BB. Exam 1 Practice Questions Intro to Biomolecules PDF

Exam 1 Practice Questions Intro to Biomolecules 1. Hydrolysis of starch releases which of the following monosaccharides in the gut? a. Glucose b. Galactose c. Fructose d. Mannose 2. Which of the following sugars is non reducing in nature> a. Maltose b. Isomaltose c. Sucrose d. Lactose 3. Sucrose is composed of which of the following monosaccharide units? a. Glucose and fructose b. Fructose and galactose c. Glucose and galactose d. Glucose and glucose 4. The modified/ derived sugar implicated in development of cataracts is: a. Glucuronic acid b. Deoxyribose c. Glucosamine d. Sorbitol 5. Which of the derived lipids listed below is used as an alternative fuel by the brain during prolonged fasting? a. Cholesterol b. Glycerol c. Ketone bodies d. Fatty acids 6. Which of the following lipids is amphipathic in nature? a. Triglycerides b. Glycerol c. Fatty acid d. Phospholipids 7. Cholesterol is required as a precursor for synthesis of which of the following compounds? a. Fatty acids b. Phospholipids c. Bile salts d. Triglycerides 8. Which of the following molecules listed below is a derived lipid? a. Cholesterol b. Phospholipids c. Triglycerides d. Glycolipids 9. Which of the following amino acids listed below is polar in nature? a. Tryptophan b. Methionine c. Leucine d. Glycine e. Serine 10. Proteins which help in folding and protecting the DNA include: a. Histones b. Scleroproteins c. Albumins d. Globulins 11. Which of the following amino acids is both glucogenic and ketogenic in nature? *We do not need to know this for the 1st exam* a. Isoleucine b. Leucine c. Valine d. Glutamic acid e. Alanine 12. Which of the following is classified as aromatic amino acid? a. Tryptophan b. Cysteine c. Aspartic acid d. Lysine 13. Which of the following sugars is present in DNA? a. Deoxyribose b. Sialic acid c. Sedo-heptulose d. Glucose 14. Which of the following nitrogenous bases is classified as a purine? a. Adenine b. Uracil c. Thymine d. Cytosine 15. Which of the following activated intermediates is used for methylation reactions? a. PAPS b. UDP-Glucose c. SAM d. CDP-Choline 16. Which of the following nucleotides is part of the second messenger system during signal transduction? a. FAD b. c-AMP c. GTP d. NADP 17. Which of the following monosaccharides is a ketose? 18. Dr. Rodda ate 2 slices of pizza containing 40g of carbohydrate each. How many calories from carbohydrates did he consume? a. 40kcal b. 80kcal c. 120kcal d. 160kcal e. 240kcal f. 320kcal 19. A marathon runner “hit-the-wall” (became extremely exhausted) after running 20 miles and had to abandon the race. After running this distance, her muscle fibers had been depleted of a storage carbohydrate. In animals, what is the primary storage carbohydrate found primarily in muscle and liver? a. Glycogen b. Glucagon c. Glucose d. Starch e. Glucosamine 20. Which of the following molecules can be hydrolyzed to the monosaccharides galactose and glucose? a. Sucrose b. Glycogen c. Starch d. Lactose e. Fructose 21. Which of the following is a pentose sugar, forming a structural component of nucleotides? a. Glucose b. Fructose c. Sialic acid d. Ribose e. Glyceraldehyde f. Erythrose 22. Non-reducing sugar is detected in the urine of a 2-year-old boy who was later diagnosed with hereditary fructose intolerance. Which of the following is the most likely non-reducing sugar present in his urine? a. Fructose b. Sucrose c. Glucose d. Lactose e. Maltose 23. Dr. Rodda’s 2 slices of pizza also contained 10g of fat each. How many calories from fat did he consume? a. 10 b. 80 c. 90 d. 120 e. 180 f. 240 24. Which of the following fatty acids is unsaturated? a. Palmitic b. Stearic c. Linoleic d. Arachidic 25. A premature male newborn, born at 31 weeks, has a rapid shallow breathing and his lips, and extremities are becoming cyanotic. He is diagnosed with acute respiratory distress syndrome due to a lack of lung surfactant. Which of the following is deficient in his lungs? a. Phosphatidylcholine b. Phosphatidylinositol c. Cholesterol d. Eicosanoids e. Fat soluble vitamins (A, D, E, K) 26. Which of the following fatty acids can’t be synthesized by humans? a. Pentadecylic acid (15C) b. Palmitic acid (16C) c. Stearic acid (18C) d. Arachidic acid (20C) e. Arachidonic acid (20C) 27. Which of the following is a precursor for the synthesis of cortisol, the major endogenous glucocorticoid hormone? a. Vitamin D b. Arachidonic acid c. Cholesterol d. Phosphatidylcholine e. Bile salts 28. A 27-year-old female got lost while hiking in a remote wilderness. She did not eat for 4 days until she was rescued. After several days of fasting, which of the following would act as an alternative fuel source for her brain? a. Fructose b. Glucose c. Arachidonic acid d. Eicosanoids e. Ketone bodies 29. Which of the following amino acids would most likely to be found on the surface of a globular protein, exposed to the aqueous environment of a cell? a. Isoleucine b. Alanine c. Tryptophan d. Asparagine e. Valine 30. Phosphoproteins are generated when a phosphate group is coupled to a hydroxyl group of an amino acid within a protein. To which of the following amino acids can a phosphate group be added? a. Tyrosine b. Alanine c. Glutamine d. Cysteine e. Proline 31. Which of the following nitrogenous bases is a purine? 32. Which of the following nucleotides is normally found in DNA but not in RNA? 33. Which if the following nucleotide-activated intermediates acts as a common sulfate donor? a. CDP-choline b. PAPS (3’-Phosphoadenosine 5’-Phosphosulfate) c. CDP - Sialic acid d. SAM (S-Adenosylmethionine) e. UDP - glucose Histology Methods 34. Estimate the sizes of these cells and their nuclei 35. Which type of microscope should you use to best visualize the intracellular organization of a cell structure 40nm in size? a. Light microscope b. Bright field microscope c. Scanning electron microscope d. Transmission electron microscope 36. The dye used to stain this image is best used to visualize: a. Structures with a net +ve charge b. Mitochondria and lysosomes c. Stored protein vesicles d. Cytoplasmic ribosomes e. Mucus and glycogen f. Eosinophilic structures 37. The dye used to stain this image is best used to visualize: a. Structures with a net +ve charge b. Nucleus DNA c. Mitochondria and ribosomes d. Stored protein vesicles e. Mucus and glycogen f. Eosinophilic structures 38. Which of the following staining methods will best highlight changes in levels of stored glycogen in liver cells under fasting and fed conditions? a. Silver nitrate b. Osmium fixation c. Hematoxylin and eosin d. Periodic acid-schiff e. Metal stain with TEM 39. Identify the specific stain used to dye this tissue. 40. Identify the cell material that attracts the blue stain in the areas indicated by the arrows. 41. Which of the following statements regarding processing of tissues for histology is FALSE? a. Fixation cross links cellular proteins b. Fixation prevents tissue degradation by cytoplasmic enzymes c. Embedding involved infiltration of tissues with a soluble medium that hardens d. Tissues are cut to generate thin sections e. Tissues are visualized within sections due to their inherent differential colors 42. Rough endoplasmic reticulum (RER) in the cytoplasm is intensely stained blue because hematoxylin: a. Binds readily to RNA b. Is an acid dye and binds to acidophilic ribosomal proteins c. Reacts with carbohydrate molecules of integral membrane proteins d. Catalyzes the precipitation of ribosomes into a dense, readily stained matrix e. Attaches to lipids in RER membranes 43. In microscopy, resolution is defined as: a. The clarity of the image in quantitative terms b. The maximum amount of magnification provided by the lenses of a microscope c. The smallest distance between two items that are discernible as separate objects d. The ability to increase the magnification of an object beyond the limit of the light microscope e. The numerical aperture of the objective lens of the microscope 44. Physical examination of a 49-year-old female with a history of diabetes reveals edema of lower extremities. A kidney disease was suspected and a kidney biopsy was performed for evaluation. Which of the following histochemistry stains is best to highlight the patients carbohydrate-rich glycoproteins in the glomerular basement membrane when examined by light microscopy? a. Periodic acid-schiff stain (PAS) b. Silver neuron stain c. Hematoxylin only d. Hematoxylin & eosin stain (H&E) e. All acidic dyes 45. Name a component that would stain with H&E, and therefore be directly visible by light microscopy in a histological section a. Microtubules b. Type I collagen c. Carbohydrates and glycoproteins d. Elastic fibers e. Mucus 46. Preparation of tissues for light or electron microscopy often involves embedding the tissues in a substance such as wax or plastic. What is the purpose of such embedding? a. To allow the tissues to be stained with histological dyes b. To provide a hard medium that can be sectioned thinly with a blade c. To ensure that no water remains in the specimen after the dehydration process d. To ensure that the optical characteristics of the tissue are appropriate fro the microscope e. To help with the process of fixation of the tissue 47. You are provided with a histological specimen from the fallopian tubes to demonstrate the presence of microtubules in the core of epithelial cilia. Which of the following microscopy preparations would you use to best visualize the intracellular organization of microtubules within cilia? a. Scanning electron microscopy b. H&E stained light microscopy c. Transmission electron microscopy d. Golgi stained SEM e. PAS stained light microscopy 48. Which of the following staining methods will clearly show changes in levels of stored glycogen in liver cells under fasting conditions? a. Metal stain with TEM b. Hematoxylin and eosin c. Osmium fixation d. Silver nitrate e. Periodic acid-schiff 49. Your patient has hypertension, haematuria, and moderate proteinuria, suggesting a syndrome involving the kidney nephrons. Immunofluorescence microscopy reveals linear deposits of immunoglobulin (typically IgG) and complement along the glomerular basement membrane (GBM). Which of the following depicts the type of microscopy used to diagnose this disease? 50. He is diagnosed with anti-GBM disease (Goodpasture syndrome). Anti-GBM antibodies target collagen type IV, a component of the GBM. Collagen is a highly abundant protein in the human body, with different types located in specific regions. Which of the following best describes collagen molecules? a. Basophilic structures b. Synthesized at the nucleus c. Net negative charge d. Best stained using eosin 51. Immunoglobulins such as IgG are proteins synthesized by plasma cells (B-lymphocytes) and secreted via constitutive exocytosis. Which of the following best describes the microscopic organization and appearance of these highly secretory cells? a. Basophilic cytoplasm b. Inactive nucleolus c. Highly developed smooth ER d. Heterochromatic nucleus 52. Which of the following microscopy techniques should you utilize to visualize the intracellular organization of renal cytoskeletal fibers? 53. Examination of renal cells in H&E stained LM slides reveals cells with an eosinophilic cytoplasm. Which of the following structures gives rise to this histological appearance? a. Ribosomes b. Mitochondria c. Euchromatin d. Smooth ER 54. The nucleus visible in this image depicts a cell in which DNA transcription is NOT occurring? (T/F) 55. There is a visible nucleolus present in the cells pictured in this image, we can therefore assume these cells are highly secretory. (T/F) 56. In healthy kidneys, accumulation of debris and other substances in the GBM is prevented by resident macrophages. Macrophages remove build-up via phagocytosis, a specialized type of endocytosis. Which of the following structures fuses with the phagosomes after endocytosis has occurred? a. Mitochondria b. Endosomes c. Lysosomes d. Microtubules 57. Match EM and LM for each structure and list their functions: ribosomes, protein vesicles, rough ER, euchromatin, mitochondria. 