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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 dont 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
11, 12
10
9
8

5
4
3
2
1

Page 1
PART A
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).

Terminations

50
40
30
20
98

94

88

86

84

82

80

78

76

74

72

10
70

Age specific rates (per


1000 women aged 15-19)

Live births

Year
a)

Describe the key information and trends demonstrated in this graph.

(3 marks)

(Your answer may continue over page)

(Please turn to next page)

Part A (cont)

b)

Page 2

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)

Q1 (a) & (b) Examiners use only

Question 2.

(6 marks)

As Maddisons 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.

(Please turn to next page)

(2 marks)

Part A (cont)

Page 3

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) Examiners use only

(Please turn to next page)

Part A (cont)
Question 3.

(a)

Page 4
(5.5 marks)

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 6 8

10 12 14 16 18 20

(Please turn to next page)

Part A (cont)
(b)

Page 5

Identify A through to G on the left hand drawing.

(3.5 marks)

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

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________
Q3 (a) & (b) Examiners use only

(Please turn to next page)

Part A (cont)
Question 4.

Page 6
(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)

Q4 (a) & (b) Examiners use only

(Please turn to next page)

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)

Q5 Examiners use only

(Please turn to next page)

Part A (cont)
Question 6.

Page 8
(10 marks)

Identify the structures marked A to U.

__________________________

____________________________

__________________________

____________________________

__________________________

____________________________

__________________________

____________________________

__________________________

____________________________

__________________________

____________________________

__________________________

____________________________

__________________________

____________________________

__________________________

____________________________

__________________________

____________________________
Q6 Examiners use only

(Please turn to next page)

Part A (cont)
Question 7.

Page 9
(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.

Q7 Examiners use only

(Please turn to next page)

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
with glucose?
(4 marks)

Q8 (a) & (b) Examiners use only

(Please turn to next page)

Part A (cont)
Question 9.
a)

Page 11
(10 marks)

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)

Q9 (a) & (b) Examiners use only

(Please turn to next page)

Part A (cont)

Page 12

Maddisons 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 obstetricians 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 DONT KNOW (D)
CIRCLE YOUR CHOICE
1)

In the situation described, Maddisons doctor owes both her


and her foetus a professional duty of care.

2)

If Maddisons doctor respected her refusal of treatment,


And did not perform a Caesarean section, but the foetus
died, the doctor could be prosecuted for foeticide.

3)

A viable foetus is defined as one which can survive outside


the uterus.

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.

5)

Maddisons refusal of the recommended Caesarean section


demonstrates that she lacks decision-making competence.

6)

In general, the law recognises that a foetus increases in


value as the pregnancy continues.

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.

Q10 Examiners use only

END OF PART A