1
Q
Q1. What is the primary function of the cytoplasm in eukaryotic cells?
A. Synthesizes ATP directly
B. Houses DNA for transcription
C. Supports organelles and metabolic reactions
D. Packages proteins for export
A
✅ Correct answer: C
2
Q
Q2. A dysfunction in the rough ER would most directly affect which process?
A. DNA replication
B. Lipid detoxification
C. Protein synthesis
D. Cellular respiration
A
✅ Correct answer: C
3
Q
Q3. A drug that induces the smooth ER in hepatocytes is most likely enhancing which function?
A. ATP production
B. Lipid synthesis and detoxification
C. Protein folding
D. mRNA transcription
A
✅ Correct answer: B
4
Q
Q4. Tay-Sachs disease involves accumulation of substances due to dysfunction of:
A. Peroxisomes
B. Ribosomes
C. Lysosomes
D. Golgi apparatus
A
✅ Correct answer: C
5
Q
Q5. A patient with mitochondrial dysfunction is most likely to present with:
A. Hyperactivity
B. Hyperreflexia
C. Muscle weakness and fatigue
D. Excessive weight gain
A
✅ Correct answer: C
6
Q
Q6. Lipid-soluble medications are generally:
A. Blocked by the plasma membrane
B. Rapidly broken down in the cytoplasm
C. Able to diffuse across the plasma membrane
D. Transported only via vesicles
A
✅ Correct answer: C
7
Q
Q7. What is the function of ribosomes?
\A. Synthesis of lipids
B. Translation of mRNA into proteins
C. Production of ATP
D. Storage of calcium
A
✅ Correct answer: B
8
Q
Q8. Which of the following best describes autophagy?
A. Uncontrolled breakdown of cell contents
B. Active removal of apoptotic cells
C. Cellular self-digestion for recycling
D. Inflammation-triggered cell death
A
✅ Correct answer: C
9
Q
Q9. What is a key distinguishing feature of apoptosis compared to necrosis?
A. Causes cellular swelling
B. Is inflammatory
C. Requires energy and is programmed
D. Involves bacterial infection
A
c
10
Q
Q10. What is rigor mortis caused by?
A. Mitochondrial replication
B. Calcium influx and ATP depletion
C. Enzyme activation in lysosomes
D. Blood pooling in capillaries
A
b
11
Q
Q11. Which of the following conditions is most likely caused by defective cilia?
A. Hypotension
B. Respiratory infections
C. Liver failure
D. Kidney stones
A
b
12
Q
Q12. What type of junction allows direct movement of ions between adjacent cells?
A. Tight junction
B. Gap junction
C. Desmosome
D. Adherens junction
A
b
13
Q
Q13. Tetracycline selectively targets bacterial ribosomes because:
A. Human ribosomes lack RNA
B. Bacteria lack membranes
C. Bacterial ribosomes are structurally different
D. Bacteria have circular nuclei
A
c
14
Q
Q14. Peroxisomes are primarily involved in:
A. Protein synthesis
B. ATP production
C. Breakdown of fatty acids and ethanol
D. Transport of hormones
A
c
15
Q
Q15. Which of the following best describes the role of the Golgi apparatus?
A. DNA transcription
B. Cell division
C. Modification and packaging of proteins
D. Lipid digestion
A
c
16
Q
Q16. Mitochondria are unique among organelles because they:
A. Perform photosynthesis
B. Do not require oxygen
C. Contain their own DNA and ribosomes
D. Only exist in muscle tissue
A
c
17
Q
Q17. Which of the following is a defining characteristic of eukaryotic cells?
A. Absence of organelles
B. Single circular chromosome
C. Presence of a nucleus
D. Peptidoglycan cell wall
A
c
18
Q
Q18. Prokaryotic cells differ from eukaryotic cells in that they:
A. Contain multiple chromosomes
B. Have a true nucleus
C. Lack membrane-bound organelles
D. Have mitochondria
A
c
19
Q
Q19. A patient on a statin reports muscle pain. What cellular component is most likely involved?
A. Ribosome
B. Peroxisome
C. Mitochondrion
D. Nucleolus
A
c
20
Q
Q20. A chemotherapy agent induces apoptosis in cancer cells. What is one advantage of apoptosis over necrosis in therapy?
A. It is slower
B. It prevents inflammation
C. It increases infection risk
D. It results in membrane rupture
A
b
21
Q
- A patient is positive for a BRCA1 mutation. What should be your next step?
A. Repeat the test
B. Disregard the result
C. Refer for genetic counseling and discuss risk-reduction options
D. Test for cystic fibrosis
A
c
22
Q
A 2-year-old child with speech delay and dysmorphic features needs genetic testing. What is first-line?
A. Karyotype
B. Microarray (CMA)
C. Sanger sequencing
D. Amniocentesis
A
b
23
Q
A child with cleft lip and congenital heart defect likely has a condition that is:
A. X-linked dominant
B. Multifactorial
C. Mitochondrial
D. Autosomal recessive
A
b
24
Q
A parent has a balanced inversion. What is the most likely clinical impact?
A. Severe physical abnormalities
B. Risk for offspring to inherit unbalanced rearrangement
C. Always results in miscarriage
D. No reproductive consequences
A
b
25
A balanced translocation typically:
A. Results in immediate disease
B. Always causes miscarriage
C. Involves no loss or gain of genetic material
D. Cannot be detected by karyotyping
c
26
A karyotype shows 47,XXY. What condition is this?
A. Turner syndrome
B. Klinefelter syndrome
C. Down syndrome
D. Triple X syndrome
b
27
Which of the following is an example of aneuploidy?
A. Deletion of a single gene
B. Inversion of a chromosome segment
C. Trisomy 21
D. Translocation between chromosomes
c
28
A mutation that introduces a premature stop codon is called:
A. Missense mutation
B. Nonsense mutation
C. Silent mutation
D. Frameshift mutation
b
29
MLPA is useful in detecting:
A. Aneuploidy
B. Mitochondrial variants
C. Gene deletions/duplications
D. Balanced inversions
c
30
What test would you order to detect a single-point mutation in a gene?
