Case 14 Questions 16-30

Question 16

In the male, which cells produce anti- Mullerian hormone?

1. Germ cells
2. Leydig cells
3. Sertoli cells
4. Myoid cells
5. Sperm cells

Sertoli cells

Germ cells – in week 4, germ cells migrate from the endoderm

Leydig cells – present in the interstitium of the testes and produces testosterone

Sertoli cells – present in the testes. Anti- Mullerian hormone is responsible for the degeneration of the paramesonephric (Mullerian) ducts

Myoid cells – smooth muscle cells which surround the seminiferous tubules in the testis

Sperm cells – male reproductive cell containing 23 chromosomes

Question 17

Which of the following hormones does NOT increase as a response to pregnancy?

1. Glucagon
2. Thyroid stimulating hormone (TSH)
3. Cortisol
4. Prolactin
5. Progesterone

Glucagon

Glucagon – glucagon is produced when glucose levels falls. However, pregnancy increases insulin resistance so there is a high glucose level in the body and therefore glucagon is not produced

Thyroid stimulating hormone (TSH) – Increase in oestrogen levels results in an increase in hepatic production of thyroid-binding globulin (TBG). As a result, more free T3 and T4 bind to the TBG, this causes more thyroid-stimulating hormone to be released from the anterior pituitary gland. Therefore, the free T3 and T4 levels remain unchanged – but the total T3 and T4 levels rise.

Progesterone – increases through pregnancy, initially being produced by the corpus luteum and later by the placenta

Question 18

Pregnancy tests are generally based on the detection in maternal urine of:

1. Oestrogen
2. Progesterone
3. Human Chorionic Somatomammotropin
4. Human Chorionic Gonadotrophin
5. Human Chorionic Corticotrophin

Human Chorionic Gonadotrophin

Question 19

Which of the following is NOT a change that occurs in the gastrointestinal system during pregnancy?

1. Increased gut motility
2. Decreased gut motility
3. Upward displacement of stomach
4. Displacement of the appendix to the right upper quadrant
5. Biliary tract stasis

Increased gut motility

Increased gut motility – the increase in progesterone in pregnancy results in smooth muscle relaxation which would reduce gut motility. This allows more time for nutrient absorption but can lead to constipation

Decreased gut motility – as above

Upward displacement of stomach – As the uterus grows, the stomach is displaced upwards which leads to an increase in intra-gastric pressure.

Displacement of the appendix to the right upper quadrant – due to the uterus enlarging.

Biliary tract stasis- relaxation of the gallbladder in response to progesterone

Question 20

What type of anaemia does pregnancy produce?

1. Pathological dilutional anaemia
2. Microcytic anaemia
3. Macrocytic anaemia
4. Normocytic anaemia
5. Physiological dilutional anaemia

Physiological dilutional anaemia

Physiological dilutional anaemia – Pregnancy results in the activation of the renin-angiotensin-aldosterone system, leading to an increase in sodium levels and water retention. This means that the total blood volume increases. However, the red cell mass does not increase by as much. This results in a physiological dilutional anemia.

Pathological dilutional anaemia – as a result of hyperviscosity syndromes such as myeloma

Microcytic anaemia – iron deficiency is a form of microcytic anaemia

Macrocytic anaemia – B12 deficiency is an example of macrocytic anaemia

Normocytic anaemia – more commonly a result of blood loss

Question 21

What hormone is released from the hypothalamus?

1. Lutenising hormone
2. Oestrogen
3. Gonadotropin Releasing Hormone
4. Follicular Stimulating Hormone
5. Inhibin

Gonadotropin Releasing Hormone

Gonadotropin Releasing Hormone- released from hypothalamus and stimulates LH and FSH release from anterior pituitary gland

Lutenising hormone- released from anterior pituitary and acts on theca cells to stimulate production and secretion of androgens

Oestrogen- released from gonads

Follicular Stimulating Hormone – released from anterior pituitary and binds to granulosa cells to stimulate follicle growth, permit the conversion of androgens (from theca cells) to oestrogens and stimulate inhibin secretion.

Inhibin – production is stimulated by FSH and acts to selectively inhibit FSH at the anterior pituitary.

Question 22

What is the effect of follicular inhibin in the follicular phase?

1. Stimulates LH release
2. Inhibits LH release
3. Stimulates FSH release
4. Inhibits FSH release
5. Stimulates oestrogen release

Inhibits FSH release

Follicular oestrogen eventually becomes high enough to initiate positive feedback at the HPG axis, increasing levels of GnRH and gonadotropins. However, the effect is only reflected in LH levels (the LH surge) due to the increased follicular inhibin, selectively inhibiting FSH production at the anterior pituitary. Granulosa cells become luteinised and express receptors for LH.

Question 23

Which hormones are secreted by the corpus luteum

1. Oestrogen, progesterone and inhibin
2. LH, oestrogen and progesterone
3. GnRH, oestrogen and inhibin
4. Progesterone and inhibin
5. Oestrogen, progesterone and FSH

Question 24

Which phase of the uterine cycle is stimulated by progesterone?

1. Proliferative phase
2. Secretory phase
3. Menses
4. Follicular phase
5. Ovulation

Secretory phase

Secretory phase- part of the uterine cycle- It occurs at the same time as the luteal phase. Progesterone stimulates the further thickening of the endometrium into a glandular secretory form, thickening of the myometrium, reduction of motility of the myometrium, thick acidic cervical mucus production (a hostile environment to prevent polyspermy), changes in mammary tissue, and other metabolic changes.

