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Summer exam 2012 Course Title: Reproduction and child health Education: Bachelor Medicine/Medicine with industrial specialisation Semester: 4th semester Exam date: 12th June 2012 Time: 9.00 til 12.00 Evalution form: Passed / not passed Important information:
Remember to write your study number – not name and cpr. nr. – on each page
to be included in the evaluation
Remember to hand in your exam paper, also if you leave the exam before time.
This paper may NOT be removed from the examination room after completion of
the exam paper. Drafting paper is not to be handed in.
The exam paper has to be photocopied so please write within the borders
allocated for each question. The space allocated for each question provides you
with an idea about the maximum length of the answer. Each question states the
maximum number of points. The box “points achieved” is only used for marking
the question.
Dictionaries are available. Quicktionary translator pen is permitted
No books, lecture notes or further resources are permitted.
Answers to questions can be written in Danish or English.
The exam is a mixture of multiple choice questions (MCQ), multiple option
questions, short and long essay type questions. Please use the separate sheet
provided on the following page for the answers to multiple choice questions
1-20.
Total number of questions Module 4.2 : 38
No form of communication is allowed
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
ANSWER SCHEME FOR MULTIPLE CHOICE QUESTIONS EXAM 4.2 CHILD GROWTH.
Opgave Svar
1
2
3.1
3.2
3.3
4
5.1
5.2
6
7.1
7.2
7.3
8
9
10
11
12
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
13
14
15.1
15.2
16
17
18
19.1
19.2
20
MCQ TOTAL = 28 points
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
Module 4.2 Questions. Questions 1-20 inclusive are Multiple Choice Questions (MCQ) and should be
answered on the separate sheet of paper after the first page.
1 Which of the following is true regarding factors that modulate growth
hormone secretion?
A Increased blood glucose stimulates growth hormone secretion
B Exercise inhibits growth hormone secretion
C Obesity stimulates growth hormone secretion
D Deep sleep stages II and IV inhibit growth hormone secretion
E Increased blood free fatty acids inhibit growth hormone secretion
Max point 1 Opnåede point
2 Identify the initial site for the formation of the fetal blood cells?
A chorion
B amniotic cavity
C embryoblast
D endoderm
E yolk sac
Max point 1 Achieved point
3 Topic: congenital defects and their basis
Options:
A Chromosomal abnormalities
B Deformation
C Disruption
D Functional defect
E Malformation
F Multiple malformation syndromes
G Sequence
H Single gene defect
I Single primary defect
J Structural defect
K Teratogenesis
Lead in: From the above list, choose the term that most fully describes the
nature of the following abnormalities
Stem:
3.1 A process which alters normal structures after their formation, e.g. amniotic bands
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
3.2 An environmental agent that causes abnormalities, e.g. rubella
3.3 Multiple abnormalities following a single primary defect, e.g. Pierre Robin Syndrome
Max point 3 Achieved point
4 Which one of the following statements does NOT apply to growth
hormone (GH) secretion and its actions on target tissues?
A GH induces secretion of Insulin-like Growth Factor (IGF) in the liver
B GH increases glucose uptake in adipose tissue
C GH increases amino acid uptake in muscle tissue
D GH exerts negative feedback on GH secretion in the anterior pituitary
E GH triggers cell division
Max point 1 Achieved point
5 Topic: Use of drugs in labour
A Beta adrenoreceptor agonist
B Beta adrenoreceptor antagonist
C Corticosteroid
D Non steroidal anti-inflammatory drugs
E Oestrogen
F Oxytocin
G Progesteron
H Prostaglandins
Lead in: For each of the circumstances below choose the most appropriate drug
from the list above.
Stem:
5.1 Used in a gel given intra-vaginally to induce labour
5.2 Used to augment a slow non-obstructed labour
Max point 2 Achieved point
6 Which one of the following statements regarding fetal/neonatal physiology and
anatomy is not correct?
A A normal umbilical cord contains two arteries and one vein
B Pulmonary vascular resistance increases at birth
C Right to left shunting occurs across the foramen ovale in utero
D Systemic vascular resistance increases at birth
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
E The ductus arteriosus begins to close within 24 hours of birth
Max point 1 Achieved point
7 Drugs in pregnancy.
A Cocaine
B Warfarin
C Alcohol
D Thalidomide
E Misoprostol
F Lithium
G Methadone
H Penicillamine
I Valproic acid
J Diazepam
Lead in: Choose the correct statement regarding teratogens:
7.1 … acts as a teratogen during all trimesters but can cause different
effects in each trimester
7.2 … acts as a teratogen during the first trimester and is likely to cause
Ebstein’s anomaly
7.3 … acts as a teratogen on the first trimester and is known to cause e.g.
neural tube defects
Max point 3 Achieved point
8 Which one of the following is correct about pregnancy?
A Basal metabolic rate rises by more than 10%
B Breasts enlarge due mainly to the action of prolactin
C Haematocrit rises
D The uterus is quiescent until the onset of labour
E Uterine muscle enlarges due mainly to cell proliferation
Max point 1 Achieved point
9 Ms JO has just delivered a baby at 29 weeks. The family asks about long term
problems resulting from this. Which one of the following is not more common
than in full term labors?
