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CHAPTER
Self-Assessment Test
Review Questions 11O4
Review Answers 1128
1103
,reviewquestions
1.IXI O -L I\. LJ \~s ±. lUINI o Each of the questions or incomplete statements that follows iscomprised of four suggested responses. Select the best answer or completion statement in each case.
1. What is the composition of the packing ofa column in gas-liquid chromatography?A. An inert materialB. A stationary phaseC. An inert material and a mobile phaseD. An inert material and a stationary phase
2. What is the principal estrogen producedduring pregnancy?A. EstroneB. IVp-EstradiolC. EstriolD. 6(3-Hydroxyestrone
3. Insecticides that are organic phosphoruscompounds, such as parathion andtetraethyl pyrophosphate, may causeinsecticide poisoning by inhibitingA. Lactate dehydrogenaseB. Acid phosphataseC. CholinesteraseD. Glucose-6-phosphate dehydrogenase
4. Which of the following is a water-solublevitamin?A. AB. CC. DD. E
5. Which of the following is a laboratoryassay used for detecting cystic fibrosis?A. Serum lipaseB. Serum amylaseC. Serum trypsinD. Sweat chloride
6. In primary hypothyroidism one wouldexpect the serum FT4 level to be
, the TSH level to be, and the TBG level to be
A. Decreased, increased, slightly increasedB. Decreased, decreased, slightly increasedC. Increased, decreased, slightly increasedD. Decreased, increased, slightly decreased
1104
REVIEW QUESTIONS • 1105
7. A serum sample is moderately hemolyzed.Which of the following analyses would bemost significantly affected by thehemolysis?A. SodiumB. PotassiumC. GlucoseD. Urea
8. A black male 62 years of age is admittedin a semiconscious state experiencingshortness of breath and a temperatureof 100°F. His skin is pale and cool, andhe has been experiencing severe painin his back and jaw for approximately75 minutes. He experienced these samesymptoms 2 days earlier. The laboratorydata shows the following:
Total CK—elevatedCK-MB—elevatedMyoglobin—elevatedcTnl—elevated
Utilizing this information, what is themost likely diagnosis for this patient?A. Pulmonary infarctionB. Acute myocardial infarctionC. Muscular dystrophyD. Angina pectoris
9. A blood specimen is drawn in themorning, and the serum is removedfrom the clot and left standing at roomtemperature until late in the afternoon.Which of the following parameters wouldbe most severely affected by delayedanalysis?A. UreaB. PotassiumC. Alanine aminotransferaseD. Bilirubin
10. In ketoacidosis, the anion gap would mostlikely be affected in what way?A. Unchanged from normalB. IncreasedC. DecreasedD. Balanced
11. If the aspartate aminotransferase (AST)and the alanine aminotransferase (ALT)serum levels are increased 50-fold over thereference range, what would be the mostconsistent diagnosis?A. Extrahepatic cholestasisB. CirrhosisC. Carcinoma of the liverD. Viral hepatitis
12. A decreased bicarbonate level in the bloodwithout a change in PCO2 will result inwhat acid/base imbalance?A. Respiratory acidosisB. Respiratory alkalosisC. Metabolic acidosisD. Metabolic alkalosis
13. Elevated serum levels of urea, creatinine,and uric acid would be suggestive of whatdisorder?A. GoutB. Chronic renal failureC. CirrhosisD. Malnutrition
1106 • CHAPTER 17: SELF-ASSESSMENT TEST
14. The following results were obtained ona pregnant female patient following theingestion of 75 grams of glucose as partof an oral glucose tolerance test.
15.
16.
Time SpecimenCollected
Fasting
1 hour
2 hours
PlasmaGlucose
124mg/dL
220 mg/dL
170mg/dL
Based on the preceding information, whatwould be the most likely diagnosis?A. Normal glucose metabolismB. Diabetes niellitusC. Gestational diabetes mellitusD. Impaired glucose tolerance
Which of the following methods may beused to quantify total protein in serum,urine, or cerebrospinal fluid?A. Coomassie brilliant blueB. Sulfosalicylic acidC. Bromcresol greenD. Ponceau S
A patient who received a blood transfu-sion experienced a moderate transfusionreaction. Because of the presence of freehemoglobin in the plasma, which serumprotein will exhibit a decreased level?A. CeruloplasminB. TransferrinC. oc2-MacroglobulinD. Haptoglobin
17. When employing a diazo method toquantify serum bilirubin, which of thefollowing blood constituents when presentin an elevated amount will cause a falselydepressed bilirubin result?A. AmmoniaB. CreatinineC. HemoglobinD. Uric acid
18. What quality incorporated into a spec-trophotometer can sometimes improve thelinearity of a chemistry procedure?A. Flow-through cuvetteB. Wider bandwidthC. Narrower bandwidthD. Chopper
19. What hormone plays a primary role incontrolling the reabsorption of sodium inthe tubules?A. CortisolB. CortisoneC. EstriolD. Aldosterone
20. Which of the following is associated withindividuals diagnosed with Addisondisease?A. HypoglycemiaB. Casual plasma glucose >200 mg/dLC. Fasting plasma glucose ^126 mg/dLD. 2-Hour post-load glucose >200 mg/dL
21. Which of the following tests when usedtogether are helpful in monitoringtreatment and identifying recurrenceof testicular cancer?A. AFPandCEAB. AFPandhCGC. CEAandhCGD. CA 125 and C A 19-9
REVIEW QUESTIONS • 1107
22. To detect respiratory distress syndrome,what specimen is used for measuring thesurfactant/albumin ratio by fluorescencepolarization?A. SerumB. PlasmaC. UrineD. Amniotic fluid
23. High levels of cholesterol leading toincreased risk of coronary artery diseasewould be associated with which lipopro-tein fraction?A. LDLB. VLDLC. HDLD. Chylomicrons
24. A female patient upon hospital admissionexhibits a serum osmolality level of 350mOsm/kg. Which of the following wouldnot be a possible cause of this result?A. Elevated serum potassium levelB. Elevated serum sodium levelC. Elevated serum glucose levelD. Dehydration
25. If the ratio of bicarbonate to carbonic acidis 30:1, what would be the blood pH?A. IncreasedB. DecreasedC. StableD. Normal
26. Upon what principle is nephelometricmeasurement based?A. Fluorescence producedB. Phosphorescence producedC. Light transmittedD. Light scattered
27. Which of the following causes beta-thalassemia major?A. Amino acid substitution in both
