Immunology Chapters 21-25

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1

All of the following describe CMV except:

1. herpes family virus

2. DNA virus

3. cell-associated virus

4. epidemic worldwide

Epidemic worldwide

2

Because CMV can persist latently, an active infection may develop as a result of all the following conditions except:

1. pregnancy

2. immunosuppressive therapy

3. organ or bone marrow transplantation

4. transfusion of leukocyte-poor blood

transfusion of leukocyte-poor blood

3

CMV is recognized as the cause of congenital viral infection in what percentage of all live births?

0.4 to 2.5%

4

Transfusion-acquired CMV infection can cause:

1. Mononucleosis-like syndrome

2. Hepatitis

3. Rejection of a transplanted organ

4. All of the above

Transfusion-acquired CMV

All of the above

5

Significant antibody response and viral shedding are caused by different strain of virus

Reinfection

6

Seronegative recipient is transfused with blood from actively or latently infected donor

Primary infection

7

Seropositive recipient is transfused with blood from a CMV antibody-positive or -negative donor

Reactivated infection

8

Antibodies to immediate-early and early antigens are associated with:

1. Primary active infection

2. Reactivated active infection

3. Latent infection

4. Either 1 or 2

Either 1 or 2

9

IgG, but IgM response unknown

Reinfection with strain of CMV different from original strain

10

Specific IgM antibody response

Primary infection

11

IgG (no detectable IgM)

Reactivation of latent infection in seropositive IgG patient

12

Appear 72 hours after infection or at the end of the viral replication cycle

Late antigens

13

Appear within 1 hour of cellular infection

Immediate-early antigens

14

Present within 24 hours

Early antigens

15

All the herpesviruses share the feature of being:

Cell-associated viruses

16

A most likely mode of CMV acquisition is

Non-irradiated blood transfusions containing viable leukocytes

17

Appears to be the only immunosuppressed group at risk of acquiring CMV infection

Seronegative patients

18

All the following are methods for the prevention of CMV except:

1. Irradiated blood products

2. Leukocyte-depleted blood products

3. Immune globulin with CMV antibodies

Transfusion of fresh blood

Transfusion of fresh blood

19

T/F: Primary and recurrent maternal CMV infections can be transmitted in utero

True

20

T/F: CMV is the most common intrauterine infection

True

21

T/F: Few CMV-infected newborns are asymptomatic

False

22

T/F: Normal adults and children usually experience CMV infection without serious complications

True

23

The Epstein-Barr virus can cause all the following except:

1. Infectious mononucleosis

2. Burkitt's lymphoma

3. Nasopharyngeal carcinoma

4. Neoplasms of the bone marrow

Neoplasms of the bone marrow

24

The primary mode of EBV transmission is:

Exposure to oral-pharyngeal secretions

25

Infants infected with EBV are more likely to experience symptomatic infection than EBV-infected adolescents

False

26

IgM heterophiles antibody is characterized by all the following features except:

1. Reacts with horse, ox, and sheep RBC's

2. Absorbed by beef erythrocytes

3. Absorbed by guinea pig kidney cells

4. Does not react with EBV-specific antigens

Absorbed by guinea pig kidney cells

27

Characteristics of EBV infected lymphocytes include all the following except:

1. B type

2. Expression of viral capsid antigen

3. Expression of early antigen

4. Expression of EBV genome

Expression of EBV genome

28

The stage of infectious mononucleosis infection characterized by antibody to Epstein-Barr nuclear antigen (EBNA)

Past infection (convalescent) period and Reactivation of latent infection

29

What percentage of the world's population is exposed to EBV

95%

30

Infectious mononucleosis post perfusion syndrome is a primary infection resulting from a blood transfusion from ________ to ________ recipient.

Immune; nonimmune

31

In infectious mononucleosis, there is no:

carrier state

32

The incubation period of infectious mononucleosis is:

10 to 50 days

33

The use of horse erythrocytes in rapid slide tests for infectious mononucleosis increases their:

Sensitivity and specificity

34

EBV-infected B lymphocytes express all the following new antigens except:

1. Viral capsid antigen VCA

2. Early antigen EA

3. Cytoplasmic antigen CA

Nuclear antigen NA

Cytoplasmic antigen CA

35

Anti-EBNA IgG does not appear until a patient has entered the:

Convalescent period

36

Distinguishes between heterophile antibodies; uses beef erythrocytes, guinea pig kidney cells, and sheep erythrocytes

