MD2 Week 18 MCQs, SAQs PDF

1. Which of the following features is characteristic of primary syphilis? - a) Multiple painful chancres - b) A rash on the palms and soles - c) A single painless chancre with raised edges - d) Condyloma lata in the groin area - **Answer:** c) A single painless chancre with raised edges - **Explanation:** Primary syphilis is marked by a single, painless chancre with raised, firm edges 2. What is the most common organ system affected by congenital cytomegalovirus (CMV) infection? - a) Cardiovascular system - b) Neurological system - c) Respiratory system - d) Gastrointestinal system - **Answer:** b) Neurological system - **Explanation:** Congenital CMV often results in severe neurological sequelae such as mental retardation and deafness 3. Which of the following is NOT typically associated with secondary syphilis? - a) Condyloma lata - b) Lymphadenopathy - c) Gummatous lesions - d) Patchy hair loss - **Answer:** c) Gummatous lesions - **Explanation:** Gummas are a feature of tertiary syphilis, not secondary 4. Infections with which herpes virus have been linked to Burkitt's lymphoma? - a) HHV-6 - b) CMV - c) Epstein-Barr virus (EBV) - d) HSV-2 - **Answer:** c) Epstein-Barr virus (EBV) - **Explanation:** EBV is a cofactor in Burkitt's lymphoma development 5. What is the most common initial presentation of measles? - a) Conjunctivitis and coryza - b) Rash starting on the trunk - c) Koplik spots in the oral cavity - d) Sensorineural deafness - **Answer:** a) Conjunctivitis and coryza - **Explanation:** The prodromal phase of measles includes conjunctivitis and coryza. 6. A typical feature of diphtheria infection includes: - a) Pharyngitis with clear exudate - b) A thick, adherent membrane in the pharynx - c) Bilateral parotitis - d) “Slapped cheek” rash - **Answer:** b) A thick, adherent membrane in the pharynx - **Explanation:** Diphtheria often presents with a thick white pharyngeal membrane. 7. What is a classic complication of mumps in post-pubertal males? - a) Orchitis - b) Oophoritis - c) Retinitis - d) Hepatitis - **Answer:** a) Orchitis - **Explanation:** Orchitis is a common complication of mumps in post-pubertal males 8. Which statement about varicella-zoster virus is TRUE? - a) It is primarily latent in lymphoid cells. - b) Reactivation results in generalised chickenpox. - c) Latency occurs in dorsal root ganglia. - d) It never causes severe illness in adults. - **Answer:** c) Latency occurs in dorsal root ganglia - **Explanation:** VZV remains latent in the dorsal root ganglia 9. Parvovirus B19 infection can lead to which condition in individuals with pre-existing haemolytic disorders? - a) Polyarthritis - b) Aplastic crisis - c) Sensorineural hearing loss - d) Encephalitis - **Answer:** b) Aplastic crisis - **Explanation:** Parvovirus B19 can cause an aplastic crisis in patients with haemolytic conditions 10. Which of the following diseases is caused by Streptococcus pyogenes? - a) Scarlet fever - b) Diphtheria - c) Actinomycosis - d) Kaposi’s sarcoma - **Answer:** a) Scarlet fever - **Explanation:** Scarlet fever is associated with strains of S. pyogenes producing pyrogenic exotoxins 11. What is the primary risk factor for developing Kaposi’s sarcoma in an immunocompromised patient? - a) Epstein-Barr virus infection - b) Human herpesvirus 8 (HHV-8) - c) Cytomegalovirus infection - d) Varicella-zoster virus reactivation - **Answer:** b) Human herpesvirus 8 (HHV-8) - **Explanation:** Kaposi’s sarcoma is strongly linked to HHV-8. 12. Which complication of congenital rubella syndrome (CRS) is most commonly seen? - a) Cataracts - b) Severe aplastic anaemia - c) Encephalitis - d) Hepatomegaly - **Answer:** a) Cataracts - **Explanation:** Cataracts are a classic manifestation of CRS 13. Which symptom is commonly associated with erysipelas caused by Streptococcus pyogenes? - a) Patchy hair loss - b) Painful, sharply demarcated skin redness - c) Vesicular lesions on mucous membranes - d) Warty growths in moist areas - **Answer:** b) Painful, sharply demarcated skin redness - **Explanation:** Erysipelas is characterised by sharply demarcated, painful skin erythema 14. What is the transmission mode for rubella? - a) Fecal-oral route - b) Airborne respiratory droplets - c) Bloodborne - d) Direct skin contact - **Answer:** b) Airborne respiratory droplets - **Explanation:** Rubella spreads through respiratory secretions 15. Which disease can present with narcotising skin lesions known as mycetomas? - a) Corynebacterium diphtheriae infection - b) Actinomycosis - c) Nocardiosis - d) Listeriosis - **Answer:** c) Nocardiosis - **Explanation:** Nocardiosis can present with mycetomas, especially in immunocompromised individuals 1. Which statement about Epstein-Barr virus is NOT correct? - a) It can cause infectious mononucleosis. - b) It is associated with Burkitt’s lymphoma. - c) It primarily establishes latency in sensory nerve ganglia. - d) It is linked to nasopharyngeal carcinoma. - **Answer:** c) It primarily establishes latency in sensory nerve ganglia. - **Explanation:** EBV establishes latency in lymphoid cells, not sensory nerve ganglia 2. Which of the following statements about congenital syphilis is NOT correct? - a) It can lead to Hutchinson’s teeth. - b) It may cause saddle nose deformity. - c) It commonly results in neonatal sepsis. - d) It is associated with perinatal death in primary maternal infection. - **Answer:** c) It commonly results in neonatal sepsis. - **Explanation:** While congenital syphilis can lead to a range of complications such as Hutchinson’s teeth and saddle nose, neonatal sepsis is not a typical primary feature 3. Which of the following clinical features is NOT typical of secondary syphilis? - a) Condyloma lata - b) Ulcerated mucous patches - c) Patchy alopecia - d) Gummas on skin and bone - **Answer:** d) Gummas on skin and bone - **Explanation:** Gummas are characteristic of tertiary syphilis, not secondary syphilis 4. Regarding Listeria monocytogenes, which of the following statements is NOT correct? - a) It can be found in undercooked chicken. - b) It may cause granulomatosis infantiseptica in neonates. - c) It is typically asymptomatic in healthy adults. - d) It forms spores that survive refrigeration. - **Answer:** d) It forms spores that survive refrigeration. - **Explanation:** Listeria monocytogenes does not form spores. It can grow at refrigeration temperatures but is non- spore forming 5. Which of the following about HHV-8 is NOT correct? - a) It is associated with Kaposi's sarcoma. - b) It establishes latency primarily in sensory ganglia. - c) Its prevalence is high among HIV-positive patients. - d) It is less common in the general population. - **Answer:** b) It establishes latency primarily in sensory ganglia. - **Explanation:** HHV-8 establishes latency in lymphoid cells, not sensory ganglia 6. Which statement about Streptococcus pyogenes and its complications is NOT correct? - a) Rheumatic fever involves polyarthritis and carditis. - b) Post-streptococcal glomerulonephritis presents with oedema and hypertension. - c) Scarlet fever is accompanied by a strawberry tongue. - d) Puerperal fever is typically associated with erysipelas. - **Answer:** d) Puerperal fever is typically associated with erysipelas. - **Explanation:** Puerperal fever is linked to systemic infections post-delivery, not specifically erysipelas. 7. Which statement about rubella infection is NOT correct? - a) It can cause congenital heart defects when transmitted in the first trimester. - b) It is more common in adult males than in children. - c) Post-auricular lymphadenopathy is a feature. - d) Up to half of rubella infections may be asymptomatic. - **Answer:** b) It is more common in adult males than in children. - **Explanation:** Rubella primarily affects children; adult male predominance is not typical 8. Which of the following regarding varicella-zoster virus (VZV) is NOT correct? - a) Primary infection can lead to chickenpox in non-immune individuals. - b) Reactivation results in shingles, which follows a dermatomal distribution. - c) Latency occurs in lymphoid cells. - d) Immunocompromised patients have a higher risk of visceral dissemination. - **Answer:** c) Latency occurs in lymphoid cells. - **Explanation:** VZV establishes latency in dorsal root ganglia, not lymphoid cells 9. Which of these complications is NOT associated with mumps infection? - a) Orchitis in post-pubertal males - b) Oophoritis in females - c) Aplastic anaemia - d) Sensorineural deafness - **Answer:** c) Aplastic anaemia - **Explanation:** Aplastic anaemia is linked to parvovirus B19, not mumps 10. Which of the following regarding the herpes simplex virus (HSV) is NOT correct? - a) HSV-1 primarily causes orofacial lesions. - b) HSV-2 reactivation is more likely to involve the sacral nerve roots. - c) Encephalitis due to HSV has a lower mortality rate when untreated. - d) Reactivation can occur without visible lesions. - **Answer:** c) Encephalitis due to HSV has a lower mortality rate when untreated. - **Explanation:** Untreated HSV encephalitis has a high mortality rate (70%) 11. Which of the following is NOT a typical feature of congenital syphilis in a surviving child? - a) Hutchinson's teeth - b) Microcephaly - c) Saddle nose deformity - d) Ocular keratitis - **Answer:** b) Microcephaly - **Explanation:** Microcephaly is more commonly associated with congenital infections like Zika or severe CMV 12. Which of the following regarding actinomycosis is NOT correct? - a) Cervicofacial actinomycosis is the most common form. - b) The infection is usually polymicrobial. - c) It typically respects tissue planes. - d) It can be mistaken for a malignancy. - **Answer:** c) It typically respects tissue planes. - **Explanation:** Actinomycosis does not respect tissue planes; it infiltrates deeply 13. Which statement regarding beta-haemolytic streptococci is NOT true? - a) S. pyogenes can cause necrotizing fasciitis. - b) S. agalactiae frequently causes meningitis in newborns. - c) Post-streptococcal glomerulonephritis only follows skin infections. - d) Rheumatic fever is a non-suppurative complication of pharyngeal infection. - **Answer:** c) Post-streptococcal glomerulonephritis only follows skin infections. - **Explanation:** It can follow both skin and pharyngeal infections 14. Which of the following regarding childhood parvovirus B19 infection is NOT true? - a) It presents as erythema infectiosum. - b) It often results in long-term immunity. - c) It can lead to hydrops fetalis during pregnancy. - d) It is commonly treated with antiviral medications. - **Answer:** d) It is commonly treated with antiviral medications. - **Explanation:** There is no specific antiviral treatment for parvovirus B19 15. Which of the following regarding diphtheria is NOT correct? - a) It primarily affects the pharynx. - b) Myocarditis is a potential complication. - c) The organism forms endospores. - d) The formation of a pseudomembrane can lead to airway obstruction. - **Answer:** c) The organism forms endospores. - **Explanation:** Corynebacterium diphtheriae does not form endospores **1. Regarding the different stages of syphilis:** - a) List the typical lesion associated with primary syphilis and describe its key characteristics. - b) Name two systemic features seen in secondary syphilis. - c) What is the primary neurological complication associated with tertiary syphilis? - **Answers:** - a) The lesion is a chancre: painless, raised, firm edges - b) Fever, lymphadenopathy - c) Neurosyphilis, specifically general paresis of the insane or tabes dorsalis **2. Discuss the clinical and public health aspects of congenital rubella syndrome (CRS):** - a) What is the most common cardiac defect in CRS? - b) Explain why early maternal infection is more dangerous to the foetus. - c) What is the recommended prevention strategy for CRS? - **Answers:** - a) Patent ductus arteriosus - b) The highest risk of severe congenital defects