General Knowledge Sections
Integumentary
1.
[1 pt] Which of the following skin cells alert the immune system to pathogens?
a. Fibroblasts
b. Melanocytes
c. Keratinocytes
d. Dendritic cells
e. Tactile cells
2. [1 pt] Melanocytes are found in the highest concentration in which layer of the skin?
a. Hypodermis
b. Papillary dermis
c. Stratum basale
d. Stratum spinosum
e. Stratum corneum
3. [1 pt] In which of the following does varicella zoster virus remain latent before reactivating and causing shingles?
a. Cerebellum
b. Epimysium
c. Dermal papillae
d. dorsal ganglion cells
4. [1 pt] What feature is pointed out in the following image?
a. Hair bulb
b. Meissner corpuscle
c. Epidermal ridge
d. Free nerve ending
e. Blood vessel
5. [1 pt] What is the depicted feature above responsible for?
a. Vibration/pressure detection
6. [1 pt] What is the primary pigment of red hair?
a. Eumelanin
b. Carotene
c. Red hair has no pigment
d. Pheomelanin
e. Souls of the damned
7. [2 pts] Which of the following HPV proteins are correctly paired with the human gene they inactivate? Select all that
apply.
a. Early 6 : p53
b. Early 2 : PUMA
c. Early 7 : pRb
d. Late 1 : EGFR
e. Late 2 : Beta-catenin
8. [2 pt] Salicylic acid is often used in skin care products as a ____________, aiding in the flaking off of dead skin cells. It
imparts this effect in part by breaking which type of cell junctions?
a. Exfoliant [1 pt], desmosomes [1 pt]
9. [2 pt] Which layer of the epidermis is thicker in the lunule? How does this contribute to its surface appearance?
a. Stratum basale [1 pt], obscures underlying blood vessels causing it to be lighter [1 pt]
10. [2 pt] Apocrine sweat glands being called “apocrine” is technically a misnomer, in terms of secretion, why is this so?
a. Because their secretions are merocrine, not damaging the cells that produce them in any way. Apocrine
secretion involves membrane budding.
11. [2 pt] People who contract Hansen’s disease present with numbness in affected areas with lesions. What bacteria
causes Hansen’s disease and what specifically are they attacking to cause this numbness?
a. Mycobacterium Leprae [1 pt], they attack schwann cells/myelin sheath [1 pt]
12. [1 pt] When a skin infection is suspected, doctors often take measurements of ESR (Erythrocyte sedimentation rate)
and C reactive protein in the blood. What specific activity are these tests looking for to indicate an infection may be
present?
a. Inflammation [1 pt]
13. [2 pts] What are friction ridges? The presence of them and what other structure is responsible for a person’s
fingerprint?
a. Friction ridges are areas of skin where dermal papillae are raised [1 pt]; sweat glands in between these ridges
and the specific patterns of friction ridges on fingertips determine one’s fingerprint [1 pt]
14. [2 pts] When I look down at my nails, I realize that they’re covered by horizontal ridges that run across the entire
width of the nail. What is this structure called? What is this typically a sign of?
a. Beau’s lines [1 pt], malnutrition or other similar underlying issues [1 pt].
15. [2.5 pts] Is skin hydrophobic? Why or why not? (Think about the cellular level of skin)
a. Yes [0.5 pt], this is because corneocytes are anucleated cells filled with keratin that are connected with cell
junctions (i.e. desmosomes) [1 pt] + they are surrounded by glycolipids [1 pt].
Skeletal
Which of the following is an incorrect statement about spongy bone?
a. Are fixed in structure as they develop entirely independent of any external stimuli
b. Filled with bone marrow that primarily turns into yellow bone marrow by adulthood
c. They are the primary sites of bone resorption, seen in conditions such as osteoporosis
d. They are vascularized and filled with honeycomb-like trabeculae
2. Which region of the metaphysis is farthest from the marrow cavity?
a. Zone of reserve cartilage
b. Zone of cell proliferation
c. Zone of cell hypertrophy
d. Zone of calcification
e. Zone of bone deposition
3. Jarcus Loshino has a mutation that causes his osteoblasts to produce misshapen OPG protein, which of the following
would you primarily expect him to present in a blood test?
1.
4.
5.
6.
7.
8.
9.
a. High C reactive protein
b. Hypernatremia
c. Hypokalemia
d. Hypercalcemia
e. Big scary monsters
[2 pts] During dental procedures around the molars, dentists often inject anesthesia directly into the mandibular
foramen. Which nerve runs through this foramen, and what other areas may become numb other than directly
around the injection site?
a. Inferior alveolar nerve (1 pt), the front of your chin, your gums, your dental sockets (1 pt for any of these)
[2 pts] Fractures that take very long to heal are sometimes treated by electrical stimulation that lowers the
production of parathyroid hormone. How may this help in speeding up healing?
a. Since PTH increases osteoclast activity, inhibiting it prevents bone calcium resorption when deposition is
needed to heal.
[1 pt each] For the following scenarios identify whether open or closed reduction would be preferred.
a. I break Connor’s femur in four different places cleanly, like insanely well cut all the way through.
i.
Open
b. Partial fracture of Katherine’s humerus
i.
Closed
c. A type 3 salter harris fracture
i.
Open
[2.5 pts] Septic arthritis is a condition that affects which structure of the skeletal system? Why might those areas be
highly prone to infection?
a. Synovial membrane/fluid [1 pt]. They’re highly prone to infection because they’re highly vascularized
(pathogens can travel there) [0.5 pt], allowing for hematogenous seeding to transmit pathogens to that area
[1 pt].
