Patho Exam 2 Practice Questions

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Exam 2 Practice Questions 31. The action of platelet-derived growth factor is to stimulate the production of which cells? a. Platelets c. Connective tissue cells b. Epidermal cells d. Fibroblast cells 32. The role of cytokines in cell reproduction is that they: a. Provide growth factor for tissue growth and development. b. Block progress of cell reproduction through the cell cycle. c. Restrain cell growth and development. d. Provide nutrients for cell growth and development. 35. Which statement is true about phagocytosis? a. Phagocytosis is an example of exocytosis. b. Phagocytosis is dependent on small vesicles. c. Phagocytosis involves the ingestion of bacteria. d. Phagocytosis focuses on solute molecules 1. Which action is a purpose of the inflammatory process? a. To provide specific responses toward antigens b. To lyse cell membranes of microorganisms c. To prevent infection of the injured tissue d. To create immunity against subsequent tissue injury 2. How do surfactant proteins A through D provide innate resistance? a. Initiate the complement cascade. b. Promote phagocytosis. c. Secrete mucus d. Synthesize lysosomes. 3. Which secretion is a first line of defense against pathogen invasion that involves antibacterial and antifungal fatty acids, as well as lactic acid? a. Optic tears c. Sweat gland perspiration b. Oral saliva d. Sebaceous gland sebum 5. What causes the edema that occurs during the inflammatory process? a. Vasodilation of blood vessels c. Endothelial cell contraction b. Increased capillary permeability d. Emigration of neutrophils 6. What process causes heat and redness to occur during the inflammatory process? a. Vasodilation of blood vessels c. Decreased capillary permeability b. Platelet aggregation d. Endothelial cell contraction

7. Activation of the classical pathway begins with: a. Viruses c. Mast cells b. Antigen-antibody complexes d. Macrophages 8. What plasma protein system forms a fibrinous meshwork at an inflamed site? a. Complement c. Kinin b. Coagulation d. Fibrinolysis 9. Which component of the plasma protein system tags pathogenic microorganisms for destruction by neutrophils and macrophages? a. Complement cascade c. Kinin system b. Coagulation system d. Immune system 10. What is the vascular effect of histamine released from mast cells? a. Platelet adhesion c. Vasodilation b. Initiation of the clotting cascade d. Increased endothelial adhesiveness 11. What is an outcome of the complement cascade? a. Activation of the clotting cascade b. Prevention of the spread of infection to adjacent tissues c. Inactivation of chemical mediators such as histamine d. Lysis of bacterial cell membranes 12. The function of opsonization related to the complement cascade is to: a. Tag of pathogenic microorganisms for destruction by neutrophils and macrophages. b. Process pathogenic microorganisms so that activated lymphocytes can be created for acquired immunity. c. Destroy glycoprotein cell membranes of pathogenic microorganisms. d. Promote anaphylatoxic activity, resulting in mast cell degranulation. 13. In the coagulation (clotting) cascade, the intrinsic and the extrinsic pathways converge at which factor? a. XII c. X b. VII d. V 14. Which chemical interacts among all plasma protein systems by degrading blood clots, activating complement, and activating the Hageman factor? a. Kallikrein c. Bradykinin b. Histamine d. Plasmin

15. The chemotactic factor affects the inflammatory process by: a. Causing vasodilation around the inflamed area b. Stimulating smooth muscle contraction in the inflamed area c. Directing leukocytes to the inflamed area d. Producing edema around the inflamed area 16. What affect does the process of histamine binding to the histamine-2 (H2) receptor have on inflammation? a. Inhibition c. Acceleration b. Activation d. Termination 17. Frequently when H1 and H2 receptors are located on the same cells, they act in what fashion? a. Synergistically c. Antagonistically b. Additively d. Agonistically 18. Some older adults have impaired inflammation and wound healing because of which problem? a. Circulatory system cannot adequately perfuse tissues. b. Complement and chemotaxis are deficient. c. Underlying chronic illness(es) exists. d. Number of mast cells is insufficient. 19. Which chemical mediator derived from mast cells retracts endothelial cells to increase vascular permeability and to cause leukocyte adhesion to endothelial cells? a. Leukotrienes c. Platelet-activating factor b. Prostaglandin E d. Bradykinin 20. What is the inflammatory effect of nitric oxide (NO)? a. Increases capillary permeability, and causes pain. b. Increases neutrophil chemotaxis and platelet aggregation. c. Causes smooth muscle contraction and fever. d. Decreases mast cell function, and decreases platelet aggregation. 21. What is the correct sequence in phagocytosis? a. Engulfment, recognition, fusion, destruction b. Fusion, engulfment, recognition, destruction c. Recognition, engulfment, fusion, destruction d. Engulfment, fusion, recognition, destruction

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22. When considering white blood cell differentials, acute inflammatory reactions are related to elevations of which leukocyte? a. Monocytes c. Neutrophils b. Eosinophils d. Basophils 23. In the later stages of an inflammatory response, which phagocytic cell is predominant? a. Neutrophils c. Chemokines b. Monocytes d. Eosinophils 24. In regulating vascular mediators released from mast cells, the role of eosinophils is to release: a. Arylsulfatase B, which stimulates the formation of B lymphocytes b. Histaminase, which limits the effects of histamine during acute inflammation c. Lysosomal enzymes, which activate mast cell degranulation during acute inflammation d. Immunoglobulin E, which defends the body against parasites 25. What is the role of a natural killer (NK) cells? a. Initiation of the complement cascade b. Elimination of malignant cells c. Binding tightly to antigens d. Proliferation after immunization with antigen 26. Which cytokine is produced and released from virally infected host cells? a. IL-1 c. TNF-D b. IL-10 d. IFN-D 27. IFN-D is secreted from which cells? a. Virally infected cells c. Macrophages b. Bacterial infected cells d. Mast cells 28. Which manifestation of inflammation is systemic? a. Formation of exudates c. Redness and heat b. Fever and leukocytosis d. Pain and edema 29. The acute inflammatory response is characterized by fever that is produced by the hypothalamus being affected by: a. Endogenous pyrogens c. Antigen-antibody complexes b. Bacterial endotoxin d. Exogenous pyrogens

34. Many neonates have a transient depressed inflammatory response as a result of which condition? a. The circulatory system is too immature to perfuse tissues adequately. b. Complement and chemotaxis are deficient. c. Mast cells are lacking. d. The respiratory system is too immature to deliver oxygen to tissues. 35. During phagocytosis, what is occurring during the step referred to as opsonization? a. Phagocytes recognize and adhere to the bacteria. b. Microorganisms are ingested. c. Microorganisms are killed and digested. d. An intracellular phagocytic vacuole is formed. 36. Fusion is the step in phagocytosis during which: a. Microorganisms are killed and digested. b. An intracellular phagocytic vacuole is formed. c. Lysosomal granules enter the phagocyte. d. Microorganisms are ingested. 37. During the process of endocytosis, the phagosome step results in: a. Microorganisms are ingested. b. Microorganisms are killed and digested. c. Phagocytes recognize and adhere to bacteria. D. An intracellular phagocytic vacuole is formed. 40. Which cell is the body’s primary defense against parasite invasion? a. Eosinophil c. T lymphocytes b. Neutrophils d. B lymphocytes 41. Which chemical mediators induce pain during an inflammatory response? (Select all that apply.) a. Prostaglandins b. Leukotrienes c. Tryptase d. Phospholipase e. Bradykinin 43. Which body fluid has the ability to attack the cell walls of gram-positive bacteria? (Select all that apply.) a. Perspiration b. Semen c. Tears d. Saliva e. Urine

