The Awesome Semester One MCQs

DISCLAIMER: These MCQs are student-made on the topics that are studied in semester one. Intended learning
objectives change year to year so they may not all be 100% relevant to what you’ve learnt. Some of the questions
are also quite a bit more difficult than the questions you’ll actually get in the exam (especially the first 60
questions), so if you can do them, you’re pretty awesome.

1. Receptors associated with innate immunity recognize microbes by detecting:

a. Insulin
b. Pathogen associated molecular patterns
c. Fc’s
d. Complement
e. None of the above

2. Immunogloblin classes must be distinguished by the type of:

a. Light chains they possess.
b. Carbohydrate on their light chains.
c. Constant regions in their light chains
d. Heavy chains they possess
e. None of the above

3. The variable regions in the light chains participate in:

a. Fc receptor binding
b. Epitope binding
c. Affinity of the complement receptors
d. Interaction of the Fab with cytokines
e. None of the above

4. J-chains are associated with:

a. IgG
b. Polymeric immunoglobulins (more than two Fab’s)
c. Serum IgA
d. IgE
e. None of the above.

5. Adoptive-acquired immunity may be the result of:

a. Transfer of bone marrow from one individual to another
b. Immunization with a vaccine
c. Exposure to an individual who has an infectious disease
d. A physician administering a gamma globulin shot to someone who has a needle stick
(immunoglobulins)
e. A and D

6. IgG binding to neutrophil cells is mediated by:

a. Fc-dependant cellular homing mechanisms
b. Sensitization of Mast cells and basophils
c. Fc receptors specific for IgG
d. ICAM’s
e. None of the above
7. IgD participates in antigen recognition by:
a. Immature T cells
b. NK cells
c. Macrophages
d. B cells
e. None of the above

8. Antibody affinity is not determined by the amino acid sequence in:

a. The constant regions of the immunoglobulin molecule
b. The variable regions of the immunoglobulin molecule
c. The Fc of the immunoglobulin molecule
d. The J-chain
e. A, c and d.

9. Avidity is important because:

a. It amplifies the binding strength of low affinity Fab’s
b. Fc receptor binding depends on it
c. G-protein-mediated signal transduction will not occur without it
d. It results in the activation of high affinity antibody producing clones
e. None of the above

10. Organized mucosa-associated lymphoid tissue is

a. Found in the lymph nodes
b. Associated with initial immune response to antigen
c. Filled with plasma cells that are producing antibodies
d. Composted primary of M-cells and L-cells
e. None of the above

11. B cells usually require T cell help to mature plasma cells because:
a. T cells present antigen to them
b. Most B cells in the circulation need thymic hormones secreted by the antigen presenting cell to
mature to plasma cells
c. T cells are antigen presenting cells that are critical to immune recognition
d. All of the above
e. None of the above

12. The antigen presenting cell

a. May be a dendritic cell in the skin
b. May be a T cell
c. Does not produce cytokines which influence the adaptive response
d. Matures upon antigenic stimulation and becomes a plasma cell
e. All of the above

13. Mucosal immunity provides most of its protection by blocking

a. Microbial receptors specific for colonization
b. The complement cascade
c. Blocking penetration of undigested food products into the mucosal tissues
d. A and C
 e. None of the above

14. Tissue macrophage are mature:

a. B cells
b. T cells
c. NK cells
d. Monocytes
e. None of the above

15. Hormone-like host peptides used for communications in innate and adaptive immunity are known as:
a. PAMPs
b. Cell adhesion molecules
c. ELISAs
d. Cytokines
e. None of the above

16. Which of these is not associated with adjuvants?:

a. Forms an antigen depot.
b. Provides non-specific T cell stimulation
c. Activates antigen-presenting cells
d. Activates the complement cascade
e. None of the above

17. Which is associated with apoptosis

a. Regulates cell migration from O-MALT migrate to D-MALT
b. Used by T cells to kill target cells
c. Mediates necrotic cell death
d. A and B
e. All of the above are correct responses

18. The lag phase of the secondary response is shorter than the primary response because:
a. The assays for detecting a primary response are not as sensitive
b. The primary response requires considerable cell proliferation and differentiation to achieve a critical
mass of cells to produce immunity
c. Of the lack of cytokines produced during the primary response
d. A and B
e. None of the above

19. The lag phase of the booster response is:

a. Very short, due to memory cells
b. Very short due to lack of antigen presenting cells
c. Very short when dendritic cells are absent
d. Very short, due to the presence of accessory cells
e. None of the above

20. The location of complement activation is determined by:

a. The location of Fc receptors
b. The location of dendritic cells
c. The location of specific antibody/antigen complexes
 d. B and C
e. None of the above

21. Complement damage is generally limited to the immediate area in which complement is activated because
of the:
a. Short half-lives of the activated components and their rapid inactivation
b. Very low concentrations of the inactivated complement components in serum
c. The inability to activate the system in the presence of IgG antibodies
d. Once activated, the destructive activities of complement are non-specific
e. None of the above

22. During serum sickness, kidney damage occurs as immune complexes form. Why?
a. The immune complexes are filtered by the kidneys and damage results from concomitant
complement activation and neutrophil activity.
b. Antigen presenting cells rapidly bind all of the complexes in their MHC-encoded receptors
c. Free antigen activates PAMP receptors in kidneys which rapidly activate adaptive immunity
d. The immune complexes bind to Mast cells and are destroyed
e. None of the above

23. Contact dermatitis generally occurs against substances that are too small to induce an immune response.
How do these substances induce an immune response?
a. These substances form deposits and are then slowly released into the blood.
b. These low molecular weight substances react with liver enzymes and are difficult to eliminate
c. These substances bind to tissues and cells, resulting in a larger total antigenic size which can then
stimulate and immune response
d. The substances trigger the complement cascade and cause neutrophils to accumulate and to serve
as antigen presenting cells
e. A and C

24. Your patient tests positive for the tuberculin antigen. You send him for a chest x-ray because:
a. The tuberculin test is only presumptive, indication that he has been exposued to tuberculosis
antigen
b. He may have other lung infections
c. You are looking for fluid in his lungs due to inflammation caused by the bacillus
d. A and B
e. None of the above

25. Which of the following are two hallmarks of the adaptive immune system?
a. Immediate and Broad
b. Specificity and Memory
c. Innate and Short
d. Non-specific and Fast
e. Immediate and Passive

26. All of the following are true about CD8 T cells EXCEPT that they
a. Are part of adaptive immunity
b. Respond to antigenic peptides presented by MHC class I molecules
c. Respond to antigenic peptides presented by MHC class II molecules
d. Are major mediators of cytotoxicity against virus-infected host cells
 e. Can make IFN-gamma

