Clinical Sciences 1

Question: 1 of 9
Theme:Timing of events of a typical menstrual cycle.
A Day 1
B Day 1 - 5
C Day 5 - 14
D Day 14
E Day 14 - 25
F Day 25 - 28
G Day 28
In a female with a 28 day menstrual cycle, choose the most appropriate time period for the following uterine
and hormonal events:
Degeneration of the endometrium resulting in menstrual flow
Incorrect - The correct answer is Day 1 - 5
Regeneration of the endometrium
Incorrect - The correct answer is Day 5 - 14
Endometrial glands cells develop secretory vacuoles and expel their contents into the gland lumen
Incorrect - The correct answer is Day 14 - 25
Ovulation
Incorrect - The correct answer is Day 14
LH, FSH and oestrogen have reached their maximal levels
Incorrect - The correct answer is Day 14
Progesterone levels increase, peak then decrease
Incorrect - The correct answer is Day 14 - 25
The menstrual phase is the period of menstruation, which typically lasts three to five days.
The proliferative phase lasts for 10 days between the menstrual phase and ovulation. Ovulation occurs half
way through the cycle.
A surge in luteinising hormone (LH) around 18 hours before ovulation induces ovulation. The hormonal
levels are thought to peak just before ovulation due to a small rise in oestrogen two days prior which causes a
positive-feedback effect on the pituitary.
The secretory phase occurs in response to the progesterone secreted by the corpus luteum.

Clinical Sciences 2

The premenstrual phase follows the secretory phase. Progesterone levels increase during the secretory phase
due to the development of the corpus luteum.

Question: 2 of 9
Are the following statements about the physiology of the fetus in utero correct?
Amniotic fluid is swallowed

Correct

Blood passes through the foramen ovale from right to left atrium

Correct

Breathing movements are detectable

Correct

The ductus venosus carries de-oxygenated blood to the inferior vena cava

Incorrect answer selected

The mean haemoglobin concentration is 18 g/dl

Correct

The fetal circulation is designed such that oxygenated blood from the umbilical vein is directed via the ductus
venosus to the inferior vena cava and via the foramen ovale to the left side of the heart and then to the head
and neck of the fetus.
The less well oxygenated blood from the superior vena cava enters the right ventricle and then enters the aorta
via the ductus arteriosus distal to the left subclavian artery. The less well oxygenated blood is therefore
diverted to the trunk and lower body of the fetus. Fetal haemoglobin concentration is high (17- 19g/dl).
Amniotic fluid cushions and protects the baby and provides it with fluids. By the second trimester, the baby is
able to breathe the fluid into his lungs and to swallow it, promoting normal growth and development of the
lungs and gastrointestinal system.

Question: 3 of 9
Is it true that the following are characteristic features of malignancy?
Abnormal mitoses

Correct

Anaplasia

Correct

Increased fibrous stroma

Incorrect answer selected

Invasiveness

Correct

Reactive hyperplasia in regional lymph nodes

Incorrect answer selected

Features of malignancy include

Invasiveness
Anaplasia (different appearance from parent tissue)
Numerous and abnormal mitoses
Invasiveness and abnormalities of the cytostructure.

Fibrous stroma would not be charcaterisitc and reaction of lymph nodes suggests infection.

Clinical Sciences 3

Question: 4 of 9
Is it true that immunological function is characteristically suppressed in the following?
By antimetabolites

Correct

By corticosteroids

Correct

By ionising radiations

Correct

In anaemia

Incorrect answer selected

In the presence of a low platelet count in the blood Incorrect answer selected
Immune function is suppressed by

Steroids
Antiproliferative agents (affect white cell generation)
Ionising radiation
Fulminant sepsis
Tumours (leukaemia but other solid cancers too)
Malnutrition deficiency.

Neither anaemia nor thrombocytopenia has any effect on immune function.

Question: 5 of 9
May wound healing be delayed by the following?
Excessive methionine in the diet
Excessive zinc in the diet

Incorrect answer selected

High doses of corticosteroids

Correct

Low temperatures

Correct

Vitamin C (ascorbic acid) deficiency

Correct

Wound healing is delayed in

Incorrect answer selected

Zinc deficiency
Methionine deficiency
Vitamin C deficiency (scurvy)
Hypothermia
Diabetes
Malnutrition
Cushing's sundrome.

