(Campbell 11th ed, chapter 1)

1. The exact position of the kidney within the retroperitoneum varies during :
a. Different phases of respiration
b. Presence of anatomic anomalies
c. Body position
d. A,b, and c
e. A and c
. d. a, b, and c. The exact position of the kidney within the retroperitoneum varies during different
phases of respiration, body position, and presence of anatomic anomalies. For example, the
kidneys move inferiorly about 3 cm (one vertebral body) during inspiration and during the
changing of body position from supine to the erect position

2. Gerota fascia envelops the kidney and the adrenal gland on all aspects but remains open :
a. Inferiorly
b. Laterally
c. Medially
d. Inferiorly and laterally
e. Inferiorly and medially
. a. Inferiorly. Gerota fascia encasing the kidneys, adrenal glands, and abdominal ureters is closed
superiorly and laterally and serves as an anatomic barrier to the spread of malignancy and a means
of containing perinephric fluid collections. Superiorly, the Gerota fascia is continuous with the
diaphragmatic fascia on the inferior surface of the diaphragm, whereas inferiorly, the anterior and
posterior layers of Gerota fascia are loosely attached where perinephric fluid collections can track
inferiorly into the pelvis without violating Gerota fascia.

3. The white line of Toldt is the lateral reflection of posterior parietal peritoneum that covers :
a. The ascending colon
b. The descending colon
c. The transverse colon
d. The ascending and descending colons
e. The ascending and transverse colon
 . d. The ascending and descending colons. To access the kidneys transperitoneally, the colon needs
to be mobilized from the white line of Toldt, which is the lateral reflection of posterior parietal
peritoneum over the ascending and descending colon

4. What are the columns of Bertin?

a. Extensions of renal medulla between the pyramids
b. Extensions of renal cortex between the pyramids
c. Cortical extensions between renal lobules
d. The collecting ducts
e. None of the above
b. Extensions of renal cortex between the pyramids. The renal cortex is about 1 cm in thickness
and covers the base of each renal pyramid peripherally and extends downwards between the
individual pyramids to form the columns of Bertin.

5. Compared with the liver, the normal adult kidneys in gray-scale ultrasound appear:
a. Hyperechoic
b. Isoechoic
c. Hypoechoic
d. B and c
e. Variable, depending on the renal function
b. Isoechoic. In adults, the normal kidneys have smooth margins and are isoechoic to the liver.
However, both renal cortices and pyramids are usually hypoechoic to the liver, spleen, and renal
sinus. Compared with renal parenchyma, renal sinus appears hyperechoic because of the
presence of hilar adipose tissue, blood vessels, and lymphatics.

6. Occulusion or injury to a segmental renal artery will cause :

a. No pathologic conditions
b. Opening of the collateral circulation
c. Segmental renal infarction
d. An effect that depends on the availability of collaterals.
e. Renal atrophy
 . c. Segmental renal infarction. After entering the hilum, each artery divides into five segmental
end arteries that do not anastomose significantly with other segmental arteries. Therefore,
occlusion or injury to a segmental branch will cause segmental renal infarction. Nevertheless, the
area supplied by each segmental artery could be independently surgically resected.

7. Ureteropelvic junction obstruction may be commonly caused by :

a. The lower anterior segmental artery when it passes anterior to the ureter
b. Crossing of the ureter by any of the renal segmental artery
c. The posterior segmental artery when it passes posterior to the renal pelvis
d. The posterior segmental artery when it passes anterior to the ureter
e. The lower anterior segmental artery when it passes posterior to the ureter.
d. The posterior segmental artery when it passes anterior to the ureter. The posterior segmental
artery from the posterior division passes posterior to the renal pelvis while the others pass
anterior to the renal pelvis. If the posterior segmental branch passes anterior to the ureter,
ureteropelvic junction obstruction may occur

