Exam Module 4 - School of Medicine and Health (SMH) 4th semester Module 4.3 Exam 17thhJUNE 2015 1 Exam Module 4.3 Medicine and MedIS, AAU, 4th. Semester 17th JUNE 2015 3 hours written

Studienummer: 4th semester Module 4.3 Exam 17thhJUNE 2015

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Exam Module 4.3

Medicine and MedIS, AAU, 4th. Semester 17th JUNE 2015

3 hours written exam without books and lecture notes.

The exam paper has to be photocopied so please write within the borders allocated for each question. Write your study number on each page. The space allocated for each question provides you with an idea about the maximum length of the answer. Each question states the maximum number of points.

Answers to questions can be written in Danish or English.

Yellow paper is for drafting answers and not to be handed in. This paper may NOT be removed from the examination room after completion of the exam paper.

The exam is a mixture of MCQ, short and long essay type questions.

Total number of questions: 40


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ANSWER SCHEME FOR MULTIPLE CHOICE QUESTIONS EXAM 4.3.

HUSK AT SKRIVE STUDIENUMMER ØVERST PÅ HVER SIDE. SKRIV IKKE NAVN ELLER CPR-NUMMER.

Opgave Svar

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Module 4.3 Questions:

Questions 1-32 inclusive are Multiple Choice Questions (MCQ) and should be answered on the separate sheet of paper after the first page.

1 Hyperplasi i et væv betyder, at

A. Antallet af blodkar er forøget

B. De enkelte cellers volumen er forøget

C. Andelen af bindevæv er forøget

D. Antallet af celler er forøget

E. Mængden af ekstracellulær matrix er forøget

Max point:1 Opnåede point

2 Dysplasi i et væv betyder, at

A. Vævet er skrumpet

B. Antallet af celler er formindsket

C. Der forekommer ekspansion af umodne celler

D. De enkelte cellers volumen er formindsket

E. Mængden af ekstracellulær matrix er formindsket


3 Et organ karakteriseres som atrofieret. Hvad betyder det?

A. Organet sidder et unormalt sted

B. Organet mangler

C. Organet er unormalt stort

D. Organet er svundet ind


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E. Organet indeholder cancerceller


4 Dyskaryosis is best described by which one of the following:

A. chromosomal abberations

B. pyknosis

C. hyperchromatosis and chromatin irregularities

D. low basophilia

E. apoptosis


5 Hvad er IKKE korrekt om nekrose?

A. Er en for cellen aktiv proces.

B. Forekommer altid under patologiske forhold

C. Cellen svulmer og lyserer under processen

D. Processen inducerer inflammation.

E. Processen er altid eksternt induceret


Hudens fysiology

Hudens lag:

A. Stratum spinosum

B. Stratum corneum


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C. Stratum papillare

D. Stratum granulosum

E. Stratum basale

F. Stratum reticulare

G. Stratum lucidum

Opgave:

6 I dette lag er cellerne forankrede med både desmosomer og hemidesmosomer

7 Dette lag findes kun i tyk hud

8 Heri findes store mængder af kollagene og elastiske fibre

Max point: 3 Opnåede point

Cancer pathology:

Proposed by Clark 1969, the risk of nodal metastases could be directly related to the depth of penetration of a tumor.

A. Tumor filling papillary dermis (localized), and compressing the reticular dermis.

B. Invasion of reticular dermis (localized).

C. Invasion into papillary dermis; invasion past basement membrane (localized).

D. Confined to epidermis (in situ).

E. Invasion of subcutaneous tissue (regionalized by direct extension).

9.0 From the list of options above, which description would best fit stage IV?

10.0 From the list of options above, which would best fit stage II?

Max point: 2 Opnåede points


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11 The pathogens most frequently associated with cervical cancer are:

A. EBV 16, 18

B. HPV 12, 13

C. HPV 16, 18

D. HPV 22, 23

E. PAPOVA 16, 18


12 Protein kinases do not play a role in which one of the following?

A. phosphorylation of receptors

B. signal transduction

C. phosphorylation of serine

D. inactivation of cAMP

E. induction of transcription


Topic: Carcinogenesis

A. Familial Adenomatous Polyposis (FAP)

B. Polyposis

C. Hereditary Non Polyposis Colon Cancer (HNPCC)

D. No polyposis

E. APC gene

F. hMSH2 gene


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G. Early onset colorectal cancer

H. hMLH1 gene

I. CDC25 gene

J MGMT gene

Lead in: From the list above, select the appropriate option.

13 Give an example of a gatekeeper gene?

14 Give 2 examples of caretaker genes?

15 An example of autosomal dominant inheritance?

16 An example where mutations are genetically recessive?


17 Which one of the following terms describes autonomously growing tissues?

A. Dysplasia

B. Hyperplasia

C. Hypertrophy

D. Metaplasia

E. Neoplasia


18 The stage of the cell cycle where each chromosome is composed of two

chromatids in preparation for mitosis.

A. G1

B. S


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C. M

D. G2

E. G1 and S


19 The first stage of mitosis when chromosomes start becoming visible in the microscope is called:

A. Anaphase

B. Prophase

C. Telophase

D. Metaphase

E. Late metaphase


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The sputum (fluid coughed up from the lungs) of many smokers contains cells with mutations (errors) in the genes for p53. The smoking induced mutations appear to be an early signal showing that cancer of the lungs will follow. What is the likely relationship between early p53 mutation and the development of lung cancer?