44. The main function of NK cells includes: (Select all that apply.) a. Recognizing virus-infected cells b. Eliminating virus-infected cells c. Recognizing bacteria-infected cells d. Eliminating bacteria-infected cells e. Eliminating previously identified cancer cells 45. Normal bacterial flora found in the intestines produce vitamin K to assist in the absorption of which of the following? (Select all that apply.) a. Calcium b. Fatty acids c. Large polysaccharides d. Iron e. Magnesium 46. An individual’s acquired immunity is dependent on the function of which cells? (Select all that apply.) a. T lymphocytes b. B lymphocytes c. Macrophages d. Opsonins e. Neutrophils 48. An older adult is particularly susceptible to infections of which body parts? (Select all that apply.) a. Lungs b. Skin c. Liver d. Eyes e. Bladder 1. Which primary characteristic is unique for the immune response? a. The immune response is similar each time it is activated. b. The immune response is specific to the antigen that initiates it. c. The response to a specific pathogen is short term. d. The response is innate, rather than acquired. 2. In which structure does B lymphocytes mature and undergo changes that commit them to becoming B cells? a. Thymus gland c. Bone marrow b. Regional lymph nodes d. Spleen

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3. What is the term for the process during which lymphoid stem cells migrate and change into either immunocompetent T cells or immunocompetent B cells? a. Clonal diversity c. Clonal selection b. Clonal differentiation d. Clonal competence 4. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? a. Passive-acquired immunity c. Passive-innate immunity b. Active-acquired immunity d. Active-innate immunity 5. What type of immunity is produced when an immunoglobulin crosses the placenta? a. Passive-acquired immunity c. Passive-innate immunity b. Active-acquired immunity d. Active-innate immunity 6. The portion of the antigen that is configured for recognition and binding is referred to as what type of determinant? a. Immunotope c. Epitope b. Paratope d. Antigenitope 7. Which characteristic is the most important determinant of immunogenicity when considering the antigen? a. Size c. Complexity b. Foreignness d. Quantity 8. When antigens are administered to produce immunity, why are different routes of administration considered? a. Different routes allow the speed of onset of the antigen to be varied, with the intravenous route being the fastest. b. Some individuals appear to be unable to respond to an antigen by a specific route, thus requiring the availability of different routes for the same antigen. c. Antigen-presenting cells are highly specialized and thus require stimulation by different routes. d. Each route stimulates a different lymphocyte-containing tissue, resulting in different types of cellular and humoral immunity. 9. The functions of the major histocompatibility complex (MHC) and CD1 molecules are alike because both: a. Are antigen-presenting molecules. b. Bind antigens to antibodies. c. Secrete interleukins during the immune process. d. Are capable of activating cytotoxic T lymphocytes

10. Where are antibodies produced? a. Helper T lymphocytes c. Plasma cells b. Thymus gland d. Bone marrow 11. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? a. IgA c. IgG b. IgE d. IgM 12. Which antibody initially indicates a typical primary immune response? a. IgG c. IgA b. IgM d. IgE 13. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? a. IgG c. IgA b. IgM d. IgE 14. The B-cell receptor (BCR) complex functions uniquely by: a. Communicating information about the antigen to the helper T cell b. Secreting chemical signals to communicate between cells c. Recognizing the antigen on the surface of the B lymphocyte d. Communicating information about the antigen to the cell nucleus 15. The generation of clonal diversity occurs primarily during which phase of life? a. Fetal c. Infancy b. Neonatal d. Puberty 16. The generation of clonal diversity includes a process that: a. Involves antigens that select those lymphocytes with compatible receptors. b. Allows the differentiation of cells into antibody-secreting plasma cells or mature T cells. c. Takes place in the primary (central) lymphoid organs. d. Causes antigens to expand and diversify their populations. 17. Which statement is true concerning clonal selection? a. Clonal selection is driven by hormones and does not require foreign antigens. b. This theory involves antigens that select those lymphocytes with compatible receptors. c. Clonal selection takes place in the primary (central) lymphoid organs. d. This process generates immature but immunocompetent T and B cells with receptors. 18. Which is an example of an endogenous antigen? a. Yeast c. Bacteria b. Cancer cells d. Fungus

19. Which cytokine is needed for the maturation of a functional helper T cell? a. IL-1 c. IL-4 b. IL-2 d. IL-12 20. Th2 cells produce IL-4 and suppress which cells? a. B lymphocytes c. Th1 cells b. Cytotoxic T lymphocytes d. Memory T lymphocytes 23. When a person is exposed to most antigens, antibodies can be usually detected in his or her circulation within: a. 12 hours c. 3 days b. 24 hours d. 6 days 24. Vaccinations are able to provide protection against certain microorganisms because of the: a. Strong response from IgM c. Memory cells for IgE b. Level of protection provided by IgG d. Rapid response from IgA 25. Why is the herpes virus inaccessible to antibodies after the initial infection? a. The virus does not circulate in the blood. b. It does not have antibody receptors. c. It resists agglutination. d. The virus is a soluble antigen 26. Increased age may cause which change in lymphocyte function? a. Increased production of antibodies against self-antigens b. Decreased number of circulating T cells c. Decreased production of autoantibodies d. Increased production of helper T cells 27. How do antibodies protect the host from bacterial toxins? a. Lysing the cell membrane of the toxins b. Binding to the toxins to neutralize their biologic effects c. Inhibiting the synthesis of DNA proteins needed for growth d. Interfering with the DNA enzyme needed for replication 28. Which T cell controls or limits the immune response to protect the host’s own tissues against an autoimmune response? a. Cytotoxic T cells c. Th2 cells b. Th1 cells d. Regulatory T (Treg) cells 29. Evaluation of umbilical cord blood can confirm that which immunoglobulin level is near adult levels? a. IgA c. IgM b. IgG d. IgE

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30. Which statement is true concerning the IgM? a. IgM is the first antibody produced during the initial response to an antigen. b. IgM mediates many common allergic responses. c. IgM is the most abundant class of immunoglobulins. d. IgM is capable of crossing the human placenta 31. Which cell has the ability to recognize antigens presented by the MHC class I molecules? a. T cytotoxic c. CD 8 b. CD 4 d. T helper 32. Which cell has a role in developing cell-mediated immunity? a. Th1 c. CD8 b. CD4 d. Th2 33. How does the aging process of the T-cell activity affect older adults? a. Poor heat regulation abilities b. Increased risk for bone fractures c. Tendency to develop various infections d. Likelihood of experiencing benign skin lesions 34. Which statement is true regarding maternal antibodies provided to the neonate? a. The antibodies enter into the fetal circulation by means of active transport. b. The antibodies are transferred to the fetus via the lymphatic system. c. The antibodies are directly related to the mother’s nutritional intake. d. The antibodies reach protective levels after approximately 6 months of age. 35. Antibodies that are associated with mucosal immune system, such as immunoglobulins, function to prevent which type of infections? a. Infections that attack the respiratory system b. Infections that tend to be chronic in nature c. Infections likely to be resistant to antibiotics d. Infections that focus on epithelial surfaces of the body 36. Cytokines are vital to a cell’s ability to do which function? a. Excrete c. Metabolize b. Reproduce d. Communicate 37. Which is an example of a bacterial toxin that has been inactivated but still retains its immunogenicity to protect the person? (Select all that apply.) a. Poliomyelitis b. Measles c. Tetanus d. Gonorrhea e. Diphtheria

38. Which statements are true concerning the humoral immune response? (Select all that apply.) a. The humoral immune response is divided into major and minor phases. b. The response has IgG and IgM produced during each of its phrases. c. It has a greater presence of IgG than IgM in one of its phases. d. The humoral immune response is produced in reaction to the presence of an antigen. e. Phases differ in their response time as a result of the effect of memory cells. 39. CD4 is a characteristic surface marker and a result of which of the following? (Select all that apply.) a. Activity in the primary lymphoid organs b. Process of cellular differentiation c. Alterations to T cells d. Changes to B cells e. Clonal selection 40. What are the necessary components of an adaptive immune response? (Select all that apply.) a. Antigen b. Gamma IgG c. Lymphocyte surface receptors d. Crystalline fragment e. Antibody 1. Hypersensitivity is best defined as a(an): a. Disturbance in the immunologic tolerance of self-antigens b. Immunologic reaction of one person to the tissue of another person c. Altered immunologic response to an antigen that results in disease d. Undetectable immune response in the presence of antigens 2. A hypersensitivity reaction that produces an allergic response is called: a. Hemolytic shock c. Necrotizing vasculitis b. Anaphylaxis d. Systemic erythematosus 3. The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins? a. IgE c. IgM b. IgG d. T cells 4. Which type of antibody is involved in type I hypersensitivity reaction? a. IgA c. IgG b. IgE d. IgM 5. Blood transfusion reactions are an example of: a. Autoimmunity c. Homoimmunity b. Alloimmunity d. Hypersensitivity

