Drug Monitoring And Pharmacogenomics Exam 2

Front 1

A study investigated the blood pressure‐lowering effect of metoprolol using two measures: clinic blood pressure and ambulatory blood pressure. People who achieved a reduction in ambulatory blood pressure were considered to be true biological responders to metoprolol (condition +), while those that did not achieve reduction in ambulatory blood pressure were considered biological non‐responders (condition ‐). Those who achieved a reduction in clinic blood pressure were classified as “responders” (test +), while those who did not achieve a reduction in clinic blood pressure were classified as “non‐responders” (test ‐). The study results are presented in the table below, and the test performance characteristics are displayed in the table legend:
Clinic Blood Pressure Responsive/Nonresponsive/Total
Responsive: 18/18/36
Nonresponsive: 6/9/15
Total: 24/27/51
Sensitivity: 0.75 (95% CI 0.53-0.89). Specificity: 0.33 (95% CI 0.17-0.54). Positive predictive value 0.50 (95% CI 0.33-0.67). Negative predictive value 0.60 (95% CI 0.33-0.83).
See 2009 Exam Table 2

True (A) or False (B), 50% of patients classified as “responders” by clinic blood pressure are true biological responders as measured by ambulatory blood pressure.

Back 1

True

Front 2

A study investigated the blood pressure‐lowering effect of metoprolol using two measures: clinic blood pressure and
ambulatory blood pressure. People who achieved a reduction in ambulatory blood pressure were considered to be true
biological responders to metoprolol (condition +), while those that did not achieve reduction in ambulatory blood
pressure were considered biological non‐responders (condition ‐). Those who achieved a reduction in clinic blood
pressure were classified as “responders” (test +), while those who did not achieve a reduction in clinic blood pressure
were classified as “non‐responders” (test ‐). The study results are presented in the table below, and the test
performance characteristics are displayed in the table legend:
Clinic Blood Pressure Responsive/Nonresponsive/Total
Responsive: 18/18/36
Nonresponsive: 6/9/15
Total: 24/27/51
Sensitivity: 0.75 (95% CI 0.53-0.89). Specificity: 0.33 (95% CI 0.17-0.54). Positive predictive value 0.50 (95% CI 0.33-0.67). Negative predictive value 0.60 (95% CI 0.33-0.83).
See 2009 Exam Table 2

True (A) or False (B), 60% of patients classified as “non‐responders” by clinic blood pressure are biological nonresponders as measured by ambulatory blood pressure.

Back 2

True

Front 3

True (A) or False (B), positive predictive value is p(test+|condition+).

Back 3

False

Front 4

True (A) or False (B), negative predictive value is p(test‐|condition‐).

Back 4

False

Front 5

You estimate the probability of tobramycin‐induced toxicity in a patient to be 25%. Then you order a Cmin,ss for the patient and it turns out to be 3.0 mcg/mL. A concentration > 2.0 mcg/ml is considered a positive test. The associated LR+ = 2.5. Which of the following statements is TRUE?
a. A serum tobramycin concentration > 2.0 mcg/ml is 2.5 times more likely to occur in a toxic patient than in a non‐toxic patient.
b. LR+ is a measure of a test’s ability to discriminate true positives from false positives.
c. Probability must be converted to odds before multiplying by the LR+.
d. All of the above are true.
e. Only two of the above are true.

Back 5

d. All of the above are true.

Front 6

A new test is proposed for use in clinical practice. The test is able to genotype individuals for polymorphisms in CYP2C9 (drug metabolism gene) and VKORC1 (drug target gene) and then classify whether or not patients will be "sensitive”/positive or “non‐sensitive”/negative to warfarin, a commonly used anticoagulant. Which of the following would be classified as a “true positive?”
a. Warfarin sensitive individual identified as “sensitive” by the test

Back 6

a. Warfarin sensitive individual identified as “sensitive” by the test

Front 7

True (A) or False (B), the gene sequence is divided into exons (coding segments) and introns (non‐coding
segments).

