

Clinical Pathology Exam Review
Course Introduction
Clinical Pathology focuses on the analysis and interpretation of bodily fluids, such as blood, urine, and cerebrospinal fluid, to diagnose, monitor, and treat diseases. The course covers core concepts in hematology, clinical chemistry, immunology, microbiology, and molecular diagnostics, emphasizing the integration of laboratory findings with clinical information. Students learn to understand laboratory test principles, perform diagnostic procedures, interpret laboratory data, and appreciate the role of laboratory medicine in clinical decision-making. The curriculum also addresses quality control, laboratory safety, and ethical issues related to laboratory practice, preparing students for effective collaboration with clinicians in patient care.
Recommended Textbook
Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics 7th Edition by Carl A. Burtis
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49 Chapters
1075 Verified Questions
1075 Flashcards
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Chapter 1: Clinical Chemistry, molecular Diagnostics, and Laboratory Medicine
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Sample Questions
Q1) The discipline involved in the selection,provision,and interpretation of diagnostic testing that uses primarily samples from patients is:
A) clinical chemistry.
B) hematology.
C) laboratory medicine.
D) molecular diagnostics.
Answer: C
Q2) Analysis of which one of the following by molecular diagnostic methods provides a measure of processes that are ongoing at the time of blood sampling?
A) Genetic variation in an individual's response to a drug
B) Circulating plasma nucleic acids
C) Malignant lymphomas
D) Histocompatibility
Answer: B
Q3) Molecular diagnostic testing methods and results can be:
A) qualitative only.
B) quantitative only.
C) either qualitative or quantitative.
Answer: C
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Chapter 2: Selection and Analytical Evaluation of
Methodswith Statistical Techniques
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Sample Questions
Q1) In a chemistry methods analysis,linearity refers to the:
A) closeness of agreement between independent results of measurements obtained under stipulated conditions.
B) closeness of agreement between the average value obtained from a large series of results of measurements and a true value.
C) analyte concentration range over which measurements are within the declared tolerances for imprecision and bias of the method.
D) relationship between measured and expected values over the range of analytical measurements.
Answer: D
Q2) A statistic is a:
A) constant that describes some particular characteristic of a population.
B) value calculated from the observations in a sample to describe a particular characteristic of that sample.
C) complete set of all observations that might occur as a result of performing a particular procedure according to specified conditions.
D) graphic device for displaying a large set of data.
Answer: B
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Chapter 3: Clinical Evaluation of Methods
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Sample Questions
Q1) In regard to the number of true-positive and negative,and false-positive and negative,results in laboratory testing,the prevalence times the sensitivity is equal to the number of:
A) true positives.
B) false positives.
C) true negatives.
D) false negatives.
Answer: A
Q2) A laboratory analysis that produces quantitative results with an infinite number of sensitivity and specificity pairs is referred to as a _____ test.
A) predictive
B) qualitative
C) dichotomous
D) continuous
Answer: D
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Chapter 4: Evidence-Based Laboratory Medicine
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Sample Questions
Q1) When developing clinical practice guidelines,what is the critical first step?
A) Requesting input from health insurance companies and government officials
B) Preparing a cost analysis based on patient needs
C) Determining the intended group that will be directly involved with implementation
D) Selecting and refining the topic upon which the investigation will center
Q2) Systematic reviews are used to assess and answer very specific clinical questions in an unbiased way.The most important of the steps in conducting a systematic review is the:
A) formulation of the clinical question that will form the basis of the review.
B) choosing of the reviewer who will perform the work.
C) primary literature search and review.
D) data extraction from the literature.
Q3) In a study of diagnostic accuracy,the selection of the study groups was not random and included only a few individuals in each group.This would likely affect which one of the following?
A) Internal validity
B) External validity
C) The clinical reference standard
D) Index test
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Page 6

Chapter 5: Establishment and Use of Reference Values
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Sample Questions
Q1) Even if somewhat impractical,which one of the following preanalytical factors should be standardized when establishing a reference interval for an analyte?
A) Location (building,city,etc.)in which the venipuncture is performed
B) The method of specimen collection
C) Reagents used in analyte analysis
D) The specific method used for analysis
Q2) Calculate the clinical sensitivity for the following data: in a group of 80 patients diagnosed with sickle cell disease,72 had positive test results.The clinical sensitivity of this test is:
A) 111%.
B) 100%.
C) 90%.
D) 75%.
Q3) Which one of the following is an example of an exclusion criterion when establishing a healthy population-based reference interval?
A) Use of oral contraceptives
B) Sex
C) Age
D) Ethnicity
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Chapter 6: Specimen Collection, processing, and Other
Preanalytical Variables
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Sample Questions
Q1) An example of a preanalytical error would be:
A) mislabeling a tube of blood with an incorrect name.
B) using expired reagents in an analysis.
C) sending the test results to the incorrect physician.
D) failing to run controls with unknown samples.
Q2) Which one of the following anticoagulants is considered unacceptable for a blood sample that will be used for DNA amplification in the polymerase chain reaction?
A) Heparin
B) EDTA
C) Iodoacetate
D) Acid citrate dextrose
Q3) Which one of the following analytes shows no difference in composition between a serum and a plasma specimen?
A) Lactate dehydrogenase
B) Potassium
C) Cholesterol
D) Total protein
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Page 8