6. During an IgE-mediated hypersensitivity reaction, which leukocyte is activated? a. Neutrophils c. Eosinophils b. Monocytes d. T lymphocytes 7. During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? a. Bronchial edema caused by the chemotactic factor of anaphylaxis b. Bronchial edema caused by binding of the cytotropic antibody c. Smooth muscle contraction caused by histamine bound to H1 receptors d. Smooth muscle contraction caused by histamine bound to H2 receptors 8. During an IgE-mediated hypersensitivity reaction, the degranulation of mast cells is a result of which receptor action? a. Histamine bound to H2 b. Chemotactic factor binding to the receptor c. Epinephrine bound to mast cells d. Acetylcholine bound to mast cells 9. What characteristic do atopic individuals have that make them genetically predisposed to develop allergies? a. Greater quantities of histamine c. Greater quantities of IgE b. More histamine receptors d. A deficiency in epinephrine 10. What is the mechanism that results in type II hypersensitivity reactions? a. Antibodies coat mast cells by binding to receptors that signal its degranulation, followed by a discharge of preformed mediators. b. Antibodies bind to soluble antigens that were released into body fluids, and the immune complexes are then deposited in the tissues. c. Cytotoxic T lymphocytes or lymphokine-producing helper T 1 cells directly attack and destroy cellular targets. d. Antibodies bind to the antigens on the cell surface. 11. When mismatched blood is administered causing an ABO incompatibility, the erythrocytes are destroyed by: a. Complement-mediated cell lysis c. Phagocytosis in the spleen b. Phagocytosis by macrophages d. Natural killer cells 12. When antibodies are formed against red blood cell antigens of the Rh system, the blood cells are destroyed by: a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Phagocytosis in the spleen d. Neutrophil granules and toxic oxygen products

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13. When soluble antigens from infectious agents enter circulation, tissue damage is a result of: a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Phagocytosis in the spleen d. Neutrophil granules and toxic oxygen products 14. How are target cells destroyed in a type II hypersensitivity reaction? a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Neutrophil granules and toxic oxygen products d. Natural killer cells 15. Graves disease (hyperthyroidism) is an example of which type II hypersensitivity reaction? a. Modulation b. Antibody-dependent cell-mediated cytotoxicity c. Neutrophil-mediated damage d. Complement-mediated lysis 16. Type III hypersensitivity reactions are a result of which of the following? a. Antibodies coating mast cells by binding to receptors that signal its degranulation, followed by the discharge of preformed mediators b. Antibodies binding to soluble antigens that were released into body fluids and the immune complexes being deposited in the tissues c. Tc cells or lymphokine-producing Th1 cells directly attacking and destroying cellular targets d. Antibodies binding to the antigen on the cell surface 17. A type IV hypersensitivity reaction causes which result? a. Antibodies coating mast cells by binding to receptors that signal its degranulation, followed by the discharge of preformed mediators b. Antibodies binding to soluble antigens that were released into body fluids and the immune complexes being deposited in the tissues c. Lymphokine-producing Th1 cells directly attacking and destroying cellular targets d. Antibodies binding to the antigen on the cell surface 18. In a type III hypersensitivity reaction, the harmful effects after the immune complexes that are deposited in tissues are a result of: a. Cytotoxic T cells c. Complement activation b. Natural killer cells d. Degranulation of mast cells 19. Raynaud phenomenon is classified as a type III hypersensitivity reaction and is due to: a. Immune complexes that are deposited in capillary beds, blocking circulation b. Mast cells that are bound to specific endothelial receptors, causing them to degranulate and creating a localized inflammatory reaction that occludes capillary circulation

c. Cytotoxic T cells that attack and destroy the capillaries so that they are unable to perfuse local tissues d. Antibodies that detect the capillaries as foreign protein and destroy them using lysosomal enzymes and toxic oxygen species 20. Deficiencies in which element can produce depression of both B- and T-cell function? a. Iron c. Iodine b. Zinc d. Magnesium 21. When the maternal immune system becomes sensitized against antigens expressed by the fetus, what reaction occurs? a. T-cell immunity c. Fetal immunity b. Alloimmunity d. Autoimmunity 22. Tissue damage caused by the deposition of circulating immune complexes containing an antibody against the host DNA is the cause of which disease? a. Hemolytic anemia c. Systemic lupus erythematosus b. Pernicious anemia d. Myasthenia gravis 23. Why does tissue damage occurs in acute rejection after organ transplantation? a. Th1 cells release cytokines that activate infiltrating macrophages, and cytotoxic T cells directly attack the endothelial cells of the transplanted tissue. b. Circulating immune complexes are deposited in the endothelial cells of transplanted tissue, where the complement cascade lyses tissue. c. Receptors on natural killer cells recognize antigens on the cell surface of transplanted tissue, which releases lysosomal enzymes that destroy tissue. d. Antibodies coat the surface of transplanted tissue to which mast cells bind and liberate preformed chemical mediators that destroy tissue. 24. Which blood cell carries the carbohydrate antigens for blood type? a. Platelets c. Lymphocytes b. Neutrophils d. Erythrocytes 25. A person with type O blood is likely to have high titers of which anti-antibodies? a. A c. A and B b. B d. O 26. Which class of immunoglobulins forms isohemagglutinins? a. IgA c. IgG b. IgE d. IgM

27. Which component of the immune system is deficient in individuals with infections caused by viruses, fungi, or yeast? a. Natural killer cells c. B cells b. Macrophages d. T cells 29. How many months does it take for the newborn to be sufficiently protected by antibodies produced by its own B cells? a. 1 to 2 c. 6 to 8 b. 4 to 5 d. 10 to 12 30. Considering the effects of nutritional deficiencies on the immune system, severe deficits in calories and protein lead to deficiencies in the formation of which immune cells? a. B cells c. Natural killer cells b. T cells d. Neutrophils 31. Urticaria are a manifestation of a which type of hypersensitivity reaction? a. IV c. II b. III d. I 32. Graves disease is a result of: a. Increased levels of circulating immunoglobulins b. The infiltration of the thyroid with T lymphocytes c. Autoantibodies binding to thyroid-stimulating hormone (TSH)-receptor sites d. Exposure to acetylates in substances such as rubber 33. Raynaud phenomenon is an example of which type of hypersensitivity? a. IV c. II b. III d. I 36. A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following? a. No antigens c. Both A and B antigens b. No antibodies d. Both A and B antibodies 37. Immunoglobulin E (IgE) is associated with which type of hypersensitivity reaction? a. I c. III b. II d. IV 38. Graves disease is an autoimmune disease that results in which maternal antibody? a. Binding with receptors for neural transmitters on muscle cells, causing neonatal muscular weakness b. Affecting the receptor for TSH, causing neonatal hyperthyroidism c. Inducing anomalies in the fetus or causing pregnancy loss d. Destroying platelets in the fetus and neonate

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39. When a tuberculin skin test is positive, the hard center and erythema surrounding the induration are a result of which of the following? (Select all that apply.) a. Histamine b. T lymphocytes c. Immune complexes d. Products of complement e. Macrophages 40. Exposure to which of the following could result in a type IV hypersensitivity reaction? (Select all that apply.) a. Poison ivy b. Neomycin c. Dairy products d. Nickel e. Detergents 41. Which disorders are considered autoimmune? (Select all that apply.) a. Crohn disease b. Addison disease c. Rheumatoid arthritis d. Systemic lupus erythematosus e. Noninsulin-dependent diabetes 42. Which statements best define acute rejection? (Select all that apply.) a. Acute rejection is a cell-mediated immune response. b. Acute rejection is usually a type III rejection. c. Immunosuppressive drugs delay or lessen the intensity of an acute rejection. d. Acute rejection is associated with the body’s response to an organ transplant. e. Acute rejection is a response against unmatched human leukocyte antigens 1. What is a significant cause of morbidity and mortality worldwide? a. Starvation c. Cardiovascular disease b. Traumatic injury d. Infectious disease 2. What is the first stage in the infectious process? a. Invasion c. Spread b. Colonization d. Multiplication 3. Which type of microorganism reproduces on the skin? a. Viruses c. Protozoa and Rickettsiae b. Bacteria and fungi d. Mycoplasma