occurs during the first trimester, when the fetal organs are forming - c) Vaccination with MMR vaccine prior to pregnancy **3. For Listeria monocytogenes infections:** - a) Name one common food item that may be a source of Listeria. - b) Describe the condition “granulomatosis infantiseptica.” - c) What is the primary clinical concern for Listeria infection in pregnant women? - **Answers:** - a) Soft cheeses - b) A rare neonatal disease characterized by widespread microabscesses and granulomas - c) Risk of miscarriage, stillbirth, or neonatal sepsis **4. Regarding the pathogenesis of herpes simplex encephalitis:** - a) Which type of HSV is most commonly implicated? - b) Identify the brain regions typically involved. - c) What is the typical mortality rate without treatment? - **Answers:** - a) HSV-1 - b) Frontal and temporal lobes - c) 70% **5. In relation to Streptococcus pyogenes infections:** - a) List two complications associated with skin infections caused by S. pyogenes. - b) What is the mechanism underlying rheumatic fever? - c) What skin feature is associated with scarlet fever? - **Answers:** - a) Cellulitis, necrotising fasciitis - b) Autoimmune response due to molecular mimicry between streptococcal antigens and host tissue - c) “Strawberry tongue” followed by desquamation **6. Describe the implications of parvovirus B19 infection:** - a) What is the hallmark rash seen in children with parvovirus B19 infection? - b) Which complication can occur in patients with haemolytic disorders? - c) What condition in pregnancy is associated with parvovirus B19 infection? - **Answers:** - a) “Slapped cheek” rash - b) Aplastic crisis - c) Hydrops fetalis **7. For cytomegalovirus (CMV):** - a) Name one serious form of CMV infection in immunocompromised hosts. - b) What neurological sequelae can result from congenital CMV infection? - c) What is the typical presentation of CMV infection in healthy adults? - **Answers:** - a) Retinitis - b) Deafness and mental retardation - c) Mononucleosis-like syndrome **8. Discuss the clinical progression of measles:** - a) Identify one early prodromal symptom. - b) What is the significance of Koplik spots? - c) Name one potential complication of measles. - **Answers:** - a) Coryza - b) They are pathognomonic for measles, appearing before the rash - c) Pneumonia **9. Describe the pathophysiology and complications of diphtheria:** - a) What is the main virulence factor of Corynebacterium diphtheriae? - b) Name one potential cardiac complication. - c) What is a visual feature associated with diphtheritic pharyngitis? - **Answers:** - a) Exotoxin production - b) Myocarditis - c) Thick, white, adherent membrane **10. Regarding Varicella-Zoster Virus (VZV):** - a) What is the typical pattern of rash distribution in chickenpox? - b) Name one serious complication of shingles. - c) What does the term “dermatomal distribution” refer to in shingles? - **Answers:** - a) Rash starts on the trunk and spreads centrifugally - b) Postherpetic neuralgia - c) Rash following the sensory nerve path associated with the latent virus **11. Discuss the complications and systemic involvement of mumps:** - a) What is the most common organ affected by mumps? - b) Name one serious complication in post-pubertal males. - c) Which neurological complication can occur? - **Answers:** - a) Parotid glands - b) Orchitis - c) Aseptic meningitis **12. Concerning neonatal herpes simplex infection:** - a) What is the primary mode of transmission? - b) Identify one serious complication in affected neonates. - c) Which HSV type is more commonly implicated? - **Answers:** - a) Passage through an infected birth canal - b) Multi-organ disease with possible encephalitis - c) HSV-2 **13. Discuss the transmission and prevention of rubella:** - a) How is rubella primarily transmitted? - b) What is the risk of CRS when infection occurs in the first trimester? - c) How is rubella immunity commonly achieved? - **Answers:** - a) Respiratory droplets - b) Up to 90% - c) MMR vaccination **14. For Streptococcus agalactiae:** - a) Identify one clinical scenario where this organism is a pathogen. - b) What is the typical onset time for neonatal disease? - c) How is maternal carriage screened for during pregnancy? - **Answers:** - a) Postpartum maternal sepsis - b) Early-onset disease within the first 7 days - c) Rectovaginal swab at 35–37 weeks **15. Regarding Kaposi’s sarcoma-associated herpesvirus (KSHV):** - a) Name one group at high risk for Kaposi’s sarcoma. - b) What type of lesion characterises this condition? - c) What virus family does KSHV belong to? - **Answers:** - a) HIV-positive patients - b) Vascular tumour-like lesions - c) Herpesviridae **16. For post-streptococcal glomerulonephritis (PSGN):** - a) Which strain of S. pyogenes is associated with PSGN? - b) What is a common clinical finding? - c) What region shows the highest incidence of PSGN? - **Answers:** - a) Nephritogenic strains - b) Dark urine - c) Australian Aboriginal communities **17. In the context of herpes zoster (shingles):** - a) What triggers reactivation? - b) What is one risk factor for postherpetic neuralgia? - c) Name one typical dermatological manifestation. - **Answers:** - a) Immune suppression - b) Age over 60 - c) Painful vesicular rash along a dermatome **18. Discuss non-suppurative complications of Streptococcus pyogenes:** - a) Name two complications. - b) What is the primary pathophysiological mechanism of rheumatic fever? - c) What diagnostic feature is associated with post-streptococcal glomerulonephritis? - **Answers:** - a) Rheumatic fever, post-streptococcal glomerulonephritis - b) Autoimmune cross-reactivity - c) Haematuria with dark urine **19. In the case of actinomycosis:** - a) What is the most common form of the disease? - b) What condition can it mimic due to its presentation? - c) Name one characteristic feature of actinomycosis. - **Answers:** - a) Cervicofacial actinomycosis - b) Malignancy. - c) Draining sinus tracts **20. For congenital cytomegalovirus infection:** - a) What is a major risk factor for severe outcomes in neonates? - b) Name one common clinical finding at birth. - c) Which type of maternal infection poses the highest risk to the foetus? - **Answers:** - a) Primary maternal infection - b) Microcephaly or hearing loss - c) Primary infection during pregnancy **Case 1:** A 32-year-old pregnant woman presents with mild flu-like symptoms and is concerned about exposure to rubella. - a) What initial test should be conducted to determine her immune status? - b) What are the potential risks to the foetus if she is infected during the first trimester? - **Answers:** - a) Rubella IgG and IgM serology - b) Risk of congenital rubella syndrome, including deafness and cardiac defects **Case 2:** A 45-year-old man presents with a painful rash along the right side of his chest. He reports a history of chickenpox in childhood. - a) What is the most likely diagnosis? - b) What is a possible severe complication he should be monitored for? - **Answers:** - a) Herpes zoster (shingles) - b) Postherpetic neuralgia **Case 3:** A neonate born to a mother who tested positive for group B Streptococcus develops respiratory distress at 3 days old. - a) What condition should be suspected? - b) What is the immediate management step? - **Answers:** - a) Early-onset neonatal sepsis - b) Initiation of empirical antibiotic therapy **Case 4:** A 28-year-old woman with a history of two miscarriages presents with fever, chills, and muscle aches. She recalls eating unpasteurised soft cheese. - a) Which pathogen should be suspected? - b) What is the risk to her current pregnancy if infected? - **Answers:** - a) Listeria monocytogenes - b) Risk of miscarriage or stillbirth **Case 5:** A 55-year-old immunocompromised patient presents with blurred vision and floaters in the eye. Examination reveals retinal haemorrhages. - a) Which opportunistic virus is likely responsible? - b) What treatment should be considered? - **Answers:** - a) Cytomegalovirus (CMV) retinitis - b) Antiviral therapy such as ganciclovir **Case 6:** A 6-year-old boy presents with fever, malaise, and a "slapped cheek" rash. His younger sibling has sickle cell anaemia. - a) What is the likely diagnosis for the boy? - b) What complication should be monitored in the sibling? - **Answers:** - a) Parvovirus B19 infection (erythema infectiosum) - b) Aplastic crisis **Case 7:** A 24-year-old man with a history of IV drug use presents with fever, malaise, and diffuse maculopapular rash on his torso and palms. - a) What sexually transmitted infection should be considered? - b) What is the next diagnostic step? - **Answers:** - a) Secondary syphilis - b) Serological testing for syphilis (RPR, TPPA) **Case 8:** A 70-year-old woman presents with a sudden high fever, headache, neck stiffness, and altered mental status. Imaging suggests temporal lobe involvement. - a) Which infection is most likely? - b) What immediate treatment should be initiated? - **Answers:** - a) HSV-1 encephalitis - b) Intravenous acyclovir **Case 9:** A mother presents with her 4-week-old infant who has difficulty feeding, irritability, and fever. The infant was born at 36 weeks gestation. - a) What neonatal infection should be suspected? - b) Which bacterium is the most probable cause? - **Answers:** - a) Late-onset neonatal sepsis - b) Streptococcus agalactiae **Case 10:** A 30-year-old woman presents with a chronic ulcerative lesion on her cheek. She has no systemic symptoms but reports a history of minor trauma to the area months ago. - a) What condition should be suspected? - b) Which pathogen might be involved? - **Answers:** - a) Actinomycosis - b) Actinomyces israelii **Case 1:** A 30-year-old pregnant woman presents with mild fever and a rash. She mentions possible exposure to a colleague diagnosed with rubella. - a) What is the incubation period for rubella? - b) If rubella infection occurs in the first trimester, list two possible outcomes for the fetus. - c) What immediate test should be performed to assess maternal infection? - **Answers:** - a) The incubation period for rubella is 14-21 days【31†source】. - b) Congenital Rubella Syndrome (CRS) may result in deafness and cardiac defects【31†source】. - c) Rubella-specific IgM and IgG serology should be performed【31†source】. - **Explanation:** Rubella is highly concerning in pregnancy, especially in the first trimester, due to the high risk of severe fetal outcomes. Confirming maternal immunity or recent infection via serology is critical for management. **Case 2:** A 47-year-old immunocompromised male presents with decreased vision and floaters. Ophthalmoscopic exam reveals retinal hemorrhages. - a) Which virus is most likely implicated in this patient's condition? - b) Name one systemic complication that can occur if this infection is untreated. - c) What is the first-line treatment for this condition? - **Answers:** - a) Cytomegalovirus (CMV)【28†source】. - b) CMV can lead to systemic complications like disseminated infection involving the liver or gastrointestinal tract【 28†source】. - c) First-line treatment is ganciclovir【28†source】. - **Explanation:** CMV retinitis is common in immunocompromised patients and can cause blindness if not treated. Antiviral therapy can control the infection and prevent progression. **Case 3:** A 4-week-old infant, born at 36 weeks, presents with fever, irritability, and poor feeding. The mother had a negative prenatal group B Streptococcus screen. - a) What is the likely diagnosis? - b) Name one common bacterial pathogen responsible for this condition. - c) What is the initial step in management? - **Answers:** - a) Late-onset neonatal sepsis【34†source】. - b) Streptococcus agalactiae (Group B Streptococcus)【34†source】. - c) Empirical antibiotic therapy should be initiated【34†source】. - **Explanation:** Neonatal sepsis, especially in preterm infants, is often due to vertically transmitted pathogens. Even with a negative