Top Score Pro For the DAT MOCK Exam 1

Survey of Natural Sciences

1) Plants store most of their energy as
a. Glycogen
b. Glucose
c. Sucrose
d. Starch
e. Cellulose
2) Secondary protein structure is characterized by
a. Interactions between side chains of amino acids.
b. The overall structure of the polypeptide chain.
c. The coiling or folding of the polypeptide backbone
d. The unique sequence of amino acids
e. Strong covalent bonds called disulfide bridges
3) All the living things are composed primarily of
a. Carbon, hydrogen, and nitrogen
b. Carbon, oxygen, and sulfur
c. Carbon, phosphorus, and nitrogen
d. A & C
e. A, B, & C
4) Cellular respiration occurs within the
a. Mitochondria
b. Golgi apparatus
c. Lysosomes
d. Nucleus
e. Ribosomes
5) The pores in the nuclear envelope serve which of the following functions?
a. It allows proteins to move into the nucleus
b. It allows ribosomal components to exit the nucleus
c. It allows mRNA to exit the nucleus
d. A & C
e. A, B, & C
6) Which of the following is primary activity of the Golgi apparatus?
a. Its a catalysis of oxidation reactions
b. It synthesizes mRNA and DNA
c. It breaks down carbohydrates
d. It breaks down lipids and steroids
e. It modifies and package proteins

7) In a redox reaction,
a. The oxidizing agent donates electrons
b. The reducing agent accepts electrons
c. The reducing agent is the most electronegative
d. The substance that is oxidized loses energy
e. The substance that is reduced loses energy
8) Fatty acids enter the degradative pathway in which of the following forms?
a. Glycerol and glucose
b. Glycerol
c. Adipose tissue
d. Keto acids
e. Acetyl CoA
9) All of the following are characteristics of mitosis except:
a. Mitosis occurs in eukaryote cells
b. During prophase chromosomes condense
c. Homologous chromosomes pair up at the metaphase plate
d. There is no crossover of chromosomes
e. The number of chromosomes remain the same after the cell division
10) All the following are true about sexual production in plants except:
a. All plants exhibits alternations of generations
b. The diploid sporophyte generation produces haploid spores
c. The haploid spores develop into the diploid gametophyte generation
d. Spores are cells that prevent the loss of water
e. Meristems provide a source of cell that can develop into an adult plant
11) During the ovarian ovulation phase, you would expect
a. An increase in estrogen followed by a decrease in progesterone
b. An increase in estrogen followed by an decrease in luteinizing hormone
c. An increase in estrogen followed by a surge in luteinizing hormone
d. A decrease in estrogen followed by an increase in progesterone
e. A decrease in estrogen followed by a surge in luteinizing hormone
12) A father is heterozygous for blood type A and the mother is heterozygous for blood type B.
What percentage of their children could be universal blood donors?
a. 25%
b. 50%
c. 75%
d. 100%
e. No children could be universal blood donors
13) The sequence of a piece of DNA has been determined to be 5ACCAAACCGAGT3. What is the
transcribed mRNA of this sequence?
a. 3TGGTTTGGCTCA5
b. 3TGGTTTCCGTGC5
c. 3UGGUUUGGCUCA5
d. 5ACCAACCGACUA5
e. 5UCCGGAAGTAGG3
14) The process whereby mRNA codons are converted into a sequence of amino acids is best known
as:
a. Transcription of RNA
b. Transcription of DNA
c. Translation of RNA
d. Translation of DNA
e. Peptide synthesis of DNA
15) The embryological origin of the circulatory system, gonads and connective tissue throughout the
body are characteristic of which embryonic germ layer?
a. Ectoderm
b. Mesoderm
c. Endoderm
d. Moruladerm
e. Gastroderm
16) Which is the correct pathway blood flows in humans?
a. Heart aorta arteries arterioles capillaries veins heart
b. Heart aorta arterioles arteries capillaries veins heart
c. Heart aorta arteries arterioles capillaries veins heart
d. Heart aorta arterioles arteries veins capillaries heart
e. Heart aorta capillaries arterioles arteries veins heart
17) Which of the following is not true concerning erythrocytes?
a. They are the oxygen-carrying component of blood
b. They are larger than leukocytes
c. Their shape increases their surface area
d. They are formed from stem cells
e. They have no mitochondria
18) All of the following are hormones of the anterior pituitary except:
a. FSH
b. LH
c. TSH
d. Prolactin
e. ADH
19) Which of the following statements is not true concerning neurons?
a. At rest a neuron is polarized
b. At rest the inside of the neuron is more negative than the outside
c. At rest the intracellular concentration of K+ is greater than Na+
d. An action potential is generated when the outside of the cell becomes less negative
e. The nerve cell body receives both excitatory and inhibitory impulses

20) Which of the following areas of the brain is incorrectly matched to its function?
a. Cerebral cortex: sensory input, motor coordination
b. Hypothalamus: sex drive, water balance
c. Thalamus: relay from the spinal chord
d. Cerebellum: motor balance, eye-hand coordination
e. Medulla oblongata: hunger, thirst, temperature control
21) Which of the following statements concerning the vertebrate skeleton is incorrectly matched?
i. Ligament: attaches muscles to bones
ii. Tendons: attaches bone to bone
iii. Origin: point of attachment of muscles to a stationary bone
iv. Insertion: point of attachment of muscles to the movable end of bone
a. I & II
b. III & IV
c. I, II, III, & IV
d. I & III
e. None are incorrectly matched
22) Which of the following produces bile and emulsifies fats?
a. Gall bladder
b. Liver
c. Pancreas
d. Small intestine
e. Large intestine
23) Respiration in earthworms can be best described by
a. Carbon dioxide excreting directly through the skin
b. Nitrogenous wastes excreted in the form of small solid uric acid crystals
c. Uric acid accumulating in the malphigian tubules
d. Contractile vacuoles specialized for waste excretion by active transport
e. Carbon dioxide diffuse from the blood and are continually exhaled
24) A dogs urine accidents are cleaned up with newspaper followed by harsh discipline. The dog
hides under a bed any time the newspaper is brought out to read. The dogs behavior illustrates
a. Operant conditioning
b. Conditioned reflex
c. Positive reinforcement
d. Imprinting
e. Classical conditioning
25) A tick bird on a rhinoceros is an example of what type of symbiotic relationship?
a. Commensalism
b. Mutualism
c. Parasitism
d. Saprophytism
e. Insectism