8. Occlusion of a segmental renal vein results in :

a. Segmental renal congestion
b. segMental renal atrophy
c. No Pathologic conditions
d. An Effect that depends on the availability of collaterals
e. Gross hematuria
c. No pathologic conditions. The renal venous drainage correlates closely with the arterial supply
with the exception that unlike the arterial supply, venous drainage has extensive collateral
communication through the venous collars around minor calyceal infundibula. Furthermore, the
interlobular veins that drain the post-glomerular capillaries also communicate freely with
perinephric veins through the subcapsular venous plexus of stellate veins. Therefore, occlusion of
a segmental venous branch has little effect on venous outflow

9. The main renal vasculature can be accurately, identified with 100% sensitivity by :
a. Doppler ultrasonography
b. Computed tomography angiography (CTA)
 c. Intravenous urography
d. Noncontrast computed tomography
e. All of the above
b. Computed tomography angiography (CTA). Doppler ultrasonography clearly identifies renal
arteries at their origin from the abdominal aorta. However, the main renal artery is often difficult
to identify at baseline ultrasonography. Therefore, CTA is currently considered the gold standard
to assess renal arteries with 100% sensitivity for identification of renal arteries and veins

10. Medial displacement of both pelvic ureteral segments might result from :
a. Pelvic lipomatosis
b. Postabdominoperineal surgery
c. Retroperitoneal fibrosis
d. All of the above
e. A and c
d. All of the above. Medial displacement of both pelvic ureteral segments might result from
retroperitoneal fibrosis, pelvic lipomatosis, or postabdominoperineal surgery. However, medial
displacement and concavity of a single pelvic ureter may result from enlarged hypogastric nodes,
a bladder diverticulum, or aneurismal dilatation of the hypogastric artery. Nevertheless, this may
be a normal finding in adult females if only the right ureter is affected because of the uterine tilt
to the left

(Campbell 11th ed chap 21)

11. The ducts of which of the following prostatic zones drain into the preprostatic urethra?
a. Periurethral glands
b. Central zone
c. Transition zone
d. Perpheral zone
e. A and c
a. Periurethral glands. At its midpoint, the urethra turns approximately 35 degrees anteriorly, but
this angulation can vary from 0 to 90 degrees. This angle divides the prostatic urethra into
proximal (preprostatic) and distal (prostatic) segments, which are functionally and anatomically
 discrete. Small periurethral glands, lacking periglandular smooth muscle, extend between the
fibers of the longitudinal smooth muscle to be enclosed by the preprostatic sphincter

(Campbell 10th ed chap2)

12. When endopelvic fascia lateral to the prostate and puboprostatic ligaments is opened, vessels
are commonly encountered that pierce the levator ani to join the periprostatic plexus laterally.
These vessels are communnicating branches from the :
a. Pampiniform plexus of veins
b. Dorsal vein of the penis
c. Internal pudendal veins
d. External pudendal veins
e. Accessory obturator veins
c. internal pudendal veins. The internal pudendal veins communicate freely with the dorsal vein
complex by piercing the levator ani. These communicating vessels enter the pelvic venous plexus
on the lateral surface of the prostate and are a common, often unexpected, source of bleeding
during apical dissection of the prostate.

13. The testicular artery may be ligated without sacrificing the testis because of collateral
circulation from :
a. Vasal and cresmasteric arteries
b. External pudendal and vasal arteries
c. External pudendal, vasal, and cresmasteric arteries
d. Numerous anastomotic branches from the scrotal arteries
e. Cremasteric and external pudendal arteries
a. vasal and cremasteric arteries. A rich arterial anastomosis occurs at the head of the epididymis,
between the testicular and capital arteries, and at the tail between the testicular, epididymal,
cremasteric, and vasal arteries.

14. On a CT Scan, a male patient is found to have enlarged lymph nodes along the abdominal
aorta between the left renal hilum and the inferior mesenteric artery. Sites of malignancy that
would commonly drain directly to these lymph nodes would NOT include the :
 a. Colon
b. Left kidney
c. Left testis
d. Left renal pelvis
e. Bladder
e. bladder. These lumbar nodal chains are extraregional or secondary drainage sites for any
metastatic process arising from the lower pelvis

(Campbell 10th ed chap 1)

15. A young man with rigth-sided abdominal pain is diagnosed with right hydroureteronephrosis
by renal ultrasonography. Which of the following inflammatory processes might impinge on
the right ureter and cause obstruction?
a. Acute appendicitis
b. Crohn ileitis
c. Perforated cecal carcinoma
d. All of the above
e. None of the above
d. All of the above. Anteriorly, the right ureter is related to the terminal ileum, cecum, appendix,
and ascending colon and their mesenteries.

