800 Questions PDF

FIRST AID ™
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Q&A
for the
NBDE
PART I
DEREK M. STEINBACHER, MD, DMD
University of Pennsylvania School of Dental Medicine
Class of 2001
Harvard Medical School
Class of 2004
Fellow, Plastic and Reconstructive Surgery
Johns Hopkins Hospital
Baltimore, Maryland
STEVEN R. SIERAKOWSKI, DMD, MDSc

University of Pennsylvania School of Dental Medicine
Class of 2001
Diplomate, American Board of Periodontology
Private Practice
Philadelphia, Pennsylvania
New York / Chicago / San Francisco / Lisbon / London / Madrid / Mexico City
Milan / New Delhi / San Juan / Seoul / Singapore / Sydney / Toronto

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D E D I C AT I O N
To the contributors who dedicated their time, energy, and insight into the
creation of this book,
and
To our families and loved ones who supported us through this endeavor.
Derek M. Steinbacher, MD, DMD

Steven R. Sierakowski, DMD, MDSc
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CONTENTS
Contributors vii
Preface ix
Acknowledgments xi
How to Contribute xiii
Chapter 1 Anatomic Sciences 1

Questions 2
Answers 23
Chapter 2 Biochemistry and Physiology 65

Questions 66
Answers 86
Chapter 3 Microbiology and Pathology 115

Questions 116
Answers 138
Chapter 4 Dental Anatomy and Occlusion 187

Questions 188
Answers 208
v
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CONTRIBUTORS
Karl C. Bruckman, DDS

Class of 2008
College of Dental Medicine
Columbia University
New York, New York
Resident
Department of Oral and Maxillofacial Surgery
Jefferson Medical College
Thomas Jefferson University
Derek J. Conover, DMD

Class of 2008
University of Pennsylvania
School of Dental Medicine
Blaine A. Keister, DMD

Class of 2008
University of Pennsylvania
School of Dental Medicine
vii
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PREFACE
First Aid Q&A for the NBDE Part I serves as the ideal companion manual for
the First Aid for the NBDE Part I, Second Edition. Included are 800 ques-
tions simulating actual NBDE examination items. These are divided equally
among the four sections included on the test: Anatomic Sciences, Biochem-
istry and Physiology, Microbiology and Pathology, and Dental Anatomy and
Occlusion. Following each block of questions are concise answer explanations.
Best of luck as you venture through the first standardized exam in dental
school.
ix
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ACKNOWLEDGMENTS
We appreciate all authors and medical and dental students who have contributed
to this work in both practice and concept. Special thanks to Karl Bruckman,
DDS for exhibiting incredible diligence, reliability, and productivity.
Thanks to our publisher, McGraw-Hill, for recognizing the need for this book
and for the assistance of their staff. Thanks to Catherine Johnson, our editor,
for her continued support and guidance.
xi
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HOW TO CONTRIBUTE
We welcome your comments, suggestions, ideas, corrections, or other submissions to help with this and
future editions of First Aid Q&A for the NBDE Part I. What information can you contribute?
■ Critiques related to the content or questions contained herein
■ Additional example questions
■ Test-taking tips and study strategies for the exam
■ Suggestions for mnemonics, diagrams, figures, and tables
If you wish to contribute, e-mail your entries or suggestions to the following address:
[email protected]
Please include your name, address, e-mail address, and school affiliation.
N OT E TO CO N T R I B U TO R S
All contributions become property of the authors and are subject to editorial manipulation. In the event
that similar or duplicate entries are received, only the first entry received will be used. Please include a
reference to a standard textbook to verify the factual data.
xiii
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CHAPTER 1
Anatomic Sciences
1
Anatomic Sciences 2 Chapter 1: Anatomic Sciences
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Q U E ST I O N S
Questions 1-3 pertain to the following clinical as intense headaches that have persisted. The patient
vignette: is worked up, and sent for imaging, which reveals a
lesion located in the petrous temporal bone.
A 23-year-old female presents to the emergency
department following a head-first collision with a 4. Suppose a lesion compromises the lower
teammate during a lacrosse match. The patient motor neuron of CN VII, occurring proximal
was stabilized, and vital signs were assessed. EMT to the greater petrosal nerve and chorda tym-
on site mentioned that the contact caused lateral pani. All of the following clinical signs will be
overextension of the neck as well as trauma to the shown EXCEPT
shoulder area.
A. ipsilateral weakness to musculature of
1. Damage to the lateral and medial cords of facial expression.
the brachial plexus would result in altered B. diminished taste sensation to the posterior
motor movements to each of the following 1/3 of the tongue.
muscles EXCEPT C. ipsilateral dryness of eye due to lost func-
tion of lacrimal gland.
A. interosseus muscles.
D. compromised function of sublingual and
B. thenar muscles.
submandibular glands.
C. extensor carpi ulnaris.
E. hyperacusis in ipsilateral ear.
D. flexor carpi ulnaris.
E. flexor carpi radialis. 5. A lesion to the upper motor neuron of CN
VII would cause which of the following?
2. Traumatic dislocation of the clavicle at the
sternoclavicular joint, in a posterior direction, A. Partial facial muscle paralysis on the ipsi-
can cause compromise to all of the following lateral side of the lesion to the lower face
structures EXCEPT only
B. Total facial muscle paralysis on the ipsilat-
A. subclavian artery.
eral side of the lesion to the upper and
B. brachial plexus.
lower face
C. trachea.
C. Partial facial muscle paralysis on the con-
D. subclavian vein.
tralateral side of the lesion to the lower
E. all of the above.
face only
D. Total facial muscle paralysis of the con-
3. The cervical plexus can also be damaged
tralateral side of the lesion to the upper
with injury to the cervical spine. Motor
and lower face
innervation to each of the following muscles
would be affected by damage to the cervical
6. Which branchial arch has its derivatives
plexus EXCEPT
innervated by CN VII?
A. sternohyoid.
A. I
B. stylohyoid.
B. II
C. omohyoid.
C. III
D. sternothyroid.
D. IV
E. none of the above.
7. The common facial vein receives drainage
Questions 4-8 pertain to the following clinical
from each of the following veins EXCEPT
vignette:
A. maxillary vein.
A 42-year-old male presents to your office com- B. anterior retromandibular vein.
plaining of weakness on one side of his face, as well
Anatomic Sciences
Questions: 1-14 3
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C. retromandibular vein. A. Ventral posterior medial nuclei (VPM)

D. anterior facial vein. B. Ventral anterior nucleus
E. internal jugular vein. C. Lateral geniculate nucleus
D. Ventral posterior lateral nuclei (VPL)
8. All of the following statements regarding blood E. Ventral lateral nucleus
and associated vasculature is true EXCEPT
12. All of the following are brainstem nuclei
A. approximately 45% of the blood is com-
involved with cranial nerve function
posed of formed elements/cellular
EXCEPT
material.
B. blood plasma lacking fibrinogen and clot- A. superior salivatory nucleus.
ting factors is considered serum. B. nucleus ambiguus.
C. the tunica adventitia of blood vessel walls C. nucleus of the solitary tract.
is the most internal layer, endothelial in D. ventromedial nucleus.
nature, and is composed of simple squa- E. inferior salivatory nucleus.
mous epithelium.
D. sinusoids are fenestrated capillaries which Questions 13 and 14 pertain to the following
allow the passage of phagocytic cells. clinical vignette:
E. individuals with type O blood contain
erythrocytes which lack A and B antigens, A 65-year-old male under your care is experiencing
and are, thus, considered universal donors. crushing chest pain. He is mentioning that the
pain is radiating outward to his left shoulder, and
Questions 9-12 pertain to the following clinical that shortness of breath is also affecting him. After
proper care is administered, it was later determined
vignette:
that the patient had experienced a myocardial
infarct.
A 29-year-old female presents to the ED status post
blunt trauma to the back of the head. The patient
complains of severe head pain, and is sent for 13. The tricuspid valve can be auscultated at
imaging. MRI shows bleeding within the cranium, which of the following anatomic locations?
and CT shows fractures of the skull. A. Level of the 5th intercostal space, at the
midclavicular line
9. Which of the following vessels is involved in B. Level of the 2nd intercostal space, at the
an epidural hematoma? right sternal border
A. Anterior communicating artery C. Level of the 2nd intercostal space, at the
B. Posterior cerebral artery left sternal border
C. Anterior cerebral artery D. Level of the 5th intercostal space, left of
D. Posterior communicating artery the sternal border
E. Middle meningeal artery E. None of the above
10. All of the following structures are located 14. Occlusion of which of the following arteries
within the posterior cranial fossa EXCEPT would most directly cause ischemia in the lat-
eral wall of the left ventricle?
A. occipital lobes.
B. jugular foramen. A. Left circumflex
C. cerebellum. B. Right coronary
D. hypoglossal canal. C. Left anterior descending
E. optic foramen. D. Acute marginal
E. Posterior descending
11. Which of the following cranial nuclei of the
thalamus are involved with mediating facial
sensation and pain?
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15. Which of the following areas of the medi- 1. Bulbus cordis

astinum contains the vagus nerve? 2. Right common cardinal vein
A. Superior 3. Truncus arteriosus
B. Posterior 4. Right anterior cardinal vein
C. Anterior 5. Right horn of sinus venosus
D. Middle A. 1 and 2
E. None of the above B. 2 and 3
C. 4 and 5
16. Regarding the fetal circulation, oxygenated D. 2 and 4
blood bypasses the pulmonary circulation by E. None of the above
way of which communication?
A. Left atrium to left ventricle 21. Which TWO of the following embryonic
B. Left atrium to right atrium structures cause an atrial septal defect if they
C. Right atrium to right ventricle fail to completely fuse?
D. Right atrium to left atrium 1. Ostium secundum
E. Left atrium to left ventricle 2. Ostium primum
3. Septum primum
17. Which of the following structures of the adult
4. Septum secundum
heart is a remnant of the foramen ovale in
the fetal heart? 5. Septum spurium
A. Crista terminalis A. 1 and 2

B. Fossa ovalis B. 2 and 3
C. Sulcus terminalis C. 2 and 4
D. Right auricle D. 3 and 4
E. Atrial appendage E. 3 and 5
18. Regarding the fetal circulation, which of the 22. Which of the following is a derivative of the
following vasculature serves as a conduit 4th aortic arch?
between the aorta and pulmonary artery? A. Hyoid artery
A. Ductus venosus B. Stapedial artery
B. Umbilical arteries C. Right subclavian artery
C. Ductus arteriosus D. Common carotid artery
D. Portal vein E. Pulmonary arteries
E. Umbilical vein
23. All of the following structures form the bound-
19. Which of the following germ layer derivatives ary known as the femoral triangle EXCEPT
comprise the epithelial lining of the cardio- A. sartorius muscle.
vascular system? B. inguinal ligament.
A. Mesoderm C. adductor longus muscle.
B. Endoderm D. cremaster muscle.
C. Ectoderm E. pectineus muscle.
D. All of the above
24. Which of the following statements regarding
E. None of the above
musculature of the abdomen is FALSE?
20. Which TWO of the following embryonic
structures combine to form the superior vena
cava?
Anatomic Sciences
Questions: 15-29 5
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A. The external oblique muscle contracts to A. blood supply to the diaphragm is via the
increase abdominal pressure. musculophrenic artery.
B. The internal oblique muscle is innervated B. the aorta passes through two crura when
by the lower intercostal, iliohypogastric, passing through the aortic opening.
and ilioinguinal nerves. C. the caval opening allows passage of the
C. The external oblique muscle is innervated superior vena cava.
only by the lower intercostal nerves. D. during the act of inspiration, the
D. The transverse muscle contracts to flex diaphragm contracts, thus, flattening out
the vertebral column. and creating a negative intrathoracic
E. The rectus abdominis muscle originates pressure.
at the pubic symphysis and inserts into E. innervation to the diaphragm is via the
the xiphoid process, as well as costal phrenic nerve (C3, C4, C5).
cartilages 5-7.
28. Relative to the thymus, which of the follow-
25. Regarding connective tissue attachments, ing statements is FALSE?
which of the following statements is TRUE?
A. Growth continues and peaks at puberty,
A. Tendons form attachments between bone and then atrophies and is replaced by
and bone. adipose tissue.
B. Aponeuroses are merely sheetlike layers of B. Lymphatic circulation returns via afferent
tendon. vessels so that lymph may be filtered.
C. Nearly all connective tissue is of neural C. It is the site of T-cell maturation.
crest origin, with head and neck regions D. Thymic corpuscles/epithelioreticular cells
of connective tissue being of mesodermal are contained within the inner medulla.
origin. E. The outer cortex holds the largest con-
D. Ligaments form attachments between centration of lymphocytes.
muscle and bone.
E. None of the above are correct. 29. Which of the following statements is TRUE
regarding vision and optic nerve fibers?
26. Which of the following statements regarding
A. Left medial/nasal fibers decussate and
the thoracic region is FALSE?
cross over at the optic chiasm en route
A. The neurovascular bundles of the inter- to the right primary visual cortex of the
costal spaces run along the costal groove occipital lobe.
at the superior surface of each rib. B. Left medial/nasal fibers decussate and stay
B. Musculature of respiration includes the ipsilateral at the optic chiasma en route to
intercostal muscles, diaphragm, and the left primary visual cortex of the occip-
accessory muscles. ital lobe.
C. The costal groove of each rib protects the C. Left lateral/temporal fibers decussate and
nerve (of the neurovascular bundle) the cross over at the optic chiasma en route to
least when injury occurs. the right primary visual cortex of the tem-
D. The rib cage contains 12 ribs: ribs I-VI poral lobe.
are true, VII-X are false, and XI-XII are D. Right lateral/temporal fibers decussate
floating. and stay ipsilateral at the optic chiasma
E. Fracture of the left 10th and 11th ribs can en route to the right primary visual cortex
cause injury to the spleen. of the temporal lobe.
27. All of the following questions pertaining to

the diaphragm are correct EXCEPT
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30. Which of the following extraocular muscles is C. Marcus-Gunn/relative afferent pupil

innervated by abducens nerve? D. Argyll Robertson/pupillary light-near dis-
sociation pupil
A. Superior oblique muscle
E. Horner syndrome
B. Medial rectus muscle
C. Inferior rectus muscle 34. All of the following blood vessels comprise
D. Lateral rectus muscle the circle of Willis EXCEPT
E. Superior rectus muscle
A. middle cerebral artery.
31. Regarding the pupillary light reflex, which of B. posterior cerebral artery.
the following is TRUE? C. internal carotid artery.
D. posterior communicating artery.
A. When shining light onto the left eye, the
E. anterior communicating artery.
direct response elicits ipsilateral afferent
firing via CN III and subsequent ipsilat- 35. Which of the following small, thin-walled
eral efferent firing via CN III to left eye. vessels can rupture and, thus, are commonly
B. When shining light onto the left eye, the involved in stroke?
consensual response elicits ipsilateral
afferent firing via CN II and subsequent A. Left anterior cerebral
contralateral efferent firing via CN III to B. Right posterior cerebral
right eye. C. Lenticulostriate
C. When shining light onto the left eye, the D. Left vertebral
consensual response elicits ipsilateral E. Left internal carotid
afferent firing via CN III and subsequent
contralateral efferent firing via CN III to 36. If damaged, all of the following bony struc-
right eye. tures would directly alter movement of the
D. When shining light onto the right eye, the tongue EXCEPT
direct response elicits contralateral affer- A. genial tubercles.
ent firing via CN II and subsequent con- B. hamulus.
tralateral efferent firing via CN III to left C. hyoid bone.
eye. D. styloid process.
32. In order to test for patency of the trochlear
nerve, one would shine a light source directed 37. Which of the following portions of the lung
at the pupil, and have patient follow it in contain the lingula?
what direction?
A. Middle lobe of right lung
A. Superiorly B. Superior lobe of right lung
B. Superiorly and medially C. Superior lobe of left lung
C. Inferiorly D. Inferior lobe of left lung
D. Laterally E. Inferior lobe of right lung
E. Inferiorly and laterally
38. Which of the following wraps around the lig-
33. Which of the following lesions involving amentum arteriosum?
vision occurring in patients with syphilis and
diabetes allows the eye to accommodate but A. Right recurrent laryngeal nerve
causes a loss of miosis function? B. Left brachiocephalic vein
C. Right subclavian vein
A. Internuclear ophthalmoplegia D. Superior laryngeal nerve
B. Ophthalmoplegia E. Left recurrent laryngeal nerve
Anatomic Sciences
Questions: 30-47 7
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39. Each of the following statements concerning dentist decides to attempt extraction of the tooth
the foramen magnum are true EXCEPT with a mandibular cowhorn forceps. The tooth is
extracted without immediate complication.
A. it is located in the occipital bone.
B. it allows passage of the medulla 44. If the patient is complaining of altered taste
oblongata/spinal cord. sensation to the anterior 2/3 of the tongue, as
C. it allows passage of the spinal accessory well as generalized paresthesia to the left lateral
nerve. tongue, which of the following structures may
D. it is located in the parietal bone. have been compromised by the extraction?
E. it allows passage of the vertebral arteries.
A. Buccal nerve
40. The articulating surface of the mandibular B. Lingual nerve
condyle is covered with C. Middle superior alveolar nerve
D. Hypoglossal nerve
A. dense fibrocartilage. E. Inferior alveolar nerve
B. loose connective tissue.
C. elastic cartilage. 45. Prior to the extraction, if an infection had
D. hyaline cartilage. formed at the root apices of tooth No. 17,
E. none of the above. which fascial plane would the infection most
likely travel within?
41. The articulating disc of the temporo-
mandibular joint attaches to the condyle via A. Sublingual
B. Parapharyngeal
A. stylomandibular ligament. C. Masticator
B. collateral ligaments. D. Submandibular
C. temporomandibular ligament. E. Parotid
D. sphenomandibular ligament.
E. none of the above. 46. Emergency management of a patient with air-
way obstruction/compromise may involve a
42. Which of the following directions does the cricothyrotomy. During this procedure, an
articulating disc of the temporomandibular airway is established by incising between the
joint most often displace?
A. hyoid bone and thyroid cartilage.
A. Anteromedially B. cartilaginous rings of trachea.
B. Laterally C. thyroid cartilage and cricoid cartilage.
C. Inferiorly D. thyroid gland.
D. Superiorly E. left 3rd and 4th intercostal muscles,
E. Posteromedially laterally.
43. The pituitary gland is seated superiorly on 47. When performing an inferior alveolar nerve
which sinus? block, the needle is accidentally directed too
A. Frontal far posteriorly. Which of the following struc-
B. Maxillary tures will be penetrated?
C. Anterior ethmoid A. Buccinator
D. Posterior ethmoid B. Lateral pterygoid
E. Sphenoid C. Medial pterygoid
D. Mylohyoid
Questions 44-46 pertain to the following clinical E. Parotid gland
vignette:
A 22-year-old male presents to your office for rou-

tine extraction of a malposed tooth No. 17. The
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48. Which of the following structures converge to 52. Which of the following is the most abundant
form the pterygomandibular raphe? cell of a healthy periodontal ligament?
A. Superior pharyngeal constrictor and A. Lymphocytes
mylohyoid B. Neutrophils
B. Medial pterygoid and mylohyoid C. Osteoblasts
C. Buccinator and superior pharyngeal D. Cementoblasts
constrictor E. Fibroblasts
D. Buccinator and mylohyoid
E. Medial pterygoid and superior pharyngeal 53. All of the following vessels contribute to
constrictor Kisselbach plexus EXCEPT
A. lesser palatine artery.
Questions 49-53 pertain to the following clinical
B. sphenopalatine artery.
vignette:
C. lateral nasal branches of facial artery.
A 55-year-old female presents to your office for D. superior labial artery.
deep scaling and root planing as part of treatment E. anterior ethmoid arteries of internal
for periodontitis. carotid artery.
49. Due to large pocket depths surrounding the Questions 54-58 pertain to the following clinical
mandibular right molars, anesthesia of this vignette:
quadrant is necessary to adequately scale and
plane the roots. In order to locate area where A 26-year-old male presents to the emergency
department following a bar fight. He mentions that
anesthesia is distributed for inferior alveolar
he was punched in the area of his right eye, and is
nerve block, you palpate which structure? complaining of a headache. You note periorbital
A. Lingula edema of his right eye, as well as complaints of
B. Coronoid notch pain when palpating right midfacial region infero-
C. Antilingula lateral to his right eye (which also seems slightly
D. Angle of the mandible depressed).
E. External oblique ridge of the mandible
54. Each of the following bones are part of the
50. As is the case with periodontal disease, peri- orbit EXCEPT
odontal attachment loss is evident. Which of A. frontal.
the following principal collagen fibers of the B. zygoma.
PDL course at right angles from the cemen- C. ethmoid.
tum to adjacent alveolar bone? D. lacrimal.
A. Horizontal E. temporal.
B. Apical
55. Which of the following arteries is the MAJOR
C. Interradicular
blood supply to the orbit and eye?
D. Transseptal
E. Oblique A. Facial
B. Ophthalmic
51. Principal collagen fibers of the PDL are com- C. Maxillary
prised of which of the following type(s) of D. Transverse facial
collagen? E. Infraorbital
A. Type I only
56. Which of the following muscles has its origin
B. Type II only
on the zygomatic process of maxilla (superfi-
C. Type III only
cially) and zygomatic arch (deep)?
D. Type I and III
E. Type II and III
Anatomic Sciences
Questions: 48-65 9
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A. Lateral pterygoid 61. Which layer of fascia contains lymphatic ves-

B. Temporalis sels within the neck?
C. Buccinator
A. Pretracheal
D. Masseter
B. Prevertebral
E. Medial pterygoid
C. Subcutaneous
57. The superior orbital fissure is located D. Investing
between which of the following bones? E. None of the above
A. Lesser wing of sphenoid and frontal. 62. Which of the following ligaments connects
B. Ethmoid and maxilla. the liver to the anterior abdominal wall?
C. Greater wing of sphenoid and maxilla.
A. Falciform
D. Greater wing of sphenoid and lesser wing
B. Gastrocolic
of sphenoid.
C. Hepatoduodenal
E. Lesser wing of sphenoid and ethmoid.
D. Gastroduodenal
58. All of the following are TRUE regarding the E. Gastrohepatic
nasolacrimal apparatus EXCEPT
63. Which of the following describes the teniae
A. the nasolacrimal duct empties into the coli of the digestive tract?
superior meatus.
A. Fatty globules on the serosal surface
B. relative to the orbit, the nasolacrimal
of the colon
apparatus is located superolaterally.
B. Lymphoid tissue of the cecum
C. tears wash across the globe in a
C. Formed pouches within the colon
superolateral → inferomedial direction.
D. Villous-like projections involved with
D. the lacrimal puncta collects tears and
absorption
then drains directly into the lacrimal
E. Smooth muscle bands of the colon
canals.
E. the lacrimal sac drains directly into the
64. Coordination of muscle movement, as well as
nasolacrimal duct.
maintenance of equilibrium and posture, are
controlled by which structure of the brain?
59. Each of the following is TRUE regarding the
lacrimal gland EXCEPT A. Medulla
B. Pons
A. it receives postganglionic parasympathetic
C. Cerebrum
fibers via the lacrimal nerve.
D. Thalamus
B. preganglionic fibers synapse at the ptery-
E. Cerebellum
gopalatine ganglion.
C. preganglionic fibers to the lacrimal gland
65. Which of the following types of cartilage has
are carried via greater petrosal nerve.
the ability to calcify?
D. the lacrimal gland is mucous secreting.
E. the superior salivatory nucleus sends pre- A. Fibrocartilage
ganglionic fibers to the lacrimal gland. B. Hyaline
C. Elastic
60. The platysma is innervated by which of the D. Elastic and hyaline
following nerves? E. Hyaline and fibrocartilage
A. Trigeminal
B. Facial
C. Glossopharyngeal
D. Spinal accessory
E. Vagus
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66. The one-cell thick layer of osteoprogenitor D. Levator veli palatini

cells on the inner surface of bone is E. Tensor veli palatine
A. endosteum. 72. Which of the following nuclei is the primary
B. haversian canal. controller of swallowing?
C. Volkmann canal.
D. lacuna. A. Superior salivatory
E. periosteum. B. Nucleus ambiguus
C. Inferior salivatory
67. Which of the following is a type of syndesmosis? D. Facial nucleus
E. Nucleus of the solitary tract
A. Tooth in socket.
B. Cranial sutures. 73. The pharyngeal plexus is comprised of which
C. Temporomandibular joint. of the following combination of nerves?
D. Epiphyseal plate of long bones.
E. Connection between radius and ulna. A. CN V, IX, X
B. CN IX, X, XII
68. All of the following statements regarding the C. CN IX, X, XI
blood are true EXCEPT D. CN V, VII, IX
E. CN V, IX, X
A. the majority of blood is plasma, which
makes up 55% of the total. 74. Which of the following nerves innervates the
B. albumin regulates the vascular oncotic stapedius muscle of the middle ear?
pressure.
C. hematocrit measures the portion of A. CN V-1
proteins in a blood sample. B. CN V-2
D. blood comprises 8% of the total body C. CN VII
weight. D. CN V-3
E. plasma is made up of 80% water. E. CN VIII
69. Which of the following is a granulocyte? 75. Relative to the oral cavity, which of the layers
of mucosa interdigitates with rete pegs?
A. T cell.
B. Macrophage. A. Stratum granulosum
C. Platelet. B. Papillary layer of lamina propria
D. Neutrophil. C. Stratum corneum
E. B cell. D. Reticular layer of lamina propria
E. Stratum spinosum
70. Each of the following zones of the adrenal
gland is of mesodermal origin EXCEPT 76. The formative cells of the enamel structure
of teeth arise from the
A. zona fasciculate.
B. chromaffin cells. A. inner enamel epithelium.
C. zona glomerulosa. B. dental follicle.
D. zona reticularis. C. dental papilla.
E. none of the above. D. dental follicle and papilla.
E. inner enamel epithelium and dental
71. Which of the following pharyngeal muscles papilla.
shortens the velum?
77. When do ameloblasts begin to secrete
A. Muscularis uvula enamel matrix?
B. Palatopharyngeus
C. Palatoglossal
Anatomic Sciences
Questions: 66-86 11
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A. During the cap stage A. C1-C5

B. After the odontoblasts form dentin B. C3-C5
C. Before the odontoblasts form dentin C. C6
D. After root formation begins D. C1-C3 only
E. Before cap stage E. C1 and C2 only
78. In the growing fetus, which specific structure 83. Each of the following arteries is a branch of
separates the external lips and cheeks from the subclavian artery EXCEPT
the internal jaw structures?
A. right carotid.
A. Tuberculum impar B. thyrocervical.
B. Buccopharyngeal membrane C. suprascapular.
C. Vestibular lamina D. transverse cervical.
D. Hypobranchial eminence E. vertebral.
E. Lateral lingual swellings
84. The external jugular vein is formed by which
79. The cribriform plate is located within which two veins?
bone?
A. Anterior retromandibular and anterior
A. Sphenoid facial
B. Ethmoid B. Maxillary vein and anterior facial
C. Frontal C. Posterior retromandibular and anterior
D. Maxilla retromandibular
E. Vomer D. Posterior auricular and posterior
retromandibular
80. Suppose one would necessitate anesthesia of E. Common facial and posterior
the anterior palatal mucosa. Which of the fol- retromandibular
lowing nerves innervates this area?
85. The stylomandibular ligament has its origin
A. Nasopalatine
at which of the following bones?
B. Middle superior alveolar
C. Posterior superior alveolar A. Temporal
D. Maxillary B. Sphenoid
E. Lesser palatine C. Occipital
D. Maxilla
81. Which of the following articulations of the E. Parietal
cervical vertebrae do NOT contain an inter-
vertebral disk? 86. Each of the following bones is unpaired
EXCEPT
A. C4 and C5
B. C5 and C6 A. occipital.
C. C2 and C3 B. sphenoid.
D. C1 and C2 C. ethmoid.
E. None of the above D. frontal.
82. The spinal accessory nerve is composed of
motor rootlets from which of the following
nerves?
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87. Which of the following is TRUE regarding C. Vomer

the attachment of the mylohyoid muscle? D. Frontal
E. Maxilla
A. It attaches superiorly at the lateral border
of the mandible and inferiorly at the body 92. Hypothetically speaking, when preparing a
of the hyoid. cavity preparation on the crown of a fully
B. It attaches superiorly at the medial border formed permanent tooth, as you initially cut
of the mandible and inferiorly at the through enamel and into dentin, which
lesser horn of the hyoid. structure is first being penetrated?
C. It attaches superiorly at the medial border
of the mandible and inferiorly at the A. Circumpulpal dentin
greater horn of the hyoid. B. Mantle dentin
D. It attaches superiorly at the medial border C. Odontoblasts
of the mandible and inferiorly at the D. Radicular dentin
body of the hyoid. E. Circumpulpal and radicular dentin
E. It attaches superiorly at the lateral border
of the mandible and inferiorly at the 93. Raschkow plexus is located
body of the hyoid. A. within the cementum of a tooth.
B. within the cell rich zone of tooth pulp.
88. Which of the following nerves innervates the C. within the dentin of a tooth.
anterior belly of the digastric muscle? D. within the cell free zone (of Weil) of
A. Inferior alveolar nerve tooth pulp.
B. Mental nerve E. within the core of the dental pulp.
C. Mylohyoid nerve
D. Auriculotemporal nerve 94. Which of the following structures of sperm
E. Facial nerve development is analogous to the stratum
basale of the skin?
89. The infrahyoid musculature of the neck A. Spermatid
receives motor innervation from B. Spermatogonium
A. C4-C6. C. Primary spermatocyte
B. ansa cervicalis. D. Secondary spermatocyte
C. lesser occipital nerve. E. Junctional complex
D. greater occipital nerve.
E. C6-C8. 95. The macula densa is located in which
portion of the kidney?
90. All of the following are branches of the exter- A. Distal convoluted tubule
nal carotid artery EXCEPT B. Bowman capsule
A. ophthalmic artery. C. Loop of Henle
B. ascending pharyngeal artery. D. Proximal convoluted tubule
C. superior thyroid artery. E. Collecting duct
D. posterior auricular artery.
E. occipital artery. 96. When extracting a tooth, one of the roots
fractures off and remains within the alveolus.
91. The crista galli is a superior extension of Which of the following would have the high-
which of the following bones? est likelihood of becoming dislodged in the
maxillary sinus?
A. Sphenoid
B. Ethmoid
Anatomic Sciences
Questions: 87-106 13
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A. Buccal root of the maxillary 1st premolar C. IX, X, XII

B. Root of the maxillary canine D. X, XI, XII
C. Root of the maxillary lateral incisor E. V, VII, X
D. Lingual root of the maxillary 1st molar
E. Lingual root of the maxillary 1st premolar 102. If one had a malfunction of pancreatic delta
cells, which of the following would be
97. All of the following bones articulate with the impaired?
zygoma EXCEPT
A. Insulin production
A. temporal. B. Trypsinogen production
B. maxilla. C. Glucagon production
C. frontal. D. Somatostatin production
D. sphenoid. E. Exocrine function
E. parietal.
103. Each of the following is an apocrine function
98. An 18-year-old female presents to the emer- of sweat glands EXCEPT
gency department with a chief complaint of
A. involved intimately with regulation of
not being able to manipulate her lower jaw.
body temperature.
You determine that luxation of her mandible
B. produces pheromones.
has occurred. In which of the following direc-
C. secretion is via myoepithelial and duct
tions would the mandibular condyles most
cells.
likely be positioned from normal?
D. strictly serous fluid secretion.
A. Posterior and superior E. cells receive sympathetic adrenergic
B. Posterior and inferior innervation.
C. Lateral and inferior
D. Anteriorly 104. Which of the following portions of the female
E. Medially reproductive tract is the site of fertilization?
A. Uterus
99. The inferior alveolar artery is a DIRECT
B. Endometrium
branch from which of the following arteries?
C. Ovary
A. Middle meningeal D. Cervix
B. Facial E. Ampulla
C. External carotid
D. Maxillary 105. Which of the following provides localized
E. Buccal attachment of epithelium to connective
tissue?
100. Bile is produced by which of the following?
A. Hemidesmosome
A. Head of the pancreas B. Zonula adherens
B. Gall bladder C. Zonula occludens
C. Liver D. Desmosome
D. Tail of the pancreas E. Gap junction
E. Duodenum
106. A-gamma fibers function in
101. Damage to the medulla would impair func-
A. touch sensation.
tion of which cranial nerve nuclei?
B. muscle spindle apparatus.
A. V, VII, IX C. pressure sensation.
B. III, IV, VI D. temperature sensation.
E. sharp pain sensation.
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107. The most inferior portion of the trachea, the A. epididymis.

carina, divides into B. ureter.
C. collecting tubules.
A. bronchioles.
D. ovaries.
B. segmental bronchi.
E. uterus.
C. main stem bronchi.
D. alveoli.
113. Neuroepithelial cells (of the fetal neural
E. lobar bronchi.
tube) give rise to each of the following
EXCEPT
108. Hilar lymph nodes are located
A. ependymal cells.
A. in the lateral thoracic cavity.
B. leptomeninges.
B. superior to the clavicle and surrounding
C. astrocytes.
the carotid sheath.
D. neuroblasts.
C. along the sternocleidomastoid muscle.
E. oligodendrocytes.
D. at the root of the lungs.
E. at the posterior base of the skull.
114. Which of the following is the correct sequence
of zygotic cell cleavage?
109. The submaxillary ganglion receives presynap-
tic efferent innervation from which nerve? A. zygote, morula, blastula, blastomere
B. morula, zygote, blastula, blastomere
A. Inferior alveolar
C. blastula, blastomere, morula, zygote
B. Facial
D. zygote, blastomere, morula, blastula
C. Buccinator
E. blastula, morula, blastomere, zygote
D. Maxillary
E. Lingual
115. After what stage of zygote development does
the zona pellucida disintegrate?
110. Rivian ducts allow drainage from which of
the following glands? A. First cleavage division
B. Two-cell stage
A. Parotid
C. Blastula
B. Sebaceous
D. Late morula
C. Lacrimal
E. Early morula
D. Sublingual
E. Mammary
116. Which of the following locations would
NOT be considered a location of ectopic
111. Each of the following is true regarding the
pregnancy?
embryological growth of the kidney EXCEPT
A. uterus
A. the ureteric bud contributes to the adult
B. ovary
kidney.
C. fallopian tube
B. the mesonephros gives rise to the ureteric
D. cervix
bud and mesonephric duct.
E. abdomen
C. the pronephros ultimately forms the
epididymis and ductus deferens.
117. Meiosis II of sperm development MOST
D. the mesonephros forms before the
LIKELY occurs
metanephros.
E. the kidney initially forms in the pelvis. A. in the uterine tube.
B. in the epididymis.
112. Of the following structures, the Wolffian duct C. in the ejaculatory duct.
ultimately aids in development of the D. in the testes.
E. in the vagina.
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118. Each of the following muscles receives motor 123. If a patient is unable to close his eyes (among
innervation from the facial nerve EXCEPT other symptoms), one must consider damage
to which of the following cranial nerve
A. risorius.
nuclei?
B. masseter.
C. orbicularis oris. A. Main motor nucleus of VII
D. mentalis. B. Nucleus of the solitary tract (of VII)
E. buccinator. C. Spinal trigeminal nucleus of V
D. Mesencephalic nucleus of V
119. The jaw-jerk reflex involves efferent signals E. Motor nucleus of V
from which of the following cranial nerves?
124. Each of the following is TRUE of nystagmus
A. V-1
EXCEPT
B. V-3
C. VII A. irritation to the cerebellum and cerebral
D. V-2 cortex can cause it.
E. IX B. it is defined as a rapid, involuntary move-
ment of the eyes.
120. Each of the following is TRUE with regard to C. the caloric test using warm water will ini-
the carotid sheath EXCEPT tiate nystagmus to the contralateral side.
A. the sternocleidomastoid muscle lies D. the caloric test examines the vestibulooc-
medial to it in the cervical region. ular reflex.
B. it lies anterior to the scalene musculature E. it involves CN VIII lesions.
in the cervical region.
125. Movement of the head would be damaged in
C. it lies anterior to the thyroid gland.
a patient with damage to which of the follow-
D. it contains the vagus nerve, jugular vein,
ing spinal cord tracts?
and common carotid artery.
E. it is associated with the carotid sinus A. Lateral spinothalamic
nerve, sympathetic nerves, and lymph B. Tectospinal
nodes. C. Vestibulospinal
D. Reticulospinal
121. Suppose you are told that a patient has E. Anterior spinothalamic
received damage to structures, which are con-
tained in the submandibular triangle. Which 126. Which of the following structures are
of the following would you NOT consider to involved in steroid synthesis and lipid/glycogen
be affected? metabolism?
A. CN XII A. Smooth endoplasmic reticulum
B. Nerve to mylohyoid B. Lysosomes
C. Lingual artery C. Peroxisomes
D. CN X D. Rough endoplasmic reticulum
E. Submandibular gland E. Mitochondria
122. If a patient is suffering from referred pain to 127. Parafollicular cells are located within the
the T4 dermatome, it will be felt at the
A. cortical bone.
A. xiphoid. B. kidney.
B. umbilicus. C. small intestine.
C. nipple. D. thyroid gland.
D. inguinal ligament. E. parathyroid gland.
E. neck.
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128. The esophagus normally contains which type 134. Which of the following is FALSE regarding
of epithelium? bone marrow of the maxilla and mandible?
A. Nonkeratinized stratified squamous. A. It is contained within the medullary
B. Columnar. spaces of spongy bone.
C. Keratinized stratified squamous. B. Red marrow contains fatty cells and is the
D. Cuboidal. predominant marrow type in the
E. Pseudostratified squamous. mandibular ramus and condyles.
C. Red marrow contains hematopoietic cells.
129. Sperm is stored in the D. Yellow marrow contains fatty cells.
A. epididymis. E. Yellow marrow is the predominant mar-
B. urethra. row type in the maxilla and mandible.
C. testis.
135. Which of the following combinations of
D. seminiferous tubules.
epithelium is contained in the nasal cavities?
E. prostate gland.
A. Stratified squamous, pseudostratified
130. Each of the following is a function of skin ciliated columnar, olfactory
EXCEPT B. Simple squamous, olfactory, simple
A. sensation of touch, pain, and pressure. columnar
B. synthesis of vitamin E from ultraviolet C. Stratified squamous, olfactory, stratified
light. columnar
C. excretion via sweat glands. D. Simple cuboidal, simple squamous,
D. homeostatic regulation of body simple columnar
temperature. E. Stratified columnar, simple squamous,
E. protection against physical and chemical simple columnar
stresses.
Questions 136 and 137 pertain to the following
131. The sphincter of Boyden is located at the clinical vignette:
A. ampulla of Vater. Suppose a patient presents to you after having

B. lower portion of the esophagus. been struck in the chin. Upon examination, you
C. common bile duct. note a laceration of the anterior portion of their
D. rectum. tongue accompanied with profuse bleeding.
E. opening of the duodenum.
136. Each of the following supply blood to the
132. The posterior 1/3 of the tongue drains tongue EXCEPT
directly into the A. facial artery.
A. deep cervical nodes. B. ascending pharyngeal artery.
B. submental nodes. C. lingual artery.
C. submandibular nodes. D. superior laryngeal artery.
D. rectopharyngeal nodes. E. external carotid artery.
E. supraclavicular nodes.
137. Each of the following muscles could possibly
133. Damage to the gastric cardiac glands would be damaged in this situation EXCEPT
affect which type of exocrine gland? A. longitudinal.
A. Coiled B. styloglossus.
B. Tubular C. hyoglossus.
C. Tubuloacinar D. transverse.
D. Acinar E. palatoglossus.
E. Apocrine
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138. Which of the following combinations of cra- C. Chondrocytes comprise a large portion
nial nerves provide motor innervation to the of it.
tongue? D. It is specialized in areas such as the
bronchi, Eustachian tube, and knee
A. VII, X
menisci.
B. X, XII
E. It can grow both appositionally and
C. VII, XII
interstitially.
D. V, XII
E. VII, IX
144. Suppose a patient presents with altered
hemostasis. Malfunction of which of the fol-
139. Which type of taste would most likely be
lowing may be the cause?
altered if the entire tip of the tongue were
damaged? A. Monocytes
B. B cells
A. Sweet
C. Megakaryocytes
B. Salt
D. Erythroblasts
C. Bitter
E. Granulocytes
D. Sour
145. If a patient has high levels of bile pigment
excreted by the liver, increased destruction of
140. Relative to fetal development, sclerotome
which of the following may be the causative
cells form
factor?
A. vertebrae and ribs.
A. Neutrophils
B. skeletal muscle within body.
B. Eosinophils
C. connective tissue of skin.
C. Erythrocytes
D. skeletal muscle within limbs.
D. Platelets
E. skeletal muscle of the body wall.
E. Macrophages
141. Formation of which of the following is NOT
146. Which of the following regarding gingival
altered in complete bilateral palatal clefting?
crevicular fluid is TRUE?
A. Lip
A. It is comprised mostly of PMNs and
B. Primary palate
leukocytes.
C. Alveolar process
B. It lacks plasma proteins and epithelial
D. Inferior nasal turbinate/concha
cells.
E. Secondary palate
C. It is contained mostly within the vestibule
142. Which of the following is a characteristic of of the buccal mucosa.
the eruptive stage of a tooth? D. It lacks function in immune defense.
E. It is not located within the gingival
A. Elongation of cervical loop and formation sulcus.
of HERS
B. Fusion of the REE and oral epithelium 147. The most likely diagnosis for a young patient
C. Disappearance of the enamel knot presenting with brownish pigmentation and
D. Formation of the enamel organ mottling of his dentition would be
E. Merging of the OEE with the IEE
A. congenital syphilis.
143. Which of the following is FALSE regarding B. nutritional deficiency.
cartilage? C. fluorosis.
D. hypocalcification.
A. It is vascularized. E. hypomineralization.
B. It contains lacunae.
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148. Malfunction of which cranial nerve would D. Stylohyoid

affect the efferent output of the gag reflex? E. Anterior belly of digastric
A. CN XII
154. Each of the following structures receives
B. CN V
blood from the external carotid EXCEPT
C. CN IX
D. CN VII A. thyroid.
E. CN X B. brain.
C. salivary glands.
149. Each of the following carries deoxygenated D. teeth.
blood EXCEPT E. jaw bones.
A. hepatic vein.
155. The vertebral artery enters the spine at which
B. superior vena cava.
level?
C. inferior vena cava.
D. pulmonary vein. A. C6
E. coronary sinus. B. T2
C. T1
150. The gastroepiploic artery forms an anastomo- D. C5
sis between which two arteries? E. C7
A. Right gastric and hepatic proper
156. The function of the salpingopharyngeus
B. Left gastric and right gastric
muscle is to
C. Right gastric and short gastric
D. Splenic and gastroduodenal A. open the auditory tube.
E. Hepatic proper and splenic B. raise the mandible.
C. propel food down pharynx.
151. The supraoptic nucleus is intricately involved D. retract the tongue.
in which of the following bodily functions? E. protrude the mandible.
A. Aggression
157. Within which bone is the vestibulocochlear
B. Satiety
nerve most contained?
C. Hunger
D. Water balance A. Parietal
E. Circadian rhythm B. Occipital
C. Temporal
152. Sensory innervation to the hypothenar region D. Frontal
of the hand travels via the E. Maxilla
A. radial nerve.
158. Which of the following regarding the pec-
B. ulnar nerve.
toralis major muscle is TRUE?
C. musculocutaneous nerve.
D. median nerve. A. It acts to protract and depress the glenoid
E. axillary nerve. of the scapula.
B. It is an accessory muscle of respiration.
153. Which of the following muscles divides the C. It is innervated by the lateral and medial
maxillary artery into three distinct anatomical pectoral nerves.
segments? D. It inserts at the coracoid process.
E. It is located superiorly to the pectoralis
A. Lateral pterygoid
minor.
B. Masseter
C. Posterior belly of digastric
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159. Which of the following arteries supplies the 164. Which type of epithelium is most commonly
maxillary canines and incisors? found lining closed body cavities?
A. Pterygoid A. Simple columnar
B. Sphenopalatine B. Simple squamous
C. Descending palatine C. Transitional
D. Infraorbital D. Stratified squamous
E. Pharyngeal E. Pseudostratified columnar
160. The cisterna chyli drains lymph from each of 165. Which of the following is TRUE of the base-
the following EXCEPT ment membrane?
A. thoracic duct. A. Lamina lucida is electron dense.
B. abdomen. B. Lamina densa is a product of the connec-
C. pelvis. tive tissue.
D. inguinal region. C. Type IV collagen is typically found in the
E. lower extremities. basal lamina.
D. Reticular lamina contains anchoring
161. As the dentin ages, which of the following is fibrils.
typically seen? E. It does not have a filtering function.
A. Increased dentinal tubule diameter
166. Which of the following oral epithelial types is
B. Decreased reparative dentin
keratinized?
C. Decreased dead tracts
D. Decreased sclerotic dentin A. Sulcular epithelium
E. Increased deposition of peritubular B. Alveolar mucosa
dentin C. Junctional epithelium
D. Attached gingiva
162. A 17-year-old patient presents at your office E. Gingival col
asking why there is a brownish-gray band
across each of her teeth. You suspect that she 167. Which of the following has the LOWEST
was previously prescribed a regimen of tetra- organic composition?
cycline most likely at which of the following
A. Cementum
ages?
B. Dentin
A. 10 C. Pulp
B. 11 D. Enamel
C. 5 E. Alveolar bone
D. 14
E. 17 168. With increased age of the pulp, each of the
following occurs EXCEPT
163. Which of the following vitamin deficiencies
A. decreased collagen content.
is LEAST likely to directly affect enamel
B. decreased size of apical foramen.
structure?
C. decreased sensitivity.
A. A D. decreased cellularity.
B. B E. increased calcification.
C. C
D. K
E. Calcium
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169. Which of the following portions of the tooth A. 0.04 µm.

or its associated structures allows for ortho- B. 1 mm.
dontic movement? C. 0.1 mm.
D. 4 µm.
A. Enamel
E. 4 mm.
B. Cementum
C. Dentin
175. Formation of which of the following brain
D. Epithelial attachment
structures normally occurs LAST in the
E. Alveolar bone
fetus?
170. What type of nerve ending is most common A. Cerebellum
in the periodontal ligament? B. Ventricles
C. Neural tube
A. Coiled
D. Hemispheres
B. Spindle
E. Temporal lobe
C. Free
D. Meissner
176. During odontogenesis, which of the follow-
E. Ruffini
ing cells determine the type of tooth to be
formed?
171. Which of the following is the depression of
the interdental gingiva that connects the lin- A. Mesoderm
gual and facial papillae? B. Mesenchyme
C. Ectomesenchyme
A. Gingival col.
D. Endoderm
B. Alveolar mucosa.
E. Ectoderm
C. Attached gingiva.
D. Mucogingival junction.
177. The area of skin covering the parotid gland
E. Interdental papilla.
receives sensory innervation from which
nerve?
172. Which of the following is FALSE regarding
the primary palate? A. Transverse cervical
B. Superficial temporal
A. It can be involved in facial clefting.
C. Long buccal
B. It contains the incisive foramen.
D. Lesser occipital
C. It usually contains no teeth.
E. Great auricular
D. It is mesenchymal in origin.
E. It is formed by fusion of two median nasal
178. Each of the following is TRUE regarding the
processes.
sacral plexus EXCEPT
173. Which of the following best describes cir- A. one of its main branches is the obturator
cumpulpal dentin? nerve.
B. it is located in the posterior pelvic wall.
A. Most is produced in the form of inter-
C. it provides motor innervation to parts of
tubular dentin.
the leg.
B. It is the initial 150 µm of dentin laid
D. it supplies sensory innervation to the
down.
lower back.
C. It lacks hydroxyapatite.
E. it is comprised of L4-L5 and S1-S4.
D. It forms before mantle dentin.
E. It lacks dead tracts.
179. Which of the following cranial nerves does
NOT have an efferent involuntary parasym-
174. During amelogenesis, enamel is laid down
pathetic function?
each day at a rate of
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A. VII C. zygoma.
B. V D. ethmoid.
C. X E. sphenoid.
D. III
E. IX 185. Terminal differentiation occurs during which
stage of the cell cycle?
180. Which is TRUE regarding general visceral
A. G1
afferent function of the vagus nerve?
B. S
A. It is involved with chemo- and barorecep- C. G0
tion from the carotid body and sinus. D. G2
B. It travels through the jugular foramen. E. Mitosis
C. Its origin of cell bodies is the nucleus
ambiguus. 186. Which of the following glands has paracrine
D. It transmits sensation from the posterior function?
meninges. A. Gastroenteropancreatic glands.
E. It is involved with taste sensation. B. Adrenal glands.
C. Gonads.
D. Salivary glands.
the adrenal gland?
E. Pituitary glands.
A. Zona fasciculata secretes glucocorticoids.
B. Outer cortex contains chromaffin cells. 187. The embryological stomodeum is lined by
C. Aldosterone is a mineralocorticoid pro- A. endoderm.
duced here. B. mesoderm.
D. Sex steroids are secreted from the inner- C. neural crest.
most layer of the outer cortex. D. ectoderm.
E. Inner medulla secretes catecholamines. E. ectomesenchyme.
182. If a patient is suffering from lack of peristalsis 188. Which of the following structures has its
in the large intestine, which of the following embryological origin located further cranial
may be affected? in a 4- to 5-week-old fetus?
A. Microvilli A. Stapes
B. Myenteric plexus B. Internal carotid artery
C. Plicae circulares C. Vagus nerve
D. Teniae coli D. Glossopharyngeal nerve
E. Crypts of Lieberkühn E. Stylopharyngeus muscle
183. Bile contains each of the following EXCEPT 189. Which of the following best describes the
A. lipoproteins. decidual reaction of embryogenesis?
B. plasmin. A. Breakdown of the zona pellucida
C. albumin. B. The first zygotic cleavage
D. prothrombin. C. Invasion of the syncytiotrophoblast into
E. alpha and beta globulins. the uterine endometrium
D. Release of an ovum from the ovary
184. The temporal bone articulates with each of
E. Enlargement of the endometrium with
the following bones EXCEPT
lipid and glycogen accumulation
A. parietal.
B. occipital.
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190. Which of the following is the number of chro- 196. Which of the following is TRUE of the heart?
mosomes present after fusion of sperm and egg?
A. The pericardium contains cardiac
A. 1/ N
2 muscle.
B. N B. The endocardium has a layer of simple
C. 2N squamous endothelium.
D. 3N C. The innermost layer of the heart is
E. 4N pericardium.
D. Normally the thickest portion of the heart
191. Each of the following contains sinusoids is the endocardium.
EXCEPT E. A layer of columnar epithelium surrounds
A. epidermis. the pericardium.
B. liver.
C. lymphatic tissue.
heart conduction?
D. endocrine glands.
E. spleen. A. The bundle of His conducts electric cur-
rent to the Purkinje fibers.
192. Peroxisomes contain which of the following B. The SA node regulates the rate of electri-
enzymes? cal conductance.
A. Elastase C. The autonomic nervous system regulates
B. Collagenase the rhythm of cardiac contraction.
C. Trypsin D. Cardiac muscle maintains an intrinsic
D. Chymotrypsin rhythmicity.
E. Catalase E. The pacemaker of the heart is the SA node.
193. Production of vitamin D occurs at which of 198. Which of the following is TRUE of platelets?
the following sites? A. They range 200,000-400,000 per mm3
A. Large intestine blood.
B. Kidney B. They are involved in immunoregulation.
C. Spleen C. The average lifespan is upward of
D. Liver 120 days.
E. Epidermis D. They are nucleated.
E. They function in blood gas transport.
194. Which of the following directly controls lens
accommodation in the eye? 199. Which of the following is the site of B-cell
maturation?
A. Ciliary body
B. Neural retina A. Lymph nodes
C. Choroids body B. Blood
D. Pupil C. Thymus
E. Iris D. Bone marrow
E. Target tissue
195. Serum includes each of the following
EXCEPT 200. Thyroxine is secreted from
A. electrolytes. A. follicular cells.

B. fibrinogen. B. outer cortex of adrenals.
C. immunoglobulins. C. pars distalis.
D. water. D. pars intermedia.
E. albumin. E. parafollicular cells.
Anatomic Sciences
Answers: 1-4 23
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AN SW E R S
1. The correct answer is C. The extensor carpi posterior to the sternum. It extends from the
ulnaris is innervated by the radial nerve C5-C6 level inferiorly to the sternal angle/
(C6-C8), which is part of the posterior cord. T4-T5 level, before branching at the Carina
The radial nerve innervates the extensor mus- into the left and right mainstem bronchi.
cles of the arm/forearm.
Answer D is incorrect. The subclavian vein
Answer A is incorrect. The interosseus mus- then forms the brachiocephalic vein, which
cles of the hand are innervated by the ulnar empties into the superior vena cava and then
nerve (C8-T1). right atrium of the heart.
Answer B is incorrect. The thenar muscles of
3. The correct answer is B. The stylohyoid
the hand are innervated by the median nerve
muscle is innervated by CN VII, and is con-
(C5-T1).
sidered a suprahyoid muscle. Motor innerva-
Answer D is incorrect. The flexor carpi ulnaris tion from the cervical plexus includes the
is innervated by the ulnar nerve (C8-T1). genioglossus muscle (C1 by way of CN XII)
and infrahyoid muscles.
Answer E is incorrect. The flexor carpi radialis
is innervated by the median nerve (C5-T1). Answer A is incorrect. The sternohyoid is an
Note that the median nerve includes the infrahyoid muscle. It is innervated by the
lateral and medial cords. It innervates muscles ansa cervicalis (C1-C3).
involved in forearm flexion. The ulnar nerve
Answer C is incorrect. The omohyoid is an
includes the medial cord. It provides innerva-
infrahyoid muscle. It is innervated by the
tion to flexor muscles of the wrist and fingers.
ansa cervicalis (C1-C3).
2. The correct answer is E. All of the structures Answer D is incorrect. The sternothyroid is
listed run in close proximity and could be an infrahyoid muscle. It is innervated by the
injured in the event of a clavicular fracture. ansa cervicalis (C1-C3).
Note that the thyrohyoid muscle is also an
Answer A is incorrect. The subclavian artery
infrahyoid muscle. It is innervated by C1.
and vein run along the posterior border of the
clavicle. Vasculature arising from the arch of
4. The correct answer is B. Taste sensation to
the aorta first branches off as the brachio-
the posterior 1/3 of the tongue is mediated by
cephalic artery, which then gives rise to the
CN IX (taste to the base of the tongue is by
right common carotid artery before continu-
way of CN X). With this lesion, one would
ing as the right subclavian artery. The arch of
expect decreased taste sensation to the ante-
the aorta then gives rise directly to the left
rior 2/3 of the tongue. Taste fibers leave the
common carotid artery and, subsequently, the
tongue via the chorda tympani, which travels
left subclavian artery. Venous drainage from
with the lingual nerve through the petrotym-
the head and neck region eventually drain
panic fissure and into the infratemporal fossa,
into the internal and external jugular veins,
and synapses with the geniculate ganglion.
which combine to form the subclavian vein.
Fibers then follow the solitary tract and
Answer B is incorrect. The brachial plexus synapse at the (gustatory) nucleus of the soli-
tracts posterior to the clavicle (along with the tary tract, en route to the VPM of the thala-
subclavian vessels), en route to innervating mus and then gustatory cortex.
the shoulder girdle and upper limb.
Answer A is incorrect. Ipsilateral weakness to
Answer C is incorrect. The trachea is an infe- musculature of facial expression will occur.
rior continuation of the pharynx (after Motor fibers of CN VII leave the main motor
branching off into the esophagus) which runs nucleus (of the pons), enter the internal
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acoustic meatus and through the facial canal, Answer D is incorrect. The ipsilateral side of
before exiting the skull base via the stylomas- the lower face is left unaffected by an upper
toid foramen. The nerve then courses motor lesion.
through the parotid gland, and gives off five Note that this is because the musculature
branches, including motor innervation to the of facial expression of the upper face receives
muscles of facial expression (as well as the bilateral innervation from CN VII. The facial
posterior belly of the digastric, stapedius, and musculature of the lower face which is inner-
stylohyoid). vated by CN VII receives only unilateral
innervation. The crossover occurs after the
Answer C is incorrect. Ipsilateral dryness of
fibers leave the motor area of the cortex (thus
eye due to lost function of lacrimal gland will
traveling via the corticobulbar tract) and
occur. The greater petrosal nerve gives fibers
before they synapse at the pons.
to the lacrimal, submandibular, and sublin-
gual glands. Parasympathetic preganglionic
6. The correct answer is B. The embryonic
fibers first leave the superior salivatory
branchial arches are mesodermal ridges,
nucleus, synapsing at the geniculate ganglion
formed from neural crest cells. Each arch
(as well as giving off sympathetics), joins the
contains a nerve, artery, cartilaginous bar,
deep petrosal nerve, and leaves the cranium
and musculature. The four main branchial
via the foramen lacerum. Fibers then either
arches develop at week 4 of life. Arch II con-
travel with the chorda tympani to synapse at
sists of the hyoid and stapedial artery, CN
the submandibular ganglion (thus, parasym-
VII, musculature of facial expression (also
pathetic innervation to the submandibular
stapedius, stylohyoid, posterior belly of digas-
and sublingual glands).
tric), and stapes, styloid process, stylohyoid
Answer D is incorrect. Compromised func- ligament, lesser cornu (of hyoid), and part of
tion of sublingual and submandibular glands hyoid bone.
will occur. An alternate path of the deep pet-
Answer A is incorrect. Arch I (gives rise to
rosal nerve may enter the pterygoid canal
mandible and most of maxilla) is comprised
(instead of the chorda tympani), which gives
of the maxillary artery, CN V, muscles of
preganglionics to the pterygopalatine gan-
mastication (also tensor tympani, mylohyoid,
glion, and subsequent postganglionic fibers to
tensor veli palatine, anterior belly of digas-
supply parasympathetic innervation to the
tric), and malleus, incus, sphenomandibular
lacrimal gland.
ligament, and Meckel cartilage.
Answer E is incorrect. Hyperacusis in ipsilat-
Answer C is incorrect. Arch III is comprised
eral ear will occur. This is due to motor
of the internal carotid artery, CN IX, stylopha-
innervation from the cranial nerve to the
ryngeus muscle, greater cornu (of hyoid),
stapedius muscle.
hypobranchial eminence, and part of hyoid
bone.
5. The correct answer is C. A lesion affecting
the upper motor neuron of CN VII would Answer D is incorrect. Arch IV consists of
cause impairment to the facial musculature the right subclavian artery and aorta, CN X,
of expression (on the contralateral side) of the pharyngeal and laryngeal musculature, and
lower face only. laryngeal cartilages. The tongue is formed
from contributions made by each arch.
Answer A is incorrect. The ipsilateral side of
Note that branchial grooves and pouches
the lower face is left unaffected by an upper
also exist, which give rise to adult structures.
motor lesion.
Groove 1 gives rise to the external ear and
Answer B is incorrect. The ipsilateral side of external auditory meatus, while grooves 2-4
the lower face is left unaffected by an upper contribute to form the cervical sinus. Pouch 1
motor lesion. gives rise to the middle ear/auditory tube,
Anatomic Sciences
Answers: 5-9 25
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pouch 2 contributes to the supratonsillar lumen, next is the tunica media, which con-
fossa, pouch 3 forms the thymus and inferior tains smooth muscle and elastic fibers. The
parathyroid gland, and pouch 4 contributes innermost layer is the tunica intima.
to the superior parathyroid gland, as well as
Answer A is incorrect. Blood is composed of
postbranchial body.
plasma (55%) (which is the liquid portion con-
taining water, protein, and electrolytes/gases,
7. The correct answer is E. The common facial
etc), and formed elements/cellular portion
vein eventually drains into the internal jugu-
(45%) (which is composed of erythrocytes,
lar vein. Venous drainage from the head and
leukocytes, and platelets).
neck (superior to inferior) starts at the superfi-
cial temporal vein, which then merges with Answer B is incorrect. Serum is defined as
the maxillary vein. The internal jugular vein blood plasma lacking fibrinogen and clotting
joins the subclavian vein. This merging of the factors.
internal jugular vein with the subclavian vein
Answer D is incorrect. Sinusoids are defined
creates the large brachiocephalic vein. The
as fenestrated capillaries which allow the pas-
left and right brachiocephalic veins merge
sage of phagocytic cells.
and form the superior vena cava.
Answer E is incorrect. ABO blood typing is
Answer A is incorrect. The maxillary vein
with regard to the antigen present on an indi-
receives drainage from the pterygoid plexus of
vidual’s erythrocytes. For example, a person
veins. It combines with the superficial tempo-
with blood type A has erythrocytes contains
ral vein. This union forms the retromandibu-
the A antigen, and, thus, plasma lacking anti-
lar vein, which then divides at the angle of
A and containing anti-B antibodies.
the mandible into anterior and posterior seg-
ments. The posterior segment of the retro- 9. The correct answer is E. The middle
mandibular vein joins with the posterior meningeal artery is ruptured in the case of an
auricular vein which then forms the external epidural hematoma, as it lies within the
jugular vein, which eventually empties into epidural space between the periosteum of the
the subclavian vein. inner surface of the skull and dura mater. A
Answer B is incorrect. The anterior segment subdural hematoma involves a bridging vein
of the anterior retromandibular vein anasto- being ruptured within the subdural space
moses with the anterior facial vein and cre- between the dura mater and arachnoid.
ates the common facial vein. Answer A is incorrect. A subarachnoid hem-
Answer C is incorrect. The retromandibular orrhage involves a ruptured aneurysm, for
vein has two segments: anterior and posterior. example, involving the anterior communicat-
It is formed by the maxillary vein and superfi- ing artery.
cial temporal vein. Answer B is incorrect. The posterior cerebral
Answer D is incorrect. The anterior facial artery is not directly involved in an epidural
vein is formed from the angular vein (which hematoma.
is a union of the supraorbital and supra- Answer C is incorrect. The anterior cerebral
trochlear veins) and it drains into the internal artery is not directly involved in an epidural
jugular vein. hematoma.
8. The correct answer is C. This statement Answer D is incorrect. The posterior com-
describes the tunica intima. The tunica municating artery is not directly involved in
adventitia is the outermost, connective tissue, an epidural hematoma.
layer of the blood vessel wall, and contains Note that the meningeal layer, from outer-
collagen, elastic fibers, and (if applicable) most to innermost, surrounding the brain
vasa vasora. Moving inward toward the and spinal cord is: periosteum of inner skull
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surface, epidural space, dura mater, subdural 12. The correct answer is D. The ventromedial
space, arachnoid, subarachnoid space, pia nucleus is located within the hypothalamus,
mater, and then the brain/spinal cord. The and functions as the satiety center involved
subarachnoid space holds cerebrospinal fluid, with body homeostasis.
and is a prime location for a spinal tap.
Answer A is incorrect. The superior saliva-
tory nucleus functions with CN VII, and
10. The correct answer is E. The optic foramen
gives off parasympathetic efferent fibers (from
is located within the middle cranial fossa.
the cortex) which control salivation (of sub-
Also contained within the middle cranial
mandibular and sublingual glands), as well as
fossa (temporal, parietal, and sphenoid
glandular secretion.
bones) are temporal lobes, pituitary gland,
superior orbital fissure, carotid canal, trigemi- Answer B is incorrect. Also giving off
nal ganglion, foramen rotundum, ovale, and parasympathetic efferents is the nucleus
spinosum. ambiguous of CN IX and X, which controls
swallowing.
Answer A is incorrect. The occipital lobes
are located within the posterior cranial fossa. Answer C is incorrect. Sensory afferents to
the brainstem (eventually relayed to the thal-
Answer B is incorrect. The jugular foramen
amus and cortex) nucleus of the solitary tract,
is located within the posterior cranial fossa.
involved with CN VII, IX, and X, mediate
Answer C is incorrect. The cerebellum is taste sensation.
located within the posterior cranial fossa.
Answer E is incorrect. The inferior salivatory
Answer D is incorrect. The hypoglossal nucleus gives off parasympathetic efferent
canal is located within the posterior cranial fibers by way of CN IX to cause salivation by
fossa. way of the parotid gland.
Note that the anterior cranial fossa (frontal Note that all cranial nerves (except CN I
and ethmoid bones) contains frontal lobes, and II) originate in the brainstem.
cribriform plate, foramen cecum, and crista
galli. The posterior cranial fossa (occipital 13. The correct answer is D. The tricuspid valve,
and temporal bones) contains the above which has three cusps and separates the right
mentioned and brainstem, internal acoustic atrium from the right ventricle, can be aus-
meatus, and foramen magnum. cultated left of the sternal border in the 5th
intercostal space.
11. The correct answer is A. The VPM of the
Answer A is incorrect. As for the mitral valve,
thalamus is involved with facial sensation and
which also contains three cusps and divides
pain. Thalamus is a sensory relay station, en
the left atrium from left ventricle, it can be
route to higher cortical areas. Lateral auditory
heard at the midclavicular line at the level of
sensation is mediated by the medial genicu-
the 5th intercostal space.
late nucleus.
Answer B is incorrect. The aortic valve is
Answer B is incorrect. The ventral anterior
auscultated at the level of the 2nd intercostal
nucleus each mediates motor function.
space, just lateral to the sternal border in the
Answer C is incorrect. The lateral geniculate right, 2nd intercostal space. This valve is con-
nucleus is involved with visual sensation. sidered semilunar (thus, containing two
Answer D is incorrect. VPL is involved with cusps), and divides the left ventricle from the
proprioception, pressure, touch, and vibration. ascending aorta.
Answer E is incorrect. The ventral lateral Answer C is incorrect. At the level of the 2nd
nucleus mediates motor function. intercostal space, left and lateral to the ster-
nal border, the pulmonic valve can be heard.
Anatomic Sciences
Answers: 10-18 27
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It is also semilunar, and separates the right Answer D is incorrect. The middle medi-
ventricle from the pulmonary arteries. astinum (subdivision of the inferior medi-
astinum) contains the pericardium, heart,
14. The correct answer is A. Blood supply to the roots of great vessels, and phrenic nerve.
lateral wall of the left ventricle is via the left
circumflex artery. The coronary arteries are 16. The correct answer is D. Oxygenated blood
the first branches of the aorta, and fill during bypasses the pulmonary circulation by a
the diastole stage of the heart cycle. communication in the fetal heart called the
foramen ovale. This opening connects the
Answer B is incorrect. The right coronary
right atrium to the left atrium. Blood, there-
artery branches off as the acute marginal and
fore, is oxygenated by the mother and enters
posterior descending arteries.
the fetal heart by way of the inferior vena
Answer C is incorrect. The left anterior cava. The blood is then shunted from the
descending artery provides blood supply to right to left atrium, where it proceeds to
the anterior wall of left ventricle and inter- flow through the left ventricle, and subse-
ventricular septum. quently out through the aorta to supply the
Answers D and E are incorrect. Such vascu- fetal head. Prostaglandins, as well as inspi-
lature supplies blood to the posterior and ration, help to close the foramen ovale
inferior walls of the left ventricle, as well as upon birth.
the entire right ventricle and atrioventricular Answers A, B, C, and E are incorrect.Oxy-
node. genated blood does not bypass the pulmonary
Note that the left coronary artery to branch circulation via these routes.
from the aorta is the left main coronary
artery, which subsequently gives off the cir- 17. The correct answer is B. The fossa ovalis,
cumflex (blood supplied to the lateral wall of which lies on the atrial septum (separating
the left ventricle) and left descending arteries. the right and left atria) is the adult remnant
of the fetal foramen ovale. Its upper margin is
15. The correct answer is B. The vagus nerve the anulus ovalis.
travels through the posterior portion of the
Answer A is incorrect. The crista terminalis
inferior mediastinum. It contains the thoracic
lies between the vena cavae openings, and is
duct, descending aorta, azygous vein, hemi-
a vertical ridge which represents the sinus
azygous vein, esophagus, vagus nerves,
venosus and fetal heart.
splanchnic nerves, and lymph nodes. Within
the thorax, between and medial to the lungs, Answer C is incorrect. The sulcus terminalis,
lies an area termed the mediastinum, which a vertical groove lying externally on the right
is divided into a superior and inferior portion. atrium, represents the internal location of the
crista terminalis.
Answer A is incorrect. The superior medi-
astinum contains the following: thoracic Answer D is incorrect. The right auricle is
duct, ascending and descending aorta, aortic an appendage of the right atrium.
arch (and branches), superior vena cava, bra-
Answer E is incorrect. The atrial appendage
chiocephalic veins, thymus (childhood), tra-
serves as a connection (in concert with the
chea, esophagus, cardiac nerve, and left
crista terminalis) of the pectinate muscula-
recurrent laryngeal nerve.
ture of the right atrium.
Answer C is incorrect. The anterior medi-
astinum (subdivision of the inferior medi- 18. The correct answer is C. The ductus arterio-
astinum) contains the thymus, connective tis- sus connects the pulmonary artery to the
sue, lymph nodes, and branches of internal aorta, thus assisting in the pumping of blood
thoracic artery. throughout the fetal vasculature.
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Answer A is incorrect. The ductus venosus is Answer B is incorrect. The truncus arteriosus
a continuation of the umbilical vein, and car- forms the ascending aorta and pulmonic
ries blood back to the inferior vena cava. trunk.
Answer B is incorrect. The umbilical arteries Answer C is incorrect. The right anterior
return deoxygenated blood from the fetus to cardinal vein combines with the right com-
the mother/placenta. mon cardinal vein to form the superior vena
cava.
Answer D is incorrect. The poral vein
Note that the primitive ventricle comprises
returns blood back to the heart by pumping
the trabeculated portions of the right and left
through the liver, then the ductus venosus
ventricles. The primitive atrium develops
and inferior vena cava.
into the trabeculated areas of the right and
Answer E is incorrect. The umbilical veins left atria. As for the venous portions, the left
deliver oxygenated blood from the mother/ horn of the sinus venosus becomes the coro-
placenta en route to the fetal heart. nary sinus, while the right horn of the sinus
venosus develops into the smooth portion of
19. The correct answer is A. Mesoderm makes the right atrium.
up the epithelial lining of the cardiovascular
system, as well as most of the urogenital sys- 21. The correct answer is D. The septum pri-
tem. It also comprises all muscle types (car- mum grows downward toward the atrial cush-
diac, smooth, skeletal), and all connective tis- ion in the developing heart, eventually meet-
sue (including cartilage, bone, and red/white ing with the septum secundum, which grows
blood cells). next to it.
Answer B is incorrect. The endodermal layer Answer A is incorrect. The ostium secun-
leads to growth of epithelial lining for the gas- dum grows next to the septum primum, and
trointestinal tract, as well as for organs bud- undergoes apoptotic changes to form a hole.
ding from the endodermal tube: pharyngeal
Answer B is incorrect. The septum primum
gland derivatives (thymus, palatine tonsils,
grows just a bit further inferiorly to the sep-
parathyroids, thyroid), the respiratory system,
tum secundum, thus, formation of the atrial
digestive organs (liver, pancreas), and termi-
septum.
nal urogenital system.
Answer C is incorrect. The ostium primum
Answer C is incorrect. As for ectoderm, it
is the opening left by the downgrowth of the
makes up superficial epithelium/epidermis,
septum primum.
and all nervous tissue (CNS tissue is from
neuroectoderm, brain and spinal cord from Answer E is incorrect. The septum spurium
neural tube, and PNS tissue from neural is a fold which demarcates the uniting of
crest). right and left venous valves.
Note that incomplete fusion of the ostium
20. The correct answer is D. The right common secundum and septum primum results in
cardinal vein and right anterior cardinal vein formation of an atrial septal defect (which is
combine to form the superior vena cava. Of typically symptomatic until middle age is
the arterial structures comprising the heart, encountered).
the truncus arteriosus eventually forms the
ascending aorta and pulmonic trunk. 22. The correct answer is C. The derivative of
the 4th aortic arch is the right subclavian
Answer A is incorrect. The bulbus cordis
artery and aortic trunk.
eventually becomes the smooth part of the
right and left ventricles. The right common Answer A is incorrect. The hyoid arteries are
cardinal vein becomes part of the superior derivatives of the 2nd aortic arch.
vena cava.
Anatomic Sciences
Answers: 19-27 29
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Answer B is incorrect. The stapedial arteries Answer B is incorrect. The internal oblique
are a derivative of the 2nd aortic arch. muscle is innervated by the lower intercostal,
iliohypogastric, and ilioinguinal nerves.
Answer D is incorrect. The common carotid
artery is a derivative of the 3rd aortic arch. Answer C is incorrect. The external oblique
muscle is innervated only by the lower inter-
Answer E is incorrect. The pulmonary arter-
costal nerves.
ies are a derivative of the 6th aortic arch.
Note that the aortic arch gives rise to arter- Answer E is incorrect. The rectus abdominis
ies of the cardiac system at approximately muscle originates at the pubic symphysis and
week 4 of development. This structure arises inserts into the xiphoid process, as well as
from the distal truncus arteriosus/aortic sac. It costal cartilages 5-7.
fuses with the paired dorsal aortae in week 5
to form the descending thoracic and abdomi- 25. The correct answer is B. Aponeuroses are
nal aortae. The 1st aortic arch also develops simply sheetlike layers of tendon.
into the maxillary artery, the 3rd into the inte- Answer A is incorrect. Tendons are connec-
rior carotid arteries, 5th involutes, and 6th tive tissue attachments between muscle and
develops into the ductus arteriosus. bone.
23. The correct answer is D. The cremaster mus- Answer C is incorrect. Connective tissue of
cle, a continuation of the internal oblique the head and neck region originates from
musculature in the lower abdominal region, neural crest, but most other connective tissue
is not a part of the femoral triangle. of the body is mesodermally derived.
Answer A is incorrect. The sartorius muscle Answer D is incorrect. Ligaments connect
forms part of the boundary known as the two separate bones.
femoral triangle. It forms the lateral border.
26. The correct answer is A. The neurovascular
Answer B is incorrect. The inguinal ligament bundle of the intercostal space runs within
forms part of the boundary known as the the costal groove on the inferior surface of
femoral triangle. It forms the superior border. each rib. Each of the other statements is cor-
Answer C is incorrect. The adductor longus rect pertaining to the thoracic cavity.
muscle forms part of the boundary known as Answer B is incorrect. Musculature of respi-
the femoral triangle. It forms the medial border. ration includes the intercostal muscles,
Answer E is incorrect. The pectineus muscle diaphragm, and accessory muscles.
forms part of the boundary known as the Answer C is incorrect. The costal groove of
femoral triangle. It forms the floor of the tri- each rib protects the nerve (of the neurovas-
angle. cular bundle) the least when injury occurs.
Note that (running laterally → medially
the triangle contains the femoral nerve, Answer D is incorrect. The rib cage contains
artery, and vein (in that order). 12 ribs: ribs I-VI are true, VII-X are false, and
XI-XII are floating.
24. The correct answer is D. The transversus Answer E is incorrect. Fracture of the left 10th
abdominis muscle contracts to increase and 11th ribs can cause injury to the spleen.
abdominal pressure. The rectus abdominis
contracts to flex the vertebral column, as well 27. The correct answer is C. The caval opening of
as increase abdominal pressure. the diaphragm allows passage of the inferior
Answer A is incorrect. The external oblique vena cava. Other openings of the diaphragm
muscle contracts to increase abdominal include the esophageal (passage of the esopha-
pressure. gus) and aortic (passage of the aorta, thoracic
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duct, azygous and hemiazygous veins). Other at the optic chiasma en route to the left pri-
structures that pass through the diaphragm mary visual cortex in the occipital lobe.
include the posterior and anterior vagal trunks,
Answer D is incorrect. The right lateral/
splanchnic nerves, sympathetic trunk, and supe-
temporal fibers decussate and stay ipsilateral
rior epigastric artery. When expiration occurs,
at the optic chiasma en route to the right pri-
the diaphragm relaxes, thus, moves upward and
mary visual cortex in the occipital lobe.
forms a dome, which creates a positive intratho-
Note that left and right lateral/temporal
racic pressure. Forceful expiration involves con-
fibers of the optic nerve decussate ipsilaterally
traction of the abdominal musculature.
to the left and right primary visual cortex of
Answer A is incorrect. Blood supply to the the occipital lobe, respectively, where images
diaphragm is via the musculophrenic artery. are developed. Left and right medial/nasal
fibers of the optic nerve decussate and cross
Answer B is incorrect. The aorta passes
over at the optic chiasma, whereby left medial/
through two crura when passing through the
nasal fibers are received by the right primary
aortic opening.
visual cortex of the occipital lobe (and right
Answer D is incorrect. During the act of fibers received by the left primary visual cor-
inspiration, the diaphragm contracts, thus, tex) where images are developed.
flattening out and creating a negative
intrathoracic pressure. 30. The correct answer is D. The abducens nerve
(CN VI) innervates the lateral rectus muscle.
Answer E is incorrect. Innervation to the
diaphragm is via the phrenic nerve (C3, C4, C5). Answer A is incorrect. The superior oblique
muscle is innervated by the trochlear nerve
28. The correct answer is B. The thymus com- (CN IV).
municates via efferent lymph vessels only to
Answer B is incorrect. The medial rectus
the systemic circulation; there are no afferent
muscle is innervated by the oculomotor nerve
vessels, and the lymph is not filtered here.
(CN III).
Answer A is incorrect. Growth continues and
Answer C is incorrect. The inferior rectus
peaks at puberty, and then atrophies and is
replaced by adipose tissue.
(CN III).
Answer C is incorrect. The thymus is the site
Answer E is incorrect. The superior rectus
of T-cell maturation.
Answer D is incorrect. Thymic corpuscles/ (CN III).
epithelioreticular cells are contained within Note that all other extraocular muscles
the inner medulla. (superior, inferior, and medial rectus, inferior
Answer E is incorrect. The outer cortex holds oblique) are innervated by the oculomotor
the largest concentration of lymphocytes. nerve (CN III).
29. The correct answer is A. Objects are 31. The correct answer is B. The papillary light
received by the retina by lateral/temporal and reflex involves stimulus to the eye (eg, right
medial/nasal fibers. eye), which then causes afferent firing via the
optic nerve (CN II), synapsing at the Edinger-
Answer B is incorrect. The left medial/nasal Westphal nucleus and then ciliary ganglia.
fibers decussate and cross over at the optic From here, postganglionic fibers, by way of the
chiasma en route to the right primary visual short ciliary nerve/oculomotor nerve/CN III,
cortex of the occipital lobe. then stimulate the constrictor pupillae muscle.
Answer C is incorrect. The left lateral/ Answer A is incorrect. When shining light
temporal fibers decussate and stay ipsilateral onto the left eye, the direct response elicits
Anatomic Sciences
Answers: 28-34 31
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ipsilateral afferent firing via CN II and subse- causes accommodation with no reaction of
quent ipsilateral efferent firing via CN III to the pupil. Therefore, the pupil does not con-
left eye. strict with near stimulus (accommodation-
convergence); that is, there is no miosis with
Answer C is incorrect. When shining light
either direct or consensual light.
onto the left eye, the consensual response
elicits ipsilateral afferent firing via CN II and Answer A is incorrect. Internuclear ophthal-
subsequent contralateral efferent firing via moplegia involves a lesion of the medial lon-
CN III to right eye. gitudinal fasciculus, thus, lost connection of
CNs III, IV, and VI. For example, if the
Answer D is incorrect. When shining light onto
lesion is on the right side, when looking later-
the right eye, the direct response elicits ipsilat-
ally to the right, both eyes will follow; when
eral afferent firing via CN II and subsequent
looking laterally to the left, only the left eye
ipsilateral efferent firing via CN III to left eye.
follows, and the right eye stares straight. This
Note that there are two distinct responses:
is due to lost function of the medial rectus
direct and consensual. The direct response is
muscle, although, it still functions in accom-
when light is shined, for example, on the left
modation.
eye. Ipsilateral afferents are sent via CN II fol-
lowed by subsequent efferents via CN III to Answer B is incorrect. Ophthalmoplegia
the ipsilateral (left) eye. The consensual involves either internal or external lesions:
response is when light is shined, again, on internal lesions spare the extraocular muscles
the left eye, thus, eliciting ipsilateral afferents but cause lost function of autonomics to the
via CN II followed by subsequent contralat- papillary sphincter and ciliary muscles, and
eral efferents via CN III to the right eye. external lesions cause lost function of all
except for the superior oblique, superior rec-
32. The correct answer is E. The trochlear nerve tus, papillary sphincter, and ciliary muscles.
(CN IV) innervates the superior oblique mus- The external lesion is seen in diabetes mellitus
cle. The main action of the superior oblique neuropathy.
muscle is to move the eyeball in an inferior
Answer C is incorrect. Marcus-Gunn/relative
and lateral direction. It is important to note
afferent pupil is a lesion of the optic nerve
that clinical testing of the extraocular eye mus-
seen with multiple sclerosis optic neuritis.
cles does not follow the same anatomical
Therefore, by use of the swinging flashlight
movements.
test, by shining a light source into the good
Answer A is incorrect. Superior movement eye, both pupils will constrict; quickly shining
of the eye is the main movement of the supe- light source into the damaged eye will cause
rior rectus muscle. immediate pupillary dilation of both eyes, due
Answer B is incorrect. Superior and medial to lost afferent function of the optic nerve.
movement of the eye is the main movement Answer E is incorrect. Horner syndrome is due
of the inferior oblique muscle. to lost oculosympathetic function. Thus, sym-
Answer C is incorrect. Downward move- pathetic fibers from the superior cervical gan-
ment of the eye is the main movement of the glion are damaged, causing apparent enoph-
inferior rectus muscle. thalmos, miosis, ptosis, and hemianhidrosis.
Answer D is incorrect. Lateral movement of 34. The correct answer is A. The middle cere-
the eye is the main movement of the lateral bral, although the largest branch of the inter-
rectus muscle. nal carotid artery, is not considered part of
the circle of Willis.
33. The correct answer is D. Argyll-Robertson/
papillary light-near dissociation pupil affects Answer B is incorrect. The posterior cerebral
patients with syphilis and diabetes, and artery is part of the circle of Willis.
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Answer C is incorrect. The internal carotid Note that each of these muscles receives
artery is part of the circle of Willis. innervation via the motor division of CN XII.
Answer D is incorrect. The posterior commu-
37. The correct answer is C. The lingual is a
nicating artery is part of the circle of Willis.
tongue-shaped depression that is present on
Answer E is incorrect. The anterior commu- the superior lobe of the left lung. This struc-
nicating artery is part of the circle of Willis. ture corresponds with the middle lobe of the
Note that these arterial anastomoses func- right lung.
tion to prevent blockage of blood flow by
Answer A is incorrect. The middle lobe of
offering collateral circulation, which is criti-
the right lung does not contain the lingula.
cal to prevent ischemia to brain tissue. Along
with the internal carotid, the vertebral and Answer B is incorrect. The superior lobe of
basilar arteries indirectly feed blood to the the right lung does not contain the lingula.
circle of Willis. Answer D is incorrect. The inferior lobe of
the left lung does not contain the lingula.
35. The correct answer is C. The lenticulostriate
arteries, sometimes known as the “arteries of Answer E is incorrect. The inferior lobe of
stroke,” are a branch of the middle cerebral the right lung does not contain the lingula.
artery (which, in turn, branches from the inter-
nal carotid). Blockage of the middle cerebral 38. The correct answer is E. The left recurrent
artery can cause severe ischemic injury, as well. laryngeal nerve, a branch of the vagus nerve
(CN X), wraps around the arch of the aorta,
Answer A is incorrect. The left anterior cere- also known as the ligamentum arteriosum, as
bral artery is not commonly involved in it ascends in the mediastinum.
stroke.
Answer A is incorrect. The right recurrent
Answer B is incorrect. The right posterior laryngeal nerve does not wrap around the lig-
cerebral artery is not commonly involved in amentum arteriosum. It wraps around the
stroke. It is part of the circle of Willis. right subclavian artery.
Answer D is incorrect. Left vertebral artery is Answer B is incorrect. The left brachio-
not commonly involved in stroke. It gives cephalic vein does not wrap around the liga-
blood to the basilar artery. mentum arteriosum.
Answer E is incorrect. The left internal Answer C is incorrect. The right subclavian
carotid artery is not commonly involved in vein does not wrap around the ligamentum
stroke. It is part of the circle of Willis. arteriosum.
36. The correct answer is B. The hamulus is not Answer D is incorrect. The superior laryn-
directly involved in attachment and move- geal nerve does not wrap around the ligamen-
ment of the tongue. It attaches the tensor veli tum arteriosum.
palatini muscle.
39. The correct answer is D. The foramen mag-
Answer A is incorrect. The genial tubercles num is located within the inferior aspect of the
directly affect movement of the tongue. They occipital bone, and acts as a passageway for the
attach the genioglossus muscle. exit of the spinal cord from the cranium.
Answer C is incorrect. The hyoid bone Answer A is incorrect. The foramen mag-
directly affects movement of the tongue. It num is located within the occipital bone.
attaches the hyoglossus muscle.
Answer B is incorrect. The foramen mag-
Answer D is incorrect. The styloid process num allows passage of the medulla oblongata/
directly affects movement of the tongue. It spinal cord.
attaches the styloglossus muscle.
Anatomic Sciences
Answers: 35-45 33
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Answer C is incorrect. The foramen magnum 43. The correct answer is E. The pituitary gland is
allows passage of the spinal accessory nerve. seated in the middle cranial fossa on the sphe-
noid bone, just superior to the sphenoid sinus.
Answer E is incorrect. The foramen mag-
num allows passage of the vertebral arteries. Answer A is incorrect. The frontal sinus is
anterosuperior to the pituitary. It is normally
40. The correct answer is A. The articulating empty.
surface of the mandibular condyle is covered
Answer B is incorrect. The maxillary sinuses
with dense fibrocartilage, which is dense con-
are each located anterolateral to the pituitary.
nective tissue. Although, most articulating
It is normally empty, but can often be filled
surfaces of diarthrodial joints are covered with
with secretions and infectious material.
hyaline cartilage.
Answer C is incorrect. The anterior ethmoid
Answer B is incorrect. The condyle is not cov-
sinus is located anterior to the pituitary. It is
ered by loose connective tissue. This is typi-
normally empty.
cally found associated with the epithelium.
Answer D is incorrect. The posterior eth-
Answer C is incorrect. The condyle is not
moid sinus is located anterior to the pituitary.
covered by elastic cartilage. This is typically
It is normally empty.
found associated with the outer ear and larynx.
Answer D is incorrect. The condyle is not 44. The correct answer is B. The lingual nerve
covered by hyaline cartilage. This is typically runs just medial to the lingual cortical plate
found covering the ends of articulating joints. of the posterior mandible. This nerve con-
tains sensory fibers, which function in taste
41. The correct answer is B. The collateral liga- recognition in the anterior 2/3 of the tongue
ments of the TMJ connect the meniscus to (CN VII), as well as general sensation to the
the medial and lateral poles of the condyle. ipsilateral side of the tongue (CN V). Thus,
These ligaments function to limit movement iatrogenic impingement of such nerve near
of the condyle in lateral excursion. Tearing of mandibular third molars may cause the afore-
these ligaments will allow the lateral ptery- mentioned symptoms.
goid muscle to displace the meniscus.
Answer A is incorrect. The buccal nerve
Answer A is incorrect. The stylomandibular would not be compromised by this type of
ligament connects to the styloid process and extraction. It is located lateral to the buccal
the angle of the mandible. shelf and within the cheek. It is a branch of
Answer C is incorrect. The temporo- CN V3.
mandibular ligament connects the temporal Answer C is incorrect. The middle superior
bone to the mandibular condyle. alveolar nerve would not be compromised by
Answer D is incorrect. The sphenomandibu- this type of extraction. It is located within the
lar ligament connects the mandible to the maxilla, superior to the dentition. It is a
sphenoid bone. It joins from the lingula of branch of CN V2.
the mandible to the spine of the sphenoid. Answer D is incorrect. The hypoglossal nerve
(CN XII) would not be compromised by this
42. The correct answer is A. When the collateral type of extraction. It enters the tongue from
ligaments which attach the meniscus to the the region of the posterior digastric muscle.
mandibular condyle tear, attachment will be
lost. Thus, the lateral pterygoid muscle will 45. The correct answer is D. Odontogenic infec-
cause anteromedial displacement of the artic- tion involving the root apices of a mandibular
ulating disc, upon contraction. molar would most likely travel within the sub-
Answers B, C, D, and E are incorrect. See mandibular fascial plane via piercing of the
above. mylohyoid muscle. This type of infection, if not
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treated appropriately, can eventually course pos- Answer B is incorrect. In order to pierce the
teriorly and, thus, cause airway compromise. lateral pterygoid muscle, one must direct the
needle in superior direction.
Answer A is incorrect. The sublingual fascial
plane is bound by the genioglossus, geniohy- Answer C is incorrect. In order to pierce the
oid, and mylohyoid muscles. medial pterygoid muscle, one must direct the
needle in an inferolateral direction.
Answer B is incorrect. The parapharyngeal
fascial plane runs from the base of the skull to Answer D is incorrect. In order to pierce the
the hyoid bone, and it is bound laterally by mylohyoid muscle, one must direct the nee-
the masticator and retropharyngeal space and dle in an inferomedial direction.
medially by the oropharynx.
48. The correct answer is C. The pterygomandibu-
Answer C is incorrect. The masticator fascial
lar raphe is formed by the convergence of the
plane is formed by the temporal, pterygoids,
buccinator and the superior pharyngeal con-
and masseter muscle.
strictor. These two muscles meet on the ante-
Answer E is incorrect. The parotid fascial rior border to the mandibular ramus.
plane encompasses the parotid gland.
Answer A is incorrect. The superior pharyn-
geal constrictor and mylohyoid muscles do not
46. The correct answer is C. In an emergency
meet to form the pterygomandibular raphe.
situation where an airway must be obtained,
an incision is made by palpating the mem- Answer B is incorrect. The medial pterygoid
brane inferior to the thyroid cartilage and and mylohyoid do not meet to form the ptery-
superior to the cricoid cartilage, thus, the gomandibular raphe.
cricothyroid membrane. This location will
Answer D is incorrect. The buccinator and
bypass any superior airway obstruction or
mylohyoid muscles do not meet to form the
laryngospasm, and allow air into the trachea
pterygomandibular raphe.
to maintain oxygen distribution to the lungs.
Answer E is incorrect. The medial pterygoid
Answer A is incorrect. An incision here
and superior pharyngeal constrictor do not
would not directly place you into an airway.
meet to form the pterygomandibular raphe.
Answer B is incorrect. An incision into the
trachea would be considered a tracheotomy. 49. The correct answer is B. In order to achieve
an inferior alveolar nerve block in a particular
Answer D is incorrect. An incision into the
mandibular quadrant, one must first locate the
thyroid gland would not directly place you
area where the inferior alveolar nerve enters
into an airway.
the mandibular body. After exiting the cranial
Answer E is incorrect. An incision between base via the foramen ovale, CN V3 courses
the left 3rd and 4th intercostal muscles, later- inferiorly along the anteromedial border of the
ally, would access an airspace, but also cause ramus and gives off numerous branches. It is
a pneumothorax. within the coronoid notch, a depression on the
anteromedial border of the ramus, that inferior
47. The correct answer is E. When attempting alveolar branch is exposed and most vulnerable
an inferior alveolar nerve block, the parotid to anesthetic deposition. The inferior alveolar
gland may be infiltrated if the needle is nerve then enters the body of the mandible via
advanced too far posteriorly. Thus, CN VII the mandibular foramen, provides sensory to
can be damaged, which would cause an ipsi- the mandibular posterior teeth, and exits anteri-
lateral facial paralysis. orly via the mental foramen.
Answer A is incorrect. In order to pierce the Answer A is incorrect. The lingula is located
buccinator muscle, one must direct the nee- on the medial border of the ramus and con-
dle in a posterolateral direction. nects the sphenomandibular ligament.
Anatomic Sciences
Answers: 46-54 35
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Answer C is incorrect. The antilingula is necessary to produce the extensive extracellu-

