Medical Care |

Medical Care



Les antibiotiques sont produits sous des formes pharmaceutiques telles que des pilules acheter du amoxil.

elles permettent d'injecter la quantité de préparation strictement nécessaire.

Microsoft word - ap1 takehome_213_skin_skeleton-formatted.docx

A&P 1 Take home Exam
Name Sign Here _ DUE DATE: April 15
(No late exams accepted without a severe deduction of points. I do accept a postmark with that date on it!) Anatomy & Physiology 1 – C Shuster
Madison College
Take home Exam
1. Place your name and class section on the cover sheet in the space provided. You will be handing in both the cover sheet and the exam booklet together, so do not separate them. You may write on the exam booklet if you wish. 2. You will need 1 scantron only. 3. Use a #2 pencil ONLY!! Make sure your scantron is clean, devoid of bends, tears, staples, creases, etc. Anything you do that causes the scantron machine to mis-grade your scantron is your responsibility. 4. If you make erasures on you scantron, do them cleanly without removing the letter underneath the pencil mark. If you make a lot of erasures, you may want to check your scantron after the instructor has graded them. 5. If you wish, you may make a xerox copy of this exam. The Questions marked with an asterix (*) cover topics that are likely candidates for the final exam. 6. Significant Ambiguity Declaration (S.A.D.). If a student feels that a question is significantly ambiguous, the student may do the following: a. On the answer sheet, encircle the number of the question in doubt and write S.A.D. in the margin. An S.A.D. must be accompanied by an answer. No answer, no consideration of an S.A.D. b. Immediately upon completion of the examination, the student must contact the faculty member and discuss the S.A.D. Merely stating that a question is ambiguous will not gain consideration of an S.A.D. The onus of proof rests with the student. He must convince the professor that an ambiguity exists. "The first sign of senility is that a man forgets his theorems. The second sign is that he
forgets to zip up. The third sign is that he forgets to zip down."
A&P 1 Take home Exam
Chapter 6 (Integument) :
We will not be covering this chapter in class. Make an outline of the chapters, and pay close attention to the astrix questions. Some of the questions may draw from related material in other chapters. Use your INDEX! *1. The skin carries out the first step in the synthesis of vitamin . A. A *2. Which of these is the deepest layer of the skin? A. *3. Underneath the deepest layer of skin we find the: _. A. 4. The newest keratinocytes would be found in which layer? A. E. A & C are correct 5. Skin color is due to the presence of melanin, myooglobin, and carotene. A. True *6. Lack of which pigment causes albinism? A. 7. Freckles are patches of skin with an unusual amount of carotene. 8. Straight hair is more _ than hair with curls. A. *9. Hair and nails are composed of _. A. A&P 1 Take home Exam
10. Merocrine sweat glands are responsible for both temperature control and milk production. 11. Pattern baldness is relatively rare in women because women have higher estrogen levels than men. 12. The pH of sweat is: A. D. sometimes low, sometimes high. *13. _ is/are necessary to infection control. A. The pH of sweat B. Removal of unhealthy tissue *14. The skin does not include A. B. the papillary layer. D. the stratum basale. 15. These are all types of cells found in the epidermis except A. E. tactile (Merkel) cells. 16. Skin covering the fingertips has: A. A&P 1 Take home Exam
This image pertains to questions 17 - 20
17. This image shows structures of the skin and subcutaneous tissue. What does "3" represent? A. stratum basale C. stratum corneum B. stratum spinosum 18. What does "1" represent? A. stratum corneum C. papillary layer D. reticular layer 19. _ are found in the layer of the skin represented as "2". A. Collagen and living keratinocytes B. Collagen and dead keratinocytes C. Collagen and fibroblasts D. Elastic fibers and melanocytes E. Elastic fibers and dendritic cells 20. Layer "1" represents _, whereas layer "2" represents _. A. simple squamous epithelium; areolar tissue B. stratified squamous epithelium; dense irregular connective tissue C. dense irregular connective tissue; stratified squamous D. simple squamous epithelium; stratified squamous epithelium E. dense regular connective tissue; stratified squamous epithelium A&P 1 Take home Exam
This image pertains to question 21