A. p53 with a mutation directly stimulates the growth of cancer cells.

B. Mutant p53 triggers the M phase of the cell cycle leading to abnormal cell division.

C. Mutations in p53 would prevent abnormal cells from dying by apoptosis.

D. p53 causes a cell to enter G0, blocking cell division.

E. p53 with a mutation stimulates the growth of cancer cells by acting on G1



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21 At which check point in the cell cycle would you expect the cell to arrest if there was an error in DNA replication ?

A. G0 - G1

B. G1 - S

C. G2 - M

D. M - G1

E. G1-G0


22 The cyclin D-cdk4 complex phosphorylates C-terminal residues of pRB upon growth factor stimulation. Which one of the following events does this lead to?

A. The cyclin A gene is expressed upon release of HATs from pRB.

B. The cyclin E gene is expressed upon release of HDAC from pRB.

C. The cyclin E gene is down regulated upon release of HDAC from pRB.

D. The cyclin D gene is expressed upon release of HDAC from pRB.

E. The cyclin A gene is regulated upon release of HATs from pRB.


Topic: Molecular Biology of cancer

Options:

A. Ras

B. Myc

C. Rb

D. abl


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E. APC

F. p53

G. ATM

23 From the list above, which 3 genes would you classify as examples of Proto-oncogenes?

24 Which one is a Tumor suppressor gene in colonic cancer


Topic: Cancer therapy/treatment

Options:

A. Cytotoxic antibody

B. Bifunctional alkylation of DNA and proteins

C. Hormone receptor antagonism

D. Ionisation of biological molecules

E. Microtubule disruption

F. Monofunctional alkylation of DNA and protein

G. Topoisomerase inhibition

H. Structural analogue of a metabolite

I. Tyrosine kinase inhibition


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Lead in: For each of the conditions and drugs below, choose the most appropriate mechanism from the list above.

Stem:

25 Dacarbazine used in Hodgkin’s disease.

26 The anthracycline, doxorubicin used to breast cancer.

27 The nitrogen mustard, cyclophosphamide widely used in solid tumours and leukaemias.


Topic: Cancer treatment

Options:

A. ATRA

B. Tamoxifen

C. Glivec

D. Rituximab

E. Taxol

F. Vinblastine

G. 5´fluorouracil

H. Cisplatin

I. Cladribine

Lead in: From the list above, which would be the best combination for treatment of the following:

Stem:

28 The treatment of colorectal cancer?


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29 Acute Promyelocytic Leukaemia?

30 Treatment of breast cancer?


31 The epidemiology of cancer:

Hvilken af nedenstående risikofaktorer er den væsentligste i forhold til udvikling af kræft?

A. Arv

B. Alkohol

C. Rygning

D. Manglende motion

E. Miljø


32 Hvad er ikke styrker ved elektroniske patient journaler (EPJ)?

A Bedre dokumentation

B Bedre datatilgængelighed

C Nem at håndtere

D Større patientsikkerhed

E Kan tilpasses lokal arbejdspraksis

F Bedre informations- og kommunikation mellem faggrupper


END OF MCQ


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ESSAY AND SHORT ANSWER QUESTIONS.

33 Forklar kort begrebet patogenese:


34 Forklar kort begrebet ætiologi:


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Nævn sårhelingens 4 faser: (Der bør ikke gives fuldt point, hvis de er i forkert rækkefølge)



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Clinical case

Dorte Pedersen 44 years, mother of 5 children, returned to the doctor at the local practice after having received a letter stating that her regular cervical smear was not normal. She was alarmed by this news and is worried she may have cervical cancer. In the report, it states that there are cellular changes or CIN 1. The doctor suggests it would be a good idea to have a colposcopy but explains that sometimes these slightly abnormal cells can go back to normal by themselves. A repeated test would be the next course of action.

Lead in: Based on the clinical case above, answer the following 4 questions. 36.1 Would you expect to find cellular changes given the age of the patient?

What normal cell types would you expect to see if the result of the smear had been negative? (2 marks)


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36.2 Describe some of the typical cellular changes that would be observed when diagnosing early stages of cervical cancer. (2 marks)

36.3 What are some of the risk factors for developing cervical cancer?


36.4 What treatment options would there be for early stages of cervical cancer? Provide a list of 4 options. (2 marks)


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37 Using skin cancer as an example:

(a) What do you understand by the terms “grade” and “stage”, with respect to neoplastic growth? (4)

(b) What are the clinical reasons for cancer staging? (2)

(a)



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38 Cell growth is a balance between cell division and cell death:

What happens to cells during apoptosis?

List some of the cellular characteristics (4)

What is the difference between the intrinsic and extrinsic pathways? (4)

How is apoptosis regulated with respect to the intrinsic pathway and what are the molecular mechanisms (6)


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39 Explain the terms below giving examples: (a) Thrombosis (2 marks) (b) Embolism (2 marks) (c) Infarction (2 marks)

(d) Explain the term aneurysm and list the different types (4 marks)


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Topic: Cancer Chemotherapy

40 The repair of mutations caused by carcinogens is accomplished by several different repair mechanisms: Below is a table with 3 columns, labeled as follows: Example of carcinogen, type of mutation and DNA repair mechanism. Complete the table 1-4 giving the 4 examples.

Example of carcinogen DNA mutation DNA repair mechanism

1.

2. Nucleotide excision repair (NER)

3. ROS

Endogenous mechanisms

4.


END OF EXAM

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Exam Module 4 - School of Medicine and Health (SMH) 4th semester Module 4.3 Exam 17thhJUNE 2015 1 Exam Module 4.3 Medicine and MedIS, AAU, 4th. Semester 17th JUNE 2015 3 hours written