27. All of the following are important functions of Type 1 IFNs EXCEPT that they
a. Induce resistance to viral infections
b. Promote MHC class I expression
c. Activate NK cell cytotoxicity
d. Are important growth and proliferation factors for B cells
e. Are part of the innate defense mechanisms

28. Hematopoetic stem cells are precursor cells for all of the following EXCEPT
a. Lymphocytes
b. Other stem cells
c. Erythrocytes
d. Vascular smooth muscle cells
e. Megakaryocytes

29. IL-12 is important for which of the following

a. CD8 expression
b. TNF production
c. IFN-gamma production
d. Eosinophil differentiation
e. CD28 expression

30. The thoracic duct

a. Facilitates transfer of maternal antibody to the fetus
b. Was a major aqueduct in ancient Rome
c. Is the lymphocyte port of entry to the blood for the lymphatic system
d. Is the Dendritic cell port of entry for travel from the periphery to the lymph node

31. Upon his return from South America, an otherwise Mike a 12 year old boy is found to be infected with
helminth parasites. He is doing well because of endogenous Th2 type cytokine response. Which of the
following would you expect to see?
a. IgA
b. CD4 T cell IFN-gamma production
c. IL-5
d. IL-12
e. CTL

32. An individual is genetically deficient for the IFN-gamma receptor. Which of the following would you expect to
be blocked?
a. NK cell development
b. Cell surface expression of functional T cell receptor for antigen on mature T cells
c. Antimicrobial defense
d. IgM antibody responses
e. Immunoglobulin gene rearrangement

33. All of the following can be part of the INNATE immune responses EXCEPT
a. Alternate pathway of complement activation
b. Natural killer cells
 c. B cells
d. Macrophages

34. The major pathways to Th1 type T cell responses during an infection includes all of the following EXCEPT
a. CD4 T cells producing IL-5
b. Innate IL-12
c. NK cell IFN-gamma production
d. CD4 T cells producing IFN-gamma

35. Which of the following can NOT be found in the lymph node?
a. Lymphoid follicle
b. Red pulp
c. B cells
d. Cortex
e. T cells

36. All of the following are function of IgG EXCEPT

a. Opsonise bacteria
b. Activate complement
c. Cross the placenta
d. Be secreted into mucus

37. Which of the following require the thymus

a. Rearrangement of genes for the T cell antigen receptor and T cell maturation
b. Differentiation of granulocytes
c. B cell differentiation
d. Rearrangement of Germline gene segments to code for variable portions of antibody molecules
e. Antigen processing and presentation of material from a peripheral infection

38. Essential steps in cytolytic distruction of target cells by either CTL or NK cells include all of the following
EXCEPT
a. Positive stimulation of cytotoxic cell by target cell
b. Delivery of a lethal hit
c. Deposition of perforin on the target cell surfaces
d. Realse of granzymes from the cytotoxic cells
e. Release of IFN-gamma from cytotoxic cells

39. Chemokines are

a. Low molecular weight cytokines important in inflammation
b. Cytokines important in proliferation
c. Activators of complement
d. Differentiation of cytokines

40. Which category of hypersensitivity reaction BEST describes haemolytic disease of the newborn caused by Rh
incompatibility?
a. Atopic or anaphylactic
b. Cytotoxic
c. Immune complex
d. Delayed
41. The principal difference between cytotoxic (type II) and immune complex (type III) hypersensitivity is
a. The class of (isotype) of antibody
b. The site where antigen-antibody complexes are formed
c. The participation of complement
d. The participation of T cells

42. A child stung by a bee experiences respiratory distress within minutes and lapses into unconsciousness. This
reaction is probably mediated by
a. IgE antibody
b. IgG antibody
c. Sensitized T cells
d. Complement
e. IgM antibody

43. A patient with rheumatic fever develops a sore throat from which beta-hemolytic streptococci are cultured.
The patient is started on treatment with penicillin, and the sore throat resolves within several days.
However, 7 days after initiation of penicillin therapy the patient develops a fever of 103 degrees F, a
generalized rash, and proteinuria. This MOST probably resulted from
a. Recurrence of the rheumatic fever
b. A different infectious disease
c. An IgE response to penicillin
d. An IgG-IgM response to penicillin
e. A delayed hypersensitivity reaction to penicillin

44. A kidney biopsy specimen taken from a patient with acute glomerulonephritis and stained with flourescein-
conjucated anti-human IgG antibody would probably show
a. No fluorescence
b. Uniform fluorescence of the glomerular basement membrane
c. Patchy, irregular fluorescence of the glomerular basement membrane
d. Fluorescent B cells
e. Fluorescent macrophages

45. A patient with severe asthma gets no relief from antihistamines. The symptoms are MOST likely to be caused
by
a. Interleukin-2
b. Slow-reacting substance A (leukotrienes)
c. Serotonin
d. Bradykinin

46. Hypersensitivity to penicillin and hypersensitivity to poison oak are both

a. Mediated by IgE antibody
b. Mediated by IgG and IgM antibody
c. Initiated by haptens
d. Initiated by Th-2 cells

47. Bone marrow transplantation in immunocompromised patients presents which major problem
a. Potentially lethal graft-versus-host disease
b. High risk of T cell leukemia
 c. Inability to use a live donor
d. Delayed hypersensitivity

48. AIDS is caused by a human retrovirus that kills

a. B lymphocytes
b. Lymphocyte stem cells
c. CD4-positive T lymphocytes
d. CD8-positive T lymphocytes

49. Polyomavirus (a DNA virus) causes tumours in “nude mice” (nude mice do not have a thymus, because of a
genetic defect) but not in normal mice. The BEST interpretation of that is
a. Macrophages are required to reject polyomavirus-induced tumours
b. Natural killer cells can reject polyomavirus-induced tumours without help from T lymphocytes
c. T lymphocytes play an important role in the rejection of polyomavirus-induced tumours
d. B lymphocytes play no role in rejection of polyomavirus-induced tumours

50. After binding to its specific antigen, a B lymphocyte may switch its
a. Immunoglobulin light-chain isotype
b. Immunoglobulin heavy-chain isotype
c. Variable region of immunoglobulin heavy chain
d. Constant region of the immunoglobulin light chain

51. Diversity is an important feature of the immune system. Which one of the follow statements about it is
INCORRECT
a. Humans can make antibodies without about 108 different VH X VL combinations
b. A single cell can synthesize IgM antibody, then switch to IgA antibody
c. The haematopoietic stem cell carries the genetic potential to create more than 104 immunoglobulin
genes
d. A single B lymphocyte can produce antibodies of many different specificities, but a plasma cell is
monospecific

