Arch Pregnancy exam answers

Question 1

What do you measure in a pregnancy test and what secretes it

Answer 1

B-HCG – initially secreted by syncytiotrophoblasts and then after 10 weeks it is the placenta

Question 2

What causes localised sharp groin pain in pregnancy

Answer 2

Stretching of the round ligament 🡪 Round ligament stretch pain → genital branch of genitofemoral nerve

Question 3

Difference between subfertility and infertility

Answer 3

Question 4

What are 3 causes of Infertility in females

Answer 4

Turner’s syndrome, STI’s, fallopian tube damage, early-menopause, Anorexia,

Question 5

Table with 3 parameters you would test for in pregnancy and the reason behind testing for it

Answer 5

BP 🡪 to monitor for pre-eclampsia

BGL 🡪 gestational diabetes

Urine analyses 🡪 proteinuria 🡪 pre-eclampsia

Hb + platelets + elevated LFTs 🡪 HELLP Syndrome

Question 6

In Down’s Syndrome, identify two common recurrent problems and their clinical

features

Answer 6

chromosomal abnormality or Robertsonian translocation 🡪 trisomy 21 🡪 Congenital heart defects (AV canal, VSD, PDA) + congenital GI tract malformation (Hirschsprung’s, duodenal stenosis/atresia, imperforate anus)

Upward slanting eye lids (palpebral fissures) Unusually shaped or small ears. Poor muscle tone. Broad, short hands with a single crease in the palm.

Most children with Down syndrome have mild to moderate cognitive impairment. Language is delayed, and both short and long-term memory is affected.

Question 7

List two other trisomy conditions tested for in maternal screening (2)

Answer 7

Patau’s Trisomy 13 and Edwards Trisomy 18

Question 8

Explain how trisomy occurs. What is the most common way in which it occurs. Use a diagram if necessary (5)

Answer 8

Most common way is non-disjunction 🡪 homologous chromosome or sister chromatids fail to separate properly during cell division (can be during meiosis 1 of oogenesis or meiosis II or spermatogenesis) 🡪 additional copy of chromosome in the child’s cells.

Less common is Robertsonian translocation 🡪 rearrangement between non-homologous acrocentric chromosome -> balanced translocation in asymptomatic parent 🡪 unbalanced in gamete 🡪 fixed copy of additional chromosome 🡪 trisomy

Question 9

What is the single most common risk factor for trisomies

Answer 9

Advanced maternal age

Question 10

How do autoimmune disorders such as SLE increase risk of miscarriages (2 marks)

Answer 10

Women with lupus are at higher risk for miscarriage and other complications during pregnancy. This is partly because lupus can cause health problems, such as kidney disease, high blood pressure and antiphospholipid antibodies (like lupus anticoagulants) that may increase the risk of a pregnancy loss.

Question 11

What are two pre-natal screening tests and what they are looking for (4 marks)

Answer 11

1. Blood type- Determines whether Rh positive or negative. Rh factor is a protein marker in the red blood cells. If mother is Rh negative and baby is Rh positive, maternal antibodies against Rh factor. This can cause problems with subsequent pregnancies.
2. NON-INVASIVE PRENATAL TESTING (NIPT)- common genetic abnormalities (Trisomy 21, 13, and 18)

Question 12

Why does pregnant lady with SLE need pre-natal screening?

Answer 12

To test for congenital issues + neonatal lupus so treatment can start before or at birth

Question 13

She has groin pain, what is the likely cause? (2 marks)

Answer 13

Round ligament stretch pain → genital branch of genitofemoral nerve

Question 14

What are 4 physiological changes that occur in women during pregnancy

Answer 14

Question 15

1. What are 3 mechanisms of the combined oral contraceptive

Answer 15

ethinyl estradiol suppresses FSH (inhibits ovulation and follicular development) and stabilises endometrium

levonorgestrel supresses LH, cause endometrial atrophy and thicken cervical mucus

Question 16

3 major physiological events that precede menarche

Answer 16

growth spurt, breast budding (thelarche) then the arrival of pubic hair growth (pubarche) and then lastly the onset of menses

Question 17

4 Combined pill risks that you would discuss with patient before starting contraception

Answer 17

Contraindications for COC

• Family History of breast cancer
• haemophilia/clotting disorders
• history of VTE
• smoker

COC use has been associated with increased risks of hypertension, myocardial infarction, and stroke in certain populations. Increased risk of breast cancer

Question 18

What are 4 risk factors for ectopic pregnancy, how do they exert their effects

Answer 18

• smoking – diminishes ciliary activity
• tubal pathology or tubal surgery
• pelvic inflammatory disease
• previous ectopic pregnancy

implantation of the blastocyst outside the uterus can result in miscarriage if there is not adequate blood supply or the embryo can begin to grow into the new location often causing bleeding/haemorrhage and pain

Question 19

What are two symptoms you would prescribe the combined OCP for and what is the mechanism of action behind this prescription?

Answer 19

can improve acne and dysmenorrhea, predictable bleeds,

Question 20

2 effects of ethanol on growing fetus

Answer 20

Alcohol use when pregnant can cause a range of lifelong physical, mental and behavioural disabilities, known as Fetal Alcohol Spectrum Disorders (FASD). Alcohol exposure can also cause miscarriage, stillbirth, premature birth, and low birth weight

Question 21

• BDNF and its effects Female Reproductive:

Answer 21

Brain-derived neurotrophic factor (BDNF) is expressed extensively in the mammalian female reproductive system and has been implicated in the development of follicles and oocytes.

Lower BDNF in late pregnancy leading to higher depressive symptoms.

Question 22

What are two common precursors to progesterone & oestrogen?

Answer 22

Cholesterol and pregnelone

Question 23

Sister had pain since menarche, what would this be classified as?

Answer 23

Period pain from your first period or shortly after, and without a specific cause, is known as primary dysmenorrhoea. Period pain caused by certain reproductive disorders, such as endometriosis, adenomyosis or fibroids, is known as secondary dysmenorrhoea.

Question 24

How is endometriosis classified in pelvic pain?

Answer 24

persistent pelvic pain = at least 3 months of pain from pelvic organs/structures which is often associated with negative behavioural, sexual and emotional consequences

often causes depression and anxiety due to sensitive nature of pelvic structures

causes may include endometriosis, IBS, fibromyalgia, interstitial cystitis

neurobiological mechanisms involved may cause pain to spread between structures and for pain pathways to be activated inappropriately

Question 25

Why is there more pain in endometriosis during menstruation?

Answer 25

Endometriosis 🡪 endometrial tissue found outside the uterus 🡪 oestrogen and progesterone release from ovary causes monthly build up of endometrial tissue 🡪 monthly progesterone withdrawal cause subsequent sloughing but in extra-uterine endometrial tissue cannot evacuate implantation site 🡪 local inflammation (release of pro-inflammatory chemicals) 🡪 activation of nociceptors at area of ectopic endometrium 🡪 cyclical menstrual pain.

Question 26

How do PG cause pain & other menstrual symptoms?

Answer 26

During your period, prostaglandins trigger muscles in your uterus to contract. These contractions help expel the uterus lining. Higher levels of prostaglandins can cause more severe menstrual cramps, and severe contractions may constrict the blood vessels around the uterus.

Question 27

2 symptoms of pelvic pain

Answer 27