Biomedicine - Semester II – August - Exam- 2013

Urinary

1.  Complete the following descriptions of the 3 Stages of Urine Formation.

(3 Marks)

·  GLOMERULAR FILTRATION occurs in the Renal Corpuscle.

·  In TUBULAR REABSORPTION, Renal Tubules & Collecting Ducts/ Tubule Cells reabsorb 99% of filtered Water & Useful Solutes

·  Urine secreted during TUBULAR SECRETION is essentially composed of Water & Waste Material including excess electrolytes, Drugs and Hormones.

Urinary

2.  A friend arrives at your home complaining of extremely severe colicky pain in his kidney area, radiating into his groin. The pain is so severe it is making him nauseous and he has a very rapid pulse.

a)  What is the most likely diagnosis? (1 mark)

Kidney Stones / Renal calculi

b) What might you find in a Urine Dipstick Test? (1 mark)

·  Microscopic Blood (Trace Blood)

c) Suggest 2 possible, underlying causes for this condition. (2 marks)

1

·  Dehydration

·  Alkaline/ Acid Urine

·  Infection

·  Urine obstruction

·  Hyperparathyroidism

·  Gout

1

d) What advice would you give him to prevent a re-occurrence? (2 marks)

·  Treat any underlying condition

·  Adjust urine pH through Diet

·  Reduce dietary load of oxalates and uric acid

·  Balance Calcium levels

·  Increase Fluid intake

.

Urinary

3.  a) Please complete the following Flow Chart by filling in the names of the 2

enzymes required. (2 Marks)

b)  Where is Angiotensinogen Made? (1 Mark)

The Liver

Urinary

4. a) What overall effect does Angiotensin II have on blood pressure? (1 mark)

Raises blood pressure.

b) Name 2 other HORMONES which are secreted as a result of Angiotensin II production, which affect Tubular Reabsorption & Secretion. PLEASE USE FULL NAMES (1 mark ½ Mark each).

·  Aldosterone.

·  Antidiuretic Hormone

Repro

5.  a) Please complete the illustration below by identifying the KEY HORMONES

and PHASES of the Menstrual Cycle. (3 Marks ½ Mark each)

b)  Which Hormone, secreted by the Anterior Pituitary, influences development & maturation of the Follicles? PLEASE USE FULL NAME (1 Mark)

Follicle Stimulating Hormone

c)  Which Hormone, secreted by the Anterior Pituitary leads to rupturing of the Mature Follicle and expulsion of the Egg? PLEASE USE FULL NAME

(1 Mark)

Luteinising Hormone

d)  Name the Hormone that is tested for in Pregnancy? (1 Mark)

•  Human Chorionic Gonadotropin (hCG)

Repro

6.  Are the following statements regarding the PLACENTA True/ False?

(2 marks- ½ mark each)

i. The Placenta develops from the Mothers Uterine Cells, when

the Zygote is implanted into the Uterine Wall. FALSE

ii.  Mother Foetal Blood Cells cross the Placenta FALSE

iii.  Certain Drugs & Stress Hormones cross the placenta TRUE

iv.  When the Placenta attaches to the uterine wall close to or

covering the Cervix, it is referred to as Placenta Praevia TRUE

Repro

7.  a) List 3 Clinical Features of Polycystic Ovary Syndrome (PCOS). (3 marks)

1

·  Cysts on ovaries

·  Multiple Follicles in Ovaries (Pearl Necklace)

·  Amenorrhea

·  Oligomenorrhoea

·  Anovulation

·  Infertility

·  ↑ Risk of miscarriage

·  Impaired glucose tolerance

·  Hyperinsulinaemia

·  Weight gain

·  High Oestrogen

·  High levels of Testosterone

·  Oily skin & Acne

·  Hirsutism

·  Acanthosis

1

b) List TWO forms of Orthodox Medical Treatment for PCOS. (1 – ½ Mark each)

•  OCP- With an anti-androgen

•  Insulin Resistance Treatment - Metformin

•  Weight Loss & Exercise

•  Selective Estrogen Receptor Modulator (SERM), Clomiphene /Clomid

Repro

8.  Please give the appropriate term for the following Descriptions. (4 Marks)

Description / Term
Mid- cycle bleeding / Bleeding between Cycles / METORRHAGIA
Absence of Periods/ Menses / AMENORRHOEA
Short Menstrual Cycle, Frequent Periods / Bleeding/ Menses / POLYMENORRHEA
Presence of breast tissue in a Male / GYNOCOMASTIA

Neuro

9.  Identify the Neuroglia associated with the following functions. (4 marks)

Main function / Type of Neuroglia
Form and maintain the Myelin Sheath in the CENTRAL Nervous System / Oligodendrocytes
Hold neurons to their blood supply & help make up the Blood Brain Barrier / Astrocytes
Form and maintain the Myelin Sheath in the PERIPHERAL Nervous System / Schwann Cells
Phagocytic Neuroglia – Mobile in the brain and multiply when the brain is damaged. / Microglia