Chapter 7: Quality Management
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Sample Questions
Q1) Upon examination of the week's analytical run of plasma glucose tests,you notice that four consecutive normal control values are +1 s (standard deviation)from the mean.In your QC report,you note that Westgard multirule _____ has been broken and realize that this rejection rule is sensitive to _____ error.
A) 1<sub>4</sub><sub>s</sub>; random
B) 4<sub>1</sub><sub>s</sub>; systematic C) R<sub>4</sub><sub>s</sub>; systematic
D) 4<sub>Rs</sub>; random
Q2) You arrive at the clinical chemistry laboratory one morning and discover that personnel from the third shift left you the QC sheet from the thyroid-stimulating hormone (TSH)run.The technician has circled the level I TSH control values,and you realize that all six of the level I control values are +3 s from the mean.No results have been released.Now it's your decision regarding what to do next.What kind of error is most likely occurring?
A) Random error due to pipetting errors
B) Systematic error due to calibration issues
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Chapter 8: Principles of Basic Techniques and Laboratory
Safety
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Sample Questions
Q1) What is the relative centrifugal force (RCF)for a centrifuge spinning at 1200 rpm with a rotor head radius of 8 inches?
A) 32.7 g
B) 3200 g
C) 130 g
D) 1300 g
Q2) What is the molarity (mol/L)of a solution containing 25 g of H<sub>2</sub>SO<sub>4</sub> (MW= 98 g)in 150 mL of deionized water?
A) 1.7 mol/L
B) 0.59 mol/L
C) 0.002 mol/L
D) 16.3 mol/L
Q3) The type of pipette that is a piece of glass tubing drawn out to a tip and graduated uniformly along its length and is used for reagent measurement is referred to as a:
A) transfer pipette.
B) volumetric pipette.
C) micropipette.
D) measuring pipette.
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Chapter 9: Optical Techniques
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Sample Questions
Q1) In a fluorometric measurement,the difference between the maximum wavelength of the excitation light and the maximum wavelength of the emitted fluorescence light is a constant referred to as:
A) Beer law.
B) chemiluminescence.
C) polarization.
D) the Stokes shift.
Q2) Which one of the following wavelengths is within the "near" ultraviolet region of the electromagnetic spectrum?
A) 320 nm
B) 450 nm
C) 540 nm
D) 690 nm
Q3) Which two optical techniques are combined operationally in a flow cytometer?
A) Laser-induced fluorometry and light scattering techniques
B) Atomic absorption spectrophotometry and light scattering techniques
C) Spectrophotometry and fluorescence polarization techniques
D) Fluorescence polarization and laser-induced fluorometry
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Chapter 10: Electrochemistry and Chemical Sensors
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Sample Questions
Q1) An electrochemical technique used to measure chloride in serum or plasma is:
A) conductometry.
B) amperometry.
C) coulometry.
D) voltammetry.
Q2) Potentiometric measurements are based on galvanic electrochemical cells.These types of cells consist of:
A) two inert metal electrodes to which an electrical potential is applied.
B) two electron or metallic conducting electrodes that are connected by an electrolyte solution that conducts ions.
C) a biological recognition element and a physicochemical transducer,often an electrochemical or optical device.
D) a polarizable working electrode to which an external voltage is applied with the resulting cathodic or anodic current of the cell being monitored.
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12

Chapter 11: Electrophoresis
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Sample Questions
Q1) A separation technique that can detect proteins in a complex mixture with the use of antibodies directed against a protein of interest is:
A) Northern blotting.
B) Western blotting.
C) capillary electrophoresis.
D) electrokinetic chromatography.
Q2) You are examining a protein electrophoresis pattern and notice an unusual band at the starting point of the electropherogram that is not present in the normal control.If the patient were healthy,what is the most likely cause of the unusual banding pattern?
A) A plasma sample was probably applied instead of serum.
B) The buffer used in the electrophoresis had the wrong pH.
C) An inappropriate support medium was used for the electrophoresis.
D) The patient likely has a genetic abnormality.
Q3) If the viscosity of the support medium used in a protein electrophoresis system is too high (thick),the migration rate will:
A) increase.
B) decrease.
C) not be affected.
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Chapter 12: Chromatography
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Sample Questions
Q1) You are preparing placental tissue for separation and isolation of a specific enzyme.The enzyme has a negative charge,so you want to use chromatography to perform your task.Which one of the following chromatographic separation mechanisms would be most useful?
A) Ion-exchange
B) Partition
C) Affinity
D) Adsorption
Q2) Some analytes must be derivatized to increase their column retention or detectability.Derivatization means:
A) altering the chemical structure of the analyte to an isomeric form to increase detection and specificity.
B) adding fluorescent labels or combining the analyte with chiral reagents or other chemicals to increase detectability.
C) removing dissolved gases in the solvent to produce a clear chromatogram.
D) using multiple detectors to assist in identification.
Q3) In column chromatography,analytes are identified by their retention times.
A)True
B)False
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Chapter 13: Mass Spectrometry
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Sample Questions
Q1) In regard to mass spectrometry,what is a molecular ion?
A) It is a component of a compound in solution.
B) It is the sum of all ions produced displayed as a function of time.
C) It is the unfragmented ion of the original molecule being studied.
D) It is the ion with the highest abundance in the mass spectrum of a compound.
Q2) In a mass spectrometer,the ion with the highest abundance in the mass spectrum that is assigned a relative abundance of 100% is referred to as the:
A) base peak.
B) ion trap.
C) ionic chromatogram.
D) time-of-flight ion.
Q3) You would like to offer a service to the researchers in your institution for identification and quantitative analysis of proteins produced by microorganisms in liquid media using your HPLC-mass spectrometer system.Which one of the ionization techniques is best suited for this analysis?
A) Electrospray
B) Chemical
C) Electron
D) Any of these would work with HPLC-MS.
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Page 15
Chapter 14: Enzyme and Rate Analyses
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Sample Questions
Q1) Statin drugs lower cholesterol by competitive inhibition of the cholesterol-synthesizing enzyme HMG-CoA reductase.A competitive inhibitor binds:
A) the enzyme at a site other than the active center,thereby decreasing the V<sub>max</sub> of the reaction.
B) to the active center of the enzyme,with no effect on the V<sub>max</sub> of the reaction.
C) to the entire enzyme-substrate complex,thereby decreasing the K<sub>m</sub>.
D) to the active center of the enzyme,thereby causing the K<sub>m</sub> to increase.
Q2) The interaction of the amino acid side chains with the arrangement of the \(\alpha\)-helices and \(\beta\)-sheets to form a three-dimensional protein structure is called the _____ structure of the protein.
A) primary
B) secondary C) tertiary
D) quaternary
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16