26) Which of the following is the correct hierarchy of the taxonomic naming system?
a. Kingdom, phylum, class, order, family, genus, species
b. Kingdom, phylum, subphylum, order, class, family, genus
c. Kingdom, phylum, class, family, order, genus, species
d. Kingdom, subphylum, class, order, family, species, genus
e. Kingdom, phylum, subphylum, order, class, genus, family
27) Analogous structures are
a. Similar in structure and similar in origin.
b. Dissimilar in structure and similar in origin.
c. Similar in structure and dissimilar in origin.
d. Dissimilar in structure and dissimilar in origin.
e. Found only in mammals
28) Which of the following is the correct sequence of events in the origin of life?
i. Formation of protobionts
ii. Synthesis of organic monomers
iii. Synthesis of organic polymers
a. I, II, III
b. II, III, I
c. III, II, I
d. III, I, II
e. I, III, II
29) According to the endosymbiotic hypothesis, which of the following organelles originated as
prokaryotic symbionts?
a. Vacuoles and the endoplasmic reticulum
b. Nuclei and thylakoids
c. Chloroplasts and mitochondria
d. Storage vesicles and ribosomes
e. Cristae and Golgi apparatus
30) Animals are considered
a. Multicellular prokaryotic heterotrophs
b. Multicellular eukaryotic heterotrophs
c. Unicellular eukaryotic homotrophs
d. Multicellular eukaryotic homotrophs
e. Unicellular prokaryotic homotrophs
31) When two or more individuals of different species associate where one member is harmed and
the other member benefits from the relationship, the relationship is termed
a. Commensalism
b. Mutualism
c. Parasitism
d. Saprophytism
e. Insectism
32) Animals represented by the genera Ascaris and Turbatrix display an unique attribute of
movement which is
a. The use of compound cilia called cirri
b. The peristaltic motions of circular muscles
c. The use of circular muscles only
d. The use of longitudinal muscles only
e. The use of pseudopodia
33) A true-breeding tall, red flowering plant is (TTRR) is crossed with a true-breeding dwarf, white
plant (ttrr). What are the phenotypes and ratios found in the F2 generation?
a. Nine tall red: three tall white: three dwarf red: one dwarf white
b. Nine tall white: three tall red: three dwarf white: one dwarf red
c. Nine tall red: three dwarf white: three dwarf red: on tall white
d. Three tall red: three tall white: three dwarf red: three dwarf white
e. None of the above
34) Which of the following best describes gene regulation and expression in an inducible system?
a. The repressor binds to the operator, forming a barrier that prevents genes from being
transcribed
b. The repressor is inactive until it combines with the corepressor allowing genes to be
transcribed
c. The inducer-repressor binds to the operator allowing genes to be transcribed.
d. The repressor-corepressor binds to the operator and represses enzyme synthesis
e. Regulation is in a constant state of transcription
35) The opening diameter of the eye (the pupil) is controlled by what structure?
a. Sclera
b. Fovea
c. Iris
d. Cornea
e. Aqueous humor
36) Gas exchange in humans between the lungs and the circulatory system occurs across the
a. Diaphragm
b. Bronchi
c. Bronchioles
d. Alveoli
e. Trachea
37) Which of the following is not true of oxidative phosphorylation?
a. It involves the electron transport chain
b. It involves redox reactions
c. It produces approximately three ATP for every NADPH that is oxidized
d. The ultimate electron donor is oxygen
e. It depends on chemiosmosis

38) Which of the following is not true concerning mitosis?
a. During anaphase, the chromosomes separate and move to opposite poles of the cells
b. The spindle apparatus disappears during anaphase
c. The nuclear membrane begins to dissolve during prophase
d. Chromosome condense, shorten, and coil during prophase
e. Chromosomes align during metaphase
39) Which of the following biome is incorrectly matched with its description?
a. Desert: widely scattered shrubs, cacti, succulents
b. Taiga: coniferous forests
c. Temperate forest: broad-leaved deciduous trees
d. Tundra: low shrubby or matlike vegetation
e. Chaparral: tropical grasses and forbs
40) One of the primary differences between a plant cell and animal cell is that plant cells contain
a. Centrioles
b. Lysosomes
c. A cell wall
d. No vacuoles
e. No chloroplasts

41) Popcorn expands and loses water when popped. If a kernels initial mass is .349g and .316g after
popping, what was the percent of water by mass in the kernel assuming all water is lost? (MM of
H
2
O = 18g)
a. ((.349 - .316)/(.349)) * 100
b. (.316 - .349) * 100
c. (.349/.316) * 100
d. ((.349 - .316)/18) * 100
e. ((.316 - .349)/18) * 100
42) Which of the following species is not isoelectronic with the others?
a. Ar
b. Ca
2+

c. Cl
-

d. S
2-

e. Na
+

43) What are the quantum numbers for the highest energy electron in the element Fluorine?
a. n = 2, l = 0, m
l
= 0, m
s
= -1/2
b. n = 2, l = 0, m
l
= 1, m
s
= +1/2
c. n = 2, l = 1, m
l
= 1, m
s
= -1/2
d. n = 2, l = 2, m
l
= 1, m
s
= +1/2
e. n = 2, l = 2, m
l
= 0, m
s
= +1/2

44) Rank the following in terms of increasing first ionization energy: F, N, K, Cs
a. F < Cs < N < K
b. Cs < K < F < N
c. K < Cs < N < F
d. Cs < K < N < F
e. N < F < K < Cs
45) Find the atomic weight of the unknown element Z, if the molar mass of the compound Na
2
Z
2
O
3
is
156 g/mole.
a. 28 g/mole
b. 31 g/mole
c. 36 g/mole
d. 40 g/mole
e. 62 g/mole
46) Which of the following are general characteristics of a covalently bonded molecule?
i. Electrons are shared between the elements
ii. The elements bonded together are usually two nonmetals
iii. The elements bonded together are never identical elements
a. I, II, & III
b. I, & II
c. II, & III
d. I only
e. III only
47) Identify the incorrect statement based on the results of the following reactions:
Reaction I: NH
3
(aq) + HCl (aq)
Reaction II: BaCO
3
(s) + HCl(aq)
Reaction III: NaF(aq) + Ba(NO
3
)
2
(aq)

a. Reaction I is an acid-base reaction
b. The net ionic equation for Reaction III is: 2F
-
(aq) + Ba
2+
(aq) BaF
2
(s)
c. Reaction II is a gas-forming reaction
d. The sum of the coefficients of the balanced net ionic equation for Reaction II is 6
e. None of these
48) Which of the following would not be considered a chlorate or chlorite?
a. ClO
2
-

b. ClO
3
-

c. ClO
4
-

d. ClO
4
2-

e. All are chlorates or chlorites

49) What is the best Lewis dot structure for XeF4?

50) Given the standard enthalpy of formation for NO(g) is 90.25 kJ/mol, calculate the free energy
change for the following reaction at 25 C.
N
2
(g) + O
2
(g) 2 NO(g)




a. 180.5 (298)(25)(1 x 10^
-3
)
b. 90.25 (298)(25)(1 x 10^
-3
)
c. 180.5 + (298)(-25)(1x10^
-3
)
d. 180.5 (298)(-25)
e. 90.25 + (298)(25)(1x10^
-3
)
51) When it is balanced, what is the sum of the coefficients of the following equation?
KOH + H
2
CO
3
K
2
CO
3
+ H
2
O
a. 4
b. 5
c. 6
d. 7
e. 8
52) In the following equation, what is the oxidizing agent?
a. PbO
b. CO
c. Pb
d. CO
2