A. Karyotype
B. Microarray
C. Sanger sequencing
D. FISH
c
31
Which genetic test is best for detecting known small deletions like DiGeorge syndrome (22q11.2)?
A. FISH
B. Karyotype
C. Microarray
D. Sanger sequencing
a
32
Which test provides a broad view of copy number changes but does not detect balanced translocations?
A. Karyotype
B. Microarray (CMA)
C. FISH
D. Sanger sequencing
b
33
A woman has a BRCA1 mutation. What is the inheritance pattern?
A. X-linked dominant
B. Autosomal dominant
C. Autosomal recessive
D. Multifactorial
b
34
A condition inherited only from the mother, affecting both sons and daughters, likely follows which inheritance pattern?
A. Autosomal dominant
B. X-linked dominant
C. Mitochondrial
D. Autosomal recessive
c
35
Which of the following is an X-linked recessive disorder?
A. Rett syndrome
B. Danon disease
C. Duchenne muscular dystrophy
D. Sengers syndrome
c
36
Cystic fibrosis follows which inheritance pattern?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Mitochondrial
b
37
What condition is commonly screened for at birth via newborn screening in the U.S.?
A. Turner syndrome
B. Trisomy 21
C. Sickle cell disease
D. Huntington's disease
c
38
Which of the following is a diagnostic prenatal test?
A. NIPT
B. First-trimester ultrasound
C. CVS
D. Maternal serum screening
c
39
A 10-week pregnant patient requests non-invasive genetic screening. Which test is most appropriate?
A. Chorionic villus sampling (CVS)
B. Amniocentesis
C. NIPT
D. Karyotyping
c
40
Proteins are made up of which building blocks?
A. Sugars
B. Nucleotides
C. Amino acids
D. Lipids
c
41
Which of the following best defines a gene?
A. A protein that directs cell activity
B. A small molecule of RNA
C. A segment of DNA that encodes a functional product
D. A sequence of amino acids
c
42
How many pairs of chromosomes are present in a normal human karyotype?
A. 20
B. 22
C. 23
D. 46
c
43
What is the role of tRNA during translation?
A. Synthesizes mRNA
B. Matches anticodons to mRNA codons
C. Binds ribosomal proteins
D. Repairs DNA
b
44
Where in the cell does translation occur?
A. Nucleus
B. Mitochondria
C. Ribosome in cytoplasm
D. Golgi apparatus
c
45
During transcription, which of the following is synthesized?
A. DNA
B. tRNA
C. mRNA
D. Ribosomal protein
c
46
Which of the following conditions is inherited in a mitochondrial pattern?
A. Rett syndrome
B. Sengers syndrome
C. Noonan syndrome
D. Klinefelter syndrome
b
47
A 16-week pregnant woman is at high risk for a fetus with thalassemia. What diagnostic test would you recommend?
A. NIPT
B. CVS
C. Amniocentesis
D. Karyotype
c
48
Which of the following is true about microarray testing?
A. It can detect balanced translocations
B. It is the first-line test for developmental delay
C. It is less sensitive than karyotyping
D. It identifies single nucleotide variants only
b
49
Q1: Which of the following best describes the hypothetical-deductive reasoning model?
A. Guessing based on instinct
B. Using pattern recognition based on past experience
C. Using logical steps to test and eliminate differential diagnoses
D. Using emotional cues to decide on diagnosis
Answer: ✅ C. Using logical steps to test and eliminate differential diagnoses
50
Q2: A patient presents with weight loss, fatigue, and night sweats. Which category from VITAMINS CD should be strongly considered?
A. Autoimmune
B. Neoplastic
C. Traumatic
D. Metabolic
Answer: ✅ B. Neoplastic
51
Q3: Which of the following is an example of a pragmatic diagnostic approach?
. Ruling out all rare diseases
B. Prioritizing the most serious conditions
C. Focusing on treatable causes
D. Only ordering imaging tests
Answer: ✅ C. Focusing on treatable causes
52
What is the primary concern when prescribing a drug with a narrow therapeutic index (e.g., warfarin, digoxin)?
A. Cost of therapy
B. Route of administration
C. Small difference between effective and toxic doses
D. Development of tolerance
Correct Answer: ✅ C
53
effect might you expect?
A. Increased effectiveness of the contraceptive
B. Decreased effectiveness due to increased metabolism
C. No interaction expected
D. Risk of estrogen toxicity
Correct Answer: ✅ B
54
Which of the following is most accurate regarding idiosyncratic drug reactions?
A. They are dose-dependent and predictable.
B. They are caused by immune system activation.
C. They are genetically determined and unpredictable.
D. They are commonly due to drug interactions.
Correct Answer: ✅ C
55
A drug that binds to a receptor but does not activate it and blocks the action of endogenous substances is called a:
A. Agonist
B. Antagonist
C. Partial agonist
D. Modulator
b
56
Which patient characteristic would most likely increase the half-life of a drug eliminated by the kidneys?
A. Pregnancy
B. Obesity
C. Hepatic failure
D. Chronic kidney disease
d
57
Which of the following best defines bioavailability?
A. The amount of drug bound to plasma proteins
B. The rate at which a drug is excreted
C. The percentage of drug that reaches systemic circulation unchanged
D. The extent of drug distribution into body tissues
c
58
Q4:
A provider considers switching a patient from oral propranolol to IV for better blood pressure control. What is the most appropriate reason for switching the route?
A. To increase drug solubility
B. To bypass the first-pass effect
C. To reduce protein binding
D. To increase renal clearance
Correct Answer: ✅ B
Rationale: Oral propranolol undergoes significant first-pass metabolism in the liver. IV administration bypasses this, leading to higher systemic levels.
59
A patient taking warfarin starts taking sulfamethoxazole-trimethoprim (Bactrim) for a UTI. Two days later, they present with easy bruising and a nosebleed. What is the most likely mechanism of this adverse effect?
A. Decreased warfarin bioavailability
B. Warfarin CYP450 enzyme induction
C. CYP450 enzyme inhibition by Bactrim
D. Idiosyncratic coagulopathy
Correct Answer: ✅ C
Rationale: Bactrim inhibits CYP2C9, which is responsible for warfarin metabolism. This increases warfarin levels and risk of bleeding.