beta-globin chainsB. Deficiency of an enzyme needed for
heme synthesisC. Decreased rate of synthesis of both
beta-globin chainsD. Presence of an unstable hemoglobin
28. The main source of erythropoietin is theA. LiverB. KidneyC. Bone marrowD. Spleen
29. Red blood cell distribution width (ROW)is a measurement of theA. Average size of the red blood cellsB. Hemoglobin content of the red blood
cellsC. Coefficient of variation of the red cell
populationD. Various maturation stages of red blood
cells
30. Aminolevulinic acid (ALA) synthase is anenzyme involved inA. Early stages of heme synthesis in the
mitochondriaB. Intermediate stages of heme synthesis
in the cytoplasmC. Globin-chain synthesisD. Embden-Meyerhof pathway
31. Hemoglobin A2 consists ofA. Two alpha- and two beta-globin chainsB. Two alpha-and two gamma-globin
chainsC. Four beta-globin chainsD. Two alpha- and two delta-globin
chains
1108 • CHAPTER 17: SELF-ASSESSMENT TEST
32. Increased osmotic fragility test resultscould be expected in which of thefollowing disorders?A. Sickle cell anemiaB. Iron-deficiency anemiaC. Beta-thalassemia minorD. Hereditary spherocytosis
33. Which of the following conditions wouldnot exhibit the red blood cell morphologyseen in Color Plate 9B?A. Pyruvate kinase deficiencyB. Sideroblastic anemiaC. Post-transfusionD. Iron-deficiency anemia post-treatment
34. Complement-induced red blood cell lysisand an abnormal sugar-water test are seenin which disorder?A. Glucose-6-phosphate dehydrogenase
deficiencyB. Hereditary spherocytosisC. Paroxysmal nocturnal hemoglobinuriaD. Paroxysmal cold hemoglobinuria
35. Which of the following will not beincreased in polycythemia vera?A. Plasma volumeB. Leukocyte alkaline phosphataseC. Platelet countD. White blood cell count
36. Which of the following stains is used tovisualize reticulocytes?A. Wright'sB. Crystal violetC. Prussian blueD. New methylene blue
37. The function of the hexose monophos-phate shunt is toA. Produce adenosine triphosphate (ATP)B. Produce 2,3-bisphosphoglycerate
(2,3-BPG)C. Prevent oxidation of hemoglobinD. Participate in heme synthesis
38. Hemoglobin is measured spectrophoto-metrically at what wavelength?A. 410 nmB. 472 nmC. 540 nmD. 610 nm
39. The red blood cells seen in Color Plate 8Bwould most likely be associated withA. Sideroblastic anemia or beta-
thalassemia majorB. Hereditary spherocytosis or warm
autoimmune hemolytic anemiaC. Iron-deficiency anemia or beta-
thalassemia minorD. Aplastic anemia or chemotherapy
40. Amino acid substitutions on globin chainscause what disorders?A. HemoglobinopathiesB. ThalassemiasC. Unstable hemoglobinsD. Porphyrias
41. The leukocyte first to migrate, engulf, anddestroy a foreign body in the tissue is theA. MacrophageB. MonocyteC. NeutrophilD. Lymphocyte
42. What immunoglobulin is increased inWaldenstrom macroglobulinemia?A. IgAB. IgEC. IgGD. IgM
REVIEW QUESTIONS • 1109
43. The leukocyte alkaline phosphatase stainis most helpful in the differentiation ofA. Neutrophilic leukemoid reaction and
degenerative left shiftB. Neutrophilic leukemoid reaction and
chronic myelogenous leukemiaC. Chronic myelogenous leukemia and
acute myelogenous leukemiaD. Acute myelogenous leukemia and
acute lymphoblastic leukemia
44. Which cell line is normally the mostnumerous in the bone marrow?A. LymphocyticB. MegakaryocyticC. ErythroidD. Myeloid
45. Which FAB type of myelodysplasticsyndrome is least likely to progress toacute myelogenous leukemia?A. Refractory anemia (RA)B. Chronic myelomonocytic leukemia
(CMML)C. Refractory anemia with excess blasts
(RAEB)D. Refractory anemia with excess blasts
in transformation (RAEB-t)
46. A 5-year-old girl has been recentlydiagnosed with acute lymphoblasticleukemia. Which of the following is nottypical of this diagnosis?A. Using WHO criteria, bone marrow
blasts will be >20%.B. CALLA (CD 10) positive type has a
poor prognosis.C. Central nervous system involvement is
common.D. Leukemic blast cells show PAS
positivity.
47. Which of the following cells will stainpositive when tartrate is added to the acidphosphatase (TRAP) stain?A. Sezary cellsB. Plasma cellsC. Hairy cellsD. Large granular lymphocytes
48. A 59-year-old patient is evaluated forsevere anemia, thrombocytopenia, andneutropenia. What test(s) will provide themost useful information?A. Ham's and sugar-water testsB. Bone marrow aspirate and biopsyC. Reticulocyte count and immature
reticulocyte fraction (IRE)D. Test for heterophile antibodies
49. The Philadelphia chromosome is aconsistent finding in patients with whatdisorder?A. Chronic myelogenous leukemiaB. Acute myelomonocytic leukemiaC. Myelodysplastic syndromeD. Chronic idiopathic myelofibrosis
50. Pelger-Huet anomaly is associated withA. Large Dohle-like bodies and giant
plateletsB. Large azurophilic granules in all
leukocytesC. Defective neutrophilic phagocytosisD. Morphologically immature but
functionally normal neutrophils
51. Plasma cells are found in large numbers inthe bone marrow and occasionally in theperipheral blood of patients with whatdisorder?A. Multiple myelomaB. Burkitt lymphomaC. Acute lymphoblastic leukemiaD. Infectious mononucleosis
1110 • CHAPTER 17: SELF-AS5ESSMENTTEST
52. The blood smear shown in Color Plate 12Bis from a 16-year-old male with com-plaints of extreme fatigue and sore throat.His WBC, hemoglobin, and platelet countresults are normal. Based on the clinicaland laboratory information, which of thefollowing is the most likely cause of hiscondition?A. Staphylococcal pneumoniaB. Infectious mononucleosisC. Chronic lymphocytic leukemiaD. Non-Hodgkin lymphoma
53. Which of the following disorders is notassociated with pancytopenia?A. Neutrophilic leukemoid reactionB. Megaloblastic anemiaC. Paroxysmal nocturnal hemoglobinuriaD. Aplastic anemia
54. Inability to obtain a bone marrow aspirateis frequently encountered in patients withwhich of the following disorders?A. Acute monocytic leukemia and
myelodysplastic syndromesB. Chronic idiopathic myelofibrosis and
hairy cell leukemiaC. Polycythemia vera and essential
thrombocythemiaD. Erythroleukemia and acute megakary-