Neuro

10.  Circle the word that most accurately describes the events taking place in a CHEMICAL SYNAPSE. (4 marks – ½ Mark Each)

a)  Nerve impulse travels down the axon and finally arrives at the Cell Body / Synaptic End Bulb.

b)  Depolarisation phase causes Sodium Channels / Calcium Channels to open, allowing Sodium / Calcium ions into this end of the neuron.

c)  An increased concentration of these ions causes Endocytosis / Exocytosis of Synaptic Vesicles / Synaptic Lysosomes, releasing Neurotransmitters into the Synaptic Cleft / Synaptic Membrane.

d)  The neurotransmitters diffuse across the synapse and bind to receptors on the Presynaptic / Postsynaptic Neuron. This opens the ion channels here, allowing ions to flow across the membrane.

e)  The change in ion concentration then triggers a Repolarisation / an Action Potential in this neuron.

Neuro

11.  a) What is the Potential energy of a neuron at REST (How many mV inside the

Resting Neuron?). (1 mark)

+/-70 mV

b)  Which Channels/ Gates in the Nerve Membrane are BLOCKED by Anaesthetics? (1 mark) Sodium Channels/ Gates

Neuro

12.  Identify the most likely Nervous System disorder associated with the group of symptoms provided in the table below. (4 marks)

SYMPTOMS / Most likely PATHOLOGY
Tonic-Clonic Seizures caused by intense / abnormal electrical activity in the brain. / Grand Mal Epilepsy
Formation of amyloid plaques in the cerebral cortex with atrophy of the nervous tissue.
Symptoms start with inability to incorporate new information and memories despite the retention of old information / Alzheimer’s Disease / Dementia
Lack of movement: mask-like face, low voice, shuffling steps
Muscle stiffness: Jerky movements, Tremors, Unstable moods
Pill-rolling of fingers / Parkinson’s Disease
Sudden, one –sided, facial paralysis following a chronic history of infection with cold sores.
The paralysis is temporary! / Bell’s palsy

Neuro

13.  a) Which Enzyme catalyses (breaks down) Serotonin? (PLEASE USE FULL NAME). (1 Mark)

Monoamine Oxidase

b) What is the main function/ effect of Nitric Oxide? (1 Mark)

Vasodilation – Thus used for Angina, ↓BP and ↑erection in Males

Neuro

14.  a) Are the following statements about Multiple Sclerosis True/ False? (4 Marks)

i.  Multiple Sclerosis is associated with progressive

demyelination of the Neurons TRUE

ii.  Multiple Sclerosis affects the Peripheral Nervous System FALSE

iii. One of the suspected causes of Multiple Sclerosis may be a Viral infection TRUE

iv. Multiple Sclerosis causes Progressive Paralysis TRUE

b)  List 2 Differential Diagnoses that may be given in place of Multiple Sclerosis.

(2 Marks)

·  Slipped Disk/ Herniated Disc

·  Sore Eyes/ Eye Infection/ Glaucoma,

·  Herpes zoster (Shingles),

·  Candidiasis,

·  Mercury Poisoning, Excess vitamin B6 in sensitive people etc.

·  Motor - Neuron Disease

Neuro

15.  Give one main function for each of the Cranial Nerves listed below:

a)  Trigeminal Nerve (CN V) (1 mark)

Facial SENSATIONS & Chewing

b)  Hypoglossal Nerve (CN XII) (1 mark)

Tongue movement Speech

c)  Trochlear Nerve (CN IV) (1 mark)

Eye Movement (Downwards & Inwards) & Proprioception

Imm

16. Identify the Cell or Protein associated with the following Non-Specific Defence Processes. (3 marks)

a)  Inhibits bacterial growth by binding to Iron thus creating an environment that is low in iron = Transferrin

b)  Tag invading cells/ pathogens for phagocytosis and attract Macrophages. Form a Membrane Attack Complex, thereby initiating Cytolysis = Complement Proteins

c)  Released by cells that are infected by a virus, thereby stopping viral replication in other nearby cells = Interferon

Imm

17.  a) List 2 Benefits of INFLAMMATION. (2 marks)

·  Promotion of Phagocytosis

·  Promotion of Immune Response (Allow Antibodies to enter tissues)

·  Toxin Dilution

·  Fibrin Formation –This can...

ü  WALL OFF the inflamed area preventing spread of infection

ü  Help BIND wound edges during healing

b)  List 2 Benefits of FEVER. (2 marks)

·  Makes interferon more effective

·  Inhibits growth of some microbes

·  Speeds up the reactions that aid repair

Imm

18.  Please answer the following questions regarding Cell-Mediated Immunity:

a)  Which 2 types of immune cells are involved in the beginning part of this process?

