Immunology, Serology and Blood Banking
1. Incorrect statement about naturally occurring antibodies:
a. React best in
saline
b. React best at room
temperature or at 4OC
c. They are usually
IgG
d. Do not usually
cross the placenta
2. Which antibody is most likely to be involved in hemolytic
disease of the newborn?
a. Anti-E
b. Anti-Lea
c. Anti-M
3. What blood type is not possible for an offspring of AO and BO
persons?
a. AB
b. A or B
c. O
d. All are possible
4. Nature of ABO antibodies:
a. IgM
b. IgG and IgM
c. IgA
d. IgG, IgM and IgA
5. Waldenström’s macroglobulinemia, multiple myeloma and
increased levels of fibrinogen is associated with what ABO discrepancy?
a. Group I
b. Group II
c. Group III
d. Group IV
6. In which of the following blood group systems may the RBC
typing change during pregnancy?
a. Kidd
b. Lewis
c. MNS
d. Kell
7. Which of the following are the RBC equivalents of human
leukocyte antigens (HLA)?
a. Kpa, Kpb,
Kpc
b. Jsa, Jsb
c. Doa, Dob
d. Bga, Bgb,
Bgc
8. Which of the following does not belong to the high titer low
avidity antibodies?
a. Anti-Ch
b. Anti-Yka
c. Anti-Co
d. Anti-JMH
9. Incorrect statement about Kell blood group:
a. 90% of the
population is Kell negative
b. Anti-K reacts best
in saline at room temperature
c. Anti-K can cause
hemolytic disease of the newborn
d. Next to Rh (D), the
Kell (K) antigen is the most immunogenic
10. Adults who have the Le, Se, and H genes will exhibit which
Lewis antigen on their red cells?
a. Lea
b. Leb
c. Lea and
Leb
d. None
11. Given the following reactions, identify the cause of
discrepancy:
Cell Typing: Serum Typing:
Anti-A = 4+ A1 cells = 0
Anti-B = 2+ B cells = 4+
a.
Hypogammaglobulinemia
b. Hodgkin’s lymphoma
c. Cold agglutinins
d. Acquired B
phenomenon
12. Which of the following is a contraindication for accepting a
donor for plateletpheresis?
a. 72 hours since the
last apheresis
b. Plasmapheresis of
800mL 1 week ago
c. Platelet count of
100 x 109/L
d. Aspirin ingestion 7
days ago
13. Which of the following donors could be accepted for blood
donation?
a. 18-year old woman
with a hematocrit value of 38%
b. 45-year old man
with a blood pressure of 180/100
c. 60-year old man with
history of Babesiosis
d. 30-year old man who
had been vaccinated for rabies 6 months ago
14. All of the following donors can be accepted for donating
blood EXCEPT:
a. 30-year old female who had a rubella vaccination 6 weeks ago
b. 20-year old male with a body temperature of 99.4OF
c. 50-year old man with night sweats and skin lesions
d. 45-year old woman who was a recipient of recombinant growth
hormone
15. A man turns pale and
complains of dizziness while donating blood. What is the best course of action?
a. Continue the donation
b. Withdraw the needle, raise his feet and administer ammonia
spirits
c. Discontinue the donation and provide a paper bag
d. Tell him to sit upright and not have a reaction until the
donation is finished
16. What would be the cause of jet-like pulsating bleeding with
bright red blood during blood donation?
a. Increased vacuum
from the blood bag
b. The donor is
hypertensive
c. Brachial artery was
punctured
d. The donor is a
chronic smoker
17. Red blood cells stored in CPDA-2 blood bag would have a
shelf-life of:
a. 21 days
b. 35 days
c. 2 days
d. 42 days
18. What is the proper storage protocol for granulocyte
concentrates?
a. 1-6OC
b. -18OC
c. Room temperature
with agitation
d. Room temperature
without agitation
19. Cryoprecipitated antihemophilic factor is not recommended
for the treatment:
a. Hemophilia A
b. von Willebrand’s
disease
c. Hemophilia B
d. Hypofibrinogenemia
20. What is the purpose of adding rejuvenating solutions to RBC
products?
