Case 14 Questions 31-44

Question 31

When does the fetus produce enough surfactant to be able to breathe on their own?

1. 24 weeks
2. 28 weeks
3. 34 weeks
4. 40 weeks

34 weeks

The correct answer is 3. they produce enough surfactant to be able to breathe on their own at 34 weeks. 1 and 2 are incorrect because surfactant usually starts to be produced between 24 and 28 weeks 4 is incorrect.

Question 32

Which of these statements best describe the development of physiological jaundice?

1. Physiological jaundice tends to appear at around 24hrs and resolves by 2 weeks of age
2. Tends to be less common in breastfed infants
3. Treated using blue light phototherapy which converts conjugated bilirubin into a soluble form which can be excreted
4. 40% of all new-born babies become visible jaundiced

Physiological jaundice tends to appear at around 24hrs and resolves by 2 weeks of age

The correct answer is 1. if the jaundice is outside of this timeframe, expect it to be pathological jaundice.

2 is incorrect. It is more common in breastfed infants due to change in nutrition

3 is partially correct – it can be treated by blue light therapy, but this is because it converts insoluble unconjugated bilirubin into the soluble form which can be excreted in the urine.

4 is not the best answer here as over 50% of all new-born babies become visibly jaundiced

Question 33

Which stage of milk production involves the production of colostrum?

1. Mammogenesis
2. Lactogenesis secondary differentiation
3. Galactogenesis
4. Lactogenesis secondary activation

Lactogenesis secondary differentiation

The correct answer is 2. The two stages of lactogenesis occur at the last two weeks of pregnancy. During secondary differentiation glands become differentiated enough to secrete colostrum, which is triggered by the reduction in oestrogen

1 is incorrect. In mammogenesis, the ductal systems grow, fat storage increases, and there are an increased number of alveolar cells.

3 is incorrect, Galactogenesis involves the maintenance of milk secretion, from 9 days following birth to involution.

4 is incorrect. During this phase, there is the onset of mature milk secretion, this occurs 3-8 days after birth and it is triggered by a reduction of progesterone.

Question 34

A 25 year old woman attends a meeting with her midwife, they discuss the benefits of breastfeeding. Which of these is not a benefit of breastfeeding?

1. Exclusive breastfeeding for at least 3 months lowers the incidence and severity of gastroenteritis, ear infection and respiratory infection.
2. Lower risk of infant developing obesity and cardiovascular risk factors such as hypertension and insulin resistance
3. Decreased risk of breast cancer for the mother
4. Prolactin heightens responsiveness and receptivity towards the infant

Prolactin heightens responsiveness and receptivity towards the infant

The correct answer is 4. The benefit described comes from oxytocin, prolactin increases feelings of relaxation and euphoria

1, 2 and 3 are true benefits

Question 35

Which of these symptoms could indicate the perimenopause?

1. Complete cessation of periods
2. Complete infertility
3. Nausea and vomiting
4. Reduced sex drive
5. Changes in bowel habit

Reduced sex drive

1 and 2 are symptoms of the menopause, as you still have some periods and it is still possible to get pregnant.

3 and 5 are not recognised common symptoms of the perimenopause, and are more likely to be side effects of treatment with HRT

Question 36

Which of the following side effects of oral HRT is most common?

1. Anxiety
2. Hypertension
3. Breast pain
4. Headache
5. Back pain

Headache

The correct answer is 4! The most common side effects, as noted by the BNF, are headache, and menstrual cycle irregularities. 1 and 2 are both rare or uncommon side effects, and 3 and 5 are more common with vaginal application of HRT, and are uncommon in oral use.

Question 37

Which of the following is a concern in patients and should be screened for in menopausal women?

1. Osteoporosis
2. Diabetes
3. IBS
4. Multiple sclerosis
5. Psychosis

Osteoporosis

The correct answer is 1! Patients who are going through the menopause can sometimes develop osteoporosis, leading to fragility fractures. Other complications that may be of concern are… Slowed metabolism, Mood changes, Cataracts, Urinary incontinence, Painful intercourse, Periodontal disease,

Question 38

Which of the following is not tested for in the newborn blood spot screening program?