Back 7

True (A)

Front 8

Abacavir is an antiretroviral drug used for the treatment of HIV. The prescribing information includes a black box
warning regarding treatment in patients who carry a particular variant allele. Which of the following best
describes the genetic association found with abacavir?
a. Polymorphism(s) in a UGT enzyme with abacavir metabolism.
b. Polymorphism(s) in alcohol dehydrogenase and abacavir metabolism.
c. Polymorphism(s) in Apolipoprotein E4 and abacavir adherence.
d. Polymorphism(s) in the major histocompatibility complex and abacavir hypersensitivity.
e. None of the above.

Back 8

d. Polymorphism(s) in the major histocompatibility complex and abacavir hypersensitivity.

Front 9

Which of the following polymorphisms is MOST likely to contribute to variability in antihypertensive response to
a β1‐selective blocker that is renally eliminated?
a. A synonymous SNP in the cytochrome P450 2D6 enzyme gene
b. A non‐synonymous SNP in the cytochrome P450 2D6 enzyme gene
c. A synonymous SNP in the β1 adrenergic receptor gene
d. A non‐synonymous SNP in the β1 adrenergic receptor gene
e. An intronic insertion/deletion polymorphism in the angiotensin converting enzyme gene

Back 9

d. A non‐synonymous SNP in the β1 adrenergic receptor gene

Front 10

To determine whether chromosomal co‐inheritance of alleles for multiple nitric oxide synthase (NOS3) SNPs was
more informative than single SNP analysis alone, investigators first determined the extent to which ‐786T

Back 10

c. Linkage disequilibrium analysis

Front 11

To determine whether chromosomal co‐inheritance of alleles for multiple NOS3 SNPs was more informative than single SNP analysis alone, investigators performed the first step as described in question 11. The second step was to determine whether chromosomal allelic combinations were differentially associated with the phenotype (arterial stiffness). What type of analysis is this?
a. Haplotype analysis
b. Genetic drift analysis
c. Linkage disequilibrium analysis
d. Hardy‐Weinberg equilibrium analysis
e. None of the above

Back 11

a. Haplotype analysis

Front 12

Which of the following is the most common type of polymorphism in the human genome?
a. Variable number of tandem repeats (VNTRs)
b. Insertion/deletion polymorphisms (I/Ds)
c. Single nucleotide polymorphisms (SNPs)
d. All of the above occur in equal frequencies
e. The most common polymorphism is not listed above

Back 12

c. Single nucleotide polymorphisms (SNPs)

Front 13

In the Risk Management Paradigm (RPM) for pharmacogenomics, prescribing/dispensing systems are considered
at what level of implementation?
a. Level 1
b. Level 2
c. Level 3
d. Level 4

Back 13

c. Level 3

Front 14

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits discrimination in health coverage and
employment on the basis of genetic information. However, the protections do not apply to genetic information
collected or acquired as part of research, defined as genetic services or participation in clinical research that
includes genetic services (genetic testing, counseling, or education) by an individual or family member.
a. True.
b. False.

Back 14

b. False.

Front 15

Which of these statements regarding GINA is TRUE?
a. GINA guarantees that health insurers will pay for particular genetic tests or the medical care, diagnostic
tests, or treatments that a genetic test indicates are appropriate.
b. GINA includes protection from genetic discrimination in life insurance, disability insurance, or long‐termcare
insurance.
c. GINA interferes with the ability of a treating healthcare professional to request or recommend that an
individual or family member undergo a genetic test.
d. GINA applies to members of the United States military and to veterans obtaining health‐care through
the Department of Veterans Affairs (VA).

Back 15

c. GINA interferes with the ability of a treating healthcare professional to request or recommend that an
individual or family member undergo a genetic test.

