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MRCOG PART 2 SBAs and EMQs

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Week 18 - Postnatal care

Week 18 - Postnatal care Posted by PAUL A.

Question 1

With respect to the neonatal circulation in the period following birth

A.   Pulmonary artery vaso-constriction occurs

B.    Pulmonary artery vaso-dilatation occurs in response to a rise in PaCO2

C.    Pulmonary artery vaso-constriction occurs in response to a rise in PaO2

D.   There is a fall in PaCO2 and a rise in PaO2 in the pulmonary artery                

E.    There is a rise in PaCO2 and a fall in PaO2 in the pulmonary artery

 

Question 2

A.   With respect to the neonatal circulation in the first days of life

B.    Functional closure of the umbilical arteries occurs in 24 – 48 hours

C.    Obliteration of the umbilical arteries occurs within 7 days

D.   The distal part of the obliterated umbilical artery forms the lateral umbilical ligaments

E.    The proximal part of the obliterated umbilical artery forms the ligamentum teres

F.    The proximal portion of the umbilical artery forms the superior vesical artery        

 

Question 3

A.   With respect to the changes in the fetal circulation around the time of birth

B.    The umbilical vein closes before the umbilical arteries

C.    The ductus venosus closes before the umbilical arteries

D.   The obliterated umbilical vein forms the ligamentum teres                

E.    The obliterated ductus venosus forms the falciform ligament

F.    The ductus venosus closes 2-3 weeks after birth

 

Question 4

With respect to the fetal and neonatal circulations, which one does not contribute to keeping the ductus arteriosus open in-utero?

A.   Prostaglandin F

B.    Low calcium concentration

C.    High PaO2                              

D.   High pulmonary pressure

E.    Low glucose concentration

 

Question 5

A.   Closure of the ductus arteriosus following birth is dependent on

B.    Fall in PaO2

C.    Prostaglandin F

D.   Rise in pulmonary pressure

E.    Rise in PaO2                                       

F.    Fall in calcium concentration

 

 

Question 6

A.   Following birth, closure of the foramen ovale is dependent on

B.    A rise in pulmonary pressure

C.    A rise in right artrial pressure

D.   A fall in left atrial pressure

E.    A fall in right atrial pressure               

F.    Prostaglandin F

 

 

Question 7

Which nerve roots are damaged in Erb-Duchenne palsy?

C5 and C6                   

C8 and T1

C6 and C7

C5, C6 and C7

C3, C4 and C5

 

Question 8

A 23 year old woman has a vaginal birth complicated by shoulder dystocia. Three years later, the child is found to have an upper limb injury. The right upper limb is medially rotated and the forearm is pronated. There is sensory loss on the materal side of the arm. Which nerve roots have been injured? 

C5 and C6                   

C8 and T1

C6 and C7

C5, C6 and C7

C3, C4 and C5

 

Question 9

A 23 year old woman has a vaginal birth complicated by shoulder dystocia. Three years later, the child is found to have an upper limb injury. The right upper limb is described as being in a ‘waiter’s tip’ position. Which nerve roots have been injured? 

C5 and C6                   

C8 and T1

C6 and C7

C5, C6 and C7

C3, C4 and C5

 

Question 10

Which nerve roots are injured in Klumpke’s palsy?

C5 and C6      

C8 and T1                               

C6 and C7

C5, C6 and C7

C3, C4 and C5


 

Question 11

A 23 year old woman has a vaginal birth complicated by shoulder dystocia. Three years later, the child is found to have an upper limb injury resulting in a ‘claw hand’. Which nerve roots have been injured?  

C5 and C6      

C8 and T1                   

C6 and C7

C5, C6 and C7

C3, C4 and C5

 

Question 12

A.   Cephalohaematoma

B.    Typically crosses the midline

C.    Is a collection of blood beneath the scalp but above the periosteum

D.   Typically does not cross suture lines             

E.    Occurs in about 5% of vaginal births

F.    Typically resolves within 3-5 days

 

Question 13

Sub-gleal (sub-aponeurotic) haematoma

A.   Occurs in about 1% of vaginal births

B.    Occurs in about 1% of vaginal operative deliveries

C.    Typically does not cross the midline

D.   Typically does not cross suture lines

E.    Is associated with neonatal anaemia and shock                      

 


Question 14

Sub-arachnoid haemorrhage

A.   Is typically associated with a poor prognosis

B.    Typically does not cross suture lines

C.    Is almost always associated with neonatal seixures

D.   Typically occurs from small veins in the sub-arachnoid space                      

E.    Typically presents with neonatal jaundice

 

.

