Download YL6 Module 3, Exam 1 Contested Questions Which of the following

YL6 Module 3, Exam 1
Contested Questions
7. Which of the following growth factors promotes angiogenesis and vasculogenesis in wound
tumors?
a. Her2/NE
b. Vascular Endothelial Growth Factor?
c. Epithelial growth factor
d. Platelet derived growth factor
The answer is C. Epithelial growth factor. But based on Robbins, Vascular Endothelial
Growth Factor “is a potent inducer of blood vessel formation in early development
(vasculogenesis) and has a central role in growth of new blood vessels (angiogenesis) in
adults. It promotes angiogenesis in chronic inflammation, healing of wounds, and in
tumors.” Therefore, couldn’t the answer be B. Vascular Endothelial Growth Factor?
Source: Kumar, et al. (2010) Robbins and Cotran Pathologic Basis of Disease. (8th Ed)
Philadelphia: Saunders, page 88
11. All of the following organs are capable of regeneration and repair EXCEPT:
a. Liver
b. Skin
c. Heart
d. Brain
The given answer is B. However, all of them, one way or another, have the capacity or
potential to repair and regenerate. The following support this claim:
Human Cardiac Stem Cells (hCSC) have been discovered back in 2007.
Source: http://www.pnas.org/content/104/35/14068.abstract
"Additionally, we have tested whether these cells have the ability to form functionally
competent human myocardium after infarction in immunocompromised animals. Here, we
report the identification in vitro of a class of human c-kit-positive cardiac cells that possess
the fundamental properties of stem cells: they are self-renewing, clonogenic, and
multipotent. "
And another from
http://www.nature.com/nrcardio/journal/v3/n3s/full/ncpcardio0409.html
"Recent developments in stem cell biology have focused on the possibility of regenerating
contractile myocardial tissue. Most of these approaches have entailed the transplantation of
exogenous cardiac-regenerating cells. Recently, we and others have reported that the adult
mammalian myocardium, including that in humans, contains a small pool of cardiac stem
and progenitor cells (CSCs) that can replenish the cardiomyocyte population and, in some
cases, the coronary microcirculation"
Another research from Children's and Massachusetts General Hospital (2008)
Source: http://www.sciencecodex.com/new_source_of_heart_stem_cells_discovered (1)
Source: http://www.jyi.org/news/nb.php?id=1555 (2)
(1) "Now, researchers at Children's have shown that heart muscle cells can also be derived
from a third type of cardiac progenitor, located within the epicardium and identifiable
through its expression of a gene called Wt1."
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(2) "A recent study shows that stem cells located on the surface of the heart may help in
repairing damaged heart tissue. Researchers at Children’s Hospital Boston, whose findings
were published online by Nature on June 22, found that stem cells on the surface of the
heart, or epicardium, can give rise to heart muscle cells, or cardiomyocytes."
Also, a separate study in 2009 studies the ability of the heart to regenerate itself.
Source: http://www.cellmedicine.com/radiocarbon-cardiac-age.asp
"According to the results of this study, less than 50% of all cardiomyocytes are naturally
regenerated by the heart throughout an entire human lifespan, and the rate of renewal slows
with age. In the typical person who is 20 years old, for example, approximately 1% of all
cardiomyocytes renew themselves each year, whereas in the typical 75-year-old person that
percentage has decreased to around 0.45% of all cardiomyocytes."
25. The following day, upon removal of the gauze, he noticed bleeding has stopped and there was...
wound. This is due to which of the following?
a. Fibroblast proliferation
b. Platelet adhesion and aggregation
c. Europhilic margination
d. Angiogenesis
According to two of the diagrams of Robbins and Cotran's Pathologic Basis of Disease, 8ed.,
FIGURES 3-18 and 3-19, proliferation starts at 6th day, and fibroblasts appear on the 3rd to
7th day.
The next closest answer would be B. Platelet adhesion and aggregation. Though this
process is not efficient as fibroblast proliferation in preventing bleeding, plate adhesion and
aggregation can stop the bleeding to a certain extent.
