exam module 4.2 medis, aau, 4th. semester 10 june 2014, 9 ... · pdf filemodule 4.2 4th...

Module 4.2 4th Semester

Exam 10th June 2014

Total points acheived on this page

Exam Module 4.2

MedIS, AAU, 4th. Semester 10th June 2014, 9.00 – 12:00

3 hours written exam without books and lecture notes. The exam paper has to be photocopied so please write within the borders allocated for each question. Write your study number on each page. 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. Answers to questions can be written in Danish or English. Yellow paper is for drafting answers and not to be handed in. This paper may NOT be removed from the examination room after completion of the exam paper. 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. Total number of questions Module 4.2: 26 Total number of points: 100


Exam 10th June 2014


ANSWER SCHEME FOR MULTIPLE CHOICE QUESTIONS EXAM 4.2 CHILD GROWTH.

HUSK AT SKRIVE STUDIENUMMER ØVERST PÅ HVER SIDE. SKRIV IKKE NAVN

ELLER CPR-NUMMER.

Opgave Svar

1

2 2.1 2.2 2.3

3

4

5 5.1 5.2 5.3

6 6.1 6.2 6.3

7

8

9

10 10.1 10.2 11 11.1 11.2 11.3

12 12.1

13 13.1 13.2 13.4

14

15

16

17

MCQ TOTAL = 28 points


Exam 10th June 2014


Module 4.2 Questions: Questions 1-17 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 not a β-lactam antibiotic?

A. Amoxicillin B. Flucloxacillin C. Gentamicin D. A and B E. A, B and C

Max point: 1 Opnåede point 2 Topic: congenital defects and their basis Options: A. Chromosomal abnormalities B. Deformation C. Functional defect D. Disruption E. Malformation F. Sequence G. Multiple malformation syndromes H. Single gene defect I. Teratogenesis J. Structural defect K. Single primary defect

Lead in: From the above list, choose the term that most fully describes the

nature of the following abnormalities. Stem: 2.1 A process which alters normal structures after their formation, e.g. amniotic bands.

2.2 An environmental agent that causes abnormalities, e.g. rubella.

2.3 Multiple abnormalities following a single primary defect, e.g. Pierre Robin Syndrome. Max point: 3 Opnåede point


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3 Which one of the following is correct about fetal circulation?

A. Blood flow in ductus arteriosus is from the aorta to pulmonary artery. B. Blood flow through the foramen ovale is from right to left. C. Blood returning from the inferior vena cava is preferentially diverted into the right

ventricle.

D. Oxygenated blood from the placenta is preferentially diverted into the right ventricle. E. The system favours delivery of oxygenated blood to the lungs and liver.

Max point: 1 Opnåede point 4 Which one of the following is correct about lung development in the fetus?

A. Most lung development takes place in the first few and last few weeks of pregnancy. B. Respiratory distress syndrome is caused by an excess of surfactant. C. Surfactant works by reducing surface tension within the lung alveoli. D. Surfactant is produced throughout fetal development. E. Surfactant is produced by Type 1 pneumocytes.

Max point: 1 Opnåede point 5 Topic: Growth and growth hormones Options: A. Cortisol B. Epidermal growth factor C. Fibroblast growth factor receptor D. Growth hormone E. Growth hormone inhibiting hormone (somatostatin) F. Growth hormone releasing hormone G. Insulin like growth factor-1 (Somatomedin C) H. Oestrogen I. Platelet derived growth factor J. Thyroxin K. Transforming growth factors

Lead in: For each of the circumstances below choose the most appropriate

substance from the list above. Stem: 5.1 Secreted by the anterior pituitary.


Exam 10th June 2014


5.2 Produced in the hypothalamus and the delta cells of the pancreas.

5.3 Stimulates the multiplication of fibroblasts. Max point: 3 Opnåede point 6 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 (better?) H. Prostaglandins

Lead in: For each of the circumstances below choose the most appropriate drug

from the list above. Stem: 6.1 Used in a gel given intra-vaginally to induce labour.

6.2 Used to augment a slow non-obstructed labour.

6.3 Used to slow labour by direct action on uterine smooth muscle receptors. Max point: 3 Opnåede point

7 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. Systemic vascular resistance increases at birth. C. Right to left shunting occurs across the foramen ovale in utero. D. Pulmonary vascular resistance increases at birth. E. The ductus arteriosus begins to close within 24 hours of birth.

Max point: 1 Opnåede point


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8 Sarah Nielsen has just delivered a baby at 28 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. Diabetes mellitus C. Learning difficulties D. Chronic lung disease E. Visual impairment


9 You are examining GH a newborn baby with a congenital abnormality. The mother is worried that drugs she took in pregnancy may have harmed the baby. You take a drug history. Which one of the following might be reasonably be held responsible?

A. Folic acid B. Sodium valproate (anticonvulsant) C. Paracetamol D. Iron supplements E. Penicillin

Max point: 1 Opnåede point 10 Hvilke af de nedstående behandlinger kan anvendes som vestimulation hvis

veerne ved en ellers normal fødsel går i stå efter, at orificium er dilateret mindst 3 cm?

A. Misoprostol tablet B. Syntocinon intramuskulær injektion C. Corticosteroid intramuskulær injektion D. Hindespængning E. Østrogen tablet F. Syntocinon intravenøs infusion G. Methylergometrin intramuskulær injektion H. Prostaglandin gel eller tablet



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11 Topic: Hormones associated with sexual cycle and pregnancy.

Molecules: A. GnRH B. Oxytocin 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.