[2 pts] Bone marrow is tasty! There are two types–yellow and red. What differentiates them, and why is most bone
marrow in adults replaced by yellow bone marrow?
a. Red bone marrow is comprised mostly of hematopoietic stem cells while yellow bone marrow is comprised
mostly of adipose cells and mesenchymal stem cells [1 pt]. As you develop, there is more fat stored via the
yellow bone marrow, hence the conversion of red -> yellow bone marrow [1 pt].
[1 pt each] For the following scenarios identify the type of fracture
a. Venom shoots Scrambler B event supervisor Vilius Staraitis (Big Man) in the femur as he tries to run away
from the accusations.
b. Daniel Lee, totally expert taekwondo enthusiast, gets his right arm broken as he got himself into a fight
trying to square up with someone. The fight was promptly stopped before he could get his right arm fully
cleaved in half.
Muscular
1.
[1 pt] When an action potential travels down the axon, which channels open in response to the impulse?
a. Voltage gated calcium channels (Points were given to everyone on the actual test because Ishan forgot to
specify at the synapse oops)
2. [1 pt] When the ion that this channel facilitates enters the cell, it triggers the release of acetylcholine vesicles from
the axon terminal. What enzyme is required to break down acetylcholine and allow its reuptake into the cell?
a. Acetylcholinesterase
3. [3 pt] [TB] Inhibitors of the enzyme from the previous question are often used to treat certain types of myasthenia
gravis. Why do they work in this scenario but are less effective for Lambert-Eaton Myasthenic syndrome?
4.
5.
6.
7.
a. Certain types of myasthenia gravis affect the Acetylcholine receptors in the receiving muscle cell, keeping
Ach out for longer will increase the concentration of Ach in the synapse overall, improving action potential
throughput to the muscle cell. Lambert-Eaton causes a dysfunction in the calcium channels that allow the
Ach vesicles to be released in the first place. Keeping Ach out for longer doesn’t help when it can’t get
released into the synapse in the first place.
[2 pt] Prevailing theories suggest that two types of hypertrophy can occur due to exercise, name the two types and
describe what they mean.
a. Myofibrillar and Sarcoplasmic [1 pt]
Myofibrillar: number of myofibrils increases [0.5]
Sarcoplasmic: sarcoplasmic fluid increases in volume [0.5]
[1 pt] Some people can individually flex the distal phalanges of their fingers. Gentle flexing of which muscle is most
directly involved in this? Be specific!
a. Flexor digitorum profundus (points were given to everyone on actual test because Ishan forgot profundus
was not on the muscle list oops)
[2 pts] Unlike the orbicularis oculi, the orbicularis oris is much more complex than a sphincter, drawing from many
fibers of surrounding muscles to form a loop around the lips capable of enacting facial movement. Name 2 muscles
from the 2024-25 muscle list that the orbicularis oris draws fibers from.
a. Buccinator [1 pt], Zygomaticus [1 pt]
[3 pts] Ishan is trying to extend his tibia using primarily his quadriceps femoris…
Here is a frontal view of his lower leg
Calculate the mechanical advantage of his quadriceps femoris if resistance acts directly at the bottom of his tibia to
the nearest 100th. Show your work!
a. 0.5-2in/~13-17in = 0.03-0.15
8. [1 pt] [TB] The MA from the last question implies that the leg acts as a lever with (low/high) power, and (low/high)
speed.
a. Low, high
FRQ Section I: Ishan and Ricky’s gym arguments (17 pts)
1.
[1 pt] Ishan and Ricky are waiting for their friend Derek to finish up his set of seated flies, a movement involving the
horizontal flexion of the arm, primarily the humerus. What would be the primary muscle targeted in this exercise?
a. Pectoralis major
2. [5 pts] Typical form for seated flies involves complete elbow extension over the course of the movement, or slight
lateral elbow flexion and extension under no resistance over the course of the full arm flexion. Derek during his set
exhibits a constant level of elbow flexion throughout his whole movement, his hands colliding at the end of the
movement (Put your fists together so that your arms make a circle in front of you, that is what Derek is doing at the
peak of the movement).
Ricky claims that this elbow flexion is causing Derek to divert load from the exercise to accessory muscles of the
movement, while Ishan claims the only downsides to this form are losing out on the full range of motion because his
arms collide earlier than they would if they were extended, and having a shorter lever arm leading to lower
resistance. Based on the information given about Derek’s form, who is more correct about the error and why? Explain
in terms of muscular function.
a. Either Ishan or Ricky points given depending on explanation.
Ishan explanation example: Since the elbow flexion is constant there is no tricep or shoulder action against
the resistance of the movement, the pectorals are still doing all of the work required to move the weight.
Ricky explanation example: Maintaining a constant level of elbow flexion requires isometric action of the
triceps, requiring nervous output to maintain the position over the course of the movement. This diverts
focus from the primary pectoral movement involved in the exercise.
3. [3 pts] Had Derek instead been leaning forward, hinging at the hips, allowing his arms to conduct more vertical
adduction along with horizontal adduction without any flex in his elbows, who would be more correct and why if
Ricky and Ishan made the same claims? Explain in terms of muscular function.
a. Ricky would be more correct (1 pt), as bringing the arms into vertical adduction will cause more deltoid
activation to occur, diverting load from the pectorals (1 pt).
4. Ricky has gotten so worked up from this argument, he’s started to load up 225 lbs for his next incline bench press set.
