Nokea
During induction of labor with syntocinon, drops increase is stopped prematurely on
- A. Achieving three moderate contractions
- B. Realizing normal maternal observations
- C. Achieving progressive cervical dilatation
- D. Observing normal fetal-related observations
Correct Answer: C
Rationale: Step-by-step rationale for choice C:
1. Progressive cervical dilatation indicates effective labor progress.
2. Stopping the syntocinon drops prematurely allows natural labor progression.
3. Prematurely stopping drops before reaching full dilation may hinder labor.
4. Achieving cervical dilatation is a crucial indicator for successful labor.
Summary:
A: Contractions should be strong, not just moderate.
B: Maternal observations alone do not determine labor progress.
D: Fetal-related observations are important but not the primary indicator for stopping drops.
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Diagnosis of occipito-posterior position:
- A. External examination and ultrasound
- B. Physical exam with pelvic exam findings
- C. Regular contractions and maternal discomfort
- D. Both A and B
Correct Answer: D
Rationale: Step-by-step rationale:
1. External examination can reveal the position of the baby's head.
2. Ultrasound can confirm the baby's position accurately.
3. Physical exam and pelvic exam findings can provide additional information.
4. Combining both methods (A and B) ensures a comprehensive assessment for accurate diagnosis.
Summary:
- Choice A alone may not provide sufficient information.
- Choice B alone may not be as accurate as combined with ultrasound.
- Choice C is not specific to diagnosing occipito-posterior position.
- Choice D is correct as it combines external examination, ultrasound, and physical exam for accurate diagnosis.
Congenital retraction of the prepuce, so that the glans is permanently exposed, is known as
- A. Phimosis
- B. Paraphimosis
- C. Hypospadias
- D. Hermaphroditism
Correct Answer: B
Rationale: Congenital retraction of the prepuce, leading to permanent glans exposure, describes paraphimosis. This condition occurs when the foreskin is pulled back and cannot return to its normal position, causing pain and swelling. Phimosis (A) is the inability to retract the foreskin over the glans. Hypospadias (C) is a urethral opening on the underside of the penis. Hermaphroditism (D) is a rare condition of having both male and female reproductive organs. Paraphimosis (B) is the specific term for the given scenario.
Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didnt want to go to the emergency room because he didnt want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes
- A. Proper cleansing and covering of the laceration, along with antibiotic therapy
- B. Local anesthesia, cleansing, and wound exploration for foreign bodies
- C. Local anesthesia, cleansing, and suture repair
- D. Cleansing, covering, antibiotic therapy, and tetanus prophylaxis
Correct Answer: C
Rationale: The correct answer is C: Local anesthesia, cleansing, and suture repair.
1. Local anesthesia is needed to numb the area before suturing.
2. Cleansing is necessary to prevent infection and remove debris.
3. Suture repair is required for a jagged laceration to promote proper wound healing and minimize scarring.
Other choices are incorrect:
A: Antibiotic therapy is not indicated for clean, non-infected wounds like this laceration.
B: Wound exploration for foreign bodies is not necessary in this case as the mechanism of injury is known and there is no indication of foreign bodies.
D: Tetanus prophylaxis is important but not directly related to the immediate management of the laceration.
The fetal head retracting against the perineum is a
- A. Gaskin sign
- B. Turtle sign
- C. Klumpke sign
- D. Chignon sign
Correct Answer: B
Rationale: The correct answer is B: Turtle sign. This occurs when the fetal head retracts against the perineum during delivery, resembling a turtle retracting into its shell. This indicates fetal shoulder dystocia, a serious complication. Gaskin sign (A) refers to the position of the mother during labor. Klumpke sign (C) is related to brachial plexus injuries during delivery. Chignon sign (D) is not a recognized term in obstetrics.
In the majority of cases, the first clinical manifestation of physiologic stress ulcer is
- A. Epigastric pain
- B. Change in mental status
- C. Fever
- D. Hemorrhage
Correct Answer: C
Rationale: The correct answer is C: Fever. The first clinical manifestation of physiologic stress ulcer is often a fever due to the body's response to stress. This is because stress can trigger an inflammatory response, leading to an increase in body temperature. Epigastric pain (choice A) is more commonly associated with peptic ulcers. Change in mental status (choice B) is not a typical early symptom of physiologic stress ulcer. Hemorrhage (choice D) is a severe complication that can occur later in the course of the disease, but it is not typically the first clinical manifestation.