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Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except
- A. Gamma-aminobutyric acid (GABA)
- B. Ammonia
- C. False neurotransmitters
- D. Serotonin
Correct Answer: D
Rationale: The correct answer is D: Serotonin. Serotonin is not a primary chemical mediator of hepatic encephalopathy. The main chemical mediators involved in hepatic encephalopathy are A: Gamma-aminobutyric acid (GABA), B: Ammonia, and C: False neurotransmitters. GABA plays a role in inhibiting neurotransmission, ammonia is a key factor in the pathogenesis of hepatic encephalopathy, and false neurotransmitters are produced due to altered amino acid metabolism in the liver. Serotonin is not a key player in the development of hepatic encephalopathy, hence it is the correct answer.
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Vaginal birth after caesarean section is known as
- A. Spontaneous vaginal delivery
- B. Trial of scar
- C. Spontaneous vertex delivery
- D. Trial of birth
Correct Answer: B
Rationale: The correct answer is B: Trial of scar. This term specifically refers to the process of attempting a vaginal birth after a previous caesarean section. It involves monitoring the previous cesarean scar for any signs of complications during labor.
A: Spontaneous vaginal delivery refers to giving birth vaginally without any previous cesarean section.
C: Spontaneous vertex delivery simply describes the position of the baby's head during birth.
D: Trial of birth is not a commonly used term in obstetrics and does not specifically relate to VBAC.
The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal
- A. Increased MCV
- B. Increased Hgb
- C. Increased platelets
- D. Increased albumin
Correct Answer: B
Rationale: Step 1: Post-splenectomy, platelet count typically drops temporarily, leading to a risk of bleeding.
Step 2: To compensate, the body increases hemoglobin (Hgb) levels to maintain oxygen-carrying capacity.
Step 3: Therefore, on postoperative day 2, an increased Hgb level is expected.
Summary: A is incorrect because MCV is not typically affected in this scenario. C is incorrect because platelet count usually decreases post-splenectomy. D is incorrect as albumin levels are not directly impacted by splenectomy for ITP.
While participating in sports, it is not uncommon for people to be subjected to sudden rotational injuries that result in the abrupt rotation of the cerebral cortex around the more fixed midbrain structures. This can interrupt input and outflow from the reticular activating system and result in what clinical phenomenon?
- A. Epidural hematoma
- B. Uncal herniation
- C. Concussion
- D. Contrecoup injury
Correct Answer: C
Rationale: Step 1: Sudden rotational injuries can disrupt brain function.
Step 2: Abrupt rotation of the cerebral cortex can affect the reticular activating system.
Step 3: Disruption of the reticular activating system can lead to altered consciousness.
Step 4: Altered consciousness is a hallmark of a concussion.
Therefore, the correct answer is C: Concussion. Other choices are incorrect because an epidural hematoma involves bleeding between the skull and dura (A), uncal herniation involves brain shifting through tentorium (B), and contrecoup injury occurs opposite the site of impact (D).
Which one of the following clinical features indicates neonatal intracranial injury?
- A. An oedematous swelling on the newborn’s scalp that resolves in 48 hours
- B. Notable bleeding between the epicranial aponeurosis & the periosteum
- C. Evidence of excessive molding or abnormal stretching of the fetal head
- D. Peripheral cyanosis as noted by the midwife on the neonate’s peripheries
Correct Answer: C
Rationale: Rationale for choice C:
1. Excessive molding or abnormal stretching of the fetal head can indicate neonatal intracranial injury due to the trauma during birth.
2. This feature suggests possible compression or trauma to the baby's head during delivery.
3. It may lead to intracranial hemorrhage or other injuries, requiring close monitoring and medical intervention.
Summary of other choices:
A. An oedematous swelling resolving in 48 hours is likely a normal finding (cephalohematoma) and not specific to intracranial injury.
B. Notable bleeding between the epicranial aponeurosis & periosteum may indicate cephalohematoma or caput succedaneum, not necessarily intracranial injury.
D. Peripheral cyanosis is related to oxygenation and circulation, not specific to intracranial injury.
A neonate whose birth weight is 1201 grams is regarded as
- A. Genetically small neonate
- B. Low birth weight neonate
- C. Very low birth weight neonate
- D. Extremely low birth weight neonate
Correct Answer: C
Rationale: The correct answer is C: Very low birth weight neonate. This designation is given to infants whose birth weight is less than 1500 grams. In this case, the neonate's weight of 1201 grams falls within the criteria for very low birth weight. Choice A is incorrect because being genetically small does not necessarily equate to low birth weight. Choice B is incorrect as low birth weight typically refers to infants weighing between 1500-2499 grams. Choice D is incorrect as extremely low birth weight pertains to infants weighing less than 1000 grams.