e. None of these
Absolute Entropies
(J/mol*K)
N
2
(g) 192
NO (g) 211
O
2
(g) 205
53) The half-life of a compound is 10.0 hours. How many hours would it take for a 72.0 g sample to
decay to one-eighth of its original activity?
a. 9
b. 10
c. 15
d. 30
e. 45
54) If K
eq
> 1, an equilibrium mixture of reactants and products will
a. Contain less products compared to the reactants
b. Contain less reactants compared to the products
c. Contain equal amounts of reactants and products
d. Will contain a reaction intermediate
e. None of these
55) If the activation energy for a reaction in the forward direction is 96 kJ, the activation energy for
the reaction in reverse is 295 kJ, and the energy f the products is 34 kJ, the energy of the
reactant is?
a. -233 kJ/mole
b. 233 kJ/mole
c. -199 kJ/mole
d. 199 kJ/mole
e. -34 kJ/mole
56) When 14.250 moles of PCl
5
gas is placed in a 3.00 liter container and comes to equilibrium at a
constant temperature, 40.0% of the PCl
5
decomposes according to the equation:
PCl
5
(g) PCl
3
(g) + Cl
2
(g)
a. (1.896)2/2.854
b. (2.854)2/1.898
c. (3.800)2/2.854
d. (2.854)(1.896)/3.800
e. None of these
57) From the following equation, we can determine that:
2 Mg(s) + O
2
(g) 2 MgO(s) H
rxn
= -1203 kJ
i. The reaction is exothermic
ii. The reaction is endothermic
iii. Heat is give off
a. I only
b. II only
c. III only
d. I & III
e. II & III
58) Given that 1 calorie = 4.184 J, if one gram of water requires 1 calorie to raise its temperature by
1 C, how many joules are required to heat 1 kg water by 1 C?
a. 4184 J
b. 418.4 kJ
c. 10 kJ
d. 41.84 kJ
e. 41.84 J
59) At constant temperature, how many liters will a gas occupy at a pressure of 3.00 atm if it
occupies 8.0 liters at a pressure of 4.5 atm?
a. 1.69 L
b. 13.5 L
c. 24 L
d. 12 L
e. 36 L
60) What is the final pressure of a gas that expands from 2.0 L at 10 C to 20.0 L at 100 C, if its
pressure was initially 6.0 atm?
a. 0.40 atm
b. 0.69 atm
c. 0.72 atm
d. 0.79 atm
e. 0.87 atm
61) What is the final volume of a gas at 70.0 K if it is initially at 280.0 K and 10.0 mL?
a. 2.5 mL
b. 19.6 mL
c. 25.0 mL
d. 32.0 mL
e. 40.0 mL
62) If the K
b
of a solvent is 3.51 C/m, and the boiling point of the pure solvent is 70.4 C, then what
is the boiling point of a 4 m solution of a solute dissolved in the solvent?
a. 70.4 C
b. 84.4 C
c. 98.5 C
d. 112.5 C
e. None of these
63) What characteristic determines where two liquids will be miscible?
a. Density
b. Electronegativities
c. The polarity of the molecules
d. Their molecular sizes
e. A & C

64) Which of the following phase changes involve gas-solid equilibria?
a. Sublimation
b. Deposition
c. Solidification
d. A & B
e. B & C
65) What is the expression for the solubility product constant, K
sp
, for BaCl
2
?
a. [Ba
2+
][Cl
2-
]
b. [Ba
2+
]
2
[Cl-]
2

c. [Ba
2+
][Cl
-
]
2

d. [Ba
+
]
2
[Cl
-
]
2

e. [Ba
+
][Cl
-
]
2

66) If you make a 500 mL of a solution containing 37.3 g of KCl, what is the molarity of the solution?
a. 0.1 M
b. 0.2 M
c. 1.0 M
d. 2.0 M
e. 10 M
67) Which one of the following acids is incorrectly named?
a. HClO: Hypochlorous acid
b. HClO
2
: Chloric acid
c. HClO
4
: Perchloric acid
d. HNO
2
: Nitrous acid
e. HNO
3
: Nitric acid
68) Which of the following is incorrect as to what happens to each base when they are in an
aqueous solution?
a. LiOH Li
+
+ OH
-

b. NH3 + H2O NH
4
+
+ OH
-

c. NaOH Na
2+
+ OH
-

d. Ba(OH)
2
Ba
+
+ 2 OH
-

e. C & D
69) What is the net ionic equation for the reaction:
HCl(aq) + NaOH(aq) H
2
O(l) + NaCl(aq)
a. H
3
O
+
(aq) + OH
-
(aq) 2H
2
O(l)
b. Na
+
(aq) + Cl
-
(aq) NaCl(aq)
c. H
+
(aq) + Cl
-
(aq) + Na
+
(aq) + OH
-
(aq) H
2
O(l) + Na
+
(aq) + Cl
-
(aq)
d. A & C
e. B & C

70) The anode is _______ and the cathode is _______ in an electrolytic cell, whereas the anode is
_______ and the cathode is _______ in a galvanic cell.
a. Positive, negative; negative, positive
b. Negative, positive; negative, positive
c. Positive, negative; positive, negative
d. Negative, positive; positive, negative
e. None of these
71) Predict the major product of the following:

72) Which of the following conformations of 1-chloropropane has the lowest potential energy?

73) The
1
H NMR spectrum of which of these compounds will show only 2 singlets?

74) Treatment of 3-fluoro-cyclohexene with KMnO4 yields which of the following?

75) The enantiomer of - D-glucose is:
a. - D-glucose
b. - D-mannose
c. - L-glucose
d. - L-mannose
e. None of these
76) Predict the major product of the following:





77) According to VSEPR theory, which of the following is predicted to be non-planar?

78) Which of the following molecules can exist as a meso compound?
a. cis-1,2-cyclopentanediol
b. trans-1,2-cyclopentanediol
c. 2,3-dihydroxybutane
d. A & B
e. A & C
79) Predict the major product of the following reaction sequence:





80) What is the correct IUPAC name for the following compound?

a. (Z)-3-chloro-1-fluoro-2-pentene
b. (E)-3-chloro-5-fluoro-3-pentene
c. (Z)-3-chloro-5-fluoro-3-pentene
d. (E)-3-chloro-5-fluoro-2-pentene
e. (Z)-3-chloro-3-ethyl-fluoropentene
81) The isoelectric point of phenylalanine is 5.91. At pH = 10, the predominant form of this amino
acid is:

82) Which of the following would be more reactive than benzene toward electro-philic aromatic
substitution?

83) Predict the major product of the S
N
2 reaction shown below:

84) Predict the product of the following Diels-Alder reaction.

85) All of the following functional groups would show a strong absorption band in the region
between 1700-1800 cm-1 in an IR spectrum except:
a. An ester
b. A carboxylic acid
c. An aldehyde
d. A ketone
e. An alcohol


86) What is the stereochemical relationship of the Fischer projection molecules shown below:

a. Enantiomers
b. Diastereomers
c. Identical compounds
d. Meso structures
e. Structural isomers
87) What is the major product of the following reaction?

88) All of the following reagents may be used to effect Markovnikov addition to an Alkene except?
a. H
2
O/Cl
2

b. Hg(OAc)
2
/H
2
O then NaBH4
c. H
2
O/H
2
SO
4

d. BH
3
then H
2
O
2
in base
e. B & D
89) All of the following compounds can be reduced by treatment with LiAlH4 except?
a. CH
3
CH
2
CHO
b. (CH
3
)
2
CO
c. CH
3
CH
2
COOH
d. CH
3
CH
2
COOCH
3

e. CH
3
CH
2
OCH
3

90) The hybridization of the oxygen atom in CH
3
OH is:
a. sp
b. sp
2

c. sp
3

d. sp
3
d
e. sp
3
d
2

91) The major product of the reaction sequence shown below is:

92) The major product of the -elimination reaction shown below is:


93) Which of the carbohydrates shown below is a reducing sugar?

94) Which of the following molecules has an R absolute configuration?

95) Which of the isomers shown below is the most stable?

96) Which of the following can be oxidized with K2Cr2O7 to form carboxylic acid?

97) Which of the following products can be formed when butadiene reacts with HCl?

98) Which of the following molecules is anti-aromatic?

99) All of the following statements regarding amino acids are true except:
a. The naturally occurring chiral amino acids all have the L configuration
b. At physiological pH, they exist as zwitterions
c. They spontaneously condense in H2O by forming amide bonds to make peptides
d. All of the 20 naturally occurring amino acids except glycine are chiral
e. All of these statements are true
100) Predict the major product of the reaction shown below.













Perceptual Ability Test
Key Hole
1.

2.

3.

4.


5.

6.

7.

8.




9.

10.

11.

12.


13.

14.

15.

Top Front End View
16.

17.


18.


19.


20.


21.