1. Cystic Fibrosis
2. Maple Syrup Urine Disease
3. Sickle Cell Disease
4. Downs Syndrome
5. Phenylketonuria

Downs Syndrome

The correct answer is 4! Downs syndrome cannot be tested for in the newborn blood spot screening program, also known as the heel prick test. The other four answers are some of the nine diseases checked for in the heel prick test.

Question 39

Select the answer which best describes what happens at a 6 week baby check.

1. Checking the baby’s wellbeing, and performing a heel prick test
2. Checking the mothers wellbeing and mental health, and whether they require contraception, or have started their period
3. Blood tests for the mother and baby
4. Checking the stitching of the mother
5. Screening the baby for any congenital abnormalities

Checking the mother’s wellbeing and mental health, and whether they require contraception, or have started their period

The correct answer is 2! The 6-week postnatal check is more based on the mother and her wellbeing unless the baby is known to be unwell. This includes checking the scars, asking about periods, mental health, contraception, and concerns about weight gain or loss.

Answer 1 is in part correct, as questions about the baby will be asked, but the heel prick is not performed at 6 weeks, but rather at birth. Answer 3 is incorrect, as no blood tests are performed routinely. Answer 4 is correct, but not the most correct, as this is not the primary objective. Answer 5 is also usually done much sooner.

Question 40

At what point should assessment of fertility occur?

1. After 6 months of unprotected sex without pregnancy
2. After 2 years of unprotected sex without pregnancy
3. Whenever patients present with concerns
4. After a year and a half of unprotected sex without pregnancy
5. After a year of unprotected sex without pregnancy

After a year of unprotected sex without pregnancy

The correct answer is 5! After a year of no pregnancy whilst performing unprotected sex each month, there may well be fertility problems, since 84% of couples can conceive within a year. All the other answers with regards to time are either too early to tell or take too long to start the process. Question 3 is incorrect, as we do not know whether their concerns are founded or not. The first course of action would be to work out what their concerns were, and help them to keep trying.

Question 41

Select the correct first line check for male fertility:

1. Semen analysis
2. Microbiology tests
3. Sperm culture
4. Endocrine tests
5. Testicular biopsy

Semen analysis

The correct answer is 1! The first-line test for sub-fertility is a semen analysis, to check how well the sperm works, what proportion works, and how much there is. The rest of the options are done as secondary care investigations.

Question 42

Select the correct first line check for female fertility:

1. Hysterosalpingography
2. Confirming ovulation via mid-luteal progesterone levels
3. Diagnostic laparoscopy
4. Ovary biopsy
5. Ultrasound pelvis

Confirming ovulation via mid-luteal progesterone levels

The correct answer is 2! The first-line test for sub-fertility in females is to confirm ovulation. If this is fine, then further tests are done, such as a hysterosalpingography, or a diagnostic laparoscopy if there are comorbidities. The other two answers are both incorrect, or not specific enough.

Question 43

Which of the following is most commonly a cause of infertility women?

1. Smoking
2. Endometriosis
3. An ovulation disorder
4. Tube damage due to ectopic pregnancy
5. Chemotherapy

An ovulation disorder

The correct answer is 3! The two most common causes of infertility in women are tied between unexplained, or ovulatory disorders, i.e. Problems with the HPG axis. This is followed by tubal damage, such as that caused in ectopic pregnancy, uterine or peritoneal disorders, such as endometriosis, PID or fibroids, which is then followed by other causes like drugs, lifestyle factors, or stress.

Question 44

Which of the following statistics is accurate regarding fertility?

1. 10% of women and 4% of men have issues with fertility.
2. 20 – 37% of couples under 30 are able to conceive in the first 3 months.
3. 30% of cases of male fertility are of unknown cause.
4. 5% of men have a complete lack of sperm.
5. In 50% of couples with infertility, there are issues with both the male and the female.

20 – 37% of couples under 30 are able to conceive in the first 3 months.

The correct answer is 2! This is a correct statistic, see here: https://www.nichd.nih.gov/health/topics/menshealth/conditioninfo/infertility

Answer 1 is incorrect, as the statistic is 9% of men and 11% of women, in the US.

Answer 3 is incorrect, as it is in 50% of cases that the cause is unknown in males.

Answer 4 is incorrect, as the statistic is 10 – 20% of infertile men have a complete lack of sperm.

Answer 5 is incorrect, as the number is actually 35%. Additionally, in 8% of cases, the male is the only problem found.