36. As a barangay health worker, which of the following would you advise to hasten the wound healing?
a. Prescribe antibiotic
b. Advise good nutrition
c. Show proper wound cleaning
d. Have blood taken to assess metabolic status
Can the answer be B. Adequate nutrition as well? According to Dr. Stanley Kho's lecture,
one of the factors which "delay wound healing" are (1) "malnutrition" and (2) "vitamin"
deficiency (Vit A, C, and Zinc). Also, one of the core principles of the prevention and
management of wound infection (from the World Health Organization, link below) is the
provision of “high energy nutrition” to prevent wound infection. Hence, this could also be
one of the essential points for preventive health especially in children in poor communities.
Source:http://www.who.int/hac/techguidance/tools/guidelines_prevention_and_managem
ent_wound_infection.pdf
41. Which of the following statements is true regarding the non-suppurative diseases caused by S.
pyogenes?
a. Post-streptococcal glomerulonephritis occurs about 3 weeks after the infection
b. Streptococcal pharyngitis is the more frequent antecedent of post-streptococcal glomerulonephritis
c. The non-suppurative sequelae of S. pyogenes infection is toxin-mediated.
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Contested Questions
d. A and B
The answer was just the one that said post-streptococcal glomerulonephritis happens 3
weeks after skin infection. However, another true statement about non-suppurative diseases
caused by S.pyogenes is that there’s also a higher incidence with patients with severe
pharyngitis. So shouldn’t B. A and B be considered as well?
42. All of the following are important virulence factors of staphylococcus aureus except:
a. Hemolysins
b. Panton-Valentine Leukocidin
c. (unknown)
d. None of the above
The answer was D. None of the above. However, I think the answer should be A.
hemolysins. In p. 187-188 of Jawetz, Melnick and Adelberg's Medical Microbiology, there
was a listing of the virulence factors and enzymes/toxins of staphylococcal bacteria and
there was no mention of hemolysin there. Also, shouldn't hemolysin be a virulence factor for
streptococcal bacteria, since there is a clear distinction between alpha, beta and gamma
hemolysis among those bacteria? Hemolysin was also not mentioned under Staphylococcal
bacteria in the lecture of Dr. Primo Valenzuela.
46. All of the following diseases are caused by toxins produced by gram-positive organisms
EXCEPT:
a. Staphylococcal scalded skin syndrome
b. Rheumatic fever
c. Diphtheria
d. Erysipeloid
Students' answer: Rheumatic fever should not be the answer because it is the most
serious sequela of S. pyogenes, a gram-positive bacterium. (Source: Dr. Valenzuela's lecture on
Gram Positive organisms on 27 July 2010)
54. Which of the following toxin demonstrates that Paracelsus may be wrong when he says...
a. Dioxins
b. Pesticides
c. Heavy metals
d. Tetrodotoxin
The answer was A. Dioxins. However, I think the answer should be D. tetrodotoxin, as that
was the example given in class by Dr. Allan Dionisio regarding Paracelsus' quote. On the
other hand, dioxins were mentioned as having "no recommended dietary allowance", which
does not answer the question at hand. (Source: Dr. Allan Dionisio's lecture, July 28, 2010)
59. Which of the following are sources of lead?
a. PVC Pipes
b. Fired Pottery
c. All types of Gasoline
d. Battery Recycling plants
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Can we consider B. Fired Pottery? Pottery can be a source of lead especially if it is not
properly formulated, applied and fired. The government of Australia even place pottery
under "Lead Alert Facts".
http://www.environment.gov.au/atmosphere/airquality/publications/pottery.html
62. Even if no liquid pesticide spraying occurs within the communities, if these communities are
near plantations that use liquid pesticides, poisoning can still occur because of which of the
following properties?
a. Physical state of the pesticide
b. Solubility of the pesticide
c. Volatility of the pesticide
d. Reactivity of the pesticide.
The answer was C. Volatility of the pesticide. However, I would like to make a case for B.