52. Neutrophils are attracted to an infected area by

a. IgM
b. Vascular permeability
c. Phagocytosis of IgE coated bacteria
d. Aggregation of C4 and C2

53. Complement fixation refers to

a. The ingestion of C3b-coated bacteria by macrophages
b. The destruction of complement in serum by heating at 56oC for 30 minutes
c. The binding of complement components by antigen-antibody complexes
d. The interaction of C3b with mast cells

54. Natural killer cells are

a. B cells that can kill without complement
b. Cytotoxic T cells
c. Increased by immunization
d. Able to kill virus-infected cells without prior sensitization
55. A positive tuberculin skin test (a delayed hypersensitivity reaction) indicates that
a. A humoral immune response has occurred
b. A cell-mediated immune response has occurred
c. Both the T and B cell systems are functional
d. Only the B cell system is functional

56. Reaction to poinsy ivy or poison oak is

a. An IgG mediated response
b. An IgE mediated response
c. A cell-mediated response
d. An arthus reaction

57. A delayed hypersensitivity reaction is characterized by

a. Oedema without a cellular infiltrate
b. An infiltrate composed of neutrophils
c. An infiltrate composed of helper T cells and macrophages
d. An infiltrate composed of eosinophils

58. The class of immunoglobulin present in highest concentration in the blood of a human newborn is
a. IgG
b. IgM
c. IgA
d. IgD
e. IgE

59. Cytotoxic T cells induced by infection with virus A will kill target cells
a. From the same host infected with any virus
b. Infected by virus A and identical at class I MHC loci of the cytotoxic T cells
c. Infected by virus A and identical at class II MHC loci of the cytotoxic T cells
d. Infected with a different virus and identical at class I MHC loci of the cytotoxic cells
e. Infected with a different virus and identical at class II MHC loci of the cytotoxic cells

60. Antigen-presenting cells that activate helper T cells must express which one of the following on their
surfaces?
a. IgE
b. Gamma interferons
c. Class I MHC antigens
d. Class II MHC antigens

61. Alice your patient became ill 10 days ago with a viral disease. Laboratory examination reveals that the
patient’s antibodies against this virus have a high ratio of IgM to IgG. What is your conclusion?
a. It is unlikely that the patient has encountered this organism previously
b. The patient is predisposed to IgE-mediated hypersensitivity reactions
c. The information given is irrelevant to previous antigen exposure
d. It is likely that the patient has an autoimmune disease

62. Your patient is a child who has no detectable T or B cells. This immunodeficiency is most probably the result
of a defect in
a. The thymus
 b. The bursal equivalent
c. T cell-B cell interaction
d. Stem cells originating in the bone marrow

63. The role of the macrophage during an antibody response is to

a. Make antibody
b. Lyse virus-infected target cells
c. Activate cytotoxic T cells
d. Process antigen and present it

64. Each of the following statements concerning class I MHC proteins is correct EXCEPT
a. They are cell surface proteins on virtually all cells
b. They are recognition elements for cytotoxic T cells
c. They are codominantly expressed
d. They are important in the skin test response to Mycobacterium tuberculosis

65. Each of the following statements concerning class II MHC proteins is correct EXCEPT
a. They are found on the surface of both B and T cells
b. They have a high degree of polymorphism
c. They are involved in the presentation of antigen by macrophages
d. They have a binding site for CD4 proteins

66. Cancer is often the result of activation of _____ to _____ and the inactivation of ____ genes
a. Oncogenes, tumour-suppressor genes, proto-oncogenes
b. Proto-oncogenes, oncogenes, tumour-suppressor genes
c. Oncogenes, proto-oncogenes, tumour suppressor genes
d. Proto-suppressor genes, suppressors, oncogenes

67. About 50% of all human cancers may involve an abnormal or missing
a. Oncogene
b. Proto-oncogene
c. P53 gene
d. BRCA-1 gene

68. Inherited retinoblastoma requires ____ mutation(s) or deletion(s)

a. One
b. Two
c. Three
d. Four

69. In which of the human cells listed below is telomerase active?

a. Blood
b. Bone
c. Muscle
d. Sperm

70. Which of the following is not a characteristic of cancer cells?

a. Loss of cell cycle control
b. Transplantability
 c. Loss of contact inhibition
d. All are characteristic

71. The Philadelphia chromosome is associated with which type of cancer?

a. Breast
b. Thyroid
c. Nerve
d. Leukemia

72. BRCA-1 is associated with which cancer?

a. Breast
b. Thyroid
c. Nerve
d. Leukemia

73. If 85% of lung cancer cases occur in heavy smokers, can lung cancer still have a genetic origin?
a. Yes
b. No

74. Which of the following statements about telomerase is incorrect?

a. It is an enzyme that adds DNA to telomeres
b. It serves as the template for telomere lengthening
c. It is not activated in cancer cells
d. Its activity continually resets the cellular clock

75. Familial cancer is caused by

a. A mutation in somatic cells only
b. A mutation in germline cells only
c. A germline mutation plus a somatic mutation in affected tissue
d. Two germline mutations

76. The p53 protein normally promotes

a. DNA repair
b. Tumour formation
c. Cell division
d. Apoptoisis

77. The p53 gene is especially prone to

a. Point mutation
b. Chromosomal rearrangements
c. Loss
d. None of the above

78. Which type of study compares the incidence of a type of cancer among very different groups of people?
a. Population
b. Case-control
c. Prospective
d. Empiric
79. Why is genetic counselling for familial breast cancer difficult?
a. BRCA1 and BRCA2 are incompletely penetrant
b. Breast cancer can occur in other ways
c. Not all mutations are associated with the disease
d. All of the above

80. Which of the following is not a traditional cancer treatment

a. Blocking telomerase
b. Inhibition angiogenesis
c. Stimulating specialization
d. None of the above

81. Which of the following may contribute to causing cancer?

a. A mutation in a gene that slows the cell cycle
b. Faulty DNA repair
c. Loss of control over telomere length
d. All of the above

82. TNM stands for

a. Temperature, Metabolism, Nutrition
b. Tumour, Nodule, Metastasis
c. Tumour, Nerve, Metastasis
d. Tumour, Node, Metastasis

83. A patient is suspicious of having breast cancer. What type of test will a physician conduct to diagnose the
cancer
a. Blood test
b. Pap test
c. CT scan
d. Mammography

84. What is cancer of the bone marrow stem cells that produce white blood cells called?
a. Leukaemia
b. Sarcoma
c. Carcinoma
d. Lymphoma