A Cerebral palsy
B. Chronic lung disease
C. Diabetes mellitus
D Learning difficulties
E Visual impairment
Max point 1 Achieved point
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
11 Question: Hvordan vil ændret stofskifte (hypothyreoidisme eller
hyperthyreodisme) vise sig hos børn.
A Dyb stemme.
B Hårtab af øjenbrynene.
C Hæmning af længdevæksten
D Kolde hænder og fødder
E Vandladningsproblemer
Max point 1 Achieved point
12 Find det forkerte svar:
Hvilken af følgende faktorer disponerer IKKE for post partum blødning?
A Instrumentiel forløsning
B Sectio
C Partus prolongata
D Partus spurius
E Multiparitet
F Preterm fødsel
H Foetus magnus
Max point 1 Achieved point
13 Hvad er den væsentligste årsag til perinatal mortalitet og svær
perinatal morbiditet i Danmark?
A Gestationel diabetes
B Preterm fødsel
C Graviditas prolongata
D Præeclampsi
E Maternel adipositas
F Intrauterin væksthæmning (IUGR)
10 Choose the correct answer:
Which of the following typically causes the least amount of
congenital malformations?
A Mechanical deformations
B Drugs, chemicals, radiation, hyperthermia
C Genetic diseases
D Maternal infection
E Maternal condition
Max point 1 Achieved point
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
G Hyperemesis gravidarum
Max point 1 Achieved point
14 Identify which TWO parts of the fetal-placental boundary that are
of maternal origin
A Chorionic plate
B Decidual plate
C Syncytiotrophoblast
D Blood in the chorionic villi
E Extraembryonic mesoderm
F Blood in the intervillous space
Max point 2 Achieved point
15 Topic: Hormones associated with sexual cycle and pregnancy.
Molecules:
A Oxytocin
B GnRH
C Progesterone
D hCG
E Prolactin
F Estriol
G FSH
H Estradiol
I LH
J Testosterone
Opgave: Vælg fra listen af molekyler den, der passer bedst til hvert af de
nedenstående udsagn.
15.1 Is the most important estrogen produced by placenta
15.2 Is involved in the lactation reflex and uterine contractions
Max point 2 Achieved point
16 The role of prolactin is to stimulate lactation; nevertheless, during
pregnancy no milk is produced. This is due to which one of the
following?
A Low levels of prolactin
B Low levels of prolactin-releasing hormone
C High levels of estrogen and progesterone
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
D High levels of oxytocin
E Absence of the neurosensory stimulation of the nipple
Max point 1 Achieved point
17 Which of the following is TRUE regarding child abuse?
A It is a physical mistreatment of children
B It can take many forms, such as neglect, physical abuse, child sexual abuse, and
psychological abuse
C Child neglect and child abuse are far more common in single-parent families
than in families where both parents are present
D Child abuse is a complex problem which has multiple causes
E All of the above
Max point 1 Achieved point
18 After delivery of a baby there is a marked fall in the level of oestrogen in the
mother’s blood. Which one of the following is unlikely to be a consequence of
this?
A Depression
B Hot flushes
C Increased blood coagulability
D Tiredness
E Vaginal dryness
Max point 1 Achieved point
19 Topic: The development of the heart.
Description:
A Fusion of the septum primum and septum secundum
B Formation of the interventricular septum
C Formation of the conotruncal septum
D Fusion of the endocardial cushions
E Folding of the endocardial heart tube
F Formation of the semilunar valves
G Closure of the ductus arteriosus
H Formation of the atrioventricular valves
Opgave: Vælg fra listen, der passer bedst til hvert af de nedenstående udsagn.
19.1 Persistent foramen ovale is a defect of ….
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
19.2 Formation of the isolated pulmonary and systemic circulations in early
postnatal life requires in addition to closure of foramen ovale, which option in
the above list
20 Which one of the following statements does NOT apply to
acromegaly?