Solubility of the pesticide. Volatility of the pesticide was never mentioned in the lecture of
Dr. Dionisio, all the other three choices were. However, since the pesticides used in the
example are liquid, wouldn't it be possible for its solubility to dictate if it can contaminate the
water of the communities, therefore causing poisoning? (Source: Dr. Allan Dionisio's
Lecture, July 28, 2010)
88. Which of the following refers to transplants from a living, non-identical donor?
a. Autografts
b. Homografts
c. Xenografts
d. Heterografts
The answer was homografts, but in the lecture Dr. Kho said Allogenic Skin grafts. However,
he did not give that as one of the answers. Was homograft discussed in the lecture?
89. Which of the following is the most common cause for a skin graft to fail to take?
a. Infection
b. Mechanical shear
c. Contamination
d. Hematoma
The given answer is A. Infection. However, during the lecture Dr. Kho said that the most
common reason for skin graft to fail is because of hematoma, blood, or seroma. He
explicitly said it’s the #1 reason for failure. Another reason was infection, but it’s not the #1
reason. Therefore, shouldn’t the answer be D. Hematoma?
Source: Lecture by Dr. Kho July 27, 2010 on Wound Healing
Even other references say that hematoma is the most common cause of skin graft failure.
From: http://www.podiatrytoday.com/article/7778
"...Researchers have often cited the formation of a seroma or hematoma as the most
common cause of postoperative graft failure."
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From: http://emedicine.medscape.com/article/876290-overview
"Skin grafting may be unsuccessful for numerous reasons. The most common reason for
skin graft failure is hematoma beneath the graft. "
90. Which of the following statements is true regarding suture selection?
a. Choose the smallest size required to hold the wound together.
b. Choose the suture with the longest absorbable time.
c. Choose monofilament sutures in infected wounds.
d. Choose braided suture for skin closure.
The given answer is D. Choose braided suture for skin closure.
However, Dr. Kho mentioned during the class that braided sutures should never be used for
infected because microorganisms can hide deep within the suture. Wouldn't that mean that
C. Monofilament sutures should be used for infected wounds can also be an answer as
well?
Alternatively, “A. Choose the smallest size required to hold the wound together” could
also be accepted because: "The accepted surgical practice is to use the smallest diameter suture
that will adequately hold the mending wounded tissue. This practice minimizes trauma as the suture is
passed through the tissue to effect closure. It also ensures that the minimum mass of the
foreign material is left in the body.” Source: (Suture Characteristics.
2008.http://www.suru.com/index.html)
Dr. Kho mentioned in his lecture that the smallest suture required should be used in order to
minimize inflammation, due to the fact that the suture is still a foreign body. (Source: Dr.
Kho’s lecture, 28 July 2010).
93. All of the following are deaths which require further investigation EXCEPT:
a. Mass graves
b. All emergency room deaths occurring within 24 hours
c. Death of inmates, incarcerated, or institutionalized individuals
d. Transport-related deaths
The answer was B. All emergency room deaths occurring within 24 hours. However I think
the answer should be A. mass graves. In the lecture given by Dr. Fortun, (slide #11), there
was a provision under the list of Report of Medico-Legal Cases (provision #15) stating that
death in any emergency treatment facility, medical walk-in center or clinic should be
reported. As for a. mass graves, the deaths by natural disaster (i.e. Payatas) may not be
deemed reportable; mass graves will only be deemed reportable if there is any evidence that
criminal violence appears to have taken place (provision #1, slide #10). Thus, the best
answer is A. Mass graves.
94. Which of the following statements is true regarding the doctor in a death investigation team?
a. He sections off the area with tape
b. He takes charge of the evidence recovered
c. He looks for potential witnesses in the crowd
d. He bags the hand of the dead person…
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The given answer is D. but coming from Dr. Fortune's lecture, it was noted from her case
examples that Dr. Fortune would often look around and ask the different witnesses
questions about the case to gather more evidence—what people were saying, who last saw
him, etc.—about the case. Therefore, from her illustrations, I gathered that the doctor also
looks around for potential witnesses in the crowd. Could the answer, C. Looks for
potential witnesses in the crowd be considered as well?