Chapter 15: Immunochemical Techniques
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Sample Questions
Q1) In a precipitin reaction,an excess of antigen over an antibody will lead to:
A) all antigen sites bound with an antibody and no precipitate formation.
B) all antibody sites bound by antigen with no formation of precipitate.
C) cross-linking of antigen and an antibody with maximal precipitate formation.
D) a lack of reaction between an antibody and antigen,and no precipitate.
Q2) In this heterogeneous assay,one of the reaction components is attached to the surface of a solid phase.An aliquot of patient sample containing the analyte of interest is added,a wash step occurs,and an enzyme-labeled antibody different from the bound antibody is added followed by the substrate.This type of assay is called:
A) enzyme-linked immunosorbent assay (ELISA).
B) reflectance immunoassay.
C) enzyme-multiplied immunoassay technique (EMIT).
D) fluorescence polarization immunoassay (FPIA).
Q3) Which one of the following methods is not a quantitative immunoassay method?
A) Nephelometry
B) Counter immunoelectrophoresis (CIE)
C) ELISA
D) Electroimmunoassay
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Chapter 16: Automation
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Sample Questions
Q1) An ion-selective electrode system for electrolyte analysis that uses a peristaltic pump to move liquid reagents and samples through a system of tubing is called a _____ analyzer.
A) random access
B) batch
C) discrete
D) continuous flow
Q2) If programmed appropriately,a multiple-channel analyzer could assess samples as a single-channel analyzer.
A)True
B)False
Q3) Specimen bar coding has allowed for the ability of a system operator to place specimens in random sequence,thereby eliminating the need for specimen load lists.
A)True
B)False
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18

Chapter 17: Point-Of-Care Instrumentation
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Sample Questions
Q1) One of the most important benefits of connectivity between a POCT device and information systems is:
A) the reduction of time that a laboratorian has to spend transcribing results.
B) the ability of any user to interface with their physician or healthcare provider.
C) the ease of comparing POCT device results with routine laboratory methods.
D) facilitation of the transfer and capture of patient POCT and quality-related data into permanent medical records.
Q2) The component of a point-of-care testing (POCT)system that detects the reaction of the analyte with a binding molecule or some other type of recognition element is the:
A) reaction cell.
B) sensor.
C) sample delivery system.
D) user interface.
Q3) An example of in vivo POCT technology would be:
A) optical fluorescence.
B) lateral flow immunoassay.
C) light scattering such as nephelometry.
D) spectrophotometry.
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19

Chapter 18: Amino Acids, peptides, and Proteins
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Sample Questions
Q1) Hyperproteinemia is caused by:
A) gastrointestinal disease.
B) liver disease.
C) kidney disease.
D) dehydration.
Q2) Which one of the following statements concerning albumin is not correct?
A) Albumin is the most abundant protein in plasma.
B) Albumin transports many substances in plasma.
C) Albumin is a negative acute phase protein.
D) Albumin is involved in plasma reduction and oxidation reactions.
Q3) Serum proteins or protein complexes that precipitate at temperatures lower than normal core body temperature and that,if precipitated in tissues,result in vasculitis and ischemic injury to peripheral tissues are referred to as:
A) essential amino acids.
B) paraproteins.
C) amyloids.
D) cryoglobulins.
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Chapter 19: Serum Enzymes
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Sample Questions
Q1) Calcium
A)Creatine kinase
B)Aspartate aminotransferase
C)Amylase
Q2) Which one of the following enzymes catalyzes the transfer of an amino group to alpha- ketoglutarate with the formation of oxaloacetate and glutamate?
A) Alanine aminotransferase (ALT)
B) Aspartate aminotransferase (AST)
C) Alkaline phosphatase (ALP)
D) 5'-Nucleotidase (NTP)
Q3) The usefulness of analyzing lipoprotein-associated phospholipase A<sub>2</sub> for the identification of individuals at risk for future cardiovascular events is because of its:
A) release of granules that destabilize complex plaque.
B) ability to transform stable coronary artery plaques to unstable ones.
C) release during inflammatory events such as coronary artery blockage.
D) upregulation in atherosclerotic lesions,particularly complex plaque.
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21
Chapter 20: Tumor Markers and Cancer Genes
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Sample Questions
Q1) Which of the following tumor markers is useful for monitoring germ cell tumors or placental tumors?
A) CEA
B) PSA
C) CA-19
D) hCG
Q2) Most oncogenes are activated through:
A) dominant mutations.
B) loss of gene expression.
C) monosomy.
D) loss of function recessive mutations.
Q3) Which of the following is considered to be a nonspecific tumor-associated marker?
A) Prostate-specific antigen (PSA)
B) Alkaline phosphatase (ALP)
C) CA 125
D) Tumor suppressor genes
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22