screen, empirical treatment is vital for suspected infections. **Case 4:** A 65-year-old HIV-positive man presents with multiple purplish skin lesions on his legs. He has a history of poor medication adherence. - a) What is the likely underlying condition? - b) Name the causative agent of this condition. - c) Which type of cells does this virus primarily affect for latency? - **Answers:** - a) Kaposi’s sarcoma【28†source】. - b) Human herpesvirus 8 (HHV-8)【28†source】. - c) HHV-8 primarily establishes latency in lymphoid cells【28†source】. - **Explanation:** Kaposi's sarcoma is associated with HHV-8 and is more prevalent in immunocompromised patients, such as those with poorly controlled HIV. **Case 5:** A 7-year-old child presents with a 3-day history of fever, fatigue, and a bright red rash on both cheeks. His mother mentions that other children at his school were sick with similar symptoms. - a) What is the most likely diagnosis? - b) What hematologic complication can arise if this infection affects a child with a pre-existing condition like sickle cell disease? - c) What type of immunity develops after this infection? - **Answers:** - a) Erythema infectiosum (Fifth disease), caused by parvovirus B19【31†source】. - b) An aplastic crisis can occur【31†source】. - c) Long-lasting immunity develops following infection【31†source】. - **Explanation:** Parvovirus B19 often causes a characteristic rash and is self-limiting in healthy children. However, it can precipitate severe anemia in patients with hemolytic disorders. **Case 6:** A 26-year-old woman reports a painless genital ulcer that developed two weeks ago. She denies any recent systemic symptoms but reports new sexual partners in the last six months. - a) What is the most probable diagnosis? - b) Name one confirmatory test for this condition. - c) What stage of the disease is this patient likely in? - **Answers:** - a) Primary syphilis【27†source】. - b) Dark-field microscopy or specific serologic testing (e.g., FTA-ABS)【27†source】. - c) Primary stage【27†source】. - **Explanation:** A painless ulcer (chancre) is characteristic of primary syphilis. Confirmatory tests help diagnose the infection and initiate appropriate treatment to prevent progression. **Case 7:** A 6-year-old child presents with high fever, cough, coryza, and conjunctivitis. Two days later, small blue-white spots with a red base appear inside the mouth near the molars. - a) What is the name of these oral lesions? - b) What is the most likely diagnosis? - c) What serious complication should clinicians be vigilant about? - **Answers:** - a) Koplik spots【30†source】. - b) Measles【30†source】. - c) Pneumonia or encephalitis【30†source】. - **Explanation:** Koplik spots are pathognomonic for measles and appear during the prodromal phase. Pneumonia is the most common cause of measles-related death. **Case 8:** A 52-year-old woman with chronic corticosteroid use presents with a unilateral, painful, vesicular rash distributed along the right thoracic dermatome. - a) What is the most probable diagnosis? - b) What is the reactivated virus involved? - c) Name a potential long-term complication of this condition. - **Answers:** - a) Herpes zoster (shingles)【33†source】. - b) Varicella-zoster virus (VZV)【33†source】. - c) Postherpetic neuralgia【33†source】. - **Explanation:** Herpes zoster results from the reactivation of latent VZV. The pain can persist as postherpetic neuralgia, especially in older or immunocompromised patients. **Case 9:** A 3-day-old newborn develops respiratory distress and lethargy. Blood cultures grow a Gram-positive cocci in chains. - a) What is the most likely causative organism? - b) What is the common term for this type of infection? - c) Which maternal factor increases the risk of this infection? - **Answers:** - a) Group B Streptococcus (Streptococcus agalactiae)【34†source】. - b) Early-onset neonatal sepsis【34†source】. - c) Maternal colonisation with GBS - **Explanation:** Early-onset GBS sepsis is a serious condition in neonates, often linked to vertical transmission from the mother during delivery. **Case 10:** A 40-year-old man presents with a chronic, indurated ulcer on the mandible with draining sinuses. He recalls a dental procedure done a few months ago. - a) What condition should be considered? - b) Name the most common causative organism. - c) What is one diagnostic method for this condition? - **Answers:** - a) Actinomycosis - b) Actinomyces israelii - c) Microscopic examination of sulfur granules in pus - **Explanation:** Actinomycosis is often linked to dental trauma or poor oral hygiene. It presents with chronic lesions that may mimic malignancies, and diagnosis involves identifying the characteristic sulfur granules. 1. **What hormonal change contributes most to the increased glomerular filtration rate (GFR) during pregnancy?** - a) Increased cortisol - b) Elevated estrogen - c) Increased aldosterone - d) Elevated progesterone - **Answer:** d) Elevated progesterone - **Explanation:** Progesterone induces renal vasodilation, enhancing blood flow and increasing GFR【50†source】. 2. **Which stage of labour is characterized by the onset of regular, painful contractions that lead to full cervical dilation?** - a) First stage - b) Second stage - c) Third stage - d) Latent stage - **Answer:** a) First stage - **Explanation:** The first stage extends from the onset of contractions to full cervical dilation【49†source】. 3. **What mechanism primarily supports fetal descent during the active phase of labour?** - a) Uterine contractions - b) Abdominal muscle contractions - c) Gravity - d) Pelvic ligament relaxation - **Answer:** a) Uterine contractions - **Explanation:** Coordinated uterine contractions drive fetal descent【49†source】. 4. **Which cardiovascular change is typical during pregnancy?** - a) Decreased heart rate - b) Increased systemic vascular resistance - c) Increased cardiac output by up to 50% - d) Increased diastolic blood pressure - **Answer:** c) Increased cardiac output by up to 50% - **Explanation:** Cardiac output increases significantly to accommodate the increased blood flow required during pregnancy【50†source】. 5. **What is the significance of ‘engagement’ during labour?** - a) It signals the start of the second stage of labour. - b) It indicates full cervical effacement. - c) It occurs when the biparietal diameter of the fetal head passes through the pelvic brim. - d) It confirms fetal rotation has occurred. - **Answer:** c) It occurs when the biparietal diameter of the fetal head passes through the pelvic brim【49†source】. 6. **Which of the following respiratory changes is NOT typical during pregnancy?** - a) Increased tidal volume - b) Decreased residual volume - c) Decreased respiratory rate - d) Increased minute ventilation - **Answer:** c) Decreased respiratory rate - **Explanation:** Respiratory rate typically remains stable, while tidal volume and minute ventilation increase【 50†source】. 7. **What is the role of relaxin in pregnancy?** - a) Reduces uterine tone - b) Increases sodium retention - c) Enhances bladder tone - d) Stimulates lactation - **Answer:** a) Reduces uterine tone - **Explanation:** Relaxin promotes relaxation of the uterine muscle and ligaments【50†source】. 8. **What fetal position most optimally aids in the second stage of labour?** - a) Direct occipito-posterior - b) Transverse lie - c) Breech - d) Direct occipito-anterior - **Answer:** d) Direct occipito-anterior - **Explanation:** The direct occipito-anterior position allows for optimal descent through the birth canal【49†source】. 9. **Which change is a normal haematologic adaptation during pregnancy?** - a) Decreased RBC production - b) Physiologic anemia due to plasma volume expansion - c) Increased platelet count - d) Decreased WBC count - **Answer:** b) Physiologic anemia due to plasma volume expansion - **Explanation:** The plasma volume increase outpaces RBC production, leading to dilutional anemia【50†source】. 10. **What defines the latent phase of labour?** - a) Cervical dilation of 4-10 cm - b) Regular, intense contractions with rapid progress - c) Initial onset of contractions until cervical dilation of 4 cm - d) Complete effacement of the cervix - **Answer:** c) Initial onset of contractions until cervical dilation of 4 cm【49†source】. 11. **Which of the following is NOT a risk associated with aortocaval compression in late pregnancy?** - a) Reduced cardiac output - b) Maternal hypotension - c) Increased venous return - d) Fetal hypoxia - **Answer:** c) Increased venous return - **Explanation:** Aortocaval compression reduces venous return, affecting maternal and fetal circulation【50†source 】. 12. **During the expulsion phase of labour, what is the primary maternal response?** - a) Relaxation of pelvic floor muscles - b) Active pushing using abdominal muscles and diaphragm - c) Increased uterine contractions without maternal effort - d) Decrease in uterine contractions - **Answer:** b) Active pushing using abdominal muscles and diaphragm【49†source】. 13. **Which maternal cardiovascular change during labour poses a risk for women with pre-existing heart conditions?** - a) Decrease in systemic vascular resistance - b) Increase in cardiac output by 70% during the third stage - c) Decrease in heart rate - d) Reduction in venous return - **Answer:** b) Increase in cardiac output by 70% during the third stage【50†source】. 14. **What is the typical respiratory adaptation seen in pregnant women to manage increased oxygen demands?** - a) Decreased tidal volume - b) Increased residual volume - c) Elevated minute ventilation - d) Lowered pH due to respiratory acidosis - **Answer:** c) Elevated minute ventilation【50†source】. 15. **Which condition can arise due to delayed gastric emptying in pregnancy?** - a) Hypoglycemia - b) Constipation - c) Gastroesophageal reflux - d) Dehydration - **Answer:** c) Gastroesophageal reflux - **Explanation:** Progesterone relaxes the lower esophageal sphincter, contributing to reflux【50†source】. 1. **Which statement regarding maternal blood volume during pregnancy is NOT correct?** - a) It increases by 50-100%. - b) It results in increased RBC production of up to 40%. - c) It decreases haematocrit due to plasma volume expansion. - d) It leads to a decrease in cardiac output. - **Answer:** d) It leads to a decrease in cardiac output. - **Explanation:** Cardiac output actually increases during pregnancy【50†source】. 2. **Which of the following statements about the first stage of labour is NOT correct?** - a) It ends when the cervix is fully dilated. - b) It includes the latent and active phases. - c) Cervical dilation progresses at approximately 2 cm per hour in active labour. - d) It begins with regular, painful contractions. - **Answer:** c) Cervical dilation progresses at approximately 2 cm per hour in active labour. - **Explanation:** The typical rate of dilation in active labour is about 1 cm per hour【49†source】. 3. **Which statement about endocrine changes during pregnancy is NOT correct?** - a) The thyroid gland decreases in size. - b) The pituitary gland enlarges. - c) TBG levels double during pregnancy. - d) Total T3 and T4 levels increase, but free T3 and T4 remain the same. - **Answer:** a) The thyroid gland decreases in size. - **Explanation:** The thyroid increases in size during pregnancy【50†source】. 4. **Which statement about the cardiovascular adaptations in pregnancy is NOT correct?** - a) Heart rate increases by 15-20 bpm. - b) Blood pressure typically rises in the first trimester. - c) Cardiac output increases by up to 50%. - d) Systemic vascular resistance decreases. - **Answer:** b) Blood pressure typically rises in the first trimester. - **Explanation:** Blood pressure usually decreases during early pregnancy, reaching its lowest in the second trimester 【50†source】. 5. **Which statement regarding cervical changes during pregnancy and labour is NOT correct?