!!! While helping him unrack the weight, Ishan hears a soft popping sound from Ricky
This guy is tweaking
as he reels in pain, his left shoulder sagging down on the bench. As they walk to the local hospital, they notice that
the area around his left shoulder is swelling, and Ricky has trouble moving his arm.
At the hospital they take a scan of Ricky’s shoulder and see this…
😱😱😱
5.
6.
[1 pt] What type of scan is this?
A. CT Scan
B. X-ray
C. MRI
D. CAT Scan
[1 pt] What is wrong with Ricky’s shoulder?
A. He strained it
B. He sprained it
C. He dislocated it
D. He fractured it
E. It’s part of Ricky ewwwwwwwwwwww
[1 pt] Along with this injury, the doctors also found that Ricky had strained some of the muscles in his rotator cuff.
Ricky, having had many injuries before (due to being a bumbling fool), explained to Ishan that he was going to follow
the typical RICE protocol for injury healing. Ishan exclaimed, “Great heavens no! That protocol hast been recanted!
”. In fact it has been recanted by Dr. Gabe Mirkin, the man who originally coined the acronym. What
is the main component of RICE that has recently been found to most likely slow the healing process?
a. Ice
[2 pts] New acronyms have been created to replace RICE using more up to date science, and multiple of these
contain the same pair of letters “OL” (Sometimes just O or reversed, but it means the same thing). What do these two
letters stand for and what do they instruct injured people to do?
a. Optimal loading (1 pt). Perform activity that doesn’t cause pain consistently until you are back to a point
where normal function doesn’t cause pain (1 pt)
After hearing about Ricky’s tragic injury, Connor Jin, from Syosset, New York, came SPRINTING to the hospital,
frantic about his beloved Rickatoni. He had made it there in record time, but on his way up the stairs he… got up
completely fine!
He then walked into the hospital and was tackled by Myles Garrett, defensive end for the Cleveland Browns and
2023 Associated Press Defensive Player of the Year.
During this tackle, Connor had his knee twisted into an awkward position and heard a pop on his way down.
Conveniently already having him in the hospital, doctors performed a sagittal MRI scan finding the following…
😡😡😡😡😡
7.
8.
[1 pt] What happened to his knee?
A. Femur fracture
B. TCL strain
C. Tibia fracture
D. ACL Tear
E. Man it fell off. RIP
9. [2 pt] Knowing that Connor is a young adult and very active individual, what is the best treatment to move forward
with? What are the two main categories of this treatment method?
a. Reconstructive surgery [1 pt]. Extra articular and Intra articular [1 pt]
🕊️
FRQ Section II: Moving hurts sometimes (16 pts)
1.
[1 pt] Ishan is presenting to the hospital with a sustained fever after just fighting off a bacterial infection. He’s
complaining about a persistent pain in his shoulder, and when he tried to massage it off, it only induced more pain.
What type of synovial joint is the shoulder joint?
a. Ball and socket
2. [1 pt] Additionally, Ishan is unable to move his shoulder joint throughout a full rotation, his shoulder hurting
whenever he raises his arm close to his head. What is this last symptom formally referred to as?
a. limited/restricted/reduced range of motion
3. [1 pt] Knowing that he’s just fought off a bacterial infection, you immediately run an arthrocentesis on his shoulder
joint, culturing the removed fluid on a petri dish overnight and finding multiple bacterial colonies. What disease did
you just confirm Ishan has?
a. Septic Arthritis
4. [3 pts] What process triggered by the bacteria causes the manifestation of Ishan’s symptoms. What tests can you
run/levels can you measure to confirm that this process is occuring
a. Inflammation [1 pt], ESR test or C-reactive protein levels [2 pts]
5. [2 pts] What characteristic of the synovium makes it so susceptible to bacterial infections that were systemic in
origin? (hint: what does it lack?)
a. It lacks a basement membrane so the blood vessels can directly transfer the bacteria into the joint
6. [2 pt] Planning ahead, you also plated some of this synovial fluid on an agar plate with 5% methicillin, and observed
no growth. So after draining the synovial fluid from Ishan’s shoulder entirely, is it reasonable to prescribe him
methicillin?
Initially this treatment seems to be working, but after a week, Ishan’s symptoms, along with an even worse systemic
illness have reemerged!
What characteristic has the bacteria affecting Ishan developed? What does this mean for your treatment approach,
what will you change?
a. Methicillin resistance [1 pt], need to give him a new antibiotic [1 pt]
7. [6 pts] Ishan explains that he has been eating a lot of food from the new charcoal grill that his dad recently bought,
possibly explaining a mutation that could’ve occurred in the bacteria affecting him. However, Ishan has been really
enjoying this new food, and wants confirmation that this is actually what is causing the issue.
So you conduct an Ames test to give him peace of mind. An Ames test involves plating 2 groups of bacteria that
cannot survive without a certain nutrient. Both of these groups are plated on media that does not contain excess of
this nutrient that they must collect from the environment, so no colonies should be able to grow unless they mutate
to no longer need this nutrient from their surroundings. One group however, has a suspected substance that may be
a mutagen added to their medium to test if it increases the rate of mutation, and therefore the amount of bacteria
that can survive the lack of a key nutrient.
You take a sample of crust from a chicken breast cooked on Ishan’s charcoal grill, grind it up, and create the two
groups of media described above, neither group containing histidine, and one group with the ground crust added as
a suspected mutagen. After seeding salmonella bacteria that cannot live without histidine to incubate overnight on
these plates you observe the following…
So should Ishan be avoiding food from the grill for the rest of his treatment, why or why not?
a. Yes [2 pt], if Ishan eats more food from this grill, there is a greater risk of the bacteria inside of him mutating
to become resistant to the antibiotics in his new treatment [4 pt]
FRQ Section III: Cooked Beyond Belief / You Snooze, You Lose (53 pts)
“And so he aimed his bow, positioned his quiver of arrows, and fired. One by one, each sun fell, until there was only one left.”
