Contemporary Clinical Immunology and Serology by Rittenhouse Olson – Test Bank

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Chapter 5 Complement Pathways

 

Multiple-Choice Questions

 

1. Complement has
 
a. about 9 different proteins that are synthesized by monocytes
b. about 35 different proteins that are synthesized by monocytes
c. about 9 different proteins that are synthesized by monocytes, the liver, macrophages, and epithelial cells
d. about 35 different proteins that are synthesized by monocytes, the liver, macrophages, and epithelial cells

 

2. Susie has an acute infection—strep throat—and her friend Zoe has a chronic illness, systemic lupus erythematosus.
 
a. Susie probably has an elevated CH 50 while Zoe probably has a decreased CH50.
b. Susie probably has a decreased CH 50 while Zoe probably has an increased CH50.
c. Both Susie and Zoe probably have an elevated CH 50.
d. Both Susie and Zoe probably have a decreased CH 50.

 

3. Complement proteins are involved in all of the following except
 
a. host defense
b. immune complex clearance
c. interaction with the coagulation pathway
d. lattice formation
e. enhancement of memory

 

4. C1q can
 
a. bind free-floating IgM that is not bound to antigen
b. become activated after interaction with one surface-bound antibody
c. bind after a conformational change occurs as the result of antigen binding
d. bind IgG4

 

5. What molecule is needed for C1q,r and s to stay together?
 
a. Mg++
b. Ca++ and Mg++
c. Ca++
d. none of the above

 

6. Sometimes a microorganism can directly activate complement through
 
a. the alternative pathway only
b. the lectin pathway only
c. the alternative and the lectin pathway
d. usually the alternative and the lectin pathways, but with some microorganisms, also the classical pathway

 

7. The difference in the three pathways is the way the C3 convertase is formed
 
a. in the classical pathway, the C3 convertase is C1C2; in the alternative pathway, it is C3wBb; and in the MBL pathway, the C3 convertase is C2aC4b
b. in the classical pathway, the C3 convertase is C2aC4b’ in the alternative pathway, it is C3wBb; and in the MBL pathway, the C3 convertase is C2aC4b
c. in the classical pathway, the C3 convertase is C1C2; in the alternative pathway, it is C3wBb; and in the MBL pathway, the C3 convertase is MBL-MASP-2
d. in the classical pathway, the C3 convertase is C2aC4b; in the alternative pathway, it is PDBb; and in the MBL pathway, the C3 convertase is C2aC4b

 

8. Amplification steps in the complement pathways occur
 
a. in the classical pathway with C1 cleaving multiple molecules of C4 and multiple C2 for every C1 and C4; in the alternative pathway with the C3b of other pathways becoming C3 convertase; and then the C3b becoming part of a C5 convertase
b. in all pathways with all the C3 convertases making multiple C3a +C3b
c. with C9 polymerization
d. all of the above
e. A and B only

 

9. The AH50 differs from the CH50 because the AH50
 
a. measures the alternative pathway and the CH50 measures the classical pathway
b. measures the classical pathway and the CH50 measures the alternative pathway
c. uses rabbit red blood cells and the CH50 uses sheep red blood cells with antibody
d. measures the alternative pathway and the CH50 measures the classical pathway and uses rabbit red blood cells and the CH50 uses sheep red blood cells with antibody
e. measures the classical pathway and the CH50 measures the alternative pathway and uses rabbit red blood cells and the CH50 uses sheep red blood cells with antibody

 

10. Complement proteins are synthesized by
 
a. the liver
b. monocytes
c. macrophages
d. epithelial cells
e. All of the above

 

11. Properdin is a
 
a. complemencomponent of the classical pathway
b. complement protein of the alternative pathway
c. complement protein of the lectin pathway
d. defensin

 

12. Inhibitors of complement include
 
a. factors I, H, and C1INH
b. vitronectin or S protein
c. CR3
d. factors I, H, and C1INH and vitronectin or S protein
e. All of the above

 

13. If the CH50 is lower than normal but the AH50 is normal, which set contains the components that could be involved?
 
a. factor B, factor D, and Properdin
b. MBL, MASP-1, MASP-2
c. C1, C4, C2, C1INH
d. C5-9

 

14. Anaphylatoxins include
 
a. C5a
b. C4a
c. C3a
d. C5a and C4a
e. all of the above

 

15. Which of the following are anaphylatoxins?
 
a. C1q, C2a, C4a
b. C2b, C4a, C5a
c. C2a, C4a, C5a
d. C3a, C4a, C5a

 

16. Which of the following are all opsonic molecules?
 
a. C3b, C1q, iC3b, C4b
b. C2a, C1q, C3b
c. C2b, C3b, C4b
d. C3b, C4b, C9

 

17. Which of the following is correct?
 
a. C1INH inactivates C1 and inhibits binding of MBL to MASP-2.
b. factor D inhibits factor B and Properdin.
c. DAF inhibits C1q binding to C1r and C1s.
d. CR2 inhibits C3b formation.

