Clinical Microbiology
Pre-Test Questions
Course Introduction
Clinical Microbiology explores the role of microorganisms in human health and disease, emphasizing their identification, characterization, and clinical significance. The course covers the structure, physiology, and genetics of bacteria, viruses, fungi, and parasites, as well as the mechanisms of pathogenicity and antimicrobial resistance. Students learn about specimen collection, diagnostic techniques, and the interpretation of laboratory results, with a focus on the application of microbiological principles to the diagnosis, treatment, and prevention of infectious diseases in clinical settings.
Recommended Textbook
Clinical Immunology and Serology A Laboratory Perspective 4th Edition by Christine Dorresteyn
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Chapter 1: Introduction to Immunity and the Immune System
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Sample Questions
Q1) All of the following are involved in adaptive immunity EXCEPT: A) memory.
B) lymphocytes.
C) specificity.
D) neutrophils.
Answer: D
Q2) Which of the following is NOT a component or characteristic of natural (innate)immunity?
A) Repeated exposure to a pathogen does not change the response.
B) The response involves acute-phase reactants.
C) The response involves phagocytosis.
D) The response involves antibodies.
Answer: D
Q3) Acquired (adaptive)immunity can be characterized as:
A) nonspecifically activated.
B) immediately responsive.
C) neutrophil dependent.
D) involving memory.
Answer: D
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Chapter 2: Nature of Antigens and the Major
Histocompatibility Complex
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Q1) Which of the following molecules is the best immunogen?
A) Protein
B) Polysaccharide
C) Nucleic acid
D) Lipid
Answer: A
Q2) Which option best describes a finding of Landsteiner's study of haptens?
A) Similar haptens trigger the same antibody response.
B) Spatial configuration is recognized by antibody.
C) Small chemical changes to a hapten do not affect antibody response.
D) A hapten can react with many different antibodies.
Answer: B
Q3) Each class II MHC molecule has specificity for:
A) any endogenous peptide.
B) related peptides that share a similar peptide sequence.
C) one very specific peptide sequence.
D) native, conformational epitopes.
Answer: B
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Chapter 3: Innate Immunity
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Sample Questions
Q1) Toll-like receptors bind to:
A) cytokines.
B) the Fc portion of IgG.
C) acute-phase proteins.
D) pathogen-associated molecular patterns.
Answer: D
Q2) Which is a characteristic of resident bacteria (microbiota)in the gastrointestinal tract?
A) Develop when a person has an immunodeficiency
B) Consist of a single species that is tolerated by the host
C) Supplant pathogenic bacteria
D) Cause gastrointestinal disease
Answer: C
Q3) Macrophages use all of the following to kill bacteria EXCEPT:
A) hydrogen peroxide.
B) perforin.
C) hydroxyl radical.
D) lysozyme.
Answer: B
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Page 5
Chapter 4: Adaptive Immunity
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Sample Questions
Q1) Which marker would be found on pre-B cells?
A) CD3
B) Mu heavy chains
C) CD16
D) IgD
Q2) T cells that respond against self-antigens are inactivated by:
A) binding to immunoglobulin.
B) intermediate-strength binding to self MHC.
C) apoptosis.
D) positive selection.
Q3) Immunoglobulin gene rearrangements occur in which stage of B-cell development?
A) Pro-B cell
B) Pre-B cell
C) Immature B cell
D) Mature B cell
Q4) The function of CD4+ T cells is:
A) to help B cells make antibody.
B) to kill virally infected cells.
C) phagocytosis.
D) production of opsonins.
Page 6
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Chapter 5: Antibody Structure and Function
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Sample Questions
Q1) Which of the following is a characteristic of IgA?
A) It is found in secretions.
B) It fixes complement.
C) It is a pentamer in serum.
D) It is the primary response antibody.
Q2) Identify the characteristic that best describes IgE.
