Take Home Portion For Exam #1
Instructions: You may use any references (including people) you find helpful. Please be sure to cite your references. You may divide the work any way wish among your group members. The group will get a group grade for the submitted answers. Everyone should be prepared to discuss the questions after the written examination. You should be prepared to speak about any of the questions below even if you did not prepare that particular answer for your group. You will get an individual grade for your participation in the discussion.
1. Esophageal adenocarcinoma often arises in a setting of chronic reflux esophagitis. How does chronic inflammation lead to cancer in this setting? Discuss the progression of normal esophageal epithelium, to reflux esophagitis, to metaplastic epithelium (Barrett esophagus), to dysplastic epithelium, to adenocarcinoma. Mention the role of cytokines. Are there other examples of tumors that arise in the setting of chronic inflammation?
2. Patients with overwhelming Gram negative sepsis can develop a life threatening coagulation abnormality known as disseminated intravascular coagulation (DIC). Describe the clinical and laboratory findings in DIC. How do the inflammatory and coagulation pathways overlap? Discuss possible mechanisms by whichinfection leads to inflammation and a cataclysmic coagulation problem in these patients. Does the biology suggest possible approaches to therapy?
3. Some patients with malignant tumors can experience a profound weight loss (cancer cachexia). Compare the weight loss in these patients to weight loss in people who are fasting or starving. What are the molecular mechanisms underlying both types of weight loss? What can be done to help patients with cancer cachexia?
4. An 82-year-old woman with early dementia lived with relatives. She became tired, listless, and febrile and remained in bed for two days refusing food and drink. The following morning she was obtunded and confused and taken to the emergency room. Her vital signs were stable and her mucus membranes were dry. Admission imaging included a chest film which showed a left lower lobe infiltrate and a normal head CT. Her admission blood work was significant for a serum sodium of 170 mmol/liter. Explain what happened. How would you approach correcting her fluid/electrolyte problem? What serious side effect could result from overly aggressive correction of her sodium? Why?
5. Bordetella pertussis is the cause of whooping cough. Discuss the molecular and clinical events that accompany its invasion, attachment, and injury of the human respiratory tract. Mention some of the the principal toxins elaborated by the organism. What are the benefits and limitations of immunization for pertussis?
6. Discuss normal neutrophil function in infections. Briefly review the steps involved in recruitment, migration, adherence, and destruction of invading organisms. How are these steps influenced in disorders such as chronic granulomatous disease, LAD deficiency, complement deficiency, and diabetes?