Chapter 21: Kidney Function Test-Screatinine, Urea, and Uric Acid
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Sample Questions
Q1) A hemolyzed serum sample from an individual is assayed for creatinine and a result is obtained that is decreased compared to the normal reference interval.If this individual has a normal glomerular filtration rate,which one of the following statements is true?
A) The individual's diet contains high levels of protein.
B) The individual must be receiving chemotherapy.
C) The assay must be subject to interference from bilirubin.
D) The assay must be subject to interference from ketones.
Q2) Primary gout is distinguished from secondary gout by:
A) decreased renal excretion (increased renal retention)of uric acid.
B) its polygenic basis.
C) having increased dietary intake of purines.
D) the increased catabolism of purines due to chemotherapy.
Q3) Creatininase reactions for creatinine assessment:
A) yield sarcosine and urea.
B) require the addition of potassium ferricyanide to reduce interference.
C) catalyze the conversion of creatinine to creatine.
D) catalyze the conversion of creatinine to N-methylhydantoin and ammonia.
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Page 23

Chapter 22: Carbohydrates
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Sample Questions
Q1) A type 1 diabetic who is in the early stages of the disease is taken to the emergency room with symptoms of hypoglycemia.Which one of the following endogenous hormones might be the cause of this?
A) Epinephrine
B) Glucagon
C) Cortisol
D) Lactate
Q2) Which one of the following coupled-enzyme glucose methods requires extended incubation time to allow for the spontaneous conversion of the \(\alpha\)-form of glucose to the \(\beta\)-form so that both forms can react with the initial enzyme in the reaction?
A) Hexokinase method
B) Glucose oxidase method
C) Self-monitoring method
D) Polarographic method
Q3) What effect does epinephrine have on blood glucose value?
A) Increases
B) Decreases
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24

Chapter 23: Lipids, lip-Oproteins, apolipoproteins, and
Other Cardiac Risk Factors
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Sample Questions
Q1) An individual visits his physician with splenomegaly,enlarged and orange-colored tonsils,and tingling feelings in the extremities,indicating peripheral neuropathy.Upon examination of the blood smear for a white blood cell differential,many foamy-appearing cells were noted.Normal triglyceride and total cholesterol values were noted; however,a marked decrease of HDL was also noted.What is the cause of this disorder?
A) Mutations in the apo B-100 gene
B) Defects in the expression or function of the LDL receptor
C) Genetic mutations in the apo E gene
D) Mutations in the ABCA1 transporter gene
Q2) A 46-year-old man visits his physician complaining of fatigue and chest pains.His family history reveals that his father and grandfather both died of heart attacks at the age of 50.Laboratory results indicated elevated total cholesterol,elevated low-density lipoprotein (LDL),and normal triglyceride.He is eventually diagnosed with familial hypercholesterolemia and atherosclerosis.What is the likely cause?
A) Genetic lack of LDL receptors on cell surfaces
B) Insulin deficiency
C) Lipoprotein lipase deficiency
D) Tangier disease
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Chapter 24: Electrolytes and Blood Gases
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Sample Questions
Q1) A blood sample from an individual with leukemia is submitted for blood gas analysis.The transport of the sample is delayed for approximately an hour before analysis.What affect,if any,will these two variables have on the blood gas analysis results?
A) There will be no effect on any of the blood gas parameters.
B) All blood gas parameters will increase in value with an elevated white blood cell count due to the presence of azurophilic granules.
C) Because of leukocyte glycolysis,pH decreases,PCO<sub>2</sub> increases,and PO<sub>2 </sub>decreases.
D) All blood gas parameters will decrease in value because of the leukocytosis-induced hemolysis.
Q2) The specimen of choice for measurement of potassium (K<sup>+</sup>)is plasma because:
A) anticoagulants preserve the potassium ionic activity better than serum.
B) platelets release potassium during the coagulation process in a serum sample.
C) hemolysis is easily avoided when obtaining a plasma sample.
D) the electrolyte exclusion effect is avoided in a plasma sample.
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26

