RDA

Question 1

What is the most important use of ultrasound?

a) Provides an accurate determination of gestational age
b) Assess overall fetal well-being
C) Measure fetal abdominal circumference accurately
D) Measurement of fetal head circumference accurately

Answer 1

b) Assess overall fetal well-being

The MOST IMPORTANT outcome is the overall assessment of the fetus and well-being, rather than any one measurement.

Question 2

Low Birth Weight (LBW) refers to infants that are:

a) Below the 10th centile
b) Below the 3rd centile
c) Less than 1500 grams
d) Less than 2500 grams

Answer 2

d) Less than 2500 grams

LBW is a measure of size only; does not consider centile information at all, so of limited use. VLBW less than 1,500g.
Also does not take account of gestational age.

Question 3

Which of the following are most important for fetal weight gain?

a) Amino acids
b) Glucose
c) Minerals
d) Vitamins

Answer 3

b) Glucose

All of the above are needed for infant development, but glucose provides the most energy of those listed. Lipids may be of importance, but not in the list!

Question 4

Centile charts are useful because:

a) They automatically compensate for genetic variability
b) The normality of fetal size can be confirmed
c) Serial measurements can be plotted
d) The impact of pathologies is included

Answer 4

c) Serial measurements can be plotted

Centile charts cannot do any of the others, as they are based on the overall population, and cannot address the other aspects. Genetic contribution is not compensated.

Question 5

Which of the following mainly affects fetal growth?

a) Maternal drug use
b) Maternal pathogens
c) Maternal alcohol consumption
d) Maternal malnutrition

Answer 5

d) Maternal malnutrition

Point here is fetal growth; fetal development more likely to be affected by the others listed.

Question 6

A study includes 200 normal babies. How many of these babies would be expected to have weights below the tenth centile?

a) 20
b) 50
c) 10
d) none

Answer 6

a) 20

10% of any normal population will be below the 10th centile, and 10% of 200 is 20.

Question 7

Comparing first and second pregnancies with the same parents:

a) The second baby is likely to be lighter
b) The second baby is likely to be heavier
c) There is usually no difference in size
d) The second baby is likely to be shorter

Answer 7

b) The second baby is likely to be heavier

This is the data observed in large population studies; individual differences may be greater than this, so all may be observed in a family.

Question 8

Fetal growth velocity is greatest at which gestational age?

a) Late first trimester
b) Mid second trimester
c) Mid third trimester
d) Just before delivery

Answer 8

c) Mid third trimester

The rate of growth (velocity) tends to fall towards the end of pregnancy. Fetal weight may increase rapidly in early pregnancy, but actual velocity (e.g. grams/week) is greater in the 3rd trimester.

Question 9

Which of the following are included in the generally accepted definition of pre-eclampsia?

a) Maternal oedema
b) Maternal seizures
c) Fetal distress
d) Maternal proteinuria

Answer 9

d) Maternal proteinuria

Only D is part of the general definition. A is observed, but not now part of the definition; seizures define Eclampsia, and fetal distress may be observed in late pregnancy.

Question 10

What is the preferred method for measuring fetal growth, if ultrasound is not available?

a) Determine symphysis-fundal height
b) Measurement of maternal weight gain
c) Palpation of the uterus
d) Determination of the maternal abdominal circumference

Answer 10

a) Determine symphysis-fundal height

There are no accurate methods for this – A is simple and has been used before ultrasound, but will only detect gross changes. Palpation is the method to be used, not the actual measurement. The others do not give enough information.

Question 11

What is the significance of ‘limit’ ages in child development?

a) Has no signifiance to child development
b) Average age a developmental milestone is achieved
c) Upper age by which a developmental milestone should be achieved
d) Minimum age at which a developmental milestone should be achieved

Answer 11

c) Upper age by which a developmental milestone should be achieved

Limit ages are the age by which a developmental milestone should have been achieved = 2 standard deviations from the mean. They indicate cause of major concern. Examples of Red flags that require urgent onwards referral to paediatrics is a child who is not able to sit unsupported by 12 months or any child that has no speech by 18 months (urgent hearing test also).