- Amy’s account of 后羿 shooting down the sons of the Jade Emperor.
Unfortunately, Anthony Egan, the Chem Lab/Materials Science writer for this invitational has been the victim of an arson
attack! He was sleeping (lie) in his bed (snug as a bug in a rug because he’s 4’3) in a conveniently fully wooded cabin in a
conveniently overstocked forest at 80°13'43.1"N 94°19'26.5"E (this place is totally forested guys trust). At 2:32 AM, his cabin
). Egan, like the snoozer he is, woke up too late,
was set on fire by mysterious arsonists (who could they be!
smelled his hair burning and promptly fell back asleep. He was rescued at 6:22 AM with burns over his legs, back, arms, and
hands. Being one of the medical staff on the scene, you are tasked to assess and treat Egan along with the primary doctor, Dr.
Gerald.
😱😱😱😱
Figure A: Adopted from Histology Drawings
Oh also Dr. Gerald can be a bit silly at times (I ran out of exposition) so he forgot how skin worked so you have to help him
while we pretend Egan isn’t a burn victim that needs emergency treatment in the background
1. [1 pt, FITB] What layer of the skin is A?
Epidermis
2. [2 pts] Which of the following are cells found in Layer A?
A. Melanocytes
B. Merkel cells
C. Langerhans cells
D. Stem cells
3. [2 pts] This skin section is (thick/thin). How do you know?
Thin [1 pt], lack of a stratum lucidum/no fifth layer to the epidermis OR thinner layers to the epidermis overall
compared to a thick skin epidermal section [1 pt].
4. [1 pt] We can expect the epithelial cells found in Layer B to be (stratified/simple).
Stratified [1 pt].
5. [3 pts] Why (in reference to the previous question)? How would that aid in skin’s function?
Layer B is the stratum corneum [1 pt], which would be the outermost exposed layer of the skin [1 pt]. In order to
protect the rest of the body from the outside elements/abrasion/penetration, the stratum corneum must be deeply
stratified [1 pt].
💀💀💀
6. [1 pt] Pretend you’re a cell in Layer E. Yippee!! Considering that you’re most likely going to end up higher up within
Layer A, which type of cell would you be (in this stage)?
Epithelial stem cell/undifferentiated keratinocyte [1 pt].
7. [1 pt] Relative to the other layers within A, how thick would Layer E be?
Layer E would be the thinnest [1 pt]. Disregarding the stratum lucidum (which doesn’t exist in this skin section) the
stratum basale (Layer E) would only be ~1 cell layer thick.
To make this experience even more uncomfortable (you grossed out yet?) We zoom further into Layer A. The following
display diagrams of cells that would be found in Layer A.
Figure B: Simple epithelial cell junctions, Labster Theory
Figure C: Keratin intermediate filaments, Qin et. al., 2012
8. [2 pts] Refer to Figure B. Check off all the types of cell junctions you would expect to find in the epidermis
A. Tight junctions
B. Gap junctions
C. Adherens junctions
D. Desmosomes
E. Epidermal cells don’t need cell junctions they generate as a blob
9. [3.5 pts] Rank all of the epidermal cell junctions in order from least to most strong (relatively). Why do we find these
junctions in the skin?
Tight junctions [0.5 pt], adherens junctions [0.5 pt], desmosomes [0.5 pt]. These junctions are found in the skin
because they help facilitate tight connections (i.e. desmosomes, tight junctions), which aid in the waterproofing and
barrier properties of the epidermis [1 pt] and allow for cells to communicate and migrate (i.e. adherens junctions) [1
pt].
10. [TB, 2 pts] Each of the following would be connective proteins found in the epithelia except
A. β -catenin
B. α-actinin
C. N-cadherin
D. Plakoglobin
11. [3 pts] How do these junctions help aid in epidermal cell polarity? Why would polarity be important in the
epidermis?
These junctions allow for cells (especially higher up in the stratum corneum) to tightly bond together, distinctly
stratifying the layers of the epidermis [1 pt]. This sort of apical-basal polarity is important to maintain as the upper
layers would help protect from the outside elements as a first line of immune defense [1 pt] while also allowing for
the transport/diffusion of molecules from the basal lamina to make its way up to enrich the upper layers [1 pt].
12. [1 pt] Refer to Figure C. The process in which a keratinocyte flattens and undergoes differentiation is known as–
Keratinization/cornification [1 pt].
13. [2 pts] In the aforementioned process, keratinocytes lose their cytoplasmic organelles in favor of being filled with the
protein keratin. Where in the epidermis does this begin to occur? What are the keratinocytes now known as?
Stratum granulosum [1 pt], corneocytes [1 pt].
14. [TB, 4 pts] Keratins are a class of proteins that vary in amino acid sequence and therefore structure. Describe the
general structure of an average keratin protein. (Only consider α-keratins)! How does that aid in their function,
specifically in the epidermis?
The secondary structure of an -keratin protein consists of central helical rods [1 pt], 2 of them which coil together
to form dimers -> 2x bond together to form a protofilament -> 2x bond together to form a protofibril -> 4x bond
together to form an intermediate filament (all bound together via disulfide linkages; level of detail previous is not
necessary) [1 pt]. Due to its strongly coiled, fibrous structure [1 pt], keratins are able to serve as excellent
anchors/components of the cytoskeleton, which would mean that they would be excellent for structural support in
the epidermis (as many cells are keratinized, or remain as just their primarily keratin cytoskeletons) [1 pt].