22.



23.


24.


25.


26.



27.


28.


29.

30.

Angle Ranking
31.

32.

33.



34.

35.



36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

Hole Punching
46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

56.

57.

58.

59.

60.







Cube Counting
61.

62.

63.

64.

65.

66.

67.

68.

69.

70.

71.

72.

73.

74.

75.

Pattern Folding
76.

77.

78.

79.

80.

81.

82.

83.

84.

85.

86.

87.

88.

89.

90.






Reading Comprehension
Passage I:
Laryngomalacia
(1) Laryngomalacia, the most common congenital laryngeal anomaly and most frequent
cause of stridor in children, has been described in medical literature for over 100 years.
During this time a variety of names have been used for this same condition. Often the
terms, congenital laryngeal stridor, tracheomalacia and laryngomalacia have been used
interchangeably. The term laryngomalacia, on the other hand, was originated by Jackson
and Jackson in 1942 and was used to describe a specific disease state with an illdefined
pathogenesis, manifested by the collapse of supraglottic laryngeal structures during
inspiration. Because laryngomalacia is the predominant congenital anomaly, its
significant clinical aspects are essential for diagnosis and treatment. These aspects range
from early noteworthy symptoms of etiology to the designation of surgical treatment
and management.

(2) The most common symptom of laryngolmalacia, stridor, is associated with numerous
pathologic conditions. When caused by a laryngeal abnormality, the type of stridor can
be a clue to the level of obstruction. Inspiratory stridor usually signifies a supraglottic or
glottic problem, while expiratory and inspiratory stridor denote subglottic obstruction.
Laryngomalacia, as well as vocal cord paralysis, laryngeal web and subglottic stenosis
are examples of intrinsic abnormalities that contribute to stridor. In severe cases, the
most common clinical manifestation of laryngomalacia is a high-pitched crowing or low-
pitched vibratory fluttering inspiratory stridor. Because stridor is inspiratory in all cases,
it is worsened by anything that increases respiration, including crying, nursing, agitation,
excitement or exertion. On occasion the stridor becomes more prominent when the
infant is lying supine, and improves in the prone position or extending the neck.

(3) The onset of symptoms is laryngomalacia usually appears within the first two weeks of
life, worsens during the first eight months, reaches a plateau phase at nine to 12
months and then spontaneously begins to resolve by two years of age. Although
obstruction can occur at any age, detection of stridor is especially crucial in the newborn
because it signals impeding asphyxiation. Pectus excavatum, a severe retraction of the
xiphoid during inspiration, is an example of this extreme degree of obstruction that can
occur. If untreated in this state, the infant may asphyxiate and die. Moreover, these
severe cases may be complicated by dysphagia, gastroesophageal reflux, failure to
thrive, cyanosis, intermittent complete obstruction and/or cardiac failure. The severity
of such symptomology occurs in only a small percentage of patients (10 to 15 percent)
and such cases indicate that surgical intervention is unavoidable.

(4) Diagnosis of laryngomalcia is implied by history and physical examination, followed by
radiographic studies of the chest and cervical airway. Lateral cine fluoroscopy of the
neck or barium swallow with cine esophagram, bronchograph and occasionally
arteriography may also be necessary in diagnosis. Diagnosis is confirmed by direct
larygoscopy. In all cases of stridor, one must include chest and larynx roentgenograms
(anteroposterior and lateral on both inspiration and expiration), esophagram and direct
laryngoscopy in the topically anesthetized awake patient. This is done to observe the
larynx in its dynamic state.

(5) As an alternative, transnasal fiberoptic laryngoscopy has the advantage of observing the
larynx in its natural anatomic position without deforming the tongue or vallecula and
without hyper-extending the neck. When dysphagia is present, barium swallow and
radionuclide scan are used to assess esophageal function and to rule out
gastroesophageal reflux and obstructive lesions such as vascular rings. The final
definitive diagnosis is performed by using a flexible nasopharyngoscope. This instrument
may show a long narrow omega-shaped epiglottis, long and floppy aryepiglottic folds,
prominent arytenoids, and a deep interarytenoud cleft.

(6) The precise pathophysiologic abnormality that causes laryngomalcia remains elusive.
However, anatomic, histologic and neurologic factors may contribute to a significant
degree to the disorder. Four anatomic abnormalities regularly identified during
inspiration are 1) inward collapse of the aryepiglottic folds, primarily the enlarged
cuneiform cartilages. Obstruction occurs as the cartilages are drawn inward during
inspiration, 2) a long, tubular epiglottis which curls upon itself and contributes to
obstruction, 3) anterior, medial collapse of the arytenoid cartilages to occlude the
laryngeal inlet and 4) posterior inspiratory displacement of the epiglottis against the
posterior pharyngeal wall of vocal folds. Some consider the omega-shape of the
epiglottis to be a factor that contributes to stridor. However, an omega-shaped
epiglottis exists in both stridulous and nostridulous patients; therefore having no proven
significance.

(7) The delay in normal development of cartilaginous support of the arytenoid and
epiglottic tissue has been suggested as another contributing factor. Laryngeal cartilage
immaturity produces a weaker and softer larynx, which results in a more pliable and
unsupporting framework during inspiration. The continuous movement, vibration, and
irritation of these tissues causes inflammation and edema, which continuous
movement, vibration, and irritation of these tissues causes inflammation and edema,
which further worsens the stridor. Although the infantile larynx has a softer, more
flaccid tissue structure than the adult larunx, this theory is weakened by the fact that
premature infants do not exhibit a greater incidence of laryngomalacia than normal-
term infants. Thus, as the child grows older, the tissue becomes firm and resistant to
inspiratory forces. The child, consequently, outgrows the condition.

(8) Finally, immature or defective neuromuscular control is an additional pathophysiologic
mechanism thought to contribute to laryngomalacia. Experiments since 1900 have
shown passive medial collapse of suproglottic structures with denervation of infant
larynges. This experiment suggests that it is possible that a delay in acquisition of
complete neuromuscular control may be one cause of laryngomalacia.

(9) Although laryngomalacia is usually self-limited, the potential exists for symptoms so
severe that operative intervention cannot be avoided. The method used to alleviate
airway compromise in severe laryngomalacia, unresponsive to conservative
management, traditionally has been tracheotomy, which bypasses the obstruction. The
disabling symptoms are relieved with tracheotomy, but the risk of morbidity and
mortality is increased. Supraglottoplasty, a term used to describe procedures that
modify flaccid obstructing suproglottic tissues, is a viable alternative to tracheotomy for
the management of severe laryngomalacia in carefully selected patients. A specific
technique, supraglottic trimming, has been implemented to remediate this particular
condition. This procedure involves trimming of the lateral edges of the epiglottis and the
aryepiglottic folds. The mucosa over the arytenoids and corniculate cartilages is also
trimmed.

(10) Another method primarily used in France is hypomandibulopexy.
Hypomandibulopexy is performed through an incision between the hyoid and mandible.
Two holes are drilled in the symphysis of the mandible and heavy nylon sutures are
used; one suspends the hyoid as close as possible to the mandible. The method causes
complete relief of stridor by pulling the hyoepiglottic ligament, pulling the epiglottis and
aryepiglottic folds anteriorly and superiorly and opening the supraglottic area.

(11) In summary, the procedure of supra glottoplasty is intended for patients with
severe airway obstruction and associated symptoms as an alternative to tracheotomy
and is not indicated for mild laryngomalacia. Through proper management of
laryngomalacia in its initial phases, more serious complications of the laryngeal inlet can
be prevented. The knowledge to implement current surgical techniques, recognize vital
symptoms, and thoroughly diagnosis and evaluate laryngomalacia are some specific
factors that need to be considered to maximize remediation of the most common
congenital laryngeal anomaly, laryngomalacia.

