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1. A patient has endured several dosage adjustments of his tricyclic
antidepressant, so the provider recommends genetic testing. Which statement
correctly describes the rationale for genetic testing?
a. The CYP2D6 gene influences metabolism of tricyclic antidepressants and certain
other drugs
b. The HER2 gene is a tumor marker that impacts metabolism of tricyclic
antidepressants
c. The BRCA2 gene influences metabolism of certain drugs and increases the risk
for breast cancer
d. The X-linked OPN1MW gene for male color blindness slows metabolism of
antidepressants
Answer: a. The CYP2D6 gene influences metabolism of tricyclic antidepressants
and certain other drugs
Rationale: CYP2D6 polymorphisms affect metabolism of 25% of prescribed drugs
(including TCAs, beta blockers, antipsychotics). HER2 and BRCA2 are cancer-
related genes, while OPN1MW is linked to color blindness — not drug
metabolism.
2. According to the CDC, the 10 most costly chronic conditions include
cardiovascular diseases, obesity, asthma, diabetes, smoking- and alcohol-related
,conditions, cancer, Alzheimer’s disease, arthritis, and stroke. Which are the top 4
from most costly to least costly?
a. Cardiovascular diseases, obesity, diabetes, cancer
b. Cardiovascular diseases, diabetes, obesity, cancer
c. Cardiovascular diseases, smoking-related conditions, alcohol-related conditions,
diabetes
d. Cardiovascular diseases, stroke, obesity, diabetes
Answer: c. Cardiovascular diseases, smoking-related conditions, alcohol-related
conditions, diabetes
Rationale: Cardiovascular disease is the costliest. Smoking and alcohol-related
illnesses account for enormous healthcare spending, followed by diabetes.
Obesity is significant but not top 4.
3. A mother learns her son has 2 X chromosomes and 1 Y chromosome per cell.
The provider explains he may have sparse body hair, long limbs, and small testes.
Which syndrome is this?
a. Klinefelter syndrome
b. Turner syndrome
c. Down syndrome
d. Kawasaki disease
Answer: a. Klinefelter syndrome
Rationale: Klinefelter = XXY, male phenotype with infertility and feminized
features. Turner = XO, female with short stature and ovarian dysgenesis. Down =
Trisomy 21. Kawasaki = childhood vasculitis.
4. A patient reports a maternal family history of Lynch syndrome. Which
laboratory finding would prompt further testing?
,a. Elevated thyroid-stimulating hormone
b. Low cortisol level
c. Positive heme-occult test
d. Sputum positive for Pseudomonas aeruginosa
Answer: c. Positive heme-occult test
Rationale: Lynch syndrome = hereditary colorectal cancer. Occult GI bleeding is a
red flag. Thyroid, cortisol, and sputum cultures are unrelated.
5. An individual’s acquired immunity is dependent on the function of which cells?
(Select all that apply.)
a. B lymphocytes
b. Opsonins
c. T lymphocytes
d. Macrophages
Answer: a. B lymphocytes, c. T lymphocytes, d. Macrophages
Rationale: Acquired immunity involves B cells (antibodies), T cells (cell-mediated
response), and macrophages (antigen presentation). Opsonins enhance innate
phagocytosis, not acquired immunity.
6. A 17-year-old female is assessed for type 2 diabetes risk. Which factor would
not increase her risk?
a. Native American ancestry
b. Family history of type 1 diabetes mellitus (T1DM)
c. Obesity
d. Personal history of polycystic ovary syndrome (PCOS)
Answer: b. Family history of type 1 diabetes mellitus (T1DM)
Rationale: T2DM risk factors include obesity, PCOS, and certain ethnicities. T1DM
is autoimmune, not hereditary in the same sense.
, 7. Some older adults have impaired inflammation and wound healing. What is the
most common cause?
a. Circulatory system cannot adequately perfuse tissues
b. Complement and chemotaxis are deficient
c. Underlying chronic illness exists
d. Number of mast cells is insufficient
Answer: c. Underlying chronic illness exists
Rationale: Diabetes, vascular disease, and malnutrition impair wound healing.
While circulation and immune function change with age, chronic disease is the
strongest factor.
8. A patient with COPD has elevated pulmonary vascular resistance. Which
symptom suggests cor pulmonale (right-sided heart failure)?
a. Bilateral crackles
b. Generalized arthralgia
c. Jugular venous distention
d. Constipation
Answer: c. Jugular venous distention
Rationale: Cor pulmonale = right-sided heart failure from pulmonary HTN. JVD,
hepatomegaly, ascites, and peripheral edema are classic signs. Crackles = left-
sided failure.
9. A parent asks why her child with Tetralogy of Fallot squats often. What is the
best explanation?
a. It alleviates chest pain
b. It relieves hypoxia