60
A 3-month-old infant is being prescribed amoxicillin. The NP calculates the dose based on weight and age. What is the key pharmacokinetic consideration when adjusting the dose in this age group?
A. Decreased liver enzyme induction
B. Increased renal excretion
C. Increased hepatic metabolism
D. Increased protein binding
Correct Answer: ✅ A
Rationale: In neonates and young infants, liver enzymes are immature, resulting in decreased metabolism. Renal excretion is also immature, but the question asks about dosing, which is more influenced here by metabolism.
61
A 78-year-old male is prescribed digoxin for atrial fibrillation. He has a history of chronic kidney disease (eGFR: 38 mL/min/1.73m²). After 5 days of treatment, he complains of nausea, blurred vision, and fatigue. What is the most likely cause of his symptoms?
A. Normal digoxin side effect
B. Drug-induced idiosyncratic reaction
C. Accumulation due to impaired renal clearance
D. Immune hypersensitivity reaction
Correct Answer: ✅ C
Rationale: Digoxin is primarily excreted renally. In CKD, it can accumulate and lead to toxicity. The symptoms listed are classic for digoxin toxicity.
Case 2: Pediatric Dosing
62
. Which of the following is NOT a major component of blood?
A) Plasma
B) Erythrocytes
C) Osteocytes
D) Leukocytes
c
63
The primary function of erythrocytes is to:
A) Fight infections
B) Transport oxygen and carbon dioxide
C) Form blood clots
D) Produce antibodies
b
64
Platelets play a critical role in:
A) Immune response
B) Oxygen transport
C) Blood clotting
D) Hormone secretion
c
65
Plasma is composed mainly of:
A) Cells and antibodies
B) Water, electrolytes, proteins, and nutrients
C) DNA and RNA
D) Red and white blood cells
b
66
Glucose-6-phosphate dehydrogenase (G6PD) deficiency primarily results in:
A) Impaired oxygen binding
B) Increased susceptibility of RBCs to oxidative damage
C) Overproduction of erythrocytes
D) Deficient platelet function
b
67
Which of the following can trigger a hemolytic crisis in a patient with G6PD deficiency?
A) Eating spinach
B) Infection or certain medications
C) Drinking water
D) Physical exercise
b
68
The inheritance pattern of G6PD deficiency is:
A) Autosomal dominant
B) Autosomal recessive
C) X-linked recessive
D) Mitochondrial inheritance
c
69
What type of anemia is seen in G6PD deficiency?
A) Macrocytic hypochromic anemia
B) Normocytic normochromic anemia with hemolysis
C) Microcytic hypochromic anemia
D) Megaloblastic anemia
b
70
Which of the following populations is most commonly affected by G6PD deficiency?
A) Northern European descent
B) African, Mediterranean, Middle Eastern, and Southeast Asian descent
C) Native American descent
D) East Asian descent
b
71
The best management for a patient with G6PD deficiency includes:
A) Blood transfusion for all patients
B) Avoidance of oxidative triggers and supportive care during crises
C) Daily iron supplementation
D) High-dose vitamin B12 injections
b
72
Anemia of chronic disease is characterized by which of the following?
A) Increased iron availability for erythropoiesis
B) Trapping of iron in storage sites and decreased erythropoietin production
C) Deficiency of Vitamin B12
D) Increased RBC lifespan
b
73
12. The most common cause of iron deficiency anemia is:
A) Chronic inflammation
B) Chronic blood loss
C) Vitamin B12 deficiency
D) Genetic mutation
b
74
Which laboratory finding is typical of iron deficiency anemia?
A) Macrocytic normochromic RBCs
B) Normocytic normochromic RBCs
C) Microcytic hypochromic RBCs with low ferritin
D) Elevated serum vitamin B12
c
75
A patient presents with fatigue, pallor, sore beefy red tongue, and neurological symptoms. Which anemia is most likely?
A) Iron deficiency anemia
B) Pernicious anemia (Vitamin B12 deficiency)
C) Folate deficiency anemia
D) Anemia of chronic disease
b
76
The mechanism of sickle cell anemia involves:
A) Lack of iron for hemoglobin synthesis
B) Mutation causing hemoglobin S production leading to sickling of RBCs
C) Deficiency of folate
D) Inhibition of erythropoietin production
b
77
Which treatment is commonly used to reduce sickle cell crises?
A) Hydroxyurea
B) Vitamin B12 injections
C) Iron supplements
D) Aspirin
a
78
Which of the following is a common adverse effect of oral iron supplementation?
A) Nausea and constipation
B) Neurological symptoms
C) Hemorrhagic stroke
D) Hyperkalemia
a
79
Why must Vitamin B12 and folate levels both be tested in macrocytic anemia?
A) Because folate deficiency masks B12 deficiency
B) Because replacing folate alone does not prevent neurological damage caused by B12 deficiency
C) They are unrelated and don’t affect each other
D) Because both cause microcytic anemia
b
80
Which anticoagulant works by directly inhibiting Factor Xa?
A) Warfarin
B) Apixaban
C) Heparin
D) Dabigatran
b
81
What is the antidote for warfarin overdose?
A) Protamine sulfate
B) Vitamin K1
C) Idarucizumab
D) Andexxa
b
82
Heparin-induced thrombocytopenia (HIT) is a known side effect of:
A) Warfarin
B) Low molecular weight heparin
C) Unfractionated heparin
D) Apixaban
c
83
Which medication is a direct thrombin inhibitor used in stroke prevention in atrial fibrillation?
A) Dabigatran
B) Clopidogrel
C) Enoxaparin
D) Aspirin
a
84
Which antiplatelet drug works by irreversibly inhibiting the P2Y12 ADP receptor on platelets?
A) Aspirin
B) Clopidogrel
C) Ticagrelor
D) Warfarin
b
85
G-CSF and GM-CSF are used clinically to:
A) Stimulate red blood cell production
B) Stimulate neutrophil and other white blood cell production
C) Inhibit platelet aggregation
D) Reverse anticoagulation
b
86
Which of the following is true regarding erythropoietin therapy?