15. [TB, 4 pts] Keratins can be classified as soft or hard, depending on the amount of disulfide linkages found within.
Keratin filaments found in the epidermis would most likely be (soft/hard), with (more/less) disulfide linkages. Why?
Soft [0.5 pt], less [0.5 pt]. Less disulfide linkages -> more flexible structure + softness to the keratin filaments [1 pt],
meaning flexibility is lent to these filaments, which is important to the epidermis [1 pt] because these cells would
frequently have to bend/slough to exterior mechanical forces [1 pt].
Now that there is sufficiently enough context to our case study, we finally are able to assess Egan’s burns. Dr. Gerald can’t
help but almost faint as he takes a look at Egan’s leg. Get his medical license revoked!!
α
α
😱😱😱
Figure D: (Totally) a picture of Egan’s burned leg, taken from Marieb Human Anatomy & Physiology
16. [1 pt] Given the information given about Egan, what burn severity would you most likely diagnose him with?
Third degree/full-thickness burn (either are accepted).
17. [1 pt] You note that it’s odd that Egan (already delirious) doesn’t appear to feel much pain when pressure is applied to
these burned areas, such as his leg. Why may that be the case?
The nerves/nerve endings burned off [1 pt].
18. [2 pts] What does that indicate in terms of what part of the skin was affected by the burn?
The burns would’ve stretched far down into the skin (at least below the papillary layer of the dermis) [1 pt] -> nerves
were affected by the burn [1 pt].
19. [1 pt] Check off all areas of tissue that would be affected in the event of a burn like this.
A. Epidermis
B. Dermis
C. Subcutaneous tissue
Figure E: Jackson’s burn zones, Hettiaratchy & Dziewulski
20. [3 pts] Refer to Figure E. Jackson’s burn zones are a method of assessing and classifying burned tissue. Which zone
of the burn would we expect the least amount of blood flow? Why?
Zone of coagulation [1 pt]; that area is the area of maximum damage [1 pt], meaning we’d expect any proteins,
extracellular matrix, cells, and vessels to be burnt off/denatured, cutting off blood flow to the area [1 pt].
21. [TB, 3.5 pts] You notice a lot of swelling occurring on Egan’s arms and legs, especially near areas where he got
burned. (Assume Egan got burned ~1 hour before you guys were able to arrive on the scene). What is this
phenomenon known as? Why might we see this occurring after he got burned, especially near the arms and legs?
Edema [0.5 pt]. Burns cause venous insufficiency/capillary leaking + a deficiency of plasma proteins & other
substances that would help supply the now burned skin [1 pt], leading to a drop in osmotic pressure and thus an
accumulation of fluid in the interstitial spaces near the burned tissues [1 pt]. Fluid would accumulate in the arms &
the legs because of its proximity to the heart and the insufficient capabilities of the heart to pump blood to these
burned areas [1 pt].
22. [3 pts] Outside of a loss of feeling in the burned areas, it’s also clear that there’s reduced blood flow to these burned
areas. Why does this occur as a burn response?
Since the burns have reached all the way down to the dermis/subcutaneous tissue [1 pt], any vessels there would’ve
been burned off [1 pt]. This has severely cut off blood flow to the area [1 pt].
23. [2 pts] What would be the immediate first step to treating Egan? Back it up with reasoning.
Either of these methods are reasonable, as long as they are backed up:
IV/any method to supply lost fluids + proteins + other substances to Egan [1 pt] -> burns would’ve severely
dehydrated him + denatured any important proteins [1 pt].
Cover burned areas with dry, sterile bandages [1 pt] -> prevents those areas from getting infected [1 pt]
Try to increase blood flow to burned areas (e.g. raising his legs, back, etc) [1 pt] -> helping promote blood flow to
those burned areas might make the tissue around it less likely to necrose [1 pt]
24. [2 pts] After Egan is stabilized, you and Dr. Gerald discuss the possibility of skin grafting. Why would we give Egan a
skin graft?
Since most of the skin has burned off, it wouldn’t be able to regenerate [1 pt]. A graft helps aid in healing and
replenishing the lost skin and prevents excess, abnormal (hypertrophic) scarring [1 pt].
25. [TB, 2 pts] In the event of severe burns like this, we would have to carefully monitor Egan’s heart. Why?
The veins and capillaries would be excessively damaged from the burn [1 pt], which might affect his heart [1 pt].
FRQ Section IV: We Were Born to Make History (Not in a Good Way) (64 pts)
😱😱😱😱
“I think that you should not write that on something that both of our names will be attached to forever” - Ishan, upon reading
)
the original quote Amy wrote for the section (5 points to whoever can guess???
“Um I go spinny spinny then go boom” - Liza Sharova (the friend who Amy wrote this case study after), 10:16 PM EST,
10/28/24
Sebastian Sharov is an otherwise healthy 19 year old (dime-a-dozen?) figure skater certified by the ISU (do NOT look his
name up on Google or ask about what he did to Lake Braddock Secondary School on March 32nd, 2025). In preparation for
the annual Grand Prix Final of figure skating, he has been skating the average workday (8 hours) on ice every day without
rest days for the past few months. This guy is locked in!!!
This day was the same as any except when
Sebastian braced himself for the impact of jumping 3.5 rotations in the air (signature of the triple axel because he can’t jump
quad flips to save his life)...