Front 16

The Roche AmpliChip CYP450 test is used to genotype which of the following enzymes?
a. CYP1A2 and CYP2C9
b. CYP2B6 and CYP2C19
c. CYP2C9 and CYP2C19
d. CYP2D6 and CYP2C19
e. CYP3A4 and CYP2C9
f. CYP3A4 and CYP3A5

Back 16

d. CYP2D6 and CYP2C19

Front 17

RT‐PCR is used to make:
a. RNA
b. Protein
c. Both RNA and DNA
d. cDNA
e. None of the above

Back 17

d. cDNA

Front 18

Which of the following statement is TRUE?
a. The use of mouthwash is often preferred to blood for DNA isolation because it is non‐invasive.
b. White blood cells (WBCs) are a good source for DNA isolation.
c. Platelets are a good source for DNA isolation.
d. a and b
e. a and c
f. b and c

Back 18

d. a and b

Front 19

Which of the following statements regarding Restriction Fragment Length Polymorphism (RFLP) is/are TRUE?
a. RFLP is a genotyping method suitable for SNPs and insertion/deletion (I/D) polymorphisms.
b. RFLP is suitable for large scale pharmacogenetic studies.
c. RFLP is suitable for multiplexing.
d. An advantage of RFLP is that there is no chance for observer error with interpretation of results.
e. All of the above are TRUE.
f. None of the above is TRUE.

Back 19

a. RFLP is a genotyping method suitable for SNPs and insertion/deletion (I/D) polymorphisms.

Front 20

Which of the following statements regarding CYP2D6 is/are FALSE?
a. About 25% of drugs are metabolized by CYP2D6.
b. CYP2D6 genetic poor metabolizers are more common in Whites than Asians.
c. CYP2D6 extensive metabolizers would have lower plasma concentrations of the antidepressant nortriptyline compared to intermediate metabolizers.
d. CYP2D6 poor metabolizers would require a higher dose of nortriptyline compared to extensive metabolizers to maintain similar blood concentrations.
e. All of the above.
f. None of the above.

Back 20

d. CYP2D6 poor metabolizers would require a higher dose of nortriptyline compared to extensive metabolizers to maintain similar blood concentrations.

Front 21

Genetic variation in which of the following enzymes is associated with decreased formation of the clopidogrel
active metabolite?
a. CYP1A2
b. CYP2A6
c. CYP2C8
d. CYP2C9
e. CYP2C19
f. CYP2D6
g. CYP3A4
h. CYP3A5

Back 21

e. CYP2C19

Front 22

Which of the following alleles is an example of a variable number of tandem repeats (VNTR) polymorphism?
a. CYP1A2*1D
b. CYP2C9*3
c. CYP2D6*4
d. CYP3A5*3
e. UGT1A1*28
f. UGT1A6*2
g. UGT2B7*2
h. UGT2B15*2

Back 22

e. UGT1A1*28

Front 23

The clearance of tacrolimus after oral administration mostly reflects CYP3A‐mediated metabolism. Which of the following statements regarding tacrolimus clearance is TRUE?
a. On average, the tacrolimus dose required to maintain the same target blood concentration would be
higher in Asians compared to Whites.
b. Patients with the highest values of dose‐adjusted tacrolimus blood concentrations are most likely to be
CYP3A5 expressers.
c. Tacrolimus clearance is not likely to be affected by co‐administration of ritonavir.
d. All of the above
e. a and b
f. a and c
g. b and c

Back 23

a. On average, the tacrolimus dose required to maintain the same target blood concentration would be
higher in Asians compared to Whites.

Front 24

Gilbert’s syndrome is the most common hereditary cause of mild hyperbilirubinemia. The syndrome is caused
primarily by mutations in the gene encoding for which of the following UGT enzymes?
a. UGT1A1
b. UGT1A6
c. UGT1A7
d. UGT1A8
e. UGT1A9
f. UGT1A10
g. UGT2B7
h. UGT2B15

Back 24

a. UGT1A1

Front 25

Which of the following would you expect in N‐acetyltransferase‐2 (NAT2) rapid (or fast) acetylators compared to
slow acetylators?
a. Lower concentrations of isoniazid at any given dose.
b. A higher incidence of hydralazine‐induced lupus erythematosus.
c. Faster appearance of antinuclear antibodies with procainamide.
d. All of the above.
e. None of the above.

Back 25

a. Lower concentrations of isoniazid at any given dose.