85. Which cells normally kill defective or mutant cells?

a. No normal cells can kill a mutant
b. Chemokiller cells
c. Antibody-producing cells
d. Cytotoxic T and natural killer cells

86. A benign epithelial cell neoplasm derived from non-glandular surfaces is referred to as
a. Papilloma
b. Sarcoma
c. Adenoma
d. Hamartoma
e. Squamous cell carcinoma
87. Which one of the following is not considered to be a distinctive pattern of non-neoplastic growth?
a. Regeneration
b. Hypertrophy
c. Hyperplasia
d. Anaplasia
e. Metaplasia

88. Which of the following is least likely to be used as a means of distinguishing a benign from a malignant
neoplasm?
a. Degree of cellular differentiation
b. Rate of growth
c. Type and amount of necrosis
d. Evidence of metastasis
e. Mode of spread

89. Which of the following are the most important and clinically useful risk factors for breast cancer?
a. Fibrocystic disease, age, and gender
b. Cysts, family history in immediate relatives, and gender
c. Age, gender, and family history in immediate relatives
d. Obesity, nulliparity, and alcohol use

90. Which of the following are true of breast cancer?

a. The life time risk of a woman developing breast cancer is 1/9
b. For most women a specific cause of their breast cancer is known
c. Prognosis is worse for affluent women
d. Incidence of breast cancer is decreasing

91. Risk factor breast cancer include

a. Young age
b. Young age at menopause
c. Young age at first birth
d. Young age at first menarche

92. Which of the following statements regarding screening for breast cancer are correct?
a. Mammography is offered to all women between the ages of 50 and 75 years in the UK
b. Studies have shown an approximate 30% reduction in mortality with screening using mammography
c. Most radiographically suspicious lesions are subsequently confirmed as malignant
d. Mammography is less sensitive in postmenopausal women

93. Which of the following is not necessary when a patient first presents with a breast lump?
a. Fine needle aspiration (FNA)
b. Chest x-ray
c. Examination of axillary lymph nodes
d. Examination of breasts with patient supine

94. Which of the following statements is true regarding adjuvant treatment for early breast cancer?
a. Radiotherapy is indicated after breast cancer conserving surgery only if >4 nodes positive or tumour
close to the resection margin
 b. Aromatase inhibitors are replacing tamoxifen in premenopausal women due to better outcomes and
greater tolerability
c. Combination chemotherapy reduces recurrence and improves survival in selected patient groups
d. No survival benefit has been demonstrated with use of trastuzumab (herceptin) in the adjuvant
setting

95. In treatment of metastatic breast cancer

a. Chemotherapy is superior to endocrine therapy
b. Biphosphonates are used to control hypocalcaemia
c. Responses to endocrine therapy tend to occur within 2 months of starting treatment
d. Trastuzumab (herceptin) in combination with chemotherapy improves survival in patients who have
tumours that overexpress HER-2

96. Which of the following are good prognostic factors in breast cancer?
a. Oestrogen receptor positivity
b. Grade III tumour
c. HER-2 receptor overexpression
d. Lymph node involvement

97. Regarding pronator teres which of the following statements is correct?

a. It forms the lateral border of the cubital fossa
b. It arises from the coronoid process of the lateral epicondyle
c. The median nerve passes deep to both heads
d. It’s medial border forms the medical boundary of the cubital fossa
e. It is the most lateral of the superficial of the flexors of the forearm

98. Group three of these forearm flexure muscles into the correct group. Which is the odd one out?
a. Flexor pollicis longus
b. Pronatos quadrates
c. Flexor digitorum profundus
d. Flexor digitorum superficialis

99. The radius bone is lateral to the ulna in the anatomical positions
a. True
b. False

100. The radial styloid process articulates with which of the carpal bones?
a. Pisiform
b. Lunate
c. Trapezoid
d. Scaphoid

101. What is the medial boundary of the cubital fossa?

a. Pronator teres
b. Brachialis
c. Brachioradialis
d. Supinator

102. The _____ muscle is not found in 15% of individuals

 a. Flexor carpi radialis
b. Palmaris retinaculum
c. Flexor carpi ulnaris
d. Palmaris longus

103. Which of the following muscles of the posterior compartment are innervated directly by the radial nerve?
a. Brachioradialis
b. Anconeus
c. Extensor carpi radialis longus
d. Triceps

104. Biceps brachii are well known for being the main flexors of the forearm. However, they are also powerful
(1) of the (2)
a. 1. Flexors 2. Humerus
b. 1. Pronators 2. Forearm
c. 1. Extensors 2. Humerus
d. 1. Supinators 2. Forearm

105. Approximately ____ percentage of spontaneous abortions result from extra or missing chromosomes
a. 10
b. 25
c. 50
d. 75

106. The most common autosomal aneuploidy is

a. Trisomy 13
b. Trisomy 15
c. Trisomy 18
d. Trisomy 21

107. A (an) ____ chromosome has its centromere near a tip so that it has one long arm and one very short arm
a. Metacentric
b. Submetacentric
c. Acrocentric
d. None of the above

108. In a (an) ______, the short arm of two acrocentric chromosomes break, and the long arms join, forming an
unusual, long chromosome.
a. Robertsonian translocation
b. Reciprocal translocation
c. Inversion
d. Duplication

109. An individual with two normal sets of autosomes and a single X chromosome has
a. Down syndrome
b. Patau syndrome (don’t google image search this)
c. Turner syndrome
d. Klinefelter Syndrome
110. This structure emanates from the centromere and contacts the spindle fibers during mitosis:
a. Alpha satellite
b. Subtelomere
c. Euchromatin
d. Kinetochore

111. Prenatal diagnostic techniques that obtain foetal chromosomes include all but
a. Amniocentesis
b. Foetal cell sorting
c. Chorionic villus sampling
d. Flouresence in situ hybridization

112. When chromatids divide along the wrong place, structures with identical arms called _____ are formed
a. Ring chromosomes
b. Translocations
c. Isochromosomes
d. Satellites

113. In nondisjunction, which parent leads to the aneuploidy XYY

a. Mother
b. Father
c. Either parent
d. Both parents

114. An individual with the chromosomal description 45, X would be a

a. Normal female
b. Female with Turner syndrome
c. Male with Klinefelter syndrome
d. Cannot be determined