Chapter 25: Hormones
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Q1) Binding to a receptor at the outer cell membrane to induce phosphorylation via adenylyl cyclase and cAMP of certain intracellular enzymes is a property of which class of hormone?
A) Protein
B) Steroid
C) Amino acid-derived
D) Both a and c
Q2) Which one of the following statements concerning steroid hormones is correct?
A) Steroid hormones attach to a receptor on the surface of a cell,which eventually induces enzyme phosphorylation within the cell.
B) Steroid hormones are hydrophobic when free and bind to intracellular receptors in the nucleus.
C) Steroid hormones,because of their structure,are not bound to carrier proteins as they circulate in the blood.
D) Steroid hormones have a very short half-life (usually <30 minutes)in the circulation.
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Chapter 26: Catecholamines and Serotonin
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Sample Questions
Q1) Urinary VMA
A)Gastroenteropancreatic endocrine tumor
B)Tumor of adrenal medullary chromaffin cells
C)Pineal gland tumor
D)Neuroblastoma
Q2) Measurement of urinary metanephrine and vanillylmandelic acid (VMA)assesses the amount of hormone secreted by the _____ and is done to detect the presence of
A) gastrointestinal (GI)tract; carcinoid tumor
B) adrenal medulla; pheochromocytoma
C) adrenal cortex; Cushing syndrome
D) medulla of the brain; neuroblastoma
Q3) Plasma/urine metanephrines
A)Gastroenteropancreatic endocrine tumor
B)Tumor of adrenal medullary chromaffin cells
C)Pineal gland tumor
D)Neuroblastoma
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Chapter 27: Vitamins, Trace Elements, and Nutritional Assessment
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Sample Questions
Q1) Cobalamin
A)Impaired blood coagulation
B)Megaloblastic anemia
C)Night blindness
D)Beriberi
Q2) Which one of the following vitamins will aid in the absorption of iron by the intestine?
A) C
B) B<sub>12</sub>
C) A
D) D
Q3) Quinone
A)Impaired blood coagulation
B)Megaloblastic anemia
C)Night blindness
D)Beriberi
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Page 29

Chapter 28: Hemoglobin, Iron, and Bilirubin
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Sample Questions
Q1) In an individual using progesterone-based oral contraceptives,serum iron _____ and TIBC _____.
A) increases; decreases
B) is normal; increases
C) decreases; decreases
D) increases; increases
Q2) What is the percent transferrin saturation given the following data: serum iron 150 \(\mu\)g/dL,TIBC 350 \(\mu\)g/dL,transferrin 300 mg/dL,and ferritin 65 ng/mL?
A) 43%
B) 55%
C) 233%
D) 500%
Q3) Increased total iron in serum is common in all of the following except:
A) iron intoxication.
B) hemosiderosis.
C) chronic inflammation.
D) sideroblastic anemia.
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Chapter 29: Porphyrins and Porphyrias
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Sample Questions
Q1) When using DNA analysis to screen a new family to identify a genetic mutation that has caused porphyria,what must be examined?
A) A single mutation is all that needs to be assessed.
B) The entire genome of each family member must be examined.
C) A Bayesian analysis must be calculated first.
D) All exons with promoters and flanking intron sequences around the mutation must be analyzed.
Q2) In the analysis of plasma porphyrins,porphyrins at neutral pH fluoresce between 610 to 640 nm.
A)True
B)False
Q3) An individual visits his physician with porphyria-like symptoms.The results of porphyrin analysis are as follows: urine 5-aminolevulinic acid (ALA),positive; urine coproporphyrin III,increased; RBC zinc protoporphyrin (ZPP),increased.What laboratory test should the physician order to determine the exact diagnosis?
A) Blood lead
B) Urinary PBG
C) Hemoglobin and hematocrit
D) Blood alcohol
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Page 31

Chapter 30: Therapeutic Drugs and Their Management
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Sample Questions
Q1) The therapeutic drug used to treat all but absence seizures by prolonging inactivation of the synaptic sodium channel and reducing synaptic transmission is: A) phenytoin.
B) ethosuximide.
C) carbamazepine.
D) gabapentin.
Q2) The steady state of a drug is defined as the: A) point at which the body concentration of the drug is in equilibrium with the rate of dose administered and the rate of elimination.
B) time required for one-half of an administered drug to be lost through metabolism and elimination.
C) metabolism of a drug with a high hepatic extraction rate by the liver before it reaches the systemic circulation.
D) action of one drug on another.
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Chapter 31: Clinical Toxicology
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Sample
Questions
Q1) An 18-year-old man who had been found unresponsive and face down in his bed after spending the day working in his garage is brought to the hospital emergency department.He had not responded to naloxone administration given by the paramedics.His history reveals that he was despondent over the recent death of his father,with whom he enjoyed restoring antique automobiles.Laboratory results indicate negative serum acetone,elevated serum urea and creatinine,normal PO<sub>2</sub>,decreased bicarbonate,increased PCO<sub>2</sub>,and increased osmol gap (corrected for ethanol)and anion gap.Urinalysis indicated many oxalate crystals.Based on these laboratory results,what is the likely compound that has affected this individual?
A) Carbon monoxide
B) Methanol
C) Ethylene glycol
D) Codeine
Q2) The best antidote for overdose with heroin is:
A) activated charcoal.
B) naloxone.
C) forced alkaline diuresis.
D) forced acid diuresis.
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Page 33