(Campbell 10th ed chap 47)

16. An adventage of the supine over the prone position for percutaneous surgery is:
a. Improved pulmonary mechanics.
b. A large horizontal working surface.
c. Easier entry info upper pole calyces.
d. Easier entry info posterior calyces.
e. Reduced pressure in the collecting system.
e. reduced pressure in the collecting system. The angle of the sheath is more horizontal in the
supine compared with the prone position for percutaneous renal surgery, which reduces pressure
in the collecting system (the volume also is reduced, which is a disadvantage). When padding is
appropriate, pulmonary mechanics are better in the prone position. The prone position also
 provides a large horizontal working surface and easier entry into posterior and upper pole calyces
compared with the supine

17. Access into which site the provides the optimal versatility and safety for percutaneous renal
surgery in the prone position.?
a. Upper pole posterior calyx
b. Upper pole infundibulum.
c. Renal pelvis.
d. Middle calyx.
e. Lower pole anterior calyx
a. Upper pole posterior calyx. This offers the most versatile access to the intrarenal collecting system,
and as long as the entry is below the 11th rib the advantages generally outweigh the risks. In the prone
position an anterior calyx offers little access to the rest of the kidney. Percutaneous access into an
infundibulum or the renal pelvis poses a greater risk of vascular injury than calyceal entry. Middle
calyces are rarely compound, and middle calyceal access usually does not provide good access to the
upper and lower calyces

(Campbell 11th ed chap 8)

18. Compared to internal ureteral stents after percutaneous renal surgery, nephrostomy tubes are
associated with :
a. Reduced need for a second procedure for removal.
b. Greater technical success rate.
c. Greater narcotic use.
d. Fewer complications.
e. Less urinary leakage from skin entry site.
. c. Greater narcotic use. Most randomized controlled trials comparing internal ureteral stents to
large-caliber nephrostomy tubes after percutaneous renal surgery have shown reduced narcotic
use in the stented patients. The difference is less significant when a small-caliber nephrostomy
tube is used. Depending on physician preference, both internal ureteral stents (if attached to a
string that exits via the flank) and small-caliber nephrostomy tubes can be removed at the
bedside. Randomized controlled trials comparing internal ureteral stents to nephrostomy tubes
 have not revealed any difference in technical success rates, complication rates, or incidence of
urinary leakage from the skin entry site.

(Campbell 11th ed chap 10)

19. What is the most common intra-abdominal site of injury associated with laparoscopic
surgery.?
a. Bowel injury.
b. Vascular injury.
c. Liver injury
d. Splenic laceration.
e. Bleadder injury.
b. Vascular injury. The most common site of injury during laparoscopic surgery, in reports in the
literature, is vascular in origin, occurring in 2.8% of patients, followed by bowel injury at 1.1%. The
most often injured intra-abdominal organ was the bowel, at an incidence of 1.2%

(Campbell 11th ed chap 12)

20. In chronic renal abscess the predominant urographic upnomality is:
a. Calyceal distortion.
b. Renal mass
c. Calculi
d. Hidronephrosis.
e. Calyceal amputation.
. b. Renal mass. In a more chronic abscess, the predominant urographic abnormalities are those
of a renal mass lesion.

(Campbell 11th ed chap 33)

21. The blood supply to the adrenal gland may include brances from the:
a. Infrenior phernic artery.
b. Aorta.
c. Renal artery.
d. A dan b.
 e. A, b, dan c.
. f. a, b, and c. The adrenal gland may receive branches from the superior adrenal artery off of the
inferior phrenic artery, the middle adrenal artery off of the aorta, and the inferior adrenal artery
off of the renal artery.