115. Heterochromatic regions at the ends of chromosomes are called

a. Centromeres
b. Euchromatin
c. Telomeres
d. Satellites

116. The photographic arrangement of chromosomes is called a (an)

a. Karyotype
b. Ideogram
c. Anagram
d. Chromogram

117. A triploid karyotype has how many chromosomes

a. 23
b. 46
c. 69
d. 92
118. Nondisjunction of chromosome 21 during meiosis II in human females can result in all of the following
chromosome complements in a zygote except (assume the oocyte is fertilized by a sperm with a normal
chromosome set)
a. No chromosome 21
b. Euploid for chromosome 21
c. Monosomic for chromosome 21
d. Trisomic for chromosome 21

119. About 90% of trisomy 21 Down conceptions are due to nondisjunction during
a. Meiosis I in the female
b. Meiosis II in the female
c. Meiosis I in the male
d. Meiosis II in the male

120. Consider the following normal sequence of genes: a b c d e f g h. The sequence of a b f e d c g h represents
a (an)
a. Deletion
b. Duplication
c. Inversion
d. Translocation

121. Which of the following karyotypes is not possible in the offspring of a translocation carrier (involving
chromosomes 14 and 21) and a normal individual
a. Deficient 14 or deficient 21
b. Normal
c. Translocation Down syndrome
d. All are possible outcomes

122. A couple seeks testing and counselling after they have a child with cystic fibrosis. Testing reveals the
mother is a carrier but the father is not. How can these results be explained?
a. The man tested is not the biological father
b. A mutation altered the child’s normal allele
c. Uniparental disomy (from the mother)
d. All are possible explanations, additional testing is needed

123. Which of the following cell types is not used to examine chromosomes?
a. White blood cells
b. Bone marrow cells
c. Red blood cells
d. All of the above can be used

124. How many chromosomes does a person with Edward syndrome have?
a. 45
b. 46
c. 47
d. 48

125. All the following aneuploids result from female nondisjunction except
a. Klinefelter syndrome
 b. Triplo-X
c. Turner syndrome
d. Jacobs syndrome

126. Which of the following human genetic disorders is NOT caused by nondisjunctions?
a. Down syndrome
b. Turner Syndrome
c. Klinefelter syndrome
d. Fragile X syndrome
e. Poly X

127. Which of the statements is NOT true about X-linked characteristics?

a. More males than females are affected
b. If a female has the characteristic, all her sons will show it
c. Females can be carriers of the gene without showing
d. The characteristic often skips a generation, from a woman’s father to her son
e. Males can have two copies of alleles for the trait, but females can have only one

128. Chorionic villus sampling uses what tissue to analyze the foetal cells and provide a karyotype?
a. Foetal blood tissue
b. Cells floating in the amniotic fluid
c. A small biopsy from the embryo itself but it readily heals
d. Membrane tissues from the embryo side of the placenta
e. Membrane tissues from the mother’s side of the placenta

129. Generally, it is not possible to determine whether nondisjunction failed to occur in oogenesis or
spermatogenesis. However, it is possible to assert that _______ resulted in nondisjunction in _______.
a. XXY; oogenesis
b. XYY; spermatogenesis
c. XXX; oogenesis
d. XXY; spermatogenesis
e. XO; oogenesis

130. Which genetic trait is NOT associated with the chromosome involved in Down syndrome?
a. Increased incidence of leukaemia
b. Cataracts
c. Mental retardations
d. Alzheimer disease
e. Cystic fibrosis

131. Which one of these is caused by repeats of base triplets rather than a whole chromosome?
a. Down syndrome
b. Edward syndrome
c. Klinefelter syndrome
d. Fragile-X syndrome
e. Turner syndrome

132. Foetal growth...

a. Accelerates in the third trimester
 b. Is independent of maternal nutrition
c. Is independent of maternal size
d. Is most rapid in early gestation
e. Requires placental amino acid transport to be constant

133. The pancreas...

a. Has acini formed from 5-8 pyramidal-shaped cells
b. Has large numbers of myoepithelial cells
c. Has a minor exocrine and a major endocrine part
d. Secretes an acidic enzyme-rich fluid
e. Secretes enzymes via the process of endocytosis

134. In the penis...

a. Each crus of the penis is attached to the ilial ramus
b. Nitric oxide causes muscle contraction
c. Parasympathetic function is important for erection
d. The corpus cavernosum is pierced by the urethra
e. The penile portion of the urethra is lined by squamous epithelium

135. Atopic asthma...

a. Initiates IgE antibody synthesis
b. Is an example of a type II hypersensitivity response
c. Is an example of a type III hypersensitivity response
d. Is associated with high levels of IgM
e. Is associated with mast cell degranulation in the lung

136. Memory B cells...

a. Are found primarily in the red pulp of the spleen
b. Generally produce IgM
c. Have short life spans
d. Recirculate in the blood between spleen and lymph nodes
e. Reside permanently in germinal centres

137. MHC class II molecules...

a. Are absent from the thymus
b. Are constitutively expressed only on specialised antigen presenting cells
c. Are expressed on all cells except those of the nervous system
d. Are formed by an alpha chain and beta-2 microglobulin
e. Bind endogenous peptides

138. Cells that enter the lymph nodes by migrating across high endothelial venules include
a. CD4+ T cells
b. Neutrophils
c. Plasma cells
d. Platelets
e. Red blood cells
139. Farah, daughter of an obligate carrier of an X-linked recessive condition, is pregnant. Assuming that Farah’s
father and the unborn child’s father are unaffected the chance that Mary’s child will have the X-linked
recessive condition is
a. 1 in 16
b. 1 in 8
c. 1 in 4
d. 1 in 2
e. None

140. A 5 year-old boy has a severe sore throat, high fever and cervical lymphadenopathy. It is suspected that the
causative agent is Streptococcus pyogenes. Prior to initiation of antibiotic therapy, the child is gen asprin to
reduce fever. The mechanism of fever reduction by asprin is
a. Increasing the hypothalamic set-point temperature
b. Inhibition of prostaglandin synthesis
c. Shivering
d. Shunting of blood from the surface of skin
e. Stimulation of cyclo-oxygenase

141. This image is a section from the skin. The region indicated by X is the
a. Dermis
b. Epidermis
c. Epidermal ridge
d. Grainy layer
e. Junction between the dermis and epidermis

142. The form of RNA that brings amino acids to the protein synthesis
machinery is called
a. mRNA
b. miRNA
c. rRNA
d. siRNA
e. tRNA

143. Nonsense mutations

a. Cause a frameshift
b. Alter an amino acid coded for by a particular codon
c. Cause premature termination of the protein chain
d. Cause promoters to become inactive
e. Result in more severe phenotype than missense mutations

144. In relation to growth during puberty...

a. Both boys and girls have their growth spurts at the same time
b. Boys finish growth before girls
c. Bows grow more than girls
d. Girls grow faster than boys
e. Girls have their growth spurt at menarche