A) It is used primarily in chronic renal failure to stimulate RBC production
B) It increases platelet count directly
C) It is contraindicated in all anemias
D) It works by increasing iron absorption
a
87
The first-line treatment for microcytic hypochromic anemia due to iron deficiency includes:
A) Folic acid supplementation
B) Oral ferrous sulfate with Vitamin C
C) Vitamin B12 injections
D) Hydroxyurea
b
88
The clotting cascade's intrinsic pathway is initiated by:
A) Tissue factor exposure
B) Contact activation involving factor XII
C) Platelet aggregation
D) Vitamin K activation
b
89
The common pathway in the coagulation cascade begins with the activation of:
A) Factor VII
B) Factor X
C) Factor XII
D) Factor VIII
b
90
Which factor is NOT vitamin K dependent?
A) Factor II (prothrombin)
B) Factor V
C) Factor VII
D) Factor X
b
91
What is the primary role of platelets in hemostasis?
A) To initiate the coagulation cascade
B) To adhere to damaged endothelium and aggregate to form a platelet plug
C) To dissolve fibrin clots
D) To inhibit clotting
b
92
In anemia of chronic disease, which cytokine primarily contributes to iron sequestration and decreased erythropoiesis?
A) Interleukin-1 (IL-1)
B) Tumor necrosis factor-alpha (TNF-α)
C) Interleukin-6 (IL-6)
D) Interferon-gamma (IFN-γ)
c
93
A 45-year-old woman has microcytic hypochromic anemia and low serum ferritin. Which of the following is the most appropriate initial treatment?
A) Blood transfusion
B) Oral folic acid supplementation
C) Oral ferrous sulfate with vitamin C
D) Vitamin B12 injections
c
94
A patient with pernicious anemia is prescribed Vitamin B12 therapy. Why might parenteral administration be necessary?
A) Poor oral adherence
B) Vitamin B12 is destroyed in the stomach
C) Intrinsic factor deficiency impairs oral absorption
D) Oral vitamin B12 causes GI irritation
c
95
Which of the following symptoms is most specific for Vitamin B12 deficiency compared to folate deficiency?
A) Glossitis
B) Fatigue
C) Peripheral neuropathy
D) Anorexia
c
96
Hydroxyurea therapy in sickle cell disease primarily works by increasing levels of:
A) Hemoglobin A
B) Hemoglobin F
C) Hemoglobin S
D) Iron stores
b
97
Which laboratory value would be expected in a patient with G6PD deficiency during a hemolytic crisis?
A) Elevated reticulocyte count
B) Low indirect bilirubin
C) Normal lactate dehydrogenase (LDH)
D) Increased haptoglobin
a
98
Which of the following drugs requires INR monitoring due to its narrow therapeutic index and interference with vitamin K?
A) Apixaban
B) Dabigatran
C) Warfarin
D) Clopidogrel
c
99
Which anticoagulant is preferred in pregnancy due to its inability to cross the placenta?
A) Warfarin
B) Unfractionated heparin
C) Dabigatran
D) Rivaroxaban
b
100
A patient develops thrombocytopenia 7 days after starting anticoagulation therapy with unfractionated heparin. What is the most likely diagnosis?
A) Disseminated intravascular coagulation
B) Heparin-induced thrombocytopenia
C) Vitamin K deficiency
D) Immune thrombocytopenic purpura
b
101
What is the primary goal of erythropoietin therapy in chronic kidney disease?
A) Reduce iron overload
B) Stimulate red blood cell production
C) Prevent clot formation
D) Increase platelet aggregation
b
101
Clopidogrel is contraindicated with which of the following medications due to increased risk of reduced antiplatelet effect?
A) Proton pump inhibitors (PPIs) like omeprazole
B) Aspirin
C) Warfarin
D) Heparin
a
102
Which cytokine stimulates macrophage production as well as neutrophils?
A) Erythropoietin
B) G-CSF
C) GM-CSF
D) Interleukin-2
c
103
Which of the following iron formulations carries the highest risk of anaphylaxis and is administered only in a hospital setting?
A) Oral ferrous sulfate
B) Iron dextran (IV)
C) Oral ferrous gluconate
D) Oral folic acid
b
104
Which clotting factor deficiency is associated with Hemophilia A?
A) Factor IX
B) Factor VIII
C) Factor X
D) Factor VII
b
104
A patient on warfarin therapy has an INR of 5.5 with no active bleeding. What is the best initial step?
A) Immediate vitamin K administration
B) Continue warfarin and recheck INR in one week
C) Hold warfarin dose and monitor INR closely
D) Start heparin bridging
c
105
A 65-year-old man with rheumatoid arthritis presents with fatigue and pallor. Labs show normocytic normochromic anemia and low serum iron but high ferritin. What is the most appropriate initial management?
1. Anemia of Chronic Disease
A) Start oral iron supplements
B) Treat the underlying inflammatory disease
C) Begin erythropoietin stimulating agents immediately
D) Administer vitamin B12 injections
106
A 30-year-old female presents with fatigue, brittle nails, and spoon-shaped nails. She has heavy menstrual bleeding. Lab results reveal microcytic hypochromic anemia and low ferritin. What is the best next step?
A) Begin oral ferrous sulfate with vitamin C
B) Order vitamin B12 levels
C) Start hydroxyurea
D) Refer for bone marrow biopsy
2. Iron Deficiency Anemia
a
107
A 55-year-old woman complains of numbness and tingling in her feet and hands, along with fatigue. Labs reveal macrocytic normochromic anemia and low vitamin B12. What is the preferred treatment?
A Oral vitamin B12 supplements
B) Intramuscular vitamin B12 injections
C) Oral folate supplements
D) Blood transfusion
3. Pernicious Anemia
b
108
A 22-year-old African American male with sickle cell disease presents with severe limb pain and pallor. He is dehydrated and febrile. What is the most appropriate initial management?
A) Start oral hydroxyurea
B) Hydration, pain control, and oxygen therapy
C) Begin iron supplementation
D) Administer folate supplements
4. Sickle Cell Disease Crisis
b
109
A 7-year-old boy of Mediterranean descent presents with jaundice and pallor after taking sulfa antibiotics. What lab finding supports G6PD deficiency?