22. Which of following statement is TRUE.?

a. The superior messentric artery (SMA) may be sacrificed without causing bowel ischemia.
b. Ligation of the inferior mesenteric artery (IMA) will cause ischemia to the large bowel but
not the small bowel.
c. The IMA may be sacrificed without colonic ischemia because of collateral circulation via
the marginal artery and hemorrhoidal arteries.
d. The IMA may be sacrificed without colonic ischemia because of collateral sirculation via
the ileocolic artery.
e. Neither the superior nor the inferior mesenteric arteries may be sacrificed without causing
bowel ischemia.
. c. The IMA may be sacrificed without colonic ischemia because of collateral circulation via the
marginal artery and hemorrhoidal arteries. The SMA supplies the pancreas (inferior
pancreaticoduodenal artery), small intestine, and the majority of the large intestine (ileocolic,
right colic, and middle colic). Ligation of the SMA will result in catastrophic bowel ischemia
(without pancreatic ischemia because of collaterals from the celiac artery and the superior
pancreaticoduodenal artery). The branches of the IMA are the left colic, sigmoid, and superior
hemorrhoidal (rectal) arteries. The collateral circulation of the sigmoid artery via the marginal
artery of Drummond and the inferior and middle hemorrhoidal arteries allows for the IMA to be
sacrificed without colonic ischemia.

23. Which of the following statement is FALSE.?

a. The right testicular vein typically drains into the inferior vena cava (IVC).
b. The left testicular vein typically drains into the left renal vein.
c. Unilateral varicoceles are more common on the left side.
d. A sudden onset unilateral right-sided varicocele should prompt retroperitoneal imaging.
e. The left ovarian vein typically drains into the IVC.
 . e. The left ovarian vein typically drains into the IVC. The venous drainage of the ovarian and
testicular veins is similar. The right testicular and the right ovarian veins typically drain into the
IVC while the left testicular and the left ovarian veins drain into the left renal vein. Unilateral
varicoceles are more common on the left, which may be a result of the increased length and
perpendicular entry of the left testicular vein into the left renal vein. Given the rarity of unilateral
right-side varicocele, a sudden-onset right-side varicocele should increase suspicion for a renal or
retroperitoneal malignancy leading to poor outflow and warrants retroperitoneal imaging

24. What statement best describes the lymphatic drainage of the right testis?
a. Superficial then deep right inguinal nides.
b. Left para-aortic with some drainage to the interaortocaval nodes.
c. Only to the interaortacaval nodes.
d. Primarily to the interaoctocaval nodes with some drainage to the right paracaval nodes.
e. Interaortacaval nodes primarily with some drainage to the right paracaval nodes and a small
but appreaciable amount of drainage to the left para-aortic nodes.
. e. Interaortocaval nodes primarily with some drainage to the right paracaval nodes and a small
but appreciable amount of drainage to the left para-aortic nodes. The right testis drains primarily
to the interaortocaval nodes with some drainage to the right paracaval nodes. The left para-aortic
region does receive a small but appreciable amount of lymphatic drainage from the right testis.
This drainage pattern is consistent with the global lymphatic flow from right to left.

25. What is the major function of the muscles innervated by the obturator nerver.?
a. Hip adduction.
b. Hip abduction.
c. Hip flexion.
d. Hip extention.
e. Knee flexion.
. a. Hip adduction. The obturator nerve innervates the muscles of the medial thigh compartment.
These include the gracilis, adductor longus, adductor brevis, adductor magnus, and obturator
externus muscles. The muscles function to adduct and rotate the thigh at the hip joint.
(Campbell 11th ed chap 2)
26. After rapidly assessing airway, breathing, and sirculation, the medical treatment of choice for
a severe, life-treatening adverse drug reaction following exposure to the contrast media is:
a. Subcutaneous injection of epinephrine 0,5 mg of 1 : 10.000 epineprhine.
b. Intravenous injection of 100 mg of methylprednisone.
c. 0,01 mg/kg of epinephrine (1:10.000 concentration) intramusculary in the literal thigh.
d. Intravenous diphenhydramine 50 mg.
e. 0,01 mg/kg of epinephrine (1:10.000 concentration) intramuscularly in the lateral thigh.
. e. 0.01 mg/kg of epinephrine (1:1,000 concentration) intramuscularly in the lateral thigh. Rapid
administration of epinephrine is the treatment of choice for severe contrast reactions.
Epinephrine can be administered intravenously (IV) 0.01 mg/kg body weight of 1 : 10,000 dilution
or 0.1 mL/kg slowly into a running IV infusion of saline and can be repeated every 5 to 15 minutes
as needed. If no IV access is available, the recommended intramuscular dose of epinephrine is
0.01 mg/kg of 1 : 1000 dilution (or 0.01 mL/kg to a maximum of 0.15 mg of 1 : 1000 if body weight
is 30 kg) injected intramuscularly in the lateral thigh.