21. This image shows strata and cell types of the epidermis. "2" represents a _, whereas "4" represents a _. A. dead keratinocyte; dendritic cell B. living keratinocyte; dead keratinocyte C. melanocyte; dendritic cell D. living keratinocyte; melanocyte E. melanocyte; living keratinocyte *22. The stratum corneum contains: A. B. a lot of tactile cells. *23. Which cell participates with the sense of touch? A. E. tactile (Merkel) cells 24. With regards to the skin, mitosis happens the fastest in the: A. 25. Which of these cells help protect against toxins, microbes and other pathogens? A. E. tactile (Merkel) cells A&P 1 Take home Exam
*26. Which of these are fingerprints? A. B. epidermal ridges. D. elastin and adipose in the dermis. 27. Quick mitosis of _ cause calluses and corns. A. 28. _ is not found in most of the outer layer of the skin? A. 29. In the manufacturing of leather, the portion of the dermis is used, because of the high concentration of . A. *30. The hypodermis has a lot of: A. E. keratinized tissue *31. Which of these might suggest that someone was punched in the face? The presence of: A. 32. What makes our lips red?. A. 33. Which of these might suggest that someone has anemia? A. *34. Differences in skin color in people from different parts of the world are due to differences in: A. UV radiation exposure. C. quantity of melanin produced. B. quantity of hemoglobin carried in the blood. D. number of melanocytes. *35. Which of these is a raised area of melanized skin? A. E. friction ridge A&P 1 Take home Exam
*36. So, what is a pilus, anyway? A. a hair. C. a tiny muscle that moves a h B. a hair follicle. D. a sensory nerve fiber around the base of a hair. E. a gland associated with a hair follicle. 37. A fetus is covered with , which is usually replaced by _ before birth. A. pilus; terminal hair C. vellus; terminal hair B. lanugo; terminal hair D. vellus; lanugo E. lanugo; vellus 38. This image shows the structure of a hair and its follicle. What does "1" represent? A. bulb B. root C. shaft D. medulla E. cuticle *39. We contract arrector pili muscles to cause: A. hairs to stand on end trapping an insulating layer of warm air next to the skin.B. generation of heat to raise the body temperatture. C. hairs to stand on end to make the individual appear bigger. D. hairs to stand on end with no apparent function. E. an increased ability to feel pain. 40. A REALLY hairy guy has: A. telogenism. 41. A finger nail has a thin area of dead skin at the proximal end. It is called the: A. eponychium (cuticle). 42. This image shows the anatomy of a fingernail. What does "2" represent? A. free edge B. nail body C. eponychium (cuticle) D. lunule E. nail root A&P 1 Take home Exam
43. Nails grow due to mitosis in the: A. 44. Oily hair is caused by glands found with the hair follicles. A. 45. _ form clumps called dander. A. E. B & C are correct. *46. What is ear wax (mostly)?. A. 47. What do we excrete through the skin? A. 48. Which is TRUE regarding alopecia? A. It commonly occurs in both genders. C. It is genetic. B. It occurs as we age. D. It is influenced by hormones. *49. The "ABCD rule" for recognizing a possibly malignant melanoma refers to the following characteristics of the raised area on the skin: A. asymmetry, border irregularity, color, and diameter B. asymmetry, brightness, color, and diameter C. aspect, brightness, color, and distance D. aspect, border irregularity, color, and distance E. area, border irregularity, color, and density *50. The least common but most deadly type of skin cancer is A. basal cell carcinoma. C. malignant melanoma. E. skin sarcoma. *51. Basal cell carcinoma arises from cells of the stratum , whereas malignant melanoma is mitosis of: _. A. A&P 1 Take home Exam
*52. _ burns involve the epidermis, all of the dermis, and often some deeper tissue. A. Partial-thickness *53. If a person has a third degree burn, what is the first threat to life? A. Bone Tissues and the Skeleton:
Some of the questions may draw from related material in other chapters. Use your INDEX! *54. The majority of blood cells are produced where? A. 55. The humerus is a/an , while the os coxae are bones. A. long, square C. regular, irregular B. long, irregular D. regular, square 56.Which of these would not be found on an X-ray of a toddler's hand? A. 57. The precursor cell of both osteoblasts and osteoclasts are called osteogenic cells . 58. "Osteoid" refers to the matrix of bone tissue with the minerals removed. A&P 1 Take home Exam