Questions:
1. Which of the following is not a term associated with laryngomalacia?
a. Tracheomalacia
b. Congenital laryngeal stridor
c. Laryngomalacia
d. Laryngeal paralysis
e. None of the above
2. Which of the following statements best describe laryngomalacia?
a. The collapse of supraglottic laryngeal structures during inspiration.
b. The collapse of subglottic laryngeal structures during inspiration.
c. The collapse of suproglottic laryngeal structures during expirations.
d. The collapse of the epiglottis into the laryngeal cavity.
e. None of the above
3. All the following are examples of intrinsic abnormalities that contribute to stridor
except:
a. Vocal cord paralysis
b. Laryngeal web
c. Supraglottic paralysis
d. Subglottic stenosis
e. Laryngomalacia
4. The most common clinical manifestation(s) of laryngomalacia include:
a. Vocal cord paralysis
b. Spasmodic coughing
c. High-pitched crowing
d. High-pitched vibratory fluttering
e. B & C
5. Which of the following anatomical abnormalities does not contribute to laryngeal
obstruction?
a. Enlarged cuneiform cartilages
b. Medial collapse of arytenoid cartilages
c. Long, tubular epiglottis
d. Inward collapse of aryepiglottic folds
e. None of the above
6. Supraglottic trimming involves trimming of the:
a. Vocal folds
b. Mucosa over the arytenoids
c. Mucosa over the corniculate cartilages
d. B & C
e. A & C
7. The plateau phase for laryngomalacia symptom is:
a. 6-8 months
b. The first 2 weeks of life
c. 4-6 months
d. At 2 years of age
e. None of the above
8. Which of the following is not a procedure used in a laryngomalacia diagnosis?
a. Bronchography
b. Anterior cine fluoroscopy
c. Laryngoscopy
d. Barium swallow with cine esophagram
e. None of the above
9. All of the following may add to the severity of pectus excavatum except:
a. Failure to thrive
b. Gastroesophageal reflux
c. High blood pressure
d. Cardiac failure
e. Cyanosis
10. Which of the following statements is false?
a. Premature infants are more prone to laryngomalacia than normal-term infants.
b. Supraglottoplasty is not appropriate for mild laryngomalacia.
c. Defective neuromuscular control may be a contributing factor of laryngomalacia
d. Immature laryngeal cartilage produces a softer larynx
e. None of the above
11. All of the following are true regarding pectus excavatum except:
a. Its an example of extreme obstruction
b. Its prevalent during inspiration
c. If untreated it could lead to death
d. Its a severe retraction of the upper sternum
e. It can be complicated by other factors like dysphagia
12. Which diagnostic procedure is used to observe the larynx in its natural position?
a. Bronchography
b. Esophagram
c. Direct laryngoscopy
d. Transnasal fiberoptic laryngoscopy
e. None of the above
13. Traditionally, what method is used to treat laryngolmalacia that is unresponsisve to
conservative management?
a. Supraglottic trimming
b. Supraglottoplasty
c. Tracheotomy
d. Hypomandibulopexy
e. None of the above
14. What condition(s) is ruled out by using a barium swallow and radionuclide scan when
dysphagia is present?
a. Vascular rings
b. Enlarged epiglottis
c. Hyoid elevation
d. Gastroesophageal paralysis
e. All of the above
15. A nasopharyngoscope may defect
a. An omega-shaped epiglottis
b. Floppy aryepiglottic folds
c. A deep interarytenoid cleft
d. Prominent arytenoids
e. All of the above
16. All of the following increase stridor except:
a. Crying
b. Nursing
c. Lying supine
d. Excitement
e. Babbling
17. Hypomandibulopexy involves an incision between the
a. Hyoid and epiglottis
b. Hyoid and larynx
c. Mandible and maxilla
d. Thyroid cartilage and mandible
e. Hyoid and mandible
18. Which of the following is characteristic of laryngomalacia stridor?
a. Inspiratory
b. Expiratory
c. Inspiratory and Expiratory
d. Soft nasal vibrations
e. Vibratory coughing


Passage II:

Diabetes Mellitus
(1) Diabetes mellitus is a complex chronic disorder characterized by disruption of normal
carbohydrate, fat, and protein catabolism and the development over time of
microvascular and macrovascular complications and neuropathies. It encompasses a
heterogeneous group of anatomic and chemical problems predominated by an absolute
and relative deficiency of insulin or its function and by glucose intolerance.

(2) Because there was a need for uniformity in classification of the various types of glucose
abnormalities encountered in practice, a classification system was developed. The
system replaces diagnostic labels such as juvenile onset diabetes and maturity onset
diabetes. It also provides for the classification of persons with impaired glucose
tolerance, previous history of glucose abnormalities, and potential for abnormalities,
thus replacing terms such as chemical diabetes, subclinical diabetes, latent diabetes,
and prediabetes. Because types 1 and 2 diabetes mellitus account for the vast majority
of known diabetic persons, this paper will focus on these two classifications. However,
most of the information applies equally to the other classifications.

(3) There are now over 7.2 million persons with known diabetes mellitus; and it has been
estimated that, for every person with diabetes, there is another person who remains
undiagnosed. Insulin-dependent diabetes mellitus (IDDM) accounts for 10 to 20 percent
of all cases, has a peak incidence in the age range of 10 to 14 years, affects boys
somewhat more frequently than girls, and has a higher incidence in whites. Noninsulin-
dependent diabetes mellitus (NIDDM) accounts for 80 to 90 percent of all cases, shows
a dramatic increase with age, occurs more frequently in females, and has a higher
incidence in nonwhite persons (particularly Hispanics and native Americans).
Gestational diabetes mellitus (GDM) occurs in 20 percent of all pregnant women and
increases with maternal age but is not affected by race.

(4) Preventive health care for diabetes mellitus may be primary (prevention of the primary
disease) or secondary (early detection and control of the disease). Primary prevention is
directed toward avoidance of obesity and weight reduction, if necessary, to prevent the
onset of NIDDM. Although the role of hereditary and genetic factors is developing,
genetic counseling is still not recommended because of the unknown nature of the
pattern of transmission. This does not deny familial history as a risk factor. In NIDDM
the inherited or genetic factor is dominant, but environmental factors have a major
influence on the onset and clinical course of the disease.

(5) In diabetes mellitus, there is an absolute or relative deficiency of insulin and its actions.
The pathogenesis of the insulin deficiencies is different in IDDM and NIDDM. It is
important to understand the pathology underlying the deficiency, particularly as it
relates to NIDDM because this is an ongoing are of research. An absolute deficiency in
insulin secretion usually occurs with IDDM and results from destruction of pancreatic
beta cells by the interaction of genetic, immunologic, hereditary, and environment
factors. Not all persons with IDDM have the same level of beta cell dysfunction, and this
may account for differences in how well these persons can be controlled. Resistance to
the peripheral action of insulin (endogenous or exogenous) may also be present in
IDDM.

(6) In NIDDM, serum insulin levels may be depressed, normal, or high. Research indicates
that the pathogenic, sequence in NIDDM (cumulating in a relative insulin deficiency)
may be the result of one factor or a combination of factors. 1) An islet cell defect results
in a slowed or delayed response in the release of insulin to a glucose load. Although
basal insulin levels are normal or high, the insulin secretion does not keep pace the
glucose demands. 2) The number of insulin receptors is reduced because of down
regulation from elevated insulin levels. Although there is sufficient insulin, cells cannot
be stimulated, because the number of receptors available for activation is decreased. 3)
A receptor abnormality inhibits insulin binding. 4) There is a postreceptor defect.
Although insulin is present and binds to the receptor, the intracellular activation
necessary for normal cell stimulation does not occur. 5) A major peripheral resistance to
insulin is induced by the hyperglycemia itself. Although insulin and other components
are present, the components are inhibited in functioning in some unknown manner.