He tumbled down onto the ice (and spontaneously combusted)! He was not able to get up for a solid 5 minutes and was
rushed to medical care immediately. The following is a CT scan taken of his spine after he was in the hospital. Dr. Gerald
saw this and immediately quit. I guess his medical license revoked itself.
😱😱😱😱😱😱😱
Adapted from Radiopaedia
“Erm what the heck” - Ishan Patel, Totally Licensed Medical Doctor
seeing the CT
1.
2.
3.
4.
5.
6.
[3 pts] Which region of the vertebra did he injure? (Be specific!) How do you know?
L4/L5 trunks [1 pt]. CT was taken showing the lower portion of the back [1 pt] and region of injury was right above the
sacral vertebrae [1 pt].
[2 pts] Why might he have injured those areas of the vertebrae? (Think about his background as a figure skater).
Spondylolisthesis most commonly occurs in lower areas of the vertebrae, especially in the lumbar vertebrae [1 pt].
Also, his background as a figure skater would mean that he would’ve exerted a lot of force on his back, increasing
susceptibility of injury [1 pt].
[TB, 2 pts] After discussing with the doctors, you find that Sebastian had no prior reported history of back injury or
pain. What do you diagnose him with, after combining that knowledge with the CT scan data?
Isthmic [1 pt] spondylolisthesis [1 pt].
[2 pts] Which of the following would you expect as a side effect of his condition?
A. Sciatica
B. Nerve compression
C. Foraminal stenosis
D. Spinal stenosis
[6 pts] Would you expect Sebastian to feel pain in the immediate few hours after his injury? If so, to what extent, and
in what region of his back? Why?
No [1 pt] – often, cases of spondylolisthesis are asymptomatic [1 pt] as back (especially in the lower lumbar area) [1
pt] and related pain [1 pt] takes a while to progress [1 pt], especially after immediate injury [1 pt].
[6 pts] What about for the next few days? How would his back pain progress then? Why?
His back pain would progress and manifest [1 pt], especially further in his lower back (near the lumbar trunks) [1 pt];
additional pain would radiate out further down to his legs (e.g. hamstring tightness) [1 pt]. This is because since the
L4 trunk slips above the L5 trunk [1 pt] as the L4 vertebra moves away from its pars interarticularis [1 pt], it
compresses the nerve roots extending out of the L4/L5 disk, causing pain that radiates out [1 pt].
7. [2.5 pts] According to Sebastian’s background, would an injury like this occur out of the blue? Why or why not?
No [0.5 pts]; most cases of spondylolisthesis go unchecked because they’re asymptomatic [1 pt]; although on the
surface level, he may appear healthy, extensive figure skating training has been shown to cause bone injuries [1 pt].
8. [TB, 4 pts] Approximate the grading of his condition using the Meyerding system. According to your approximated
severity, is surgery necessary? Why or why not?
Grade II [1 pt]. Surgery isn’t necessary in this case [1 pt], as the general procedure is to not give surgery to
spondylolisthesis grades lower than III [1 pt], and it doesn’t seem to present as severe to the point where the pars
defect is fractured [1 pt].
9. [3.5 pts] As his doctor, what other treatment would you recommend Sebastian undergo? Would he be able to skate
for the next few weeks? Why or why not?
No, he will not be able to skate for the next few weeks [0.5 pts] as it would exacerbate the symptoms and possibly
further injure his spine [2 pts]. Painkillers (e.g. NSAIDs), heat, light exercise, bracing, and bedrest are all possible
treatments [1 pt].
As Sebastian sits in the hospital contemplating a possible end to his career, he flashes back to his childhood. He thinks about
his early start to figure skating (K.I.S.S. the ice, stupid!), his first pair of ice skates, his competitive career so far, and
his…height. “Why am I 5’5…” he keeps thinking to himself. Help him out.
10. [1 pt] All vertebral development undergoes ___________ ossification
Endochondral
Refer to the following figures for questions 87 - 96.
Figure I: Adapted from [Thompson, 2010] & [Silva, 2022]
Figure II: Adapted from Mark Nowell Spine Surgeon
11. [1 pt] Often you hear about growth plates in height and development. What are growth plates also known as?
Epiphyseal plates [1 pt] (0.5 pts for epiphyseal lines).
12. [2 pts] Refer to Figure I. Where would the growth plates controlling longitudinal growth (think height) be located in
the vertebrae?
B [1 pt], or the vertebral body [1 pt].
13. [2 pts] Often, when people discuss growth in height, they talk about growth plates “closing”. When does this
typically happen in a person?
In early adolescence [1 pt], closing from 14-16 (in those AFAB) and 16-18 (in those AMAB) to as late as 25 [1 pt].
14. [4 pts] Growth plate “closing” is actually a misnomer. Why? What actually happens?
Growth plates don’t “close” because they aren’t structures that seal up at a certain predetermined time that’s the
exact same for everyone [1 pt]. Instead, the zones of metaphysis in the epiphyseal plates are filled with hyaline
cartilage [1 pt], which eventually entirely ossify (convert entirely to bone, which is the actual process that lengthens
bones in our case, thus making you grow “taller”) [1 pt], meaning that any bone lengthening stops [1 pt].
15. [1 pt] Let’s say, for the sake of argument, I break Sebastian’s spine at just the right place, somewhere in the zone of
metaphysis in a vertebra. A fracture in which region would have the most consequence on (successfully) further
stunting his growth?