Chapter 32: Toxic Metals
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Sample Questions
Q1) The occurrence of cell membrane damage causing normal cells to be replaced with fibroblasts occurs in the heart because of a deficiency of which one of the following metals?
A) Selenium
B) Chromium
C) Silica
D) Copper
Q2) Lead
A)Reduced to a nontoxic form in biological specimens
B)Blood specimens are not especially useful; urine is best
C)Requires a lymphocyte proliferation test; serum or urine quantification is not useful
D)To examine erythrocytes,EDTA-anticoagulated blood is specimen of choice
Q3) Beryllium
A)Reduced to a nontoxic form in biological specimens
B)Blood specimens are not especially useful; urine is best
C)Requires a lymphocyte proliferation test; serum or urine quantification is not useful
D)To examine erythrocytes,EDTA-anticoagulated blood is specimen of choice
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Chapter 33: Diabetes
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Sample Questions
Q1) Which one of the following 2-hour plasma glucose oral glucose tolerance test (OGTT)results would be classified as diagnostic for impaired glucose tolerance if an individual's fasting blood glucose value is 120 mg/dL (healthy glucose reference interval is 74 to 99 mg/dL)?
A) 195 mg/dL
B) 105 mg/dL
C) 130 mg/dL
D) 75 mg/dL
Q2) Insulin deficiency in diabetes mellitus will cause:
A) increased insulin resistance and hyperglycemia.
B) increased glucose uptake by cells leading to hyperglycemia and cell death.
C) decreased lipolysis leading to ketosis.
D) increased glucagon concentration,which contributes to hyperglycemia and ketosis.
Q3) Which of the following is characteristic of type 1A diabetes mellitus?
A) Normal blood insulin levels
B) Lack or decrease of functional insulin receptors on cells
C) Circulating autoantibodies formed against pancreatic insulin-secreting cells.
D) Individuals with this type of diabetes are not prone to ketosis.
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35

Chapter 34: Cardiovascular Disease
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Sample Questions
Q1) An ideal cardiac marker should be elevated in the circulation for how long following a cardiac event?
A) At least several days
B) 1 to 2 months
C) 1 to 3 hours
D) 1 to 3 years
Q2) Which one of the following is considered to be the most specific marker for adverse ventricular remodeling following an acute myocardial infarction?
A) CK-2
B) Troponin
C) Myoglobin
D) Brain natriuretic peptide (BNP)
Q3) Laboratory measurements for brain natriuretic peptide (BNP)be reported in:
A) millimoles/liter.
B) grams/deciliter.
C) nanograms/liter.
D) picomoles/milliliter.
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Chapter 35: Kidney Disease
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Sample Questions
Q1) Secretion of renin and aldosterone is induced by low blood pressure and volume.Renin is synthesized in the _____ and aldosterone is made in the _____.
A) kidney; adrenal gland
B) kidney; brain
C) adrenal gland; brain
D) adrenal gland; kidney
Q2) An individual presents to his physician with generalized weakness and fatigue.Blood is collected and an elevated WBC count with lymphocytosis is noted.Serum protein is moderately decreased,but the urine reagent dipstick does not indicate proteinuria.Upon confirmatory testing with a precipitation test,the urine protein is 4+.Based on other symptoms,the physician suspects multiple myeloma.What might be the cause of the discrepancy in urine protein values?
A) Increased WBCs will interfere with urine protein dipstick values.
B) The urine reagent dipsticks are outdated and must be discarded.
C) The precipitation test was performed without controls.
D) Reagent dipsticks respond mostly to urine albumin and not to other proteins.
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Chapter 36: Physiology and Disorders of
Water,Electrolyte,and Acid-Base Metabolism
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Sample Questions
Q1) In regard to respiration,peripheral chemoreceptors located in the carotid arteries and aorta are stimulated by:
A) HCO<sub>3</sub> content of arterial blood.
B) PO<sub>2</sub> content of blood only.
C) pH only.
D) pH and PO<sub>2</sub> content of blood.
Q2) Hypokalemia (<3.0 mmol/L)is considered a serious health threat because:
A) the heart rate increases,leading to weakness,difficulty in breathing,and eventual cardiac arrest.
B) the heart rate slows because of the lowered excitability of cardiac smooth muscle,leading to possible cardiac standstill.
C) the body gains water through the kidney reabsorption,leading to severe edema.
D) arterial pH will decrease (increased H<sup>+ </sup>concentration),leading to metabolic acidosis.
Q3) The most important buffer of plasma is the _____ system.
A) bicarbonate/carbonic acid
B) protein/albumin
C) phosphoric acid/phosphate
D) hemoglobin erythrocyte

Page 38
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Chapter 37: Liver Disease
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Sample Questions
Q1) Cirrhosis
A)Decreased flow of bile
B)Inflammation of bile ducts
C)Gallstones in bile ducts
D)Fibrosis of the liver
Q2) The type of RNA virus that is considered to be the cause of the most common type of acute hepatitis that does not lead to chronic hepatitis is:
A) hepatitis A virus.
B) hepatitis B virus.
C) hepatitis C virus.
D) Reye syndrome.
Q3) The most common cause of toxic hepatitis in North America leading to direct damage of hepatocytes is acetaminophen overdose.
A)True
B)False
Q4) Alkaline phosphatase is a soluble enzyme localized in the cytosol of hepatocytes.
A)True
B)False
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Page 39