145. Surgical removal of the seminal vesicles would

a. Cause sterility because sperm production would cease
 b. Cause sterility because sperm would remain in the male reproductive tract
c. Have minimal effect on semen volume
d. Result in increased likelihood of pregnancy with the withdrawal method of birth control
e. Result in semen lacking energy-providing nutrients for sperm

146. Embryonic ectoderm gives rise to

a. Cartilage
b. Dermis
c. Gut epithelium
d. Neural crest cells
e. Vascular endothelium

147. “Non-directive” genetic counselling involves providing advice to people affected by a genetic disorder,
principally so that they can...
a. Assess the pros and cons of the different options
b. Reach a decision in their own time
c. Reach and independent decision
d. Reach a reasoned outcome
e. Reach the most acceptable decision

148. An adolescent experiences a delay in developing secondary sexual characteristics. His testosterone levels
are tested and found to be normal. A possible cause for his problem may be...
a. Decreased levels of a cell membrane testosterone receptor
b. Decreased levels of a serum testosterone binding protein
c. Decreased levels of intracellular testosterone binding protein
d. Inability to produce second messenger signal molecules after the binding of testosterone to its cell
membrane receptor
e. Loss of function of a tyrosine kinase

149. The T cell receptor on CD4+ T cells

a. Changes class upon T cell activation
b. Is secreted to recognise antigen in association with MHC
c. Recognises antigenic peptide in association with class I MHC
d. Recognises antigenic peptide in association with class II MHC
e. Recognises parts of DNA

150. Antibody class is determined by the

a. Antigen binding site
b. Constant heavy chain region
c. Hypervariable region
d. J chains
e. Light chains

151. Loss of heterozygosity can be described as

a. An inherited chromosomal abnormality
b. Deletion of a whole chromosome
c. Losing one allele
d. Meiotic recombination
e. Switching to a haploid state
 152. Cells are most susceptible to radiation damage when in the
a. G0 phase of the cell cycle
b. G1 phase of the cell cycle
c. G2 phase of the cell cycle
d. M phase of the cell cycle
e. S phase of the cell cycle

153. The matrix of bone is primarily composed of

a. Calcium phosphate and hydroxapatite
b. Collagen fibres and calcium phosphate
c. Osteocytes, collagen and calcium ions
d. Type I collage and calcium carbonate
e. Type II collagen and calcium salts

154. In a normal distribution, the percentage of values that lie between plus one and minus one standard
deviation of the mean is approximately
a. 2.5%
b. 5%
c. 34%
d. 68%
e. 95%
A 5 year old girl developed prominent nipples about a year ago and now has noticeable breast development. Her
height is 115cm (91st percentile) and mid-parental height is 163cm (50th centile).
155. Breast development results directly from increased secretion of:
a. Oestrogen
b. FSH
c. LH
d. Progesterone
e. Prolactin

156. As an adult, she is most likely to be

a. Average height
b. Overweight
c. Short
d. Tall
e. Underweight
This is a transverse section through the hand that really loves coming up in exams

157. The distal carpal bone A is the

a. Capitates
b. Hamate
c. Lunate
d. Scaphoid
e. Trapezoid

158. In the anatomical position, B represents the

a. Dorsal surface of the hand
b. Lateral surface of the hand
c. Medial surface of the hand
d. Palmar surface of the hand
e. Ventral surface of the hand

159. A month-old baby would rather look at a face than a neutral stimulus, this is an example of
a. Genetic predisposition
b. Inborn preference
c. Inherent
d. Learned response
e. Maturation
f. Nature versus nuture
g. Reflex

160. Some changes in ability are due to increasing age alone, this is an example of
a. Genetic predisposition
b. Inborn preference
c. Inherent
d. Learned response
e. Maturation
f. Nature versus nuture
g. Reflex
161. A man with familial hypercholesterolaemia is very likely to develop heart disease, this is an example of
a. Genetic predisposition
b. Inborn preference
c. Inherent
d. Learned response
e. Maturation
f. Nature versus nuture
g. Reflex

162. The peritoneum reflected from the side of the uterus to the lateral walls of the pelvis is the
a. Broad ligament
b. Perimetrium
c. Rectouterine pouch
d. Round ligament
e. Uterosacral ligament

163. What prevents the body of the uterus from moving ateriorly and inferiorly
a. Broad ligament
b. Perimetrium
c. Rectounterine pouch
d. Round ligament
e. Uterosacral ligament

164. A man carries a mutation in one copy of a gene coding for a membrane protein essential for normal lung
function. His wife has two copies of this gene. What is the probability that their unborn son will suffer from
lung disease if the mutation is autosomal dominant
a. 0
b. 0.25
c. 0.5
d. 0.75
e. 1

165. Same scenario as 164 but the mutation is autosomal recessive

a. 0
b. 0.25
c. 0.5
d. 0.75
e. 1

166. Same scenario as 164 but the mutation is Y-linked

a. 0
b. 0.25
c. 0.5
d. 0.75
e. 1

167. Each of the following statements regarding the genetics of cystic fibrosis (CF) is correct EXCEPT:
a. The CF gene codes for a protein called cystic fibrosis transmembrane regulator (CFTR)
 b. CFTR is largely expressed in epithelial cells of the airways, the pancreas, the biliary system, the
genitourinary system, and the sweat glands
c. Although there are a few hundred mutations that exist for CF, the most prevelant among northern
Europeans is W1282X
d. Severity of lung disease and liver disease cannot be predicted by genotype

168. Which of the following exocrine glandular ducts are NOT obstructed in cystic fibrosis
a. Pancreas
b. Lungs
c. Sweat glands
d. Glands of the uterine cervix

169. Which of the following is NOT a pulmonary complication of CF?

a. Massive hemoptysis and pneumothorax
b. Atelectasis and acute respiratory failure
c. Allergic bronchopulmonary aspergillosis and hypertrophic pulmonary osteoarthorapathy
d. Lymphangiomyomatosis and chylothorax

170. Each of the following statements regarding pregnancy in women with CF is correct EXCEPT
a. Impairment of pulmonary function is the major predictor of both maternal and foetal outcome
b. CF patients have an increased risk for premature delivery
c. The maternal and foetal outcome is good for most cystic fibrosis patients
d. The pregnancy need not be a planned one

171. CF affects which body system?

a. Circulatory system
b. Respiratory system
c. Digestive system
d. Nervous system
e. b and c

172. Which symptom in an infant or young child might indicate CF?

a. Abnormal stools that may be pale, foul or float
b. Frequent wheezing or pneumonia
c. Salty-tasting skin
d. Chronic cough
e. All of the above