ocytic leukemia
55. The cytoplasmic inclusion present in thecell shown in Color Plate 17'• excludes adiagnosis ofA. Acute myelogenous leukemia without
maturation (FAB Ml)B. Acute promyelocytic leukemia
(FAB M3)C. Acute myelomonocytic leukemia
(FAB M4)D. Acute lymphoblastic leukemia
56. Which of the following is considereddiagnostic for Hodgkin lymphoma?A. Sezary cellB. BurkittcellC. Reed-Sternberg cellD. Reider cell
57. The test of choice to detect abnormalitiesin the intrinsic pathway of secondaryhemostasis is theA. Bleeding timeB. ThrombintimeC. Activated partial thromboplastin timeD. Prothrombin time
58. A patient experiencing bleeding problemshas a prothrombin time of 23 seconds(control = 12.0 seconds) and activatedpartial thromboplastin time of 61 seconds(control = 33.0 seconds). Of the follow-ing, which one is probably not deficient?A. Factor IIB. FactorVC. Factor XIID. Factor X
59. Which of the following describes plasmin?A. Enzyme that can digest cross-linked
fibrin into D-dimersB. Activator of plasminogenC. Circulates freely in the plasma ready
to digest fibrin clotsD. Forms a complex with tissue plasmino-
gen activators to digest fibrinogen
60. By what mechanism does aspiriningestion impair platelet function?A. Blocks glycoprotein receptors on the
surface of the plateletB. Decreases thrombopoietin levels and
subsequent bone marrow plateletproduction
C. Interferes with the ability of plateletsto adhere to subendothelial collagen
D. Decreases thromboxane A2 formationby inhibiting cyclooxygenase
REVIEW QUESTIONS • 1111
61. Which of the following describesidiopathic thrombocytopenic purpura?A. Occurs only in a chronic formB. A platelet autoantibody is responsible
for platelet destruction.C. Develops in the majority of cases after
recovery from a bacterial infectionD. Causes decreased bone marrow
synthesis of platelet precursors
62. The most important naturally occurringinhibitor to clotting isA. AntithrombinB. Lupus inhibitorC. Protein CD. a2-Antiplasmin
63. The prothrombin time is usually notprolonged in patients withA. Hemophilia AB. Severe liver diseaseC. Factor VII deficiencyD. Venous thromboembolism treated with
Coumadin®
64. An 18-year-old male was seen in theemergency department following amotorcycle accident. The patient was notweaiing his helmet at the time of theaccident. He was comatose and wasadmitted to the hospital with a diagnosis ofsevere closed head injury. The next day thepatient was noted to have increasedbleeding from venipuncture sites. Given thefollowing results, what was the most likelydiagnosis for this patient?
Tests
PT
aPTT
Fibrinogen
Thrombintime
Plateletcount
FDPtest
D-dimer
PatientResults
25.0 seconds
89.0 seconds
65 mg/dL
45 seconds
32 X 109/L
>20 |a,g/mL
>1.0 jjig/mL
ReferenceRanges
1 1.0-13.0 seconds
22.0-38.0 seconds
150-400 mg/dL
15-20 seconds
1 50-450 X 1 09/L
<5 ixg/mL
<0.5 (xg/mL
A.B.C.D.
Hemophilia APrimary fibrinogenolysisThrombotic thrombocytopenic purpuraDisseminated intravascularcoagulation
65. Of the following conditions that causebleeding, the most common isA. Hemophilia AB. ThrombocytopeniaC. von Willebrand diseaseD. Hemophilia B
1112 • CHAPTER 17: SELF-ASSESSMENTTEST
66. Which of the following will patients withclassic von Willebrand disease notexhibit?A. Easy bruisingB. Decreased platelet aggregation with
ristocetinC. Prolonged prothrombin timeD. Prolonged bleeding time
67. How are individuals with cellular immunedeficiencies best identified?A. Determining serum complement
concentrationB. Human leukocyte antigen (HLA)
typingC. Serum electrophoresis testingD. Skin testing
68. Which of the following is characteristic ofDiGeorge syndrome?A. Defective T lymphocyte productionB. Depressed B cell developmentC. Suppressed intracellular killing by
polymorphonuclear cellsD. Suppressed complement levels
69. The interaction between antigen-presenting cells and T helper cells ismediated by surface expressed antigen andA. Interferon gammaB. Interleukin 2C. Interleukin 3D. MHC class II molecules
70. Which of the following cell types is animportant mediator of antibody-dependentcellular cytotoxicity (ADCC) reactions?A. B cellsB. Cytotoxic T cellsC. Natural killer cellsD. Suppressor T cells
71. What is the portion of an antigen thatbinds specifically to the binding site of anantibody called?A. EpitopeB. HaptenC. IdiotopeD. Paratope
72. Which of the following is true of thealternative complement pathway?A. Activated by bacterial polysaccharideB. C3 is not involved.C. Cl initiates activation.D. Primarily activated by antibody
73. A type I hypersensitivity reaction requiresA. IgAB. IgDC. IgED. IgG
74. A substance able to induce an immuneresponse describes which of the following?A. AllotypeB. AntigenC. EpitopeD. Immunogen
75. The B cell surface receptor for antigen isA. CDSB. ImmunoglobulinC. Interleukin 2D. MHC I antigen
76. Which of the following frequentlyfunctions as an antigen-presenting cell?A. Dendritic cellB. Cytotoxic T lymphocyteC. Natural killer cellD. T helper cell
REVIEW QUESTIONS • 1113
77. Which of the following cell types containsclass II human leukocyte antigens?A. All nucleated cellsB. B cells onlyC. Platelets onlyD. White blood cells only
78. The presence of antinuclear antibodies issuggestive of a(n)A. Acute glomerulonephritisB. Autoimmune diseaseC. Cell-mediated immune deficiencyD. Humoral-mediated immune deficiency
79. Graves disease is an autoimmune diseaseprimarily affecting theA. Adrenal glandB. Nerve synapsesC. PancreasD. Thyroid
80. Which of the following markers is foundon mature T helper cells?A. CD4B. CDSC. CD10D. CD25
81. Which of the following is an example of adouble diffusion assay?A. Immunofixation electrophoresisB. OuchterlonyC. Radial immunodiffusionD. Rocket electrophoresis
82. Patients with hyper-IgM syndromeproduce large amounts of IgM andmarkedly decreased IgG and IgA.What causes this phenomenon?A. Antigen is only presented to B cells
capable of making IgM.B. B cells capable of synthesizing IgG
and IgA are lacking.C. Lack of class switching occurs.D. T cells secrete lymphokines that
stimulate the production of IgM.