27. Which of the following is not a risk factor for developing contrast-induced nephropathy
(CIN).?
a. Type 2 diabetes mellitus.
b. Dehydration.
c. Hypertention.
d. Verticular ejection fraction <50%.
e. Chronic kidney disease ( glomerular filtrastion rate [GFR] <mL/min).
. d. Ventricular ejection fraction <50% (no. 8)

(Campbell 10th ed chap4)

28. Research support all of the following strategies for the prevention of CIN EXCEPT :
a. Hydration with intravenous normal saline 1 ml/kg/hr for 6 hours after the contrast study.
b. Intravenous 5% dextrose with water and sodium bicarbonate 254 meq/L for 1 hour be for
the procedure.
 c. Intravenous furosemide 20mg immediately following contrast study.
d. Use of iso-osmolar or low-osmolar contrast media.
e. N-acetylcystein 600 mg twice daily for two doses be for and two doses after the study.
c. intravenous furosemide 20 mg immediately following contrast study. The summary of the
metaanalysis for the prevention of CIN after contrast media use supports using hydration,
bicarbonate, iso- or lo-osmolar contrast media, and N-acetylcysteine. In one review article N-
acetylcysteine was determined to be more protective than hydration alone. Furosemide was
found to increase the risk of developing CIN. (Pannu, 2006; Kelly, 2008).

29. the apropriate array’s frequency for scrotal ultrasound transducer is generally un the range of
…MHz
a. 2-4
b. 2-6
c. 6-12
d. 12-14
e. 14-16

30. According to scrotal ultrasound finding. Grade 2 ( moderate ) varicocele definition is

dilatation of the testicular with ………. In diameter without valsava.
a. 2,0-2,5 mm.
b. 2,5-4,0 mm.
c. 4,0-5,0 mm
d. 5,0-6,0 mm.
e. 6,0-6,5 mm.

(11th ed chap 46)

31. The renal structure is greatest risk for ischemic injury is the :
a. Afferent arterioral
b. Cortical collecting duct
c. Juxtaglomerular apparatus
d. Straight segment (S3) proximal tubule
 e. Distal convoluted tubule
d. Straight segment (S3) proximal tubule. The S3 segment of the proximal tubule is associated
with the greatest ischemic damage. Other structures that sustain injury in this region include the
medullary thick ascending limb, which is metabolically active and rich in the energy-requiring Na+
,K+ -ATPase.

32. A patient with acute kidney injury (AKI) has a urinary sodium of 10 mEq/L, urinary
osmolality of 650, and a renal failure index of <1. Urinalysis shows 10 to 20 red blood cells
(RBCs) per high-power field (HPF), 3 to 5 white blood cells per HPF, 2+ proteinuria, and
RBC casts. The most likely diagnosis is :
a. Acute tubular necrosis
b. Prerenal azotemia
c. Acute glomerulonephritis
d. Acute Interstitial nephritis
e. Obstruction
. c. Acute glomerulonephritis. A low fractional excretion of sodium (or renal failure index) may be
associated with either prerenal azotemia or acute glomerulonephritis. These entities could be
separated clinically by examination of the urinalysis results. Conditions associated with prerenal
azotemia would have a bland urinalysis, whereas proteinuria, RBCs, and RBC casts would be seen
with acute glomerulonephritis.