Front 26

Tamoxifen active metabolite concentrations have been associated with the genotype for which of the following
CYP enzymes?
a. CYP1A2
b. CYP2A6
c. CYP2C8
d. CYP2C9
e. CYP2C19
f. CYP2D6
g. CYP3A4
h. CYP3A5

Back 26

f. CYP2D6

Front 27

Which of the following statements regarding UGT1A1*28 is/are TRUE?
a. UGT1A1*28 is a variant allele associated with increased gene expression and increased glucuronidation.
b. A majority of the population is heterozygous for UGT1A1*28.
c. Individuals with a homozygous UGT1A1*28 genotype are at greater risk for neutropenia with
irinotecan (Camptosar).
d. a and b
e. a and c
f. b and c

Back 27

c. Individuals with a homozygous UGT1A1*28 genotype are at greater risk for neutropenia with
irinotecan (Camptosar).

Front 28

Gene duplication has been identified for which of the following CYP enzymes?
a. CYP1A2
b. CYP2A6
c. CYP2C8
d. CYP2C19
e. CYP3A5

Back 28

b. CYP2A6

Front 29

The data in the table below were obtained in a pharmacokinetic study of a drug that is metabolized mostly by CYP2D6 to a single active metabolite. Which of the statements below provides a plausible description of the
metabolite data in the table?
Cmax (nM) / Half‐life (hrs) / AUC (nM x hrs)
Group A 8.6 / 4.9 / 42
Group B 4.2 / 10.0 / 33
Group C 1.2 / 19.3 / 15
See 2009 Exam Question 30

a. The subjects in Group A are extensive metabolizers and carry more active CYP2D6 alleles than subjects
in Group B.
b. The subjects in Group B are extensive metabolizers and carry more active CYP2D6 alleles than subjects
in Group C.
c. The subjects in Group C are extensive metabolizers and carry more active CYP2D6 alleles than subjects
in Group A.
d. a and b
e. a and c
f. b and c

Back 29

d. a and b

Front 30

Results from a sample of 500 patients using digoxin are available. The digoxin serum concentration (DSC) was compared to the toxic (tx+) vs. nontoxic (tx‐) status for each patient. A DSC cutoff (threshold) of 2 ng/mL was used for the diagnostic test of patient status. From the results, the true‐positive rate was 0.8 and the false positive rate was 0.4.
Statement #1: DSC>2 ng/ml is two times more likely to occur in a toxic patient
than in a non‐toxic patient.
Statement #2: The likelihood ratio positive for the test is 2.0.
a. both statements 1 and 2 are true
b. both statements 1 and 2 are false
c. only statement 1 is true
d. only statement 2 is true

Back 30

a. both statements 1 and 2 are true

Front 31

You have been nominated to an advisory committee to help determine whether a pharmacogenetic test should be used in clinical practice. The committee is comprised of a council of academic advisors, and you were recruited because of your expertise in therapeutic drug monitoring, understanding of test performance, and background in pharmacogenetics. The test is able to genotype individuals for polymorphisms in CYP2C9 (drug metabolism gene) and VKORC1 (drug target gene) and then classify whether or not patients will be “sensitive”/positive or “non-sensitive”/negative to warfarin, a commonly used anticoagulant. Questions 1-4 pertain to this scenario.
1. At the meeting, someone asks you a general question about the International Normalized Ratio (INR), which is the standard way to currently monitor warfarin therapy. Your colleague mentions that he heard the “normal” range for the INR is 0.9-1.1. Which of the following statements is TRUE regarding the normal or reference range?
a. The terms normal range and reference range should not be used interchangeably.
b. 5/100 healthy individuals fall above or below the reported reference range for a given
test.
c. People who are within the reference range are less likely to have a clinically relevant
condition than those who are outside of the reference range.
d. The reference range is usually defined by the population mean plus and minus two standard deviations.
e. All of the above statements are true.

Back 31

e. All of the above statements are true.