58. Identify the material indicated by the blue arrow in the image 59. Describe the process occurring in the region indicated by the blue arrow 60. You sample and receive and H&E stained for histopathological study notice that it consists of clusters of cells with cytoplasmic regions of both basophilia and intense eosinophilia. The nuclei are highly euchromatic and contain prominent nucleoli. Which of the following most likely describes the function of these cells? a. Protein secretion b. Lipid storage c. Glycogen storage d. Ion pumping e. Lipid hormone secretion 61. Which cells are more likely to be involved in protein secretion? 62. What is the function of these structures? 63. Consider a cellular modification where you extended the cytoplasm to form a finger-like process. To perform its function this extension needs to be filled with a cytoskeletal fiber that is both dynamic and strong. Which cytoskeletal fiber should it contain? a. Intermediate filaments b. Actin filaments c. Microfilaments d. Microtubules e. Keratin filaments 64. Name the structure indicated by the blue arrow 65. Name the structure indicated by the tip of the black arrow 66. A 47-year old patient presents with a cancerous tumor containing cells that seem to be secreting high amounts of proteins into the surrounding tissue. A pathology resident attempting to locate the borders of the mass obtained a biopsy and prepared an H&E stained slide. Since the cancerous cells are highly secretory, which of the following features would you most likely observe in the affected cells? a. Basophilic cytoplasm b. Eosinophilic cytoplasm c. Vacuolated cytoplasm d. Heterochromatic nucleus e. Elongated nucleus 67. A 28-year old female suffered a miscarriage at 5-month gestation. She is seeking genetic counseling to understand the cause of death of her child. Histopathological studies revealed abnormally shaped cells from various tissues. EM examinations show decreased density of terminal web, abnormal core microvilli and fewer cytoskeletal tracks for myosin motor proteins. Which of the following cellular fibers is most likely affected? a. Intermediate filaments b. Microtubules c. Elastic fibers d. Microfilaments e. Collagen fibers 68. A 47-year old patient presents with a cancerous tumor containing cells that seem to be secreting high amounts of proteins into the surrounding tissue. A pathology resident attempting to determine the level of transcription in the cells obtained a biopsy and prepared a TEM of a cell's nucleus. Which of the following labeled regions most likely contains actively transcribing DNA? a. C b. A c. B d. D 69. You receive a biopsy for histopathology analysis of the pancreatic secretory cells from a patient exhibiting a wide range of digestive and metabolic symptoms. Analysis revealed abnormal appearance of the cell's nucleoli. Which of the following functional deficits are these cells most likely to experience? a. Normal function of rRNA b. Decreased euchromatin levels c. Inadequate ribosome synthesis d. Increased activity of heterochromatin e. Increased protein secretion 70. You receive an H&E stained sample for histopathological study and notice that it consists of clusters of cells with cytoplasmic regions of both basophilia and intense eosinophilia. The nuclei are highly euchromatic and contain prominent nucleoli. Which of the following most likely describes the function of these cells? a. Protein secretion b. Ion pumping c. Glycogen storage d. Lipid hormone secretion e. Lipid storage 71. You receive an H&E stained sample for histopathological study and notice that it consists of clusters of cells with entirely eosinophilic cytoplasm. The nuclei are centrally located and contain both euchromatin and heterochromatin, nucleoli are not clearly distinguishable from heterochromatin. Which of the following most likely describes the function of these cells? a. Produce high amounts of mucus b. Stored secretory proteins c. Produce high amounts of ATP d. Secretes steroid hormones e. Secretes glucose 72. Consider a cellular modification where you extend the cytoplasm to form a finger-like process. To perform its function this extension needs to be filled with a cytoskeletal fiber that is both dynamic (able to modify its length) and strong. Which cytoskeletal fiber should it contain? a. Microtubules b. Microfilaments c. Keratin filaments d. Actin filaments e. Intermediate filaments 73. You receive an H&E stained sample for histopathological study and notice that it consists of clusters of cells with entirely basophilic cytoplasm. You suspect that the cell’s basophilia is caused by its rER content, and thus the cell must be actively involved in protein secretion. Which mechanism of transcellular vesicular transport do these cells most likely use? a. Pinocytosis b. Constitutive phagocytosis c. Regulated exocytosis d. Signal-mediated endocytosis e. Constitutive exocytosis 74. A 5-month old baby is brought to the pediatrician after her parents noticed that she has gradually lost the ability to crawl and move. Following a series of examinations, she is diagnosed with Tay-Sachs, a type of lysosomal storage disease affecting neurons. Lysosomes in patients with this condition contain hydrolytic enzymes that are unable to break down glycolipids. Histopathological analysis of the affected neurons would most likely reveal: a. Decreased residual body content b. Decreased secondary lysosome content c. Increased glycogen content d. Increased lipofuscin granule content e. Increased secretory granule content 75. Which of the following statements concerning PAS staining is FALSE? a. It is commonly used to detect mucus b. It gives a reddish-pink color c. It can be used to detect the lateral boundary of all epithelia d. It can be used to detect basement membranes e. It is specific for carbohydrates 76. Choose the correct sequence of locations of a secretory protein as it is synthesized and secreted. a. Secretory vesicle b. Golgi cis-face c. d. e. f. Golgi trans-face Cistern of rER Extracellular space Transfer vesicle A. f,d,e,b,a,c B. d,f,e,b,c,a C. d,f,c,e,b,a D. d,f,b,c,a,e E. f,d,b,c,a,e 77. Which of the following statements regarding the Golgi apparatus is FALSE? a. It is composed of membrane cisternae with dilated edges b. It plays a role in the sorting and packaging of protein at its cis-face c. It does not stain well with hematoxylin or eosin d. It is well developed in secretory cells e. It receives proteins from the rough ER 78. Which of the following statements concerning the nucleus is FALSE? a. The nucleolus is involved in the synthesis and assembly of ribosomal RNA b. The amount of euchromatin is related to transcriptional activity c. Euchromatin consists of tightly packed inactive DNA d. Peripheral heterochromatin outlines the boundary of the nucleus in the light microscope e. Nuclear pores are involved in the bi-directional transport of proteins 79. Name an important function of the nucleolus: a. Sequesters free DNA b. Forms the nuclear envelope c. Packages DNA within chromosomes d. Produces ribosomal RNA subunits e. Forms heterochromatin 80. Which organelle is illustrated in these electron micrographs of a typical cell? a. Lysosomes b. Nuclear envelope c. Smooth ER d. Rough ER e. Golgi apparatus 81. What is heterochromatin? a. The material found within the nucleolus b. Chromatin that is actively involved in transcription of DNA c. Chromatin found in mitochondria d. Condensed chromatin in a the nucleus that stains dark e. Chromatin found in the cytoplasm, outside the nucleus Ethics: Foundations of Professionalism in Medicine 82. Clinical ethics is best defined as: a. The standards that guide ethically appropriate professional behavior b. The application of ethical guidelines to issues that occur in patient care c. A list of the priority of ethical principles d. The ability to distinguish between right and wrong and to act accordingly 83. An ethical dilemma occurs when: a. Patients or their families file a lawsuit against a physician or medical institution b. Equally compelling ethical or moral reasons exist for taking opposing courses of action c. A patient refuses to be treated by a resident or medical student d. One or more physicians disagree about the appropriate medical treatment for a patient 84. LaKeesha Gaskins is a 14-year-old girl who has come with her mother to see Dr. Mikhail Pappas, a plastic surgeon. LaKeesha wants cosmetic rhinoplasty (a “nose job”) to correct what she feels is her “ugly” nose. Dr. Pappas is concerned that the risks of this procedure to LaKeesha are too great and refuses to perform it. He bases his decision on the ethical principle that physicians should avoid harming their patients. This is the principle of: a. Non-maleficence b. Justice c. Autonomy d. Beneficence 85. The Hippocratic Oath, the American College of Physicians Ethics Manual, and the AMA Principles of Medical Ethics are all examples of professional standards. Of the following, which statement is the most accurate with respect to such standards? a. They provide clear and specific rules on what to do in difficult ethical situations b. They provide a clear explanation of the body of special knowledge possessed by medical professionals c. They represent attempts to codify and clarify professional obligations and values which members of the medical professional agree are important d. They specify recommended punishments for physicians who engage in unprofessional behavior 86. Petra Breda is completing her first year of residency in pulmonology. She has just discovered that her chief resident, Carl Rains, has been regularly using amphetamines to stay awake when he is on-call. Petra has tried talking to Carl to express her concerns. However, he is not willing to discuss the issue, telling her “It’s none of your business so just leave me alone.” What should Petra’s next step be? a. Consult with the hospitals risk manager b. Schedule a meeting with the residency program director c. Report carl to the state licensing board d. Request that carl be sanctioned by the hospital ethics committee 87. One of the defining characteristics of a profession is that: a. It is practiced according to specific rules and regulations established by the government b. It is governed by a multidisciplinary board which includes members of the community c. Its members are upstanding members of the community and very well-off financially d. Its members possess a special body of knowledge and are accorded a certain level of respect in resture for the services they provide 88. Dr. Lorne Garrison is an obstetrician covering his friend Dr. Paula Kimber’s practice while she is away on vacation. He has been called into the hospital to see one of Dr. Kimber’s patients, Victoria Moore. However, when he goes to introduce himself to her, she becomes upset and angry telling him that she made it clear to Dr. Kimber that she did NOT want a male doctor under any circumstances. Dr. Garrison informs her that he is covering all of Dr. Kimber’s patients in her absence but that, if she would prefer, he can ask one of the hospital’s female attending obstetricians to attend her. He adds that he will stay in the hospital until the delivery is complete in case the other obstetrician has any concerns about Ms. Moore’s care. She says she would prefer that, and he leaves to make the necessary arrangements. This is an example of: a. b. c. d. Respecting the patient's wishes and acting in her best interests Violating the hippocratic oath Patient abandonment Breaking promises to a colleague Introduction to the Musculoskeletal System 89. A 23-year-old man comes into the emergency room with a crush injury to the elbow joint. Which of the following types of movement would most likely be impaied in this type of accident? a. Reposition b. Abduction