(1 mark – ½ Mark each)

T-lymphocyte & Phagocytes /Macrophages,

b) Name the main Cytokine or Inflammatory Mediator involved in this type of immunity. (1 mark)

Interleukin 2. (IL-2) (Can also say IL-1 released by Macrophage)

C) What is the name given to the process of differentiation and proliferation of the activated immune cells involved in Cell Mediated Immunity? (1 mark)

Clonal selection

d)  Name 2 types of cells formed at the end of this process. (1 mark – ½ mark each)

·  Cytotoxic / Killer- T Lymphocytes,

·  Memory T-cells

·  Helper T-cells

Imm

19.  Complete the Table on Acquired Immunity by giving ONE example of each type of Immunity provided. (3 Marks)

Type of Acquired Immunity / ONE Example
Artificially acquired, Active Immunity / Vaccination
Artificially acquired, Passive Immunity / Injection with Antibodies e.g. Snake anti-venom
Naturally acquired, Passive Immunity / Transfer of antibodies to the baby across the Placenta and through Mother’s milk (Breast feeding)

Imm

20. True/False? The following are Autoimmune Conditions: (2 marks – ½ Mark each)

a) Grave’s Disease

TRUE

b) Osteoarthritis FALSE

c) Ankylosing Spondylitis TRUE

d) Coeliac Disease TRUE

e) Systemic Lupus Erythematosus TRUE

Infx Dx

21. A Client comes to see you looking quite Anaemic and complaining of persistent Malaise accompanied by a Recurrent, Cyclical Fever which she describes as episode beginning with Chills followed by Fever & Extreme Sweating. She also suffers with bouts of Nausea & Vomiting and says her joints all Ache. During the Consultation you establish that all of this began after a trip to Tropical Asia, including India & Sri Lanka. On taking a Urine Sample you find that she has Haemoglobinuria.

a)  Which Infectious Disease do you suspect she may have contracted? (1 mark)

Malaria

b)  What is the Causative Organism of this Infectious Disease? (1 mark)

Protozoal- PlasmodiumParasite – carried by the Female, Anopheles Mosquito

c)  Explain why this Client is Anaemic with Haemoglobinuria. (1 mark)

The Plasmodium parasite infects the Red Blood Cells causing Haemolysis, releasing excessive amounts of Haemoglobin into the plasma, which is filtered by & excreted by theKidneys as Urine.

Infx Dx

22 Identify the causative microorganism (Bacterial / Fungal / Viral or Protozoal) associated with the following Infectious Diseases. (3marks- ½ mark each)

Infectious Disease

/ Causative Microbe
Chickenpox / Viral
Candidiasis / Fungal/ Yeast
Shingles / Viral
Measles / Viral
Tuberculosis / Bacterial
Impetigo / Bacterial

Infx Dx

23.  a) Which Immune Cells are targeted by the Human Immunodeficiency Virus (HIV)?

(1 Mark – ½ Mark each)

T-Helper Cells/ T-Lymphocytes & Macrophages

b)  List 2 common Opportunistic Infections that may occur in Late Stage HIV / AIDS.

(1 Mark – ½ Mark each)

1

·  Candida albicans

·  Pneumonia

·  Karposi’s sarcoma

·  Cervical cancer

·  Herpes zoster (shingles)

·  Active TB

·  Herpes simplex

·  Cytomegalovirus

·  Lymphoma

·  Salmonella poisoning

1

c)  Suggest 2 reasons why it is difficult to develop HIV drugs (2 marks)

o  The virus hides in host cells

o  The virus has very few structures of its own

o  The virus is able to mutate

Onco

24.  A 60 year old male comes to see you because he is having Problems Swallowing. When he eats he experiences Pain & Discomfort behind his Sternum and feels like the food is either “not going down” or that it is being Regurgitated with a Non-sour Reflux. This discomfort causes him to Cough severely after Swallowing. He is also worried because he has become quite Anaemic & noticed that he has Lost quite a bit of Weight & Muscle, WITHOUT changing his diet in any way. You establish that the symptoms are NOT related to or triggered by any specific foods and he has NO Indigestion or Heart burn.

a) What Condition do you suspect? (1 Mark)

Oesophageal Cancer

b)  Give 1 Risk Factor for the development of the Condition diagnosed in 24 a). (1 Mark)

·  Smoking

·  Alcohol Consumption

·  History of Chronic Acid Reflux / GORD

c)  What is the Medical Term for; ‘Weight Loss, Muscle Atrophy, Fatigue, Weakness & Involuntary wasting away’? (1 Mark)

Cachexia

Onco

25.  List 4 Early Warning Signs of Cancer. (2 Marks – ½ Mark each)

1

·  Unusual bleeding or discharge

·  Anaemia and persistent fatigue

·  Change in bowel or bladder habits

·  A change in appearance of a wart or mole

·  A sore which does not heal

·  Unexplained weight loss

·  Persistent cough or hoarseness

·  A solid Lump

1

Onco

26.  Please explain why people with Leukaemia often present with Shortness of Breath & Extreme Fatigue. (2 marks)

·  Leukaemia leads to an overproduction of white blood cells and so compromises/ reduces the capacity of the bone marrow to produce other types of cells such as Erythrocytes/ Red Blood Cells & Platelets/ Thrombocytes.

·  Leukaemia thus leads to Anaemia which typically presents with SOB & Fatigue because the Erythrocytes carry oxygen - So when the Erythrocyte numbers are low a patient with Leukaemia will feel hypoxic/ deprived of adequate oxygen and thus breathlessness (SOB)