Davidsohn differential test

37

Detects heterophile antibodies and uses horse erythrocytes

MonoSlide agglutination test

38

Detects heterophile antibodies and uses sheep erythrocytes

Paul-Bunnell screening test

39

Typical form of hepatitis with associated jaundice

Acute hepatitis

40

This rare form is associated with hepatic failure

Fulminant acute hepatitis

41

Probably accounts for persons with serum antibodies but no history of hepatitis

Subclinical hepatitis without jaundice

42

Accompanied by hepatic inflammation and necrosis

Chronic hepatitis

43

Intact virus is the Dane particle

Hepatitis B

44

Transmission by both parenteral and nonparenteral routes

Hepatitis C

45

Requires HBV as a helper

Hepatitis D

46

Most common form of hepatits

Hepatitis A

47

Should receive immune globulin intramuscularly after exposure

Hepatitis A

48

Defective or incomplete RNA virus

Delta agent

49

Has an epidemiology similar to that of HAV

Hepatitis C

50

Previously called Australia antigen

Hepatitis B

51

Indicator of recent HBV infection may be only serologic marker during the window phase

Anti-HBc

52

Found in the serum of some patients who are HBsAg positive; marker for level of virus, inefectivity

HBeAg

53

A serologic marker of recovery and immunity

Anti-HBs

54

Initial detectable marker found in serum during incubation period of HBV infection

HBsAg

55

In the case of acute hepatitis, the first serologic evidence of the convalescent phase

Anti-Hbe

56

Of patients in the United States with chronic hepatitis B, ______ of them acquired the virus in childhood.

20-30%

57

The rate of post transfusion hepatitis C decreased to _____ after the introduction of serologic testing in the screening of blood donors.

15%

58

Hepatitis A incubation time

25 days

59

Hepatitis B incubation time

75 days

60

Hepatits C incubation time

50 days

61

Which form of hepatitis does not have a chronic form of the disease?

Hepatitis A

62

Another name for hepatitis B infection is:

Long incubation hepatitis

63

The most frequent clinical response to hepatitis B virus is:

Asymptomatic infection and subclinical infection

64

The first laboratory screening test of donor blood was for the detection of:

HBsAg

65

Which surface marker is a reliable marker for the presence of high levels of hepatitis B virus (HBV) and a high degree of infectivity?

HBeAg

66

The only serologic marker during the anti-core window period of hepatitis B (the time between disappearance of detectable HBsAg and appearance of detectable anti-has) may be:

Anti-HBc

67

A characteristic of the delta agent is:

Usually replicates only in HBV-infected hosts

68

Which virus is rarely implicated in transfusion-associated hepatitis?

Hepatitis A

69

In health care workers, the risk of contracting hepatitis C is _____ the risk of contracting AIDS.

Higher than

70

The specific diagnostic test for hepatitis C is:

Anti-HCV

71

The earliest detectable serologic marker of acute hepatitis C is:

HCV-RNA

72

Primary hepatitis viruses are given this name because they primarily attack the:

liver

73

Hepatits A has all the following characteristics except:

1. DNA virus

2. Short incubation hepatitis

3. Crowded, unsanitary conditions as a risk factor

4. Rare occurrence of transfusion acquisition

DNA virus

74

_______ has the highest incidence of acute hepatitis C

Illegal drug use

75

_______ has the lowest incidence of acute hepatitis C.

Transfusion

76

Hepatitis A transmission

Fecal-oral

77

Hepatitis B transmission

Parenteral

78

Hepatitis C transmission

Parenteral and nonparenteral

79

Hepatitis E transmission

Fecal-oral

80

A group of individuals that should not receive rubella vaccination

Pregnant women

81

The greatest risk of the manifestation of anomalies in maternal rubella is ______ of gestation

during the first trimester

82

In a patient with primary rubella infection, the appearance of ____ and ____ antibodies is associated with the clinical signs and symptoms, when present.

IgG and IgM

83

Testing for _____ antibody is invaluable for the diagnosis of congenital rubella syndrome.

IgM

84

Before the licensing of rubella vaccine in the United States in 1969, epidemics occurred at ____ year intervals

6-9

85

Acute rubella infection lasts from ____ days.

3-5

86

IgM antibodies to rubella virus reach peak levels at ____ days.

7-10

87

IgG antibodies to rubella virus increase rapidly for ____ days after the acquisition of infection.

7-21

88

Which percentage of serologically confirmed cases of maternal infection occur before 11 weeks of gestation?