Chapter 38: Gastrointestinal and Pancreatic Diseases
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Sample Questions
Q1) What special specimen requirements must be met when collecting and preparing a sample for gastrin analysis?
A) Whole blood is the specimen of choice,collected in EDTA-containing tubes,placed on ice,and then refrigerated immediately upon receipt in the lab.
B) Blood must be collected into a heparin-containing tube,separated in a refrigerated centrifuge,and frozen within 15 minutes of collection.
C) Serum is the specimen of choice and must be collected into non-anticoagulant-containing tubes and kept warm until analysis is complete.
D) A 12-hour overnight collection of gastric juice must be assessed for gastrin.
Q2) A peptide secreted by the upper intestinal mucosa that causes gallbladder contraction and release of digestive enzymes from the pancreas,and is also localized in the nervous system,is:
A) secretin.
B) VIP.
C) insulin.
D) CCK.
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Chapter 39: Disorders of Bone and Mineral Metabolism
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Sample Questions
Q1) An individual's serum phosphate level is decreased but his physician cannot determine a physiological basis for this abnormal result.What could possibly have caused this result?
A) Individual not fasting when blood was drawn
B) Specimen hemolysis
C) Use of IV carbohydrate therapy to stimulate insulin secretion
D) Diurnal variation
Q2) In a case of severe osteomalacia,would bone-specific alkaline phosphatase be increased,decreased,or remain unchanged?
A) Increased
B) Decreased
C) Remain unchanged
Q3) What makes up the organic matrix component of bone?
A) Calcium,protein,and collagen
B) Cells and collagen only
C) Minerals and cells only
D) Cells only
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Chapter 40: Disorders of the Pituitary
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Sample Questions
Q1) An individual using antidepressants visited her physician with a complaint of water retention.Laboratory results indicated decreased urine volume,low serum sodium,low plasma osmolality,decreased serum uric acid,and urea.Antidiuretic hormone was measured and found to be elevated.What is the likely diagnosis?
A) Acromegaly
B) Hypothyroidism
C) Diabetes insipidus
D) Syndrome of inappropriate ADH secretion (SIADH)
Q2) Inhibition of growth hormone (GH)occurs through the action of:
A) acetylcholine.
B) somatostatin release-inhibiting hormone.
C) norepinephrine.
D) gonadotropin-releasing inhibiting hormone.
Q3) The follicle-stimulating hormone (FSH)and luteinizing hormone (LH)are important in the reproductive function of the male and female and are released in response to:
A) gonadotropin-releasing hormone (GnRH).
B) corticotrophin-releasing hormone (CRH).
C) TSH.
D) oxytocin.
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Page 42

Chapter 41: Disorders of the Adrenal Cortex
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Sample Questions
Q1) In the classic plasma renin activity assay that measures the main function of the enzyme and uses inhibitors of angiotensinase,what is actually measured at the end of the assay?
A) Plasma renin
B) Angiotensin-converting enzyme
C) Angiotensin I
D) Angiotensin II
Q2) A hypertensive,hypokalemic patient with increased aldosterone production and decreased plasma renin activity likely has:
A) Cushing syndrome.
B) Addison disease.
C) Conn syndrome.
D) congenital adrenal hyperplasia.
Q3) The adrenal cortical hormone that promotes sodium resorption and potassium and hydrogen ion excretion by the renal tubules and thus affects water balance in the body is:
A) androstenedione.
B) cortisol.
C) aldosterone.
D) calcium.
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Chapter 42: Thyroid Disorders
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Sample Questions
Q1) Increased TSH,decreased T<sub>3</sub>,and decreased T<sub>4 </sub>with the presence of goiter indicate:
A) primary hypothyroidism.
B) secondary hypothyroidism.
C) tertiary hypothyroidism.
D) pseudohypothyroidism.
Q2) Which one of the following statements is correct regarding reverse T<sub>3 </sub>(rT<sub>3</sub>)?
A) rT<sub>3</sub> is physiologically active,but less so than T<sub>3</sub>.
B) rT<sub>3</sub> is formed in the blood by central deiodination of T<sub>4</sub>.
C) rT<sub>3</sub> is decreased in patients with the "euthyroid sick syndrome."
D) Renal failure is associated with elevated rT<sub>3</sub> concentrations.
Q3) What causes the total thyroxine (T<sub>4</sub>)levels to be increased in pregnant women?
A) Inappropriate iodine metabolism
B) hCG-induced thyrotoxicosis
C) Altered glucose metabolism
D) Change in thyroglobulin synthesis
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Chapter 43: Reproduction-Related Disorders
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Sample Questions
Q1) During the luteal phase,which hormone,when decreased in the absence of conception,releases its inhibition on pituitary gland synthesis and release of FSH?
A) Chorionic gonadotropin
B) Progesterone
C) Estrone
D) Estradiol
Q2) Prolactin
A)Occurrence of ovulation
B)Assesses ovarian function
C)Screens for fetal Down syndrome
D)Assesses amenorrhea
Q3) Dehydroepiandrosterone sulfate (DHEA-S):
A) concentrations exhibit a circadian rhythm that reflects the secretion of adrenocorticotropic hormone (ACTH).
B) is an important screening test used to evaluate women with hirsutism and virilization.
C) concentration is increased in 17\(\alpha\)-hydroxylase deficiency-caused amenorrhea.
D) analysis is performed using heparinized plasma.
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45