A) Fixes complement
B) Binds to mast cells
C) Found on mucosal surfaces
D) Participates in agglutination reactions
Q3) Which immunoglobulin can cross the placenta?
A) IgM
B) IgE
C) IgA
D) IgG
Q4) The combination of a plasma cell fused to a myeloma cell is called a:
A) melanoma.
B) hybridoma.
C) mycetoma.
D) myeloma.
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Chapter 6: Cytokines
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Sample Questions
Q1) Which of the following would be an effective therapy for rheumatoid arthritis?
A) TNF
B) IL-6
C) Antibodies against TNF receptors
D) Antibodies against IL-2
Q2) IL-4 functions by:
A) inhibiting macrophages.
B) inducing hematopoiesis.
C) activating B cells.
D) activating macrophages.
Q3) Characteristic of cytokines include which of the following?
A) They are directly cytotoxic to bacteria.
B) They are produced primarily by the liver.
C) They are chemical messengers that regulate the immune system.
D) They are polysaccharides.
Q4) What is one of the main activities of IL-4?
A) Downregulates the immune response
B) Increases production of neutrophils
C) Generates Th2 cells
D) Protects cells from viral invasion
8
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Chapter 7: Complement System
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Sample Questions
Q1) Which complement factor polymerizes to cause lysis of a foreign cell?
A) C5
B) C6
C) C8
D) C9
Q2) C4 binding protein (C4BP)acts in association with which factor to inactivate C4b?
A) Factor B
B) Factor D
C) Factor I
D) C1INH
Q3) C5b6789 functions in:
A) target cell lysis.
B) recognition of antigen.
C) chemotaxis.
D) complement inhibition.
Q4) What is cleaved by C3bBb?
A) C3
B) C5
C) C6
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Chapter 8: Safety and Quality Management
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Sample Questions
Q1) What are the three variables monitored in a quality control program?
A) Accuracy, precision, and reliability
B) Turnaround time, reliability, and reproducibility
C) Reagent purity, specimen collection, and cost impact
D) Avoiding trends, turnaround time, and cost impact
Q2) What does the acronym PASS stand for?
A) Pull, aim, squeeze, sweep
B) Pass, activate, sweep, scram
C) Pull, alarm, squeeze, sweep
D) Pass, activate, scram, scream
Q3) A coworker says she has an allergy to latex.As her supervisor,what should you advise her to do?
A) Wear latex gloves but wash her hands often to stop the allergy.
B) Wear gloves made of an alternative material.
C) Do not wear gloves.
D) Wash the latex gloves before using.
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Chapter 9: Principles of Serological Testing
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Sample Questions
Q1) Calculate the positive predictive value of the assay.
A)57%
B)75%
C)80%
D)90%
Q2) If you want to make 4 mL of a 1:20 dilution,how much serum would be needed?
A) 0.2 mL
B) 2 mL
C) 0.5 mL
D) 1 mL
Q3) What is the sensitivity of the assay?
A)57%
B)75%
C)80%
D)90%
Q4) How should a 1:50 dilution be made if the final volume needed is 10 mL?
A) 0.1 mL of serum and 9.9 mL of diluent
B) 0.2 mL of serum and 9.8 mL of diluent
C) 0.2 mL of serum and 10.0 mL of diluent
D) 0.5 mL of serum and 9.5 mL of diluent
11
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Chapter 10: Precipitation and Agglutination Reactions
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Sample Questions
Q1) A solution has 4 pentomeric IgM antibodies per microliter.What concentration of antigen molecules is necessary for the solution to be in the zone of equivalence? The antigen has 4 identical epitopes on each molecule.
A) 4 antigen molecules per microliter
B) 5 antigen molecules per microliter
C) 10 antigen molecules per microliter
D) 20 antigen molecules per microliter
Q2) If the concentration of free antibody (Ab)= 3 mol/L,the concentration of free antigen (Ag)= 2 mol/L,and the concentration of antigen-antibody complex = 6 mol/L,then the equilibrium constant K equals:
A) 1.