A) Increased serum ferritin
B) Decreased reticulocyte count
C) Hemolytic anemia with Heinz bodies on peripheral smear
D) Macrocytic anemia
5. G6PD Deficiency
c
110
A 70-year-old patient with atrial fibrillation is started on warfarin. His INR is 4.8 without bleeding. What is the next step?
A) Continue warfarin at the same dose
B) Administer vitamin K immediately
C) Hold warfarin dose and monitor INR
D) Switch to low molecular weight heparin
6. Anticoagulation Therapy
c
111
A patient receiving unfractionated heparin develops a platelet count drop and new thrombosis. What is the most appropriate next step?
A) Continue heparin and monitor closely
B) Switch to low molecular weight heparin
C) Discontinue heparin and start a direct thrombin inhibitor
D) Give platelet transfusion
7. Heparin Induced Thrombocytopenia
c
112
A patient with recent coronary stent placement is prescribed clopidogrel and a proton pump inhibitor (PPI). What is a major concern?
A) Increased risk of GI bleeding
B) Reduced antiplatelet effect of clopidogrel
C) Increased risk of stroke
D) Risk of thrombotic thrombocytopenic purpura
8. Clopidogrel Use
b
113
A patient with chronic kidney disease and anemia of chronic disease is prescribed oral iron supplements. What is an important consideration?
A) Iron supplementation is always beneficial
B) Iron overload can occur if ferritin is already high
C) Iron supplements cause neurological symptoms
D) Iron supplements should be stopped during infection
9. Iron Supplementation Caution
b
114
A pregnant woman presents with fatigue and glossitis. Labs show macrocytic anemia and low serum folate. What is the appropriate treatment?
A) Oral vitamin B12 injections
B) Oral folic acid supplementation
C) Blood transfusion
D) Hydroxyurea therapy
10. Folate Deficiency
b
115
1. Which of the following genetic mutations is associated with loss of tumor suppression and contributes to uncontrolled cell growth?
A. MYCN gene overexpression
B. p53 inactivation
C. VEGF secretion
D. RAS gene activation
b
116
What is the mechanism behind replicative immortality in cancer cells?
A. Overexpression of growth factors
B. Activation of proto-oncogenes
C. Telomerase activation
D. Loss of angiogenesis
c
117
A tumor that is poorly differentiated, has a high mitotic index, and is invasive would most likely be classified as:
A. Benign
B. Carcinoma in situ
C. Malignant
D. Hyperplastic
c
118
Which cytokine-secreting cell type is associated with chronic inflammation and promotes tumor survival?
A. Natural killer (NK) cells
B. T cytotoxic cells
C. Tumor-associated macrophages (TAMs)
D. Neutrophils
c
119
he Warburg effect describes cancer cells' preference for:
A. Oxidative phosphorylation under hypoxic conditions
B. Fatty acid metabolism in normoxia
C. Glycolysis under normal oxygen conditions
D. Anaerobic respiration only
c
120
. Which tumor marker is most often used to screen for prostate cancer?
A. CEA
B. PSA
C. AFP
D. CA-125
b
121
Which of the following treatments utilizes the patient’s immune system to destroy cancer cells?
A. Chemotherapy
B. Immunotherapy (CAR-T)
C. Radiation
D. Surgery
b
122
Which cancer staging component assesses lymph node involvement?
A. T
B. N
C. M
D. G
b
123
What histological feature is MOST characteristic of cancer cells?
A. Small uniform nuclei
B. Organized tissue structure
C. Anaplasia
D. Encapsulation
c
124
Which pediatric cancer is most common?
A. Neuroblastoma
B. Retinoblastoma
C. Leukemia (ALL)
D. Osteosarcoma
c
125
A 55-year-old male presents for a follow-up after a routine LDCT reveals a 3 cm solitary pulmonary nodule. He has a 35 pack-year history of smoking and quit 10 years ago. What is the next best step in his management?
A. Reassurance and repeat scan in 5 years
B. PET scan and possible biopsy
C. Immediate surgical resection
D. Start chemotherapy
b
126
A 7-year-old boy presents with fever, fatigue, and bruising. Labs show anemia, thrombocytopenia, and leukocytosis. Bone marrow biopsy reveals >25% lymphoblasts. What is the most likely diagnosis?
A. Hodgkin's lymphoma
B. Acute lymphoblastic leukemia (ALL)
C. Chronic myeloid leukemia (CML)
D. Aplastic anemia
b
127
A 62-year-old female with peptic ulcer disease tests positive for Helicobacter pylori. She also reports unintentional weight loss and early satiety. Endoscopy reveals an ulcerated mass in the stomach. What type of cancer is most associated with this condition?
A. Colorectal carcinoma
B. Gastric adenocarcinoma
C. Pancreatic carcinoma
D. Lymphoma of the thyroid
b
128
A 48-year-old male undergoing chemotherapy develops high-grade fever, chills, and hypotension. His WBC count is severely reduced. What is the most likely cause of his condition?
A. Autoimmune reaction
B. Opportunistic infection due to neutropenia
C. Drug allergy
D. Chemotherapy-induced thyroiditis
b
129
A 30-year-old female is diagnosed with early-stage cervical cancer. She asks about the cause. Which of the following is most likely associated?
A. Epstein-Barr Virus (EBV)
B. Helicobacter pylori
C. Human papillomavirus (HPV)
D. Hepatitis B
c
130
Which of the following BEST defines the function of proto-oncogenes?
A. Encode enzymes that repair DNA damage
B. Promote uncontrolled cell growth when mutated
C. Inhibit apoptosis under normal conditions
D. Regulate normal cell growth and differentiation
d
131
Which gene is commonly amplified in neuroblastoma and glioblastoma?
A. MYC
B. BRCA1
C. MYCN
D. RAS
c
132
What best describes Stage 4 cancer in the TNM staging system?
A. Localized tumor with node involvement
B. No lymph node involvement and no metastasis
C. Tumor with regional lymph node spread
D. Distant metastasis is present
d
133
What is the hallmark feature of epithelial-to-mesenchymal transition (EMT) in cancer?
