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THE UNIVERSITY OF QUEENSLAND

THIS PAPER MUST NOT BE REMOVED FROM THE EXAMINATION ROOM

MBBS1000

FINAL SUMMATIVE ASSESSMENT, 28 October 2002

PAPER 1

THIS PAPER HAS FIVE (5) PARTS – YOU MUST COMPLETE ALL PARTS

TIME ALLOWED:

Three hours (3) for working.

Ten minutes for perusal before examination begins.

You should spend about

55 minutes on Part A

45

minutes on Part B

10

minutes on Part C1 To be handed in to receive Part C2

25

minutes on Part C2

45

minutes on Part D

YOU MUST WRITE IN INK. DO NOT WRITE IN PENCIL.

YOU MUST PRINT YOUR FULL NAME AND STUDENT NUMBER ON THE FRONT PAGE OF EACH PART OF THE EXAMINATION.

ALL questions to be answered.

Answers should be confined to the spaces provided.

The marks allocated to each question are shown on the examination paper.

NOTE:

YOU MAY TEAR OFF THIS FRONT PAGE TO KEEP WITH YOU DURING THE EXAMINATION

STUDENT NAME:

STUDENT NUMBER:

THE UNIVERSITY OF QUEENSLAND

MBBS1000

FINAL SUMMATIVE ASSESSMENT, 28 OCTOBER 2002

PAPER 1 - PART A

Total number of marks = 64.5

You should spend about 55 minutes on Part A

YOU MUST WRITE IN INK. DO NOT WRITE IN PENCIL.

YOU MUST PRINT YOUR FULL NAME AND STUDENT NUMBER ON THE FRONT PAGE OF EACH PART OF THE EXAMINATION.

ALL questions to be answered.

Answers should be confined to the spaces provided.

The marks allocated to each question are shown on the examination paper.

Multiple true/false questions are scored:

2

marks for a correct answer

1

mark for a ‘don’t know’ answer

0

marks for a wrong answer

0

marks if responses are left blank

There are 7 statements in each question so there is a maximum of 14 points per question.

This is converted to a score out of 5 marks by:

13, 14

5

11, 12

4

10

3

9

2

8

1

PART A

Page 1

Maddison B-F, who is 19, presents after work to your general practice, and complains of urinary frequency and a bloated feeling in the abdomen. You record her recent history, discover that her last period was 7 weeks ago, and are not surprised to find that a pregnancy test is positive.

Maddison too is not altogether surprised that she is pregnant, although she becomes upset and agitated. She is an A-grade netballer, and has been keenly anticipating the beginning of the new season. However, you are also aware that her family is strongly active in one of the local church communities, and she tells you that her parents would be devastated by both her unplanned pregnancy and the prospect of a termination of the pregnancy.

You spend thirty minutes with her before finishing for the day.

Question 1.

(5 marks)

Teenage pregnancies are a significant public health issue.

The Graph below shows the age-specific live birth and termination rates for Australian teenagers from 1971 – 1998 (Figure adapted from Condon 1992 and Australian Bureau of Statistics data. Data points for some years in the 1990s are missing).

Live births Terminations 50 40 30 20 10 Age specific rates (per 1000 women aged
Live births
Terminations
50
40
30
20
10
Age specific rates (per
1000 women aged 15-19)
70
72
74
76
78
80
82
84
86
88
94
98

Year

a) Describe the key information and trends demonstrated in this graph.

(3 marks)

Part A (cont)

Page 2

b) Given that research shows that the rate of sexual activity amongst teenagers over this time period has not changed significantly, give two (2) major reasons for the

demonstrated trends.

(2 marks)

Question 2.

(6 marks)

Q1 (a) & (b) Examiner’s use only

2. (6 marks) Q1 (a) & (b) Examiner’s use only As Maddison’s GP, you confirmed that

As Maddison’s GP, you confirmed that she was pregnant by performing a urine pregnancy test. You wonder how the urine pregnancy test compares with the “gold standard” serum beta hCG (pregnancy) test. Read the information given below regarding a diagnostic study of urine and serum pregnancy tests, and answer the questions that follow.