Front 32

Which of the following would be classified as a “true positive” based on the above information:
a. Warfarin sensitive individual identified as “sensitive” by the test

Back 32

a. Warfarin sensitive individual identified as “sensitive” by the test

Front 33

Which of the following would be classified as a “false negative” based on the above
information:
a. Warfarin sensitive individual identified as “sensitive” by the test

Back 33

b. Warfarin sensitive individual identified as “non-sensitive” by the test

Front 34

The conditional probability p(test-|condition-) refers to which of the following:
a. Warfarin sensitive individual identified as “sensitive” by the test

Back 34

d. Warfarin non-sensitive individual identified as “non-sensitive” by the
test

Front 35

See 2007 Exam Question 5

Which of the following is CORRECT regarding the decision tree above?
a. The decision-maker is most likely to be the clinician
b. The tree is a visual representation of the process of choosing to dose warfarin
based on genetic testing over dosing without testing
c. Once the choice to dose based on testing is made, the downstream consequences
are out of the decision-maker’s control
d. All of the above are true
e. Only two of the above are true

Back 35

d. All of the above are true

Front 36

The analysis above initially found that genotype-based prescribing yielded a higher
expected value than standard of care (i.e., non-genotype based describing). However,
you suggest performing a sensitivity analysis on the data. Sensitivity analysis can be
defined as the process of:
a. combining the likelihood ratio with additional information to produce an overall
estimate of the strength of a condition being present or absent
b. measuring how well a test correctly classifies individuals that do not meet the
condition under study
c. considering whether realistic variations in cost and probability values would
change the preferred alternative
d. statistically determining how well a dichotomous test correctly identifies a
condition
e. None of the above is correct

Back 36

c. considering whether realistic variations in cost and probability values would
change the preferred alternative

Front 37

Which of the following is a patient-specific factor that might affect interpretation of a
laboratory value?
a. Unit of measurement
b. Age
c. Assay used
d. Specimen collected
e. Time of day the lab was drawn

Back 37

b. Age

Front 38

A patient presents to the hospital with signs and symptoms of phenytoin toxicity. An
appropriately drawn total phenytoin concentration is reported to be within the therapeutic
range at 18 mcg/ml (range 10-20 mcg/ml). Which of the following statements is TRUE?
a. The patient may be in the therapeutic range and still experience signs and
symptoms of phenytoin toxicity.
b. The patient’s total phenytoin concentration may not reflect the free fraction of
phenytoin, and the concentration is actually supratherapeutic.
c. The patient may have a low albumin state allowing for more phenytoin to freely
circulate and cause toxicity.
d. All of the above statements are true.
e. None of the above statements is true.

Back 38

d. All of the above statements are true.

Front 39

Which statement is TRUE regarding quantitative tests results? They are reported as
a. Continuous variables
b. Dichotomous variables
c. Varying degrees of negativity
d. Varying degrees of positivity
e. Varying degrees of relativity

Back 39

a. Continuous variables

Front 40

Which of the following is an appropriate definition of “precision”?
a. The extent to which assay results of a test are reproducible
b. Plus or minus 2 standard deviations from the reference mean
c. p(test-|condition-)
d. Reproducibility of a test
e. The proximity of the reported value to the true value

Back 40

a. The extent to which assay results of a test are reproducible

Front 41

See 2007 Exam Figure 2
Figure 2 above describes the sensitivity for three methods of breast cancer screening,
mammography, magnetic resonance imaging (MR), and ultrasonography (US) as recently
reported by Lehman and colleagues in Radiology 2007;244:381-8. The sensitivity of
mammography, MR, and US are 33%, 100%, and 33%, respectively. Which of the
following statements is TRUE?
a. US will correctly classify 33 out of every 100 women with breast cancer
b. p(test-|condition+) for mammography > p(test+|condition+) for MR
c. Specificity and false-positive rate are two test performance characteristics
associated with women who have breast cancer
d. Only two of the above are true
e. None of the above are true

