Week 1

Question 1

List the 7 core competences of osteopathic medicine

Answer 1

I. osteopathic philosophy and OMM II. Medical knowledge III. Patient care IV. interpersonal and communication skills V. Professionalism VI. Practice based learning and improvement VI. Systems based practice

Question 2

Define and give example for I.

Answer 2

The first core competency of the osteopathic profession is Osteopathic Philosophy and Osteopathic Manipulative Medicine. This competency requires those practicing osteopathic medicine to remain up to date and fully understand the correct Osteopathic Manipulative Treatment related to their individual specialty. OMT and osteopathic concepts should be incorporated when appropriate to provide the best possible medical care for the patient. The physician should always apply osteopathic principles and philosophy when interacting and treating patients to ensure the highest standard of patient-centered ethical care is provided.

Question 3

Define and give example for II.

Answer 3

The second core competency is medical knowledge. Residents must remain knowledgeable and proficient at providing the accepted standards of care related to their specialty. They must participate and contribute to life-long learning activities related to medicine such as conducting research and educating fellow or future physicians.

Question 4

Define and give example for III.

Answer 4

Patient care the third core competency is the need for residents to be able to provide the highest standard of patient-centered medical care. This is achieved by integrating osteopathic philosophy with excellent medical care including preventative medicine proper medical interviewing and effective diagnosis and treatment practices.

Question 5

Define and give example for IV.

Answer 5

The fourth core competency interpersonal and communication skills is the need for residents to develop appropriate doctor-patient relationships as well as display effective interpersonal and communication skills with everyone they interact with in the medical profession.

Question 6

Define and give example for V.

Answer 6

Professionalism is the fifth core competency and is the adherence of the Osteopathic Oath among all aspects of the physician’s life. The resident must treat the patient family members and coworkers with respect and honesty. The resident must also be knowledge of and integrate ethical principles into their medical practice.

Question 7

Define and give example for VI.

Answer 7

The sixth core competency is practice-based learning and improvement. This requires the resident to critically evaluate their methods of medical practice effectively treat patients with the most current accepted standard of care and have a complete understanding of research methods medical informatics and how technology is applied to medicine.

Question 8

Define and give example for VII.

Answer 8

Systems-based Practice is the final core competency. It requires residents to understand all aspects of health care delivery systems and their influence on patient care and professional practice. The resident must also advocate quality care for the patient and help the patient with any difficulties they encounter in the medical system.

Question 9

Team-based learning

Answer 9

Team-based learning (TBL) is designed to shift the way students learn. Instead of students acquiring information during class time through lectures TBL makes it so the students are responsible for learning most information outside the classroom and class time is for application.Students are given the readings for the week in advance and then have a Individual Readiness Assurance Process Test (iRAT) and tRAT They may appeal the tRAT only. The professor then gives a lesson based on the material that proved most difficult for the class.

Question 10

Team-based learning is structured in what way?

Answer 10

According to the 4 S’s including 1. Significant problem 2. Same problem 3. Specific problem 4. Reveal answers Simultaneously

Question 11

List the 7 characteristics of helpful feedback

Answer 11

1. descriptive not evaluarive 2. Specific 3. Honest and sincere 4. Expressed in terms relevant to the receiver’s needs 5. Timely 6. Desired by the receiver 7. Usable

Question 12

Concept map prompt

Answer 12

Directs the overall construction of the map and arrangement of concepts usually asking for a physiological explanation for a patient’s presentation.

Question 13

Domains of knowledge

Answer 13

These are the pools that contain the concepts used for the basic scaffolding of the map usually basic science and clinical presentation.

Question 14

Concept

Answer 14

The actual words that are placed on the concept map pulled from the domain of knowledge

Question 15

Cross-link

Answer 15

Arrows with a verb or phrase used to show the connection of concepts. These will ultimately define the relationship of the concepts and answer the prompt.