Proliferative phase- part of the uterine cycle- occurs following menses. It occurs at the same time as the follicular phase in preparing the reproductive tract for fertilization and implantation. Oestrogen initiates fallopian tube formation, thickening of the endometrium, increased growth and motility of the myometrium, and production of a thin alkaline cervical mucus (to facilitate sperm transport).

Menses- Menses marks the beginning of a new menstrual cycle. It occurs in the absence of fertilisation once the corpus luteum has broken down and the internal lining of the uterus is shed.

Follicular phase- part of the ovarian cycle – follicles begin to mature and prepare to release an oocyte. It involves FSH production

Ovulation – part of the ovarian cycle – occurs in response to an LH surge, causing the follicle to rupture and a mature oocyte is assisted to the fallopian tubes by fimbria

Question 25

What is the source of hCG in pregnancy?

1. Cytotrophoblastic cells
2. Syncytiotrophoblastic cells
3. Amnion
4. Chorion
5. Inner cell mass

Syncytiotrophoblastic cells

The answer is B, the syncytiotrophoblast is a source of hCG. These cells invade maternal blood vessels by forming lacunae. The cytotrophoblast is the inner cellular layer of the trophoblast, this does not release hCG The amnion is a membrane that covers the embryo when it is first formed The chorion is the outermost fetal membrane The inner cell mass cells can become any cells but the placenta

Question 26

A 28 year old male is unwell with a fever during a sperm count and it is noticed that his sperm count is low. When would we repeat the readings?

1. Give antibiotics, wait one hour and repeat
2. Repeat in 16 days
3. Repeat in 24 days
4. Repeat in 64 days

Repeat in 64 days

The correct answer is repeat in 64 days. A full cycle of spermatogenesis takes 64 days. Some things that can affect sperm count are being overweight, overheating of the testicles, fever, smoking, alcohol, stress, caffeine, medications and anabolic steroids

1 is incorrect as the sperm count wouldn’t change within the hour

2 is incorrect because 16 days into the sperm cycle is where we see primary spermatocytes

3 is incorrect because secondary spermatocytes are seen 24 days after the primary spermatocytes

Question 27

Which of these birth defects are likely to become apparent at 3-4 weeks of development?

1. Tetralogy of Fallot
2. Neurulation defects, anencephaly and spina bifida
3. Abnormal rotation of kidneys
4. Meckel’s diverticulum

Tetralogy of Fallot

The correct answer is Tetralogy of Fallot. heart defects can become apparent after 3-4 weeks of development

2 is incorrect because these defects are likely to be picked up at < 3 weeks of development

3 is incorrect because kidney defects become apparent at 6-10 weeks

4 is incorrect, GI abnormalities show at 4-10 weeks of development

Question 28

Select the correct order of the sexual response in males

1. Arousal, orgasm without refraction period, plateau, resolution
2. Arousal, plateau, orgasm with refraction period, resolution
3. Arousal, plateau, orgasm without refraction period, resolution
4. Resolution, orgasm with refraction period, plateau, arousal

Arousal, plateau, orgasm with refraction period, resolution

The correct answer is ‘Arousal, plateau, orgasm with refraction period, resolution ‘. The sexual response in males includes the refraction period, this is a period where the males cannot orgasm again.

1 is incorrect

2 is incorrect, this is the sexual response in women

3 is incorrect, this is the reverse of the sexual response

Question 29

What is the correct definition of stillbirth?

1. Death of those aged 1 and under
2. Death of a baby after 28 days of life and within 1 year of age
3. Death of a baby before or during birth after 24 weeks of gestation
4. The number of neonatal deaths per thousand births

Death of a baby before or during birth after 24 weeks of gestation

The correct answer is ‘ Death of a baby before or during birth after 24 weeks of gestation’. Death of a baby before or during birth after 24 weeks of gestation is the UK definition. (The WHO definition is >28 weeks)

Death of those aged 1 and under is incorrect. Death of those aged 1 and under is the definition of infant mortality

Death of a baby after 28 days of life and within 1 year of age is incorrect. Death of a baby after 28 days of life and within 1 year of age is the definition of post-neonatal death

The number of neonatal deaths per thousand births is incorrect. The number of neonatal deaths per thousand births is the neonatal death rate

Question 30

A 29-year-old woman has just given birth to her first child. Which of these structural changes will not occur during the puerperium?

1. The uterus shrinks from 1kg post-delivery to less than 60-80g in a few weeks
2. She will get red, brown and yellow discharge over this time
3. Her cervix will regain its circular shape
4. Her vagina will gradually regain its tone and return to a more normal capacity

Her cervix will regain its circular shape

The correct answer is ‘Her cervix will regain its circular shape.” the appearance of the external os is permanently elliptical after childbirth

1 is true

2 is true, this discharge is called lochia. It is red from day 5-7 (rubra), red/brown until day 10-14 (serosa) and yellow from day 14-21 (alba)

3 is true. The vagina is smooth, soft and oedematous in the first few days, then it regains its tone in the puerperium. After multiple births, the vagina is more capacious and the introitus is permanently larger than a nulliparous woman.