c. Flexion d. Dorsiflexion e. Eversion 90. Which of the following best describes the layer of the skin and the type of tissue found within the outlined region: a. Hypodermis, adipose tissue b. Dermis, adipose tissue c. Hypodermis, connective tissue d. Epidermis, epithelial tissue e. Epidermis, connective tissue f. Dermis, epithelial tissue 91. Which of the following is the major contractile portion of a muscle? a. Investing fascia b. Ligament c. Neurovascular bundle d. Belly e. Tendon 92. Long bones are still relatively light due to which of the following factors? a. Long bones have no spongy bone b. Long bones have an outer layer of compact bone overlying spongy bone c. Long bones have compact bone only d. Long bones have no compact bone 93. Fibrous joints have which of the following properties? a. Allows for very slight movement b. Immovable c. Allows for extensive movement d. Allows for slight movement 94. Which of the following is most likely about the median plane of section? a. Median plane of section divides the body into 2 equal right and left sections b. Medical plane of section divides the body into 2 equal anterior and posterior sections c. Medical plane of section divides the body into superior and inferior sections d. Meridian plane of section divides the body oblique sections 95. The epidermis is which one of the following 4 types of tissue? a. Connective tissue b. Muscle tissue c. Nerve tissue d. Epithelial tissue 96. Which of the following separates individual muscle fibers, fascicles, and muscles? a. Ligaments b. Fat and underlying superficial fascia c. Neurovascular bundles d. Tendons e. Connective tissue coverings/deep investing fascia 97. Which of the following bone structures is involved in formation of a joint? a. Shaft b. Crest c. Condyle d. Foramen e. Tubercle 98. Which of the following joints permit extensive abduction? a. Hinge b. Primary cartilaginous joint c. Fibrous d. Ball and socket e. Gomphosis Learning the Basics of Radiology 99. What color does the free air appear on the X-ray? a. Gray b. Balck and whiet c. White d. Black 100. Which kidney contains 2 simple cysts on CT scan? 101. a. Left b. Right What color does the urine appear on the ultrasound exam of urinary bladder a. Dark (hypoechoic) b. White (hyperechoic) c. Black (anechoic) d. Gray (Isoechoic) 102. What imaging modalities carry no risk or least risk during pregnancy? a. Conventional radiography and magnetic resonance imaging (MRI) b. Nuclear medicine studies and CT c. Fluoroscopy and ultrasound examination d. Ultrasound examination and non contrast magnetic resonance imaging (MRI) 103. Which imaging modality does not belong to cross-sectional imaging techniques? a. Fluoroscopy b. CT c. MRI d. Ultrasound 104. A 24-year-old man presented to the ER after he developed a sudden onset of shortness of breath and pain in the right side of his chest.You suspect he may experience the spontaneous pneumothorax, which is the lung collapse and free air in the lung cavity.The x-ray examination of the chest was performed. What color does free air appear on the X-Ray? a. White b. Black and white c. Black d. Gray 105. A 41-year-old male presents to the office because of the 2-week duration of his back pain. It started suddenly when he lifted a heavy object in his garden. Now the pain is radiating to his right big toe and he also experiences weakness and numbness in his right leg. The PE supports your provisional diagnosis of slipped disc most likely in lumbar spine. Because of the neurological findings of weakness and numbness you decide to perform additional tests to evaluate the nerve root that is most likely compressed. What is the best diagnostic test to evaluate the disc and soft tissue in this patient’s condition? a. X-ray b. MRI c. CT scan d. Ultrasound 106. A 32-year-old man presented to ER with acute abdominal pain, vomiting and fever of 101 F for the past 6 hours. On PE the tests are positive for acute appendicitis. What are the diagnostic tests that would help to establish the diagnosis? a. CT and MRI b. X-ray and MRI c. X-ray and ultrasound d. CT and ultrasound 107. A 50 years- old male patient was brought by the ambulance to the Emergency Department with a gunshot wound in his right chest. The chest X-ray reveals right sided pneumohemothorax (air and blood in pleural cavity). The bullet is located on the level between 4th and 5th posterior ribs. What are the densities of air, blood, and the bullet? a. Air is whitest, bullet is darkest, and blood is as white as liver and right hemidiaphragm b. Air is dark as fat; bullet is as dense as bone and blood is darker than bullet c. Air is darkest (black), bullet is white and blood is as white as liver and right hemidiaphragm d. Air is darkest (black) and bullet and blood are similar densities 108. What projections of the X-rays should be done to precisely localize the bullet in the chest. (see above case) a. Only PA chest X-ray b. Only AP Chest X-ray c. Only lateral chest X-ray d. PA and lateral chest X-rays 109. A 35-year-old patient was admitted to the hospital with a 7 day history of muscle pain, fever, and shortness of breath. His Sat is 89% on room air. PMH and SH are unremarkable except he has not received the COVID 19 vaccine. His COVID 19 test came back positive, and CT of his lungs was ordered. What type of CT window will allow for the best evaluation of lung parenchyma? a. Bone window b. Lung window c. Mediastinal window d. The type of window does not make any difference in evaluation of the lung parenchyma 110. The radiologist who reported the patient's chest XRay had to write in his report that the patient’s depth of inspiration was not adequate. What would be the adequate inspiration? a. The inspiration does not play any role in evaluation of the chest X-Ray b. Posterior parts of ribs IV-V should be visible c. Posterior parts of ribs VI-VII should be visible d. Posterior part of ribs VIII-IX should be visible 111. As a first-year medical student, you were asked by your attending to carefully check all hidden areas on the chest X ray. The hidden areas on the chest X Ray are: a. Apices of the lungs b. Both hila c. Areas behind the heart and both domes of the diaphragms d. All of the above are correct 112. The attending radiologist you are working with has asked you how you orient the patient body looking at the scan on the monitor. After the lecture Intro to Radiology, you are very well prepared, and you know that on standard CT scan: a. The patient’s head is behind the monitor, the patient feet are facing you, patient’s left side is on the right side of the monitor and patient’s right side on the left side of the monitor b. The patient’s head is behind the monitor, the patient feet are facing you, patient’s right side is on the right side of the monitor and patient’s left side on the left side of the monitor c. The patient’s feet are behind the monitor, the patient head is facing you, patient’s left side is on the right side of the monitor and patient’s right side on the left side of the monitor d. The patient’s feet are behind the monitor, the patient head is facing you, patient’s right side is on the right side of the monitor and patient’s left side on the left side of the monitor 113. During an abdominal exam free fluid was detected in the patient's peritoneal cavity. What echogenicity in the scale of gray has fluid in ultrasound? a. Hyperechogenic(white) b. Isoechogenic( echogenicity between white and black) c. Hypoechogenic ( darker) d. Anechogenic ( black) 114. What anatomical plane is presented on the attached scan? 115. a. Sagittal b. Coronal c. Axial d. Oblique What is most safe modality for pregnant patient for evaluation of the abdomen: a. Abdominal CT without contrast. b. Abdominal CT with i.v. contrast c. Abdominal X Ray d. Abdominal MRI without contrast Anatomy of Cardiovascular System 116. 117. Blood returning to the heart from the body organs enters the: a. Right atrium through the vena cava b. Left atrium through the aorta c. Right ventricle by the pulmonary vein d. Left ventricle by the pulmonary vein The systemic circuit of the cardiovascular system extends: a. From the heart to the body's organs and tissues b. From the heart to the lungs 118. 119. 120. 121. 122. 123. 124. 125. 126. c. From the gastrointestinal tract to the liver d. From heart to the coronary arteries The only vein in the body that transports oxygen-rich blood is the: a. Aortic vein b. Coronary vein c. Pulmonary vein d. Hepatic portal vein The semilunar valves prevent blood from flowing backwards: a. Into the liver b. Into the brain c. Into the aorta d. Into the ventricles All of the following apply to the bicuspid valve except: a. It is also called the mitral valve b. It is semilunar valve c. It is found on the left side of the heart d. It prevents blood from backing into the left atrium The mitral valve may be auscultated in one of the following areas: a. Left 2nd intercostal space b. Left 5th intercostal space c. Over the base of the xiphoid process d. Right 2nd intercostal space The pulmonary valve may be auscultated in one of the following areas: a. Right 2nd intercostal space b. Left 2nd intercostal space c. Over the base of xiphoid process d. Left 5th intercostal space The mediastinum has following number of compartments: a. 2 b. 4 c. 1 d. 3 The tunica interna of the vascular wall consists of one of the below: a. Connective tissue b. Smooth muscle cells c. Elastic fibers d. Endothelium The main arteries of the heart are the: a. Pulmonary trunk and aorta b. Superior and inferior venae cava c. Pulmonary arteries d. Pulmonary veins The ascending aorta branches following arteries: a. Right common carotid and right subclavian 127. 128. 129. 130. 131. 132. 133. 134. 135. b. Intercostal arteries c. Right and left coronary arteries d. Left common carotid and left subclavian The subclavian artery immediately continues with the one of the following vessels: a. Brachial artery b. Axillary artery c. Femoral artery d. Radial artery The popliteal artery is a direct continuation of the one of the following vessels: a. Common iliac artery b. Lumbar artery c. Femoral artery d. Great saphenous vein The venus angle is formed by a confluence of the following vessels: a. Hepatic veins and IVC b. Subclavian and internal jugular veins c. Cephalic and basilic veins d. Azygos and hemiazygos veins The internal iliac vein drains one of the following organs: a. Kidney b. Uterus c. Small intestine d. Spleen The following statements about the renal veins are true except: a. The left renal vein is longer than the right one b. The right suprarenal vein drains into the IVC c. The right testicular vein drains into the right renal vein d. The left suprarenal vein enters the left renal vein The portal vein carries nutrients from the intestine to one of the following organs: a. Spleen b. Liver c. Urinary bladder d. Brain The superior and inferior venae cava anastomose via one of the following veins: a. Femoral b. Azygos c. Intercostal d. Subclavian The right lymphatic duct collects lymph from one of the following regions: a. Pelvis b. Abdomen c. Right arm d. Right leg and thigh The lymph re-enters the blood circulation in one of the following locations: a. Femoral vein b. Portal vein c. Right atrium d. Venous angle 136. The lymph from the lower limbs is drained by one of the following vessels: a. Broncho-meduastinal trunk b. Subclavian trunk c. Jugular trunk d. Thoracic duct 137. The following organs constitute the lymphatic system, except: a. Suprarenal gland b. Lymph nodes c. Red bone marrow d. Thymus 138. A 44-year-old male patient comes to the doctor’s office. On the surface of the chest, the physician is able to locate the apex of the heart: a. At the level of the sternal angle b. In the left second intercostal space c. In the left fifth intercostal space d. In the right fifth intercostal space e. At the level of the xiphoid process of the sternum 139. A radiologist examines anterior-posterior (AP) chest