83. Which of the following is a nonphagocyticcytotoxic cell able to kill cells rapidlywithout having been previously exposedto antigens on that cell?A. Cytotoxic T cellB. T helper cellC. Natural killer cellD. Suppressor T cell
84. Which of the following is a granulocyticcell with IgE receptors?A. Cytotoxic T cellB. Mast cellC. Natural killer cellD. Plasma cell
85. Which of the following is an oncofetalantigen whose presence in adult serum issuggestive of carcinoma?A. a-FetoproteinB. C-reactive proteinC. Lymphocyte function-associated
antigen 1D. Nuclear antigens
86. An adaptive or specific immune responseincludesA. Antibody synthesisB. Complement activationC. InflammationD. Phagocytosis
87. Information obtained from a volunteerblood donor at the time of registrationis designed to protect the health of bothdonor and recipient. Of the followingresponses, which would cause the donorto be deferred from the collection process?A. Received his last injection in a vaccine
series for hepatitis B 3 weeks agoB. Had a tooth filled 1 week agoC. Took aspirin yesterday for a headacheD. Taking Tegison
1114 CHAPTER 17: SELF-ASSESSMENTTEST
88. Interpret the following reactions:
Patientserum
A,cells
+w
Bcells
4+ Patientcells
Anti-A
3+ mf
Anti-B
0
A. Group A7 patient with anti-Aj in hisserum
B. Group A patient having rouleauxC. Group A patient transfused with group
O cellsD. Group A patient with acquired B
antigen
89. The inlet port on a closed unit of red bloodcells collected in CP2D is defective,preventing the addition of Adsol®. Whatwill be the resulting shelf life of the redblood cells?A. 24 hoursB. 21 daysC. 35 daysD. 42 days
90. When testing blood donors for HIV, whatis the major advantage of NAT over EIAtesting for anti-HIVl?A. Simplicity of performanceB. Less expensiveC. Requires less "tech time"D. Increased specificity
91. What is the expiration date for freshfrozen plasma (FFP) that is stored at-18°C or colder?A. 1 yearB. 3 yearsC. 5 yearsD. 7 years
92. A 35-year-old male is found to have afactor V deficiency. He should be treatedfor the deficiency withA. Cryoprecipitated AHFB. Red blood cellsC. Fresh frozen plasmaD. Pooled platelet concentrates
93. Which of the following donors wouldmost likely be allowed to donate autolo-gous blood for elective surgery if all othercriteria are acceptable?A. 15-year-old girl with a hemoglobin of
12 g/dLB. 17-year-old boy with intermittent
bacteremiaC. 30-year-old man with aortic stenosisD. 25-year-old woman who had a baby
4 weeks ago
94. A 32-year-old female, pregnant with herfourth child, is seen in the emergencydepartment for childbirth. There are norecords of her prenatal care available. Sheis group AB, D-negative, weak D negative.She gives birth to a group O, D-negative,weak D positive girl. Her husband is groupO, D-negative, weak D positive. Which ofthe following may explain these results?A. NonpaternityB. Mother carries the cis-AB geneC. Father has been mistypedD. Child has been switched with another
woman's infant
95. Hemophilia A and B (Christmas disease)both provide a classic example of whichpattern of inheritance?A. X-linked recessiveB. X-linked dominantC. Autosomal recessiveD. Autosomal dominant
REVIEW QUESTIONS • 1115
96. A and B blood group antigens are derivedwhen glycosyltransferases add specificsugars to precursor H. What is theterminal sugar for the B antigen?A. FucoseB. ./V-acetylglucosamineC. ./V-acetylgalactosamineD. D-Galactose
97. Which of the following does not charac-terize Rhnull individuals?A. Red blood cells lack all antigens in the
Rh system.B. Red blood cell morphology shows
stomatocytes.C. Red blood cell survival is shortened
with compensated anemia.D. Condition may be inherited or acquired.
98. Which of the following antigens is themost immunogenic after A, B, and Dantigens?A. CB. EC. Fya
D. K
99. In a lymphocytotoxicity test, 80% of apatient's WBCs are highly refractile in thewells in which anti-HLA-A7 and anti-HLA-A12 were placed. The wells inwhich anti-HLA-A5 and anti-HLA-A27were placed show no refractile patientWBCs. You would interpret thesereactions as meaning that the patientis(has)A. HLA-A7 and HLA-A12 positiveB. HLA-A5 and HLA-A27 positiveC. Antibody to HLA-A7 and HLA-A12D. An invalid test for HLA-A7 and
HLA-A12
100. Following compatibility testing, for howlong must the patient's blood sample andthe donor's red blood cells be retained?A. 7 days after crossmatchingB. 7 days after transfusionC. 9 days after crossmatchingD. 10 days after transfusion
101. An antibody screen gives the followingresults. What do the results indicate aboutthe patient?
is
37°C LISS
AHG(monospecific)
CC V
1+
3+
V
A. Autoantibody reacting at all phases oftesting
B. Alloantibody showing dosageC. More than one alloantibodyD. Rouleaux reaction
102. The use of an autocontrol during antibodyscreening for pretransfusion testingA. Is requiredB. Is optionalC. May be eliminated if a DAT is
performedD. May aid in detecting alloantibody
1116 • CHAPTER 17: SELF-ASSESSMENTTEST
103. A "type and screen" established that apremature infant is group A, D-positivewith a negative antibody screening test.Numerous small volume transfusions arepredicted. If only group O RBC are to betransfused, how often must the infant becrossmatched?A. Before transfusion and whenever
3 days have elapsed before the nexttransfusion
B. Before transfusion and whenever7 days have elapsed before the nexttransfusion
C. If during the same admission, not untilhe reaches 2 months of age
D. If during the same admission, not untilhe reaches 4 months of age
104. The serum from a patient with warmautoimmune hemolytic anemia is found tocontain autoanti-e and alloanti-E. Youwould transfuse this patient with red bloodcells that areA. E-negative, e+B. e-Negative, E+C. E-negative, e-negative
D- Rhnun
105. Following removal of plasma from awhole blood unit, the RBCs may beresuspended in an additive solution.Which of the following does not describethese solutions?A. Must be added within 72 hours after
plasma separationB. Contain inosine and pyruvate
Maintain increased levels of ATP instored cellsExtend the shelf life of red blood cells
C.
