Name:___________________ <br />BIOL E-163 Human Pathophysiology II<br />Harvard University Extension School<br />FINAL EXAMINATION GRADUATE STUDENTS<br />You have 2 hoursSample Exam<br />SECTION A: Multiple Choice 2 pts each<br /><ul><li> Which of the following factors increase the likelihood of gastroesophageal reflux?
All of the above are true</li></ul>2. Which of the following statements about molar pregnancies is NOT true? <br /><ul><li>A molar pregnancy can develop into a malignancy
A molar pregnancy is characterized by excessive placental growth and almost no fetal development.
A woman with a molar pregnancy appears to be pregnant, but does not have a positive pregnancy blood test.
Molar pregnancies are most common in very young (< age 16) and older (> age 40) mothers.
All of the above are true</li></ul>3. Which of the following changes would you expect to see in a man who is taking anabolic steroids (i.e. drugs that resemble testosterone)<br /> increased sperm production<br />lower circulating levels of LH<br />bigger than expected muscles in response to weight lifting<br />a and c are both correct<br />b and c are both correct<br />all of the above<br />4. A person who is in liver failure would be likely to have higher than normal blood levels of<br /> Albumin<br />Alkaline phosphatase<br />Vitamin K<br />Fibrinogen<br />5. Which of the following statements about endometriosis is true?<br />A. The use of birth control pills worsens the symptoms of endometriosis<br />B. Women with endometriosis have a higher than normal infertility rate.<br />C. In this disease, endometrial growths can occur outside the reproductive tract.<br />D. b and c are both true<br />E. all of the above are true <br />6. Which of the following statements about progesterone is true?<br />A. Progesterone levels are high during the follicular phase, then fall after ovulation<br />B. Progesterone stimulates the contractility of the myometrium (uterine muscle)<br />C. Progesterone is secreted by the corpus luteum and by the placenta<br />D. Progesterone causes the cervical mucus to thicken.<br />E. a and b are true<br />F. c and d are true<br />SECTION B: True/False. If you answer “false”, give one reason why the statement is not true. (2 pts)<br />_______ 7. In virtually all cases, a pregnant woman with a spinal cord injury will have to delivery her baby by C-Section.<br />_______ 8. The greatest risk of hemorrhagic diarrhea due to E. coli 0157:H7 bacteria is in grass-fed beef from small farms.<br />_______ 9. Male sexual function requires both the sympathetic and the parasympathetic nervous systems.<br />_______10. Most reproductive endocrinologists agree that sperm counts have fallen dramatically over the past century.<br />______ 11. Giving additional testosterone is an effective treatment for erectile dysfunction in men with normal endogenous testosterone levels<br />______ 12. Rising levels of estrogen towards the end of the follicular help bring about the LH surge, necessary for ovulation.<br />_______13. People with celiac disease are at greater risk of developing several types of GI cancer.<br />_______ 14. Helobacter pylori is a rare bacteria, which is only found in people who have peptic ulcers.<br />SECTION C: Fill in the blank / Short answer<br />15. One of the first signs of pre-eclampsia is a sudden rise / fall (circle the correct answer) in blood pressure. It is also characterized by the presence of _______________ in the urine. (2 points)<br />16. A gallstone is made up of crystals of ____________________ obstructing the common bile duct. The presence of gallstones interferes with fat digestion by blocking the secretion of ________________ and _________________ by the liver, and of _______________ by the pancreas. All three are necessary for normal fat digestion. The symptoms of gallstones include __________________ and ___________________.(6 points)<br />17. A. Name one common physical cause of erectile dysfunction, and tell me how it is thought to cause this problem. (2 points)<br />B. Many men with erectile dysfunction are given the drug Viagra. Viagra facilitates erection by stimulating the release of __________________, which causes dilation of blood vessels in the penis. (1 point)<br />18. You’ve been called in as a public health expert to help control the cholera outbreak in Zimbabwe. <br />A. Of the three treatments listed below, which is the safest and most effective for treating cholera? (1 point)<br /><ul><li> Antibiotics
Oral rehydration therapy (ORT), consisting of sodium and glucose</li></ul>B. Briefly explain how your treatment of choice helps combat this disease. (3 points)<br />C. A person who is a carrier of the cystic fibrosis trait (i.e. has one normal copy of the gene, and one abnormal copy) would be more vulnerable / less vulnerable (circle the correct answer) to the effects of cholera, in comparison to a person with two normal copies of the gene. (1 point)<br />19. Bob (age 45) and his neighbor Sam (age 75) have both been diagnosed with prostate cancer. A. Circle the correct answers below: (2 points)<br />Whose cancer is more likely to have a hereditary basisBob Sam<br />Which man will most likely be advised to try “watchful waiting”Bob Sam<br />B. Men with metastatic prostate cancer are often given androgen deprivation therapy. Why would this help control the spread of prostate cancer? (3 points)<br />20. Briefly discuss the relationship between body weight and the onset of puberty in girls. What hormone is involved in this relationship, and how does it influence the timing of puberty? (4 points) <br />21. One of the consequences of celiac disease (non-tropical sprue) is anemia. <br /> What is the cause of celiac disease? (1 point) <br /> Why does anemia occur in celiac disease? (2 points)<br />22. Briefly describe one GI symptom that is common in people with spinal cord injury and tell me why it tends to occur in people with this condition. (3 points)<br />23. Mark and Jill want to have a baby, but have not had any success, despite 1 year of trying. They consult a fertility expert who suggests that Mark’s sperm be tested.