(7) It has been proposed that NIDDM both peripheral resistance to insulins function and a
defect in islet cell function that slows insulin secretion are present. At this time it is not
known which event occurs first, but either deficit can eventually result in the other
defect. For example, peripheral insulin resistance from receptor problems can result in
islet cell dysfunction, and the resultant hyperinsulinemia can cause peripheral insulin
resistance.

(8) Persons with diabetes have a defect in pancreatic alpha cell function in addition to the
beta cell dysfunction. Diabetic persons show insensitivity in the regulation of glucagon
(secreted by the alpha cells) in response to hyperglycemia or hypoglycemia, resulting in
a continual elevated glucagon level. Controversy exists about whether 1) this is primary
defect associated with diabetes mellitus or secondary to a lack of insulin action, 2)
elevation in glucagon is a necessary prerequisite for the alteration in metabolism seen in
diabetes, or 3) treatment designed to suppress glucagon should be part of the regiment
for persons with diabetes. At this time it is known that glucagon levels are elevated and
they can worsen the metabolic alterations; however, the same alterations can occur in
the presence of only a deficiency of insulin or its actions.

(9) A lack of insulin or its actions results in hyperglycemia. After a meal, because insulin
levels are low or the function of insulin is impaired, glucose is not taken up from the
portal vein by the liver (its normal function). Thus glucose enters the general circulation,
and glycogenesis is inhibited. In addition, the liver continues to synthesize glucose (via
glycogenolysis or gluconeogenesis) and to release glucose into the blood steam,
worsening the hyperglycemia. Insulin-dependent peripheral tissues such as skeletal
muscle and adipose tissue do not extract glucose from the blood as they normally
would, and muscle cells metabolize their own glycogen supply.

(10) Amino acid transport into cells also requires insulin, thus amino acid uptake and
protein synthesis is impaired. Proteins are actually catabolized, and amino acids are
liberated to provide the substrates necessary for gluconeogenesis. The metabolism of
fatty acids, triglyceride, and glycerol is altered; and, instead of lypogenesis, lipolysis is
seen. The liver will continue the formation of ketone bodies (ketogenesis), which may
occur at a brisk rate.

(11) The buildup of glucose in the blood results in more glucose being filtered than
can be reabsorbed in the renal system, and glucose is excreted in the urine. This usually
occurs when the serum glucose level is over 180mg/100mL, given that renal function is
normal. The glucose excretion results in an osmotic diuresis and the loss of fluid and
electrolytes. If the level of ketones is higher than the renal threshold, ketones also are
excreted in the urine, producing additional fluid and electrolyte losses.

(12) The severity of the altered metabolism depends on the severity of insulin
deficiency and its action. In mildly deficient states, altered glucose metabolism with
hyperglycemina and glycosuria may occur only after meals. In the fasted state, glucose
levels may be normal, and protein metabolism is normal. As the deficiency increases in
severity, hyperglycemia, glycosuria, and protein catabolism will be present all the time.
The altered lipid metabolism resulting in abnormally high production of ketones may
only be seen in markedly insulin-deficient states and is usually only present in IDDM.

Questions:
19. Gestational diabetes occurs most often in
a. High risk teenage pregnancies.
b. Pregnant women age 35 and above.
c. Pregnant women with a significant family history of diabetes.
d. Women who smoke during the first trimester of pregnancy.
e. Native American women.
20. A lack of insulin produces the following condition:
a. Lypogenesis
b. Hypoglycemina
c. Hyperglycemia
d. Protein catabolism
e. Ketogenesis
21. Insulin-dependent diabetes mellitus most often develops between the ages of
a. 10-15
b. 15-30
c. 30-50
d. 50-60
e. 65 and older
22. Pancreatic alpha cells are responsible for
a. Glucagon production.
b. Glucagon secretion.
c. Glycogenesis.
d. Gluconeogenesis.
e. Glycogenolysis
23. The insulin deficiency found in IDDM is primarily related to
a. Endogenous peripheral resistance to insulin
b. Exogenous peripheral resistance to insulin
c. Destruction of pancreatic alpha cells
d. Destruction of pancreatic beta cells
e. Islet cell defects
24. Peripheral resistance to insulin found in NIDDM is closely related to the following
disease
a. Obesity
b. Peripheral neuropathies
c. Defects in islet cell function
d. Hyperinsulinemia
e. Hypoinsulinemia
25. When a diabetic person is experiencing severe hyperglycemia, you would expect
him/her to be
a. Retaining fluid
b. Severely hypotensive
c. Severely hypertensive
d. Constantly urinating
e. Sweating excessively
26. With both IDDM and NIDDM, altered glucose metabolism with hyperglycemia and
glycosuria occurs most likely
a. After strenuous exercise
b. After meals
c. Before meals
d. During a fasting state
e. After protein catabolism
27. The excessive loss of fluid and electrolytes through the kidneys caused by hyperglycemia
is related to
a. Active transport
b. Diffusion
c. Renal impairment
d. Osmosis
e. The presence of ketones
28. With NIDDM, serum insulin levels are affected by the following combination of factors:
a. Islet cell defects resulting in a delayed release of insulin
b. Down regulation
c. Peripheral resistance to insulin
d. All of the above
e. A & C
29. Insulin is required for cell uptake of which of the following:
a. Glucose
b. Glycerol
c. Amino acids
d. A & C
e. All of the above
30. With normal renal function, the renal threshold for glucose is
a. Serum glucose levels below 120mg/100mL
b. Serum glucose levels above 120mg/100mL
c. Serum glucose levels below 180mg/100mL
d. Serum glucose levels above 180mg/100mL
e. None of the above
31. All of the following factors play a significant role in the disease processes of diabetes
mellitus except:
a. Alpha and beta dysfunction
b. Glucagon production
c. Receptor and postreceptor defects
d. Insulin secretion
e. Peripheral resistance
32. IDDM has a higher incidence rate in which of the following:
a. Caucasians
b. Hispanics
c. Native Americans
d. Non-white persons
e. African Americans
33. Glucose uptake from the portal vein is a specific function of the
a. Liver
b. Pancreatic alpha cells
c. Pancreatic beta cells
d. Islet cells
e. Kidneys
34. Genetic predisposition of diabetes mellitus most likely found in
a. Juvenile diabetes
b. Gestational diabetes
c. NIDDM
d. IDDM
e. Latent diabetes
35. Altered lipid metabolism resulting in ketogenesis is usually seen only in
a. Gestational diabetes
b. Juvenile diabetes
c. Latent diabetes
d. NIDDM
e. IDDM


Passage III:

Cellular Adaptation to Injury
(1) The life cycle of a cell exists on a continuum that includes normal activities and
adaptation, injury, or lethal changes. The pathologic changes exhibited may be obvious
or very difficult to detect. The cell constantly makes adjustments to a changing, hostile
environment in order to keep the organism functioning in a normal steady state. These
adjustments are termed adaptation and are necessary to ensure the survival of the
organism. Adaptive changes may be temporary or permanent. The point at which an
adapted cell becomes an injured cell is the point at which the cell cannot functionally
keep up with the stressful environment affecting it. Injured cells exhibit alternations
that may affect body function and are manifested as disease.