** - a) Cervical dilation is complete at 10 cm. - b) Effacement refers to the shortening and thinning of the cervix. - c) The cervix is rigid and unchanging until the onset of labour. - d) The mucus plug serves as a barrier to infection during pregnancy. - **Answer:** c) The cervix is rigid and unchanging until the onset of labour. - **Explanation:** The cervix undergoes softening and preparation before the onset of labour【49†source】【50†source 】. 6. **Which statement about the immune changes during pregnancy is NOT correct?** - a) Cellular immunity remains strong during pregnancy. - b) Humoral immunity becomes dominant. - c) Pregnancy involves a shift to a more tolerant immune state. - d) There is increased susceptibility to infections during pregnancy. - **Answer:** a) Cellular immunity remains strong during pregnancy. - **Explanation:** Cellular immunity decreases, making the mother more susceptible to infections【50†source】. 7. **Which of the following statements about maternal respiratory changes during pregnancy is NOT correct?** - a) Tidal volume increases. - b) Respiratory rate decreases. - c) Minute ventilation increases. - d) Residual volume decreases. - **Answer:** b) Respiratory rate decreases. - **Explanation:** Respiratory rate typically stays the same, while tidal volume and minute ventilation increase【 50†source】. 8. **Which of the following statements about maternal changes in the gastrointestinal system during pregnancy is NOT correct?** - a) There is an increase in gastric acidity. - b) Motility slows down due to hormonal influences. - c) There is a higher risk of gastroesophageal reflux. - d) The stomach's emptying time is delayed. - **Answer:** a) There is an increase in gastric acidity. - **Explanation:** Gastric acidity decreases, contributing to changes like reflux【50†source】. 9. **Which statement about haematologic changes in pregnancy is NOT true?** - a) White blood cell count increases. - b) There is an increase in fibrinogen and clotting factors. - c) Hematocrit levels increase due to higher RBC production. - d) Pregnancy is a hypercoagulable state. - **Answer:** c) Hematocrit levels increase due to higher RBC production. - **Explanation:** Hematocrit decreases because plasma volume expands more than RBC production【50†source】. 10. **Which of the following statements about maternal urinary system changes in pregnancy is NOT correct?** - a) Renal blood flow increases. - b) Ureteral dilation is common. - c) Glycosuria can be a normal finding. - d) Urinary output decreases due to fluid retention. - **Answer:** d) Urinary output decreases due to fluid retention. - **Explanation:** Urinary output typically remains adequate, though there is increased frequency【50†source】. 11. **Which statement about the stages of labour is NOT correct?** - a) The first stage involves full cervical dilation. - b) The second stage begins after full cervical dilation. - c) The third stage involves expulsion of the placenta. - d) The latent phase is part of the first stage. - **Answer:** a) The first stage involves full cervical dilation. - **Explanation:** The first stage ends at full cervical dilation【49†source】. 12. **Which statement about breast changes during pregnancy is NOT correct?** - a) There is increased pigmentation of the nipple and areola. - b) Colostrum production begins at 16 weeks. - c) Areolar glands remain unchanged. - d) Breast size increases due to hormonal stimulation. - **Answer:** c) Areolar glands remain unchanged. - **Explanation:** Areolar glands, such as Montgomery tubercles, enlarge during pregnancy【50†source】. 13. **Which of the following statements about placental hormone production is NOT correct?** - a) Progesterone production shifts from the corpus luteum to the placenta by the second trimester. - b) Estrogen levels rise steadily throughout pregnancy. - c) Placental hormones contribute to insulin sensitivity. - d) Human placental lactogen contributes to maternal insulin resistance. - **Answer:** c) Placental hormones contribute to insulin sensitivity. - **Explanation:** Placental hormones, particularly human placental lactogen, contribute to insulin resistance【 50†source】. 14. **Which of the following is NOT a physiological cardiovascular change in pregnancy?** - a) Increased heart rate - b) Decreased blood pressure in the second trimester - c) Increased systemic vascular resistance - d) Increased cardiac output - **Answer:** c) Increased systemic vascular resistance. - **Explanation:** Systemic vascular resistance decreases due to hormonal effects【50†source】. 15. **Which statement about fetal monitoring during labour is NOT correct?** - a) Continuous electronic monitoring is always required for low-risk labours. - b) Intermittent auscultation is used to assess fetal heart rate in low-risk cases. - c) Late decelerations may indicate fetal distress. - d) Baseline fetal heart rate should be between 110-160 bpm. - **Answer:** a) Continuous electronic monitoring is always required for low-risk labours. - **Explanation:** Continuous monitoring is not necessary for low-risk labours; intermittent monitoring is acceptable【 49†source】. 1. Describe the endocrine changes in pregnancy:** - a) What happens to the size and function of the anterior pituitary during pregnancy? - b) How do total T3 and T4 levels change, and why do free levels remain stable? - c) What role does progesterone play in vascular tone? - **Answers:** - a) The anterior pituitary increases in size and activity【50†source】. - b) Total T3 and T4 increase due to higher TBG levels; free levels remain stable【50†source】. - c) Progesterone induces vasodilation, reducing vascular resistance【50†source】. - **Explanation:** Hormonal changes during pregnancy optimize maternal and fetal physiology. Progesterone’s role in relaxing smooth muscle helps accommodate increased blood volume. 2. Explain cardiovascular changes during labour:** - a) How does cardiac output change in the first and second stages of labour? - b) What risk does this pose to women with pre-existing cardiac conditions? - c) When does cardiac output return to pre-pregnancy levels? - **Answers:** - a) Cardiac output increases by 15% in the first stage and 50% in the second stage【50†source】. - b) The increase in cardiac output can lead to pulmonary edema【50†source】. - c) Cardiac output returns to normal approximately 2 weeks postpartum【50†source】. - **Explanation:** Labour increases the cardiovascular workload, requiring close monitoring, especially in women with cardiovascular disorders. 3. Discuss maternal haematologic adaptations during pregnancy:** - a) What is the primary reason for physiologic anemia during pregnancy? - b) Which coagulation factors increase, contributing to a hypercoagulable state? - c) What is gestational thrombocytopenia, and how does it differ from other thrombocytopenias? - **Answers:** - a) Physiologic anemia is due to the expansion of plasma volume outpacing the increase in RBC production【 50†source】. - b) Fibrinogen and most coagulation factors increase, except for factors II, V, and XII【50†source】. - c) Gestational thrombocytopenia is a mild, pregnancy-related decrease in platelet count that typically does not cause significant bleeding【50†source】. - **Explanation:** Haematologic changes in pregnancy prepare the mother for blood loss during delivery but also increase the risk of thrombosis. 4. Describe the stages of labour and key features of each:** - a) What marks the transition from the latent to the active phase of the first stage of labour? - b) What are the main phases of the second stage of labour? - c) What characterizes the third stage of labour? - **Answers:** - a) Transition occurs at around 4-6 cm of cervical dilation【49†source】. - b) The second stage includes the propulsive phase (no urge to push) and the expulsive phase (active pushing)【 49†source】. - c) The third stage is defined by the expulsion of the placenta and membranes【49†source】. - **Explanation:** Understanding each stage helps in managing labour effectively and anticipating complications. 5. Explain respiratory adaptations in pregnancy:** - a) How does progesterone influence respiratory function during pregnancy? - b) What is the clinical significance of increased minute ventilation? - c) Why might pregnant women experience earlier hypoxia during physical exertion? - **Answers:** - a) Progesterone stimulates increased tidal volume and ventilation【50†source】. - b) Increased minute ventilation aids in managing the elevated metabolic demands and CO2 clearance from the fetus 【50†source】. - c) Reduced oxygen reserves and increased oxygen consumption lead to quicker onset of hypoxia【50†source】. - **Explanation:** Respiratory adaptations ensure efficient oxygen delivery and CO2 removal but make pregnant women more vulnerable to respiratory issues. 6. Detail the anatomical changes in the uterus and cervix during pregnancy:** - a) By how much does the weight of the uterus increase by term? - b) What is the significance of cervical effacement in labour? - c) Describe the composition and role of the mucus plug. - **Answers:** - a) The uterus increases from 50 g to approximately 1,000 g by term【50†source】. - b) Cervical effacement is the thinning and shortening of the cervix, allowing for dilation【49†source】【50†source】. - c) The mucus plug is composed of cervical secretions that form a barrier against infection during pregnancy【 50†source】. - **Explanation:** These anatomical changes prepare the reproductive system for labour and delivery, enhancing maternal and fetal safety. 7. Discuss the role of placental hormones in pregnancy:** - a) What are the primary sources of estrogen and progesterone during pregnancy? - b) How does human placental lactogen (hPL) affect maternal metabolism? - c) What is the role of placental progesterone in maintaining pregnancy? - **Answers:** - a) The ovary produces hormones early in pregnancy, later taken over by the placenta【50†source】. - b) hPL contributes to maternal insulin resistance to ensure glucose availability for the fetus【50†source】. - c) Progesterone maintains the uterine lining and reduces uterine contractions【50†source】. - **Explanation:** Placental hormones orchestrate a range of maternal adaptations to support the growing fetus. 8. Explain the mechanisms of maternal cardiac output change during pregnancy:** - a) What factors contribute to the increase in cardiac output? - b) How is systemic vascular resistance affected? - c) What implications do these changes have for blood pressure? - **Answers:** - a) Increased heart rate and stroke volume contribute to higher cardiac output【50†source】. - b) Systemic vascular resistance decreases due to hormonal effects【50†source】. - c) Blood pressure generally decreases in the second trimester but rises slightly towards term【50†source】. - **Explanation:** Cardiac output adaptations are critical for supporting increased circulatory demands during pregnancy. 9. Describe fetal positioning and its impact on labour:** - a) What is meant by "fetal lie"? - b) Which fetal position is most optimal for delivery, and why? - c) How does a posterior fetal position impact labour? - **Answers:** - a) Fetal lie refers to the relationship between the long axis of the fetus and the long axis of the maternal spine【 49†source】. - b) The direct occipito-anterior position is optimal as it facilitates smooth passage through the birth canal - c) A posterior position can lead to prolonged labour and increased back pain【49†source】. - **Explanation:** Understanding fetal positioning helps anticipate challenges and plan for interventions if needed. 10. Explain changes in the maternal urinary system during pregnancy:** - a) What structural changes occur in the ureters during pregnancy? - b) How does progesterone influence the urinary system? - c) What risks do these changes pose for urinary tract infections (UTIs)? - **Answers:** - a) The ureters dilate due to mechanical pressure and smooth muscle relaxation【50†source】. - b) Progesterone reduces bladder and ureteric tone, contributing to stasis【50†source】. - c) Increased urinary stasis heightens the risk for UTIs and pyelonephritis【50†source】. - **Explanation:** Changes in the urinary system support increased renal function but pose infection risks due to reduced tone and stasis. 