4. Phagocytosis involves neutrophils actively attacking, engulfing, and destroying which microorganisms? a. Bacteria c. Viruses b. Fungi d. Yeasts 5. Once they have penetrated the first line of defense, which microorganisms do natural killer (NK) cells actively attack? a. Bacteria c. Viruses b. Fungi d. Mycoplasma 6. Which statement concerning exotoxins is true? a. Exotoxins are contained in cell walls of gram-negative bacteria. b. Exotoxins are released during the lysis of bacteria. c. Exotoxins are able to initiate the complement and coagulation cascades. d. Exotoxins are released during bacterial growth. 7. Which statement is true concerning a fungal infection? a. Fungal infections occur only on skin, hair, and nails. b. Phagocytes and T lymphocytes control fungal infections. c. Fungal infections release endotoxins. d. Vaccines prevent fungal infections. 8. Cytokines are thought to cause fevers by stimulating the synthesis of which chemical mediator? a. Leukotriene c. Prostaglandin b. Histamine d. Bradykinin 9. Considering the hypothalamus, a fever is produced by: a. Endogenous pyrogens acting directly on the hypothalamus. b. Exogenous pyrogens acting directly on the hypothalamus. c. Immune complexes acting indirectly on the hypothalamus. d. Cytokines acting indirectly on the hypothalamus. 10. Which statement about vaccines is true? a. Most bacterial vaccines contain attenuated organisms. b. Most viral vaccines are made by using dead organisms. c. Vaccines require booster injections to maintain life-long protection. d. Vaccines provide effective protection against most infections. 11. Vaccines against viruses are created from: a. Killed organisms or extracts of antigens b. Live organisms weakened to produce antigens c. Purified toxins that have been chemically detoxified d. Recombinant pathogenic protein

12. Which statement is a characteristic of HIV? a. HIV only infects T-helper (Th) cells. b. HIV is a retrovirus. c. HIV carries genetic information in its DNA. d. HIV has five identified strains. 13. What is the role of reverse transcriptase in HIV infection? a. Reverse transcriptase converts single-stranded DNA into double-stranded DNA. b. It is needed to produce integrase. c. It transports the RNA into the cell nucleus. d. It converts RNA into double-stranded DNA 14. After sexual transmission of HIV, a person can be infected yet seronegative for how many months? a. 1 to 2 c. 18 to 20 b. 6 to 14 d. 24 to 36 15. Which cells are primary targets for HIV? a. CD4+ Th cells only b. CD4+ Th cells, macrophages, and natural killer cells c. CD8-positive cytotoxic T (Tc) cells and plasma cells d. CD8-positive Tc cells only 16. What area in the body may act as a reservoir in which HIV can be relatively protected from antiviral drugs? a. Central nervous system c. Thymus gland b. Bone marrow d. Lungs 17. AIDS produces a striking decrease in the number of which cells? a. Macrophages c. CD4+ Th cells b. CD8+ T cells d. Memory T cells 18. HIV antibodies appear within how many weeks after infection through blood products? a. 1 to 2 c. 10 to 12 b. 4 to 7 d. 20 to 24 19. What is the final stage of the infectious process? a. Colonization c. Multiplication b. Invasion d. Spread

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20. Toxigenicity is defined as the: a. Ability of the pathogen to invade and multiply in the host b. Pathogen’s ability to produce disease by the production of a soluble toxin c. Ability of an agent to produce disease d. Potency of a pathogen measured in terms of the number of microorganisms required to kill the host 21. The ability of the pathogen to invade and multiply in the host is referred to as: a. Infectivity c. Pathogenicity b. Toxigenicity d. Virulence 22. Some bacterial surface proteins bind with the crystalline fragment (Fc) portion of an antibody to: a. Hide in cells to avoid triggering an immune response b. Form self-protecting toxins c. Make staining possible for microscopic observation d. Produce a protective “self” protein 25. Which secretion transmits HIV? (Select all that apply.) a. Semen b. Urine c. Saliva d. Breast milk e. Sweat 27. Which statement is true regarding the development of HIV symptoms? (Select all that apply.) a. Symptoms generally appear in the clinical latency stage. b. Symptoms are generally observable within 5 years of the initial infection. c. T cells levels, particularly those of memory T cells, progressively decrease. d. Untreated infected individuals may remain asymptomatic for up to10 years. e. Secondary lymphoid organs experience damage and resulting malfunction. 28. Which statements are true regarding endotoxins? (Select all that apply.) a. Endotoxins are lipopolysaccharides. b. Endotoxins are located in the walls of bacteria. c. Endotoxins are created during the process of lysis. d. Endotoxins are found in gram-negative microorganisms. e. Endotoxins are released during the destruction of its host. 29. Which statements are true regarding viruses? (Select all that apply.) a. Viruses are very complex microorganisms. b. Viruses are referred to as eukaryotes. c. Viruses are capable of producing messenger RNA (mRNA).

d. Viruses penetrate plasma membranes via endocytosis. e. Viruses are capable of uncoating cytoplasmic nucleocapsid. 30. Which of the following play a role in the control of fungal infections? (Select all that apply.) a. Cytokines b. Macrophages c. Natural killer cells d. Neutrophils e. T lymphocytes 31. Complications of AIDS include: (Select all that apply.) a. Kaposi sarcoma b. Helicobacter pylori c. Cytomegalovirus retinitis d. Herpes simplex infection e. Legionella pneumophila 1. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful? a. Flight or fight c. Adaptation b. Alarm d. Arousal 2. Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? a. Adrenal cortex c. Anterior pituitary b. Hypothalamus d. Limbic system 3. During an anticipatory response to stress, the reaction from the limbic system is stimulated by the: a. Retronucleus of the anterior pituitary b. Anterior nucleus of the hippocampus c. Paraventricular nucleus of the hypothalamus d. Prefrontal nucleus of the amygdala 4. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? a. Norepinephrine b. Epinephrine c. Cortisol d. Adrenocorticotropic hormone (ACTH) 5. Perceived stress elicits an emotional, anticipatory response that begins where? a. Prefrontal cortex c. Limbic system b. Anterior pituitary d. Hypothalamus

6. During a stress response, the helper T (Th) 1 response is suppress by which hormone? a. ACTH c. Prolactin b. Cortisol d. Growth hormone 7. What is the effect that low-serum albumin has on the central stress response? a. Impaired circulation of epinephrine and norepinephrine b. Impaired wound healing c. Lessened circulation of cortisol d. Diminished oncotic pressure 8. Stress-age syndrome directly results in depressed function of which system? a. Respiratory c. Digestive b. Endocrine d. Immune 9. Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of: a. Epinephrine and aldosterone c. Epinephrine and norepinephrine b. Norepinephrine and cortisol d. Acetylcholine and cortisol 10. Stress-induced norepinephrine results in: a. Pupil constriction c. Increased sweat gland secretions b. Peripheral vasoconstriction d. Decreased blood pressure 11. Released stress-induced cortisol results in the stimulation of gluconeogenesis by affecting which structure? a. Adrenal cortex c. Liver b. Pancreas d. Anterior pituitary 12. What is the effect of increased secretions of epinephrine, glucagon, and growth hormone? a. Hyperglycemia c. Bronchodilation b. Hypertension d. Pupil dilation 13. Which hormone increases the formation of glucose from amino acids and free fatty acids? a. Epinephrine c. Cortisol b. Norepinephrine d. Growth hormone 14. What effect do androgens have on lymphocytes? a. Suppression of B-cell responses and enhancement of T-cell responses b. Suppression of T-cell responses and enhancement of B-cell responses c. Suppression of B- and T-cell responses d. Enhancement of B- and T-cell responses