D.to 42 days
106. Platelets prepared in polyolefin (PL-732)differ from platelets prepared inpolyvinylchloride (PVC) because bagswithout plasticizersA. Increase platelet shelf life to 7 daysB. Allow platelet storage at 1-6°CC. Promote improved gas exchange with
environmental airD. Promote accelerated lactic acid
production
Using the chart below, what is(are) themost likely antibody specificity(ies) in thispatient's serum?A. Anti-C and anti-Jka
B. Anti-K and anti-Jkb
C. Anti-C showing dosage and anti-ED. Anti-Jkb
Cell*
i
2
3
4
5
D
+
+
+
0
0
C
0
0
+
+
0
E
0
0
+
0
+
K
+
0
0
+
0
Jk«
0
+
+
0
0
Jk" .
0
0
0
+
+
AHG
2+
0
0
4+
1 +
«DV
V
REVIEW QUESTIONS • 1117
108. A blood wanning device would most likelybe used in which of the following situations?A. Transfusing a patient with PCHB. Intrauterine transfusionC. Transfusion of a patient having
bacterial sepsisD. Transfusing FFP to a patient with
anti-Lea
109. What is the most common cause of anemialeading to transfusion in sick neonates?A. Bleeding from the umbilicusB. Red blood cell destruction because of
HDNC. Blood drawn for laboratory testingD. Immature bone marrow response
110. What is the initial step to perform when apatient is suspected of having a transfu-sion reaction?A. Perform a DAT on a post-transfusion
specimenB. Compare the pretransfusion and post-
transfusion serum for evidence ofhemolysis
C. Check identification of the patient anddonor blood
D. Stop the transfusion
111. Which of the following laboratoryfindings does not occur in hemolytictransfusion reactions?A. HemoglobinuriaB. HaptoglobinemiaC. HemoglobinemiaD. Bilirubinemia
112. To which organization must the hospitaltransfusion service laboratory report allcases of transfusion-associated disease?A. Blood-collecting facilityB. Centers for Disease Control and
Prevention (CDC)C. Food and Drug Administration (FDA)D. State Health Department
113. To comply with the requirements ofAABB Standards, which of the followingtests must be performed on each unitbefore blood bank personnel may issueautologous units of blood drawn in theirfacility?A. ABO and Rh typingB. HBsAgC. Anti-HIVlD. DAT
114. The CDC recommends that "standardprecautions" be exercised by all health-care workers to prevent transmission ofhepatitis B virus, HIV, and other blood-borne pathogens. What do these precau-tions include?A. Wearing protective clothing when
testing blood specimens from patientsin specific areas
B. Using special precautionary methodswhen testing blood specimens with abiohazard label
C. Handling every patient bloodspecimen as if it were infectious
D. Carefully recapping needles beforediscarding
115. To ensure proper reactivity, how fre-quently must all blood bank reagents bequality controlled?A. With each testB. DailyC. Each day of useD. Weekly
116. What should one do to validate thereaction obtained in the antiglobulin test?A. Use green antiglobulin reagentB. Add IgG-coated red cells to each test
tubeC. Add IgG-coated red cells to each
positive reactionD. Add IgG-coated red cells to each
negative reaction
1118 • CHAPTER 17: SELF-ASSESSMENT TEST
117. Which of the following strategies will nothelp to minimize the outdate rate of bloodin inventory?A. Providing transfusion guidelinesB. Implementing a first-in, last-out
(FILO) policyC. Monitoring crossmatch to transfusion
(CT) ratiosD. Instituting a maximum surgical blood
order schedule (MSBOS)
118. Clotting may be incomplete in bloodspecimens from patients treated withheparin. Which of the following alterna-tives will not provide an acceptablespecimen for pretransfusion testing?A. Adding protamine sulfateB. Adding thrombinC. Adding chloroquine diphosphateD. Using an EDTA specimen for testing
119. A person with the genotype AO, HH, Sese,Lele will have which of the followingcombination of substances in hersecretions?A. A,H, Se,Lea
B. Lea,Leb
C. A,H,Lea,Leb
D. A, O,Leb
120. An immediate spin (IS) crossmatch or acomputer crossmatch (if the computersystem is validated for this use) may beused as the sole compatibility test when apatient has a confirmed blood type, anegative antibody screening test, andA. A negative DAT resultB. No history of unexpected antibodyC. No record of previous transfusionD. The same ABO and Rh type as the
donor
121. Within how many hours after poolingmust pooled platelet concentrates betransfused?A. 4B. 6C. 8D. 12
122. Pus with a blue-green color was aspiratedfrom an empyema. A Gram stain of theaspirated material showed many whiteblood cells and numerous gram-negativebacilli. What would be the most likelyetiologic agent?A. Legionella pneumophilaB. Pseudomonas aeruginosaC. Morganella morganiiD. Serratia marcescens
123. In the early stages of typhoid fever,Salmonella Typhi is most likely to berecovered from which of the followingspecimen types?A. BloodB. FecesC. UrineD. Skin lesions
124. Symptoms of gastritis and pepticulceration are most closely associatedwith which of the following?A. Campylobacter jejuniB. Enterotoxigenic Escherichia coliC. HelicobacterpyloriD. Vibrio cholerae
REVIEW QUESTIONS • 1119
125. A patient with impaired cell-mediatedimmunity presents with evidence of apulmonary abscess and neurologicinvolvement. A brain abscess was detectedby MRI. Material from the abscess grewan aerobic, filamentous, branching gram-positive organism, which stained weaklyacid-fast. What is the most likely etiologicagent?A. Propionibacterium acnesB. Nocardia asteroidesC. Actinobacillus israeliiD. Bacillus cereus
126. The organism Borrelia recurrentis is theetiologic agent ofA. Lyme diseaseB. Relapsing feverC. Undulant feverD. Weil disease
127. Most cases of legionellosis are acquiredfromA. Environmental water sourcesB. Person-to-person transmissionC. MosquitoesD. Farm animals
128. What chemical is commonly added toblood culture media as an anticoagulant?A. ARDB. CNAC. CIND. SPS
129. Which of the following statements is trueregarding anaerobic infections?A. Anaerobic pulmonary infections are
rare because lung tissue is wellventilated.
B. Because of the inaccessibility oforgans such as the liver and brain toindigenous flora, they are seldominfected with anaerobes.
C. Bacteremia due to anaerobes is benignbecause anaerobes do not possessendotoxin.
D. Intra-abdominal abscesses, peritonitis,and wound infections can occurpostoperatively when devitalized tissueis contaminated with bowel contents.