located on the lateral border of the ramus and lar matrix of the PDL, namely the ground
marks the position of the lingula (on the substance (which is made of water (~ 70%))
medial border). and proteoglygans, glycosaminoglycans, gly-
coproteins.
Answer D is incorrect. Palpating the angle of
the mandible would not assist in locating the Answer A is incorrect. Lymphocytes are
inferior alveolar nerve. It is located too far located within the PDL, but are not the most
inferior. abundant cells.
Answer E is incorrect. The external oblique Answer B is incorrect. Neutrophils are
ridge of the mandible would not assist in located within the PDL, but are not the most
locating the inferior alveolar nerve. It is abundant cells.
located too far anterior.
Answer C is incorrect. Osteoblasts are
located within the PDL, but are not the most
50. The correct answer is A. The horizontal
abundant cells.
fibers of the PDL run from the cementum, at
right angles, to the alveolar bone. Answer D is incorrect. Cementoclasts are
located within the PDL, but are not the most
Answer B is incorrect. The apical fibers
abundant cells.
extend from the apical region of cementum
to alveolar bone.
53. The correct answer is A. The lesser palatine
Answer C is incorrect. The interradicular fibers artery is not part of Kiesselbach plexus. This
run from radicular cementum to interradicular plexus of five arterial anastomoses includes the
alveolar bone (ONLY in multirooted teeth) above arteries, as well as the greater palatine
artery. Any of these vessels are typically
Answer D is incorrect. The transseptal fibers
involved in cases of epitasis owing to trauma
run from cementum to cementum of two
to the nasal mucosa.
adjacent teeth.
Answer B is incorrect. The sphenopalatine
Answer E is incorrect. The oblique fibers
artery is considered a part of Kiesselbach plexus.
run from cementum to alveolar bone in an
oblique fashion. Answer C is incorrect. The lateral nasal
branches of the facial artery are considered a
51. The correct answer is D. The principal colla- part of Kiesselbach plexus.
gen fibers of the periodontal ligament are
Answer D is incorrect. The superior labial
composed mostly of Type I collagen, as well
artery is considered a part of Kiesselbach plexus.
as some Type III.
Answer E is incorrect. The anterior ethmoid
Answer A is incorrect. Type I collagen fibers
arteries of internal carotid artery are consid-
comprise tendons and parts of bone.
ered a part of Kiesselbach plexus.
Answer B is incorrect. Type II collagen fibers
comprise hyaline and articular cartilage. 54. The correct answer is E. The temporal bone
is not part of the orbit. The orbit of the eye is
Answer C is incorrect. Type III collagen
composed of seven separate bones: frontal,
fibers comprise bone, tendon, and cartilage,
zygoma, sphenoid, lacrimal, maxilla, palatine,
amongst other connective tissue.
and ethmoid.
Answer E is incorrect. Principal collagen fibers
Answer A is incorrect. The frontal bone con-
of the PDL are not made of Type III collagen.
tributes to part of the orbital cavity.
52. The correct answer is E. Fibroblasts are the Answer B is incorrect. The zygoma bone
most abundant cells of the PDL. They are contributes to part of the orbital cavity.
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Answer C is incorrect. The ethmoid bone 57. The correct answer is D. The superior
contributes to part of the orbital cavity. orbital fissure is located between the greater
and lesser wings of the sphenoid bone, in the
Answer D is incorrect. The lacrimal bone
posterior portion of the orbit. This foramina
contributes to part of the orbital cavity.
transmits CN III, IV, V1, VI, and superior
55. The correct answer is B. The ophthalmic ophthalmic vein. These nerves then provide
artery serves as the major blood supply of the motor function to the musculature associated
eye and orbit. It is a branch of the internal with eye movement (III, IV, VI), glandular
carotid and, after branching, enters the orbit function (lacrimal of V1), and sensation
via the optic canal (along with CN II). (frontal and nasociliary of V1).
Answer A is incorrect. The facial artery sup- Answer A is incorrect. The superior orbital
plies blood to the superficial facial tissues. fissure is not located between the lesser wing
of the sphenoid and frontal bones.
Answer C is incorrect. The maxillary artery
supplies blood to the internal maxillary area. Answer B is incorrect. The superior orbital
fissure is not located between the ethmoid
Answer D is incorrect. The transverse facial and maxilla bones.
artery supplies blood to the masseter muscle
and parotid gland. Answer C is incorrect. The superior orbital
fissure is not located between the greater
Answer E is incorrect. The infraorbital artery wing of the sphenoid and maxilla bones.
supplies blood to the anterior maxillary teeth
and some extraocular muscles. Answer E is incorrect. The superior orbital
fissure is not located between the lesser wing
56. The correct answer is D. The masseter muscle of the sphenoid and ethmoid bones.
has both a deep (zygomatic arch) and superfi-
cial (zygomatic process of maxilla) as its origin, 58. The correct answer is A. The nasolacrimal
and a superficial (angle of mandible) and deep duct drains into the inferior meatus of the
(lateral ramus) insertion. This muscle of masti- nasal cavity.
cation serves as an elevator of the mandible, as Answer B is incorrect. The lacrimal gland,
well as assisting in retrusion and lateral excur- which is located in the superolateral portion
sions (ipsilaterally) of the mandible. of the orbit, produces tears which are col-
Answer A is incorrect. The lateral pterygoid lected into the lacrimal puncta.
muscle attaches to the articular disk (of the Answer C is incorrect. Tears wash across
TMJ) and originates from the lateral ptery- the globe in a superolateral → inferomedial
goid plate of the sphenoid bone. direction.
Answer B is incorrect. The temporalis mus- Answer D is incorrect. The puncta then
cle originates on the temporal bone and drains into inferior and superior lacrimal
inserts into the coronoid process. canals and joins the lacrimal sac before drain-
Answer C is incorrect. The buccinator mus- ing into the nasolacrimal duct.
cle attaches to the pterygomandibular raphe Answer E is incorrect. The lacrimal sac
and originates from the alveolar processes of drains directly into the nasolacrimal duct.
the maxilla and mandible.
59. The correct answer is D. The lacrimal
Answer E is incorrect. The medial pterygoid
glands are serous secreting.
muscle at the medial border of the mandible
and originates from the lateral pterygoid plate Answer A is incorrect. The lacrimal gland
of the sphenoid bone. receives postganglionic parasympathetic fibers
via the lacrimal nerve.
Anatomic Sciences
Answers: 55-64 37
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Answer B is incorrect. Preganglionic fibers to Answer B is incorrect. The prevertebral layer

the lacrimal gland synapse at the pterygopala- contains the subclavian vein and brachial
tine ganglion. nerves.
Answer C is incorrect. Preganglionic fibers Answer D is incorrect. The investing layer
to the lacrimal gland are carried via greater contains the trapezius muscle.
petrosal nerve.
62. The correct answer is A. The falciform liga-
Answer E is incorrect. The superior saliva-
ment helps suspend the liver by connecting it
tory nucleus sends preganglionic fibers to the
to the anterior abdominal wall. It also con-
lacrimal gland.
tains the ligamentum teres.
Note: The paired lacrimal glands receive
parasympathetic innervation via the following Answer B is incorrect. The gastrocolic liga-
pathway: superior salivatory nucleus (of brain- ment connects the greater curvature of the
stem) → greater petrosal nerve/VII (pregan- stomach to the transverse colon.
glionics) → pterygopalatine ganglion → lacrimal Answer C is incorrect. The hepatoduodenal lig-
nerve/V1 (postganglionics) → lacrimal gland ament connects liver to first part of duodenum.
and serous fluid production.
Answer D is incorrect. The gastroduodenal
60. The correct answer is B. The platysma, con- ligament connects lesser curvature of stom-
sidered a muscle of facial expression, is inner- ach to duodenum.
vated by the facial nerve (CN VII). Answer E is incorrect. The gastrohepatic lig-
Answer A is incorrect. The trigeminal nerve ament connects liver to the lesser curvature
innervates the muscles of mastication. of the stomach.
Answer C is incorrect. The glossopharyngeal 63. The correct answer is E. Teniae coli are three
nerve innervates the stylopharyngeal muscle. smooth muscle bands which are located
Answer D is incorrect. The spinal accessory within the colon.
muscle innervates the trapezius and stern- Answer A is incorrect. Epiploic appendages
ocleidomastoid muscles. are fatty globules on the serosal surface of the
Answer E is incorrect. The vagus nerve colon.
innervates multiple involuntary muscles. Answer B is incorrect. Lymphoid tissue of
the cecum would be considered GALT (gut-
61. The correct answer is C. The subcutaneous
associated lymphoid tissue).
layer of neck fascia contains lymphatic vessels.
This layer of fascia is also known as the super- Answer C is incorrect. Formed pouches
ficial cervical fascia, and also contains blood within the colon wall are called haustra.
vessels, (cutaneous) nerves, fat, and the Answer D is incorrect. Fingerlike projections
anterolateral portion of the platysma. Tissue involved with absorption in the intestine are
layers of the neck proceed as follows (superfi- called villi.
cial → deep): skin → superficial/subcutaneous
fascia → deep/muscular fascia (investing → pre- 64. The correct answer is E. The cerebellum is
tracheal → prevertebral). The deep fascial involved with coordinating skeletal muscle
layer supports the thyroid gland, musculature, movements of the body, including mainte-
and deep lymph nodes. nance of posture and equilibrium. Proprio-
Answer A is incorrect. The pretracheal layer ceptive/positional inputs are received via the
contains the pharynx, trachea, thyroid, esoph- dorsal columns.
agus, and larynx. Answer A is incorrect. The medulla controls
autonomic functions of the body.
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Answer B is incorrect. The pons serves as a also holds osteoprogenitor cells, as well as
relay center between the cerebrum and cere- fibroblasts and collagen.
bellum.
67. The correct answer is E. An example of a
Answer C is incorrect. The cerebrum is the
syndesmosis involves the radius and ulna
part of the brain which functions in memory,
bones.
olfaction, communication, and motor skills.
Answer A is incorrect. A gomphosis is a joint
Answer D is incorrect. The thalamus is
such as a tooth in socket.
involved with sleep and is intimately involved
with numerous other functions from different Answer B is incorrect. The cranial bones are
regions of the brain. held together by cranial/sutural joints.
Answer C is incorrect. The TMJ is a synovial
65. The correct answer is B. Hyaline is the only
joint.
type of cartilage which has the ability to cal-
cify. This is seen in formation of the condyle. Answer D is incorrect. The epiphyseal plates
Also, hyaline cartilage is found within long of long bones are synchondroses.
bones (articulating surfaces), nose, trachea,
bronchi, and costal cartilages of ribs. 68. The correct answer is C. The amount of
hematocrit found in blood is actually a mea-
Answer A is incorrect. Fibrocartilage does sure of the erythrocyte percentage. Normally,
not have the ability to calcify. in males the value is 45%; in females it is
Answer C is incorrect. Elastic cartilage does 40%.
not have the ability to calcify. Answer A is incorrect. Blood, as a whole, is
Answer D is incorrect. Hyaline cartilage does 55% plasma and 45% formed elements/cellular
have the ability to calcify, but elastic does not. material.
Answer E is incorrect. Hyaline cartilage does Answer B is incorrect. Albumin regulates the
have the ability to calcify, but fibrocartilage vascular oncotic pressure.
does not. Answer D is incorrect. Another portion of
plasma is comprised of 8% protein (55%
66. The correct answer is A. The endosteum of
albumin, 38% globulins, 7% clotting factors/
bone is one-cell thick, and is located on the
fibrinogen), and the remainder (2%) is elec-
inner surface of bone (whereas, periosteum
trolytes, blood gases, hormones, enzymes, and
surrounds the outer surface of bone). This
metabolic products. The formed elements
layer is mostly osteoprogenitor cells, and also
include erythrocytes, leukocytes, and platelets.
contains bone marrow.
Answer E is incorrect. Plasma is broken
Answer B is incorrect. The haversian canals
down as 80% water.
are formed by lamellae within compact bone.
They offer a means of communication 69. The correct answer is D. Granulocytes include
between osteocytes. neutrophils, basophils, and eosinophils.
Answer C is incorrect. The Volkmann canals Answer A is incorrect. T cells are formed
offer connection between the periosteum and from lymphoid stem cells. They are lympho-
osteons. They are perpendicular to haversian cytes.
canals.
Answer B is incorrect. Macrophages are
Answer D is incorrect. Lacuna is the area formed from myeloid stem cells. They are
which surrounds an osteocyte. considered myelogenous cells.
Answer E is incorrect. The periosteal layer is Answer C is incorrect. Platelets are formed
a fibrous connective tissue capsule which from the breakdown of megakaryocytes.
Anatomic Sciences
Answers: 65-75 39
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Answer E is incorrect. B cells are formed Answer A is incorrect. The superior saliva-
from lymphoid cells. They are lymphocytes. tory nucleus functions with the facial nerve to
Note: The process of hematopoiesis begins control motor stimulation to various glands.
with pluripotent stem cells, which are then
Answer C is incorrect. The inferior salivatory
capable of forming lymphoid (T and B cells)
nucleus functions with the glossopharyngeal
or myeloid (granulocyte, monocyte, erythrob-
nerve to control motor stimulation to the
last, megakaryocyte) stem cells. Hematopoiesis
parotid gland.
is regulated by colony stimulating factors and
erythropoietin, mostly, and occurs primarily in Answer D is incorrect. The facial nucleus is
the bone marrow. Lymphocytes then mature a lower motor neuron which controls the
in the lymphatic tissue. muscles of facial movement.
Answer E is incorrect. The nucleus of the
70. The correct answer is B. The chromaffin
solitary tract receives afferents from cranial
cells of the adrenal glands are located within
nerve VII, IX, X, and XI. It functions with
the inner/medullary portion of the gland, and
special sensation (taste).
are of neural crest origin.
Answer A is incorrect. The cells of the zona 73. The correct answer is C. The pharyngeal
fasciculata are of mesodermal origin. plexus is innervated by CNs IX, X, and XI.
Thus, motor innervation is sent to the pha-
Answer C is incorrect. The cells of the zona
ryngeal constrictors (IX and X), palatoglossus
glomerulosa are of mesodermal origin.
(X), palatopharyngeus (XI), and cricopharyn-
Answer D is incorrect. The cells of the zona geus (X).
reticularis are of mesodermal origin.
Answers A, B, D, and E are incorrect. See
above.
71. The correct answer is A. The muscularis
uvula (CN XI) constricts to shorten the
74. The correct answer is C. The stapedius mus-
velum.
cle receives motor stimulus from a branch of
Answer B is incorrect. The palatopharyngeus the facial nerve (CN VII). It is important to
(CN X) depresses the velum, as well as raises distinguish this from innervation to the tensor
and constricts the pharynx. tympani (CN V3).
Answer C is incorrect. The palatoglossal Answer A is incorrect. Cranial nerve V1 does
muscle (CN X) works to raise the velum. not provide motor stimulation to any muscles
of the ear.
Answer D is incorrect. The levator veli pala-
tini (CN X) works to raise the velum. Answer B is incorrect. Cranial nerve V2 does
not provide motor stimulation to any muscles
Answer E is incorrect. The tensor veli pala-
of the ear.
tini (CN V) tenses the velum.
Note: Failure of these muscles to function Answer D is incorrect. Cranial nerve V3 pro-
leads to velopharyngeal incompetence. vides motor innervation to the tensor tympani
(a muscle of the middle ear).
72. The correct answer is B. The nucleus
Answer E is incorrect. Cranial nerve VIII
ambiguus (CN X) is located within the
does not provide motor innervations to any
medulla oblongata, and receives sensory
muscles of the ear. It is purely sensory.
afferents from the pharynx. It sends special
visceral efferents to the pharyngeal con-
75. The correct answer is B. The papillary layer
strictors, palatopharyngeus, levator veli
of the lamina propria contains fingerlike pro-
palatine, palatoglossus, and laryngeal mus-
jections that interdigitate with the epithelial
culature.
rete pegs. This wavy, ridgelike interface can
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be appreciated histologically to differentiate this occurs, the dental papilla nearby follows
between the epithelium and connective suit, and differentiates into odontoblasts.
tissue. Odontoblasts then begin to secrete the dentin
matrix. Enamel matrix deposition then fol-
Answer A is incorrect. The stratum granulo-
lows via ameloblasts.
sum is the layer which contains live cells,
such as squamous cells. Answer A is incorrect. During the cap stage,
the cells of the tooth begin to arrange. The
Answer C is incorrect. The stratum corneum
dental papilla, dental follicle, and enamel
is the outermost layer of cells (nonliving)
organ are all present.
which protect the skin.
Answer C is incorrect. Ameloblasts do not
Answer D is incorrect. The reticular layer of
begin to secrete enamel matrix prior to odon-
the lamina propria is the innermost layer. It is
toblast formation of dentin.
synthesized by connective tissue.
Answer D is incorrect. Ameloblasts begin to
Answer E is incorrect. The stratum spin-
secrete dentin prior to root formation.
osum helps to provide structural support by
synthesizing intermediate filaments to join Answer E is incorrect. Ameloblasts begin to
adjacent cell layers. secrete dentin prior to the cap stage.
76. The correct answer is A. The inner enamel 78. The correct answer is C. The vestibular lam-
epithelium provides the formative cells of the ina separates the lips and cheeks (externally)
enamel structure of teeth. These cells, along from the jaw structures (internally) in the
with the outer enamel epithelium, are con- developing fetus.
sidered the enamel organ, and form during
Answer A is incorrect. The tuberculum
the cap stage of tooth development. The
impar forms the central part of the tongue.
enamel organ is altogether a downgrowth of
the dental lamina. Answer B is incorrect. The buccopharyngeal
membrane separates the primitive stomodeum
Answer B is incorrect. The dental follicle
from the pharynx.
gives rise to cementoblasts, osteoblasts, and
fibroblasts. Answer D is incorrect. Hypobranchial emi-
nence forms the root of the tongue.
Answer C is incorrect. The dental papilla
contains the odontoblasts. It forms the pulp Answer E is incorrect. The lateral lingual
and dentin. swellings form the lateral aspects of the tongue.
Answer D is incorrect. Both the dental folli- 79. The correct answer is B. The ethmoid bone
cle and papilla are not the formative cells of contains the cribriform plate. This structure
the tooth. is located in the superiormost portion of the
Answer E is incorrect. The IEE contains the nasal cavity, and transmits sensory afferents
formative cells of enamel, but not the dental by way of CN I from the olfactory epithe-
papilla. lium. The olfactory nerve projects to the pri-
Note: The tooth germ is comprised of the mary olfactory/pyriform cortex.
enamel organ, dental papilla, and dental Answer A is incorrect. The sphenoid bone
follicle. does not contain the cribriform plate.
77. The correct answer is B. Ameloblasts begin Answer C is incorrect. The frontal bone does
secreting the enamel matrix after the odonto- not contain the cribriform plate.
blasts first form dentin. Preameloblasts are Answer D is incorrect. The maxilla does not
first formed when the inner enamel epithe- contain the cribriform plate.
lium elongates and becomes columnar. Once
Anatomic Sciences
Answers: 76-85 41
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Answer E is incorrect. The vomer does not Answer D is incorrect. C1-C3 forms the ansa
contain the cribriform plate. cervicalis.
Answer E is incorrect. C1 and C2 are part of
80. The correct answer is A. The nasopalatine
the ansa cervicalis.
nerve supplies sensory innervation to the
mucosa of the anterior hard palate. This
83. The correct answer is A. The right carotid
nerve is a branch of CN V3.
artery is a branch of the brachiocephalic
Answer B is incorrect. The middle superior trunk. Once giving off the carotid, the bra-
alveolar nerve supplies sensation to the adult chiocephalic trunk then continues as the sub-
premolars and buccal gingival. It is a branch clavian artery. This then branches off as the
of CN V2. thyrocervical, vertebral, and suprascapular
arteries. The transverse cervical is a branch of
Answer C is incorrect. The posterior supe-
the thyrocervical artery.
rior alveolar nerve supplies sensation to the
adult molars and buccal gingival. It is a Answer B is incorrect. The thyrocervical
branch of CN V2. artery is a branch of the subclavian.
Answer D is incorrect. The greater palatine Answer C is incorrect. The suprascapular
nerve supplies sensation to the hard palate artery is a branch of the subclavian.
mucosa and anterior portion of the soft palate.
Answer D is incorrect. The transverse cervi-
Answer E is incorrect. The lesser palatine cal artery is a branch of the subclavian.
nerve supplies sensation to the soft palate.
Answer E is incorrect. The vertebral artery is
a branch of the subclavian.
81. The correct answer is D. The joint created
between cervical vertebrae 1 (axis) and 2 (atlas)
84. The correct answer is D. The external jugu-
contains no intervertebral disk. This allows for
lar vein is formed by a communication
an increased range of motion for the axis (and,
between the posterior auricular and posterior
thus, the head), on the atlas.
retromandibular veins. This structure drains
Answer A is incorrect. There is an interverte- the skin, parotid gland, and musculature of
bral disk in the joint between C4 and C5. the face and neck before emptying into the
subclavian vein.
Answer B is incorrect. There is an interverte-
bral disk in the joint between C5 and C6. Answer A is incorrect. The retromandibular
vein unites and continues on with the facial
Answer C is incorrect. There is an interverte-
vein.
bral disk in the joint between C2 and C3.
Answer B is incorrect. The maxillary and
82. The correct answer is A. The spinal acces- anterior facial veins do not meet and form
sory nerve is a combination of motor rootlets any structures.
from C1 to C5. Once these nerves unite, they
Answer C is incorrect. The anterior and pos-
pass back through the foramen magnum,
terior retromandibular veins do not meet and
then exit the cranium via the jugular foramen
form any structures.
as CN XI.
Answer E is incorrect. The retromandibular
Answer B is incorrect. C3 is part of the ansa
vein unites and continues on with the facial
cervicalis. C4 is a part of the cervical plexus,
vein.
and C5 part of the brachial plexus, as well as
the cervical plexus. C3-C5 also form the
85. The correct answer is A. The stylomandibular
phrenic nerve.
ligament has its origin at the styloid process,
Answer C is incorrect. C6 is part of the which projects from the temporal bone. The
brachial plexus. ligament then inserts into the angle of the
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mandible. It is also considered an accessory Answer D is incorrect. The auriculotempo-

ligament to the temporomandibular joint. ral nerve (branch of CN V3) provides sensory
innervations to the auricle, tympanic mem-
Answer B is incorrect. The sphenomandibu-
brane, and external auditory meatus. It also
lar ligament has its origin at the sphenoid
innervates skin of the temporal region of the
bone.
head.
Answer C is incorrect. The stylomandibular
Answer E is incorrect. The facial nerve
ligament does not have its origin at the occip-
(CN VII) innervates the muscles of facial
ital bone.
expression.
Answer D is incorrect. The stylomandibular
ligament does not have its origin at the maxil- 89. The correct answer is B. The ansa cervicalis
lary bone. is comprised of cervical nerves 1-3, and pro-
vides motor innervation to the infrahyoid
Answer E is incorrect. Stylomandibular liga-
muscles of the neck (omohyoid, sternohyoid,
ment does not have its origin at the parietal
thyrohyoid, sternothyroid). As a generality,
bone.
these muscles work together to depress the
86. The correct answer is D. The frontal bone hyoid and larynx.
forms as two separate entities, which later Answer A is incorrect. Nerves C4-C6 are not
fuse together to appear as one bone. Occipi- part of the ansa cervicalis. C4 provides inner-
tal, sphenoid, and ethmoid bones each are vations to the cervical plexus and phrenic
unpaired, singular bones of the cranium. nerve. C5 provides innervation to the
Answers A, B, and C are incorrect. See brachial plexus, cervical plexus, and phrenic
above. nerve. C6 is part of the brachial plexus.
Answer C is incorrect. The lesser occipital
87. The correct answer is D. The mylohyoid nerve is a branch of C2 and innervates the
muscle attaches superiorly at the mylohyoid scalp and lateral head.
line, which is located on the medial portion
of the mandible. The muscle then tracks infe- Answer D is incorrect. The greater occipital
riorly and eventually attaches to the body of nerve is a branch of C2. It innervates the
the hyoid bone. scalp and areas of skin covering the parotid
gland.
Answers A, B, C, and E are incorrect. See
above. Answer E is incorrect. C6-C8 are part of the
brachial plexus.
88. The correct answer is C. The mylohyoid
nerve (branch of CN V3) innervates the ante- 90. The correct answer is A. The ophthalmic
rior belly of the digastric muscle, which is artery is a branch of the internal carotid
considered part of the suprahyoid muscula- artery. The other arteries listed in the question
ture of the neck. This nerve also innervates are branches of the external carotid artery, as
the mylohyoid muscle. well as the facial, maxillary, lingual, and tem-
poral arteries.
Answer A is incorrect. The inferior alveolar
nerve (branch of CN V3) innervates the den- Answer B is incorrect. The ascending pha-
tition of the mandible. It continues on anteri- ryngeal artery is a branch of the external
orly as the mental nerve. carotid artery.
Answer B is incorrect. The mental nerve Answer C is incorrect. The superior thyroid
(branch of CN V3), a continuation of the artery is a branch of the external carotid artery.
inferior alveolar nerve, innervates the lower Answer D is incorrect. The posterior auricular
lip and buccal mucosa of anterior mandible. artery is a branch of the external carotid artery.
Anatomic Sciences
Answers: 86-96 43
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Answer E is incorrect. The occipital artery is Answer E is incorrect. The core of the dental
a branch of the external carotid artery. pulp contains the tooth’s vasculature and
nerve supply.
91. The correct answer is B. The crista galli is a
superior projection of the ethmoid bone. It is 94. The correct answer is B. The stratum basale
located in the midline of the cranium. of the skin and the spermatogonium (of the
Sertoli cell) are similar relative to the fact
Answers A, C, D and E are incorrect. See
they are both the least differentiated, most
above.
immature cellular layer in the development
92. The correct answer is B. As one is preparing of their respective structures.
a cavity preparation on the crown of a perma- Answer A is incorrect. The spermatid is a
nent tooth, once the bur penetrates through form of male gamete. It is 11/2N.
the enamel and meets the dentinoenamel
Answer C is incorrect. The primary sperma-
junction, from the list given in the question,
tocyte is a form of male gamete. It is 2N
the first structure penetrated would be the
(diploid).
mantle dentin, which is classified as the ini-
tial 150-µm dentin laid down in a tooth. The Answer D is incorrect. The secondary sper-
odontoblast then secretes dentin matrix as it matocyte is a form of male gamete. It is N
retreats toward the pulp. (haploid).
Answer A is incorrect. The circumpulpal Answer E is incorrect. The junctional com-
dentin, as well as odontoblasts, would be plex consists of tight junction, intermediate
located nearer the pulp. junction, and desmosome.
Answer C is incorrect. Odontoblasts are
95. The correct answer is A. The macula densa
located most closely to the pulp.
is a structure which is located on the distal
Answer D is incorrect. Radicular dentin is convoluted tubule. It is a specialized collec-
within the root, thus, would not first be tion of cells that function as part of the juxta-
encountered in preparing the crown of a glomerular apparatus (along with the juxta-
tooth. glomerular cells) to monitor body fluid
concentration, and, thus, systemically release
Answer E is incorrect. Circumpulpal dentin
renin when appropriate.
is the layer just occlusal to that of the odonto-
blasts. Answer B is incorrect. The Bowman capsule
is a part of the nephron. It initially filters the
93. The correct answer is D. Raschkow (parietal) solute through which will enter the nephron.
plexus is located within the cell free zone of
Answer C is incorrect. The loop of Henle is
Weil, a portion of the pulp which is lacking
a part of the nephron. Its primary function is
cellular material in the mature tooth. Also
reabsorption of water and solutes via a coun-
located here is vasculature of the tooth.
tercurrent multiplier.
Answer A is incorrect. The cementum layer
Answer D is incorrect. The proximal convo-
of the tooth contains attachments of the peri-
luted tubule is a part of the nephron. Its pri-
odontal ligament fibers.
mary function is the reabsorption of sodium.
Answer B is incorrect. The cell rich zone of
Answer E is incorrect. The collecting duct is
the pulp contains undifferentiated mesenchy-
a part of the nephron. Its primary function is
mal cells. It also contains fibroblasts.
the reuptake of water.
Answer C is incorrect. The dentin layer of
the tooth contains odontoblastic processes 96. The correct answer is D. Of the following
and other proteins. options, the lingual root of the maxillary 1st
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molar would have the highest probability of most likely be displaced in an anterior
becoming dislodged into the maxillary sinus direction, necessitating hand manipulation
upon excessive force of a hand instrument in of the mandible to reseat the condylar heads
an apical direction. The maxillary sinus typi- in the glenoid fossa. In the case of subluxa-
cally dips down inferiorly as it encounters the tion, the joint will autoreduce.
region of the maxillary 1st molar. Thus, as
Answer A is incorrect. The mandibular
the other options are placed anterior to this
condyles most likely would not luxate in a
location, they would have a lower probability
posterior and superior direction. This is
of sinus penetration than the lingual root of
because the articular eminence does not
the maxillary 1st molar.
interrupt its path back into the joint.
Answer A is incorrect. The buccal root of the
Answer B is incorrect. The mandibular
maxillary 1st premolar would not typically
fracture and become dislodged in the maxil-
posterior and inferior direction. This is
lary sinus. In most cases, it is placed too far
because the articular eminence does not
anteriorly.
interrupt its path back into the joint.
Answer B is incorrect. The root of the maxil-
Answer C is incorrect. The mandibular
lary canine would not typically fracture and
condyles most likely would not luxate in a lat-
become dislodged in the maxillary sinus. In
eral and inferior direction. This is because
most cases, it is placed too far anteriorly.
the articular eminence does not interrupt its
Answer C is incorrect. The root of the maxil- path back into the joint.
lary lateral incisor would not typically fracture
Answer E is incorrect. The mandibular
and become dislodged in the maxillary sinus.
In most cases, it is placed too far anteriorly.
medial direction. This is because the articular
Answer E is incorrect. The lingual root of eminence does not interrupt its path back
the maxillary 1st premolar would not typi- into the joint.
cally fracture and become dislodged in the
maxillary sinus. In most cases, it is placed too 99. The correct answer is D. The inferior alveo-
far anteriorly. lar artery directly branches from the maxillary
artery, which in turn is a branch of the exter-
97. The correct answer is E. The parietal bone nal carotid artery.
does not articulate with the zygoma.
Answer A is incorrect. The inferior alveolar
Answer A is incorrect. The zygoma articu- artery does not branch from the middle
lates with the temporal bone posteriorly. meningeal artery. The middle meningeal artery
is a branch of the internal carotid and enters the
Answer B is incorrect. The zygoma articu-
skull through foramen spinosum. The middle
lates with the maxilla anteriorly.
meningeal artery is medial to the TMJ and can
Answer C is incorrect. The zygoma articu- be injured during TMJ procedures.
lates with the frontal bone superiorly.
Answer B is incorrect. The inferior alveolar
Answer D is incorrect. The zygoma articu- artery does not branch directly from the facial
lates with the sphenoid bone (specifically the artery. The facial artery first branches off into
greater wing) medially. the maxillary artery before it gives off the
inferior alveolar.
98. The correct answer is D. Luxation of the
mandible occurs when the lower jaw becomes Answer C is incorrect. The inferior alveolar
overextended in a manner that causes the artery does not branch directly from the exter-
condyles to sufficiently translate over the nal carotid artery. The external carotid first
articular eminence. Thus, the condyles will branches off as the facial and then maxillary
artery prior to the inferior alveolar.
Anatomic Sciences
Answers: 97-104 45
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Answer E is incorrect. The inferior alveolar Answer A is incorrect. Insulin is produced in

artery does not branch from the buccal artery. the pancreatic beta cells of the islet of
This artery is a branch of the maxillary Langerhans.
artery.
Answer B is incorrect. Trypsinogen is a proen-
zyme produced by the exocrine pancreas.
100. The correct answer is C. Bile is formed by
hepatocytes within the liver. From here, bile Answer C is incorrect. Glucagon is pro-
is transported and stored within the gall blad- duced in the pancreatic alpha cells of the
der until it receives stimuli from enzymes islet of Langerhans.
which are secreted by the stomach and duo-
Answer E is incorrect. The exocrine func-
denum. From here, bile travels through a net-
tion of the pancreas would not be disturbed
work of ducts from the gall bladder and even-
in this situation.
tually is deposited into the duodenum by way
of the ampulla of Vater. 103. The correct answer is A. Eccrine, not apoc-
Answer A is incorrect. The head of the pan- rine, glands are involved with regulating body
creas produces insulin and glucagon, amongst temperature. Eccrine glands, also known as
other digestive enzymes. sweat glands, also have myoepithelial and
duct cells, as well as clear and dark, and are
Answer B is incorrect. The gall bladder
located throughout the body (except on lips
stores the bile which is produced by the liver.
and portions of the external genitalia).
Answer D is incorrect. The tail of the pan- Eccrine cells receive sympathetic cholinergic
creas produces insulin and glucagon, amongst innervation.
other digestive enzymes.
Answer B is incorrect. Apocrine glands pro-
Answer E is incorrect. The duodenum produce pheromones.
duces the digestive enzymes cholecystokinin
Answer C is incorrect. Secretion of apocrine
and secretin.
glands is via myoepithelial cells.
101. The correct answer is C. The medulla Answer D is incorrect. Apocrine gland secre-
houses the nuclei of cranial nerves IX, X, and tion is strictly serous fluid.
XII, thus, impairment of certain functions
Answer E is incorrect. Apocrine sweat
involving the glossopharyngeal, vagus, and
gland cells receive sympathetic adrenergic
hypoglossal nerves.
innervation.
Answer A is incorrect. CN V and VII nuclei
are located in the pons. 104. The correct answer is E. Fertilization occurs
in the ampulla, which is the longest exten-
Answer B is incorrect. CN III and IV
sion of the oviduct (a part of the fallopian
nuclei are located in the midbrain. CN VI
tubes).
is in the pons.
Answer A is incorrect. The uterus is the site
Answer D is incorrect. CN XI nucleus is
of embryonic and fetal development.
located in the medulla.
Answer B is incorrect. The endometrium is
Answer E is incorrect. CN V nucleus is
the layer of the uterus which the zygote
located in the pons.
implants into (or is shed during menstruation).
102. The correct answer is D. Somatostatin is pro- Answer C is incorrect. The ovary is the site
duced by delta cells of the endocrine pan- of ovum development.
creas (ie, pancreatic islet cells). Somatostatin
Answer D is incorrect. The cervix produces
functions to inhibit glucagon and insulin.
fluid which bathes the vaginal cavity.
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105. The correct answer is A. Hemidesmosomes Answer B is incorrect. Segmental bronchi

provide attachment of the epithelial layer of are a continuation of the lobar bronchi, and
the cell to the connective tissue layer. lead into the bronchioles.
Answer B is incorrect. Zonula adherens (inter- Answer D is incorrect. Alveoli are the termi-
mediate junction) is a beltlike junction around nal end of the bronchioles.
a cell while leaving an intercellular space.
Answer E is incorrect. Lobar bronchi are
Answer C is incorrect. Zonula occludens branches of the main stem bronchi, and lead
(tight junction) is a beltlike junction around into the segmental bronchi.
a cell which closes-off intercellular spaces
between cells. 108. The correct answer is D. Hilar lymph nodes
are located at the root of the lungs, and thus
Answer D is incorrect. Desmosomes (mac-
are involved in lymphatic drainage of the
ula adherens) provide localized adhesion
lungs.
between adjacent cells.
Answer B is incorrect. The supraclavicular
Answer E is incorrect. Gap junctions allow
nodes drain the head and neck, and are
cell-to-cell communication.
located laterally at the base of the neck, supe-
rior to the clavicle.
106. The correct answer is B. The muscle spindle
apparatus, which senses proprioception within Answer C is incorrect. Superficial cervical
a muscle, communicates with the CNS via nodes are located along the sternocleido-
A-gamma fibers. mastoid muscle and drain the head and
neck.
Answer A is incorrect. Touch sensation is
mediated by A-beta fibers. Answer E is incorrect. The occipital nodes
are located at the posterior base of the skull
Answer C is incorrect. Pressure sensation is
and drain the scalp.
mediated by A-beta fibers.
Answer D is incorrect. Temperature sensa- 109. The correct answer is E. The lingual nerve
tion is mediated by C fibers. provides presynaptic efferents to the submax-
illary ganglion.
Answer E is incorrect. Sharp pain sensation
is mediated by A-delta fibers. Answer A is incorrect. The inferior alveolar
Note: A-alpha fibers function with proprio- nerve gives postsynaptic sensory innervation
ception and motor nerves, A-beta with sen- to the teeth of the mandible.
sory, touch, and pressure, and A-delta with
Answer B is incorrect. The facial nerve
sharp pain, temperature, and touch. B fibers
mainly provides motor innervation to the
are involved with preganglionic autonomic
muscles of facial expression.
nerves, and C fibers with dull pain, tempera-
ture, and postganglionic autonomic nerves. Answer C is incorrect. The buccinator nerve
innervates the buccinator muscle.
107. The correct answer is C. The trachea extends
Answer D is incorrect. The maxillary nerve
inferiorly in the superior mediastinum and
provides mainly sensory innervation to struc-
bifurcates (marked by the carina) into right
tures of the midface/maxillary region.
and left main stem bronchi. Main stem
bronchi then divide (as they course inferiorly 110. The correct answer is D. The sublingual
in each lung) into lobar bronchi, segmental gland drains into the oral cavity via the rivian
bronchi, bronchioles, and then alveoli. ducts.
Answer A is incorrect. Bronchioles are a con- Answer A is incorrect. The parotid gland
tinuation of the segmental bronchi, and lead drains by Stensen duct into the oral cavity.
into the alveoli.
Anatomic Sciences
Answers: 105-115 47
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Answer C is incorrect. The lacrimal glands Mesenchymal cells of the neural tube give
drain via numerous interlobular ducts onto rise to microglia.
the globe.
Answer A is incorrect. The ependymal cells
Answer B is incorrect. The sebaceous glands are formed from neuroepithelial cells. They
empty into sweat pores. form the epithelial lining of the ventricles of
the brain.
Answer E is incorrect. The mammary glands
drain by way of lactiferous ducts. Answer C is incorrect. The astrocytes are
formed from neuroepithelial cells. They are
111. The correct answer is C. The pronephros glial cells of the brain which work with
does not give rise to any structures of the endothelial cells.
adult kidney. Rather, it regresses shortly after
Answer D is incorrect. The neuroblasts are
formation in the 4th week of fetal develop-
formed from neuroepithelial cells. They give
ment. The pronephros forms first, followed
rise to neurons and glia.
by the mesonephros (gives rise to
mesonephric duct and ureteric bud) and Answer E is incorrect. The oligodendrocytes
then metanephros (the adult kidney, formed are formed from neuroepithelial cells. They
by ureteric bud and metanephric mass). The offer insulation to axons.
early adult kidney forms in the pelvis before
ascending into the abdominal region. 114. The correct answer is D. Once fertilization
occurs, the zygote undergoes cell division
Answer A is incorrect. The ureteric bud con-
and cleavage. The first cell division leads to
tributes to the adult kidney.
the blastomere (×2), then after multiple
Answer B is incorrect. The mesonephros cleavage divisions, the morula forms, fol-
gives rise to the ureteric bud and mesonephric lowed by the blastula.
duct.
Answer A is incorrect. The blastomere forms
Answer D is incorrect. The mesonephros before the morula.
forms before the metanephros.
Answer B is incorrect. The zygote forms
Answer E is incorrect. The kidney initially before the morula, and the blastomere prior
forms in the pelvic region. to formation of the morula.
Answer C is incorrect. The zygote forms
112. The correct answer is A. The Wolffian duct
first, followed by the blastomere, morula, and
is synonymous with the mesonephric duct.
blastula.
Thus, it develops (in the male) into the
ductus deferens, epididymis, ejaculatory Answer E is incorrect. This order is reversed
duct, and seminal vesicles. It is obliterated in from the correct one.
females.
115. The correct answer is C. The zona pellucida
Answers B, C, D and E are incorrect. The
protects the zygote from the initial fertiliza-
ureter, the collecting tubules, the ovaries and
tion up until the multiple cleavages have
the uterus are NOT formed from the Wolffian
occurred through the blastula stage. Once
duct.
the blastula forms, the zona pellucida breaks
down, and implantation into endometrial tis-
113. The correct answer is B. Leptomeninges are
sue of the uterus occurs.
formed from neural crest cells. The neural
crest gives rise to sensory ganglia, dorsal root Answer A is incorrect. The zona pellucida
ganglia, Schwann cells, enterochromaffin cells, has already disintegrated by this point.
melanocytes, odontoblasts, parasympathetic/
Answer B is incorrect. The zona pellucida
sympathetic ganglia, and parafollicular cells.
has already disintegrated by this point.
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Answer D is incorrect. The zona pellucida This motion begins with tapping of the chin
has already disintegrated by this point. (mouth open in a physiologic rest position),
thus, activating proprioceptive afferents of V3.
Answer E is incorrect. The zona pellucida
Upon processing, efferents are sent by way of
has already disintegrated by this point.
V3 which causes closure of the mouth.
116. The correct answer is A. Normal pregnancy Answer A is incorrect. CN V1 is responsible
involves implantation of the cleaved zygote for sensation on the forehead and part of the
into the uterine endometrial walls. Thus, if upper face.
implantation does not occur here, it is con-
Answer C is incorrect. CN VII is responsi-
sidered ectopic.
ble for movement of the muscles of facial
Answers B, C, D, and E are incorrect. The expression.
ovaries, the fallopian tubes, the cervix and the
Answer D is incorrect. CN V2 is responsible
abdomen are potential locations of ectopic
for sensation in the midface.
pregnancy.
Answer E is incorrect. CN IX is responsible
117. The correct answer is A. Regarding sperm for motor innervations to the stylopharyngeus
development, the 2nd meiotic cell division muscle and special sensation to the tongue.
does not occur until postfertilization of the
ovum. Thus, the most likely place for this to 120. The correct answer is C. The carotid sheath
occur is within the uterine tube (where the lies posterior to the thyroid gland. It contains
sperm typically fertilizes the ovum). the common carotid artery, jugular vein, and
vagus nerve, as well as sympathetic nerves,
Answers B, C, D and E are incorrect. Meio-
lymph nodes, and carotid sinus nerve. The
sis II has not yet occurred at these points in
sheath begins at the root of the neck, extend-
development.
ing medial to the sternocleidomastoid muscle
118. The correct answer is B. The masseter and anterior to the scalene musculature,
receives innervation from the 3rd branch of bilaterally, up to the base of the cranium.
the trigeminal nerve. Answer A is incorrect. The sternocleidomas-
Answer A is incorrect. The risorius is inner- toid muscle lies lateral to the carotid sheath
vated by CN VII. This muscle is involved in the cervical region.
with movement of the angle of the mouth. Answer B is incorrect. The carotid sheath
Answer C is incorrect. The orbicularis oris is lies anterior to the scalene musculature in the
innervated by CN VII. This muscle is cervical region.
involved with puckering of the lips. Answer D is incorrect. The carotid sheath
Answer D is incorrect. The mentalis is contains the vagus nerve, jugular vein, and
innervated by CN VII. This muscle elevates common carotid artery.
the skin on the chin. Answer E is incorrect. The carotid sheath is
Answer E is incorrect. The buccinator is associated with the carotid sinus nerve, sym-
innervated by CN VII. This muscle compresses pathetic nerves, and lymph nodes.
the buccal mucosa up against the dentition.
121. The correct answer is D. The vagus nerve is
Note: Also innervated from CN VII is
contained within the anterior triangle of the
the platysma, orbicularis oculi, frontalis,
neck.
stapedius, and occipitalis muscles.
Answer A is incorrect. CN XII passes
119. The correct answer is B. The mandibular through the submandibular triangle prior to
branch of the trigeminal nerve is responsible inserting into and innervating the tongue
for the efferent signaling of the jaw-jerk reflex. musculature.
Anatomic Sciences
Answers: 116-126 49
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Answer B is incorrect. The nerve to the Answer C is incorrect. The spinal trigeminal
mylohyoid passes through the submandibular nucleus mediates pain and temperature.
triangle prior to innervating the mylohyoid
Answer D is incorrect. The mesencephalic
muscle.
nucleus mediates proprioception.
Answer C is incorrect. The lingual artery
Answer E is incorrect. The motor nucleus of
passes through the submandibular triangle
V mediates motor sensation to masticatory
after branching from the inferior alveolar
musculature.
artery and prior to inserting into the tongue.
Answer E is incorrect. The submandibular 124. The correct answer is C. The caloric test is
gland rests within the submandibular triangle. one of which nystagmus is initiated by appli-
Note: The submandibular triangle is cation of warm and then cool water to the
bounded inferiorly by the bellies of the external auditory meatus. For example, cool
digastrics and superiorly by the inferior bor- water stimulation applied to the right ear will
der of the mandible, the “roof” being the cause nystagmus to the left side, and warm
skin, superficial fascia, platysma, and deep water stimulation to the right ear will cause
fascia, and the “floor” being the mylohyoid nystagmus to the right side.
and hyoglossus muscles. This formed area Answer A is incorrect. Nystagmus can occur
contains the submandibular gland and lymph when irritation occurs to any or all of the fol-
nodes, hypoglossal and mylohyoid nerves, lowing: labyrinth, vestibular nerve/nuclei,
and lingual and facial arteries/veins. cerebellum, visual system, and cerebral cortex.
122. The correct answer is C. The T4 dermatome Answer B is incorrect. Nystagmus itself is a
refers pain to the area of the nipples. fast, involuntary movement of the eyes.
Answer A is incorrect. As for the xiphoid Answer D is incorrect. This is a test of the
process, it is relative to the T7 dermatome. vestibuloocular reflex, involving CN VIII.
Answer B is incorrect. The umbilicus refers Answer E is incorrect. Nystagmus involves
to the T10 dermatome. CN VIII lesions.
Answer D is incorrect. The inguinal liga- 125. The correct answer is B. Damage to the tec-
ment refers to the L1 dermatome. tospinal tract of the spinal cord would affect
Answer E is incorrect. The neck refers to the movement of the head.
C3 dermatome. Answer A is incorrect. The lateral spinothala-
mic tract of the spinal cord transmits sensa-
123. The correct answer is A. The main motor
tion of pain and temperature.
nucleus of the facial nerve is involved with motor
movements of the facial musculature involved Answer C is incorrect. The vestibulospinal
with expression. Thus, as the orbicularis oculi tract transmits equilibrium sense.
muscle mediates closing of the eyelids and its Answer D is incorrect. The reticulospinal
motor innervation is received via CN VII, one tract carries sensation involved with muscle
must suspect damage to the main motor nucleus tone and sweat gland function.
of VII. Also affected by damage to this nuclei
includes other muscles of facial expression, poste- Answer E is incorrect. The anterior spinothala-
rior belly of the digastric, stylohyoid, and mic tract transmits touch and pressure sensation.
stapedius muscles. Musculature which is
involved with the upper face would be affected 126. The correct answer is A. Smooth endoplas-
bilaterally, and of the lower face unilaterally. mic reticulum is an intracellular organelle
which has differing functions dependent on
Answer B is incorrect. The nucleus of the its cellular location. For example, within the
solitary tract mediates taste sensation.
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liver, the SER is involved in the metabolism which changes the lining layer from squa-
of glycogen and lipids, whereas in the adrenal mous to columnar (especially in the lower
cortex and testis, it functions in steroid esophagus → as with Barrett esophagus).
anabolism as well as calcium sequestrum in
Answer B is incorrect. Columnar epithelium
skeletal and cardiac muscle.
is found in the stomach and intestines,
Answer B is incorrect. Lysosomes contain amongst other areas.
digestive enzymes which breakdown invading
Answer C is incorrect. Keratinized stratified
pathogens and dead cells.
squamous epithelium is found comprising
Answer C is incorrect. Peroxisomes contain the outer covering of skin.
enzymes which breakdown toxic products in
Answer D is incorrect. Cuboidal epithelium
the cell.
is found lining the kidney tubules.
Answer D is incorrect. Rough endoplasmic
Answer E is incorrect. Pseudostratified
reticulum is an organelle which produces
squamous epithelium is found lining the
proteins within a cell.
trachea.
Answer E is incorrect. Mitochondria are
organelles which produce the majority of 129. The correct answer is A. Sperm travels to the
ATP in a cell. epididymis, where it matures and is stored
until ejaculation.
127. The correct answer is D. Parafollicular cells
Answer B is incorrect. The urethra serves as
are located within the thyroid gland. Their
a pathway for the exit of ejaculate and urine
function is to secrete calcitonin, which acts on
from the male body.
the intestines, kidneys, and osteoclasts, to ulti-
mately decrease the level of blood calcium. Answer C is incorrect. The testis produces
male sex hormones.
Answer A is incorrect. Cortical bone does
not contain parafollicular cells. Answer D is incorrect. Sperm is produced in
the seminiferous tubules (of the testis).
Answer B is incorrect. The kidney does not
contain parafollicular cells. They do, though, Answer E is incorrect. The prostate gland
contain other cells which produce hormones provides the fluid which mixes with sperm
involved with acid-base balance. prior to ejaculation.
Answer C is incorrect. The small intestine 130. The correct answer is B. The skin uses ultravio-
does not contain parafollicular cells. They let light to produce vitamin D. Vitamin E is an
contain cells which produce digestive essential vitamin, which must be ingested by
enzymes, though. humans. The skin functions include protection,
Answer E is incorrect. The parathyroid gland homeostasis, synthesis, sensation, and excretion.
does not contain parafollicular cells. They Answer A is incorrect. The skin functions to
contain parathyroid cells which produce achieve the sensation of touch, pain, and
parathyroid hormone. pressure.
128. The correct answer is A. The esophagus, in Answer C is incorrect. The skin serves to
normal conditions, is lined with nonkera- excrete via sweat glands.
tinized stratified squamous epithelium. This Answer D is incorrect. The skin functions
type of epithelium is found in areas of the include homeostatic regulation of body tem-
body which are continually kept moist, and is perature.
a protective layer which turns over rapidly.
Thus, in states of esophageal pathology, meta- Answer E is incorrect. The skin provides pro-
plastic changes may occur in the epithelium tection against physical and chemical stresses.
Anatomic Sciences
Answers: 127-136 51
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131. The correct answer is C. The sphincter of Answer C is incorrect. The tubuloacinar
Boyden is located in the common bile duct. cells are a combination of tubular and acinar
cells, and comprise the major salivary glands.
Answer A is incorrect. The ampulla of Vater
contains the sphincter of Oddi, which allows Answer E is incorrect. Apocrine cells are
communication between pancreatic duct and defined by their secretory mechanism (as they
common bile duct. are defined by their secretory unit), thus, having
their secretory portion released into the cyto-
Answer B is incorrect. The lower esophageal
plasm. Examples of such are mammary and
sphincter seals the opening into the stomach.
apocrine sweat glands.
Answer D is incorrect. The rectum contains
an internal and external sphincter. 134. The correct answer is B. The red marrow
does NOT contain fatty cells, although, it is the
Answer E is incorrect. The pyloric sphincter
predominant marrow type in the mandibular
separates the stomach from the duodenum.
ramus and condyles.
132. The correct answer is A. The posterior 1/3 of Answer A is incorrect. Both types of marrow
the tongue drains directly into the deep cervi- are located within the medullary spaces of
cal lymph nodes. spongy bone.
Answer B is incorrect. The submental nodes Answer C is incorrect. The red marrow does
drain the tip of the tongue, anterior floor of also contain hematopoietic cells.
mouth, and anterior buccal mucosa/lip region.
Answer D is incorrect. Yellow marrow con-
Answer C is incorrect. The submandibular tains fatty cells, and is the predominant mar-
nodes drain the anterior 2/3 of the tongue, row type of the maxilla and mandible.
submental nodes, upper lip, cheek, gingiva of
Answer E is incorrect. Yellow marrow is the
hard palate, all teeth (except mandibular
predominant marrow type in the maxilla and
anteriors), and posterior floor of mouth.
mandible.
Answer D is incorrect. The rectopharyngeal
nodes drain the posterior nasal cavity, 135. The correct answer is A. The nasal cavities
nasopharynx, soft palate, middle ear, and are lined by stratified squamous epithelium
external auditory meatus. to withstand stresses, pseudostratified ciliated
columnar which aid in absorption, and spe-
Answer E is incorrect. The supraclavicular
cialized olfactory cells for smelling sense.
nodes receive lymphatic drainage from the
entire body, and are common sites of metastasis. Answers B, C, D and E are incorrect. The
nasal cavity is not lined by these types of
133. The correct answer is D. The cardiac glands epithelium.
of the gastric mucosa are exocrine acinar
glands. These types of glands are defined by 136. The correct answer is D. The superior laryn-
their secretory portion which is a saclike dila- geal artery does not supply blood to the tongue;
tion. The other exocrine glands listed in it supplies the musculature of the larynx.
question 133 are not particularly involved
Answer A is incorrect. The facial artery
with the gastric mucosa.
(specifically its branches) supplies blood to
Answer A is incorrect. Coiled glands have a the tongue. It is a branch of the external
secretory portion shaped like a coiled tube, carotid artery.
and an example is the eccrine sweat gland.
Answer B is incorrect. The ascending pha-
Answer B is incorrect. The tubular cells have ryngeal artery supplies blood to the tongue. It
a tube-shaped secretory portion, and are is a branch of the external carotid artery.
involved in intestinal glands.
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Answer C is incorrect. The lingual artery Answer E is incorrect. CN IX does not pro-
supplies blood to the tongue. It is a branch of vide motor innervation to the tongue. It
the external carotid artery. innervates the stylopharyngeus muscle.
Answer E is incorrect. The external carotid
139. The correct answer is A. Receptors for sweet
artery (specifically its branches) supplies
sensation are mostly congregated at the ante-
blood to the tongue.
rior tip of the tongue.
137. The correct answer is E. The palatoglos- Answer B is incorrect. As for salt receptors,
sus inserts on the posterolateral portion of they are bilaterally located, just a bit posterior
the tongue, and, thus, would not be dam- to the sweet receptors.
aged if the anterior portion of the tongue
Answer C is incorrect. Bitter taste receptors
was lacerated.
are mostly found at the posterior portion of
Answer A is incorrect. The longitudinal mus- the tongue.
cle (intrinsic muscle of the tongue) could
Answer D is incorrect. Sour taste is sensed
possibly be affected in this situation.
bilaterally in the middle portion of the tongue.
Answer B is incorrect. The styloglossus
(extrinsic muscle of the tongue) inserts into 140. The correct answer is A. Somites are comprised
the tongue near its anterior portion. Thus, it of mesoderm and line the primitive neural tube.
could possibly be damaged in this situation. They eventually form dermatomes, myotomes,
and sclerotomes. Sclerotome cells develop
Answer C is incorrect. The hyoglossus
into vertebrae and ribs.
(extrinsic muscle of the tongue) inserts into
the tongue near its anterior portion. Thus, it Answer B is incorrect. Myotomes form skele-
could possibly be damaged in this situation. tal muscle components of the body.
Answer D is incorrect. The transverse Answer C is incorrect. Dermatomes eventu-
(intrinsic muscle of the tongue) could possi- ally develop into connective tissue of the skin.
bly be affected in this situation. Answer D is incorrect. Myotomes form
skeletal muscle components of the body.
138. The correct answer is B. The vagus and
hypoglossal nerves provide motor innervation Answer E is incorrect. Myotomes form skele-
to the tongue. Cranial nerve X innervates the tal muscle components of the body.
palatoglossus muscle, which elevates the
tongue. The other extrinsic muscles are inner- 141. The correct answer is D. The formation of the
vated by cranial nerve XII (genioglossus (pro- inferior nasal turbinate/concha is not altered
trusion), hyoglossus (depression), and styloglos- in a complete bilateral cleft palate. In this situ-
sus (retraction)). The intrinsic musculature of ation, there is incomplete fusion of the lip, pri-
the tongue is also innervated by the hypoglossal mary (anterior) palate, secondary (posterior)
muscle. palate, and alveolar process. Thus, surgical
closure is necessary to restore normal anatomy.
Answer A is incorrect. CN VII does not pro-
vide motor innervation to the tongue. It Answers A, B, C, and E are incorrect. For-
innervates the muscles of facial expression. mation of these are compromised in com-
plete bilateral palatal clefting.
Answer C is incorrect. CN VII does not pro-
vide motor innervation to the tongue. It 142. The correct answer is B. Fusion of the
innervates the muscles of facial expression. reduced enamel epithelium with oral epithe-
Answer D is incorrect. CN V does not pro- lium marks eruption of a tooth. This action
vide motor innervation to the tongue. It forms the dentogingival junction/epithelial
innervates the muscles of mastication. attachment.
Anatomic Sciences
Answers: 137-147 53
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Answer A is incorrect. Elongation of the cer- of erythrocytes. The other cells would not
vical loop and formation of HERS is indica- cause such to occur.
tive of the root formation stage.
Answer A is incorrect. Increased breakdown
Answer C is incorrect. Disappearance of the of neutrophils would not cause high levels of
enamel knot occurs in the bell stage. bile excretion.
Answer D is incorrect. The cap stage Answer B is incorrect. Increased breakdown
demonstrates formation of the enamel organ. of eosinophils would not cause high levels of
bile excretion.
Answer E is incorrect. Merging of the OEE
with IEE occurs during the appositional Answer D is incorrect. Increased breakdown
stage. of platelets would not cause high levels of
bile excretion.
143. The correct answer is A. Cartilage is an avas-
Answer E is incorrect. Increased breakdown
cular substance. This type of substance is
of macrophages would not cause high levels
formed by chondroblasts secreting an exten-
of bile excretion.
sive extracellular matrix.
Answer B is incorrect. Chondrocytes reside 146. The correct answer is A. GCF is a fluid that
in lacunae once they have completed deposi- is comprised of numerous cellular elements,
tion of cartilaginous matrix. such as PMNs and leukocytes.
Answer C is incorrect. These chondroblasts Answer B is incorrect. The GCF contains
then reside as chondrocytes within their indi- plasma proteins and epithelial cells.
vidual lacunae.
Answer C is incorrect. GCF is not contained
Answer D is incorrect. Cartilage can be spe- within the vestibule of the buccal mucosa.
cialized in different areas of the body (ie, hya-
Answer D is incorrect. It functions in the
line, elastic, and fibrocartilage).
immune response, and some studies have shown
Answer E is incorrect. Cartilage can grow by that hyperactivity of such reaction may have
both interstitial and appositional stages. implications regarding periodontal disease.
Answer E is incorrect. Bacteria are also
144. The correct answer is C. The typical func-
found in this fluid, which is contained mostly
tion of megakaryocytes is fragmentation into
within the gingival sulcus.
platelets. Platelets are the primary factor
involved in the clotting of blood.
147. The correct answer is C. When excessive fluo-
Answer A is incorrect. Monocytes form ride uptake occurs in patients, they tend to suf-
macrophages. fer clinically from a brown pigmentation and
mottling of their teeth. This process occurs
Answer B is incorrect. B cells are lymphocytes
prior to eruption of the teeth, where excessive
which are involved with the immune reaction.
fluoride is detrimental. Once the teeth erupt,
Answer D is incorrect. Erythroblasts form fluoride treatment helps to improve the strength
red blood cells. of the tooth by substituting with oxygen to form
Answer E is incorrect. Granulocytes form fluorapatite (rather than hydroxyapatite).
white cells. Answer A is incorrect. Congenital syphilis
presents with Hutchinson incisor and Mul-
145. The correct answer is C. When the body berry molars.
breaks down erythrocytes, the by-products are
excreted by the liver in the form of bile pig- Answer B is incorrect. Nutritional deficiency
ment. Thus, high levels of bile pigment would result in hypocalcification of the
would be indicative of increased breakdown formed tooth.
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Answer D is incorrect. Hypocalcification branches from the celiac trunk, the gastroduo-
would present as a chalky white tooth which denal artery gives rise to the right gastric and
is soft. right gastroepiploic arteries. The right gas-
troepiploic artery then courses along the stom-
Answer E is incorrect. Hypomineralization
ach where it continues as the left gastroepi-
typically causes hypocalcification of the tooth.
ploic artery. The left gastroepiploic artery is
148. The correct answer is E. The gag reflex is attached to the splenic artery.
mediated via both the glossopharyngeal and Answer A is incorrect. The right gastric and
vagus nerves. Stimuli which activates such hepatic proper arteries do not anastomose
activates afferents by way of CN IX. This into the gastroepiploic artery.
occurs in a unilateral fashion. Efferents are
Answer B is incorrect. The left and right gas-
then sent out via CN X bilaterally to cause
tric arteries do not anastomose into the gas-
constriction of the pharyngeal musculature.
troepiploic artery.
Answer A is incorrect. CN XII would not be
Answer C is incorrect. The right gastric and
involved in this reflex. It provides motor
short gastric arteries do not anastomose into
innervation to the tongue.
the gastroepiploic artery.
Answer B is incorrect. CN V would not be
Answer E is incorrect. The hepatic proper
involved in this reflex. It provides motor
and splenic arteries do not anastomose into
innervation to the muscles of mastication.
the gastroepiploic artery.
Answer C is incorrect. CN IX would not be
affected in the efferent output of the gag reflex. 151. The correct answer is D. The supraoptic
It is responsible for the afferent aspect of it. nucleus controls the body’s balance of water.
This nucleus is located within the hypothala-
Answer D is incorrect. CN VII would not be
mus. Production of such hormones as antidi-
involved in this reflex. It is responsible for
uretic and oxytocin are produced here and
innervation of the muscles of facial expression.
released upon stimulation.
149. The correct answer is D. The pulmonary Answer A is incorrect. Aggression is controlled
vein does not carry deoxygenated blood. This by the septal nucleus of the hypothalamus.
vein receives oxygenated blood from the
Answer B is incorrect. Satiety is controlled
lungs and returns it to the heart.
by the pineal gland of the epithalamus.
Answer A is incorrect. The hepatic vein car-
Answer C is incorrect. Hunger is controlled
ries deoxygenated blood from the liver to the
by the pineal gland of the epithalamus.
inferior vena cava.
Answer E is incorrect. The circadian rhythm
Answer B is incorrect. The superior vena cava
is controlled by the pineal gland of the epi-
carries deoxygenated blood from the upper
thalamus.
extremities/head and neck region into the heart.
Answer C is incorrect. The inferior vena 152. The correct answer is B. The ulnar nerve
cava carries deoxygenated blood from the innervates the hypothenar region of the
lower portions of the body into the heart. hand. This nerve provides sensory innerva-
tion for the medial 1/2 digits (pinky finger),
Answer E is incorrect. The coronary sinus
medial arm/forearm, and medial palm. As for
carries deoxygenated blood from the heart
motor function, the ulnar nerve flexes the
and returns it to the right atrium.
wrist and fingers, ulnar two lumbricals, and
150. The correct answer is D. The gastroepiploic interosseus musculature.
artery forms an anastomosis between the Answer A is incorrect. The radial nerve pro-
splenic and gastroduodenal arteries. Once it vides motor innervation to the triceps muscle
Anatomic Sciences
Answers: 148-156 55
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as well as the extensors of the hand and wrist, Answer A is incorrect. The thyroid gland
and sensory innervation to the dorsal hand receives blood supply via the superior thyroid
(excluding the pinky finger). artery.
Answer C is incorrect. The musculocuta- Answer C is incorrect. The salivary glands
neous nerve provides motor innervation to receive blood supply via the facial artery.
the biceps, coracobrachialis, and portion of
Answer D is incorrect. The maxillary teeth
the brachialis muscles.
receive blood supply via the posterior supe-
Answer D is incorrect. The median nerve rior alveolar and infraorbital arteries. The
provides motor innervation to multiple flexors mandibular teeth receive blood supply via the
of the forearm, 1st and 2nd lumbricals, thenar inferior alveolar artery.
eminence, and sensory innervation on the
Answer E is incorrect. The mandible receives
palmar surface of the hand from the thumb to
blood supply via the inferior alveolar arteries
medial 1/2 of the ring finger.
and overlying periosteum (branches of the
Answer E is incorrect. The axillary nerve external carotid system). The maxilla receives
provides motor innervation to the teres minor its blood supply via the superior alveolar ves-
and deltoid muscles, and sensory innervation sels, ascending pharyngeal, nasal vessels (pri-
to the skin covering in the deltoid region as marily external carotid system).
well as the shoulder joint.
155. The correct answer is A. The vertebral
153. The correct answer is A. The lateral ptery- artery enters the spine at the 6th cervical
goid divides the maxillary artery into differing vertebrae after branching off the subclavian
segments. The maxillary artery branches from artery. It then continues superiorly within
the external carotid artery posterior to the the transverse processes/foramina of the
ramus at the level of the mastoid process and spinal column until it reaches the skull
continues on until it meets the lateral ptery- base. Here it then combines with the con-
goid muscle. It is here that the lateral ptery- tralateral vertebral artery to form the basilar
goid inserts into the meniscus of the temporo- artery.
mandibular joint. The maxillary artery is then
Answers B, C, D and E are incorrect. See
divided in this region into the mandibular,
above.
pterygoid, and pterygopalatine arteries.
Answer B is incorrect. The masseter does not 156. The correct answer is A. The salpingopha-
divide the maxillary artery. ryngeus is a muscle of the pharynx, and is
actually part of the palatopharyngeus muscle.
Answer C is incorrect. The posterior belly of
It is also considered a longitudinal pharyn-
the digastric does not divide the maxillary
geal muscle. It connects to cartilage of the
artery.
auditory tube and, thus, upon contraction it
Answer D is incorrect. The stylohyoid does opens it. It also elevates the nasopharynx.
not divide the maxillary artery. Motor innervation is supplied by CN XI (car-
ried by CN X).
Answer E is incorrect. The anterior belly of
the digastric does not divide the maxillary Answer B is incorrect. The action of raising
artery. the mandible is performed by the masseter
and medial pterygoid muscles.
154. The correct answer is B. The brain does not
Answer C is incorrect. The action of pro-
receive blood from the external carotid.
pelling food down the pharynx is performed
Blood reaches the brain via the internal
by the pharyngeal constrictors (superior, mid-
carotid artery as well as the vertebrobasilar
dle, inferior).
system (see circle of Willis).
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Answer D is incorrect. The action of retract- Answer A is incorrect. The pterygoid artery
ing the tongue is performed by the styloglos- supplies blood to the pterygoid muscles.
sus muscle.
Answer B is incorrect. The sphenopalatine
Answer E is incorrect. The action of protrud- artery supplies blood to the anterior palate. It
ing the mandible is performed by the lateral does this via anastomoses with the palatine
pterygoid muscle. arteries.
Answer C is incorrect. The descending pala-
157. The correct answer is C. The vestibulo-
tine artery supplies blood to the mucosa of
cochlear nerve (CN VIII) is mostly found
the soft palate.
within the confines of the temporal bone. It
originates from the brainstem near the junc- Answer E is incorrect. The pharyngeal artery
tion of the pons and medulla. Here is where supplies blood to the pharynx.
the cochlear nucleus and the vestibular
nuclear complex are located. This nerve 160. The correct answer is A. The cisterna chyli is
functions in hearing and balance. a central point of lymphatic drainage from
the region inferior to the diaphragm. Thus, it
Answer A is incorrect. The parietal bone
drains lymph from the abdomen, pelvis,
does not house the majority of CN VIII.
inguinal region, and lower extremities. From
Answer B is incorrect. The occipital bone this point, the cisterna chyli continues superi-
does not house the majority of CN VIII. orly and drains into the thoracic duct.
Answer D is incorrect. The frontal bone Answer B is incorrect. The cisterna chyli
does not house the majority of CN VIII. receives lymphatic drainage from the abdomen.
Answer E is incorrect. The maxilla does not Answer C is incorrect. The cisterna chyli
house the majority of CN VIII. receives lymphatic drainage from the pelvis.
Answer D is incorrect. The cisterna chyli
158. The correct answer is C. The pectoralis
receives lymphatic drainage from the
major is innervated by the lateral and medial
inguinal region.
pectoral muscles.
Answer E is incorrect. The cisterna chyli
Answer A is incorrect. Its function is to medi-
receives lymphatic drainage from the lower
ally rotate, flex, and adduct the humerus.
extremities.
Answer B is incorrect. The pectoralis major
is not an accessory muscle of respiration. 161. The correct answer is E. As the dentin
increases in age, there is an increase in depo-
Answer D is incorrect. It originates on the
sition of peritubular dentin.
medial half of the clavicle, as well as the
costal cartilages and sternum and inserts at Answer A is incorrect. There is a decrease in
the greater tubercular crest. dentinal tubule diameter.
Answer E is incorrect. The pectoralis major Answer B is incorrect. There is an increase
is located inferiorly to the pectoralis minor. in reparative dentin formation.
Answer C is incorrect. There is an increase
159. The correct answer is D. The infraorbital
in dead tracts.
artery supplies blood to the maxillary canines
and incisors. It is a branch of the pterygopala- Answer D is incorrect. There is an increase
tine artery, which in turn is a continuation of in sclerotic dentin formation.
the maxillary artery. Blood supply to the max-
illary molars and premolars is via the postero- 162. The correct answer is C. This patient was
superior artery (also branched from the same probably taking tetracycline at the age of
source as the infraorbital artery). 5 years (of the given options). Tetracycline
Anatomic Sciences
Answers: 157-167 57
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causes this clinical phenomenon due to its Answer C is incorrect. Transitional epithelium
ability to chelate divalent cations, thus is a barrier which also allows for distension.
incorporating into mineralizing tissue. There-
Answer D is incorrect. Stratified squamous
fore, tetracycline should not be given to a
epithelium is used as protection on the outer
patient under the age of 8, which marks the
surface of skin.
completion of calcification of the 2nd molars.
Answer E is incorrect. Pseudostratified
Answer A is incorrect. The age of 10 is too
columnar epithelium functions to transport,
old. By this time, complete calcification of all
absorb, and secrete.
teeth (except the permanent 3rd molars)
should be complete. 165. The correct answer is C. The basal lamina
Answer B is incorrect. The age of 11 is too contains type IV collagen. This layer is also
old. By this time, complete calcification of all known as the basement membrane.
teeth (except the permanent 3rd molars) Answer A is incorrect. The lamina lucida is
should be complete. an electron-clear layer.
Answer D is incorrect. The age of 14 is too Answer B is incorrect. The lamina densa is a
old. By this time, complete calcification of all product of the epithelium and contains pro-
teeth (except the permanent 3rd molars) teoglycans, laminin, fibronectin, and type VII
should be complete. collagen (anchoring fibrils).
Answer E is incorrect. The age of 17 is too Answer D is incorrect. The reticular layer (a
old. By this time, complete calcification of all product of the connective tissue) contains
teeth (except the permanent 3rd molars) type III collagen, also known as reticular
should be complete. fibers.
163. The correct answer is D. Vitamin K (of the Answer E is incorrect. The basement mem-
options given) is least likely to directly affect brane has a filtering function.
enamel structure. This vitamin is most inti-
mately involved in formation of blood clot- 166. The correct answer is D. The attached gin-
ting factors II, V, VII, and IX. giva, as is the case with all types of gingiva, is
keratinized.
Answer A is incorrect. Vitamin A can, in a
deficient state, cause enamel pitting. Answer A is incorrect. The sulcular epithe-
lium of the oral cavity is nonkeratinized.
Answer B is incorrect. Vitamin B can, in a
deficient state, cause enamel pitting. Answer B is incorrect. The alveolar mucosa
of the oral cavity is nonkeratinized.
Answer C is incorrect. Vitamin C can, in a
deficient state, cause enamel pitting. Answer C is incorrect. The junctional epithe-
lium of the oral cavity is nonkeratinized.
Answer E is incorrect. Calcium can, in a
deficient state, cause enamel pitting. This is Answer E is incorrect. The gingival col of
due to the enamel matrix being less calcified the oral cavity is nonkeratinized.
than normal.
167. The correct answer is D. The enamel
164. The correct answer is B. The internal lining layer has only approximately 4% organic
of all closed body cavities is simple squamous composition.
epithelium. Another term used to classify this Answer A is incorrect. The cementum is
layer is mesothelium. This epithelial type has comprised of 45% organic constituents.
a barrier function.
Answer B is incorrect. The dentin is com-
Answer A is incorrect. Simple columnar epithe- prised of 30% organic constituents.
lium functions to transport, absorb, and secrete.
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Answer C is incorrect. The pulp is comprised Answer B is incorrect. The spindle nerve
of greater than 95% organic constituents. endings are found in the PDL and have a
function with mechanoreception.
Answer E is incorrect. The alveolar bone is
comprised of nearly 50% organic constituents. Answer D is incorrect. Meissner nerve end-
ings (touch) are not found in the PDL.
168. The correct answer is A. As one ages, the
Answer E is incorrect. Ruffini corpuscles are
pulp becomes more collagenous.
also found in the PDL. They have a function
Answer B is incorrect. There is a decreased size with mechanoreception.
of the apical foramen of the pulp as one ages. Note that each of the PDL nerve endings is
Answer C is incorrect. There is a decreased associated with the trigeminal nerve.
sensitivity of the pulp as one ages.
171. The correct answer is A. The gingival col is a
Answer D is incorrect. There is a decreased depression located just apical to the contact
cellularity of the pulp as one ages. of adjacent teeth. It is located in the interden-
Answer E is incorrect. There is an increased tal gingiva connecting the buccal and lingual
calcification of the pulp as one ages. papilla. It is nonkeratinized.
Note that the overall size of the pulp Answer B is incorrect. The alveolar mucosa
chamber decreases due to continuous deposi- is not found in this location.
tion of dentin.
Answer C is incorrect. The attached gingiva
169. The correct answer is B. Cementum affords serves to line and protect the oral cavity.
the tooth resistance to resorption. This is due Answer D is incorrect. The mucogingival
to continuous cementum deposition at the junction is the line formed between the gin-
apex of the tooth’s root. This resistance to gival and alveolar mucosa.
resorption in cementum even surpasses that
Answer E is incorrect. The interdental
of alveolar bone.
papilla is triangular in shape and located in
Answer A is incorrect. The enamel does not the interproximal embrasure between two
allow for orthodontic movement. It serves to teeth.
protect the underlying structures of the tooth
and assist in the tooth’s normal functioning. 172. The correct answer is C. The primary palate
contains the central and lateral incisor.
Answer C is incorrect. The dentin does not
allow for orthodontic movement. It serves to Answer A is incorrect. The primary palate
cushion the enamel during mastication. can be involved in facial clefting.
Answer D is incorrect. The epithelial attach- Answer B is incorrect. The primary palate is
ment does not allow for orthodontic movement. known as the premaxilla and also contains
It serves as an attachment for the gingival. the incisive foramen.
Answer E is incorrect. The alveolar bone does Answer D is incorrect. It is formed once
not allow for orthodontic movement. It serves mesenchyme differentiates lateral to the nasal
as a housing of the entire tooth apparatus. placodes.
Answer E is incorrect. The median nasal
170. The correct answer is C. Free nerve endings
processes form from the primary palate and
are the most abundant neuronal ending of
eventually fuse.
the PDL. Generally speaking, they sense touch,
temperature, and pain.
173. The correct answer is A. Circumpulpal
Answer A is incorrect. The coiled nerve end- dentin is most produced in the form of inter-
ings are found in the PDL and have a func- tubular dentin.
tion with mechanoreception.
Anatomic Sciences
Answers: 168-178 59
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Answer B is incorrect. It is secreted by odon- underlying ectomesenchymal layer during