11. Discuss skeletal and postural changes during pregnancy:** - a) What is the primary change in spinal alignment during pregnancy? - b) How do hormonal changes affect pelvic ligaments? - c) What are the implications of these changes for maternal balance? - **Answers:** - a) Lumbar lordosis increases to accommodate the growing uterus【50†source】. - b) Hormones such as relaxin increase the flexibility of pelvic ligaments【50†source】. - c) These changes can lead to a shifted center of gravity and increased fall risk【50†source】. - **Explanation:** Adaptations in the musculoskeletal system help support pregnancy but can increase the risk of musculoskeletal discomfort and falls. 12. Explain the physiological basis of maternal hypoxia during labour:** - a) What respiratory changes occur during the second stage of labour? - b) Why is maternal oxygen consumption increased during labour? - c) How should maternal hypoxia be managed in a clinical setting? - **Answers:** - a) Increased respiratory rate and deeper breaths due to exertion【50†source】. - b) Maternal oxygen consumption increases due to the physical effort of labour【50†source】. - c) Hypoxia should be managed with high-flow oxygen and position changes to improve ventilation【50†source】. - **Explanation:** Increased oxygen demand during labour can lead to maternal hypoxia, requiring prompt management to protect both mother and fetus. **Case 1:** A 28-year-old woman in her third trimester presents to the emergency department with shortness of breath, palpitations, and mild peripheral edema. Her blood pressure is 100/65 mmHg, and her heart rate is 95 bpm. - a) What cardiovascular changes in pregnancy might explain her symptoms? - b) Name two differential diagnoses that should be considered. - c) What investigations would you prioritize? - **Answers:** - a) Increased cardiac output and decreased systemic vascular resistance during pregnancy can cause symptoms such as palpitations and shortness of breath【50†source】. - b) Differential diagnoses include anemia and peripartum cardiomyopathy【50†source】. - c) Prioritize a full blood count, ECG, and echocardiogram【50†source】. - **Explanation:** The cardiovascular adaptations of pregnancy can mimic pathological conditions, making it essential to rule out complications like cardiomyopathy. **Case 2:** A 34-year-old woman, G2P1, arrives in labour at 39 weeks. She reports regular, painful contractions and has a cervical dilation of 5 cm. - a) What phase of labour is she in? - b) Describe two key aspects of monitoring required at this stage. - c) What should be checked during a vaginal examination at this point? - **Answers:** - a) She is in the active phase of the first stage of labour【49†source】. - b) Monitor the frequency, duration, and strength of contractions and assess fetal heart rate【49†source】. - c) Assess effacement, dilation, the position of the presenting part, and fetal station【49†source】. - **Explanation:** Proper monitoring and examination are crucial to ensure safe progression of labour and identify any potential issues. **Case 3:** A 32-year-old pregnant woman at 28 weeks gestation reports frequent urination, back pain, and fever. Urine dipstick shows positive nitrites and leukocytes. - a) What is the most likely diagnosis? - b) What physiological changes in pregnancy predispose her to this condition? - c) What is the first-line treatment for this condition? - **Answers:** - a) The most likely diagnosis is a urinary tract infection (UTI)【50†source】. - b) Ureteral dilation and reduced bladder tone due to progesterone predispose to urinary stasis and UTIs【50†source】. - c) Empirical antibiotic therapy, such as cephalexin, is typically first-line【50†source】. - **Explanation:** UTIs are common in pregnancy due to anatomical and hormonal changes, which increase the risk of pyelonephritis if left untreated. **Case 4:** A 30-year-old G1P0 woman is in active labour at 40 weeks. Her contractions are regular, but she reports intense back pain. Fetal heart rate monitoring is normal. - a) What is the most likely fetal position contributing to her symptoms? - b) What non-pharmacological method can help alleviate her back pain? - c) What intervention may be needed if progress stalls? - **Answers:** - a) Occipito-posterior position【49†source】. - b) Position changes such as hands-and-knees or pelvic tilts may help【49†source】. - c) Manual rotation or assisted delivery with forceps or vacuum may be needed if progress stalls【49†source】. - **Explanation:** Back labour is often associated with an occipito-posterior position, which may slow progression and require intervention. **Case 5:** A 27-year-old woman at 38 weeks presents for a routine antenatal visit. She reports increased swelling in her legs and face over the past week. Blood pressure is 145/95 mmHg. - a) What is the most concerning diagnosis to rule out? - b) What additional symptom would further support this diagnosis? - c) What is the immediate management step? - **Answers:** - a) Pre-eclampsia【50†source】. - b) Proteinuria would further support the diagnosis【50†source】. - c) Immediate management includes monitoring blood pressure and considering antihypertensive therapy【50†source 】. - **Explanation:** Pre-eclampsia is a hypertensive disorder of pregnancy that can lead to severe complications if not managed promptly. **Case 6:** A 24-year-old G2P1 at 40 weeks gestation is admitted with strong contractions but has not progressed past 6 cm dilation after several hours. Fetal monitoring is reassuring. - a) What term describes this lack of progress? - b) What potential cause should be assessed? - c) What management options are available? - **Answers:** - a) Arrest of labour【49†source】. - b) Inadequate uterine contractions should be assessed【49†source】. - c) Options include oxytocin augmentation or artificial rupture of membranes【49†source】. - **Explanation:** Arrest of labour can result from various factors, and management should aim to enhance uterine efficiency while monitoring fetal well-being. **Case 7:** A 35-year-old woman in her second trimester presents with complaints of heartburn and regurgitation, especially when lying down. - a) What physiological change in pregnancy contributes to her symptoms? - b) Name one lifestyle modification that may help. - c) What pharmacologic option is safe for treatment? - **Answers:** - a) Relaxation of the lower esophageal sphincter due to progesterone【50†source】. - b) Elevating the head of the bed or avoiding meals before lying down【50†source】. - c) Antacids like calcium carbonate are generally safe【50†source】. - **Explanation:** Gastroesophageal reflux is common in pregnancy due to hormonal influences, and treatment includes both lifestyle and pharmacologic measures. **Case 8:** A 29-year-old woman at 30 weeks presents with a sudden onset of dyspnea and chest pain. Her vitals include tachycardia and low oxygen saturation. - a) What serious condition should be considered first? - b) Name one immediate diagnostic test to confirm this condition. - c) What is the first step in management? - **Answers:** - a) Pulmonary embolism (PE)【50†source】. - b) CT pulmonary angiography or a ventilation-perfusion (V/Q) scan【50†source】. - c) Initiate anticoagulation therapy immediately【50†source】. - **Explanation:** Pregnancy increases the risk of thromboembolic events, and a PE is a medical emergency requiring prompt diagnosis and treatment. **Case 9:** A 40-year-old G4P3 presents in labour at 41 weeks. On admission, her membranes rupture, revealing meconium-stained amniotic fluid. - a) What fetal condition might this indicate? - b) What immediate monitoring should be conducted? - c) What potential intervention should be prepared for delivery? - **Answers:** - a) Fetal distress【49†source】. - b) Continuous fetal heart rate monitoring【49†source】. - c) Prepare for neonatal resuscitation at delivery【49†source】. - **Explanation:** Meconium-stained fluid can signal fetal distress, warranting close monitoring and preparedness for potential interventions. **Case 10:** A 33-year-old woman presents at 37 weeks gestation with complaints of severe itching, particularly on the palms and soles, without a rash. Liver function tests show elevated bile acids. - a) What is the most likely diagnosis? - b) Name one potential risk to the fetus. - c) What is a key component of management for this condition? - **Answers:** - a) Intrahepatic cholestasis of pregnancy (ICP)【50†source】. - b) Increased risk of preterm delivery or stillbirth【50†source】. - c) Management includes ursodeoxycholic acid and close fetal monitoring【50†source】. - **Explanation:** ICP poses risks to the fetus and requires monitoring and treatment to minimize complications. 1. **What is the most significant risk factor for breast cancer related to estrogen exposure?** - a) Early menarche and late menopause - b) Use of aromatase inhibitors - c) Use of progestogen-only therapy - d) Late first pregnancy - **Answer:** a) Early menarche and late menopause - **Explanation:** Extended exposure to estrogen due to early menarche and late menopause increases the risk of breast cancer【66†source】【67†source】. 2. **Which drug is contraindicated during pregnancy due to its association with congenital abnormalities, including spina bifida?** - a) Paracetamol - b) Valproate - c) Metformin - d) Gabapentin - **Answer:** b) Valproate - **Explanation:** Valproate is associated with a significantly increased risk of neural tube defects and other congenital abnormalities【68†source】. 3. **What is the mechanism of action of selective estrogen receptor modulators (SERMs) like tamoxifen in breast tissue?** - a) Agonist activity in breast tissue - b) Antagonist activity in breast tissue - c) Neutral effect in breast tissue - d) Dual activity depending on hormone levels - **Answer:** b) Antagonist activity in breast tissue - **Explanation:** Tamoxifen acts as an anti-estrogen in breast tissue, reducing the proliferative effects of estrogen on ER-positive cancer cells【66†source】. 4. **Which of the following is most accurate regarding the safety of SSRIs during pregnancy?** - a) All SSRIs are classified as Category A drugs. - b) Paroxetine is associated with a higher risk of congenital abnormalities. - c) SSRIs are contraindicated in all trimesters. - d) They increase the risk of neural tube defects. - **Answer:** b) Paroxetine is associated with a higher risk of congenital abnormalities【68†source】. - **Explanation:** Paroxetine, especially in the first trimester, has been linked to congenital cardiac defects. 5. **Which of the following correctly describes the genetic inheritance pattern in a consanguineous couple with recurrent neonatal deaths due to a genetic disorder?** - a) Autosomal dominant inheritance - b) Autosomal recessive inheritance - c) X-linked dominant inheritance - d) Mitochondrial inheritance - **Answer:** b) Autosomal recessive inheritance - **Explanation:** Consanguinity increases the likelihood of autosomal recessive disorders due to shared genetic variants【65†source】. 6. **What is the primary risk associated with hormone therapy (HT) in postmenopausal women when using combined estrogen and progestogen therapy?** - a) Osteoporosis - b) Reduced risk of cardiovascular disease - c) Increased risk of breast cancer - d) Prevention of cognitive decline - **Answer:** c) Increased risk of breast cancer - **Explanation:** Combined hormone therapy has been shown to increase the risk of breast cancer compared to estrogen-only therapy【67†source】. 7. **Which of the following is a significant long-term benefit of menopause hormone therapy (MHT)?** - a) Reduced risk of stroke - b) Increased risk of thromboembolism - c) Prevention of osteoporosis - d) Decreased LDL cholesterol with no impact on bone density - **Answer:** c) Prevention of osteoporosis - **Explanation:** MHT is effective in maintaining bone density and reducing the risk of fractures【67†source】. 