130. Foul-smelling pus aspirated from apostsurgical cholecystectomy patient grewa gram-positive bacillus. When culturedon an anaerobically incubated blood agarplate, it grew colonies surrounded by aninner zone of complete red blood cell lysisand an outer zone of incomplete cell lysis.What would be the most likely identifica-tion of this isolate?A. Fusobacterium nucleatumB. Clostridium perfringensC. Clostridium tetaniD. Bacteroidesfragilis
131. A common cause of mild primary atypicalpneumonia isA. Bordetella parapertussisB. MycoplasmapneumoniaeC. Pseudomonas aeruginosaD. Streptococcus pneumoniae
132. Which of the following antimicrobialsusceptibility tests would not provide theminimal inhibitory concentration?A. Agar dilutionB. Broth dilutionC. Disk diffusionD. Gradient diffusion
1120 • CHAPTER 17: SELF-ASSESSMENT TEST
133. Which of the following is associated withStreptococcus agalactiae?A. Common cause of pharyngitis in adultsB. Important cause of neonatal sepsis and
meningitisC. Is also called viridans StreptococcusD. Is implicated in dental caries
134. The presence of spirochetes seen in materialcollected from a chancre is diagnostic forA. ChancroidB. Lyme diseaseC. Relapsing feverD. Syphilis
135. Which of the following is associated withVibrio cholerae?A. Sucrose fermentation negativeB. Requires media with high salt
concentrationC. Is a component of the normal flora of
the human intestineD. Produces a toxin that causes increased
secretion of water and electrolytesfrom the gut
136. A blood culture grew a small, pleomor-phic, anaerobic, gram-negative rod. Itgrew on kanamycin-vancomycin laked-sheep blood agar, grew in the presence of20% bile, and was esculin positive. Thisorganism is most likelyA. BacteroidesfragilisB. Clostridium perfringensC. Fusobacterium nucleatumD. Veillonella sp.
137. A coagulase-negative Staphylococcus wasisolated from a urine culture. It wasidentified as Staphylococcus saprophyti-cus on the basis of it beingA. Coagulase positiveB. Resistant to novobiocinC. DNase positiveD. Mannitol positive
138. A nonhemolytic gram-positive, catalase-negative bacterium isolated from a urineculture gave the following reactions: bileesculin positive and no growth in 6.5%NaCl. This microorganism should beidentified asA. Streptococcus agalactiaeB. EnterococcusfaecalisC. Streptococcus mutansD. Streptococcus bovis group
139. Refer to Color Plate 26B. The organismseen on this Gram stain was isolated fromthe cerebrospinal fluid of an infant. It grewon sheep blood agar with faint beta-hemolysis. It was catalase positive. Whatmicroorganism should be suspected?A. Bacillus subtilisB. Lactobacillus sp.C. Bifidobacterium dentiumD. Listeria monocy to genes
140. You isolate a small, pleomorphic, gram-negative rod from the cerebrospinal fluidof a 9-month-old infant. It fails to grow onsheep blood agar or MacConkey agar, butit grows well on chocolate agar incubatedin 5% CO,,. What bacterium would yoususpect?A. Escherichia coliB. Streptococcus agalactiaeC. Haemophilus influenzaeD. Listeria monocytogenes
REVIEW QUESTIONS • 1121
141. An oxidase-positive, gram-negativebacillus was isolated from a burn patient.It gave the following reactions: OFglucose open, acid; OF glucose closed,alkaline; OF maltose open, alkaline;positive for pyocyanin production;positive for fluorescein production; andgood growth at 42°C. The microorganismis most likelyA. AlcaligenesfaecalisB. Pseudomonas aeruginosaC. Stenotrophomonas maltophiliaD. Acinetobacter anitratus
142. What is the etiologic agent ofpseudomembranous colitis?A. Clostridium difficileB. HeUcobacterpyloriC. Streptococcus pyogenesD. Vibrio parahemolyticus
143. A gram-negative bacillus was isolatedon MacConkey agar and appeared as anon-lactose fermenter. It was oxidasenegative and gave the following reactions:TSI-K/A with H9S, motile, urease positive,and lysine negative. Which of the followingwould be characterized by these reactions?A. Salmonella TyphimuriumB. Shigella sonnetC. Proteus mirabilisD. Edwardsiella tarda
144. A patient with severe abdominal painand diarrhea was admitted to the hospital.When the stool was cultured, no suspi-cious colonies were seen on Hektoenenteric or xylose-lysine-desoxycholateagars. However, on the MacConkey plateseveral non-lactose-fermenting colonieswere observed. Biochemical results forthese colonies gave the followingreactions:
TSI-A/A, no gas, no H2SUrease positiveMotility negative at 35°C;
positive at 22°COxidase negative
The most likely organism would beA. Shigella sonnetB. Vibrio choleraeC. Salmonella TyphiD. Yersinia enterocolytica
145. A 45-year-old woman came to theemergency department after being bittenon the hand by her cat. The wound wasextremely painful and produced a largeamount of pus. The pus was cultured onsheep blood agar (SBA) and MacConkeyagar. After 24 hours, growth was observedon the SBA plate as tiny colonies thatproduced a slight greening on the underly-ing medium. A Gram stain revealed tinygram-negative rods. There was no growthon the MacConkey agar. Biochemical testsgave the following reactions:
TSI-A/AOxidase positiveNonmotileUrease negative
The most likely organism would beA. Pasturella multocidaB. Corynebacterium diphtheriaeC. Brucella abortusD. Bordetella pertussis
1122 • CHAPTER 17: SELF-ASSESSMENTTEST
146. Buffered charcoal yeast extract agar(BCYE) is the primary medium for theisolation ofA. Bartonella bacilliformisB. Chlamydia pneumoniaeC. Legionella pneumophilaD. Mycoplasma pneumoniae
147. Coccidioides immitis produces arthroconi-dia when grown at room temperature.What form of the fungus is found inhuman tissue?A. YeastB. SpheruleC. Hyaline aseptate hyphaeD. Macroconidia with budding yeast
148. Selective medium for the isolation of thedimoiphic fungi often contain what agent toinhibit the growth of the saprophytic fungi?A. CyclohexamideB. ChloramphenicolC. SulfonamideD. Gentamicin
149. In regard to the true systemic dimorphicpathogens, the phase of growth that ismost infectious is theA. Phase seen in tissueB. Phase that grows at 22-30°CC. Phase that grows at 37°CD. All phases are equally infectious.