Back 41

a. US will correctly classify 33 out of every 100 women with breast cancer

Front 42

See 2007 Exam Figure 2
In the same paper cited in previous question, the PPVs for mammography, MR, and US were reported to be 50%, 43%, and 25%, respectively. Based on this information, which of the
following statements is TRUE?
a. One out of every two positive mammograms will come from a woman with breast
cancer
b. p(condition+|test+) for mammography > p(condition+|test+) for MR
c. PPVs of these tests are likely to decrease as the prevalence of breast cancer
increases
d. Only two of the above are true
e. None of the above is true

Back 42

d. Only two of the above are true

Front 43

In 2007, Zineh and colleagues investigated the association between endothelial nitric
oxide synthase gene (NOS3) polymorphisms and arterial stiffness in children with type 1
diabetes (Diabetes Care 2007;30:689-93.). Which of the following NOS3
polymorphisms is an example of a non-synonymous single nucleotide polymorphism
(SNP)?
a. -786T

Back 43

b. 298Glu

Front 44

In the paper cited in question 13, the investigators wanted to make sure their genotyping
assays were valid. One way to do so is to compare whether or not the observed genotype
frequencies in the study were consistent with what would be mathematically expected
under conditions of random mating. This approach uses which of the following
principles?
a. Haplotype analysis
b. Genetic drift
c. Linkage disequilibrium
d. Hardy-Weinberg equilibrium
e. None of the above

Back 44

d. Hardy-Weinberg equilibrium

Front 45

In the paper cited in question 13, the investigators wanted to determine whether
chromosomal co-inheritance of alleles for multiple NOS3 SNPs was more informative
than single SNP analysis alone. The first step was to determine to what extent -786T

Back 45

c. Linkage disequilibrium analysis

Front 46

In the paper cited in question 13, the investigators wanted to determine whether
chromosomal co-inheritance of alleles for multiple NOS3 SNPs was more informative
than single SNP analysis alone. They performed the first step as described in question
15. The second step was to determine whether chromosomal allelic combinations were
differentially associated with the arterial stiffness phenotype. What type of analysis is this?
a. Haplotype analysis
b. Genetic drift analysis
c. Linkage disequilibrium analysis
d. Hardy-Weinberg equilibrium analysis
e. None of the above

Back 46

a. Haplotype analysis

Front 47

A test to determine whether a person is a CYP2D6 “poor metabolizer” of drugs has a
reported sensitivity of 90% and a specificity of 95%. Which of the following statements
about the test is TRUE?
a. The test will incorrectly classify 1 out of every 100 poor metabolizers as having
some other drug metabolizing phenotype
b. The false-positive rate > the false negative rate
c. p(test+|condition-) > p(test-|condition+)
d. The true-negative rate of the test is greater than the true-positive rate of the test
e. The sensitivity and specificity of the test will vary depending on the prevalence of
poor metabolizers in the community in which the test is used

Back 47

d. The true-negative rate of the test is greater than the true-positive rate of the test

Front 48

See 2007 Question 18
Figure 3 below is a schematic of statin pharmacogenetic study as outlined by Zineh in
Current Atherosclerosis Reports 2007;9:187-94. Informed consent, initial eligibility
determination, and samples for genotyping are obtained at the pre-screening visit.
Subjects with needed genotypes are asked to return to meet biochemistry inclusion
criteria. In this scenario, wild-type homozygotes (A/A) and variant homozygotes (B/B)
will be enrolled to maximize likelihood of seeing genotype-effects. If eligible,
participants are given statins and protein biomarkers are measured and compared by
genotype groups at the end of study. An alternative iteration (dashed lines) includes a
parallel placebo arm or employs a cross-over design within genotype groups. Which of
the following best describes this approach?
a. Phenotype-to-genotype
b. Genotype-to-phenotype
c. Haplotype-to-phenotype
d. Genotype-to-haplotype
e. None of the above

Back 48

b. Genotype-to-phenotype

Front 49

Css levels of reslomycin were obtained independent of assessments of toxic or nontoxic status for
a reslomycin serum concentration (RSC) of 50 mcg/mL. The following test performance
characteristics were obtained in 1000 patients, using an RSC test cutoff of 50 mcg/mL for
classifying patients as toxic or nontoxic.
TPR = 0.60 FPR = 0.09
TNR = 0.91 FNR = 0.40
PPV = 0.75 NPV = 0.84
LR+ = 6.70 LR- = 0.44

True (A) or false (B), 75% of patients who have a negative RSC test result (Css < 50 mcg/mL) are truly non-toxic.

