Physiology Test (Part 1)

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1) Regarding the use of Erythropoietin (recombinant human erythropoietin AKA rHuEPO) in pregnancy which of the following statements is correct ?

A) rHuEPO has been shown to be have adverse maternal effects when used antenatally

B) rHuEPO has been shown to be have adverse fetal effects when used antenatally

C) rHuEPO has been shown to be have adverse neonatal effects when used antenatally

D) The use of rHuEPO is only recommended for non‐end‐stage renal anaemia

E) None of the above

2) Which of the following statements regarding thyroid function testing in pregnancy is true?

A) TSH levels increase in pregnancy

B) TSH levels remain constant through the trimesters

C) Total T3 levels drop in pregnancy

D) Free T3 levels drop during pregnancy

E) Thyroid hormone binding globulin levels drop during pregnancy

3) Oxytocin causes increased myometrial contractions via which of the following messenger pathways?

A) Activates phospholipase‐C which produces IP3 which triggers intracellular Calcium ion release

B) Releases cAMP that triggers intracellular Calcium ion release

C) Releases protein kinase A that triggers intracellular Calcium ion release

D) Releases protein kinase A that triggers extracellular Calcium ion release

E) None of the above

4) Where in the kidney is the majority of Sodium and Glucose reabsorbed

A) Bowmans Capsule

B) Loop of Henle

C) Proximal Tubule

D) Distal Tuble

E) Collecting Duct

5) What percentage of haemoglobin is HbF in the newborn?

A) <0.5%

B) 1‐2%

C) 10‐20%

D) 25‐50%

E) 50‐90%

6) What is the average lifespan of a basophil (white blood cell)?

A) 3‐4 days

B) 10‐14 days

C) 30 days

D) 60 days

E) 120 days

7) Placental production of hPL, hCG, Oestragen and Progesterone are examples of which type of mechanism

A) Endocrine

B) Exocrine

C) Apocrine

D) Autocrine

E) Intracrine

8) A 52 year old patient attends clinic for the results of her bone density scan. Her T‐score is ‐2.2. She tells you she has previously fractured her 5th metatarsal and patella following a fall from a bike. You diagnose her as:

A) Normal bone density

B) Osteopenic

C) Severely Osteopenic

D) Osteoporosis

E) Severely Osteoporotic

9) According to the UK food standards agency which of the following RDIs (recommended daily intake) is 3 times higher in pregnancy than the non‐pregnant state?

A) Iron

B) Vitamin A

C) Folic Acid

D) Vitamin C

E) Vitamin D

10) During wound healing collagen alignment along tension lines is part of which phase?

A) Haemostasis

B) Inflammation

C) Granulation

D) Proliferation

E) Remodelling

11) During pregnancy the GFR changes as follows:

A) GFR remains the same

B) GFR decreases by 15%

C) GFR increases by 15%

D) GFR decreases by 40%

E) GFR increases by 40%

12) Pregnant patients are at higher risk of thromboembolism due to a hypercoaguable state. Which of the following clotting factors reduces during pregnancy?

A) Factor II

B) Factor VII

C) Fibrinogen

D) Factor X

E) Factor XI

13) A patient asks you how long it will be before her C‐section wound is "at full strength." What is the typical time taken for wounds closed by primary intention to reach full tensile strength?

A) 3 weeks

B) 6 weeks

C) 12 weeks

D) 24 weeks

E) 36 weeks

14) Dilatation of the uterine cervix at parturition is primarily achieved by:

A) Muscle relaxation under the influence of oestriol

B) Prostaglandin E1 mediated Interleukin release

C) Constriction of cervical small vessels

D) Macrophage mediated collagen degradation

E) Degradation of type I collagen by interstitial collagenase

15) In the earliest phase of wound healing platelets are held together by what?

A) Fibroblasts

B) Type 2 Collagen

C) Type 1 Collagen

D) PGE1

E) Fibrin

16) During wound healing the clotting cascade is activated. Which of the following activates the extrinsic pathway?