Source: Dr. Fortune's Lecture on Death and Trauma July 27, 2010.
95. All of the following are objectives of a death investigation system EXCEPT:
a. Determination of cause and manner of death
b. Determination of fact of death
c. Identification of the deceased
d. None of the above
The answer was d. none of the above. However, I would like to make a case for B.
Determination of fact of death.
By definition, a death investigation system deals with deaths, thus wouldn't it be a
prerequisite for the person to be dead for the death investigation system to take into effect?
The determination of fact of death is the responsibility of the paramedics/death
pronouncers.
102. Cause of death statements on the death certificate is most useful for which of the following?
a. Settlement of insurance benefits
b. Census purposes
c. Public health studies
d. Criminal investigation
Students' answer: D. Criminal investigation gains substantial information from autopsies
and relies heavily on them in order to gain knowledge on the cause of death, manner of
death; and it could perhaps point to evidence on the identity of the attacker. It seems that
autopsies are more important in criminal investigations as it is one of the few means one can
recreate the scene of the crime. On the other hand, public health studies can rely on cohort
studies, case-control studies, etc. without the immediate need for autopsies.
103. An objective and careful documentation of injuries can provide useful information regarding
what?
a. Evaluation of the alleged circumstances of the event.
b. Identity of the assailant
c. Possible motive of the assault.
d. All of the Above
In the case of the "hostage" incident of the child who was killed by the police when they
tried to shoot the guy with the ice pick, wasn't it a case that helped the authority identify the
"assailant", which it turned out to be, not the hostage-taker, but the police themselves?
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And the case of the military guy who died of heat stroke, didn't that case show that there it
was not a case of hazing, as most people had thought, but rather a mere accident, and that
there was no motive for that alleged "assault"? Based on these cases, wouldn't D. All of the
above be a possible correct answer?
106. All of the following are physical evidences that can help reconstruct the events leading to the
death of the victim EXCEPT:
a. Clothing worn by the victim
b. Victim's injuries
c. Witnesses' accounts
d. None of the above
The answer was d. none of the above. However, I think the answer should be C. Witnesses'
accounts.
The question specifically asked for PHYSICAL evidences that can help reconstruct the
events leading to the death of the victim. Clearly, witnesses' accounts are not physical
evidences.
107. The best method to document fine details of injuries on the body is through which of the
following?
a. Photograph
b. Detailed descriptions
c. Body Diagram
d. Drawings
The given answer is A. Photograph. However, Dr. Furton mentioned, "What you see may
not be what it is." Wouldn't that make A. Photograph an inadequate documentation?
108. A 15-year old male who became paralyzed because of spinal cord injury sustained when he was
crossing the street died a year after the incident from pneumonia. Which of the following is the
manner of death?
a. Natural
b. Homicide
c. Accident
d. Undetermined
I was wondering if A. Natural could be considered. The case did not mention that the
pneumonia is secondary to the spinal cord injury. The patient could have contracted
pneumonia after the incident. If that is the case, then the manner of death is natural.
In addition, the manner of death cannot be accident since that event transpired a year ago.
The accident is the underlying cause, but the manner of death is still natural since the person
died of pneumonia.
110. If a pilot has a massive heart attack (Acute MI) while in flight and his plane crashes, killing
everyone on board, the manner of death of the pilot and passengers is best classified as which...?
a. Natural-homicide
b. Natural-accident
c. Both are accident
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d. (unknown choice)
The answer is b. natural-accident. However, I would like to make a case for C. Both are
accident. It was never mentioned in the question that the acute MI was fatal (although it
was said to be severe). There can be the scenario that the pilot was still alive when the plane
crashed, thus the manner of death would be accident. It may depend on the flight altitude or
where the plane crashed, but the important thing here to consider is the interval of time
between the onset of the acute myocardial infarction and the crash of the plane.
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