Question 16

Predict correctly the effects of 1. temperature 2. solubility 3. surface area 4. molecular weight 5. diffusion distance and 6. concentration gradient on the rate of simple diffusion of substances across cell membranes

Answer 16

Temperature: Higher temperatures increase the rate of diffusion.
Solubility: Molecules must be lipid soluble to pass through membranes. Hydrophobic molecules diffuse faster than hydrophilic molecules.
Surface area of membrane: Greater membrane surface area increases the rate of diffusion.
Surface area of diffusing molecule: Greater molecular surface area usually increases with molecular weight and decreases diffusion rate.
Molecular weight: Increased molecular weight decreases the rate of diffusion.
Diffusion distance: Rates slow as molecules are farther from the membrane.
Concentration gradient: A steep concentration gradient produces faster diffusion than a shallow gradient. Transport can occur in either direction with net transport depending on the direction of the gradient. This rate decreases as molecules pass through the membrane and decrease the gradient.

Question 17

Describe how extracellular signals are transduced through receptors on the plasma membrane resulting in intracellular changes

Answer 17

Extracellular signals typically include hormones growth factors neurotransmitters and cytokines. These signals bind to their specific transmembrane receptors on the surface of the cell membrane. The binding of this signal molecule changes the conformation of the receptor protein which is detected inside the cell. This activates a relay molecule within the cell to begin the intracellular signal pathway. The signal-activated receptor activates another molecule which activates another continuing the transduction cascade until the protein that produces the final cellular response is activated within the cell.
Regardless of if the response occurs in the nucleus or in the cytoplasm it can be fine-tuned. The signal is amplified as it passes through the cell while the multi-step pathway allows many points for regulation. The overall efficiency of the response is enhanced by scaffolding proteins while the termination of the signal (as proteins return to their inactive form) ultimately dictates the cellular response. Three major types of cell-surface transmembrane receptors include G protein-coupled receptor receptor tyrosine kinases and ion channel receptors

Question 18

Identify the major difference between chemical messengers that are specific for intracellular receptors and those that are specific for plasma membrane receptors

Answer 18

Chemical messengers that are specific for intracellular receptors are lipid-soluble ligands that can cross the cell membrane to reach their intracellular receptor. Lipid insoluble chemical messengers are specific for plasma membrane receptors and act as allosteric effectors by binding the receptor on the extracellular domain to control the receptor protein’s intracellular enzymatic activity.

Question 19

Describe how extracellular signals such as capsaicin result in cellular changes leading to the perception of pain

Answer 19

Extracellular signals such as pressure temperature and various chemicals can activate various receptors on pain sensing neurons nociceptors. Capsaicin is an activator of the TRVP1 receptor present on some nociceptors. Once the receptor is activated impulses are sent down two different fibers. One fiber the A-delta fiber is a fast myelinated fiber that releases glutamate and is responsible for the first pain (fast pain/epicritic pain) which allows for the localization of the stimulus. The second fiber the C fiber is an unmyelinated fiber responsible for the delayed second pain (slow pain/protopathic pain) through the release of glutamate and substance P.
Cellular responses caused by noxious stimuli can lead to increased sensitivity of nociceptive fibers causing the presentation of hyperalgesia which is the exaggerated response to noxious stimuli and allodynia which is the sensation of pain in response to a normal stimulus. Injured cells may release K+ which can depolarize the nerve terminals and make nociceptors more sensitive. Bradykinin may also be released from injured cells which can also activate both A-delta and C fibers leading to the perception of first and second pain. Injured tissue may also release nerve growth factor (NGF) which is picked up by nerve terminals and transported to the dorsal root ganglia. This can lead to the alteration of gene expression and increases pain perception because NGF increases production of Substance P and can convert nonnociceptive neurons to nociceptive neurons.