11.1 Is produced by theca interna cells 11.2 Is the most important estrogen produced by placenta 11.3 Is involved in the lactation reflex and uterine contractions

Max point: 3 Opnåede point 12 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 Opnåede point 13 Leader subject: Child Growth and Development Options: A. Parathyroid hormone and PKU (phenylketonuria). B. Undernutrition and malnutrition C. IGF (insulin like growth factor) and PKU D. Iron deficiency E. Chronic infections F. Thyroid hormone and PKU G. Steno-Fallot H. Thyroid hormone deficiency


Exam 10th June 2014


I. Asthma J. VSD K. Malnutrition L. ASD

Opgave: Vælg fra listen af molekyler den, der passer bedst til hvert af de nedenstående udsagn.

13.1 Which test is done on the heel blood on newborn babies

13.2 The most common causes of growth retardation WORLD WIDE:

13.3 Malformations: The most common cause of Cyanosis due to heart failure

Max point: 3 Opnåede point 14 Which answer is wrong?

Which of the following statements concerning the gonadal axis before puberty is wrong?

A Low plasma concentrations of estrogen B Negative feedback mechanism from ovary to hypothalamus C FSH response to single GnRH dose is greater than that of LH. D Extremely powerful suppression of hormone secretion from hypothalamus E Positive feedback mechanisms from ovary control secretion of FSH

Max point: 1 Opnåede point 15 Which of the following factors inhibits growth hormone secretion?

A Deep sleep B Protein deficiency C Aging D Decreased blood glucose E Trauma



Exam 10th June 2014


16 Which of the following is NOT a correct statement regarding the placenta?

A The placental syncytiotrophoblast expresses HLA B The placenta is not an efficient barrier against many viruses. C The placenta actively transports IgG. D The placenta consists of maternal and fetal parts. E The placenta does not have all enzymes necessary for the synthesis of estrogens.

Max point: 1 Opnåede point 17 Which answer is wrong?

Which of the following combinations of drugs given during pregnancy and the typical adverse effects on fetus are NOT correct?

A Valproic acid – Neural tube defect B Thalidomide - Phocomelia C Lithium – Ebstein’s anomaly D Warfarin – Hypoplastic nose E Tetracycline - Sudden infant death syndrome


END of MCQ


Exam 10th June 2014


SHORT ANSWER AND ESSAY QUESTIONS TO BE COMPLETED IN SPACES PROVIDED.

18

Billedet viser et histologisk præparat af placenta, 2 måneder, farvet med toluidin blå (kernesyrer blå, polysakkarider lilla) A. Beskriv den histologiske opbygning af placenta og inkluder forskelle ved den tidlige placenta, før uge 20, og efter uge 20 til den fuldbårne placenta. (8 marks) B. På billedet ses et histologisk præparat af placenta ved 2 måneder af fosterudviklingen: Markér 6 strukturer med pile og angiv hvilke strukturer pilene peger på. (6 marks)


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Max point: 14


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19 In 2004, a study revealed that there are 4 main categories for the causes of human congenital malformations during the first year of life. The estimated percentages were 65-75 %, 15-25 %, 10 % and <1 %. 1. Which of the above percentages do chemicals and prescription drugs contribute to congenital malformations in these 4 categories? (1 mark) 2. What does the term teratogen mean? give 2 examples. (3 marks)

Max point 4


Exam 10th June 2014


20 Describe with the use of a simple table, the key developmental events that

take place during WEEKS 1 - 12 of pregnancy. (15 marks)


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Max point: 15


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21 Case question:

Rikke is 12 years old. She attends the doctor’s practice today because of concerns about her short stature. She is in general good health, but has recently become rather withdrawn and is having a difficult time at school where she is being bullied about her height. Her father is 168 cm. Her mother is 160 cm and had her menarche at the age of 15 years. Rikke’s height is 127 cm (below the 0.4th centile) and her weight is 26 kg (0.4th centile). Questions: 1. Make a brainstorm of the above case. (5 marks) Note, marks not allocated for repetition of text above.

2. When should you become concerned about short stature? (5 marks) 3. Describe some pathological causes of short stature. (3 marks)


Exam 10th June 2014


Max point: 13


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22 1. Med hvilken af caputs diametre er det mest gunstig for barnet at trænge

ned igennem bækkenet under fødslen?

2. Og ud fra hvilke strukturer på caput kan man ved vaginal eksploration følge barnets rotation og nedtræning under fødslen?

Max point: 2

23 Barnets tilstand:

Hvordan observeres barnets tilstand under den normale fødsel? (4 marks)

Max point: 4


Exam 10th June 2014


24 Intrauterin væksthæmning er den næsthyppigste årsag til perinatal mortalitet og alvorlig morbiditet. Nævn mindst 4 eksempler på morbiditet, som ses hos børn med Intrauterin væksthæmning. (4 marks)

Max point: 4

25 En mor med et 3 uger gammelt barn henvender sig til egen læge med ønske

om medicin til ammeophør pga stærke smerter i venstre bryst: Hvad vil du undersøge og hvordan bør kvinden herudfra rådgives og behandles? (4 marks)

Max point: 4


Exam 10th June 2014


26 A patient has been diagnosed with pre-eclempsia (Præeklampsi):

(A) What are the risk factors and causes for pre-eclempsi? (10 marks) (B) What methods are used in the routine diagnosis of pre eclempsi? (2 marks)


Exam 10th June 2014


Max 12 points


Exam 10th June 2014


exam module 4.2 medis, aau, 4th. semester 10 june 2014, 9 ... · pdf filemodule 4.2 4th...

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