90%

89

T/F German measles and measles are caused by the same virus.

False

90

Laboratory confirmation of rubeola antibody is done by:

1. Detection of IgM antibodies in serum

2. Detection of measles virus RNA by nucleic acid amplification in a clinical specimen

3. Isolation of rubella virus

4. Either a or b

Either A or B

91

The major structural protein (core) of the HIV-1 virus is:

p24

92

The infectious process of AIDS begins when the gp120 protein on the viral envelope bends to the protein receptor, ______, on the surface of a target cell.

CD4

93

HIV can infect cells except:

Polymorphonuclear leukocytes

94

The most rapidly growing segment of the HIV-infected population is:

IV drug users and their sexual partners

95

In HIV infections, a window period of seronegativity extends from the time of initial infection up to:

6-12 weeks or longer

96

HIV antibodies are usually detectable by ________ and confirmed by _______.

Enzyme immunoassay; Western blot

97

The AIDS-causing virus HIV has also been referred to as:

1. Human T-lymphotropic virus type III

2. HTLV-III

3. Lymphadenopathy-associated virus (LAV)

4. All of the above

AIDS virus

all of the above

98

HTLV-III was unique when it was isolated because it:

was identified as the cause of AIDS

99

Codes for p24 and for proteins such as p17, p9, and p7

gag

100

Codes for two glycoproteins, gp41 and gp120

env

101

Produces DNA polymerase; produces endonuclease

pol

102

The criteria for HIV infection for persons 13 years of age or older include:

1. Repeatedly reactive screening test for HIV antibody

2. Specific HIV antibody identified by use of supplemental tests

3. Direct identification of the virus

4. All of the above

HIV 13+

All of the above

103

After the early period of primary HIV infection, the patient enters a period of clinical latency that lasts a median of ____ years.

10

104

As AIDS progresses, the quantity of ________ diminishes and the risk of opportunistic infection increases.

CD4+ T lymhocytes

105

The clinical symptoms of the later phase of AIDS are:

1. Weight loss and decreased polymorphonuclear leukocyte (PMN) cells

2. Extreme weight loss and fever

3. Multiple secondary (opportunistic) infections

4. Both b and c

both b and c

106

The most frequent malignancy observed in AIDS patients is:

Kaposi's sarcoma

107

Sources of error in the Western blot test include

Technical skill and experience of the technologist performing the test

108

All the following methods have been developed to detect HIV-1 antigen except

1. Transcriptase method

2. Synthetic peptide approach

3. Immunofluorescence assay

4. Immunohistochemical staining

Synthetic peptide approach

109

All the following methods have been developed to detect the presence of HIV-1 viral gene except:

1. Radioimmunoassay

2. In situ hybridization

3. Southern blot analysis

4. DNA amplification

Radioimmunoassay

110

Cytomegalovirus (CMV) is related to:

a. Epstein-Barr virus (EBV).

b. herpes simplex 1.

c. herpes simplex 2.

d. all of the above.

CMV

All of the above

111

Herpesviruses all share the characteristic of being:

cell-associated

112

Individuals with the greatest risk of developing cytomegalovirus (CMV) infection are:

a. fetuses.

b. immunocompromised individuals.

c. persons older than 20 years.

d. both a and b.

Both a and b

113

Patients with the highest risk of mortality from cytomegalovirus (CMV) are:

allograft transplant, seronegative patients who receive tissue from a seropositive donor.

114

Forms of transfusion-acquired cytomegalovirus (CMV) infection include all except:

latent infection

115

Seronegative recipient is transfused with blood from actively or latently infected donor.

Primary CMV infection

116

Seropositive recipient is transfused with blood from a CMV antibody-positive or antibody-negative donor.

Reactivated CMV infection

117

CMV strain in the donor’s blood differs from the strain originally infecting the recipient.

CMV Reinfection

118

All the following statements about Epstein-Barr virus (EBV) are true except:

a. it usually causes an acute benign condition.

b. it usually causes a self-limiting lymphoproliferative condition.

c. it is the cause Burkitt’s lymphoma.

d. it is not an agent in the development of nasopharyngeal carcinoma.

it is not an agent in the development of nasopharyngeal carcinoma.

119

Epstein-Barr virus (EBV) is:

a. a DNA herpesvirus.

b. harbored by B lymphocytes..

c. the most ubiquitous virus known to humans.

d. all of the above.