150. Which of the following is the definitivehost for Plasmodium spp.?A. HumansB. MosquitoesC. LiceD. Ticks
151. What is the source of most humaninfections caused by Toxoplasma gondii?A. CatsB. DogsC. FleasD. Humans
152. Refer to Color Plate 43B. What is theinfective form of this parasite?A. OvaB. OocystsC. Filariform larvaeD. Rhabditiform larvae
153. In what way are hepatitis B virus andhuman immunodeficiency virus similar?A. Ability to survive in the environmentB. Have cross-reacting antigensC. Nucleic acid compositionD. Require RNA-dependent
DNA-polymerase for replication
154. The reactivation of varicella results inA. Chicken poxB. Cold soresC. ShinglesD. Smallpox
155. Material collected from the nasopharynx ofa 1-year-old child with pneumonia is addedto HEp-2 cells. In a few days, enlarged cellswith several nuclei are seen. What is themost likely cause of the infection?A. Respiratory syncytial virusB. RotavirusC. Coxsackie virusD. Adenovirus
156. Which of the following is an example of asignal amplification method?A. bDNAB. Ligase chain reactionC. Polymerase chain reactionD. Strand displacement amplification
157. Stringency can be decreased by increasingA. Incubation timeB. Incubation temperatureC. Ionic strength (e.g., NaCl)D. pH
REVIEW QUESTIONS • 1123
158. In their correct order, what are the stepsinvolved in the polymerase chain reaction?A. Denaturation of dsDNA, annealing of
primers, synthesis of complementaryDNA strand
B. Annealing of primers, denaturation ofdsDNA, synthesis of complementaryDNA strand
C. Synthesis of complementary DNAstrand, denaturation of dsDNA,annealing of primers
D. Denaturation of dsDNA, synthesis ofcomplementary DNA strand, anneal-ing of primers
159. Sickle cell anemia is a genetic diseasecaused by a single base mutation in thebeta-globin gene. The single changeabolishes a Cvnl restriction site. Usingspecific primers that target a portion ofbeta-globin gene, a 726 base pair PCRproduct is generated. After enzymedigestion of PCR products from normalindividuals with Cvnl, fragments of thefollowing sizes are produced: 256 bp,201 bp, 181 bp, and 88 bp. Which of thefollowing restriction fragment patternsrepresent the results you would see in apatient homozygous for the sickle cellgene?A. Two bands—457 bp and 269 bpB. Three bands—382 bp, 256 bp,
and 88 bpC. Four bands—382 bp, 201 bp, 181 bp,
and 88 bpD. Five bands—382 bp, 256 bp, 201 bp,
181 bp, andSSbp
160. In a PCR assay, which control is necessaryto distinguish between a true negativeresult and a false negative result?A. Blank (no DNA template) control
containing all PCR reagentsB. Negative template control containing
DNA sample known not to containtarget sequence
C. Internal control containing secondprimer set to sequence found in allsamples but unrelated to target sequence
D. Positive control containing targetsequence
161. Real-time PCR (i.e., qPCR) is a targetamplification technique that is bothquantitative and highly sensitive. Theprimary level of specificity of the reactionis determined by the primers employedin the reaction; however, an additional levelof specificity can be obtained by the useof probes that generate a fluorescentsignal only when they hybridize to targetsequences. Which of the following systemsutilizes a probe that contains a shortspecific target specific sequence flankedby a short inverted repeat whose 5' end isa fluorescent reporter molecule that formsa stem and loop structure with a 3' endquencher molecule when not bound to thetarget sequence?A. SYBR green detection systemB. TaqMan probe detections systemC. Fluorescent resonance energy transfer
detection systemD. Molecular Beacons® detection system
162. In what form does the reclamation offiltered bicarbonate ion in the proximaltubular cells occur?A. Carbonic acidB. Carbon dioxideC. Sodium carbonateD. Sodium bicarbonate
1124 • CHAPTER 17: SELF-ASSESSMENT TEST
163. In what area of the nephron does approxi-mately 65% of renal reabsorption occur?A. Proximal tubuleB. Distal tubuleC. Bowman capsuleD. Glomerulus
164. What is the renal blood flow for a 70-kgmale/female?A. 12 mL/minB. 120 mL/minC. 1200 mL/minD. 12L/min
165. The concentration of a solute in plasma atwhich no additional amount of the solutewill be absorbed from the proximal tubuleis known as theA. Plasma thresholdB. Tubular thresholdC. Renal thresholdD. Blood threshold
166. Which biochemical component would bepresent in an increased amount in a darkyellow-amber-colored urine?A. BiliverdinB. BilirubinC. UrobilinD. Blood
167. When should a 2-hour postprandial urinebe collected?A. 2 hours after fluid ingestionB. 2 hours after a renal drug ingestionC. 2 hours after eatingD. 2 hours after voiding a fasting
specimen
168. Peritoneal fluid is derived from whichsource?A. Abdominal cavityB. Knee jointsC. Central nervous systemD. Space around the lungs
169. Which of the following formed elementsare present in the high-power field seen inColor Plate 55mlA. Transitional epithelial cells, oval fat
bodies, spermB. Renal epithelial cells, mucus, calcium
oxalateC. Red blood cells, squamous epithelial
cells, white blood cellsD. Yeast, squamous epithelial cells,
mucus
170. Which of the following is true abouturomodulin (Tamm-Horsfall) protein?A. Measured using the conventional
reagent test stripsB. Appears only in abnormal urineC. Matrix of hyaline casts but not
granular castsD. Produced by renal tubules in small
quantities
171. Which of the following procedures is usedto assess glomerular permeability?A. Clearance testB. OsmolalityC. 24-hour urine total proteinD. Renal blood flow
172. With which crystals are urinary uric acidcrystals often confused?A. Calcium pyrophosphateB. CystineC. CholesterolD. Calcium oxalate
REVIEW QUESTIONS • 1125
173. In what sequence does urine formationoccur?A. Proximal convoluted tubule, loop of
Henle, distal convoluted tubule,collecting duct, Bowman's space
B. Glomerulus, Bowman's space,proximal convoluted tubule, loop ofHenle, distal convoluted tubule,collecting duct
C. Bowman's space, glomerulus,proximal convoluted tubule, loop ofHenle, distal convoluted tubule,collecting duct
D. Bowman's space, glomerulus, distalconvoluted tubule, proximal convo-luted tubule, collecting duct
174. Renal clearance tests are used to evaluatewhich of the following parameters?A. Concentrating abilityB. Glomerular filtration rateC. Glomerular permeabilityD. Tubular reabsorption
175. Which of the following do the formedelements present in the high-power fieldin Color Plate 46B suggest?A. Nephrotic syndromeB. PyelonephritisC. Excessive exerciseD. Diabetic nephropathy
176. The formed elements present in the high-power field in Color Plate 52B can bedetected by the appropriate reagent strippad reacting with theirA. PseudoperoxidaseB. EsteraseC. Glucose oxidaseD. Acetoacetate
177. When using polarized light microscopy,which urinary sediment componentexhibits Maltese cross formation?A. RBCsB. WBCsC. YeastsD. Oval fat bodies
178. Which urinary sediment component isfrequently confused with the componentin Color Plate 48«?A. YeastsB. WBCsC. ParasitesD. Casts
179. Which of the following is a urinary ketonebody that is measured using the acetest?A. AcetylCoAB. AcetoacetateC. (3-HydroxybutyrateD. Sodium nitroprusside
180. What type of microscopy may also beused to observe the urinary components inColor Plate 50m?A. PolarizedB. DarkfieldC. Phase contrastD. Electron
181. Which of the following urine biochemicalresults would be obtained in hemolyticanemia?A. Positive bilirubinB. Negative bloodC. Positive nitriteD. Positive urobilinogen
182. The absorbance of a 6 mg/L standard is0.50. An unknown has an absorbance of0.38. What is the value of the unknown?A. 7.9 mg/LB. 6.3 mg/LC. 4.6 mg/LD. 2.3 mg/L
1126 • CHAPTER 17: SELF-ASSESSMENTTEST
183. If 30 grams of H2SO4 (mol wt = 98) aredissolved in 500 mL of water, what is thenormality of the solution?A. 0.82B. 1.22C. 2.94D. 3.40
184. Which of the following statementsdescribes standard precautions?A. Everyone should be careful before
entering a patient room.B. Treat all human blood and other
potentially infectious materials asthough they contained infectiousparticles.