173. What happens to the mucus glands in a child with CF?

a. Too little mucus is produced
b. The mucus produced is too thing
c. The mucus produced it too thick
d. The mucus accumulates in the body
e. c and d

174. How is the digestive system affected by excess mucus in CF?

a. The mucus can cause stomach ulcers
b. The mucus can damage the bile ducts in the liver
c. The mucus can clog the ducts in the pancreas
 d. The mucus can damage the rectum
e. b and c

175. How is CF diagnosed?

a. Sweat test
b. Blood test
c. Lung volume test
d. Urine test
e. a and b

176. Currently no effective treatment is available to correct the cause of CF. Doctors can, however, slow the
progression of the disease. Which of these types of medication can do this?
a. Bronchodilators
b. Antibiotics
c. Decongestants
d. Mucolytics
e. All of the above

177. Modeling is enhanced when the person being modelled is

a. A low-status person
b. Attractive
c. Speaking a foreign language
d. A social isolate
e. A child

178. People’s expectations that they are capable of performing a behaviour that will produce desired outcomes
in any particular situation is called
a. Outcome expectancy
b. Self-efficacy
c. Distortion of consequences
d. The self-system

179. Which technique is LEAST likely to increase a person’s self-efficacy?

a. Verbal persuasion
b. Increased emotional arousal
c. Vicarious experiences
d. Performance accomplishments

180. Which of these is MOST likely to increase self-efficacy

a. Verbal persuasion
b. Increased emotional arousal
c. Decreased emotional arousal
d. Performance accomplishments

181. Wallston (1978) has described three dimensions of (multi-dimensional) health locus of control. These are:
a. Internal, external, and powerful others
b. External, powerful others, and self-efficacy
c. Powerful others, internal, and self-efficacy
d. Internal, self-efficacy, and external
182. The behaviour of people around us creates a perceived:
a. Attitude
b. Social normal
c. Value
d. Intention

183. Attitudes consist of three related parts. What are they?

a. Influence, emotion, and perception
b. Thought, emotion, and behaviour
c. Emotion, behaviour, and influence
d. Thought, influence, and emotion

184. Connor says “I use condoms more regularly than most of my friends, so my risk of contracting a STD is low”.
This is an example of:
a. Social normal
b. Self-efficacy
c. Unrealistic optimism
d. External health locus of control

185. “Exercise will make me fitter” is an example of:

a. A goal
b. Unrealistic optimism
c. An outcome expectancy
d. Self-regulation

186. Which of the following is NOT a component of the health belief model?
a. Perceived barriers
b. Perceived susceptibility
c. Perceived behaviour control
d. Perceived severity

187. Which of the following is NOT a criticism of the health belief model?
a. It overlooks the role of disease severity
b. It assumes human beings are rational
c. It underestimates the role of social influence
d. It overestimates the role of threat

188. According to the health belief model, women who perform regular breast self-examinations (BSE):
a. Believe that the benefits of BSE outweigh the barriers to them
b. Believe that they are susceptible to breast cancer
c. Believe that developing breast cancer would have serious effects
d. All of the above

189. The _____ report was the first British publication to identify poverty as a cause of ill health
a. Brown
b. Black
c. Red
d. White
190. The provision of healthcare differences according to where you live is known as the
a. County lottery
b. Area lottery
c. Postcode lottery
d. Health authority lottery

191. What are the five consistent themes of ‘illness representations’ as identified by Leventhal?
a. Identity, consequences, cause, timeline and curability/controllability
b. Identity, coping, cause, timeline, and curability/controllability
c. Identity, consequences, cause, coping, and curability/controllability
d. Identity, consequences, coping, timeline, and curability/controllability

192. Which of the following is an example of a cognitive schema?

a. Sorting by colour
b. Grasping a rattle
c. Looking at an object
d. Sucking a pacifier

193. According to Piaget, the incorporation of new information into existing schemas is called:
a. Operational thought
b. Equilibration
c. Accommodation
d. Assimilation

194. Tim likes to explore his parent’s house through touch. One day he touches the oven and burns his hand.
Tim learns that although some objects are safe to touch, ovens are not. According to Piaget, this is an
example of:
a. Assimilation
b. Accommodation
c. Negative reinforcement
d. Positive reinforcement

195. How many stages of cognitive development did Piaget identify?

a. Three
b. Four
c. Five
d. Six

196. When Mat was 5 months old, he looked at a toy train, but when his view of the train was blocked, he did
not search for it. Now that he is 9 months old, he does search for it, reflecting his development of:
a. Object permanence
b. Self-differentiation
c. Assimilation
d. Schemata

197. Evie understands that her father can also be a son and a brother, all at the same time. This suggests that
Evie is in the:
a. Sensorimotor stage
 b. Preoperational stage
c. Concrete operational stage
d. Formal operational stage

198. In Piagetian terms, the cognitive ability to solve problems that develop in adolescence is called:
a. Trial-and-error reasoning
b. Hypothetical-deductive reasoning
c. Concrete thinking
d. Transitivity

199. Chieun, a preschooler, insists on dressing herself each morning for school, even though she generally
selects mismatching outfits, misses buttons, and wears her shoes on the wrong feet. When her mother tries
to dress Chieun or fix her outfit, Chieun brushes her mother off and insists on doing it herself. What stage of
psychosocial behaviour best describes Chieun’s behaviour?
a. Trust vs. Mistrust
b. Autonomy vs. Shame and Doubt
c. Initiative vs. Guilt
d. Industry vs. Inferiority

200. The central theme of Erikson’s theory of psychosocial stages was the development of
a. Personality
b. Psychosocial conflict
c. Social status
d. Ego identity

201. At each stage of Erikson’s theory of psychosocial development, people experience a (an) ________ that
serves as a turning point.
a. Epiphany
b. Conflict
c. Paradigm shift
d. Turmoil

202. The stage that occurs between birth and one year of age is concerned with
a. Trust vs. Mistrust
b. Autonomy vs. Shame and Doubt
c. Initiative vs. Guilt
d. Identity vs. Role confusion

203. Erikson believed that people move through a series of ____ psychosocial stages throughout the lifespan.
a. Four
b. Eight
c. Ten
d. Twelve

204. The crisis that arises in young adulthood is concerned with

a. Trust vs. Mistrust
b. Industry vs. Inferiority
c. Integrity vs. Despair
d. Intimacy vs. Isolation
205. Eight year old Raj has a difficult time making friends at school. He has trouble completing his schoolwork
accurately and on time, and as a result, receives little positive feedback from his teacher and parents.
According to Erikson’s theory, failure at this stage of development results in ________?
a. Feelings of inferiority
b. A sense of guilt
c. A poor sense of self
d. Mistrust