59. Intramembranous ossification occurs mostly in newborns, while endochondral ossification is more common in teens. *60. Bones get thicker via _ growth. A. 61. Hypercalcemia directly causes . A. a lowered response of the nervous system *62. Parathyroid hormone (PTH) directly attaches to which? A. B. the endosteum D. receptors on osteoblasts. 63. Osteomalacia commonly causes bone to be brittle. *64. Osteoporosis may lead to kyphosis. *65. Which of these is not a function of the skeleton? A. store calcium and phosphate ions. C. provide support for most muscles. B. store red blood cells. D. protect the CNS. *66. All bone tissue is an example of tissue. A. 67. Which of these would you NOT expect to find in a long bone? A. *68. Whcih of these becomes modified on a long bone for the articulation? A. 69. The external membrane on a bone is called the , whereas the internal surface is lined with _. A. osseous facia; mucous membrane C. mucous membrane, endosteum B. deep facia, endosteum D. periosteum; endosteum A&P 1 Take home Exam
*70. Cells that make osteoid are called: A. Osteogenic (osteoprogenitor) cells *71. Once become trapped in lacunae, they turn into _. A. osteogenic cells; osteoblasts C. osteoblasts; osteocytes *72. What do we call the inorganic component of the bone tissue? A. Glycosaminoglycans 73. Spicules and trabeculae are characteristics of which of the following? A. *74. makes bone tissue hard, but give it flexibility. A. Hydroxyapatite and other minerals; proteins B. Collagen and elastic fibers; minerals C. Glycoproteins; proteoglycans D. Calcium carbonate; calcium phosphate E. Proteins; collagen 75. What would you find in the diaphysis of an adult femur? A. 76. What does one get from Intramembranous ossification? A. irregular bones of the vertebrae. C. long bones of the limbs. B. flat bones of the skull. D. short bones of the wrist. 77. During Endochondral ossification, _ is replaced by bone. A. E. fibrocartilage. 78. The _ is the area where, during growth in length, bone can be seen replacing hyaline cartilage. A. B. primary ossification center D. osteoid tissue A&P 1 Take home Exam
*79. Achondroplastic dwarfism is NOT: A. genetic C. a problem with hyaline production. B. a problem at the epiphyseal plate. D. shortened long bones, but not flat bones. *80. Bones are remodeled throughout life by: A. intramembranous ossification. C. interstitial growth. B. endochondral ossification. D. appositional growth. *81. Bone grow in length via adding: A. E. A&C are correct. 82. A growing long bone in a child has only two areas of cartilage at the epiphysis. These two areas are: A. elastic cartilage and epiphyseal plate. B. epiphyseal plate and epiphyseal line. C. primary and secondary ossification centers. D. fibrocartilage and articular cartilage. E. articular cartilage and epiphyseal plate. *83. _ is the process of dissolving bone and returning its minerals to the bloodstream. A. 84. Which is FALSE regarding Parathyroid hormone (PTH)? It: A. promotes calcium reabsorption by the kidneys. B. stimulates osteoclast activity. C. lowers blood calcium. D. promotes calcitriol synthesis. E. inhibits osteoblast activity. *85. The skin, kidneys, and liver all are involved in the production of which important hormone critical I the mineralization of bone? A. 86. Which of these is FALSE regarding calcitriol? It causes: A. cartilage growth in the epiphyseal plate B. increased osteoclast activity C. more intestinal absorption of Ca2+ D. less calcium in the urine E. more phosphate in the urine A&P 1 Take home Exam
87. Which of the following would not put someone at risk of hypocalcemia? A. Lactation B. Pregnancy C. Removal of the parathyroid glands D. Removal of the thyroid gland E. Lack of exposure to UV radiation 88. Blood Ca2+ deficiency stimulates secretion, which leads to _. A. calcitonin; more urinary phosphate reabsorption B. calcitriol; more urinary phosphate excretion C. parathyroid hormone; increased osteoclast activity D. growth hormone; increased osteoblast activity E. thyroid hormone; less urinary calcium excretion 89. What is a symptom of hypocalcemia? A. emotional disturbances. B. depression of the nervous system. C. muscle weakness. D. sluggish reflexes. E. spasms. 90. Arteriosclerosis is an example of: A. the solubility product has been reached. B. artery mineralization by osteoblasts. C. abnormal calcification of a tissue. D. accumulation of collagenous fibers in blood vessels. E. ossification of an entire blood vessel. 