Question 12

How is obesity defined in children?

a) Obesity is assessed on the BMI centile position
b) Obesity is defined differently depending on the culture the child is from
c) Same as adults - BMI of over 25 kg/m2 is overweight and over 30 kg/m2 is obese.
d) There is no universally accepted definition for obesity in children

Answer 12

a) Obesity is assessed on the BMI centile position

Children have lower BMI than adults.
This changes with age so these figures do not apply.
Obesity is assessed on the BMI centile position.
Some nations have a much higher rate of obesity than others.
In some cultures being overweight is seen as a desirable feature indicating wealth and high status.

Question 13

When a child is 2 years old, what key milestone would a child be expected to reach?

a) Copy a circle
b) Stand briefly on one foot
c) Join 2-3 words when talking
d) Use 6-12 words

Answer 13

c) Join 2-3 words when talking

By 2 years old, a child would be expected to join 2-3 words when talking, know some body parts and identify objects in pictures regarding their speech and language development. In addition, they would be expected to possibly kick a ball, climb stairs 2 feet per step regarding gross motor. With respect of fine motor, they would be able to build a tower 6-7 cubes and do circular scribbles. With social development they should be able to remove some clothes.

Question 14

Is there any difference between height velocity and cumulative growth?

a) Cumulative growth is the height velocity at one age minus the height velocity at another age
b) There is no difference between height velocity and cumulative growth
c) Height velocity is the total growth at any given point and cumulative growth is how fast a child is growing in cm per year
d) Height velocity is how fast a child is growing in cm per year. Cumulative growth is the total growth at any given point

Answer 14

d) Height velocity is how fast a child is growing in cm per year. Cumulative growth is the total growth at any given point

Centile charts we use are for cumulative height- how tall the child is now.
Height velocity is how fast a child is growing in cm per year, usually this is calculated over a whole year.
Most short children are growing at a completely normal speed.
Other useful information when assessing growth is the height of family members- parents and siblings.
Ideally measure them yourself because people can be very inaccurate in assessing their own height.

Question 15

Growth hormone is released by the pituitary. Which hormones are directly involved in stimulation and suppression?

a) Somatostatin stimulates secretion and growth hormone releasing hormone suppresses secretion
b) Growth hormone releasing hormone stimulates secretion and somatostatin suppresses secretion
c) Insulin like growth factor stimulates and suppresses directly
d) No hormones are directly are directly involved in the stimulation and secretion of growth hormone

Answer 15

b) Growth hormone releasing hormone stimulates secretion and somatostatin suppresses secretion

Growth hormone (GH) is the most important hormonal factor in growth.
Hypothalamus secretes growth hormone releasing hormone (GHRH) which stimulates secretion of growth hormone from pituitary. Somatostatin is produced by the hypothalamus and inhibits secretion of growth hormone from hypothalamus.
GH is released by the pituitary as pulses most of which occur overnight.
GH has some growth effect itself and also stimulates the release of IGF1 (insulin like growth factor 1).
IGF 1 circulates bound to a number of binding proteins and stimulates growth in all the tissues of the body.

Question 16

At 12 months what gross motor milestone would you expect most children to reach?

a) Independent walking alone
b) Kicks a ball
c) Runs
d) Pulls to stand

Answer 16

d) Pulls to stand

At 12 months, we would expect most children to pull to stand. Some may stand alone, or possibly cruise or possibly even walk alone briefly. With fine motor skills, we would expect children to put blocks in a cup. Language skills that would be emerging are saying 1-2 words and imitating adult sounds. Social milestone expected would be to drink from a cup and have object permanence (understanding objects are there even when out of sight). At 18 months, we would expect a child to run and by 2 to kick a ball.

Question 17

What is the initial clinical approach to an 18 month child whose parent is concerned about their child’s development?

a) Physical examination
b) Thorough history
c) Metabolic blood tests
d) Paediatric referral

Answer 17

b) Thorough history

It is paramount a history is taken from the parent, and any collateral history they may also have i.e. nursery. It is important to understand what aspect of development they are concerned with or if the concern is global developmental delay. In addition, an understanding of their vision and hearing is also important. Of course A, C, D may also happen after.

