Exam Module 4 - Aalborg Universitet · Studienummer: 4th semester Module 4.3 Exam 25thhAugust 2014 7 D. As CLL progresses hypogammaglobulinaemia may, and often does, develop. E. CLL

Studienummer: 4th semester Module 4.3 Exam 25thhAugust 2014

1

Exam Module 4.3

Medicine and MedIS, AAU, 4th. Semester 25th August 2014

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 short and long essay type questions.

Total number of questions: 39

Total number of points: 81


2

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

1

2

3

4

5

6

7

8

9

11

12

13

14

15

16

17 17.1 17.2

18

19

20

21

22

23

24


3

25

26

MCQ TOTAL = 26


4

Module 4.3 Questions:

Questions 1-26 inclusive are Multiple Choice Questions (MCQ) and should be answered on the separate sheet of paper after the first page.

1 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.

E. Organet indeholder cancerceller.

Max point: 1 Opnåede points

2 En mikroskopisk undersøgelse afslører, at et væv udviser hypertrofi. Hvad betyder det?

A. Vævets celler er mere metabolisk aktive end normalt.

B. Vævets celler er større end normalt.

C. Vævet indeholder flere celler end normalt.

D. Vævets celler farves kraftigere med histologiske farver end normalt.

E. Vævet har kraftigere blodforsyning end normalt.


3 Which statement regarding skin is correct?

A. Apocrine glands have parasympathetic innervations.

B. Krause corpuscules are also found in other organs.

C. Free nerve endings end in dermis.

D. Merocrine glands have parasympathetic innervations.

E. Meissner corpuscules are found epidermis.


5


4 Select the secondary skin lesion!

A. Nodule.

B. Vesicle.

C. Pustule.

D. Keloid.

E. Wheal.


5 Select the primary skin lesion!

A. Scale.

B. Papule.

C. Excoriation.

D. Scar.

E. Lichenification.


6 Which one is NOT a typical clinical sign of Lichen simplex chronicus?

A. Itching.

B. Scratching.

C. Pale skin.

D. Leathery skin.

E. Thick skin.



6

7 Which of the following is present in thick skin but not in thin skin?

A. Stratum germinativum.

B. Stratum granulosum.

C. Stratum corneum.

D. Stratum lucidum.

E. Dermal papillae.


8 Which one of the following is the correct name for the treatment of acute promyelocytic leukemia by the administration of all-trans retinoic acid?

A. Differentiation therapy.

B. Apoptotic therapy.

C. Anti-angiogenic therapy.

D. Conventional chemotherapy.

E. Gene therapy


9 With respect to chronic lymphocytic leukaemia (CLL) which of the following statements is FALSE?

A. The appearance of the lymphocytes in CLL is typically a heterogeneous population of reactive type cells.

B. Most CLL is of B cell origin.

C. Rarely occurs in patients less than 40 years of age.


7

D. As CLL progresses hypogammaglobulinaemia may, and often does, develop.

E. CLL is often found as an incidental finding, with an absolute lymphocyte count between 10 and 150 x 10E9/L.


10 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.


11 Which one of the following statements about aneuploidy is false?

A. It is the condition of having an abnormal chromosome number and content.

B. It may be caused by defects in centrosomes.

C. It is a common characteristic of human solid tumors.

D. It may be caused by defects in apoptosis.

E. It is a condition often seen in cancer cells


12 Which one of the following statements correctly describes an oncogene?


8

A. A gene that codes for proteins that help inhibit tumor growth and formation.

B. A mutated gene whose protein product is produced in increased quantities or has increased activity and contributes to carcinogenesis.

C. A type of cancer therapy.

D. A mutated gene whose protein product is produced in deficient quantities and contributes to carcinogenesis.

E. Oncogenes are only involved in cell cycle regulation.


13 Which of the following does not apply to tumor suppressor genes?

A. Mutation in only one allele can lead to tumor development.

B. Mutations in both alleles result in tumor development.

C. Mutation in only one allele results in increased production of gene product and acts in a dominant manner.

D. The product of a tumor suppressor gene may inhibit growth and inhibits carcinogenesis.

E. Mutation in only one allele results in increased production of gene product and acts in a recessive manner.


14

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.


9

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.


15 Which of the following characterizes scabies, Sarcoptes scabiei?

A. Pediculus capitis, Pediculus corporis, and Phthrirus pubis are the three types.

B. Scabies are blood-sucking, nocturnal parasite of man.

C. Scabies are identical to fleas.

D. Scabies are characterized by burrows and papules.

E. Scabies are identical to lice.


16 Which of the following is associated with atopic dermatitis?

A. It has a prevalence rate of 50% to 75%.

B. Blood eosinophilia is a common finding in atopic dermatitis.

C. There is often an increased IgG level.

D. Itching is a rare finding.

E. There is often a decreased IgE level.


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


10

C. Invasion of reticular dermis (localized).

D. Confined to epidermis (in situ).

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

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

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


18 Which one of the following does not represent an invasive form of malignant melanoma?

A. Acral lentiginous melanoma.

B. Lentigo maligna melanoma.

C. Lentigo maligna.

D. Nodular melanoma.

E. Superficial spreading melanoma.


19 Which one of the following cancer drugs alters the conformation of the DNA and interferes with replication?

A. Methotrexate.

B. Vincristine

C. Doxorubicin


11

D. Cyclophosphamide.

E. Tamoxifen


Topic: Cancer therapy/treatment:

