibody

A. Binds T cell receptor

B. Consists of two light chains only
C. Consists of two heavy chains only
D. Contains the hypervariable reagion
 Question #70

Which of the following statements applies to the Fc fragment of

an immunoglobulin molecule?

A. It consists of the entire heavy chain.

B. It contains the variable region of the heavy chain.
C. It contains the antigen binding sites of the molecule.
D. It is the region of the molecule that binds to receptors on
various white blood cells.
 Question #71

Which best describes the structure of the light chain of the

immunoglobulin?

A. 1 variable & 2 constant regions

B. 1 variable & 1 constant regions
C. 2 variable & 1 constant regions
D. 2 variable & 2 constant regions
 Question #72

Identical antibodies produced from a single clone of plasma

cells describes

A. Polyclonal antibodies
B. Cold agglutinins
C. Heterophile antibodies
D. Monoclonal antibodies
Production of monoclonal and polyclonal AHG
i. Monoclonal AHG
• It is produced through hybridoma technology developed by Kohler and
Milstein
• It starts with injecting laboratory animals such as mice with purified
human globulin. After a suitable immune response, mouse spleen cells
containing B lymphocytes are isolated and fused with myeloma cells.
• The resulting “hybridomas” are screened for antibodies with the
required specificity and affinity.
• Myeloma immortalized B-cell Hybridoma may then be grown in tissue
culture or by inoculation into mice, where the antibody is collected as
ascites.
Production of monoclonal and polyclonal AHG
ii. Polyclonal AHG
• It is prepared using the conventional method of AHG production, using
live animals (rabbits or sheep and goats).
• Usually, rabbits are used however when large volumes of antibodies
are required, sheep or goats may be used.
• Modern production starts with the purification of the human globulin
from a large pool of normal sera.
• Then, they immunize one colony of rabbits with IgG antigen and
another colony for C3 antigen and then antibodies are collected from
multiple rabbits and are purified.
 Question #73

What is the purpose of HAT medium in the preparation of

monoclonal antibody?

A. Fusion of the two cell types

B. Restricting the growth of myeloma cells
C. Restricting the growth of spleen cells
D. Restricting antibody production to the IgM class
 Hybridoma Production
HYBRIDOMA - Fusion of two
different types of cells

Myeloma cells – has a deficiency

of the enzyme hypoxanthine-
guanine phosphoribosyltransferase
(HGPRT) and Thymidine Kinase

HAT medium
• Hypoxanthine
• Aminopterin
• Thymidine
 Question #74

Monoclonal antibodies are produced by

A. Cultured T cells
B. Human plasma cells
C. Mouse plasma cells
D. Hybridomas
 Question #75

The type of immunity that follows the injection of an

immunogen is termed

A. Artificial active
B. Natural active
C. Artificial passive
D. Innate
 Question #76

The type of immunity that follows the injection of antibodies

synthesized by another individual or animal is termed

A. Artificial active
B. Natural adaptive
C. Artificial passive
D. Natural passive
 Question #77

A major advantage of passive immunization compared to

active immunization is that

A. Antibody is available more quickly

B. Antibody persists for the life of the recipient
C. IgM is the predominant antibody class provided
D. Oral administration can be used
 Question #78

HLA antigens are found on

• Human leukocyte antigens (HLAs)
A. All nucleated cells are a group of antigens originally
B. Red blood cells only described on human white cells.
C. Solid tissue only • It is now known that they are
D. White blood cells only found on all nucleated cells of the
body, including solid tissue cells.
• HLAs are not found on red blood
cells.
 Question #79

The HLA complex is located primarily on

A. Chromosomes The HLA complex is located within the

B. Chromosome 6 6p21.3 region of the short arm of
C. Chromosome 9 chromosome 6
D. Chromosome 17
 Question #80

Which of the following are products of HLA class III genes?

A. T-cell immune receptors

B. HLA-D antigens on immune cells
C. Complement proteins C2, C4, and Factor B
D. Immunoglobulin VL regions

• HLA-A, HLA-B, and HLA-C antigens are classified as class I

antigens
• HLA-D, HLA-DR, HLA-DQ, and HLA-DP antigens as class II
antigens
• Complement components C2 and C4 of the classic pathway
and Factor B of the alternative pathway are class III molecules.
• class I MHC (HLA) molecules
• Proteins coded for by genes at three loci (A, B, C) in the
major histocompatibility complex (MHC).
• These molecules are expressed on all nucleated cells and
are important to consider in tissue typing for
transplantation.
• class II MHC (HLA) molecules
• Proteins coded for by the DR, DP, and DQ loci of the
major histocompatibility complex (MHC).
• These molecules are found on B lymphocytes, activated T
lymphocytes, monocytes, macrophages, dendritic cells, and
endothelium
 Question #81

Which of the following is true of MHC (HLA) class II antigens?

A. They are found on all nucleated cells.

B. They are found on B cells and macrophages.
C. They all originate at one locus.
D. They are coded for on chromosome 9.
 Question #82

An important part of the nonspecific immune response is(are)

A. B cells
B. Basophils
C. Complement cascade
D. Cytotoxic T lymphocytes
 Question #83

What is the purpose of C3a, C4a, and C5a, the split products
of the complement cascade?

A. To bind with specific membrane receptors of lymphocytes

and cause release of cytotoxic substances
B. To cause increased vascular permeability, contraction of
smooth muscle, and release of histamine from basophils
C. To bind with membrane receptors of macrophages to
facilitate phagocytosis and the removal of debris and foreign
substances
D. To regulate and degrade membrane cofactor protein after
activation by C3 convertase
 Question #84

All of the following are characteristics of complement

components except

A. normally present in serum.

B. mainly synthesized in the liver.
C. present as active enzymes.
D. heat-labile.
 Question #85

Which complement protein is present in the greatest

concentration in human serum?