A. Zone of reserve cartilage
B. Zone of cell proliferation
C. Zone of cell hypertrophy
D. Zone of calcification
E. Zone of bone deposition
16. [2 pts] Why? (Support your reasoning for the previous question)
Zone of cell proliferation is where chondrocytes actually begin to multiply and differentiate [1 pt], meaning if you
wanted to cut off growth in metaphyseal zones in Sebastian’s spine, that would be the best place to stunt his growth
[1 pt].
17. [4 pts] Refer to Figure II. Why is the human spine typically curved like this? (Think about developmental and
growth factors that come into play).
Kyphoses in the thoracic and sacral vertebral trunks + lordoses in the cervical and lumbar vertebral trunks [1 pt]
naturally develop as an infant matures [1 pt] (namely, activities such as looking up and walking stimulates these
spinal curvatures to develop) [1 pt] to support and distribute stresses evenly + support the organs/the body as it
walks upright [1 pt].
18. [1 pt] Spinal curvatures happen all the time! What is the most common spinal deformity involved with curvature?
Scoliosis [1 pt].
19. [3 pts] List two common risk factors involved with spinal curvature disorders. Why might they increase one’s risk to
these disorders?
[Any two of the following risk factors, for 0.5 pt each]: age; poor posture; fractures; disorders (especially those that
decrease bone density, such as osteoporosis); repeatedly carrying large amounts of weight, especially on your back.
All of these have a few factors in increasing risk to spinal curvature disorders – they all wear your vertebral column
out [1 pt] and/or cause them to develop/progress into deformed states [1 pt].
20. [2 pts] Haha, disks are so funny! Why are intervertebral disks so important in supporting the vertebra? (Think about
the previous few questions)
Intervertebral disks do a lot of things – they act as shock absorbers and supports, preventing the vertebrae from
excessively wearing each other out (acting as cushions) [1 pt] as well as maintaining flexibility and transmitting
loads within the vertebral column [1 pt].
This doctor’s visit is taking a while, huh? After we’ve helped walk Sebastian through a height discussion (somewhat), he
thinks a bit more (bro thinks he’s the ponderer). His train of thought now stops at hormones – he’s been on a course of
masculinizing hormone therapy (basically: testosterone + puberty blockers to aid in his transition from FTM) for a few years
now. To entertain him, please help him contemplate the implications of testosterone on the skeletal system for the next 5
questions. (Amy is trying to not go off system this time, she swears).
21. [3 pts] Compare the structures of estrogen and testosterone, shown below.
A: Estradiol, image from AbMole
B: Testosterone, image from AbMole
What do you notice is similar and what do you notice is different with these two hormones? (Don’t go too in depth I
ain’t reading allat respectfully - Amy)
Estradiol and testosterone are extremely similar in overall structure, both clearly derived from cholesterol, with the
benzene rings [1.5 pts]. However, testosterone is clearly more modified, with slightly different side groups extending
from the benzenes compared to the estradiol (e.g. a double-bonded oxygen vs a hydroxyl on the far left) [1.5 pts].
22. [2 pts] We know that testosterones and other androgens are able to be converted to many estrogens (e.g. estradiol)
via aromatization in metabolic pathways. We also know that estrogen production helps prevent bone density loss.
Therefore, we can conclude that estrogen most directly—
A. Inhibits osteoblast apoptosis, increasing their life span, reinforcing bones
B. Helps stimulate osteoblast production, promoting bone-building
C. Inhibits osteocyte apoptosis, allowing for prolonged bone remodeling
D. Helps stimulate osteoclast apoptosis, decreasing the rates of bone resorption
23. [2 pts] Sebastian has concerns with the testosterone he is taking and the negative effect he thinks it’ll have on his
bone density.
Given the previous information, are Sebastian’s concerns grounded in reality? Select the best answer(s)
A. Yes, because testosterone inhibits osteoblast formation
B. Yes, because exogenous testosterone would decrease estrogen production
C. No, because some of the testosterone would be converted into estrogens
D. No, because testosterone counteracts any effects of lowered estrogen by stimulating osteoblasts
24. [2 pts] Those AMAB (assigned male at birth) who have matured past puberty tend to have taller height and larger
bones compared to their AFAB (assigned female at birth) counterparts (who also have matured past puberty). Why
might this be?
Those AMAB, although typically developing later in puberty compared to those AFAB [1 pt], develop for way longer,
meaning they typically grow much taller [1 pt].
25. [TB, 4 pts] What effects can you conclude about Sebastian’s course of testosterone and the effect it’ll have on his
bone density/development?
He shouldn’t have any concerns in regards to bone density [1 pt], as he’s still producing testosterone and estrogens [1
pt], which would regulate his bone development. The additional testosterone might also boost his bone mass/width
(although that is highly unlikely because the effects of testosterone on bone development are not always direct) [1
pt]. As long as he continues his course of hormones properly, his bones should be relatively healthy (bone health in
transgender male populations typically stay relatively healthy post-transition) [1 pt].
Funny note: Amy got a flare-up of her back pain writing this section. They believe it was the pre-scoliosis getting to them
again. Life imitates art after all
😟😟😟
FRQ Section V: Sarcomere Shenanigans [48 pts]
Ishan doesn’t actually like anatomy, and he is devastated with this rotation change, so here’s his excuse to talk about mol bio
for a bunch of questions.
Figure 1: Electron micrograph of sarcomere in a skeletal muscle. Luther, Pradeep & Squire, John. (2014). The
Intriguing Dual Lattices of the Myosin Filaments in Vertebrate Striated Muscles: Evolution and Advantage. Biology.
3. 846-865. 10.3390/biology3040846.
1.