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15. Which gland regulates the immune response and mediates the apparent effects of circadian rhythms on immunity? a. Anterior pituitary c. Basal ganglia b. Adrenal d. Pineal 16. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? a. IL–1 and IL-6 c. IFN and IL-12 b. IL-2 and TNF-D d. TNF-ß and IL-4 17. The release of which cytokines is triggered by bacterial or viral infections, cancer, and tissue injury that, in turn, initiate a stress response? a. IL-1 and IL-2 b. IL-12, TNF-D, and colony-stimulating factor c. IFN, TNF-ß, and IL-6 d. IL-4 and IL-24 18. The action of which hormone helps explain increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory diseases in women as a result of stimulation of the CRH gene promoter and central norepinephrine system? a. Progesterone c. Estrogen b. Cortisol d. Prolactin 19. What effect does estrogen have on lymphocytes? a. Depression of B-cell functions and enhancement of T-cell functions b. Depression of T-cell functions and enhancement of B-cell functions c. Depression of B- and T-cell functions d. Enhancement of B- and T-cell functions 20. Which statement is true concerning the differences between stress-induced hormonal alterations of men and women? a. After injury, women produce more proinflammatory cytokines than men, a profile that is associated with poor outcomes. b. Androgens appear to induce a greater degree of immune cell apoptosis after injury, creating greater immunosuppression in injured men than in injured women. c. Psychologic stress associated with some types of competition decreases both testosterone and cortisol, especially in athletes older than 45 years of age. d. After stressful stimuli, estrogen is increased in women, but testosterone is decreased in men. 21. Diagnostic blood work on individuals who perceive themselves to be in a chronic stress state will likely demonstrate: a. Decreased Th lymphocytes c. Decreased Tc cells b. Increased erythrocytes d. Increased platelets

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23. The most influential factor in whether a person will experience a stress reaction is his or her: a. General state of physical health c. Intellectual abilities b. Spiritual belief system d. Ability to cope 24. A reduction is an individual’s number of natural killer (NK) cells appears to correlate with an increased risk for the development of: a. Depression b. Type 1 diabetes c. Obsessive compulsive disorder (OCD) d. Gastroesophageal reflux disorder (GERD) 26. The effect epinephrine has on the immune system during the stress response is to increase which cells? (Select all that apply.) a. NK cells b. Immunoglobulins c. Cytokines d. T cells e. Th cells 27. Which immune cells are suppressed by the corticotropin-releasing hormone (CRH)? (Select all that apply.) a. Monocyte-macrophage cells b. Cytokines c. Tc cells d. Th cells e. B cells 28. The increased production of proinflammatory cytokines is associated with which considerations? (Select all that apply.) a. Chronic respiratory dysfunction b. Elevated anxiety levels c. Immune disorders d. Age and gender e. Dementia 29. Which statements are true regarding lymphocytes? (Select all that apply.) a. Lymphocytes are involved in the production of the human growth hormone. b. Elevated catecholamine levels influence lymphocytes. c. Lymphocytes are synthesized in the anterior pituitary gland. d. Lymphocytes have receptors for the hormone prolactin. e. Lymphocytes produce endorphins in large amounts. 23. Which cancers are all associated with chronic inflammation? a. Brain, muscle, and endocrine

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b. Colon, thyroid gland, and urinary bladder c. Bone, blood cells, and liver d. Eye, tracheal, and kidney 24. Chronic inflammation causes cancer by: a. Increasing vasodilation and permeability that alter cellular response to DNA damage b. Liberating lysosomal enzymes when cells are damaged that initiates mutations c. Releasing compounds such as reactive oxygen species that promote mutations d. Increasing the abundance of leukotrienes that are associated with some cancers 33. What is the cause of anemia in a patient diagnosed with pancreatic cancer? a. Impaired pancreatic function c. Chronic bleeding b. Malnutrition d. Malabsorption of iron 7. Research data support a carcinogenic relationship in children resulting from exposure to which virus? a. Herpes simplex virus c. Varicella zoster virus b. Influenza d. Epstein-Barr virus 8. A child diagnosed with acquired immunodeficiency syndrome (AIDS) has an increased risk of developing: a. Non-Hodgkin lymphoma c. Epstein-Barr b. Retinoblastoma d. Leukemia 1. What is the most abundant class of plasma protein? a. Globulin c. Clotting factors b. Albumin d. Complement proteins 2. What is the effect of low plasma albumin? a. Clotting factors decrease, thus increasing the chance of prolonged bleeding. b. Fewer immunoglobulins are synthesized, thus impairing the immune function. c. Less iron is stored, thus increasing the incidence of iron deficiency anemia. d. Osmotic pressure decreases, thus water moves from the capillaries to the interstitium. 3. What is the life span of an erythrocyte (in days)? a. 20 to 30 c. 100 to 120 b. 60 to 90 d. 200 to 240 4. Which statement concerning erythrocytes is true? a. Erythrocytes contain a nucleus, mitochondria, and ribosomes. b. Erythrocytes synthesize proteins. c. Erythrocytes have the ability to change shape to squeeze through microcirculation. d. Erythrocyte colony-stimulating factor (E-CSF) stimulates erythrocytes.

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5. Granulocytes that contain granules of vasoactive amines, such as histamine, are called: a. Neutrophils c. Monocytes b. Eosinophils d. Basophils 6. Which of the following are formed elements of the blood that are not cells but are disk- shaped cytoplasmic fragments essential for blood clotting? a. Monocytes c. Macrophages b. Platelets d. Erythrocytes 7. Blood cells that differentiate into macrophages are known as: a. Monocytes c. Eosinophils b. Neutrophils d. Basophils 8. Without prior exposure to an antigen, which cells are able to destroy some types of tumor cells and some virus-infected cells? a. Lymphocytes c. Megakaryocytes b. Plasma cells d. Natural killer (NK) cells 9. What is the life span of platelets (in days)? a. 10 c. 90 b. 30 d. 120 10. Fetal hematopoiesis occurs in which structure? a. Gut c. Bone marrow b. Spleen d. Thymus 11. What is the consequence of a splenectomy? a. The level of iron in circulation increases. b. Antibody production increases to improve immune function. c. The number of defective cells in circulation increases. d. The number of clotting factors increases. 12. During an infection, why do lymph nodes enlarge and become tender? a. B lymphocytes proliferate. b. The nodes are inflamed. c. The nodes fill with purulent exudate. d. The nodes are not properly functioning 12. During an infection, why do lymph nodes enlarge and become tender? a. B lymphocytes proliferate. b. The nodes are inflamed. c. The nodes fill with purulent exudate. d. The nodes are not properly functioning

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14. Which blood cells are biconcave in shape and have the capacity to be reversibly deformed? a. Neutrophils c. Eosinophils b. Monocytes d. Erythrocytes 15. Which hemoglobin is made from oxidized ferric iron (Fe3+) and lacks the ability to bind oxygen? a. Deoxyhemoglobin c. Methemoglobin b. Oxyhemoglobin d. Glycosylated hemoglobin 16. The absence of parietal cells would prevent the absorption of an essential nutrient necessary to prevent which type of anemia? a. Iron deficiency c. Folic acid deficiency anemia b. Pernicious anemia d. Aplastic anemia 17. Which nutrients are necessary for the synthesis of DNA and the maturation of erythrocytes? a. Protein and niacin c. Cobalamin (vitamin B12) and folate b. Iron and vitamin B6 (pyridoxine) d. Pantothenic acid and vitamin C 18. Which nutrients are necessary for hemoglobin synthesis? a. Protein and niacin c. Cobalamin (vitamin B12) and folate b. Iron and vitamin B6 (pyridoxine) d. Pantothenic acid and vitamin C 19. Recycling of iron from erythrocytes is made possible by which of the following? a. Transferrin c. Apoferritin b. Hemosiderin d. Erythropoietin 20. By which structure are mature erythrocytes removed from the bloodstream? a. Liver c. Thymus b. Lymph nodes d. Spleen 21. Which substance is used to correct the chronic anemia associated with chronic renal failure? a. Iron c. Cobalamin (vitamin B12) b. Erythropoietin d. Folate 22. What is the role of thromboxane A (TXA2) in the secretion stage of hemostasis? a. Stimulates the synthesis of serotonin. b. Promotes vasodilation. c. Stimulates platelet aggregation. d. Promotes formation of cyclooxygenase. 23. Which of the following is the role of nitric oxide (NO) in hemostasis? a. Stimulates the release of fibrinogen to maintain the platelet plug. b. Stimulates the release of clotting factors V and VII.

