Chief Complaint: 52-year-old male with abdominal pain and nausea.  

History: The patient was woken up by abdominal pain located in his right lower quadrant, in the right groin and radiating into his right testicle. He was transported to the hospital. He reports that his pain is a “10” on a 1 to 10 scale. He is nauseated but has not vomited. The patient is normal weight and otherwise healthy. Upon palpation his abdomen is soft with mild tenderness in the right lower quadrant. Following the discovery of blood in his urine he is diagnosed with a ureteral obstruction, a computed tomography scan shows a calcified stone in the right ureter at the ureterovesical junction.

Guiding Questions

1. The ureterovesical junction (where the ureter passes through the wall of the bladder) is a common site for kidney stones to become impacted. Can you propose two additional sites within the ureter where kidney stones are likely to become impacted based on the anatomy of the ureters?

2. This patient was advised to increase his water intake to prevent subsequent kidney stones. Why would an increased fluid intake lower his chances for a repeat incident?

3. Assume that the kidney stone in question has reached the bladder. What is the pathway of exit for this stone (i.e. what anatomic structures must the stone still pass through)? Based on the anatomy of those structures, do you predict this to be difficult or easy? Defend your answer.

4. Propose a possible treatment for the patient in this case study. How does this treatment improve conditions for the patient? Are these improvements seen at the cellular, tissue, organ or systemic level?

Define “muscle dysmorphia”. Compare the behaviors associated with muscle dysmorphia to the behaviors associated with other addictions, such as alcohol or drug abuse. What are some similarities? Differences?

Dr. Clement shared the bad news with his patient. “I’m sorry, Oliver, but it appears that the Gleevec you have been taking is no longer working against your cancer, and your white blood cells are growing out of control again. We’ll do some genetic testing to confirm, but the most likely cause of this relapse is that the BCR-ABL gene has mutated once again, and that mutation has rendered the protein resistant to the Gleevec you have been taking.” Dr. Clement sat in his office reviewing the most recent genetic testing results with Oliver. “As I expected,” he said, “you have acquired a resistance mutation in BCR-ABL that is preventing Gleevec from doing its job. But the good news is, we have another drug, dasatinib, that should be able to counteract this mutation. I am going to call in a prescription for dasatinib that you should start right away.”

Oliver was skeptical. If Gleevec wasn’t working against his cancer, what was so magical about this new drug, dasatinib?

What class of inhibitor is dasatinib?

Compare and contrast the function of dasatinib and the function of imatinib/Gleevec.

Dasatinib, at nanomolar concentrations, inhibits the following kinases: BCR-ABL, SRC family (SRC, LCK, YES, FYN), c-KIT, EPHA2, and PDGFRβ. Imatinib, at nanomolar concentrations, inhibits primarily BCR-ABL. How may these properties may affect Oliver’s new treatment?

QUESTION 1

1. Please match the genotypic blood types with their respective phenotypic blood types. Note, you may use answer choices more than once and may not use all the answer choices.

   -       A.       B.       C.       D.       E.       F.       G.       H.    OO : +/-       -       A.       B.       C.       D.       E.       F.       G.       H.    AA : -/-       -       A.       B.       C.       D.       E.       F.       G.       H.    AB : +/+       -       A.       B.       C.       D.       E.       F.       G.       H.    BB : -/-       -       A.       B.       C.       D.       E.       F.       G.       H.    AO : -/-       -       A.       B.       C.       D.       E.       F.       G.       H.    OO : -/-       -       A.       B.       C.       D.       E.       F.       G.       H.    AB : +/+       -       A.       B.       C.       D.       E.       F.       G.       H.    BO : -/-

   A. AB Negative B. A Positive C. O Positive D. O Negative E. B Positive F. B Negative G. A Negative H. AB Positive

2 points   

QUESTION 2

1. Please indicate whether the donor and recipient combination are compatible or incompatible (IE will result in a transfusion reaction where the donors blood will agglutinate with the recipients blood). Note, you may use each answer more than once, AND FOR D ANTIGEN ASSUME IT IS A SECOND EXPOSURE

   -       A.       B.    Donor - A Positive : Recipient - B Negative       -       A.       B.    Donor - O Negative : Recipient - B Positive       -       A.       B.    Donor: A Positive : Recipient - A Negative       -       A.       B.    Donor - O Positive : Recipient - AB Negative       -       A.       B.    Donor - O Negative : Recipient - O Positive       -       A.       B.    Donor - B Positive : Recipient - AB Positive       -       A.       B.    Donor - AB Positive : Recipient - A Positive       -       A.       B.    Donor - B Negative : Recipient - B Positive

   A. Incompatible B. Compatible

2 points   

QUESTION 3

1. Transfusion reactions occur because antibodies present on the surface of a donors erythryocytes (red blood cells), bind to antigens present within the recipients blood.