(2) Because the cell is constantly making adjustments to a changing, hostile environment,
many agents potentially can cause cellular injury or adaptation. Cellular injury may lead
to further injury and death of the cell, or the cell may respond to the noxious
stimulation by undergoing a change that enables it to tolerate the invasion. Stimuli that
can alter the steady state are categorized as physical agents, chemical agents,
microorganisms, hypoxia, genetic defects, nutritional imbalances, and immunologic
reactions.

(3) Physical agents are such factors as mechanical trauma, temperature gradients, electrical
stimulation, atmospheric pressure gradients, and irradiation. Physical stimuli directly
damage cells, cause rupture or damage of the cell walls, and disrupt cellular
reproduction. Chemical agents that can cause cellular injury may include simple
compounds such as glucose or complex agents such as poisons. Therapeutic drugs often
chemically disrupt the normal cellular balance. Microorganisms cause cellular injury in a
variety of ways depending on the type of organism and the innate defense of the human
body. Some bacteria secrete exotoxins, which are injurious to the host. Others liberate
endotoxins when they are destroyed. Viruses interfere with the metabolism of the host
cells and cause cellular injury by releasing viral proteins toxic to the cell.

(4) Hypoxia is the most common cause of cellular injury and may be produced by
inadequate oxygen in the blood or by decreased perfusion of blood to the tissues. The
end results are disturbance of cellular metabolism and local or generalized release of
lactic acid. Genetic defects can affect cellular metabolism through inborn errors of
metabolism or gross malformations. The mechanisms for cellular disruption vary widely
with the genetic defect byt may result in intracellular accumulation of abnormal
material.

(5) Nutritional imbalances produce sickness and death in over one-half of the worlds
population. The imbalances include serious deficiencies of proteins and vitamins
especially. Malnutrition may be primary or secondary, depending upon whether it is a
socioeconomic problem in the underprivileged areas of the world or is self- or disease
induced. No matter the cause, nutritional deficiency is a significant cause of cellular
dysfunction and death. On the other hand, excessive food intake leads to nutritional
imbalances and cell injury through the production of excessive lipids in the body.
Excessive intake has been shown to be associated with cardiovascular diseases, and
respiratory and gastrointestinal disorders. Immunologic agents may cause cellular
injury, especially when hypersensitivity reactions occur, causing the release of excess
histamine and other substances.

(6) Cellular swelling is the initial response to disruption of cellular metabolism. It occurs
most frequently with cellular hypoxia and impairs the cells ability to synthesize
adenosine triphosphate. It results in a shift of extracellular fluid to be intracellular
compartment, causing cloudy intracellular swelling with enlargement of the cell.
Ultimately, organs are affected. Cellular swelling is frequently reversible when sufficient
oxygen is delivered to the cell and normal ATP synthesis resumes. Continued
accumulation of water in the cells often has the appearance of small or large vacuoles of
water, which may represent portions of endoplasmic reticulum that have been
sequestered.

(7) Lipid accumulation refers to a fatty change process that occurs in the cytoplasm of
parenchymal cells of certain organs. Fat droplets accumulate as a result of improper
metabolism and commonly are present in degenerative liver conditions. The heart and
kidneys also can undergo fatty change when placed under abnormal stimulation, such as
exposure to hepatotoxins or hypoxia. Large, fatty intracellular accumulations have been
shown to stimulate progressive necrosis, fibrosis, and scarring of organs. This leads to
functional impairment of the involved organ.

(8) In some cases the cell undergoes an acutual change so as to adapt to an injurious agent.
The changes often manifested are atrophy, dysplasia, hypertrophy, hyperplasia, and
metaplasia. These adaptations are methods by which the cell stays alive and adjusts
workload to demand. Atrophy refers to a decrease in cell size resulting from decreased
workload, loss of nerve supply, decreased blood supply, inadequate nutrition, or loss of
hormonal stimulation. The word implies previous normal development of the cell and
that the cell has lost structural components and substance.

(9) Dysplasia refers to the appearance of cells that have undergone some atypical changes
in response to chronic irritation. It is not a true adaptive process in that it serves no
specific function. Dysplasia is presumable controlled reproduction of cells, but it is
closely related to malignancy in that it may transform into uncontrolled, rapid
reproduction. Epithelial cells are the most common types to exhibit dysplasia; changes
include alterations in the size and shape of cells, causing loss of normal architectural
orientation of one cell with the next. Dysplastic changes frequently occur in the bronchi
of chronic smokers and in the cervical epithelium.

(10) Hypertrophy is an increase in the size of individual cells, resulting in increased
tissue mass without an increase in the number of cells. It usually represents the
response of a specific organ to an increased demand for work. Hypertrophied cells
increase their number of intracellular organelles, especially mitochondria. A good
example physiology hypertrophy is the enlargement of muscles of athletes or weight
lifters. The individual muscle cells englarge but do not proliferate, and this provides
increased strength. Limiting factors to hypertrophy exist, and these may have to do with
limitation to the vascular supply or the capability of cells to produce energy.
Hypertrophy may also be pathologic and frequently affects the myocardium.

(11) Hyperplasia is a common condition seen in cells that are under an increased
physiologic workload or stimulation. It is defined as an increase of tissue mass due to an
increase in the number of cells. Cell that undergo hyperplasia are those that are capable
of dividing and thus of increasing their number. Whether hyperplasia, rather than
hypertrophy, occurs depends on the regenerative capacity of the specific cell.
Hyperplasia is induced by a known stimulus and almost always stops when the stimulus
has been removed. This controlled reproduction is an important differentiating feature
of hyperplasia from neoplasia. There is a close relationship between certain types of
pathologic hyperplasia and malignancy.

(12) Metaplasia is a reversible change in which one type of adult cell is replaced by
another type. It is probably an adaptive substation of one cell type, more suited to the
hostile environment, for another. Metaplasia is commonly seen in chronic bronchitis;
stratified squamous epithelial cells replace the normal columnar ciliated goblet cells.
The latter cells are better suited for survival in the face of chronic, irritating smoke
inhalation or environmental pollution. Metaplasia increases are closely related to
malignancy, which probably indicates that chronic irritation causes the initial change.

Questions:
36. The most common cause of cellular injury is
a. Mechanical trauma
b. Nutritional imbalances
c. Immunologic responses
d. Hypoxia
e. Invasion of microorganisms
37. The following statements about cellular swelling are true except:
a. It impairs the cells ability to synthesize ATP
b. It results in a shift of intracellular fluid to the extracellular space
c. It occurs most frequently with cellular hypoxia
d. It is frequently reversible
e. It can appear as small or large vacuoles of water
38. Immunologic agents can be particularly damaging to cells when an excess of which
substance is secreted?
a. Lymphocytes
b. White blood cells
c. Histamine
d. Plasma
e. None of the above
39. Physical agents that alter the steady state of cell metabolism include
a. Exotoxins
b. Endotoxins
c. Poisons
d. Viral proteins
e. None of the above
40. Hyperplasia is most often found with the presence of
a. Uncontrolled, rapid reproduction
b. A known stimulus
c. A decrease physiologic workload
d. An increase tissue mass without an increase in the number of cells
e. None of the above
41. The following organ changes can be a result of large, fatty intracellular accumulations
except:
a. Hypertrophy
b. Necrosis
c. Fibrosis
d. Scarring
e. Functional impairment
42. Which of the following is associated with cell hypertrophy?
a. It can be defined as an increased tissue mass with an increase in the number of
cells
b. It is seen in organs with cells that are capable of cell regeneration
c. It is increase in the size of individual cells
d. It is usually irreversible
e. It has no pathological effects
43. Lipid accumulation generally occurs in which type of cells?
a. Striated
b. Squamous
c. Parenchymal
d. Stratified
e. None of the above
44. Which organ can be most severely affected by lipid accumulation?
a. Heart
b. Kidney
c. Brain
d. Epithelium
e. Liver
45. Metaplasia is commonly seen in
a. Malignant carcinoma
b. Cervical epithelium
c. Myocardial infarctions
d. Chronic bronchitis
e. Asthmatics
46. Decreased blood supply or inadequate nutrition can lead to cell
a. Swelling
b. Metaplasia
c. Atrophy
d. Dysplasia
e. None of the above
47. The initial response to a disruption of cellular metabolism is
a. Atrophy
b. Lipid accumulation
c. Infiltration
d. Hyperplasia
e. Swelling
48. Stimuli that can alter a cells steady state include all of the following except:
a. Nutritional imbalances
b. Chemical agents
c. Reproduction
d. Immunologic responses
e. Hypoxia
49. Atypical changes in cell appearance are most likely a result of
a. Chronic irritation
b. Malignant reproduction
c. Sudden increase in workload
d. Sudden increase in tissue mass
e. Adaptive substitution
50. Adaptive changes can be classified as all of the following except:
a. Temporary
b. The point at which the cell becomes injured
c. Necessary for the survival of the organism
d. Very difficult to detect
e. Permanent
