91. John has a thyroid tumor that is actively secreting. What might we expect? A. an elevated level of osteoclast activity. B. an elevated level of osteoblast activity. C. a reduced rate of endochondral ossification. D. a rise in blood calcium concentration. E. increasingly brittle bones. *92. A soft callus characterizes: A. endochondral ossification. B. intramembranous ossification. C. bone growth at the metaphysis. D. the remodeling of bone. E. the healing of a fracture. *93. Osteoporosis is most common in women after menopause because of the lack of _, which would otherwise inhibit . A. dietary calcium; estrogen production B. osteoblasts; osteoclast activity C. estrogen; osteoclast activity D. parathyroid hormone; osteocyte activity E. exercise; osteoblast activity A&P 1 Take home Exam
*94. A fracture in which the bone is broken into three or more pieces is called a fracture. A. linear B. pott C. comminuted D. greenstick E. compound 95. Soft bones due to mineral deficiencies is called _ in children and _ in adults. A. osteomalacia; rickets B. rickets; osteomalacia C. osteoporosis; osteomalacia D. osteomyelitis; osteosarcoma E. osteomyelitis; osteomalacia *96. Bone protrudes through skin in a fracture called A. complete. B. incomplete. C. closed. D. open. E. displaced. *97. Give the correct series of events during bone repair: A. bone remodeling –> soft callus formation –> hard callus formation –> hematoma formation B. bone remodeling –> hard callus formation –> soft callus formation –> hematoma formation C. hematoma formation –> soft callus formation –> hard callus formation –> bone remodeling D. hematoma formation –> hard callus formation –> soft callus formation –> bone remodeling E. soft callus formation –> hard callus formation –> hematoma formation –> bone remodeling 98. During the repair process, areas of fibrocartilage are called , whereas a bony collar formed around the fracture is called _. A. fracture hematoma; granulation tissue B. granulation tissue; soft callus C. fracture hematoma; hard callus D. granulation tissue; hard callus E. soft callus; hard callus *99. The most common bone disease: A. Osteomyelitis B. Osteoporosis C. Osteosarcoma D. Osteomalacia E. Rickets 100. Condyles are found in the axial skeleton only. A. True 101. You can palpate both the medial epicondyle and condyle of the humerus. A. Yes A&P 1 Take home Exam
*102. Paranasal sinuses are lined by mucous membranes, and filled with mucus. A. True 103. Sutures are found in the os coxae and facial bones of adults. A. True 104. All ribs articulate with the vertebral column and sternal body. A. True *105. Men have one rib fewer than women. A. True *106. There are bones in the pollex. A. 1 107. Can the pubic symphysis be palpated? Try it! A. True 108. Medial and lateral condyles of the femur are involved in the hip joint. A. True 109. How many bones are found in the adult skeleton on average? A. 56. B. 106. C. 156. D. 206. E. 256. 110. All the bones listed below belong to the axial skeleton, except _, which belongs to the appendicular. A. lacrimal B. vomer C. navicular D. coccyx E. malleus *111. Any bony bump, where (often) a muscle attaches: A. an epicondyle. B. a tubercle. C. a fossa. D. a head. E. a process. *112.Adults have fewer bones than kids because: A. osteoporosis leads to bone loss with age B. separate bones gradually fuse with age C. many bones are replaced by cartilage with age D. bones are reabsorbed with age E. osteoclast activity overcomes osteoblast activity with age A&P 1 Take home Exam
*113. A hole through a bone that usually allows passage for nerves and blood vessels is called a/an: A. 114. All the bones listed below belong to the appendicular skeleton except the A. *115. Most of the bones of the skull are connected by immovable joints called A. 116. Which of these does not have sinus? A. sphenoid bone. B. frontal bone. C. temporal bone. D. maxilla. E. parietal bone. *117. The _ houses the pituitary gland (hypophysis) and is found in the . A. foramen magnum; occipital bone B. sella turcica; sphenoid bone C. lambdoid suture; parietal bones D. supraorbital margin; frontal bone E. occipital condyle; occipital bone *118. Fontanels are in an infant. A. spaces between the un-fused cranial bones B. cartilages covering cranial bones C. fibrous connective tissues lining the cranial cavity D. fibrous connective tissues lining the orbits E. fibrous connective tissues lining paranasal sinuses 119. A common problem with the spine is a lateral curvature called A. 120. The axis is the only vertebra with a A. transverse foramen. B. spinous process. C. dens (odontoid process). D. vertebral arch. E. superior articular facet. A&P 1 Take home Exam