A Excess growth hormone during childhood causes overgrowth of the long
bones and very tall stature
B Enlarged lips, nose, and tongue
C Excessive sweating and skin odor
D Abnormalities of menstrual cycle, sometimes breast discharge
E Swelling of the hands and feet is often an early feature
Max point 1 Achieved point
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
SHORT ANSWER AND ESSAY QUESTIONS TO BE COMPLETED IN
SPACES PROVIDED
Jimmi Cooper, a boy aged 16 months, is brought to see you by his parents. He has
been slow in walking and has recently been seen by the local paediatrician and a
diagnosis of Duchenne muscular dystrophy has been made.
21.1 At what age does this disease usually first manifest?
Max point 1 Achieved point
21.2 What is the appearance of the muscles on physical examination and why does this happen?
Max point 1 Achieved point
21.3 As part of the screening process, a PCR will be run on biomarker gene.
The materials needed for running the PCR are listed in the table below.
Calculate the volumes needed (column 3) for a 20µl reaction based on the
final concentrations stated in column 2 of the table.
Calculate what volumes you would need for each of the reagents in a 20
µl reaction.
Reagents and template Final concentration in a
reaction volume of 20 µl
Volume (µl)
10 x Taq buffer 1 x
dNTP Mix, 25 mM 0.25 mM
Forward primer, 200 µM 1 µM
Reverse primer, 100 µM 1 µM
Taq DNA polymerase, 5u/µl 0.5 u
Template 1 µl 1µl
MgCl2, 10 mM 2 mM
Water Fill to 20 µl
Mark 5
22 What are the main hypothalamic hormones regarding growth regulation
(give six examples)?
21 Patient History
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
What are the main anterior pituitary hormones regarding growth
regulation (give four examples)?
What are the main posterior pituitary hormones regarding growth regulation (name both hormones)?
Hypothalamic:
Anterior pituitary gland:
Posterior pituitary gland
-
Max point 6 Achieved point
23 What is the purpose of chorionic villus sampling during pregnancy?
What are some risk factors associated with this test?
Max points 2 Achieved point
24 Perinatal mortalitet og maternel mortalitet er to centrale
epidemiologisk mål i forhold til fødsler:
Hvordan defineres henholdsvis perinatal mortalitet og maternel
mortalitet? (2 points)
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
Perinatal mortalitet –
Maternel mortalitet –
Max point 2 Achieved point
25
Cite and explain succinctly the 2 most common types of hearing
impairment
Max point 2 Achieved point
26 The placenta can have abnormalities in the way it adheres to the uterine wall.
Name 2 examples of placenta abnormalities?
Max point 2 Achieved point
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
27 Give three important reasons for examination of the placenta immediately
after its birth.
Max point 3 Achieved point
28 Describe the remnants of fetal circulation that are present in adult life.
Max point 3 Achieved point
29 Explain the changes to blood circulation immediately after birth?
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
Max point 4 Achieved point
30 Topic: The development of the heart
Formation of the isolated pulmonary and systemic circulations in early
postnatal life requires closure of 2 important structures. What are these
structures?
Max point 2 Achieved point
31 I henhold til de danske anbefalinger for svangreomsorg, hvornår bør
lavrisikogravide da tilbydes konsultation hos egen læge?
Max point 2 Achieved point
32 Hvad er en double test og hvornår kan en sådan test udføres?
Max point 2 Achieved point
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
33 Beskriv lægens opgaver ved den første, rutinemæssige svangreundersøgelse
Max point 4 Achieved point
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
34 What is an Apgar score and what parameters are measured? Answer by
making a table to explain the points system
Max point 6 Achieved point
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
35 Draw and describe a classical growth curve for children in the first 5
years. For maximum points label the axis correctly. (5) If a child if failing to thrive, where would it be placed on the growth
curve (place a mark/line on your drawing) and substantiate your
answer giving an example. (3)
Max point 8 Achieved point
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
36 Hvad er forskellen på symmetrisk og asymmetrisk intrauterin
væksthæmning (IUGR)?
Symmetrisk væksthæmning:
Asymmetrisk væksthæmning:
Max points : 2 Achieved point
37.0 Case Question:
Christina Petersen is 17 years old and a patient in your practice. She is pregnant for the first time.
37.1 On enquiry you ascertain that she smokes 15 cigarettes at the weekend.
What is the consequence of smoking on the fetus? Give 2 examples
1
37.2 You also determine that she drinks about ten units of alcohol at the
weekend. Give two consequences for the fetus of alcohol consumption.
2
37.3 What would you prescribe to the patient at this point in the pregnancy and
why?
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
2
38 Draw a diagram illustrating the placental anatomy at 4 months gestation
labeling the fundamental structures and layers.
Module 4.2 Questions
Exam 12th June 2012 4th Semester
Total points acheived on this page
Max points 8 Achieved point