toblasts and formed after mantle dentin (the approximately week 6 in utero. Thus, the site
initial 150 µm of dentin) is laid down. of a forming tooth is formed from this ectomes-
enchymal interaction with overlying ectoderm.
Answer C is incorrect. It becomes mineral-
ized and calcified over time by way of hydrox- Answer A is incorrect. The mesodermal layer
yapatite crystal fusion. does not determine the shape of the tooth.
Answer D is incorrect. Circumpulpal dentin Answer B is incorrect. The mesenchyme layer
forms after mantle dentin formation. does not determine the shape of the tooth.
Answer E is incorrect. This form of dentin Answer D is incorrect. The endoderm layer
contains dead tracts. does not determine the shape of the tooth.
Answer E is incorrect. The ectoderm layer
174. The correct answer is D. The enamel matrix
does have a part in determination of tooth
is laid down at a rate of 4 µm per day. This is
shape, but the ectomesenchyme is the main
achieved by actively secreting ameloblasts. It
mediator.
is comprised mostly of amelogenins, among
other proteins.
177. The correct answer is E. The great auricular
Answer A is incorrect. The rate of 0.04 nerve (C2/C3) offers sensory innervation to
µm/day is much too slow. the area of skin covering the parotid gland, as
well as posterior auricle and area of skin
Answer B is incorrect. The rate of 1 mm/day
forming the area between the angle of the
is far too rapid a growth rate.
mandible and mastoid process.
Answer C is incorrect. The rate of 0.1
Answer A is incorrect. The transverse cervical
mm/day is far too slow a growth rate.
nerve (C2/C3) innervates the skin of the neck
Answer E is incorrect. The rate of 4 mm/day and scalp (posterosuperior to the auricle).
is far too rapid a growth rate.
Answer B is incorrect. The superficial tem-
175. The correct answer is E. This stage of devel- poral nerve (CN V) innervates the skin in the
opment completes at around the 12th week temporal region.
of fetal development when the temporal Answer C is incorrect. The long buccal
lobe, sulci, and gyri begin to form. nerve (of CN V) innervates oral gingiva from
Answer A is incorrect. The cerebellum forms the first mandibular molar posteriorly.
at approximately the 5th week of development. Answer D is incorrect. The lesser occipital
Answer B is incorrect. The ventricles form nerve (C2) innervates skin of the anterior tri-
approximately the 5th week of development. angle of the neck.
Answer C is incorrect. Development of the 178. The correct answer is A. The obturator nerve
brain begins at the 3rd week of fetal life when is a branch of the lumbar plexus (L1-L4).
the neural tube takes shape.
Answer B is incorrect. This plexus is located
Answer D is incorrect. The hemispheres in the posterior pelvic wall.
form approximately the 5th week of devel-
Answer C is incorrect. The sacral plexus pro-
opment.
vides motor innervation to parts of the lower
Note: This developmental stage continues
limbs.
on for the remainder of gestation.
Answer D is incorrect. The sacral plexus pro-
176. The correct answer is C. As odontogenesis is vides sensory innervation to the pelvis and
initiated, the ectodermal layer of the oral cavity lower back.
is induced to proliferate. This occurs via the
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Answer E is incorrect. The sacral plexus is 181. The correct answer is B. Chromaffin cells
made up of lumbar nerves 4 and 5, as well as are located within the inner medulla, and
sacral nerves 1-4. secrete catecholamines (epinephrine and
Note: The sacral plexus branches off as the norepinephrine).
sciatic nerve, which is the largest nerve of the
Answer A is incorrect. The zona fasciculata
body, as well as the gluteal and greater
secretes glucocorticoids. An example of this is
splanchnic nerves.
cortisone.
179. The correct answer is B. The trigeminal Answer C is incorrect. The zona glomeru-
nerve (CN V) does not have an efferent losa secretes mineralocorticoids. An example
involuntary parasympathetic function. CN III of this is aldosterone.
distributes such efferents to the ciliary mus-
Answer D is incorrect. The inner layer, the
cles, sphincter pupillae, dilator pupillae, and
zona reticularis, secretes gonadocorticoids.
tarsal muscles.
Examples of these are sex steroids.
Answer A is incorrect. CN VII distributes
Answer E is incorrect. The inner medulla
parasympathetic efferents to the lacrimal
secretes catecholamines.
gland, and nasal and palatal glands.
Answer C is incorrect. CN X distributes 182. The correct answer is D. Teniae coli are lon-
efferent involuntary parasympathetics to gitudinal bands of smooth muscle in the large
numerous smooth muscles. intestine which function to regulate peri-
staltic movements within it.
Answer D is incorrect. CN III distributes
efferent involuntary parasympathetics to the Answer A is incorrect. Microvilli are located
ciliary muscle, sphincter pupillae, dilator in the small intestine and are involved with
pupillae, and tarsal muscles. reabsorption.
Answer E is incorrect. CN IX gives involun- Answer B is incorrect. The myenteric (Auer-
tary parasympathetic efferents to the parotid bach) plexus maintains peristalsis in the
gland. small intestine.
Answer C is incorrect. The plicae circulares
180. The correct answer is B. General visceral
are involved in reabsorption.
afferents of the vagus nerve travel through the
cranial base via the jugular foramen. Answer E is incorrect. The crypts of
Lieberkühn are involved in reabsorption.
Answer A is incorrect. CN IX is involved
with afferent transmission from the carotid 183. The correct answer is B. Plasmin is a protein
body and sinus. involved in physiological regulation of blood
Answer C is incorrect. This afferent function clotting, and is not found in bile. Bile is com-
has cell bodies in the nodose ganglion and posed of many proteins formed in the liver, as
function to transmit sensation from viscera of well as degradation products or red blood
the pharynx, larynx, thoracic, and abdominal cells.
regions (to the left colic flexure). Answer A is incorrect. Lipoproteins are
Answer D is incorrect. Sensation from the found comprising bile. They transport lipid.
posterior meninges (and external ear) is a Answer C is incorrect. Albumin is found
general somatic afferent function of CN X. comprising bile. It is a carrier protein.
Answer E is incorrect. The nucleus Answer D is incorrect. Prothrombin is found
ambiguus has cell bodies involved with spe- comprising bile. It is involved in the clotting
cial visceral efferents of CN X. Taste is a spe- cascade.
cial visceral function of CN X.
Anatomic Sciences
Answers: 179-189 61
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Answer E is incorrect. Alpha and beta globu- Answer D is incorrect. The salivary glands
lins are found comprising bile. Together they are exocrine in function. They secrete prod-
form hemoglobin molecules. ucts nonspecifically via ducts.
184. The correct answer is D. The ethmoid bone 187. The correct answer is D. The stomodeum,
is located anteriorly within the internal aspect also known as the primitive mouth, is lined by
of the skull. Thus, it does not articulate with ectoderm. This structure is separated from the
the temporal bone. pharynx by the buccopharyngeal membrane.
Answer A is incorrect. The parietal bone Answer A is incorrect. The endodermal layer
articulates with the temporal bone superiorly. lines the pharynx.
Answer B is incorrect. The occipital bone Answers B, C, and E are incorrect. These do
articulates with the temporal bone posteriorly. not line the stomodeum.
Answer C is incorrect. The zygoma articu-
188. The correct answer is A. The stapes is a deriv-
lates with the temporal bone anteriorly.
ative of the 2nd branchial arch, which is
Answer E is incorrect. The sphenoid bone located further cranially than any of the corre-
articulates with the temporal bone anteriorly. sponding branchial arches in the answers
given above. At the 4th-5th week of embryonic
185. The correct answer is C. Terminal differenti- development, the branchial arches are most
ation occurs in the G0 stage of the cell cycle. evident and line up in a cranial-caudal fashion
There is no cellular activity at this time. It is (arch 1 most cranial and arch 4 most caudal).
part of interphase.
Answer B is incorrect. The internal carotid
Answer A is incorrect. The G1 phase is part artery is a derivative of the 3rd branchial arch.
of interphase. This is the 1st stage of cellular
Answer C is incorrect. The vagus nerve is a
growth.
derivative of the 4th branchial arch.
Answer B is incorrect. The S phase is part of
Answer D is incorrect. The glossopharyngeal
interphase. Synthesis of DNA occurs here.
nerve is a derivative of the 3rd branchial arch.
Answer D is incorrect. The G2 phase is part
Answer E is incorrect. The stylopharyngeus
of interphase. This is the 2nd stage of cellular
muscle is a derivative of the 3rd branchial arch.
growth.
Answer E is incorrect. Mitosis consists of cell 189. The correct answer is E. The decidual reac-
division. tion occurs during week 2 of embryogenesis
and involves endometrial enlargement via
186. The correct answer is A. Gastroenteropancre- lipid and glycogen accumulating within this
atic glands are an example of paracrine func- portion of the uterus.
tion. Paracrine-type glands affect cells within
Answer A is incorrect. The breakdown of the
the same epithelium by way of secretion of
zona pellucida occurs once the blastula forms.
products into the extracellular space. An exam-
ple of this is the secretion of cholecystokinin Answer B is incorrect. The first zygotic
by the pancreas into the small intestine. cleavage has no formal name.
Answer B is incorrect. The adrenal glands Answer C is incorrect. Invasion of the syncy-
are endocrine in function. They secrete prod- tiotrophoblast into the endometrium of the
ucts into the blood stream. uterus is part of implantation of the zygote.
Answer C is incorrect. The gonads are Answer D is incorrect. The release of an
endocrine in function. They secrete products ovum from the ovary occurs during the men-
into the blood stream. strual cycle.
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190. The correct answer is C. The chromosomal Answer A is incorrect. Elastase is contained
number 2N represents the fusion of sperm within the cell. Its function is the breakdown
and egg. This represents 46 chromosomes. of elastin.
Answer A is incorrect. The chromosomal Answer B is incorrect. Collagenase is con-
number 1/2 N does not occur in the normal tained within the cell. Its function is the
physiological development of sperm and egg. breakdown of collagen.
Answer B is incorrect. Each male and Answer C is incorrect. Trypsin is contained
female pronuclei has an N chromosome within the pancreas (as a proenzyme). It is a
number (thus, 23 chromosomes). digestive enzyme.
Answer D is incorrect. The chromosomal Answer D is incorrect. Chymotrypsin is con-
number 3N does not occur in the normal tained in the pancreas. It is a digestive (prote-
physiological development of sperm and egg. olytic) enzyme.
Answer E is incorrect. The chromosomal
193. The correct answer is E. The epidermis pro-
number 4N occurs prior to the first meiotic
duces vitamin D. It must undergo other steps
division in each of the sperm and egg.
to become biologically active.
191. The correct answer is A. The epidermis does Answer A is incorrect. Vitamin D is not pro-
not contain sinusoids. Sinusoids are modified duced at the large intestine. It has no func-
capillaries that contain discontinuities within tion in vitamin D production.
them referred to as fenestrae. These have a
Answer B is incorrect. Vitamin D is not pro-
more complex structure than conventional
duced in the kidney. It does hydroxylate vita-
capillaries and are also larger in overall size.
min D, though, to a biologically active form.
This structure provides adaptation to reticu-
loendothelial cells infiltrating a particular Answer C is incorrect. Vitamin D is not
region of tissue. produced at the spleen. It has no function in
vitamin D production.
Answer B is incorrect. The liver contains
sinusoids. Drainage of blood from the portal Answer D is incorrect. Vitamin D is not pro-
circulation occurs here. duced in the liver. It does hydroxylate vita-
min D, though, to a biologically active form.
Answer C is incorrect. The lymphatic tissue
contains sinusoids. Here is where lymph is 194. The correct answer is A. The ciliary body
contained. most directly controls accommodation. This
Answer D is incorrect. Endocrine glands portion of the eye contains smooth muscle
contain sinusoids. The function varies, but and thus can receive neural input which
this is a place where one may find hormones. alters lens shape.
Answer E is incorrect. The spleen contains Answer B is incorrect. The neural retina
sinusoids. Here is where immune reactions contains rods and cones, so its function is
occur. photoreception.
Answer C is incorrect. The choroid layer is
192. The correct answer is E. Peroxisomes con-
involved with vascularity of the eye.
tain catalase. These organelles function to
remove substances which may be toxic to the Answer D is incorrect. The pupil is an aper-
cell. For example, catalase is an enzyme ture which allows light into the eyeball.
which oxidizes hydrogen peroxide (which is Answer E is incorrect. The iris (which also
cytotoxic) into water and other non toxic contains smooth muscle) alters the shape of
products. These organelles are typically found the eyeball’s central aperture, the pupil.
in the liver, and organ which has a detoxifying
function for the body.
Anatomic Sciences
Answers: 190-200 63
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195. The correct answer is B. Fibrinogen, as well 198. The correct answer is A. Platelets range in
as other clotting factors, is not found in number some 200,000-400,000 per mm3 of
serum. Serum is composed of all other ele- blood.
ments found in the blood plasma.
Answer B is incorrect. Platelets are involved
Answer A is incorrect. Electrolytes are found with hemostasis.
within the blood serum.
Answer C is incorrect. Platelets have a
Answer C is incorrect. Immunoglobulin is lifespan/turnover rate of 7-10 days.
found within the blood serum.
Answer D is incorrect. Platelets are anu-
Answer D is incorrect. Water is found within cleate.
the blood serum.
Answer E is incorrect. Platelets do not func-
Answer E is incorrect. Albumin is found tion in blood gas transport. They are involved
within the blood serum. in the blood clot.
Note that blood gases, hormones, enzymes,
and metabolic products are also found in the 199. The correct answer is D. Bone marrow is the
serum. site of B-cell maturation. Here is where
pluripotent stem cells become phagocytes or
196. The correct answer is B. A layer of simple squa- lymphocytes.
mous endothelium can be found lining the
Answer A is incorrect. The lymph nodes are
lumen of the heart as part of the endocardium.
the site for further lymphocyte differentiation
Answer A is incorrect. The pericardium is as well as lymph filtering.
the outermost layer. It contains connective
Answer B is incorrect. The blood is the site
tissue and adipose tissue.
for further lymphocyte differentiation.
Answer C is incorrect. The endocardium is Immunologic reactions also occur here.
the innermost layer of the heart.
Answer C is incorrect. The thymus is the site
Answer D is incorrect. The thickest portion of T-cell maturation.
of the heart is the myocardium. It is in the
Answer E is incorrect. The target tissue is
center of the heart layers and contains cardiac
a site of further lymphocyte differentiation.
musculature.
Immunologic response also occurs here.
Answer E is incorrect. A layer of simple squa-
mous epithelium surrounds the outermost 200. The correct answer is A. Thyroxine (T4) is
layer, the pericardium. secreted from follicular cells of the thyroid
gland, as is triiodothyronine (T3). T4 is pro-
197. The correct answer is C. The autonomic duced from precursor thyroglobulin molecules.
nervous system is involved with heart rate.
Answer B is incorrect. The outer cortex of
This is accomplished by firing of neural sig-
the adrenals produces steroids involved with
nals onto the SA node, which then passes the
sugar, salt, and sexual regulation.
current on to the AV node.
Answer C is incorrect. The pars distalis is
Answer A is incorrect. The bundle of His con-
part of the anterior pituitary gland. It secretes
ducts electric current to the Purkinje fibers.
prolactin and growth hormone.
Answer B is incorrect. The SA node regu-
Answer D is incorrect. The pars intermedia
lates the rate of electrical conductance.
is part of the anterior pituitary gland. It
Answer D is incorrect. The cardiac muscle secretes lipotropic hormone.
maintains an intrinsic rhythmicity.
Answer E is incorrect. The parafollicular
Answer E is incorrect. The pacemaker of the cells of the thyroid gland secrete calcitonin.
heart is the SA node.
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CHAPTER 2
Biochemistry and
Physiology
65
66 Chapter 2: Biochemistry and Physiology
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Q U E ST I O N S
1. The plateau in the cardiac action potential is 6. All of the following are true of cardiac muscle
caused by which of the following? EXCEPT
A. Influx of Na+ A. contractile activity is mediated
B. Efflux of Na+ intrinsically.
C. Influx of Ca2+ B. it contains T tubules.
D. Efflux of Ca2+ C. it does not contain troponin.
E. Influx of K+ D. each cell has one centrally located
Biochemistry and Physiology
nucleus.
2. The first law of thermodynamics states that E. it is striated.
the entropy of a closed system always
increases. The second law of thermodynam- 7. What autosomal recessive disease is caused by a
ics states that the total energy of a closed sys- deficiency of muscle glycogen phosphorylase?
tem is conserved.
A. Pompe disease
A. Both statements are true. B. McArdle syndrome
B. Both statements are false. C. Hunter syndrome
C. The first statement is true; the second D. Von Gierke disease
statement is false. E. Hurler syndrome
D. The first statement is false; the second
statement is true. 8. Extracellular fluid comprises what amount of
total body water?
3. Which of the following is not a peptide
A. 25%
hormone?
B. 33%
A. PTH C. 50%
B. Insulin D. 66%
C. GH E. 75%
D. Aldosterone
E. ADH 9. Which of the following types of cartilage may
calcify?
4. Which of the following types of blood vessels
A. Elastic
is responsible for the greatest proportion of
B. Hyaline
vascular resistance?
C. Fibrocartilage
A. Arteries D. B and C
B. Arterioles E. All of the above
C. Capillaries
D. Venules 10. All of the following are key enzymes in DNA
E. Veins synthesis EXCEPT
A. polymerase.
5. All of the following are true of carbonic anhy-
B. exonuclease.
drase EXCEPT
C. aminotransferase.
A. most isoforms contain a central zinc atom. D. topoisomerase.
B. interconverts carbon dioxide and E. helicase.
bicarbonate.
C. significantly increases the reaction rate.
D. highly active in platelets.
E. critical in osteoclastic activity.
Questions: 1-21 67
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11. All of the following tissues are involved in a 17. Which of the following is the most abundant
feedback axis with the hypothalamus EXCEPT glycosaminoglycan?
A. thyroid. A. Keratan sulfate
B. parathyroid. B. Heparan sulfate
C. pituitary. C. Chondroitin sulfate
D. adrenal. D. Dermatan sulfate
E. testicular. E. Hyaluronic acid
12. Which of the following catalyze bond 18. All of the following are true of the pulmonary
cleavage? circulation compared to the systemic circula-

tion EXCEPT
A. Hydrolases and lyases
B. Transferases and isomerases A. it has higher resistance.
C. Ligases and oxidoreductases B. it has higher compliance.
D. Transferases and lyases C. it has a lower blood pressure.
E. Hydrolases and isomerases D. it has a similar volume of blood flow.
E. it conducts deoxygenated blood via the
13. Which of the following decreases gastric pulmonary artery.
motility?
19. Which of the following anterior pituitary
A. Gastrin
hormones does not directly act on a specific
B. Secretin
target tissue?
C. GIP
D. B and C A. FSH
E. All of the above B. GH
C. ACTH
14. Which of the following respiratory volumes is D. Prolactin
incorrect? E. TSH
A. ERV = FRC – RV
20. Which of the following is a type of frameshift
B. VC = TLV – RV
mutation?
C. TLV = IRV + TV + ERV + RV
D. IC = IRV – TV A. Nonsense mutation
E. VC = TV + IRV + ERV B. Repeat mutation
C. Transverse mutation
15. Which of the following is TRUE of ∆G? D. Missense mutation
A. Determines reaction rate
B. Exergonic reactions will have a positive ∆G
21. Aldosterone is secreted in a pathway in
C. Determines reaction equilibrium
response to the release of which hormone?
D. Dependent on the path of the reaction
E. Determines reaction direction A. Renin
B. ADH
16. All of the following are true of the somatic C. Vasopressin
nervous system EXCEPT D. Erythropoietin
E. ACTH
A. it consists of 12 cranial nerves.
B. it transmits temperature and pain.
C. it innervates skeletal muscle.
D. it has short preganglionic motor neurons.
E. all are true of the somatic nervous system.
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22. All of the following are true of plasma mem- C. lactose.

branes EXCEPT D. mannose.
A. Selectively permeable
28. The intrinsic coagulation pathway is initiated
B. Function as barriers
by which of the following clotting factors?
C. Symmetrical
D. Contain cholesterol A. I
E. Have a hydrophobic inner layer B. II
C. VII
23. Most connective tissue (CT) originates from D. VIII
mesoderm. The majority of dense CT is reg- E. XII
ular in its cellular arrangement.

29. What type of GI contraction is most common
A. Both statements are true.
in the duodenum?
B. Both statements are false.
C. The first statement is true, the second A. Tonic contractions
statement is false. B. Peristalsis
D. The first statement is false, the second C. Segmentation
statement is true. D. None of the above
24. There are four basic tastes. Each taste cell 30. All of the following are zymogens EXCEPT
can sense all of the basic tastes. A. clotting factor I.
A. Both statements are true. B. calmodulin.
B. Both statements are false. C. trypsinogen.
C. The first statement is true, the second D. clotting factor X.
statement is false. E. procollagen.
D. The first statement is false, the second
statement is true. 31. Hyperventilation results in all of the following
EXCEPT
25. In general, reaction rate will increase as a A. increased PO2.
result of all of the following EXCEPT B. hypocapnia.
A. an increase in temperature. C. decreased cerebral blood flow.
B. an increase in enzyme concentration. D. increased PCO2.
C. an increase in activation energy. E. respiratory alkalosis.
D. an increase in substrate concentration.
E. a decrease in activation energy. 32. Which of the following is TRUE of protein
synthesis?
26. A sarcomere is defined as the area within a A. Aminoacyl-tRNA synthetase adds each
myofibril located between two amino acid to tRNA.
A. A bands. B. mRNA carries the anticodon to each
B. H bands. tRNA.
C. I bands. C. Two ribosomal subunits of equal size bind
D. M lines. to mRNA.
E. Z lines. D. Occurs only in cells that contain 80s
ribosomes.
27. All of the following are disaccharides E. Occurs in a 3′ to 5′ direction.
EXCEPT
A. sucrose.
B. maltose.
Questions: 22-43 69
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33. Local anesthetics function by 39. All of the following are true of total periph-
A. activating Na+ channels. eral resistance (TPR) EXCEPT
B. blocking Na+ channels. A. it is influenced by sympathetic activation.
C. activating K+ channels. B. it is directly proportional to cardiac
D. blocking K+ channels. output.
E. none of the above. C. it is directly proportional to mean arterial
pressure.
34. Which of the following pressure changes will D. it is influenced by thermal changes.
result in edema?
A. Decreased capillary hydrostatic pressure 40. Which of the following converts acetyl-CoA

B. Decreased interstitial oncotic pressure to malonyl-CoA?
C. Decreased capillary oncotic pressure A. Vitamin E
D. Increased interstitial hydrostatic pressure B. Vitamin B1
E. All of the above C. Vitamin B6
D. Vitamin B12
35. A noncompetitive inhibitor increases Km and E. Biotin
decreases Vmax.
A. Both actions are true. 41. Calmodulin functions by
B. Both actions are false. A. binding calcium.
C. The first action is true; the second action B. activating myosin light-chain kinase.
is false. C. hydrolyzing ATP.
D. The first action is false; the second action D. A and B.
is true. E. all of the above.
36. Which of the following have been implicated 42. All of the following are true of allosteric regu-
in osteonecrosis of the jaws? lation EXCEPT
A. Pamidronate A. Follows simple Michaelis-Menten
B. Zolendronate kinetics
C. Alendronate B. The allosteric and catalytic sites on the
D. All of the above enzyme are spatially unique
E. None of the above C. May involve feedback regulation
D. Can raise Km without an effect on Vmax
37. All of the following are true of α-amylase E. Can lower Vmax without an effect on Km
EXCEPT
A. it is secreted by the parotid gland. 43. FSH is only functional in females. LH stimu-
B. it cleaves α-1,6-glycosidic linkages. lates the production of testosterone in testicu-
C. it catabolizes starch. lar Leydig cells.
D. it is a hydrolase. A. Both statements are true.
38. Hyperparathyroidism will cause all of the fol- C. The first statement is true; the second
lowing EXCEPT statement is false.
A. decreased renal phosphate reabsorption. D. The first statement is false; the second
B. increased renal calcium reabsorption. statement is true.
C. increased alveolar bone density.
D. A and B.
E. all are true of hyperparathyroidism.
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44. What is the normal pH of blood? D. Corticospinal tract (of the pyramidal
system)
A. 5.8
E. Medial lemniscal pathway
B. 6.6
C. 7.0 50. All of the following are true of glycolysis
D. 7.4 EXCEPT
E. 8.2
A. Converts glucose to two molecules of
45. Which of the following proteins functions in pyruvate
monitoring DNA integrity? B. Takes place in the cytosol
C. Also called the Embden-Meyerhof pathway
A. p53
D. The rate-limiting step is the conversion of

B. p54
glucose-6-phosphate to fructose-6-
C. p55
phosphate
D. p56
E. Directly produces 4 ATP per glucose
E. p57
51. The first heart sound (S1) indicates closure of
46. Insulin is released from which type of gland?
the semilunar valves. It is typically louder and
A. Merocrine longer than the second heart sound (S2).
B. Acinar
C. Tubular
D. A and B
C. The first statement is true; the second
statement is false.
47. The total amount of oxygen carried in blood
statement is true.
occurs via
A. bicarbonate. 52. Which of the following stimulates the release
B. dissolved O2. of bile from the gallbladder?
C. bound to hemoglobin.
A. Cholecystokinin
D. B and C.
B. Secretin
C. Bilirubin
D. Chymotrypsin
48. Which of the following is not found in
E. Pepsinogen
plasma membranes?
A. Sphingomyelin 53. Which of the following amino acids is not
B. Cholesterol synthesized from glucose?
C. G proteins
A. Valine
D. Collagen
B. Arginine
E. Arachidonic acid
C. Serine
D. Glutamate
49. Which pathway transmits pain and tem-
E. Alanine
perature?
A. Dorsal column pathway 54. Which of the following muscles is not
B. Anterior spinothalamic tract (of the involved in swallowing?
anterolateral pathway)
A. Salpingopharyngeus
C. Lateral spinothalamic tract (of the antero-
B. Levator veli palatini
lateral pathway)
C. Palatopharyngeus
D. Tensor veli palatini
E. Inferior pharyngeal constrictor
Questions: 44-65 71
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55. Fluoride inhibits which of the following gly- D. alanine.

colytic enzymes? E. lactate.
A. Enolase 61. All of the following are characteristics of
B. Phosphofructokinase skeletal muscle with a type II twitch speed
C. Lactate dehydrogenase EXCEPT
D. Hexokinase
E. Aldolase A. it has a fast contraction speed.
B. it has a relatively low SR content.
56. Glucagon secretion results in all of the fol- C. it has a relatively low myoglobin content.
lowing EXCEPT D. it has a relatively large fiber diameter.

E. it has a relatively high rate of ATPase
A. increased blood glucose level.
activity.
B. increased fatty acid synthesis.
C. increased urea synthesis. 62. Which of the following formulas is not
D. B and C. correct?
E. all are true glucagon secretion.
A. MAP = CO • TPR
57. Parathyroid hormone (PTH) functions pri- B. CO = HR • SV
marily at which segment of the nephron? C. R = 8ηL/πr2
D. (Pout − Pin) = T/r
A. Proximal convoluted tubule
E. F = Pπr4/8ηL
B. Descending loop of Henle
C. Ascending loop of Henle 63. Epinephrine is derived from which of the fol-
D. Distal convoluted tubule lowing amino acids?
E. Collecting duct
A. Histidine
58. Which laboratory technique determines RNA B. Serine
content of a protein sample? C. Glycine
D. Tryptophan
A. PCR
E. Phenylalanine
B. Western blot
C. Northern blot 64. All of the following result in increased alveo-
D. Southern blot lar gas exchange EXCEPT
E. Southwestern blot
A. decreased alveolar thickness.
59. A fresh extraction socket will fill with new B. increased oxygen solubility.
bone over the next few months. What type of C. greater PaO2 than PAO2.
bone formation occurs during this time D. increased alveolar surface area.
period? E. all cause increased alveolar gas exchange.
A. Intramembranous 65. Which of the following are produced after
B. Endochondral one turn of the Krebs cycle?
C. Intermembranous
D. A and B A. 2 ATP, 2 NADH, 3 FADH2
E. None of the above B. 12 ATP, 1 GTP, 2 NADH
C. 1 ATP, 1 NADH, 3 FADH2
60. All of the following are direct metabolic fates D. 2 GTP, 2 NADH, 3 FADH2
of pyruvate EXCEPT E. 1 GTP, 3 NADH, 1 FADH2
A. oxaloacetate.
B. acetyl-CoA.
C. glucose.
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66. Which of the following receptors is largely D. distal convoluted tubule.

responsible for detecting stretch? E. collecting duct.
A. Free nerve endings 72. Hematopoiesis occurs primarily in which
B. Meissner corpuscles tissue?
C. Ruffini corpuscles
D. Pacinian corpuscles A. Lymph nodes
E. Merkel discs B. Red marrow
C. Yellow marrow
67. ADH is produced in which structure? D. Spleen
E. Thymus
A. Hypothalamus
B. Anterior pituitary 73. The Na+/K+ pump functions via facilitated

C. Posterior pituitary diffusion because it requires ATP.
D. Adrenal medulla
E. Adrenal cortex A. Both the statement and the reason are
correct and related.
68. Which of the following enzymes does not B. Both the statement and the reason are
match one of its functions? correct but not related.
C. The statement is correct, but the reason is
A. DNA polymerase: Synthesizes comple-
not.
mentary DNA strand in 5′ to 3′ direction
D. The statement is not correct, but the
B. Exonuclease: Cleaves nucleotide primers
reason is correct.
C. Helicase: Winds the DNA molecule after
E. Neither the statement nor the reason is
replication
correct.
D. DNA ligase: Ligates Okazaki fragments
E. Restriction endonuclease: Cleaves DNA 74. Which of the following is the correct
at specific points sequence of electrical conduction through
the heart?
69. Which of the following secretions is typically
the most acidic? A. SA node, AV node, bundle of His,
Purkinje fibers, ventricular myocytes
A. Bile
B. Ventricular myocytes, SA node, AV node,
B. Pancreatic
bundle of His, Purkinje fibers
C. Gastric
C. SA node, bundle of His, Purkinje fibers,
D. Intestinal
AV node, ventricular myocytes
D. AV node, SA node, bundle of His,
70. The most common amino acid found in col-
Purkinje fibers, ventricular myocytes
lagen is which of the following?
E. SA node, AV node, Purkinje fibers,
A. Aspartate bundle of His, ventricular myocytes
B. Proline
C. Glycine 75. In erythrocytes, glycolysis always ends in
D. Lysine lactate because they do not contain mito-
E. Glutamine chondria.
A. Both the statement and the reason are
71. Water is reabsorbed in all of the following
segments of the nephron EXCEPT
B. Both the statement and the reason are
A. proximal convoluted tubule. correct but not related.
B. descending loop of Henle. C. The statement is correct, but the reason is
C. ascending loop of Henle. not.
Questions: 66-85 73
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D. The statement is not correct, but the A. increased temperature.

reason is correct. B. decreased pH.
E. Neither the statement nor the reason is C. increased 2,3-biphosphoglycerate.
correct. D. increased PCO2.
E. all will cause a right shift.
76. Most skeletal muscle is innervated by what
type of motor neuron? 82. All preganglionic sympathetic neurons use nor-
epinephrine as the major neurotransmitter. All
A. α
postganglionic parasympathetic neurons use
B. β
acetylcholine as the major neurotransmitter.
C. γ

D. δ A. Both statements are true.
77. An individual who has been taking pred- C. The first statement is true; the second
nisone for several months will most likely statement is false.
acquire which of the following? D. The first statement is false; the second
A. Addison disease statement is true.
B. Cushing disease
83. DNA synthesis occurs in which cell cycle
C. Cushing syndrome
phase?
D. Plummer disease
E. Myxedema A. Prophase
B. Metaphase
78. A deficiency in which of the following amino C. Anaphase
acids causes albinism? D. Telophase
A. Tyrosine E. Interphase
B. Tryptophan
84. Osmosis is the simple diffusion of any liquid
C. Arginine
caused by a concentration gradient. Osmolar-
D. Leucine
ity is the osmotic pressure of a solution (in
E. Alanine
osmols/kg).
79. Which cranial nerves transmit taste to the A. Both statements are true.
brain? B. Both statements are false.
A. VII C. The first statement is true; the second
B. IX statement is false.
C. X D. The first statement is false; the second
D. A and B statement is true.
E. All of the above
85. Which of the following is the final electron
80. The Cori cycle functions by converting acceptor in the ETC?
A. glycogen to glucose A. NAD+

B. NAD+ to NADH B. NADH
C. acetyl-CoA to malonyl-CoA C. O2
D. lactate to glucose D. Q
E. pyruvate to glucose E. H2O
81. All of the following will result in a right shift

of the O2-Hb dissociation curve EXCEPT
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86. All of the following are effects of parathyroid D. FSH

hormone (PTH) EXCEPT E. Oxytocin
A. Increases renal calcium reabsorption 92. During contraction, the length of each A
B. Increases blood calcium levels band remains constant, but the H band short-
C. Stimulates bone resorption ens in length.
D. Decreases renal phosphate reabsorption
E. Decreases intestinal calcium absorption A. Both statements are true.
87. Ventricular depolarization occurs during C. The first statement is true; the second
which portion of the ECG wave? statement is false.

A. PR interval
statement is true.
B. ST segment
C. P wave 93. Both transcription and translation occur in
D. T wave the nucleus. Protein synthesis occurs in the 5′
E. QRS complex to 3′ direction.
88. All of the following events in collagen synthe- A. Both statements are true.
sis occur intracellularly EXCEPT B. Both statements are false.
A. hydroxylation of proline and lysine
statement is false.
residues.
B. cleavage of N- and C-terminal
statement is true.
propeptides.
C. glycosylation of α-chains. 94. Aldosterone functions primarily at which seg-
D. synthesis of α-chains. ment of the nephron?
89. Jaundice is caused by an increased blood A. Proximal convoluted tubule
level of B. Descending loop of Henle
C. Ascending loop of Henle
A. bilirubin
D. Distal convoluted tubule
B. bile
E. Collecting duct
C. hemoglobin
D. cholesterol 95. Which of the following statements is TRUE
E. cholecystokinin about myoglobin?
90. In the ETC, which of the following is the ter- A. Contains only one central zinc atom
minal cytochrome? B. Transports oxygen in muscle tissue
C. Can bind up to four molecules of oxygen
A. Cytochrome oxidase
D. Consists of one globin molecule
B. Cytochrome reductase
E. Has less of an oxygen affinity compared to
C. Ubiquinone
hemoglobin
D. α-Ketoglutarate dehydrogenase
E. NADH dehydrogenase 96. Endochondral osteogenesis occurs by which
of the following types of growth?
91. A surge of which hormone results in
ovulation? A. Interstitial
B. Appositional
A. Estrogen
C. All of the above
B. Progesterone
D. None of the above
C. LH
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97. Inspiration is generally an active process. 102. Which of the following is most important in
Inspiration causes decreased alveolar and regulating serum calcium levels?
intrapleural pressures. A. PTH
A. Both statements are true. B. Calcitonin
B. Both statements are false. C. Vitamin D
C. The first statement is true; the second D. Hydroxyapatite
statement is false. E. None of the above
statement is true 103. Prednisone acts on which of the following
enzymes?

98. Which disease is caused by a mutation of A. Phospholipase A2
a cAMP-regulated Cl − plasma membrane B. Lipoxygenase
channel? C. HMG-CoA reductase
A. Achondroplasia D. Cyclooxygenase-1
B. Cystic fibrosis E. Cyclooxygenase-2
C. Tay-Sachs disease
D. Diabetes mellitus 104. You decide to take a break after a long study
E. Multiple sclerosis session. As you get started on the treadmill,
which of the following would not likely
99. The motor end plate contains which type of occur?
receptor? A. Increased cardiac output
A. Muscarinic B. Decreased β1 activity
B. Nicotinic-1 C. Increased inotropic effect
C. Nicotinic-2 D. Decreased venous compliance
D. Alpha-1 E. Increased β2 activity
E. Alpha-2
105. A type I diabetic will have which change in
100. Which of the following is incorrect regarding enzymatic activity?
the pentose phosphate pathway? A. Increased glycogen synthase
A. Takes place in the cytosol B. Decreased lipase
B. Produces 2 ATP C. Increased acetyl-CoA carboxylase
C. Converts glucose-6-phosphate to D. Increased fatty acid synthase
ribose-5-phosphate E. Increased glycogen phosphorylase
D. The rate-limiting step is the conversion of
glucose-6-phosphate to 106. All of the following occur in the liver
6-phosphogluconolactone EXCEPT
E. Also called the hexose monophosphate A. urea cycle.
shunt B. gluconeogenesis.
C. cholesterol synthesis.
101. The glossopharyngeal nerve (CN IX) pro- D. Entner-Doudoroff pathway.
vides afferent fibers to which of the following E. pentose phosphate pathway.
regulators?
A. Carotid body chemoreceptors
B. Aortic arch baroreceptors
C. Atrial stretch receptors
D. A and B
E. All of the above
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107. All of the following will create a decrease in C. vallate.

glomerular filtration rate (GFR) EXCEPT D. foliate.
A. increased hydrostatic pressure in Bowman
113. Both HDL and LDL generally transport
space.
lipids to the liver. Lipoproteins contain various
B. decreased renal perfusion.
proportions of cholesterol, triglycerides, bile
C. decreased blood plasma oncotic pressure.
salts, and phospholipids.
D. afferent arteriole vasoconstriction.
E. none of the above. A. Both statements are true.
108. All of the following are post-transcriptional C. The first statement is true; the second
modifications EXCEPT statement is false.

A. removal of introns.
statement is true.
B. removal of Okazaki fragments.
C. addition of a 5′ cap.
114. All of the following will cause hypoxemia
D. addition of a 3′ poly(A) tail.
EXCEPT
E. ligation of exons.
A. hyperventilation.
109. The “fight-or-flight” response is regulated by B. V/Q mismatch.
which type of cell? C. decreased alveolar surface area.
D. decreased FiO2.
A. Dust cell
E. respiratory shunt.
B. Chief cell
C. Parietal cell
115. Which of the following is the fastest mode of
D. Chromaffin cell
nerve transmission?
E. M cell
A. Saltatory conduction
110. In humans, fatty acids can be converted to B. Continuous conduction
glucose, and glucose can be converted to C. Axonotmesis
fatty acids. D. Neurotmesis
116. All of the following are metabolic fates of
acetyl-CoA EXCEPT
statement is false. A. glucose synthesis.
D. The first statement is false; the second B. cholesterol synthesis.
statement is true. C. fatty acid synthesis.
D. ATP production.
111. Postsynaptic nicotinic receptors are located E. ketone body synthesis.
on which portion of skeletal muscle?
117. Renin ultimately results in activity of which
A. T tubule
tissue?
B. Sarcolemma
C. Endomysium A. Adrenal cortex
D. Perimysium B. Adrenal medulla
E. Sarcomere C. Anterior pituitary
D. Posterior pituitary
112. Taste buds are found on all of the following E. Hypothalamus
papillae EXCEPT
A. fungiform.
B. filiform.
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118. Reverse transcriptase 123. Under normal cellular conditions, all of the
following have a higher extracellular concen-
A. synthesizes a complementary strand of
tration than intracellular concentration
RNA from DNA.
EXCEPT
B. synthesizes a complementary strand of
DNA from RNA. A. Na+.
C. ligates each anticodon to tRNA. B. Mg2+.
D. copies cellular RNA. C. Cl−.
E. copies cellular DNA. D. Ca2+.
E. HCO3−.
119. Hematocrit is defined as

124. All of the following are secreted by pancreatic
A. the concentration of hemoglobin within
acinar cells EXCEPT
erythrocytes.
B. the percentage of erythrocytes in blood A. pepsin.
plasma volume. B. lipase.
C. the number of erythrocytes in blood C. amylase.
volume. D. trypsin.
D. the percentage of erythrocytes in blood E. chymotrypsin.
volume.
E. the percentage of hemoglobin in blood 125. All of the following are caused by an overac-
volume. tive thyroid EXCEPT
A. Grave disease.
120. Which of the following are common methods
B. Plummer disease.
of assessing GFR?
C. Hashimoto thyroiditis.
A. Inulin clearance D. cretinism.
B. Creatinine clearance E. toxic multinodular goiter.
C. Urine production
D. A and B 126. Which of the following amino acids is not
E. All of the above transaminated?
A. Aspartate
121. Which of the following has the strongest base
B. Alanine
pair bond in DNA?
C. Glutamate
A. Guanine-cytosine D. Serine
B. Adenine-uracil E. Tryptophan
C. Guanine-thymine
D. Adenine-thymine 127. Which type of muscle tissue behaves as a
E. Adenine-cytosine functional syncytium?
A. Skeletal
122. Renin is secreted by cells in which segment
B. Cardiac
of the nephron?
C. Smooth
A. Afferent arteriole D. B and C
B. Glomerulus E. All of the above
C. Bowman capsule
D. Efferent arteriole
E. Proximal convoluted tubule
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128. Place the following organization of DNA in 133. Sodium is impermeable to which segment of
order of smallest to largest. the nephron?
A. Chromatin fibril, double-helix, chromo- A. Proximal convoluted tubule
some, nucleosome B. Descending loop of Henle
B. Double-helix, nucleosome, chromatin C. Ascending loop of Henle
fibril, chromosome D. Distal convoluted tubule
C. Nucleosome, chromatin fibril, double- E. Collecting duct
helix, chromosome
D. Double-helix, nucleosome, chromosome, 134. Which antibiotic inhibits bacterial protein
chromatin fibril synthesis?
A. Amoxicillin
129. All of the following will increase cardiac out-
B. Doxycycline
put EXCEPT
C. Metronidazole
A. norepinephrine. D. Cephalexin
B. SA nodal discharge. E. Ciprofloxacin
C. preload.
D. contractile force. 135. The mandible contains only cortical bone.
E. efferent vagal activity. The maxilla contains only cancellous bone.
130. Metabolic alkalosis typically results in respi-
ratory acidosis. The compensatory mechanism
is hypoventilation.
statement is false.
A. Both statements are true. D. The first statement is false; the second
B. Both statements are false. statement is true.
statement is false. 136. All of the following are true of RNA EXCEPT
D. The first statement is false; the second A. the backbone sugar is ribose.
statement is true. B. bases include adenine, uracil, guanine,
and cytosine.
131. Transamination reactions require which of
C. it can be synthesized in the nucleolus.
the following as a cofactor?
D. it is single stranded.
A. Vitamin B2 E. it is abundant in smooth endoplasmic
B. Vitamin B6 reticulum.
C. Vitamin B12
D. Vitamin C 137. Which of the following is not a common sec-
E. Vitamin E ond messenger in extracellular receptor
signaling?
132. Which of the following may be an inhibitory
A. cAMP
neurotransmitter?
B. Na+
A. Acetylcholine C. Ca2+
B. GABA D. IP3
C. Glycine E. DAG
D. B and C
E. All of the above
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138. The intrinsic and extrinsic clotting pathways 143. All of the following are true of antidiuretic
meet with the activation of what factor? hormone (ADH) EXCEPT
A. II A. it is released from the posterior pituitary
B. IX gland.
C. X B. it increases water reabsorption.
D. XI C. its release is stimulated by increased
E. XII thirst.
D. it functions primarily at the collecting
139. Which amino acid is largely responsible for duct.
oxidative deamination reactions? E. all are true of ADH.

A. Alanine
144. Eccrine sweat glands are controlled by
B. Leucine
cholinergic neurons. Apocrine sweat glands
C. Glutamate
produce pheromones.
D. Methionine
E. Valine A. Both statements are true.
140. Cholecystokinin is secreted in response to C. The first statement is true; the second
duodenal disaccharides. The stimulation of statement is false.
gallbladder contraction is one of its major D. The first statement is false; the second
functions. statement is true.
145. Each tRNA contains an anticodon. tRNA is
the least prevalent RNA.
statement is false. A. Both statements are true.
D. The first statement is false; the second B. Both statements are false
statement is true. C. The first statement is true; the second
statement is false.
141. During swallowing, food may become lodged D. The first statement is false; the second
in which of the following structures? statement is true.
A. Vallecula
146. Which of the following is the most important
B. Pyriform recess
factor in determining the affinity of hemoglo-
C. Salpingopharyngeal fold
bin for oxygen?
D. A and B
E. All of the above A. PCO2
B. PO2
142. All of the following are true about the urea C. pH
cycle EXCEPT D. Hb concentration
A. Occurs in hepatocytes E. Temperature
B. Requires aspartate
C. Eliminates ammonia
D. Produces urea
E. Produces 3 ATP
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147. Place the following events of protein synthesis 150. Which of the following results from a disorder
in chronological order of urea synthesis?
A. RNA polymerase activity, small ribosomal A. Phenylketonuria
subunit binds to mRNA, splicing of B. Alkaptonuria
exons, anticodon binds to complementary C. Pernicious anemia
codon, transfer of mRNA from the D. Citrullinemia
nucleus to cytoplasm E. Richner-Hanhart syndrome
B. Transfer of mRNA from the nucleus to
cytoplasm, splicing of exons, small riboso- 151. Which of the following are released by the
mal subunit binds to mRNA, anticodon hypothalamus?
binds to complementary codon, RNA A. TRH

polymerase activity B. GHRH
C. RNA polymerase activity, splicing of C. GnRH
exons, transfer of mRNA from the D. A and C
nucleus to cytoplasm, anticodon binds to E. All of the above
complementary codon, small ribosomal
subunit binds to mRNA 152. All of the following would likely result in an
D. Transfer of mRNA from the nucleus to individual with severe anemia EXCEPT
cytoplasm, small ribosomal subunit binds
to mRNA, RNA polymerase activity, anti- A. fatigue.
codon binds to complementary codon, B. cyanosis.
splicing of exons C. hypoxia.
E. RNA polymerase activity, splicing of D. increased cardiac output.
exons, transfer of mRNA from the E. pulmonary vasoconstriction.
nucleus to cytoplasm, small ribosomal
subunit binds to mRNA, anticodon binds 153. Which of the following is not true of purines?
to complementary codon A. Synthesized from ribose-5-phosphate
B. Include adenine and guanine
148. If the left side of the spinal cord was damaged, C. Catabolized to acetyl-CoA
an individual would lose which functions? D. Pair with pyrimidines
A. Right-side pain and temperature sense, E. Cyclic structures composed of nitrogen
and left-side motor function and carbon
B. Left-side pain and temperature sense, and
left-side motor function 154. Thyroglobulin is a glycoprotein largely con-
C. Left-side pain and temperature sense, and sisting of what amino acid?
right-side motor function A. Tryptophan
D. Right-side pain and temperature sense, B. Arginine
and right-side motor function C. Lysine
D. Proline
149. The stretch reflex is mediated by muscle spin- E. Tyrosine
dle receptors. It results in skeletal muscle
relaxation. 155. The immersion of cells in a hypotonic solu-
A. Both statements are true. tion will result in which of the following?
B. Both statements are false. A. Cellular swelling
C. The first statement is true; the second B. Cellular shrinkage
statement is false. C. No change
D. The first statement is false; the second D. None of the above
statement is true.
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156. Exocytosis is the process by which cells C. folic acid.

release macromolecules to the ECM. Pinocy- D. vitamin E.
tosis is a type of exocytosis. E. biotin.
162. Which of the following is a transient cessa-
tion of breathing?
statement is false. A. Hypoventilation
D. The first statement is false; the second B. Dyspnea
statement is true. C. Hypocapnia
D. Apnea

157. All of the following stimulate osteoclastic E. Hyperapnea
activity EXCEPT
163. Beta-2 adrenergic agonists cause which of the
A. IL-1.
following?
B. TNF-β
C. IL-8. A. Vascular smooth muscle vasoconstriction
D. PTH. B. Bronchodilation
E. RANKL. C. Miosis
D. Increased heart rate
158. Which of the following is NOT TRUE of the E. GI relaxation
Entner-Doudoroff pathway?
164. All of the following are true of the genetic
A. Produces 1 ATP per glucose
code EXCEPT
B. Coverts glucose to pyruvate
C. Occurs in hepatocytes A. Universal
D. Produces 1 NADH B. Degenerate
E. Produces glyceraldehyde-3-phosphate C. Unambiguous
D. Overlapping
159. Intrinsic factor binds to which of the follow- E. Without punctuation
ing vitamins?
165. The length of the absolute refractory period
A. Vitamin B1
of the cardiac action potential is dictated by
B. Vitamin B2
which of the following?
C. Vitamin B3
D. Vitamin B6 A. Na+ channel opening
E. Vitamin B12 B. K+ channel opening
C. Na+ channel closure
160. During skeletal muscle contraction, calcium D. K+ channel closure
binds to which of the following? E. Ca2+ channel opening
A. Tropomyosin
166. β-Oxidation converts
B. Actin
C. Calmodulin A. fatty acids to acyl-CoA.
D. Myosin B. triglycerides to fatty acids.
E. Troponin C. acetyl-CoA to malonyl-CoA.
D. acetyl-CoA to HMG-CoA.
161. All of the following are water-soluble vitamins E. acyl-CoA to acetyl-CoA.
EXCEPT
A. vitamin B6.
B. vitamin C.
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167. Central diabetes insipidus is most commonly 173. After completing a lengthy dental procedure,
caused by a defect in the activity of which you sit your patient up to rinse out. He
structure? quickly becomes dizzy and loses his balance
due to orthostatic hypotension. Which of the
A. Adrenal cortex
following regulatory mechanisms is responsi-
B. Adrenal medulla
ble for the physiologic correction several sec-
C. Anterior pituitary
onds later?
D. Posterior pituitary
A. Bainbridge reflex
168. The countercurrent exchange system is based B. Chemoreceptor activity
on which of the following? C. Baroreceptor activity
A. Na+ reabsorption D. A and C

B. H2O reabsorption E. None of the above
C. H2O impermeability
174. Which of the following is a portion of a tran-
D. A and C
scriptional promoter?
E. All of the above
A. TATA box
169. A deficiency in which of the following results B. Zinc finger
in pernicious anemia? C. snRNP
A. Cobalt D. Leucine zipper
B. Iodine E. Helix-turn-helix
C. Magnesium
175. All are true of smooth muscle cells EXCEPT
D. Manganese
E. Zinc A. they have only one nucleus.
B. they are typically very long.
170. Which of the following may impair odon- C. their myofibrils are not striated.
togenesis? D. they have an extensive SR.
A. Cephalexin E. they do not have T tubules.
B. Amoxicillin
176. Which of the following metabolic reactions
C. Doxycycline
and their location of action are incorrect?
D. Clindamycin
E. None of the above A. Fatty acid synthesis: Cytosol
B. ETC: Inner mitochondrial membrane
171. Which of the following metabolic enzymes C. β-Oxidation: Mitochondrial matrix
require ATP? D. Pentose phosphate pathway: Mitochondr-
A. Phosphofructokinase ial matrix
B. Carbonic anhydrase E. Glycolysis: Cytosol
C. Lactate dehydrogenase
177. All of the following are secreted by the small
D. HMG-CoA reductase
intestine EXCEPT
E. Transaminase
A. oligosaccharidases.
172. Which of the following muscles contains the B. peptidases.
food bolus in proximity of the teeth for opti- C. lipase.
mal mastication? D. mucin.
A. Medial pterygoid E. all are intestinal secretions.
B. Masseter
C. Buccinator
D. Lateral pterygoid
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178. Which of the following will likely occur in an C. oxaloacetate, pyruvate, glycerol, HMG-
individual who has just reached the peak of CoA, cholesterol
Mount McKinley? D. pyruvate, fatty acid, HMG-CoA, acetyl-
CoA, cholesterol
A. O2-Hb curve shifts to the right
E. ketone body, HMG-CoA, mevalonate,
B. Respiratory alkalosis
acetyl-CoA, cholesterol
C. Increased erythropoietin release
D. Pulmonary vasoconstriction
183. Gastric emptying is regulated by which of the
E. All of the above
following?
179. Retinol is essential for vision because it is a A. CN IX

constituent of rhodopsin and iodopsin. B. CN X
C. CN XI
A. Both the statement and the reason are
D. Spinal nerves
E. All of the above
B. Both the statement and the reason are
correct but not related.
184. DNA polymerase synthesizes DNA from the
C. The statement is correct, but the reason is
lagging strand in the 5′ to 3′ direction. DNA
not.
polymerase synthesizes DNA from the lead-
D. The statement is not correct, but the rea-
ing strand in the 3′ to 5′ direction.
son is correct.
E. Neither the statement nor the reason is A. Both statements are true.
correct. B. Both statements are false.
180. The ventral horn of the spinal cord carries statement is false.
what fibers? D. The first statement is false; the second
statement is true.
A. Motor: skeletal muscle
B. Motor: smooth muscle
185. Hormones that affect females only are
C. Sensory: pain and temperature
secreted by which of the following glands?
D. Sensory: touch and pressure
A. Adrenal medulla
181. Sodium has a much higher intracellular con- B. Anterior pituitary
centration than extracellular concentration. C. Posterior pituitary
Blood plasma makes up about 8% of total D. B and C
body water. E. All of the above
186. According to the Frank-Starling mechanism,
which of the following is the most important
determinant in cardiac output?
statement is false.
D. The first statement is false; the second A. End diastolic volume
statement is true. B. Stroke volume
C. Heart rate
182. In order to convert alanine to cholesterol, the D. Oxygen consumption
correct sequence of intermediates is E. Systolic intraventricular pressure
A. oxaloacetate, acyl-CoA, fatty acid, meval-
onate, cholesterol
B. pyruvate, acetyl-CoA, HMG-CoA, meval-
onate, Cholesterol
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187. All of the following are not true of vitamin K D. Distal convoluted tubule
EXCEPT E. Collecting duct
A. deficiency causes a prolonged PTT.
192. All of the following are essential to TCA
B. it activates clotting factors II, VIII, X,
cycle function EXCEPT
and XI.
C. it is also known as tocopherol. A. vitamin B1.
D. it activates prothrombin. B. vitamin B2.
E. it is critical component of the intrinsic C. vitamin B3.
clotting pathway. D. vitamin B5.
E. vitamin B6.
188. Calcium is stored in which of the following

muscle cell components? 193. All of the following regulate bone remodeling
EXCEPT
A. Sarcoplasmic reticulum
B. Sarcomere A. calcitonin.
C. Sarcolemma B. osteoprotegerin.
D. Sarcoplasm C. parathyroid hormone.
E. T tubules D. osteopontin.
E. BMP-2.
189. G6PD deficiency causes hemolytic anemia
due to a decrease in NADPH production in 194. All of the following are true of human mito-
erythrocytes. chondrial DNA EXCEPT
A. Both the statement and the reason are A. Circular
correct and related. B. Double stranded
B. Both the statement and the reason are C. Contains about 1% of all cellular DNA
correct but not related. D. Has lower mutation rate than nuclear
C. The statement is correct, but the reason is DNA
not. E. Transmitted by maternal non-Mendelian
D. The statement is not correct, but the inheritance
reason is correct.
E. Neither the statement nor the reason is 195. Carbon dioxide is carried in blood as
correct. A. dissolved CO2.
B. bicarbonate.
190. Bitter taste cells transmit taste stimuli by C. carbaminohemoglobin.
A. production of H+ which closes K+ D. A and B.
channels. E. all of the above.
B. activating IP3 which increases intracellu-
lar Ca2+. 196. Under anaerobic conditions, how many net
C. Na+ influx through passive ion channels. ATPs are produced per glucose?
D. activating cAMP which closes K+ A. 0
channels. B. 1
C. 2
191. Amino acids are primarily reabsorbed in D. 4
which segment of the nephron? E. 6
A. Proximal convoluted tubule
B. Descending loop of Henle
C. Ascending loop of Henle
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197. Which of the following tissues have post- 199. Translation usually begins with what codon?
ganglionic sympathetic neurons that are
A. AAC
cholinergic?
B. AUG
A. Sebaceous glands C. UAC
B. Skeletal muscle vasculature D. UAG
C. Sweat glands E. UGA
D. B and C
E. All of the above 200. Sickle cell anemia is caused by what type of
mutation?
198. All of the following anatomic structures
A. Nonsense mutation

release hormones that will increase blood
B. Transition mutation
glucose levels EXCEPT
C. Repeat mutation
A. anterior pituitary gland. D. Transverse mutation
B. adrenal medulla. E. Missense mutation
C. adrenal cortex.
D. pancreatic α-cells.
E. pancreatic β-cells.
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AN SW E R S
1. The correct answer is C. The plateau results Answer B is incorrect. CA interconverts car-
from a very slow influx of calcium ions, bal- bon dioxide and bicarbonate.
anced against the efflux of potassium ions. Answer C is incorrect. CA accelerates the
This period ends with the decline in calcium reaction by a factor of more than a million.
permeability as potassium permeability
increases, resulting in repolarization. Answer E is incorrect. CA II provides pro-
tons to neutralize intracellular OH− ions after
H+ ions are pumped across osteoclastic ruf-

above. fled borders.
2. The correct answer is B. The first law of
Carbonic anhydrase
thermodynamics states that the total energy
CO2 + H2O H2CO3 H+ + HCO3−
of a closed system is conserved. The second
law of thermodynamics states that the entropy
of a closed system always increases. 6. The correct answer is C. Cardiac muscle
Answers A, C, and D are incorrect. See contraction occurs via actin-linked regula-
above. tion, which is dependent on calcium-
troponin interactions. Remember that tro-
3. The correct answer is D. Aldosterone is a ponin is a thin myofilament attached to
steroid hormone, derived from cholesterol. tropomyosin.
Steroid hormones function by binding to Answers A, B, D, and E are incorrect. See
intracellular receptors, forming hormone above.
response elements (HREs). Peptide hor-
mones are synthesized as a precursor form, 7. The correct answer is B. McArdle syndrome
transported unbound in blood, and bind to (type V glycogenosis) causes muscle cramp-
plasma membrane receptors, generating ing and results in decreased exercise toler-
second messengers. Examples include pitu- ance. Muscles have abnormally high glyco-
itary hormones, pancreatic hormones, and gen content. There is little or no lactic acid
parathyroid hormone. in blood after exercise.
Answers A, B, C, and E are incorrect. See Answer A is incorrect. Pompe disease (type II
above. glycogenosis) results from a deficiency of
lysosomal glucosidase.
4. The correct answer is B. Arterioles account
for the largest proportion of peripheral vascu- Answer C is incorrect. Hunter syndrome is a
lar resistance. Remember that there is about mucopolysaccharide storage disease caused
a 50% drop in blood pressure as blood travels by a deficiency of L-iduronate sulfatase.
from arteries to arterioles. Answer D is incorrect. Von Gierke disease
Answers A, C, D, and E are incorrect. See (type I glycogenosis) results from a deficiency
above. of glucose-6-phosphatase.
Answer E is incorrect. Hurler syndrome is a
5. The correct answer is D. CA is highly active mucopolysaccharide storage disease caused
in erythrocytes and nephrons. by a deficiency of α-L-iduronidase.
Answer A is incorrect. Most isoforms of CA
contain a central zinc atom. 8. The correct answer is B. ECF comprises
approximately 1/3 of total body water. Recall
Answers: 1-15 87
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that it contains higher concentrations of Na+, Answer C is incorrect. Ligases join two mol-
Cl−, and bicarbonate. Intracellular fluid ecules together; oxidoreductases catalyze
makes up the remaining 2/3 of total body redox reactions.
water. It has greater concentrations of K+, Answers D and E are incorrect. See above.
Mg2+, PO43−, and protein.
Answers A, C, D, and E are incorrect. See 13. The correct answer is D. Both GIP and
above. secretin decrease gastric acid secretion and
gastric motility. Secretin is released by a
9. The correct answer is B. Only hyaline carti- drop in pH in the duodenum, as chyme is
lage has the ability to calcify, as it is the precur- passed through the pyloric sphincter. Gas-

sor to endochondral ossification. However, not tric inhibitory peptide (GIP) is secreted by
all hyaline cartilage calcifies. Hyaline cartilage the presence of fats and glucose in the
is found at the articular surfaces of long bones, duodenum.
ribs, nose, trachea, bronchi, and larynx. Answer A is incorrect. Gastrin stimulates gas-
Answers A, C, D, and E are incorrect. See tric HCl secretion and increases gastric motil-
above. ity. It is released by the presence of peptides
and amino acids within the stomach lumen.
10. The correct answer is C. Aminotransferases Answers B, C, and E are incorrect. See
function as transaminases, converting one above.
amino acid to another. They are not involved
in DNA synthesis. 14. The correct answer is D. Inspiratory capacity
Answer A is incorrect. DNA polymerase syn- (IC) is the maximum volume of air that can
thesizes the new complementary strand in be inhaled after a normal expiration.
the 5′ → 3′ direction. IC = IRV + TV.
Answer B is incorrect. Exonuclease removes Answer A is incorrect. Expiratory reserve vol-
the nucleotide primer at the completion of ume (ERV) is the maximum amount of air
DNA synthesis. that can be exhaled at the end of tidal
Answer D is incorrect. Topoisomerase volume.
secures the replication fork of the DNA ERV = FRC − RV.
molecule.
Answers B and E are incorrect. Vital capac-
Answer E is incorrect. Helicase unwinds the ity (VC) is the volume of air that can be
DNA molecule. exhaled after maximum inspiration.
11. The correct answer is B. The parathyroid VC = TLV – RV, and also = TV + IRV + ERV.
gland is not directly linked by hypothalamic Answer C is incorrect. Total lung volume
regulation. Plasma Ca2+ is the major determi- (TLV) is the total volume of air in the lungs
nant of PTH secretion. after maximum inspiration.
Answers A, C, D, and E are incorrect. See TLV = VC + RV, and also = IRV + TV +
above. ERV + RV.
12. The correct answer is A. Hydrolases cleave 15. The correct answer is E. The Gibbs free
bonds by hydrolysis; lyases cleave bonds by energy change (∆G) determines the direction
elimination. of a reaction. If ∆GS > ∆GP, then the ∆G will
Answer B is incorrect. Transferases transfer be negative and the reaction will proceed spon-
functional groups; isomerases catalyze a taneously toward equilibrium. Equilibrium is
change in molecular structure. attained when ∆G = 0.
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Answer A is incorrect. ∆G provides no infor- Answers B, C, D, and E are incorrect. See

mation about the reaction rate. above.
Answer B is incorrect. Exergonic reactions
19. The correct answer is B. Growth hormone
will release energy; ∆G will be negative.
(GH) exerts its effects on almost all tissues.
Answer C is incorrect. ∆G does not deter-
Answer A is incorrect. FSH acts on testicular
mine reaction equilibrium.
and ovarian tissue.
Answer D is incorrect. ∆G is independent of
Answer C is incorrect. ACTH acts on the
the path of the reaction.
adrenal gland.
16. The correct answer is D. The somatic ner- Answer D is incorrect. Prolactin acts on
vous system is a subdivision of the peripheral breast tissue.
nervous system. It consists of the 12 cranial
Answer E is incorrect. TSH acts on the thy-
nerves and 31 pairs of spinal nerves. Somatic
roid gland.
motor neurons do not synapse in a peripheral
ganglion (there is only one efferent neuron 20. The correct answer is E. A frameshift muta-
from the CNS to the end organ). However, tion involves the deletion or insertion of 1-2
somatic sensory neurons (transmitting pain, base pairs, changing the entire reading frame
temperature, touch, etc) synapse in the dorsal of the DNA template, and thus the translated
root ganglion. amino acid sequence. Remember that point
Answers A, B, C, and E are incorrect. See mutations involve the substitution of one base
above. for another. Although this may alter the
amino acid sequence, it only does so for that
17. The correct answer is C. Chondroitin sul- particular codon.
fates are the most prominent proteoglycans in
Answer A is incorrect. A nonsense mutation
cartilage and bone.
is a type of point mutation that results in a
Answer A is incorrect. Keratin sulfates are stop codon, terminating the polypeptide
most prominent in the cornea (type I) and chain elongation.
loose connective tissue (type II).
Answer B is incorrect. A repeat mutation is
Answer B is incorrect. Heparin sulfate is an amplification of the same three-
present mostly in basement membranes, cell nucleotide sequence. This will create con-
surfaces, and ECM. secutive strings of the same amino acid, but
does not alter the entire reading frame of the
Answer D is incorrect. Dermatan sulfate is
DNA template.
widely distributed in skin and vascular tissue.
Answer C is incorrect. A transverse mutation
Answer E is incorrect. Hyaluronic acid is the
is a type of point mutation in which the
most unique GAG in that it consists of an
purine-pyrimidine orientation is changed.
unbranched chain of repeating disaccharide
units. It does not form a proteoglycan and Answer D is incorrect. A missense mutation
does not contain sulfur. It is widely distrib- is a type of point mutation that results in the
uted in ECM, vitreous humor, synovial fluid, translation of a different amino acid for that
and loose connective tissue. particular codon (eg, valine replaces gluta-
mate causing sickle cell anemia).
18. The correct answer is A. The pulmonary cir-
culation has less resistance than the systemic 21. The correct answer is A. Renin is secreted by
circulation. Recall that it is a much shorter the JGA in response to a decrease in renal
cycle than the systemic circulation. blood pressure and GFR. It converts
Answerss: 16-28 89
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angiotensinogen to angiotensin I. Angiotensin Answers A, B, and D are incorrect. See

I is then converted to angiotensin II by ACE. above.
Angiotensin II causes vasoconstriction, and
stimulates the adrenal cortex to release aldos- 25. The correct answer is C. Activation energy is
terone, which increases sodium retention. the energy needed to initiate a reaction.
Therefore, an increase in activation energy
Answers B, C, D, and E are incorrect. See
will slow the reaction rate. Enzymes function
above.
by lowering the activation energy of a reaction.
22. The correct answer is C. Plasma membranes Answer A is incorrect. A rise in temperature
are asymmetrical. will increase reaction rate. However, an

extreme increase in temperature can cause
Answer A is incorrect. Plasma membranes
enzyme denaturation.
are selectively permeable, enabling only cer-
tain molecules (water and small, nonpolar) to Answer B is incorrect. An increase in enzyme
easily pass. concentration will increase reaction rate.
Answer B is incorrect. Plasma membranes Answer D is incorrect. An increase in sub-
function as barriers. strate concentration will increase reaction rate.
Answer D is incorrect. Plasma membranes Answer E is incorrect. See above.
contain phospholipids, glycosphingolipids,
and cholesterol in varying ratios. 26. The correct answer is E. The Z line is a dark
band that bisects each I band. The portion of
Answer E is incorrect. Plasma membranes
a myofibril located between two Z lines is
have an amphipathic lipid bilayer consisting
defined as a sarcomere.
of outer, hydrophilic head groups and inner,
hydrophobic tail groups. Answer A is incorrect. The A band is a dark
band consisting of myosin filaments (centrally)
23. The correct answer is C. Almost all CT orig- and actin filaments (laterally). It is bisected by
inates from mesoderm. However, some CT of the M line.
the head and neck region derives from neural
Answer B is incorrect. The H band is a
crest ectoderm. Recall that the calvarium,
lighter band that bisects the A band.
facial bones, clavicle, and jaws arise from
neural crest ectoderm. Dense CT provides Answer C is incorrect. The I band is a light
structural support because it has a greater band that consists only of actin.
fiber concentration than loose CT. However, Answer D is incorrect. The M line bisects
most dense CT has an irregular arrangement both the A band and the sarcomere.
of fibers and cells. Regular CT, consisting of
an ordered arrangement of cells and fibers, is 27. The correct answer is D. Mannose is an
commonly found in ligaments, tendons, and aldose monosaccharide.
aponeuroses.
Answer A is incorrect. Sucrose is a disaccha-
Answers A, B, and D are incorrect. See ride of glucose + fructose.
above.
Answer B is incorrect. Maltose is a disaccha-
24. The correct answer is C. The four basic tastes: ride of glucose + glucose.
sweet, sour, bitter, and salty. Each taste bud Answer C is incorrect. Lactose is a disaccha-
contains various taste cells surrounded by ride of glucose + galactose.
epithelial cells. So, although each taste bud
may be able to sense all four of the basic tastes, 28. The correct answer is E. The intrinsic path-
there is a unique taste cell for each taste. way is initiated by the activation of factor XII
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(Hageman factor) from collagen, platelets, and CO2. Thus, hyperventilation results in a
fibrin. Recall that the extrinsic clotting pathway decrease of PCO2 to its normal physiologic
is initiated by tissue factor (tissue thromboplas- range.
tin) as a response to contact with injured tissue.
Answer A is incorrect. The increased respira-
Answers A, B, C, and D are incorrect. See tory rate causes a ↑ PO2.
above.
Answer B is incorrect. The resultant
decrease in CO2 causes hypocapnia.
29. The correct answer is C. Segmentation (mix-
ing) is most common in the small intestine, Answer C is incorrect. The resultant
decreasing its rate as you progress further decrease in PCO2 causes vasoconstriction,
down the GI tract. It involves rhythmic con- leading to ↓ cerebral blood flow.
tractions which serve to chop chyme, mixing
Answer E is incorrect. Respiratory alkalosis
it with digestive enzymes, and keeping it in
occurs due to the ↑ pH.
contact with the gut wall for maximum
absorption. In the duodenum, it occurs at a 32. The correct answer is A. Aminoacyl-tRNA
rate of 11-12 cycles per minute. synthetase adds each amino acid to tRNA.
Answer A is incorrect. Tonic contractions Answer B is incorrect. tRNA carries the anti-
occur at sphincters throughout the GI tract, codon to each mRNA.
and last much longer than segmentation.
Answer C is incorrect. Although there are
Answer B is incorrect. Peristalsis is a series of two ribosomal subunits that are involved in
coordinated contractions that propels chyme protein synthesis, they are of different sizes.
down the GI tract.
Answer D is incorrect. Protein synthesis
Answers D and E are incorrect. See above. occurs in both prokaryotic (containing 70S
ribosomes) and eukaryotic cells (containing
30. The correct answer is B. Zymogens are enzy-
80S ribosomes).
matically inactive precursors of proteolytic
enzymes. Proteases cleave the proenzyme Answer E is incorrect. Translation occurs in
propeptides, activating the enzyme. Calmod- the 5′ to 3′ direction.
ulin is an already active enzyme that binds
Ca2+, activating the actin-myosin complex 33. The correct answer is B. By blocking sodium
of smooth muscle. It also serves other channels, the absolute refractory period is
microfilament-mediated functions such as prolonged (APs cannot be generated), and
cell motility, conformational changes, mitosis, transient anesthesia occurs.
exocytosis, and endocytosis. Answers A, C, D, and E are incorrect. See
Answer A is incorrect. Factor I (fibrinogen) is above.
cleaved by thrombin to form fibrin.
34. The correct answer is C. You need to under-
Answer C is incorrect. Trypsinogen is stand Starling forces to correctly answer this
cleaved by enteropeptidase to form trypsin. question. Hydrostatic pressure is the “push”
Answer D is incorrect. Factor X is cleaved by created by a fluid (moving that fluid from one
tissue factor complex to form factor Xa. space to another). Oncotic pressure, on the
other hand, is the “pull” force exerted by pro-
Answer E is incorrect. Procollagen is cleaved teins and large molecules (which do not dif-
by endopeptidases to form tropocollagen. fuse). Recall that edema is excess fluid in the
interstitial space. The only answer choice
31. The correct answer is D. Hyperventilation is
which creates a gradient that moves fluid from
initiated due to an increase in PCO2. The
the vasculature to the surrounding connective
increased rate of breathing “blows off” excess
tissue is decreased capillary oncotic pressure.
Answers: 29-42 91
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Answers A, B, D, and E are incorrect. See TPR is indirectly proportional to CO. It is

above. also highly regulated by the sympathetic ner-
vous system (α1 activation ↑ TPR, β2 activa-
35. The correct answer is B. Competitive tion ↓ TPR), and thermal changes (extreme
inhibitors increase Km without any change cold ↑ TPR).
in Vmax. Noncompetitive inhibitors decrease
Answers A, C, and D are incorrect. See
Vmax without any change in Km.
above.
above. 40. The correct answer is E. Both vitamin H
(biotin) and vitamin B5 (pantothenic acid)

36. The correct answer is D. All of these drugs are are cofactors for acetyl-CoA carboxylase,
bisphosphonates, which are potent inhibitors which converts acetyl-CoA → malonyl-CoA
of osteoclasts. Several case reports and reviews during fatty acid synthesis.
have associated their use with a rare condition
Answer A is incorrect. Vitamin E (toco-
called osteonecrosis of the jaws (ONJ), in
pherol) is a potent antioxidant.
which portions of the maxilla or mandible
become exposed and necrotic. Intravenous bis- Answer B is incorrect. Vitamin B1 (thiamine)
phosphonates (pamidronate and zolendronate) is a cofactor for pyruvate dehydrogenase (con-
are often used to treat bone cancers (such as verts pyruvate → acetyl-CoA), α-ketoglutarate
multiple myeloma); while oral bisphospho- dehydrogenase (converts α-ketoglutarate →
nates (alendronate, risedronate, and iban- succinyl-CoA in TCA cycle), and ketoacid
dronate) are used to treat osteopenia and dehydrogenase (metabolism of leucine, iso-
osteoporosis. leucine, and valine).
Answers A, B, C, and E are incorrect. See Answer C is incorrect. Vitamin B6 (pyridox-
above. ine) is a cofactor in transamination
reactions.
37. The correct answer is B. Amylases cleave
Answer D is incorrect. Vitamin B12 (cobal-
α-1,4-glycosidic linkages. Isomaltase cleaves
amin) is a cofactor for methionine synthase
α-1,6-glycosidic linkages.
(converts homocysteine → methionine) and
Answer A is incorrect. α-Amylase is secreted methylmalonyl-CoA isomerase (converts
by both the parotid gland and the pancreas. methylmalonyl-CoA → succinyl-CoA).
Answers C and D are incorrect. Amylases cat-
41. The correct answer is D. Calmodulin is an
alyze the hydrolysis of starch to dextrins, and a
integral part of myosin-linked regulation dur-
mixture of glucose, maltose, and isomaltose.
ing smooth muscle contraction. Calcium
(from the SR or extracellular sources) binds
38. The correct answer is C. Hyperparathy-
calmodulin, which then activates a myosin
roidism (↑ PTH) results in increased bone
light-chain kinase.
resorption and loss of bone density. On peri-
apical radiographs, you may find a loss of a Answers C and E are incorrect. It is the
normal trabecular pattern, widened PDL myosin light-chain kinase that transfers a Pi
spaces, absence of a lamina dura, and radi- from ATP to myosin, enabling interaction with
olucent cystlike spaces (brown tumors). actin, and thus contracting the muscle fibers.
42. The correct answer is A. Simple Michaelis-
above.
Menten kinetics is not followed in most
allosteric enzyme reactions.
39. The correct answer is B. Remember that
TPR is the vascular resistance of the systemic Answer B is incorrect. Both the allosteric and
circulation. TPR = (MAP − CVP)/CO. Thus, catalytic binding sites on enzymes are unique.
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Answer C is incorrect. Many allosteric reac- Answers A, B, C, and D are incorrect. See
tions involve feedback regulation (either neg- above.
atively or positively).
47. The correct answer is C. Although the vast
Answer D is incorrect. Allosteric effects can be
majority of oxygen is transported in blood by
on Km or on Vmax. For some reactions, substrate
hemoglobin, a small amount is dissolved in
concentration kinetics are competitive in the
the blood.
sense that Km is increased without a change in
Vmax. However, other reactions follow noncom- Answer A is incorrect. Recall that CO2 is car-
petitive substrate concentration kinetics in that ried mostly by serum bicarbonate.
Vmax is lowered without affecting Km.
Answers B, D, and E are incorrect. See
Answer E is incorrect. See above. above.
43. The correct answer is D. Both FSH and LH 48. The correct answer is D. Collagen is not a
function in both males and females. FSH component of plasma cell membranes.
stimulates sperm production (in testicular
Answer A is incorrect. Sphingomyelin and
Sertoli cells) and graafian follicle develop-
phosphoglycerides are the two major phos-
ment (in ovaries). LH promotes testosterone
pholipids commonly found in plasma
production (in testicular Leydig cells) and
membranes.
estrogen production (in ovaries).
Answer B is incorrect. Cholesterol is com-
Answers A, B, and C are incorrect. See
monly found in plasma membranes.
above.
Answer C is incorrect. G proteins are trans-
44. The correct answer is D. Blood is slightly membrane GTPase receptors.
alkaline. Its pH is tightly regulated by the
Answer E is incorrect. Arachidonic acid
bicarbonate to CO2 ratio.
accounts for 5%-15% of the fatty acids in
Answers A, B, C, and E are incorrect. See phospholipids of plasma membranes.
above.
49. The correct answer is C. Pain and tempera-
45. The correct answer is A. The tumor suppres- ture afferent neurons are carried in the
sor, p53, is a DNA binding transcription fac- anterolateral pathway (lateral spinothalamic
tor that plays a key role in G1 and G2 check- tract) of white matter. After synapsing in the
point control. An increased level of p53 dorsal root ganglion, recall that these fibers
activates a series of genes that delay the cell decussate in the dorsal horn (gray matter)
cycle. If DNA damage is too severe, the before entering the ascending column (con-
affected cell undergoes apoptosis. tralateral ascension).
Answers B, C, D, and E are incorrect. See Answers A and E are incorrect. The dorsal
above. column pathway transmits touch and pres-
sure afferent neurons (ipsilateral ascen-
46. The correct answer is E. Remember that the sion). When they enter the medulla, they
pancreas is both an endocrine and an synapse with neurons in the dorsal column
exocrine gland. Insulin, glucagon, and nuclei, decussate, and enter the thalamus
somatostatin are released from the endocrine as part of the medial lemniscal pathway.
portion (pancreatic islets) directly into the The neurons in the thalamus then extend
bloodstream. Only the pancreatic exocrine into the cortex.
products (lipase, amylase, trypsinogen, etc)
Answer B is incorrect. Light touch afferents
are secreted via ducts. Thus, if the question
are carried in the anterolateral pathway (ante-
had asked about these secretions, the answer
rior spinothalamic tract) of white matter.
would be “D,” merocrine and acinar.
Answers: 43-56 93
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Answer D is incorrect. The corticospinal tract Answer C is incorrect. Serine is a nonessen-

transmits efferent motor neurons that control tial amino acid.
fine, skilled movements of skeletal muscle.
Answer D is incorrect. Glutamate is a
nonessential amino acid.
50. The correct answer is D. The rate-limiting
step in glycolysis is the conversion of fructose- Answer E is incorrect. Alanine is a nonessen-
6-phosphate to fructose-1,6-biphosphate via tial amino acid.
phosphofructokinase (PFK). This step
requires the hydrolysis of 1 ATP. 54. The correct answer is A. The salpingopha-
ryngeus elevates the nasopharynx and opens
Answer A is incorrect. Each molecule of glu-
the auditory tube. It is generally not involved

cose is converted to 2 molecules of pyruvate.
in swallowing.
Answer B is incorrect. Glycolysis is also
Answer B is incorrect. The levator veli pala-
called Embden-Meyerhof pathway.
tini raises the palate.
Answer C is incorrect. Glycolysis occurs in
Answer C is incorrect. The palatopharyn-
the cytosol.
geus raises the pharynx and larynx.
Answer E is incorrect. The metabolism of one
Answer D is incorrect. The tensor veli pala-
glucose molecule produces 4 ATP. Remem-
tini tenses the palate.
ber, though, that 2 ATP are hydrolyzed via
hexokinase and PFK. Therefore, glycolysis Answer E is incorrect. All of the pharyngeal
results in the direct net production of 2 ATP. constrictors contract in waves (to propel food
downward).
51. The correct answer is D. The first heart
sound (S1 – “lub”) is caused by the closure of 55. The correct answer is A. Enolase converts
the AV (mitral and tricuspid) valves, and indi- 2-phosphoglycerate → phosphoenolpyruvate.
cates the start of systole (ventricular contrac-
Answer B is incorrect. PFK converts
tion). The second heart sound (S2 – “dub”) is
fructose-6-phosphate → fructose-1,6-biphos-
caused by the closure of the semilunar (aortic
phate. This is the rate-limiting reaction of
and pulmonic) valves, and indicates the
glycolysis.
beginning of diastole (ventricular filling). S1
is generally louder and longer than S2. Answer C is incorrect. Lactate dehydroge-
nase converts pyruvate → lactate.
above. Answer D is incorrect. Hexokinase converts
glucose → glucose-6-phosphate. This is the
52. The correct answer is A. Cholecystokinin first step in glycolysis.
stimulates contraction of the gallbladder and
Answer E is incorrect. Aldolase converts
relaxation of the sphincter of Oddi. This, in
fructose-1,6-biphosphate → dihydroxyacetone
turn, releases bile into the small intestine.
phosphate + glyceraldehyde-3-phosphate.
above. 56. The correct answer is E. Glucagon is released
from pancreatic alpha cells in response to states
53. The correct answer is A. Valine is an essen- of hypoglycemia. It significantly increases
tial amino acid and cannot be synthesized glycogenolysis, fatty acid synthesis, amino acid
from dietary intake of glucose. Remember
synthesis, and urea synthesis. Remember that
the mnemonic for the essential amino acids:
its effects are opposite of insulin.
Private Tim Hall.
Answer B is incorrect. Arginine is a Answers A, B, C, and D are incorrect. See
nonessential amino acid. above.
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57. The correct answer is D. The regulation of 61. The correct answer is B. A type II skeletal
Ca2+ reabsorption by PTH occurs at the dis- muscle twitch produces fast and powerful
tal convoluted tubule. Recall that Na+ and contractions. Since there will need to be an
Cl− are also reabsorbed in this portion of the ample supply of Ca2+, the SR content will be
nephron. relatively high.
Answers A, B, C, and E are incorrect. See Answers A, C, D, and E are incorrect. See
above. above.
58. The correct answer is C. The Northern blot 62. The correct answer is C. Resistance is
allows visualization of RNA fragments.
inversely proportional to the radius to the