 

18. Complement can lyse which of the following cells?
 
a. fungal cells
b. gram-positive bacteria
c. gram-negative bacteria
d. all of the above

 

19. Individual complement components measured with
 
a. AH50
b. CH50
c. RID
d. bacterial cell lysis

 

20. We would expect that a patient who has chronic liver disease would have complement levels that would be
 
a. elevated
b. normal
c. decreased
d. indeterminate because there is too little information

 

21. To study antibody in a patient’s blood in a way that removes the complement,
 
a. freeze and thaw the serum
b. use serum instead of plasma
c. add LPS and then heat to 100°C for 2 minutes
d. heat the serum to 56oC for 30 minutes

 

22. Complement
 
a. causes lysis of gram-positive cells and has no effect on gram-negative cells
b. causes lysis of gram-negative cells and has no effect on gram-positive cells
c. causes lysis of gram-positive cells and increases the amount of phagocytosis of gram-negative cells
d. causes lysis of gram-negative cells and increases the amount of phagocytosis of gram-positive cells

 

23. Complement
 
a. aids in immune complex clearance
b. interacts with the coagulation pathway
c. can be involved in immune memory enhancement
d. all of the above
e. A and C only

 

24. The three different pathways of complement activation are
 
a. different until the C5 convertase is formed
b. different until the membrane attack complex forms
c. different until activation of C3
d. different until C6 convertase forms

 

25. Which of the following is an active C3 convertase?
 
a. C4bC2a
b. C3bC5b
c. C4bC2a
d. BbDd

 

26. Calcium ions are required
 
a. to keep C4bC2a together
b. to keep C6,7,8 together
c. to allow C9 to polymerize
d. to keep C1q,r,s together

 

27. C-reactive protein can
 
a. activate complement in the classical pathway
b. activate complement in the lectin pathway
c. activate complement in the alternative pathway
d. activate complement in the classical pathway and activate complement in the alternative pathway

 

28. Because a particular antigen is far on the bacteria from another antigen, antibodies binding to these antigens
 
a. would activate complement only if antibodies bound to them underwent a comformational shift
b. would activate complement only if antibodies bound to them were close enough for the Fc regions of the bound antibodies to bind different globular heads of the C1q molecule
c. would activate complement only if antibodies bound to them underwent a comformational shift and would activate complement only if antibodies bound to them were close enough for the Fc regions of the bound antibodies to bind different globular heads of the C1q molecule
d. none of the above

 

29. Which of the following has a short half-life unless it lands on the cell surface?
 
a. C4b
b. C2b
c. C5a
d. C3a

 

30. Which pathway(s) can act as a powerful amplifier of the other pathways?
 
a. the classical pathway
b. the alternative pathway
c. the lectin pathway
d. all of the pathways can amplify each other

 

31. Which is involved in immune complex clearance by phagocytosis or splenic clearance?
 
a. CR1
b. CR2
c. CR3
d. CR1 and CR3

 

32. Collectin is
 
a. another name for the mannose-binding lectin
b. a name for the collective processes involved in all complement pathways
c. a receptor for C3b
d. a receptor for C1q

 

33. MBL binds
 
a. mannose and MASP-2 become associated and cleave C2 and C4
b. mannose and MASP-1 become associated and cleave C4
c. ficolin and MASP-2 become associated and cleave C2 and C4
d. membranes and MASP-1 become associated and cleave C2 and C4

 

34. The factors in the alternative pathway that are involved in the progression of the pathway are_______ and ___________. The factors that are involved in inhibition of the pathway are _____ and _________.
 
a. Factor C and D , Factor Properdin and Factor I
b. Factor B and D , Factor E and F
c. Factor B and D, Factor ficolin and Factor I
d. Factor B and D, Factor H and I

 

Answer Key

 

 

1. d. about 35 different proteins that are synthesized by monocytes, the liver, macrophages, and epithelial cells

 

2. a. Susie probably has an elevated CH 50 while Zoe probably has a decreased CH50.