Question 18

Which of the options is a cause of abnormal growth resulting in short stature?

a) Marfan syndrome
b) Obesity
c) Chronic disease e.g. Coeliac disease
d) Hyperthyroidism

Answer 18

c) Chronic disease e.g. Coeliac disease

Commonest concern about growth is short stature.
Majority of short children have a normal growth pattern, and do not have anything wrong with them.
If a child grows slower than normal over a significant period of time they will fall in their centile position. This is abnormal and a cause should be looked for:
• Poor nutrition • Chronic disease • Endocrine causes- GH deficiency, thyroid hormone deficiency • Genetic disorders affecting bone growth (e.g achondroplasia, Turner syndrome, Down syndrome). • Psychological distress and neglect.

Question 19

In precocious puberty, growth spurt occurs very early, how do these children usually present?

a) Tall stature with early physical signs of puberty
b) Short stature with physical signs of puberty
c) Tall stature with no physical signs of puberty
d) Average stature with physical signs of puberty

Answer 19

a) Tall stature with early physical signs of puberty

Tall stature is a very unusual concern.
Most tall children have a normal growth pattern and do not have anything wrong with them.
Causes to consider are:
• Syndromes of overgrowth including Marfan syndrome and Soto syndrome.
• GH excess from a pituitary tumour. This is very rare indeed, most of the “tallest men and women in the world” have had this diagnosis.
In precocious puberty the pubertal growth spurt occurs very early and so children with this can present with tall stature.
However growth stops early as well so they can then be short as adults.

Question 20

Mother, brings in her 5 year old daughter to the GP, who is having trouble at school. Speech appears to be normal but mother complains she doesn’t always do what she is asked to do. Child was born at 32 weeks, and mother had a traumatic birth. What cause of action would you take?

a) Obtain more knowledge of the cause of the prematurity
b) Establish an up to date developmental history
c) Hearing test
d) Better understanding of what trouble at school means

Answer 20

d) Better understanding of what trouble at school means

All of these stems could potentially be correct. However, with all aspects of clinical medicine it is important to start with the parents Ideas, concerns and expectations. Possibly trouble at school might be inattention or possibly that she does not appear to have any friends or possibly another issue such as enuresis.

Question 21

How do you plot height on a centile chart?

a) Plot the height ( x axis) against age ( y axis)
b) Plot the age ( x axis) against height ( y axis)
c) Plot the age ( x axis) against height velocity ( y axis)
d) Plot the height velocity ( x axis) against age ( y axis)

Answer 21

b) Plot the age ( x axis) against height ( y axis)

To use a centile chart you plot the age (x axis) against height (y axis).
Centile charts are used for a range of growth measurements- height, weight, head circumference and BMI are the commonest.
Based on surveys of large numbers of children- in the UK we use both UK population based charts and ones from the WHO which look at an international population.

Question 22

When measuring children’s height, which option is important for an accurate measurement?

a) Parents’ median height
b) Child is measured in the morning
c) Weight is measured at the same time
d) The child’s shoes are removed

Answer 22

d) The child’s shoes are removed

Getting an accurate height and weight is important in assessing growth.
Equipment should be accurate and maintained properly.
Position the child properly to get an accurate height (read the instructions on the growth chart).
Make sure you get rid of things which interfere with measuring- shoes off, hair out of the way and clothes off for weight.

Question 23

Mum is worried as her daughter is following the 25th centile on the growth chart in her red book, what does this mean?

a) 75% of children are taller than this patient
b) 75% of children are growing faster than this patient
c) 25% of children are growing faster than this patient
d) 25% of children are taller than this patient

Answer 23

a) 75% of children are taller than this patient

75% of children will be taller than the 25th centile.
25% shorter than the 25th centile, and so on.
Centile charts are not a “normal range”, they are just a way of looking at where height is compared to others
There are different centile charts for girls and boys.