Clinical Sciences 4

Question: 6 of 9
Are the following true regarding perinatal mortality?
Is approximately 8/1000.

Correct

Is mostly due to congenital abnormality

Incorrect answer selected

Is related to social class

Correct

Is similar across ethnic groups

Incorrect answer selected
Rate is defined as stillbirths and deaths within the first week of life per 1,000 births after 28 weeks
gestation
Incorrect answer selected
Perinatal mortality is the sum of stillbirths and neonatal deaths in the first week of life per 1,000 births after
24 weeks gestation.
The national figure is about 8 per 1,000. and varies markedly by social class with the highest rates seen in
Asian women.
Other factors that may contribute include

General health
Increasing maternal age
Socio-economic status
Uptake of antenatal care.

Question: 7 of 9
Are the following statements concerning occipito-posterior position of the fetal head correct?
10% of women enter labour with an occipito-posterior position

Correct

An anthropoid pelvis is a recognised predisposing factor

Correct

It is a cause of non-engagement of the head in late pregnancy

Incorrect answer selected

Occipito-frontal is likely to be the presenting diameter

Correct

The posterior fontanelle is easily palpable during labour

Correct

Occipito-posterior position is the most common malposition and occurs in 13% of vertex presentations.
Most fetuses in this position rotate spontaneously after striking the pelvic floor. Approximately 10% of
labours begin this way.
With an anthropoid pelvis, the fetal head usually engages in an occipito-posterior position because there is
more space in the posterior pelvis.
Postulated causes include

A pendulous abdomen
Anthropoid or android pelvic brim

Clinical Sciences 5

A flat sacrum with a poorly flexed head and

The placenta lying on the anterior uterine wall.

On vaginal examination, the presenting part is usually the vertex.

However, with incomplete flexion of the fetal head, the anterior fontanelle is readily felt in the anterior part of
the pelvis.
The posterior fontanelle is not readily felt till the head is in the lower pelvic cavity.
The occipitofrontal diameter is usually the presenting diameter.

Question: 8 of 9
Is it true that hypoglycaemia in the newborn is a recognised feature of the following?
Infants born of diabetic mothers

Correct

Intracranial injury

Incorrect answer selected

Intrauterine growth retardation

Correct

Prematurity

Correct

Ventouse delivery

Incorrect answer selected

Hypoglycaemia of the newborn is defined as a blood glucose level of less than 2.5 mmol per litre.
It occurs in 0.4% of all births, but is much more common in infants of diabetic mothers (previously diagnosed
diabetics or gestational diabetics) and in low birth weight and premature infants.
Symptoms include

Jitteriness
Irritability
Apnoea
Cyanosis
Hypotonia
Poor feeding
Convulsions.

It is not a recognised feature of ventouse delivery and intracranial injury; however, abnormally low levels can
cause an encephalopathy and have the potential to produce long term neurological injury.

Clinical Sciences 6

Question: 9 of 9
The following blood gases are obtained from a woman as part of her pre-operative assessment for
transabdominal hysterectomy and oophorectomy (normal values in brackets).
7.35
(7.36-7.44)
pH
7.3 kPa
(4.7-6.0)
pCO2
7.9 kPa
(11.3-12.6)
pO2
Standard bicarbonate 35 mmol/l (20-28)
+4.6 mmol/l (-2 to +2)
Base excess
Which of the following statements are correct interpretations for this patient's biochemistry?
She does not require a HDU bed post-operatively

Incorrect answer selected

She does not require any further investigations pre-operatively

Incorrect answer selected

There is a respiratory acidosis

Correct

There is renal compensation with excretion of bicarbonate

Incorrect answer selected

This patient has type II respiratory failure

Correct

The pH is low with a high pCO2 indicating respiratory acidosis.

There is renal compensation as evidenced by the retention of bicarbonate.
She has a low pO2 and high pCO2 as seen in type II respiratory failure. Type I respiratory failure occurs with
low O2 and normal CO2.
This patient has significant chest disease and would require lung function tests and a chest x ray if she has not
had one in the previous six months.
She would require at least an HDU bed as she is at high risk of post-operative respiratory complication.