Options:

A. Bifunctional alkylation of DNA and proteins.

B. Cytotoxic antibody.

C. Hormone receptor antagonism.

D. Ionisation of biological molecules.

E. Microtubule disruption.

F. Monofunctional alkylation of DNA and protein.

G. Structural analogue of a metabolite.

H. Topoisomerase inhibition.

I. Tyrosine kinase inhibition.

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

Stem:

20 Dacarbazine used in Hodgkin’s disease.

21 The anthracycline, doxorubicin used to breast cancer.



12

22 What is a response element?

A. A short sequence of DNA within the coding sequence of a gene.

B. A short sequence of DNA within the promoter region of a gene.

C. A protein that binds to the promoter region for gene expression.

D. A gene that only responds to high levels of serum.

E. A short sequence of DNA with modified amino acids.


23 Which one of the following statements is false?

A. Telomeres shorten with each round of replication.

B. Telomeres are composed of thousands of TTAGGG repeats.

C. Telomeres play a role in the replicative potential of a cell.

D. Telomerase activity is decreased in 90% of tumors.

E. Telomerase activity is increased in 90% of tumors.


24 Most carcinogens are mutagens. They induce mutations by modifying DNA. The original DNA sequence is as follows:-

ATG AGC AGC TAT TAG AAA

A. ATG AGC AGC TAT TAG AAA

B. ATG AGC AGC TAT TAG AAA

C. ATG AGC GGC TAT TAG AAA

D. ATG AGC AGC TAT TAG AAA

E. ATG AGC AGC AAT TAG AAA


13

F. ATG AGC AGC TAT TAG AAA

From the sequence options above, select the one that best describes the mutation below:

Transition.


25 The epidemiology of cancer

Hvilken kræftform er den hyppigst forekommende blandt mænd?

A. Tyktarmskræft

B. Blærehalskirtelkræft

C. Endetarmskræft

D. Lungekræft

E. Prostatkræft

Max point 1 Opnåede point

26 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


14

Max point 1 Opnåede point

END OF MCQ QUESTIONS


15

ESSAY AND SHORT ANSWER QUESTIONS.

27

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

Max point: 2 Opnåede point

28 Celledød. Nævn mindst fem forskelle mellem nekrotisk og apoptotisk celledød: (5 Points)

Nekrose Apoptose


16

Max point: 5

29 Describe the stages involved in the development of atherosclerotic plaque?


30 Clinical case

Mrs Smith 42 years, 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


17

themselves. A repeated test would be the next course of action.

Lead in: Based on the clinical case above answer the following 4 questions. 30.1 Describe some of the typical cellular changes that would be observed

when diagnosing early stages of cervical cancer. (4 marks)

30.2 What is a colposcopy? (2 marks)



18

30.3 A womans risk of developing cervical cancer increases if? Provide a list of 4 risk factors.


30.4 What treatment options would there be for early stages of cervical cancer? Provide a list of 4 options.


Topic: Molecular Biology of cancer

31 Cell cycle Regulation:

The cell cycle and one regulatory pathway: Shown on the graph below are levels of cyclin D1 and CDK4. Which is which?


19

ANSWER:

a)

b)


32 Explain how the cell cycle is regulated with respect to the action of the different cyclin dependent kinases (CDK)? (5 marks)

5 marks

G1 S

(a)

(b)


20

33 Using colorectal cancer as an example:

(a) What do you understand by the terms “grade” and “stage”, with respect to a tumour? (2)

(b) Suggest two clinical reasons for cancer staging? (2)


34 Cancer pathology:

What are the properties of a benign tomour


21


35 Carcinogenesis:

Distinguish somatic and germline mutations. (2 points)

Explain why germline mutations can predispose an individual to cancer, giving an example to illustrate your answer. (2 points)



22

Topic: Cancer Treatment

36 Retinoic is used in the treatment of what type of cancer? (I point) How does this drug function? (2 points)


37

Cancer Treatment:

Give an example of a topoisomerase inhibitor? (1 mark)

With the aid of a diagram (1 mark), explain the mechanism of action of this type of agent? (2 marks)


23



24

38 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. Alkylating agents

nitrosamines

2.

Pyrimidine dimers

3.

Chemically altered bases eg. 8-oxoguanine

4. X-rays

Max point: 8

39 Give 2 ways you would advise your patient on how to cope with body image concerns once he/she undergoes chemotherapy treatment?


25


END OF EXAM

Documents

Exam Module 4 - Aalborg Universitet · Studienummer: 4th semester Module 4.3 Exam 25thhAugust 2014 7 D. As CLL progresses hypogammaglobulinaemia may, and often does, develop. E. CLL