200 women who thought they may be pregnant, had both urine and serum

hCG pregnancy tests performed. The results of the blood test indicated that

155 women were pregnant. Of these, only 139 had tested positive on the urine

test. There were a total of 57 negative urine tests.

a) Calculate the sensitivity and specificity of the urine pregnancy test.

(2 marks)

tests. a) Calculate the sensitivity and specificity of the urine pregnancy test. (2 marks) (Please turn
tests. a) Calculate the sensitivity and specificity of the urine pregnancy test. (2 marks) (Please turn
tests. a) Calculate the sensitivity and specificity of the urine pregnancy test. (2 marks) (Please turn
tests. a) Calculate the sensitivity and specificity of the urine pregnancy test. (2 marks) (Please turn

(Please turn to next page)

Part A (cont)

Page 3

b) If the pre-test probability of a particular patient being pregnant is only about ~20%,
b)
If the pre-test probability of a particular patient being pregnant is only about ~20%,
what is the post-test probability of that patient being pregnant given the positive test
result?
(2 marks)
b)
List two (2) potential harms associated with false negative pregnancy test results and
two (2) potential harms associated with false positive pregnancy test results.
(2 marks)

Q2 (a), (b) & (c) Examiner’s use only

false positive pregnancy test results. (2 marks) Q2 (a), (b) & (c) Examiner’s use only (Please
false positive pregnancy test results. (2 marks) Q2 (a), (b) & (c) Examiner’s use only (Please

(Please turn to next page)

Part A (cont)

Page 4

Question 3.

(5.5 marks)

Part A (cont) Page 4 Question 3. (5.5 marks) (a) Circle the number of weeks after

(a) Circle the number of weeks after fertilization each of the two drawings depicts. (2 marks)

Left side drawing

2 4 6 8 10 12 14 16 18 20 Right side drawing 2 4
2
4
6
8
10
12
14
16
18
20
Right side drawing
2
4
6
8
10
12
14
16
18
20

(Please turn to next page)

Part A (cont)

Page 5

(b)

Identify A through to G on the left hand drawing.

Possible answers:

1.

Uterine cavity

2.

Decidua parietalis

3.

Amnion

4.

Allantois

5.

Chorion laeve

6.

Yolk sac

7.

Decidua capsularis

8.

Mucous plug

9.

Cervix

10.

Decidua basalis

11.

Chorion frondosum

12.

Endometrium

A

B

C

D

E

F

G

(Please turn to next page)

(3.5 marks)

Q3 (a) & (b) Examiner’s use only

A B C D E F G (Please turn to next page) (3.5 marks) Q3 (a)

Part A (cont)

Page 6

Question 4.

(6 marks)

a) Explain why, on the information provided, some people believe that if Maddison were to have a termination of her pregnancy, it would be an illegal procedure in

Queensland.

(3 marks)

b) Briefly explain the basis of the liberal moral view concerning the status of the foetus

and its implications for abortion law.

(3 marks)

(Please turn to next page)

Q4 (a) & (b) Examiner’s use only

and its implications for abortion law. (3 marks) (Please turn to next page) Q4 (a) &

Part A (cont)

Page 7

Fifteen (15) years pass. You saw Maddison only a couple of times following the termination of her pregnancy at the age of 19. She returns to see you at the surgery where you work part-time, having taken on two younger doctors who now run the practice.

At this visit, she tells you she has returned to be closer to her parents, having spent considerable time in Melbourne, developing a career in financial planning, and having married John, a banker.

She tells you that she is ten weeks pregnant, but she appears to be quite stressed and anxious. She has been referred to a local IVF specialist to continue managing the pregnancy. She tells you that it has taken almost three years to become pregnant, and that it has been possible only after numerous IVF attempts. She is currently working full-time. She is taking a beta-blocker for hypertension, which has become somewhat more difficult to manage during the pregnancy. She reluctantly indicates that she is still smoking.