a. To restore ATP and
2,3-DPG
b. To stabilize RBC
membrane
c. To prevent lysis of
RBCs during storage at cold temperature
d. To increase the
harvest of WBCs
21. Prothrombin complex concentrates are used to treat which of
the following?
a. Hemophilia A
b. Hemophilia B
c. Hemophilia C
d. von Willebrand’s
disease
22. What is the purpose of adding citric acid to blood bag
preservatives?
a. To prevent
coagulation
b. To restore ATP
levels
c. To improve survival
of red cells
d. To prevent
caramelization
23. Fresh frozen plasma stored at -65OC would have a
shelf-life of:
a. 1 year
b. 5 years
c. 7 years
d. 10 years
24. Each unit of cryoprecipitate prepared from whole blood
should contain approximately how many units of factor VIII?
a. 40
b. 80
c. 150
d. 200
25. Quality control for RBCs requires a maximum hematocrit level
of:
a. 75%
b. 80%
c. 85%
d. 90%
26. Cryoprecipitate that has been thawed must be transfused
within ___ hours
a. 6
b. 8
c. 4
d. 24
27. Platelets prepared from a whole blood donation require which
of the following?
a. A light spin
followed by a heavy spin
b. Two light spins
c. A hard spin
followed by a light spin
d. Two heavy spins
28. A single unit of granulocyte concentrate should contain at
least ____ WBCs
a. 1.0 x 109
b. 1.0 x 1010
c. 3.0 x 1011
d. 5.5 x 1010
29. Which of the following antibodies is most responsible for
immediate hemolytic transfusion reactions?
a. Anti-N
b. Anti-D
c. Anti-B
d. Anti-Leb
30. When a suspected hemolytic transfusion reaction occurs, the
first thing to do is:
a. Slow the transfusion rate and call the physician
b. Administer medication to stop the reaction
c. First inform the laboratory to begin an investigation
d. Stop the transfusion but keep the intravenous line open with
saline
31. Transfusion reactions can be caused by:
1. Overheated donor blood 3.
Hypokalemia
2. Bacterial contamination 4.
Citrate toxicity
a. 1, 2 and 4
b. 2, 3 and 4
c. 1, 3 and 4
d. 1, 2, 3 and 4
32. Hepatitis B virus remains infectious on environmental
surfaces for:
a. 7 days
b. 1 month
c. 1 year
d. 3 days
33. HBV is transmitted most frequently:
a. By unknown methods
b. Through blood
transfusion
c. By needle sharing
among IV drug abusers
d. By sexual activity
34. Which of the following blood-borne pathogens is destroyed under
prolonged cold temperature storage?
a. Babesia microti
b. Trypanosoma cruzi
c. Treponema pallidum
d. Plasmodium falciparum
35. What procedure would help to distinguish between an anti-C
and anti-Fyb in an antibody mixture?
a. Use a thiol reagent
b. Run an enzyme panel
c. Lower the pH of
test serum
d. Run a regular panel
36. What samples are required to perform compatibility testing?
a. Patient serum and
donor serum
b. Patient serum and
donor cells
c. Donor serum and
patient cells
d. Donor cells and
patient cells
37. What is the minimum testing required for a massively
transfused patient?
a. Immediate spin
crossmatch or forward typing ABO
b. ABO, Rh, crossmatch
c. ABO, forward and
reverse typing
d. Antibody screen and
ABO typing
38. What is the major advantage of gel technology?
a. No cell washing
steps
b. Specialized
equipments
c. Standardization
d. Use of IgG-coated
control cells
39. The purpose of immediate spin crossmatch is:
a. To ensure survival
of transfused RBCs
b. To determine ABO
compatibility between donor and recipient
c. Detect
cold-reacting unexpected antibodies
d. Meet computer
crossmatch requirements
40. Blood donor and recipient samples used in crossmatching must
be stored for a minimum of how many days following transfusion?