Answer A is incorrect. PCR (polymerase fourth power. So, the equation should be:
chain reaction) amplifies DNA sequences. R = 8ηL/πr4. This is an important concept in
fluid dynamics.
Answer B is incorrect. The Western blot
allows visualization of protein fragments. Answer A is incorrect. Mean arterial pressure
is defined as cardiac output times total
Answer D is incorrect. The Southern blot peripheral resistance.
allows visualization of DNA fragments.
Answer B is incorrect. Cardiac output is
Answer E is incorrect. The Southwestern defined as heart rate times stroke volume.
blot allows visualization of protein and DNA
interactions. Answer D is incorrect. Laplace law.
Answer E is incorrect. Poiseuille law.
59. The correct answer is A. Recall that the max-
illa and mandible (except the condyles) are 63. The correct answer is E. Epinephrine is
developed by intramembranous ossification. derived from phenylalanine.
Extraction sites heal in the same manner.
Answer A is incorrect. Histamine is derived
Answer C is incorrect. There is no such from histidine.
thing as intermembranous ossification.
Answer B is incorrect. Signal transduction
Answers B, D, and E are incorrect. See above. enzymes are derived from serine.
60. The correct answer is C. Although pyruvate can Answer C is incorrect. Creatine and heme is
be converted back to glucose, it must first be derived from glycine.
converted to glucose-6-phosphate. Remember Answer D is incorrect. Serotonin is derived
that gluconeogenesis is not a direct reversal of from tryptophan.
glycolysis, and is under strict hormonal control.
Phenylalanine hydroxylase Melanin
Answer A is incorrect. Pyruvate is converted
Phenylalanine Tyrosine Dopa
to oxaloacetate via pyruvate carboxylase. Dopamine NE Epi
Answer B is incorrect. Pyruvate is converted

to acetyl-CoA via pyruvate dehydrogenase.
Answer D is incorrect. Pyruvate is converted 64. The correct answer is C. An increase in alve-
to alanine via alanine aminotransferase. olar gas exchange occurs when there is a par-
tial pressure gradient from high to low. Recall
Answer E is incorrect. Pyruvate is converted that oxygen diffuses from alveoli to the blood.
to lactate via lactate dehydrogenase. Thus, PAO2 (partial alveolar oxygen pressure)
Answers: 57-72 95
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must be greater than PaO2 (partial pulmonary Answers B, C, D, and E are incorrect. See
artery oxygen pressure). above.
Answers A, B, D, and E are incorrect.
68. The correct answer is C. Helicase unwinds
Increased alveolar gas exchange is also a
the DNA molecule prior to replication.
function of alveolar barrier thickness, gas sol-
ubility, and alveolar surface area. Answer A is incorrect. DNA polymerase syn-
thesizes a complementary DNA strand in the
65. The correct answer is E. The Krebs cycle 5′ to 3′ direction.
produces 1 GTP, 3 NADH, and 1 FADH2 per
Answer B is incorrect. Exonuclease cleaves

turn. Remember that, in the metabolism of
nucleotide primers.
one glucose molecule, the Krebs cycle will
turn twice (once per pyruvate) yielding 2 GTP, Answer D is incorrect. DNA ligase joins
6 NADH, and 2 FADH2. Assuming all reduc- Okazaki fragments.
ing equivalents are transferred to the ETC, Answer E is incorrect. Restriction endonu-
one turn of the Krebs cycle will produce clease cleaves DNA at specific points.
12 ATP.
Answers A, B, C, and D are incorrect. See 69. The correct answer is C. Gastric secretions
above. (including HCl) are by far the most acidic, with
a pH range of 1.0 to 3.5. Intestinal secretions
66. The correct answer is C. Ruffini corpuscles are mainly mucous, so their pH ranges from 7.5
are encapsulated stretch receptors. They are to 8.0. Bile has a pH of about 7.8. The pH of
located in the dermis of hairy skin. pancreatic secretions rang from 8.0 to 8.3.
Answer A is incorrect. Free nerve endings Answers A, B, and D are incorrect. See
detect primarily pain, but also touch, pres- above.
sure, and temperature. They are unencapsu-
lated, and located in skin, cornea, alimentary 70. The correct answer is C. The typical amino
tract, connective tissue, haversian systems, acid sequence of each α-chain is gly-x-y.
and dental pulp. Answers A, B, D, and E are incorrect. See
Answer B is incorrect. Meissner corpuscles above.
are encapsulated mechanoreceptors, allowing
two-point discrimination. They are located in 71. The correct answer is C. The ascending loop
the dermal papillae of skin. of Henle is impermeable to H2O. Here, Na+,
Cl−, and K+ are reabsorbed.
Answer D is incorrect. Pacinian corpuscles
are encapsulated vibration and pressure Answers A, B, D, and E are incorrect. See
receptors. They are located in the dermis, above.
subcutaneous tissue, ligaments, and joints.
72. The correct answer is B. Hematopoiesis,
Answer E is incorrect. Merkel discs are blood cell formation, occurs primarily in red
unencapsulated touch receptors. They are bone marrow, as it contains pluripotential
located in hairless skin, including fingertips. stem cells. It is also to site of B-cell maturation.
67. The correct answer is A. Careful! Remember Answer A is incorrect. Lymph nodes house
that ADH (and oxytocin) is produced in the T cells and B cells.
hypothalamus, but stored and secreted from Answer C is incorrect. Yellow marrow con-
the posterior pituitary gland. tains mostly fat cells.
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Answer D is incorrect. The spleen is the site 77. The correct answer is C. Cushing syndrome
of fetal erythropoiesis. In adults, lymphocyte is often caused by a long-term use of exoge-
proliferation and erythrocyte scavenging nously administered glucocorticoids. It may
occur here. also result from an increase in endogenous
Answer E is incorrect. The thymus is the site cortisol release as a result of a cortisol-
of T-cell maturation. secreting adrenocortical tumor. Cushing syn-
drome is characterized by central obesity
73. The correct answer is E. The Na+/K+ pump with abdominal striae, moon face, buffalo
functions via primary active transport, which hump, proximal muscle wasting, and
requires the direct participation of ATP. For hypertension.
each ATP hydrolyzed, 3 Na+ ions are moved Answer A is incorrect. Addison disease is
outside the cell, and 2 K+ ions are brought caused by adrenocortical insufficiency.
into the cell. Digitalis and other cardiac gly-
cosides inhibit the Na+/K+ ATPase by binding Answer B is incorrect. Cushing disease is
to the extracellular domain. caused by an increase in endogenous cortisol
secretion secondary to excess ACTH release
Answers A, B, C, and D are incorrect. See (often from a pituitary tumor).
above.
Answer D is incorrect. Plummer syndrome is
74. The correct answer is A. The SA node is the hyperthyroidism resulting in toxic multinodu-
pacemaker of the heart. The correct sequence lar goiter.
leading to ventricular contraction is SA Answer E is incorrect. Myxedema is adult-
node → AV node → bundle of His → Purk- onset hypothyroidism.
inje fibers → ventricular myocytes.
Answers B, C, D, and E are incorrect. See 78. The correct answer is A. Tyrosine is con-
above. verted to acetyl-CoA, but can also be converted
to melanin. The lack of melanin expression
75. The correct answer is A. Erythrocytes do not causes albinism.
contain mitochondria. All of the pyruvate Answer B is incorrect. Tryptophan is con-
formed from glycolysis is converted to lactate verted to acetyl-CoA, but can also be con-
via lactate dehydrogenase. Further oxidation verted to serotonin.
of pyruvate (in the Krebs cycle) and
NADH/FADH2 (in the ETC) is impossible Answer C is incorrect. Arginine is converted
since these reactions occur in mitochondria. to α-ketoglutarate, but can also be converted
Remember that lactic acid is converted back to nitric oxide (NO).
to glucose via the Cori cycle in hepatocytes. Answer D is incorrect. Leucine is converted
Answers B, C, D, and E are incorrect. See to acetyl-CoA.
above. Answer E is incorrect. Alanine is converted
to pyruvate.
76. The correct answer is A. The majority of
skeletal muscle contains extrafusal fibers, 79. The correct answer is E. CN VII (via the
which are innervated by α-motor neurons. chorda tympani nerve) carries taste sensation
Remember that intrafusal skeletal muscle from the anterior 2/3 of the tongue. CN IX
fibers are innervated by γ-motor neurons. conveys taste fibers from the posterior 1/3 of
Answers B, C, and D are incorrect. See the tongue. CN X carries taste sensation from
above. the area around the epiglottis.
Answers: 73-86 97
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Answers A, B, C, and D are incorrect. See Answers A, B, and C are incorrect. See
above. above.
80. The correct answer is D. Lactic acid is con- 83. The correct answer is E. Interphase consists
verted back to glucose via the Cori cycle in of G1, S, and G2. DNA synthesis occurs dur-
the liver. It provides quick ATP production ing the S (synthesis) phase, which takes about
during anaerobic glycolysis in muscle and 7 hours to complete.
erythrocytes.
Answer A is incorrect. In prophase, the
Answer A is incorrect. Glycogen is catabo- chromatin coils within the nucleus and the

lized to glucose through a series of enzymatic mitotic spindle forms.
reactions. Remember that glycogen phospho-
Answer B is incorrect. In metaphase, the
rylase is under strict hormonal regulation.
chromosomes line up at the equatorial plate
Answer B is incorrect. NAD+ is reduced to of the mitotic spindle.
NADH as a coenzyme in numerous dehydro-
Answer C is incorrect. In anaphase, the chro-
genase reactions.
mosomes split to opposite poles of the cell.
Answer C is incorrect. Acetyl-CoA is con-
Answer D is incorrect. In telophase, cytoki-
verted to malonyl-CoA via acetyl-CoA car-
nesis occurs, dividing the cytoplasm into two
boxylase in the cytosol of hepatocytes during
daughter cells.
fatty acid synthesis.
Answer E is incorrect. Pyruvate can be con- 84. The correct answer is D. Osmosis is the sim-
verted to glucose-6-phosphate (then glucose) ple diffusion of water caused by a concentra-
via gluconeogenesis reactions. Remember tion gradient. Osmolality is the osmotic pres-
that these reactions are tightly regulated by sure of water (in osmols/kg). Recall that
several hormones. osmotic pressure is defined as the pressure
developed as a result of net osmosis into a
81. The correct answer is E. Remember that a solution (it depends on the number of solute
right shift favors the release of O2 in the tis- particles present).
sues due to an acidic environment (eg, exer-
cising muscle). Thus, a right shift occurs
above.
when there is ↓ pH, caused by ↑ CO2, lactic
acid buildup, 2,3-DPG formation (from gly- 85. The correct answer is C. Oxygen is the final
colysis), and temperature. A left shift, on the electron receptor in complex IV.
other hand, favors oxygen uptake in the lungs.
Answer A is incorrect. See below.
Answers A, B, C, and D are incorrect. See
above. Answer B is incorrect. NADH is reoxidized
back to NAD+ via NADH dehydrogenase.
82. The correct answer is D. All preganglionic Answer D is incorrect. Q (ubiquinone) is a
autonomic neurons (sympathetic and coenzyme that links flavoproteins to
parasympathetic) are cholinergic. All post- cytochrome b in complex III.
ganglionic parasympathetic neurons are also
cholinergic. All postganglionic sympathetic Answer E is incorrect. Water is the final end
neurons are adrenergic except for those product of the ETC.
innervating eccrine sweat glands and skeletal
86. The correct answer is E. PTH, secreted by
muscle vasculature.
parathyroid chief (principal) cells, functions
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to increase serum calcium levels. In order to Answers B, C, D, and E are incorrect. See
do so, more calcium must be retained (and above.
less excreted). Thus, PTH will ↑ renal and
intestinal Ca2+ reabsorption, and ↓ renal 90. The correct answer is A. Cytochrome oxi-
PO43− reabsorption. Since excess calcium is dase is the final cytochrome in complex IV. It
also taken from hydroxyapatite, bone resorp- combines the final reducing equivalents with
tion occurs. molecular oxygen to form water and ATP.
Because it has a high affinity for O2, it func-
tions continuously until all of the oxygen has
above.
been depleted.
87. The correct answer is E. Both ventricular Answer B is incorrect. Cytochrome reduc-
depolarization and atrial repolarization occur tase is in complex III.
within the QRS complex.
Answer C is incorrect. Ubiquinone (Q) is a
Answer A is incorrect. The PR interval is the coenzyme that links flavoproteins to cytochrome
length of time between atrial depolarization b in complex III.
and ventricular depolarization.
Answer D is incorrect. α-Ketoglutarate dehy-
Answer B is incorrect. The ST segment is drogenase converts α-ketoglutarate →
the length of time the action potential is in succinyl-CoA in the Krebs cycle.
ventricular muscle.
Answer E is incorrect. NADH dehydroge-
Answer C is incorrect. The P wave repre- nase oxidizes NADH → NAD+. The result-
sents atrial depolarization. ing reducing equivalents are passed on to Q.
Answer D is incorrect. The T wave repre-
sents ventricular repolarization. 91. The correct answer is C. Although estrogen
stimulates LH release, it is a surge of LH that
88. The correct answer is B. Endopeptidases promotes ovulation. Recall that ovulation
cleave the N- and C- terminal propeptides of occurs about 14 days prior to menses (regard-
procollagen, forming tropocollagen, extracel- less of cycle length).
lularly. Tropocollagen then aggregates to Answers A, B, D, and E are incorrect. See
form collagen fibrils. above.
Answer A is incorrect. Occurs in the rER.
92. The correct answer is A. The A band is a
Answer C is incorrect. Occurs in the Golgi. dark band consisting of myosin filaments
Answer D is incorrect. Occurs in the rER. (centrally) and actin filaments (laterally). It
will remain the same length during contrac-
89. The correct answer is A. Bilirubin is derived tion. Both the H band and I band decrease in
from catabolized hemoglobin. It is normally length as the sarcomere contracts.
carried to the liver, conjugated, and excreted
Answers B, C, and D are incorrect. See
into the intestine as a component of bile.
above.
Elevated blood levels of bilirubin cause jaun-
dice, a yellowish discoloration of the skin 93. The correct answer is D. Transcription
and sclera. Jaundice is a common sign of occurs in the nucleus, but translation occurs
liver disease (hepatitis or cirrhosis), but may in the cytoplasm (in ribosomes). Both DNA
also be caused by hemolytic anemia and and protein syntheses (translation) occur in
choledocholithiasis. the 5′ → 3′ direction.
Answers: 87-99 99
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Answers A, B, and C are incorrect. See passive process resulting from lung recoil
above. (except in certain respiratory diseases such as
emphysema). The decrease in alveolar and
94. The correct answer is E. Na+ reabsorption is intrapleural pressures creates a gas flow
regulated in the collecting duct by aldos- down-gradient from the mouth to the alveoli.
terone. H2O reabsorption is tightly regulated The opposite happens during expiration.
here by ADH. Recall that urine concentrates
Answers B, C, and D are incorrect. See above.
as it descends the collecting duct (as more
and more water is reabsorbed). 98. The correct answer is B. CF is a recessive

Answers A, B, C, and D are incorrect. See genetic disease affecting Caucasians in North
above. America and certain parts of northern
Europe. The abnormality of membrane Cl−
95. The correct answer is D. Both hemoglobin permeability results in the increased viscosity
and myoglobin contain only one globin of many bodily secretions, especially those of
molecule. the respiratory tract.
Answer A is incorrect. Myoglobin contains Answer A is incorrect. Achondroplasia is
only one heme, which has a central iron atom. caused by a mutation of a FGF receptor,
Answer B is incorrect. Myoglobin generally resulting in impaired maturation of cartilage
stores oxygen in muscle tissue. in the developing growth plate. Dwarfism
commonly results.
Answer C is incorrect. Myoglobin can only
bind one molecule of oxygen since it con- Answer C is incorrect. Tay-Sachs disease is
tains only one heme. an autosomal recessive disorder caused by a
deficiency of hexosaminidase A, leading to an
Answer E is incorrect. Myoglobin has a sig- accumulation of gangliosides. It is rapidly fatal.
nificantly higher oxygen affinity compared to
hemoglobin. Answer D is incorrect. Diabetes mellitus is a
chronic disorder of carbohydrate, fat, and pro-
96. The correct answer is C. Endochondral tein metabolism, resulting in hyperglycemia.
osteogenesis can occur by both appositional It can be inherited (often as a defect in
and interstitial growth. During appositional insulin production/secretion), or acquired.
growth, new bone matrix is added once osteo- Answer E is incorrect. Multiple sclerosis is an
progenitor cells contact existing bony autoimmune disease caused by an overactive
spicules, and differentiate into osteoblasts. In T-cell response against myelin. It is the most
interstitial growth, mesenchymal cells first common demyelinating disease of the CNS.
differentiate and deposit a cartilage matrix.
The cartilage matrix then calcifies, and bone 99. The correct answer is C. Nicotinic-2 recep-
matrix is deposited in the same manner as in tors are cholinergic receptors located at the
appositional growth. neuromuscular junction. Stimulation results
Answers A, B, and D are incorrect. in muscle contraction.
Intramembranous osteogenesis develops only Answer A is incorrect. Muscarinic receptors
by appositional growth. are cholinergic receptors located on postgan-
glionic parasympathetic effector organs, as
97. The correct answer is A. Inspiration requires well as sweat glands and skeletal muscle vas-
muscular effort, and is thus an active process. culature which are under postganglionic
Expiration, on the other hand, is generally a sympathetic control.
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Answer B is incorrect. Nicotinic-1 receptors Answers B, C, D, and E are incorrect. See

are cholinergic receptors located on postgan- above.
glionic autonomic (parasympathetic and sym-
pathetic) neurons. 102. The correct answer is A. Compared to PTH,
calcitonin plays a minor role in regulating
Answer D is incorrect. Alpha-1 receptors are
serum calcium levels.
adrenergic receptors located on vascular
smooth muscle. Answer B is incorrect. Calcitonin is more
important during bone development.
Answer E is incorrect. Alpha-2 receptors are
adrenergic receptors located at presynaptic Answer C is incorrect. Vitamin D is essential
nerve terminals, platelets, adipocytes, and the for the GI absorption of calcium.
GI tract wall. Answer D is incorrect. Hydroxyapatite is the
crystalline mineral content of bone, which
100. The correct answer is B. The pentose phos-
serves as a source of calcium and phosphorus:
phate pathway does not produce any ATP.
Ca10(PO4)6(OH)2.
Answer A is incorrect. It occurs in the
Answer E is incorrect. See above.
cytosol of several (but not all) cells including
liver, adipose, adrenal cortex, thyroid, mam- 103. The correct answer is A. Corticosteroids
mary gland, and erythrocytes. inhibit PLA2, blocking the synthesis of
Answer C is incorrect. Its function is to convert arachidonic acid.
glucose-6-phosphate → ribose-5-phosphate, Answer B is incorrect. 5-LOX converts
forming ribose (for nucleotide synthesis) and arachidonic acid to leukotrienes. 15-LOX
NADPH (for fatty acid and steroid synthesis). converts arachidonic acid to lipoxins.
Answer D is incorrect. The rate-limiting step Answer C is incorrect. HMG-CoA reductase
is the conversion of glucose-6-phosphate → 6- converts HMG-CoA to mevalonate. Statins
phosphogluconolactone via G6PD. inhibit HMG-CoA reductase.
Answer E is incorrect. The PPP is also called Answer D is incorrect. COX-1 constitutively
the hexose monophosphate shunt. converts arachidonic acid to prostaglandins to
maintain renal blood flow, vasomotor tone, and
Glucose-6-phosphate + 2 NADP+ + H2O → mucosal integrity in the stomach. Aspirin and
Ribose-5-phosphate + 2 NADPH + 2 H+ + CO2
NSAIDs inhibit both COX-1 and COX-2.
101. The correct answer is A. Both carotid body Answer E is incorrect. COX-2 converts
chemoreceptors and carotid sinus baroreceptors arachidonic acid to prostaglandins during
receive afferent fibers from CN IX. The atrial inflammation. Aspirin and NSAIDs
stretch receptors, aortic body chemoreceptors, inhibit both COX-1 and COX-2. Selective
and aortic arch baroreceptors receive their affer- COX-2 inhibitors include celecoxib and
ent fibers from the vagus nerve (CN X). meloxicam.
Lipoxins
15-LOX
Plasma membrane PLA-2
5-LOX
Arachidonic acid Leukotrienes
Diet COX
PGI-2 Prostacyclins
Prostaglandins
TXA-2 Thromboxanes
Answers: 100-109 101
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104. The correct answer is B. During exercise, GFR. The opposite is true of an increased
there is a significant increase in α1-, β1-, and hydrostatic pressure in Bowman space.
β2-adrenergic function. β1 receptor activation Decreased blood flow (↓ renal perfusion and
in the heart will increase HR, SV (from afferent arteriole vasoconstriction) to the
↑ inotropic effect), and thus CO. The glomerulus will result in a decreased GFR.
increase in preload will decrease venous Efferent arteriole vasodilation will also lower
compliance. β2 stimulation will cause central GFR.
vasodilation. Activation of α1 receptors will
result in peripheral vasoconstriction and
above.
increased arterial pressure.

Answers A, C, D, and E are incorrect. See 108. The correct answer is B. Okazaki fragments
above. are the series of complementary DNA strands
synthesized from the lagging strand during
105. The correct answer is E. Type I diabetes DNA synthesis. They are not formed during
often results from a defect in insulin produc- transcription or translation.
tion, secretion, or receptor function, leading
Answer A is incorrect. The removal of
to increased blood glucose. Remember that
introns (noncoding segments) is a part of
insulin promotes glycogen synthesis. Thus, a
RNA splicing after transcription.
decrease in insulin allows for increased glyco-
gen phosphorylase activity, leading to an Answer C is incorrect. The 5′ cap is added
increase in blood glucose. post-transcription to enable translation initia-
tion and to prevent binding of the 5′ end by
Answer A is incorrect. Insulin positively
exonucleases.
regulates glycogen synthase activity.
Answer D is incorrect. The 3′ poly(A) tail is
Answer B is incorrect. Insulin negatively
added post-transcription to prevent binding of
regulates lipase activity.
the 3′ end by exonucleases.
Answer C is incorrect. Insulin positively
Answer E is incorrect. The ligation of exons
regulates acetyl-CoA carboxylase activity.
(coding segments) is a part of RNA splicing
Answer D is incorrect. Insulin positively after transcription.
regulates fatty acid synthase.
109. The correct answer is D. The catecholamines
106. The correct answer is D. Recall that the (epinephrine and norepinephrine) regulate the
Entner-Doudoroff pathway is the main gly- “fight-or-flight” response. They are released by
colytic pathway in aerobic bacteria. The liver chromaffin cells of the adrenal medulla.
has a myriad of functions, including mineral
Answer A is incorrect. Dust cells are alveolar
and vitamin storage; carbohydrate, protein,
macrophages.
and lipid metabolism; cholesterol synthesis;
detoxification; phagocytosis of foreign anti- Answer B is incorrect. Gastric chief cells
gens; and bile production. secrete pepsinogen. Additionally, parathyroid
chief (principal) cells release PTH.
above. Answer C is incorrect. Gastric parietal cells
release HCl and intrinsic factor.
107. The correct answer is C. A decrease in plasma
Answer E is incorrect. M cells are located in
oncotic pressure creates a gradient of flow from
the Peyer patches of the ileum. They absorb
the vasculature to Bowman space, increasing
antigens into the underlying lymphatic tissue.
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110. The correct answer is D. There is no path- 114. The correct answer is A. Hypoxemia (PO2 < 85
way in humans to convert fatty acids to glu- mm Hg), is induced by hypoventilation. This
cose; however, glucose is converted to fatty can result from a decreased respiratory drive, or
acids using acetyl-CoA as an intermediate. the decreased ability for chest excursion.
Answers A, B, and C are incorrect. See Answer B is incorrect. An unequal ventila-
above. tion and perfusion ratio will result in a seg-
ment of the lung that is ventilated, but not
111. The correct answer is B. Remember that perfused.
each motor unit consists of a motor neuron,
Answer C is incorrect. Diffusion limitations
synaptic cleft, and the associated muscle
include decreased alveolar surface area, a

fibers. When an action potential arrives at the
thicker blood-gas barrier, and a decreased
NMJ, acetylcholine is released from the axon
ability for hemoglobin to carry oxygen.
terminus and binds to the nicotinic receptors
on the plasma membrane of skeletal muscle Answer D is incorrect. Less inspired oxygen
cells. will certainly cause hypoxemia.
Answer A is incorrect. T tubules transmit the Answer E is incorrect. A shunt will result in
action potential from the sarcolemma to the a segment of the lung that is perfused, but
sarcoplasmic reticulum of two adjacent not aerated.
sarcomeres.
115. The correct answer is A. Saltatory conduc-
Answer C is incorrect. The endomysium is a
tion occurs in myelinated nerves. Because
CT layer that surrounds each muscle fiber.
there is decreased membrane capacitance,
Answer D is incorrect. The perimysium is a action potentials “jump” from one node of
CT layer that surrounds each fascicle. Ranvier to another.
Answer E is incorrect. The sarcomere is the Answer B is incorrect. Continuous conduc-
functional unit of each myofibril. tion occurs in unmyelinated nerves. Action
potentials travel along the entire membrane
112. The correct answer is B. Filiform papillae do surface. This type of conduction is much
not contain taste buds. The most taste buds slower (about 1 m/s).
are found on vallate papillae. In addition to
Answer C is incorrect. Axonotmesis is a form
papillae, they can also be found in the
of nerve injury in which the axon is damaged,
epithelium of the soft palate, posterior phar-
but the connective sheath remains intact.
ynx, and epiglottis.
Answer D is incorrect. Neurotmesis is a form
of nerve injury in which the entire nerve
above.
trunk is severed.
113. The correct answer is C. IDL, LDL, and
116. The correct answer is A. Acetyl-CoA cannot
HDL generally carry triglycerides and choles-
be directly converted back to glucose.
terol to the liver. Chylomicrons and VLDL
generally carry lipids to the extrahepatic tis- Answer B is incorrect. Acetyl-CoA can form
sues. Lipoproteins contain varying propor- cholesterol through HMG-CoA via HMG-
tions of cholesterol, cholesterol esters, triglyc- CoA lyase.
erides, and phospholipids, but not bile salts.
Answer C is incorrect. Acetyl-CoA can form
Answers A, B, and D are incorrect. See fatty acids through malonyl-CoA via acetyl-CoA
above. carboxylase.
Answers: 110-122 103
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Answer D is incorrect. Acetyl-CoA can lead Answer B is incorrect. Recall that plasma is
to ATP production through the Krebs cycle whole blood volume minus formed elements
and then oxidative phosphorylation. (cells and platelets).
Answer E is incorrect. Acetyl-CoA can form Answer C is incorrect. The number of RBCs
ketone bodies through HMG-CoA via HMG- in a sample of blood is counted in millions
CoA reductase. per microliter (µl).
Answer E is incorrect. The amount of hemo-
117. The correct answer is A. Renin, released from
globin (Hb) in a sample of blood is measured
the renal JGA, converts angiotensinogen to
in gram per deciliter (g/dl).

angiotensin I. ACE converts angiotensin I to
angiotensin II, which then stimulates the
120. The correct answer is D. Inulin is the “gold stan-
adrenal cortex to secrete aldosterone. Recall
dard” for measuring GFR because it is cleared
that aldosterone will increase sodium and
from the plasma unhindered, solely by glomeru-
water reabsorption (↑ Na+ and water plasma
lar filtration. However, inulin needs to be
levels), and decrease potassium reabsorption
infused, and is later measured by taking a blood
(↓ K+ plasma levels).
sample. Due to this inconvenience, endogenous
Answers B, C, D, and E are incorrect. See creatinine clearance is often used. Although cre-
above. atinine is secreted as well as filtered, the differ-
ence is usually small. The amount of urine pro-
118. The correct answer is B. Reverse transcrip- duction will not provide information on what is
tase forms a complementary strand of DNA being filtered at the glomerulus.
from the original RNA.
Answer A is incorrect. RNA polymerase above.
synthesizes a complementary strand of RNA
from DNA. 121. The correct answer is A. Guanine binds
cytosine via three H-bonds in DNA.
Answer C is incorrect. Aminoacyl-tRNA syn-
thetase adds each amino acid to tRNA. Answer B is incorrect. Adenine binds uracil
via 2 H-bonds in RNA.
Answer D is incorrect. RNA polymerase
synthesizes a complementary strand of RNA Answer C is incorrect. Guanine does not
from the original DNA. pair with thymine.
Answer E is incorrect. DNA polymerase Answer D is incorrect. Adenine binds
synthesizes a complementary strand of DNA thymine via 2 H-bonds in DNA.
from the original DNA.
Answer E is incorrect. Adenine does not pair
with cytosine.
119. The correct answer is D. Hematocrit (HCT)
is the percentage of erythrocytes in a sample
122. The correct answer is A. Renin is secreted by
of blood. The normal value for males is about
juxtaglomerular cells, which are modified
47% and 42% for females.
smooth muscle cells of the afferent arterioles.
Answer A is incorrect. The mean corpuscu- The juxtaglomerular apparatus (JGA) consists
lar hemoglobin (MCH) index measures the of the macula densa, juxtaglomerular cells,
concentration of hemoglobin in a sample of and extraglomerular mesangial cells.
erythrocytes in picograms (pg).
above.
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123. The correct answer is B. Mg2+ has a higher (2 nm) < nucleosome (10 nm) < chromatin
intracellular concentration: 30 mmol/L versus fibril (30 nm) < chromosome (1400 nm).
1.5 mmol/L. Answers A, C, and D are incorrect. See
Answer A is incorrect. Na+
has a higher above.
extracellular concentration: 140 mmol/L
versus 10 mmol/L. 129. The correct answer is E. Vagus nerve (CN X)
activity decreases SA nodal discharge and the
Answer C is incorrect. Cl− has a higher rate of depolarization through the heart.
extracellular concentration: 100 mmol/L Thus, cardiac output will eventually decrease.
versus 4 mmol/L.

Answer D is incorrect. Ca2+ has a higher above.
extracellular concentration: 2.5 mmol/L
versus 0.1 µmol/L. 130. The correct answer is A. Metabolic alkalosis
Answer E is incorrect. HCO3−
has a higher leads to an increase in blood pH due to any
extracellular concentration: 27 mmol/L cause (eg, vomiting) other than a decrease
versus 10 mmol/L. in PCO2. The compensatory hypoventilation
↑ PCO2, leading to ↓ pH. Remember that the
124. The correct answer is A. The presence of opposite occurs with metabolic acidosis.
HCl converts pepsinogen to pepsin in the Answers B, C, and D are incorrect. See
stomach. Recall that pepsinogen is secreted above.
by gastric chief cells; and HCl is released by
gastric parietal cells. 131. The correct answer is B. Vitamin B6 (pyri-
Answers B, C, D, and E are incorrect. See doxine) is a required cofactor for all transami-
above. nation reactions.
Answer A is incorrect. Vitamin B2 (riboflavin)
125. The correct answer is D. Cretinism is is a component of FAD and FMN.
adolescent-onset hypothyroidism.
Answer C is incorrect. Vitamin B12 (cobal-
Answers A, B, C, and E are incorrect. All amin) is a coenzyme in the conversion of
result from hyperthyroidism. methylmalonyl-CoA to succinyl-CoA.
126. The correct answer is D. Only lysine, serine, Answer D is incorrect. Vitamin C is a coen-
and threonine are not transaminated. zyme for the hydroxylation of praline and
lysine in collagen synthesis.
above. Answer E is incorrect. Vitamin E is a potent
antioxidant.
127. The correct answer is D. Both cardiac and
smooth muscle act as a functional syncytium. 132. The correct answer is E. Glycine and GABA
Recall that most of these cells relay the action are strictly inhibitory. Acetylcholine may be
potential via gap junctions. Thus, even though inhibitory at some postganglionic parasympa-
not all cells are directly innervated, the entire thetic end organs.
muscle functions as though they are. Answers A, B, C, and D are incorrect. See
Answers A and E are incorrect. See above. above.
128. The correct answer is B. Arranged in order 133. The correct answer is B. The descending
of smallest to largest: DNA double-helix loop of Henle is impermeable to Na+. Water
Answers: 123-142 105
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is primarily reabsorbed in this portion of the Answers A, C, D, and E are incorrect. See
nephron. above.
Answers A, C, D, and E are incorrect. See
138. The correct answer is C. Both the intrinsic
above.
and extrinsic clotting pathways converge with
134. The correct answer is B. Doxycycline (and the activation of factor X.
the tetracyclines) inhibits bacterial protein Answers A, B, D, and E are incorrect. See
synthesis by binding to 30S ribosomal sub- above.
units, blocking aminoacyl-tRNA binding.
139. The correct answer is C. Oxidative deami-

Answer A is incorrect. Amoxicillin (and the
nation serves as an alternative to the transam-
penicillins) inhibits cell wall peptidoglycan
ination of amino acids. It results in the for-
cross-linking.
mation of α-ketoacids (for energy) and
Answer C is incorrect. Metronidazole ammonia (for urea formation). In humans, the
inhibits bacterial DNA synthesis. vast majority of oxidative deamination derives
Answer D is incorrect. Cephalexin (and the from glutamate.
cephalosporins) inhibits cell wall peptidogly- Answers A, B, D, and E are incorrect. See
can cross-linking. above.
Answer E is incorrect. Ciprofloxacin (and
140. The correct answer is D. Cholecystokinin is
the fluoroquinolones) inhibits bacterial DNA
secreted by the duodenum in response to the
gyrase (topoisomerase).
presence of fat and amino acids. In addition
135. The correct answer is B. The maxilla and to stimulating digestive enzyme release by the
mandible contain both cortical and cancel- pancreas, it also promotes gallbladder con-
lous bone. However, mandibular bone often traction, which then results in the secretion
has thicker cortical bone than the maxilla. of bile.
Answers A, C, and D are incorrect. See Answers A, B, and C are incorrect. See
above. above.
136. The correct answer is E. rRNA is the major 141. The correct answer is D. The vallecula is a
component of ribosomes, which are found on small depression located within the median
rough ER. glossoepiglottic fold. The pyriform recess is a
trough that lies between the lateral glos-
Answer A is incorrect. The backbone of soepiglottic fold and the lateral wall of the
RNA is ribose. laryngeal pharynx.
Answer B is incorrect. RNA bases include Answer C is incorrect. The salpingopharyn-
adenine, uracil, guanine, and cytosine. geal fold is located in the nasopharynx.
Answer C is incorrect. rRNA is synthesized Answers A, B, and E are incorrect. See
in the nucleolus. tRNA and mRNA are syn- above.
thesized in the nucleus.
Answer D is incorrect. RNA is single stranded. 142. The correct answer is E. The urea cycle does
not produce ATP.
137. The correct answer is B. Sodium is critical Answer A is incorrect. It occurs in the cytosol
in maintaining the resting potential of plasma and mitochondrial matrix of hepatocytes.
membranes, but is not a second messenger.
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Answer B is incorrect. It requires aspartate. exons, transfer of mRNA from the nucleus to
cytoplasm, small ribosomal subunit binding
Answer C is incorrect. It eliminates ammo-
to mRNA, anticodon binding to complemen-
nia in the form of urea.
tary codon. Remember that transcription
Answer D is incorrect. See above. occurs in the nucleus, but translation occurs
in the cytoplasmic ribosomes.
CO2 + NH4+ + 3 ATP + Aspartate + 2H2O →
Urea + 2 ADP + 2 Pi + AMP + PPi + Fumarate Answers A, B, C, and D are incorrect. See
above.
143. The correct answer is E. ADH (also called
148. The correct answer is A. Remember that a
vasopressin) functions to retain water by

lesion on one side of the spinal cord causes ipsi-
increasing its reabsorption. It is secreted by
lateral motor (corticospinal) loss, and contralat-
the posterior pituitary.
eral pain and temperature (spinothalamic) loss.
above.
above.
144. The correct answer is A. Eccrine sweat
149. The correct answer is C. The muscle spin-
glands secrete sweat to regulate body temper-
dles of the stretch reflex detect muscle length
ature. They are innervated by postganglionic
and tension. However, this reflex results in
sympathetic cholinergic fibers. Remember:
contraction, not relaxation. Remember, the
All postganglionic sympathetic neurons are
stretch reflex maintains muscle tone.
adrenergic except for those innervating
eccrine sweat glands and skeletal muscle vas- Answers A, B, and D are incorrect. See
culature. Apocrine sweat glands secrete a above.
serous fluid containing pheromones. These
sweat glands are innervated by postganglionic 150. The correct answer is D. Citrullinemia is
sympathetic adrenergic neurons. caused by a defect in argininosuccinate syn-
thase activity, the enzyme that converts cit-
Answers B, C, and D are incorrect. See above.
rulline → argininosuccinate in the urea cycle,
causing elevated plasma and CSF citrulline
145. The correct answer is C. Each tRNA carries
levels.
the anticodon to the mRNA-ribosomal com-
plex, where it binds to its complementary Answer A is incorrect. Phenylketonuria
codon. It is the most prevalent RNA. mRNA (PKU) is caused by a defect in phenylalanine
is the least prevalent RNA. hydroxylase, the enzyme that converts pheny-
lalanine → tyrosine. PKU has a frequency of
Answer A, B, and D are incorrect. See above.
1:10,000 and causes severe mental retardation.
146. The correct answer is B. The PO2 deter- Answer B is incorrect. Alkaptonuria is caused
mines the affinity of hemoglobin for oxygen by a defect in homogentisate oxidase, the
binding by causing a conformational change enzyme that converts homogentisate → maley-
in the Hb molecule. lacetoacetate in tyrosine catabolism. It causes
Answers A, C, D, and E are incorrect. See urine to turn black due to the oxidation of the
above. excreted homogentisic acid.
Answer C is incorrect. Pernicious anemia is
147. The correct answer is E. In chronological caused by a deficiency of vitamin B12
order: RNA polymerase activity, splicing of (cobalamin).
Answers: 143-160 107
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Answer E is incorrect. Richner-Hanhart syn- Thus, there is a greater cellular uptake of sol-
drome (type II tyrosinemia) is caused by a defect vent leading to cellular swelling.
in tyrosine aminotransferase, the enzyme that
converts tyrosine → hydroxyphenylpyruvate.
above.
151. The correct answer is E. The hypothalamus
156. The correct answer is C. Exocytosis is the
releases thyrotropin-releasing hormone (TRH),
process by which cells release large mole-
growth hormone-releasing hormone (GHRH),
cules to the ECM. Endocytosis is the process
gonadotropin-releasing hormone (GnRH), and
by which cells take in large molecules.
corticotrophin-releasing hormone (CRH), som-

Pinocytosis and phagocytosis are two types of
atostatin, among others.
endocytosis.
Answers A, B, and D are incorrect. See
above.
above.
152. The correct answer is B. Cyanosis does not typi-
157. The correct answer is C. IL-8 is a chemotac-
cally occur in severe anemia since it would take
tic factor for PMNs. It has no effect on bone
more than 5 g of deoxygenated hemoglobin per
metabolism.
100 mL of blood in order to clinically detect.
Answers A, B, D, and E are incorrect. IL-1,
Answers A, C, D, and E are incorrect. All are
IL-6, and TNF-β stimulate osteoclast matura-
typical of an individual with severe anemia.
tion. Parathyroid hormone (PTH) and
receptor-activated nuclear kappa-b ligand
153. The correct answer is C. In humans, purines
(RANKL) induce osteoclast activity. Recall
are catabolized to uric acid. Pyrimidines are
that RANKL binds to RANK receptors on
catabolized to water-soluble metabolites such
the osteoclast cell membrane, initiating
as CO2, NH3, and β-alanine.
resorption.
Answer A is incorrect. Purines are synthe-
sized from ribose-5-phosphate. 158. The correct answer is C. The Entner-
Doudoroff pathway is the glycolytic pathway in
Answer B is incorrect. Adenine and guanine
aerobic bacteria. It converts glucose → pyru-
are the two purines.
vate + glyceraldehyde-3-phosphate. It yields
Answer D is incorrect. Purines pair with 1 ATP, 1 NADH, and 1 NADPH per glucose
pyrimidines in DNA and RNA. molecule.
Answer E is incorrect. Purines are cyclic Answers A, B, D, and E are incorrect. See
structures composed of nitrogen and carbon. above.
154. The correct answer is E. Thyroglobulin is a gly- 159. The correct answer is E. Intrinsic factor is a
coprotein that contains many tyrosine residues, glycoprotein secreted in the stomach that is
which are incorporated into the two major thy- essential for the absorption of vitamin B12
roid hormones. It is synthesized by thyroid fol- (cobalamin) in the small intestine.
licular cells, and stored in follicular colloid.
Answers A, B, C, and D are incorrect. See above.
above.
160. The correct answer is E. Calcium binds to
155. The correct answer is A. A hypotonic solu- troponin C, which is attached to tropomyosin.
tion is one in which the solute < solvent. Both are bound to the actin, forming a
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functional filament. Once calcium is bound, 164. The correct answer is D. The genetic code
tropomyosin undergoes a conformational is nonoverlapping, meaning that it does not
change, allowing the actin filament to inter- involve any overlap of codons.
act with myosin.
Answer A is incorrect. It is virtually universal,
Answers A, B, C, and D are incorrect. See meaning that, for the most part, each codon
above. codes for only one specific amino acid.
Answer B is incorrect. It is degenerate,
161. The correct answer is D. Remember the four
meaning that the same codon will decode the
fat-soluble vitamins: A, D, E, and K.
same amino acid.
Water-soluble. Answers A, B, C, and E are

Answer C is incorrect. It is unambiguous,
incorrect. These are water-soluble.
meaning that only a specific amino acid is
162. The correct answer is D. Apnea is the tran- indicated for any codon.
sient cessation of breathing. In individuals Answer E is incorrect. It is without punctua-
who suffer from sleep apnea, respiration can tion, meaning that the message is read in a
stop for relatively long periods of time (often continuing sequence of nucleotides until a
30 to 60 seconds). stop codon is reached.
Answer A is incorrect. Hypoventilation is
165. The correct answer is C. The absolute refrac-
↓ alveolar ventilation, which leads to ↑ PCO2.
tory period is the period in which a second AP
Answer B is incorrect. Dyspnea is a difficulty cannot be generated regardless of how much
in breathing. the cell membrane is depolarized. During this
Answer C is incorrect. Hypocapnia is ↓ CO2 time, sodium gates are closed and have not
in arterial blood, secondary to ↑ ventilation. been reset. Remember that depolarization
occurs with the rapid influx of Na+ ions.
Answer E is incorrect. Hyperapnea is abnor-
mally deep and rapid breathing. Answers A, B, D, and E are incorrect. See
above.
163. The correct answer is B. Beta-2 adrenergic
receptors are located on skeletal muscle 166. The correct answer is E. β-Oxidation con-
(causing vasodilation) and bronchial smooth verts acyl-CoA → acetyl-CoA in fatty acid
muscle (causing bronchodilation). metabolism.
Answer A is incorrect. Activation of alpha-1 Answer A is incorrect. Fatty acids are con-
adrenergic receptors causes vascular smooth verted to acyl-CoA by acyl-CoA synthetase.
muscle vasoconstriction. Carnitine serves as a cofactor in this reaction.
Answer C is incorrect. Activation of alpha-1 Answer B is incorrect. Triglycerides are con-

adrenergic receptors causes miosis. verted to fatty acids by various lipases.
Answer D is incorrect. Activation of beta-1 Answer C is incorrect. Acetyl-CoA is con-

adrenergic receptors causes increased heart verted to malonyl-CoA by acetyl-CoA car-
rate and contractility. boxylase. Biotin and vitamin B5 serve as
cofactors in this reaction.
Answer E is incorrect. Activation of alpha-2
adrenergic receptors causes presynaptic nerve Answer D is incorrect. Acetyl-CoA is con-
inhibition and GI tract relaxation. densed with acetoacetyl-CoA to form HMG-
CoA by HMG-CoA synthase.
Answers: 161-174 109
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167. The correct answer is D. Diabetes insipidus Answers A, B, D, and E are incorrect. Peni-
is generally caused by a decrease in ADH, cillins, cephalosporins, and clindamycin are
which is secreted from the posterior pituitary. relatively safe to administer during preg-
However, DI can also result from a lessened nancy, and in children.
renal tubule response to ADH (but ADH
secretion is normal). 171. The correct answer is A. PFK is the rate-
limiting step in glycolysis, converting fructose-
Answers A, B, and C are incorrect. See above.
6-phosphate → fructose-1,6-biphosphate. It
168. The correct answer is D. The countercurrent requires 1 ATP.

exchange system occurs due to the reabsorp- Answer B is incorrect. Carbonic anhydrase
tion of Na+ in the thick ascending loop of interconverts CO2 and bicarbonate.
Henle. Recall that this segment of the
Answer C is incorrect. Lactate dehydroge-
nephron is impermeable to water. This cre-
nase converts pyruvate → lactic acid.
ates a gradient in the collecting duct to allow
for more concentrated urine in the renal cor- Answer D is incorrect. HMG-CoA reductase
tex compared to the medulla. converts HMG-CoA → mevalonate.
Answers A, B, C, and E are incorrect. See Answer E is incorrect. Transaminases cleave
above. the α-amino nitrogen of most amino acids.
169. The correct answer is A. Cobalt is a major 172. The correct answer is C. The buccinator is
constituent of vitamin B12 (cobalamin). A the accessory muscle of mastication, inner-
deficiency of vitamin B12 results in perni- vated by CN VII. It compresses the cheeks
cious anemia. against the teeth, keeping food inside the
mouth.
Answer B is incorrect. Iodine is a major con-
stituent of T3 and T4. Its deficiency results in Answers A, B, and D are incorrect. These
cretinism or myxedema. are muscles of mastication that control
mandibular movement.
Answer C is incorrect. Magnesium is a
major constituent of chlorophyll. 173. The correct answer is C. A sudden drop in
Answer D is incorrect. Manganese is a cofac- upper-body blood pressure when sitting up is
tor for several enzymes. sensed by baroreceptors, such as those in the
carotid sinus or aortic arch. There is a result-
Answer E is incorrect. Zinc is a major con-
ing decrease in parasympathetic activity with
stituent of MMPs. Its deficiency results in
concomitant increase in sympathetic activity.
altered collagen metabolism.
This ultimately increases heart rate, cardiac
170. The correct answer is C. Tetracyclines, output, and blood pressure.
because they chelate divalent cations, can be Answers A, B, D, and E are incorrect. See
incorporated into mineralizing tissues (includ- above.
ing bone, dentin, cementum, and enamel)
during their development. This can result 174. The correct answer is A. The TATA box is a
in brownish-gray banding within enamel. portion of the DNA promoter region.
Because of this, these antibiotics should not be Answer B is incorrect. The zinc finger is a
given to pregnant mothers or children under motif that mediates the binding of regulatory
the age of 8 (about the time the permanent proteins to DNA.
second molars complete calcification).
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Answer C is incorrect. snRNP is involved in (because of ↑ respiratory rate), an O2-Hb curve

mRNA splicing. shift to the right (because of ↑ glycolysis), and
increased renal bicarbonate excretion (to com-
Answer D is incorrect. The leucine zipper is
pensate for respiratory alkalosis).
a motif that mediates the binding of regula-
tory proteins to DNA. Answers A, B, C, and D are incorrect. See
above.
Answer E is incorrect. The helix-turn-helix is
a motif that mediates the binding of regula-
179. The correct answer is A. Vitamin A (retinol)
tory proteins to DNA.
is the major constituent of the visual proteins:
rhodopsin (in rods) and iodopsin (in cones).
175. The correct answer is D. Smooth muscle

A deficiency of retinol results in night blind-
cells have a poorly developed sarcoplasmic
ness and xerophthalmia.
reticulum. Recall that relaxation occurs
when Ca2+ is taken up by the SR. With a less Answers B, C, D, and E are incorrect. See
extensive SR, smooth muscle can maintain above.
contraction for longer periods of time.
180. The correct answer is A. The ventral horns
(of gray matter) contain efferent motor nerves
above.
that innervate skeletal muscle. Recall that the
dorsal horns (of gray matter) carry sensory
176. The correct answer is D. The PPP occurs in
fibers (received from the dorsal root ganglia).
the cytosol.
Answer B is incorrect. Motor function to
Answer A is incorrect. Fatty acid synthesis
smooth muscle is carried by the autonomic
occurs in the cytosol.
nervous system (SNS and PNS).
Answer B is incorrect. The ETC occurs in
Answer C is incorrect. The anterolateral path-
the inner mitochondrial membrane.
way (of white matter) carries afferent pain and
Answer C is incorrect. β-oxidation occurs in temperature fibers. Recall that these nerves
the mitochondrial matrix. decussate when they enter the spinal cord.
Answer E is incorrect. Glycolysis occurs in Answer D is incorrect. The dorsal column
the cytosol. pathway (of white matter) carries afferent
touch and pressure fibers. Remember that
177. The correct answer is C. Lipase is secreted these nerves decussate in the medulla.
by the pancreas. It is the only enzyme of the
GI tract that can catabolize triacylglycerols. 181. The correct answer is D. Na+ concentration is
Answers A, B, D, and E are incorrect. See much higher extracellularly. K+, on the other
above. hand, has a significantly greater intracellular
concentration. Blood plasma constitutes about
178. The correct answer is E. In high altitudes, 25% of the ECF, which comprises approxi-
there is a significant decrease in the fraction mately 1/3 total body water. Thus, plasma
of inspired oxygen (↓ FiO2). This causes alve- makes up roughly 8% of total body water.
olar hypoxia (↓ PAO2) and arterial hypoxemia Answers A, B, and C are incorrect. See
(↓ PaO2). As a result, there will be pulmo- above.
nary vasoconstriction (because of alveolar
hypoxia), increased erythropoietin release 182. The correct answer is B. The steps to form
(which ↑ RBC production), respiratory alkalosis cholesterol from alanine include the following:
Answers: 175-190 111
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(1) Alanine is transaminated to pyruvate. (2) Answer A is incorrect. Vitamin K deficiency

Pyruvate is oxidized to acetyl-CoA. (3) Acetyl- affects prothrombin, resulting in a prolonged PT.
CoA is converted to HMG-CoA. (4) HMG-CoA
Answer B is incorrect. Vitamin K activates
is reduced to mevalonate. (5) Mevalonate is con-
clotting factors II, VII, IX, and X.
verted to cholesterol through a series of reactions.
Answer C is incorrect. Phylloquinone,
menaquinones, and menadione have the bio-
above.
logic activity of vitamin K.
183. The correct answer is B. The vagus nerve Answer E is incorrect. Vitamin K (and its

(CN X) regulates gastric emptying. It is the clotting factors) is a critical component of the
major nerve of the PNS, originating in the extrinsic clotting pathway.
medulla.
188. The correct answer is A. The SR is an exten-
sive network of channels throughout the cyto-
above.
plasm that stores calcium. All muscle types
184. The correct answer is C. DNA polymerase have SR, but it is much less developed in
always forms a complementary strand of smooth muscle.
DNA in the 5′ → 3′ direction, regardless of Answer B is incorrect. The sarcomere is the
which strand it uses. It forms a continuous functional unit of the myofibril.
complementary strand from the leading
Answer C is incorrect. The sarcolemma is
strand, but forms several Okazaki fragments
the plasma membrane of muscle cells.
from the lagging strand.
Answer D is incorrect. The sarcoplasm is the
cytoplasm of muscle cells.
above.
Answer E is incorrect. T tubules transmit the
185. The correct answer is D. Oxytocin stimulates action potential from the sarcolemma to the
uterine contraction and breast milk ejection. sarcoplasmic reticulum. Only skeletal and
It is secreted by the posterior pituitary. Pro- cardiac muscle cells have T tubules.
lactin promotes breast milk production. It is
secreted by the anterior pituitary. 189. The correct answer is A. The NADH pro-
duced from the pentose phosphate pathway
(PPP) is normally used to rid cells of free rad-
above.
icals and H2O2. A defect in G6PD reduces
186. The correct answer is A. The most important the amount of NADH produced, thereby
determinant of CO is venous return (end increasing the amount of oxidizing agents
diastolic volume). An increase in EDV results within erythrocytes and causing hemolytic
in an increase in preload, which leads to an anemia.
increase in contraction force, stroke volume, Answers B, C, D, and E are incorrect. See
and ultimately cardiac output. above.
190. The correct answer is B. Bitter taste cells ini-
above.
tiate nerve conduction via second messen-
187. The correct answer is D. Vitamin K activates gers. Intracellular Ca2+ levels are increased
prothrombin and the vitamin K–dependent by activation of IP3 at the cell membrane
clotting factors: II, VII, IX, and X. receptor.
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Answer A is incorrect. This is the pathway in an inhibitory signal to osteoclasts (preventing

sour taste cells. resorption).
Answer C is incorrect. This is the pathway in Answer C is incorrect. Parathyroid hormone
salty taste cells. (PTH), released by chief cells of the parathy-
roid gland, stimulates osteoclastic activity
Answer D is incorrect. This is the pathway in
(stimulating resorption).
sweet taste cells.
Answer E is incorrect. Bone morphogenetic
191. The correct answer is A. All larger molecules proteins (BMPs) belong to the transforming
such as glucose, amino acids, and proteins growth factor (TGF) superfamily of protein
are reabsorbed in the proximal convoluted growth factors. Both BMP-2 and BMP-7 stim-
tubule. H2O, Na+, Cl−, K+, and bicarbonate ulate osteoblast differentiation, increasing
are also reabsorbed here. bone formation.
194. The correct answer is D. Mitochondrial
above.
DNA has 5-10 times the mutation rate of
192. The correct answer is E. Vitamin B6 (pyri- nuclear DNA.
doxine) is a coenzyme in transamination Answer A is incorrect. It is circular.
reactions.
Answer B is incorrect. It is double stranded.
Answer A is incorrect. Vitamin B1 (thi-
Answer C is incorrect. It contains about 1%
amine) is a coenzyme in the decarboxylation
of all cellular DNA.
of α-ketoglutarate in the Krebs cycle.
Answer E is incorrect. It is transmitted by
Answer B is incorrect. Vitamin B2
non-Mendelian inheritance.
(riboflavin) is a component of FAD, an
important dehydrogenase cofactor in the 195. The correct answer is E. Most carbon diox-
Krebs cycle. ide is transported in the blood as bicarbonate
Answer C is incorrect. Vitamin B3 (niacin) is (in both serum and erythrocytes). A small
a component of NAD, an important dehydro- portion is also dissolved in the blood. About
genase cofactor in the Krebs cycle. 20% of CO2 is carried by carbaminohemo-
globin, which contains an amino group (not
Answer D is incorrect. Vitamin B5 (pan-
Fe2+).
tothenic acid) is a component of coenzyme
A, the cofactor attached to active carboxylate Answers A, B, C, and D are incorrect. See
residues in the Krebs cycle. above.
193. The correct answer is D. Osteopontin (bone 196. The correct answer is C. One molecule of
sialoprotein I) is an extracellular structural glucose is converted to two molecules of
protein of bone. It is synthesized by osteoblasts, pyruvate in glycolysis. Under anaerobic con-
osteocytes, odontoblasts, and other tissue cells. ditions, though, pyruvate is reduced to lactic
Its secretion is regulated by vitamin D. acid instead of being oxidized to acetyl-CoA.
There are only 2 net ATP produced in glycol-
Answer A is incorrect. Calcitonin, secreted by
ysis (4 gross ATP are produced, but 2 are
parafollicular cells of the thyroid gland, inhibits
used in the hexokinase and PFK reactions).
osteoclastic activity (preventing resorption).
Answer B is incorrect. Osteoprotegerin
above.
(OPG), secreted by osteoblasts, functions as
Answers: 191-200 113
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197. The correct answer is D. All postganglionic Answer A is incorrect. AAC codes for
sympathetic neurons are adrenergic except asparagine.
for eccrine sweat glands and skeletal muscle
Answer C is incorrect. UAC codes for
blood vessels (cholinergic).
tyrosine.
Answer D is incorrect. UAG is a stop codon.
above.
Answer E is incorrect. UGA is a stop codon.
198. The correct answer is E. Pancreatic β-cells
produce insulin, which decreases blood glu- 200. The correct answer is E. In sickle cell ane-
mia, a missense mutation causes valine to be

cose (by promoting glycogen formation and
fatty acid synthesis). replaced by glutamate.
Answer A is incorrect. The anterior pituitary Answer A is incorrect. A nonsense mutation
produces ACTH, which stimulates glucocor- is a type of point mutation that results in a
ticoid production in the adrenal cortex, and stop codon, terminating the polypeptide
increases blood glucose. chain elongation.
Answer B is incorrect. The adrenal medulla Answer B is incorrect. A transition mutation
produces epinephrine and norepinephrine, is a type of point mutation in which a purine
both of which increase blood glucose. is replaced by another purine, or a pyrimi-
dine is replaced by another pyrimidine.
Answer C is incorrect. The adrenal cortex
produces cortisol, which increases blood Answer C is incorrect. A repeat mutation is
glucose. an amplification of the same three-nucleotide
sequence.
Answer D is incorrect. Pancreatic α-cells
produce glucagon, which increases blood Answer D is incorrect. A transverse mutation
glucose. is a type of point mutation in which the
purine-pyrimidine orientation is changed.
199. The correct answer is B. AUG, which codes
for methionine, is a start codon.
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CHAPTER 3
Microbiology and
Pathology
115
116 Chapter 3: Microbiology and Pathology
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Q U E ST I O N S
Questions 1-4 pertain to the following clinical 5. Each of the following is true of cell-mediated
vignette: immunity EXCEPT
A 30-year-old male presents to your office for rou- A. it is responsible for type IV hypersensitiv-
tine dental care. The patient complains of frequent ity reactions.
night sweats and generalized malaise. On physical B. it defends against parasites.
exam, you note multiple enlarged, swollen, rubbery C. it is important in transplant rejection.
nodes upon palpation of the cervical and sub- D. it involves NK cells and macrophages.
mandibular regions. After weeks of increase in size E. it involves predominantly B cells.
of the affected nodes, you decide to refer the
patient for a nodal biopsy. Questions 6-10 pertain to the following clinical
vignette:
1. Which of the following diseases show the
presence of Reed-Sternberg cells on cytologi- A 17-year-old male presents to your office for
cal exam? extraction of all four third molars. The patient
denies any significant medical history, and you pro-
A. Non-Hodgkin lymphoma ceed with the procedure. While starting an intra-
B. Acute lymphocytic leukemia venous line, the patient’s arm is accidentally cut,
C. Chronic myelogenous leukemia and he begins bleeding excessively.
D. Hodgkin lymphoma
E. Multiple myeloma 6. Which of the following secondary hemostatic
disorders is this patient MOST likely affected
2. Each of the following are signs/symptoms one by
would find in a patient with non-Hodgkin
lymphoma EXCEPT A. von Willebrand disease
Microbiology and Pathology
B. Hemophilia A
A. night sweats. C. Bernard-Soulier syndrome
B. malaise. D. Thrombocytopenia
C. fatigue. E. Hemophilia C
D. weight gain.
E. solid tumor masses. 7. Each of the following with regard to von
Willebrand disease is correct EXCEPT
3. Each of the following regarding Burkitt lym-
phoma is true EXCEPT A. it is a qualitative platelet defect.
B. vWF allows adhesion of platelets to
A. close association with Epstein Barr virus. collagen.
B. high-grade T-cell malignancy. C. it affects both the platelet plug and coagu-
C. cytogenic chromosomal change seen is lation cascade.
t(8; 14). D. vWF functions independent of factor VIII.
D. it is a form of non-Hodgkin lymphoma. E. it is an autosomal dominant disorder.
E. lymph nodes are often spared.
8. Which of the following is TRUE regarding
4. Which of the following diseases show Pautrier vitamin K deficiency?
microabscesses on histological exam?
A. Increased activity of clotting factors II,
A. Ewing sarcoma VII, IX, X
B. Osteosarcoma B. Decreased PT
C. Mycosis fungoides C. No change in PTT
D. Multiple myeloma D. Caused by malabsorption of fat
E. Chronic lymphocytic leukemia E. Abnormal platelet count
Questions: 1-16 117
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9. Each of the following regarding wound repair 13. Which of the following is TRUE regarding
is true EXCEPT the viral growth curve?
A. secondary intention wound healing A. Eclipse period is when both virions and
occurs when a sizeable gap exists between nucleic acid grow exponentially.
margins. B. Virions and viral nucleic acid have nearly
B. a large extraction socket heals by primary an identical growth curve during the rise
intention. period.
C. the inflammatory stage occurs immedi- C. The rise period occurs first once a virus
ately after tissue injury. enters a cell.
D. contact inhibition occurs when migrating D. One virus normally takes days to double.
epithelial wound margins meet. E. During the rise period, there is a
E. healing by primary intention occurs at a decreased number of virions.
faster rate than secondary intention.
14. Which of the following bacteria is most
10. Each of the following is a topical antibiotic strongly associated with sex-steroid-induced
EXCEPT gingivitis?
A. neomycin. A. Lactobacillus casei
B. bacitracin. B. Prevotella intermedia
C. polymyxin B. C. Streptococcus mutans
D. ofloxacin. D. Actinomyces viscosus
E. all of the above are topical antibiotics. E. Lactobacillus acidophilus
11. Which of the following bacteria is a gram- 15. Which of the following components of the
positive cocci that commonly causes skin complement system mediates opsonization?
infection and abscess formation?
A. C5a

A. Staphylococcus aureus B. C6
B. Streptococcus bovis C. C8
C. Streptococcus viridans D. C9
D. Staphylococcus saprophyticus E. C3b
E. Actinomyces israelii
12. Each of the following antibiotics is correctly clinical vignette:
matched with its mode of action EXCEPT
A 55-year-old woman presents to your office com-
A. macrolide—inhibits protein synthesis by plaining of burning mouth, dry eyes, and a rash on
binding 50S ribosomal subunit. her midface. On exam, you note multiple carious
B. cephalosporin—inhibits cell wall synthe- lesions and a lack of saliva. You decide to order a
sis by blocking peptidoglycan cross- blood draw and labs for certain immunologic
linking. markers prior to beginning routine dental care.
C. penicillin—inhibits cell wall synthesis by
blocking peptidoglycan cross-linking. 16. Suppose that lab results show the presence of
D. tetracycline—inhibits protein synthesis by antinuclear antibodies. Which of the follow-
binding 30S ribosomal subunit. ing diseases would one expect this to be
E. clindamycin—inhibits DNA gyrase. indicative of?
A. Reiter syndrome
B. Behcet syndrome
C. Scleroderma
D. Ankylosing spondylitis
E. Sjögren syndrome
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17. What is the most common autoimmune dis- 21. Which of the following diseases does this
order in the United States? patient most likely have?
A. Sjögren syndrome A. Cystic fibrosis
B. Rheumatoid arthritis B. von Hippel-Lindau disease
C. Lupus C. Tay-Sachs disease
D. Polyarteritis nodosa D. Fabry disease
E. Dermatomyositis E. Marfan syndrome
18. Which of the following is FALSE with regard 22. Which of the following genes would you sus-
to the Stephan curve? pect to be mutated with this condition?
A. Nonfermentable carbohydrates cause a A. VHL
rapid decrease in salivary pH. B. Fibrillin
B. It takes up to 40 minutes to recover nor- C. BRCA-1
mal salivary pH after eating sugar. D. N-myc
C. Sucrose ingestion can greatly affect E. BRCA-2
salivary pH.
D. Normal salivary pH is around 7.0. Questions 23-25 pertain to the following clinical
E. Enamel begins to demineralize at a pH of 5.5. vignette:
19. Which of the following plaque control agents A 20-year-old male presents as a referral for extrac-
has the highest alcohol content? tion of a necrotic tooth. You decide that the tooth
cannot be immediately extracted due to an active
A. Total (sodium fluoride triclosan) infection, and you place the patient on a regimen
B. Gel-Kam (stannous fluoride) of penicillin for 1 week. The patient calls your
C. Listerine (phenolic/essential oil office the next day complaining of a bulls-eye rash
compound) on the back of his hand and forearm.
D. Peridex (chlorhexidine gluconate)

E. Scope (cetylpyridinium chloride) 23. What do you believe this patient is suffering
from?
20. Which of the following is TRUE about the A. Impetigo
bacterial growth curve? B. Type IV hypersensitivity
A. Cell growth plateaus during the stationary C. Bullous pemphigoid
phase. D. Pemphigus vulgaris
B. The initial phase is signified by increased E. Erythema multiforme
cell death.
C. There is an exponential increase in bacte- 24. What type of hypersensitivity reaction do you
rial growth during the log phase. believe this lesion to be from?
D. There is increased metabolic activity A. Type I
during the lag phase. B. Type II
E. The lag phase is characterized by a lack of C. Type III
required bacterial nutrients. D. Type IV
E. Not a hypersensitivity reaction
clinical vignette: 25. Which of the following is TRUE regarding
pemphigus vulgaris and bullous pemphigoid?
Suppose a patient presents to you with tall and
thin stature, abnormally long legs and arms, and A. Both lesions have very different clinical
spiderlike fingers. They also mention that they suf- presentations.
fer from cystic medial necrosis of the aorta. B. They are both mediated by IgM.
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C. Histology is of no diagnostic help when D. Mumps

differentiating between the two. E. Parvovirus
D. Only pemphigus vulgaris has Tzanck
cells. 29. Which of the following hypersensitivity reac-
E. Immunofluorescence shows the same tions occur with this illness?
features between the two. A. Type I
B. Type II
26. Which of the following bacteria possesses
C. Type III
hyaluronidase and is known to cause glo-
D. Type IV
merulonephritis?
E. Not a hypersensitivity reaction
A. Bordetella pertussis
B. Streptococcus pyogenes 30. Each of the following are included in the
C. Haemophilus influenzae grouping of Aschoff bodies EXCEPT
D. Helicobacter pylori A. Anitschkow cells.
E. Francisella tularensis B. multinucleated giant cells.
C. Aschoff myocytes.
D. focal interstitial myocardial inflammation.
bacterial classification?
E. lines of Zahn.
A. Gram-positive microorganisms contain
LTA in their cell walls. 31. Which of the following Streptococcal strains
B. Obligate anaerobes typically grow well in are seen in rheumatic fever?
oxygenated environments. A. Group A beta-hemolytic
C. Spores are produced by gram-positive B. Group C
rods only. C. Group B beta-hemolytic
D. Only one bacterium is differentiated by D. Alpha-hemolytic

the acid-fast stain. E. Group D beta-hemolytic
E. Bacteria designated as cocci are micro-
scopically round. 32. According to the Jones Criteria, how many
major and minor criteria are met from the
Questions 28-32 pertain to the following clinical following symptoms—arthritis, fever, ECG
vignette: changes, arthralgias?
A 12-year-old male presents to your office for regu- A. 3 major, 1 minor
lar dental cleanings. While taking a health history, B. 2 major, 2 minor
his mother tells you that he had a “bad sore throat C. 1 major, 3 minor
which went away, then a fever returned a few D. 4 major
weeks with small bumps on his knee and wrist.” E. 4 minor
You are suspicious of this illness, and decide to fur-
ther investigate via physician referral. 33. Which of the following is FALSE concerning
necrotic changes?
28. Upon receiving physician workup, you see
that (more specifically) the patient experi- A. Ischemia is seen with coagulative necrosis.
enced polyarthritis, erythema marginatum, B. Fatty acids are released with liquefactive
chorea, carditis, and subcutaneous nodules. necrosis.
What illness are these symptoms indicative of? C. Myocardial infarcts cause liquefactive
necrosis.
A. Rheumatic fever
D. Caseous necrosis is seen in tuberculosis
B. Measles
infection.
C. Pneumonia
E. Granulomas are considered as being
characteristic of caseous necrosis.
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34. Which of the following is secreted by B cells? fatigued lately and very weak. You decide to send
for a physician’s consultation on the patient as well
A. IL-4 as labs prior to treatment.
B. INF-γ
C. IL-2 38. The above symptoms coupled with the fol-
D. TGF-β lowing labs (decreased cortisol, increased
E. TNF-α serum sodium, increased serum potassium),
you would expect which of the following?
35. Each of the following cellular injuries is
matched up correctly with its causative A. Cushing disease
chemical EXCEPT B. Addison disease
C. Primary hyperparathyroidism
A. methanol—blindness. D. Cushing syndrome
B. cyanide—renal tubular necrosis. E. Plummer disease
C. lead—basophilic stippling of red blood
cells. 39. What does the ACTH stimulation test
D. mercury—pneumonitis. accomplish?
E. carbon tetrachloride—fatty liver.
A. Differentiates between primary and sec-
36. Each of the following is true regarding peri- ondary hyperparathyroidism
odontal health EXCEPT B. Differentiates between hyper- and
hypothyroidism
A. the epitactic concept states that calculus C. Differentiates between Cushing disease
formation is independent of proteins. and syndrome
B. materia alba is largely composed of D. Differentiates between primary and sec-
desquamated cells and is easily washed ondary Addison disease
away. E. Differentiates between acromegaly and
C. subgingival plaque is largely composed of dwarfism
gram-negative bacteria.
D. chlorhexidine gluconate is the most effec- 40. Which of the following would be an ade-
tive antiplaque mouthrinse. quate treatment for Addison disease?
E. supragingival plaque is largely composed
of gram-positive bacteria. A. Administer cortisol
B. Administer aldosterone
37. Which of the following types of periodontal C. Administer androgens
disease commonly presents with punched-out D. Administer growth hormone
interproximal papillae, fetor oris, and marginal E. Administer parathyroid hormone
gingival pseudomembrane formation?
41. Which of the following diseases presents with
A. Chronic periodontitis cystic bone lesions, nephrocalcinosis, and
B. Aggressive periodontitis metastatic calcifications?
C. Plaque-induced gingivitis
D. Necrotizing ulcerative gingivitis A. Hyperparathyroidism
E. Candidiasis B. Grave disease
C. Hyperthyroidism
Questions 38-40 pertain to the following clinical D. Hypoparathyroidism
vignette: E. Addison disease
A patient presents to you for extraction of several

teeth. Upon examining intraorally, you notice dif-
fuse mucosal pigmentation of the gingiva, tongue,
hard palate, and buccal mucosa. When question-
ing the patient, he mentions that he has been
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42. Chvostek and Trousseau sign test for which of 46. Each of the following is found within the
the following? PMNs cytoplasmic granules EXCEPT
A. Chronic hypocalcemia A. neuraminidase.
B. Acute hypercalcemia B. hydrolase.
C. Acute hypocalcemia C. myeloperoxidase.
D. Acute hypercalcemia D. lactoferrin.
E. Hyperphosphatemia E. interferon.
43. Each of the following is true of adrenal gland 47. A young patient presents to you with the fol-
neoplasia EXCEPT lowing symptoms: multiple white lesions on
the buccal mucosa and a nonpruritic macu-
A. pheochromocytoma causes an increase in
lopapular brick-red rash. Which family of
catecholamine release.
viruses do you believe to be suspect?
B. eurofibromatosis and von Hippel-Lindau
disease are related to neuroblastoma. A. Rhabdovirus
C. the N-myc gene is found mutated in B. Paramyxovirus
neuroblastoma. C. Papovirus
D. metastatic spread to the liver is a sequelae D. Reovirus
of neuroblastoma. E. Calicivirus
E. the symptoms of pheochromocytoma
include paroxysmal HTN and 48. Each of the following is an RNA enveloped
hyperglycemia. virus EXCEPT
A. poliovirus.
44. Which of the following endogenous pig-
B. rubella virus.
ments is formed via auto-oxidation, accumu-
C. human T-cell leukemia virus.
lates in Kupffer cells, and is indicative of
D. human immunodeficiency virus.

hepatocellular injury?
E. hepatitis C virus.
A. Ceroid
B. Lipofuscin 49. Each of the ADA-standardized guidelines for
C. Hemosiderin antibiotic prophylaxis below are correct
D. Melanin dosages EXCEPT
E. Bilirubin A. adult unable to take oral medication:
ampicillin 2 g IM or IV 30 minutes prior
45. Each of the following are true regarding
to procedure.
immune defense EXCEPT
B. children allergic to penicillins:
A. acquired immunity includes cell- and cephalexin 50 mg/kg PO 1 hour prior to
antibody-mediated defense. procedure.
B. innate immunity exhibits immunological C. adults allergic to penicillins: clindamycin
memory. 2 g PO 1 hour prior to procedure.
C. active and passive defense are different D. adult standard prophylaxis: penicillin 2 g
ways to classify acquired immunity. PO 1 hour prior to procedure.
D. lysozymes are an example of innate E. children allergic to penicillin:
immunity. clindamycin 20 mg/kg PO 1 hour prior to
E. B lymphocytes are an example of procedure.
acquired immunity.
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50. Which of the following is FALSE regarding 54. Which of the following conditions is caused
bacterial vaccines? by backflux of acid and a weak lower
esophageal sphincter?
A. Antitoxin vaccine is a form of active
immunity. A. Achalasia
B. Immunity from cholera is provided via B. Mallory-Weiss syndrome
killed vaccine. C. Hiatal hernia
C. Active immunity includes whole bacteria, D. Intestinal lymphangiectasia
capsular polysaccharides, or toxoids. E. Gastroesophageal reflux disease
D. Antitoxin vaccine contains antibodies to
bacterial exotoxins. 55. Each of the following is characteristic of basal
E. Passive immunity includes preformed cell carcinoma EXCEPT
antibody preparations which elicit A. it is locally aggressive.
immunity. B. it is malignant.
C. it is the most common skin cancer.
51. Which of the following is TRUE with regard
D. it appears as a pearly papule.
to cellular dysplasia?
E. it is the most common form of cancer in
A. It is nonmalignant cellular growth. the United States.
B. It involves atypical cells with invasion.
C. It is disorganized and structureless matu- 56. Which of the following is TRUE regarding
ration and spatial arrangement of cells. the diagnosis and treatment of basal cell
D. It can be caused by chronic irritation. carcinoma?
E. There is increased mitosis and A. Because it is not malignant, the stage of
pleomorphism. treatment is not vital.
B. It rarely metastasizes.
52. Each of the tumor markers are correctly
C. It is not disfiguring when left alone.
matched to their associated cancer EXCEPT

D. It presents as neoplastic epidermoid cells.
A. CEA—adenocarcinoma. E. Surgical excision is rarely effective in
B. LSA—lymphomas. early stages.
C. AFP—neuroblastoma.
D. hCG—choriocarcinoma. Questions 57-60 pertain to the following clinical
E. desmin—rhabdomyosarcoma. vignette:
Questions 53-54 pertain to the following clinical A 9-year-old patient presents to your office for con-
vignette: sultation. The patient begins to sneeze upon your
entrance into the room, and says his chest is tight
Suppose a 35year-old male patient has been taking and he is wheezing. Not knowing any medical his-
excessive doses of NSAIDs due to odontogenic tory about this patient (and having the mother
pain. The patient is now experiencing extreme down the hallway in the restroom), you quickly
pain of the peritoneum. The patient did note one contemplate what to do.
bout of hematemesis a few days ago.
57. Based on the given information, what would
53. Based on the above case presentation, which you suspect this patient is suffering from?
of the following illnesses would you suspect? A. Chronic bronchitis
A. Peptic ulcer disease B. Emphysema
B. Duodenal ulcers C. Asthma
C. Gastroesophageal reflux disease D. Asbestosis
D. Hiatal hernia E. Anthracosis
E. Inflammatory bowel disease
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58. Each of the following is true regarding 63. Regarding different types of endocarditis,
chronic bronchitis EXCEPT each of the following are true EXCEPT
A. it is caused by mucous hypersecretion in A. Libman-Sacks form of endocarditis is
the bronchi and smaller airways. caused by intrinsic bacteremia.
B. symptoms include a productive cough B. dental seeding and intravenous drug use
and wheezing. cause the infective form.
C. there is a decreased Reid index. C. the mitral valve is most often affected in
D. you would expect to find an increased the Libman-Sacks form.
PO2. D. the rheumatic form occurs in areas of
E. they are known as “blue bloaters.” greatest hemodynamic stress.
E. the mitral valve is most often affected in
59. Aortic dissection is characterized by all of the rheumatic form.
following EXCEPT
64. The specific accumulation of serious fluid in
A. rupture can cause pericardial tamponade.
the pericardial space is referred to as
B. the carotid artery may become occluded,
leading to stroke. A. hemopericardium.
C. it can be life threatening. B. acute pericarditis.
D. blood “dissects” between the intima and C. constrictive pericarditis.
adventitia of the aorta. D. hydropericardium.
E. the mitral valve often becomes damaged. E. myocarditis.
60. A pregnant woman (22 weeks) with diabetes 65. Consider a patient who is unaware of the car-
and normal blood pressure readings suddenly diac condition he is suffering from. You note
develops frequent readings of 144/92. Which splinter hemorrhages under his finger nails.
of the following complications would you be What is this clinical sign indicative of?

concerned of?
A. Cardiac tamponade
A. Malignant hypertension. B. Endocarditis
B. Aortic aneurysm. C. Primary hypertension
C. Primary hypertension. D. Coronary artery disease
D. Preeclampsia. E. Angina
E. Cardiac tamponade.
61. Each of the following endocrine disorders can antigenicity?
contribute to secondary hypertension EXCEPT
A. Most antigens are proteins.
A. Cushing syndrome. B. Haptens illicit immune response on their
B. diabetes. own.
C. pheochromocytoma. C. Adjuvants enhance the immune response
D. hypoaldosteronism. to antigen.
E. hyperthyroidism. D. The binding site for an antigen is an
epitope.
62. Which of the following bacteria is implicated E. They induce an immune response by
in the majority of subacute bacterial endo- binding to antibody.
carditis?
A. Streptococcus viridians
B. Streptococcus epidermidis
C. Staphylococcus aureus
D. Streptococcus sanguis
E. Streptococcus mutans
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67. With regard to immune defense, macrophages C. isolated IgA deficiency.

D. Job syndrome.
A. are formed within the thymus.
E. ataxia telangiectasia.
B. lack the ability to produce cytokines.
C. present antigen via class II MHC.
72. Each of the following is seen with DiGeorge
D. lack the ability to phagocytose within
syndrome EXCEPT
connective tissue.
E. cannot be activated by bacterial A. hypercalcemia.
components. B. thymic hypoplasia.
C. microdeletion of chromosome 22.
68. An important defense of the body against par- D. palatal clefting.
asitic infection is mediated by
73. Which of the following is TRUE of a type IV
A. eosinophils.
hypersensitivity reaction?
B. basophils.
C. mast cells. A. It is mediated by B cells.
D. PMNs. B. It is an immediate response.
E. dendritic cells. C. It involves the binding of class II MHC to
a TCR.
69. Each of the following is an antigen present- D. An example of this reaction is seen with
ing cell EXCEPT hemolytic anemia.
E. An example of this reaction is seen with
A. monocytes.
atopic allergy.
B. B cells.
C. macrophages.
74. Which of the following types of graft is from
D. Langerhans cells.
genetically different individuals of the same
E. PMNs.
species?
Questions 70-74 pertain to the following clinical A. Xenograft

vignette: B. Allograft
C. Autograft
A 3-year-old patient presents to your pediatric den- D. Isograft
tal practice with an emergency of odontogenic ori- E. None of the above
gin. Clinically, you notice deformation of his ear
and lip. The mother mentions that he was born 75. The antibody which can cross the placenta is
with a syndrome that also affects his immune sys-
tem, but cannot remember the name. A. IgA.
B. IgG.
70. Which of the following disorders do you C. IgD.
believe this child has? D. IgE.
E. IgM.
A. Common variable immunodeficiency
B. Wiskott-Aldrich syndrome
76. Immunoglobulin A is secreted via exocrine
C. SCID
glands and
D. Bruton X-linked agammaglobulinemia
E. DiGeorge syndrome A. mediates type I hypersensitivity.
B. activates complement.
71. Each of the following presents with a defect C. its response is uncertain.
in B cell function EXCEPT D. is the main antimicrobial defense of the
primary response.
A. Bruton X-linked agammaglobulinemia.
E. prevents mucosal membrane attachment
B. Wiskott-Aldrich syndrome.
of microbes.
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77. Each of the following is true of an antibody’s A. Neurofibromatosis (type 1)

general structure EXCEPT B. Tuberous sclerosis
C. Fanconi anemia
A. activation of complement via the alterna-
D. McCune-Albright syndrome
tive pathway.
E. Vitiligo
B. its Fab regions determine the idiotype.
C. its Fc regions determine the isotype.
83. What type of thrombus typically forms after a
D. the constant regions bind APC or C3b.
myocardial infarct or from atrial fibrillation?
E. the variable regions bind specific antigen.
A. Mural
78. Trisomy 18 is seen in which of the following B. Agonal
syndromes? C. Red
D. White
A. Patau
E. Fibrin
B. Klinefelter
C. Down
84. Each of the following is a characteristic of the
D. Turner
nonprogressive/early stage of shock EXCEPT
E. Edward
A. it is considered compensated.
79. Regarding pathological development, which B. the body is maintaining perfusion to vital
of the following is NOT teratogenic? organs.
C. increased total peripheral resistance.
A. Cytomegalovirus
D. metabolic acidosis.
B. Rubella
E. increase in sympathetic nervous output.
C. Toxoplasmosis
D. Herpes simplex virus
85. Which of the following is TRUE of septic
E. Influenza
shock?