8. **What is a major concern with the use of ACE inhibitors during pregnancy?** - a) Increased blood pressure - b) Renal failure and fetal death - c) Hyperglycemia - d) Reduced maternal weight gain - **Answer:** b) Renal failure and fetal death - **Explanation:** ACE inhibitors are associated with severe fetal effects, including renal failure and death【68†source】. 9. **In reproductive genetics, what is the risk calculation for having an affected child when one parent is a carrier for an autosomal recessive disorder, and the other parent is not tested but has a population risk of 1 in 40?** - a) 1 in 160 - b) 1 in 99,200 - c) 1 in 620 - d) 1 in 20,000 - **Answer:** b) 1 in 99,200 - **Explanation:** This combines the carrier risk for the non-tested parent and the autosomal recessive inheritance【 65†source】. 10. **What differentiates aromatase inhibitors from SERMs in terms of their mechanism in breast cancer therapy?** - a) They bind estrogen receptors directly. - b) They block the production of estrogen by inhibiting its synthesis. - c) They have agonist effects in bone. - d) They act as partial agonists in breast tissue. - **Answer:** b) They block the production of estrogen by inhibiting its synthesis【66†source】. - **Explanation:** Aromatase inhibitors lower estrogen levels by preventing its synthesis, making them effective in postmenopausal breast cancer treatment. 1. **Which statement regarding tamoxifen is NOT correct?** - a) It acts as an estrogen receptor antagonist in breast tissue. - b) It is associated with a decreased risk of endometrial cancer. - c) It can cause venous thromboembolism (VTE). - d) It is used for both early-stage and metastatic ER-positive breast cancer. - **Answer:** b) It is associated with a decreased risk of endometrial cancer. - **Explanation:** Tamoxifen is associated with an increased risk of endometrial cancer in postmenopausal women【 66†source】. 2. **Which statement about hormone therapy (HT) in menopause is NOT correct?** - a) Estrogen alone is used in women with a uterus. - b) HT reduces the risk of osteoporosis. - c) Combined HT may increase the risk of breast cancer. - d) Transdermal estrogen has fewer effects on coagulation than oral estrogen. - **Answer:** a) Estrogen alone is used in women with a uterus. - **Explanation:** Women with a uterus should receive combined estrogen and progestogen to prevent endometrial hyperplasia【67†source】. 3. **Which statement regarding the pharmacokinetics of drugs in pregnancy is NOT correct?** - a) Increased renal blood flow enhances the clearance of certain drugs. - b) Plasma protein binding is unaffected during pregnancy. - c) Hepatic metabolism can be increased due to hormonal changes. - d) Gastrointestinal motility is reduced, affecting drug absorption. - **Answer:** b) Plasma protein binding is unaffected during pregnancy. - **Explanation:** Plasma protein binding decreases due to lower albumin levels【68†source】. 4. **Which statement regarding genetic carrier screening is NOT correct?** - a) Carrier screening primarily identifies autosomal dominant disorders. - b) Carriers typically do not show symptoms of the disorder. - c) Screening can inform reproductive decision-making. - d) Both partners need to be carriers for autosomal recessive disorders to pose a risk. - **Answer:** a) Carrier screening primarily identifies autosomal dominant disorders. - **Explanation:** Carrier screening is mainly used to identify autosomal recessive and X-linked disorders【65†source】. 5. **Which of the following about aromatase inhibitors is NOT correct?** - a) They are used primarily in premenopausal women. - b) They decrease estrogen production. - c) They are associated with an increased risk of osteoporosis. - d) They provide a survival benefit in postmenopausal ER-positive breast cancer. - **Answer:** a) They are used primarily in premenopausal women. - **Explanation:** Aromatase inhibitors are used primarily in postmenopausal women【66†source】. 6. **Which statement about menopause is NOT correct?** - a) It is defined as occurring 12 months after the last menstrual period. - b) Hormone therapy can be used to manage severe symptoms. - c) Diagnosing menopause requires routine blood tests for FSH and LH. - d) Perimenopause can last up to a decade. - **Answer:** c) Diagnosing menopause requires routine blood tests for FSH and LH. - **Explanation:** Diagnosis is clinical and does not typically require hormone level testing【67†source】. 7. **Which of the following about the safety of SSRIs in pregnancy is NOT correct?** - a) Paroxetine is safe to use in all trimesters. - b) SSRIs can lead to neonatal withdrawal syndrome if used in late pregnancy. - c) Most SSRIs are classified as Category C drugs. - d) The use of paroxetine in the first trimester is associated with congenital heart defects. - **Answer:** a) Paroxetine is safe to use in all trimesters. - **Explanation:** Paroxetine is associated with an increased risk of congenital heart defects, particularly in the first trimester【68†source】. 8. **Which statement about estrogen receptor (ER) activity is NOT correct?** - a) ERα activation is critical for the proliferation of breast ductal cells. - b) ERβ generally acts as a suppressor in breast cancer. - c) ERβ has no role in bone health. - d) ERα is more prominently expressed in breast and uterine tissues. - **Answer:** c) ERβ has no role in bone health. - **Explanation:** Both ERα and ERβ play roles in bone health, with ERβ helping to modulate ERα's activity【66†source 】. 9. **Which statement about selective estrogen receptor modulators (SERMs) is NOT correct?** - a) SERMs like tamoxifen can act as agonists in bone tissue. - b) Raloxifene is used primarily for osteoporosis prevention. - c) SERMs uniformly act as antagonists in all tissues. - d) Tamoxifen can increase the risk of endometrial cancer. - **Answer:** c) SERMs uniformly act as antagonists in all tissues. - **Explanation:** SERMs can act as agonists in some tissues (e.g., bone) and antagonists in others (e.g., breast)【 66†source】. 10. **Which statement regarding drugs in pregnancy is NOT correct?** - a) Paracetamol is considered safe for use throughout pregnancy. - b) High-dose aspirin is safe in the third trimester. - c) NSAIDs are generally avoided in the third trimester due to risks like premature closure of the ductus arteriosus. - d) Metformin is used safely during pregnancy. - **Answer:** b) High-dose aspirin is safe in the third trimester. - **Explanation:** High-dose aspirin is avoided in the third trimester due to risks such as premature closure of the ductus arteriosus【68†source】. **1. Discuss the mechanisms of action and clinical uses of selective estrogen receptor modulators (SERMs):** - a) What is the primary action of tamoxifen in breast tissue? - b) How does raloxifene differ from tamoxifen in its effects on the endometrium? - c) Name one key side effect of tamoxifen related to coagulation. - **Answers:** - a) Tamoxifen acts as an estrogen receptor antagonist in breast tissue【66†source】. - b) Raloxifene does not stimulate endometrial proliferation, unlike tamoxifen【66†source】. - c) Tamoxifen increases the risk of venous thromboembolism (VTE)【66†source】. - **Explanation:** SERMs are designed to act as antagonists or agonists depending on the target tissue, balancing benefits and risks such as VTE. **2. Evaluate the safety of hormone therapy (HT) in postmenopausal women:** - a) Which component of combined HT is associated with an increased risk of breast cancer? - b) How does transdermal estrogen differ from oral estrogen in terms of VTE risk? - c) When is HT most beneficial in terms of cardiovascular protection? - **Answers:** - a) The progestogen component is associated with an increased risk of breast cancer【67†source】. - b) Transdermal estrogen is associated with a lower risk of VTE compared to oral estrogen【67†source】. - c) HT is most beneficial when started within 10 years of menopause onset【67†source】. - **Explanation:** The "window of opportunity" for cardiovascular benefits emphasizes timing for initiating HT to minimize risks and optimize benefits. **3. Outline the safety considerations for antidepressant use in pregnancy:** - a) Which SSRI is associated with congenital heart defects if used in the first trimester? - b) What potential neonatal condition may arise if SSRIs are used in the third trimester? - c) What is the general classification of most SSRIs regarding pregnancy safety? - **Answers:** - a) Paroxetine【68†source】. - b) Neonatal withdrawal syndrome【68†source】. - c) Most SSRIs are classified as Category C drugs【68†source】. - **Explanation:** Careful selection and timing of antidepressant use are crucial to managing maternal mental health while minimizing fetal risk. **4. Describe the main pharmacological approaches for treating ER-positive breast cancer:** - a) What is the mechanism of action of aromatase inhibitors? - b) Why are aromatase inhibitors preferred in postmenopausal women? - c) What is one common side effect associated with aromatase inhibitor use? - **Answers:** - a) Aromatase inhibitors block the conversion of androgens to estrogens【66†source】. - b) Postmenopausal women primarily produce estrogen through peripheral conversion, which aromatase inhibitors target【66†source】. - c) Osteoporosis【66†source】. - **Explanation:** Aromatase inhibitors effectively reduce estrogen levels in postmenopausal women, thereby slowing ER-positive breast cancer growth. **5. Explain the genetic basis and implications of carrier screening for reproductive risk:** - a) What is the inheritance pattern for cystic fibrosis? - b) How does carrier screening impact reproductive decision-making? - c) What is the significance of residual risk in carrier screening? - **Answers:** - a) Autosomal recessive【65†source】. - b) Carrier screening informs potential parents of their risk of having affected children【65†source】. - c) Residual risk refers to the remaining chance of being a carrier despite negative screening results【65†source】. - **Explanation:** Carrier screening aids in assessing genetic risks and informs couples of options like IVF with genetic testing. **6. Analyze the use and risks of hormone therapy (HT) in women with a history of VTE:** - a) What form of estrogen administration is preferred in women at risk of VTE? - b) What is one non-hormonal alternative for managing menopausal symptoms? - c) Why is combined estrogen-progestogen therapy contraindicated in women with active VTE? - **Answers:** - a) Transdermal estrogen【67†source】. - b) SSRIs or SNRIs【67†source】. - c) It increases the risk of recurrent VTE【67†source】. - **Explanation:** Transdermal estrogen bypasses the liver's first-pass effect, reducing coagulation factor synthesis and lowering VTE risk. **7. Detail the implications of drug pharmacokinetics in pregnancy:** - a) How does pregnancy affect renal clearance of drugs? - b) Why might drug dosages need to be adjusted during pregnancy? - c) Name one example of a drug category that may require dose adjustment. - **Answers:** - a) Renal clearance increases due to increased renal blood flow【68†source】. - b) Changes in body water, protein binding, and metabolism necessitate dosage adjustments【68†source】. - c) Anticonvulsants【68†source】. - **Explanation:** Understanding pharmacokinetic changes is essential to ensure therapeutic drug levels and minimize risks to both mother and fetus. **8. Discuss the management and risks of using NSAIDs during pregnancy:** - a) Why are NSAIDs avoided in the third trimester? - b) What condition can NSAIDs cause if taken near delivery? - c) What safer analgesic alternative is recommended for use during pregnancy? - **Answers:** - a) Risk of premature closure of the ductus arteriosus【68†source】. - b) Persistent pulmonary hypertension in the