EBV

All of the above

120

In infectious mononucleosis, Epstein-Barr virus:

a. infects B lymphocytes.

b. produces lymphocytes in peripheral blood with T cell characteristics.

c. induces a cytotoxic response against the EBV-infected circulating B lymphocytes.

d. all of the above.

Infectious Mono

All of the above

121

Epstein-Barr virus (EBV) is transmitted primarily by:

close contact with infectious oral-pharyngeal secretions.

122

Viral capsid antigen (VCA) is produced by:

infected B lymphocytes

123

Anti-VCA immunoglobulin G (IgG) is usually detectable within _________________.

4 to 7 days

124

Which of the following stages of infectious mononucleosis is characterized by antibody to Epstein-Barr nuclear antigen (EBNA)?

a. Recent (acute) infection

b. Past infection (convalescent) period

c. Reactivation of latent infection

d. Both b and c

Both b and c

125

In rapid MonoSlide testing, a false-positive result can be caused by:

a. observing agglutination after the observation time.

b. misinterpreting agglutination.

c. residual heterophil antibody present after clinical symptoms have subsided.

d. all of the above.

MonoSlide Testing

All of the above

126

Primary hepatitis viruses account for approximately ______% of cases of hepatitis.

95

127

A patient with a known exposure to hepatitis B 3 weeks earlier has negative results for all markers when a hepatitis profile is performed, except for IgM anti-HBc. What is a possible reason for this result?

HBsAg was still too low in concentration to detect.

128

The serologic markers in expected order of appearance in the serum of a patient with hepatitis B infection are:

HBsAg, HBeAg, HBcAb, HBeAb, and HbsAb

129

Which hepatitis viruses can result in chronic infection and the potential development of liver cancer?

Hepatitis C

130

Which hepatitis viruses have been scientifically identified as being spread by the transfusion of unscreened blood transfusion products?

Hepatitis B and Hepatitis C

131

Which hepatitis B serologic marker is the classic first indication of a hepatitis B infection?

HBsAg

132

Infectious hepatitis or short-incubation hepatitis

Hepatitis A virus infection

133

Long-incubation hepatitis

Hepatitis B virus infection

134

Rubella is also known as:

a. German measles.

b. 3-day measles.

c. infectious rubeola

d. both a and b

both a and b

135

Rubella infection is transmitted by:

respiratory secretions

136

The risk of fetal anomalies in congenital rubella infections is highest at the

first trimester

137

Testing for ________antibody in the newborn is diagnostic for the confirmation of congenital rubella syndrome.

IgM

138

T/F: Rubella and rubeola are caused by the same virus and cause the same type of infection.

False

139

The incubation period of acquired rubella infection varies, but ____ days is typical.

12-14

140

Infected persons are usually contagious for 12 to 15 days, beginning ____days before the appearance (if present) of a rash.

5-7

141

Acute rubella infection lasts from ____ days and generally requires minimal treatment. Permanent effects are extremely rare in acquired infections.

3-5

142

IgM antibodies against the rubella virus become detectable a few days after the onset of signs and symptoms and reach peak levels at ____.

7-10 days

143

These IgM antibodies persist but rapidly diminish in concentration over the next ____ until antibody is no longer clinically detectable

4-5 weeks

144

Which of the following statements is (are) true about retroviruses?

a. They contain a single, positive-stranded ribonucleic acid (RNA).

b. They contain a special enzyme called reverse transcriptase in their core.

c. They reverse the normal process of transcription in which DNA is converted to RNA.

d. All of the above.

Retroviruses

All of the above

145

The major structural protein (core) of the human immunodeficiency virus type 1 (HIV-1) encoded by the gag gene is _______________.

p24

146

One of the glycoproteins associated with the viral envelope is _______________.

gp41

147

The HIV infectious process begins when the protein on the viral envelope binds to the protein receptor _______ on the surface of a target cell.

CD4

148

The human immunodeficiency virus (HIV-1) attaches itself to receptor sites by means of _________.

gp120

149

In HIV infections, a window period of seronegativity extends from the time of initial infection up to ______________.

6-12 weeks or longer

150

The enzyme immunoassay for the HIV-1 antigen detects primarily uncomplexed ______antigen.

p24

151

Which procedure is considered to be a screening procedure for the detection of HIV?

EIA

152

Which analysis is currently considered the standard method for confirming HIV-1 seropositivity?

Western blot

153

A positive Western blot (WB) test result for HIV infection is indicated by the presence of two of the following bands, along with a positive EIA test result:

p24 and gp41