Nokea
A medical/obstetric predisposing factor to puerperal sepsis includes
- A. Delivery by unskilled birth attendants
- B. Emergency cesarean section
- C. Poor personal hygiene
- D. Delay in care seeking
Correct Answer: B
Rationale: The correct answer is B: Emergency cesarean section. Emergency cesarean sections can increase the risk of puerperal sepsis due to the urgency of the procedure, which may lead to inadequate sterilization or contamination. Other choices are less directly associated with puerperal sepsis: A may increase the risk of infection, but not specifically puerperal sepsis. C relates to general hygiene practices and D focuses on delays in seeking care, which may affect treatment outcomes but are not direct predisposing factors to puerperal sepsis.
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S. R. is a 51-year-old male patient who is being evaluated for fatigue. Over the last few months he has noticed a marked decrease in activity tolerance. Physical examination reveals a variety of ecchymoses of unknown origin. The CBC is significant for a Hgb of 10.1 gdL, an MCV of 72 fL and a platelet count of 65,000L the remainder of the CBC is normal. Coagulation studies are normal, but bleeding time is prolonged. The AGACNP recognizes that initial management of this patient will include
- A. Avoidance of elective surgery and nonessential medications
- B. Prednisone 60 mg daily until platelets normal
- C. Monoclonal antibody therapy such as rituximab
- D. Splenectomy
Correct Answer: D
Rationale: The correct answer is D: Splenectomy. In this case, the patient presents with signs of immune thrombocytopenic purpura (ITP) with low platelet count and bleeding time prolongation. Splenectomy is the definitive treatment for ITP as the spleen is the site of platelet destruction. Avoiding elective surgery and medications (choice A) may be necessary to prevent bleeding complications but do not address the underlying issue. Prednisone (choice B) is used for acute treatment but not for long-term management. Monoclonal antibody therapy (choice C) is an option for refractory cases but not first-line therapy.
Traumatic diaphragmatic hernias present in both acute and chronic forms. Patients with a more chronic form are most likely to be present with
- A. Respiratory insufficiency
- B. Sepsis
- C. Bowel obstruction
- D. Anemia
Correct Answer: A
Rationale: The correct answer is A: Respiratory insufficiency. Chronic traumatic diaphragmatic hernias can lead to gradual compromise of respiratory function due to herniation of abdominal contents into the chest cavity, causing compression of the lungs and reduced lung capacity. This results in symptoms such as dyspnea, cough, and chest pain. Sepsis (B) is more commonly associated with acute traumatic diaphragmatic hernias. Bowel obstruction (C) is a possible complication but typically presents with acute symptoms like abdominal pain and distension. Anemia (D) is not a common presentation of diaphragmatic hernias.
A condition of trial of scar is
- A. Estimated fetal weight of less than 3600g
- B. Availability of a level one hospital nearby
- C. Not more than two previous caesarean section scars
- D. An adequate pelvis with true conjugate 10.5cm
Correct Answer: C
Rationale: The correct answer is C: Not more than two previous caesarean section scars. This is because a trial of scar refers to a trial of labor in a woman who has had previous cesarean sections. The guideline typically recommends that a trial of scar should be considered in women with no more than two previous cesarean section scars to reduce the risk of uterine rupture. Choices A, B, and D are incorrect because the estimated fetal weight, availability of a level one hospital, and pelvis size are not specific criteria used to determine eligibility for a trial of scar.
Effects of preeclampsia on the reproductive system include
- A. Development of infarcts and placental abruption
- B. Lowered vaginal discharge pH and haemorrhage
- C. Congestive cardiac failure and fetal hypoxia
- D. Poor placental anchorage and severe infarction
Correct Answer: D
Rationale: The correct answer is D because preeclampsia can lead to poor placental anchorage, which results in reduced blood flow to the placenta, leading to severe infarction. This can cause adverse effects on the fetus and the mother. Choice A is incorrect because infarcts and placental abruption are not specific effects of preeclampsia on the reproductive system. Choice B is incorrect because lowered vaginal discharge pH and hemorrhage are not typical effects of preeclampsia. Choice C is incorrect because congestive cardiac failure and fetal hypoxia are not direct effects of preeclampsia on the reproductive system.
What role does the placenta play in managing fetal waste products?
- A. Filters toxins
- B. Facilitates nutrient absorption
- C. Removes carbon dioxide
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D because the placenta performs multiple functions in managing fetal waste products. It filters toxins, facilitates nutrient absorption, and removes carbon dioxide. The placenta acts as a barrier between the mother and the fetus, allowing for the exchange of nutrients and waste products. Therefore, all of the above choices are correct in describing the role of the placenta in managing fetal waste products. The other choices are incorrect because they do not encompass all the functions that the placenta serves in this context.