 

3. d. lattice formation

 

4. c. bind after a conformational change occurs as the result of antigen binding

 

5. c. Ca++

 

6. d. usually the alternative and the lectin pathways, but with some microorganisms, also the classical pathway

 

7. b. in the classical pathway, the C3 convertase is C2aC4b’ in the alternative pathway, it is C3wBb; and in the MBL pathway, the C3 convertase is C2aC4b

 

8. e. A and B only

 

9. d. measures the alternative pathway and the CH50 measures the classical pathway and uses rabbit red blood cells and the CH50 uses sheep red blood cells with antibody

 

10. e. All of the above

 

11. b. complement protein of the alternative pathway

 

12. d. factors I, H, and C1INH and vitronectin or S protein

 

13. c. C1, C4, C2, C1INH

 

14. e. all of the above

 

15. d. C3a, C4a, C5a

 

16. a. C3b, C1q, iC3b, C4b

 

17. a. C1INH inactivates C1 and inhibits binding of MBL to MASP-2.

 

18. c. gram-negative bacteria

 

19. c. RID

 

20. c. decreased

 

21. d. heat the serum to 56oC for 30 minutes

 

22. d. causes lysis of gram-negative cells and increases the amount of phagocytosis of gram-positive cells

 

23. d. all of the above

 

24. c. different until activation of C3

 

25. a. C4bC2a

 

26. d. to keep C1q,r,s together

 

27. a. activate complement in the classical pathway

 

28. c. would activate complement only if antibodies bound to them underwent a comformational shift and would activate complement only if antibodies bound to them were close enough for the Fc regions of the bound antibodies to bind different globular heads of the C1q molecule

 

29. a. C4b

 

30. b. the alternative pathway

 

31. a. CR1

 

32. d. a receptor for C1q

 

33. b. mannose and MASP-1 become associated and cleave C4

 

34. b. Factor B and D , Factor E and F

 

 

 

 

Chapter 17 Hepatitis

 

Multiple-Choice Questions

 

1. A patient who uses drugs intravenously and comes to the clinic with all the signs and symptoms of hepatitis should be tested for
 
a. hepatitis A
b. hepatitis B
c. hepatitis C
d. A and C
e. all of the above

 

2. The patient in question 1 should be tested for
 
a. anti-HAV
b. IgM anti-HBcAg and HBsAg
c. anti-HCV
d. B and C
e. all of the above

 

3. A patient named Lily who works at an area sushi restaurant is looking rather yellow and feels acutely ill. She loves raw seafood and had a special treat when a customer brought her some sushi from Southeast Asia. The customer is also ill. Lily is given her test results; she has non-A non-B hepatitis. She most likely has
 
a. hepatitis A
b. hepatitis B
c. hepatitis C
d. hepatitis D
e. hepatitis E

 

4. Is it a concern that Lily worked with and served raw fish? She did not serve the fish from Southeast Asia that she was given; she ate all of that herself.
 
a. It is a concern for all her customers because this always spreads from person to person even if they did not eat any raw food.
b. It is a concern mostly for people who bought and ate the same fish that she did because this rarely spreads from person to person.
c. Because it is not infectious, it is not a concern for other people who ate the fish or for her other customers.
d. None of the above

 

5. Your friend Lizbeth received her hepatitis B vaccine 2 years ago. She had her titer checked and she had a great immune response. This morning she got a needle stick from a patient with fulminant hepatitis B and hepatitis D. The source patient tested negative for hepatitis C and HIV.
What should Lizbeth do?
 
a. get a booster shot
b. start on pegylated interferon
c. abstain from alcohol and wait and watch for 6 months to see whether she shows symptoms.
d. relax because she is not at risk

 

6. A car accident occurred right outside the hospital. Your friend Eddie who works in administration ran to the accident victim. He pressed a bandana over the cut on the victim’s arm that was spurting blood until the emergency crew came. The victim was positive for hepatitis Be antigen. Is Eddie, who has not been vaccinated, at risk?
 
a. Yes, HBeAg indicates that the patient is infectious.
b. No, hepatitis E is spread only through fecal oral contact.
c. No, HBeAg is present during recovery, so the patient has hepatitis but is not very infectious.
d. Yes, but he can take penicillin to prevent the infection

 

7. Using the protocol with the high signal to cut-off ratio, a patient’s sample was tested three times by HCV EIA with a high single to cut-off ratio. The next step is to
 
a. do a molecular based test
b. confirm with a RIBA
c. report that no additional testing is needed
d. none of the above

 

8. Liver damage in hepatitis can be measured by measuring which of the following?
 
a. alanine aminotransferase
b. aspartate aminotransferase
c. alkaline phosphatase
d. all of the above
e. A and C only

 

9. Intravenous drug users are at risk for
 
a. hepatitis A
b. hepatitis B
c. hepatitis C
d. all of the above

 

10. Which of the following protects against a hepatitis A infection?
 
a. Twinrex® (GSK), VAQTA® (Merck), and HAVRIX® (GSK)
b. Engerix-B® and Recombivax®
c. Comvax
d. Pediarix ®
e. all of the above

 