33. When AKI is first recognized in a patient, the initial therapeutic interventionshould be to :
a. Begin low-dose dopamine
b. Administer a cardiac inotropic agent
c. Restore adequate circulating blood volume.
d. Administer a loop diuretic
e. Begin a mannitol infusion
. c. Restore adequate circulating blood volume. During the initial stages, a trial of parenteral
hydration with isotonic fluids may correct acute renal failure (ARF) secondary to prerenal causes

34. Loop diuretics are of benefit in the management of AKI due to

 a. Improved patient survival
b. Decreased metabolic demand
c. Decreased hypoxic cell swelling
d. Free radical scavenging
e. Increased renal vascular resistance
. b. Decreased metabolic demand. Loop diuretics decrease active NaCl transport in the thick
ascending limb of Henle and thereby limit energy requirements in the metabolically active
segment, which often bears the greatest ischemic insult.

35. The major risk of MRI with gadolinium in patients with advanced chronic kidney
disease(CKD) is :
a. Nephrotoxicity
b. Anaphylaxis
c. Nephrogenic systemic fibrosis
d. Seizures
e. Hepatotoxicity
. c. Nephrogenic systemic fibrosis. Recently, gadolinium-based contrast agents have been
associated with the development of nephrogenic systemic fibrosis. At-risk patients include those
with advanced CKD. It is important that these compounds be given to these patients only after
careful consideration of the indication for the study.

(11th ed chap 20)

36. Urothelium is associated with :
a. A high reparative capacity
b. An inherent capacity for artificial extracellular matrix attachment
c. Frequent malignant differentiation
d. Poor growth parameters
e. None of the above
. a. a high reparative capacity. It has been well established for decades that the bladder is able to
regenerate generously over free grafts. Urothelium is associated with a high reparative capacity.
Bladder muscle tissue is less likely to regenerate in a normal manner.
 (11th ed chap 92)
37. The most common histologic bladder cancer cell type is :
a. Squamous
b. Adeno
c. Urothelial
d. Small cell
e. Leiumyosarcoma
c. Urothelial. Histologically, 90% of bladder cancers are of urothelial origin, 5% squamous cell,
and less than 2% adenocarcinoma or other variants (Lopez-Beltran, 2008). Urothelial carcinoma
is the most common malignancy of the urinary tract and is the second most common cause of
death among genitourinary tumors

(11th ed chap19)
38. Which of the following hereditary tumor syndromes are associated with genitourinary tumors?
a. Von Hippel-Lindau syndrome
b. Birt-Hogg-Dube syndrome
c. Beckwith Wiedemann syndrome
d. None of the above
e. All of the above
. e. All of the above. Each of these syndromes includes increased risk of specific genitourinary
malignancies among their spectra of pathologies.

39. Which of the following chromosomal rearrangements is NOT typically associated with a
genitourinary malignancy?
a. Fusion of BCR to ABL by chromosome translocation
b. Fusion of TMPRSS2 to ERG by intrachromosomal deletion
c. Fusion of MITF/TFE gene family members by chromosome translocation
d. Isochromosome 8q
e. Loss of chromosome 9
a. Fusion of BCR to Abl via chromosome translocation. This particular chromosomal abnormality
is typically found in chronic myelogenous leukemia patients, not in solid tumors. TMPRSS2-ERG
 gene fusions are found in approximately 50% of prostate cancer cases. MiTF/TFE gene family
translocations have been associated with a subset of renal cell carcinomas. Isochromosome 8q is
found in a subset of prostate cancers and is often associated with the loss of 8p. Loss of
chromosome 9 is observed in a subset of urothelial cancers, and enumeration of this
chromosome by FISH is one of the components of a molecular test used for detecting bladder
cancer.

(10th ed chap 92)

40. The gleason grade in a radical prostatectomy factors in the :
a. Two highest grade architectural patterns
b. Most prevalent, second most prevalent architectural patterns, and a tertiary grade if present
c. Highest and lowest grade architectural patterns
d. Highest architectural pattern, highest cytologic grade, and tertiary grade if present
e. Most prevalent architectural pattern, cytologic grade, and tertiary grade if present
b. most prevalent, second most prevalent architectural patterns, and a tertiary grade if
present. It is recommended that in radical prostatectomy specimens, the routine Gleason
score, consisting of the most prevalent and second most prevalent architectural patterns,
should be recorded along with a note stating that there is a tertiary high-grade pattern (Pan
et al, 2000).

