Immunology Serology in Laboratory

Medicine 5th Edition Turgeon Test Bank

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Chapter 13: Automated Procedures
Test Bank

MULTIPLE CHOICE

1. Latex particles act as ______________________ in nephelometry.

a. antigen-coated reaction intensifiers
b. antigen-coated reaction stabilizers of precipitate
c. sensitivity enhancers
d. color reaction intensifiers
ANS: A
Specific antigen-coated latex particles acting as reaction intensifiers are agglutinated by their
corresponding antibody.

DIF: Cognitive Level: II REF: p. 171

2. A fundamental prerequisite for nephelometric protein quantitation is the:

a. dissolution of large protein molecules.
b. formation of a macromolecular complex.
c. pH of the solution.
d. ionic strength of the solution.
ANS: B
Increased light scatter of a solution can be measured by nephelometry as the macromolecular
complexes form.

DIF: Cognitive Level: II REF: p. 171

3. In nephelometry measurement, if antigen overwhelms the quantity of antibody, the measured

signal:
a. increases.
b. decreases.
c. remains the same.
d. fluctuates between high and low.
ANS: B
The relationship between the quantity of antigen and measuring signal at a constant antibody
concentration is expressed by the Heidelberger curve. If antibodies are present to excess, a
proportional relationship exists between the antigen and resulting signal. If the antigen
overwhelms the quantity of antibody, the measured signal decreases.

DIF: Cognitive Level: II REF: p. 172

4. Which of the following is a correct statement regarding measurements of turbidity?

a. Light is scattered at a determined angle.
b. It is unaffected by large particles precipitating out of a solution.
c. The reference value is recorded in units of relative light scatter.
d. It represents the scattered light in forward direction.
ANS: A
 Nephelometry is based on the principle that light is scattered by a homogeneous particulate
solution at a variety of angles. Three types of scatter can occur: (1) scatter around the
particles; (2) forward scatter caused by out of phase backscatter; and (3) forward scatter
exceeding backscatter.

DIF: Cognitive Level: II REF: p. 172

5. In nephelometry measurement, a __________________method is used.

a. variable-time
b. fixed-time
c. fluorescent-tagging
d. competitive immunoassay
ANS: B
A fixed-time method is used routinely for precipitation reactions.

DIF: Cognitive Level: II REF: p. 172

6. Nephelometry can be used to assay all the following except:

a. IgM.
b. IgG.
c. IgD.
d. IgA.
ANS: C
Currently, instruments using a rate method and fixed-time approach are commercially
available with tests for immunoglobulin G (IgG), IgA, IgM, C3, C4, properdin, C-reactive
protein (CRP), rheumatoid factor, ceruloplasmin, 1-antitrypsin, apolipoproteins, and
haptoglobins.

DIF: Cognitive Level: II REF: p. 172

7. Cryoglobulins are proteins that precipitate or gel when cooled to:

a. −18 C.
b. 0 C.
c. 4 C.
d. 18 C.

ANS: B
Cryoglobulins are proteins that precipitate or gel when cooled to 0 C and dissolve when
heated.

DIF: Cognitive Level: II REF: p. 172

8. Monoclonal cryoglobulins are most often:

a. IgM.
b. IgG.
c. IgA.
d. either a or b.
ANS: D
In most cases, monoclonal cryoglobulins are IgM or IgG.
 DIF: Cognitive Level: II REF: p. 172

9. Cryoglobulin analysis can be useful in the diagnosis of:

a. hypothermia.
b. Raynaud’s phenomenon.
c. infectious hepatitis.
d. rheumatoid arthritis.
ANS: B
Cryoglobulin analysis is frequently requested when patient symptoms such as pain, cyanosis,
Raynaud’s phenomenon, and skin ulceration on exposure to cold temperatures are present.

DIF: Cognitive Level: II REF: p. 172

10. A blood specimen for testing for the presence of cryoglobulins should be:
a. immediately placed in warm water after collection.
b. immediately placed on ice after collection.
c. immediately refrigerated at 4 C.
d. not treated in any special way.
ANS: A
To test for the presence of cryoglobulins, blood is collected, placed in warm water, and
centrifuged at room temperature. The serum is then put into a graduated centrifuge tube and
placed in a 4-C environment for 7 days. If a gel or precipitate is observed, the tube is
centrifuged and the precipitate is washed at 4 C, redissolved at 37 C, and evaluated by
double diffusion and immunoelectrophoresis for the content of the cryoglobulin. Newer
methods use nephelometry with cold treatment for analysis.