11. A patient who comes into the clinic states that she has very recent known exposure to hepatitis A. She has not received a hepatitis A vaccine. What should be done?
 
a. test for antibody to hepatitis A
b. give her interferon alpha
c. give her immune globulin
d. give her the hepatitis A vaccine
e. C or D

 

12. A patient has severe hepatitis B and has been admitted to the hospital. You realize that Simon, one of the clinical lab scientists in the lab that you supervise has been exposed to this patient’s blood. Simon has not been vaccinated. What should be done?
 
a. Give Simon one dose of antihepatitis B immunoglobulin.
b. Give Simon multiple doses of anti-hepatitis B immunoglobulin.
c. Give Simon alpha interferon.
d. B and C

 

13. Six main genotypes of this virus exist; they are
 
a. hepatitis A
b. hepatitis B
c. hepatitis C
d. hepatitis D
e. hepatitis E

 

14. This virus is said to be a quasi-species because of its high mutation rate. It is
 
a. hepatitis A
b. hepatitis B
c. hepatitis C
d. hepatitis D
e. hepatitis E

 

15. Hepatitis D is a
 
a. dsDNA virus that causes hepatitis in Asia
b. satellite virus that infects with hepatitis B
c. satellite virus that infects with hepatitis C
d. satellite virus that infects with hepatitis A

 

16. The incidence of hepatitis B dramatically dropped in 1991 as the result of the
 
a. development of a vaccine from plasma of infected patients
b. use of a new vaccination strategy to eliminate hepatitis B
c. development of a vaccine to hepatitis B using recombinant HBsAg produced in E. coli
d. B and C

 

17. Hepatitis C is tested for using
 
a. EIA with or without the signal-to-cutoff ratio decision making
b. RIBA
c. nucleic acid testing
d. A and B
e. all of the above

 

18. Pegylated interferon is used in the
 
a. treatment of chronic hepatitis B
b. treatment of hepatitis C
c. the replacement of interferon because it has a longer half-life
d. all of the above
e. B and C

 

19. A patient who comes to the health clinic with nausea, abdominal pain, fever, malaise, anorexia, dark urine, clay-colored stool, and jaundice should be tested for
 
a. hepatitis A, B, and C
b. toxoplasmosis
c. rubella
d. Candida albicans
e. all of the above

 

20. Which of the following indicates that the hepatitis B infection in a patient with hepatitis B is resolving?
 
a. anti-HBcAg
b. anti-HBcAg IgM
c. anti-HDV
d. anti-HBsAg

 

21. Antibody to which of the following is not protective?
 
a. hepatitis A
b. hepatitis B
c. hepatitis C
d. A and B
e. C and D

 

22. Which of the following is true?
 
a. Asymptomatic hepatitis B is more likely to become chronic than symptomatic hepatitis B.
b. Symptomatic hepatitis B is more likely to become chronic than asymptomatic hepatitis B.
c. Asymptomatic hepatitis C is more likely to become chronic than symptomatic hepatitis C.
d. A and C
e. B and C

 

23. The screening test for which of the following involves a third-generation indirect enzyme immunoassay that uses a mixture of viral antigens in a microtiter well or on microbeads?
 
a. hepatitis B
b. hepatitis C
c. hepatitis E
d. none of the above

 

24. Which of the following assays is most like a western blot?
 
a. RIBA
b. NAT
c. assay for hepatitis E
d. assay for hepatitis A

 

25. One of the hepatitis viruses that has partially double stranded DNA is

 

 
a. hepatitis A
b. hepatitis B
c. hepatitis C
d. hepatitis D
e. hepatitis E

 

Answer Key

 

 

1. e. all of the above

 

2. e. all of the above

 

3. e. hepatitis E

 

4. b. It is a concern mostly for people who bought and ate the same fish that she did because this rarely spreads from person to person.

 

5. d. relax because she is not at risk

 

6. a. Yes, HBeAg indicates that the patient is infectious.

 

7. a. do a molecular based test

 

8. d. all of the above

 

9. d. all of the above

 

10. a. Twinrex® (GSK), VAQTA® (Merck), and HAVRIX® (GSK)

 

11. e. C or D

 

12. b. Give Simon multiple doses of anti-hepatitis B immunoglobulin.

 

13. c. hepatitis C

 

14. c. hepatitis C

 

15. b. satellite virus that infects with hepatitis B

 

16. b. use of a new vaccination strategy to eliminate hepatitis B

 

17. e. all of the above

 

18. d. all of the above

 

19. a. hepatitis A, B, and C

 

20. d. anti-HBsAg

 

21. c. hepatitis C

 

22. d. A and C

 

23. b. hepatitis C

 

24. a. RIBA

 

25. b. hepatitis B

 

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