A) Damaged endothelium

B) Thromboxane A2

C) Prostaglandin E2

D) Tissue Factor

E) Fibrin

17) During wound healing the clotting cascade is activated. Which of the following activates the extrinsic pathway?

A) Shortening of the cervix

B) Dilatation of the cervix

C) Descent of the baby

D) Birth of the baby

E) Expulsion of the placenta and membranes

18) Which of the following tests is used to detect antibodies or complement bound to red blood cell antigens in vivo?

A) Direct Coombs

B) Indirect Coombs

C) Guthrie

D) Mantoux

E) Heaf

19) Where in the kidney is the majority of Bicarbonate reabsorbed

A) Bowmans Capsule

B) Proximal Convoluted Tubule

C) Descending Loop of Henle

D) Ascending Loop of Henle

E) Distal Convoluted Tubule

20) Which of the following is the primary stimulator of uterine involution following child birth??

A) Oxytocin

B) Prolactin

C) FSH

D) Progesterone

E) LH

21) At what gestational age does the luteo‐placental shift occur?

A) 1‐2 weeks

B) 6‐8 weeks

C) 18‐20 weeks

D) 24‐28 weeks

E) 32‐36 weeks

22) When using the MDRD formula to calculate GFR (Glomerular filtration rate) which of the following is not factored into the equation?

A) Creatinine

B) Urea

C) Sex

D) Age

E) Ethnic Background

23) Which structure is the primary mechanism for shunting blood away from the fetal pulmonary circulation?

A) Foramen Ovale

B) Ductus Arteriosis

C) Arteria Umbilicalis

D) Ductus Venosus

E) Umbilical Arteries

24) What is the typical oxygen consumption in a 75kg non‐pregnant women?

A) 5ml/min

B) 15ml/min

C) 50ml/min

D) 150ml/min

E) 250ml/min

25) Which of the following is a primary site of Prostaglandin E2 (PGE2) production?

A) Corpus Luteum

B) Ductus Venosus

C) Placenta

D) Hypothalamus

E) Maternal liver

26) Cardiac output is calculated by

A) End diastolic volume X End systolic volume

B) End diastolic volume ‐ End systolic volume

C) End diastolic volume X Stroke volume

D) Stroke Volume X Heart Rate

E) End Systolic Volume X Heart Rate

27) Following parturition uterine contractions called Afterpains may typically continue for how long?

A) 2‐3 hours

B) 12‐24 hours

C) 7‐14 days

D) 21‐28 days

E) None of the above

28) Which of the following is a potent stimulator of Aldosterone

A) Alkolosis

B) Acidosis

C) Hypokalaemia

D) Hyperkalaemia

E) Hypernatraemia

29) Where in the kidney is the majority of Bicarbonate reabsorbed

A) Bowmans Capsule

B) Proximal Convoluted Tubule

C) Loop of Henle

D) Distal Convoluted Tubule

E) Collecting Duct

30) Regarding heart rate in pregnancy which of the following statements is true?

A) Heart rate decreases by 15 beats per minute

B) Heart rate remains constant

C) Heart rate increases by 15 beats per minute

D) Heart rate increases by 25 beats per minute

E) None of the above

31) Regarding cardiac examination during pregnancy which of the following findings should be considered pathological

A) Diastolic murmur

B) T‐wave flattening in lead III on ECG

C) Systolic murmur

D) Left axis deviation on ECG

E) Third heart sound

32) During wound healing the clotting cascade is activated. Which of the following activates the intrinsic pathway?

A) Fibrin

B) Damaged endothelium

C) Tissue Factor

D) Thrombin

E) Prothrombin

33) What is the typical peak change in oxygen consumption in a pregnant vs a non‐pregnant women?

A) 5%

B) 20%

C) 60%

D) 100%

E) 120%

34) What is the primary form of haemoglobin in a 18 week old foetus?