radiographs of a car accident. Which of the following structures does contribute to the right border of the cardiovascular silhouette? a. Arch of the aorta b. Pulmonary trunk c. Superior vena cava d. Ascending aorta e. Left ventricle 140. The attending faculty in the coronary intensive care unit demonstrates to his students a normal heart examination. The first heat sound is produced by near-simultaneous closure of which of the following valves? a. Aortic and tricuspid b. Aortic and pulmonary c. Tricuspid and mitral d. Mitral and pulmonary e. Tricuspid and pulmonary 141. Which chamber of the heart does oxygenated blood enter returning from the lungs? a. Right atrium b. Left atrium c. Right ventricle d. Left ventricle e. Right auricle 142. A 46-year-old patient comes to his doctor’s office complaining of chest pain and headache. His computed tomography (CT) scan reveals a tumor located just superior to the root of the right lung. Blood flow in which of the following veins is most likely blocked by this tumor? a. Hemiazygos b. Arch of the azygos vein c. Right subclavian vein d. Right brachiocephalic vein e. Accessory hemiazygos vein 143. A cardiac catheter introduced via the femoral artery will eventually reach which of the following chambers of the heart? a. Right atrium b. Left atrium c. Right ventricle d. Left ventricle 144. Choose the correct order of vessels that catheter would pass on its way to the heart: a. External iliac a. – internal Iliac a. – pulmonary trunk – pulmonary v. b. External iliac a. – common iliac a. – internal iliac a. – uterine a. c. External iliac a. – IVC – right atrium - SVC d. External iliac a. - common iliac a. – descending aorta – arch of aorta 145. A 76-year-old patient comes to his doctor’s office complaining of chest pain and headache. The X-Ray reveals a tumor located in the apex of the left lung. Which lymphatic vessel drains the affected organ? a. Thoracic duct b. Right lymphatic duct c. Right bronchomediastinal trunk d. Left bronchomediastinal trunk e. Left jugular trunk Microcirculation 146. Which of the following best describes the changes to blood in an emphysematous lung? a. Decreased blood oxygen b. Increased blood glucose c. Increased alveolar surface area d. Increased blood volume e. Decreased blood carbon dioxide 147. Which of the following blood vessels transports oxygen poor and nutrient rich blood to the liver? a. Portal vein b. Hepatic vein c. Bile duct d. Inferior vena cava e. Hepatic artery 148. Which of the following structures best describes the site of blood filtration in the kidneys? a. Hepatocytes b. Sinusoids c. Renal ureter d. Alveoli e. Nephron 149. A 12-year old boy is brought to the clinic because of facial edema (swelling due to liquid retention). A biopsy sample demonstrates glomerulonephritis (inflammation of the glomerulus, a capillary bed in the nephrons) with deposits of immune complexes that ruptured urinary filtration barrier. Which of the following is the most likely consequence of the observed finding? a. Urinalysis would reveal decreased levels of large proteins in the urine b. Urinary filtration barrier would block filtration of all large and charged particles c. Urinary output would be unaffected d. Urinalysis would reveal increased levels of large proteins in the urine e. Urinary filtration barrier would only allow filtration of small uncharged particles Introduction to the Respiratory System 150. A newborn infant with signs of rapid and labored breathing was diagnosed as having hyaline membrane disease (infant respiratory distress syndrome). This condition is the result of: a. Abnormal differentiation of type I pneumocytes b. Deficiency of pulmonary surfactant c. Excess pulmonary surfactant d. Prolonged pregnancy e. Lack of type i alveolar pneumocytes 151. Cardiothoracic surgeons must be familiar with bronchopulmonary segments since individual segments of the lung can be removed, leaving the rest of the lung intact and functional. Which of the following is a correct characterization of bronchopulmonary segments? a. The arterial supply is located in the periphery of each segment b. They are separated by parietal pleura c. Each segment is supplied by a secondary or lobar bronchus d. Pulmonary veins are used to localize the planes between two segments e. They are arranged with their bases directed toward the hilum of the lung 152. A 1-day-old is referred to the clinic with Neonatal Respiratory Distress Syndrome (NRDS). This syndrome is a life-threatening occurrence due to which of the following? a. Constriction of the primary bronchi b. Los of visceral pleura c. Loss of arterial supply to the terminal bronchi d. Loss of lymphatic drainage of the lung e. Lack of surfactant causing alveoli damage 153. Which of the following is NOT a component of bronchopulmonary segment? a. Pulmonary lymph nodes b. Connective tissue septa c. Tertiary bronchi d. Pulmonary artery e. Intersegmental pulmonary veins 154. Embryologically the inner lining and outer wall of the alveoli consists of which of the following? a. Endoderm and visceral lateral plate mesoderm. b. Endoderm only c. Parietal lateral plate mesoderm d. Neural crest cells e. Paraxial mesoderm 155. Which of the following is least likely about lung development? a. Right lung has tertiary bronchi b. Bronchial buds form 1o ,2o, 3o bronchi c. Terminal bronchioles -> respiratory sac -> terminal sacs -> alveoli d. Pulmonary arteries are not in close contact with alveoli. e. Type II pneumocytes secrete surfactant 156. Which of the following is NOT a content of the root of the lung? a. Pulmonary artery b. Pulmonary ligament c. Bronchial vein d. Tertiary bronchus. e. (Broncho)pulmonary lymph nodes 157. A tumor is found pressing on the superior lingual bronchopulmonary segment of the lung. To localize this lobe, the surgeon should look for which area of the lung? a. Above the horizontal fissure of the right lung b. Between the horizontal and oblique fissures of the right lung c. Below the oblique fissure of the right lung d. Above the oblique fissure of the left lung. e. Below the oblique fissure of the left lung 158. Which of the following structures is the major structure of normal quiet inspiration. a. Vascular tissue damage b. Cardiac tamponade c. Diaphragm. d. Muscles of the chest wall e. Aorta Introduction to Renal System 159. Which of the following labeled items in the CT scan are the kidneys? a. D,F b. B,G c. G,F d. A,B e. C,E f. A,F g. B,F h. A,G i. D,G 160. Which of the following structures function to store urine until the body is ready to release the urine? a. Urethra b. Uterus c. Urinary bladder d. Kidney e. Ureter 161. A 45-year-old woman developed a urinary tract infection (UTI) caused by E. coli (bacteria). She did not seek appropriate medical care because she “does not trust science or doctors” and decided to use a remedy she found on Facebook in the comments section that touts 100% effectiveness in treating a UTI in dogs. Two months later the woman is in the emergency room with severe abdominal pain. The UTI has spread to her entire urinary system. Which of the following is the most likely pathway that the bacterial infection was able to spread in this woman? a. Bladder to urethra to ureters to kidneys b. Kidneys to ureters to bladder to urethra c. Ureters to bladder to urethra to kidneys d. Kidneys to urethra to ureters to bladder e. Urethra to bladder to ureters to kidneys f. Bladder to ureters to urethra to kidneys g. Urethra to kidneys to ureters to bladder 162. A 44-year-old man sustained trauma to his body after a motorcycle accident and several rib fractures can be seen in the medical image. Which of the following structures is the most likely to be at risk of injury due to the fracture indicated within the dashed yellow circle? a. Proximal part of urethra b. Spleen c. Right kidney d. Proximal part of left ureter e. Left kidney f. Distal part of right ureter g. Urinary bladder 163. Following the death of a 57-year-old male at home, an autopsy was performed. The two organs seen in Picture A were noted by the pathologist during the autopsy. Which of the following medical images most closely correlates with the organs seen in Picture A a. 1 b. 2 c. 3 d. 4 164. “A tube that curves along its normal course, has a function to transport urine, and it is located inferior to an organ that temporarily stores urine.” This statement is most likely referring to which of the following in a person? a. Uterine tube in a 37-year-old woman b. Left ureter in a 55-year-old man c. Urethra in a 23-year-old woman d. Right kidney in a 55-year-old man e. Right ureter in a 28-year-old woman f. Urethra in a 42-year-old man g. Left kidney in a 63-year-old woman 165. A 48-year-old man will undergo a surgical procedure within his pelvic region. Prior to this procedure, a Foley catheter needs to be placed within the urethra and into the urinary bladder to collect urine over time. Which of the following is the correct assumption about a normal ureter in this patient? a. There are normally constrictions located throughout its length. b. It is located anterior to the pubic symphysis. c. It is located inferior to the urethra. d. It is typically shorter in length and straighter in a female than in a male. e. There is normally only one in a person. Ethics: Communication 166. Daniel Watson is a 30-year-old man who is visiting his dermatologist Dr. Nicholas Blake for a strange rash. Dr. Blake examines the rash carefully and asks relevant questions about Daniel’s medical history, activities and general health. Dr. Blake informs Daniel this is probably a form of dermatitis, and gives him a prescription for an ointment to put on the rash. He explains how the ointment is to be applied and tells Daniel that he does not expect it to cause any side effects. He adds that he would like to see Daniel in 2 weeks for a follow-up visit. Before leaving, Dr. Blake asks if there is anything else Daniel needs or cares to discuss. This is an example of: a. Patient autonomy b. A professional standard c. Appropriate allocation of resources d. Good communication 167. Mrs. Thompson is an otherwise healthy and alert 84-year-old woman who has recently been diagnosed with metastatic breast cancer. It is the consensus of the medical team caring for her that cure is not an option for Mrs. Thompson given the extent of the disease and her age. Should her physician: a. Arrange a meeting with Mrs. Thompson and her family to discuss her diagnosis and prognosis? b. Tell Mrs. Thompson that she is “just fine” and send her home with a prescription for pain medicine to take as needed? c. Arrange a meeting with Mrs. Thompson to discuss her diagnosis and prognosis suggesting that she should feel free to invite any friends or family to attend the meeting as well d. Inform Mrs. Thompson’s family of her diagnosis without her knowledge? 