Nokea
A maternal cause of shoulder presentation includes
- A. A sub-septate uterus
- B. Oligohydramnios
- C. Prematurity
- D. Multiple pregnancy
Correct Answer: B
Rationale: The correct answer is B: Oligohydramnios. Oligohydramnios leads to reduced volume of amniotic fluid, which can result in poor fetal movements and inadequate cushioning for the fetus. This can increase the likelihood of abnormal fetal positions like shoulder presentation. Other choices are incorrect because: A: A sub-septate uterus is a structural uterine abnormality and not directly related to shoulder presentation. C: Prematurity may lead to preterm labor but is not specifically associated with shoulder presentation. D: Multiple pregnancy can increase the risk of malpresentation but is not a direct maternal cause of shoulder presentation.
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The AGACNP is evaluating a patient who reportedly fell down a flight of steps. Her history is significant for several emergency room visits, but she denies any significant medical conditions. Some documentation in her chart indicates that she may have been subjected to physical abuse. Today she presents with a periorbital ecchymosis of the left eye and swelling in the left side of the face. Her neurologic examination is within normal limits. Which head imaging study would be most useful in assessing for findings consistent with a history of abuse?
- A. Radiographs
- B. CT scan without contrast
- C. MRI
- D. PET scan
Correct Answer: B
Rationale: The correct answer is B: CT scan without contrast. A CT scan is the most useful imaging study in assessing for findings consistent with a history of abuse in this patient. CT scan is preferred for acute trauma to the head as it provides detailed images of the brain, skull, and facial bones. It can detect acute hemorrhages, fractures, or other signs of trauma. In this case, the patient's presentation with periorbital ecchymosis and facial swelling raises suspicion for traumatic injury, which can be assessed effectively with a CT scan.
Radiographs (choice A) are not as sensitive as CT scans in detecting subtle fractures or soft tissue injuries in the head and face. MRI (choice C) is not typically used in acute trauma assessment and may not provide timely information needed in this case. PET scan (choice D) is not indicated for evaluating traumatic head injuries and is more commonly used for assessing metabolic and functional activity in the body.
What are the risks of untreated gestational hypertension?
- A. Preeclampsia
- B. Placental abruption
- C. Preterm labor
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D, All of the above. Untreated gestational hypertension can lead to serious complications such as preeclampsia, characterized by high blood pressure and organ damage, placental abruption which is the separation of the placenta from the uterine wall, and preterm labor, resulting in premature birth. Each of these complications poses significant risks to both the mother and the baby, highlighting the importance of managing gestational hypertension. Therefore, all the choices A, B, and C are consequences of untreated gestational hypertension.
Delivery of breech with an extended head is accomplished through
- A. Burns Marshall maneuver
- B. Lovset maneuver
- C. Mauriceau-Smellie-Veit
- D. McRobert’s maneuver
Correct Answer: C
Rationale: The correct answer is C: Mauriceau-Smellie-Veit maneuver for delivery of breech with an extended head. This maneuver involves flexing the head while still in the vagina to allow for easier delivery. The Burns Marshall maneuver (A) is for impacted fetal shoulders, Lovset maneuver (B) is for shoulder dystocia, and McRobert's maneuver (D) is for shoulder dystocia as well. The Mauriceau-Smellie-Veit maneuver is specifically designed for delivering a breech with an extended head, making it the correct choice in this scenario.
In laryngeal stridor, the noise is more marked during
- A. Inspiration
- B. Expiration
- C. Feeding
- D. Play
Correct Answer: A
Rationale: The correct answer is A: Inspiration. Laryngeal stridor is caused by narrowed or obstructed airway, resulting in noisy breathing. During inspiration, the air is drawn through the narrowed larynx, causing the stridor sound. During expiration, the air is leaving the body, so the noise may not be as prominent. Choices C and D, feeding and play, are unrelated to the respiratory process and do not affect the presence of laryngeal stridor.
The CORRECT statement with regards to face to pubis delivery is
- A. It results due to a 135˚ anterior rotation of the occiput
- B. It results due to a persistent occipito posterior position
- C. It results due to a 45˚ anterior rotation of the occiput
- D. It results due to a 45˚ anterior rotation of the sinciput
Correct Answer: C
Rationale: Rationale:
Face to pubis delivery occurs when the fetal face presents towards the mother's pubic bone during birth. Choice C is correct because a 45˚ anterior rotation of the occiput is needed for this positioning. This allows the fetal face to be directed towards the mother's pubis for a successful face to pubis delivery. Choices A and D are incorrect as they mention incorrect angles of rotation. Choice B is incorrect as a persistent occipito posterior position would result in a face to sacrum delivery, not face to pubis.