A. Formation of a fibrous tumor capsule
B. Loss of apoptosis resistance
C. Increased cell differentiation
D. Increased migration and invasion capabilities
d
134
Which screening method is recommended for colorectal cancer in asymptomatic patients aged 60–74?
A. Annual colonoscopy
B. Biannual fecal occult blood or immunochemical testing
C. CT scan of abdomen
D. Digital rectal exam every year
b
135
Which of the following growth factors is MOST associated with tumor angiogenesis?
A. EGF
B. VEGF
C. IL-2
D. IGF
b
136
Which gene is inactivated in retinoblastoma and plays a role in tumor suppression?
A. BRCA2
B. RB
C. MYCN
D. RAS
b
137
A patient’s tumor secretes immunosuppressive factors into the tumor microenvironment. This contributes to:
A. Accelerated mitosis
B. Decreased angiogenesis
C. Resistance to chemotherapy and radiation
D. Increased telomere shortening
c
138
What is the role of tumor-associated macrophages (TAMs) in cancer progression?
A. Promote T-cell cytotoxicity
B. Enhance immune surveillance
C. Suppress immune response and promote tumor spread
D. Repair tumor vasculature
c
139
Which therapy type is best described as "using the body’s immune system to target cancer cells"?
A. Hormonal therapy
B. Immunotherapy
C. Targeted radiation
D. Traditional chemotherapy
b
140
A 72-year-old female presents with fatigue, abdominal bloating, and early satiety. She has no family history of cancer. A pelvic exam reveals a fixed adnexal mass. What is the next most appropriate investigation?
A. Routine Pap test
B. CA-125 and pelvic ultrasound
C. Mammography
D. BRCA1 genetic testing
b
141
A 68-year-old male presents with bone pain and an elevated PSA level. Bone scan confirms metastatic lesions. What is the most likely primary diagnosis?
A. Bladder cancer
B. Lung cancer
C. Prostate cancer
D. Multiple myeloma
c
142
A patient receiving immunotherapy for lymphoma develops diarrhea, rash, and hyperthyroidism. These symptoms are MOST likely due to:
A. Paraneoplastic syndrome
B. Secondary infection
C. Immune-related adverse effects
D. Allergic reaction to chemotherapy
c
143
A 45-year-old female undergoing chemotherapy develops neutropenic fever. What is the immediate management step?
A. Start antiviral therapy
B. Send blood cultures and start broad-spectrum IV antibiotics
C. Discharge with oral antibiotics
D. Administer high-dose steroids
b
144
65-year-old man with newly diagnosed colon cancer asks about the staging of his cancer. Imaging shows a 5 cm mass invading nearby lymph nodes, but no distant metastasis. What is his cancer stage?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
c
145
Which patient is most at risk for complications from olanzapine therapy?
A. A 28-year-old with asthma
B. A 40-year-old with nausea
C. A 70-year-old with a history of falls
D. A 55-year-old with hypertension
c
146
Olanzapine is being used off-label for nausea in a cancer patient. Which of the following is the most important adverse effect to monitor?
A. Hypertension
B. Lethargy and sedation
C. Anaphylaxis
D. GI bleeding
b
147
An NP is prescribing ondansetron for an outpatient with constipation. What nursing intervention is appropriate?
A. Educate to avoid fiber
B. Add a stool softener to the regimen
C. Discontinue the medication
D. Increase dairy intake
b
148
What is a significant cardiac-related side effect associated with ondansetron?
A. Bradycardia
B. Prolonged QT interval
C. Hypertension
D. Tachyarrhythmia
b
149
What neurotransmitter pathway does aprepitant target?
A. Dopamine
B. Acetylcholine
C. Serotonin
D. Substance P / Neurokinin-1
d
150
Which of the following statements about aprepitant is correct?
A. It can be used as monotherapy for chemotherapy-induced nausea
B. It is contraindicated in elderly patients
C. It is only effective for nausea due to vertigo
D. It must be used in combination with other antiemetics
d
151
A patient receiving dimenhydrinate complains of blurred vision, dry mouth, and confusion. What is the best explanation for these symptoms?
A. Dopaminergic effect
B. Extrapyramidal side effects
C. Anticholinergic toxicity
D. Allergic reaction
c
152
Dimenhydrinate exerts its antiemetic effect primarily by:
A. Blocking dopamine receptors
B. Enhancing serotonin release
C. Antagonizing histamine and acetylcholine receptors
D. Stimulating NK-1 receptors
c
153
Which of the following patients would require extra caution when receiving dexamethasone?
A. A patient with anemia
B. A patient with glaucoma
C. A patient with diabetes
D. A patient with a low platelet count
c
154
A nurse practitioner is prescribing dexamethasone as part of an antiemetic regimen for chemotherapy. What is the primary reason for adding this medication?
A. It treats neuropathic pain
B. It prevents delayed nausea and vomiting
C. It prevents immediate allergic reactions
D. It replaces fluid lost through vomiting
b
155
. What is the primary tissue affected in RA?
A) Bone marrow
B) Synovial membrane
C) Muscle tissue
D) Cartilage
b
156
c
157
What cytokine plays a key role in RA inflammation?
A) IL-2
B) TNF-α
C) IFN-β
D) IL-10
b
158
RA is characterized by which of the following joint symptoms?
A) Unilateral stiffness and swelling
B) Asymmetric involvement
C) Morning stiffness lasting <30 minutes
D) Symmetric joint pain and prolonged stiffness
d
159
Pannus in RA refers to:
A) Extra fluid in the synovial space
B) A type of autoantibody
C) Inflamed granulation tissue that erodes cartilage and bone
D) Muscle degeneration
c
160
Which of the following is NOT a phase of wound healing?
A) Inflammatory
B) Regeneration
C) Proliferation
D) Remodeling
b
161
What is the primary function of fibroblasts during healing?
A) Fight infection
B) Form blood vessels
C) Lay down collagen and extracellular matrix
D) Release histamine
c
162
Which of the following impairs wound healing?
A) Good nutrition
B) Normal oxygenation
C) Infection
D) Controlled blood sugar
c
163
Keloids form due to:
A) Poor circulation
B) Excess collagen production
C) Vitamin deficiency
D) Low platelet levels
b
164
What is the result of poor perfusion during wound healing?