[1 pt] What is the approximate length of this sarcomere in nm?
a. 2400-2800 nm acceptable
2. [2 pts] Assuming this length is optimal muscle tone for this body, would the tension upon stimulation be
greater if the sarcomere was contracted in a resting state to 1000 nm or stretched in a resting state to 3000
nm?
a. Stretched to 3000 nm
3. [4 pts] Which letters in figure 1 correspond to the following in order…
M line, A band, Z disc/line, portion of I band
a. B, D, C, A
4. [1 pt] Let’s go into some deeper protein features before we talk about physiology! The lighter components of
region A are mainly composed of thin filament.
Thin filament is primarily composed of actin, nebulin, troponin, and tropomyosin. What are the singular
subunits that make up filamentous actin called?
a. G/Globular Actin
5. [2 pts] On each subunit comprising the larger actin molecule, there exists an active site. What protein is
supposed to bind to this active site to trigger muscle contraction, and what protein occludes the active sites
in a resting state?
a. Myosin and tropomyosin respectively
6. [6 pts] Another protein in the thin filament, troponin, consists of 3 binding sites, Tn-I, Tn-T, and Tn-C.
Amy has a mutation that causes the Tn-C site to lose binding affinity to its usual ligand. (You can tell Ishan
wrote this section LOL - Amy). How does this affect the ability for her muscles to contract, and how exactly
would this effect take place (explain using the molecules and ions that troponin interacts with, as well as the
other sites of troponin)?
a. Tn-C dysfunction would render troponin unable to bind to calcium [1 pt] which would make it
unable to move tropomyosin away from the active sites of actin’s active sites by altering its shape to
move Tn-T [3 pts]. This causes myosin to be unable to bind to actin and trigger the power stroke,
leading to an inability for muscle contraction [2 pt]
7. [1 pt] Instead of troponin, another protein conducts a similar function in smooth muscles, what is this
protein called?
a. Calponin
8. [1 pt] What types of filament, thick, thin, both, or neither compose region D?
a. Both
9. [3 pts] Myosin within the thick filament is composed of a head, tail and neck region depicted below…
Figure II: Myosin protein components (SpringerLink)
The neck (labeled light chain in the diagram) is composed of two different types of light chains, the
regulatory light chain (RLC), and essential light chain (ELC).
In excitation contraction coupling, the RLC is modified to activate another portion of the myosin protein.
What is this modification, what protein conducts the modification, and what part of myosin does it activate
to allow muscle contraction?
a. Phosphorylation [1 pt] by myosin light chain kinase/MLCK [1 pt] activates Myosin ATPase [1 pt]
10. [5 pts] This modification usually occurs on a polar serine in the RLC. If a mutation causes this residue to be
replaced by glycine, what, if any, effect on muscle contraction is it likely to have and why?
a. It will prevent muscle contraction [1 pt] because no phosphorylation can happen on a nonpolar
amino acid [2 pt] meaning no activation of myosin ATPase can occur [2 pt]
11. [1 pt] What protein connects the large dark sections of region D to the dark section of region B?
a. Titin
12. [2 pt] Fill in the blanks: Region B is primarily composed of creatine kinase, ________, and _________.
a. Myomesin, C-proteins
13. [1 pt] Fill in the blanks: Creatine kinase moves a phosphate group from ______ to ______ to replenish energy
during strenuous exercise that takes place over 15 seconds or less.
a. Creatine phosphate (0.5) ADP (0.5)
14. [1 pt] Which muscle type has a greater concentration of creatine phosphate? Fast or slow twitch?
a. Fast twitch
15. [2 pts] Brenton Lee’s 200 meter sprint PR is 22.71 seconds. Which of the following sources of energy were his
muscles using over the course of this run? Select all that apply.
a. Oxidative phosphorylation
b. Glycolysis
c. Standing Muscle ATP stores
d. Creatine phosphate transfer
e. Lipolysis
16. [5 pts] Woah got a bit too large in scale there, what is this, an anatomy test???
Also attached to our thin filaments is dystrophin, which binds to actin and membrane proteins of the
sarcolemma. How does the nature of dystrophin in cases of Duchenne and Myotonic muscular dystrophy
explain their different presentations?
a. In duchenne dystrophin is limited in production, leading to more severe and early onset with weak
muscular membranes (due to a lack of a dystrophin glycoprotein complex) and replacement of
muscle with connective and fibrous tissue, whereas in Myotonic a less functional version of
dystrophin is produced in normal amounts, leading to less severe symptoms of just muscle
weakness
17. [5 pts] Type I myotonic dystrophy (DMI) exhibits an inheritance phenomenon called anticipation, where
successive generations experience more severe and earlier onsetting symptoms than the last. What genetic
feature causes DMI and why does anticipation occur (what about the genotype changes between each
generation to make it more severe)?
a. High amount of CTG repeats in the dystrophin gene (>50) (1 pt). Maternal transmission has the
tendency to increase the amount of CTG repeats in the next generation (1 pt), and since DMI severity
scales with the amount of CTG repeats, anticipation occurs (3 pt)
18. [6 pts] Wait hold on… how does the action of the sarcomere even lead to contraction of the overall muscle
anyways? Describe how movements of individual sarcomeres are connected all the way up to the tendon
that attaches the muscle to its bone (so large, scary). Hint: starts with something from a previous question
a. Dystrophin moves with the thin filaments as they slide, and dystrophin connects to glycoproteins in
the sarcolemma, which connect via linking proteins to the basal lamina of the endomysium (3). The
endomysium is continuous connective tissue with the perimysium, which is continuous with the
epimysium, which is continuous with the fascia, which is continuous with the tendon (3)