C. Treat human blood as infectious onlyif it is known to be.
D. All human blood and other infectiousmaterial must be handled using arespirator.
185. Which of the following is true of avolumetric pipette?A. Blow out the last dropB. Is labeled "to contain" (TC)C. Is used for diluting control materialD. Is rinsed out
186. Which type of fire extinguisher should beused to deal with a laboratory fireconsisting of ordinary combustibles(e.g., wood and paper)?A. AB. BC. CD. D
187. What term describes the extent ofagreement among repeated analyses?A. Random errorB. PrecisionC. AccuracyD. Reliability
188. Which of the following is the range ofvalues described as the mean plus orminus some number of standard devia-tions, forming the basis of statistical rulesfor acceptance and rejection of qualitycontrol values?A. VarianceB. Degrees of freedomC. Coefficient of variationD. Confidence interval
189. Which of the following is material ofknown composition available in a highlypurified form?A. StandardB. ControlC. Technical reagentD. Test analyte
190. Which coding system is a systematizedseries of numbers corresponding to alldiseases, and other medical, surgical,and mental health conditions, publishedannually by the American MedicalAssociation (AMA) for the purpose ofstandardizing and coding for statistical andbilling activities in healthcare?A. CPTB. HCPCSC. ICD-9-CMD. DRG
191. When pricing new tests, a laboratory mustuse a factor to calculate the allowance forthe hospital's cost for utilities, housekeep-ing, administration, and other services.What are these costs known as?A. DirectB. OverheadC. DepreciationD. Indirect labor
REVIEW QUESTIONS • 1127
192. What is the authority relationship fromadministration to department head tosupervisor to staff known as?A. Line authorityB. Staff authorityC. Formal authorityD. Job-related authority
193. The verbs "comply with" and "support"would most likely be used in writing anobjective in which of the followingdomains?A. AffectiveB. CognitiveC. PsychomotorD. Technical
194. Classify the following objective: "Thestudent will calibrate a spectrophotometeraccording to the procedure manual."A. Cognitive domainB. Psychomotor domainC. Psychosocial domainD. Affective domain
195. Which of the following testing items iseasy to develop but difficult to grade?A. True/falseB. Multiple choiceC. MatchingD. Essay
196. Which of the following describes aninterval scale with a true zero point?A. Interval scaleB. Nominal scaleC. Ordinal scaleD. Ratio scale
197. Which of the following is not part of aquestionnaire?A. Short and clear questionsB. Double negative questionsC. Ask only important questionsD. Reference points or comparisons are
used
198. Which of the following requires acontinuous electrical supply to thecomputer for data retention?A. Hard diskB. DVDC. ROMD. RAM
199. A laboratory information system canimprove patient care by performing deltachecks. What is a delta check?A. Plotting quality control results on a
chartB. Comparing the results of an analyte on
a patient to previous resultsC. Monitoring the system for security
breachesD. Monitoring data storage to be sure it is
properly backed up
200. Tape drives are often used to archivedigital data. This storage device is slowerthan most others because the data arestoredA. SequentiallyB. RandomlyC. MagneticallyD. Optically
reviewanswers
1.2.
3.
4.
5.
6.
7.
8.
9.10.
11.12.
13.
14.
15.16.
17.
18.19.20.
21.22.
23.
24.
D
CCBD
AB
BD
B
D
CBD
ADCCDABDAA
25.
26.
27.
28.
29.
30.
31.32.
33.34.
35.
36.37.
38.39.40.
41.
42.
43.
44.
45.
46.
47.
48.
AD
CB
CA
DD
A
C
AD
C
CBACDBDABCB
49.
50.51.52.
53.54.55.
56.
57.
58.59.
60.
61.62.
63.64.65.66.67.
68.69.
70.
71.72.
AD
ABA
BD
C
C
CA
DB
A
ADB
CDADCAA
73.
74.
75.
76.
77.
78.
79.
80.
81.82.
83.
84.85.
86.87.88.89.90.
91.92.
93.94.
95.
96.
CD
BA
A
BD
AB
C
CB
AA
DCBDAAABAD
1128
REVIEW ANSWERS • 1129
97.
98.99.
100.101.102.
103.104.
105.106.107.
108.
109.
110.
111.112.113.
114.115.
116.117.
118.119.120.121.122.
DD
BB
CBD
A
B
CBA
CD
B
AA
CCD
B
CCBAB
123.124.
125.
126.
127.
128.129.
130.131.132.
133.134.
135.
136.
137.
138.139.
140.141.
142.
143.144.
145.146.
147.
148.
A
CBBA
D
DB
B
CB
D
D
A
BDD
CB
A
CDACBA
149.150.151.
152.
153.
154.
155.
156.
157.
158.
159.
160.
161.162.
163.164.
165.
166.167.
168.
169.170.171.
172.
173.
174.
B
BA
CD
CA
A
CA
B
C
D
B
A
C
CB
CA
CD
CBBB
175.
176.177.
178.
179.
180.181.
182.
183.184.
185.
186.
187.
188.
189.
190.191.
192.193.
194.
195.
196.197.198.199.
200.
B
AD
DB
CD
CB
B
CA
B
D
A
CB
AAB
D
DBDBA