B) 2.
C) 4.
D) 9.
Q3) Which best describes hemagglutination tests?
A) Patient antibody reacts with hemoglobin.
B) The reaction involves red blood cells.
C) Patient antibody is always involved.
D) Hemoglobin binds to antigen.
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Page 12
Chapter 11: Labeled Immunoassays
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Sample Questions
Q1) Rheumatoid factor can cause false-positive results in which type of assay?
A) Homogeneous competitive
B) Heterogeneous competitive
C) Homogeneous noncompetitive
D) Heterogeneous noncompetitive
Q2) Which assay format is the best choice for measuring small molecules,such as drugs and small peptide hormones?
A) Latex agglutination
B) Fluorescence polarization
C) Capture ELISA
Q3) Select the technique that would most likely be used to determine the concentration of a therapeutic drug.
A) Radioimmunoassay
B) Chemiluminescent assay
C) Fluorescence polarization immunoassay
D) Enzyme immunoassay
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13
Chapter 12: Molecular Diagnostic Techniques
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Sample Questions
Q1) ddNTPs terminate the lengthening of a DNA strand because they lack chemical groups that:
A) allow hydrogen bonding to the template strand.
B) are recognized by DNA polymerase.
C) protect the strand from endonucleases.
D) form phosphodiester bonds in the backbone of the strand.
Q2) Which type of RNA is used to directly translate the DNA code into making functional proteins?
A) Transfer RNA
B) Ribosomal RNA
C) Messenger RNA
D) Probe RNA
Q3) Select the strand of RNA that is complementary to this single strand of DNA: A T T A G C C G T A T
A) T A A T C G G C A T A
B) U A A U C G G C U A U
C) T U U T C G G C A U A
D) T A A T U G G U A T A
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Chapter 13: Flow Cytometry and Laboratory Automation
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Sample Questions
Q1) In flow cytometry,fluorescence is usually used to determine:
A) intrinsic cell parameters.
B) extrinsic cell parameters.
Q2) A mature cytotoxic T cell expresses which markers?
A) CD3, CD4, and CD8
B) CD4, CD3, and CD5
C) CD5, CD8, and CD3
D) CD8, CD3, and CD2
Q3) Fluorescently labeled antibodies are used in flow cytometry to determine:
A) the size of a cell.
B) the granularity of a cell.
C) proteins associated with a cell.
D) the shape of the nucleus.
Q4) How close a measured value is to the actual (true)value is called:
A) accuracy.
B) precision.
C) analytic sensitivity.
D) analytic specificity.
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15
Chapter 14: Hypersensitivity
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Sample Questions
Q1) Preformed mediators that are released during the activation phase of a type I hypersensitivity response include which of the following?
A) Histamine
B) Cyclooxygenase
C) Leukotriene
D) Prostaglandin
Q2) Which of the following occurs in hemolytic disease of the newborn?
A) IgE builds up on the mother's cells.
B) The Rh- mother is exposed to Rh+ baby cells.
C) The Rh+ mother is exposed to Rh- baby cells.
D) The baby must be Rh-.
Q3) An example of a condition that involves type III hypersensitivity is:
A) myasthenia gravis.
B) allergic rhinitis.
C) contact sensitivity.
D) rheumatoid arthritis.
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Chapter 15: Autoimmunity
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Sample Questions
Q1) A 54-year-old woman presents to her optometrist complaining that she has been having difficulty focusing on objects near and far.Her vision problems are getting progressively worse.She also thinks that her eyelids are drooping,and she is thinking of getting plastic surgery to "put them back up." The optometrist cannot find a good reason for her vision problems but is able to fit her with glasses and recommends that she see a rheumatologist.What autoantibody would you recommend be tested for in this patient?
