Nokea
In eclampsia, violent contraction and relaxation of the whole body occurs in
- A. Clonic stage
- B. Coma stage
- C. Premonitory stage
- D. Tonic stage
Correct Answer: A
Rationale: The correct answer is A: Clonic stage. In eclampsia, the clonic stage is characterized by violent contraction and relaxation of the whole body due to generalized seizures. During this stage, rhythmic jerking movements occur. The other choices are incorrect because:
B: Coma stage - In this stage, the individual is unconscious and not experiencing violent body movements.
C: Premonitory stage - This stage includes warning signs like headache and visual disturbances, but not the violent body movements seen in eclampsia.
D: Tonic stage - This stage involves sustained muscle contractions without relaxation, unlike the alternating contraction and relaxation seen in the clonic stage of eclampsia.
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What are the main causes of postpartum hemorrhage?
- A. Uterine atony
- B. Retained placenta
- C. Vaginal trauma
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D, "All of the above." Postpartum hemorrhage can be caused by uterine atony, which is the failure of the uterus to contract after delivery; retained placenta, where parts of the placenta remain in the uterus; and vaginal trauma, such as tears or lacerations during delivery. Each of these factors can contribute to excessive bleeding after childbirth. Therefore, selecting all the choices is necessary to encompass the main causes of postpartum hemorrhage.
Which of the following is an indication for forceps delivery?
- A. Cephalopelvic disproportion
- B. Occipito posterior position
- C. Breech presentation
- D. Placenta abruption
Correct Answer: B
Rationale: The correct answer is B: Occipito posterior position. Forceps delivery may be indicated in this situation to help rotate the baby's head and facilitate delivery. Occipito posterior position can lead to prolonged labor and fetal distress, making forceps delivery necessary for a safe delivery.
Incorrect choices:
A: Cephalopelvic disproportion is not an indication for forceps delivery as it refers to mismatch between the size of the baby's head and the mother's pelvis.
C: Breech presentation typically requires a different approach such as cesarean section rather than forceps delivery.
D: Placenta abruption, a medical emergency, would not be managed with forceps delivery but rather require immediate intervention to prevent harm to both the mother and baby.
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.
Ms. OReilly is a 69-year-old patient who is having a bowel resection for a malignant tumor of the right colon. She has several chronic medical conditions and takes numerous daily medications, including metoprolol 100 mg daily, warfarin 5 mg daily, vitamin E 200 units daily, and metformin 1000 mg bid. Which of the following regimens is the most appropriate approach to managing her medications preoperatively?
- A. All medications should be taken up to and including the morning of surgery
- B. The beta blocker may be taken up until the day of surgery, metformin should be held the day of surgery, and the remaining medications should be d/c’d 5–7 days before surgery
- C. Warfarin should be held 5 days before surgery; all other medications may be taken through the morning of surgery
- D. Metformin should be held if the morning blood sugar is < 200 mg/dL; all other medications except warfarin may be given the day of surgery
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. Metformin should be held if the morning blood sugar is < 200 mg/dL to reduce the risk of lactic acidosis postoperatively.
2. Warfarin should be held 5 days before surgery to prevent excessive bleeding during the procedure.
3. Beta blocker (metoprolol) can be continued on the day of surgery to prevent rebound hypertension.
4. Vitamin E can be continued as it does not have significant interactions or adverse effects in this scenario.
Summary:
- Choice A is incorrect as it does not address the need to hold metformin and warfarin appropriately.
- Choice B is incorrect as it discontinues medications too early and does not address metformin management.
- Choice C is incorrect as it only addresses warfarin and does not consider metformin or other medications.
- Choice D is the most appropriate approach as it addresses the specific considerations for each medication based on their effects and interactions.
T. S. is a 31-year-old female who is admitted following a catastrophic industrial accident. She had multiple injuries, and after a 10-day hospital stay that included several operations and attempts to save her, she is declared brain dead. She had an organ donor notation on her drivers license. Which of the following circumstances precludes her from serving as a liver donor?
- A. Encephalopathy
- B. Hepatitis C infection
- C. A long history of alcohol use
- D. Biliary cirrhosis
Correct Answer: C
Rationale: The correct answer is C: A long history of alcohol use. In this case, the patient T. S. is brain dead following a catastrophic accident. Although she had an organ donor notation, her long history of alcohol use precludes her from serving as a liver donor. Chronic alcohol use can lead to liver damage and compromise the quality of the liver for transplantation. Encephalopathy (choice A) is a potential complication of liver disease, but it does not preclude her from being a liver donor. Hepatitis C infection (choice B) and biliary cirrhosis (choice D) may affect the liver, but they do not automatically disqualify her as a donor.