Question 15

Intra-ventricular haemorrhage

Occurs in about 2% of normal term neonates                 

 

Is associated with about 50% risk of cerebral palsy

 

Is one form of sub-arachnoid haemorrhage

 

Typically occurs as a result of tentorial tears

 

Occurs in about 20% of vaginal operative births

 

 

Question 16

 

Sub-dural haematomas

Are typically located beneath the periosteum

 

Typically have a good prognosis

 

Are associated with tentorial tears                 

 

Typically extend into the germinal matrix

 

Typically arise from bleeding veins within the sub-aracnoid space

 

 

Question 17

 

With respect to bilirubin metabolism in the neonate

 

Conjugated bilirubin is water insoluble

 

Bilirubin is transported in plasma bound to albumin                         

 

Conjugated bilirubin is broken down by the liver enzyme glucuronyl transferase

 

Unconjugated bilirubin does not cross the blood-brain barrier

 

Pre-term neonates have high glucuronyl transferase activity in their livers

 

 

 

Question 18

 

With respect to bilirubin metabolism and neonatal jaundice

 

Breastfeeding is associated with conjugated hyper-bilirubinaemia

 

Jaundice typically progresses from the neonates face to feet                                    

 

Jaundice typically occurs when serum bilirubin concentration is above 25 microM/L

 

Jaundice typically occurs when serum bilirubin concentration is above 250 microL/L

 

 

Question 19

 

Physiological neonatal jaundice

 

Is typically associated with conjugated hyper-bilirubinaemia

 

Typically peaks on day 3 in the term neonate                                   

 

Typically peaks on day 2 in the pre-term neonate

 

Is caused by high activity of hepatic glucuronyl transferase

 

Typically presents within 24 hours of birth

 

 

 

Question 20

 

Maternal treatment with which drug is not associated with an increased risk of neonatal jaundice?

 

Oxytocin

 

Salicylates

 

Corticosteroids

 

Diazepam

 

Low molecular weight heparin                        

Posted by Reena G.
1)-D 2)proximal portion of UA forms SVA 3)obliterated UV form ligament im teres 4)C 5)rise in Pa02 6)fall in rt atrial pressure 7)C5 C6 8)C5 C6 9)C5 C6 10) C8 T1 11)C8T1 12 does not cross suture line 13) E 14)D 15) occurs in 2% term neonates 16)associated with tectorial tears 17)bilirubin transported in plasma bound to albumin 18) typically progress from face to feet 19) typically peaks on day 3 in term neonates 20) LMWH
Posted by abdulnasir O.

D,F\E,D\C,C,E,E,A,B,A,B,B,D,E,D,A,C,B,B,B,E.

newborn Posted by rasheeda B.

1d )2f )3d ) 4c ) 5e) 6e) 7a) 8b) 9a) 10b) 11b) 12d)13e) 14c) 15c) 16e)17a) 18b(face to feet) 19b) 20e)

postnatal Posted by Hamdy H.

1-e 2-f 3-d 4-c 5-e 6-e 7=a 8=a 9-b 10-b

11- b 12-d 13-e 14d 15-a 16-c 17-b 18-b 19=b 20-a

Posted by Mobina C.

  1-D    2-F     3-D     4-C    5-E    6-E   7-A   8- A   9-A   10-B   11-B   12-F  13-E   14D  15-A  16-C   17-B   18-D  19-B  20-E

 

ANTI-D Posted by docvee V.

Dear Paul,

Please let me know:

Anti-D prophylaxis should be given for all  medical management of Miscarriage and ectopic before 12 weeks?

Both RCOG AND NICE recommendations are different.

 

ANSWERS Posted by PAUL A.

We are sorry the numbering of questions seems to have gone wrong as these questions were set on different software then combined.

 

Answers

 

1)   D

2)   E

3)   C

4)   C

5)   D

6)   D

7)   A

8)   A

9)   A

10)                  B

11)                  B

12)                  C

13)                  E

14)                  D

15)                  A

16)                  C

17)                  B

18)                  B

19)                  B

20)                  E

 

Posted by PAUL A.
ANTI-D Posted by docvee V.
Tue Feb 10, 2015 11:09 pm

Dear Paul,

Please let me know:

Anti-D prophylaxis should be given for all  medical management of Miscarriage and ectopic before 12 weeks?

Both RCOG AND NICE recommendations are different.

 

SUGGEST YOU USE RCOG AS THESE REMAIN ACTIVE AND HAVE NOT BEEN ARCHIVED.

 

Posted by Mobina C.

Hello Paul, 

Could u explain as my concepts are that 1-proximal portion of obliterated umblical arteries are sup vesical artery & obliterated distal part is medial umblical ligament. Closure of foramen ovale is due to rise in left atrial pressure & thats even the cause of PFO in adults ( rise in left atrial pressure cause a flap to wall against fO).

After birth , Its increase O2 which stimulate muscle contracetion leading closure of ductus arteriosus rather than rise in pulmonary pressure.

I really appreciate if u could clarify so that i can straigthen up my concepts.

Thank U