A) Hb Gower 1

B) Hb Gower 2

C) Hb Portland 1

D) Hb Portland 2

E) HbF

35) Several mechanisms have been proposed as to what causes closure of the Ductus Arteriosus (DA) at Parturition. Which of the following is the most important in maintaining the patency of the DA during pregnancy?

A) Oxytocin

B) Progesterone and Oestragen

C) PGE2

D) PGE1

E) Prolactin

36) Which of the following lung function values is unchanged in pregnancy?

A) FRC

B) ERV

C) FEV1

D) Tidal Volume

E) ERV

37) During pregnancy which hormone(s) inhibit lactogenesis?

A) Prolactin

B) Oxytocin

C) Oestrogen and Progesterone

D) Prolactin and hPL (human Placental Lactogen)

E) Oxytocin and hPL

38) Regarding the closure of the ductus arteriosus (DA) after birth which of the following most accurately describes the mechanisms leading to closure of the DA?

A) Increased arterial pO2, decreased bradykinin & decreased Prostaglandin E2

B) Increased arterial pO2, decreased bradykinin & decreased Prostaglandin E1

C) Increased arterial pO2, increased bradykinin & decreased Prostaglandin E2

D) Increased arterial pO2, increased bradykinin & increased Prostaglandin E2

E) None of the above

39) Angiogenesis and collagen deposition are features of which stage of wound healing?

A) Haemostasis

B) Proliferation

C) Inflammation

D) Maturation

E) Remodelling

40) What is the typical volume increase from a non‐pregnant to term uterus?

A) 10ml to 5000ml

B) 100ml to 500ml

C) 1000ml to 5000ml

D) 10ml to 1000ml

E) 40ml to 1200ml

41) Lactogenesis at term is stimulated by which hormone?

A) Oxytocin

B) hPL

C) Progesterone

D) Prolactin

E) Dopamine

42) You review a patient who is 34 weeks pregnant. She complains of gradually worsening itching over the past 6 weeks particularly to the hands and feet which is worse at night. You order some bloods. Which of the following would you normally expect to increase in the 3rd trimester?

A) ALT

B) ALP

C) Bilirubin

D) Albumin

E) Calcium

43) What is the primary form of haemoglobin in a 6 week old foetus?

A) Hb Gower 1

B) Hb Gower 2

C) Hb Portland 1

D) Hb Portland 2

E) HbF

44) The amniotic fluid volume peaks at around 900ml. At what gestation does the amniotic fluid reach its maximum volume?

A) 28 weeks

B) 32 weeks

C) 35 weeks

D) 38 weeks

E) 40 weeks

45) At what gestation does the fetus typically start swallowing?

A) 6 weeks

B) 12 weeks

C) 18 weeks

D) 24 weeks

E) 32 weeks

46) In the 3rd trimester anaemia is defined by?

A) Haemoglobin < 90 g/l

B) Haemoglobin < 105 g/l

C) Haemoglobin < 110 g/l

D) Haemoglobin < 115 g/l

E) Haemoglobin < 130 g/l

47) Which of the following hormones inhibits Galactopoiesis and Lactogenesis postpartum?

A) Oxytocin

B) Progesterone

C) Dopamine

D) hPL

E) Prolactin

48) Regarding blood volume in pregnancy which of the following statements is TRUE?

A) Blood volume remains constant

B) Blood Volume increases by approximately 5%

C) Blood Volume increases by approximately 10‐15%

D) Blood Volume increases by approximately 20‐25%

E) Blood Volume slowly increases by 40‐50%

49) You review a 58 year old patient in clinic. She asks what the results of her recent DEXA scan are. You note her hip BMD hip T‐score is ‐1.4. You note she has a history of olecranon fracture 4 years ago. What is her classification according to WHO criteria?

A) Normal bone density

B) Osteopenia

C) Severe Osteopenia

D) Osteoporosis

E) Severe Osteoporosis

50) What is the typical weight of a non‐pregnant premenopausal uterus?

A) 40g

B) 200g

C) 400g

D) 800g

E) 1200g

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