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Eksamen i Modul 5.3. MedIS, AAU, 5. semester 17. januar 2011, 9:00 – 12:00 3 timers skriftlig eksamen uden hjælpemidler. Besvarelserne skal fotokopieres, så skriv venligst tydeligt. Skriv studienummer på alle sider. Besvarelser indskrives i de angivne rammer. Rammernes størrelse angiver samtidig den ønskede maksimale længde på besvarelserne af essayspørgsmål. Der må således ikke skrives mere til det enkelte spørgsmål, end det kan rummes inden for den relevante ramme. Den enkelte opgaves vægt i point er angivet forneden. Rammen ”points achieved” er kun til brug ved censureringen. Besvarelsen skal være på dansk og / eller engelsk; hvis du er usikker på, hvad et begreb hedder på dansk, er det acceptabelt, at du skriver det på engelsk. Ternet/linieret papir er kun til kladdebrug, men skal afleveres i mapperne. Eksamen er en blanding af multiple choice questions, multiple option questions og short essay type questions. Total antal af spørgsmål er 35 (17 MCQ). Total antal af point for Blok 5.3: 35 point 1 1 Which of the following statements about a visceral pain is NOT correct? Localization of pain is typically exact and not diffuse. A. Perception of visceral pain typically non-specific. B. Pain does not arise from all viscera. C. Referred pain is a common phenomenon in visceral pain. D. Max point: 1 Achieved point 2 Pathogens often invade the body via mucous membranes. Give three examples of unspecific defense mechanisms in the gut against infections. What does the abbreviation MALT stand for? Give two examples of specific defense mechanisms in the gut against infections. Max point: 4 Achieved point 3 A. B. Choose the correct answer. IgA facilitates (increases) IgE-mediated anaphylactic reactions. IgA facilitates inflammatory IgM- and IgG-mediated reactions such as complement activation. TGF-β is produced by epithelial cells in the gut. C. TGF-β signals differentiated B-cells to produce IgG. D. TGF-β signals differentiated T-cells to produce IgG. E. Max point: 1 Achieved point 4 A. B. Which statement is NOT correct? Calcium absorption occurs within the colon and the small intestine. Iron absorption occurs within the duodenum and the proximal small intestine. Lactose intolerance is classified as pre-epithelial malabsorption. C. Epithelial malabsorption is characterized as rather specific for nutrients D. such as fat or carbohydrates. Type II diabetes is a disease typically associated with obesity. E. Max point: 1 Achieved point 2 5 What do “marasmus” and “kwahsiorkor” have in common and how can they easily be distinguished? (briefly) Max point: 2 6 Achieved point What are the typical complications to chronic inflammatory bowel diseases (IBD) such as Morbus Crohn and Ulcerative colitis? What extraintestinal complications can arise typically within IBD (give 2 examples)? A proctocolectomoty is typically performed in which of those two diseases? Max point: 3 Achieved point 7 Microbiology of the gut A. Salmonella typhi B. Escherichia coli C. Norovirus D. Campylobacter jejuni E. Staphylococcus aureus F. Rotavirus G. Shigella sonnii H. Helicobacter pylori I. Chlamydia trachomatis J. Influenza virus Lead in: From the list above, select the appropriate option. … is the most common cause of the Guillain-Barrés syndrome. … is the most common cause of sexually transmitted reactive arthritis (Reiter’s syndrom). The pathophysiology of this microorgansim involves production of large amounts of urease. Member of this family cause gut toxicity by production of Shiga toxins and enterohemorrhagic toxin. Max point: 4 Achieved point 8 Which is NOT a feature of Helicobacter pylori? Rod-like appearance. A. Gram-positive. B. Transmission via fecal-oral route C. Pathogenesis involves heat shock protein HspB. D. Pathogenesis involves heat vacuolating cytotoxin. E. Max point: 1 Achieved point 3 9 Which microorganism had an outbreak in Germany and Denmark in between May and June 2011 causing hemolytic uremic syndrome? The production of which toxin causes its pathogenicity? Max point: 2 Achieved point 10 At what blood alcohol content starts typically which impairment? A. 0.2 promille B. 0.5 promille C. 0.8 promille D. 2 promille E. 3 promille F. 4 promille Lead in: From the list above, select the appropriate option. Increased reaction times Loss of urinary bladder control Adaptation of the eye for light/dark Max point: 3 Achieved point 11 Give two examples of drugs used in the medical treatment of alcoholism. What other psychological alternatives can be considered (give two examples)? Max point: 2 Achieved point 12 Which of the following statements about a Medical Decision Support System (MDSS) is NOT correct? A Rule-based MDSS relies on knowledge for its construction. A. A Model-based MDSS relies both on knowledge and data for its B. construction. The main developers of a MDSS are an expert in a particular medical field C. and a knowledge engineer. One of criteria for successful implementation of a MDSS in clinical D. practice is an easy transfer of such a system between hospitals. Infectious Diseases is the only application area of a MDSS. E. Max point: 1 Achieved point 4 13 Give three examples of techniques which can be used to build a Medical Decision Support System Max point: 3 14 Achieved point What are the main two processes in drug elimination? Give a very short description (one sentence). Name two main routes of drug elimination. Drugs with small molar volumes and polar characteristics are mainly eliminated via … ? What about lipophilic drugs? Max point: 5 15 Achieved point