Hans Dietz is a 25 year old male patient with a family history of Marfan Syndrome (MFS). He is generally well and enjoys attending regular fitness sessions in his local gymnasium. During a recent gym session, he experienced dizziness followed by a fainting episode. He presented at the emergency department and a new systolic murmur was heard. Mr Dietz subsequently underwent screening for cardiovascular abnormalities associated with his family history of Marfan Syndrome.

Question 1

The fibrous structure of the heart is comprised predominantly of connective tissue proteins.

Describe the microscopic composition of the layers of the mitral valve. Your answer must include a description of the connective tissue element, the cell types found in each layer and how the layers are arranged (i.e. their structure or architecture).

Question 2

Upon further evaluation with an echocardiogram (cardiac ultrasound), Mr Dietz was found to have an enlarged (dilated) proximal ascending aorta, mitral valve prolapse with myxomatous changes and elongated chordae.

The patient was noted as having myxomatous changes in the mitral valve leaflets and associated elongation of the chordae tendineae. Explain what is meant by the term myxomatous changes. Your answer must include a description of the cellular and structural changes that occur within the valve.

Question 3

Where on the body would be the ideal position for the clinician to auscultate for a systolic murmur associated with the mitral valve?

Question 4

Describe the secondary complications (or consequences) that will occur as a result of the changes in the structure of the mitral valve in a patient with Marfan syndrome. Your answer should link to the clinical sign of the new systolic murmur noted in this patient.

Name the ventricles and describe the relationship between the choroid plexuses, ventricles, and CSF

1)

Which of the following statements is true regarding fluid shifts?

2)

Regarding the stomach, which of the following statements is INCORRECT?

3)

All but one of the following statements is true with regard to the blood testis barrier. Select the one statement that is FALSE.

1)

If you are searching for the muscles of the perineum, which statement about these muscles will help you CORRECTLY identify them?

2)

When the blood becomes acidic (acidosis) and bicarbonate ions have been depleted, new bicarbonate ions must be generated in the plasma. Which of the following is NOT a means for replenishing bicarbonate ions?

3)

QUESTION 28

1. Pepsinogen is inactive until it comes into contact with secretions from which cell type?

   	A.	None of the answers listed are correct
   	B.	Mucous cells
   	C.	Enteroendocrine cells
   	D.	Chief cells
   	E.	Surface epithelial cells

1)

Respiratory acidosis can occur when _______________.

2)

Which product(s) do the major duodenal ampulla AND papilla deliver?

I. Pancreatic juice

II. Bile

III. Insulin

IV. Chyme

3)

Given the following values taken from arterial blood:

pH = 7.51

pCO2 = 36

HCO3- = 27

(Normal values: pH = 7.35-7.45 pCO2 = 35-45 mm Hg HCO3- = 22-26 mEq/L)

Which of the following statements is CORRECT?

True/False  

47. Fiber type is primarily determined by the alpha motor neuron

48. Endurance exercise promotes the conversion of Type IIa to Type I

49. ATP is required to “break” the attachment of the myosin head from actin (to relax).

50. An increase in the number of androgen receptors would increase after chronic (several months) of exposure to supra physiological (abnormally high) levels of testosterone.

51. A male and female with the same muscle mass will be similar in strength

52 . During a concentric contraction the size of the H zone will decrease

1. The kidneys handle Na+ in different places of the nephron. Which statement is correct?

   		Water is filtered out of glomerular capillaries by bulk flow.
   		Water is actively reabsorbed from the proximal tubule, and Na+ follows down its diffusion gradient.
   		The permeability of the ascending limb of the loop of Henle is modified by vasopressin.
   		Vasopressin inserts pumps in the collecting duct membrane that move water against its concentration gradient.

muscles that move the eyeball:

1. levator and depressor labii
2. levator and depressor labii
3. masseter, temporalis
4. orbicularis oculi, orbicularis oris
5. superior and inferior obliques

The central nervous system:

1. excludes the cranial and spinal nerves, ganglia and sensory receptors.
2. is the source of thoughts and emotions.
3. is the destination of action potentials from motor neurons.
4. A and B are correct.
5. A, B and C are correct.

Which neuroglia cells produce myelin?

1. oligodendrocytes
2. Schwann cells
3. satellite cells
4. A and B are correct.
5. A, B and C are correct.

1. Why is it important for a hominid to have a more centralized to anterior foramen magnum position?

2. What does the shape of the pelvis indicate about its function in hominids?

3. What are some benefits of standing upright and moving as a biped rather than as a quadruped?

The smallest diameter motor neuron is found with which fiber type:

a) SO

b) FG

c) FOG

d) all have the same size neuron

What is the movement of the neutrophil toward a chemical substance called?

A)Emigration B) leukocytosis C) diapedesis D) margination E) chemotaxis

As we have discussed several times in class, cells need to be close to a source of oxygen and nutrients in order to survive. Briefly explain how this fact affects 1) the size of osteons in compact bone; 2) the size of trabeculae in spongy bone; and 3) the order of events in endochondral ossification

1. Describe the role of the lipoproteins in transport of triglycerides and cholesterol.

2. Describe the flow of bile from its site of production to where it enters the GI tract.

3. Describe the movement of Oxygen and CO2 in gas exchange between the lungs, blood and peripheral cells. You do not have to give exact numbers for the pressures. Indicate the direction of the movement of the gases.

4. If a person had end diastolic volume of 150 mL and end systolic volume of 70 mL with a heart rate of 100 bpm, what is their stroke volume and cardiac output?

5. The blood hydrostatic pressure (HPb) at the arterial end of the capillary is 35 mm Hg. The HPb at the venous end is 15 mm Hg. The colloid osmotic pressure of the blood is 25 mm Hg. Calculate net filtration pressures and say where filtration and reabsorption occur.

6. Describe hormonal changes during the different stages of the menstrual cycle.

Hyperparathyroidism is a rare disorder resulting from overactive parathyroid glands (they secrete too much parathyroid hormone, or PTH). Where does PTH act and what does it do? What do you think happens to the bones of people with this disorder and why? How does this disorder relate to osteoporosis? What other body systems might be affected?

Does surgical fat removal or reshaping have permanent effects? Provide your opinion about the surgical fat removal (liposuction)