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c. Causes vasoconstriction and stimulates platelet aggregation. d. Controls platelet activation through cyclic adenosine monophosphate (cAMP)–mediated signaling. 24. The drug heparin acts in hemostasis by which processes? a. Inhibiting thrombin and antithrombin III (AT-III) b. Preventing the conversion of prothrombin to thrombin c. Shortening the fibrin strands to retract the blood clot d. Degrading the fibrin within blood clots 25. What is plasmin’s role in the clotting process? a. Stimulates platelet aggregation. b. Inhibits platelet adhesion and aggregation. c. Prevents the conversion of prothrombin to degrade the fibrin within blood clots. d. Degrades the fibrin within blood clots. 26. What does polycythemia at birth indicate? a. Hypoxia in utero c. Congenitally absent spleen b. Dysfunctional bone marrow d. Dehydration in utero 29. What is the role of collagen in the clotting process? a. Initiates the clotting cascade. c. Stimulates fibrin. b. Activates platelets. d. Deactivates fibrinogen 30. Which form of iron (Fe) can be used in the formation of normal hemoglobin? a. Fe+ c. Fe3+ b. Fe2+ d. Fe 32. What changes to the hematologic system is related to age? a. Platelet adhesiveness decreases. b. Lymphocyte function decreases. c. Cellular immunity increases. d. Erythrocyte reproduction accelerates. 33. What is the function of erythrocytes? a. Tissue oxygenation c. Infection control b. Hemostasis d. Allergy response 34. Which characteristics allow erythrocytes to function as gas carriers? (Select all that apply.) a. Permanent shape b. Compactness c. Reversible deformability d. Presence of hyperactive mitochondria e. Biconcavity

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35. Which statements about plasma proteins are correct? (Select all that apply.) a. Provide clotting factors. b. Transport triglycerides. c. Synthesize complement proteins. d. Create hydrostatic pressure. e. Transport cholesterol. 36. What are the primary anticoagulant mechanisms? (Select all that apply.) a. Antithrombin III b. Tissue factor pathway inhibitor c. Hematopoiesis d. Protein C e. Phagocytosis 37. Which statements are true regarding the role of the endothelium in clot formation? (Select all that apply.) a. The surface of the endothelium produces plasma protease inhibitors. b. Plasma protease inhibitors assist in preventing clot formation. c. Thrombomodulin is a protein that is converted on the surface of endothelial cells. d. Protein A binds to thrombomodulin e. Activated protein C enhances the adhesion ability of neutrophils 38. Which statements characterize albumin? (Select all that apply.) a. Retains sodium to maintain water balance. b. Provides colloid osmotic pressure. c. Is synthesized in the liver. d. Is a carrier for drugs that have low water solubility. e. Is a small molecule 1. What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias? a. Poikilocytosis c. Anisocytosis b. Isocytosis d. Microcytosis 2. What is the fundamental physiologic manifestation of anemia? a. Hypotension c. Hypoxia b. Hyperesthesia d. Ischemia 3. The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of the following? a. Reduction in acetylcholine receptors in the postsynaptic nerves b. Myelin degeneration in the spinal cord c. Destruction of myelin in peripheral nerves d. Altered function of neurons in the parietal lobe

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4. Which of the following describes how the body compensates for anemia? a. Increasing rate and depth of breathing b. Decreasing capillary vasoconstriction c. Hemoglobin holding more firmly onto oxygen d. Kidneys releasing more erythropoietin 5. Which of the following is classified as a megaloblastic anemia? a. Iron deficiency c. Sideroblastic b. Pernicious d. Hemolytic 6. Deficiencies in folate and vitamin B12 alter the synthesis of which of the following? a. RNA c. DNA b. Cell membrane d. Mitochondria 7. The underlying disorder of which anemia is a result of the defective secretion of the intrinsic factor, which is essential for the absorption of vitamin B12? a. Microcytic c. Hypochromic b. Pernicious d. Hemolytic 8. After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result? a. Iron deficiency c. Folic acid b. Aplastic d. Pernicious 9. What causes the atrophy of gastric mucosal cells that result in pernicious anemia? a. Erythrocyte destruction c. Vitamin B12 malabsorption b. Folic acid malabsorption d. Poor nutritional intake 10. Which statement best describes a Schilling test? a. Administration of radioactive cobalamin and the measurement of its excretion in the urine to test for vitamin B12 deficiency b. Measurement of antigen-antibody immune complexes in the blood to test for hemolytic anemia c. Measurement of serum ferritin and total iron-binding capacity in the blood to test for iron deficiency anemia d. Administration of folate and measurement in 2 hours of its level in a blood sample to test for folic acid deficiency anemia. 11. What is the treatment of choice for pernicious anemia (PA)? a. Cyanocobalamin by oral intake b. Vitamin B12 by injection c. Ferrous fumarate by Z-track injection d. Folate by oral intake

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12. Which condition resulting from untreated pernicious anemia (PA) is fatal? a. Brain hypoxia c. Heart failure b. Liver hypoxia d. Renal failure 13. How is the effectiveness of vitamin B12 therapy measured? a. Reticulocyte count c. Hemoglobin b. Serum transferring d. Serum vitamin B12 14. Which statement about folic acid is false? a. Folic acid absorption is dependent on the enzyme folacin. b. Folic acid is stored in the liver. c. Folic acid is essential for RNA and DNA synthesis within erythrocytes. d. Folic acid is absorbed in the upper small intestine. 15. Which anemia produces small, pale erythrocytes? a. Folic acid c. Iron deficiency b. Hemolytic d. Pernicious 16. Which type of anemia is characterized by fatigue, weakness, and dyspnea, as well as conjunctiva of the eyes and brittle, concave nails? a. Pernicious c. Aplastic b. Iron deficiency d. Hemolytic 17. What is the most common cause of iron deficiency anemia (IDA)? a. Decreased dietary intake c. Vitamin deficiency b. Chronic blood loss d. Autoimmune disease 18. Continued therapy of pernicious anemia (PA) generally lasts how long? a. 6 to 8 weeks c. Until the iron level is normal b. 8 to 12 months d. The rest of one’s life 19. Sideroblastic anemia can occasionally result from an autosomal recessive transmission inherited from which relative? a. Mother c. Grandfather b. Father d. Grandmother 20. Clinical manifestations of mild-to-moderate splenomegaly and hepatomegaly, bronze- colored skin, and cardiac dysrhythmias are indicative of which anemia? a. Iron deficiency c. Sideroblastic b. Pernicious d. Aplastic

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21. Considering sideroblastic anemia, what would be the expected effect on the plasma iron levels? a. Plasma iron levels would be high. b. Levels would be low. c. Levels would be normal. d. Levels would be only minimally affected. 22. In aplastic anemia (AA), pancytopenia develops as a result of which of the following? a. Suppression of erythropoietin to produce adequate amounts of erythrocytes b. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes c. Lack of DNA to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes d. Lack of stem cells to form sufficient quantities of leukocytes 23. What is the most common pathophysiologic process that triggers aplastic anemia (AA)? a. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells b. Malignancy of the bone marrow in which unregulated proliferation of erythrocytes crowd out other blood cells c. Autoimmune disease against hematopoiesis by activated immunoglobulins d. Inherited genetic disorder with recessive X-linked transmission 24. An allogenic bone marrow transplantation remains the preferred method for treating which anemia? a. Polycythemia vera c. Sideroblastic b. Aplastic d. Anemia of chronic disease (ACD) 25. Which statement is true regarding warm autoimmune hemolytic anemia? a. Warm autoimmune hemolytic anemia occurs primarily in men. b. It is self-limiting and rarely produces hemolysis. c. Erythrocytes are bound to macrophages and sequestered in the spleen. d. Immunoglobulin M coats erythrocytes and binds them to receptors on monocytes. 26. When considering hemolytic anemia, which statement is true regarding the occurrence of jaundice? a. Erythrocytes are destroyed in the spleen. b. Heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin. c. The patient has elevations in aspartate transaminase (AST) and alanine transaminase (ALT). d. The erythrocytes are coated with an immunoglobulin. 27. Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia? a. Aplastic c. Anemia of chronic disease b. Sideroblastic d. Iron deficiency