121. The spinous process has a bifid tip in most _ vertebrae. A. cervical 122. In a herniated ("ruptured" or "slipped") disc, the ring of fibrocartilage called the _ cracks and the _ oozes out. A. nucleus pulposus; anulus fibrosus B. lamina; nucleus pulposus C. anulus fibrosus; nucleus pulposus D. anulus fibrosus; body E. nucleus pulposus; lamina *123. Costal cartilages connect A. the clavicles with the sternum. B. true ribs with the scapula. C. floating ribs with xiphoid process. D. false ribs with the viscera and peritoneum. E. ribs with the sternum. 124. _ do(does) not belong to the pectoral girdle. A. The glenohumeral joint B. The acromioclavicular joint C. The sternoclavicular joint D. The sacroiliac joint E. The clavicle and scapula *125. The acromion is a feature of the A. clavicle. B. scapula. C. ulna. D. scaphoid. E. pollex. 126. The glenoid cavity of the _ articulates with the head of the _. A. scapula; sternum B. radius; humerus C. humerus; scapula D. sternum; humerus E. scapula; humerus 127. Which one of features listed below is not found in the ethmoid bone? A. crista galli C. middle nasal conchae B. inferior nasal conchae D. superior nasal concha A&P 1 Take home Exam
128. In some cases the epiphyseal plate of the long bones of children closes too early. What might be the cause? A. overproduction of thyroid hormone B. elevated levels of sex hormones C. too much vitamin D in the diet D. osteoblast activity exceeds osteoclast activity E. more than one of the above are correct. *129. The olfactory nerve tracts could be most easily damaged by a fracture of the _ bone. A. 130. The "funny bone" refers to the A. lateral epicondyle. B. capitulum. C. medial epicondyle. D. olecranon process. E. more than one is correct. 131. The tibia is one of the major weight-bearing bones of the leg and articulates inferiorly with this weight-bearing bone called the A. femur. B. talus. C. calcaneus. D. fibula. E. more than one is correct 132. When doing CPR, to move blood out of the heart you always find the inferior end of the sternum as a landmark and then move superiorly before beginning compression. The inferior end of the sternum that you do not want to compress is the A. manubrium. D. xiphoid process. 133. The palatine process of the maxillary bone along with the palatine bone form the A. superior wall of the nasal cavity. B. lateral wall of the nasopharynx. C. posterior wall of the orbit of the eye. D. hard palate or anterior root of the oral cavity. E. more than one is correct 134. Which of the following skull bones is not paired? A. sphenoid A&P 1 Take home Exam
135. A fracture of the distal end of the radius and ulna is called a A. colles. 136. A soft callus forms during A. endochondral ossification. C. bone growth at the metaphysis B. intramembranous ossification. D. the remodeling of bone. 137. The main reason osteoporosis is most common in elderly women is their lack of A. estrogen. C. parathyroid hormone. B. osteoclast activity. D. dietary calcium. 138. The skeletal system performs all of the following functions except A. protective enclosure of the viscera. B. maintenance of electrolyte balance. C. maintenance of acid-base balance. D. regulation of body temperature. E. production of blood cells. 139. Osteocytes pass nutrients and chemical signals to other osteocytes and osteoblasts by way of that are found in slender channels called . A. gap junctions; canaliculi B. cytoplasmic processes; Haversian canals C. gap junctions; perforating canals D. tight junctions; nutrient foramina E. gap junctions; Haversian canals 140. At the epiphyseal plate, in the zone of calcification A. osteoclasts erode spongy bone to form the marrow cavity. B. osteoblasts deposit bone along the calcified matrix forming spongy bone with osteocytes. C. minerals are deposited between lacunae, chondrocytes die, and a calcified matrix is left. D. hydroxyapatite is deposited onto collagenous fibers. E. chondroblasts deposit more cartilage to increase the size of the epiphyseal plate. 141. In the zone of bone deposition, _ cells rapidly invade the calcified matrix and lay down bone. Then cells erode the spongy bone to form the marrow cavity. A. osteoblast; osteoclast C. osteocyte; osteoclast B. osteoblast; osteocyte D. osteoclast; osteoblast 142. The pituitary gland is housed in the: A. vomer bone. C. sella turcica of the sphenoid. B. sinuses of the ethmoid. D. foramen lacerum. A&P 1 Take home Exam