neonate【68†source】. - c) Paracetamol【68†source】. - **Explanation:** NSAIDs' effects on fetal circulation necessitate cautious use, particularly in the third trimester. **9. Explore the clinical and genetic implications of balanced translocations:** - a) What is a Robertsonian translocation? - b) How can balanced translocations lead to recurrent miscarriages? - c) What type of genetic analysis is used to detect translocations? - **Answers:** - a) A chromosomal rearrangement involving the fusion of two acrocentric chromosomes【65†source】. - b) Segregation during meiosis can lead to unbalanced gametes【65†source】. - c) Karyotyping【65†source】. - **Explanation:** Balanced translocations often do not affect carriers directly but can result in abnormal gamete formation. **10. Describe the indications and contraindications for using tamoxifen in premenopausal women:** - a) What is the primary use of tamoxifen in premenopausal women? - b) Name one absolute contraindication for tamoxifen use. - c) What is a significant side effect associated with tamoxifen in the uterus? - **Answers:** - a) Treatment of ER-positive breast cancer【66†source】. - b) Active pregnancy【66†source】. - c) Increased risk of endometrial cancer【66†source】. - **Explanation:** Tamoxifen is a cornerstone of therapy in ER-positive breast cancer but has specific risks that must be managed. **Case 1:** A 32-year-old premenopausal woman with a family history of ER-positive breast cancer presents for risk assessment and possible preventive treatment. - a) What preventive therapy could be considered for this patient? - b) What is the mechanism of action of this therapy? - c) Name one major side effect that needs to be monitored. - **Answers:** - a) Tamoxifen【66†source】. - b) Tamoxifen acts as an estrogen receptor antagonist in breast tissue, preventing the proliferative effects of estrogen【 66†source】. - c) Increased risk of venous thromboembolism (VTE)【66†source】. - **Explanation:** Tamoxifen can reduce the risk of breast cancer in high-risk premenopausal women but carries risks such as VTE, requiring careful consideration and monitoring. **Case 2:** A 40-year-old woman who has been diagnosed with osteoporosis after early menopause is considering treatment options. - a) What type of therapy can help prevent further bone loss? - b) Why would a selective estrogen receptor modulator (SERM) like raloxifene be considered? - c) What is one side effect of raloxifene? - **Answers:** - a) Menopause hormone therapy (MHT) or SERMs【67†source】. - b) Raloxifene acts as an estrogen receptor agonist in bone, helping maintain bone density【66†source】. - c) Increased risk of VTE【66†source】. - **Explanation:** Raloxifene can provide benefits for bone health without stimulating breast or endometrial tissues, making it suitable for postmenopausal osteoporosis management. **Case 3:** A 35-year-old woman with a history of multiple recurrent first-trimester miscarriages is evaluated for genetic counseling. Chromosome analysis of the couple reveals a balanced translocation in the male partner. - a) What is a balanced translocation? - b) How does this contribute to recurrent miscarriages? - c) What are potential reproductive options for this couple? - **Answers:** - a) A balanced translocation involves a rearrangement of chromosomal material without a net gain or loss【65†source 】. - b) Balanced translocations can result in unbalanced gametes during meiosis, leading to miscarriages【65†source】. - c) Options include preimplantation genetic testing (PGT) with IVF【65†source】. - **Explanation:** Genetic counseling and advanced reproductive techniques can help couples with balanced translocations achieve successful pregnancies. **Case 4:** A 29-year-old woman in her third trimester presents with sudden severe chest pain, shortness of breath, and tachycardia. She has a history of smoking. - a) What is the most likely diagnosis? - b) What immediate test would confirm this diagnosis? - c) What treatment should be initiated upon confirmation? - **Answers:** - a) Pulmonary embolism (PE)【68†source】. - b) CT pulmonary angiography or a ventilation-perfusion (V/Q) scan【68†source】. - c) Anticoagulation therapy【68†source】. - **Explanation:** Pregnancy increases the risk of thromboembolic events, particularly in women with additional risk factors such as smoking. **Case 5:** A 45-year-old postmenopausal woman presents with severe vasomotor symptoms affecting her quality of life. She has a history of a DVT 5 years ago. - a) What is the safest approach to hormone therapy for this patient? - b) Why is transdermal estrogen considered over oral formulations? - c) What non-hormonal alternatives could be explored if HT is not suitable? - **Answers:** - a) Transdermal estrogen with caution, considering her DVT history【67†source】. - b) Transdermal estrogen has a lower risk of VTE compared to oral estrogen【67†source】. - c) SSRIs or SNRIs for vasomotor symptom management【67†source】. - **Explanation:** Transdermal estrogen avoids the liver's first-pass effect and is associated with a lower risk of clotting, making it preferable in patients with a history of VTE. **Case 6:** A 38-year-old woman presents for counseling about the use of anti-migraine medication during pregnancy. She has a history of severe migraines that worsen without treatment. - a) Which category of anti-migraine drugs should be avoided during pregnancy? - b) What non-pharmacologic interventions can be recommended? - c) Which pharmacologic treatment could be considered safer? - **Answers:** - a) Triptans, especially sumatriptan (Category B3), should be avoided if possible【68†source】. - b) Lifestyle modifications, hydration, and relaxation techniques【68†source】. - c) Low-dose propranolol may be considered with caution【68†source】. - **Explanation:** Managing migraines in pregnancy requires a careful balance of minimizing risks while ensuring maternal well-being. **Case 7:** A 50-year-old woman reports worsening hot flushes, insomnia, and decreased libido. She underwent a hysterectomy at 45 and is considering MHT. - a) What type of MHT would be most appropriate for her? - b) Why is progestogen not required in her MHT regimen? - c) Name one benefit of MHT in this context. - **Answers:** - a) Estrogen-only MHT【67†source】. - b) Progestogen is unnecessary because she no longer has an endometrium【67†source】. - c) Relief from vasomotor symptoms and improved quality of life【67†source】. - **Explanation:** Estrogen-only therapy is suitable for women without a uterus, as there is no risk of endometrial hyperplasia. **Case 8:** A 25-year-old pregnant woman presents with a mild cough and fever. She has been prescribed an antibiotic. - a) What category of antibiotics is considered safest during pregnancy? - b) Name one antibiotic that should be avoided and why. - c) What non-antibiotic supportive care can be offered? - **Answers:** - a) Penicillins (Category A)【68†source】. - b) Tetracyclines should be avoided due to the risk of fetal dentition staining【68†source】. - c) Hydration and rest【68†source】. - **Explanation:** While many antibiotics are safe during pregnancy, careful selection is essential to avoid teratogenic risks. **Case 9:** A 52-year-old postmenopausal woman with a history of migraines reports that her migraines have worsened since she started MHT. - a) What adjustment can be made to her MHT regimen? - b) Why is transdermal estrogen preferred over oral estrogen in women with migraines? - c) What additional treatment approach can be considered? - **Answers:** - a) Switch to transdermal estrogen【67†source】. - b) Transdermal estrogen provides more stable hormone levels and reduces the risk of triggering migraines【67†source 】. - c) Adjusting the dose or considering non-hormonal treatments【67†source】. - **Explanation:** Transdermal MHT can help maintain stable estrogen levels, minimizing the exacerbation of migraines. **Case 10:** A 34-year-old pregnant woman with a history of epilepsy controlled by valproate is seeking advice on medication safety. - a) What is the major risk associated with the continued use of valproate during pregnancy? - b) What safer alternative can be considered? - c) What is essential for managing epilepsy during pregnancy? - **Answers:** - a) Increased risk of neural tube defects【68†source】. - b) Lamotrigine may be considered safer【68†source】. - c) Ensuring seizure control while minimizing drug-related risks【68†source】. - **Explanation:** Valproate poses significant teratogenic risks, and alternatives should be explored to maintain seizure control with less risk to the fetus. 1. **Which microbe is associated with intrauterine infections and significant risk to the fetus if maternal infection occurs in the first 20 weeks?** - a) Listeria monocytogenes - b) Parvovirus B19 - c) Group B Streptococcus - d) Cytomegalovirus (CMV) - **Answer:** b) Parvovirus B19 - **Explanation:** Parvovirus B19 can cause hydrops fetalis and fetal loss when maternal infection occurs in the early stages of pregnancy【84†source】【85†source】. 2. **What is the most common serious outcome of early-onset neonatal Group B Streptococcus (GBS) infection?** - a) Meningitis - b) Pneumonia - c) Sepsis - d) Neonatal jaundice - **Answer:** c) Sepsis - **Explanation:** Early-onset GBS primarily causes sepsis, and it can be fatal if not promptly treated【85†source】. 3. **Which immune component shows impaired function in neonates, increasing their susceptibility to bacterial infections?** - a) Mature CD8+ T cells - b) Toll-like receptor (TLR) response - c) IgA production - d) Cytotoxic T cell response - **Answer:** b) Toll-like receptor (TLR) response - **Explanation:** Neonates exhibit reduced TLR responses, impacting their ability to mount effective immune reactions to infections【87†source】. 4. **What mechanism contributes to the reduced adaptive immune response observed in the elderly?** - a) High levels of IgA production - b) Increased CD8+ T cell production - c) Thymic atrophy - d) Hyperactive natural killer (NK) cells - **Answer:** c) Thymic atrophy - **Explanation:** Thymic atrophy reduces the production of naïve T cells, diminishing adaptive immune responses【 88†source】. 5. **Which statement best describes the main consequence of maternal CMV infection during pregnancy?** - a) No risk of vertical transmission - b) High risk of congenital abnormalities - c) Mild respiratory illness in the mother only - d) Increased maternal morbidity without fetal impact - **Answer:** b) High risk of congenital abnormalities - **Explanation:** CMV can cause significant congenital issues, including microcephaly and other abnormalities【 84†source】. 6. **Which physiological mechanism helps prevent maternal immune rejection of the fetus?** - a) Increased CD8+ T cell activation - b) Enhanced production of pro-inflammatory cytokines - c) Increase in regulatory T cells (Tregs) - d) Increased antigen presentation by dendritic cells - **Answer:** c) Increase in regulatory T cells (Tregs) - **Explanation:** Regulatory T cells help maintain immune tolerance to fetal antigens, preventing maternal immune rejection【87†source】. 7. **Which age-related change is linked to decreased antibody diversity and quality in older adults?** - a) Reduced cytokine production by T helper cells - b) Decline in bone marrow plasma cell niches - c) Increased thymic output - d) Enhanced B cell activation - **Answer:** b) Decline in bone marrow plasma cell niches - **Explanation:** Aging reduces access to plasma cell niches, leading to decreased antibody quality and diversity【 88†source】. 8. **What is a critical risk factor for neonatal sepsis in preterm infants?** - a) Maternal rubella vaccination history - b) Preterm birth and low birth weight - c) Elevated maternal iron levels - d) High maternal BMI - **Answer:** b) Preterm birth and low birth weight - **Explanation:** Prematurity is associated with multiple immune defects, increasing the risk of sepsis【87†source】. 9. **What maternal intervention reduces the risk of severe congenital outcomes in neonates exposed to infections such as rubella?