168. Josey Canfield is a 27-year-old woman who is currently in the hospital recovering from surgery to repair a broken leg. After taking her antibiotics this morning, Josey complained of a headache and nausea, and then suffered a very mild seizure. The medical team was called immediately, and a number of tests were performed all of which were negative for any significant changes in her medical condition. On further investigation, it was discovered that Josey had been given another patient’s medication by mistake. The most ethically appropriate course of action for the physician to take would be to: a. Inform Josey that she suffered an unexpected adverse effect to her medication, but seems to have suffered no serious or lasting effects b. Tell Josey that he (the physician) is not sure why she had a seizure today, but assure her that she seems to have suffered no serious or lasting effects c. Have the nurse caring for Josey to go in and explain that she gave Josey the wrong medication this morning d. Apologize and explain to Josey that she received the wrong medication, but she seems to have suffered no serious or lasting effects 169. Mrs. Rahim presents to the emergency room with her husband. He tells the triage nurse that his wife is experiencing some vaginal bleeding and that she needs to see a doctor right away. The nurse brings them both back to an exam room and says the doctor will be there shortly. Dr. Geoff Aaron comes in and introduces himself, and then asks Mrs. Rahim to tell him what is going on. Mr. Rahim stands in front of his wife and says politely “We would prefer to see a female physician. Due to our cultural practices, it is not considered appropriate for my wife to be examined by a man.” How should Dr. Aaron respond? a. “I understand your concern and would like to help. No female physicians are available right now, but I will get someone as soon as possible. For now, would it be acceptable for a female nurse to get some information from you about what is going on?” b. “I’m sorry but right now i’m the doctor assigned to your wife. I would be happy to call in a female nurse to be in the room with us.” c. “There are not female physicians in the ER tonight. If you wish to be treated by a female physician, you will have to go to another hospital.” d. “Your wife’s condition could be life-threatening and I need to examine her right away.” Introduction to Gastrointestinal System 170. Which of the following organs has a function of storing bile? a. Small intestine b. Liver c. Pancreas d. Gallbladder e. Stomach 171. The large intestine consists of the duodenum, jejunum and ileum (T/F) 172. Which of the following organs does not play a role in the digestive process of food? a. Stomach b. Spleen c. Gallbladder d. Jejunum e. pancreas 173. In the image, which number identifies the structure that is responsible for the (mechanical and chemical) breakdown of ingested food? a. 1 b. 2 c. 3 d. 4 e. 5 174. You are a radiologist reviewing this abdominopelvic CT scan. Which of the following statements is CORRECT concerning this image? a. C is the ileum and B is the left kidney. b. D is the descending colon. c. A is the liver seen on sagittal MRI scan. d. C is the gallbladder and B is the right kidney. e. A is the stomach seen on a coronal CT scan. f. B is the spleen seen on axial CT scan 175. Bony landmarks can be used to help locate the position of other structures. The anterior superior iliac spine is one of those bony landmarks. Where on the image can it be palpated? a. Location 1 b. Location 2 c. Location 3 d. Location 4 e. Location 5 176. A 38-year-old man presented to the Emergency Department with a 3-day history of abdominal pain, abdominal distension, nausea, and no passage of stools (feces). Barium contrast x-rays reveal a twisting in a part of the gastrointestinal (GI) tract that is distal to the descending colon. Which organ/part of the GI tract is most likely twisted in this case? a. Jejunum b. Ileum c. Ascending colon d. Cecum e. Sigmoid colon f. Stomach 177. A 46-year-old woman, with a medical history of well-controlled depression, was referred for urgent investigation due to weight loss and diarrhea. Evaluation and diagnostic studies revealed a linear foreign body in an organ (organ indicated by the tip of the yellow arrow in the image.) On subsequent questioning, the patient recalled unintentionally swallowing a plastic pen 25 years earlier. She was investigating something near her tonsil with the pen when she slipped, fell and swallowed the pen by mistake. Which of the following is the normal function of the organ indicated at the arrow? a. Store bile b. Dehydration and compaction of indigestible materials c. Absorption of water and vitamins d. Mechanical breakdown of food by enzymes e. Production of bile 178. A 29-year-old man was shot from the front by someone with a hand-gun. The bullet entered the right lower abdominal quadrant. At the emergency department a physician determines that the bullet is lodged only within the right lower abdominal quadrant. Which organ is the most likely to be at risk of injury from the gunshot wound? a. Sigmoid colon b. Gallbladder c. Stomach d. Transverse colon e. Cecum f. Liver g. Duodenum h. Pancreas 179. A forensic pathologist determined that a 32-year-old man died from acute drug intoxication. The man had ingested 87 ovoid packets containing heroin to conceal them within his gastrointestinal system to smuggle into another country, but some of the packets had burst inside him. During the autopsy, which of the following organ(s) is not likely to contain any of the drug packets? a. Sigmoid colon b. Pancreas c. Stomach d. Descending colon e. Cecum f. Duodenum g. Ileum 180. This organ can be identified as which of the following labeled structures on the axial CT scan? a. Choice A b. Choice B c. Choice C d. Choice D e. Choice E f. Choice F 181. A 56-year-old female is undergoing surgery to remove her ascending colon (hemicolectomy) due to cancerous tumors located only in that segment of the GI tract. For the surgeon to cut and remove the ascending colon only, which of the following would most likely apply in this case? a. Make sure to identify the correct part of the large intestine which is located on the left side of the body and cut that segment out. b. Cut between the proximal part of the jejunum and distal part of the ileum and remove the segment of small intestine. c. Cut between the cecum and beginning part of the transverse colon and remove the segment of the large intestine. d. Cut between the cecum and sigmoid colon and remove the segment of the large intestine. e. Cut between duodenum and distal end of transverse colon and remove the segment of the large intestine. 182. Where can the epigastric region be palpated as in the image? a. b. c. d. e. Location 1 Location 2 Location 3 Location 4 Location 5 Introduction to Hematology 183. What protein gives rise to the eosinophilic staining of these cells? 184. Are all the cells in the image normally shaped? a. No b. Yes 185. A 2-year old girl has an infection. A complete blood count reveals increased numbers of the white blood cell type shown in the image. Which of the following conditions is most consistent with this laboratory result? a. b. Chronic inflammation c. Bacterial infection d. Internal bleeding e. Parasitic infection f. Viral infection 186. Reticulocytes are bone marrow precursors for which of the following blood cell types? a. Lymphocytes b. Monocytes c. Erythrocytes d. Neutrophils e. Thrombocytes 187. What is abnormal about this blood smear? Which type of disease does this blood smear suggest? 188. Suspected of having a rare genetic disorder, a patient and her daughter both have biopsies of their thymus. The biopsy of the thymus of the daughter shows a highly cellular thymus that contains many lymphocytes, while the maternal thymus appears less robust, with large areas of fatty tissue and numerous inclusions. What can you conclude based upon the results of this test? a. Nothing, the thymus is normally very active in adults b. The mother is showing signs of abnormal tissue damage c. Nothin, theses are normal observations of pre- and post- puberty thymus samples d. The daughter may be experiencing an autoimmune reaction e. Nothing, the thymus is normally inactive until puberty 189. Identify the eosinophilic cells seen in this image 190. In 2-3 words state the primary function of the cell marked by the yellow arrow, be specific. 191. Identify the cell 192. Identify the cell indicated by the RED arrow 193. Identify the cell type indicated by the black arrow indicated by the RED arrow 194. A characteristic feature of reticulocytes is that they a. Decrease in number following a hemorrhage b. Have residual ribosome inclusions in the cytoplasm c. Are the cells that are misshapen in sickle cell anemia d. Have a large round central nucleus e. Are more abundant than erythrocytes in a blood smear 195. A patient with disorder affecting the efficiency of megakaryocytes will be most likely presented with symptoms of: a. Multiple subcutaneous nodules in the arm and shoulder b. Bacterial infections c. Brittle bones d. Excessive bleeding e. Hypersensitivity to sun exposure 196. A characteristic feature of monocytes is that they: a. Differentiate into macrophages b. Are approximately the same size as reticulocytes c. Are the most abundant type pf white blood cell d. Are elevated during parasitic infections e. Differentiate into plasma cells 197. The majority of formed elements in the blood are of which cell type? a. Monocytes b. Eosinophils c. Lymphocytes d. Erythrocytes e. Neutrophils 198. Which blood cell attacks blood-borne larvae of parasites? a. Basophil b. Eosinophil c. Monocyte d. Red blood cell e. Neutrophil 199. The large cell in the image with a segmented nucleus 200. a. Protects against bacterial infections b. Belongs to the agranulocytic lineage c. Functions prominently in allergic reactions d. Is the most abundant formed element of blood e. Produces antibodies The cell identified by the red arrow: a. Belongs to the granulocyte lineage b. Is abundant during parasitic infections c. Transport oxygen and carbon dioxide d. Differentiates into a macrophage e. Differentiates into a plasma cell 201. Which statement regarding formed elements of blood is TRUE? a. Neutrophils take up residence in extravascular tissues to secrete antiparasitic substances. b. Basophils leave the bloodstream to become mast cells. c. Monocytes circulate in the blood and then pass into tissues to become macrophages. d. Mature red blood cells contain small numbers of mitochondria for energy production e. Platelets release granules containing heparin and histamine 202. In your infectious disease sub-internship, you see a patient who has been experiencing fevers and fatigue. His white cell count comes back and you see that his neutrophil levels are elevated. What type of diagnosis do you suspect? a. Parasitic infection b. Bacterial infection c. Allergic reaction d. Cancer e. Viral infection 203. A 7-year old girl has an infection. A complete blood count reveals increased numbers of the white blood cell type shown in the image. Which of the following conditions is most consistent with this laboratory result? a. Allergic reaction b. Parasitic infection c. Viral infection d. Bacterial infection e. Chronic inflammation 204. A drug that specifically depletes reticulocytes would block formation of which of the following? a. Neutrophils b. Macrophages c. B-lymphocytes d. Thrombocytes e. Erythrocytes 205. A 32-year old woman visits her physician due to a month of nasal discharge, coughing and sore throat. She is diagnosed with a subtype of blood cancer resulting in uncontrolled production of abnormal agranulocytes. Erythrocyte and granulocyte counts are within normal limits and their bone marrow precursors appear normal as well. Which of the following is the most likely consequence of this patient’s condition? a. Inadequate response against parasitic infections b. Inadequate response against viral infections c. Decreased blood reticulocytes d. Inadequate vasodilation and blood coagulation e. Normal levels of blood monocytes 206. A 67-year old man visits the clinic with a 15-year history of coughing, fatigue, and headaches. Patient history reveals he worked for over 30 years as a construction worker in demolition sites known to contain asbestos. As a result of his chronic exposure to air filled with this foreign substance, the resident macrophages of the lungs, dust cells, would have phagocytosed the asbestos for years requiring constant turnover and replacement. Given this patient’s medical history, which of the following cell types would most likely be elevated in a peripheral blood smear? a. Eosinophils b. Lymphocytes c. Monocytes d. Thrombocytes e. Neutrophils 207. Which of the following statements best describes the cell labeled by the black arrows in the image below? a. Does not leave blood vessels to perform its function b. Most abundant blood cell type c. Is classified as an agranulocyte d. Granules released are toxic to parasites and worms e. Largest leukocyte f. Phagocytoses