a. 2
b. 5
c. 7
d. 10
41. After the addition of IgG-coated RBCs to a negative AHG
reaction during an antibody screen, a negative result is observed. Which of the
following is a correct interpretation?
a. The antibody screen
is negative
b. Reactive AHG
reagent was added
c. The saline washings
were adequate
d. AHG reagent was
neutralized
42. RBCs must be washed in saline at least three times before
the addition of AHG reagent to:
a. Wash away any
hemolyzed cells
b. Neutralize any
excess AHG reagent
c. Increase the
antibody binding to antigen
d. Remove traces of
free serum globulins
43. Blood for intrauterine transfusion should be all of the
following EXCEPT:
a. Compatible with
maternal serum
b. Screened for CMV
c. Gamma-irradiated
d. More than 7 days
old
44. What should be done if Wharton’s jelly cannot be removed
from cord cells?
a. Collect a heelstick
sample
b. Wash cells with
0.6N HCl
c. Obtain another cord
sample
d. Test cells using
saline typing reagents
45. Cold AIHA is sometimes associated with infection by:
a. Staphylococcus aureus
b. Mycoplasma pneumoniae
c. Escherichia coli
d. Streptococcus pyogenes
46. Cephalosporin given in massive doses has been associated
with RBC hemolysis. Which of the classic mechanisms is involved in the
hemolytic process?
a. Membrane
modification
b. Drug adsorption
c. Immune complex
formation
d. Autoantibody
formation
47. Backup copies of the information system:
a. Can be used to
restore the information system data and software
b. Are used to
maintain hardware components
c. Are performed once
a month
d. Are created any
time changes are made to the system
48. User passwords should be:
a. Shared with others
b. Never changed
c. Kept confidential
d. Posted at each
terminal
49. All of the following items should be checked quarterly
EXCEPT:
a. Cell washers
b. Centrifuge timers
c. Blood warmers
d. Platelet incubators
50. What is the principle involved in the gel technology?
a. Hemadsorption
b.
Hemagglutination-inhibition
c. Hemagglutination
d. Precipitation
51. Which of these match(es) is(are) correct?
1. Karl Landsteiner – ABO blood group 3. Rosalyn Yallow - ELISA
2. Elie Metchnikoff – Phagocytosis 4. Jules Bordet – Complement fixation
a. 1, 2 and 3
b. 1, 2 and 4
c. 2, 3 and 4
d. 1, 2, 3 and 4
52. When was T cell receptor gene discovered?
a. 1979
b. 1987
c. 1984
d. 1981
53. Cytokine produced mainly by macrophages:
a. IL-1
b. IL-2
c. IL-6
d. IL-12
54. It is a non-specific indicator of inflammation believed to
be an antibody to the C-polysaccharide of pneumococci:
a. Alpha1-antitrypsin
b. C-reactive protein
c. Serum amyloid A
d. Ceruloplasmin
55. Acquired immunodeficiency syndrome (AIDS) shows a change in
the ratio of:
a. T/B cells
b. B1/B2
cells
c. Albumin/Globulin
d. CD4+/CD8+ cells
56. Hybridomas are formed from:
a. Antibodies
b. B lymphocytes
c. T lymphocytes
d. Phagocytes
57. T cells are involved in:
a. Humoral immunity
b. Wheal and flare
reaction
c. Cell-mediated
immunity
d. Antibody production
58. What is the major component of natural humoral immunity?
a. Immunoglobulins
b. Complement
c. B cells
d. Cytokines
59. Interferon can be produced by which of the following?
1. Macrophages 3.
Virus-infected cells
2. T lymphocytes 4.
All of these
a. 1 and 2 c. 2 and 3
b. 1 and 3 d. 4
60. Which of the following IgG subclasses does not cross the
placenta?
a. IgG1
b. IgG2
c. IgG3
d. IgG4
61. What is the major amino acid component of the hinge region
of an immunoglobulin molecule?