A) Antibody to the acetylcholine receptor
B) Antibody to myelin basic protein
C) Antibody to basement membrane antigens
D) Anti-neutrophil cytoplasmic antibodies (ANCAs)
Q2) Hashimoto's thyroiditis can best be differentiated from Graves disease on the basis of which of the following?
A) Decrease in thyroid hormone levels
B) Presence of thyroid peroxidase antibodies
C) Enlargement of the thyroid
D) Presence of lymphocytes in the thyroid
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17
Chapter 16: Transplantation Immunology
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Sample Questions
Q1) To correctly read a complement-dependent cytotoxicity test,the technologist should record the number of viable cells.
A)True
B)False
Q2) In a patient who is exhibiting signs of graft-versus-host disease,which cell type is most likely responsible for the reaction?
A) B cells
B) T cells
C) Macrophages
D) Eosinophils
Q3) Which histocompatibility system activates gamma or delta T-cell receptors?
A) ABO blood group antigen
B) Killer immunoglobulin-like receptors
C) MHC class-I related chain A (MICA) antigen
D) Minor histocompatibility antigens
Q4) In direct allorecognition,the recipient T cells bind and respond directly to foreign HLA proteins.
A)True
B)False
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Chapter 17: Tumor Immunology
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Sample Questions
Q1) Cancer antigen 125
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
Q2) What is the definition of a sarcoma?
A) A cancer that is derived from skin or epithelial linings of internal organs or glands
B) A cancer that is derived from muscle, bone, fat or soft tissues
C) A cancer that is derived from blood and lymphatic systems
D) A cancer that is derived from brain and spinal tissue
Q3) Cancer antigen 19-9
A)Hepatocellular carcinoma
B)Ovarian cancer
C)Colorectal, breast, or lung cancer
D)Breast cancer only
E)Pancreatic and gastrointestinal cancers
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Chapter 18: Immunoproliferative Diseases
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Q1) A patient whose malignant clone is positive for the CD markers CD15 and CD30 is most likely to have what clinical disease?
A) Non-Hodgkin lymphoma
B) Hodgkin lymphoma
C) Acute lymphocytic leukemia
D) Hairy-cell leukemia
Q2) Which type of gene is required for cell growth and division but can cause malignant transformation when altered?
A) Tumor suppressor gene
B) Proto-oncogene
C) Anti-tumor gene
D) Immunoglobulin gene
Q3) Which of the following is not a characteristic in the identification of lymphoma of B-cell origin?
A) Surface immunoglobulins
B) Cell-surface proteins CD19 and CD20
C) Rearrangement of immunoglobulin genes
D) Presence of CD14 and CD15
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Chapter 19: Immunodeficiency Diseases
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Sample Questions
Q1) Which of the following is associated with DiGeorge syndrome?
A) Small or missing thymus
B) Missing B-cell precursors
C) Inherited as X-linked recessive
D) M spike in the gamma region
Q2) The most common complement component deficiency is:
A) C1q.
B) factor B.
C) MASP.
D) C2.
Q3) A child suspected of having an inherited humoral immunodeficiency disease is given a 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 does have this 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
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Chapter 20: Serological and Molecular Detection of Bacterial Infections
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Q1) Antibodies detected by reacting patient serum with rickettsial antigens,followed by incubation with an anti-immunoglobulin with a fluorescent tag,could be used to diagnose:
A) Rocky Mountain spotted fever.
B) Mycoplasma pneumonia.
C) stomach ulcers.
D) rheumatic fever.
Q2) Which bacterium is transmitted to humans via tick or flea bites?
A) Streptococcus pyogenes
B) Mycoplasma pneumoniae
C) Rickettsia rickettsii
D) Helicobacter pylori
Q3) Which test is inappropriate for identifying Helicobacter pylori?
A) Polymerase chain reaction
B) Urease
C) Enzyme immunoassay
D) DNase
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Page 22
Chapter 21: Spirochete Diseases
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Q1) Which of the following is a cause of a biological false-negative result in the nontreponemal tests for syphilis?