bacteria 208. A drug that specifically depletes monocytes would block formation of which of the following? a. Erythrocytes b. B lymphocytes c. Helper T lymphocytes d. Natural killer cells e. Macrophages 209. A 45-year old homeless man comes to the emergency department because of a 1-week history of pain in his right foot and a 2-day history of difficulty walking. His sock is blood-encrusted. Physical examination shows a 5-cm wound surrounded by edema on the ball of the right foot. A thick exudate containing abundant dead and dying leukocytes is expressed on palpation of the wound. Which of the following types of leukocytes most likely predominated at the wound site 1 day after the initial injury? a. Neutrophils b. Basophils c. Monocytes d. T lymphocytes e. B lymphocytes f. Eosinophils 210. Which of the following cell types secretes substances that prevent blood coagulation and increase the permeability of small blood vessels to allow movement of cells from the blood into adjacent connective tissue? a. Fibroblasts b. Neutrophils c. Endothelial cells d. Mast cells e. Eosinophils f. Thrombocytes 211. A 35-year-old man came to the physician because of pain and swelling of his right arm where he scraped it on a tree branch 2 days ago. His temperature is 38.3°C (101°F). Examination of the right forearm shows swelling around a fluctuant lesion at the site of trauma, and upon perforation of the skin a thick yellowish pus exudate can be observed likely due to a bacterial infection. Which of the following cell types is most likely elevated in his peripheral blood? a. Erythrocytes b. Monocytes c. Reticulocytes d. Neutrophils e. Megakaryocytes 212. A 29-year-old woman has been treated for mild anemia since childhood but visits her family physician due to worsening episodes of breathlessness and fatigue. Concerned about this persistent anemia despite therapy, she is referred to the hematology department, where genetic tests revealed her anemic symptoms were due to a rare type of hemoglobin mutation. Which of the following laboratory findings is most likely to support this diagnosis? a. Increased blood reticulocyte levels b. Increased blood oxygen levels c. Decreased blood reticulocyte levels d. Increased blood monocyte levels e. Decreased blood circulation dioxide levels 213. Your patient is experiencing jaundice and fatigue due to increased hemolysis (destruction of red blood cells) triggered by a viral infection. Complete blood count would reveal increased levels of which of the following cell types? 214. Physical examination of your patient reveals lymphadenopathy: enlarged lymph nodes. Which of the following best explains the cause of this enlargement? a. Migration of neutrophils b. Edema of lymph node c. Proliferation of T-cells d. Red pulp congested with RBCs 215. Complete blood count revealed 10.8% reticulocytes, normal levels range between 0.5% - 1.5%. Your patient’s results are most indicative of which of the following? a. Increased rate of erythropoiesis b. Increase thymus cell maturation c. Active neutrophil proliferation d. Stimulation of monocyte differentiation 216. Which of the following cell types is an erythrocyte precursor? 217. Which of the following best explains why hemolytic anemia gives rise to fatigue? a. Increased blood hemoglobin levels b. Decreased blood oxygen levels c. Increased blood bilirubin levels d. Decreased blood albumin levels 218. The patient has no prior medical problems. He is consistently at the 50th percentile for height and weight. He takes no medications, and his immunizations are up to date. Pallor, scleral icterus, and palpable splenomegaly are seen on examination. The patient’s peripheral smear shows spherocytes, which are approximately 2/3 of the diameter of normal red blood cells. The patient’s presentation is consistent with hereditary spherocytosis and autosomal dominant hemolytic anemia due to a red blood cell membrane defect.Which of the following peripheral smears was most likely obtained from your patient’s blood? 219. Which of the following arrows is pointing to the spleen? 220. Which of the following best explains the underlying pathogenesis for your patient’s splenomegaly? 221. 222. a. Congested splenic red pulp b. Inhibition of erythropoiesis c. Activated splenic white pulp d. Impaired B-cell proliferation Which of the following best describes the direct cause of your patient’s jaundice? a. Increased blood reticulocytes b. Increased blood carbon dioxide levels c. Increased blood bile levels d. Increased blood bilirubin levels Which of the following vessels is highlighted in pink in the image? a. Portal Vein b. Splenic Artery c. Inferior Vena Cava d. Splenic Vein 223. During the child’s visit you notice his father also has slight yellow pigmentation of his skin. Incidentally you discover that the cause for his jaundice is not spherocytosis but rather liver cirrhosis. Edema and accumulation of fluid as ascites is the most common complication of cirrhosis. This is occurring in about 50% of patients within 10 years of the diagnosis of cirrhosis. Impaired hepatic function results in hypoalbuminemia. Which of the following accurately describes the mechanism by which hypoalbuminemia causes edema? a. Increases hydrostatic pressure b. Decreases oncotic pressure c. Increases blood endothelium permeability d. Decreases lymph endothelium permeability 224. Which cell type would be elevated in the blood in a patient with bacterial peritonitis? a. Neutrophils b. Monocytes c. Eosinophils d. Basophils Introduction to Lymphatic System 225. Which of the following is NOT a normal component of lymph fluid? a. White blood cells b. Red blood cells c. Interstitial fluid d. Lymphocytes e. Water 226. Viral infected cells exhibit viral proteins on their MHC-I surface molecules. Which of the following cell types would be responsible for detecting these foreign proteins and initiating an immune response against the viral infected cells? a. Antigen presenting cells b. Helper T cells c. B cells d. Killer T Cells e. Plasma cells 227. Lymphatic tissue consists of large aggregations of lymphocytes embedded in connective tissue. This tissue can be found deep to epithelial linings and acts as our body’s surveillance system against pathogens that penetrate the epithelium. Which of the following is composed of this ”battleground” type of lymphatic tissue? a. Tonsils b. Bone marrow c. Blood vessels d. Thymus e. Skeletal muscle 228. Lymph nodes contain large amounts of which of the following cell types? a. Monocytes b. Lymphocytes c. Reticulocytes d. Eosinophils e. Erythrocytes 229. Which of the following best describes one of the main functions of the spleen? a. Formation of new erythrocytes b. Filters lymph for pathogens c. Formation and education of new lymphocytes d. Filters blood for old lymphocytes e. Filters blood for old erythrocytes 230. Which of the following structures of the spleen is correctly matched with its function: a. White pulp: destruction of old red blood cells b. Red pulp: filtration of old and damaged RBCs c. White pulp: education of T cells d. Red pulp: antibody production e. Red pulp: storage of leukocytes 231. Suspected of having a rare genetic disorder, a patient and her daughter both have biopsies of their thymus. The biopsy of the thymus of the daughter shows a highly cellular thymus that contains many lymphocytes, while the maternal thymus appears less robust, with large areas of adipose tissue and numerous inclusions. What can you conclude based upon the results of this test? a. The mother is showing signs of abnormal tissue damage b. Nothing, the thymus is normally inactive until puberty c. Nothing, the thymus is normally very active in adults d. The daughter may be experiencing an autoimmune reaction e. Nothing, these are normal observations of pre- and post- puberty thymus samples 232. Which of the following lymphatic tissues/organs is correctly matched with its function: a. Thymus: site of immune reactions b. Tonsils: site of T-cell education c. Spleen: site of lymph filtration d. Lymph nodes: reservoir of lymphocytes e. Lymph nodes 233. Lymphoid stem cells initially originate from the bone marrow and develop into mature T-lymphocytes in the: a. Lymph nodes b. Tonsils c. Thymus d. Thyroid e. Spleen f. Bone marrow 234. A 3-year-old girl from Tanzania was referred to the Hospital with severe anemia, fever, cough, pallor, weakness and tachypnea that aggravated six day ago. On abdominal examination, she had hepatosplenomegaly, and blood work revealed sickle-cells. Splenomegaly is often observed in children with sickle-cell anemia since damaged red blood cells are filtered at the spleen and removed by: a. B cells b. Neutrophils c. Hepatocytes d. Lymphocytes e. Macrophages 235. Filtration of abnormally shaped and old erythrocytes occurs in the absence of specific receptors because of the action of which of the following structures? a. Lymph nodes b. Thymus c. Splenic microvasculature d. White pulp e. Thyroid follicles 236. This cell produces antibodies by differentiating into a plasma cell: a. Basophil b. Monocyte c. Reticulocyte d. B lymphocyte e. T lymphocyte Biostats: Introduction to Biostatistics/Measures of Health 237. Which of the following is true of case fatality rate? a. The denominator is the number of lab-confirmed cases b. The numerator is the number of deaths from the disease c. Can be reported per 100,000 per population d. All of the above 238. A study is looking to examine the number of new cases of a disease. In a community of 2,000, 35 have the disease. Between January 1, 2021 and September 3, 2021, there are 5 new cases. What is the incidence? a. 5/2000 b. (5/2000)*100,000 c. (5/2000)*1000 d. 5/(2000-35) 239. How are prevalence and incidence most likely to change if a cure for a disease is discovered? a. Prevalence will go down, incidence may or may not be affected b. Prevalence will increase, the incidence may or may not be affected c. Prevalence will remain the same, the incidence will increase d. Prevalence and incidence will increase 240. How are incidence and/or prevalence most likely to change if a vaccine is discovered? a. Both incidence and prevalence will increase b. The incidence will decrease, and over time prevalence will decrease c. The incidence will remain the same d. Prevalence will increase 241. How are prevalence and/or incidence most likely to change if treatment is discovered that prolongs life? a. Prevalence and incidence will increase b. Prevalence will remain the same c. Prevalence will increase d. Incidence will decrease 242. How are incidence and/or prevalence most likely to change if the person-to-person transmission is decreased? a. Incidence will increase, but prevalence will stay the same b. The incidence will increase, and over time prevalence will increase c. Incidence and prevalence will remain the same d. Incidence will decrease and over time prevalence will decrease 243. How are incidence and/or prevalence most likely to change if we have better screening for disease? a. Both incidence and prevalence will increase b. Both incidence and prevalence will decrease c. The incidence will increase, and prevalence will decrease d. The incidence will decrease, and the prevalence will remain the same 244. Out of a sample of 10,000, what was the prevalence of Hepatitis C between April 1, 2020, and March 31, 2021? a. 1/10,000 b. 4/10,000 c. 7/10,000 d. Cannot be determined 245. In 1997 in Country X the population was 1,265,000, and there were 109 new cases of salmonellosis. Calculate the annual incidence rate of salmonellosis per 100,000 in Country X. a..00086 per 100,000 b. 8.6 per 100,000 c. 86/100,000 d. 860/100,000 246. In a sample of 100 in a community, what was the incidence of rheumatoid arthritis in 2002? a. 2/95 b. 5/95 c. 2/100 d. 7/100 247. A local health department is investigating a norovirus gastroenteritis outbreak among a total of 2000 college students living on campus. Of these students, 1600 people ate strawberries, and 400 