Nokea
Icterus gravis and hydrops fetalis are conditions highly associated with:
- A. Rhesus D incompatibility
- B. ABO incompatibility
- C. Physiological jaundice
- D. Instant perinatal death
Correct Answer: A
Rationale: The correct answer is A: Rhesus D incompatibility. Icterus gravis and hydrops fetalis are conditions associated with hemolytic disease of the newborn, caused by Rhesus D incompatibility between the mother and fetus. This occurs when the mother is Rh-negative and the baby is Rh-positive, leading to the production of antibodies by the mother that attack the baby's red blood cells. This can result in severe jaundice (icterus gravis) and excessive fluid accumulation in the fetus (hydrops fetalis).
Summary:
- Choice B (ABO incompatibility) is incorrect because it typically causes less severe jaundice and anemia compared to Rhesus D incompatibility.
- Choice C (Physiological jaundice) is incorrect as it is a common benign condition in newborns due to immature liver function.
- Choice D (Instant perinatal death) is incorrect as it does not specifically relate to the conditions mentioned.
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R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as cramping but has become more constant over the last day. She reports constipation over the last few days but admits that for as long as she can remember she has had variable bowel habits. Her vital signs are normal, but physical examination reveals some tenderness in the left lower quadrant. Which diagnostic test is most likely to support the leading differential diagnosis?
- A. CT scan with IV, oral, and rectal contrast
- B. CBC with WBC differential
- C. Colonoscopy
- D. Barium enema
Correct Answer: D
Rationale: The correct diagnostic test for the patient is a barium enema. This test is commonly used to evaluate the colon and rectum for conditions such as colonic obstruction, inflammatory bowel disease, or colorectal cancer. In this case, the patient's presentation of left lower quadrant pain with a history of constipation and variable bowel habits suggests a possible colonic obstruction, which can be visualized through a barium enema. A CT scan with contrast may be helpful in some cases but may not provide as clear a view of the colon as a barium enema. CBC with WBC differential is a general blood test and would not directly aid in diagnosing colonic issues. Colonoscopy, while a valuable tool for evaluating the colon, may not be suitable for this patient initially due to the acute nature of the presentation and the need to first rule out a potential obstruction.
A student AGACNP just beginning his clinical rotation is observing his preceptor perform a physical survey on a patient who is brought in following a serious motor vehicle accident. The student observes that the physical examination includes rectovaginal examination, inspection of the urethral meatus, and palpation of the pelvic landmarks. The student knows the patient is being assessed for
- A. Peritoneal bleeding
- B. Retroperitoneal bleeding
- C. Paresthesia
- D. Pelvic fracture
Correct Answer: A
Rationale: The correct answer is A: Peritoneal bleeding. In a patient with a serious motor vehicle accident, a physical examination that includes rectovaginal examination, inspection of the urethral meatus, and palpation of pelvic landmarks is aimed at assessing for signs of internal bleeding, particularly peritoneal bleeding. Rectovaginal examination can detect blood in the rectouterine pouch, inspection of the urethral meatus can reveal blood at the urethral opening, and palpation of pelvic landmarks can identify tenderness or instability associated with internal bleeding. These findings would be indicative of potential peritoneal bleeding requiring urgent evaluation and management.
Summary of other choices:
B: Retroperitoneal bleeding - While physical examination findings may include signs such as flank ecchymosis or tenderness, the specific examinations mentioned are not typically performed to assess retroperitoneal bleeding.
C: Paresthesia - Paresthesia refers to abnormal sensations like tingling or numbness and
The main feature in the initial stage of shock is
- A. Cyanosis
- B. Tachycardia
- C. Sweat beads
- D. Hypotension
Correct Answer: B
Rationale: The correct answer is B: Tachycardia. In the initial stage of shock, the body tries to compensate for decreased perfusion by increasing heart rate to maintain blood flow to vital organs. Cyanosis (A) is a late sign of shock due to inadequate oxygenation. Sweat beads (C) are a non-specific response and not a defining feature of shock. Hypotension (D) typically occurs in the later stages of shock as the body's compensatory mechanisms start to fail. Tachycardia is the earliest and most consistent sign of shock, reflecting the body's attempt to maintain cardiac output.
In breech delivery, the midwife is advised to keep her hands off the breech as it progressively descends so as to
- A. Ascertain the fetal wellbeing in utero
- B. Allow enough room for the fetus to pass
- C. Allow gravitating descent of the fetus
- D. Prevent excessive traction being applied
Correct Answer: D
Rationale: The correct answer is D: Prevent excessive traction being applied. This is because in a breech delivery, excessive traction can lead to complications such as fetal injuries or umbilical cord prolapse. The midwife should avoid pulling on the baby's legs or body to prevent undue stress on the baby. The other choices are incorrect because: A: Ascertain the fetal wellbeing in utero - this is typically done through other means such as fetal monitoring. B: Allow enough room for the fetus to pass - this should be done by ensuring proper positioning and allowing natural descent. C: Allow gravitating descent of the fetus - this is not a recommended practice as it can cause complications.
Mother-to-child transmission of TB organisms never occurs during labor.
- A. TRUE
- B. FALSE
- C. -
- D. -
Correct Answer: B
Rationale: Step 1: TB can be transmitted from an infected mother to her child during labor.
Step 2: The TB bacteria can be present in the mother's respiratory secretions.
Step 3: During labor, the baby can inhale these bacteria and contract TB.
Step 4: Therefore, the statement that mother-to-child transmission of TB organisms never occurs during labor is FALSE.
Summary: Option B is correct because it accurately reflects the possibility of mother-to-child transmission of TB during labor. Option A is incorrect as it contradicts the factual information. Options C and D are not applicable as they provide no information.