A) Improved angiogenesis
B) Enhanced leukocyte function
C) Ischemia
D) Vasodilation
c
165
Which of the following is a mechanical barrier in innate immunity?
A) Lysozyme
B) Mucus and cilia
C) IL-1
D) Complement proteins
b
166
What enzyme in tears and saliva breaks down bacterial walls?
A) Protease
B) Lysozyme
C) Histamine
D) Defensin
b
167
Antimicrobial peptides like defensins and cathelicidins:
A) Promote antibody production
B) Kill microbes directly
C) Act as vaccines
D) Neutralize toxins only
b
168
What role does the normal microbiome play in immunity?
A) Produces histamine
B) Enhances prostaglandin release
C) Competes with pathogens and produces toxins
D) Forms collagen
c
169
Which physical process helps remove pathogens from the airway?
A) Degranulation
B) Apoptosis
C) Coughing and mucociliary clearance
D) Diapedesis
c
170
Which immune cell is dominant in early acute inflammation?
A) Eosinophils
B) Macrophages
C) B cells
D) Neutrophils
d
171
Which cytokine is an endogenous pyrogen?
A) IL-10
B) IL-1
C) IFN-α
D) IL-4
b
172
Which of the following is a systemic sign of inflammation?
A) Redness
B) Swelling
C) Fever
D) Pain
c
173
What causes pain during inflammation?
A) Increased neutrophils
B) Histamine only
C) Prostaglandins, pressure, and cytokines
D) Vasoconstriction
c
174
Which cells dominate chronic inflammation?
A) Basophils
B) Neutrophils
C) Lymphocytes and macrophages
D) Platelets
c
175
What do mast cells release during degranulation?
A) Prostaglandins
B) Histamine
C) IL-10
D) IFN-γ
b
176
Interferons primarily protect against:
A) Parasites
B) Bacterial sepsis
C) Viral infections
D) Fungal overgrowth
c
177
Which PRR type recognizes pathogens?
A) DAMPs
B) BCRs
C) TLRs
D) MHC II
c
178
What is the function of dendritic cells?
A) Kill viruses
B) Phagocytose neutrophils
C) Present antigen to T-cells
D) Secrete histamine
c
179
PECAMs are involved in which immune process?
A) Clotting
B) Diapedesis (cell migration)
C) Mast cell activation
D) Antibody production
b
180
What is a major side effect of NSAIDs?
A) Sedation
B) Hepatotoxicity
C) GI bleeding and ulcers
D) Hypoglycemia
c
181
Which drug is safest in pregnancy and children for fever?
A) Naproxen
B) Aspirin
C) Acetaminophen
D) Ibuprofen
c
182
What is the mechanism of glucocorticoids?
A) Direct bacterial killing
B) Immunosuppression and anti-inflammation
C) Stimulate B cell maturation
D) Block histamine receptors
b
183
What should be monitored when using TNF inhibitors?
A) Blood glucose
B) Renal function
C) TB and infections
D) Thyroid levels
c
184
Which drug class blocks IL-6 receptors in RA treatment?
A) NSAIDs
B) TNF inhibitors
C) IL-6 inhibitors (e.g. Tocilizumab)
D) Antihistamines
c
185
Newborns acquire passive immunity via:
A) T-cell activation
B) Skin contact
C) Placenta and breast milk
D) Vaccines at birth
c
186
Why do elderly individuals have impaired wound healing?
A) Increased collagen
B) Reduced oxygen saturation
C) Chronic inflammation and decreased perfusion
D) Increased neutrophils
c
187
What immune deficiency is found in newborns?
A) Overactive macrophages
B) Inability to make B cells
C) Poor chemotaxis and low complement
D) High histamine levels
c
188
What effect does C-section have on newborn immunity?
A) Increases WBC count
B) Causes neutropenia
C) Reduces gut microbiome diversity
D) Enhances antibody production
c
189
A 45-year-old woman presents with bilateral joint pain and morning stiffness lasting over an hour. Which of the following findings best supports a diagnosis of RA?
A) Positive anti-CCP antibodies
B) Elevated creatine kinase
C) Negative rheumatoid factor and normal ESR
D) Unilateral joint involvement
a
190
A patient with RA is started on methotrexate. What is an important lab test to monitor during treatment?
A) Blood glucose
B) Liver function tests
C) Serum creatinine
D) Electrolytes
b
191
Which clinical feature is most characteristic of RA rather than osteoarthritis?
A) Pain worsens with activity
B) Joint pain improves throughout the day
C) Symmetric joint involvement
D) No systemic symptoms
c
192
A patient with a diabetic foot ulcer shows delayed healing. Which factor is most likely contributing to poor wound healing?
A) Normal oxygen perfusion
B) Excessive collagen deposition
C) Ischemia due to poor blood flow
D) Adequate nutrition
c
193
A nurse practitioner notes redness, swelling, and pain around a wound site. What phase of healing is the patient most likely in?
A) Inflammatory phase
B) Proliferative phase
C) Remodeling phase
D) Chronic phase
a
194
Which of the following systemic signs would you expect in acute inflammation?
A) Fatigue and malaise
B) Low-grade fever and leukocytosis
C) Absence of fever
D) Chronic joint pain
b
195
A 7-year-old child presents with recurrent bacterial infections. Which immune defect would be consistent with impaired neutrophil chemotaxis?
A) Deficient B-cell function
B) Poor complement protein production
C) Impaired neutrophil migration to infection site
D) Decreased T-cell activation
c
196
During an allergic reaction, which mediator released by mast cells causes vasodilation and increased vascular permeability?
A) Leukotrienes
B) Histamine
C) Prostaglandins
D) Platelet activating factor
b
197
Which cytokine produced by infected cells signals neighboring cells to produce antiviral proteins?
A) IL-1
B) TNF-alpha
C) IFN-alpha/ß
D) IL-6
c
198
Which medication should be avoided in a pregnant patient with RA due to teratogenicity?
A) Methotrexate
B) Acetaminophen
C) Prednisone
D) Hydroxychloroquine
a
199
A patient on long-term prednisone therapy develops hyperglycemia and osteoporosis. What is the most appropriate nursing intervention?