80. Which of the following is TRUE of impetigo? A. Causes vasodilation.
B. Due to exotoxin release.
A. Noncontagious
C. Caused by gram-positive bacteria.
B. Primarily affects the elderly
D. Caused by injury to the CNS.
C. Caused by Staphylococcus aureus or
E. It is a type I hypersensitivity reaction.
Streptococcus pyogenes
D. Invades deep into the skin structure
86. If a patient is stricken with Caisson disease,
E. Very low cure rate
one would expect to find
81. Each of the following is commonly found in A. solid mass occluding a vessel.
patients afflicted with cystic fibrosis EXCEPT B. fatty emboli from a broken bone.
C. air embolizing within the circulation.
A. malfunction of the Cl− transporter.
D. a blood clot.
B. meconium ileus.
E. emboli caused by amniotic fluid.
C. pathology of chromosome 9.
D. pancreatic exocrine insufficiency.
E. bronchiectasis.
82. Suppose a patient presents with café au lait

spots, which of the following is NOT com-
monly associated with this clinical finding?
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87. Each of the following is true regarding hyper- C. Hypothyroidism

emia EXCEPT D. Addison disease
E. Type I diabetes mellitus
A. increased arteriolar dilation in active
hyperemia.
91. Nephrogenic diabetes insipidus is character-
B. chronic passive hyperemia of the liver is
ized by all of the following EXCEPT
caused directly by left-sided heart failure.
C. passive hyperemia causes a decrease in A. sensitized kidney tubules to ADH.
venous return. B. a genetic (sex-linked) predilection to men.
D. inflammation and blushing is a clinical C. normal ADH production and secretion.
finding of active hyperemia. D. large volumes of dilute urine are
E. obstruction and increased back pressure is produced.
a clinical finding of chronic hyperemia. E. can be caused by lithium.
88. A dietary deficiency of vitamin B12 causes 92. Each of the following have different values in
which of the following? type I diabetes mellitus and type II diabetes
mellitus EXCEPT
A. Aplastic anemia
B. Sickle cell anemia A. symptoms.
C. Pernicious anemia B. cause.
D. Plummer-Vinson syndrome C. genetic predisposition.
E. Folate deficiency anemia D. treatment.
E. age of onset.
89. Which of the following is TRUE of poly-
cythemia? 93. Hyperglycemia is characterized by blood glu-
cose levels greater than
A. True polycythemia has a decrease in RBC
mass and decrease in total blood volume. A. 100 mg/dL.
B. Primary polycythemia has no genetic B. 90 mg/dL.

predisposition. C. 125 mg/dL.
C. Spurious polycythemia (Gaisböck syn- D. 75 mg/dL.
drome) is a form of relative polycythemia. E. 50 mg/dL.
D. In secondary polycythemia, erythropoi-
etin levels are decreased. 94. Each of the following is true of ketoacidosis
E. In primary polycythemia, erythropoietin EXCEPT
levels are increased. A. it is caused by starvation or severe insulin
deficiency.
Questions 90-95 pertain to the following clinical B. it is most common in type II diabetes.
vignette: C. it is caused by an accumulation of ketone
bodies.
A 59-year-old female presents to your office for root
canal therapy for tooth No. 9. She mentions that D. it is acetoacetic acid and beta-
an experience of increased thirst, blurred vision, hydroxybutyric acid are synthesized from
and frequent urination. You take a fingerstick and free fatty acids.
note that her blood glucose level is 180 mg/dL. E. it can be life threatening.
90. Which of the following diseases do you sus- 95. Which of the following best describes the
pect this patient has? term glycosylated hemoglobin?
A. Hyperthyroidism A. Value used to assess the short-term control
B. Type II diabetes mellitus of diabetes.
B. Reversible glycosylation of specific hemo-
globin molecules.
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C. Accurately measures glucose levels over 101. The hyperacute phase of tissue graft rejection
the past 2-3 days. is most directly mediated by which of the
D. Normal levels range from 4%-7%. following?
E. The reaction is based on enzymatic
A. T cells attacking foreign class I MHC
glycosylation.
B. Preformed antibody to graft antigen
C. Necrosis of graft vasculature via antibody
96. Bence-Jones proteins are found in the urine
D. T cells attacking foreign class II MHC
of patients stricken with which of the follow-
E. PMN attack of graft antigen
ing illnesses?
A. Non-Hodgkin lymphoma 102. Which of the following is TRUE with regard
B. Burkitt lymphoma to blood typing?
C. Multiple myeloma
A. Anti-B antibody is considered blood type B.
D. Chronic myelogenous leukemia
B. Blood type O has both A and B antigens.
E. Acute myelogenous leukemia
C. Patients with erythrocyte antigen A has
anti-A plasma antibody.
97. Each of the following findings is consistent
D. Plasma antibody A and B are seen in
with multiple myeloma EXCEPT
patients with blood type O.
A. increased platelet count. E. Blood type AB is the universal recipient.
B. decreased white blood cell count.
C. decreased red blood cell count. 103. Hemagglutination occurs when
D. increased plasma cell count.
A. blood type A is given to a patient with
E. increase in osteolytic lesions.
anti-B plasma antibodies.
B. blood type AB is given to a patient with
98. Which of the following illnesses can directly
anti-A plasma antibodies.
lead to development of type II diabetes?
C. blood type B is given to a patient with

A. Amyloidosis anti-A plasma antibodies.
B. Pheochromocytoma D. blood with erythrocyte antigen A is given
C. Small cell carcinoma to a patient anti-B plasma antibody.
D. Neuroblastoma E. blood with erythrocyte antigen B is given
E. Rheumatoid arthritis to a patient with anti-A plasma antibody.
99. Each of the following is a characteristic of an 104. Malfunction of oxidative phosphorylation is

eosinophilic granuloma EXCEPT seen in poisoning with
A. it is benign and common in males in the A. lead.
3rd decade of life. B. carbon monoxide.
B. the maxilla is most commonly affected. C. cyanide.
C. mobile teeth and periodontal inflamma- D. mercury.
tion are symptoms. E. none of the above.
D. it is typically asymptomatic.
E. it is caused by abnormal histiocytes. 105. Each of the following enzymes is elevated
after a myocardial infarct and heart damage
100. Each of the following illnesses is a histiocyto- EXCEPT
sis X disease EXCEPT
A. CK-MB.
A. Letterer-Siwe disease. B. troponin T.
B. Hand-Schüller-Christian disease. C. myoglobin.
C. Haberman disease. D. creatine phosphokinase.
D. eosinophilic granuloma. E. alkaline phosphatase.
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106. Each of the following conditions can lead to 111. Which of the following is transmitted through
tissue hypoxia EXCEPT inhalation?
A. carbon monoxide poisoning. A. Cryptosporidium parvum
B. decreased tissue perfusion. B. Pneumocystis carinii
C. decreased blood oxygenation. C. Entamoeba histolytica
D. vascular ischemia. D. Toxoplasma gondii
E. none of the above. E. Trichomonas vaginalis
107. Which of the following is a type of irreversible 112. Which of the following troche-form antifun-
cell injury? gal drugs is effective via inhibition of ergos-
terol synthesis?
A. Karyorrhexis.
B. Ribosomal detachment from endoplasmic A. Clotrimazole
reticulum. B. Ketoconazole
C. Chromatin clumping. C. Fluconazole
D. Cellular and organelle swelling. D. Nystatin
E. Bleb formation. E. Amphotericin B
108. Each of the following cellular reactions is Questions 113-115 pertain to the following clini-
correctly matched EXCEPT cal vignette:
A. aplasia → complete lack of cells. Suppose that a patient presents to you for compre-
B. hypertrophy → increase in number of hensive dental care. When taking a medical his-
cells. tory, he begins complaining of frequent itching of
C. metaplasia → cellular change from one his scalp, groin, and feet. You note that he has nail
type to another. fungus on his toes. Although you are his dentist, it
D. atrophy → decrease in cellular mass. is still your responsibility to refer him to the correct
E. hypoplasia → decrease in number of cells. medical practitioner.
109. Which of the following is transmitted by 113. Which of the following diseases do you suspect
ingestion of undercooked pork? this patient has?
A. Taenia saginata A. Histoplasmosis.
B. Taenia solium B. Coccidioidomycosis.
C. Trichinella spialis C. Blastomycosis.
D. Enterobius vermicularis D. Dermatophytosis.
E. Giardia lamblia E. Mucormycosis.
110. Regarding the parasites’ phylogeny, each of 114. Treatment could include each of the follow-
the following is true EXCEPT ing EXCEPT
A. sporozoans are a type of Protozoa. A. miconazole.
B. parasites are comprised of Protozoa and B. clotrimazole.
Metazoa. C. trimethoprim.
C. Nemathelminthes are a type of Protozoa. D. tolnaftate.
D. “flatworms” is another name for E. griseofulvin.
Platyhelminthes.
E. Trematoda and Cestoda are subgroups of 115. Which of the following is TRUE of fungi?
Platyhelminthes. A. They are gram positive.
B. Cell walls are composed of ergosterol.
C. They are obligate anaerobes.
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D. They are prokaryotic. C. Hepatitis C

E. Their asexual form of reproduction is via D. Hepatitis D
spores. E. Hepatitis E
Questions 116-121 pertain to the following clini- 120. Which of the following forms of sterilization
cal vignette: is adequate for killing hepatitis B?
A 45-year-old male patient presents to your office A. Autoclaving

for extraction of multiple teeth. He appears jaun- B. Ethylene oxide gas
diced to you, and mentions that he is often C. Chemical vapor
fatigued with a generalized muscle ache. The D. Formaldehyde
patient frequently has fevers, a loss of appetite, and E. Glutaraldehyde
feels bouts of nausea. He is sexually active with
multiple partners, and has not ever had any sort of 121. Which of the following is TRUE of using glu-
testing done. You decide to order labs prior to pro- taraldehyde 2% as a sterilization technique?
ceeding with his treatment.
A. The technique takes very little time.
116. With the symptoms noted in the clinical B. It is not associated with hypersensitivity.
vignette, which of the following diseases would C. It alkylates nucleic acids and proteins.
you suspect is evident? D. It denatures proteins.
E. It is the preferred method of sterilizing
A. HIV liquid solutions.
B. Syphilis
C. Hepatitis C 122. An endemic infection is BEST described as
D. Gonorrhea
E. Chlamydia A. an infection occurring more frequently
than normal within a population.
117. A lab finding of HBsAg is consistent with B. an infection occurring worldwide.

which disease? C. an infection which occurs within different
countries.
A. Acute hepatitis C infection D. an infection occurring at a minimal level
B. Acute hepatitis A infection within a population.
C. Acute hepatitis B infection E. none of the above.
D. Chronic hepatitis E infection
E. Chronic hepatitis B infection 123. Ludwig angina involves all of the following
fascial spaces EXCEPT
118. For which type of hepatitis is there a com-
monly administered vaccine for healthcare A. sublingual.
workers? B. submandibular.
C. submental.
A. Hepatitis A D. parapharyngeal.
B. Hepatitis B E. none of the above.
C. Hepatitis C
D. Hepatitis D 124. Which of the following is defined as a fluid-
E. Hepatitis E filled sac lined by true epithelium?
119. The picornavirus is responsible for which A. Granuloma.

form of hepatitis? B. Abscess.
C. Cellulitis.
A. Hepatitis A D. Cyst.
B. Hepatitis B E. All of the above.
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125. Which of the following infectious states is C. congestive heart failure.

characterized as having active growth of D. constrictive pericarditis.
microorganisms with or without symptoms? E. nephrotic syndrome.
A. Chronic
B. Acute
syndromes of malabsorption?
C. Latent
D. Subclinical A. It can result in steatorrhea.
E. Carrier B. Celiac disease is most likely caused by
infection of some sort.
126. The correct temperature for autoclaving/ C. There is a correlation between increased
sterilization with moist heat is length of breastfeeding and Whipple
disease.
A. 121°C for 15-20 minutes.
D. Malabsorption is due to nutrients not
B. 320°F for 2 hours.
being absorbed by the large intestine.
C. 170°C for 1 hour.
E. Sore tongue is a clinical complication of
D. 250°F for 4 hours.
Whipple disease.
E. 132°C for 20-30 minutes.
132. Which of the following is TRUE of caries
127. The greatest risk of bloodborne infection
pathogenesis?
amongst healthcare workers is
A. Glucans and fructans inhibit the adher-
A. Hepatitis B.
ence of plaque to the tooth surface.
B. HSV.
B. Lactic acid buildup causes an increase in
C. HIV.
salivary pH.
D. HPV.
C. The most detrimental effect on salivary
E. Hepatitis C.
pH is frequency of carbohydrate intake.
128. Which of the following is TRUE regarding D. Sucrose is a byproduct of glucan metabo-
tuberculosis infection? lism. The quantity of carbohydrate intake
is not detrimental to salivary pH.
A. Secondary form is widely disseminated.
B. Ghon complex is characteristic of the 133. Each of the following typically comprises the
primary and secondary form. majority of dental calculus EXCEPT
C. It is a viral infection.
A. calcium.
D. It is contracted via bloodborne
B. hydroxyapatite.
transmission.
C. carbohydrate.
E. It does not involve lymph nodes.
D. desquamated cells.
129. Hemoptysis is a clinical symptom of each of E. by-products of viral replication.
the following diseases EXCEPT
134. Each of the following is true of free radical
A. pneumonia. injury EXCEPT
B. tuberculosis.
A. it can lead to cross-linking of proteins.
C. emphysema.
B. it is generated from redox reactions.
D. bronchitis.
C. it can induce autocatalytic reactions.
E. idiopathic pulmonary hemosiderosis.
D. it is formed from catalase.
130. Ascites is characteristic of each of the follow- E. it is induced by activated oxygen species.
ing diseases EXCEPT
A. pancreatitis.
B. pneumonia.
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135. Which of the following is TRUE of patho- 139. Which of the following is TRUE regarding
logic calcification? pathological primary hypertension?
A. Metastatic calcification occurs in dam- A. There is hypertrophy of capillaries.
aged heart valves. B. Decreased wall-to-lumen ratio.
B. Metastatic calcification is due in part to C. Increased arteriolar and capillary density.
increased phosphate concentration. D. Decreased smooth muscle growth.
C. Serum calcium is normal in dystrophic E. Decreased cross-sectional area of
calcification. capillaries and arterioles.
D. Dystrophic calcification occurs with
normal tissue. 140. Each of the following is a risk factor for ather-
E. Eggshell calcification cannot be seen on osclerosis EXCEPT
chest x-ray. A. smoking.
B. hypertension.
136. Which of the following definitions is NOT
C. premenopause.
correct regarding classical signs of acute
D. nephrosclerosis.
inflammation?
E. diabetes.
A. Calor → due to decreased tissue perfusion
B. Tumor → due to tissue edema 141. Which of the following is TRUE of right
C. Rubor → due in part to vasodilation sided heart failure?
D. Function laesa → due to pain and A. Isolated right heart failure is common.
swelling B. Typically occurs independent of left heart
E. Dolor → due to inflammatory mediators failure.
C. Can be a sequelae of cor pulmonale.
137. Each of the following is true of acute inflam-
D. Typical symptoms include rales and
mation EXCEPT
cardiac enlargement.

A. PMNs are the first leukocyte to respond. E. A S3 of S4 (gallop rhythm) is heard when
B. granuloma formation includes formation present.
of pus from neutrophils, necrotic cells,
and exudates. 142. A decrease in alpha-1 antitrypsin is seen in
C. regeneration is the first stage of wound which of the following diseases?
repair following inflammation. A. Asthma
D. chronic inflammation differs from acute B. Chronic bronchitis
in that monocytes and macrophages C. Emphysema
are present. D. Pneumonia
E. elimination of infectious agents and rid- E. Tuberculosis
ding of necrotic tissue occur in the initial
response to tissue injury. 143. A patient with a history of alcoholism pre-
sents with a lung abscess. Which of the fol-
138. Which of the following autosomal chromoso- lowing bacteria would you most suspect is the
mal abnormalities occur most frequently? causative agent?
A. Edward syndrome A. Klebsiella
B. Patau syndrome B. Staphylococcus
C. Klinefelter syndrome C. Streptococcus
D. Down syndrome D. Bacillus
E. Turner syndrome E. Clostridium
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144. Which of the following bacteria will show 149. The smallest bacterium is
characteristic sulfur granules on histological
A. Chlamydia trachomatis.
study?
B. Mycobacterium tuberculosis.
A. Listeria monocytogenes C. Mycoplasma pneumoniae.
B. Staphylococcus aureus D. Rickettsia rickettsii.
C. Actinomyces israelii E. Borrelia burgdorferi.
D. Clostridium botulinum
E. Clostridium tetani 150. Each of the following diseases is caused by
infection of Picornavirus EXCEPT
145. Each of the following can be caused by
A. aseptic meningitis.
Neisseria infection EXCEPT
B. herpangia.
A. septic arthritis. C. polio.
B. Waterhouse-Friderichsen syndrome. D. hepatitis B.
C. meningitis. E. common cold.
D. gonorrhea.
E. pseudomembranous colitis. 151. Which of the following is TRUE of coronary
artery disease?
146. Infection by which species of Clostridium
A. Increased blood flow to myocardium.
after ingestion of reheated meats causes symp-
B. Increased oxygen and nutrients to
toms of necrotizing fasciitis and myonecrosis?
myocardium.
A. Dificile C. Hypotension is a risk factor.
B. Perfringens D. The classic symptom is angina.
C. Tetani E. Ischemia is a rare consequence of it.
D. Botulinum
E. None of the above 152. Each of the following is seen in a patient with
a myocardial infarct EXCEPT

147. Which of the following bacteria is correctly
A. pain radiating to the right arm.
matched with the disease it causes?
B. sweating.
A. Shigella → dysentery C. ECG changes.
B. Escherichia → typhoid fever D. angina.
C. Klebsiella → peptic ulcers E. leakage of cardiac enzymes.
D. Vibrio → urinary tract infection
E. Helicobacter → cholera 153. Which of the following definitions is correctly
matched to its form of angina?
148. Which of the following is TRUE of syphilis
A. Stable angina → intermittent chest pain
infection?
at rest
A. The secondary form is characterized by B. Prinzmetal angina → vasospasm
gumma formation. C. Prinzmetal angina → most common type
B. It is treated with penicillin. D. Unstable angina → most common type
C. It is caused by Mycobacterium infection. E. Stable angina → precipitated by exertion
D. The primary form includes a highly infec-
tious maculopapular rash. Questions 154-158 pertain to the following clini-
E. The tertiary stage is characterized by a cal vignette:
painless ulcer.
A 70-year-old male patient presents for endodontic
therapy. He mentions to you that he is a 30 pack-
year smoker since he was 20 years of age. While in
your chair, he demonstrates labored breathing and
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when he coughs, it seems dry and nonproductive. A. Precipitation →ABO blood typing
The patient shows you a note from his physician B. Radioimmunoassay → detection of anti-
stating that he has an increased total lung capacity, gen in histologic section
increased residual volume, and decreased FEV1/ C. Immunofluorescence → detection of
FVC. serum antigen
D. Agglutination → antibody cross-linking
154. Which of the following diseases do you suspect with soluble antigen
this patient has? E. ELISA → substrate-activated enzyme
A. Chronic bronchitis reaction labeling antigen-antibody
B. Asthma complex
C. Emphysema
D. Pneumonia 160. Which of the following is TRUE of T cells?
E. Tuberculosis A. TH-1 cells secrete IL-4 and -5.
B. CD8 lymphocytes respond to class II
155. Asthma is precipitated by each of the follow- MHC proteins.
ing mechanism EXCEPT C. Memory T cells do not respond to
A. increased sympathetic stimulation. reexposure.
B. cox inhibitors. D. TH-2 cells signal B cells to differentiate
C. direct bronchodilator release. into plasma cells.
D. increased vagal stimulation. E. CD4 lymphocytes are considered cyto-
E. type I hypersensitivity reaction. toxic lymphocytes.
156. The term “blue bloater” is given to patients 161. Tissue regeneration occurs in each of the fol-
stricken with which of the following conditions? lowing EXCEPT
A. Emphysema A. liver.

B. Asthma B. cartilage.
C. Chronic bronchitis C. skeletal muscle.
D. Pneumonia D. bone.
E. Bronchiectasis E. intestinal mucosa.
157. Each of the following is a possible complica- 162. Which of the following is TRUE of histamine
tion of chronic bronchitis EXCEPT function?
A. peripheral edema. A. Causes vasodilation.
B. chronic productive cough. B. Causes bronchodilation.
C. right ventricular overload. C. It has no effect in type I hypersensitivity
D. noncaseating granulomas. reactions.
E. bronchogenic carcinoma. D. It is secreted by leukocytes.
E. It activates complement.
158. Each of the following is a mechanism of air-
way obstruction EXCEPT 163. Regarding inflammatory mediators, each of
the following is correctly matched up with its
A. increased elastic recoil.
precursor EXCEPT
B. increased mucous.
C. airway hyperreactivity. A. serotonin → tryptophan.
D. increased elastic recoil. B. complement protein → hepatocytes.
E. none of the above. C. nitric oxide → histidine.
D. bradykinin → kininogen.
159. Which of the following is TRUELY matched E. leukotrienes → arachidonic acid.
with its definition?
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164. TGF-β is secreted by each of the following A. it contains only one strand of RNA.
EXCEPT B. gp120 mediates attachment to CD4.
C. gp41 mediates fusion to the host cell.
A. monocytes.
D. p24 and p7 combine to form the
B. fibroblasts.
nucleocapsid.
C. T cells.
E. it contains reverse transcriptase.
D. B cells.
E. macrophages.
170. Which of the following is TRUE of
cephalosporins?
165. Each of the following is part of the cellular
stage of acute inflammation EXCEPT A. They inhibit protein synthesis.
B. They contain beta lactam rings.
A. diapedesis.
C. They are bacteriostatic.
B. margination.
D. There is only one generation of the drug
C. chemotaxis.
available.
D. vasodilation.
E. There is 90% cross-hypersensitivity with
E. adhesion.
penicillins.
166. Which of the following is TRUE of subgingival
171. Haemophilus influenzae can cause each of
plaque?
the following illnesses EXCEPT
A. It is located coronal to the gingival
A. otitis media.
margin.
B. epiglottitis.
B. It is not affected by diet and saliva.
C. meningitis in children.
C. It is predominately gram-positive faculta-
D. upper respiratory tract infection.
tive cocci.
E. enterocolitis.
D. The calculus it forms is due to saliva.
E. It does not attach to gingival epithelial
Questions 172-175 pertain to the following clini-

sources.
cal vignette:
167. Which of the following is TRUE of bacterio- An 8-year-old female presents to your office for regu-
phages? lar dental care. On physical exam, you note that she
A. There are three pathways of replication. has delayed eruption of several teeth and dentin and
B. The lytic cycle includes a prophage. enamel defects. The caries rate also seems high.
C. The host cell is not destroyed in the lyso-
genic cycle. 172. Which of the following diseases do you sus-
D. They are viruses. pect this patient has?
E. DNA is incorporated into the host-cell A. Osteomalacia
chromosome in the lytic cycle. B. Paget disease
C. Fibrous dysplasia
168. Which of the following cannot be prevented D. Osteoporosis
with a vaccine? E. Osteitis fibrosa cystic
A. Infectious mononucleosis
B. Primary varicella 173. Each of the following is a cause of vitamin D
C. Smallpox deficiency EXCEPT
D. Hepatitis B A. decreased dietary intake.
E. Hepatocellular carcinoma B. malabsorption.
C. increased phosphate intake.
169. Each of the following is true of human D. decreased sunlight exposure.
immunodeficiency virus EXCEPT E. kidney failure.
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174. The laboratory findings of anemia, increased 178. Each of the following is true of a stroke
alkaline phosphatase, and increased urinary EXCEPT
hydroxyproline are seen in
A. it is due to an infarct of the cerebrum or
A. Paget disease. another part of the brain.
B. fibrous dysplasia. B. it can be caused by a thrombus of
C. osteoporosis. embolism of the carotid artery.
D. osteochondrosis. C. symptoms vary based on what part of the
E. osteopetrosis. brain is affected.
D. sudden paralysis and numbness of the
175. Each of the following classifications of frac- body on the ipsilateral side of the stroke is
tures is correctly matched with its definition common.
EXCEPT E. hemorrhage of the brain can cause a stroke.
A. greenstick → bone cracks through one
179. Which of the following signs and symptoms
side only.
are incorrectly matched with their causative
B. comminuted → bone is crushed into
disease?
many pieces.
C. open → bone pierces skin. A. Alzheimer disease → Lewy bodies
D. complete → bone bends but does not B. Parkinson disease → depigmentation of
break. the substantia nigra
E. single → bone breaks only in one place. C. Werdnig-Hoffman disease → tongue
fasciculations
Questions 176-179 pertain to the following clini- D. Poliomyelitis → lower motor neuron
cal vignette: damage
E. Huntingdon disease → chorea and dementia
A 79-year-old female presents to your office
requesting a consultation about dental implants.

180. Each of the following tumors is matched up
While reviewing her medical history, you notice with their definition EXCEPT
that her hand is shaking as she sits in your chair.
You ask her if she is nervous, and she denies. As A. choristoma → normal tissue misplaced
she is leaving the room after the consultation, you within another organ.
become aware that she has a shuffling gait as she is B. myxoma → malignant tumor derived
walking. from connective tissue.
C. teratoma → neoplasm comprised of all
176. Which of the following diseases do you suspect three embryonic germ cell layers.
this patient is suffering from? D. adenoma → neoplasm of glandular
A. Multiple sclerosis epithelium.
B. Myasthenia gravis E. papilloma → tumor from surface
C. Alzheimer disease epithelium.
D. Parkinson disease
E. Eaton-Lambert syndrome 181. Each of the following causes of mutagenesis
is correctly matched with its mechanism of
177. Which of the following is NOT part of the action EXCEPT
triad of symptoms seen with multiple sclerosis? A. ultraviolet light → produces free radicals
A. Scanning speech that can attack DNA bases.
B. Dementia B. dimers → interfere with DNA replication.
C. Intention tremor C. chemicals → may alter an existing DNA
D. Nystagmus base.
E. None of the above D. viruses → frameshift mutations.
E. viruses → frameshift deletions.
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182. The clinical signs of peau d’orange and C. Squamous cell carcinoma
enlarged axillary lymph nodes are evident in D. Actinic keratosis
which of the following neoplasias? E. Melanoma
A. Squamous cell carcinoma
187. Which of the following skin neoplasms is
B. Lung cancer
benign?
C. Colorectal cancer
D. Breast cancer A. Pigmented nevus
E. Uterine cancer B. Squamous cell carcinoma
C. Melanoma
183. Which of the following cells has the lowest D. Keratocanthoma
radiosensitivity? E. None of the above
A. Lymphocytes
188. Each of the following is true regarding squa-
B. Reproductive cells
mous cell carcinoma of the skin EXCEPT
C. Nerve cells
D. Epithelial cells A. keratin pearls are seen histologically.
E. Bone marrow B. there are increased laminin receptors
seen in malignant epithelial cells.
184. Which of the following is a highly malignant C. a normal treatment regimen requires
cerebellar tumor that is also of primitive neu- chemotherapy.
roectodermal origin? D. it can be caused by sun damage and
radiation.
A. Glioblastoma multiforme
E. it typically presents as a scaling,
B. Medulloblastoma
indurated, ulcerative nodule.
C. Low-grade astrocytoma
D. Craniopharyngioma
E. Ependymoma
melanoma of the skin?

185. Which of the following cancers has the highest A. It is a malignancy of melanocytes of nevus
incidence in men? cells.
B. The most common form is superficial
A. Colorectal
spreading type.
B. Urinary tract
C. It is the most deadly form of skin cancer.
C. Prostate
D. The clinical course may include very
D. Lung
rapid spread.
E. Leukemia
E. The initial phase of growth is vertical
Questions 186-189 pertain to the following clini- followed by radial.
cal vignette:
A 64-year-old male presents to you complaining of Ewing sarcoma?
a painful growth on his midface. It appears some- A. Histology alone is not specific for diagnosis.
what pearly with overlying telangiectatic vessels. B. It is not sensitive to radiation therapy.
He mentions that it sometimes bleeds and it doesn’t C. It occurs in the 5th-6th decades of life.
seem to ever heal. You decide to perform a biopsy.
D. It originates in skeletal muscle.
E. It is benign.
186. Which of the following do you suspect this
lesion is?
191. Each of the following is a possible cause of dis-
A. Dermatofibroma seminated intravascular coagulation EXCEPT
B. Basal cell carcinoma
A. major trauma.
B. malignancy.
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C. gram-negative sepsis. C. There is a decrease in plasma colloid

D. amniotic fluid embolism. osmotic pressure.
E. type I hypersensitivity reaction. D. There is a decrease in capillary hydrostatic
pressure.
192. Which of the following is FALSE regarding E. Fluid moves into the intravascular space.
iron deficiency?
A. It can be caused by chronic blood loss.
the pathophysiology of shock?
B. Clinical symptoms include pallor, fatigue,
and shortness of breath. A. There is a decrease in urinary output.
C. It results in macrocytic anemia. B. The patient becomes hypertensive.
D. It can lead to Plummer-Vinson syndrome. C. There is an increase in blood flow.
E. Poor diet can be a cause. D. There is an increase in cardiac output.
E. There is an increase in stroke volume.
193. Each of the following is a cause of vitamin
B12 deficiency EXCEPT 198. Each of the following can lead to cirrhosis of
the liver EXCEPT
A. pernicious anemia.
B. duodenal resection. A. hemochromatosis.
C. gastric resection. B. biliary obstruction.
D. specific dietary deficiency. C. Wilson disease.
E. none of the above. D. viral hepatitis.
E. portal hypertension.
194. Which of the following lab findings would be
seen with nephrotic syndrome? 199. Each of the following is true of hemolytic
anemia EXCEPT
A. Hyperalbuminemia
B. Hypolipidemia A. the first sign is yellow sclera.

C. Hypocholesterolemia B. hyperbilirubinemia is a common labora-
D. Optimally functioning renal glomeruli tory finding.
E. Proteinuria C. there is a decrease in unconjugated biliru-
bin in the blood.
195. In general, which of the following is TRUE D. conjugated bilirubin forms from albumin
of the systemic response to infection? and unconjugated bilirubin.
A. Giardia infections are largely associated E. hemoglobinuria is a common laboratory
with neutrophilia. finding.
B. Rubella infections are largely associated
200. Which of the following is TRUE of sickle
with lymphocytosis.
cell anemia?
C. It rarely results in fever.
D. Leukocytosis is a rare result of bacterial, A. The homozygotic form is less severe.
parasitic, and viral infection. B. The spleen is rarely affected.
E. Clostridium infections are largely associ- C. Caucasians are most commonly affected.
ated with eosinophilia. D. It is an inherited autosomal dominant
disease.
196. Which of the following is TRUE regarding E. Patients with sickle-cell trait are
the physiology of edema? heterozygotic.
A. There is a decrease in capillary permeability.
B. There is an increase in interstitial fluid
colloid osmotic pressure.
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AN SW E R S
1. The correct answer is D. Reed-Sternberg Answer C is incorrect. With this disease, a

cells are pathognomonic for Hodgkin lym- chromosomal change is seen at t(8; 14), and
phoma. These cells are true neoplastic cells is noted on genetic studies.
found within lymph nodes of affected persons,
Answer D is incorrect. Burkitt lymphoma is
and are also malignant.
a form of NHL, and is signified by defective
Answer A is incorrect. Non-Hodgkin lym- B cells. The illness is also closely related to
phoma is a disease with similar symptoms to ALL.
Hodgkin, but lacking the presence of Reed-
Answer E is incorrect. Lymph nodes are
Sternberg cells. Diagnosis is based on clinical
often spared with this disease.
symptoms and histology.
Answer B is incorrect. Acute lymphocytic 4. The correct answer is C. Mycosis fungoides
leukemia is a malignancy of the bone mar- is a form of NHL which is characterized by
row. It is characterized by overexpression of eczematoid-type skin lesions with regional
immature white blood cells. erythema. The lesions eventually progress to
tumors. Histologically, one would find atypi-
Answer C is incorrect. Chronic myeloge-
cal CD4 cells with cerebriform nuclei and
nous leukemia is a form of cancer affecting
Pautrier microabscesses, which are small
myelogenous cells of the bone marrow. Pres-
pockets of tumor cells within the epidermis.
ence of the Philadelphia chromosome is
diagnostic. Answer A is incorrect. Ewing sarcoma is a
cancer of bone frequently found in teenagers.
Answer E is incorrect. Multiple myeloma is
Its clinical presentation and radiographic
a cancer which is characterized by unregu-
analysis are diagnostic.
lated proliferation of plasma cells.

Answer B is incorrect. Osteosarcoma is a
2. The correct answer is D. Weight gain is not malignant bone disease which is diagnosed
commonly seen in patients suffering from histologically based on the presence of
non-Hodgkin lymphoma. affected osteoid.
Answer A is incorrect. Night sweats are seen Answer D is incorrect. Multiple myeloma is
in patients with non-Hodgkin lymphoma. a cancer which is due to uncontrolled prolif-
eration of plasma cells and is diagnosed
Answer B is incorrect. Malaise is a symptom
histologically.
seen in patients with non-Hodgkin lymphoma.
Answer E is incorrect. Chronic lymphocytic
Answer C is incorrect. Fatigue is a symptom
leukemia (CLL) is a cancer which affects the
seen in patients with non-Hodgkin lymphoma.
bone marrow. Proliferation of B cells is most
Answer E is incorrect. Solid tumor masses in commonly involved.
the cervical and supraclavicular region of the
neck. 5. The correct answer is E. Cell-mediated immu-
nity is a part of the host defense which involves
3. The correct answer is B. Burkitt lymphoma T lymphocytes, NK cells, and macrophages,
is not a high grade T-cell malignancy. but is not predominately B-cell mediated.
Answer A is incorrect. EBV also is thought Answer A is incorrect. Cell-mediated immu-
to play a significant role in Burkitt lym- nity is responsible for type IV hypersensitivity
phoma, especially in African nations (95% of reactions. This involves T-cell immunological
cases). attack.
Answers: 1-9 139
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Answer B is incorrect. Cell-mediated immu- which allows adhesion of platelets to

nity helps the body defend against parasites, collagen.
as well as intracellular bacteria, viruses, and
Answer C is incorrect. von Willebrand dis-
fungi.
ease affects the platelet plug and the coagula-
Answer C is incorrect. Cell-mediated immu- tion cascade. Under normal conditions, vWF
nity is important in transplant rejection. Dys- (which is located on platelets) allows adhe-
function of this sect of the host defense can sion of platelets to collagen. This is how pri-
lead to granulomatous infection, tumor sup- mary hemostasis (platelet plug) is achieved.
pression, rejection of organs posttransplant, vWF also has binding sites for factor VIII,
and graft-vs-host reaction. thus, involvement in secondary hemostasis
(coagulation cascade).
Answer D is incorrect. Cell-mediated immu-
nity involves NK cells and macrophages. Answer E is incorrect. von Willebrand dis-
ease is an autosomal dominant disorder.
6. The correct answer is B. This patient is most
likely suffering from Hemophilia A. This form 8. The correct answer is D. Vitamin K defi-
of Hemophilia is seen in males (X-linked) com- ciency is caused by malabsorption of fat.
monly under the age of 25. With this disease, This is commonly due to pancreatic and GI
one would experience excessive bleeding from dysfunction.
minor wounds (superficial cuts, etc.) as well as
Answer A is incorrect. There is a decreased
hematomas, hemarthroses, and epistaxis.
activity of clotting factors II, VII, IX, and X.
Answer A is incorrect. von Willebrand dis- With a lack of vitamin K, there is a subse-
ease (primary and secondary hemostatic dis- quent lack in production of coagulation fac-
order) has a common predilection between tors II, VII, IX, and X.
males and females (autosomal dominant).
Answer B is incorrect. There is an increase

Answer C is incorrect. Bernard-Soulier dis- in PT. It measures the extrinsic pathway of
ease is a disorder characterized by dysfunc- coagulation.
tion of primary hemostasis.
Answer C is incorrect. There is a change in
Answer D is incorrect. Thrombocytopenia is PTT. It measures both intrinsic and common
a disorder characterized by dysfunction of pri- pathways of coagulation.
mary hemostasis.
Answer E is incorrect. The platelet count is
Answer E is incorrect. Hemophilia C (sec- found to be normal.
ondary hemostatic disorder) is not sex linked With this problem with secondary hemo-
and there is far less severe bleeding. stasis, one would expect to see an increase in
It is important to note that disorders of pri- PT, increase in PTT, and no change in
mary hemostasis deal with the platelet plug, platelet quantity.
whereas secondary hemostatic disorders affect
coagulation. 9. The correct answer is B. A large extraction
socket does not heal by primary intention.
7. The correct answer is D. von Willebrand dis- Rather, it heals by secondary intention. A
ease is bleeding and it functions independent normal extraction site is an example of heal-
of factor VIII. ing by secondary intention. Wound healing is
a process which begins as soon as tissue is
Answer A is incorrect. von Willebrand dis-
damaged. There are three stages to wound
ease is a qualitative platelet disorder, thus the
repair, all of which possess some overlap:
overall number of platelets is not affected.
inflammatory stage (immediately after tissue
Answer B is incorrect. von Willebrand disease injury) fibroplastic stage (3-4 days after injury
involves dysfunction of the vWF glycoprotein, and lasts for 2-3 weeks, characterized by
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completion of epithelial migration, angiogen- The major virulence factors include protein A,
esis, and increased collagen formation), and β-lactamase, and enterotoxin.
remodeling stage (begins 2-3 weeks after
Answer B is incorrect. Streptococcus bovis is
injury and continues indefinitely; collagen
a gram-positive coccus. Infection causes
remodeling and wound contraction with scar
endocarditis.
formation occurs).
Answer C is incorrect. Streptococcus viridans
Answer A is incorrect. Secondary intention
is a gram-positive coccus. Infection causes
wound healing occurs when a sizeable gap
caries and endocarditis.
exists between margins. The two methods of
wound healing include primary intention Answer D is incorrect. Staphylococcus sapro-
(when wound margins are closely approxi- phyticus is a gram-positive coccus. Infection
mated, resulting in faster healing, examples causes urinary tract infections.
include well-reduced bone fracture or inci- Answer E is incorrect. Actinomyces israelii,
sion margin) and secondary intention (gap although it does cause abscesses, is a gram-
between wound margins, slower healing, positive bacillus. It produces sulfur granules.
examples includes large burns/ulcers and
extraction sockets). 12. The correct answer is E. Clindamycin does
Answer C is incorrect. The inflammatory not inhibit DNA gyrase. It is bacteriostatic by
stage occurs immediately after tissue injury. inhibiting protein synthesis via binding of
It lasts 3-5 days, characterized by fibrin clot 50S ribosomal subunits in organisms.
formation and commencing of epithelial Answer A is incorrect. Macrolides are bacte-
migration. riostatic and have narrow (erythromycin) and
Answer D is incorrect. Contact inhibition more broad (azithromycin) spectrum formu-
occurs when migrating epithelial wound mar- lations. They inhibit protein synthesis by
gins meet. binding 50S ribosomal subunit.
Answer E is incorrect. Healing by primary Answer B is incorrect. Cephalosporins are

intention occurs at a faster rate than sec- bacteriocidal. They inhibit cell-wall synthesis
ondary intention. by blocking peptidoglycan cross-linking.
Answer C is incorrect. Penicillin is bacterio-
10. The correct answer is D. Ofloxacin is an cidal. It inhibits cell-wall synthesis by block-
example of a fluoroquinone. It is not used in ing peptidoglycan cross-linking.
topical form.
Answer D is incorrect. Tetracycline is a
Answer A is incorrect. Neomycin is an broad spectrum, bacteriostatic antibiotic. It
antibiotic used via topical application. It is an inhibits protein synthesis by binding 30S
aminoglycoside. ribosomal subunit.
Answer B is incorrect. Bacitracin is an antibi-
otic used via topical application. It functions 13. The correct answer is B. Virions and viral
to inhibit cell-wall synthesis. nucleic acid have nearly an identical growth
curve during the rise period.
Answer C is incorrect. Polymyxin B is an
antibiotic used via topical application. It func- Answer A is incorrect. The eclipse period is
tions by altering cell-membrane permeability. when one virion enters a cell and there is an
immediate decrease in their quantity.
11. The correct answer is A. Staphylococcus aureus Answer C is incorrect. The rise period is
is a gram-positive coccus which causes abscess when there is an exponential increase in
formation, gastroenteritis, endocarditis, toxic nucleic acid and virions. It occurs prior to
shock syndrome, and scalded skin syndrome. virus release.
Answers: 10-17 141
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Answer D is incorrect. One virus can double 16. The correct answer is E. Sjögren syndrome
within hours. It is possible that one virus may has the classic clinical triad of xerostomia
replicate for a yield of up to hundreds of new (dry mouth), keratoconjunctivitis (dry eyes),
virions. and systemic lupus erythematous (character-
istic butterfly rash on face). Sjögren most
Answer E is incorrect. During the rise period,
often affects women around the age of 50
there is an increased number of virions.
years. Rheumatoid arthritis may also be pre-
14. The correct answer is B. Prevotella intermedia sent. Ultimately, exocrine glands are infil-
is often found in high proportions where gin- trated by lymphocytes and become fibrotic
givitis is caused by sex steroid fluctuation. and atrophied. This leads to decreased secre-
These fluctuations are commonly seen with tions and the above symptoms, as well as ram-
pregnancy, puberty, menstrual cycle, and oral pant caries from increased acidogenic bacte-
contraceptive use. P. intermedia use these ria in the oral cavity.
steroids as growth factors. Answer A is incorrect. Reiter syndrome is an
Answers A, C, D, and E are incorrect. Lacto- autoimmune condition characterized by
bacillus casei, Streptoccus mutans, Actino- arthritis, conjunctivitis, and urethritis.
myces viscosus, and Lactobacillus acidophilus Answer B is incorrect. Behcet syndrome is
are commonly found as part of oral environ- an immune disease characterized by symp-
ment flora, but are not strongly correlated to toms of ulcers, skin and eye inflammation,
sex-steroid-induced gingivitis. and arthritis, to name a few.
15. The correct answer is E. Opsonization, Answer C is incorrect. Scleroderma is a dis-

which functions to enhance phagocytosis, is ease characterized by localized and systemic
mediated by C3b. This component of the deposits of collagen. It can occur in the skin,
complement system binds to the Fc site of as well as other organs of the body.

immunoglobulin (which in turn binds anti- Answer D is incorrect. Ankylosing spondyli-
gen), thus, allowing phagocytes to bind this tis is a chronic disease which involves arthritis
complex and destroy the invader. of the spine. It can be seen radiographically
Answer A is incorrect. C5a is a part of the when spinal fusion occurs.
complement system. It functions to mediate
17. The correct answer is B. Rheumatoid arthri-
chemotaxis.
tis is the most common autoimmune disor-
Answer B is incorrect. C6 is a part of the der. It is a chronic inflammatory disorder
complement system. It combines with other which affects joints and surrounding tissue by
complement factors to form the membrane proliferative inflammation of synovial mem-
attack complex. branes. Organ systems may also become
Answer C is incorrect. C8 is a part of the affected. Middle age females have nearly a
complement system. It combines with other 2.5x predilection for the disease. Genetically,
complement factors to form the membrane persons more likely to be stricken with this
attack complex. illness possess HLA-DR4 markers.
Answer D is incorrect. C9 is a part of the Answer C is incorrect. Lupus is an autoim-

complement system. It combines with other mune disorder found in peoples worldwide,
complement factors to form the membrane but it is not the most common.
attack complex. Answer D is incorrect. Polyarteritis nodosa
Note that complement factors C5a, and is an autoimmune disorder found in peo-
C6, C8, and C9 (combined with C5b and ples worldwide, but it is not the most
C7) form the membrane attack complex. common.
This disrupts cell membrane permeability.
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Answer E is incorrect. Dermatomyositis is Answer E is incorrect. Scope (cetylpyri-

an autoimmune disorder found in peoples dinium chloride) contains about 10% alcohol.
worldwide, but it is not the most common.
Collagen vascular diseases include rheuma- 20. The correct answer is B. The initial stage
toid arthritis, SLE, polyarteritis nodosa, der- (lag phase) is characterized by increased
matomyositis, and scleroderma. All collagen metabolic activity and a slight upswing in the
vascular diseases are characterized by inflam- curve. The bacterial growth curve is broken
matory damage to connective tissue and up into four stages (lag, log, stationary,
blood vessels, as well as the deposition of death).
fibrinoid material in these regions. Answer A is incorrect. The stationary phase
is signified by a plateau on the graph and
18. The correct answer is A. Fermentable carbo-
demonstrates a balance in the number of new
hydrates cause a rapid decrease in salivary
and dead cells which is caused by a lack of
pH. The Stephan Curve shows the relation-
required nutrients.
ship between salivary pH over a span of
roughly one hour. Once a fermentable carbo- Answer C is incorrect. The log phase begins
hydrate (ie, sucrose) is ingested, it is synthe- an exponential growth and division of bacte-
sized by oral microflora to produce lactic ria which is shown by an increase in the
acid. curve.
Answer B is incorrect. It takes up to 40 min- Answer D is incorrect. There is increased
utes to recover normal salivary pH after eat- metabolic activity during the lag phase.
ing sugar. Recovery can occur as early as 15 Answer E is incorrect. The lag phase is char-
minutes. acterized by a lack of required bacterial
Answer C is incorrect. Sucrose ingestion can nutrients.
greatly affect salivary pH. Within minutes of The final stage, the death phase, shows an
eating sugar, oral bacteria can cause rapid exponential increase in bacterial death and is
enamel demineralization. shown as a decrease on the growth curve.
Answer D is incorrect. Normal salivary pH is 21. The correct answer is E. Marfan syndrome is
around 7.0. Acid causes a rapid decrease in the an uncommon hereditary connective tissue
salivary pH (within minutes) below the thresh- disorder in which patients present with the
old of enamel demineralization (pH of 5.5). above clinical features. They suffer from cys-
tic medial necrosis of the aorta which puts
19. The correct answer is C. Listerine contains
the patient at an increased risk of aortic
the highest alcohol content of all chemical
incompetence and dissecting aortic aneurysms.
plaque control agents. It contains a phenolic/
They also have a distensible mitral valve.
essential oil compound and 26.9% alcohol.
Along with these skeletal and cardiovascular
This product inhibits plaque buildup and
abnormalities, these patients also suffer from
concomitant gingivitis.
ocular lens dislocation.
Answer A is incorrect. Total (sodium fluoride/
Answer A is incorrect. Cystic fibrosis is a pro-
triclosan) contains 0.3% triclosan. It does not
gressive disease which is due to malfunction
contain alcohol.
of chloride channels throughout the body. It
Answer B is incorrect. Gel-Kam (stannous results in excessive, thick mucous production.
fluoride) does not contain alcohol. It is autosomal recessive.
Answer D is incorrect. Peridex (0.12% Answer B is incorrect. von-Hippel Lindau
chlorhexidine gluconate) typically contains disease is an autosomal dominant disorder
about 11.6% alcohol. which is characterized by cysts and adenomas
of the liver, kidney, adrenals, and pancreas.
Answers: 18-25 143
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Answer C is incorrect. Tay-Sachs disease is bodies against epidermal intercellular cement

an x-linked disorder which involves lysosomal substance.
storage. It is autosomal recessive. Bullous pemphigoid and pemphigus vulgaris
are differentiated by immunofluorescence
Answer D is incorrect. Fabry disease is an x-
and histology.
linked disorder which involves lysosomal stor-
age. It is autosomal dominant.
24. The correct answer is C. Erythema multi-
forme causes a type III hypersensitivity reac-
22. The correct answer is B. Fibrillin is commonly
tion. Type III reactions are due to antigen
found mutated in patients with Marfan syn-
and antibody forming complexes and deposit-
drome. This gene causes connective tissue dis-
ing themselves in areas such as vessel walls,
orders in patients. The mutation, though, is
thus allowing complement to be activated
quite uncommon.
and damage to adjacent tissue.
Answer A is incorrect. VHL is a gene found
Answer A is incorrect. Type I reactions are
mutated in von Hippel-Lindau disease.
anaphylactic and caused by IgE binding to
Answer C is incorrect. BRCA-1 is a gene mast cells with subsequent cross-linking of
mutated in breast cancer. antibody and allergen. This activates the mast
Answer D is incorrect. N-myc is a gene mutated cell to release histamine and cause systemic
in neuroblastoma. reactivity.
Answer E is incorrect. BRCA-2 is a gene Answer B is incorrect. Type II reactions are

mutated in breast cancer. cytotoxic hypersensitivity, with IgG binding
to antigen on a red blood cell with eventual
23. The correct answer is E. This patient most complement destruction being an example.
likely has erythema multiforme. This skin Answer D is incorrect. Type IV reactions are
lesion is caused by medications (sulfa, peni- delayed/cell mediated and involve T-helper

cillins, barbiturates), infections, HSV, and cells binding via MHC protein and TCR to
mycoplasma. Damage occurs to blood vessels antigen and macrophage to cause release of
of the skin by way of immune complex for- inflammatory mediators.
mation. Clinically, one would find a “target,”
“bulls-eye,” or “iris” skin lesion on the loca- Answer E is incorrect. It is a hypersensitivity
tions listed above. Systemic complications are reaction.
not present.
25. The correct answer is D. Pemphigus vulgaris
Answer A is incorrect. Impetigo is a bacterial has Tzanck cells histologically.
skin infection common in children with itchy
Answer A is incorrect. Both pemphigus vul-
blisters.
garis and bullous pemphigoid are immuno-
Answer B is incorrect. Type IV hypersensitiv- logic skin lesions which have very similar
ity can cause a skin rash and other allergic clinical presentation: oral mucosal lesions,
responses. skin lesions, rupture bullae and susceptible
Answer C is incorrect. Bullous pemphigoid surface left to infection.
is an immunologic skin lesion characterized Answer B is incorrect. IgG autoantibodies
by oral and skin lesions due to IgG autoanti- are present against epidermal intercellular
bodies against epidermal intercellular cement cement substance in both.
substance.
Answer C is incorrect. Immunofluorescence
Answer D is incorrect. Pemphigus vulgaris is can be diagnostic in both diseases, with encir-
an immunologic skin lesion characterized cling epidermal cells (pemphigus vulgaris)
by oral and skin lesions due to IgG autoanti- and linear bands (bullous pemphigoid) shown
in each.
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Answer E is incorrect. Histologically, one (round), bacilli (rods), spirochetes (spiral),

would expect to find intraepidermal bullae and pleomorphic (multiple shapes).
with pemphigus vulgaris and subepidermal
bullae with bullous pemphigoid. 28. The correct answer is A. Rheumatic fever is
an acute inflammatory disease which presents
26. The correct answer is B. S. pyogenes is a with the above symptoms: polyarthritis, ery-
group A beta hemolytic, gram positive. Strep- thema marginatum, chorea, carditis, subcuta-
tolysin O and S as its major virulence factors. neous nodules, and fever. The disease devel-
It is implicated in many cases of glomeru- ops weeks after an untreated streptococcal
lonephritis, pharyngitis, pyogenic infections, infection. The most common age for
meningitis, scarlet and rheumatic fever. rheumatic fever is 5-15 years old. Patients are
normally asymptomatic in the latent period
Answer A is incorrect. B. pertussis infection
between streptococcus infection and rheumatic
causes whooping cough.
fever onset. Mild cases last from 3-4 weeks,
Answer C is incorrect. H. influenzae infec- whereas more severe illnesses can take up to
tion causes meningitis (in children). 3 months to clear.
Answer D is incorrect. H. pylori infection is Answer B is incorrect. Measles is a disease
implicated in peptic ulcers and gastritis. characterized by Koplik spots (characteristic
Answer E is incorrect. F. tularensis infection rash) as well as a fever, cough, and con-
causes tularemia (transmitted via tick bite). junctivitis.
Answer C is incorrect. Pneumonia is a dis-
27. The correct answer is B. Obligate anaerobes ease which involves inflammation of the
typically grow well in nonoxygenated envi- lungs. It is of viral or bacterial origin.
ronments. Oxygen requirements can catego-
rize bacteria, also: obligate aerobes require Answer D is incorrect. Mumps is a viral
disease which is characterized by swelling
oxygen for growth, obligate anaerobes lack

superoxide dismutase and/or catalase, thus of the salivary glands. Rashes may also be
cannot live in oxygen-containing environ- seen.
ments, and facultative anaerobes can grow in Answer E is incorrect. Parvovirus rarely
the presence or lack of oxygen (using fermen- affects humans, but can cause a rash and
tation for energy when necessary). arthritis. Blood cells can also be affected.
Answer A is incorrect. Gram-positive microor-
29. The correct answer is C. Type III hypersensi-
ganisms contain LTA in their cell walls. Gram
tivity reactions occur with rheumatic fever.
stain differentiates based on cell-wall composi-
This inflammatory disease is not actually an
tion: gram positive contain LTA and have a
infection, but rather an inflammatory reaction
thick peptidoglycan wall with no endotoxin;
to an infection. As with this type of hypersensi-
gram negative are the opposite with LPS in
tivity reaction, antigen/antibody complexes are
their walls.
formed to the bacterial infection which eventu-
Answer C is incorrect. Spores are produced ally attacks the endocardium and valves. From
by gram-positive rods only. Thus, spore pro- this, permanent damage to the heart and its
duction can also differentiate bacteria. valves often occurs. This “phase” is referred to
Answer D is incorrect. Only one bacterium as rheumatic heart disease. The mitral, aortic,
is differentiated by the acid-fast stain. This and tricuspid valves are most commonly
bacterium is Mycoplasma pneumonia. affected; the pulmonic valve is rarely damaged.
Answer E is incorrect. Bacteria designated as Answer A is incorrect. Type I hypersensitivity

cocci are microscopically round. Another reactions are allergic in nature and seen with
bacteria is classified is by shape, such as cocci anaphylaxis and asthma.
Answers: 26-33 145
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Answer B is incorrect. Type II hypersensitiv- and cause neonatal illnesses (meningitis and
ity reactions are cytotoxic and are seen in sepsis).
such diseases as Goodpasture and erythroblas-
Answer D is incorrect. Alpha-hemolytic strep-
tosis fetalis.
tococci are found in dental caries and endo-
Answer D is incorrect. Type IV hypersensi- carditis, and is of the Viridans group.
tivity reactions are cell mediated and are seen
Answer E is incorrect. Group D streptococci
in cases of contact dermatitis.
include Enterococci and S. bovis, and cause
Answer E is incorrect. A hypersensitivity UTIs and endocarditis, respectively.
reaction does occur.
32. The correct answer is C. The Jones criteria
30. The correct answer is E. Lines of Zahn are are used to diagnose rheumatic fever. The
found to be associated with arterial thrombi; diagnosis can be made based on clinical find-
they are seen morphologically as red and ings of at least 2 major or 1 major and 1
white laminations within the thrombus. minor criterion. The major criteria include
carditis, arthritis, chorea, erythema margina-
Answer A is incorrect. Anitschkow cells are
tum, and subcutaneous nodules. The minor
large, unusual cells included in the grouping
criteria include fever, arthralgias, history of
of Aschoff bodies.
rheumatic fever, and ECG changes. Also
Answer B is incorrect. Multinucleated giant involved in the diagnosis of rheumatic fever
cells (Aschoff myocytes) are included in the are pathological changes such as Aschoff bod-
grouping of Aschoff bodies. ies and laboratory findings including an
Answer C is incorrect. Aschoff myocytes are increase in ASO titers and increase in ery-
a form of multinucleated giant cells. They are throcyte sedimentation rate.
included in the grouping of Aschoff bodies. Answers A, B, D, and E are incorrect. These
are not the proper number of major and

Answer D is incorrect. Focal interstitial
myocardial inflammation with fragmented minor Jones criteria.
collagen and fibrinoid material is included in
33. The correct answer is C. Myocardial infarcts
the grouping of Aschoff bodies.
are an example of coagulative necrosis. This
Note that Aschoff bodies are a grouping of
type of necrosis is characterized by ischemia,
pathological findings seen in association with
protein denaturation, preservation of tissue
rheumatic fever.
architecture, and a triangular-shaped area of
31. The correct answer is A. Group A beta- infarction.
hemolytic streptococcal strain are known to Answer A is incorrect. Ischemia is seen with
cause rheumatic fever if left untreated for coagulative necrosis. Gangrenous necrosis, a
long periods of time. This bacterium, also subgroup seen here, is ischemic with putre-
known as Streptococcus pyogenes, contains faction and an example is gangrene.
hyaluronidase, streptokinase, erythrogenic
Answer B is incorrect. Fatty acids are
toxin, and streptolysin O and S as its major
released with liquefactive necrosis. Liquefac-
virulence factors. It is implicated in pyogenic
tive necrosis shows enzymatic digestion, sup-
infections, pharyngitis, glomerulonephritis,
puration, and loss of tissue architecture. An
meningitis, and scarlet fever, as well as
example is focal bacterial infections. Acute
rheumatic fever.
pancreatitis, an example of fat necrosis (a
Answer B is incorrect. Group C streptococci subgroup of liquefactive), has areas of adipose
are very rarely found in humans. liquefaction and fatty acid release.
Answer C is incorrect. Group B beta- Answer D is incorrect. Caseous necrosis is seen
hemolytic streptococci include S. agalactiae in tuberculosis infection. It is characterized by
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granulomatous inflammation and a clumped, Answer B is incorrect. Materia alba is com-

cheesy material. posed of desquamated cells, food, and plaque
Answer E is incorrect. Granulomas are con- which is easily washed off the teeth.
sidered as being characteristic of caseous Answer C is incorrect. Subgingival plaque is
necrosis. gram-negative anaerobic bacilli and spiro-
chetes.
34. The correct answer is D. TGF-β is secreted
by B cells as well as monocytes, Answer D is incorrect. Chlorhexidine glu-
macrophages, and T cells. It functions as an conate is the most effective antiplaque
anticytokine, inhibits of T cells, B cells, mouthrinse.
PMNs, monocytes, macrophages, and NK Answer E is incorrect. Supragingival plaque
cells, and stimulation of collagen formation is largely composed of gram-positive faculta-
and wound healing. Interleukin function is tive cocci.
vast and is secreted by different cells.
37. The correct answer is D. Necrotizing ulcera-
Answer A is incorrect. IL-4 is in interleukin
tive gingivitis is characterized by punched-
which is secreted from TH-2 cells and stimu-
out interproximal papillae, plaque, fetid odor
lates B cells and IgE.
of the mouth, gingival bleeding, marginal
Answer B is incorrect. INF-γ is secreted by gingival pseudomembrane formation, and
TH-1 cells and stimulates monocyte, pain. It is commonly associated with emo-
macrophage, NK cell, and PMN activation. tional stress, malnutrition, smoking, and/or
Answer C is incorrect. IL-2 is secreted by TH-1 immunocompromise. Spirochetes are a com-
cells and stimulates other TH and TC cells. mon finding in the microbial flora.
Answer E is incorrect. TNF-α is secreted Answer A is incorrect. Chronic periodonti-

by monocytes and stimulates adhesion tis is characterized by peridontal attachment
molecules. loss. The amount of periodontal destruction

is often consistent with the presence of sub-
35. The correct answer is B. Cyanide poisoning gingival plaque and calculus accumulation.
causes inhibition of cellular oxidation. Answer B is incorrect. Aggressive periodonti-
Answer A is incorrect. Methanol poisoning tis is characterized by attachment loss that is
can lead to blindness. often not consistent with the amount of sub-
gingival microbial deposits detected. It typi-
Answer C is incorrect. Lead poisoning can cally affects people less than 30 years old.
lead to basophilic stippling of red blood cells.
Answer C is incorrect. Plaque-induced gingivi-
Answer D is incorrect. Mercury poisoning tis is characterized by gingival inflammation in
can lead to pneumonitis. the absence of peridontal attachment loss.
Answer E is incorrect. Carbon tetrachloride Answer E is incorrect. Candidiasis is a fungal
poisoning can lead to fatty liver. infection and does not have a direct effect on
Not listed above is carbon monoxide, the periodontium.
which causes systemic hypoxia if overexpo-
sure occurs. 38. The correct answer is B. Addison disease is
an adrenal hypofunction or insufficiency that
36. The correct answer is A. The epitactic con- is either caused by pathological changes in
cept of calculus formation states that protein the adrenal cortex or hypofunction of the
and carbohydrate complexes and/or bacteria adrenal cortex. Both of the diseases present
induce focal mineralization on teeth which with the same clinical findings of lethargy,
eventually forms a calcified mass. depression, and hypotension. There is also a
Answers: 34-41 147
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decrease in cortisol, increased serum sodium, of excessive or deficient growth hormone,

and increased serum potassium. respectively.
Answer A is incorrect. Cushing disease
40. The correct answer is A. In Addison disease,
would show an increase in cortisol levels.
primary or secondary, there is a lack of corti-
Answer C is incorrect. Primary hyper- sol. This is due to ill-response of the adrenal
parathyroidism leads to increased PTH in the cortex to stimulation by ACTH. Thus, exoge-
blood. nous cortisol would overcome this decreased
function and help to reverse symptoms of the
Answer D is incorrect. Cushing syndrome
disease.
would show an increase in cortisol levels.
Answer B is incorrect. Aldosterone adminis-
Answer E is incorrect. Plummer disease
tration would affect the kidneys. It would not
would have an increase in thyroid hormone
be an adequate treatment for Addison disease.
and nearly opposite clinical symptoms of
Addison disease. Answer C is incorrect. Androgen administra-
tion would affect the HPA axis. It would not
39. The correct answer is D. The ACTH stimu- be an adequate treatment for Addison disease.
lation test is used to differentiate between pri-
Answer D is incorrect. Growth hormone
mary and secondary Addison disease. Primary
administration would affect the thyroid gland.
Addison is due to autoimmune, infectious,
It would not be an adequate treatment for
neoplastic, or hemorrhagic damage to the
Addison disease.
adrenal cortex. Secondary Addison is caused
by a decrease in ACTH from the pituitary Answer E is incorrect. PTH administration
gland, thus hypofunction of the adrenal cor- would affect calcium and phosphate balance.
tex. Thus, the stimulation test is accom- It would not be an adequate treatment for
plished by administering ACTH exogenously Addison disease.

to a suspect patient. If cortisol increases, then
primary Addison is suspected (adrenal cortex 41. The correct answer is A. Hyperparathy-
still functioning). If cortisol levels stay the roidism is a condition characterized by an
same, then secondary Addison is suspected. increase in PTH. There are two forms: pri-
This is due to inability of the adrenal cortex mary and secondary. Both primary and sec-
to respond to the ACTH. ondary hyperparathyroidism share the same
clinical characteristics: cystic bone lesions
Answer A is incorrect. Primary and sec-
(eg, osteitis fibrosa cystica, von Reckling-
ondary hyperparathyroidism would be differ-
hausen disease), nephrocalcinosis (renal cal-
entiated by disease of the parathyroid glands
culi), and metastatic calcifications. The dif-
or another separate source, respectively.
ference between the two is the causative
Answer B is incorrect. Hyper- and hypothy- factor of the symptoms: with primary, there is
roidism would be differentiated by determin- typically a secreting adenoma of the parathy-
ing thyroid function. This could be done by roid gland which causes an increase in PTH;
evaluating T3 and T4 values, as well as TSH with secondary, this is usually due to hypocal-
levels. cemia (secondary to chronic renal disease)
which causes a subsequent increase in
Answer C is incorrect. Cushing disease and
parathyroid gland function. The labs seen
syndrome would be differentiated by looking
with primary hyperparathyroidism include
at levels of ACTH. When elevated, Cushing
increased calcium and phosphorus, and a
disease is evident (ie, caused by a pituitary
decrease in alkaline phosphatase; secondary
tumor).
hyperparathyroidism has a decrease in cal-
Answer E is incorrect. Acromegaly and cium and increase in phosphorus. The main
dwarfism would be differentiated by levels cause of damage with hyperparathyroidism is
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due to PTH-activation of osteoclasts. The 43. The correct answer is B. Neurofibromatosis

actions of osteoclasts lead to bone lesions, and von Hippel-Lindau disease (as well as
kidney stones, pain, and peptic ulcers. multiple endocrine neoplasia) are often asso-
ciated with pheochromocytoma, not neuro-
Answer B is incorrect. Grave disease presents
blastoma.
with exophthalmos and hyperthyroidism.
Answer A is incorrect. Pheochromocytoma
Answer C is incorrect. Hyperthyroidism pre-
causes an increase in catecholamine release.
sents with fatigue, weight loss, anxiety, and
It is a chronic chromaffin cell tumor (benign)
sweating. Other symptoms may be evident.
which is uncommon and affects men and
Answer D is incorrect. Hypoparathyroidism women of any age (usually 30-60).
presents with cramping, pain, and paresthesias.
Answer C is incorrect. The N-myc gene is
Answer E is incorrect. Addison disease pre- found mutated in neuroblastoma.
sents with weight loss, fatigue, diarrhea,
Answer D is incorrect. Metastatic spread to
sweating, and vomiting.
the liver is a sequela of neuroblastoma. Other
42. The correct answer is C. These two tests will complications include local invasion and
confirm the suspected lack of calcium in a direct spread.
patient. Briefly, hypocalcemia can be caused Answer E is incorrect. The symptoms of
by numerous mechanisms (eg, renal disease) pheochromocytoma include paroxysmal HTN
and can lead to many systemic problems and hyperglycemia. Other symptoms include
(bone loss, tetany, etc). In the example of hypermetabolic rate and abdominal distension.
tetany (due to hypoparathyroidism or Pheochromocytoma and neuroblastoma
decreased vitamin D), when blood calcium are tumors of the adrenal medulla. Neurob-
falls to 6 mg% (from normal 10 mg%), the lastoma is the most common malignant
CNS and PNS are disturbed. Thus, muscle tumor of childhood and infancy.
twitching, cramping, carpopedal spasm, and

if severe, laryngospasm and seizures occur. If 44. The correct answer is A. Ceroid is an
tetany is suspected, one may attempt two endogenous pigment formed via autooxida-
tests: Chvostek sign is viewed by tapping the tion, which accumulates in Kupffer cells, and
facial nerve near the earlobe/mandibular is indicative of hepatocellular injury.
angle—if tetany is present, the upper lip
Answer B is incorrect. Lipofuscin is a yellow-
twitches; Trousseau sign is seen by applying a
brown pigment, which is known as a wear-
blood pressure cuff to arm and inflating-
and-tear pigment. It’s derived from lipid per-
carpopedal spasm (thumb adduction and
oxidation, accumulates in the heart, liver,
phalangeal extension) confirms tetany.
and brain, and is indicative of brown atrophy
Answer A is incorrect. Chronic hypocal- and increased age.
cemia would show symptoms of paresthesia,
Answer C is incorrect. Hemosiderin is a pig-
tetany, and possibly arrhythmias.
ment that is golden brown in color, derived
Answer B is incorrect. Acute hypercalcemia from heme, and is actually aggregates of fer-
would show symptoms of depression, confu- ritin micelles. It can be identified by Prussian
sion, fatigue, nausea, and vomiting. blue stain and accumulates in phagocytes of
the bone marrow, liver, and spleen. It’s indica-
Answer D is incorrect. Acute hypocalcemia
tive of hemosiderosis and hemochromatosis.
would show symptoms of tetany and
paresthesia. Answer D is incorrect. Melanin is a brown-
black pigment derived from tyrosine which
Answer E is incorrect. Hyperphosphatemia
accumulates in skin, eyes, and hair. If increased,
would show symptoms of calcifications
it indicates normal physiology, suntan, and
throughout the body.
Answers: 42-49 149
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Addison disease; if decreased, it shows albinism Answer C is incorrect. Myeloperoxidase

and vitiligo. causes the respiratory burst by producing
hypochlorous acid. It is a primary cytoplasmic
Answer E is incorrect. Bilirubin is a yellowish
granule found in PMN.
pigment of the bile which is derived from heme.
When it accumulates in the skin, it causes jaun- Answer D is incorrect. Lactoferrin has a high
dice and is indicative of biliary tree obstruction, affinity for iron which helps its antimicrobial
hepatocellular injury, and hemolytic anemias. potency. It is a secondary cytoplasmic granule
found in PMN.
45. The correct answer is B. Innate immunity
does NOT exhibit immunological memory; 47. The correct answer is B. This patient pre-
this is a function of acquired immunity. sents with symptoms consistent with measles/
rubeola. This disease is caused by the measles
Answer A is incorrect. Acquired immunity
virus, under the family paramyxovirus. It is
includes cell- and antibody-mediated defense.
single, linear, with no treatment, but a vaccine
There are two types of immune defense:
is available.
innate (natural) and acquired (adaptive).
There are two types of acquired immunity: Answer A is incorrect. The rhabdovirus fam-
cell mediated (T cells) and antibody mediated ily contains the rabies virus.
(B cells, immunoglobulins).
Answer C is incorrect. The papovirus family
Answer C is incorrect. Active and passive contains the human papilloma virus.
defense are different ways to classify acquired
Answer D is incorrect. The reovirus family
immunity. Acquired immunity is also classi-
has both the rotavirus and orbivirus.
fied as either active (after exposure to foreign
antigen) or passive (after exposure to pre- Answer E is incorrect. The calicivirus family
formed antibody from another host). contains hepatitis E and Norwalk virus.

Answer D is incorrect. Lysozymes are an 48. The correct answer is A. The polio virus, of
example of innate immunity. Innate immunity the family picornavirus, is an RNA nonen-
functions immediately after microbial infiltra- veloped virus.
tion. It is nonspecific and has no memory.
Examples include NK cell, PMNs, and Answer B is incorrect. Rubella virus is an
complement. RNA enveloped virus.
Answer E is incorrect. B-lymphocytes are an Answer C is incorrect. Human T-cell
example of acquired immunity. Acquired leukemia virus is an RNA enveloped virus.
immunity takes days after microbial insult to Answer D is incorrect. HIV is an RNA
function. This type of defense is specific for enveloped virus.
certain antigen, exhibits diversity, and has
immunologic memory. Answer E is incorrect. Hepatitis C virus is an
RNA enveloped virus.
46. The correct answer is E. Interferon is a Note the following with RNA enveloped
cytokine which is produced by monocytes, viruses: the viral envelope, in general, is an
macrophages, and lymphocytes. Its function outer membrane. It is composed of plasma
is to interfere with virus replication. membrane lipoproteins and glycoproteins.
These are obtained from the host cell upon
Answer A is incorrect. Neuraminidase func- budding.
tions to cleave salicylic acid residues. It is a
primary cytoplasmic granule found in PMNs. 49. The correct answer is C. For adults allergic to
Answer B is incorrect. Hydrolase will penicillins, the correct dose for clindamycin is
hydrolyze chemical bonds. It is a primary 600 mg PO 1 hour prior to dental procedures.
cytoplasmic granule found in PMNs.
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Answer A is incorrect. For adults unable to Answer A is incorrect. Dysplasia is a nonma-

take oral medication: ampicillin 2 g IM or IV lignant cellular growth that can become
30 minutes prior to procedure. malignant.
Answer B is incorrect. For children allergic Answer C is incorrect. It is characterized by
to penicillins: cephalexin 50 mg/kg PO 1 hour disorganized, structureless maturation and
prior to procedure. spatial arrangement of cells that are atypical
and without invasion.
Answer D is incorrect. For adult standard
prophylaxis: penicillin 2 g PO 1 hour prior to Answer D is incorrect. It is reversible, and is
procedure. caused by such things as chronic irritation,
chemicals, cigarette smoke, and chronic
Answer E is incorrect. For children allergic
inflammatory irritation, to name a few.
to penicillin: clindamycin 20 mg/kg PO 1
hour prior to procedure. Answer E is incorrect. The cells display pleo-
Note that for some adult patients who are morphism and an increased in mitosis.
allergic to penicillins and unable to take oral Involving the epithelial layer, acanthosis is
medicines, clindamycin may be given IV at a noted, which is an abnormal thickening of
dose of 600-mg IV 30 minutes prior to proce- the prickle cell layer.
dure, or cefazolin 1-g IM or IV within 30
minutes of dental procedure. 52. The correct answer is C. AFP is the tumor
marker for hepatoma and yolk sac tumors,
50. The correct answer is A. Antitoxin vaccine is a and enolase is the marker for neuroblastoma.
form of passive immunity. There are two forms Answer A is incorrect. CEA is the tumor
of immunity when developing bacterial vac- marker for adenocarcinoma.
cines: active and passive. Both types of immu-
nity are meant to present some form of bacte- Answer B is incorrect. LSA is the tumor
ria, which elicits an immune response that marker for lymphoma.
confers protection from bacterial offense in the Answer D is incorrect. hCG is the tumor
future. marker for choriocarcinoma.
Answer B is incorrect. Immunity from Answer E is incorrect. Desmin is the tumor
cholera is provided via killed vaccine. marker for rhabdomyosarcoma.
Answer C is incorrect. Active immunity These common tumor markers can often
includes whole bacteria, capsular polysaccha- be analyzed in blood draws, thus leading the
rides, or toxoids. It includes live attenuated doctor to suspect certain regions of pathology
(TB, tularemia), killed (cholera, typhoid fever, to further investigate.
pertussis), toxoid (tetanus, diphtheria), capsu-
lar polysaccharide (pneumonia, meningitis— 53. The correct answer is A. Peptic ulcer disease
both of the bacterial form). is an erosion of the stomach (or duodenal) lin-
ing. It most often occurs in men 20-50 years
Answer D is incorrect. Antitoxin vaccine old, and duodenal (80%) or gastric (20%)
contains antibodies to bacterial exotoxins. ulceration is the complication. It is caused by
Answer E is incorrect. Passive immunity either bacterial infection (Helicobacter pylori)
includes preformed antibody preparations or due to an imbalance between acid and
which elicit immunity. It includes antitoxin mucosal protection. For example, NSAIDs
(tetanus, diphtheria, botulism). cause a decrease in mucosal protection which
leads to a decrease in prostaglandin produc-
51. The correct answer is B. Cellular dysplasia tion. Also, acid hypersecretion can cause
involves atypical cells that do not invade the ulceration. The main symptom is pain, with
basement membrane. bleeding complication (erosion into blood
vessels or ulcer bleeding), and perforation
Answers: 50-57 151
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(transmural ulceration → acute peritonitis; often lymph nodes lining the small intestine. It
duodenal ulcers). Malignant change is uncom- results in fluid retention.
mon. Treatment is based on the causative factor,
so antibiotics, antacid medications, or proton 55. The correct answer is B. Basal cell carcinoma
pump inhibitors are used to treat. is a benign condition.
Answer B is incorrect. Duodenal ulcers pre- Answer A is incorrect. Basal cell carcinoma
sent with the same symptoms as peptic ulcer is locally aggressive. It is also destructive and
disease. If left untreated, perforation is com- tends to ulcerate and bleed.
mon with this type of ulcer. Answer C is incorrect. Basal cell carcinoma
Answer C is incorrect. Gastroesophageal is the most common form of skin cancer.
reflux disease presents with heartburn, regur- Answer D is incorrect. Clinically, basal cell
gitation of food, hoarse voice, wheezing, and carcinoma presents as a pearly papule. More
coughing. than 90% occur on regions of the body most
Answer D is incorrect. Hiatal hernia presents exposed to sun (head and neck, upper face)
with heartburn, dysphagia, and belching. as a pearly papule with telangiectatic vessels.
Answer E is incorrect. Inflammatory bowel Answer E is incorrect. It is the most common
disease presents with abdominal pain and form of skin cancer in the United States and is
obstruction. Bloody diarrhea is also possible derived from the basal cells of the epidermis.
(occult/microscopic or gross).
56. The correct answer is B. Basal cell carci-
54. The correct answer is E. GERD is a chronic noma rarely metastasizes due to its benign
condition caused by acid reflux due to back- nature.
flow from the stomach into the esophagus. Answer A is incorrect. The stage of treatment
The most often complication is a weak lower is vital with basal cell carcinoma. The prog-

esophageal sphincter and risk factors include nosis is very good when found and treated
scleroderma and hiatal hernia. Symptoms early.
would be heartburn, food regurgitation,
hoarse voice, wheezing, and coughing. This Answer C is incorrect. Basal cell carcinoma
condition is treated by antacids and proton can be quite disfiguring, disabling, and
pump inhibitors. Left untreated, this chronic destructive when left untreated.
irritation of esophageal lining leads to Barrett Answer D is incorrect. Histologically, there
esophagus (which is premalignant). are clusters of darkly staining basaloid cells
Answer A is incorrect. Achalasia is caused by with a palisading arrangement of nuclei at the
nerve dysfunction. It is characterized by a periphery of the tumor cells.
decrease in propulsion of food down the Answer E is incorrect. Surgical excision is
esophagus. Hence, there is a decrease in the best treatment with radiation in lesions
peristalsis. which may have questionable margins after
Answer B is incorrect. Mallory-Weiss syn- excision.
drome is also caused by a weak LES, but is
not due to acid reflux (it is due to mucosal 57. The correct answer is C. From the given
lacerations from chronic vomiting). options and based on the clinical situation,
one would suspect the patient is suffering from
Answer C is incorrect. Hiatal hernia is caused an asthma attack. Asthma is a chronic reactive
by the protrusion of part of the stomach airway disorder which is caused by airway
through the diaphragm into the thoracic cavity. obstruction. Very few adults (3.5% over 30) are
Answer D is incorrect. Intestinal lymphang- affected by asthma. On the other hand, nearly
iectasia is caused by enlargement of the 50% of asthma cases occur in children less
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than 10 years old with a 2:1 male predilection. bronchitis. This is due to their barrel-chested,
The symptoms are dyspnea, expiratory wheezes, cyanotic appearance.
chest tightness, and cough. There are two types
of asthma (generally speaking): extrinsic (allergic/ 59. The correct answer is E. The aortic valve is
atopic/immune) and intrinsic (nonimmune, most often distorted in cases of aortic
idiosyncratic). dissection.
Answer A is incorrect. Chronic bronchitis is Answer A is incorrect. Rupture can cause
seen in patients with a history of smoking, in pericardial tamponade. Rupture can also lead
most cases. to hemomediastinum/hemothorax and dis-
tortion of the aortic valve.
Answer B is incorrect. Emphysema is seen in
patients with a history of smoking, in many Answer B is incorrect. The carotid artery
cases. may become occluded, leading to stroke.
Occlusion of branches of the aorta and their
Answer D is incorrect. Asbestosis is seen in
effects include carotid—stroke, coronary—
patients with a positive history of asbestos
myocardial infarct, splanchnic—organ infarc-
exposure.
tion, renal—acute renal failure.
Answer E is incorrect. Anthracosis presents
Answer C is incorrect. It can be life threaten-
in patients who have had years of exposure to
ing. This life-threatening condition is caused
carbon dust.
by blood dissecting the adventitial layer of the
Chronic bronchitis, emphysema, asbesto-
aorta from the intima.
sis, and anthracosis affect older adults and not
children. This is due to the fact that years and Answer D is incorrect. Blood “dissects”
years of pathological changes are necessary to between the intima and adventitia of the
cause illness to occur. aorta. Symptoms include a tearing chest pain
as well as blood pressure measurements
58. The correct answer is C. There is an which differ on one arm from the other.
increased Reid index seen in patients
afflicted with chronic bronchitis. The Reid 60. The correct answer is D. Preeclampsia is a
index measures the ratio of mucous gland form of secondary hypertension which is
thickness to bronchial wall thickness. pregnant women of at least 20 weeks gestation.
It is characterized by hypertension (> 140
Answer A is incorrect. Chronic bronchitis
systolic and > 90 diastolic), proteinuria, and
sufferers have mucous hypersecretion in the
edema. Predisposing conditions for it include
bronchi and smaller airways. This illness is
hypertension, diabetes, autoimmune diseases,
caused by a long history of cigarette smoking.
hyperuricemia, and thrombocytopenia. This
It is defined as at least 3 months of the year, for
can lead to eclampsia, which includes
2 years, of having a chronic productive cough.
episodes of seizures.
Answer B is incorrect. Clinically, there is
Answer A is incorrect. Malignant hyperten-
also wheezing and rhonchi/noisy chest on
sion is characterized by a sudden rapid
auscultation along with a productive, sputum-
increase in blood pressure without a precipi-
filled cough.
tating event (usually). It can be life threaten-
Answer D is incorrect. Patient stricken with ing. It’s most common in African Americans.
chronic bronchitis have an increased PO2.
Answer B is incorrect. Aortic aneurysm is
Complications include pulmonary hyperten-
characterized by abnormal, localized dilation
sion and increased risk of lung cancer.
of the aorta. It is caused by atherosclerosis,
Answer E is incorrect. “Blue bloaters” is the cystic medial necrosis, infection aortitis, and
term used to describe patients with chronic vasculitis. Rupture is a major risk.
Answers: 58-64 153
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Answer C is incorrect. Primary hypertension endocarditis cases. However, it is usually sec-

is characterized by an increase in blood pres- ondary to systemic infection or intravenous
sure. There is no identifiable cause. It is, drug use.
though, related to increase in cardiac output
Answer D is incorrect. Streptococcus sanguis
and total peripheral resistance.
is not greatly implicated in endocarditis.
Answer E is incorrect. Cardiac tamponade
Answer E is incorrect. Streptococcus mutans
is characterized by an extrinsic compres-
is not greatly implicated in endocarditis.
sion of the heart, typically from fluid. Car-
diac compression ensures with decreased 63. The correct answer is A. The Libman-Sacks
venous return, decreased cardiac output, form of endocarditis occurs in systemic lupus
and death. erythematous. The mitral valve is most often
implicated, and small vegetation form on the
61. The correct answer is D. Hypoaldosteronism
leaflet.
does not lead to secondary hypertension. Sec-
ondary hypertension is hypertension of Answer B is incorrect. Dental seeding and
known causes (5%-10% of all hypertensive intravenous drug use cause the infective
cases). It is often correctable. It is caused by, form.
most commonly, renal disease (RAS system— Typically, infective form is usually caused
leads to renal parenchymal diseases or renal by an intrinsic bacteremia from the oral cav-
artery stenosis). ity, upper respiratory tract, urologic tract,
lower gastrointestinal tract, and also intra-
Answer A is incorrect. Cushing syndrome
venous drug use and introduced/extrinsic
can contribute to secondary hypertension.
bacteria.
This is due to increased sensitivity to cate-
cholamines, increased angiotensinogen, and Answer C is incorrect. The mitral valve is
increased aldosterone receptors. most often affected in the Libman-Sacks

form. The tricuspid valve is also often
Answer B is incorrect. Diabetes may con-
affected with this form of endocarditis, espe-
tribute to secondary hypertension. This is due
cially in intravenous drug users.
to vascular insult from not controlling the
disease. Answer D is incorrect. The rheumatic form
occurs in areas of greatest hemodynamic
Answer C is incorrect. Pheochromocytoma
stress. The mitral valve is often involved and
may contribute to secondary hypertension.
calcification (stenosis, insufficiency, or both)
This is due to increased catecholamine
occurs.
production.
Answer E is incorrect. The mitral valve is
Answer E is incorrect. Hyperthyroidism may
most often affected in rheumatic form.
contribute to secondary hypertension. This is
due to an increase in the body’s metabolic rate. 64. The correct answer is D. Hydropericardium
is the accumulation of serous fluid within the
62. The correct answer is A. Streptococcus viri-
pericardial space. Pleural effusion is the gen-
dans is known to cause subacute bacterial
eral term for any fluid accumulation in the
endocarditis in more than 50% of all cases. It
pericardial space and can lead to cardiac tam-
is seen in patients with preexisting cardiac
ponade (which can be fatal).
valvular damage and is caused by an oral
source. Answer A is incorrect. Hemopericardium
is the accumulation of blood in the
Answer B is incorrect. Staphylococcus epider-
pericardium.
midis is not greatly implicated in endocarditis.
Answer B is incorrect. Acute pericarditis is
Answer C is incorrect. Staphylococcus aureus
the inflammation of the pericardium.
infections cause approximately 50% of acute
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Answer C is incorrect. Constrictive peri- They are comprised of proteins, polysaccha-

carditis is a chronic pathology involving rides, lipoproteins, and nucleoproteins.
thickening and scarring of the pericardium.
67. The correct answer is C. Macrophages pre-
Answer E is incorrect. Myocarditis is the
sent antigen via class II MHC.
inflammation of cardiac tissue.
Answer A is incorrect. Macrophages are
65. The correct answer is B. Splinter hemorrhag- derived from bone marrow histiocytes, exist
ing is seen in patients afflicted with endo- in plasma as monocytes and in tissue as
carditis. This illness is an inflammation of the macrophages.
endocardium and/or heart valves which can
Answer B is incorrect. Other than phagocy-
develop quickly (acute) or slowly (subacute).
tose, macrophages also present antigen via
The symptoms include fever, nonspecific con-
class II MHC and produce cytokines.
stitutional symptoms, malaise, headache, and
night sweats. Upon further exam, you would Answer D is incorrect. Macrophages are a
expect to find heart murmur, which is sec- form of agranular leukocytes which function
ondary to vegetations, splenomegaly, and to phagocytose materials.
splinter hemorrhages. Answer E is incorrect. Macrophages can be
Answer A is incorrect. Cardiac tamponade activated by numerous components, includ-
shows symptoms of distended neck veins, ing bacterial lipopolysaccharide, peptidoglycan,
hypotension, decreased heart sounds, tachyp- DNA, and interferon gamma.
nea, and weak or absent peripheral pulse.
68. The correct answer is A. Eosinophils are gran-
Answer C is incorrect. Primary hypertension ular leukocytes which defend against parasitic
typically does not have any clinically identifi- infection. Other functions include phagocyto-
able symptoms. sis and binding of IgG or IgE (when antigen-
Answer D is incorrect. Coronary artery dis- bound), thus mediating hypersensitivity reac-
ease shows symptoms of angina. This is the tions. They do not present antigen to T cells.
classical symptom. Answer B is incorrect. Basophils mediate
Answer E is incorrect. Angina shows symp- hypersensitivity reactions.
toms of squeezing substernal chest discomfort. Answer C is incorrect. Mast cells mediate
It may radiate to the left arm, jaw, shoulder hypersensitivity reactions.
blade, and neck.
Answer D is incorrect. PMNs produce
66. The correct answer is B. Haptens are anti- cytokines and function in phagocytosis.
gens that must bind to a carrier protein to Answer E is incorrect. Dendritic cells pre-
elicit an immune response. sent antigen to other cells.
Answer A is incorrect. Most antigens are pro-
teins. Antigens are considered molecules that 69. The correct answer is E. PMNs do not pre-
react with antibody to induce an immune sent antigen; their main function is phagocy-
response. tosis of materials, as well as to produce
cytokine.
Answer C is incorrect. Adjuvants, related to
antigenicity, are molecules that enhance the Answer A is incorrect. Monocytes function
immune response to an antigen. as antigen presenting cells.
Answer D is incorrect. The binding site for Answer B is incorrect. B cells function as
on antigen is an epitope. antigen presenting cells.
Answer E is incorrect. Antigens induce an Answer C is incorrect. Macrophages can
immune response by binding to antibody. function as antigen presenting cells.
Answers: 65-74 155
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Answer D is incorrect. Langerhans cells Answer E is incorrect. Ataxia telangiectasia is

function as antigen presenting cells. They are seen in patients with defective B-cell function.
the major dendritic cells of the oral gingival
epithelium, 72. The correct answer is A. DiGeorge syn-
These cells present antigen throughout the drome causes a decrease in blood calcium
body via their MHC II proteins. The presen- levels. The parathyroid gland is also patholog-
tation is made to CD4 T cells. ical, thus decreased PTH which causes this
hypocalcemia.
70. The correct answer is E. DiGeorge syndrome
Answer B is incorrect. Thymic hypoplasia is
is due to defective development of the 3rd and
seen with these patients. This causes a T-cell
4th pharyngeal arches. Thus, patients will pre-
defect.
sent with deformity of the ear and lip, as well as
cardiac malformation (more specifically, that of Answer C is incorrect. Microdeletion of
the aortic arch). Also, patients will have defec- chromosome 22 causes this syndrome.
tive immune defense due to thymic hypoplasia. Answer D is incorrect. Palatal clefting is a clin-
Their parathyroids are also impaired. ical presentation with these patients leading to
Answer A is incorrect. Common variable hypocalcemia. These patients are more suscep-
immunodeficiency affects B-cell maturation tible to viral and fungal infections, as well as a
into plasma cells. decrease in type IV hypersensitivity reactions.
Note that cardiac abnormalities and abnor-
Answer B is incorrect. Wiskott-Aldrich syn-
mal facies are also common clinical symp-
drome is a combined B- and T-cell pathology
toms with these patients.
which is caused by defective IgM response to
bacterial LPS. 73. The correct answer is C. A type IV hypersen-
Answer C is incorrect. SCID (severe com- sitivity reaction involves the binding of a class
bined immunodeficiency) is a defect in stem- II MHC to a TCR. It also involves the pre-

cell differentiation that causes a lack of lym- sentation of antigen by macrophage to T
phoid tissue. cells, thus producing tissue destruction. This
damage to tissue is mediated by lymphokines.
Answer D is incorrect. Bruton is caused by
Malfunction of T cells will alter the effective-
pre-B cells not differentiating into mature B
ness of this hypersensitivity reaction.
cells.
Answer A is incorrect. This type of reaction
71. The correct answer is D. Job syndrome is a (type IV) is mediated by T cells.
disease characterized by pathological T cells.
Answer B is incorrect. A type IV hypersensi-
In this syndrome, T-helper cells are not pro-
tivity reaction is not immediate. This is due
ducing interferon-gamma. Thus, there are
to the fact that it is cell mediated.
increased bacterial infections due to poor
PMN chemotaxis. There is also an increase Answer D is incorrect. Hemolytic anemia is an
in IgE levels. Staphylococcus aureus is a com- example of a type II hypersensitivity reaction.
mon infection seen with this disease. Answer E is incorrect. Atopic allergy is an
Answer A is incorrect. Bruton X-linked example of a type I hypersensitivity reaction.
agammaglobulinemia is seen in patients with Examples of diseases associated with this
defective B cell function. reaction include contact dermatitis, tuber-
culin testing (PPD), tuberculosis, sarcoidosis,
Answer B is incorrect. Wiskott-Aldrich syn-
and leprosy.
drome has a combined B- and T-cell pathology.
Answer C is incorrect. Isolated IgA deficiency 74. The correct answer is B. An allograft
is seen in patients with defective B-cell involves the transplantation of tissue between
function. two genetically different individuals within
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the same species. Transplantation is a com- Answer D is incorrect. IgA is not the main
plicated process by which means immuno- antimicrobial defense in the primary
suppression is often necessary to suppress immunological response.
and allow the immune system to accept a IgA is the 2nd most abundant antibody in
graft. humans (1st is IgG) and is comprised of two
subunits. The other antibodies are secreted
Answer A is incorrect. A xenograft is trans-
by either B cells (IgM-monomer, IgD), mast
plantation of tissue between two different
cells, basophils and eosinophils (IgE), or
species.
plasma (IgM-pentamer, IgG).
Answer C is incorrect. An autograft is graft-
ing between different sites within the same 77. The correct answer is A. Antibody can acti-
individual. vate complement via the classical pathway,
not alternate. It is a Y-shaped glycoprotein
Answer D is incorrect. An isograft is trans-
that is secreted by plasma cells. It is com-
plantation of tissue between two genetically
prised of two identical light chains and two
identical individuals of the same species.
identical heavy chains held together by disul-
75. The correct answer is B. IgG can readily fide bonds.
cross the placental barrier and function in Answer B is incorrect. The Fab regions of
passive immunity. IgG is the most abundant the heavy and light chains are considered
antibody in humans and is located within the variable, specific for binding antigen, and
plasma. It is the main antimicrobial defense determine idiotype.
of the secondary response, and it opsonizes
Answer C is incorrect. The Fc regions of the
bacteria, activates complement, and neutral-
heavy chains are considered constant and
izes bacterial toxins and viruses. It also has
determine the isotype.
four subclasses.
Answer D is incorrect. The constant regions
Answer A is incorrect. IgA cannot cross the

of antibody bind APC (antigen presenting
placental barrier.
cells) or C3b (of the complement cascade).
Answer C is incorrect. IgD cannot cross the
Answer E is incorrect. The variable regions
placental barrier.
of antibody bind specific antigen.
Answer D is incorrect. IgE cannot cross the
placental barrier. It functions to mediate type 78. The correct answer is E. Trisomy 18 is seen
I hypersensitivity reactions. in Edward syndrome. This syndrome is char-
acterized by mental retardation, small head,
Answer E is incorrect. IgM cannot cross the
micrognathia, pinched facial appearance,
placental barrier.
and malformed ears (amongst other systemic
76. The correct answer is E. IgA acts to prevent findings). The prognosis for these patients is
mucosal membrane attachment of microbes. grim, surviving only months.
Answer A is incorrect. IgA does not mediate Answer A is incorrect. Patau syndrome is
type I hypersensitivity reactions. It does not defined as trisomy 13 and is characterized by
have a major function in any hypersensitivity mental retardation, microcephaly, microph-
reactions. thalmia, cleft lip and palate, and brain
abnormalities with a life expectancy of less
Answer B is incorrect. IgA does not activate than 1 year.
complement.
Answer B is incorrect. Klinefelter syndrome
Answer C is incorrect. Its response is not is defined as having XXY chromosomal
uncertain. IgA is secreted in an exocrine abnormality.
manner from glands.
Answers: 75-83 157
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Answer C is incorrect. Down syndrome is tri- brane regulator which controls Cl− and Na+
somy 21 with the characteristics of retarda- transport across epithelial membranes. CF is
tion, epicanthal folds, large protruding the most common fatal genetic disease in Cau-
tongue, small head with low-set ears, simian casian children. The life expectancy is 28 years.
crease, and a broad flat fact.
Answer A is incorrect. Chloride transporters
Answer D is incorrect. Turner syndrome malfunction due to an error with chromosome
patients have a XO chromosomal arrangement. 7q. Sodium channels are affected, especially
mucous and sweat glands.
79. The correct answer is E. Influenza is not
found to be teratogenic. Answer B is incorrect. Meconium ileus is a
common clinical symptom with these patients.
Answers A, B, C, and D are incorrect. It is characterized by intestinal obstruction.
Cytomegalovirus, rubella, toxoplasmosis and
herpes simplex virus are known teratogens. Answer D is incorrect. Pancreatic exocrine
These agents can all be passed on from the insufficiency is a common clinical symptom
mother to the fetus during pregnancy. This is with these patients.
known as the TORCH complex. The acronym Answer E is incorrect. Bronchiectasis is a
stands for toxoplasmosis, other agents, rubella, common clinical symptom with these
Cytomegalovirus, herpes simplex virus. Ter- patients. This is due to thick mucous obstruc-
atogens can cause death, growth retardation, tion and leads to lung infection.
malformation, and functional impairment to
the fetus. The mechanism of such is specific to 82. The correct answer is E. Vitiligo is character-
each teratogen, and susceptibility of the fetus ized by hypopigmentation due to an acquired
to the offending agent depends on such factors loss of melanocytes. The other diseases are all
as the developmental stage and dose. of the hyperpigmentation variety.
Answer A is incorrect. Neurofibromatosis