Question 5.

(4 marks)

Give two (2) ways in which a policy relating to Assisted Reproductive Technology could (arguably) be ethically unjust, and briefly explain the basis of the alleged injustice.

(4 marks)

(Please turn to next page)

Q5 Examiner’s use only

and briefly explain the basis of the alleged injustice. (4 marks) (Please turn to next page)

Part A (cont)

Page 8

Question 6.

(10 marks)

Identify the structures marked A to U.

6. (10 marks) Identify the structures marked A to U. A L B M C N

A

L

B

M

C

N

D

O

E

P

F

Q

G

R

H

S

J

T

K

U

(Please turn to next page)

Q6 Examiner’s use only

O E P F Q G R H S J T K U (Please turn to

Part A (cont)

Page 9

Question 7.

(7 marks)

List five (5) symptoms of early (before 16 weeks) pregnancy and two (2) signs of early pregnancy, other than urinary frequency and feeling of bloated abdomen.

(Please turn to next page)

Q7 Examiner’s use only

other than urinary frequency and feeling of bloated abdomen. (Please turn to next page) Q7 Examiner’s

Part A (cont)

Page 10

The developing foetus has a high demand for glucose.

Question 8.

(6 marks)

a) Explain why the foetus uses more glucose per kilogram body weight than does a

newborn infant.

(2 marks)

b) How does the mother's metabolism change to ensure that the foetus is well supplied

(4 marks)

with glucose?

(Please turn to next page)

Q8 (a) & (b) Examiner’s use only

the foetus is well supplied (4 marks) with glucose? (Please turn to next page) Q8 (a)

Part A (cont)

Page 11

Question 9.

(10 marks)

a) Birth defects are reported in 2-3% of live births in Australia. Major neural tube defects such as spina bifida have been proposed to be due to a lack of folic acid.

Suggest four (4) key questions that the parents of infants with spina bifida may ask you in a discussion on the possible role of folate deficiency and indicate your replies. (8 marks)

b) Does the placenta protect the foetus from potential damage from drugs taken orally by

the mother? Explain your answer.

(2 marks)

(Please turn to next page)

Q9 (a) & (b) Examiner’s use only

orally by the mother? Explain your answer. (2 marks) (Please turn to next page) Q9 (a)

Part A (cont)

Page 12

Maddison’s hypertension becomes increasingly difficult to manage during the pregnancy. She is advised that she will probably need a caesarean section to deliver the baby safely. She is distressed by this, since she always had looked forward to natural childbirth, and despite earlier contrary advice, had made arrangements for a home delivery. She refuses her obstetrician’s strong advice that she will need to come into hospital soon for the caesarean.

Question 10.

(5 marks)

Respond to the following statements as TRUE (T), FALSE (F) OR DON’T KNOW (D)

CIRCLE YOUR CHOICE

1)

In the situation described, Maddison’s doctor owes both her and her foetus a professional duty of care.

T

F

D

2)

If Maddison’s doctor respected her refusal of treatment, And did not perform a Caesarean section, but the foetus died, the doctor could be prosecuted for foeticide.

T

F

D

3)

A viable foetus is defined as one which can survive outside the uterus.

T

F

D

4)

It is necessary to define the moral and legal status of the foetus, before it can be decided whether foetuses can be harmed through negligent medical care.

T

F

D

5)

Maddison’s refusal of the recommended Caesarean section demonstrates that she lacks decision-making competence.

T

F

D

6)

In general, the law recognises that a foetus increases in value as the pregnancy continues.

T

F

D

7)

It is generally agreed that legal enforcement of good antenatal care will lead to better outcomes for children than educational campaigns about antenatal care.

T

F

D

Q10 Examiner’s use only

for children than educational campaigns about antenatal care. T F D Q10 Examiner’s use only END

END OF PART A