<br /><ul><li> The doctor found that Mark had a low sperm count. What are two lifestyle and/or environmental factors that could cause a low sperm count? (2 points)
The doctor also examined Mark’s testes to determine if he had a varicocele. What is a varicocele, and how is it thought to reduce sperm counts? (2 points)
In his discussion with his doctor, Mark recalled that he had suffered a traumatic injury to one of his testicles when he was a teenager, and he wonders whether this injury could influence his fertility. How might physical trauma to the testes reduce a man’s fertility many years later? Hint: think immune system. (3 points)</li></ul>24. The risk of reproductive and GI cancers is affected by lifestyle. Select 3 of the cancers listed below, and give one lifestyle or behavioral factor that is associated with the risk of this cancer. In about 1 sentence, describe how each is thought to increase the risk of the cancer you selected. (6 points)<br />Breast CancerPancreatic CancerOral Cancer<br />Cervical CancerStomach CancerProstate Cancer<br />A.<br />B.<br />C.<br />25. Richard is an alcoholic who has been diagnosed with cirrhosis. One day while resting at home, he suddenly began bleeding into his GI tract, causing him to lose massive quantities of blood. <br /><ul><li> Why would cirrhosis cause bleeding specifically into the GI tract? (3 points)
When he was brought to the hospital, the doctors had a hard time stopping Richard’s bleeding. Briefly describe three ways in which cirrhosis interferes with the normal blood clotting mechanisms. (3 points)</li></ul>SECTION D: Longer Answer Questions<br />26. Angela, a 36 year-old lawyer, and her husband Stephen wish to have a baby, and visit her gynecologist to discuss their concerns. Angela worries that she may be infertile, since she has always had irregular menstrual periods. In addition she is approximately 75 pounds overweight, and is concerned that her obesity might complicate a pregnancy. <br />The doctor notes that Angela has an unusual amount of facial and body hair, and that she is beginning to show some hair loss that resembles male pattern baldness. Her doctor tells her that she may have polycystic ovary syndrome (PCOS), and she confirms the diagnosis by performing an ovarian ultrasound.<br />What would you expect to see in the ovarian ultrasound of a woman with PCOS? Why? Be sure to be mechanistic in your answer. Think hormones! (5 points)<br /> <br />What effect would you expect this condition to have on the following parameters? (circle the correct answers) (2 points)<br />Risk of type 2 diabetes : increased decreased no change<br />Plasma levels of testosterone: increased decreased no change<br />27. Your friend Barbara, who is 30, has been obese since she was a teenager. Now she’s beginning to feel the health effects of this condition -- she’s been diagnosed with type 2 diabetes, and has arthritis in her knees from carrying extra weight. She’s considering having bariatric surgery, and has asked your advice about the procedure. <br />A. Barbara wants to know how her eating habits will have to change after the surgery, and what kinds of adverse consequences might occur if she continues to eat as she always has. Answer these questions, and describe the mechanism by which these adverse consequences occur. (3 points)<br />B. Once she gets her weight is under control, Barbara is interested in having a baby. She is concerned about how the surgery will affect her nutritional status, and how this, in turn might influence the health of her baby. What are 2 kinds of nutritional deficiencies that are common after bariatric surgery, and how would they affect a developing fetus? (4 points)<br />C. Barbara is also concerned about the affect of her type II diabetes on her pregnancy. What effect does high blood glucose have on fetal growth? What are the potential complications of this? (2 points)<br />28. Jenny, a 25 year old student who has been suffering from Crohn’s disease since her early teens, is really worried about her pathophysiology final exam. She’s behind in her studies, and knows from past experience that stressful situations make her symptoms worse. <br /><ul><li> Which branch of the autonomic nervous system becomes activated when we are under stress? What effect does it have on GI secretion and motility? How does it influence blood flow to the gut? (3 points)
What advice would you have for Jenny to help her cope with the stress of this exam? What kinds of coping strategies would likely be counter-productive, and which would likely help? (3 points)