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EH 208 Your Name: Pathophysiology of Human Disease Spring 2005 Exam I 1.In ischemic cell injury, what is the first major biochemical consequence of decreased oxygen? Starting at this point, outline a sequence of subsequent intracellular biochemical changes that span from reversible to irreversible ischemic injury. Provide two examples of how changes in intracellular calcium contribute. 2. For the role of free radicals in cell injury, provide: a) a definition of a free radical; b) one example of how free radicals may be generated within cells; c) two examples of reactions of free radicals which mediate cell injury (i.e., biochemical targets). 3. Provide short definitions of necrosis and apoptosis. Enter best matches for biochemical events and morphologic results in table below : Biochemical Event Predominance of denaturation of proteins Predominance of degradation of proteins Synthesis & Activation of specific endonucleases Generalized enzyme activation Causes: Morphologic Result A. DNA breakdown at internucleosomal sites B. Coagulative necrosis C. Pus/Abscess D. Random DNA breaks and chromatin condensation 4. What are the three major components of acute inflammation? Name 3 of the major signs of inflammation and state which of the three components causes these signs. 5.Summarize the steps involved in either (your choice) A) the recruitment of leukocytes to sites of acute inflammation or B) the killing of microbes by polymorphonuclear leukocytes, providing examples of specific molecules involved in the steps you identify. 6. Answer A or B: A) Match the mediator with these categories MEDIATOR ORIGIN: superoxide anion a. cell origin, preformed leukotrienes : b. cell origin, newly synthesized C5a : c. plasma, complement activation Plasmin : d. plasma, Hageman factor activation histamine nitric oxide EH 208 Your Name: Pathophysiology of Human Disease Spring 2005 Exam I B) Match the mediator with its major effect (answers can be used more than once or not at all) MEDIATOR C5a Causes: a. vasodilation interleukin 1 b. leukocyte chemotaxis histamine c. fever bradykinin d. pain Free radicals Neutrophil lysosomal enzymes e. tissue damage f. heartburn 7. What are the possible outcomes of acute inflammation? Pick one and identify factor(s) that favor it over the other possibilities. 8. Match the major events in wound healing with their time course: Event Cellular connective tissue with minimal leukocytes Neutrophils at edge of incision Influx of monocytes/macrophages begins Neovascularization maximal; incisional space filled with granulation tissue Occurs at: A. 72 hours B. 24 hours C. 3 months D. 5 days Match the event/problem in wound healing with mechanism: Event Occurs at: Abdominal wound dehiscence after A. Infection coughing spell Poor/delayed wound healing in B. Contraction by myofibroblasts malnutrition Poor healing, persistent purulent C. Mechanical stress when wound exudate tensile strength is still low Gradual reduction of skin wound D. Lack of vitamin C dependent size collagen modification . 9. State three of the four major mechanisms for non-inflammatory edema. Define transudate and exudate and state which one describes the fluid in an infected injury site. EH 208 Pathophysiology of Human Disease Spring 2005 Your Name: Exam I 10. What are the three major influences that predispose to thrombus formation (pathologic clotting)? Pick one and detail how it leads to thrombus formation, providing a specific example 11. Identify the possible fate of thrombi, including at least one potentially fatal complication. 12. Provide a definition of shock, state the three major types of shock, and provide a specific example and outline the principle mechanism(s). 13. Describe one of the four major 'hypersensitivity' patterns of immune-mediated disease, starting at the molecule(s) and finishing with the signs/symptoms the process causes. Name a prototypical disease that illustrates the process. 14. Give an example of a primary or secondary immunodeficiency, identify the typical problems (specific disease or sign/symptoms) associated with the disorder and explain the pathogenesis. EH 208 Your Name: Pathophysiology of Human Disease Spring 2005 Exam I 15. ANSWER A OR B: A) Identify three categories that describe how microorganisms can cause injury to a host. Detail one of them, providing an example. B) Name a specific bacterial exotoxin and provide an outline of its mechanism of action, including the final clinical health effect: 16. Match the usual pattern of tissue reaction to infection with the organism M. tuberculosis Staphylococcal pneumonia final pathway for multiple types of infections Viral mediated damage, e.g. herpes Clostridium perfringens a. suppurative inflammation b. granulomatous inflammation c. cytopathiccytoproliferative inflammation d. necrotizing inflammation e. chronic inflammation and scarring Match the normal defense mechanism with the organ system where it operates: mucociliary clearance a. GI tract acid secretions b. Respiratory Tract low pH and fatty acid c. Urinary Tract content of milieu lytic enzymes and bile d. Skin detergents frequent clearance by fluid e. Brain flow dense keratinized layer as f. biliary system barrier EH 208 Your Name: Pathophysiology of Human Disease Spring 2005 Exam I 17.Summarize the major criteria by which benign and malignant tumors are distinguished. 18. Identify four classes of genes that are implicated in carcinogenesis. Name a specific example for each class. Discuss one in detail (i.e., outline its mechanism) 19. ANSWER A OR B; A) Name the mechanisms by which protooncogenes can be activated. Provide a specific example for one of your categories. B) Summarize the steps required for a an epithelial tumor to metastasize 20. Match effects of tumors with most likely mechanism: headache and seizures a. invasion and impingement on local structures b. paraneoplastic secretion of parathormone-like substance c. direct endocrine production by tumor hypoglycemia from insuling production by pancreatic beta-cell adenoma hemoptysis (coughing up blood) in lung cancer coma due to elevated blood calcium in lung d. metastasis (e.g. from a colon cancer) cancer pulmonary embolism e. paraneoplastic hypercoaguable state OPTIONAL: 21. Make up a question and answer it to illustrate your knowledge of a topic that has not been covered in this exam. 22. Make up a question and answer it to illustrate your knowledge of a topic that has not been covered in this exam.