DIF: Cognitive Level: II REF: p. 172

11. Laser is an acronym for:

a. light amplification by stimulated emission of radiation.
b. light augmentation by stimulated emitted radiation.
c. light amplified by stimulated energy radiation.
d. large angle stimulation by emitted radiation.
ANS: A
Laser is light amplification by stimulated emission of radiation.

DIF: Cognitive Level: II REF: p. 172

12. A photon is a:
a. basic unit of light.
b. basic unit of all radiation.
c. component of an atom.
d. component of laser light.
ANS: B
 When an atom extends beyond the orbits of its electrons or when a molecule vibrates or
changes its shape, it instantly snaps back, shedding energy in the form of a photon. The
photon is the basic unit of all radiation. When a photon reaches an atom of the medium, the
energy exchange stimulates the emission of another photon in the same wavelength and
direction. This process continues until a cascade of growing energy sweeps through the
medium.

DIF: Cognitive Level: II REF: p. 173

13. A fluorochrome is a(n):

a. dye.
b. immunologic reagent.
c. nonspecific indicator.
d. both a and b.
ANS: D
A fluorochrome is an immunologic reagent, a dye that stains a specific component.

DIF: Cognitive Level: II REF: p. 173

14. The principle of flow cytometry is based on:

a. antigen-antibody reactions.
b. the formation of immune complexes.
c. the reaction of dyes with the cellular component of interest.
d. the reaction of dyes with immune complexes.
ANS: C
The principle of flow cytometry is based on cells being stained in suspension with an
appropriate fluorochrome or some other marker with specific reactivity. Fluorescent dyes used
in flow cytometry must bind or react specifically with the cellular component of interest.

DIF: Cognitive Level: II REF: p. 173

15. The major application(s) of flow cell technology is (are):

a. identification of cells.
b. cell sorting before further analysis.
c. diagnosis of autoimmune disease.
d. both a and b.
ANS: D
The major applications of flow cell technology are identification of cells and cell sorting
before further analysis.

DIF: Cognitive Level: I REF: pp. 175-178

16. Immunophenotyping includes the detection or identification of:

a. CD34+ stem cells.
b. minimal residual disease in patients with leukemia.
c. T and B lymphocytes.
d. all of the above.
ANS: D
 Any fresh specimen that can be placed into a single-cell suspension is a valid candidate for
immunophenotyping (e.g., T cells, B cells, CD34+ stem cells, detection of minimal residual
disease in leukemia).

DIF: Cognitive Level: II REF: p. 173

17. The most frequently used fluorochrome(s) is (are):

a. fluorescein isothiocyanate (FITC).
b. phycoerythrin (PE).
c. peridinin chlorophyll protein (PerCP).
d. all of the above.
ANS: D
The four most common fluorochromes are FITC, phycoerythrin (PE), peridinin chlorophyll
protein (PerCP), and allophycocyanin (APC).

DIF: Cognitive Level: II REF: p. 174

18. Current fluorescent methods can perform up to _______-color analysis.

a. two
b. four
c. eight
d. 16
ANS: C
Current fluorescent methods such as the BD FACSCanto II flow cytometer can perform up to
eight-color analysis. Eight-color immunofluorescence offers the advantages of greater
sensitivity and specificity, with increased ability to identify and subclassify individual cells.
The BD LSRII flow cytometer, with up to four lasers, can measure up to 16 colors. It can use
four monoclonal antibodies (MAbs), each directly conjugated to a distinct fluorochrome, per
tube of patient cell suspension.

DIF: Cognitive Level: II REF: p. 174

19. A fluorescent polarization immunoassay can perform a(n):

a. microparticle enzyme immunoassay.
b. fluorescence polarization immunoassay.
c. ion capture technologies.
d. all of the above.
ANS: D
The fluorescent polarization immunoassay, the IMx System (Abbott Laboratories), is an
automated analyzer designed to perform microparticle enzyme immunoassay, fluorescence
polarization immunoassay, and ion capture technologies. This unique combination allows
both high- and low-molecular-weight analytes to be measured. This expands the range of
available assays to include tests for endocrine function, fertility, cancer, hepatitis,
transplantation, rubella, and congenital disease.

DIF: Cognitive Level: II REF: p. 178

TRUE/FALSE
1. Nephelometry is less expensive initially than other forms of testing.