Question 20

Describe the pattern of pain distribution (dermatomes) associated with a herpes zoster infection

Answer 20

Dermatomes are patterns of neuronal innervation that are affected in Herpes Zoster infection. Typical presentation involves reactivation of the Herpes zoster virus with emanation from the dorsal root or cranial nerve. Of note these dermatomes do NOT cross the midline. Trigeminal cervical thoracic and lumbar regions are most commonly affected by this disease.
The rash is often preceded by prodromal (pattern of symptoms which precede the full-fledged illness) symptoms of tickling itching or pain which may be present for 2-3 days in either continuous or episodic manner. This is often associated with misdiagnosis. The rash begins as macules and papules which later evolve into vesicles and then pustules (see below).
Macule: A macule is a change in surface color without elevation or depression and therefore nonpalpable well or ill-defined variously sized but generally considered less than either 5 or 10 mm in diameter at the widest point.
Papule: A papule is a circumscribed solid elevation of skin with no visible fluid varying in size from a pinhead to less than either 5 or 10 mm in diameter at the widest point. Papules are palpable
Vesicle: A vesicle is a circumscribed fluid-containing epidermal elevation generally considered less than either 5 or 10 mm in diameter at the widest point.
Pustule: A pustule is a small elevation of the skin containing cloudy or purulent (i.e. pus filled) material usually consisting of necrotic inflammatory cells. These can be either white or red. (basically a pus-filled elevation of skin)

Question 21

Allodynia

Answer 21

pain in response to what are normally innocuous stimuli. Examples include pain from warm showers or light touch after a sunburn

Question 22

Hyperalgesia

Answer 22

an exaggerated response to noxious (i.e. normally harmful unpleasant) stimuli. Ex: Increased pain to area of previous scar tissue when scratched

Question 23

Viral adsorption or entry

Answer 23

Viruses gain entry to the cell by binding to host receptor proteins (such as measles) which causes the viral envelope to fuse with the host cell membrane. This process releases the contents within the virus including the genome into the host cell. Another example of this is the ability of the rhinovirus to bind to ICAM-1 a glycoprotein for intercellular adhesion which results in virus gaining entry to the host cell. Another method of viral entry occurs when the host cell “swallows” the virus through endocytosis or phagocytosis with an endosome.

Question 24

Viral uncoating

Answer 24

removal of the capsid after entry to the cell via adsorption allowing release of viral

Question 25

Baltimore Virus Classifications

Answer 25

I: dsDNA viruses (e.g. Adenoviruses Herpesviruses Poxviruses)
II: ssDNA viruses (+ strand or “sense”) DNA (e.g. Parvoviruses)
III: dsRNA viruses (e.g. Reoviruses)
IV: (+)ssRNA viruses (+ strand or sense) RNA (e.g. Picornaviruses Togaviruses)
V: (−)ssRNA viruses (− strand or antisense) RNA (e.g. Orthomyxoviruses Rhabdoviruses)
VI: ssRNA-RT viruses (+ strand or sense) RNA with DNA intermediate in life-cycle (e.g. Retroviruses)
VII: dsDNA-RT viruses (e.g. Hepadnaviruses)

Question 26

Lytic cycle

Answer 26

During the lytic cycle of viral replication the viral genome gets into the host cell by first adsorbing to the cell surface and injection of the genome into the host cell in the case of phage lambda. The viral genome is then transcribed into mRNA and translated into capsid protein by the host cell’s own machinery which are termed early genes. The cell then replicates the viral genome which is then packaged into the capsids. This takes place in defined stages. Lastly a late gene from the genome expresses an enzyme that lyses the host cell. Virulent virus

Question 27

Lysogenic cycle

Answer 27

During the lysogenic cycle the viral genome is incorporated into the host cell genome. The viral genome is then replicated along with the host genome as the host divides. Once an infected cell enters a state of stress such as when UV light is directed at it the lysogenic cycle ends and the lytic cycle begins. The viral genome will remain in the lysogenic cycle as long as the cells growth is strong and the potential to survive is high. Temperate virus