a. Lysine
b. Glutamine
c. Proline
d. Tryptophan
62. What region determines the immunoglobulin class?
a. Fc
b. CH
c. VL
d. CL
63. Marker for NK cells:
a. CD19
b. CD45
c. CD34
d. CD56
64. How are cytotoxic T cells and NK cells similar?
a. Effective against
virally infected cells
b. Recognize antigen
in association with HLA Class II markers
c. Do not bind to
infected cells
d. Require antibody to
be present
65. Which immunology cross-links mast cells to release
histamine?
a. IgG
b. IgM
c. IgE
d. IgA
66. Humoral immunity is due to:
a. Macrophage activity
b. Suppressor T
lymphocytes
c. B lymphocytes that
transform into plasma cells
d. Lymphokines
67. The predominant antibody in an anamnestic response is:
a. IgG
b. IgM
c. IgA
d. IgD
68. The binding strength of an antibody for an antigen is
referred to as its:
a. Specificity
b. Affinity
c. Avidity
d. Titer
69. The HLA complex is located primarily on:
a. Chromosome 3
b. Chromosome 6
c. Chromosome 9
d. Chromosome 17
70. For an antibody-coated antigen to be phagocytized, what part
of the antibody molecule fits into a receptor on the phagocytic cell?
a. Fab region
b. Hinge region
c. Variable region
d. Fc region
71. These are substances added to a vaccine to enhance the
immune response:
a. Haptens
b. Mitogens
c. Adjuvants
d. Immunogens
72. The alternative pathway of the complement cascade is
initiated by:
1. IgG and IgM 3.
Yeast cell wall 5. Lipopolysaccharides
2. Aggregates of IgA 4. Mannose group 6. Cobra venom factor
a. 1, 2 and 3
b. 2, 3, 5 and 6
c. 3, 4, 5 and 6
d. 1, 2, 3 and 5
73. Deficiency of C3 complement component is associated with:
a. Paroxysmal
nocturnal hemoglobinuria
b. Hereditary
angioneurotic edema
c. Gonococcal or
meningococcal infection
d. Severe recurrent
bacterial infection
74. Fetus in a mother’s womb is considered a(n):
a. Allograft
b. Autograft
c. Heterograft
d. Syngeneic graft
75. HLA-B27 is most commonly associated with:
a. Systemic lupus
erythematosus
b. Rheumatoid
arthritis
c. Ankylosing
spondylitis
d. Graves’ disease
76. If the interval between heating the serum for the VDRL test
and testing exceeds 4 hours, the serum should be reheated at:
a. 37OC for
30 minutes
b. 37OC for
10 minutes
c. 56OC for
30 minutes
d. 56OC for
10 minutes
77. Patients with syphilis develop an antibody response to a
substance known as:
a. Reagin
b. Complement
c. Cardiolipin
d. Hemolysin
78. The fluorescein-antihuman gamma globulin used in the FTA-ABS
test:
a. Makes the
antigen-antibody reaction visible
b. Is added to the
serum before the antigen is added
c. Is added to the
antigen before the serum is added
d. Makes the antibody
visible
79. The reactions on DNA-methyl green substrates when testing
for the presence of anti-DNase are:
a. (+) Blue, (-)
Yellow
b. (+) Red, (-) Orange
c. (+) Green, (-)
Colorless
d. (+) Purple, (-)
Yellow
80. The Widal and Weil-Felix reactions are examples of techniques
to detect:
a. Heterophil
antibodies
b. Febrile agglutinins
c. Reagin
d. Forssman antigen
81. Forssman antibodies are adsorbed by:
a. Beef erythrocytes
b. Guinea pig kidney
cells
c. Both
d. Neither
82. What is the first antibody to be produced in a patient with
hepatitis B virus infection?
a. Anti-HBs
b. Total anti-HBc
c. IgM anti-HBc
d. Anti-HBe
83. What is the first antibody to be produced in a patient with
HIV infection?
a. Antibody to p24
b. Antibody to gp41
c. Antibody to gp120
d. Antibody to p15
84. Among the following congenital infections, which one is the
most common?
a. Congenital syphilis
b. Rubella infection
c. Cytomegalovirus
infection
d. Herpes virus
infection
85. In the exoantigen test for Histoplasma capsulatum, which bands are present in a positive
result?