** - a) High-dose vitamin D supplementation - b) Early antiviral therapy - c) Maternal vaccination before pregnancy - d) Increased folic acid intake - **Answer:** c) Maternal vaccination before pregnancy - **Explanation:** Vaccination before pregnancy is crucial to prevent infections such as rubella, which can lead to severe congenital issues【86†source】【87†source】. 10. **What type of immune response is dominant in neonates and contributes to their susceptibility to certain pathogens?** - a) Th1-dominant response - b) Th2-dominant response - c) Enhanced cytotoxic response - d) Pro-inflammatory cytokine storm - **Answer:** b) Th2-dominant response - **Explanation:** Neonates typically exhibit a Th2-dominant response, which is less effective against certain bacterial infections【87†source】. 11. **Which statement correctly describes the aging immune system?** - a) Increased production of naïve T cells - b) Decrease in chronic inflammation markers - c) Reduced CD8+ T cell response to novel antigens - d) Increased effectiveness of mucosal immunity - **Answer:** c) Reduced CD8+ T cell response to novel antigens - **Explanation:** Aging is associated with reduced CD8+ T cell responses and impaired ability to respond to new antigens【88†source】. 12. **Which factor contributes significantly to antenatal complications such as preterm birth?** - a) High maternal BMI - b) Daily physical activity - c) Exclusive intake of vegetarian diet - d) Maternal undernutrition only - **Answer:** a) High maternal BMI - **Explanation:** High maternal BMI is linked to complications like preterm birth and increased risk of neonatal morbidities【86†source】. 13. **What condition results from insufficient nutrient flow through the placenta and is associated with chronic disease risk later in life?** - a) Pre-eclampsia - b) Intrauterine growth restriction (IUGR) - c) Fetal macrosomia - d) Maternal anemia - **Answer:** b) Intrauterine growth restriction (IUGR) - **Explanation:** IUGR is linked to insufficient nutrient flow and increased risk of chronic diseases such as type 2 diabetes and cardiovascular disease later in life【86†source】【88†source】. 14. **What is a major immune alteration seen in preterm neonates?** - a) Increased phagocytic activity - b) Enhanced expression of MHC class II molecules - c) Reduced production of mannose-binding lectin (MBL) - d) High levels of circulating IgG - **Answer:** c) Reduced production of mannose-binding lectin (MBL) - **Explanation:** Preterm neonates often have reduced MBL, which impairs their immune response to pathogens【 87†source】. 15. **What factor decreases the effectiveness of vaccines in the elderly?** - a) Overactive immune responses - b) Increased production of naïve B cells - c) Limited affinity maturation in antibodies - d) Higher levels of IgG3 - **Answer:** c) Limited affinity maturation in antibodies - **Explanation:** The aging immune system shows impaired germinal center function, which affects the maturation of antibodies【88†source】. 1. **Which statement about neonatal immunity is NOT correct?** - a) Neonates have a fully functional complement system. - b) Neonates rely on passive immunity for protection against pathogens. - c) Neonatal B-cells lack the capacity for class switching at birth. - d) The innate immune response in neonates is limited. - **Answer:** a) Neonates have a fully functional complement system. - **Explanation:** Neonates have reduced complement activity, which contributes to increased infection susceptibility 【87†source】. 2. **Which statement about the microbiome's role in neonates is NOT correct?** - a) Colonization by microbes begins before birth. - b) Vaginal delivery promotes colonization by protective Bacteroides species. - c) Antibiotic exposure during cesarean delivery enhances the diversity of the gut microbiome. - d) The neonatal gut microbiome influences immune system development. - **Answer:** c) Antibiotic exposure during cesarean delivery enhances the diversity of the gut microbiome. - **Explanation:** Antibiotic exposure during cesarean delivery can disrupt the natural colonization process, leading to reduced diversity and dominance of less beneficial bacteria【87†source】. 3. **Which of the following statements regarding immunosenescence is NOT correct?** - a) There is an increased production of naïve T cells in the elderly. - b) Thymic atrophy contributes to decreased T cell output. - c) The elderly have impaired responses to new antigens. - d) CD8+ T cell responses are reduced in effectiveness. - **Answer:** a) There is an increased production of naïve T cells in the elderly. - **Explanation:** The production of naïve T cells decreases significantly with age due to thymic atrophy【88†source】. 4. **Which statement about intrauterine growth restriction (IUGR) is NOT correct?** - a) It is associated with maternal hypertension. - b) It increases the risk of childhood obesity. - c) It is exclusively due to fetal chromosomal abnormalities. - d) It poses a higher risk for type 2 diabetes in adulthood. - **Answer:** c) It is exclusively due to fetal chromosomal abnormalities. - **Explanation:** IUGR has multiple causes, including placental insufficiency and maternal factors such as hypertension【86†source】. 5. **Which statement about maternal immune adaptations during pregnancy is NOT correct?** - a) Treg cell numbers increase to promote tolerance of the fetus. - b) The maternal immune system completely suppresses innate immunity. - c) Cytotoxic T cell activity is reduced to prevent fetal rejection. - d) The syncytiotrophoblast lacks MHC class I expression to avoid immune detection. - **Answer:** b) The maternal immune system completely suppresses innate immunity. - **Explanation:** The maternal immune system maintains active innate immunity while modulating adaptive responses 【87†source】. 6. **Which of the following about neonatal immune responses is NOT correct?** - a) Neonates have reduced NK cell cytolytic activity. - b) The innate immune system in neonates is hyperactive. - c) TLR signaling is diminished in neonates. - d) Neonates have lower cytokine production from dendritic cells. - **Answer:** b) The innate immune system in neonates is hyperactive. - **Explanation:** Neonates have a reduced and less effective innate immune response【87†source】. 7. **Which statement about maternal infections and pregnancy outcomes is NOT correct?** - a) Maternal CMV infection can cause congenital hearing loss in the neonate. - b) Listeria monocytogenes infection often results in asymptomatic maternal presentation. - c) Parvovirus B19 infection poses no risk to the fetus if acquired during pregnancy. - d) Group B Streptococcus can cause sepsis in neonates if transmitted during birth. - **Answer:** c) Parvovirus B19 infection poses no risk to the fetus if acquired during pregnancy. - **Explanation:** Parvovirus B19 infection can lead to severe outcomes, such as hydrops fetalis, if acquired during early pregnancy【84†source】【85†source】. 8. **Which of the following regarding the maternal-fetal interface is NOT correct?** - a) Placental syncytiotrophoblasts express MHC class II molecules. - b) Treg cells help prevent maternal rejection of the fetus. - c) TLRs on the placenta can detect maternal infections. - d) Villous structures facilitate nutrient exchange between mother and fetus. - **Answer:** a) Placental syncytiotrophoblasts express MHC class II molecules. - **Explanation:** Syncytiotrophoblasts lack MHC class II expression, which helps evade maternal immune detection【 87†source】. 9. **Which statement regarding senescence is NOT correct?** - a) Cellular senescence contributes to the prevention of cancer early in life. - b) The accumulation of senescent cells enhances tissue repair in aging individuals. - c) Senescent cells secrete inflammatory cytokines that can promote chronic diseases. - d) Cellular senescence is associated with reduced regenerative capacity in tissues. - **Answer:** b) The accumulation of senescent cells enhances tissue repair in aging individuals. - **Explanation:** Accumulation of senescent cells is associated with chronic inflammation and tissue dysfunction, not enhanced repair【88†source】. 10. **Which of the following statements about maternal health and global disparities is NOT correct?** - a) Maternal mortality is significantly higher in low-income countries compared to high-income ones. - b) Antenatal care accessibility is uniform across all regions. - c) Maternal undernutrition contributes to higher rates of perinatal mortality. - d) Female genital mutilation can increase the risk of neonatal death. - **Answer:** b) Antenatal care accessibility is uniform across all regions. - **Explanation:** Access to antenatal care varies widely, contributing to differing maternal and neonatal outcomes【 86†source】. **1. Discuss the immune adaptations during pregnancy:** - a) What type of T cells increase in number to maintain fetal tolerance? - b) How does the placenta contribute to preventing immune rejection of the fetus? - c) Which part of the immune system remains intact to protect against maternal infections? - **Answers:** - a) Regulatory T cells (Tregs)【87†source】. - b) The syncytiotrophoblast lacks MHC class I expression, preventing immune detection【87†source】. - c) The innate immune system remains active to defend against infections【87†source】. - **Explanation:** Tregs and the unique properties of the placenta help ensure that the maternal immune system does not attack the fetus, while the innate immune system still protects the mother from pathogens. **2. Explain the immune vulnerabilities of neonates:** - a) Why do neonates rely heavily on passive immunity? - b) Name one deficiency in the neonatal innate immune system. - c) When do neonates start producing their own IgG? - **Answers:** - a) Neonates have immature immune systems and rely on maternal antibodies for protection【87†source】. - b) Reduced production of mannose-binding lectin (MBL)【87†source】. - c) Neonates begin producing their own IgG around 3 months of age【87†source】. - **Explanation:** The reliance on maternal antibodies highlights the need for maternal health and immunity. Deficiencies in innate components make neonates more susceptible to infections. **3. Analyse the role of the microbiome in neonatal immune development:** - a) How does the delivery method affect the composition of the neonatal gut microbiome? - b) What key function does the gut microbiome play in neonates? - c) What is one consequence of antibiotic exposure during delivery? - **Answers:** - a) Vaginal delivery promotes colonization by beneficial microbes such as Bacteroides【87†source】. - b) It contributes to the development of the immune system【87†source】. - c) Antibiotic exposure can lead to a dysbiotic microbiome with reduced diversity【87†source】. - **Explanation:** The gut microbiome's establishment is crucial for immune development. Antibiotic disruption can delay or alter this process. **4. Examine the causes and consequences of intrauterine growth restriction (IUGR):** - a) What maternal condition is commonly associated with IUGR? - b) How does IUGR affect long-term health in offspring? - c) What hypothesis explains the link between IUGR and chronic disease? - **Answers:** - a) Maternal hypertension【86†source】. - b) It increases the risk of chronic conditions like type 2 diabetes and cardiovascular disease - c) The Barker hypothesis, or the "thrifty phenotype" hypothesis【86†source】. - **Explanation:** IUGR is linked to adverse developmental programming, which predisposes the individual to chronic diseases later in life. **5. Discuss the implications of maternal infections for neonatal health:** - a) What is a significant risk of congenital CMV infection? - b) How can maternal vaccination reduce risks associated with congenital infections? - c) Name one infection that can cause perinatal death if untreated. - **Answe

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