143. Wolff's law is concerned with A. vertical growth of bones being dependent on age. B. the thickness and shape of a bone being dependent on stresses placed upon it. C. the function of bone being dependent on shape. D. the diameter of the bone being dependent on the ratio of osteoblasts to osteoclasts. 144. Which of the following glands or organs produces hormones that tend to decrease blood calcium levels? A. pineal gland 145. Bone grows in two ways, appositional and interstitial. Appositional growth is: A. growth at the epiphyseal plate. B. the secretion of new matrix against existing bone. C. along the sides of the bone only. D. the lengthening of hyaline cartilage. E. more than one of the above are correct. 146. Which of the following statements best describes "interstitial growth"? A. Growth occurs in the lining of the long bones. B. Fibroblasts give rise to chondrocytes that differentiate and form cartilage. C. Unspecialized cells from mesenchyme develop into chondrocytes, which divide and form cartilage. D. Chondrocytes in the lacunae divide and secrete matrix, allowing the cartilage to grow from within. 147. In the epiphyseal plate, cartilage grows: A. from the diaphysis to the epiphysis. C. from the edges inward. B. from the epiphysis to the diaphysis. D. in a circular fashion. 148. Osteogenesis is the process of: A. bone healing. C. bone formation. B. bone remodeling. D. bone formation and bone remodeling. The following questions may take a little research. Your author does not directly address these questions. You can use any source you want to answer the questions. 149. A farmer's finger is pulled completely off his hand by a piece of farm machinery. This is A. A displaced fracture. B. A complete fracture. 150. Which of the following would normally be impossible to palpate on a living person? A. The superior nuchal line C. The zygomatic arch B. The occipital condyles D. The mastoid process A&P 1 Take home Exam
151. Nerves and blood vessels that supply the lower teeth pass through this foramen. Dentists inject anesthetics near this foramen to deaden sensation from the lower teeth. This foramen is called the A. mental foramen. C. supraorbital foramen. B. infraorbital foramen. D. mandibular foramen. 152. Look this one up! The _ is/are fractured more often than any other bone in people under the age of 70. A. 153. Look this one up! The _ is fractured more often than any other bone in people over the age of 70. HINT to get you started: what do four of these have in common? A. proximal end of femur C. distal end of femur 154. It is thought that remodeling or bone growth is in response to the forces placed on it. Which of the following hypotheses may explain how mechanical forces communicate with cells responsible for bone remodeling? NOTE: your author doesn't talk about this, so look it up! A. An increase in the synthesis of growth hormone directs the remodeling process. B. Vitamin D enhances the remodeling process by attracting osteoblasts. Active bone makes Vitamin D. C. Bone deposition by osteoblasts is directly affected by horizontal stress. D. Electrical signals seem to direct the osteoblasts and therefore the remodeling process. 155. Which is true regarding the hyoid bone? A. It is the only bone of the body that does not articulate with any other bone. B. As its name suggest, it is shaped like a "w". C. It is covered with mucosa. D. It contains a structure called the "cornu". E. More than one of these is correct. 156. Which of the following statements best describes what fingernails actually are? A. Finger nails are a modification of the epidermis. B. Finger nails are derived from osseous tissue. C. Finger nails are extensions of the carpal bones. D. Finger nails are a separate tissue from the skin, formed from a different embryonic layer.


and pains would be overdiagnosed.Ó to 2.3 percent above the 1990 level, to Some preexisting categories were re- 1,369 million metric tons. tested but none removed. In the past, The governmentÕs own carbon emis- 2 emissions may put gay activists lobbied to have homosex- reduction goal beyond reach sion numbers will be published later uality erased from the DSM register;

Ogp/ipieca 'guide to malaria management programmes' (2006)

A Guide toMalariaManagementProgrammesin the oil and gas industry A Guide toMalaria ManagementProgrammesin the oil and gas industry IPIECAInternational Petroleum Industry Environmental Conservation Association 5th Floor, 209–215 Blackfriars Road, London SE1 8NL, United Kingdom