people ate lettuce. A total of 800 students became ill; 160 of them ate strawberries, and 80 ate lettuce. Which of the following indicates the probability of diarrhea having developed among students who consumed strawberries? a. 0.08 b. 0.10 c. 0.20 d. 0.30 e. 0.50 248. A 65-year-old man is referred for diagnostic cardiac catheterization (coronary angiogram) for cardiomyopathy. Previous studies have indicated that 20% of patients require admission to the hospital following this procedure. Three percent of admitted patients acquire a hospital-associated infection. What is the patient’s risk for acquiring a hospital-associated infection following this procedure? a. 2/100 b. 6/100 c. 6/1000 d. 15/100 e. 2/1000 249. The incidence of Disease X has remained stable for the last 50 years, but the prevalence has decreased at the same time. Which of the following is the best explanation for this? a. Increased diagnostic accuracy b. The disease is curable c. Poor screening of the disease d. Better management of complications 250. After two people at a summer camp were diagnosed with giardiasis by stool sample analysis, epidemiologists began to track the incidence of giardiasis at the camp to determine the likely source of infection. The two most likely sources of infection were the common well water supply and the lake used for swimming. New campers arrived at the beginning of each month. The results of their observations are reported below: Observation period Total number of campers Number of campers using the lake Confirmed cases of giardiasis in lake users Confirmed cases of giardiasis in non-lake users June 4352 2891 5 0 July 3987 2650 9 0 August 4155 2768 1 0 Totals 12494 8309 15 0 The researchers concluded that exposure to the lake is the only source of the infection. Which of the following best represents the incidence of giardiasis in the month of July? a. 9/2,650 b. 9/2,768 c. 9/2,891 d. 9/3,987 e. 9/8,309 251. A study examined the no-age-adjusted trends over time for a type of cancer found less commonly in the US than in other parts of the world. Mortality exceeded incidence, but both decreased between 1990 and 2002. Which of the following factors best explains these changes in incidence and mortality? a. Improvements in population-based primary prevention programs b. Changes in age distribution of the population c. Improved patient adherence with established treatment regimens d. Improvements in chemotherapeutic agents e. Improvements in early diagnostic techniques 252. On May 10, 2021, there were 2,487,480 lab-diagnosed cases of COVID-19 in Texas https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab0 1e8b9cafc8b83. The population of Texas at that time was approximately 29,730,300 (https://worldpopulationreview.com/states/texas-population). Calculate the approximate incidence rate of COVID-19 in Texas per 100,000 population. a. 7,625 cases per 100,000 b. 8,367 cases per 100,000 c. 9,255 cases per 100,000 d. The answer cannot be determined with the information provided 253. In a city with a population of 1 million, 10,000 individuals develop a sexually transmitted disease (STD). During a year, there are 1,000 new cases of this STD. The incidence of this STD in the city during the year is given by which of the following expressions? a. 800/990,000 b. 800/1,000,000 c. 1,000/990,000 d. 1,000/1,000,000 e. 2,500/1,000,000 f. 10,000/1,000,000 254. A group of investigators is evaluating an outbreak of salmonella poisoning at a local restaurant. They gather evidence of what patrons ate and which patrons became ill. Of the 100 patrons, 24 ate egg-drop soup, 30 ate raw clams, and 46 ate the chicken special. Of these, 79 became ill. Among those who became ill, 20 ate egg-drop soup, 38 ate raw clams, and 21 ate the chicken special. Based on these data, which if the following is the attack rate for those persons who ate egg-drop soup? a. 4/20 b. 20/24 c. 20/79 d. 20/100 Introduction to Endocrinology 255. Pheochromocytomas are tumors that usually lead to hypersecretion of the catecholamines (epinephrine and norepinephrine). Which region of the adrenal gland is involved in production of catecholamines? a. Zona glomerulosa b. Capsular connective tissue c. Medulla d. Zona reticularis e. Zona fasciculata 256. Neuroendocrine signaling cascades that regulate T3/T4 hormone secretion primarily involve coordinated activity amongst which organs? a. Hypothalamus, parathyroid glands, adrenal glands b. Pituitary glands, adrenal glands, parathyroid glands c. Pituitary glands, adrenal glands, thyroid glands d. Liver, pituitary glands, adrenal glands e. Hypothalamus, pituitary glands, thyroid glands 257. A 45-year old male experiencing severe headaches visits his local hospital where radiological exams revealed a tumor in the anterior pituitary gland, but no infiltration or impingement of the posterior pituitary. Given the location of the tumor, symptoms of such a condition vary widely depending on the type of cells involved. Secretion of all of the following hormones could be affected, EXCEPT: a. Luteinizing hormone b. Antidiuretic hormone c. Growth hormone d. Thyroid stimulating hormone e. Adrenocorticotropic hormone 258. The zona reticularis is the i. ____________ layer of the adrenal gland cortex, it contains cells that secrete ii. _______________ and whose activity is regulated by iii. ______________ a. i. Outermost, ii. Weak Androgens, iii. Adrenocorticotropic Hormone b. i. Innermost, ii. Androgens, iii. Adrenocorticotropic Hormone c. i. Outermost, ii. Cortisol, iii. Sympathetic neurons d. i. Innermost, ii. Epinephrine, iii. Sympathetic neurons e. i. Middle, ii. Aldosterone, iii. Adrenocorticotropic Hormone 259. Cell bodies in the hypothalamus that produce oxytocin have axons that terminate at: a. capillary beds in the adenohypophysis b. capillary beds in the pars nervosa c. capillary beds in the hypothalamus d. capillary beds in the pars distalis e. capillary beds in the anterior pituitary 260. The basophils of the anterior pituitary: a. are regulated by hypothalamic releasing and inhibiting factors b. are found only in the pars nervosa c. secrete hormones produced by neurons and released by axons d. produce prolactin e. produce growth hormone 261. Match the layers of the adrenal gland numbered 1-4, with the corresponding hormone secreted by the cells within the layer (V-Z): 1) Zona Glomerulosa 2) Zona Fasciculata 3) Zona Reticularis 4) Medulla Chromaffin Cells V. Cortisol (Glucocorticoids) X. Aldosterone (Mineralocorticoids) Y. Epinephrine and Norepinephrine (Catecholamines) Z. Androgens (Gonadocorticoids) a. b. c. d. 1X, 2Z, 3V, 4Y 1V, 2X, 3Y, 4Z 1V, 2X, 3Z, 4Y 1X, 2V, 3Z, 4Y e. 1Y, 2V, 3Z, 4X 262. The zona glomerulosa is the i. ____________ layer of the adrenal gland cortex, it contains cells that secrete ii. _______________ and whose activity is regulated by iii. ______________ a. i. Middle, ii. Aldosterone, iii. Adrenocorticotropic Hormone b. i. Innermost, ii. Epinephrine, iii. Sympathetic neurons c. i. Outermost, ii. Weak Androgens, iii. Adrenocorticotropic Hormone d. i. Outermost, ii. Cortisol, iii. Sympathetic neurons e. i. Outermost, ii. Aldosterone, iii. Adrenocorticotropic Hormone 263. Which statement concerning cells in the zona glomerulosa of the adrenal cortex is FALSE? a. their cytoplasm contains an abundant number of mitochondria b. they are regulated by ACTH c. they contain enzymes located in mitochondria and smooth ER involved in aldosterone synthesis d. they produce mineralocorticoids urine ions and blood pressure e. they secrete hormones classified as catecholamines 264. Which statement regarding the adrenal medulla is FALSE? a. it produces norepinephrine b. it is regulated by ACTH c. it releases epinephrine in response to sympathetic nervous stimulation d. it lies adjacent to the zona reticularis e. it drains blood from the entire adrenal gland 265. ADH producing cells have axons that terminate at: a. Endocrine cells present in the pars intermedia. b. Capillaries present in the pars nervosa. c. The hypothalamo-hypophysiotropic nuclei. d. Capillaries present in the pars distalis. e. Epithelial cells in the anterior pituitary 266. A 34-year old woman comes to the office with chronic hypertension and irregularities in urine production. She also experienced abnormal menstrual periods and hirsutism (male-pattern hair growth). Laboratory studies reveal elevated blood levels of both androgens and aldosterone, but normal cortisol levels. Which of the following histopathologic findings are most likely to be present in this patient’s adrenal glands? a. Atrophy (cell death) of all layers of the adrenal cortex b. Hyperplasia (enlargement) of the zona fasciculata and reticularis c. Hyperplasia (enlargement) of the zona glomerulosa and reticularis d. Atrophy (cell death) of the zona glomerulosa and fasciculata e. Hyperplasia (enlargement) of the adrenal medulla 267. A 27-year old female has experienced sudden onset and unexplained weight gain with fat deposits throughout her body, most notably in her face giving rise to a more rounded appearance. She also complains of abnormal thirst and urination, loss of libido and amenorrhea (absence of menstruation) and growth of extra facial hair. Radiologic examination revealed a mass in her pituitary gland, as well as adrenal gland hyperplasia (enlargement). Given the combination of symptoms experienced by the patient, which of the following pituitary cell types is most likely affected? a. Corticotrophs b. Mammotrophs c. Gonadotrophs d. Pineal glandular cells e. Thyrotrophs 268. A 32-year old woman comes to the office due to vision problems and frequent headaches. Brain MRI reveals a large anterior pituitary tumor compressing on the optic chiasm. Light microscopy examination of the tumor reveals hormone-secreting basophils. Which of the following processes is regulated by pituitary basophils and is most likely affected in this patient? a. Circadian rhythm and sleeping patterns b. Stimulation of gonads including ovarian follicles c. Contraction of uterine muscle during labor d. Release of stored calcium from bone e. Growth of bones, muscle and adipose 269. During hormone regulation, hormones are released, either directly by an endocrine gland or indirectly through the action of the hypothalamus of the brain, which stimulates other endocrine glands to release hormones in order to maintain homeostasis. Which of the following hormones is NOT secreted nor regulated by the hypothalamus? a. Oxytocin from neurohypophysial axons b. Luteinizing hormone from gonadotrophs c. Norepinephrine from chromaffin cells d. Mineralocorticoids from zona glomerulosa e. T3/T4 hormone from follicular cells 270. Which of the following cell types would increase their stimulatory-hormone secretion in response to abnormally low thyrotroph activity? a. Hypothalamic supraoptic neurons b. Pineal gland cells c. Thyroid follicle cells d. Hypothalamo-hypophysiotrophic neurons e. Adenohypophysis corticotrophs 271. Pheochromocytomas are tumors that usually lead to hypersecretion of the catecholamines. Which region of the adrenal gland is involved in production of catecholamines? a. Medulla b. Zona reticularis c. Zona glomerulosa d. Capsular connective tissue e. Zona fasciculata 272. Administration of a drug causes increased secretion of norepinephrine and epinephrine by the adrenal medulla. This most likely occurs because the drug: a. Mimics the activity of sympathetic neurons b. Inhibits production of steroid hormones c. Stimulates release of hypothalamic inhibitory hormones d. Activates enzymes that mediate the breakdown of cortisol derivatives e. Increases secretion of ACTH 273. Neuroendocrine signaling cascades that regulate cortisol secretion primarily involve coordinated activity amongst which organs? a. Pituitary glands, adrenal glands, parathyroid glands b. Hypothalamus, pituitary glands, adrenal glands c. Liver, pituitary glands, adrenal glands d. Hypothalamus, parathyroid glands, adrenal glands e. Pituitary