a. A
b. H and/or M
c. 1, 2, 3
d. HS, HL, F
86. If only anti-HBs is positive, which of the following can be
ruled out?
a. HBV vaccination
b. Distant past
infection with HBV
c. HBIG injection
d. Chronic HBV
infection
87. This test will detect parasitic lactate dehydrogenase enzyme
present in malarial organisms:
a. Optimal
b. Malaquick
c. Monospot
d. Streptozyme
88. Which is most likely a positive Western blot result for
infection with HIV?
a. Band at p24
b. Bands at gp160
c. Bands at p24 and
p31
d. Band at p24 and
gp120
89. Which disease might be indicated by antibodies to smooth
muscle?
a. Myasthenia gravis
b. Primary biliary
cirrhosis
c. Chronic active
hepatitis
d. Hashimoto’s
thyroiditis
90. Which immunofluorescent pattern indicates the need for
further testing by Ouchterlony double diffusion?
a. Solid
b. Mottled
c. Rim
d. Nucleolar
91. What disease is indicated by a high titer of anti-centromere
antibodies?
a. Scleroderma
b. Sclerodactyly
c. MCTD
d. SLE
92. Which of the following is a sialylated Lewis blood group
antigen associated with colorectal carcinoma?
a. CA 19-9
b. CEA
c. CA 549
d. CA 15-3
93. Associated with increased serum alpha1-fetoprotein
level:
1. Testicular cancer 3.
Pancreatic carcinoma
2. Hepatocellular carcinoma 4.
Prostatic carcinoma
a. 1 and 2
b. 1, 2 and 3
c. 3 and 4
d. 1, 2 and 4
94. Not true regarding hCG:
a. Beta subunit
confers immunogenic specificity
b. Used to confirm
pregnancy
c. Used as a tumor
marker
d. Found in hepatoma
95. What immune elements are involved in a reaction to poison
ivy?
a. IgE antibodies
b. NK cells and IgG
antibody
c. B cells and IgM
antibody
d. T cells and
macrophages
96. Needles used to deliver VDRL antigen should be checked:
a. Monthly
b. Bimonthly
c. Daily or every time
tests are performed
d. Weekly
97. When preparing monoclonal antibodies:
a. Inject an animal
with an antigen
b. Fuse B lymphocytes
with a malignant cell
c. Remove the B lymphocytes
d. All of the above
98. The air temperature throughout the serology laboratory is 20OC.
How will this affect RPR test result?
a. No effect – the
acceptable test range is 20-24OC
b. Weaken reactions so
that false negatives occur
c. Strengthen
reactions so that positive titers appear elevated
d. Increase the number
of false positives from spontaneous clumping
99. A device used to measure radioactivity in radioimmunoassay:
a. Spectrophotometer
b. Scintillation
counter
c. Fluorometer
d. None of these
100. Most commonly used label in ELISA:
a. HRP
b. FITC
c. Tritiated hydrogen
d. G6PD
ANSWER KEY: ISBB
1. C
2. A
3. D
4. D
5. C
6. B
7. D
8. C
9. B
10. B
11. D
12. C
13. A
14. C
15. B
16. C
17. D
18. D
19. C
20. A
21. B
22. D
23. C
24. B
25. B
26. A
27. A
28. B
29. C
30. D
31. A
32. A
33. D
34. C
35. B
36. B
37. A
38. C
39. B
40. C
41. D
42. D
43. D
44. A
45. B
46. A
47. A
48. C
49. D
50. C
51. B
52. C
53. A
54. B
55. D
56. B
57. C
58. B
59. D
60. B
61. C
62. B
63. D
64. A
65. C
66. C
67. A
68. C
69. B
70. D
71. C
72. B
73. D
74. A
75. C
76. D
77. C
78. A
79. C
80. B
81. B
82. C
83. A
84. C
85. B
86. D
87. A
88. D
89. C
90. B
91. B
92. A
93. B
94. D
95. D
96. C
97. B
98. B
99. B
100. A
ANSWER KEY: ISBB