206. The central conflict in the eight stage of Erikson’s theory focuses on Integrity vs. Despair and involves
reflecting back on your life. Those who are unsuccessful at resolving this conflict will look back with regret,
anger, and bitterness. Those who are successful will feel a sense of satisfaction with the life they have lived.
According to Erikson, those who are successful in this stage emerge with _________.
a. Hope
b. Fidelity
c. Purpose
d. Wisdom

207. Which is the dominant cell type in the paracortex of lymph nodes?
a. Adipocyte
b. Mast cell
c. T-lymphocyte
d. M-cell

208. What tissue type is pictured here to the right?

a. Simple columnar epithelium
b. White adipose tissue
c. Keratinized stratified squamous epithelium
d. Unicellular exocrine gland (goblet cell)

209. Which cell type releases histamine?

a. Mast cell
b. Fibrocyte
c. Mesenchymalcell
d. Reticular cell

210. What tissue type is pictured here to the right?

a. Stratified sqaumous epithelium
b. Simple columnar epithelium
c. Stratified cuboidal epithelium
d. Simple squamous epithelium

211. What tissue type is pictured here to the right?

a. Loose irregular connective tissue
b. White adipose tissue
c. Dense irregular connective tissue
d. Mesenchymal connective tissue

212. Sperm pass through all the following structures EXCEPT the _______
 a. Ductus deferens
b. Ejaculatory duct
c. Urinary bladder
d. Urethra

213. Following delivery, which pair of hormones is most closely associated with lactation?
a. Prolactin and oxytocin
b. Oestrogen and prolactin
c. Progesterone and prolactin
d. Oestrogen and progesterone

214. Immature egg cells are called _______

a. Graafian cells
b. Follicles
c. Fimbriae
d. Oocytes

215. Sperm are produced in the ________

a. Prostate gland
b. Vas deferens
c. Seminiferous tubules
d. Epididymis

216. Which hormone, produced by the early embryo that makes the corpus luteum persist in the ovary, is tested
for in a pregnancy test?
a. Testosterone
b. Oxytocin
c. Lutenizing hormone (LH)
d. Human chorionic gonadotropin (HCG)

217. Which pituitary hormone stimulates ovulation and can be used to predict the time of ovulation?
a. Progesterone
b. Lutenizing hormone (LH)
c. Follicle-stimulating hormone (FSH)
d. HCG

218. The receptor for steroid hormones lies

a. In the cytoplasm
b. Within the plasma membrane
c. Within the nuclear envelope
d. In the blood plasma

219. Second messengers are activated in response to

a. Steroid hormones
b. Thyroxine
c. Peptide hormones
d. All of these

220. Which of the following hormones is not released by the anterior pituitary?
 a. Melanocyte-stimulating hormone
b. Gonadotrophin-releasing hormone
c. Thyroid-stimulating hormone
d. Growth hormone

221. ______ hormone stimulates the adrenal cortex to produce several of its hormones
a. Follicle-stimulating
b. Luteinizing
c. Adrenocorticotropic
d. Growth

222. Parathyroid hormone acts to ensure that

a. Calcium levels in the blood never drop too low
b. Sodium levels in urine are constant
c. Potassium levels in the blood don’t escalate
d. The concentration of water in the blood is sufficient

223. The adrenal cortex release _______, which stimulates Na+ reabsorption by the kidneys
a. Epinephrine
b. Aldosterone
c. Glucose
d. Cortisol

224. Individuals with type I diabetes

a. Lack beta cells in the iselets of Langerhans
b. Produce enough insulin but lack functional receptors on their cells
c. Can control their diabetes with diet and exercise
d. All of the above

225. Which of the following hormones is NOT important in calcium homeostasis?

a. Calcitonin
b. Parathyroid hormone
c. 1,25-dihydrocyholecalciferol
d. Glucagon

226. Which of the following statements regarding calcium homeostasis is NOT true?
a. Extracellular calcium concentration is monitored by the parathyroid
b. Inhibition of osteoclast activity helps restore high extracellular calcium concentration to normal
levels
c. Calcitonin and parathyroid hormone have opposing effects on extracellular calcium concentration
d. 1,25-dihydrocycholecalciferol and parathyroid hormone have opposing effects on extracellular
calcium concentration

ANSWERS:

1 b
 2 d
3 b
4 b
5 a
6 c
7 d
8 e
9 a
10 b
11 e
12 a
13 d
14 d
15 d
16 d
17 b
18 b
19 a
20 c
21 a
22 a
23 c
24 a
25 b
26 c
27 d
28 d
29 c
30 c
31 c
32 c
33 c
34 a
35 b
36 d
37 a
38 e
39 a
40 d
41 b
42 a
43 d
44 c
45 b
46 c
47 a
48 c
49 c
50 b
51 d
52 c
 53 c
54 d
55 b
56 c
57 c
58 A
59 b
60 D
61 A
62 D
63 d
64 d
65 a
66 b
67 c
68 b
69 d
70 d
71 d
72 a
73 a
74 c
75 c
76 d
77 a
78 a
79 d
80 d
81 d
82 b
83 d
84 a
85 d
86 a
87 d
88 c
89 c
90 a
91 d
92 b
93 b
94 c
95 d
96 a
97 e
98 d
99 a
100 d
101 a
102 d
103 a
104 d
105 c
106 d
107 c
108 a
109 c
110 d
111 d
112 c
113 b
114 b
115 c
116 a
117 c
118 a
119 a
120 c
121 d
122 d
123 c
124 c
125 d
126 d
127 e
128 d
129 b
130 e
131 d
132 a
133 a
134 c
135 e
136 d
137 b
138 a
139 c
140 b
141 e
142 e
143 c
144 c
145 e
146 d
147 c
148 c
149 d
150 b
151 c
152 d
153 b
154 c
155 a
156 c
157 b
158 b
159 b
160 e
161 a
162 a
163 e
164 c
165 a
166 e
167 c
168 c
169 d
170 d
171 e
172 e
173 e
174 e
175 e
176 e
177 b
178 b
179 b
180 d
181 a
182 b
183 b
184 c
185 c
186 c
187 a
188 d
189 c
190 c
191 a
192 a
193 d
194 b
195 b
196 a
197 c
198 b
199 b
200 d
201 b
202 a
203 b
204 d
205 a
206 d
207 c
208 c
209 a
210 a
211 c
212 c
213 a
214 d
215 c
216 c
217 b
218 a
219 c
220 b
221 c
222 a
223 b
224 a
225 d
226 d