80. The correct answer is C. Impetigo is caused
by Staphylococcus aureus or Streptococcus (type 1) is the most frequent neurocutaneous
pyogenes infection. syndrome.
Answer A is incorrect. Impetigo is a highly Answer B is incorrect. Tuberous sclerosis

contagious disease. It is the ooze which is presents clinically with café au lait spots.
contagious. Answer C is incorrect. Fanconi anemia pre-
Answer B is incorrect. This is a common sents clinically with café au lait spots.
skin infection in preschool age children, typi- Answer D is incorrect. McCune-Albright
cally in warm weather. syndrome presents clinically with café au lait
Answer D is incorrect. This infection is very spots.
superficial. Clinically, it presents as a sore, Café au lait spots are due to an increase in
which progresses to a blister that breaks and melanin content with giant melanosomes.
oozes. Acute glomerulonephritis can occur
83. The correct answer is A. A mural thrombus
occasionally in Streptococcus infection if left
typically forms after an MI or atrial fibrilla-
untreated.
tion. This type of thrombus is from the endo-
Answer E is incorrect. The cure rate is cardial surface and protrudes into the lumen
extremely high with little scarring. Treatment of the heart or large vessel. It is caused by MI,
is topical antimicrobial or oral antibiotic. a-fib, or aortic atherosclerosis.
81. The correct answer is C. Cystic fibrosis patients Answer B is incorrect. Agonal thrombi are
have an error with chromosome 7q. This chro- intracardiac and caused by prolonged heart
mosome encodes the cystic fibrosis transmem- failure.
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Answer C is incorrect. Red thrombi are Note that Hypovolemic shock is caused
mostly composed of RBCs and caused by due to decreased blood volume (eg, hemor-
their accumulation. rhage), cardiogenic shock is caused by pump
failure and sudden decrease in cardiac output
Answer D is incorrect. White thrombi are
(eg, massive MI).
mostly comprised of platelets and caused by
their accumulation.
86. The correct answer is C. Caisson disease is
Answer E is incorrect. Fibrin thrombi are caused by air gaining entry into the circula-
mostly composed of fibrin and caused by tory system. The result of this is an air
their accumulation. embolism.
Answer A is incorrect. A solid mass occlud-
84. The correct answer is D. Metabolic acidosis is
ing a vessel would not be seen here. This
a characteristic of the progressive stage of shock.
could be caused by a thromboemboli or
Answer A is incorrect. The nonprogressive/ tumor embolism.
early stage of shock is considered to be com-
Answer B is incorrect. Fatty emboli are not
pensated. This means that the body can over-
seen in Caisson disease. Fat embolism is
come the changes it incurs.
commonly seen with long bone fractures.
Answer B is incorrect. The body is still main-
Answer D is incorrect. Blood clots are not
taining perfusion to vital organs in the non-
seen in this disease. This could be caused
progressive/early stage of shock.
by a thromboemboli (most common type;
Answer C is incorrect. There is increased because of blood clot).
total peripheral resistance to organs in the
Answer E is incorrect. Emboli caused by
nonprogressive/early stage of shock.
amniotic fluid are not seen in Caisson dis-
Answer E is incorrect. There is an increase ease. This amniotic fluid embolism is seen at
in sympathetic nervous output in the nonpro- time of delivery and can activate DIC.
gressive/early stage of shock. Emboli are some type of intravascular mass
The other two stages of shock are progres- such as solid, liquid, and gas. They travel
sive (decreased cardiac perfusion, cardiac within a blood vessel and may lodge at a dis-
depression, decreased cardiac output, meta- tant site, thus occluding flow and possibly
bolic acidosis, no longer compensated), and leading to infarction.
irreversible (organ damage, decrease in high-
energy phosphate reserves, death). 87. The correct answer is B. Chronic passive
congestion of the liver is caused more directly
85. The correct answer is A. Septic shock can by right-sided heart failure. The passive form
cause systemic vasodilation. can further be broken down into acute (shock
Answer B is incorrect. This form of shock or right-sided heart failure) and chronic (lung
occurs due to bacteria with subsequent endo- congestion).
toxin release. Answer A is incorrect. Active hyperemia is
Answer C is incorrect. Septic shock is caused caused by increased arteriolar dilation. It
by infection of gram-negative bacteria. leads to inflammation.
Answer D is incorrect. Neurogenic shock is Answer C is incorrect. Passive hyperemia is

caused by CNS injury. caused by decreased venous return. It leads to
obstruction.
Answer E is incorrect. Anaphylactic shock is
caused by type I hypersensitivity, histamine Answer D is incorrect. Inflammation and
release, and vasodilation (eg, allergy). blushing is a clinical finding of active
hyperemia.
Answers: 84-92 159
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Answer E is incorrect. Obstruction and Answer E is incorrect. In primary poly-

increased back pressure is a clinical finding cythemia, erythropoietin levels are decreased.
of chronic hyperemia.
Hyperemia, which is another term for 90. The correct answer is B. This patient most
congestion, is due to an increased volume of likely has type II diabetes mellitus. The symp-
blood in local capillaries and small vessels. toms of this disease include polyuria, polydip-
sia, polyphagia, blurred vision, paresthesias,
88. The correct answer is C. A deficiency of vita- and weakness. It is typically a disease associ-
min B12 will cause pernicious anemia. This is ated with increased age/adulthood in obese
an autoimmune disorder in which intrinsic peoples. Insulin production may or may not
factor fails to form. There are anti-intrinsic fac- be normal, rather there is insulin resistance
tor and anti–parietal cell antibodies. Thus, with receptors. The genetic predisposition is
without intrinsic factor, no B12 may be strong. Treatment includes diet, weight loss,
absorbed. Achlorhydria is also seen with this and oral hypoglycemic drugs.
illness. Pernicious anemia is also characterized
Answer A is incorrect. Hyperthyroidism pre-
by macrocytic red blood cells, and abnormal
sents clinically with symptoms of irritability,
Schilling test, hypersegmented neutrophils,
weight loss, tremor, diarrhea, and sweating.
lemon-yellow skin, stomatitis, glossitis, and
subacute degeneration of the spinal cord. Answer C is incorrect. Hypothyroidism pre-
sents clinically with symptoms of mental
Answer A is incorrect. Aplastic anemia is due
slowing, cold intolerance, weight gain, consti-
to decreased production of RBCs.
pation, and dry skin.
Answer B is incorrect. Sickle cell anemia is
Answer D is incorrect. Addison disease presents
from abnormal Hb-S.
clinically with symptoms of weakness, fatigue,
Answer D is incorrect. Plummer-Vinson syn- depression, hypotension, and skin bronzing.
drome is anemia due to iron deficiency (with

Answer E is incorrect. Type I diabetes pre-
esophageal webbing).
sents clinically with symptoms of polyuria,
Answer E is incorrect. Folate deficiency ane- polydipsia, polyphagia, paresthesias, weakness,
mia is caused by a lack of dietary folate. and blurred vision.
89. The correct answer is C. Polycythemia is a 91. The correct answer is A. Kidney tubules are
general term for an increase in RBCs. Rela- not sensitized to ADH in patients with
tive polycythemia is decreased plasma volume nephrogenic diabetes insipidus.
causing increased concentration of RBCs. It is
Answer B is incorrect. It has a genetic com-
known as Gaisböck syndrome.
ponent, as it is sex linked and it affects men.
Answer A is incorrect. True polycythemia is
Answer C is incorrect. In nephrogenic dia-
increased RBC mass and increased total
betes insipidus, ADH production and secre-
blood volume.
tion is normal, but there is resistance of ADH
Answer B is incorrect. Primary poly- receptors.
cythemia, known as polycythemia vera, is a
Answer D is incorrect. The result of desensi-
genetic, myeloproliferative disease. It is char-
tization to ADH receptors is a large volume
acterized by decreased sensitivity of myeloid
of dilute urine.
precursors to erythropoietin.
Answer E is incorrect. Nephrogenic diabetes
Answer D is incorrect. Secondary poly-
insipidus can be caused by patients taking
cythemia is increased RBCs due to conditions
Lithium, as well as other medications.
other than polycythemia vera. These include
renal disease, chronic hypoxia, tumors, andro- 92. The correct answer is A. The symptoms
gen therapy, and Bartter syndrome. experienced with both type I and II diabetes
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mellitus are the same. In each case, patients 94. The correct answer is B. Ketoacidosis is rare
experience the 3 Ps (polyuria, polyphagia, in type II diabetes, but a very common con-
polydipsia), as well as blurred vision, pares- cern in type I diabetics.
thesias, weakness, and fatigue.
Answer A is incorrect. This reaction occurs in
Answer B is incorrect. The cause is different cases of severe insulin deficiency or starvation.
in type I and II diabetes. Type I diabetes is
Answer C is incorrect. Ketoacidosis is caused
due to a lack of insulin production, whereas
by an accumulation of ketone bodies which
in type II diabetes there is a desensitization of
are synthesized from free fatty acids.
insulin receptors.
Answer D is incorrect. Blood ketones consist of
Answer C is incorrect. There is a genetic
acetoacetic acid and beta-hydroxybutyric acid.
predisposition in both type I and II diabetes.
There is a much stronger genetic component Answer E is incorrect. In advanced cases of
to type II diabetes. type II diabetes, ketoacidosis may become a
concern. It can be life threatening when left
Answer D is incorrect. The treatment differs
untreated.
between the two types of diabetes. Type I dia-
betes is treated with mainly insulin injec- 95. The correct answer is D. The normal range
tions, whereas type II diabetes is mainly diet of glycosylated hemoglobin is from 4%-7%.
controlled.
Answer A is incorrect. HbA1c is used to
Answer E is incorrect. The age of onset for assess long-term control of diabetics, not the
type I and II diabetes is not the same. Type I short term.
diabetes is a disease which has an early age of
onset. Type II diabetes occurs in the later Answer B is incorrect. Glycosylated hemo-
stages of life. globin, also known as HbA1c, is formed from
The incidence of type I diabetes is far less the irreversible glycosylation of hemoglobin.
(only 15% of diabetics have this form) than type Answer C is incorrect. This value reflects
II. Insulin production is nearly nonexistent, and glucose levels over the past 2-3 months.
it is caused by either a viral or immune destruc-
tion of B cells. It has a weak genetic predisposi- Answer E is incorrect. The reaction is a
tion. Ketoacidosis is a real concern with this nonenzymatic glycosylation.
type of diabetes (unlike type II). The treatment Note that HbA1c is a form of an advanced
is insulin injection and diet control. glycosylated end product (other products
formed from glycosylation are Schiff bases and
93. The correct answer is C. Hyperglycemia is Amadori products → both are reversible). Levels
characterized by a blood glucose level greater greater than 7% would lead one to believe that a
than 125 mg/dL. Other values of importance patient is poorly controlling their diabetes.
include hypoglycemia (blood glucose level
less than 50 mg/dL), glycosuria (blood glu- 96. The correct answer is C. Bence-Jones proteins
cose levels greater than 160-180 mg/dL), and are found in patients with multiple myeloma.
normal range (blood glucose in range of This finding is sensitive, but not specific.
70-110 mg/dL). These values can be ascer- Therefore, it can confirm the diagnosis of mul-
tained by evaluating plasma glucose levels tiple myeloma, but the absence of the protein
with either overnight fasting, 72-hour fasting, cannot rule it out. Multiple myeloma is a can-
or oral glucose tolerance tests. cer of plasma cells, and it arises in the bone
marrow. There is an increase in plasma cells
Answers A, B, D, and E are incorrect. These which interferes with other bone marrow cell
values are too low to be characterized as lineages. Also, patients tend to have osteolytic
hyperglycemia. lesions due to the plasma cell proliferation and
expansion in the bone marrow.
Answers: 92-100 161
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Answer A is incorrect. Non-Hodgkin lym- amyloid may be local, generalized, or sys-

phoma would have symptoms similar to temic. If the amyloid deposits in islet cells, it
Hodgkin, but an absence of Reed-Sternberg can cause type II diabetes mellitus by damag-
cells. ing receptors. Amyloid can be seen with
Congo red stain.
Answer B is incorrect. Burkitt lymphoma has
a chromosomal change located at t(8;14). Answers B, C, D and E are incorrect.
Pheochromocytoma, small cell carcinoma,
Answer D is incorrect. Patients with CML
neuroblastoma, and rheumatoid arthritis do
(chronic myelogenous leukemia) have the
not lead to development of diabetes.
Philadelphia chromosome, which can be
seen in genetic testing.
99. The correct answer is B. The mandible, not
Answer E is incorrect. Patients with AML the maxilla, is the most commonly affected
(acute myelogenous leukemia) have a rapid region from an eosinophilic granuloma.
increase in myelocytes. This can be noted on
Answer A is incorrect. This condition is
laboratory exam.
mostly benign and affects males in the early
3rd decade of life.
97. The correct answer is A. One would find a
decrease in the platelet count in cases of mul- Answer C is incorrect. Intraorally, mobile
tiple myeloma. This causes difficulty with teeth and periodontal inflammation is present.
blood clotting.
Answer D is incorrect. Clinically, one would
Answer B is incorrect. Patients with multiple find an asymptomatic patient with possibly some
myeloma have a decreased white blood cell localized pain. There would be swelling of the
count. Thus, they are susceptible to increased mouth, with the mandible being most affected.
infections.
Answer E is incorrect. It is a histiocytosis X
Answer C is incorrect. Patients with multiple disease. Therefore, it involves increased

myeloma have a decreased red blood cell abnormal histiocytes.
count. Thus, they typically have anemia.
100. The correct answer is C. Haberman disease
Answer D is incorrect. Patients with multiple
is not one of the Histiocytosis X diseases.
myeloma have an increased plasma cell
Rather, it is a skin condition characterized by
count. Thus, plasma cells are functioning
eruption of polymorphous skin macules,
abnormally which leads to increased infec-
papules, and hemorrhaging vesicles. It does
tion rate.
not involve histiocytes. The diseases of histio-
Answer E is incorrect. Patients with multiple cytosis X all include an increase in abnormal
myeloma have an increase in osteolytic histiocytes.
lesions. This is due to increased osteoclastic
Answer A is incorrect. Letterer-Siwe disease
function.
presents clinically with a rash, fever, ane-
mia, hemorrhage, splenomegaly, and lymph-
98. The correct answer is A. Amyloidosis can
adenopathy.
lead to development of type II diabetes melli-
tus. This is a rare chronic disease affecting Answer B is incorrect. Hand-Schüller-
middle-aged and older people. It is due to Christian disease has the clinical presentation
accumulation of amyloid (which is abnormal of exophthalmos, diabetes insipidus, bone
fibrillar scleroprotein). These deposit in vari- destruction, and some intraoral pathology.
ous organs and tissues of the body, and even-
Answer D is incorrect. Eosinophilic granu-
tually compromise such normal function.
loma causes clinical symptoms consistent
These disease states may be inflammatory,
with asymptomatic swelling of mandible and
hereditary, or neoplastic. The deposition of
intraoral regions.
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Note that the treatment for Histiocytosis X antibody, “universal donor”). If blood types
is radiation and/or chemotherapy, and typi- are mismatched, hemagglutination occurs.
cally the prognosis is poor.
103. The correct answer is B. Hemagglutination
101. The correct answer is B. The hyperacute would occur when blood type AB is given to
phase of tissue graft rejection is most directly a patient with anti-A plasma antibody. This
mediated by preformed antibody to graft concept deals with a reaction which occurs
antigen. This occurs within minutes after between a mismatch of donor and recipient
transplantation. blood.
Answer A is incorrect. T cells attacking for- Answer A is incorrect. Blood type A can be
eign class I MHC occurs during the acute given to a patient with anti-B plasma anti-
phase of graft rejection. This occurs over bodies. This recipient cannot receive blood
weeks after transplantation. type B.
Answer C is incorrect. The chronic phase Answer C is incorrect. Blood type B can be
occurs months to years after transplantation, given to a patient with anti-A plasma antibod-
and is characterized by antibody-mediated ies. This recipient cannot receive blood type A.
necrosis of graft vasculature.
Answer D is incorrect. Blood with erythro-
Answer D is incorrect. T cells attacking for- cyte antigen A can be given to a patient with
eign class II MHC occurs during the acute anti-B plasma antibodies. This recipient cannot
phase of graft rejection. receive blood type B.
Answer E is incorrect. PMN attack of graft Answer E is incorrect. Blood with erythro-
antigen does not occur during the acute cyte antigen B can be given to a patient with
phase of graft rejection. anti-A plasma antibodies. This recipient cannot
receive blood type A.
102. The correct answer is E. Patients with blood Note that if a patient whose plasma con-
type AB are considered the universal tains antibodies to, for example, erythrocyte
recipients. antigen A (patient would be blood type B),
Answer A is incorrect. Anti-B antibody is they cannot be transfused with blood type A
found in patients which are blood type A. (which has erythrocytes containing antigen
A). If this occurs, hemagglutination, which is
Answer B is incorrect. Blood type O has nei- a clumping of blood cells because of an
ther A nor B antigens on red blood cells. antibody-antigen reaction, will cause rejection
Answer C is incorrect. Patients with erythro- of the transfusion.
cyte antigen A have anti-B plasma antibody.
104. The correct answer is C. Cyanide poisoning
Answer D is incorrect. Both plasma anti- causes malfunction of oxidative phosphoryla-
body A and B are seen in patients with blood tion. Thus, patients suffering from cyanide
type O. intoxication cannot optimally produce ATP
Note that ABO blood typing deals with within mitochondrion. Death will ensue
the alloantigens located on all erythrocytes. because of this.
There are only two genes involved in this (A
and B), with four possible antigenic combi- Answer A is incorrect. Lead poisoning causes
nations of blood types: A (contain erythro- stippling of RBCs. This causes a decrease in
cyte A antigen, patients have anti-B plasma oxygen-carrying capacity.
antibody), B (B antigen, anti-A plasma anti- Answer B is incorrect. Carbon monoxide poi-
body), AB (both A and B antigen, no plasma soning will cause hypoxia due to decreased
antibody, “universal recipient”), O (no ery- oxygen binding.
throcyte antigens, have anti-A and -B plasma
Answers: 101-109 163
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Answer D is incorrect. Mercury poisoning are two types of cellular injury, irreversible
causes renal tubular necrosis as well as pneu- and reversible. These changes occur to cells
monitis, GI ulceration, and gingival lesions. based mainly on the severity and duration of
insult. It also depends on the cells’ own adap-
105. The correct answer is E. Alkaline phos- tive mechanism to the offending agent.
phatase is elevated in the body of patients
Answer B is incorrect. Ribosomal detach-
who are suffering from bone, liver, and skele-
ment from endoplasmic reticulum is an
tal abnormalities, to name a few.
example of reversible cell injury.
Answer A is incorrect. CK-MB is a cardiac
Answer C is incorrect. Chromatin clumping
enzyme. It is found elevated in a patient which
is an example of reversible cell injury.
just experienced a myocardial infarction.
Answer D is incorrect. Cellular and
Answer B is incorrect. Troponin T is a car-
organelle swelling is an example of reversible
diac enzyme. It is found elevated in a patient
cell injury. This is due to a Ca2+ influx which
who just experienced a myocardial infarction.
ultimately reverses itself.
Answer C is incorrect. Myoglobin is a car-
Answer E is incorrect. Bleb formation is an
diac enzyme. It is found elevated in a patient
example of reversible cell injury.
who just experienced a myocardial infarction.
Note that another example of reversible
Answer D is incorrect. Creatine phosphoki- cell injury includes increased lipid deposi-
nase is a cardiac enzyme. It is also found in tion. Irreversible cell injury includes: exten-
the brain and skeletal muscle. It is found ele- sive plasma membrane damage, massive Ca2+
vated in a patient who just experienced a influx, diminished oxidative phosphorylation
myocardial infarction. within mitochondrion, lysosomal enzyme
release into cytoplasm, nuclear fragmentation
106. The correct answer is E. All of the answer (karyorrhexis), and cell death.

choices listed in the question can lead to
tissue hypoxia. Tissue hypoxia results from 108. The correct answer is B. Hypertrophy is a
decreased oxygen being delivered to tissue. term describing an increase in cell mass, not
Answer A is incorrect. Carbon monoxide in number of cells.
poisoning can lead to tissue hypoxia. This is Answer A is incorrect. Aplasia describes the
due to hemoglobin’s increased affinity for complete lack of cells.
CO compared to O2.
Answer C is incorrect. Metaplasia is a term
Answer B is incorrect. Decreased tissue per- which describes cellular change from one
fusion can lead to tissue hypoxia. An example type to another cell type. It is a morphological
of this is seen in shock and cardiac failure. change.
Answer C is incorrect. Decreased blood oxy- Answer D is incorrect. Atrophy describes a
genation can lead to tissue hypoxia. An example decrease in cellular mass.
of this is seen in anemia, and pulmonary disease.
Answer E is incorrect. Hypoplasia is a term
Answer D is incorrect. Vascular ischemia which describes the decrease in the number
can lead to tissue hypoxia. This is due to a of cells.
decrease in blood flow, thus decreased oxy- Note that these changes can occur in specific
genation of tissue. tissue and organs and can be caused by such
Note that tissue hypoxia affects the heart, conditions as decreased neurovascular supply,
brain, and lungs most severely. nutrition, endocrine dysfunction, and stress.
107. The correct answer is A. Karyorrhexis is a 109. The correct answer is B. Taenia solium is a
type of cell injury which is irreversible. There helminth which is transmitted by ingestion of
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undercooked pork. It causes cysticercosis. mised patients. The other protozoa listed in
Helminths (also known as metazoans) are the question have other routes of transfer.
associated with numerous forms of human
Answer A is incorrect. Cryptosporidium
infection.
parvum is transmitted via fecal-oral route and
Answer A is incorrect. Taenia saginata causes giardiasis.
causes tapeworm infection. It can be trans-
Answer C is incorrect. Entamoeba histolytica
mitted from undercooked beef. It does not
causes amebiasis and dysentery by the fecal-
cause cysticercosis.
oral route.
Answer C is incorrect. Trichinella spiralis
Answer D is incorrect. Toxoplasma gondii is
causes trichinosis. It can be transmitted from
transmitted not only via fecal-oral route, but
ingestion of undercooked meat. It causes
also transplacental, and causes toxoplasmosis
muscle pain, periorbital edema, fever, and
which is a CNS infection.
eosinophilia.
Answer E is incorrect. Trichomonas vaginalis
Answer D is incorrect. Enterobius vermicu-
is transmitted sexually and causes trichomo-
laris causes pinworm infection. It is transmit-
niasis, vaginitis, and urethritis.
ted from ingestion of worm eggs. It causes
perianal pruritus. 112. The correct answer is A. Clotrimazole is an
Answer E is incorrect. Giardia lamblia antifungal agent, which inhibits ergosterol
causes giardiasis, a parasitic infection of the synthesis via troche form. Antifungal agents
intestine. It causes severe diarrhea and stom- are typically used to treat such problems as
ach upset. Giardia infection is one of the candidiasis, amongst other types of fungal
most common waterborne diseases in the infection.
United States. Answer B is incorrect. Ketoconazole is an
antifungal (in tablet form), which functions
110. The correct answer is C. Nemathelminthes are

by blocking fungal cytochrome p450.
a type of Metazoa, not Protozoa. Parasites are
unicellular eukaryotes which infect blood cells, Answer C is incorrect. Fluconazole is an
intestinal and urogenital tissue, and meninges. antifungal (in table form), which functions
by blocking fungal cytochrome p450.
Answer A is incorrect. Sporozoans are a type of
Protozoa. Protozoa are subdivided into Sarcodina Answer D is incorrect. Nystatin is an antifun-
(amebas), Sporozoa (aporozoans), Mastigophora gal (in topical and oral suspension form),
(flagellates), and Ciliata (ciliates). which functions by binding ergosterol.
Answer B is incorrect. There are two groups Answer E is incorrect. Amphotericin B is an
of parasites: Protozoa and Metazoa. antifungal (in topical, oral suspension, and
intravenous form), which functions by bind-
Answer D is incorrect. “Flatworms” is
ing ergosterol.
another name for Platyhelminthes. They
Note that Clotrimazole is an antifungal (in
further subdivide into Trematoda (Flukes),
troche form), which inhibits ergosterol synthe-
Cestoda (Tapeworms), and Nemathelminthes
sis. Ergosterol is a component of fungal cell
(Roundworms).
membranes which alters their permeability.
Answer E is incorrect. Trematoda and Ces-
toda are subgroups of Platyhelminthes. Platy- 113. The correct answer is D. Dermatophytosis is
helminthes are a subgroup of Metazoa. a disease caused by molds which includes
tinea corporis, tinea capitis, tinea cruris, tinea
111. The correct answer is B. Pneumocystis is pedis, and tinea unguium.
transmitted through inhalation. This proto-
Answer A is incorrect. Histoplasmosis is a
zoa causes pneumonia in immunocompro-
dimorphic fungus which is found in bird and
Answers: 110-117 165
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bat droppings in the Ohio and Mississippi Answer E is incorrect. Fungi reproduce either
Valleys and causes damage within host sexually (via spores) or asexually (via conidia).
macrophages. Examples of fungal spores include zygospores,
ascospores, and basidiospores, and examples of
Answer B is incorrect. Coccidioidomycosis
conidia include arthrospores, chlamydospores,
is also dimorphic, endemic in the southwest
blastospores, and sporangiospores.
USA and Latin America, and causes respira-
tory infection when inhaled from arthrospores.
116. The correct answer is C. Hepatitis C is the
Answer C is incorrect. Blastomycosis, also disease described in this patient. Hepatitis C
dimorphic, is endemic in North America and is a viral disease characterized by increased
causes respiratory infection after inhalation of incidence of chronic liver disease, cirrhosis,
microconidia. and hepatocellular carcinoma. Symptoms
include fever, loss of appetite, nausea, and
Answer E is incorrect. Mucormycosis is
jaundice.
caused by a mold and inhalation of it causes
respiratory, skin, paranasal sinus, and brain Answer A is incorrect. Symptoms of HIV are
infection. similar, with constitutional symptoms being
present. No jaundice would be expected,
114. The correct answer is C. Trimethoprim is a though.
bacteriostatic antibiotic. It would not be
Answer B is incorrect. Syphilis presents clini-
effective in this situation.
cally with varying forms and symptoms.
Answer A is incorrect. Miconazole would be There is a primary, secondary, latent, and
effective in this situation. It is an antifungal, tertiary form of the disease. Each one has a
which affects fungal membrane permeability differing presentation.
by inhibition of ergosterol.
Answer D is incorrect. Gonorrhea presents
Answer B is incorrect. Clotrimazole would clinically with dysuria in males and females,

be effective in this situation. It is an antifun- as well as a discharge which could be present.
gal, which affects fungal membrane perme-
Answer E is incorrect. Chlamydia presents
ability by inhibition of ergosterol.
clinically with symptoms of the genital, ocu-
Answer D is incorrect. Tolnaftate would be lar, or joint regions. Each region presents a
effective in this situation. It is an antifungal, different clinical symptom.
which affects fungal membrane permeability
by inhibition of ergosterol. 117. The correct answer is C. Acute hepatitis B
infection would have a lab finding of the HBs
Answer E is incorrect. Griseofulvin would be
Ag. This antigen designated chronicity of dis-
effective in this situation. It is an antifungal,
ease with hepatitis B, as well as acute infec-
which affects fungal membrane permeability
tion of the virus.
by inhibition of ergosterol.
Answer A is incorrect. Acute hepatitis C
115. The correct answer is A. Fungi are gram infection would have anti-HCV markers seen
positive. in lab results during this phase.
Answer B is incorrect. Their cell walls are Answer B is incorrect. Acute hepatitis A
composed primarily of chitin, and their infection has IgM anti-HAV markers in this
membranes formed from ergosterol. stage. There is no particular marker in
Answer C is incorrect. These microorgan- chronic disease.
isms are either obligate or facultative aerobes. Answer D is incorrect. Chronic hepatitis E
Answer D is incorrect. Fungi are eukaryotic infection would have no markers in this
microorganisms. stage. Although, one would expect to find
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IgM anti-HEV markers on lab studies with Answer D is incorrect. Hepatitis D infection
acute hepatitis E infection. is caused by Deltavirus, a single-stranded
RNA virus.
Answer E is incorrect. Chronic hepatitis B
infection is evidenced by a lab finding of Answer E is incorrect. Hepatitis E is caused
HBsAg. It is the same marker found in the by infection of the single-stranded RNA virus,
acute stage. Calicivirus.
Note that Hepatitis D has IgM anti-HDV
markers in lab studies. 120. The correct answer is A. Autoclaving is the
only way to be sure that hepatitis B virus is
118. The correct answer is B. Hepatitis B is the effectively destroyed. This form of steriliza-
form of hepatitis infection in which a vaccine tion uses moist heat to denature proteins at
is commonly administered to healthcare work- 121°C/205°F in 15-20 minutes. It is the most
ers. Hepatitis B is very easily transmissible common form of sterilization and can cor-
through blood contact with an infected patient. rode or dull carbon-steel instruments.
Answer A is incorrect. Hepatitis A does not Answer B is incorrect. Ethylene oxide gas is
have a vaccine which is commonly given to used mostly in hospitals for heat-sensitive
healthcare workers. A vaccine does exist for materials and is very slow (8-10 hours).
it, though.
Answer C is incorrect. Chemical vapor uses
Answer C is incorrect. Hepatitis C does not a combination of alcohol and formaldehyde
have a vaccine which is commonly given to and does not corrode or dull instruments.
healthcare workers. No vaccine exists for this
Answer D is incorrect. Formaldehyde is a less
virus.
efficacious form of sterilization which uses a
Answer D is incorrect. Hepatitis D does not 37% solution in water, formalin, to sterilize.
have a vaccine which is commonly given to
Answer E is incorrect. Glutaraldehyde is
healthcare workers. No vaccine exists for this

used for heat-sensitive materials and is very
virus.
slow, taking up to 10 hours.
Answer E is incorrect. Hepatitis E does not
have a vaccine which is commonly given to 121. The correct answer is C. Glutaraldehyde 2%
healthcare workers. No vaccine exists for this is a sterilization technique which alkylates
virus. nucleic acids and proteins to achieve sterile
Note that only hepatitis B and hepatitis A conditions.
have vaccines (hepatitis A → killed vaccine; Answer A is incorrect. It is a slow process,
hepatitis B → immune globulin vaccine/ though, taking up to 10 hours.
passive immunity and subunit vaccine/active
immunity). Answer B is incorrect. Glutaraldehyde 2% is
associated with hypersensitivity reaction.
119. The correct answer is A. Picornavirus is Answer D is incorrect. It does not denature
responsible for hepatitis A infection. It is a proteins. It is used mostly for heat-sensitive
single-stranded RNA virus, which lacks an materials.
envelope.
Answer E is incorrect. The preferred method
Answer B is incorrect. Hepadnavirus is a of sterilizing liquid solutions is filtration,
double-stranded DNA virus, which causes which physically and electrostatically traps
hepatitis B infection. microorganism larger than its pore size.
Answer C is incorrect. Flavivirus is a single-
stranded RNA virus responsible for hepatitis 122. The correct answer is D. An endemic infec-
C infection. tion is one that occurs at a minimal level
within a population.
Answers: 118-127 167
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Answer A is incorrect. An infection occur- Answer A is incorrect. The chronic stage is

ring more frequently than normal within a the infectious state in which there is long-
population is called an epidemic. term active growth of microorganisms. There
are symptoms present.
Answer B is incorrect. An infection occurring
at a worldwide level is called a pandemic. Answer B is incorrect. The acute stage is the
infectious state in which there is short-term
Answer C is incorrect. An infection which
active growth of microorganism. There are
occurs within different countries does not
symptoms present.
have a specific classification.
Answer C is incorrect. The latent stage is the
123. The correct answer is D. Ludwig angina infectious state with no active growth of
does not involve the parapharyngeal fascial microorganisms. Reactivation is possible,
space. though.
Answer A is incorrect. The sublingual fascial Answer D is incorrect. The subclinical stage
space is involved in Ludwig angina. is the infectious state that is only detectable
Answer B is incorrect. The submandibular via serology. The patient is clinically asymp-
fascial space is involved in Ludwig angina. tomatic.
Answer C is incorrect. The submental fascial 126. The correct answer is A. Autoclaving (moist
space is involved in Ludwig angina. heat sterilization) is a process which must be
Note that Ludwig angina is a cellulitis done with heat at 121°C/250°F for 15-20
which rapidly progresses to involve the sub- minutes. Other forms of sterilization are car-
mandibular, sublingual, and submental fas- ried out at differing levels of heat and at vari-
cial spaces. The key to this infection is that it able time intervals.
occurs bilaterally and treatment is emergent
Answer B is incorrect. Dry heat sterilization
in that it can quickly obstruct the airway, thus

is completed at 160°C/320°F for 2 hours.
compromising oxygenation.
Answer C is incorrect. Dry heat sterilization
124. The correct answer is D. A cyst is a fluid- is completed at 170°C(340°F) for 1 hour.
filled sac lined by true epithelium. The other
Answer D is incorrect. There is no steriliza-
terms listed in the question have definitions
tion method which uses these parameters for
which are similar, yet correct usage and dif-
treatment.
ferentiation of them is vital when describing
pathology. Answer E is incorrect. Chemical vapor steril-
ization is completed at 132°C/270°F for
Answer A is incorrect. A granuloma is a
20-30 minutes.
chronic inflammatory lesion consisting of
Note that the sterilization method of using
granulation tissue (fibrosis, angiogenesis,
ethylene oxide gas is for 8-10 hours, and glu-
inflammatory cells).
taraldehyde 2% for 10 hours. Glutaraldehyde
Answer B is incorrect. An abscess is an acute 2% and filtration have no specific time interval.
inflammatory lesion with pus being sur-
rounded by a fibrous wall. 127. The correct answer is A. Hepatitis B infec-
tion presents the greatest risk of bloodborne
Answer C is incorrect. Cellulitis is an acute,
infection amongst healthcare workers.
diffuse swelling along fascial planes that sepa-
Because of the high risk of bloodborne infec-
rate muscle bundles.
tion with this and other diseases, universal
125. The correct answer is E. The carrier stage is precautions have been implicated in the den-
the infectious state characterized as having tal office (as well as in hospital settings). It
active growth of microorganisms with or with- says that all human blood, as well as other
out symptoms. body fluids which contain blood, should be
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treated as infectious for HIV, hepatitis B, and diseases: respiratory infection, bronchitis, tuber-
other bloodborne pathogens. culosis, pneumonia, bronchogenic carcinoma,
and idiopathic pulmonary hemosiderosis.
Answer B is incorrect. HSV (herpes simplex
virus) poses a risk. Answer A is incorrect. Patients with pneumo-
nia typically have bouts of hemoptysis.
Answer C is incorrect. HIV (human immuno-
deficiency virus) poses a bloodborne risk to Answer B is incorrect. Patients with tubercu-
healthcare workers. This risk is not greater losis typically have bouts of hemoptysis.
than hepatitis B, though.
Answer D is incorrect. Patients with bronchitis
Answer D is incorrect. HPV (human papil- pneumonia typically have bouts of hemoptysis.
loma virus) poses a risk to healthcare workers.
Answer E is incorrect. Patients with idio-
This virus is contractible via touching of the
pathic pulmonary hemosiderosis typically
lesion.
have bouts of hemoptysis.
Answer E is incorrect. HCV (hepatitis C
virus) poses a bloodborne risk to healthcare 130. The correct answer is B. Ascites is not a char-
workers. This risk is not greater than hepatitis acteristic of pneumonia. It occurs when
B, though. excess fluid accumulates in the space
between the membranes lining the abdomen
128. The correct answer is B. Regarding tubercu- and abdominal organs. It can be free serous
losis infection, Ghon complex is characteris- or protein-laden fluid. Disorders associated
tic of the primary and secondary form of TB. with this include cirrhosis, hepatitis, portal
In the primary form, the bacterium is vein thrombosis, constrictive pericarditis, con-
between the upper and middle lobes of lung. gestive heart failure, liver cancer, nephrotic
Ghon complex consists of parenchymal syndrome, and pancreatitis.
lesion and hilar lymphadenopathy.
Answer A is incorrect. Patients with pancre-
Answer A is incorrect. The miliary form is atitis may have symptoms of ascites.
widely disseminated. The lesions found look
Answer C is incorrect. Patients with congestive
like “millet seed” with multiple extrapul-
heart failure may have symptoms of ascites.
monary sites. In the secondary form, the lung
apices are involved due to high oxygen tension, Answer D is incorrect. Patients with constric-
and Ghon complex reactivated. tive pericarditis may have symptoms of ascites.
Answer C is incorrect. Tuberculosis is Answer E is incorrect. Patients with nephrotic
caused by a bacterium. The offending agent syndrome may have symptoms of ascites.
is Mycobacterium tuberculosis, an acid fast,
strict anaerobe. Because of this, it lives viably 131. The correct answer is A. Steatorrhea is a
within the lungs. result of certain malabsorptive disorders. This
symptom is soft, bulky, foul-smelling, light-
Answer D is incorrect. This disease is con- colored stool. It occurs when fat is not
tracted by aerosolized droplets which are absorbed. This can be seen in such cases as
inhaled. pancreatic disease (decrease in digestive
Answer E is incorrect. Tuberculosis does enzymes) and bile obstruction (decrease bile
involve the lymph nodes. Hilar lymphade- for emulsification).
nopathy is part of the Ghon complex. Answer B is incorrect. Celiac disease is
caused by gluten sensitivity, not infection.
129. The correct answer is C. Hemoptysis is not a
clinical symptom of emphysema. Hemoptysis Answer C is incorrect. There is no correla-
is the coughing up of blood and/or blood- tion between increased length of breastfeed-
streaked sputum. It is seen in the following ing and Whipple disease.
Answers: 128-135 169
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Answer D is incorrect. Malabsorption is Answer D is incorrect. Desquamated cells

due to nutrients not being absorbed by the are a component of dental calculus. This is
small intestine. It can cause growth retarda- an organic component, which makes up
tion, failure to thrive, and in adults, weight roughly 10%-30% of calculus.
loss.
134. The correct answer is D. Catalase is an antiox-
Answer E is incorrect. Sore tongue is not a
idant, thus rids the body of free radical injury.
clinical complication of Whipple disease.
Note that other forms of malabsorption Answer A is incorrect. Free radicals can cause
include tropical sprue (etiology unknown; various forms of cellular injury. These include
probably an infection) and Whipple disease membrane lipid peroxidation, nucleic acid
(caused by Tropheryma whippelii infection). denaturation, and cross-linking of proteins.
Answer B is incorrect. They are generated
132. The correct answer is C. The most detri-
from redox reactions. Also, radiation, drugs
mental effect on salivary pH is the frequency
and chemicals, and reperfusion injury can
of carbohydrate intake.
cause free radical formation.
Answer A is incorrect. Dental caries is
Answer C is incorrect. They initiate autocat-
caused by bacteria which synthesize glucans
alytic reactions which cause cellular damage.
(dextrans) and fructans (levans) from metabo-
lism of dietary sucrose. These contribute to Answer E is incorrect. Free radicals are
bacterial adherence to tooth surfaces and induced by activated oxygen species.
plaque formation. Examples of antioxidants include supero-
xide dismutase, catalase, vitamin E, and
Answer B is incorrect. Lactic acid is a by-
ceruloplasmin.
product of this metabolism and it reduces
salivary pH. This creates sites of enamel dem- 135. The correct answer is C. Serum calcium is
ineralization and cavitation.

normal in dystrophic calcification. There
Answer D is incorrect. The reverse is true. are two types of pathologic calcification—
Glucans (and fructans) are the by-products of dystrophic and metastatic.
sucrose metabolism. Answer A is incorrect. Metastatic calcifica-
Answer E is incorrect. Also detrimental to tion does not occur in damaged heart valves.
salivary pH is the quantity of carbohydrate This calcification occurs at such locations as
intake. the stomach, lungs, and kidneys. Metastatic
calcification is defined as calcification of nor-
133. The correct answer is E. By-products of viral mal tissue.
replication are not typically a major compo-
Answer B is incorrect. There are abnormal
nent of dental calculus.
serum calcium levels. Pathogenesis involves
Answer A is incorrect. Calcium is a compo- the precipitation caused by tissue acidity and
nent of dental calculus. This is an inorganic increased calcium concentration. It is associ-
component of it, which makes up roughly ated with hyperparathyroidism, vitamin D
70%-90% of calculus. intoxication, and bone destruction.
Answer B is incorrect. Hydroxyapatite is a Answer D is incorrect. Dystrophic calcifica-
component of dental calculus. It is made up tion is the calcification of degenerate or necrotic
of calcium and phosphorus. tissue. The serum calcium levels remain
normal. The pathogenesis is enhanced by
Answer C is incorrect. Carbohydrate is a
collagen and acidic phosphoproteins, and it is
component of dental calculus. This is an
commonly seen in hyalinized scars, degener-
organic component, which makes up roughly
ated leiomyoma foci, caseous nodules, damaged
10%-30% of calculus.
heart valves, and atherosclerotic plaques.
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Answer E is incorrect. Eggshell calcification disorder. This syndrome occurs at a frequency

can be seen on chest x-ray. of 1 in 700 births.
Answer A is incorrect. Next most common
136. The correct answer is A. The calor sign of
autosomal chromosomal abnormality is
acute inflammation is due to increased tissue
Edward syndrome at 1 in 3000 births.
perfusion. It is seen clinically as a localized
heat. Answer B is incorrect. Patau syndrome is the
third most common autosomal chromosomal
Answer B is incorrect. Tumor is a swelling. It
abnormality. It occurs at a frequency of 1 in
is due to tissue edema.
5000 births.
Answer C is incorrect. Rubor is a clinical
Answer C is incorrect. Klinefelter syndrome
redness. It is due to vasodilation and
is not autosomal, rather it is sex related. It
increased vascular permeability.
occurs at a frequency of 1 in 500 male births.
Answer D is incorrect. Function laesa is the
Answer E is incorrect. Turner syndrome is
loss of function. It is due to swelling and
not autosomal. It is a sex-related chromoso-
pain.
mal abnormality that occurs 1 in 3000 female
Answer E is incorrect. Dolor is pain. It is due births.
to inflammatory mediators and pressure due
to edema. 139. The correct answer is E. There is decreased
Note that these classical signs of inflamma- cross-sectional area of capillaries and arteri-
tion comprise the initial responses to tissue oles in cases of primary hypertension. Pri-
injury. mary hypertension accounts for 90%-95% of
all hypertensive cases, and there is no identi-
137. The correct answer is B. It is not granuloma, fiable cause. Although, it is related to
but abscess formation which includes pus from increased cardiac output and increased total
neutrophils, necrotic cells, and exudates. peripheral resistance.

Acute inflammation is the initial response to
Answer A is incorrect. In primary hyperten-
tissue injury. It is largely leukocyte infiltra-
sion, there is hypertrophy of arteries and arte-
tion with rids of the offending factor and
rioles and not the capillaries (because there is
degrades necrotic tissue from the damage.
no smooth muscle in capillaries).
Answer A is incorrect. PMNs are the first
Answer B is incorrect. There is also
leukocyte to respond.
increased wall-to-lumen ratio of arteries and
Answer C is incorrect. Regeneration is the arterioles (due to increased smooth muscle
first stage of wound repair following inflam- cell growth) seen in primary hypertension.
mation. It involves the resolution of affected
Answer C is incorrect. Patients have
tissues. Also, repair (fibrosis of affected tis-
decreased arteriolar and capillary density with
sues), abscess formation, and chronic inflam-
primary hypertension.
mation are the other stages of wound repair.
Answer D is incorrect. There is increased
Answer D is incorrect. Chronic inflammation
smooth muscle growth in patients with primary
differs from acute in that monocytes and
hypertension.
macrophages are present in this chronic phase.
Answer E is incorrect. Elimination of infec- 140. The correct answer is C. Being a pre-
tious agents and ridding of necrotic tissue menopausal woman is not a risk factor for ath-
occur in the initial response to tissue injury. erosclerosis. The risk factors for atherosclerosis
include smoking, hypertension, nephrosclerosis,
138. The correct answer is D. Down syndrome is and diabetes. This is a disease in which degen-
the most frequent autosomal chromosomal erative changes occur in artery walls. Plaques
Answers: 136-144 171
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(fatty material) accumulate under the walls of Answer A is incorrect. Asthma is a hypersen-
vessels (commonly arteries). This disease is the sitivity reaction due to overreactive airways.
most important contributor to arterial thrombo-
Answer B is incorrect. Chronic bronchitis is
sis and the most susceptible arteries are the
due to chronic inflammation of the bronchial
aorta and coronary arteries.
tree. It is often from years of offending ciga-
Answer A is incorrect. Smoking is a risk fac- rette smoke.
tor for atherosclerosis.
Answer D is incorrect. Pneumonia is due to
Answer B is incorrect. Hypertension is a risk either bacterial or viral infection.
factor for atherosclerosis.
Answer E is incorrect. Tuberculosis is caused
Answer D is incorrect. Nephrosclerosis is a by bacterial infection. It is not due to a
risk factor for atherosclerosis. decrease in alpha-1 antitrypsin.
Answer E is incorrect. Diabetes is a risk factor
143. The correct answer is A. Klebsiella infection
for atherosclerosis.
can often cause lung abscess in alcoholic
patients. Lung abscesses are localized collec-
141. The correct answer is C. Right-sided heart
tions of pus in the lung caused by aspiration,
failure can be caused by cor pulmonale. This
bronchial obstruction, or septic emboli. The
is defined as increased pulmonary vascular
most commonly found organisms include
resistance causing right heart strain.
Pseudomonas, Klebsiella, Proteus, and anaer-
Answer A is incorrect. Isolated right heart obes. Clinically, one would expect to find a
failure is uncommon. These pathological productive cough with large amounts of foul-
changes to the right side of the heart are typi- smelling sputum, fever, dyspnea, chest pain,
cally caused by left heart failure. cyanosis, and a fluid-filled cavity seen on
Answer B is incorrect. Right heart failure chest x-ray.

usually occurs due to left heart failure. Thus, Answer B is incorrect. Staphylococcus infec-
it is not independent of it. tion does not present with lung abscesses.
Answer D is incorrect. The symptoms of The clinical presentation of infection with
right heart failure include elevated venous this bacterium varies based upon the species.
pressure, hepatomegaly, and dependent Answer C is incorrect. Streptococcus infec-
edema, as well as systemic venous congestion tion does not present with lung abscesses.
and peripheral edema (ie, swollen ankles). The clinical presentation of infection with
Answer E is incorrect. A gallop rhythm is not this bacterium varies based upon the species.
typically heard when right heart failure is Answer D is incorrect. Bacillus infection
present. does not present with lung abscesses. The
clinical presentation of infection with this
142. The correct answer is C. A decrease in alpha- bacterium varies based upon the species.
1 antitrypsin is seen in emphysema. Emphy-
sema is typically a disease of smokers. It is Answer E is incorrect. Clostridium infection
either centrilobular (due to cigarette smoking) does not present with lung abscesses. The
or panlobular (due to familial antiproteinase clinical presentation of infection with this
deficiency, a decrease in alpha-1 antitrypsin). bacterium varies based upon the species.
This allows the destruction of elastic fibers in
144. The correct answer is C. When viewed histo-
alveolar walls distal to respiratory bronchioles.
logically, sulfur granules will appear in sam-
Thus, there is a decrease in elastic recoil,
ples taken from patients infected with Actino-
decrease in radial traction, and decrease in
myces israelii. A israelii is an anaerobic
functioning parenchyma.
bacterium which contains no virulence factors.
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It causes actinomycosis. This disease is char- toxin, which causes gas gangrene. Clostrid-
acterized by not only sulfur granules but also ium genus is a gram-positive bacilli.
slow-growing, lumpy abscesses. The other
Answer A is incorrect. C difficile is an anaero-
above bacteria listed do not have characteris-
bic bacterium. Its virulence factors are exo-
tic histological findings as listed above with A
toxin A and B and it can cause pseudomem-
israelii.
branous colitis.
Answer A is incorrect. L monocytogenes can
Answer C is incorrect. C tetani is an anaero-
be identified microscopically with its long
bic bacterium. Its virulence factor is tetanus
actin tails. It can also be detected by molecu-
toxin, and it causes tetanus.
lar biology techniques.
Answer D is incorrect. C botulinum is an
Answer B is incorrect. S aureus can be iden-
anaerobic bacterium. Its virulence factor is
tified microscopically by its characteristic
botulinum toxin, and it causes botulism.
grapelike clusters. It can also be grown on
blood-rich agar places. 147. The correct answer is A. Shigella species
Answer D is incorrect. C botulinum can causes dysentery. This bacterium is faculta-
be identified microscopically with special tive and has virulence factors including
staining—gentian violet. It also can be identi- enterotoxin and endotoxin.
fied using monoclonal antibodies. Answer B is incorrect. Excherichia coli is a
Answer E is incorrect. C tetani can be iden- facultative bacterium. Its virulence factors are
tified microscopically with its tennis racket enterotoxin and endotoxin, and infection
appearance. causes urinary tract infections, traveler’s diar-
rhea, and neonatal meningitis.
145. The correct answer is E. Pseudomembranous
Answer C is incorrect. Klebsiella pneumoniae
colitis is not caused by Neisseria; it is due to
is a facultative bacterium. Its virulence factor
antibiotic-induced overgrowth of Clostridium

includes endotoxin infection, and it causes
difficile. Neisseria genus is a gram-negative
pneumonia and urinary tract infections.
cocci which has two species: N meningitides
(aerobic; contains LPS, IgA protease, and Answer D is incorrect. Vibrio cholerae is a
polysaccharide capsule), and N gonorrhoeae facultative bacterium. Its virulence factors are
(aerobic; contains LOS, fimbriae, and IgA endotoxin and enterotoxin, and infection
protease). causes cholera.
Answer A is incorrect. Septic arthritis is Answer E is incorrect. Helicobacter pylori is
caused by N gonorrhoeae. a facultative bacterium. Its virulence factor is
endotoxin, and infection causes gastritis, peptic
Answer B is incorrect. Waterhouse-
ulcers, and gastric carcinoma.
Friderichsen syndrome is caused by N
meningitides. 148. The correct answer is B. Syphilis infection is
Answer C is incorrect. Meningitis is caused treated with penicillin.
by N meningitides. Answer A is incorrect. The tertiary form is char-
Answer D is incorrect. Gonorrhea is caused acterized by gumma formation. This gumma
by N gonorrhoeae. can be found on the palate and the tongue.
Answer C is incorrect. Syphilis is a disease
146. The correct answer is B. Clostridium perfrin-
caused by the spirochete Treponema pallidum.
gens causes the symptoms of necrotizing
fascitis and myonecrosis after becoming inoc- Answer D is incorrect. The secondary form
ulated from ingestion of reheated meats. It is includes a highly infectious maculopapular
anaerobic, and its virulence factor is alpha rash. Also, condyloma lata is present on the
skin and mucosa.
Answers: 145-152 173
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Answer E is incorrect. The primary form is virus also causes pleurodynia, myocarditis, and
characterized by a painless ulcer/chancre at pericarditis. Hepatitis A virus causes hepatitis A
the site of local contact. infection.
149. The correct answer is C. Mycoplasma pneu- 151. The correct answer is D. The classic symp-
monia is the smallest bacterium. It is a wallless tom of coronary artery disease is angina.
bacteria with a cell membrane that contains
Answer A is incorrect. Coronary artery disease
cholesterol. It causes atypical pneumonia.
is characterized by atherosclerotic plaques
These bacteria are classified in a group by
and decreased blood supply to the myo-
themselves.
cardium.
Answer A is incorrect. C trachomatis is a
Answer B is incorrect. The result of
bacterium which causes infection of the
decreased blood supply to the myocardium is
lower genitourinary tract in both men and
ischemia and infarction of the heart. This is
women. It cannot be Gram stained. Micro-
due to decreased oxygen and nutrients to the
scopically, one can view small inclusion
myocardium.
bodies.
Answer C is incorrect. Risks include hyper-
Answer B is incorrect. M tuberculosis is diag-
tension, hyperlipidemia, smoking, obesity,
nosed microscopically using an acid-fast
inactivity, diabetes, and being male.
stain. It causes tuberculosis infection.
Answer E is incorrect. Ischemia is a com-
Answer D is incorrect. R rickettsii is a bac-
mon consequence of coronary artery disease.
terium which causes Rocky Mountain spot-
Note that myocardial infarction can be
ted fever. It is transmitted via tick bites.
noted with ECG changes and cardiac enzymes
Answer E is incorrect. B burgdorferi is a bac- in the blood in patients with coronary artery
terium which causes Lyme disease. It is trans- disease.

mitted via tick bite.
152. The correct answer is A. A patient experienc-
150. The correct answer is D. Hepatitis B is ing a myocardial infarct would not have pain
caused by infection of hepadnavirus. Hepad- radiating to the right arm, but rather to the
navirus is a double-stranded, circular DNA left arm.
virus which is also associated with hepatocel-
Answer B is incorrect. Symptoms seen in
lular carcinoma.
patients suffering from an MI include angina,
Answer A is incorrect. Aseptic meningitis is sweating, and nausea.
caused by Coxsackie A and B viruses. This
Answer C is incorrect. ECG changes can
virus is a subgroup of Picornavirus. Picor-
also be seen in these patients. This is because
navirus is the smallest family of RNA viruses.
of disruption in electrical conductivity in the
Answer B is incorrect. Herpangina is caused heart.
by Coxsackie A virus. This virus is a subgroup
Answer D is incorrect. Angina is a common,
of Picornavirus.
early symptom experienced by patients having
Answer C is incorrect. Polio is caused by an MI. The pain is said to be crushing.
poliovirus. This virus is a subgroup of
Answer E is incorrect. Lab values would
Picornavirus.
show an increase in cardiac enzymes in the
Answer E is incorrect. Common cold is circulation.
caused by Rhinovirus. This virus is a sub- Note that myocardial infarction is due to
group of Picornavirus. prolonged interruption of coronary blood
Note that acute lymphonodular pharyngitis flow to the myocardium, thus, coagulative
is caused by Coxsackie A virus. Coxsackie B necrosis eventually ensues after the lack of
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blood flow to the heart. There are two types Answer D is incorrect. Patients with pneu-
of cardiac occlusion: complete (transmural monia have constitutional symptoms, produc-
infarct-ST elevation on ECG) and partial tive cough, blood-tinged sputum, dyspnea,
(subendocardial infarct—non-ST elevation). and chest pain.
The prognosis is good if patients are treated
Answer E is incorrect. Tuberculosis patients
quickly.
show hemoptysis, weight loss, night sweats,
malaise, and weakness.
153. The correct answer is E. Stable angina is
precipitated by exertion. Angina is character-
155. The correct answer is A. Asthma is not pre-
ized as squeezing substernal chest discomfort.
cipitated by increased sympathetic stimula-
This pain may also radiate to the left arm,
tion. Asthma is a chronic reactive airway dis-
neck, jaw, and shoulder blades. Angina is
order caused by episodic airway obstruction.
caused by ischemia of the myocardium, ath-
erosclerotic narrowing, and vasospasm. Answer B is incorrect. Cox inhibitors precip-
itate asthma by leading to an increase in
Answer A is incorrect. Stable angina is the
leukotrienes and bronchoconstrictors.
most common type of angina. It is seen with
coronary artery disease and atherosclerotic Answer C is incorrect. Direct bronchocon-
narrowing, and it is precipitated by exertion. strictor release is caused by chemical inhala-
tion or medications.
Answer B is incorrect. Prinzmetal angina is
seen clinically as intermittent chest pain at Answer D is incorrect. Increased vagal stimu-
rest. It is due to vasospasm. lation is due to viral infection and upper res-
piratory tract infection. This leads to a lower-
Answer C is incorrect. The most common
ing of the respiratory threshold.
type of angina is stable angina, not
Prinzmetal. Answer E is incorrect. Type I hypersensitivity
causes mast-cell degranulation which leads to
Answer D is incorrect. Unstable angina will

bronchospasm and increased inflammatory-
occur even at rest. It is the most severe coro-
cell recruitment.
nary artery disease, and could be a sign of
Note that asthma can occur at any age, but
oncoming myocardial infarct.
greater than half of the cases occur in children
under age 10. The mechanism of asthma is bro-
154. The correct answer is C. This patient is suf-
ken up into two categories, allergic (immune:
fering from emphysema. This disease is due to
type I hypersensitivity) and intrinsic (nonim-
destruction of elastic fibers in alveolar walls. It
mune: direct bronchoconstrictor release,
is most often caused by a history of cigarette
increased vagal stimulation, cox inhibitors).
smoking, but also has a genetic predilection.
Symptoms include dyspnea, labored breath-
156. The correct answer is C. A blue bloater is
ing, and a nonproductive cough. Pulmonary
someone who has chronic bronchitis.
function tests would show increased total lung
Chronic bronchitis is a disease in people with
capacity, increased residual volume, and
a history of cigarette smoking. By definition,
decreased ratio of forced expiratory volume 1
it is someone who has a chronic, productive
to forced vital capacity.
cough for at least 3 months of the year for two
Answer A is incorrect. Chronic bronchitis years. These patients are blue due to cyanosis
patients suffer from a productive cough and caused by increased partial pressure oxygen.
wheezing. They also have a positive chest
Answer A is incorrect. Patients with emphy-
auscultation.
sema are considered “pink puffers.” This is
Answer B is incorrect. Dyspnea has clinical because they purse their lips to overcome airway
symptoms of expiratory wheezes, cough, and collapse.
chest tightness.
Answers: 153-160 175
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Answer B is incorrect. Patients with asthma Answer B is incorrect. Increased mucous can
have clinical symptoms of shortness of breath cause airway obstruction. An example of this
and chest tightness. is seen in chronic bronchitis.
Answer D is incorrect. Patients with pneu- Answer C is incorrect. Airway hyperreactiv-
monia typically present with a cough, fever, ity, for example bronchospasm, can cause air-
increased respiratory rate, and possibly rales way obstruction. An example of this occurs in
(when auscultating). patients with asthma.
Answer E is incorrect. Patients with
159. The correct answer is E. An ELISA test is a
bronchiectasis typically present with frequent
substrate-activated enzyme reaction labeling
respiratory infections and the symptoms
antigen-antibody complexes. If the reaction is
which accompany them.
positive, there will be a visible color reaction.
This type of testing is used to detect antigen
157. The correct answer is D. Noncaseating gran-
or antibody in patient specimens.
ulomas are not a possible complication of
chronic bronchitis. Chronic bronchitis is a Answer A is incorrect. Precipitation reactions
disease which causes a productive cough, are characterized by antibody cross-linking
wheezing, and positive chest auscultation with a soluble antigen. This test detects serum
(noisy chest, rhonchi). antigen or antibody.
Answer A is incorrect. Peripheral edema is a Answer B is incorrect. Radioimmunoassay reac-
complication of chronic bronchitis. This is tions are characterized by radio-labeled antibody
due to pulmonary hypertension (which cross-linking with unlabeled antigen. This test is
causes right ventricular overload and cor used to detect serum antigen or hapten.
pulmonale/right heart failure).
Answer C is incorrect. Immunofluorescence
Answer B is incorrect. Chronic productive reactions are characterized by fluorescent-

cough is a complication of chronic bronchi- labeled antibody bind to unlabeled antigen.
tis. This is due to volume overload. This test is used to detect antigen in histo-
logic sections or tissue specimen.
Answer C is incorrect. Right ventricular
overload is a complication of chronic bron- Answer D is incorrect. Agglutination reac-
chitis. This occurs secondary to pulmonary tions are characterized by antibody cross-
hypertension, and leads to cor pulmonale linking with particulate antigen. This test is
and peripheral edema. used in ABO blood typing.
Answer E is incorrect. Bronchogenic carci-
160. The correct answer is D. TH-2 cells signal B
noma is a complication of chronic bronchitis.
cells to differentiate into plasma cells. T cells
This increased lung cancer risk is due to
are lymphocytes which differentiate in the
squamous metaplasia from chronic lung
thymus. They have a long life span which
inflammation.
ranges from months to years.
158. The correct answer is D. Increased elastic Answer A is incorrect. TH-2 cells function to
recoil is not a mechanism of airway obstruc- signal B cells. They secrete the cytokines IL-4
tion. Airway obstruction can be caused by and IL-5.
many mechanisms.
Answer B is incorrect. CD8 cells (also called
Answer A is incorrect. Decreased elastic TC cells) function to kill virus-infected,
recoil causes airways to collapse and, thus, tumor, and allograft cells. They respond to
airway obstruction. An example of this is seen MHC I receptors. TH-1 cells signal CD8 and
with patients that have emphysema. macrophages. They also secrete IL-2 and
INF-γ.
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Answer C is incorrect. Memory T cells func- in vascular permeability, pain, inflammatory

tion by responding to reexposure of antigen. mediation, immunological mediation, and
tissue damage.
Answer E is incorrect. CD4 cells (also called
TH cells) function by responding to antigen Answer A is incorrect. Serotonin is derived
associated with MHC II. from the amino acid, tryptophan.
Note that T cells also have a CD3-associated
Answer B is incorrect. Complement protein
T-cell receptors which recognize antigen only
is derived from hepatocytes.
in conjunction with MHC proteins.
Answer D is incorrect. Bradykinin is derived
161. The correct answer is C. Skeletal muscle from its proform, kininogen.
does not exhibit tissue regeneration. Tissue
Answer E is incorrect. Leukotrienes are
regeneration is a concept in which a tissue or
derived from the cell-membrane molecule,
organ may restore itself by way of an adaptive
arachidonic acid.
mechanism. This can occur at many tissue
levels: liver, bone, cartilage, intestinal 164. The correct answer is B. Fibroblasts do not
mucosa, and surface epithelium are all capa- secrete TGF-β. TGF-β is an important
ble of regeneration. There are also some tis- inflammatory cytokine. Cytokines are small
sues that cannot regenerate, including: skele- peptides secreted by many cell types and are
tal muscle, cardiac muscle, and neurons. For involved in host defense and immunity. It is
example, the regenerative capacity of the liver secreted by many cells, including monocytes,
makes it a very uncommon site for infarction. macrophages, T cells, and B cells. Its func-
Answers A, B, D, and E are incorrect. Tissue tion is to inhibit T cells, B cells, PMNs,
regeneration occurs with liver, cartilage, monocytes, macrophages, and NK cells.
bone, and intestinal mucosa tissues. TGF-β also stimulates collagen formation
and wound healing.
162. The correct answer is A. One function of his-

Answer A is incorrect. Monocytes secrete
tamine is to cause vasodilation. Histamine is
TGF-β. TGF-β is known as the anticytokine.
a molecule which functions generally as an
inflammatory mediator. Answer C is incorrect. T cells secrete TGF-β.
Answer B is incorrect. The bronchial response Answer D is incorrect. B cells secrete TGF-β.
to histamine causes broncho-constriction. Answer E is incorrect. Macrophages secrete
Answer C is incorrect. Histamine also acti- TGF-β.
vates a type I hypersensitivity response
(involving in anaphylaxis). 165. The correct answer is D. vasodilation is not
part of the cellular stage of acute inflamma-
Answer D is incorrect. Histamine is secreted tion. Acute inflammation is the initial response
by mast cells and basophils. to tissue injury and it consists largely of leukocyte
Answer E is incorrect. Histamine does not infiltration ridding of bacteria and necrotic tis-
activate complement. It binds to receptors to sue. There are two main stages: vascular and
cause its cell-specific reaction. cellular. The vascular stage is mediated by
Note that histamine is derived from the histamine-producing cells (including mast
amino acid histidine. cells, basophils, and platelets).
An exudative edem (straw-colored, protein-
163. The correct answer is C. Nitric oxide is not rich exudates of extravascular fluid) is clini-
derived from histidine. Rather, it is derived cally evident.
from arginine. The major inflammatory
Answer A is incorrect. Diapedesis is part of
mediators of the body have numerous specific
the cellular stage of acute inflammation. It is
responses, but in general they cause changes
a part of the cellular stage.
Answers: 161-169 177
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Answer B is incorrect. Margination is part Answer E is incorrect. Viral DNA is incorpo-

of the cellular stage of acute inflammation. rated into the host-cell chromosome in the
It is a part of the cellular stage. Phagocyto- lysogenic cycle. This integrated DNA is termed
sis and leukocyte degranulation lead to a prophage and it is replicated when host DNA
microbial cell lysis as well as host tissue is damaged.
damage. Note that the lytic cycle of virus replication
states that the process by which a phage repli-
Answer C is incorrect. Chemotaxis is part of
cates within the host cell is via production of
the cellular stage of acute inflammation. It is
hundreds of new progeny phage. The host
a part of the cellular stage. Mostly PMNs are
cell is eventually destroyed.
activated toward the site of injury.
Answer E is incorrect. Adhesion is part of the 168. The correct answer is A. Infectious mononu-
cellular stage of acute inflammation. It is a cleosis cannot be prevented with a vaccine.
part of the cellular stage. This disease is self-limiting, typically lasting
anywhere from 2 to 3 weeks.
166. The correct answer is B. Subgingival plaque
Answer B is incorrect. Primary varicella (vari-
is not affected by diet and saliva.
cella zoster virus) has a vaccine for its preven-
Answer A is incorrect. Supragingival plague tion. This virus can cause the following:
is located at or coronal to the gingival margin. chickenpox, macular lesions, and is some-
Subgingival plaque is located apical to the times associated with Reye syndrome.
gingival margin.
Answer C is incorrect. Smallpox (variola
Answer C is incorrect. Supragingival is com- virus) has a vaccine for its prevention.
prised mostly of gram-positive facultative
Answer D is incorrect. Hepatitis B (hepad-
cocci. Subgingival plaque is largely com-
navirus) has a vaccine for its prevention.
prised of gram-negative anaerobic bacilli and

spirochetes. Answer E is incorrect. Hepatocellular carci-
noma (hepadnavirus) has a vaccine for its
Answer D is incorrect. Supragingival plaque
prevention.
is affected by diet and saliva. Subgingival
plaque is not affected by diet and saliva.
169. The correct answer is A. Human immunodefi-
Answer E is incorrect. Supragingival plaque ciency virus does not contain only one strand
is found attached to gingival epithelial and of RNA; rather, it contains two strands. HIV is
tooth surfaces, as well as loosely adherent to of the retrovirus family. It is a single, linear
intraoral structures. RNA virus. There are two viruses associated
with this family, HTLV (adult T-cell leukemia,
167. The correct answer is C. The host cell is not chronic progressive myelopathy) and HIV
destroyed in the lysogenic cycle of bacterio- (AIDS).
phage activity.
Answer B is incorrect. gp120 protein medi-
Answer A is incorrect. There are two path- ates attachment to CD4 molecules.
ways of bacteriophage replication: the lytic
Answer C is incorrect. gp41 protein mediates
and lysogenic cycles.
fusion to the host cell.
Answer B is incorrect. The lysogenic cycle in-
Answer D is incorrect. p24 and p7 proteins
cludes a prophage. It does this by incorporation
combine to form the nucleocapsid.
of their DNA into the host-cell chromosome.
The host cell is kept vital. Answer E is incorrect. HIV contains reverse
transcriptase. It uses this to replicate within
Answer D is incorrect. Bacteriophages are
the nucleus of a host cell.
viruses. They infect bacterial cells.
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170. The correct answer is B. Cephalosporins 172. The correct answer is A. This patient is most
contain beta lactam rings. likely afflicted with osteomalacia. Osteomala-
cia is a disease of the bones which is due to
Answer A is incorrect. Cephalosporins func-
bone softening secondary to decreased vitamin
tion by inhibition of peptidoglycan cross-
D. Thus, the osteoid matrix does not calcify
linking via blockage of transpeptidase during
without vitamin D. Radiologic findings include
the last stage of cell-wall synthesis.
diffuse radiolucency which mimics osteoporo-
Answer C is incorrect. These antibiotics are sis. In order to diagnose, lab values are impor-
bacteriocidal. tant as it is difficult to distinguish osteoporosis
Answer D is incorrect. There are currently from osteomalacia on bone biopsy. There is a
four generations of this drug: first (narrow predilection for females with this disease.
spectrum: gram-positive cocci and some Answer B is incorrect. Paget disease is seen
gram-negative bacilli), second (broader spec- clinically with odd-shaped, abnormal, enlarged
trum: fewer gram-positive cocci and more bones.
gram-negative bacilli), third (broader spec-
Answer C is incorrect. Fibrous dysplasia is
trum: fewer gram-positive cocci and more
seen clinically only in certain instances. If
gram-negative bacilli, anaerobes), and fourth
bone of the head and neck region is involved,
(broader spectrum: fewer gram-positive cocci
one may see bone which is enlarging due to
and more gram-negative bacilli, anaerobes).
tumor growth within the medullary spaces.
Answer E is incorrect. They contain beta
Answer D is incorrect. Osteoporosis is seen
lactam rings in their formulation. Thus,
clinically with weakened, brittle bones caus-
cephalosporins have a 10% cross-hypersensitivity
ing weakness and an increased predilection
with penicillins.
for fracture.
171. The correct answer is E. Infection by H. Answer E is incorrect. Osteitis fibrosa cystica
influenzae does not cause enterocolitis. This is seen clinically with painful bones and pos-
disease is caused by such bacteria as Salmo- sible pathologic fractures.
nella, Shigella, and Campylobacter (all
referred to as enteric bacilli). Haemophilus 173. The correct answer is C. Increased phosphate
influenzae is a gram-negative, “respiratory” intake is not a cause of vitamin D deficiency.
bacilli. It is a facultative anaerobe and it pro- The opposite is true. Vitamin D deficiency
duces endotoxin as its major virulence can lead to numerous diseases of the bone
factor. including osteoporosis and osteomalacia.
Answer A is incorrect. Otitis media is a dis- Answer A is incorrect. Vitamin D deficiency
ease caused by H. influenzae. It is an infec- can be caused by decreased dietary intake of
tion of the middle ear. the vitamin.
Answer B is incorrect. Epiglottitis media is a Answer B is incorrect. Vitamin D deficiency
disease caused by H. influenzae. It is an infec- can be caused by decreased absorption of the
tion of the throat. vitamin.
Answer C is incorrect. Meningitis in children. Answer D is incorrect. Vitamin D deficiency
Otitis media is a disease caused by H. influen- can be caused by decreased sunlight exposure.
zae. This is an infection of the meninges of
Answer E is incorrect. Vitamin D deficiency
the brain.
can be caused by kidney failure.
Answer D is incorrect. Upper respiratory Note that there are other reasons for vita-
tract infection, Otitis media is a disease caused min D deficiency: hereditary or acquired dis-
by H. influenzae. orders of vitamin D metabolism, acidosis,
and medication side effects.
Answers: 170-176 179
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174. The correct answer is A. The laboratory find- Answer A is incorrect. A greenstick fracture
ings of anemia, increased alkaline phosphatase, is when bone is broken only on one side. It is
and increased urinary hydroxyproline indicate not through and through.
that Paget disease is present. Paget disease is a
Answer B is incorrect. A comminuted frac-
metabolic bone disease (referred to as osteitis
ture is when bone is crushed into two or
deformans) which occurs mostly in the elderly.
more pieces.
The etiology of this disease is unknown,
although it is believed to be associated with Answer C is incorrect. An open fracture is
viral infection such as mumps, measles, and when bone breaks and pierces the skin.
paramyxovirus. There is also a genetic compo- Answer E is incorrect. A single fracture is
nent. It is characterized by cycles of bone when bone is broken in one place.
destruction and regrowth of abnormal bone Note that there is another term to define
(which is enlarged and weakened). Its presenta- fracture classification: bending (no break).
tion is widespread and it will localize to one or Bone then heals in three phases after fracture:
two areas of the skeleton. Dealing with the head inflammatory (formation of blood clot), repar-
and neck, there is increased skull size, cranial ative (formation of cartilage callus → replaced
nerve foramina constriction, and teeth displace- by bony callus), and remodeling (cortex is
ment. Lab findings show anemia, increased revitalized). A nonunion is a fracture which
alkaline phosphatase (marker of osteoblastic fails to heal, whereas a malunion is a bone
activity), and increased urinary hydroxyproline which heals in an abnormal position.
(marker of osteoclastic activity). These patients
have an increased risk of osteosarcomas. 176. The correct answer is C. This patient has
Answer B is incorrect. Fibrous dysplasia has Alzheimer disease. Alzheimer is a disease
lab values showing a decrease in phosphorus characterized as being neurodegenerative
levels, and increased calcium and alkaline due to amyloid plaques and neurofibrillary
phosphate. These alone are not diagnostic. tangles. Common symptoms include demen-

tia seen in the elderly.
Answer C is incorrect. Osteoporosis may
have lab values showing low calcium levels, Answer A is incorrect. Multiple sclerosis,
although these alone are not diagnostic. a demyelinating disease, is due to damage of
white matter and symptoms of visual
Answer D is incorrect. Osteochondrosis has changes, hemisensory findings, and loss of
lab values which are not of diagnostic value. bladder control.
This disease is caused by a decrease in
blood supply to bone. Thus, a cycle of Answer B is incorrect. Myasthenia gravis
necrosis, regeneration, and reossification is a neuromuscular disease characterized by
occurs. weakness of voluntary muscles due to an
autoimmune attack of postsynaptic receptors
Answer E is incorrect. Osteopetrosis has lab in neuromuscular junctions.
values of increased acid and alkaline phos-
phatase levels. This alone is not diagnostic, Answer D is incorrect. Parkinson disease is
though. One must also view imaging studies a neurodegenerative disease caused by Lewy
to search for osteosclerosis. bodies and depigmentation of the substantia
nigra.
175. The correct answer is D. Complete fractures Answer E is incorrect. Eaton-Lambert
occur when a bone is broken into two distinct syndrome has the same symptoms as myas-
segments. In general, a fracture is a break in thenia gravis but it is not autoimmune
bone. It is the most common bone lesion and (rather, it is caused by a decrease in
occurs when force exerted overcomes bone acetylcholine).
strength.
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177. The correct answer is B. Dementia is not Answer B is incorrect. Lewy bodies are seen
part of the triad of symptoms seen with multi- with Parkinson disease.
ple sclerosis. Multiple sclerosis is a demyeli-
Answer C is incorrect. Werdnig-Hoffman
nating disease of autoimmune etiology.
disease is neurodegenerative disease seen
Answer A is incorrect. Scanning speech is with floppy babies (clinically, one would
part of the clinical triad seen clinically with find a patient with tongue fasciculations, as
multiple sclerosis. well).
Answer C is incorrect. Intention tremor is Answer D is incorrect. Poliomyelitis is a
part of the clinical triad seen clinically with lower motor neuron disease.
multiple sclerosis.
Answer E is incorrect. Huntingdon disease is
Answer D is incorrect. Nystagmus is part of an autosomal dominant disease with symp-
the clinical triad seen clinically with multiple toms of chorea and dementia.
sclerosis.
Note that these symptoms are due to a 180. The correct answer is B. A myxoma is not a
decrease or block in nerve transmission and malignant tumor derived from connective tis-
it usually begins at age 20-40 and has a sue. It is, in fact, derived from connective tis-
predilection for females. Lab findings include sue but is a benign disease. The other tumors
an increase in IgG in cerebrospinal fluid. listed in the question are all benign.
Intravenous interferon can decrease the fre- Answer A is incorrect. The choristoma is a
quency of relapses. small benign nonneoplastic mass of normal
tissue misplaced within another organ (ie,
178. The correct answer is D. Sudden paralysis
pancreatic tissue in the stomach wall).
and numbness of the body on the ipsilateral
side of the stroke is not common: these symp- Answer C is incorrect. A teratoma is a neo-
toms are seen on the contralateral side of the plasm comprised of all three embryonic germ
stroke. cell layers (it MAY become malignant,

though).
Answer A is incorrect. A stroke is due to an
infarction of the cerebrum or another part of Answer D is incorrect. Adenomas are benign
the brain. neoplasm of glandular epithelium of several
variants: papillary cystadenoma (adenoma-
Answer B is incorrect. It is caused by arterial
tous papillary processes extending into cystic
occlusion to and/or in the brain. This occlu-
spaces) and fibroadenoma (proliferating con-
sion is caused by thrombus or embolism and
nective tissue surrounding neoplastic glandular
hemorrhage/brain bleed.
epithelium).
Answer C is incorrect. Symptoms depend
Answer E is incorrect. A papilloma is a
on the area of the brain affected. They often
benign tumor of surface epithelium.
include hemiparesis and numbness on the
side of the body opposite the stroke. 181. The correct answer is A. Ultraviolet light
Answer E is incorrect. Hemorrhage of the does not produce free radicals that can attack
brain can cause a stroke. This is due to DNA bases. This is actually the definition of
ischemia secondary to blood loss. ionizing radiation (form gamma and x-rays).
Ultraviolet light causes cross-linking of adja-
179. The correct answer is A. Alzheimer disease cent pyrimidine bases, and viruses cause
is not characterized by the presence of Lewy frameshift mutations of deletions.
bodies. Patients stricken with Alzheimer dis-
Answer B is incorrect. Dimers (eg, thymine
ease show the presence of amyloid plaques
dimers) interfere with DNA replication.
and neurofibrillary tangles.
Answers: 177-185 181
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Answer C is incorrect. Chemicals (nitrous an increased rate of mutagenesis comes an

oxide, alkylating agents, benzpyrene) alter increase in the response to radiation therapy.
existing bases and bind existing DNA bases to
Answer A is incorrect. Lymphocytes have a
cause frameshifts.
high cell turnover. Thus, they have an
Answer D is incorrect. Viruses cause frame- increased radiosensitivity.
shift deletions.
Answer B is incorrect. Reproductive cells
have a high turnover. Thus, they have an
182. The correct answer is D. Breast cancer is
increased radiosensitivity.
characterized clinically by peau d’orange
(swollen, pitted surface on breast) and Answer D is incorrect. Epithelial cells have a
enlarged axillary lymph nodes. This neo- high turnover. Thus, they have an increased
plasm is the most common cancer in women. radiosensitivity.
It usually does not affect women until they
Answer E is incorrect. Bone marrow cells
have reached menopause. There is a strong
have high turnover. Thus, they have an
genetic component of the disease and it is
increased radiosensitivity.
due to mutation of the BRCA-1 and BRCA-2
Note that cells with low turnover and thus
genes. Other clinical symptoms include a
low radiosensitivity include: nerve cells,
painless mass in the breast and skin/nipple
mature bone cells, and muscle cells.
retraction. The left breast is more often
affected. Metastasis and spread goes to the 184. The correct answer is B. A medulloblas-
chest wall, axillary nodes, and other distant toma is a highly malignant cerebellar tumor
sites (other breast, liver, bone, brain). Histo- that is also of primitive neuroectodermal
logically, the appearance is that of adenocar- origin. This type of tumor occurs in
cinoma and the prognosis is made based on children.
the nodal involvement.
Answer A is incorrect. Glioblastoma multi-

Answer A is incorrect. The clinical signs of forme occurs in adults. It is the most com-
squamous cell carcinoma are totally depen- mon primary brain tumor in humans.
dent on the area of concern. For example,
sites on the skin may have unusual, nonheal- Answer C is incorrect. A low-grade astrocy-
ing areas which are growing and/or changing toma occurs in children. It occurs in the pos-
appearance. terior cranial fossa.
Answer B is incorrect. The clinical signs of Answer D is incorrect. A craniopharyngioma
lung cancer are coughing, dyspnea, hemopty- occurs in children. It is a benign tumor, and
sis, chest pain, and wheezing. can cause bitemporal hemianopia. It is derived
from Rathke pouch.
Answer C is incorrect. The clinical signs of
colorectal cancer are changes in stool appear- Answer E is incorrect. An ependymoma is a
ance and/or consistency, as well as anorexia tumor which occurs in children. This hap-
and malaise. pens, often, in the 4th ventricle, can cause
hydrocephalus.
Answer E is incorrect. The clinical signs of Note these other tumors which occur in
uterine cancer are unusual bleeding and pain humans: meningioma (adults: 2nd most com-
in the pelvic region. mon primary brain tumor, arises from arach-
noid) and pituitary adenoma (adults: usually
183. The correct answer is C. Nerve cells have
secrete prolactin, can present as bitemporal
the lowest radiosensitivity. This concept is
hemianopia).
based on a cell’s rate of proliferation: the
higher the rate of proliferation, the more 185. The correct answer is C. The cancer with
sensitive the cell is to radiation. Thus, with the highest incidence in men is prostate
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cancer. It is the 2nd highest cause of cancer Answer D is incorrect. Actinic keratosis
death in men. presents clinically with scaly, crust-ridden,
thicker than normal skin. It is premalignant.
Answer A is incorrect. Colorectal cancer has
the 2nd highest incidence of cancer in men. Answer E is incorrect. Melanoma presents
It also has the 3rd highest cause of cancer clinically with lesion that is asymmetric, has
death in men. ragged borders, an odd color, and a larger
diameter.
Answer B is incorrect. Urinary tract cancer
has the 4th highest incidence of cancer in
187. The correct answer is A. Of the listed neo-
men.
plasms, pigmented nevus is the only one that
Answer D is incorrect. Lung cancer has the is benign. The other cancers are all malig-
2nd highest incidence of cancer in men. It is nant. Pigmented nevus is a benign neoplasm,
the highest cause of cancer death in men. which presents in four forms: nevocellular
(common mole: hamartoma, cluster of nevus
Answer E is incorrect. Leukemia has the 4th
cells derived from melanocytes), junctional
highest cause of cancer death in men.
(confined to epidermal-dermal junction),
Note: The cause of prostate cancer is
compound (occurs at epidermal-dermal junc-
unknown, although it is possibly due to an
tion and in the dermis), and intradermal
increase in testosterone (increase in dietary
(within the dermis and often not pigmented).
fat leads to increased testosterone). Labora-
tory findings include an increase in prostate- Answer B is incorrect. Squamous cell carci-
specific antigen (PSA) and increased acid noma presents with symptoms that are totally
phosphatase. Histologically, it mimics adeno- dependent on the area affected.
carcinoma and its common sites of metastasis
Answer C is incorrect. Melanoma presents
include bones and lungs.
with a lesion that has atypical shape, irregular
borders, multiple colors, and a large diameter.
186. The correct answer is B. This patient most

likely has basal cell carcinoma. This type of Answer D is incorrect. Keratocanthoma pre-
neoplasm is the most common skin cancer sents with a lesion which is usually solitary,
(75% of all skin cancers) and is the most firm, round, skin-colored, and it rapidly pro-
common form of all cancers in the United gresses to a dome-shaped nodule.
States. It is derived from basal cells of the
epidermis. Clinically, most occur on sun- 188. The correct answer is C. Squamous cell car-
exposed areas of the head and neck. It cinoma of the skin is not normally treated
appears as a pearly papule with overlying with chemotherapy. Treatment is excision
telangiectatic vessels. Basal cell carcinoma is and sometimes radiation therapy. This type of
locally aggressive, invasive, and destructive. It cancer is malignant and of epithelial origin.
ulcerates, bleeds, and appears nonhealing. It is more aggressive than basal cell carci-
The histology shows darkly staining basaloid noma and the mean age is 50 years old.
cells with a typical palisade arrangement of Answer A is incorrect. Histologically, there
nuclei at the periphery of tumor cell clusters. are sheets and islands of neoplastic epidermal
The prognosis is good when treated early. cells in the middle of the epidermis, as well
Answer A is incorrect. Dermatofibroma pre- as keratin pearls.
sents clinically with benign skin lumps on the Answer B is incorrect. These malignant cells
body. There is a predilection for the legs. have increased laminin receptors.
Answer C is incorrect. Squamous cell carci- Answer D is incorrect. Causes include the
noma presents with many different clinical sun, radiation, x-ray exposure, and chemical
presentations, depending on the part of the carcinogens.
body affected.
Answers: 186-192 183
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Answer E is incorrect. Clinically, it may sometimes with increasing pain with time.
appear as normal skin, damaged skin (burn, One-third of children have metastasis at time
scar, chronic inflammation), or sun-damaged of diagnosis.
skin (face, dorsal hands). The lesion is scaling,
Answer E is incorrect. Ewing sarcoma is a
indurated, ulcerated, and painless initially.
nonosseous malignant bone tumor.
Squamous cell carcinoma is locally invasive
and metastasizes to nodes and organs. 191. The correct answer is E. Type I hypersensitiv-
ity reaction is not a possible cause of dissemi-
189. The correct answer is E. Regarding
nated intravascular coagulation. This condition
melanoma of the skin, the initial phase of
is life threatening and involves uncontrolled,
growth is not vertical. The histology shows
cyclic bleeding and clotting throughout the
growth phases that begin in a radial phase (no
body. There is extensive microclot formation
metastasis, lateral spread, characteristic of the
and the bleeding accompanies fibrinolysis
“spreading” types of melanoma) and subse-
(thus increased fibrin split products/D-
quent vertical phase (into reticular dermis or
dimers → important indicators of DIC). Lab
deeper, metastasis possible, depth of growth
findings include decreased platelet count,
determines prognosis, and this type is charac-
increased PT and PTT, hypofibrinogenemia,
teristic of nodular melanoma).
and decreased levels of all clotting factors and
Answer A is incorrect. It is a malignant fibrinolytic proteins.
tumor of melanocytes or nevus cells and has
Answer A is incorrect. Major trauma is a
a high incidence. Causes are sunlight (specif-
possible cause of disseminated intravascular
ically, sunburns at an early age).
coagulation.
Answer B is incorrect. The most common
Answer B is incorrect. Malignancy is a possi-
form of melanoma of the skin is the superfi-
ble cause of disseminated intravascular
cial spreading type.
coagulation.