Question 24

Which of the following statements concerning endometrial organisation during the menstrual cycle is most accurate?

a) Most layers of the endometrium are sloughed during the proliferative phase
b) The endometrium decreases in thickness during the first half of the cycle
c) After ovulation the endometrium becomes more highly vascularised
d) The endometrium is supplied by 4 types of arteries
e) Vascular necrosis factor is expressed after ovulation

Answer 24

c) After ovulation the endometrium becomes more highly vascularised

Question 25

Which of the following directs formation of the neural tube?

a) Neural plate
b) Notochord
c) Mesoderm
d) Primitive streak
e) Primitive node

Answer 25

b) Notochord

Question 26

Which sequence of embryonic tissue differentiation is correct?

a) Inner cell mass – trophectoderm - epiblast
b) Epiblast – hypoblast – mesoderm
c) Inner cell mass - hypoblast – trophectoderm
d) Inner cell mass – epiblast – mesoderm
e) Epiblast – endoderm – mesoderm

Answer 26

d) Inner cell mass – epiblast – mesoderm

Question 27

What is the most important factor in deciding if a child’s growth pattern is normal:

a) Parental height
b) Position on the centile chart
c) Speed of growth over time
d) Whether parents are satisfied with height
e) Bone age

Answer 27

c) Speed of growth over time

Question 28

A common feature of Turner syndrome is:

a) Tall stature
b) Early puberty
c) Food-seeking behavior
d) Short limbs
e) Failure to progress in puberty

Answer 28

e) Failure to progress in puberty

Turner syndrome is caused by partial or complete loss of an X chromosome in a female, resulting in a 45X genotype. Turner syndrome patients undergo rapid depletion of their eggs, so that their supply is often gone before they reach the age of puberty, and so they commonly fail to go through puberty.

Short stature is also a key feature of Turner syndrome, as is a webbed neck, swelling in the hands and feet at birth, and low-set ears. There are no particular abnormalities in limb proportion associated with Turner syndrome, and option ‘b’ (food-seeking behaviour) is seen not in Turner syndrome, but in Prader-Willi syndrome.

Question 29

Which of the following fetal hormones are considered to have major direct effects on fetal growth?

a) Follicle stimulating hormone
b) Insulin
c) Luteinizing hormone
d) Prolactin
e) Somatotrophin

Answer 29

b) Insulin

Question 30

Which factor is associated with IUGR?

a) High birth weight
b) Single intrauterine pregnancy
c) Placenta praevia
d) Maternal age 16-35

Answer 30

c) Placenta praevia

Placenta praevia is when the placenta latches on to the endometrium too far down in the uterus, near to, or over, the cervical opening. This can lead to a whole host of maternal and fetal complications during gestation and labour. As a general rule, anything that can cause

Question 31

At what gestation do we define a stillbirth?

a) 12 weeks
b) 14 weeks
c) 24 weeks
d) 32 weeks

Answer 31

c) 24 weeks

Question 32

How long is a MOCA assessment supposed to take?

a) <10 minutes
b) 10-15 minutes
c) 30 minutes
d) 30-60 minutes

Answer 32

b) 10-15 minutes

Question 33

What are the physical changes associated with an ageing brain?

a) Volume of CSF around the brain decreases
b) Ventricles enlarge
c) Brain weight increases
d) Gaps between the major gyri narrow

Answer 33

b) Ventricles enlarge

Question 34

At what stage of development is a foetus most susceptible to teratogens?

a) Implantation
b) Before conception
c) 1st trimester
d) 2nd Trimester
e) 3rd Trimester

Answer 34

c) 1st trimester

Question 35

During the first trimester, where is main production of oestrogen & progesterone?

a) Corpus luteum
b) Placenta
c) Fallopian tube
d) Ovary
e) Embryo

Answer 35

a) Corpus luteum

Question 36

Which of these cells are derived from the neural crest?

a) Oligodendrocytes
b) Astrocytes
c) Schwann cells
d) Ependymal cells
e) Primordial germ cells

Answer 36

b) Astrocytes

QUERY

Question 37

Which of the options would a 20-week ultrasound scan of a foetus be most useful for?

a) Assess risk of pre-eclampsia
b) Assess for serious heart defects
c) Estimate fetal weight
d) Determine body measurements (e.g. femur length)
e) Investigate for multiple foetuses

Answer 37

b) Assess for serious heart defects

Question 38

What milestone should be reached by 2 years of age?

a) Build 6 block high tower
b) Use phrases when speaking
c) Smiles
d) Fears strangers
e) Symbolic play

Answer 38

e) Symbolic play