A. C1
B. C2
C. C3
D. C4
 Question #86

Which of the following complement proteins is part of the

membrane attack complex?

A. C1
B. C3
C. C4
D. C5
 Question #87

The alternative complement pathway

A. Can be activated by bacterial capsule polysaccharides

B. Uses C5b as a C3 convertase
C. Bypasses steps C3 through C5
D. Is inactivated by properdin
 Question #88

Which of the following describes the role of properdin in the

alternative pathway?

A. Stabilization of C3/C5 convertase

B. Conversion of B to Bb
C. Inhibition of C3 convertase formation
D. Binding to the initiating antigen
 Question #89

After activation of the complement system, leukocytes and

macrophages are attracted to the site of complement
activation by

A. C3
B. C5a
C. C8
D. IgM
 Question #90

The classical complement pathway is activated primarily by

A. Most viruses.
B. Antigen–antibody complexes.
C. Fungal cell walls.
D. Mannose in bacterial cell walls
 Question #91

Which of the following is referred to as C3 convertase?

A. C1qrs C3 convertase C5 convertase

B. C4b2a Classical Pathway C4b2a C4b2a3b
C. C3bBb Alternative Pathway C3bBb C3bBb3b
D. C3a MBL Pathway Same with Classical Same with Classical
E. Only b and c
 Question #92

Which best describes the role of an anaphylatoxin?

A. Coats cells to increase phagocytosis

B. Attracts WBCs to the area of antigen concentration
C. Increases production of interleukin-1
D. Increases permeability of blood vessels
Anaphylatoxins
• Activation of the complement cascade generates
complement fragments like C3a, C4a, and C5a known as
anaphylatoxins.
• An anaphylatoxin is a small peptide that causes increased
vascular permeability, contraction of smooth muscle, and
release of histamine from basophils and mast cells.
• C5a is the most potent pro-inflammatory anaphylatoxin,
which is involved in inflammatory signaling in many
tissues
 Question #93

A living donor is being sought for a child who requires a kidney

transplant. The best odds of finding an MHC-compatible donor
occur between the child and

A. A sibling (brother or sister)

• Between an offspring and either
B. An unrelated individual parent, there is, statistically, a 25%
C. The child's father chance of an HLA match.
D. The child's mother • Between siblings, there is a 50%
chance of an HLA match.
 Question #94

Corneal tissue may be transplanted successfully from one

patient to another because

A. The cornea is nonantigenic

B. Corneal antigens do not activate T cells
C. Anticorneal antibodies are easily suppressed
D. The cornea occupies a privileged site not usually seen by the
immune system

Other sites with immune privilege include the brain, testes, placenta
and fetus.
 Question #95

A kidney transplant from one identical twin to another is an

example of a(n)

A. Allograft
B. Autograft
C. Isograft
D. Xenograft
 Question #96

MHC Class II molecules are found on all nucleated cells.

MHC class I molecules are found on macrophages only.

A. Both statements are false

B. Both statements are true
C. First statement is true. Second statement is false
D. First statement is false. Second statement is true
• class I MHC (HLA) molecules
• Proteins coded for by genes at three loci (A, B, C) in the
major histocompatibility complex (MHC).
• These molecules are expressed on all nucleated cells and
are important to consider in tissue typing for
transplantation.
• class II MHC (HLA) molecules
• Proteins coded for by the DR, DP, and DQ loci of the
major histocompatibility complex (MHC).
• These molecules are found on B lymphocytes, activated T
lymphocytes, monocytes, macrophages, dendritic cells, and
endothelium
 Endogenous Pathway
Mainly present peptides synthesized
within the cell to CD8 (cytotoxic) T cells
Calnexin Keeps the α chain in a partially
folded state while it awaits binding to
β2–microglobulin.
Class I MHC-Peptide Interaction Proteasomes Packets of enzymes that cleaved
peptides into the proper size for delivery
to class I molecules.
TAP (Transporters Associated with TAP1 and TAP2 are most efficient at
Antigen Processing) transporting peptides that are between 8
to 16 amino acids in size.
Exogenous Pathway
Present exogenous antigen to CD4
Class II MHC–Peptide Interaction (helper) T cells
Endosomes Digest antigen into peptides
Invariant Chain (Ii) Serves to protect the binding site.
 Question #97

Which of the following cell surface molecules is classified as an

MHC class II antigen?

A. HLA-A
B. HLA-B
C. HLA-C
D. HLA-DR
 Question #98

Which MHC class of molecule is necessary for antigen

recognition by CD4-positive T cells?

A. Class I
B. Class II
C. Class III
D. No MHC molecule is necessary for antigen recognition
 Question #99

A child suspected of having an inherited humoral

immunodeficiency disease is given diphtheria/ tetanus vaccine.
Two weeks after the immunization, his level of antibody to the
specific antigens is measured. Which result is expected for this
patient if he/she indeed has a humoral deficiency?

A. Increased levels of specific antibody

B. No change in the level of specific antibody
C. An increase in IgG-specific antibody but not IgM-specific
antibody
D. Increased levels of nonspecific antibody
 Question #100

Which of the following symptoms in a young child may indicate

an immunodeficiency syndrome?

A. Anaphylactic reactions
B. Severe rashes and myalgia
C. Recurrent bacterial, fungal, and viral infections
D. Weight loss, rapid heartbeat, breathlessness
END