Answer C is incorrect. Melanoma is the
Answer C is incorrect. Gram-negative sepsis
most deadly form of skin cancer. It is most
is a possible cause of disseminated intravascu-
common in fair-skinned persons or those
lar coagulation.
with blue/green eyes and red/blonde hair.
Answer D is incorrect. Amniotic fluid
Answer D is incorrect. The clinical course
embolism is a possible cause of disseminated
may include very rapid spread. Melanoma of
intravascular coagulation.
the skin occurs in many forms. It may appear
on what were normal skin, a mole, and other 192. The correct answer is C. Iron deficiency
skin area that has changed appearance. does not result in macrocytic anemia. Iron
deficiency leads to a form of anemia called
190. The correct answer is A. Ewing sarcoma is a
hypochromic microcytic (pale, small RBCs).
disease in which histology alone is not spe-
cific for diagnostic purposes. Answer A is incorrect. Chronic blood loss
can cause iron deficiency, thus leading to a
Answer B is incorrect. Ewing sarcoma is
form of anemia.
highly radiosensitive.
Answer B is incorrect. Clinical findings of
Answer C is incorrect. This form of cancer
iron deficiency include pallor, fatigue, short-
typically afflicts children aged 10-20 years old.
ness of breath, glossitis, and koilonychias.
Answer D is incorrect. This cancer originates
Answer D is incorrect. Iron deficiency can
in the bone marrow and invades long and flat
lead to Plummer-Vinson syndrome. This is
bones such as the femur, tibia, fibula, and
iron-deficiency anemia due to upper eso-
humerus, as well as the pelvis, ribs, skull, ver-
phageal webbing.
tebra, and facial bones. Symptoms are few,
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Answer E is incorrect. Iron deficiency can be Answer C is incorrect. Hypercholesterolemia

caused by a poor diet. is a common lab finding seen with nephrotic
syndrome. It is characterized by an increase
193. The correct answer is B. Duodenal resection
of cholesterol in the blood.
would not cause vitamin B12 deficiency.
Answer D is incorrect. The renal glomeruli
Answer A is incorrect. Pernicious anemia is
are not function properly with nephrotic syn-
caused by decreased intrinsic factor. This is
drome. Thus, filtration is malfunctioning.
due to autoimmune gastritis.
Answer C is incorrect. Gastric resection is 195. The correct answer is B. Rubella infections
the removal of cells producing intrinsic fac- are largely associated with lymphocytosis.
tor, thus, parietal cells.
Answer A is incorrect. Giardia is a parasite.
Answer D is incorrect. Dietary deficiency of Thus, they would be associated with
B12 is commonly seen in strict vegetarians. eosinophilia.
Note that ileal resection (removal of
Answer C is incorrect. Fever is a common
intestinal cells that absorb B12) can cause
systemic response to infection.
anemia. This type of deficiency results in
megaloblastic anemia. Patients would have Answer D is incorrect. Leukocytosis is a
an abnormal Schilling test, fatigue, shortness common result of bacterial, parasitic, and
of breath, tingling sensations, difficulty walk- viral infection. The systemic effects of inflam-
ing, and diarrhea. mation can be generalized by three types of
leukocytosis: neutrophilia, eosinophilia, and
194. The correct answer is E. Proteinuria would lymphocytosis.
be seen with nephrotic syndrome. This type
Answer E is incorrect. Clostridium is a bac-
of kidney disorder is due to inflammation
terium. Thus, it is largely associated with
affecting the glomeruli. This inflammation
neutrophilia.
leads to numerous types of glomeru-

Note that these responses are based on the
lonephropathies (rapidly progressive nephritic
type of offending organism within the body.
syndrome, nephrotic syndrome, chronic
Bacterial infections are associated with neu-
nephritic syndrome). Nephrotic syndrome
trophilia, parasitic infections are associated
can occur at any age and is characterized by
with eosinophilia, and viral infections are asso-
proteinuria, hypoalbuminemia, hyperlipidemia,
ciated with lymphocytosis. Fever also occurs
and edema. The specific cause of these symp-
with most of these types of leukocytosis.
toms is increased glomerular capillary perme-
ability, thus leading to decreased blood protein 196. The correct answer is B. Regarding edema,
and increased protein in the urine. This syn- there is an increase in interstitial fluid colloid
drome is associated with many diseases and osmotic pressure. Edema is an abnormal
the clinical symptoms are vast, including loss accumulation of fluid in interstitial spaces of
of appetite, malaise, puffy eyelids, abdominal body cavities.
pain, frothy urine, muscle wasting, and tissue
edema. Answer A is incorrect. There is an increase
in capillary permeability seen with tissue
Answer A is incorrect. Hypoalbuminemia is edema.
a common lab finding seen with nephrotic
syndrome. It is characterized by a decrease of Answer C is incorrect. There is an increase
the protein-carrier albumin in the blood. in plasma colloid osmotic pressure seen with
tissue edema.
Answer B is incorrect. Hyperlipidemia is a
common lab finding seen with nephrotic syn- Answer D is incorrect. There is an increase
drome. It is characterized by an increase of in capillary hydrostatic pressure seen with
lipids in the blood. tissue edema.
Answers: 193-200 185
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Answer E is incorrect. Fluid tends to move Answer C is incorrect. Wilson disease can
out of the intravascular space in instances of lead to cirrhosis of the liver.
tissue edema.
Answer D is incorrect. Viral hepatitis can
Note that there are two main types of edema:
lead to cirrhosis of the liver.
transudative (more watery/serious, noninflam-
Note that alcoholism (most common → 75%)
matory, due to altered intravascular hydrostatic
and inborn errors of metabolism can also
or osmotic pressure) and exudative (more
lead to cirrhosis of the liver. Clinically, the
protein-rich, inflammatory, due to increased
patient would be suffering from ascites,
vascular permeability with inflammation).
splenomegaly, jaundice, coagulopathy, confu-
sion/hepatic encephalopathy, portal hyper-
197. The correct answer is A. There is a decrease
tension, and esophageal varices.
in urinary output in patients suffering from
systemic shock. Shock is a condition due to
199. The correct answer is C. There is not a
decreased tissue perfusion.
decrease in unconjugated bilirubin in the
Answer B is incorrect. Patients experiencing blood in patients with hemolytic anemia.
shock become hypotensive. This is typically Hemolytic anemia is a blood disorder character-
due to a loss of blood. ized by decrease in red blood cell life span and
thus increased red blood cell destruction. There
Answer C is incorrect. There is a decrease in
is hyperbilirubinemia and hemoglobinemia.
blood flow in patients that are undergoing
shock. Answer A is incorrect. Bilirubin, the break-
down product of hemoglobin, is increased in
Answer D is incorrect. There is a decrease
its unconjugated form (which is water insolu-
in cardiac output in patients experiencing
ble) leading to jaundice. This leads to yellow
shock. This is primarily due to a decrease in
under the tongue and yellow sclera, the first
stroke volume, and secondarily due to
clinical sign of the disease.
hypovolemia.

Answer B is incorrect. Hyperbilirubinemia is
Answer E is incorrect. There is a decrease in
a common laboratory finding in patients with
stroke volume in patients experiencing shock.
hemolytic anemia. This is due to increased
This is due to hypovolemia.
red blood cell breakdown.
Note: There are hemodynamic changes
which result in decreased blood flow and thus Answer D is incorrect. Conjugated bilirubin
decreased oxygen and metabolic supply to forms from albumin and unconjugated
tissues. The end outcome is multiple organ bilirubin.
damage or failure. Symptoms include fatigue
Answer E is incorrect. The pathophysiology
and confusion. Signs are pallor, thready pulse,
includes broken down red blood cells in
hypotension, and decreased urine output.
which hemoglobin is liberated and found in
Immediate medical treatment is necessary.
the urine and blood. Thus, hemoglobinuria
is a common laboratory finding.
198. The correct answer is E. Portal hypertension
Note that the autoimmune form of this
does not lead to cirrhosis. It is a result of cir-
anemia is due to IgG antibodies combining
rhosis, though. Cirrhosis is the most common
with red blood cell surface antigen. This is
chronic liver disease characterized by scar-
diagnosed with a positive direct Coombs test.
ring/fibrosis, loss of architecture, and forma-
tion of regenerative nodules.
200. The correct answer is E. Patients with sickle-
Answer A is incorrect. Hemochromatosis can cell trait are heterozygotic for the disease.
lead to cirrhosis of the liver. Sickle-cell anemia is a disease of primarily
African Americans. It is inherited autosomal
Answer B is incorrect. Biliary obstruction
recessive (Hb-S from both parents) resulting
can lead to cirrhosis of the liver.
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in an abnormal type of hemoglobin. The Note: This form of anemia deals with sickled
globin portion has a valine substituted for red blood cells, thus, hemoglobin instability
glutamic acid in the sixth position. when exposed to stress. This results in hypoxic
conditions (decreased oxygen). There are
Answer A is incorrect. The heterozygotic
four types of crises which can occur because
form is termed sickle cell trait, and is less
of this: sickle-cell pain crisis (formation of
severe. The homozygotic version is sickle cell
small blood clots), hemolytic crisis (life-
disease, and is more severe.
threatening breakdown of damaged RBCs),
Answer B is incorrect. The spleen is often splenic sequestration crisis (enlarged spleen
affected. This is due to sickled red blood cells due to trapping of sickled RBCs), and aplastic
becoming entrapped within the spleen. crisis (infection causes bone marrow to stop
Answer C is incorrect. African Americans are producing RBCs). Repeated bouts of sickle
most commonly affected by sickle cell cell crises can damage the kidneys, lungs,
anemia. bones, eyes, and the CNS.
Answer D is incorrect. It is an inherited auto-

somal recessive disease.
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CHAPTER 4
Dental Anatomy
and Occlusion
187
188 Chapter 4: Dental Anatomy and Occlusion
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Q U E ST I O N S
1. Which feature allows one to distinguish C. The first statement is true; the second is
between the permanent mandibular lateral false.
incisor and the permanent mandibular central D. The first statement is false; the second is
incisor from an occlusal view? true.
A. A decreased mesiodistal length of the
6. All of the following muscles involved in mas-
lateral incisor.
tication are innervated by the mandibular
B. The cingulum location is slightly distal of
branch of trigeminal nerve EXCEPT
center on the central incisor.
C. The distolingual twist of the lateral A. temporalis.
incisor’s incisal edge. B. masseter.
D. The incisal edge of central incisor is C. buccinator.
lingual to the root axis line. D. medial pterygoid.
E. lateral pterygoid.
2. How many cusp tips can be seen on a
mandibular 1st molar when viewed directly 7. The horizontal distance between the labioin-
from the buccal? cisal surfaces of mandibular incisors and the
linguoincisal surfaces of maxillary teeth is
A. 2
referred to as
B. 3
C. 4 A. overjet.
D. 5 B. overbite.
C. openbite.
3. All of the following are true regarding the D. crossbite.
curve of Spee EXCEPT
8. The primary mandibular 2nd molar most
A. the curve in the lower arch is concave.
closely resembles which permanent tooth?
B. the curve in the upper arch is convex.
C. the curve is formed by the lingual inclina- A. Mandibular 1st molar
tion of the mandibular molars. B. Mandibular 2nd molar
D. the curve is directed anteroposteriorly. C. Maxillary 1st molar
D. Maxillary 2nd molar
4. Which tooth has the most prominent lingual
ridge with mesial and distal fossae? 9. The primary teeth erupt in which of the fol-
lowing sequences?
A. Maxillary central incisor
B. Mandibular lateral incisor A. ABCDE
C. Maxillary lateral incisor B. BACDE
D. Mandibular canine C. ABDCE
E. Maxillary canine D. ACBDE
5. On a maxillary molar the palatal root is the 10. A triangular outline form is present on which
longest of the three roots. Among all maxil- of the following teeth when viewed from the
lary teeth, the palatal root of the maxillary 1st proximal aspect?
Dental Anatomy
and Occlusion
molar is the 3rd longest root. A. Mandibular 1st premolar

A. Both statements are true. B. Maxillary 1st molar
B. Both statements are false. C. Mandibular central incisor
D. Mandibular 1st molar
Questions: 1-19 189
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11. A patient presents to your office with what 16. Which tooth has a mesial marginal ridge that
appears to be five mandibular incisors. How- is more cervically located than the distal mar-
ever, upon radiographic examination, you ginal ridge?
count four roots. The most likely explanation
A. Maxillary 1st premolar
for this finding is
B. Maxillary 2nd premolar
A. concrescence. C. Mandibular 1st premolar
B. hypercementosis. D. Mandibular 2nd premolar
C. fusion.
D. gemination. 17. In an ideal occlusion, the lingual cusp of the
E. fibrous dysplasia. permanent maxillary 1st premolar occludes
where?
12. Angle classification of occlusion is based pri-
A. Mesial triangular fossa of the mandibular
marily on
1st premolar
A. the relationship between the maxillary B. Distal triangular fossa of the mandibular
and mandibular anterior teeth. 1st premolar
B. the position of the maxillary canines. C. Distal marginal ridge of the mandibular
C. the relationship between the maxillary 1st premolar
and mandibular 1st molars. D. Mesial marginal ridge of the mandibular
D. the amount of anterior overjet. 2nd premolar
E. Mesial triangular fossa of the mandibular
13. Primary teeth are more constricted at the cer- 2nd premolar
vical 3rd than their permanent counterparts.
Pulp chambers are comparatively smaller in 18. Of the mandibular premolars, the 1st premo-
primary teeth. lar has the longest and sharpest buccal cusp.
Among maxillary premolars, the 2nd premo-
lar has the longest and sharpest buccal cusp.
C. The first statement is true; the second is A. Both statements are true.
false. B. Both statements are false.
D. The first statement is false; the second is C. The first statement is true; the second is
true. false.
D. The first statement is false; the second is
14. Which of the following premolars does not true.
have a transverse ridge?
19. All of the following are true regarding primary
molars in comparison to permanent molars
EXCEPT
C. Mandibular 1st premolar
D. Mandibular 2nd premolar (2-cusp type) A. primary teeth have roots that are longer,
E. Mandibular 2nd premolar (3-cusp type) more slender, and highly divergent.
B. primary molars have a much more pro-
15. When the mandible shifts to the left, the nounced buccal cervical ridge.
right condylar head moves in which direction C. deciduous enamel is thinner, and has a
relative to articular eminence? more consistent depth throughout the
crown.
Dental Anatomy
A. Anteriorly, downward, laterally

and Occlusion
B. Anteriorly, downward, medially D. primary molars have shorter root trunks.

C. Anteriorly, upward, laterally E. primary molars have well-defined
D. Anteriorly, upward, medially occlusal anatomy with pronounced ridges
E. Posteriorly, upward, laterally and deep fossae.
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20. How many premolars are found in each D. Distal; 1st molar
quadrant of a normal deciduous dentition? E. Distobuccal; 2nd molar
A. 0
26. Which of the following teeth have a func-
B. 1
tional lingual surface?
C. 2
D. 3 I. Maxillary incisors
E. 4 II. Maxillary canines
III. Mandibular incisors
21. Which of the following are supporting cusps? IV. Mandibular canines
A. Distobuccal cusp of maxillary 1st molars A. I only
B. Lingual cusp of mandibular 2nd B. I and IV
premolars C. III and IV
C. Mesiolingual cusp of maxillary 1st molars D. I and II
D. Distolingual cusp of mandibular 1st molars E. None of the above
22. Which of the following is TRUE of individuals 27. How many point angles are found on tooth
with anodontia? No. 12?
A. They have additional or supernumerary A. 1
teeth. B. 2
B. They have congenitally missing teeth. C. 3
C. They have additional maxillary and D. 4
mandibular incisors. E. 5
D. They have all teeth shaped as incisors.
E. None of the above. 28. All of the following cusp tips occlude in the
central fossa of an opposing tooth during
23. The primary sensory innervation of the TMJ ideal intercuspation EXCEPT
arises from what cranial nerve?
A. mesiobuccal of mandibular 1st molar.
A. CN V B. distobuccal of mandibular 1st molar.
B. CN VII C. mesiolingual of maxillary 2nd molar.
C. CN VIII D. distobuccal of mandibular 2nd molar.
D. CN IX
E. CN XI 29. Using the Universal Numbering System,
which of the following represents the four
24. Which posterior tooth is most symmetrical permanent adult canines?
from an occlusal view?
A. 13, 23, 33, 43
A. Maxillary 1st premolar B. 6, 11, 22, 27
B. Maxillary 2nd premolar C. C, H, R, M
C. Maxillary 1st molar D. 6, 12, 22, 27
D. Mandibular 1st premolar E. 53, 63, 73, 83
E. Mandibular 1st molar
30. Which tooth is most likely to have two canals
25. In an ideal occlusion, the _____ cusp of the in a single root?
Dental Anatomy
mandibular _____ contacts the central fossa

and Occlusion
of the maxillary 1st molar. A. Mandibular lateral incisor

B. Mandibular canine
A. Buccal; 2nd premolar C. Mandibular 2nd premolar
B. Mesiobuccal; 1st molar D. Maxillary central incisor
C. Distobuccal; 1st molar E. Maxillary canine
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31. The mandibular condyle and its associated C. The mesiobuccal groove of the mandibu-
disc slide against which surface in normal lar 2nd molar
mandibular opening? D. The buccal embrasure between the
mandibular 1st and 2nd molars
A. Posterior one-fourth of mandibular fossa
B. Anterior portion of articular eminence
36. Which one of the following normally single-
C. Posterior portion of articular eminence
rooted teeth is most likely to have a bifur-
D. Articular (glenoid) fossa
cated root?
32. The crown of the primary maxillary central A. Maxillary central incisor
incisor B. Maxillary lateral incisor
C. Maxillary canine
A. has a longer length incisocervically and is
D. Mandibular canine
smaller mesiodistally than the permanent
E. Maxillary 1st premolar
maxillary central incisor.
B. has a longer length incisocervically and is
37. Which tooth is likely to have root depressions
larger mesiodistally than the permanent
on both the mesial and distal root surfaces?
maxillary central incisor.
C. has a shorter length incisocervically and A. Maxillary central incisor
is smaller mesiodistally than the perma- B. Maxillary lateral incisor
nent maxillary central incisor. C. Maxillary 2nd premolar
D. has a shorter length incisocervically and D. Mandibular 2nd premolar
is larger mesiodistally than the perma-
nent maxillary central incisor. 38. The mandible functions as what type of lever?
A. Class I
33. In a maxillary 1st molar, a depression associ- B. Class II
ated with a furcation might be detectable on C. Class III
all of the following surfaces EXCEPT D. Class IV
A. buccal.
B. palatal. 39. At what age is a child expected to have 12 pri-
C. mesial. mary teeth and 12 permanent teeth?
D. distal. A. 61/2 years
B. 71/2 years
34. Which of these surfaces is a proximal surface? C. 81/2 years
A. Facial D. 101/2 years
B. Lingual E. 121/2 years
C. Incisal
D. Buccal 40. All of the following are true of the functional
E. Mesial outer aspect (FOA) in ideal occlusions
EXCEPT
35. In an ideal occlusion, the mesiobuccal cusp A. it is located on the outer aspect of
of the permanent maxillary 2nd molar supporting cusps.
opposes which of the following? B. it may contact the inner incline of
A. The buccal groove of the mandibular supporting cusps.
Dental Anatomy
2nd molar C. in the mandibular arch, it is a continuous

and Occlusion
B. The distobuccal groove of the mandibu- ribbon which runs from the buccal of one
lar 1st molar 3rd molar to the other, covering the
incisal edges of the lower anterior teeth.
D. it does not exist on maxillary anterior teeth.
E. it is no more than 1 mm wide.
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41. When viewed from the occlusal, the proxi- D. Mandibular lateral incisor
mal contact between mandibular 1st and 2nd E. Mandibular canine
molars is located
47. All posterior teeth have a height-of-contour
A. slightly lingual to the middle 3rd.
located in which segment of the crown?
B. in the middle 3rd.
C. slightly buccal to the middle 3rd. A. Occlusal 3rd of the lingual surface
D. in the cervical 3rd. B. Middle 3rd of the buccal surface
C. Middle 3rd of the lingual surface
42. How many teeth in the primary dentition D. Cervical 3rd of the lingual surface
normally have a cingulum?
48. The maxillary 1st premolar typically has a
A. 6
pulp chamber of what shape (at the level of
B. 8
the CEJ)?
C. 10
D. 12 A. Round
E. 14 B. Egg shaped
C. Oval (flattened mesiodistally)
43. The maxillary buccal and mandibular lingual D. Oval (flattened buccolingually)
cusps function as supporting cusps in which E. Rectangular
of the following occlusal schemes?
49. During mandibular movement, which aspect
A. Ideal intercuspal relationship
of a mandibular molar will never contact its
B. Nonworking side movement
maxillary antagonist, assuming all occlusal
C. Working-side movement
relationships are ideal?
D. Posterior crossbite
A. Outer aspect of the buccal cusps
44. A 25-year-old patient presents with mamelons B. Inner aspect of the buccal cusps
on the incisors. Which of the following is the C. Inner aspect of the lingual cusps
most likely explanation for this finding? D. Outer aspect of the lingual cusps
A. Posterior crossbite
50. Which succedaneous tooth erupts beneath
B. Anterior crossbite
tooth J?
C. Variation of normal
D. Anterior open bite A. 1
E. Nocturnal bruxism B. 10
C. 13
45. Which muscle inserts in the articular disc D. 20
and condylar neck? E. 21
A. Masseter
51. The greatest contour of the cervical line
B. Medial pterygoid
(CEJ) can be found on the
C. Lateral pterygoid
D. Temporalis A. mesial aspect of anterior teeth.
B. mesial aspect of posterior teeth.
46. Which of the following has both mesial and C. distal aspect of anterior teeth.
distal contact areas located at the same height D. distal aspect of posterior teeth.
Dental Anatomy
in the incisal 3rd?

and Occlusion
52. Which cusp on permanent maxillary molars

generally gets progressively smaller from the
B. Maxillary lateral incisor
1st to the 3rd molar?
C. Mandibular central incisor
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A. Mesiolingual C. Cusp of Carabelli

B. Distolingual D. Mesiobuccal
C. Mesiobuccal E. Distobuccal
D. Distobuccal
58. The incisal edge or cusp tip of which tooth
53. A working interference is a premature con- ideally lies in the facial embrasure between
tact of the posterior teeth on the same side as the mandibular canine and mandibular 1st
the direction of the mandibular movement. A premolar?
protrusive interference is a premature contact
A. Maxillary lateral incisor
between the mesial aspects of maxillary poste-
B. Maxillary canine
rior teeth and the distal aspects of mandibular
C. Maxillary 1st premolar
posterior teeth.
D. Maxillary 2nd premolar
B. Both statements are false. 59. Which cusp is most likely to be absent on a
C. The first statement is true; the second maxillary 2nd molar?
statement is false. A. Mesiolingual
D. The first statement is false; the second B. Distolingual
statement is true. C. Cusp of Carabelli
D. Mesiobuccal
54. Which of the following teeth contacts only
E. Distobuccal
one other tooth in the opposing arch in an
ideal occlusion? 60. The bud stage of tooth development starts at
A. Maxillary central incisor about
B. Maxillary lateral incisor A. 6 weeks in utero.
C. Mandibular central incisor B. 8 weeks in utero.
D. Maxillary 3rd molar C. 9 weeks in utero.
E. Both C and D D. 11 weeks in utero.
E. 18 weeks in utero.
55. Which of the following has the highest fre-
quency of impaction? 61. As a dentist, how many determinants of
A. Maxillary lateral incisor occlusion can you directly control?
B. Maxillary canine A. 0
C. Maxillary 1st molar B. 1
D. Mandibular canine C. 2
E. Mandibular 2nd premolar D. 3
E. 4
56. A cervical ridge is found on the facial surface
of how many primary teeth? 62. Molar crowns typically taper from buccal to
A. 4 lingual when viewed from the occlusal.
B. 8 Which tooth, as an exception, is most likely
C. 12 to taper from lingual to buccal?
D. 16 A. Mandibular 1st molar
E. 20
Dental Anatomy
B. Mandibular 2nd molar

and Occlusion
C. Maxillary 1st molar

57. Which cusp has two triangular ridges on the
maxillary 1st molar?
A. Mesiolingual
B. Distolingual
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63. How many teeth contact both anterior and A. Maxillary central incisor
posterior segments of the opposing arch in B. Maxillary lateral incisor
ideal intercuspation? C. Maxillary canine
D. Mandibular central incisor
A. 0
E. Mandibular lateral incisor
B. 2
C. 4
69. Which of the following muscles is/are most
D. 6
active in maintaining centric occlusion?
E. 8
I. Masseter
64. Which cusp is the longest and largest on a II. Medial pterygoid
maxillary 1st molar? III. Lateral pterygoid
A. Mesiolingual IV. Temporalis
B. Distolingual A. I only
C. Mesiobuccal B. I and II
D. Distal C. I and IV
E. Distobuccal D. II and III
E. I, II, and IV
65. Unique features of the primary mandibular 1st
molar include all of the following EXCEPT 70. In total, how many grooves can be found on
A. the mesial marginal ridge is overdevel- the buccal and lingual surfaces of both
oped and resembles a cusp. mandibular 1st and 2nd molars?
B. the mesiolingual cusp is the largest. A. 2
C. the occlusal table distal to the transverse B. 3
ridge is larger than the portion mesial to C. 4
the transverse ridge. D. 5
D. there is no central fossa. E. 6
E. the crown is much wider mesiodistally
than buccolingually. 71. Which of the following is the best description
of where primate spaces are located?
66. Which tooth is most likely to have a cervical
enamel projection? A. Between all the primary anterior teeth
B. Between the canine and 1st premolar in
A. Maxillary central incisor the mandible
B. Maxillary canine C. Distal to the primary canines in the maxilla
C. Mandibular 1st premolar D. Between the canine and 1st and 2nd pri-
D. Mandibular 2nd premolar mary molars
E. Mandibular 2nd molar E. Distal to primary canines in the mandible
67. The mandibular canine is most likely to 72. How many transverse ridges exist on a maxil-
occlude with the _____. lary molar?
A. maxillary canine only A. 0
B. maxillary canine and 1st premolar B. 1
C. maxillary 1st premolar only C. 2
Dental Anatomy
D. maxillary lateral incisor only D. 3

and Occlusion
E. maxillary lateral incisor and canine E. 4
68. Which of the following teeth has the roundest

pulp chamber (at the level of the CEJ)?
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73. In an ideal dentition, which of the following A. MB of maxillary 1st molar

teeth occludes with only one other tooth in B. DB of maxillary 1st molar
the opposing arch during the full range of C. ML of maxillary 1st molar
mandibular movements? D. DL of maxillary 1st molar
E. Buccal of maxillary 2nd premolar
A. Mandibular 1st molar
B. Mandibular lateral incisor
79. The primary maxillary 1st molar most closely
C. Mandibular central incisor
resembles which permanent tooth?
D. Maxillary lateral incisor
E. Maxillary central incisor A. Mandibular 1st molar
74. A maxillary molar has _____ fossae; and the C. Maxillary 1st premolar
mandibular molar has _____ fossae on the D. Maxillary 1st molar
occlusal surface. E. Maxillary 2nd molar
A. 3; 3
80. The facial height-of-contour of the maxillary
B. 3; 4
2nd premolar is in what segment of the
C. 4; 3
crown?
D. 4; 4
A. Incisal 3rd
75. Maxillary 1st molars are wider mesiodistally on B. Junction of the incisal and middle 3rds
the buccal than the lingual. Mandibular 1st C. Middle 3rd
molars are wider on the lingual than buccal. D. Junction of the middle and cervical 3rds
E. Cervical 3rd
81. Ordinarily, a 7-year-old child would have
C. The first statement is true; the second is
what teeth clinically visible in the mouth?
false.
D. The first statement is false; the second is A. All 20 primary teeth and 4 permanent 1st
true. molars
B. 18 primary teeth and 2 permanent teeth
76. What TMJ ligament is derived from the 1st C. 16 primary teeth and 8 permanent teeth
branchial arch? D. 12 primary teeth and 12 permanent teeth
A. Temporomandibular
82. In an Angle class III malocclusion, the cusp
B. Sphenomandibular
tip of the maxillary canine is located
C. Stylomandibular
D. Lateral A. distal to the buccal embrasure created by
the mandibular canine and 1st premolar.
77. Which of the following is the term for a B. centered in the embrasure created by the
supernumerary tooth in the maxillary anterior mandibular canine and 1st premolar.
region? C. mesial to the buccal embrasure created by
the mandibular canine and 1st premolar.
A. Mesiodens
D. none of the above.
B. Distodens
C. Dens-in-dente
83. The 2nd largest cusp on a mandibular 2nd
D. Paramolar
molar is the
Dental Anatomy
E. Talon cusp
and Occlusion
A. mesiolingual.
78. Which of the following cusp tips passes B. distolingual.
through the buccal groove of mandibular 1st C. mesiobuccal.
molar during a working-side movement? D. distobuccal.
E. distal.
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84. All of the following are true of the articular C. Erosion

disc EXCEPT D. Abrasion
A. it is biconcave, with a central avascular
89. Mandibular molar crowns tilt lingually at the
intermediate zone.
cervix. Maxillary molar crowns are aligned
B. it is composed of dense hyaline cartilage.
directly over the roots.
C. it consists of thick anterior and posterior
bands. A. Both statements are true.
D. fibers of the lateral pterygoid attach to its B. Both statements are false.
most anterior portion. C. The first statement is true; the second is
E. it divides the area between the glenoid false.
fossa and the condyle into two compart- D. The first statement is false; the second is
ments: superior and inferior. true.
85. After preparing an ideal endodontic access for 90. Which of the following primary teeth has the
tooth No. 3, you notice a 4th canal. In which longest root?
root is this 4th canal most likely located? A. Maxillary central incisor
A. Mesiobuccal B. Maxillary canine
B. Distobuccal C. Maxillary 2nd molar
C. Palatal D. Mandibular canine
D. Any of the above E. Mandibular 2nd molar
86. Which tooth has the greatest root-to-crown 91. The crowns of all primary teeth begin to cal-
ratio? cify at what time?
A. Maxillary central incisor A. 2-4 months in utero
B. Maxillary canine B. 4-6 months in utero
C. Mandibular canine C. 6-8 months in utero
D. Mandibular 1st molar D. At birth
E. 2-4 months postpartum
87. Which of the following is correct?
92. Which is the principal muscle that protrudes
A. VDR = VDO – FS
the mandible?
B. VDO = CO – FS
C. VDR = VDO + FS A. Masseter
D. VDO = CO + CR B. Medial pterygoid
E. VDR = VDO + CO C. Lateral pterygoid
D. Temporalis
88. A 30-year-old patient presents with shallow,
cup-shaped depressions on the cervicofacial 93. Which of the following is the most repro-
surface of the maxillary anterior teeth. The ducible mandibular position?
posterior teeth also exhibit extensive loss of A. Centric occlusion
the occlusal surface, including numerous B. Functional occlusion
noncarious class VI lesions. Tooth No. 30 has C. Postural position
an amalgam restoration that extends about D. Centric relation
1 mm above the level of the tooth structure.
Dental Anatomy
and Occlusion
Which of the following is the most likely 94. Mandibular molars usually have how many
cause of this wear? roots?
A. Abfraction A. 1
B. Attrition B. 2
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C. 3 dislocation. What is the initial direction that

D. 4 you should redirect the mandible to treat the
E. 5 problem?
A. Push the ramus superiorly
95. A “zig-zag” occlusal pattern can be found on
B. Push the ramus posteriorly
which of the following teeth?
C. Push the ramus downward
A. Mandibular 2nd molar D. Slide the ramus mesially
B. Mandibular 1st molar E. Slide the ramus laterally
C. Maxillary 2nd molar
D. Maxillary 1st molar 99. Which of the following teeth is most likely to
E. Maxillary 2nd premolar be congenitally absent?
A. Maxillary lateral incisor
96. Which of the following points in the sagittal
B. Maxillary canine
view of Posselt envelope of motion below is
C. Mandibular canine
centric occlusion?
D. Mandibular 1st premolar
E. Mandibular 2nd premolar
B
A C 100. In which age range would one normally
D expect to see all 20 primary teeth present, but
no permanent teeth yet visible?
A. 0.5-1 years
B. 1-1.5 years
C. 1-2 years
D. 2.5-5.5 years
E. 3.5-6.5 years
101. Which of the following is the smallest tooth

of both arches?
E A. Maxillary central incisor
A. A C. Mandibular central incisor
B. B D. Mandibular lateral incisor
C. C
D. D 102. In an ideal occlusion, the mesiolingual cusp
E. E of the mandibular 1st molar articulates with
which of the following?
97. All anterior teeth develop from how many A. The distal marginal ridge of the maxillary
lobes? 2nd premolar
A. 2 B. The lingual embrasure between the max-
B. 3 illary 2nd premolar and 1st molar
C. 4 C. The mesial marginal ridge of the maxil-
D. 5 lary 1st molar
Dental Anatomy
E. 6 D. The central fossa of the maxillary 1st

and Occlusion
molar
98. After a difficult extraction of tooth No. 31, you E. The lingual embrasure between the max-
notice that your patient’s jaw cannot close. illary 1st and 2nd molar
You diagnose the problem as a right-side TMJ
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103. Which of the following pulp canal configura- C. The statement is correct, but the reason is
tions has two separate canals exiting the pulp not.
chamber, but merge together to form one D. The statement is not correct, but the
canal just short of the apex? reason is correct.
E. Neither the statement nor the reason is
A. Type I
correct.
B. Type II
C. Type III
108. The incisal edge (cusp tip) is positioned more
D. Type IV
to the lingual of the root axis line in which of
the following teeth?
104. The primary mandibular 1st molar most
closely resembles which permanent tooth? A. Maxillary incisors
B. Mandibular incisors
C. Maxillary canine
E. B and D
109. The cingulum is centered mesiodistally on the
105. Which of the following has the greatest A. maxillary central incisor.
mesial cervical line (CEJ) curvature? B. mandibular lateral incisor.
C. maxillary canine.
D. all of the above.
C. Maxillary canine
D. Maxillary 1st premolar
110. Humans are classified as having which types
E. Maxillary 2nd premolar
of dentition?
106. In an ideal occlusion, the lingual cusp of the A. Homodont, diphyodont
maxillary 2nd premolar contacts which of the B. Heterodont, polyphyodont
following? C. Heterodont, diphyodont
D. Homodont, monophyodont
A. Mesial marginal ridge of the mandibular
E. Homodont, polyphyodont
2nd premolar
B. Distal triangular fossa of the mandibular
111. Permanent incisors often erupt ______ to
2nd premolar
their primary counterparts.
C. Distal marginal ridge of the mandibular
2nd premolar A. buccal
D. Mesial marginal ridge of the mandibular B. lingual
1st molar C. directly underneath
E. Mesial triangular fossa of the mandibular D. lateral
1st molar
112. In ideal maximum intercuspation, the oblique
107. A 12-year-old boy fractures the neck of his ridge of the maxillary 1st molar opposes
right condyle after falling off his bicycle. The which of the following areas of the mandibu-
mandible will deviate to the right side because lar 1st molar?
the left lateral pterygoid is still functional.
Dental Anatomy
A. Buccal groove
and Occlusion
A. Both the statement and the reason are B. Distobuccal groove

correct and related. C. Lingual groove
B. Both the statement and the reason are D. Mesial marginal ridge
correct but not related. E. Distal marginal ridge
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113. Which of the following teeth has a nearly 119. A nonworking side interference would be
straight crown-root profile on the mesial sur- present on which of the following surfaces?
face when viewed from the facial?
A. Inner aspects of a supporting cusp
A. Maxillary central incisor B. Outer aspects of a guiding cusp
B. Maxillary lateral incisor C. Inner aspects of a guiding cusp
C. Maxillary canine D. Outer aspects of a supporting cusp
E. Mandibular 1st premolar 120. You suspect a 2nd canal on tooth No. 23. In
which direction should you look?
114. How many cusps does the primary mandibu-
A. Mesial
lar 2nd molar typically have?
B. Distal
A. 1 C. Buccal
B. 2 D. Lingual
C. 3 E. None, there is no possibility of a 2nd
D. 4 canal
E. 5
121. You are having a hard time mobilizing tooth
115. Which ligament helps retain the condyle No. 18 during a routine extraction. After
within the glenoid fossa? looking at the radiograph again, you cannot
see a PDL space all the way around the roots.
A. Sphenomandibular ligament
Which of the following would best describe
B. Temporomandibular ligament
the reason why you can’t elevate the tooth?
C. Stylomandibular ligament
D. Pterygomandibular ligament A. It is ankylosed.
B. It is a taurodont.
116. An individual diagnosed with posterior bite C. It has a dilaceration.
collapse will most likely have a decrease in D. It has hypercementosis.
which of the following? E. It has a cervical enamel projection.
A. Freeway space
122. All of the primary teeth have just completed
B. Postural position
root formation at what age?
C. VDR
D. Maximum opening A. 1-11/2 years
E. VDO B. 11/2-2 years
C. 2-3 years
117. The only tooth with three different occlusal D. 3-4 years
schemes is the E. 4-5 years
A. mandibular 1st premolar.
123. Which of the following jaw positions is deter-
B. mandibular 2nd premolar.
mined almost exclusively by the behavior of
C. mandibular 1st molar.
the musculature?
D. mandibular 2nd molar.
A. Centric occlusion
118. Which tooth has the longest root in the per- B. Centric relation
manent dentition? C. Postural position
Dental Anatomy
A. Maxillary central incisor D. All of the above

and Occlusion

C. Maxillary canine
D. Maxillary 1st molar
E. Mandibular canine
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124. In comparison to the maxillary canine, the 129. The terminal hinge position occurs when the
mandibular canine has a condyles are in the most _____ location
within the glenoid fossa.
A. sharper cusp.
B. more pronounced labial ridge. A. Anterior and superior
C. more cervical mesial contact. B. Anterior and inferior
D. centered cingulum. C. Medial and superior
E. more narrow mesiodistal crown width. D. Lateral and superior
E. Posterior and superior
125. All primary maxillary molars have three roots.
All primary mandibular molars have two 130. Calcification of the permanent dentition typi-
roots. cally starts at what time?
A. Both statements are true. A. 4-6 months in utero
B. Both statements are false. B. 6-8 months in utero
C. The first statement is true; the second C. Birth
statement is false. D. 1-2 months postpartum
D. The first statement is false; the second E. 2-4 months postpartum
statement is true.
131. In which Angle classification would you typi-
126. Anterior guidance allows only the molars to cally find a deep overbite with proclined
disarticulate during protrusive movement. maxillary lateral incisors?
Cusp length is generally longest with a deep
A. Class I
overbite and minimal overjet.
B. Class II, division I
A. Both statements are true. C. Class II, division II
B. Both statements are false. D. Class III, division I
C. The first statement is true; the second E. Class III, division II
statement is false.
D. The first statement is false; the second 132. Which incisor exhibits the most variability?
statement is true. A. Maxillary central
B. Maxillary lateral
127. Permanent canine cusps have mesial cusp
C. Mandibular central
ridges shorter than distal cusp ridges. Their
D. Mandibular lateral
crowns are wider faciolingually than mesio-
distally. 133. A labial ridge can be found on which tooth
A. Both statements are true. type?
B. Both statements are false. A. Incisor
C. The first statement is true; the second is B. Canine
false. C. Premolar
D. The first statement is false; the second is D. Molar
true.
134. Which of the following is not TRUE of pri-
128. Aside from the mandibular lateral incisor, a mary teeth compared to permanent teeth?
distolingual twist of the incisal edge can be
found on which of the following teeth? A. They are generally whiter.
Dental Anatomy
and Occlusion
B. Their crowns are more bulbous.

A. Mandibular central incisor C. Their CEJs are more constricted.
B. Maxillary lateral incisor D. Their root trunks are longer.
C. Maxillary canine E. Their pulp chambers are larger.
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135. The length of the permanent maxillary arch C. Mandibular 1st premolar
is about 8 mm longer than the permanent D. Mandibular 2nd premolar
mandibular arch. The permanent arches are E. None of the above
generally more circular than the primary
arches. 140. Maxillary incisor protrusion, anterior open
bite, crowded laterals, and a high palatal
vault are most likely caused by which of the
following?
statement is false. A. Mouth breathing
D. The first statement is false; the second B. Thumb sucking
statement is true. C. Tongue thrusting
D. Nocturnal bruxism
136. The lingual height-of-contour of all anterior
teeth is in what segment of the crown? 141. Which of the following is the 1st succeda-
neous tooth to erupt?
A. Incisal 3rd
B. Junction of the incisal and middle 3rds A. Maxillary 1st molar
C. Middle 3rd B. Mandibular 1st molar
D. Junction of the middle and cervical 3rds C. Maxillary central incisor
E. Cervical 3rd D. Mandibular central incisor
137. Which of the following best describes a Bennett
shift? 142. Which premolar has the most square occlusal
table shape?
A. The lateral movement of the working-side
condyle in the opposite direction of the A. Maxillary 1st premolar
excursive movement B. Maxillary 2nd premolar
B. The lateral movement of the working-side C. Mandibular 1st premolar
condyle in the same direction of the D. Mandibular 2nd premolar
excursive movement
C. The anterior translation of both condyles 143. Which of the following is a microdont?
during protrusive movement A. Geminated incisor
D. The anterior translation of the contralat- B. Cusp of Carabelli
eral condyle during lateral excursive C. Peg-shaped lateral
movement D. Dens evaginatus
E. The anterior translation of the ipsilateral E. Mulberry molar
condyle during lateral excursive movement
144. All of the following are true of primary
138. Two pulp canals are most commonly found canines EXCEPT
in which of the following teeth?
A. when viewed from the facial, the crown
A. Maxillary 1st premolar shapes are pentagonal.
B. Mandibular 1st premolar B. they have cingula.
C. Maxillary 2nd premolar C. the mesial cusp ridge of the maxillary
D. Mandibular 2nd premolar canine is longer than the distal cusp ridge.
Dental Anatomy
D. the distal cusp ridge of the mandibular

and Occlusion
139. Which of the following premolars has a canine is longer than the mesial cusp ridge.
shorter buccal cusp than lingual cusp? E. all of the above.
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145. In an ideal occlusion, protrusive contacts can A. A

occur on which of the following surfaces? B. B
C. C
A. Maxillary distal inclines and mandibular
D. D
mesial inclines
E. E
B. Maxillary mesial inclines and mandibular
distal inclines 150. Which is the only premolar with a longer
C. Maxillary distal inclines and mandibular mesial buccal cusp ridge than distal buccal
distal inclines cusp ridge?
D. Maxillary mesial inclines and mandibular
mesial inclines A. Maxillary 1st premolar
146. The principal muscle that protrudes the C. Mandibular 1st premolar
tongue is innervated by which cranial nerve? D. Mandibular 2nd premolar
A. CN V 151. On average, how much root structure must
B. CN VII be formed before a tooth erupts?
C. CN IX
D. CN X A. 0%-25%
E. CN XII B. 25%-33%
C. 33%-50%
147. Which portion of the maxillary 1st molar root D. 50%-66%
typically has the greatest surface area? E. 66%-75%
A. Root trunk 152. The glenoid fossa is a portion of which bone?
B. MB root
C. DB root A. Zygomatic
D. Palatal root B. Temporal
C. Maxilla
148. All of the following are features of the perma- D. Mandible
nent mandibular canine EXCEPT E. Palatine
A. the mesial cusp ridge is shorter than distal 153. Which of the following is the smallest pri-
cusp ridge. mary molar?
B. the mesial cusp ridge is almost horizontal.
C. the mesial crown outline is in line with A. Maxillary 1st
the root. B. Maxillary 2nd
D. the cusp tip is located labial to the mid–- C. Mandibular 1st
root-axis line. D. Mandibular 2nd
149. Which of the following points in the horizon- 154. A posterior bitewing radiograph reveals a
tal view of Posselt envelope of motion below 2 mm × 2 mm radiopaque mass on the distal
is the anterior edge-to-edge position? surface of tooth No. 2, just apical to the CEJ.
Which of the following is most likely the
A
B finding?
A. Enamel pearl
Dental Anatomy
B. Cervical enamel projection

and Occlusion
E C. Taurodont
C
D. Distodens
E. Hypercementosis
D
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155. In an unworn dentition, tooth-to-tooth contacts C. Buccal groove of the mandibular 1st molar
may be characterized as all of the following D. Distobuccal groove of the mandibular 1st
EXCEPT molar
E. Buccal embrasure between the mandibular
A. point-to-point.
1st and 2nd molar
B. point-to-area.
C. edge-to-edge.
161. The proximal contact positions of the maxil-
D. edge-to-area.
lary canine are in which areas?
E. area-to-area.
A. Mesial: Incisal 3rd; Distal: Junction of the
156. All of the following teeth typically have one incisal and middle 3rds
root canal EXCEPT B. Mesial: Incisal 3rd; Distal: Middle 3rd
C. Mesial: Junction of the incisal and middle
A. maxillary central incisor.
3rds; Distal: Junction of the incisal and
B. maxillary lateral incisor.
middle 3rds
C. maxillary canine.
D. Mesial: Junction of the incisal and middle
D. mandibular canine.
3rds; Distal: Middle 3rd
E. Mesial: Middle 3rd; Distal: Junction of
157. Which of the following teeth is most likely to the incisal and middle 3rds
have a trifurcation?
162. All of the following are true of eruption
A. Maxillary 1st premolar EXCEPT
B. Mandibular 1st premolar
A. boys’ teeth generally erupt before girls’
teeth.
B. mandibular teeth generally erupt before
158. Tooth No. 18 has what general crown shape maxillary teeth.
when viewed from the distal? C. teeth generally erupt in contralateral pairs.
D. eruption starts after at least 50% of root
A. Square formation is complete.
B. Rectangular E. all of the above are true.
C. Rhomboidal
D. Trapezoidal 163. The occlusal surface of the primary maxillary
E. Oval 1st molar is
159. Which two muscles form a sling around the A. square.

mandible? B. rectangular.
C. trapezoidal.
A. Masseter and temporalis D. rhomboidal.
B. Medial pterygoid and lateral pterygoid
C. Masseter and medial pterygoid 164. An individual who never formed 3rd molars
D. Masseter and lateral pterygoid has which of the following?
A. Anodontia
160. During working-side excursion, the distobuc- B. Hypodontia
cal cusp of the maxillary 1st molar passes C. Oligodontia
D. Hyperdontia
Dental Anatomy
through which of the following?

and Occlusion
E. Metadontia
A. Lingual groove of the mandibular 1st
molar
B. Lingual embrasure between the
mandibular 1st and 2nd molar
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165. The nonworking pathway of the mesial cusps C. Maxillary canine

on mandibular posterior teeth is in which D. Mandibular central incisor
direction? E. Mandibular canine
A. Distofacial
171. On a 3-cusped mandibular 2nd premolar,
B. Distolingual
how many cusps can be seen from the mesial
C. Mesiofacial
and distal, respectively?
D. Mesiolingual
A. 2 from the mesial; 2 from the distal
166. The mesial proximal contact area of tooth B. 3 from the mesial; 2 from the distal
No. 29 is located where? C. 2 from the mesial; 3 from the distal
D. 3 from the mesial; 3 from the distal
A. Incisal 3rd
B. Junction of the incisal and middle 3rds
172. Which of the following is typically the last
C. Middle 3rd
primary tooth to exfoliate?
D. Junction of the middle and cervical 3rds
E. Cervical 3rd A. Maxillary canine
B. Mandibular canine
167. Which of the following intrinsic muscle C. Maxillary 2nd molar
fibers flattens and broadens the tongue? D. Mandibular 2nd molar
E. Maxillary 1st molar
A. Vertical
B. Horizontal
173. Which of the following cusps on a mandibu-
C. Longitudinal
lar 1st molar has the largest pulp horn?
D. Transverse
A. Mesiobuccal
168. Anterior teeth have 4 line angles. Posterior B. Distobuccal
teeth have 6 line angles. C. Mesiolingual
D. Distolingual
E. Distal
C. The first statement is true; the second is
174. In which of the following mandibular posi-
false.
tions would you find the greatest increase in
D. The first statement is false; the second is
VDO from centric occlusion?
true.
A. Centric relation
169. If not coincidental, the average slide from B. Maximum protrusion
centric relation to centric occlusion is C. Anterior edge-to-edge position
D. Postural position
A. 1-2 mm.
E. Maximum opening
B. 2-4 mm.
C. 4-6 mm.
175. Which of the following chronic conditions
D. 6-8 mm.
may cause tooth abrasion?
170. You are evaluating maxillary and mandibular A. GERD
CT scans for a patient who has recently had B. Nocturnal bruxism
facial trauma. Out of curiosity, you notice the C. Occlusal trauma
Dental Anatomy
natural inclination of roots within the alveolar D. Pipe smoking

and Occlusion
bone on the sagittal slices. Which tooth root E. Cigarette smoking

has the greatest horizontal axial inclination?
176. What are the typical positions of the maxil-
lary and mandibular teeth, and the tongue
during empty-mouth swallowing?
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A. Centric occlusion; the tongue touches 182. All of the following muscles are involved in
the palate. right lateral excursive movement EXCEPT
B. Centric occlusion; the tongue touches
A. right masseter.
the lingual aspects of the anterior teeth.
B. right temporalis.
C. Retruded contact; the tongue touches the
C. right medial pterygoid.
palate.
D. left medial pterygoid.
D. Retruded contact; the tongue touches the
E. left lateral pterygoid.
lingual aspects of the anterior teeth.
E. Rest position; the tongue touches the palate. 183. By age 91/2, how many teeth will a young boy
have?
177. On which primary tooth can one find an
oblique ridge and, occasionally, a fifth cusp A. 12 primary and 12 permanent teeth
of Carabelli? B. 10 primary and 12 permanent teeth
C. 10 primary and 14 permanent teeth
D. 8 primary and 16 permanent teeth
E. 6 primary and 16 permanent teeth
D. Maxillary 2nd molar 184. Which of the following regions in the sagittal
view of Posselt envelope of motion below
178. The lingual surface of which incisor is the
represents a free opening or closing of the
most concave?
mandible?
A. Maxillary central
A
B. Maxillary lateral
C. Mandibular central
D. Mandibular lateral
B D
179. In right lateral excursion, which of the fol-
lowing is correct?
A. The mandibular teeth move to the right. C
B. The mandibular teeth move to the left.
C. The left mandibular teeth are on the
E
working side.
D. Both A and C.
E. Both B and C.
180. Which anterior tooth has the greatest mesiodis- A. A

tal length when viewed from the facial? B. B
A. Maxillary central incisor C. C
B. Maxillary lateral incisor D. D
C. Maxillary canine E. E
D. Mandibular central incisor
E. Mandibular lateral incisor 185. Failure to properly close a proximal contact
when restoring a posterior tooth can lead to
181. Which premolar is typically the largest? which of the following?
Dental Anatomy
and Occlusion
A. Maxillary 1st premolar A. Mesial drifting of the tooth

B. Maxillary 2nd premolar B. Gingival inflammation
C. Mandibular 1st premolar C. A food trap
D. Mandibular 2nd premolar D. All of the above
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186. Which anterior tooth has the greatest 191. How many embrasures are present per con-
faciolingual-to-mesiodistal length ratio when tact area?
viewed from the occlusal?
A. 1
A. Maxillary central incisor B. 2
B. Maxillary lateral incisor C. 3
C. Mandibular central incisor D. 4
D. Mandibular lateral incisor E. 5
E. Mandibular canine
192. The mandibular 1st molar may have a 4th
187. The mesial proximal contact is more cervical canal in which root?
than the distal in which of the following?
A. Mesial
A. Primary maxillary canine B. Distal
B. Primary mandibular canine C. Buccal
C. Permanent maxillary 1st premolar D. Lingual
D. Permanent mandibular 2nd premolar
E. None of the above 193. In an ideal occlusion, the distal cusp of the
mandibular 2nd molar articulates with which
188. In an ideal occlusion, the lingual cusp of the of the following?
mandibular 2nd premolar sits between which
A. The central fossa of the maxillary 2nd
of the following?
molar
A. MARGINAL ridges of the maxillary 1st B. The marginal ridges of the maxillary 2nd
and 2nd premolar and 3rd molars
B. Marginal ridges of the maxillary 2nd pre- C. The buccal groove of the maxillary 2nd
molar and 1st molar molar
C. Central fossa of the maxillary 2nd premolar D. The central fossa of the maxillary 3rd
D. Lingual embrasure of the maxillary 1st molar
and 2nd premolar E. None of the above
E. Lingual embrasure of the maxillary 2nd
premolar and 1st molar 194. Which of the following ridges is not located
on the corresponding tooth type?
189. The oblique ridge on a maxillary molar
A. Cervical ridge: All molars
extends between what two cusps?
B. Labial ridge: All anterior teeth
A. MB and DB C. Oblique ridge: Maxillary molars
B. MB and ML D. Marginal ridge: All teeth
C. MB and DL E. Buccal cusp ridge: All premolars
D. DB and DL
E. DB and ML 195. From which view is only one root visible on a
mandibular 1st molar?
190. A synovial membrane covers the articular
A. Mesial
disc, enabling smoother movement along the
B. Distal
articular eminence. The glenoid fossa is lined
C. Buccal
with a layer of hyaline cartilage.
D. Lingual
Dental Anatomy
A. Both statements are true. E. Occlusal

and Occlusion

C. The first statement is true; the second 196. Following root canal therapy, gutta percha
statement is false. extending beyond the apex of which tooth is
D. The first statement is false; the second most likely to impinge on the mental
statement is true. foramen?
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A. Mandibular canine 199. The TMJ is what type of joint?

B. Mandibular 1st premolar
A. Synovial synarthrosis
C. Mandibular 2nd premolar
B. Synovial amphiarthrosis
C. Synovial diarthrosis
E. Mandibular 2nd molar
D. None of the above
197. The closer a tooth is to an occlusal determi-
200. Which of the following tooth roots is most
nant, the _____ it will be influenced by that
likely to be pushed into the maxillary sinus
determinant. The _____ teeth ideally guide
during extraction?
the mandible in lateral excursive and protru-
sive movements. A. Maxillary canine
B. Maxillary 1st premolar
A. less; anterior
C. Maxillary 2nd premolar
B. more; anterior
D. Maxillary 1st molar
C. less; posterior
E. Maxillary 2nd molar
D. more; posterior
198. What mandibular position is represented by

the point in the frontal view of Posselt enve-
lope of motion below?
A. Centric occlusion
B. Retruded contact
C. Anterior edge-to-edge position
D. Maximum opening
E. Maximum protrusion
Dental Anatomy
and Occlusion
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AN SW E R S
1. The correct answer is C. From an occlusal than the buccal cusps, thus giving rise to the
view, the major feature distinguishing the curve of Wilson, or mediolateral curve.
mandibular lateral incisor from the mandibular
Answers A, B, and D are incorrect. When
central incisor is the presence of a distolingual
viewed from the buccal, the cusp tips of pos-
twist found in the distal half of the lateral’s
terior teeth follow a gradual curve that is con-
incisal edge. This distolingual twist follows the
vex in the maxillary arch and concave in the
natural arch shape of the mandible and, there-
mandibular arch (relative to a flat plane of
fore, also allows one to easily distinguish right
occlusion between the two arches). The
from left mandibular lateral incisors. The
curve of Spee runs anteroposteriorly, and is
mandibular central incisor, on the other hand,
sometimes referred to as the anteroposterior
is bilaterally symmetrical with a centered cin-
curve.
gulum, making it very difficult to determine
right from left. 4. The correct answer is E. Both maxillary and
Answer A is incorrect. Unlike maxillary mandibular canines have characteristic labial
incisor crowns, where the central is larger and lingual ridges, but those on maxillary
than the lateral, the mandibular lateral incisor canines are more prominent. The vertical lin-
crown is slightly larger in all dimensions. gual ridge extends to the cingulum of the
canines, creating mesial and distal fossae on
Answer B is incorrect. The cingulum of the
either side of the lingual ridge.
mandibular lateral incisor is slightly distal of
center (similar to the maxillary central Answers A, B, and C are incorrect. None of
incisor and mandibular canine). Anterior these teeth have labial or lingual ridges.
teeth that have a centered cingulum on the Instead, these teeth have a single concave lin-
lingual surface include the mandibular cen- gual fossa bounded by mesial and distal mar-
tral incisor, maxillary canine, and maxillary ginal ridges, and a convex cingulum on the
lateral incisor. lingual surface.
Answer D is incorrect. Both the mandibular Answer D is incorrect. The question asks for
central and lateral incisors have incisal edges the tooth with the most prominent lingual
that are lingual to the root-axis line, and ridge. The lingual ridge on the maxillary
therefore is not a distinguishing feature. canine is more prominent.
2. The correct answer is D. All 5 cusp tips can 5. The correct answer is A. The palatal root is
be seen from the buccal. The somewhat stag- the longest of the three roots in a maxillary
gered arrangement of the 3 buccal and 2 lin- molar, but 3rd longest among roots of maxil-
gual cusps allow the tips of the lingual cusps lary teeth, after the maxillary canine and 2nd
to peak above the buccal and distobuccal premolar roots.
grooves. Answers B, C, and D are incorrect. See
Answers A, B, and C are incorrect. Mini- above.
mally, the 3 buccal cusps would be visible.
6. The correct answer is C. The buccinator
3. The correct answer is C. The lingual inclina- muscle assists in mastication by compressing
Dental Anatomy
and Occlusion
tion of the crowns of mandibular posterior the cheek against molar teeth, thus holding
teeth helps define the curve of Wilson, not the food under the teeth. It originates from the
curve of Spee. When viewed from the ante- pterygomandibular raphe and maxillary and
rior, the lingual cusps of the posterior teeth in mandibular buccal alveolar processes. Its
both arches are aligned at a more inferior level upper and lower fibers crisscross to insert into
Answers: 1-11 209
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the lower and upper lip, respectively. The 9. The correct answer is C. Central incisors (A)
buccinator receives its innervation from the erupt around 6 months of age, lateral incisors
facial nerve (CN VII, buccal branch). (B) at 9 months, primary 1st molars (D) at 12
months, primary canines (C) at 18 months,
Answers A, B, D, and E are incorrect. These
and primary 2nd molars (E) at 24 months.
are the four muscles of mastication, all inner-
Mandibular primary teeth typically erupt
vated by CN V3.
before the maxillary primary teeth with the
7. The correct answer is A. Overjet is defined exception of the primary lateral incisors.
as horizontal overlap of the incisors, normally Remember: ABDCE at 6,9,12,18,24.
2-3 mm. Answers A, B, and D are incorrect. See
Answer B is incorrect. Overbite is defined as above.
the vertical overlap of the incisors, normally
10. The correct answer is C. When viewed from
1-2 mm.
the mesial or distal aspects, all anterior teeth
Answer C is incorrect. There is no vertical (centrals, laterals, and canines) have a trian-
overlap of the incisors in an openbite. Ante- gular or wedge-shaped outline.
rior openbite can result, for example, from a
Answer A is incorrect. When viewed from
persistent thumb-sucking habit.
the proximal aspect, all mandibular posterior
Answer D is incorrect. Crossbite is a reversed teeth (premolars and molars) have a rhom-
horizontal overlap relationship of the teeth. If boidal shape because the crowns tilt lingually
the lower incisors are anterior to the upper from the cervix.
incisors in centric occlusion, the condition is
Answer B is incorrect. All maxillary posterior
called anterior crossbite or reverse overjet. Pos-
have a trapezoidal crown outline when
terior crossbite exists when the maxillary poste-
viewed from the mesial or distal, with longest
rior teeth are lingually positioned relative to
uneven side at the base of the crown. Unlike
the mandibular teeth in centric occlusion.
mandibular posterior crowns which tilt lin-
8. The correct answer is A. The primary gually from the cervix, maxillary crowns are
mandibular 2nd molar resembles the aligned directly over the roots from the proxi-
mandibular 1st molar; however, the three buc- mal view.
cal cusps of the primary tooth are nearly equal Answer D is incorrect. The outline form of
in size, whereas the permanent 1st molar bears this tooth from the proximal aspect is rhom-
a distal cusp which is typically considerably boidal, as it is with all mandibular posterior
smaller. teeth.
Answer B is incorrect. No primary tooth
11. The correct answer is D. Both gemination
resembles the permanent mandibular 2nd
and fusion can be described as conditions in
molar.
which “double teeth” occur. They occur
Answer C is incorrect. The primary maxil- most often in the maxillary and anterior
lary 2nd molar resembles the permanent regions and are differentiated by counting the
maxillary 1st molar. They are similar in most number of teeth in the dentition. In gemina-
respects (albeit the primary 2nd molar is tion (or twinning), one tooth bud splits to
smaller), with an oblique ridge and fossae form what appears to be two teeth (1 root, 2
(and sometimes even a cusp of Carabelli) teeth). The single root is not split and has a
Dental Anatomy
and Occlusion
corresponding to those of the permanent common pulp canal. Both twinned and fused
maxillary 1st molar. crowns typically appear double in width com-
Answer D is incorrect. No primary tooth pared to a single tooth but notched since the
resembles the permanent maxillary 2nd molar. division is incomplete.
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Answer A is incorrect. Concrescence occurs taken when preparing class I and class II cav-
when the roots of two or more unique teeth ity preps, especially on the mesial half.
are united by cementum.
Answer B is incorrect. Hypercementosis is above.
the nonneoplastic deposition of excessive
cementum. Blunting of the roots is frequently 14. The correct answer is E. On 2-cusped pre-
seen upon radiographic examination. molars, the triangular ridges of the buccal
and lingual cusps converge at the central
Answer C is incorrect. In fusion, two adja-
groove and join together to form a transverse
cent tooth germs fuse during development
ridge. However, the three triangular ridges of
(2 roots, 2 teeth). Unlike gemination, radi-
the 3-cusped mandibular 2nd premolar (one
ographs usually reveal two separate but fused
large buccal and two smaller lingual cusps
roots with separate pulp chambers.
resulting in a Y-shaped occlusal groove pat-
Answer E is incorrect. Fibrous dysplasia is a tern) do not meet, and thus no transverse
developmental condition in which bone is ridge is formed.
progressively replaced by fibrous tissue. The
Answers A, B, C, and D are incorrect. A
key radiographic appearance of fibrous dys-
transverse ridge crosses the occlusal surface of
plasia is described as “ground glass.” There is
these premolars, running between the buccal
no association between any of the above con-
and lingual cusps. Specifically, the triangular
ditions and fibrous dysplasia.
ridges of the buccal and lingual cusps unite
to form the transverse ridge.
12. The correct answer is C. Angle classification
is primarily based on molar relationships. For
15. The correct answer is B. During left working
example, a class I molar relationship is one in
movement, the right (nonworking) condyle
which the MB cusp of the maxillary 1st
rotates and translates anteriorly, downward
molar opposes the buccal groove of the
along the articular eminence, and medially to
mandibular 1st molar. If the maxillary 1st
the left. The left (working) condyle rotates
molar is mesial to this position, a class II
forward and typically translates slightly later-
molar relationship exists. If it is distal, a class
ally to the left (a Bennett shift).
III molar relationship exists.
Answer A is incorrect. This has no bearing
above.
on Angle classification of occlusion.
Answer B is incorrect. Although the canine 16. The correct answer is C. Both the mesial
relationship can be classified as class I (ie, contact and marginal ridge is more cervical
maxillary canine tip falls between the than the distal, which is a feature that is
mandibular canine and 1st premolar), class II, unique to the mandibular 1st premolar.
or III, it is the molar relationship that primar- Answers A, B, and D are incorrect. These
ily defines Angle classification of occlusion. premolars have mesial marginal ridges located
Answer D is incorrect. This has no bearing more occlusally than the distal marginal ridge.
on Angle classification; however, excessive Recall that mesial marginal ridge grooves are
overjet may be seen as a sequela of class II, almost always present on maxillary 1st premo-
division I occlusion. lars. Furthermore, the mesial marginal ridge
of the mandibular 2nd premolar is more hori-
Dental Anatomy
and Occlusion
13. The correct answer is C. Primary teeth are zontal than the cervically sloping mesial mar-
more constricted at the cervical 3rd than per- ginal ridge of the mandibular 1st premolar.
manent teeth. Pulp chambers are compara-
tively larger in primary teeth, especially in the 17. The correct answer is B. The lingual cusps of
mesial horns. Therefore, great care must be the maxillary premolars tilt mesially and,
Answers: 12-22 211
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therefore, will articulate with the distal triangu- Answer D is incorrect. Primary molars have
lar fossae of their mandibular premolar coun- much shorter root trunks than their perma-
terparts. Recall that mandibular teeth are situ- nent counterparts. This allows their roots to
ated mesially and lingually to their counterparts diverge at a more coronal level, accommodat-
in the maxilla. Therefore, as a general rule, a ing the size of the underlying permanent
maxillary tooth will articulate with its mandibu- tooth.
lar counterpart and the tooth distal to it; like-
wise, a mandibular tooth will articulate with its 20. The correct answer is A. There are no pre-
maxillary counterpart and the tooth mesial to it. molars in the deciduous (primary) dentition.
Accordingly, the maxillary 1st premolar will Premolars are only found in the adult perma-
occlude with the mandibular 1st premolar nent dentition, and succeed the primary
(counterpart) and the mandibular 2nd premo- molars.
lar (the tooth distal to the counterpart). Answer B is incorrect. In the permanent (not
Answers A, C, D, and E are incorrect. the primary) dentition, there are 2 premolars
Nothing rests in these fossae in ideal inter- per quadrant, 4 premolars per arch, for a total
cuspation. of 8 premolars in both arches (maxilla and
mandible).
18. The correct answer is C. The 1st premolars
Answers C, D, and E are incorrect. See
in both arches have the longest and sharpest
above.
buccal cusps relative to the 2nd premolars.
Remember that all premolars except the 21. The correct answer is C. Remember that sup-
mandibular 1st premolar have a longer buc- porting cusps are the maxillary lingual and
cal cusp than lingual cusp. mandibular buccal cusps. These cusps (also
Answers A, B, and D are incorrect. See called working cusps) function by grinding
above. against the opposing teeth. Supporting cusps
tend to be rounder and located than nonsup-
19. The correct answer is E. Primary molars porting cusps. The tips of the supporting cusps
have a shallow occlusal anatomy relative to rest in the opposing marginal ridge areas with
their permanent counterparts. Cusps are the exception of the ML cusp of maxillary
short, ridges are not as pronounced, and the molars and DB cusps of mandibular molars
fossae are not as deep. which rest in the opposing central fossa.
Answer A is incorrect. The roots of primary Answers A, B, and D are incorrect. All
molars are very divergent, which allows for mandibular lingual and maxillary buccal cusps
the eruption of the permanent premolars. are nonsupporting cusps. These cusps tend to
They are also much less curved, and there is be taller and sharper than supporting cusps,
little to no root trunk. and their function is to help disarticulate the
teeth during excursive jaw movements. Note
Answer B is incorrect. The mesial cervical
that nonsupporting cusps do not occlude in
ridge of primary molars is very prominent,
any fossae or marginal ridge areas, but they do
and the cervical lines course more apically
oppose grooves and embrasure areas.
on the mesial half due to this prominence.
Recall that all primary anterior teeth also
22. The correct answer is B. Anodontia refers to
have prominent cervical ridges.
the total lack of tooth development. These
Dental Anatomy
Answer C is incorrect. Enamel is approxi- individuals do form any teeth. Someone with
and Occlusion
mately 1 mm thick and of relatively uniform partial anodontia is congenitally missing one
thickness in primary molars as opposed to that or more teeth. Remember that an edentulous
of permanent molars, which is 2.5 mm thick patient does not necessarily suffer from
on the occlusal surface. anodontia.
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Answer A is incorrect. Hyperdontia is the Answer C is incorrect. With its prominent

development of an increased number of mesiolingual cusp and oblique ridge con-
teeth, which may be associated with condi- necting to the distobuccal cusp, it’s quite evi-
tions such as cleidocranial dysplasia, Down dent that the occlusal outline is asymmetric.
syndrome, Gardner syndrome, and Sturge-
Answer D is incorrect. The mesiolingual
Weber angiomatosis.
groove that separates the mesial marginal
Answers C, D, and E are incorrect. See ridge from the lingual cusp renders this
above. tooth relatively asymmetric when viewed
from the occlusal. There is more bulk on
23. The correct answer is A. The auriculotempo- the distal half, and the mesial side of the
ral nerve conducts the primary innervation to crown appears pushed in on the mesiolingual
the TMJ. It transmits pain within the capsule, corner.
and also provides parasympathetics to the
Answer E is incorrect. The presence of a
parotid gland. The auriculotemporal nerve is
minor fifth cusp (distal cusp) on the buccal
a branch of CN V3. Two other nerves also
creates an asymmetric occlusal outline. Over-
supply sensory fibers to the TMJ: the nerve to
all, there are 3 buccal cusps (MB, DB, distal)
the masseter and the posterior deep temporal
and 2 lingual cusps (ML, DL).
nerve, both of which are innervated by CN
V3. Remember that the TMJ only receives
25. The correct answer is C. Only the DB cusps
sensory innervation, not motor.
of mandibular molars and ML cusps of maxil-
Answers B, C, D, and E are incorrect. See lary molars reside in their counterpart’s cen-
above. tral fossa in ideal intercuspation. The remain-
ing supporting cusps reside in the mesial
24. The correct answer is B. The maxillary 2nd marginal ridge areas of their counterparts.
premolar, with its oval occlusal outline, is
Answer A is incorrect. The buccal cusp of
typically much more symmetrical than the
the 2nd premolar resides in the mesial trian-
1st premolar, which has a decidedly more
gular fossa of the maxillary 2nd premolar.
asymmetric, hexagonal occlusal outline. In
fact, the only part of the occlusal outline of Answer B is incorrect. The MB cusp con-
the maxillary 1st premolar that appears sym- tacts the mesial marginal ridge of the maxil-
metrical is the buccal surface, with its lary 1st molar and the distal marginal ridge of
rounded, inverted V-shape due to the promi- the 2nd premolar.
nent buccal ridge. The remaining lingual
Answer D is incorrect. The DB cusp of the
three-fourths of the 1st premolar, on the
mandibular 1st molar resides in the central
other hand, appears bent to the mesial.
fossa of the maxillary 1st molar; the distal
Answer A is incorrect. An asymmetric cusp of the mandibular 1st molar opposes the
occlusal outline is a distinguishing feature of distal fossa of the maxillary 1st molar.
the maxillary 1st premolar that is not present
Answer E is incorrect. The DB cusp contacts
on the 2nd premolars. The mesial outline
the central fossa of the maxillary 2nd (not the
appears straight or concave, and is bisected
1st) molar.
by a mesial marginal ridge groove not present
on the distal. Moreover, the mesial marginal 26. The correct answer is D. Both maxillary
ridge is shorter buccolingually than the more incisors and maxillary canines have a func-
Dental Anatomy
convex distal marginal ridge such as the lin-

and Occlusion
tional lingual surface. The maxillary canines

gual three-fourths of the crown appear bent are unique as the only cusped teeth with a
to the mesial. Lastly, the lingual cusp tip is functional lingual surface. The lingual sur-
positioned more to the mesial and the buccal faces, in part, help guide the mandible in
cusp tip more to the distal, versus 2nd premo- excursive and protrusive movements.
lars which are more symmetrical overall.
Answers: 23-31 213
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Answers A, B, C, and E are incorrect. The Recall that the primary teeth are identified by
incisofacial aspect of mandibular incisors and letter rather than number in this system, start-
canines function against the lingual surfaces ing with the primary maxillary right 2nd
of maxillary incisors and canines, respec- molar as A, lettering across the maxillary arch
tively. They aid in disarticulating the poste- to J (primary maxillary left 2nd molar), drop-
rior teeth during protrusive and excursive ping down to K (primary mandibular left 2nd
movements (anterior guidance versus canine molar), and ending at T (mandibular right
guidance). 2nd molar).
Answer D is incorrect. Tooth No. 12 identi-
27. The correct answer is D. Remember that a
fies the permanent maxillary left 1st premolar
point angle is formed by the junction of 3
using the Universal Numbering System; how-
surfaces. All teeth have 4 point angles. In the
ever, tooth No. 12 in the FDI system identi-
example in question, tooth No. 11 is the max-
fies the permanent maxillary right lateral
illary left 1st premolar, which has mesio-
incisor.
facial-occlusal, disto-facial-occlusal, mesio-
lingual-occlusal, and disto-lingual-occlusal Answer E is incorrect. This choice identifies
point angles. the primary canines according to the FDI
System. In the primary dentition, the upper
right (UR) quadrant is designated “5”, the UL
above.
is “6”, LL is “7”, and LR is “8”, and the
28. The correct answer is A. The MB cusp tip of canine is the 3rd (“3”) tooth from the mid-
the mandibular 1st molar contacts the inter- line, numbering distally.
proximal marginal ridges of the maxillary 1st
30. The correct answer is A. Mandibular lateral
molar and 2nd premolar.
incisors, which are single rooted, frequently
Answers B, C, and D are incorrect. Remem- have two canals (up to 40%).
ber: the DB cusps of mandibular molars and
Answer B is incorrect. The mandibular
ML cusps of maxillary molars occlude in the
canine is typically single rooted with one
central fossae of their opposing counterparts
canal. Although a two-rooted (buccal and lin-
in ideal intercuspation.
gual), two-canal variant exists (4%-20%), the
29. The correct answer is B. The Universal question asks for the tooth that has 2 canals
Number System numbers the permanent within a single root.
dentition 1 through 32 starting with the max- Answer C is incorrect. The mandibular 2nd
illary right 3rd molar as No. 1 and the premolar will have a single canal within a
mandibular right 3rd molar as No. 32. single root 97.5% of the time.
Answer A is incorrect. If the question had Answer D is incorrect. Invariably, the maxil-
asked you to use the Federation Dentaire lary central incisor has 1 root and 1 canal.
Internationale (FDI) system, then this answer
Answer E is incorrect. Like the maxillary
choice would be correct. In the FDI number-
central incisor, expect a single root with 1
ing system, the 1st digit represents the quad-
canal in the maxillary canine.
rant and arch in which the tooth is found, as
well as whether or not the tooth is primary or
31. The correct answer is C. The articular emi-
permanent; the 2nd number denotes the
nence is located just anterior and inferior to
Dental Anatomy
tooth position relative to the midline, from

and Occlusion
the articular (glenoid) fossa. The functional

closest to farthest away.
portion is on the posterior inferior aspect of
Answer C is incorrect. The primary, not the articular eminence where the mandibular
permanent, canines are identified with the condyle (and intervening articular disc) rubs
Universal Numbering System in this answer. against during mandibular movement.
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Answer A is incorrect. This portion of the MB root buccolingually, this furcation is

mandibular fossa does not articulate with any centered buccolingually.
part of the condyle or disc.
34. The correct answer is E. The proximal sur-
Answer B is incorrect. Only when the
faces are the sides of a tooth generally next to
condyle and disc slip past the articular emi-
an adjacent tooth. The mesial surface is
nence, can the anterior aspect of the articular
closer to the midline, whereas the distal sur-
eminence be engaged. However, this is a
face is farther from the midline.
pathologic, painful condition resulting in an
open-locked jaw. Answer A is incorrect. The facial surface
rests against the lip or cheek.
Answer D is incorrect. The anterior three-
fourths of the mandibular fossa, also called Answer B is incorrect. The lingual surface is
the articular (glenoid) fossa, is considered nearest the tongue.
nonfunctioning because, when the teeth are Answer C is incorrect. The incisal surface is
in tight centric occlusion, there is no contact the cutting edge of an anterior tooth.
among the condylar head, disc, and this part
of the temporal bone. Answer D is incorrect. The buccal surface is
the same as the facial surface, but more com-
32. The correct answer is D. In general, the monly used for posterior teeth.
crowns of primary anterior teeth are wider
mesiodistally compared to their incisocervical 35. The correct answer is A. Just like an ideal 1st
height. Hence, primary teeth appear “short molar relationship, the MB cusp of the maxil-
and squat” relative to their permanent lary 2nd molar opposes the buccal groove of
counterparts. its counterpart, the mandibular 2nd molar.
Answers A, B, and C are incorrect. See Answer B is incorrect. The DB cusp of the
above. maxillary 2nd molar opposes this groove in
ideal intercuspation.
33. The correct answer is B. The large palatal Answer C is incorrect. An MB groove does
root spans the entire width of the lingual sur- not exist on the mandibular 2nd molar which
face, tapering from the CEJ to a blunted or has only 2 buccal cusps and a single buccal
rounded apex. No furcation can be detected groove (opposed by the MB cusp of the max-
on this surface. Remember: palatal roots are illary 2nd molar).
wider in the mesiodistal than in the bucco-
palatal direction. Answer D is incorrect. This relationship
could exist in a class II malocclusion in
Answer A is incorrect. The buccal furcation which the buccal groove of the mandibular
entrance may be detected between the MB 1st permanent molar is distal to the MB cusp
and DB roots an average of 4.2 mm from the of the maxillary 1st permanent molar. How-
CEJ. ever, the question asks for the molar relation-
Answer C is incorrect. The mesial furcation ship in the ideal intercuspal position.
entrance may be detected between the MB
and palatal roots an average of 3.6 mm from 36. The correct answer is D. Longitudinal root
the CEJ. This furcation is most easily depressions exist on both sides of the mandibu-
accessed from the palatal given the relatively lar canine root, and when deep enough,
Dental Anatomy
large breadth of the MB root buccolingually. clearly bifurcate the root labiolingually.
and Occlusion
Answer D is incorrect. The distal furcation Answers A, B, and C are incorrect. Maxil-
entrance may be detected between the DB lary central incisors, laterals incisors, and
and palatal roots an average of 4.8 mm from canines almost always have one canal and are
the CEJ. Since the DB root is not as wide as invariably single rooted.
Answers: 32-41 215
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Answer E is incorrect. Careful! This tooth is Answer D is incorrect. This is not a simple
not normally single rooted; rather, it typically lever classification type.
has two roots and a bifurcation.
39. The correct answer is C. Follow the eruption
37. The correct answer is C. Typically the maxil- sequence of permanent teeth until you get to
lary 2nd premolar has only one root, and the 12 permanent teeth: 4 first molars + 4 central
shallow mesial developmental groove that incisors + 4 lateral incisors = 12 permanent
exists on the root does not extend onto the teeth. Eight primary incisors were replaced
crown, as it does on the maxillary 1st premo- by the 8 permanent incisors (20 − 8 = 12 pri-
lar. The root depression on the distal is often mary teeth remaining). The child described
deeper than on the mesial. above is at the end of the early mixed denti-
tion phase and is most likely 81/2 years old.
Answer A is incorrect. The cross-section of
the root at the cervix of the maxillary central Answer A is incorrect. At most, only 8 per-
incisor is somewhat triangular in shape and manent teeth (4 first molars and 4 [upper and
there are no prominent root depressions. The lower] central incisors) would be expected at
distal root surface is convex; and at the very this age. All primary teeth except the lower
most, the mesial surface may be flattened or and upper central incisors would remain
have a very slight longitudinal depression. (20 − 4 = 16 primary teeth).
Answer B is incorrect. A shallow longitudinal Answer B is incorrect. It is likely that the
root depression is often found in the middle permanent maxillary lateral incisors would
of the mesial root surface on a maxillary lat- not have erupted by this age (usually around
eral, but not on the distal. age 8-9).
Answer D is incorrect. Longitudinal depres- Answer D is incorrect. At the very least, one
sions are not common on the mesial root sur- would expect the mandibular canine and/or
face, but are frequent on the distal surface. In the maxillary 1st premolar to have erupted at
contrast, the mandibular 1st premolar has this age, yielding 14-16 permanent teeth and
root depressions present on both sides, deeper 8-10 primary teeth.
on the distal. Sometimes these depressions
Answer E is incorrect. By this age, no pri-
may be quite deep and end in a buccolingual
mary teeth should remain. The permanent
apical bifurcation.
2nd molars likely would have erupted (at
about age 11-13).
38. The correct answer is C. A class III lever is
comparable to “tweezers” in which the effort is
40. The correct answer is B. The FOA has the
between the fulcrum and the load. In the case
potential to make contact with the inner
of the mandible, the fulcrum is the TMJ. The
incline of guiding cusps.
effort is supplied by the masseter, medial ptery-
goid, and temporalis muscles which attach at Answers A, C, D, and E are incorrect. The
locations anteroinferiorly to the TMJ (ie, coro- lingual inclines of the maxillary anterior
noid process, inferior border of mandible, lat- teeth are guiding inclines.
eral and medial aspects of the ramus, etc), and
the load is imparted upon incising food. 41. The correct answer is C. All posterior teeth,
when viewed from the occlusal, have proxi-
Answer A is incorrect. A class I lever is a mal contacts that are slightly buccal to the
“see-saw” in which the fulcrum is between
Dental Anatomy
middle 3rd.
and Occlusion
the effort and the load.