   True

   False

0.5 points   

QUESTION 4

1. Coagulation and agglutination are different names for the same biological process.

   True

   False

1. Thrombopoiesis is the production of platelets. Which of the following hematopoietic cell types do platelets form from?

   	A.	Lymphocytes
   	B.	Megakaryocytes
   	C.	Neutrophils
   	D.	Monocytes
   	E.	Both B and D
   	F.	Both A and D

1 points   

QUESTION 2

1. Coagulation, also known as blood clotting, requires the activation of a vast number of clotting enzymes. Which of the following clotting enzymes is responsible for the cleavage of fibrinogen (inactive) to fibrin (active)?

   	A.	Plasmin
   	B.	Factor XII
   	C.	Thromboplastin
   	D.	Thrombin
   	E.	None of the above

1 points   

QUESTION 3

1. Following a laceration, there are three major steps that occur that cause the cessation of bleeding. Please put them in the correct order from when the first one starts to when the last one starts.

         -       1.       2.       3.      

   Coagulation

   
         -       1.       2.       3.      

   Platelet Plug Formation

   
         -       1.       2.       3.      

   Vascular Spasm

1.5 points   

QUESTION 4

1. Von Willebrand factor is responsible for preventing the platelets from sticking to the walls of undamaged blood vessels.

   True

   False

0.5 points   

QUESTION 5

1. Which of the following layers of the heart is the most superficial?

   	A.	Myocardium
   	B.	Fibrous Pericardium
   	C.	Endocardium
   	D.	Parietal Pericardium

1 points   

QUESTION 6

1. Which of the following valves does the blood flow through as it leaves the left ventricle?

   	A.	Bicuspid (Mitral Valve) AKA Right atrioventricular valve
   	B.	Tricuspid Valve AKA Left atrioventricular valve
   	C.	Aortic semilunar valve
   	D.	Pulmonary semilunar valve

Describe the trend of mortality in Saudi Arabia due to any one health phenomena and suggest any 2 measures to control it - Example maternal mortality, perinatal mortality, accident mortality, mortality due to any type of cancer etc. 

Define “muscle dysmorphia”. Compare the behaviors associated with muscle dysmorphia to the behaviors associated with other addictions, such as alcohol or drug abuse. What are some similarities? Differences?

1) Compare the fate of Pyruvate in aerobic and anaerobic cell respiration

2) Explain how much ATP is produced in oxidative phosphorylation and where in the pathway it comes from    

One of the objects in your visual field is a ball that is round, red, and moving. Describe the steps involved in being able to see the ball and identify it as a ball that is round, red, and moving. In other words, describe the pathway through the visual system (the eye, the optic nerve, and the parts of the brain) that the information travels before you can identify the object as a ball that is round, red, and moving.

The zika virus was first identified in Uganda in 1947. The virus is transmitted from person to person by a bite from a mosquito. It is commonly carried by the Aedes mosquito which is prevalent throughout Central Africa. The virus has more recently spread to the Americas (South, Central, and now North) and is expected to spread to Europe. There is a concern that the virus may reach epidemic proportions. Zika virus is related to yellow and dengue fever. Common symptoms are low grade fever and a distinctive skin rash and other symptoms include vomiting, headache, and muscle and/or joint pain. Pregnant women should avoid traveling to areas known to have zika virus present because the virus is known to cause microcephaly and developmental difficulties related to the central nervous system.

Based on the paragraph above, class discussions, and other VALID (be careful with your selection of e-materials! CDC – Center for Disease Control is a good place to start) sources of information please answer the following questions.

1. State a reason why the virus has spread to the Americas and likely to spread to Europe.

2. Define the term microcephaly.

3. What bones of the fetal skull would be affected by zika?

4. Specifically, what area of the CNS is not fully developed in microcephalic individuals.

5. In 1 -3 sentences describe the developmental difficulties of microcephalic individuals.

6. How does one know if they have contracted zika?

7. Do men need to be concerned about contracting zika?

8. How does one avoid contracting zika?

9. In a short paragraph (2-5 sentences!) provide one example of a scientific measure that could possibly control the spread of zika and explain how the measure works (controls the spread).