Back 49

False (B)

Front 50

Css levels of reslomycin were obtained independent of assessments of toxic or nontoxic status for
a reslomycin serum concentration (RSC) of 50 mcg/mL. The following test performance
characteristics were obtained in 1000 patients, using an RSC test cutoff of 50 mcg/mL for
classifying patients as toxic or nontoxic.
TPR = 0.60 FPR = 0.09
TNR = 0.91 FNR = 0.40
PPV = 0.75 NPV = 0.84
LR+ = 6.70 LR- = 0.44

True (A) or false (B), 60% of patients who have a positive RSC test result (Css > 50 mcg/mL) are truly toxic.

Back 50

False (B)

Front 51

Css levels of reslomycin were obtained independent of assessments of toxic or nontoxic status for
a reslomycin serum concentration (RSC) of 50 mcg/mL. The following test performance
characteristics were obtained in 1000 patients, using an RSC test cutoff of 50 mcg/mL for
classifying patients as toxic or nontoxic.
TPR = 0.60 FPR = 0.09
TNR = 0.91 FNR = 0.40
PPV = 0.75 NPV = 0.84
LR+ = 6.70 LR- = 0.44

True (A) or false (B), if there is a positive RSC test result, it will occur 0.75 times more
often in truly toxic patients than in truly non-toxic patients.

Back 51

False (B)

Front 52

Css levels of reslomycin were obtained independent of assessments of toxic or nontoxic status for
a reslomycin serum concentration (RSC) of 50 mcg/mL. The following test performance
characteristics were obtained in 1000 patients, using an RSC test cutoff of 50 mcg/mL for
classifying patients as toxic or nontoxic.
TPR = 0.60 FPR = 0.09
TNR = 0.91 FNR = 0.40
PPV = 0.75 NPV = 0.84
LR+ = 6.70 LR- = 0.44

True (A) or false (B), truly toxic patients are correctly classified by the RSC test more often than truly nontoxic patients are correctly classified by the test.

Back 52

False (B)

Front 53

The Roche AmpliChip CYP450 test is used to genotype which of following enzymes?
a. CYP2C9 and CYP2C19
b. CYP2D6 and CYP3A4
c. CYP1A2 and CYP3A5
d. CYP2D6 and CYP2C19
e. None of the above.

Back 53

d. CYP2D6 and CYP2C19

Front 54

The UGT1A1 Invader test may be used as a pharmacogenetic test for which of the
following drugs?
a. azathioprine
b. irinotecan
c. mercaptopurine
d. warfarin

Back 54

b. irinotecan

Front 55

Which of the following cells can NOT be used for DNA isolation?
a. lymphocytes
b. neutrophils
c. red blood cells
d. skeletal muscle cells
e. smooth muscle cells

Back 55

c. red blood cells

Front 56

After DNA isolation, agarose gel electrophoresis is typically used to estimate which of
the following?
a. Concentration of isolated DNA
b. Purity of isolated DNA
c. Molecular weight of isolated DNA
d. Suitability of isolated DNA for PCR amplification

Back 56

c. Molecular weight of isolated DNA

Front 57

Which of the following statements regarding Restriction Fragment Length Polymorphism
(RFLP) is TRUE?
a. RFLP is a genotyping method suitable for SNPs and insertion/deletion (I/D)
polymorphisms.
b. RFLP is suitable for large scale pharmacogenetic studies.
c. RFLP is suitable for multiplexing.
d. An advantage of RFLP is that there is no chance for observer error with
interpretation of results.
e. All of the above are TRUE.
f. None of the above is TRUE.

Back 57

a. RFLP is a genotyping method suitable for SNPs and insertion/deletion (I/D)
polymorphisms.