A) Recommend stopping prednisone immediately
B) Educate on calcium and vitamin D intake and monitor blood sugar
C) Switch to NSAIDs only
D) Ignore these side effects as they are unavoidable
b
200
What is a major safety concern when prescribing TNF inhibitors?
A) Increased risk of tuberculosis and serious infections
B) Kidney failure
C) Hypoglycemia
D) Liver failure within 24 hours
a
201
A 60-year-old diabetic patient with a chronic foot ulcer shows increased redness, swelling, and fever. What is the most appropriate initial management?
A) Start broad-spectrum antibiotics and obtain wound cultures
B) Recommend rest and watchful waiting
C) Prescribe NSAIDs for pain and inflammation only
D) Refer for surgical amputation immediately
a
202
An elderly patient presents with slow wound healing after minor trauma. Which of the following is the most likely contributing factor?
A) Increased subcutaneous fat
B) Enhanced immune function
C) Reduced perfusion and chronic inflammation
D) High oxygen delivery to tissues
c
203
A child born via cesarean section has reduced gut microbiome diversity. Which of the following might be an implication?
A) Increased risk of allergies and infections
B) Enhanced neutrophil function
C) Lower risk of autoimmune disease
D) No clinical significance
a
204
In RA, what process leads to joint destruction?
A) Autoimmune attack on cartilage and bone by pannus formation
B) Excessive bone growth
C) Viral infection of synovium
D) Calcium deposition in joints
a
205
Which cell type plays a key role in connecting innate and adaptive immunity?
A) Neutrophils
B) Dendritic cells
C) Eosinophils
D) Mast cells
b
206
Which complement pathway is primarily activated by antigen-antibody complexes?
A) Alternative pathway
B) Lectin pathway
C) Classical pathway
D) Coagulation pathway
c
207
Which complement protein acts as an opsonin to enhance phagocytosis?
A) C3a
B) C5a
C) C3b
D) C9
c
208
Bradykinin primarily causes which of the following effects during inflammation?
A) Vasoconstriction and decreased permeability
B) Vasodilation, increased vascular permeability, and pain
C) Activation of B cells
D) Formation of membrane attack complex
b
209
Factor XII (Hageman factor) plays a critical role in activating which two systems?
A) Complement and kinin
B) Kinin and clotting
C) Clotting and antibody production
D) Complement and antibody production
b
210
The membrane attack complex (MAC) formed during complement activation leads to:
A) Enhanced chemotaxis
B) Increased antibody production
C) Direct lysis of target cells
D) Vasodilation
c
211
Which enzyme converts kininogen into bradykinin?
A) Plasmin
B) Kallikrein
C) Thrombin
D) Factor X
b
212
Which statement best describes the clotting system’s role in innate immunity?
A) It exclusively stops bleeding without any role in inflammation.
B) It forms fibrin clots that trap pathogens and promotes leukocyte migration.
C) It neutralizes pathogens by releasing antibodies.
D) It triggers complement activation only.
b
213
Which complement fragments are considered anaphylatoxins that promote inflammation?
A) C1 and C4
B) C3a and C5a
C) C7 and C8
D) C2a and C3b
b
214
In a patient with a genetic deficiency of C3, which immune process would be most impaired?
A) Formation of fibrin clots
B) Opsonization and membrane attack complex formation
C) Bradykinin production
D) Activation of Factor XII
b
215
Excessive activation of the kinin system could result in which clinical symptom?
A) Hypertension
B) Hypotension and angioedema
C) Hypercoagulability
D) Fever without inflammation
b
216
A patient presents with recurrent bacterial infections and is found to have a complement deficiency. Which complement protein deficiency is most likely responsible for inability to opsonize bacteria?
A) C1q
B) C3
C) C5
D) C9
b
217
During an acute inflammatory response, which system is primarily responsible for the pain experienced by the patient?
A) Complement system via C5a
B) Kinin system via bradykinin
C) Clotting system via fibrin formation
D) Adaptive immunity via antibodies
b
218
Which of the following best explains the relationship between Factor XII and the inflammatory response?
A) Factor XII directly lyses bacterial cells
B) Factor XII initiates both the clotting cascade and the kinin system, promoting inflammation
C) Factor XII inhibits the complement system
D) Factor XII produces antibodies
b
219
A patient develops hereditary angioedema, characterized by excessive bradykinin activity. Which enzyme or protein is most likely deficient or dysfunctional?
A) C1 inhibitor (C1-INH)
B) Kallikrein
C) Factor XII
D) Plasmin
a
220
What is the main effect of thrombin in the clotting cascade related to inflammation?
A) It cleaves C3 into C3a and C3b
B) It converts fibrinogen to fibrin, creating a clot that traps pathogens
C) It inhibits leukocyte migration
D) It acts as an anaphylatoxin
b
221
A patient on anticoagulant therapy develops impaired wound healing. Which aspect of innate immunity might be affected by this therapy?
A) Complement activation
B) Kinin-mediated pain response
C) Formation of fibrin clots that help contain infection
D) Antibody production
c
222
The complement component C5a contributes to inflammation by:
A) Forming pores in bacterial membranes
B) Acting as a chemoattractant for neutrophils
C) Directly lysing pathogens
D) Stimulating antibody production
b
223
Which lab test would help assess activation of the clotting system in a patient with suspected disseminated intravascular coagulation (DIC)?
A) Serum complement levels
B) Activated partial thromboplastin time (aPTT) and D-dimer
C) Kallikrein activity
D) C-reactive protein (CRP)
b
224
In anaphylaxis, which of the following systems and mediators are primarily responsible for vasodilation and increased vascular permeability?
A) Complement system - C3b
B) Kinin system - Bradykinin and complement anaphylatoxins (C3a, C5a)
C) Clotting system - Fibrin
D) Adaptive immunity - T cells
b
225
Which of the following correctly pairs the system with its primary trigger in innate immunity?
A) Complement - Tissue injury and antibody-antigen complexes
B) Kinin - Activation of Factor VIII
C) Clotting - Direct binding of pathogens to TLRs
D) Complement - Bradykinin release
a
226