Answer A is incorrect. No tooth in an ideal
Answer B is incorrect. A class II lever is a dentition has a proximal contact that is lin-
“wheelbarrel” in which the load is between gual to the middle 3rd when viewed from the
the fulcrum and effort. occlusal.
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Answer B is incorrect. If the question asked Answer A is incorrect. In a posterior cross-

you to evaluate the proximal contact from the bite, the anterior teeth would most likely
buccal or lingual views, then this answer remain in function during excursive move-
would have been correct. ments, and the mamelons would have worn
away.
Answer D is incorrect. The occlusocervical
position of a proximal contact cannot be eval- Answer B is incorrect. In an anterior cross-
uated when viewing a tooth from the bite, the anterior teeth would most likely
occlusal. Rather, one would have to look remain in function during excursive move-
from the buccal or lingual views. Nonethe- ments, and the mamelons would have worn
less, when viewed from the buccal or lingual, away.
the contact described in the question above
Answer C is incorrect. The presence of
would be in the middle 3rd (as it is for all
mamelons is considered normal only when
posterior teeth).
they are present on newly erupted teeth that
haven’t yet contacted their antagonists.
42. The correct answer is D. All anterior teeth
(incisors and canines) in both the permanent Answer E in incorrect. Grinding of the teeth
and primary dentitions have a cingulum, or at night would lead to attrition, flattening the
bulge, on the cervical 3rd of the lingual sur- incisal edges or cusp tips, thus wearing
face. 4 central incisors + 4 lateral incisors + mamelons away.
4 canines = 12 teeth.
45. The correct answer is C. The superior fibers
Answers A, B, C and E are incorrect. See
of the lateral pterygoid originate at the roof of
above.
the infratemporal fossa, and insert in the
articular capsule and disc. Its inferior fibers
43. The correct answer is D. In posterior cross-
originate on the lateral side of the lateral
bite situations, the supporting and guiding
pterygoid plate, and insert on the anterior
cusps are reversed. That is, the maxillary buc-
condylar neck. Functions of the lateral ptery-
cal and mandibular lingual cusps would be
goid muscle include mandibular protrusion,
supporting, while the maxillary lingual and
depression, and contralateral excursion.
mandibular buccal cusps would function as
guiding (nonsupporting) cusps. Answer A is incorrect. The superior fibers of
the lateral pterygoid originate at the roof of
Answers A, B, and C are incorrect. In both
the infratemporal fossa, and insert in the
working and nonworking movements of an
articular capsule and disc. Its inferior fibers
ideal intercuspal relationship, the supporting
originate on the lateral side of the lateral
cusps are the maxillary lingual cusps and the
pterygoid plate, and insert on the anterior
mandibular buccal cusps.
condylar neck. Functions of the lateral ptery-
44. The correct answer is D. Mamelons are goid muscle include mandibular protrusion,
small enamel tubercles on the incisal edges depression, and contralateral excursion.
of anterior teeth formed from the three facial Answer B is incorrect. The medial pterygoid
developmental lobes. They normally wear originates at the medial side of the lateral
away when the tooth comes into functional pterygoid plate, and inserts on the medial
contact with its opposing tooth. In an anterior side of the mandibular angle. Functions of
open bite situation, there is no contact the medial pterygoid muscle include
Dental Anatomy
between the maxillary and mandibular ante- mandibular elevation, protrusion, and con-
and Occlusion
rior teeth. The age of the patient suggests that tralateral excursion.
if the teeth were in contact, the mamelons
Answer D is incorrect. The temporalis origi-
would have been worn away.
nates at the lower temporal line, temporal
fossa, and temporal fascia, and inserts on the
Answers: 42-49 217
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medial coronoid process and anterior ramus. Answer D is incorrect. All anterior teeth
Functions of the temporalis muscle include (incisors and canines) have a lingual HOC in
mandibular elevation, retrusion, and ipsilat- the cervical 3rd (at the cingulum).
eral excursion.
48. The correct answer is C. The maxillary 1st pre-
46. The correct answer is C. In general, mesial molar has an oval-shaped pulp chamber, flat-
contact areas of anterior teeth are located in tened mesiodistally (like an hourglass). Remem-
the incisal 3rd, and distal contact areas are ber that it generally has two roots. Mandibular
positioned more cervically. The only excep- incisors also have pronounced hourglass-shaped
tion is the mandibular central incisors. Due pulp chambers. The mesiodistal constriction of
to the highly symmetric nature of the the oval is less pronounced in the canines and
mandibular centrals about their root-axis line, other premolars.
both mesial and distal contacts exist at the
Answer A is incorrect. Although no tooth has
same level (the incisal 3rd).
a perfectly round pulp chamber (at the level
Answer A is incorrect. Although the mesial of the CEJ), the maxillary central incisor has
contact is in the incisal 3rd, the distal contact the roundest.
is located at the junction of the incisal and
Answer B is incorrect. The maxillary lateral
middle 3rds.
incisor has an egg-shaped pulp chamber.
Answer B is incorrect. Both maxillary lateral
Answer D is incorrect. No teeth have an
incisor and maxillary canine have mesial con-
oval-shaped pulp chamber that is flattened
tact areas at the junction of the incisal and
buccolingually.
middle 3rds, and distal contacts located in
the middle 3rd. Answer E is incorrect. The mandibular 1st
molar has a rectangular-shaped pulp chamber.
Answer D is incorrect. Although both mesial
and distal contacts are located in the incisal 49. The correct answer is D. The buccal cusps
3rd of the mandibular lateral incisor, the dis- of the mandibular posterior teeth are support-
tal contact is located slightly more cervically ing cusps, which mean that they contact the
than the mesial (ie, they are not at the same opposing dentition in areas called centric
height occlusocervically). stops. Not only do these buccal cusps contact
Answer E is incorrect. With a mesial contact their maxillary antagonists in the intercuspal
in the incisal 3rd and a distal contact area in position, they also can contact their maxillary
the middle 3rd, the mandibular canine has antagonist during working and nonworking
the greatest difference in height between its lateral movements. The lingual cusps of the
proximal contacts than any other tooth. mandibular molar, on the other hand, are
nonsupporting, and do not rest in a central
47. The correct answer is C. All posterior teeth fossa or marginal ridge area of a maxillary
(premolars and molars) have a lingual HOC antagonist. However, the buccal incline of
in the middle 3rd, and a buccal HOC in the the lingual cusps can serve as a guiding
cervical 3rd, when viewed from the proximal. incline for the maxillary lingual supporting
cusps during mandibular movement.
Answer A is incorrect. No tooth has a buccal
or lingual HOC in the occlusal 3rd of its Answer A is incorrect. On the working side
crown. Remember, though, that the proximal during lateral excursion, the outer aspect of
Dental Anatomy
HOC is located in the occlusal 3rd in most the mandibular buccal (supporting) cusp can
and Occlusion
anterior teeth. glide along the inner or lingual incline of

the maxillary buccal guiding (nonsupporting)
Answer B is incorrect. The buccal HOC of
cusp.
posterior teeth is in the cervical 3rd.
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Answer B is incorrect. On the nonworking fact, the smaller DL cusp of the maxillary
side, the lingual supporting cusps of the max- 2nd molar, compared to the wider, promi-
illary teeth can be guided along the inner nent DL cusp of 1st molars, gives the appear-
aspect of the buccal cusps. ance of more taper (narrowing) from buccal
to lingual on 2nd molars.
Answer C is incorrect. The lingual aspect
(nearest the cusp tip) of the lingual maxillary Answers A, C, and D are incorrect. See
supporting cusps can be guided along the above.
inner incline of the lingual mandibular cusps
during excursive movements (working side). 53. The correct answer is C. Working interfer-
ences are premature contacts of posterior
50. The correct answer is C. Tooth J is the pri- teeth on the working side during lateral
mary left maxillary 2nd molar, which is excursive movement. Recall that nonworking
replaced by the maxillary left 2nd premolar, interferences occur on the nonworking side.
No. 13. Protrusive interferences occur between the
distal aspects of maxillary posterior teeth and
Answer A is incorrect. The maxillary right
mesial aspects of mandibular posterior teeth.
permanent 3rd molar is not a succedaneous
tooth. Answers A, B, and D are incorrect. See
above.
Answer B is incorrect. Tooth No. 10, the
maxillary left lateral incisor, replaces the pri-
54. The correct answer is E. The narrow
mary left lateral incisor, G.
mandibular incisor opposes a relatively wide
Answer D is incorrect. Tooth No. 20, the central incisor, and therefore only contacts
mandibular left 2nd premolar, replaces the this tooth. Also recall that the maxillary poste-
primary left mandibular 2nd molar, K. riors are positioned distally to their mandibu-
lar counterparts, so the maxillary 3rd molar
Answer E is incorrect. Tooth No. 21, the
can contact only the mandibular 3rd molar.
mandibular left 1st premolar, replaces the
The mandibular 3rd molar, on the other
primary left mandibular 1st molar, L.
hand, can contact the distal marginal ridge of
51. The correct answer is A. Generally, teeth the maxillary 2nd molar, as well as the cen-
have a greater proximal cervical line curva- tral fossa of the maxillary 3rd molar via its
ture mesially than distally. The curvature is MB and DB cusps, respectively.
greatest on the incisors and decreases toward Answer A is incorrect. The width of the max-
the last molar, in which there may be no cur- illary central incisor allows it to be contacted
vature at all. by both the mandibular central and lateral
Answer B is incorrect. The mesial and distal incisors.
proximal cervical line contours of the ante- Answer B is incorrect. The mandibular lat-
rior teeth have more curvature than on poste- eral incisor and canine can articulate with
rior teeth. the maxillary lateral incisor.
Answer C is incorrect. The mesial surface gen-
55. The correct answer is B. An impacted tooth
erally has a greater curvature than the distal.
is one that does not erupt within the expected
Answer D is incorrect. The least amount of time. Although 3rd molars are the most com-
curvature (if any) can be expected on the dis- monly impacted teeth in the adult dentition,
Dental Anatomy
and Occlusion
tal aspects of posterior teeth. it is not represented as a choice. Maxillary

canines are the 2nd most common impacted
52. The correct answer is B. This is one of the teeth, followed by mandibular premolars.
most obvious characteristics that distinguishes Recall that maxillary canines are the last non-
1st, 2nd, and 3rd molars from each other. In molar teeth to erupt in the maxillary arch,
Answers: 50-61 219
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emerging after all the incisors and premolars Answer A is incorrect. The incisal edge of
have erupted. Given their long path of erup- the maxillary lateral incisor opposes the
tion, and the possibility of insufficient arch mandibular lateral incisor and canine.
space, they may become impacted, typically
Answer C is incorrect. The cusp tip of the
to the palatal.
maxillary 1st premolar resides between the
Answer A is incorrect. Although impaction mandibular 1st and 2nd premolars.
of these teeth is not unheard of, the fre-
Answer D is incorrect. The cusp tip of the
quency is less than that of 3rd molars and
maxillary 2nd premolar lies in the facial
maxillary canines.
embrasure between the mandibular 2nd pre-
Answers C, D, and E are incorrect. See molar and 1st molar.
above.
59. The correct answer is C. Maxillary 2nd
56. The correct answer is E. The cervical ridge molars rarely have a cusp of Carabelli. It is
runs mesiodistally in the cervical 3rd of the also noteworthy to mention that the DL cusp
buccal surface of all primary teeth (as well as is absent in more than one-third of these
all permanent molars). The cervical ridge is teeth!
prominent in primary anterior teeth, and is
best seen when viewed from the proximal.
above.
The cervical ridge of primary molars is most
prominent on the mesial-facial aspect. 60. The correct answer is B. During the bud
Answers A, B, C, and D are incorrect. See stage, epithelial cells from the primary epithe-
above. lial band proliferate into the underlying
ectomesenchyme.
57. The correct answer is A. The large ML cusp
Answer A is incorrect. The primary epithelial
has one triangular ridge that meets the MB
band forms at about week 6 in utero.
triangular ridge to form a transverse ridge. Its
2nd triangular ridge extends toward the DB Answer C in incorrect. The cap stage, in
cusp and forms part of the oblique ridge. which the bud splits into a caplike structure,
and where the enamel organ, dental papilla,
Answer B is incorrect. The DL cusp has only
and dental follicle begin to take shape, starts
one, inconspicuous triangular ridge that
at about week 9 in utero.
abuts with the oblique ridge at a roughly per-
pendicular angle. Answer D is incorrect. The bell stage of
tooth development, in which cells differenti-
Answer C is incorrect. The cusp of Carabelli
ate in preparation for the formation of hard
does not have a triangular ridge.
tissues, starts at about week 11 in utero.
Answer D is incorrect. The MB cusp has
Answer E is incorrect. At approximately 18
only one triangular ridge (forming a trans-
weeks in utero, the tooth enters the crown
verse ridge with ML cusp).
stage in which enamel and dentin are actively
Answer E is incorrect. The DB cusp has only synthesized.
one triangular ridge, which joins with one
from the ML cusp to form part of the oblique 61. The correct answer is B. Remember the four
ridge. determinants of occlusion: the right and left
Dental Anatomy
TMJs, the neuromusculature, and the teeth.

and Occlusion
58. The correct answer is B. In an ideal occlu- As a dentist, the only one that can be directly
sion, the cusp tip of the maxillary canine sits controlled is the teeth (by restorations, ortho-
between the mandibular canine and 1st dontics, and equilibration).
premolar.
above.
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62. The correct answer is C. Maxillary 1st Answer A is incorrect. It has a very well-
molars can present with a wide, prominent developed mesial marginal ridge.
DL cusp that results in a wider lingual half
Answer C is incorrect. The occlusal table is
than buccal half. Keep in mind, though, that
much larger on the distal side of the trans-
all molar crowns in general will taper from
verse ridge compared to the mesial side.
buccal to lingual, even maxillary 1st molars.
It’s only those maxillary 1st molars with large Answer D is incorrect. The occlusal table has
distolingual cusps that serve as an exception a small mesial triangular fossa and a large dis-
to this rule. tal fossa, but no central fossa due to the pres-
ence of a prominent transverse ridge extending
Answer A is incorrect. With three buccal
between the MB and ML cusps.
cusps and two lingual cusps, the mandibular
1st molar clearly tapers to the lingual. Answer E is incorrect. The mesiodistal
length is greater than the buccolingual width.
Answer B is incorrect. Although this tooth
exhibits less crown taper from buccal to lin- 66. The correct answer is E. Cervical enamel
gual than the mandibular 1st molar, the lin- projections (CEPs) are apical extensions of
gual side is still narrower. enamel located at furcation entrances on
Answer D is incorrect. Compared to maxil- molar teeth (28% mandibular, 17% maxil-
lary 1st molars, 2nd molars taper more from lary). CEP size can vary greatly from small
the buccal to the lingual due to their smaller projections at the CEJ to larger extensions
distolingual cusp. into the furcation proper. They are most
commonly found on buccal surfaces. In
63. The correct answer is C. The maxillary decreasing order of incidence: Mandibular
canines contact mandibular canines (anterior 2nd molars > Maxillary 2nd molars >
segment) and mandibular 1st premolars (pos- Mandibular 1st molars > Maxillary 1st
terior segment). Likewise, the mandibular 1st molars. Like enamel pearls, CEPs can predis-
premolar contacts the opposing maxillary pose a tooth to periodontal attachment loss
canine (anterior) and 1st premolar (poste- since connective tissue does not attach to the
rior). Thus, 2 maxillary canines + 2 mandibu- enamel (where cementum would normally
lar 1st premolars = 4 total teeth. Remember: be located).
Maxillary teeth contact their opposing coun-
terpart and the tooth distal to it. Mandibular
above.
teeth contact their opposing counterpart and
the tooth mesial to it. 67. The correct answer is E. This arrangement is
Answers A, B, D, and E are incorrect. See found in an ideal class I canine occlusion.
above. Answer A is incorrect. In an ideal occlusion,
the maxillary canine occludes with the
64. The correct answer is A. Maxillary 1st molar:
mandibular canine and 1st premolar.
ML > MB > DB > DL > cusp of Carabelli.
Answer B is incorrect. This arrangement
Answers B, C, and E are incorrect. See
may be found in a class II occlusion.
above.
Answer C is incorrect. In an ideal occlusion,
Answer D is incorrect. No distal cusp exists
the maxillary 1st premolar occludes with the
on this tooth. Instead, a distal cusp is found
Dental Anatomy
mandibular 1st and 2nd premolars.

and Occlusion
on the mandibular 1st molar.

Answer D is incorrect. In an ideal occlusion,
65. The correct answer is B. The MB cusp is the maxillary lateral incisor articulates with
always the largest and longest cusp, occupy- the mandibular canine and lateral incisor.
ing nearly two-thirds of the buccal surface.
Answers: 62-74 221
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68. The correct answer is A. The maxillary cen- Answer A is incorrect. Spacing is normal
tral incisor has the roundest pulp chamber throughout the anterior part of the primary
(although it is not perfectly round). It is dentition, but is most notable in the primate
slightly egg shaped with the widest portion spaces mentioned above.
buccally.
Answer B is incorrect. Careful! Primate
Answer B is incorrect. The maxillary lateral spaces are found only in the primary denti-
incisor has an egg-shaped pulp chamber with tion (premolars are only found in the perma-
the widest portion buccally. nent dentition).
Answer C is incorrect. The maxillary canine Answer C is incorrect. The primate space is
has an oval-shaped pulp chamber, flattened mesial to the primary canines in the maxilla.
mesiodistally (hourglass shaped).
Answer D is incorrect. This answer choice
Answer D is incorrect. The mandibular cen- most closely resembles the definition of lee-
tral incisor has an oval-shaped pulp chamber, way space, which is the difference between
flattened mesiodistally (hourglass shaped). the sum of the mesiodistal widths of the pri-
mary canine, 1st and 2nd molars, and the
Answer E is incorrect. The mandibular lat-
succeeding permanent canine, 1st and 2nd
eral incisor has an oval-shaped pulp chamber,
premolars.
flattened mesiodistally (hourglass shaped).
72. The correct answer is B. Each maxillary
69. The correct answer is E. When the mandible
molar has one transverse ridge, which runs
is at rest, the teeth generally do not contact
between the MB and ML cusps.
each other. In order for the teeth to touch in
centric occlusion, muscles that elevate the Answers A, C, D, and E are incorrect. See
mandible must contract. The major elevators above.
of the mandible are the masseter, medial
pterygoid, and temporalis muscles. 73. The correct answer is C. In centric relation,
lateral excursions, and mandibular protru-
sion, the mandibular central incisor will only
above.
articulate with the lingual or incisal aspect of
the maxillary central incisor.
70. The correct answer is D. The mandibular 1st
molar has 3 grooves: buccal, distobuccal, and Answer A is incorrect. The mandibular 1st
lingual. The 2nd molar has 2 grooves: buccal molar articulates with the maxillary 1st molar
and lingual. and 2nd premolar in maximum intercuspa-
tion and during lateral excursive and protru-
sive movements.
above.
Answer B is incorrect. The mandibular lat-
71. The correct answer is E. Primate spaces are eral incisor can articulate with the maxillary
located mesial to the primary canines in the lateral and central incisors.
maxilla (between the lateral incisors and
Answer D is incorrect. The maxillary lateral
canines), and distal to primary canines in the
incisor can articulate with the mandibular
mandible (between the primary canines and
lateral incisor and canine.
primary 1st molars). The primate spaces (so
named because most subhuman primates Answer E is incorrect. Both the mandibular
Dental Anatomy
and Occlusion
have these spaces throughout life) are nor- central and lateral incisors can contact the lin-
mally present from the time the primary teeth gual surface of the maxillary central incisor.
erupt, and close with the eruption of the per-
manent 1st molars (early mesial shift). 74. The correct answer is C. Each maxillary
molar has 4 fossae: mesial triangular, central
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(bounded by the mesial transverse ridge and of the crown or root that is lined by enamel.
the oblique ridge), distal triangular, and distal In order of decreasing frequency, the perma-
(within the distal oblique groove, and nent teeth most commonly affected are the
between the oblique ridge and DL cusp). following: Lateral incisors > Central
Each mandibular molar has 3 fossae: mesial, incisors > Premolars > Canines > Molars.
central, and distal.
Answer D is incorrect. A supernumerary
Answers A, B, and D are incorrect. See tooth situated lingually or buccally to a molar
above. tooth is termed a paramolar.
Answer E is incorrect. A talon cusp (dens
75. The correct answer is B. Maxillary 1st molars
evaginatus of an anterior tooth) is a well-
are typically rhomboidal in shape when
delineated additional cusp (not an additional
viewed from the occlusal, and often a promi-
tooth) that is located on the surface of an
nent distolingual cusp exists such as the lin-
anterior tooth. These cusps occur most com-
gual portion of the occlusal surface is in fact
monly on maxillary lateral and central
wider than the buccal portion. Mandibular 1st
incisors, projecting from the lingual surface,
molars have a somewhat trapezoidal occlusal
and forming a three-pronged pattern resem-
outline, with the shortest side (mesiodistally)
bling an eagle’s talon.
on the lingual. In general, maxillary 1st molars
are wider on the lingual, and mandibular
78. The correct answer is A. Recall that, in an
molars are wider on the buccal.
ideal occlusion, the MB cusp of the maxillary
Answers A, C, and D are incorrect. See 1st molar opposes the buccal groove of the
above. mandibular 1st molar. As the mandible moves
to laterally to the working side, the MB cusp
76. The correct answer is B. The spheno- tip slides through the buccal groove.
mandibular ligament is a remnant of Meckel
cartilage, originally derived from the 1st
branchial arch. It extends from the spine of
the sphenoid bone to the mandibular lingula.
Answers A and D are incorrect. The tem-
poromandibular ligament (also called the lat-
eral ligament) does not directly derive from
one of the branchial arches.
ligament is not originally derived from one of
the branchial arches. It extends from the sty-
loid process to the mandibular angle.
77. The correct answer is A. A mesiodens is a

small supernumerary tooth that typically Answers B, C, D, and E are incorrect. See
forms between maxillary central incisors. It above.
has a cone-shaped crown with a short root, 79. The correct answer is C. Although they can
and may remain unerupted. resemble each other, there are enough differ-
Dental Anatomy
Answer B is incorrect. A supernumerary ences that you will not confuse them. Even
and Occlusion
4th molar is often called a distodens, or though the primary tooth has 4 cusps, the DB
distomolar. and DL cusps are inconspicuous, making the
larger MB and ML cusps look like maxillary
Answer C is incorrect. Dens-in-dente (tooth- premolar cusps. The grooves form an “H”
within-a-tooth) is a deep surface invagination pattern, which is somewhat similar to a
Answers: 75-84 223
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maxillary premolar. However, a distinct In a couple of years (ages 10-12), the child
notch can be seen separating the large MB should expect the eruption of the permanent
cusp from the diminutive DB cusp when mandibular canine and permanent mandibu-
viewed from the buccal. lar and maxillary premolars, followed by the
permanent maxillary canine.
Answer A is incorrect. The primary
mandibular 2nd molar most closely resembles
82. The correct answer is A. A class III canine
the adult mandibular 1st molar.
relationship occurs when the maxillary
Answer B is incorrect. No primary tooth canine occludes distal to the distal cusp ridge
resembles the permanent mandibular 2nd of the mandibular canine.
molar.
Answer B is incorrect. This defines an Angle
Answer D is incorrect. The primary maxil- class I occlusion.
lary 2nd molar most closely resembles the
Answer C is incorrect. This defines an Angle
adult maxillary 1st molar.
class II occlusion.
Answer E is incorrect. No primary tooth
Answer D is incorrect. See above.
resembles the permanent maxillary 2nd
molar. 83. The correct answer is B. For a mandibular
2nd molar, the order from largest to smallest
80. The correct answer is E. Remember that the
cusps is ML > DL > MB > DB. The same is
buccal/facial HOC of all permanent teeth is
true for the four major cusps of the mandibu-
located in the cervical 3rd of the crown. The
lar 1st molar; the minor 5th distal cusp is the
lingual HOC of all anterior teeth is also
smallest of all (ML > DL > MB > DB > D).
located in the cervical 3rd (at the cingulum).
Answer C is incorrect. The lingual HOC of
above.
all posterior teeth (premolars and molars) is
located in the middle 3rd of the crown. 84. The correct answer is B. Remember that
Answers A, B, and D are incorrect. See the articular disc (meniscus) is composed of
above. dense fibrocartilage, providing the most pro-
tection against compression and tension.
81. The correct answer is C. The 8 permanent
Answers A and C are incorrect. The disc is
teeth include 4 permanent central incisors
elliptical and biconcave, consisting of thick
and 4 permanent 1st molars. All of the pri-
anterior and posterior bands. The central
mary teeth are present except the four pri-
intermediate zone is much thinner and com-
mary central incisors (20 − 4 = 16), which
pletely avascular.
exfoliated when the permanent central
incisors erupted at approximately age 6-7. Answer D is incorrect. The superior inser-
tion areas of the lateral pterygoid muscle are
Answer A is incorrect. This is likely a 6-year-
the anterior portion of the articular disc and
old child with permanent 1st molars that has-
capsule. Its inferior insertion site is the ante-
n’t yet exfoliated any primary central incisors.
rior condylar neck.
Answer B is incorrect. This is an unlikely
Answer E is incorrect. Because it is bicon-
scenario in which the permanent mandibular
cave, the disc has two reciprocal articular sur-
central incisors erupted prior to the perma-
Dental Anatomy
faces: one between its superior aspect and the

and Occlusion
nent 1st molars, for example.

glenoid fossa and articular eminence; the other
Answer D is incorrect. This is an older child between the inferior aspect and the condyle.
(about 8 years old) with permanent 1st The spaces between these structures create
molars (4), central incisors (4), lateral incisors superior and anterior compartments.
(4), and primary canines (4) and molars (8).
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85. The correct answer is A. A fourth canal may as acids. It typically affects smooth surfaces,
be found in the mesiobuccal (30% preva- including lingual and occlusal surfaces,
lence). The MB II canal is located about resulting in cup-shaped defects. Erosion lim-
1.8-mm lingual to the MB I canal. ited to the facial surfaces of the maxillary
anterior teeth is often associated with dietary
sources of acid (eg, sucking on lemons);
above.
whereas palatal erosion is often associated
86. The correct answer is D. Don’t be troubled if with regurgitation of gastric acids (eg, GERD
you missed this question since it’s unlikely that or bulimia). The amalgam restoration extend-
anyone would get it correct unless you like to ing above the remaining occlusal surface of
memorize random tables. If anything, this No. 30 suggests that an erosive process is at
question is an exercise in reading a question play, rather than attrition.
carefully and thinking about it before answer- Answer A is incorrect. Abfraction is the loss
ing. Many may have chosen the maxillary of tooth structure resulting from abnormal
canine, since it has the longest root in the per- occlusal stresses. As a tooth flexes under
manent dentition. However, it also has a rela- stress, enamel rods fracture just coronal to the
tively long crown length (only the mandibular CEJ, leading to V-shaped cervical-facial
canine and maxillary central incisor are lesions.
longer), making the root-to-crown ratio less
Answer B is incorrect. Attrition is wear
than thought. The answer is a tooth with a rel-
caused by tooth-tooth contact. Large, flat,
atively squat crown and reasonably long roots.
smooth, and shiny wear facets are the typical
The mandibular 1st molar fits this bill: its root-
presentation.
to-crown ratio is 1.87. The maxillary 1st molar
is a close 2nd with a 1.78 root-to-crown ratio. Answer D is incorrect. Abrasion is wear
caused by abnormal mechanical means (often
Answer A is incorrect. Root-to-crown
overzealous oral hygiene or other factitious
ratio = 1.24 (the lowest of all teeth).
habits). Toothbrush abrasion typically presents
Answer B is incorrect. Root-to-crown ratio = as a V-shaped notch in the cervical region, fre-
1.70. quently in the canine-premolar area.
Answer C is incorrect. Root-to-crown
89. The correct answer is A. Both mandibular
ratio = 1.45.
premolar and molar crowns tilt toward the
87. The correct answer is C. The vertical dimen- lingual (relative to the root-axis line) when
sion of rest (VDR) is the vertical dimension viewed from the proximal. Moreover, the
of the face with the mandible in the postural cusp tips of the mandibular canines, as well
(rest) position. The vertical dimension of as the incisal edges of the mandibular
occlusion (VDO) is the vertical dimension of incisors, are typically positioned lingual to
the face when the teeth contact in centric the root-axis line. The opposite is true of the
occlusion (CO). For a dentate patient, then, maxillary incisors and canines, which typi-
VDR > VDO. The difference between the cally have incisal edges/cusp tips that are
two is the freeway space (FS), the distance positioned slightly labial to the root-axis line.
the teeth are separated when the mandible is Maxillary molar and premolar crowns do not
in the postural position (typically 1-3 mm). tip noticeably in any direction, and appear
Thus, VDR = VDO + FS. aligned directly over the roots.
Dental Anatomy
and Occlusion
Answers A, B, D, and E are incorrect. Answers B, C, and D are incorrect. See

Another way to state it is VDO = VDR – FS. above.
88. The correct answer is C. Erosion is the loss 90. The correct answer is B. Just like its perma-
of tooth structure from chemical means, such nent counterpart, the primary maxillary
Answers: 85-95 225
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canine has the longest root of all deciduous Answer D is incorrect. The temporalis func-
teeth, averaging 13.5 mm in length. tions in mandibular elevation, retrusion, ipsi-
lateral excursion, and maintaining its rest
Answer A is incorrect. The primary maxillary
position.
central incisor has one of the shorter roots,
measuring about 10 mm in length. Remem-
93. The correct answer is D. Centric relation
ber that the mandibular central incisor has
(CR) is the intercuspation of the teeth when
the shortest primary root (9 mm in length).
the condyles are located in the most anterior
Answer C is incorrect. The primary maxil- and superior position of the glenoid fossae.
lary 2nd molar roots average 11.7 mm in Because the condylar position of CR is
length. anatomically defined, it is relatively easy for
dentists to consistently position the mandible
Answer D is incorrect. The primary
there when changing a patient’s VDO.
mandibular canine root averages 11.5 mm in
length. Answers A and B are incorrect. These
mandibular positions may present challenges
Answer E is incorrect. The primary
in reproducibility because occlusal interfer-
mandibular 2nd molar roots average 11.3
ences or tooth-to-tooth contacts may shift the
mm in length.
mandible slightly in another direction.
91. The correct answer is B. The incisors begin Answer C is incorrect. Any variation is mus-
to calcify around 41/2 months, the canine and cle contractility can alter the postural posi-
1st molar around 5 months, and the 2nd tion dimension.
molar around 6 months in utero.
94. The correct answer is B. Mandibular molars
Answer A is incorrect. Although tooth devel-
have a larger mesial root and a smaller distal
opment starts at about 6 weeks in utero, calci-
root.
fication has not yet started by 16 weeks.
Answer A is incorrect. All anterior teeth, as
Answer C is incorrect. At 6-8 months in
well as mandibular premolars and maxillary
utero, all of the primary teeth are in a stage of
2nd premolars, are typically single rooted.
calcification, but none of the permanent
teeth have begun to calcify. Answer C is incorrect. Maxillary molars have
three roots.
Answer D is incorrect. The 1st permanent
teeth start to calcify at birth. Answer D is incorrect. No tooth typically has
four roots.
Answer E is incorrect. By 16 weeks postpar-
tum, all of the primary central and lateral Answer E in incorrect. Come on—are you
incisors have completed calcification, but kidding me!
none have erupted.
95. The correct answer is B. The central groove
92. The correct answer is C. The lateral ptery- of the mandibular 1st molar zigzags mesiodis-
goids are the primary protractors of the tally between the three buccal cusps and two
mandible. It also functions in mandibular lingual cusps.
depression and contralateral excursion.
Answer A is incorrect. The mandibular 2nd
Answer A is incorrect. The masseter func- molar has buccal and lingual grooves that
Dental Anatomy
tions in mandibular elevation (primary func- align to intersect with the central groove to
and Occlusion
tion), retrusion, and ipsilateral excursion. form a “plus-sign” occlusal pattern.

Answer B is incorrect. The medial pterygoid Answers C and D are incorrect. Maxillary
functions in mandibular elevation, protru- molars have an oblique ridge running diago-
sion, and contralateral excursion. nally across the occlusal surface separating
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the DL cusp from the other cusps, and cre- Answers A and B are incorrect. No tooth
ates a discontinuous occlusal pattern. develops from only 2 or 3 lobes. Four lobes is
the minimum.
Answer E is incorrect. The maxillary 2nd
premolar has a short central groove with mul- Answer D is incorrect. As a general rule,
tiple supplemental grooves. each molar cusp forms from one lobe. There-
fore, the mandibular 1st molar develops from
96. The correct answer is C. Centric occlusion five lobes (three buccal and two lingual).
is typically the most superior position, but
Answer E is incorrect. A variant of the
retruded contact (D) is the most posterior. In
mandibular 1st molar bears six cusps (a 3rd
some individuals, however, RC may coincide
lingual cusp called tuberculum inter-
with CO, but it is never more anterior than
medium), each of which is developed from a
CO.
single lobe.
B
C
98. The correct answer is C. A TMJ dislocation
A
D occurs when the condyle translates anteriorly,
in front of the articular eminence. To correct,
you should apply firm downward pressure on
the posterior mandible and ramus, with con-
comitant upward pressure on the chin. This
motion, coupled with natural TMJ muscular
guidance, will allow the condyle to move back
over the articular eminence into its original
position within the glenoid fossa. Reduction
attempts should be made as soon as possible to
prevent severe pain and/or muscle spasm.
E
above.
Answer A is incorrect. This is maximum
protrusion. 99. The correct answer is A. The most frequently
Answer B is incorrect. This is the anterior congenitally missing teeth: 3rd molars > Max-
edge-to-edge position. illary laterals > Mandibular 2nd premolars.
Answer D is incorrect. This is retruded Answers B, C, D, and E are incorrect. See
contact. above.
Answer E is incorrect. This is maximum 100. The correct answer is D. The 1st primary
opening. teeth to erupt are the mandibular central
incisors at about 6 months of age; the last are
97. The correct answer is C. Three facial lobes
the 2nd molars at about age 2. The 1st per-
and one lingual lobe (cingulum) comprise
manent teeth to erupt are the 1st molars
the four developmental lobes of anterior
around age 6. Therefore, the answer to this
teeth. Canines and most premolars also
question must be between ages 2 and 6 years.
develop from four lobes (three of which com-
prise the facial aspect). The only exception is Answer A is incorrect. By age 1, all of the pri-
Dental Anatomy
the three-cusped mandibular 2nd premolar mary 1st molars may not have erupted.
and Occlusion
which develops from five lobes (three facial Answer B is incorrect. By age 11/2, all of the
lobes of the buccal cusp and two lobes for primary canines may not have erupted.
each of the two lingual cusps).
Answer C is incorrect. By age 2, all of the
primary 2nd molars may not have erupted.
Answers: 96-108 227
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Answer E is incorrect. By age 61/2, the per- Answers A, B, C, and D are incorrect. See
manent 1st molars have most likely erupted. above.
101. The correct answer is C. All mandibular 105. The correct answer is A. As a general rule,
incisors are quite small relative to the rest of the mesial cervical line curvature is always
the dentition, yet the mandibular central greater than the distal on any given tooth.
incisor is smaller in mesiodistal width, faci- Furthermore, the convexity of the curvature
olingual width, crown height, and root length will diminish (or flatten more) as one moves
compared to the mandibular lateral incisor. away from the midline (posteriorly). The
proximal cervical lines curve toward the
Answers A, B, and D are incorrect. See incisal (convex), whereas the facial or lingual
above. cervical lines curve apically.
102. The correct answer is B. Remember that Answers B, C, D, and E are incorrect. See
mandibular lingual cusps occlude in the above.
embrasure between their maxillary counter-
part and the tooth mesial to it. However, the 106. The correct answer is B. The lingual cusps
DL cusps of mandibular molars articulate of the maxillary premolars tilt mesially and,
with the lingual grooves of their maxillary therefore, will articulate with the distal trian-
counterparts. gular fossae of their mandibular premolar
counterparts.
Answers A and C are incorrect. The MB
cusp of the mandibular 1st molar occludes Answers A, C, D, and E are incorrect. Noth-
with these two marginal ridges. ing rests in these fossae in ideal inter-
cuspation.
Answer D is incorrect. The DB cusp of the
mandibular 1st molar occludes here. 107. The correct answer is A. A fracture of the
Answer E is incorrect. The ML cusp of the right condyle will result in the right lateral
mandibular 2nd molar articulates here. pterygoid to not function, allowing the left
lateral pterygoid to act unopposed. The
103. The correct answer is B. A type II canal sys- mandible will thus deviate to the right side as
tem has two separate canals leaving the pulp it is pulled forward and downward. Remem-
chamber, but later merge together just short ber that the mandible deviates to the same
of the apical foramen. side as the damaged condyle or articular disc.
Answer A is incorrect. A type I canal system Answers B, C, D, and E are incorrect. See
has a single canal from the pulp chamber to above.
the apical foramen.
108. The correct answer is E. The mandibular
Answer C is incorrect. A type III canal sys- teeth are housed within the confines of the
tem has two separate canals leaving the pulp maxillary teeth, so it’s not surprising that the
chamber which exit the root at two separate incisal edges of the anterior teeth reside lin-
apical foramina. gual to the root-axis line.
Answer D is incorrect. A type IV canal system Answer A is incorrect. The incisal edge of
has a single canal leaving the pulp chamber, maxillary incisors is located slightly labial to
but dividing into two separate canals which the labiolingual center of the root.
Dental Anatomy
exit the root at two separate apical foramina.

and Occlusion
Answer C is incorrect. The incisal edge of

104. The correct answer is E. The primary the maxillary canine is located slightly labial
mandibular 1st molar is unique in that it does to the labiolingual center of the root.
not resemble any other primary or permanent
tooth.
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109. The correct answer is C. Teeth that have a Answers A, B, C, and E are incorrect. See
centered cingulum include the maxillary lat- above.
eral incisor, maxillary canine, and mandibu-
lar central incisor. The cingula of the maxil- 114. The correct answer is E. The primary
lary central incisor, mandibular lateral mandibular 2nd molar has five cusps: MB,
incisor, and mandibular canine are slightly ML, D, DB, and DL. Unlike the permanent
distal of center. mandibular 1st molar, the distal cusp is typi-
cally just as large as the MB and DB cusps.
above. Answer A is incorrect. All incisors and
canines (both primary and permanent) have
110. The correct answer is C. Humans have a only one cusp.
heterodont, diphyodont dentition. A het-
Answer B is incorrect. No primary tooth has
erodont dentition is one in which the teeth
two cusps.
have a different morphologies; whereas a
homodont dentition has the same morphol- Answer C is incorrect. No primary tooth has
ogy throughout. Diphyodonts have two sets three cusps.
of teeth throughout their lifetime (eg, in Answer D is incorrect. Both primary maxil-
humans, deciduous and permanent denti- lary 1st and 2nd (although this may have a
tions). As their names suggest, monophyo- five-cusp variant) molars, and the mandibular
donts have only one set of teeth, and polyphy- 1st molar have four cusps.
odonts have multiple sets of teeth.
Answers A, B, D, and E are incorrect. See 115. The correct answer is B. The temporo-
above. mandibular ligament (also called the lateral
ligament) prevents the inferior and posterior
111. The correct answer is B. Permanent incisors displacement of the condyle. Its fibers run
typically erupt lingual to their primary coun- downward and posteriorly from the lateral
terparts. This is why the facial part of the aspect of the articular eminence to the poste-
remaining primary root will usually be longest rior aspect of the condylar neck.
and most securely attached to the gingiva. Answer A is incorrect. The sphenomandibu-
Answers A, C, and D are incorrect. See lar ligament is an accessory ligament, which
above. runs from the spine of the sphenoid bone to
mandibular lingula.
112. The correct answer is B. The maxillary
oblique ridge directly opposes the DB devel-
ligament is an accessory ligament, which
opmental groove of the mandibular molar
runs from the styloid process to the angle of
counterpart.
the mandible.
Answer D is incorrect. This ligament does
above.
not exist.
113. The correct answer is D. Mandibular canines
116. The correct answer is E. Posterior bite col-
have a mesial crown contour that appears
lapse occurs when posterior teeth are lost,
continuous with the root surface when viewed
leading to tipping and migration of adjacent
from the labial. This feature allows one to eas-
Dental Anatomy
teeth. This results in overclosure and bite

and Occlusion
ily identify right from left mandibular canines,

deepening, which causes the mandibular ante-
as well as maxillary from mandibular canines
rior teeth to impinge on the palatal surfaces of
since the mesial aspect of maxillary canines
the maxillary anterior teeth. Over time, these
bulges beyond the root outline.
teeth often flare anteriorly, collapsing the face,
and resulting in a decreased VDO.
Answers: 109-121 229
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Answer A is incorrect. As VDO decreases, Non-working

Working
interference
the freeway space will increase. interference
Answer B is incorrect. The postural position

will likely remain the same. B
L L
B
Answer C is incorrect. Because the rest posi-
tion will be similar, so will the VDR.
Answer D is incorrect. The maximum open-
ing length will likely remain the same.
117. The correct answer is B. The mandibular Answers B, C, and D are incorrect. See
2nd premolar has three occlusal schemes: above.
(1) Y-shaped pattern (most common) has three 120. The correct answer is D. The lingual canal is
cusps with a unique lingual groove and central most frequently missed during root canal
fossa; (2) H-shaped pattern has a mesial fossa, therapy when the access preparation does not
central groove, and distal fossa; and (3) U- extend far enough lingually. Remember that
shaped pattern has a curved central groove. mandibular lateral incisors will frequently
Answer A is incorrect. The mandibular 1st (up to 40%) have a second canal.
premolar has a prominent transverse ridge Answers A, B, C, and E are incorrect. See
without a central groove, separating the above.
mesial and distal fossae. It typically has a dis-
tinct mesiolingual developmental groove. 121. The correct answer is A. Ankylosis is the
Answer C is incorrect. The mandibular 1st fusion of the tooth to the alveolar bone.
molar has two transverse ridges, three fossae Because of this, it is difficult to discern a PDL
with pits, two buccal grooves, and a short space (as there isn’t one) on a radiograph.
lingual groove. The central groove zigzags, Teeth that are ankylosed need to be surgically
resembling a “+<” pattern. removed.
Answer D is incorrect. The mandibular 2nd Answer B is incorrect. A taurodont is a molar
molar has two transverse ridges, three fossae with an elongated root trunk, which typically
with pits, three secondary grooves, one buc- has an enlarged pulp chamber. Although not
cal groove with a pit, and a short lingual always the case, taurodontism generally
groove. The central groove is relatively occurs in patients with amelogenesis imper-
straight with a “+” pattern. fecta, Down syndrome, or Klinefelter syn-
drome. These teeth would not pose a problem
118. The correct answer is C. The maxillary during routine extraction.
canine has the longest root in the permanent Answer C is incorrect. A dilaceration is a
dentition (averaging 17 mm). bend in the root of a tooth. Depending on its
Answers A, B, and D are incorrect. See above. location and severity, the dilacerations in the
root tip may increase the difficulty of an
Answer E is incorrect. The mandibular
extraction. If you are not careful, the root
canine has the longest mandibular root (aver-
may fracture within the alveolar bone.
aging 16 mm).
Answer D is incorrect. Hypercementosis is
Dental Anatomy
and Occlusion
119. The correct answer is A. Nonworking inter- the excess deposition of cementum along a
ferences occur between maxillary lingual root. Care must be taken during extraction to
cusps and mandibular buccal cusps (both are widen the alveolar bone enough to success-
supporting cusps). This is the only time that fully deliver the tooth. If severe enough, these
these areas contact each other outside the teeth may need to be surgically removed.
intercuspal position.
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Answer E is incorrect. Cervical enamel pro- Answer A is incorrect. The cusp angle of the
jections are apical extensions of enamel maxillary canine is sharper than the more
located at furcation entrances on molar teeth. blunt cusp of the mandibular canine.
Although they do not pose a problem during
Answer B is incorrect. The vertical labial
routine extraction, they may put a molar at a
ridge is less pronounced on the mandibular
higher risk for periodontal attachment loss
than maxillary canine.
(connective tissue will not attach to enamel).
Answer C is incorrect. Mandibular canines
122. The correct answer is D. The apices of pri- have more incisally positioned proximal con-
mary teeth are complete 1-2 years after erup- tacts in comparison to their maxillary coun-
tion. Since the last tooth erupts by age 2, terparts. Most notably, the mesial contact of
complete root formation will occur between the mandibular canine is in the incisal 3rd
ages 3 and 4. due to its nearly horizontal mesial cusp ridge.
The distal contact area, as expected, is more
Answer A is incorrect. By age 1-11/2, only the
cervical than the mesial, at the junction of
primary central incisors are close to being
the middle and incisal 3rds.
complete.
Answer D is incorrect. The cingulum on a
Answer B is incorrect. By age 11/2-2, all of
mandibular canine is often slightly offset to
the primary incisors have completed root
the distal, whereas the maxillary canine has a
formation.
centered, more prominent, cingulum.
Answer C is incorrect. By age 2-3, the apices
of the primary 1st molars are complete. 125. The correct answer is A. Just like their per-
manent counterparts, primary maxillary
Answer E is incorrect. The primary root
molars have 3 roots, and primary mandibular
apices will have been well-completed by this
molars have 2 roots.
time.
123. The correct answer is C. The postural posi- above.
tion is the physiologic rest position of the
mandible, creating the vertical dimension of 126. The correct answer is D. Anterior guidance
rest (VDR). It is a purely muscle-guided posi- enables all of the posterior teeth to disarticu-
tion since no teeth contact in this position. late during protrusive and excursive move-
The resulting 1-3 mm space is called the free- ments. The maximum disarticulation occurs
way space (FS). when the anterior teeth are edge-to-edge.
Cusp height is highly influenced by the
Answer A is incorrect. Centric occlusion
overbite-overjet relationship of the incisors
(CO) is a purely tooth-guided position, in
and canines. A deep overbite with minimal
which the maxillary and mandibular teeth
overjet is associated with long cusps. Con-
contact each other in maximum intercuspa-
versely, a long overjet with minimal overbite
tion. This position creates the vertical dimen-
is associated with short cusps.
sion of occlusion (VDO).
Answer B is incorrect. Centric relation (CR)
above.
is a purely ligament-guided position, in
which the condyles are in the most anterior
127. The correct answer is A. Similar to premo-
and superior position of the glenoid fossa.
Dental Anatomy
lars, mandibular incisors, and maxillary

and Occlusion
Answer D is incorrect. See above. molars (but in contrast to maxillary central

incisors and mandibular molars), canine
124. The correct answer is E. All other answer crowns are wider faciolingually than
choices are features characteristic of the max- mesiodistally. Another general class trait of
illary canine.
Answers: 122-132 231
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canines is that the mesial cusp ridge is shorter Answer B is incorrect. At 6-8 months in
than the distal cusp ridge due to a more utero, all of the primary teeth are in a stage of
incisally located mesial proximal contact calcification, but none of the permanent
area. teeth have begun to calcify.
Answers B, C, and D are incorrect. See Answer D is incorrect. By 8-weeks postpar-
above. tum, only the primary central incisors are
close to completion.
128. The correct answer is D. On mandibular
Answer E is incorrect. By 16-weeks postpar-
canines, the distal cusp ridge bends distolin-
tum, all of the primary central and lateral
gually, following the curvature of the lower
incisors have completed calcification, but
arch.
none have erupted.
Answer A is incorrect. Mandibular centrals
are highly symmetrical, and their incisal 131. The correct answer is C. You will typically
edges have no twist, running at right angles to find proclined maxillary laterals with con-
a line bisecting the facial and lingual heights- comitant retroclined maxillary centrals, creat-
of-contour when viewed from the incisal. ing a deeper overbite. Remember that any
class II malocclusion is defined as one in
Answer B is incorrect. Maxillary lateral
which the MB cusp of the maxillary 1st
incisor ridges run mesiodistally with no twist.
molar articulates mesial to the MB groove of
Answer C is incorrect. Incisal ridges on max- the mandibular 1st molar; and the maxillary
illary canines are straighter mesiodistally than canine occludes mesially to the distal surface
on mandibular canines when viewed from of the mandibular canine.
the incisal.
Answer A is incorrect. Class I occlusions are
129. The correct answer is A. The condyles are in the most prevalent. A class I occlusion is
the terminal hinge position during centric defined as one in which the MB cusp of the
relation (CR). This is the most superior and maxillary 1st molar articulates with the MB
anterior position along the articular emi- groove of the mandibular 1st molar; and the
nence of the glenoid fossa, with the articular maxillary canine occludes between the
disc located in between. Only condylar rota- mandibular canine and 1st premolar.
tion can occur in this position. Answer B is incorrect. In a class II, division I
Answers B, C, D, and E are incorrect. See malocclusion, all of the maxillary anterior
above. teeth are flared, creating a large overjet.
Molar and canine relationships are the same
130. The correct answer is C. Calcification of the as for any other class II malocclusion.
1st permanent tooth to erupt, the mandibular Answers D and E are incorrect. There are
1st molar, typically starts at birth. By age 3, all no separating divisions of class III malocclu-
of the permanent 1st molars have completed sions. It is defined as one in which the MB
calcification. The last permanent tooth to cusp of the maxillary 1st molar articulates dis-
erupt, the 3rd molar, usually finishes calcifi- tal to the MB groove of the mandibular 1st
cation by age 16. molar; and the maxillary canine occludes dis-
Answer A is incorrect. Calcification of the tally to the distal surface of the mandibular
1st primary teeth begins at about 18 weeks in canine.
Dental Anatomy
and Occlusion
utero. The primary central and lateral

incisors have completed calcification by 12 132. The correct answer is B. Maxillary lateral
weeks postpartum. The last primary tooth to incisors have the most morphological vari-
erupt, the 2nd molar, usually finishes calcifi- ability of all incisors. They are often narrow,
cation by age 1. conical, and peg shaped. They are also the
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most common tooth to exhibit both dens 136. The correct answer is E. The lingual HOC
invaginatus (dens-in-dente) and dens evagina- of all anterior teeth (incisors and canines) is
tus (talon cusp). Maxillary laterals have a 1%- the cingulum, located in the cervical 3rd of
2% incidence of being congenitally absent. the crown.
Answers A, C, and D are incorrect. See Answer C is incorrect. Remember that the
above. lingual HOC of all posterior teeth (premolars
and molars) is located in the middle 3rd of
133. The correct answer is B. The canines are the the crown.
only teeth with a distinct vertical labial ridge.
Shallow developmental depressions lie mesial
above.
and distal to the labial ridge, which runs
incisocervically near the center of the crown
137. The correct answer is B. A Bennett shift
in the middle and incisal 3rds. The labial
occurs during lateral excursive movements
ridge can be quite prominent on the maxil-
in which the working-side condyle bodily
lary canine.
moves laterally, toward the working side. The
Answer A is incorrect. Two shallow vertical mean length of the movement ranges from
developmental depressions separate the facial 0.5 to 1 mm. An immediate or early Bennett
surface of incisors into three lobes (mesial, shift occurs in about 86% of lateral excursive
middle, and distal), but no labial ridge exists. movements.
Answer C is incorrect. Although premolars Answers A, C, D, and E are incorrect. See
have a similar looking ridge on the labial sur- above.
face, it is called a buccal ridge, not a labial
ridge. 138. The correct answer is A. The maxillary 1st
premolar will typically have 2 canals.
Answer D is incorrect. No molar has a labial
Remember that this tooth often has a bifur-
ridge.
cated root.
134. The correct answer is D. The root trunks of Answer B is incorrect. The mandibular 1st
primary teeth are generally shorter than those premolar most commonly has one pulp
of permanent teeth. canal.
Answer A is incorrect. Primary teeth are Answer C is incorrect. The maxillary 2nd
whiter than permanent teeth. premolar most commonly has one pulp
canal.
Answers B and C are incorrect. Primary
crowns appear much more bulbous, largely Answer D is incorrect. The mandibular 2nd
because their CEJs are more constricted premolar most commonly has one pulp canal.
compared to permanent teeth.
139. The correct answer is D. The mandibular
Answer E is incorrect. Primary teeth have
2nd premolar has a shorter and blunter buc-
larger pulp chambers than permanent teeth.
cal cusp than lingual cusp.
135. The correct answer is B. On average the per- Answer A, B, C, and E are incorrect. All
manent maxillary arch is only about 2 mm other premolars have a longer buccal cusp
longer than the mandibular arch (128 mm vs than lingual cusp. On some occasions,
Dental Anatomy
126 mm). Primary dental arches are much though, the two cusps of the maxillary 2nd
and Occlusion
rounder than the permanent arches. premolar may be the same length (but the
lingual is never larger than the buccal).
above.
140. The correct answer is B. Chronic thumb
sucking generally causes openbite, protrusion
Answers: 133-147 233
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and proclination of maxillary incisors (and Answer B is incorrect. The cusp of Carabelli
sometimes mandibular incisors), and often a is a small part of a normally sized tooth.
high palatal vault. On occasion, posterior
Answer D is incorrect. A dens evaginatus
crossbite may occur due to lowered tongue
(talon cusp) is a small part of a normally
posturing.
sized tooth.
Answer A is incorrect. Chronic mouth
Answer E is incorrect. A mulberry molar is
breathing is associated with a narrow upper
larger than a normal molar.
arch (but not a high palatal vault), anterior
open bite (due to supereruption of posterior 144. The correct answer is E. Both maxillary and
teeth), and posterior crossbite (due to low mandibular primary canines have defined
tongue posturing). cingula, and pentagonal-shaped crowns when
Answer C is incorrect. Chronic tongue viewed from the facial. Remember that the
thrusting typically results in anterior open mesial cusp ridge is longer in the maxillary
bite with or without pronounced overjet. canine so that it will enable proper intercus-
pation with the mandibular canine, which
Answer D is incorrect. Nocturnal bruxism is
has a longer distal cusp ridge. Their roots are
more likely to occur in adults, resulting in
the longest in each arch, with the maxillary
tooth attrition, wear facets, widened PDL
canine having the longest root of all primary
spaces, and other dentoalveolar lesions associ-
teeth. The cusp of the primary maxillary
ated with occlusal trauma.
canine is longer and sharper than that of the
permanent maxillary canine.
141. The correct answer is D. The mandibular
central incisor is the 1st succedaneous tooth Answers A, B, C, and D are incorrect. See
to erupt. Remember that succedaneous teeth above.
are permanent teeth that replace the position
of primary teeth. Only permanent incisors, 145. The correct answer is A. On posterior teeth,
canines, and premolars are succedaneous the FOA of the supporting cusps will con-
teeth (molars are not). tact the inner inclines of the guiding cusps
close to the central fossa line. For anterior
teeth, the FOA of the mandibular incisors
above.
will contact the guiding inclines of the max-
illary anterior teeth.
142. The correct answer is D. The occlusal table
of the mandibular 2nd premolar is the most Answers B, C, and D are incorrect. See
square shaped. above.
Answers A and B are incorrect. Both maxil-
146. The correct answer is E. The genioglossus is
lary premolars have a relatively rectangular
the main muscle that protrudes the tongue
occlusal table shape.
anteriorly. Its origin is on the genial tuber-
Answer C is incorrect. The occlusal table of cles. The inferior portion inserts on the hyoid
the mandibular 1st premolar is more oval bone; the superior portion inserts in the
shaped than the 1st premolar. tongue. The genioglossus, like the hyoglossus
and styloglossus, is innervated by the
143. The correct answer is C. A microdont is a hypoglossal nerve (CN XII).
tooth that is smaller than normal. Remember
Dental Anatomy

and Occlusion
that maxillary lateral incisors exhibit great

above.
variability, one form of which is narrow and
peg shaped, smaller than the normal size.
147. The correct answer is A. The maxillary
Answer A is incorrect. A geminated incisor molar root trunk averages about 32% of the
will look slightly larger than a normal incisor. total root surface area. Thus, when periodontal
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attachment loss occurs to the furcation Answer A is incorrect. This is retruded

entrances on this tooth, it has already lost contact.
about one-third of its support.
Answer B is incorrect. This is centric
Answer B is incorrect. MB root surface area occlusion.
averages 25% of the total root surface area.
Answer D is incorrect. This is maximum
Answer C is incorrect. DB root surface area protrusion.
Answer E is incorrect. This is the maximum
Answer D is incorrect. Palatal root surface area right lateral contact position.
150. The correct answer is A. The maxillary 1st
148. The correct answer is D. The cusp tip of the premolar has a longer mesial buccal cusp
permanent mandibular canine lies lingual to ridge than distal cusp ridge.
the root-axis line, as it does on all lower anterior
Answers B, C, and D are incorrect. All other
teeth. The cusp tip on the maxillary canine, on
premolars have a longer buccal distal cusp
the other hand, may lie on or labial to this line.
ridge than mesial cusp ridge.
Answer A is incorrect. A shorter mesial cusp
ridge is common (characteristic) to all canines. 151. The correct answer is D. Teeth generally
erupt into the oral cavity when their roots are
Answer B is incorrect. Since the mesial con- 1/ -2/ developed.
tact area on the mandibular canines resides 2 3
in the incisal 3rd just below the mesioincisal Answers A, B, C, and E are incorrect. See
angle, the mesial cusp ridge appears almost above.
horizontal.
152. The correct answer is B. The glenoid (articu-
Answer C is incorrect. One of the most rec- lar) fossa is a part of the temporal bone. Its
ognizable features of a mandibular canine is anterior border is the articular eminence,
that its mesial crown outline is almost flat while its posterior border is the tympanic por-
and nearly in line with the mesial side of the tion of the temporal bone.
root (a feature not seen on maxillary canines).
The distal side of the mandibular canine is Answer A, C, D, and E are incorrect. See
convex in the incisal two-thirds, and concave above.
in the cervical 3rd (when viewed from the
labial), yielding noticeably more crown distal 153. The correct answer is A. The primary maxil-
to the root-axis line than mesial to it. lary 1st molar is the smallest primary molar.
149. The correct answer is C. The anterior edge- above.
to-edge position is anterior to the CR and
CO, but posterior to maximum protrusion. It 154. The correct answer is A. An enamel pearl is
is usually located near the center of the trac- a focal mass of enamel located near the furca-
ing mediolaterally. tions of molar teeth. They have about a 3%
prevalence rate, and are most common on
A
B maxillary 2nd and 3rd molars. Their presence
will predispose those tooth surfaces to peri-
Dental Anatomy
odontal attachment loss.

and Occlusion
E Answer B is incorrect. CEPs are much

C
smaller and less protrusive than enamel pearls.
Furthermore, they are more commonly found
D
Answers: 148-161 235
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in buccal furcations and will not likely be Answer D is incorrect. The maxillary 1st
seen on a radiograph. molar has two roots, and thus has a bifurcation.
Answer C is incorrect. A taurodont is a
158. The correct answer is C. Tooth No. 18 is the
molar with an elongated root trunk, which
mandibular left 2nd molar. All mandibular
typically has an enlarged pulp chamber.
posterior crowns have a rhomboidal shape
Answer D is incorrect. A distodens is a super- when viewed from the proximal. Recall that
numerary 4th molar, often found distal to the their crowns are tilted lingually from the
3rd molar. cervix.
Answer E is incorrect. Hypercementosis is Answer A is incorrect. No tooth is square
an excessive deposition of cementum on the shaped when viewed from the proximal.
root of a tooth.
Answer B is incorrect. No tooth is rectangu-
lar shaped when viewed from the proximal.
155. The correct answer is E. Remember that
unworn cusps and grooves are curved, not Answer D is incorrect. All maxillary posterior
straight and flat. Thus, the occlusal contacts crowns have a rhomboidal shape when
between opposing teeth will be on many viewed from the proximal. Unlike mandibular
points, or very small contact areas. It is only posterior crowns, which tilt lingually from the
in pathologic occlusions (such as bruxism) cervix, maxillary crowns are aligned directly
that one will find area-to-area contacts. over the roots from the proximal view.
Answers A, B, C, and D are incorrect. See Answer E is incorrect. No tooth is oval
above. shaped when viewed from the proximal.
156. The correct answer is E. Maxillary central 159. The correct answer is C. Both the masseter
and lateral incisors, canines, and 2nd premo- and the medial pterygoid muscles form a sling
lars commonly only have one canal. around the mandible. The superficial fibers of
Mandibular central incisors, canines, and 1st the masseter insert onto the lateral angle of
and 2nd premolars will typically have one the mandible; the medial pterygoid inserts
canal. onto the medial angle of the mandible. Both
function in elevation of the mandible.
above. Answers A, B, D, and E are incorrect. See
above.
157. The correct answer is C. Because maxillary
molars have three roots, they will have three 160. The correct answer is D. During working-
furcations. Keep in mind, however, that max- side movements, the FOAs of the supporting
illary 2nd and especially 3rd molars may have cusps slide slightly mesially or distally
fused roots, preventing them from having (depending on the arch) over the inner
true trifurcations, only deep depressions. aspects of opposing guiding cusps, such that
cusp tips pass between opposing cusp tips.
Answer A is incorrect. The maxillary 1st pre-
molar often has a bifurcation as it typically Answers A, B, C, and E are incorrect. See
has two roots. above.
Answer B is incorrect. The mandibular 1st
161. The correct answer is D. The maxillary
Dental Anatomy
premolar generally has a single root, and thus

and Occlusion
canine has its mesial contact in the junction

has no furcation. It does, though, have devel-
of the incisal and middle 3rds, and the distal
opmental depressions along the length of the
contact in the middle 3rd.
proximal surfaces of the root.
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Answer B is incorrect. The mandibular Answer D is incorrect. Hyperdontia is the

canine has its mesial contact in the incisal presence of one or more supernumerary teeth
3rd, and the distal contact in the middle 3rd. in addition to a complete dentition.
Answers A, C, and E are incorrect: See Answer E is incorrect. Metadontia is not a
above. dental term.
162. The correct answer is A. In general, girls’ 165. The correct answer is D. In nonworking
teeth erupt prior to boys’ teeth. movement, mandibular supporting cusps
move mesiolingually to their opposing max-
illary supporting cusps. Contrarily, maxil-
above.
lary supporting cusps move distobuccally to
163. The correct answer is B. The maxillary 1st their opposing mandibular supporting
molar has a rectangular occlusal surface, with cusps. Remember that the potential for
the shortest sides being the mesial and distal nonworking contacts (interferences) occur
marginal ridges. Recall that the mandibular on maxillary distal inner inclines and
2nd molar also has a rectangular occlusal mandibular mesial inner inclines of sup-
surface. porting cusps.
Answer A is incorrect. No primary tooth has

a square-shaped occlusal surface.
Answer C is incorrect. No primary tooth has
a trapezoidal-shaped occlusal surface.
Answer D is incorrect. The maxillary 2nd
molar and the mandibular 1st molar have a
rhomboidal occlusal surface.
164. The correct answer is B. Hypodontia is a

type of partial anodontia in which there is a
congenital absence of one or a few teeth.
Patients with congenitally missing maxillary
lateral incisors also have hypodontia. It is gen-
erally not associated with systemic disease or
developmental disturbances. Answers A, B, and C are incorrect. See above.
Answer A is incorrect. Anodontia is the com- 166. The correct answer is C. Tooth No. 29 is the
plete congenital absence of teeth. This is gen- mandibular right 2nd premolar. Both of its
erally caused by developmental abnormalities mesial and distal contact areas are in the middle
such as ectodermal dysplasia. Do not confuse 3rd of the crown. In fact the mesial and distal
anodontia with edentulism. All patients with contact points of all maxillary and mandibular
anodontia are edentulous, but not all edentu- posterior teeth (premolars and molars) are
lous patients have anodontia (they may have located in the middle 3rd.
lost their teeth to periodontitis, caries,
trauma, etc). Answers A, B, D, and E are incorrect. See
above.
Dental Anatomy
Answer C is incorrect. Oligodontia is a type

and Occlusion
of partial anodontia in which there is a con- 167. The correct answer is A. The vertical muscle
genital absence of most, but not all teeth. fibers run inferior superiorly. When con-
This is typically caused by developmental tracted, they will broaden and flatten the
abnormalities such as ectodermal dysplasia. tongue.
Answers: 162-175 237
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Answer B is incorrect. The muscle fibers that by the permanent maxillary canine. The
run mediolaterally comprise the transverse mixed dentition ends with the exfoliation of
muscle. See answer D below. the last primary tooth. Remember that man-
dibular teeth generally erupt prior to maxillary
Answer C is incorrect. The longitudinal
teeth.
muscle fibers run anteroposteriorly. They will
shorten the length of the tongue, curling it Answers B, C, D, and E are incorrect. See
upward or downward (depending on which above.
fibers contract).
173. The correct answer is A. Remember that the
Answer D is incorrect. The transverse fibers
size of a pulp horn is directly proportional to
arise from the median fibrous septum and
the size of its cusp. Since the MB cusp is the
run laterally. When contracted, they will nar-
largest cusp in a mandibular 1st molar, it also
row and elongate the tongue.
has the largest pulp horn. Contrarily, the distal
cusp has the smallest pulp horn.
168. The correct answer is B. Anterior teeth have
6 line angles: mesiofacial, distofacial, mesi- Answers B, C, D, and E are incorrect. See
olingual, distolingual, incisofacial, and inci- above.
solingual. Posterior teeth have 8 line angles:
mesiobuccal, distobuccal, mesiolingual, 174. The correct answer is C. In the anterior
distolingual, occlusobuccal, occlusolingual, edge-to-edge position, the incisal edges of the
mesioocclusal, and distoocclusal. anterior teeth occlude, providing the greatest
VDO while teeth are still in contact.
above. Answers A and B are incorrect. Although
there may be an increase in VDO during
169. The correct answer is A. A centric slide is centric relation and maximum protrusion
more common than not, with some studies positions, the change is not as large as it is in
showing a prevalence of up to 78%-90%. If the anterior edge-to-edge position.
present, it is usually about 1 mm long.
Answers D and E are incorrect. Be careful!
Answers B, C, and D are incorrect. See above. Clearly, the maximum opening position will
create the greatest vertical dimension of the
170. The correct answer is A. The maxillary cen- face, but it (and the rest position) does not
tral incisor has the greatest horizontal axial involve any tooth-to-tooth contacts. Thus,
inclination when viewed in the sagittal plane. these positions do not contribute to VDO.
However, when viewed in the facial plane, it
is almost vertical within the alveolar bone. 175. The correct answer is D. Remember that abra-
sion is the loss of tooth structure due to abnor-
mal mechanical means. Long-time pipe smok-
above.
ers often have a notch in one or two of their
171. The correct answer is C. Between the two incisors, where they typically hold the pipe stem.
lingual cusps found on this tooth, the ML Answer A is incorrect. GERD is associated
cusp is by far the largest, obscuring the view with dental erosion.
of the smaller DL cusp when viewed from
Answer B is incorrect. Nocturnal bruxism is
the mesial.
associated with dental attrition.
Dental Anatomy
and Occlusion
Answers A, B, and D are incorrect. See above.

Answer C is incorrect. Occlusal trauma is
172. The correct answer is A. The maxillary associated with dental attrition.
canine is typically the last primary tooth to Answer E is incorrect. Cigarette smoking is
exfoliate, usually around age 12. It is replaced not associated with dental wear.
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176. The correct answer is A. When you swallow, Answers B, C, D, and E are incorrect. See
the normal position of the teeth is in centric above.
occlusion, and the tongue moves superiorly
to touch the palate. 181. The correct answer is A. The maxillary 1st
premolar is usually the largest permanent
Answers B, C, D, and E are incorrect.
premolar.
Remember that during a tongue-thrust habit,
the tongue is positioned anteriorly between Answer C is incorrect. The smallest perma-
the incisors. nent premolar is typically the mandibular 1st
premolar.
177. The correct answer is D. Recall that the pri-
Answers B and D are incorrect. See above.
mary maxillary 2nd molar most closely
resembles the permanent maxillary 1st molar, 182. The correct answer is C. During right-side
which will appear next to each other in the excursive movement, the left medial ptery-
arch until the primary molar exfoliates to goid contracts, not the right. Remember that
make room for the 2nd premolar. both of the pterygoid muscles function in
Answers A, B, and C are incorrect. See contralateral excursive movement, while the
above. masseter and temporalis provide ipsilateral
excursive movements.
178. The correct answer is B. The most concave
Answers A, B, D, and E are incorrect. All of
lingual surface is on the maxillary lateral
these muscles contribute to right-side mandib-
incisor. Compared to mandibular incisors,
ular excursive movement.
the maxillary lateral has a more prominent
cingulum, which creates more of a lingual 183. The correct answer is C. By age 91/2, this
depression. child will likely have 24 teeth (10 primary and
Answers A, C, and D are incorrect. See 14 permanent): 4 primary 1st molars, 4 pri-
above. mary 2nd molars, 2 primary canines (maxil-
lary), 4 permanent centrals, 4 permanent lat-
179. The correct answer is A. The working side is erals, and 2 permanent canines (mandibular).
defined as the side to which the mandible Remember that the permanent mandibular
moves in an excursive movement. In an canines erupt around age 9-10, while the per-
excursive movement of the mandible to the manent maxillary canines erupt at age 11-12.
patient’s right side, both the maxillary and
Answer A is incorrect. This configuration
mandibular right side are the “working side,”
would likely be found in an 81/2-9 year old.
while the left side is considered the “non-
working side.” Answer B is incorrect. This configuration of
22 teeth would not likely exist. Remember
Answers B, C, D, and E are incorrect. If the
that the mixed dentition has 24 teeth by age 7
mandible moves to the right, then the right
(when all of the permanent 1st molars have
mandibular (and maxillary) teeth are on the
erupted).
working side. The left mandibular (and max-
illary) teeth are on the nonworking side. Answer D is incorrect. This configuration
might be found in a 10 years old, but would
180. The correct answer is A. The maxillary cen- not last for a long time as more primary teeth
tral has the widest crown of all anterior teeth. would quickly be replaced by their permanent
Dental Anatomy
and Occlusion
In order of decreasing size, the widths of max- counterparts.

illary anterior teeth: central incisor > canine >
Answer E is incorrect. This configuration
lateral incisor. For mandibular anterior teeth:
might be found in a 10-11 years old, but
canine > lateral incisor > central incisor.
would not last for a long time as more primary
Answers: 176-189 239
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teeth would quickly be replaced by their per- papillae by shunting food toward the buccal
manent counterparts. and lingual “spillways.”
184. The correct answer is B. Remember that this
above.
tracing represents the extreme borders of
mandibular movement in the sagittal plane.
186. The correct answer is C. When looking
Normal chewing and mastication generally
down on a mandibular central incisor from
occurs somewhere in between all of the
the occlusal, its faciolingual length is greater
borders.
than its mesiodistal length. It has a 1.2
faciolingual-to-mesiodistal length ratio.
A
Recall that this is the smallest tooth in all
dimensions.
Answers A and B are incorrect. The maxillary
central and lateral incisors are the only ante-
B D
rior teeth with a larger mesiodistal length than
faciolingual length (when viewed from the
occlusal). The maxillary central faciolingual-
C to-mesiodistal length ratio is 0.82. The maxil-
lary lateral faciolingual-to-mesiodistal length
ratio is 0.92.
E
Answer D is incorrect. Faciolingual-to-
mesiodistal length ratio is 1.18.
Answer E is incorrect. Faciolingual-to-
mesiodistal length ratio is 1.07.
Answer A is incorrect. This represents pro- 187. The correct answer is A. Both the primary
trusive movement from the anterior edge-to- maxillary canine and permanent mandibular
edge position to maximum protrusion. 1st premolar are unique in that the mesial
Answer C is incorrect. This represents the contact is more cervical than the distal.
most anterior position of the mandible as the Answers B, C, D, and E are incorrect. All
jaw opens from maximum protrusion to maxi- other teeth, primary or permanent, have the
mum opening. distal contact area located more cervically
Answer D is incorrect. This represents the than on the mesial.
rotation of the condyles in their most poste-
rior position as the jaw opens. 188. The correct answer is D. Mandibular lingual
cusps are guiding cusps, so they will not artic-
Answer E is incorrect. This represents the ulate with central fossae or marginal ridges.
translational movement of the condyles in Instead, they always oppose lingual embra-
their most posterior position as the mandible sure spaces. The only exception to this rule is
reaches maximum opening. the DL cusp of mandibular molars, which
occlude with their maxillary counterpart’s
185. The correct answer is D. The contact point lingual groove.
between adjacent teeth has three important
Dental Anatomy
and Occlusion
functions: (1) it stabilizes the position of Answers A, B, C, and E are incorrect. See
teeth within the dental arches (preventing above.
drift), (2) it prevents food impaction, which
can contribute to decay and periodontal 189. The correct answer is E. The oblique ridge is
disease, and (3) it protects the interdental present on all maxillary molars and connects
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the DB and ML cusps. It separates the MB 194. The correct answer is B. The labial ridge is
and DL cusps. only found on canines. It runs incisocervi-
cally in the center of the facial crown surface,
and is more prominent on the maxillary
above.
canine.
190. The correct answer is B. Although the syn- Answer A is incorrect. All molars have cervi-
ovial membrane secretes synovial fluid which cal ridges which run mesiodistally in the cer-
lubricates the TMJ, it lines the internal sur- vical 3rd of the buccal crown surface. Recall
face of the articular capsule, not the articular that all primary teeth also have prominent
disc (meniscus). Unlike most synovial joints, cervical ridges.
the articular surfaces of the glenoid fossa and
Answer C is incorrect. Only maxillary molars
mandibular condyle are lined by a layer of
have an oblique ridge which runs from the
dense fibrous tissue (there is still debate as to
DB cusp to the ML cusp on the occlusal
whether this is true fibrocartilage). Recall
surface.
that the articular disc itself is composed of
avascular fibrocartilage. Answer D is incorrect. All teeth have mesial
and distal marginal ridges.
above. Answer E is incorrect. Only premolars have
a buccal cusp ridge which runs occlusocervi-
191. The correct answer is D. All teeth have four cally in the center of the buccal crown sur-
embrasures per contact area: buccal, lingual, face. It is more prominent on 1st premolars.
occlusal, and cervical. In health, the gingival
papilla fills the cervical embrasure. The other 195. The correct answer is A. The mandibular 1st
three embrasures aid in deflecting food away molar has two roots, mesial and distal. The
from the contact area. mesial root is very broad buccolingually, with
a blunt and wide apex, hiding the distal root.
above. Answer B is incorrect. From the distal view,
the less broad (buccolingually) and shorter
192. The correct answer is B. The mandibular 1st distal root, as well as the larger mesial root,
molar may have a 4th canal in the distal root can be seen.
(25% prevalence). In general, two canals are
Answers C and D are incorrect. Both the
located in the mesial root (MB and ML), and
mesial and distal roots can be seen from the
one canal is found in the distal root.
buccal as well as the lingual. Often, the roots
Answer A is incorrect. See above. of the mandibular 1st molar are described as
Answer C is incorrect. The mandibular 1st looking like “plier handles.”
molar does not have a buccal root. Answer E is incorrect. Most likely, no roots
Answer D is incorrect. The mandibular 1st can be seen from the occlusal given the large
molar does not have a lingual root. occlusal outline of the 5-cusped mandibular
1st molar.
193. The correct answer is E. Remember that a
distal cusp does not usually exist on a 196. The correct answer is C. The root of the
mandibular 2nd molar. If the question had mandibular 2nd premolar is typically closest
Dental Anatomy
to the mental foramen. Remember, though,

and Occlusion
asked about the distal cusp on the mandibular

1st molar, however, it occludes with the distal that this anatomy is variable: the mental fora-
triangular fossa of the maxillary 1st molar. men can be closer to the apices of 1st premo-
lars and even canines at times. A periapical
Answers A, B, C, and D are incorrect. See radiograph will help you evaluate the local
above. anatomy.
Answers: 190-200 241
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Answers A, B, D, and E are incorrect. See Answer B is incorrect. The retruded contact
above. point would likely be located just below the
centric occlusion point (assuming that they
197. The correct answer is B. A tooth closer to the do not coincide).
anterior of the mandible will be more influ-
enced by anterior guidance, and less by the Answer C is incorrect. The anterior edge-to-
TMJs. Conversely, a posterior tooth will be edge position would likely be located just
less influenced by anterior guidance, and below the centric occlusion point.
more by the TMJs. In an ideal occlusion, it is Answer D is incorrect. The maximum open-
the anterior teeth that provide the guidance ing position is the most inferior point on the
in lateral excursive and protrusive move- tracing.
ments. The anterior teeth (especially the
Answer E is incorrect. The maximum pro-
canines) will allow the posterior teeth to dis-
trusive point will not be seen from the frontal
articulate preventing interferences and fric-
view (only the sagittal and horizontal).
tional wear.
Answers A, C, and D are incorrect. See 199. The correct answer is C. The vast majority of
above. joints are synovial, meaning that they are
lined by a synovial membrane, which
198. The correct answer is A. Remember that the secretes synovial fluid (a lubricant). A
most superior position is typically maximum diarthrosis is a fully moveable joint, such as
intercuspation during centric occlusion (see the shoulder, hip, and TMJ.
also the sagittal view of Posselt envelope of
Answer A is incorrect. A synarthrosis is an
motion).
immoveable joint, such as the cranial sutures.
Answer B is incorrect. An amphiarthrosis is a
slightly moveable joint, such as the symphysis
pubis.
Answer D is incorrect. See above.
200. The correct answer is D. The roots of the

maxillary 1st molar are generally closest to
the maxillary sinus floor, and are most com-
monly pushed through if fractured during
extraction. Depending on the individual’s
anatomy, though, any tooth in close proxim-
ity to the maxillary sinus is at risk for penetra-
tion through the floor.
above. Dental Anatomy
and Occlusion

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What is the main topic covered in the text?

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What anatomical structure is most at risk during extraction of the maxillary first molar?

What anatomical structure is most at risk during extraction of the maxillary first molar?

FIRST AID ™

STEVEN R. SIERAKOWSKI, DMD, MDSc

Milan / New Delhi / San Juan / Seoul / Singapore / Sydney / Toronto

Derek M. Steinbacher, MD, DMD

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How to Contribute xiii

Chapter 1 Anatomic Sciences 1

Chapter 2 Biochemistry and Physiology 65

Chapter 3 Microbiology and Pathology 115

Chapter 4 Dental Anatomy and Occlusion 187

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Karl C. Bruckman, DDS

Derek J. Conover, DMD

Blaine A. Keister, DMD

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C. retromandibular vein. A. Ventral posterior medial nuclei (VPM)

15. Which of the following areas of the medi- 1. Bulbus cordis

A. Crista terminalis A. 1 and 2

27. All of the following questions pertaining to

30. Which of the following extraocular muscles is C. Marcus-Gunn/relative afferent pupil

A 22-year-old male presents to your office for rou-

A. Lateral pterygoid 61. Which layer of fascia contains lymphatic ves-

66. The one-cell thick layer of osteoprogenitor D. Levator veli palatini

A. During the cap stage A. C1-C5

87. Which of the following is TRUE regarding C. Vomer

A. Buccal root of the maxillary 1st premolar C. IX, X, XII

107. The most inferior portion of the trachea, the A. epididymis.

A. ampulla of Vater. Suppose a patient presents to you after having

148. Malfunction of which cranial nerve would D. Stylohyoid

169. Which of the following portions of the tooth A. 0.04 µm.

A. electrolytes. A. follicular cells.

Answer C is incorrect. The antilingula is necessary to produce the extensive extracellu-

Answer B is incorrect. Preganglionic fibers to Answer B is incorrect. The prevertebral layer

mandible. It is also considered an accessory Answer D is incorrect. The auriculotempo-

Answer E is incorrect. The inferior alveolar Answer A is incorrect. Insulin is produced in

105. The correct answer is A. Hemidesmosomes Answer B is incorrect. Segmental bronchi

Answer B is incorrect. It is secreted by odon- underlying ectomesenchymal layer during

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Biochemistry and Physiology

22. All of the following are true of plasma mem- C. lactose.

ular in its cellular arrangement.

Biochemistry and Physiology

D. The rate-limiting step is the conversion of

55. Fluoride inhibits which of the following gly- D. alanine.

Biochemistry and Physiology

66. Which of the following receptors is largely D. distal convoluted tubule.

B. Anterior pituitary 73. The Na+/K+ pump functions via facilitated

D. The statement is not correct, but the A. increased temperature.

Biochemistry and Physiology

A. glycogen to glucose A. NAD+

81. All of the following will result in a right shift

86. All of the following are effects of parathyroid D. FSH