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28. What is the primary cause of the symptoms of polycythemia vera? a. Decreased erythrocyte count c. Increased blood viscosity b. Destruction of erythrocytes d. Neurologic involvement 29. Treatment for polycythemia vera involves which of the following? a. Therapeutic phlebotomy and radioactive phosphorus b. Restoration of blood volume by plasma expanders c. Administration of cyanocobalamin d. Blood transfusions 30. Considering iron replacement therapy prescribed for iron deficiency anemia, who is likely to require long-term daily maintenance dosage? a. A woman who has not yet experienced menopause b. A teenager who is involved in strenuous athletics c. A middle-aged man who smokes two packs of cigarettes a day d. An older person demonstrating signs of dementia 31. Which statement is true regarding the physical manifestations of vitamin B12 deficiency anemia? a. Vitamin B12 deficiency anemia seldom results in neurologic symptoms. b. The chances of a cure are good with appropriate treatment c. The condition is reversible in 75% of the cases. d. Symptoms are a result of demyelination. 32. A 2000 ml blood loss will produce which assessment finding? (Select all that apply.) a. Air hunger b. Normal blood pressure in the supine position c. Rapid thready pulse d. Cold clammy skin e. lactic acidosis 33. Which medications are associated with an intermediate increase in a person’s risk for developing aplastic anemia? (Select all that apply.) a. Penicillin b. Chloramphenicol (Chloromycetin) c. Phenytoin (Dilantin) d. Trimethoprim-sulfamethoxazole (Bactrim) e. Thiazides 34. Which conditions are generally included in the symptoms of pernicious anemia (PA)? (Select all that apply.) a. Weakness b. Weight gain c. Low hemoglobin

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d. Paresthesias e. Low hematocrit 35. What are the clinical manifestations of folate deficiency anemia? (Select all that apply.) a. Constipation b. Flatulence c. Dysphagia d. Stomatitis e. Cheilosis 36. Which diseases are commonly associated with anemia of chronic disease? (Select all that apply.) a. Rheumatoid arthritis b. Acquired immunodeficiency syndrome (AIDS) c. Polycythemia vera d. Systemic lupus erythematosus e. Chronic hepatitis 1. What change is observed in leukocytes during an allergic disorder (type I hypersensitivity) often caused by asthma, hay fever, and drug reactions? a. Neutrophilia c. Eosinophilia b. Basophilia d. Monocytosis 2. In infectious mononucleosis (IM), what does the Monospot test detect? a. Immunoglobulin E (IgE) c. Immunoglobulin G (IgG) b. Immunoglobulin M (IgM) d. Immunoglobulin A (IgA) 3. Which description is consistent with acute lymphocytic leukemia (ALL)? a. ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. b. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c. B cells fail to mature into plasma cells that synthesize immunoglobulins. d. The translocation of genetic material from genes 9 and 22 create an abnormal, fused gene identified as BCR-ABL. 4. Which description is consistent with chronic myelogenous leukemia (CML)? a. Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein. b. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c. B cells fail to mature into plasma cells that synthesize immunoglobulins.

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d. The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL1. 5. Which description is consistent with chronic lymphocytic leukemia (CLL)? a. Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein. b. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c. B cells fail to mature into plasma cells that synthesize immunoglobulins. d. The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL.’ 6. Which electrolyte imbalance accompanies multiple myeloma (MM)? a. Hyperkalemia c. Hyperphosphatemia b. Hypercalcemia d. Hypernatremia 8. Local signs and symptoms of Hodgkin disease–related lymphadenopathy are a result of which of the following? a. Pressure and ischemia c. Inflammation and ischemia b. Pressure and obstruction d. Inflammation and pressure 10. Which term is used to describe a red-purple discoloration caused by diffuse hemorrhage into the skin tissue? a. Petechiae c. Ecchymosis b. Hematoma d. Purpura 11. Which statement best describes heparin-induced thrombocytopenia (HIT)? a. Immunoglobulin G immune–mediated adverse drug reaction that reduces circulating platelets b. Hematologic reaction to heparin in which the bone marrow is unable to produce sufficient platelets to meet the body’s needs c. Immunoglobulin E–mediated allergic drug reaction that reduces circulating platelets d. Cell-mediated drug reaction in which macrophages process the heparin and platelet complexes that are then destroyed by activated cytotoxic T cells. 12. Immune thrombocytopenia (ITP) is a(n) _____ condition in adults and a(n) _____ condition in children. a. Acute; acute c. Acute; chronic b. Chronic; chronic d. Chronic; acute 13. Vitamin _____ is required for normal clotting factor synthesis by the _____. a. K; kidneys c. K; liver b. D; kidneys d. D; liver

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14. What is the most common cause of vitamin K deficiency? a. Administration of warfarin (Coumadin) b. Total parenteral nutrition with antibiotic therapy c. An immunoglobulin G–mediated autoimmune disorder d. Liver failure 15. Which disorder is described as an unregulated release of thrombin with subsequent fibrin formation and accelerated fibrinolysis? a. Disseminated intravascular coagulation (DIC) b. Immune thrombocytopenic purpura (ITP) c. Heparin-induced thrombocytopenia (HIT) d. Essential thrombocythemia (ET) 16. In disseminated intravascular coagulation (DIC), what activates the coagulation cascade? a. Cytokines, such as platelet-activating factor (PAF), and tumor necrosis factoralpha (TNF-D) b. Thromboxane A, causing platelets to aggregate and consume clotting factors c. Tissue factor (TF) located in the endothelial layer of blood vessels and subcutaneous tissue d. Endotoxins from gram-negative and gram-positive bacteria circulating in the bloodstream 17. Which proinflammatory cytokines are responsible for the development and maintenance of disseminated intravascular coagulation (DIC)? a. Granulocyte colony-stimulating factor (G-CSF); interleukin (IL)–2, IL-4, and IL-10; and tumor necrosis factor-gamma (IFN-J) b. Granulocyte-macrophage colony-stimulating factor (GM-CSF); and IL-3, IL-5, IL-9, and IFN-J c. Macrophage colony-stimulating factor (M-CSF); IL-7, IL-11, and IL-14; and PAF d. Tumor necrosis factor-alpha (TNF-D); IL-1, IL-6, and IL-8; and platelet-activating factor (PAF) 18. In disseminated intravascular coagulation (DIC), what are the indications of microvascular thrombosis? a. Reduced amplitude in peripheral pulses b. Symmetric cyanosis of fingers and toes c. Numbness and tingling in fingers and toes d. Bilateral pallor and edema of fingers and toes 19. What is the most reliable and specific test for diagnosing disseminated intravascular coagulation (DIC)? a. Prothrombin time (PT) b. Activated partial thromboplastin time (aPTT) c. Fibrin degradation products (FDP) d. D-dimer 20. What term is used to identify thrombi that occlude arterioles and capillaries and are made up of platelets with minimal fibrin and erythrocytes? a. Essential (primary) thrombocythemia (ET)

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b. Acute idiopathic thrombotic thrombocytopenic purpura c. Thrombotic thrombocytopenic purpura (TTP) d. Immune thrombocytopenic purpura (ITP) 21. Which of the following is characterized by what is referred to as pathognomonic pentad of symptoms? a. Acute idiopathic thrombotic thrombocytopenic purpura b. Essential (primary) thrombocythemia (ET) c. Immune thrombocytopenic purpura (ITP) d. Thrombotic thrombocytopenic purpura (TTP) 22. Which statement relates to immune thrombocytopenic purpura (ITP)? a. ITP is formed in conditions of low flow and is made up of mostly red cells with larger amounts of fibrin and few platelets. b. An alteration of multipotent stem cells, resulting in an excess production of platelets, causes ITP. c. Mononuclear phagocytes in the spleen remove antibody-coated platelets from circulation. d. Arterial clots are made up of mostly platelet aggregates held together by fibrin strands. 23. When the demand for mature neutrophils exceeds the supply, immature neutrophils are released indicating: a. A shift to the right c. Leukocytosis b. A shift to the left d. Leukemia 24. Hodgkin disease is characterized by the presence of which of the following? a. Philadelphia chromosome c. Microvascular thrombi b. Virchow triad d. Reed-Sternberg (RS) cells 25. Which classic clinical manifestations are symptoms of IM? (Select all that apply.) a. Lymph node enlargement b. Hepatitis c. Pharyngitis d. Edema in the area of the eyes e. Fever 26. Early detection of acute leukemia would include which of the following symptoms? (Select all that apply.) a. Dizziness b. Paresthesia c. Anorexia d. Bruising e. Bone pain