Quantitative Reasoning

1. A man walked 10 miles in 2.5 hours. What is the mans rate in miles per hour?
a. 3
b. 4
c. 5
d. 6
e. 7
2. Tom has 20 stamps worth 72 cents. If some stamps are 3 cent and some are 4 cent
stamps, how many 3 cent stamps does tom have?
a. 4
b. 8
c. 10
d. 12
e. 14
3. In the figure, what is the value of angle x.

a. 30
b. 60
c. 77
d. 120
e. 150

4. If ( )

()
, find x.
a. 12
b. 15
c. 17
d. 22
e. 45
5. How many arrangements can six people can be seated round a circular table?
a. 21
b. 24
c. 120
d. 720
e. 810

6. Evaluate ()

a.

b.

c.

d. 9x
2

e. 2x
2

7. Evaluate

a. .01
b. .001
c. 10
d. 100
e. 1000
8. If = 287, which of the following is not true?
a. sin 287 < 0
b. tan 287 < 0
c. cos 287 < 0
d. sec 287 < 0
e. cot 287 < 0
9. What is the probability of six tails out of nine tosses of a fair coin?
a. 21/128
b. 21/64
c. 84/128
d. 22/64
e. 42/64
10. A donut shop bakes a dozen donuts at a cost of $4. To achieve a 33% profit on sales,
what is the minimum sales price the donut shop should set for each donut?
a. 6 cents
b. 20 cents
c. 25 cents
d. 40 cents
e. 50 cents

11. If a + b = 3 and 2b + c = 2, then 2a c =
a. -4
b. 4
c. 1
d. -1
e. 0
12. A square is inscribed in a circle of radius 4. Find the shaded area.

a. 16
b. 4 32
c. 8 64
d. 16 32
e. 16 64
13. Joes house faucet can fill a 1000 gallon pool in 10 hours, and his neighbors faucet can
fill the same pool in 6 hours. How many hours will it take to fill the pool if both faucets
fill the pool at the same time?
a. 3.25
b. 3.5
c. 3.75
d. 4
e. 4.25
14. If is an acute angle such that sin = 8/17, find the value of the cot .
a. 17/8
b. 15/17
c. 17/15
d. 8/15
e. 15/8
15. Kim is 1/3 the age of her older sister Sue. In 13 years, Sue will be one year younger than
twice Kims age. How old is Sue?
a. 10
b. 12
c. 24
d. 36
e. 49
16. Given that L
1
L
2
, find the angle y.

a. 32
b. 64
c. 120
d. 140
e. 148
17. Solve: 4 csc
2
1 = 0 for all values 0 < 360.
a. {1/2, -1/2}
b. {0, 1}
c. {- }
d. {- }
e. {empty}
18. The greater the two numbers is five more than twice the smaller. If the sum of the
numbers is 17, what is the value of the smaller number?
a. 13
b. 10
c. 7
d. 6
e. 4
19. Mark has $7200 invested, part at 4% the rest at 5%. If annual income from both
investments is the same, what is the income from his investment?
a. $120
b. $160
c. $280
d. $320
e. $400
20. If a certain casino, you are paid winnings if you roll a seven with two die. What are your
chances of rolling a seven in one toss?
a. 1/6
b. 1/3
c. 1/36
d. 3/36
e.
21. What is the simple interest on $4000 at a 4% semiannual rate over three years?
a. $330
b. $660
c. $960
d. $1030
e. $1200
22. A maps key shows that = 42 miles. How many inches apart on the map will the two
cities be if they are exactly 14 miles apart?
a. 6
b. 8
c. 1/12
d. 1/6
e. 1/8
23. The number 9 is what percent of 72
a. 6.25%
b. 12.5%
c. 15%
d. 20%
e. 25%
24. Chord AB and CD of Circle O intersect at E. If AE = 4, AB = 5, CE = 2, find ED.
a. 2
b. 3
c. 7
d. 8
e. 10
25. A candy store mixes jaw breakers worth 36 cents a pound with lolly pops worth 52 cents
a pound to make a 200 pound mixture worth 40 cents a pound. How many pounds of
the lolly pops did the store use?
a. 30
b. 50
c. 75
d. 100
e. 150


26. In a regular deck of fifty-two cards, what is the probability of drawing a diamond on the
first try?
a. 13/26
b. 1/13
c.
d. 1/26
e. 1/52
27. A decorative board for a fence is three inches wide. The part of the yard that needs
decorative boards is 107 feet wide. Starting with a decorative board and spacing each
board four inches apart, how many fence boards do you need?
a. 16
b. 180
c. 184
d. 321
e. 428
28. 18 is what percent of 90?
a. 15%
b. 18%
c. 20%
d. 22%
e. 23%
29. Evaluate [

a.
b. 1/12
c. 5/9
d. 8/9
e. 1
30. Evaluate:

a. -

b.
()

c.

d.

e.

31. A cow can produce 265 ounces of milk a day. If a dairy has five milk producing cows,
how much milk can the dairy sell after four days?
a. 41 gallons, 2 quarts
b. 41 gallons, 1 quart
c. 20 gallons, 2 quarts
d. 82 gallons, 3 quarts
e. 82 gallons, 2 quarts
32. What is the probability of rolling double threes in one toss of a nine sided die and a six
sided die?
a. 1/36
b. 1/6
c. 1/15
d. 1/27
e. 1/54
33. The roots of the equation x
2
6x 2 = 0 are:
a.
b.
c.
d.
e.
34. Evaluate

a. 99/84
b. 99/21
c. 73/84
d. 103/84
e. 105/85
35. IF 4x + 2y = 7 and 3x 4y = 8, then x y is:
a. 0
b. .5
c. 1.5
d. 2
e. 2.5
36. Evaluate (2x
4
y
3
)
3
=
a. 8x
12
y
9

b. 6x
12
y
9

c. 8x
64
y
27

d. 6x
64
y
27

e. 8x
7
y
6

37.

evaluates to:
a.

b.

c.

d.

e.

38. Evaluate

=
a. a
24
b
3

b. a
11
b
4

c.

d.

e. a
5
b
2

39. Solve for x: 3x + 2 5x 10
a. x 6
b. x 6
c. x -12
d. x -12
e. x =6
40. The number 45 is 4.5% of which of the following?
a. 10
b. 100
c. 1000
d. 450
e. 4500