A) Rotated too long
B) Rheumatoid arthritis
C) Secondary syphilis
D) Slow rotator speed
Q2) The Centers for Disease Control and Prevention recommends which two-tiered testing procedure for Lyme disease?
A) Screening by IFA or EIA with positive or borderline result followed by Western blot for confirmation
B) Screening by IFA followed by EIA for confirmation
C) Screening by Western blot followed by PCR for confirmation
D) Screening by EIA followed by PCR for confirmation
Q3) At which stage of syphilis is the RPR the most sensitive?
A) Primary
B) Secondary
C) Tertiary
D) Latent
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Chapter 22: Serological and Molecular Diagnosis of Parasitic
and Fungal
Infections
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Q1) To correctly determine an infection with toxoplasmosis within the last 12 months,both IgG and IgM should be negative.
A)True
B)False
Q2) Suppose a parasite invades a patient and causes disease.The patient develops immunity and is ultimately cured.This outcome is considered what type of host-parasite interaction?
A) Symbiosis
B) Commensalism
C) Sterilizing immunity
D) Concomitant immunity
Q3) A patient presents with a fungal infection.Which components of the immune system are activated early in the course of the patient's infection?
A) Macrophages and dendritic cells
B) Natural killer cells and antibodies
C) Polysaccharides and chitins
D) T cells and B cells
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Page 24
Chapter 23: Serology and Molecular Detection of Viral Infections
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Q1) Serology is performed on a patient with a rash and fever.Results are: rubella IgM = positive; rubella IgG = positive; measles IgM = negative; measles IgG = positive; varicella-zoster IgM = negative; varicella-zoster IgG = negative.What is the interpretation of these results?
A) Acute infection with rubella virus
B) Acute infection with measles virus
C) Not immune to measles or rubella viruses
D) Immune to varicella-zoster virus only
Q2) A physician suspects that his patient has infectious mononucleosis.Heterophile antibody tests are negative.Serological testing for Epstein-Barr virus (EBV)was performed,with the following results obtained: EBV VCA IgM = neg; EBV VCA IgG = neg; EBV-EA = neg; EBV-NA = neg.What is this person's status with regard to EBV?
A) Acute EBV
B) Convalescent EBV
C) Never infected with EBV
D) Past exposure to EBV
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Chapter 24: Laboratory Diagnosis of HIV Infection
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Q1) In the Western blot test for HIV antibody,a positive test result is indicated by the bands p24 and p55.
A)True
B)False
Q2) The most commonly used HIV drug-resistance assays are based on:
A) culture of HIV in the presence of antiretroviral drugs.
B) detection of genetic mutations in HIV.
C) ability of HIV antibodies to react with drug-resistant viral strains.
D) typing for the HLA-B27 allele.
Q3) Which of the following peripheral blood measurements is used to determine the stage of HIV infection?
A) The number of CD4 T cells
B) The number of CD8 T cells
C) The number of HIV RNA copies
D) The HIV antibody titer
Q4) Of the designated subtypes of HIV,which is the most common in the United States?
A) Subtype B
B) Subtype C
C) Subtype A
D) Subtype K
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Chapter 25: Immunization and Vaccines
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Q1) Passive immunity involves the activation of IgD.
A)True
B)False
Q2) An inactivated vaccine is used clinically to prevent:
A) chickenpox.
B) measles.
C) mumps.
D) influenza.
Q3) Adoptive immunity
A) Immunization with a specific antigen
B) Transfer of antibodies from immunized host to nonimmune host
C) Transfer of cells, usually lymphocytes, from an immune host to a nonimmune host
Q4) Hypersensitivity responses to vaccines have been known to develop by all of the following mechanisms except for:
A) type I hypersensitivity.
B) type II hypersensitivity.
C) type III hypersensitivity.
D) type IV hypersensitivity.
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