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27. What are the most significant risk factors for the development of thrombus formation as referred to by the Virchow triad? (Select all that apply.) a. Endothelial injury to blood vessels b. Turbulent arterial blood flow c. Rapid coagulation of the blood d. Stagnant venous blood flow e. History of obesity 28. Which statements are true regarding leukemias? (Select all that apply.) a. A single progenitor cell undergoes a malignant change. b. Leukemia is a result of uncontrolled cellular proliferation. c. Bone marrow becomes overcrowded. d. Leukocytes are under produced. e. Hematopoietic cell production is decreased 29. The two major forms of leukemia, acute and chronic, are classified by which criteria? (Select all that apply.) a. Predominant cell type b. Rate of progression c. Age of individual when cells differentiation occurs d. Stage of cell development when malignancy first occurs e. Serum level of leukocytes 1. What is the cause of polycythemia in the fetus? a. Fetal hemoglobin has a greater affinity for oxygen as a result of diphosphoglycerate (DPG). b. The fetus has a different hemoglobin structure of two D- and two J-chains rather than two D- and two E-chains. c. Increased erythropoiesis occurs in response to the hypoxic intrauterine environment. d. The lungs of the fetus are undeveloped and unable to diffuse oxygen adequately to the pulmonary capillaries 2. Why does fetal hemoglobin have a greater affinity for oxygen than adult hemoglobin? a. The fetus does not have its own oxygen supply and must rely on oxygen from the maternal vascular system. b. The fetus has two J-chains on the hemoglobin, rather than two E-chains as in the adult. c. Fetal hemoglobin interacts less readily with diphosphoglycerate (DPG), which inhibits hemoglobin-oxygen binding. d. Fetal hemoglobin production occurs in the vessels and liver rather than in the bone marrow as in the adult. 3. Which blood cell type is elevated at birth but decreases to adult levels during the first year of life?

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a. Monocytes c. Neutrophils b. Platelets d. Lymphocytes 4. In a full-term infant, the normal erythrocyte life span is _____ days, whereas the adult erythrocyte life span is _____ days. a. 30 to 50; 80 c. 90 to 110; 140 b. 60 to 80; 120 d. 120 to 130; 150 5. What is the most common cause of insufficient erythropoiesis in children? a. Folic acid deficiency c. Hemoglobin abnormality b. Iron deficiency d. Erythrocyte abnormality 6. How does hemolytic disease of the newborn (HDN) cause acquired congenital hemolytic anemia? a. HDN develops when hypoxia or dehydration causes the erythrocytes to change shapes, which are then recognized as foreign and removed from circulation. b. HDN is an alloimmune disease in which the mother’s immune system produces antibodies against fetal erythrocytes, which are recognized as foreign and removed from circulation. c. HDN develops when the polycythemia present in fetal life continues after birth, causing the excessive number of erythrocytes to be removed from circulation. d. HDN is an autoimmune disease in which the fetus’s immune system produces antibodies against fetal erythrocytes, which are recognized as foreign and removed from circulation. 15. Glucose 6-phosphate dehydrogenase (G6PD) deficiency is what type of inherited disorder? a. X-linked dominant c. Autosomal dominant b. X-linked recessive d. Autosomal recessive 16. Sickle cell disease is classified as a(an): a. Inherited X-linked recessive disorder b. Inherited autosomal recessive disorder c. Disorder initiated by hypoxemia and acidosis d. Disorder that is diagnosed equally in men and women 17. Hemoglobin S (HbS) is formed in sickle cell disease as a result of which process? a. Deficiency in glucose 6-phosphate dehydrogenase (G6PD) that changes hemoglobin A (HbA) to HbS. b. Genetic mutation in which two amino acids (histidine and leucine) are missing. c. Genetic mutation in which one amino acid (valine) is replaced by another (glutamic acid). d. Autoimmune response in which one amino acid (proline) is detected as an antigen by abnormal immunoglobulin G (IgG). 18. Sickle cell disease (SCD) is what type of inherited disorder? a. Autosomal dominant c. X-linked dominant

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b. Autosomal recessive d. X-linked recessive 19. What is the reason most children diagnosed with sickle cell anemia are not candidates for either bone marrow or stem cell transplants? a. Well-matched stem cell donors are difficult to find. b. The child is usually too weak to survive the procedure. c. The child’s immune system will not appropriately respond to the antirejection medications. d. Although effective for adults, neither procedure has been proven effective for children. 20. Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants? a. Atelectasis and pneumonia b. Edema of the hands and feet c. Stasis ulcers of the hands, ankles, and feet d. Splenomegaly and hepatomegaly 21. What is the chance with each pregnancy that a child born to two parents with the sickle trait will have sickle cell disease (SCD)? a. 20% c. 33% b. 25% d. 50% 22. Which type of anemia occurs as a result of thalassemia? a. Microcytic, hypochromic c. Macrocytic, hyperchromic b. Microcytic, normochromic d. Macrocytic, normochromic 23. What is the fundamental defect that results in beta-thalassemia major? a. The spleen prematurely destroys the precipitate-carrying cells. b. A severe uncoupling of D- and E-chain synthesis occurs. c. All four beta-forming genes are defective. d. Hemoglobin H (HbH) develops when three genes are defective. 24. The alpha- and beta-thalassemias are considered what types of inherited disorder? a. Autosomal recessive c. X-linked recessive b. Autosomal dominant d. X-linked dominant 25. Hemophilia B is caused by a deficiency of which clotting factor? a. V c. IX b. VIII d. X 26. Hemophilia A is considered to be what type of inherited disorder? a. Autosomal dominant c. X-linked recessive b. Autosomal recessive d. X-linked dominant 27. Which disease is an autosomal dominant inherited hemorrhagic disease? a. Hemophilia A c. Christmas disease

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b. von Willebrand disease d. Hemophilia B 28. Idiopathic thrombocytopenic purpura (ITP) is an autoimmune process involving antibodies attacking which type of cells? a. Neutrophils c. Platelets b. Eosinophils d. Basophils 29. Which disorder results in decreased erythrocytes and platelets with changes in leukocytes and has clinical manifestations of pallor, fatigue, petechiae, purpura, bleeding, and fever? a. Idiopathic thrombocytopenic purpura (ITP) b. Acute lymphocytic leukemia (ALL) c. Non-Hodgkin lymphoma (NHL) d. Iron deficiency anemia (IDA) 30. When does fetal erythrocyte production shift from the liver to the bone marrow? a. Fourth month of gestation c. Eighth month of gestation b. Fifth month of gestation d. At birth 31. Which disease is caused by clotting factor VIII deficiency and is an autosomal dominant trait? a. Hemophilia A c. Hemophilia C b. Hemophilia B d. von Willebrand disease 32. Which type of hemophilia affects only men? a. Hemophilia A c. Hemophilia C b. Hemophilia B d. von Willebrand disease 33. Which hemophilia occurs equally in both men and women? a. Hemophilia A c. Hemophilia C b. Hemophilia B d. von Willebrand disease 35. What is the significance of hyperdiploidy when diagnosing and treating leukemia? a. Hyperdiploidy indicates a good prognosis. b. Hyperdiploidy indicates a poor prognosis. c. Hyperdiploidy indicates poor response to a specific treatment. d. Hyperdiploidy indicates the achievement of remission 36. What are the common triggers for sickle cell crisis? (Select all that apply.) a. Fever b. Infection c. Dehydration d. Alkalosis e. Exposure to the cold

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