Give a definition of the so-called “first pass effect”? What is its direct consequence regarding the route of drug administration? Max point: 2 Achieved point 16 At what blood alcohol content starts typically which impairment? A. Phase I reactions typically catabolic, that means that … B. Phase II reactions typically anabolic, that means that … Lead in: From the list above, select the appropriate option. … the products of the metabolized drug is usually chemically more active. … the products of the metabolized drug is usually chemically less active. Achieved point Max point: 2 5 17 A. Which of the following statements is NOT correct? Bromfenac (NSAID) is withdrawn from the market due to induction of severe liver damage. Drug metabolism of paracetamol is not hepatotoxic as long as there is B. hepatic glutathione present. Steatosis is one possible clinical manifestation of drug-induced liver C. damages. Adverse drug reactions are typically classified in type A (intrinsic or D. pharmacological) and type B (idiosyncratic). Inhibition of cytochrome P450 enzymes enhances drug metabolism. E. Max point: 1 Achieved point 18 Name the three Icterus categories and give one example for each category. Max point: 3 Achieved point 19 A. Which of the following statements is NOT correct? Increased levels of transaminases in the blood are present with infectious hepatitis. The hepatitis B virus is a hepadna virus. B. Cholestasis describes a condition of enhanced bile (gall) flow from the C. liver to the duodenum. The hepatitis A virus is an ssRNA virus. D. Hepatocyte function involves amongst others production of serum E. albumin. Max point: 1 Achieved point 20 What are the main characteristics of the Cushing’s syndrome and Addison’s disease (dysfunction, tissue)? Max point: 2 Achieved point 6 21 Kidney anatomy & function Fill in the appropriate names within the kidney tissue (top) and what is mainly synthesized within them (bottom)? 1 2 3 4 7 6 5 Max point: 4 8 Achieved point 22 Which of the following statements is NOT correct? Glucocorticoids … … have a dose-related effect on carbohydrate, protein and fat metabolism. A. … exert anti-inflammatory effects via inhibition of prostaglandin B. synthesis. …increases the humoral immunity. C. …in large doses over longer periods leads to redistribution of fat. D. … exert anti-inflammatory effects via inhibition of COX II E. (cyclooxgenase). Max point: 1 Achieved point 7 23 What is typically the effect of the hypovolemic shock on the pulse? What happens to the skin? How does the pulse and skin change during a neurogenic shock? Max point: 4 Achieved point 24 Which of the following statements is true? Aldosterone … … decreases renal tubular reabsorption of sodium. A. … in excessive levels decreases extracellular fluid volume. B. … in excessive levels decreases arterial pressure. C. … in low levels can lead to metabolic alkalosis. D. All statements above are incorrect. E. Max point: 1 Achieved point 25 Which of the following statements is NOT correct regarding the typical symptoms of colon cancer? Pain A. Rectal bleeding (Blood in stool) B. Anemia C. Unexplained fatigue D. Hematemesis E. Max point: 1 Achieved point 26 Give two general approaches in the treatment of diarrhea Max point: 1 27 Achieved point Give two characteristics of constipation. Max point: 1 Achieved point 8 28 Laxatives A. Methylcellulose B. Magnesium sulfate C. Glycerin D. Cascara E. Tegaserod Lead in: From the list above, select the appropriate option. …belongs to the group of stimulant laxatives. …is a laxative that works as a stool softener. …is an osmotic laxative … belongs to the group of bulk-forming laxatives. Max point: 4 Achieved point 29 Conflicts of interest between these groups (give two examples) provide the dilemma of measuring quality in the healthcare sector. Max point: 1 Achieved point 30 Which of the following statements is NOT correct regarding gastrointestinal bleedings (GIB)? Vascular ectasia is one of the most frequent causes of GIB of the small A. intestine. The Mallory-Weiss syndrome is characterized by bleeding localized at the B. transition between the esophagus and the stomach. Esophageal varices are often seen in patients with liver cirrhosis. C. Intake of NSAIDS typically reduces the risk of developing peptic ulcers D. (ulcus duodeni) Hemorrhoids one of the major causes for colon bleedings. E. Max point: 1 Achieved point 31 Name four different types and causes of shock. Max point: 4 Achieved point 9 32 Kidney blood supply Fill in the appropriate names of the blood vessels. 3 2 1 4 6 5 Max point: 3 33 Drug metabolism generally consists of Phase I and II reactions. Give one example each for Phase I and Phase II reactions? Max point: 2 34 Achieved point Achieved point Which of the following is true regarding cancer of the colon? Change in bowel habits is unusual. It tends to occur in children and youngsters. Alcohol abuse does not increase risk for colon cancer. Colorectal cancer is the most frequent cause of cancer death in developing countries. Cancer of the small intestine is rare. E. Max point: 1 Achieved point A. B. C. D. 10 35 Some foods increase the risk of cancer, whereas other foods decrease its risk. Which of the following statement best describes dietary factors associated with cancer risk? Foods containing vitamins A, C, D, and E are considered to have antiA. cancer properties. Fiber, fruits and vegetables have anti-cancer properties. B. Fat and high glycemic index carbohydrates have pro-cancer properties. C. All statements above are correct. D. Max point: 1 Achieved point 11