glands, adrenal glands, thyroid glands 274. A 30-year old woman is diagnosed with Addison’s disease, adrenal gland insufficiency most commonly caused by autoantibodies against the adrenal cortex, without affecting chromaffin cells. Histopathological examination of an adrenal gland biopsy confirms the diagnosis by revealing atrophy (cell death) of all three cortical zones. As a result of her condition, this patient will most likely exhibit which of the following symptoms? a. Low blood calcium levels and brittle bones b. Insomnia and other sleep abnormalities c. Inadequate regulation of urine volume and blood pressure d. Abnormal cell metabolism, heat production, and sweating 275. A 62-year old man is brought to the office due to recurrent headaches and vomiting. Neurological examination suggests an intracranial mass located in the dorsal midbrain. These types of tumors typically arise from the pineal gland; it is therefore possible for this patient to experience circadian rhythm abnormalities. Which of the following best describes normal regulation of circadian rhythms? a. Sunlight stimulates melatonin production b. Darkness stimulates pituitary cell secretion c. Darkness inhibits pineal cell secretion d. Sunlight inhibits pineal cell secretion e. Darkness stimulates melanin production 276. A drug that blocks the secretory activity of pituitary acidophilic cells would most likely: a. Decrease secretion of growth hormone by mammotrophs b. Increase secretion of oxytocin from the posterior pituitary c. Decrease secretion of calcitonin from the thyroid gland d. Increase secretion of aldosterone by adrenal gland e. Decrease stimulation of mammary glands 277. A 45-year old male experiencing severe headaches visits his local hospital where radiological exams revealed a tumor in the pars distalis of his pituitary gland, but no infiltration or impingement of the pars nervosa. Given the location of the tumor, symptoms of such a condition vary widely depending on the type of cells involved. Secretion of all of the following hormones could be affected, EXCEPT: a. Adrenocorticotropic hormone b. Thyroid stimulating hormone c. Antidiuretic hormone d. Growth hormone e. Luteinizing hormone 278. A 32-year-old female is diagnosed with a pituitary adenoma, a tumor arising from the secretory cells of the adenohypophysis. Given the location of the tumor, symptoms of such a condition vary widely depending on the type of cells and hormones involved. All of the following are possible symptoms resulting from overproduction of hormones within the adenohypophysis, EXCEPT: a. Painful labor-like contractions of the uterus in females b. Acromegaly (enlargement of the extremities or limbs and thickening of the skull and jaw) c. Weight loss, anxiety, elevated heart rate and blood pressure changes d. Changes in menstrual cycles in women and erectile dysfunction in men e. Inappropriate growth of breasts and increased lactation 279. A 55-year-old man suffers massive head trauma in a motor vehicle accident after he fainted suddenly while driving. He was rushed to the emergency department but passed away a few days later. Histological sections of the patient’s pituitary gland are examined at autopsy and anomalies are observed in the posterior lobe. Which of the following functional deficits was most likely involved in causing this patient to faint? a. Sudden shift in circadian rhythms b. Decreased blood glucose levels c. Abnormal secretion of noradrenaline d. Inadequate calcium regulation e. Abnormal water and ion homeostasis 280. Which of the following cells secrete thyroid stimulating hormone under normal conditions? a. Acidophilic Somatotrophs b. Acidophilic corticotrophs c. Hypothalamic Basotroph d. Thyroid follicular cells e. Basophilic Thyrotrophs 281. A 37-year old female experiencing severe migraines visits her local hospital where radiological exams revealed a mass in the anterior lobe of her pituitary gland. Given the location of the mass, symptoms of such a condition vary widely depending on the type of cells involved. Secretion of all of the following cells could be affected, EXCEPT: a. Oxytotrophs b. Gonadotrophs c. Mammotrophs d. Somatotrophs e. Thyrotrophs 282. A 24-year-old male moved from Canada to Australia to attend medical school, and as expected he experienced feelings of jet-lag. One month after his flight he is still experiencing difficulty falling asleep at night time and fatigue throughout the daytime. After attending the endocrine lecture in his histology class, he self-diagnoses as having abnormal levels of melatonin. If his diagnosis is correct, this is most likely indicative of abnormal secretory activity of which of the following glands? a. Thyroid Gland b. Pineal Gland c. Adrenal Gland d. Parathyroid Gland e. Pituitary Gland Introduction to the Reproductive System 283. Reproductive organs are mostly situated (located) in which region of the body? a. Cranial cavity b. Thoracic cavity c. Pelvic cavity d. Oral cavity e. Abdominal cavity 284. The structure labeled by the number 5 in the image is the site of egg production. (T/F) 285. On a testicular examination, which of the following structures can most likely be palpated? a. Prostate gland only b. Epididymis only c. Prostate gland and rectum d. Testis, epididymis and vas deferens e. Testis, vas deferens and seminal gland (seminal vesicle) 286. Which of the following structures is NOT considered a reproductive organ of the female? a. Ovary b. Uterine tube c. Rectum d. Vagina e. Uterus 287. The penis in a male is considered to be homologous to what structure of the female? a. Ovary b. Uterus c. Uterine tube d. Clitoris e. Cervis f. Vagina 288. A 23-year-old woman underwent her first ever physical examination by a medical doctor. She reported a social history of being raised in a family that was part of a religious group who held beliefs against most forms of traditional medical care. The patient informs the gynecologist that she left the religious group and her family a year ago to pursue a new life, and one day get married and have children. She denies smoking, drinking alcohol, or using recreational or prescription drugs. She reports that she has never been sexually active and she has never had a menstrual cycle. Surgical history is negative. Full physical, laboratory and diagnostic examinations were performed. Findings revealed: Normal female external genitalia, normal breast and pubic hair development. Chromosomal analysis confirms the patient is a biological female. Urine hCG is negative and rules out pregnancy. All hormone levels, including estrogen and progesterone are normal. MRI as shown. What organ/structure is the cause for concern in this patient’s case? a. Uterine tube b. Uterus c. Urinary Bladder d. Ovaries e. Epididymis f. Clitoris 289. A 33-year-old man is unable to impregnate his wife and have children. After undergoing several lab tests his physician has determined that his ejaculate fluid (semen) flows normally during ejaculation, and the fluid has the normal chemical composition. Testing also reveals that sperm are being produced, matured and stored normally. But sperm are missing from the ejaculate fluid. Which of the following structures is the most likely to be the problem in this case? a. Seminal vesicle b. Prostate gland c. Urethra d. Vas deferens e. Ureter f. Testicle 290. A 3D CT scan shows severe pelvis fractures due to a car accident. Which structure is the most likely at risk of injury because it is located directly posterior to the area marked by the dashed yellow circle. a. Penis b. Rectum c. Urinary bladder d. Seminal vesicle e. Epididymis 291. A medical resident has to insert a catheter, which is a tube, to drain urine from the urinary bladder in a 58-year-old woman prior to surgery. Which of the following correctly lists the sequence of order of structures that the catheter passes within reach the urinary bladder in this woman? a. Clitoris, urethra, urinary bladder b. Clitoris, vagina, urethra, urinary bladder c. Vagina, urethra, cervix, uterus, urinary bladder d. Vagina, urethra, prostate gland, urinary bladder e. Urethra, urinary bladder 292. A 38-year-old woman visits her gynecologist for her annual examination. During a bimanual pelvic examination, which of the following structures is the most likely that can be palpated through the vaginal canal by the physician? a. Anterior aspect of urinary bladder b. Iliac crest c. Seminal vesicle d. Cervix e. Top of uterus 293. The positional relationship of an ovary within the female pelvic cavity can be correctly stated as which of the following? a. Lateral to the uterus b. Inferior to the urethra c. Posterior to the sacrum d. Anterior to the pubic symphysis e. Medial to the urinary bladder 294. On review of the medical image, which of the following statements is most likely correct? a. Uterus is seen b. Image shows pelvis c. Urinary d. Cervix is in the e. Vagina is viewable in the image Introduction to the Central Nervous System in a coronal plane of view an anatomically normal/biological male bladder is absent wrong location 295. What part of the neuron receives the afferent signals from the other cells? a. Nucleus b. Dendrite c. Cell body d. Axon 296. White matter is a collection of one of the below: a. Unmyelinated dendrites b. Neuronal cell bodies c. Glial cells d. Myelinated axons 297. What does the peripheral nervous system include? a. Brain and spinal cord b. Brain and CNs c. CNs and SNs d. Spinal cord and SN 298. The brainstem includes the following parts of the brain: a. Cerebrum, midbrain, pons b. Midbrain, cerebellum, pons c. Thalamus, hypothalamus, midbrain d. Midbrain, pons, medulla 299. The cortex of the postcentral gyrus is responsible for the processing of one of the following signals: a. Somatic sensation b. Taste c. Visceral sensation d. Sound 300. If the cerebral aqueduct gets obstructed, the CSF would accumulate in one of the following locations: a. Subarachnoid space b. Lateral ventricles c. 4th ventricle d. Central canal 301. The frontal lobe of the cerebrum is supplied by one of the following vessels: a. External carotid b. Vertebral c. Basilar d. Internal carotid 302. The eye develops from one the the following parts of the brain: a. Midbrain b. Medulla oblongata c. Cerebrum d. Diencephalon 303. Identify the structure labeled 1-5 in the image below. 304. 305. Identify the structures labeled 1-4 in the image below. Identify the structure labeled 1-5 in the image below. 306. Which structures belong to the central nervous system? a. Brain b. Brainstem c. Spinal cord d. Ventricles e. All of the above Which parts of neurons contribute to the gray matter of the CN and PN systems? a. Dendrites b. Axons c. Cell bodies From the options below, choose the gray matter structure which belongs to the CNS: a. Basal ganglia b. Thalamic nuclei c. Cerebellar cortex d. Cerebral cortex e. All of the above 307. 308. 309. A 14-year-old patient with delayed motor development and progressive weakness of both legs undergoes radiologic examination. If the diagnosis “multiple sclerosis” was confirmed, which structures would change their appearance on the MRI? a. Cortex b. Thalamic nuclei c. Tracts d. Dorsal root ganglia e. Spinal nerves 310. In which of the following spaces does the CSF normally circulate? a. Epidural b. Subdural c. Subarachnoid d. Subperiosteal e. Subaponeurotic 311. Where is CSF produced in our body? a. In subarachnoid space b. In the ventricles of the brain c. In blood vessels d. In GIT e. In central canal 312. A newborn with an enlarged head is diagnosed with obstructive hydrocephalus. Which part of his ventricular system is most likely obstructed? a. Foramen monro b. Third ventricle c. Central canal d. Cerebral aqueduct e. Foramen lushka 313. If the cerebral aqueduct is obstructed, which part of the ventricular system would enlarge? a. Subarachnoid space b. Fourth ventricle c. Central canal d. Lateral ventricle e. Lumbar cistern

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