41. Stem cells in the bone marrow produce T lymphocytes or T cells, and release them into the
vascular system. The T cells then migrate where to mature?
a. Spleen
b. Liver
c. Thymus
d. Pancreas
(sumber : https://www.ncbi.nlm.nih.gov/books/NBK27123/)

42. Cell-mediated immunity is involved in resistance to infectious disease caused by bacteria and
some viruses. It is also involved in cell mediated hypersensitivity reactions. Which of these
does not cause a cell-mediated hypersensitivity reaction?
 a. Latex
b. Poison ivy
c. X-ray dye
d. Blood transfusion
(sumber : https://www.studystack.com/flashcard-730523)

43. Passive immunity is immunity that is transferred from another source and lasts only weeks to
months. What is an example od passive immunity?
a. An injection of gamma-globulin
b. An immunization
c. Exposure to poison ivy
d. Allergy shots

(11th ed chap 18)

44. The JAK/STAT signaling pathways are critical in regulating cytokine expression. Inborn
deficiencies in these pathway may lead to disease such as :
a. Burkitt lymphoma
b. Wilms tumor
c. Neuroblastoma
d. Retinoblastoma
e. Severe combined immunodeficiency
e. Severe combined immunodeficiency. The biologic importance of different JAKs and STATs has
been revealed by deficiencies of these proteins both in human and animal models. Mutations in
JAK3 have resulted in patients having severe combined immunodeficiency (SCID) that is similar
to X-linked SCID, which occurs because of a mutation in the common cytokine receptor chain.

45. The receptor on B cells that recognizes antigen and transmits signals to the nucleus for gene
expression is :
a. The T-cell receptor
b. The surface IgD molecule
c. The surface IgM molecule
 d. CD40
e. CD28
. b. The surface IgD molecule. The receptor on B cells that recognizes antigen and transmits
signals to the nucleus for gene expression is composed of a cell surface immunoglobulin
containing heavy and light chains with variable regions

46. Programmed cell death, apoptosis, is a mechanism responsible for the elimination of aged,
damaged redundant cells. Caspase proteins are responsible for executing the suicide program
by :
a. Release of granxyme B
b. Activating the alternative complement pathway
c. Activating natural killer cells
d. Mediating DNA fragmentantation and condensation
e. Release of perforin
. d. Mediating DNA fragmentation and condensation. The proteins responsible for executing the
suicide program, the caspases, are essentially common to all the stimuli and pathways and
mediate the nuclear and cytoplasmic alterations characteristic of apoptotic cell death. The
specific roles of each member of the caspase cascade are gradually becoming defined, whereby
caspases 3, 6, and 7 have been identified as the terminal effectors mediating DNA fragmentation
and chromatin condensation

47. Although most human tumors are antigenic, the immune system is often not a significant
barrier to tumor metastasis. A major reason for the relative weakness of the immune system
to eradicate tumors is :
a. Absence of costimulation by tumors leading to anergy
b. Tumor-induced alterations of immune function
c. Impaired function of tumor neovasculature
d. Rapid tumor cell proliferation
e. Lack of tumor cell Fc receptors
 b. Tumor-induced alterations of immune function. Tumorinduced alterations in the functional
status of immune cells may be responsible for the poor development of antitumor immunity in
many cancer patients.

48. T cells stimulated by peptide-MHC complexes, displayed on antigen presenting cells, in

costimulation undergo which one of the following processes?
a. Activation
b. Anergy
c. Apoptosis
d. Differentiation
e. Proliferation

49. Dendritic cells, macrophages, and what other cell types are considered “professional antigen
capable of antigen presentation to T helper cells?
a. B cells
b. Basophils
c. Eosinophils
d. Mast cells
e. Neutrophils

50. Antigen from which one of the following microbes would be presented on MHC
macrophages?
a. Ascaris lumbricoides
b. Candida albicans
c. Haemophilus influenzae
d. Influenza virus
e. Streptococcus pneumoniae