Chapter 44: Pregnancy and Prenatal Testing
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Sample Questions
Q1) Early in gestation,amniotic fluid has a composition similar to:
A) intracellular fluid.
B) extracellular fluid.
C) urine.
D) water.
Q2) The primary function of amniotic fluid is to:
A) provide nourishment to the fetus.
B) facilitate oxygen and carbon dioxide exchange in fetal lungs.
C) synthesize hormones before the brain develops.
D) provide protection,constant temperature,and moisture for the fetus.
Q3) The cells that form surfactant in fetal lungs are the:
A) type II pneumocytes.
B) placental trophoblasts.
C) fetal hepatocytes.
D) maternal lung cells.
Q4) Greenish amniotic fluid indicates the presence of:
A) fetal meconium.
B) hemolysis.
C) increased surfactant.
D) fetal death.
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Chapter 45: Newborn Screening and Inborn Errors of Metabolism
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Sample Questions
Q1) An example of a confirmatory laboratory test used to verify a borderline abnormal newborn screening test result in an asymptomatic individual would be gas chromatography combined with mass spectrometry,particularly for organic acid analysis.
A)True
B)False
Q2) A newborn screening test using a dried blood spot is positive for congenital adrenal hyperplasia (CAH).What laboratory testing would be done next?
A) No next step as this test is the confirmatory analysis
B) DNA analysis of genetic mutation
C) A stimulating hormone test
D) A second-tier test for CAH,such as an MS/MS steroid profile
Q3) Of the following,what is the inborn error of metabolism for glutaric acidemia type 1?
A) Disorder of fatty acid oxidation
B) Aminoacidopathy
C) Organic acidemia
D) Disorder of carbohydrate metabolism
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Chapter 46: Pharmacogenetics
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Q1) The metabolizing enzyme that catalyzes the transfer of an acetyl moiety from acetyl-CoA to homocyclic and heterocyclic arylamines and hydrazines in,for example,substrates related to cigarette smoke is:
A) CYP2C6.
B) CYP2D9.
C) NAT1.
D) UGT1A1.
Q2) Which one of the following metabolizing enzymes is considered a phase 1 enzyme?
A) CYP2C6
B) VKORC1
C) NAT1
D) UGT1A1
Q3) A combination of alleles that are located closely together on the same chromosome and are inherited together is the definition of: A) haplotype.
B) pseudogene.
C) allelic diversity.
D) genotype.
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Chapter 47: Principles of Molecular Biology
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Q1) Which one of the following sequences contains a signal that indicates the end of a protein?
A) 5' GUG ACU AGG UGG CGA CCC UAU 3'
B) 5' AAC CGA CUC AUC CAG GUA UAA 3'
C) 5' ACC CGA CCA UCC AGG CUG AGG 3'
D) 5' AGC CGA CUC AUC AGG UUU GAU 3'
Q2) The proteins that wrap DNA tightly to condense it into nucleosomes are called: A) histones.
B) hormones.
C) lysosomes.
D) nucleotides.
Q3) The expressed function or biological effect of a gene product is termed a: A) genotype.
B) promoter.
C) codon.
D) phenotype.
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Chapter 48: Nucleic Acid Techniques and Applications
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Sample Questions
Q1) If RNA is to be used in a PCR amplification procedure,what is the initial step that must be performed?
A) The RNA must be denatured to form single strands for annealing to primers.
B) RNA should never be used in a PCR reaction because thermostable enzymes cannot synthesize strands to anneal to it.
C) A reverse transcription procedure must be performed to form cDNA.
D) RNA must first be treated with RNases to remove interfering substances from the target.
Q2) The increase in the quantifiable signal observed early on in real-time PCR is dependent upon the:
A) amount of fluorescent dye added to the reaction.
B) initial amount of fluorescent primer added.
C) amount of fluorescent quenching.
D) initial amount of target DNA.
Q3) The purpose of restriction fragment polymorphism analysis (RFLP)is to:
A) determine the purity of DNA isolation.
B) evaluate the integrity of isolated genomic DNA.
C) assess the exonuclease activity of DNA polymerase.
D) identify the presence of mutations or sequence changes.
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Page 50

Chapter 49: Genomes and Nucleic Acid Alterations
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Sample Questions
Q1) An example of epigenetic variation that affects gene expression would be:
A) heteroplasmy.
B) chromosomal translocation.
C) copy number alteration.
D) histone modifications.
Q2) If you were interested in studying plasmid structure,which one of the following cell types would be appropriate for you to examine?
A) Human cells
B) Fungal cells
C) Bacterial cells
D) All cell types
Q3) Which one of the following statements regarding the human genome below is correct?
A) Mobile genetic elements (transposons)comprise almost half of the human genome.
B) An intron is located within a transposon segment of a chromosome.
C) Genes that contain instructions for making proteins are located in transposons.
D) Unique sequences that code for protein make up only 10% of the human genome.
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