ANS: F
The disadvantages of nephelometry include high initial equipment cost and interfering
substances such as microbial contamination, which may cause protein denaturation and
erroneous test results. Intrinsic specimen turbidity or lipemia may exceed the preset limits. In
these cases, a clearing agent may be needed before an accurate assay can be performed. In
addition, low-molecular-weight immunoglobulins and monoclonal immunoglobulins also may
produce spurious results in nephelometry.

DIF: Cognitive Level: II REF: p. 172

2. Microbial contamination can produce erroneous results in nephelometry.

ANS: T
The disadvantages of nephelometry include high initial equipment cost and interfering
substances such as microbial contamination, which may cause protein denaturation and
erroneous test results. Intrinsic specimen turbidity or lipemia may exceed the preset limits. In
these cases, a clearing agent may be needed before an accurate assay can be performed. In
addition, low-molecular-weight immunoglobulins and monoclonal immunoglobulins also may
produce spurious results in nephelometry.

DIF: Cognitive Level: II REF: p. 172

3. Monoclonal antibodies can produce spurious results in nephelometry.

ANS: T
The disadvantages of nephelometry include high initial equipment cost and interfering
substances such as microbial contamination, which may cause protein denaturation and
erroneous test results. Intrinsic specimen turbidity or lipemia may exceed the preset limits. In
these cases, a clearing agent may be needed before an accurate assay can be performed. In
addition, low-molecular-weight immunoglobulins and monoclonal immunoglobulins also may
produce spurious results in nephelometry.

DIF: Cognitive Level: II REF: p. 172

4. Laser light is concentrated.

ANS: T
In contrast to other diffuse forms of radiation, laser light is concentrated. It is almost
exclusively of one wavelength or color, and its parallel waves travel in one direction. Through
the use of fluorescent dyes, laser light can occur in numerous wavelengths. The types of lasers
include glass-filled tubes of helium and neon (most common), yttrium-aluminum-garnet
(YAG, an imitation diamond), argon, and krypton. Lasers sort the energy in atoms and
molecules, concentrate it, and release it in powerful waves.

DIF: Cognitive Level: II REF: p. 172

5. Laser light is multicolored.

 ANS: F
In contrast to other diffuse forms of radiation, laser light is concentrated. It is almost
exclusively of one wavelength or color, and its parallel waves travel in one direction. Through
the use of fluorescent dyes, laser light can occur in numerous wavelengths. The types of lasers
include glass-filled tubes of helium and neon (most common), yttrium-aluminum-garnet
(YAG, an imitation diamond), argon, and krypton. Lasers sort the energy in atoms and
molecules, concentrate it, and release it in powerful waves.

DIF: Cognitive Level: II REF: p. 172

6. The most common type of laser light used in laboratory instrumentation is neon.

ANS: T
In contrast to other diffuse forms of radiation, laser light is concentrated. It is almost
exclusively of one wavelength or color, and its parallel waves travel in one direction. Through
the use of fluorescent dyes, laser light can occur in numerous wavelengths. The types of lasers
include glass-filled tubes of helium and neon (most common), yttrium-aluminum-garnet
(YAG, an imitation diamond), argon, and krypton. Lasers sort the energy in atoms and
molecules, concentrate it, and release it in powerful waves.

DIF: Cognitive Level: II REF: p. 172

7. Lasers sort the energy in atoms and molecules, concentrate it, and release it in powerful
waves.

ANS: T
In contrast to other diffuse forms of radiation, laser light is concentrated. It is almost
exclusively of one wavelength or color, and its parallel waves travel in one direction. Through
the use of fluorescent dyes, laser light can occur in numerous wavelengths. The types of lasers
include glass-filled tubes of helium and neon (most common), yttrium-aluminum-garnet
(YAG, an imitation diamond), argon, and krypton. Lasers sort the energy in atoms and
molecules, concentrate it, and release it in powerful waves.

DIF: Cognitive Level: II REF: p. 172

MATCHING

Match the activity with the appropriate phase of testing related to laboratory automation.
a. Preanalytical
b. Analytical
c. Postanalytical

1. Quality control
2. Specimen labeling
3. Validation of results
4. Documentation of quality control data

1. ANS: B DIF: Cognitive Level: II REF: p. 170

2. ANS: A DIF: Cognitive Level: II REF: p. 170
3. ANS: B DIF: Cognitive Level: II REF: p. 170
4. ANS: C DIF: Cognitive Level: II REF: p. 170