Nokea
In face presentation, obstructed labor is likely to result because
- A. The face is an ill-fitting presenting part
- B. Of the larger presenting diameters
- C. Of failure in molding unlike in vertex delivery
- D. Of presence of a caput succedaneum
Correct Answer: A
Rationale: In face presentation, the face is an ill-fitting presenting part, leading to obstructed labor. The face has larger diameters, making it difficult to pass through the birth canal. This differs from vertex delivery where the head can mold to fit. Caput succedaneum is swelling of the soft tissues on the baby's head and does not directly cause obstructed labor.
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How does the maternal microbiome influence the health of the fetus during pregnancy?
- A. By increasing fetal weight
- B. By altering immune development
- C. By reducing placental oxygen levels
- D. By enhancing amniotic fluid
Correct Answer: B
Rationale: The correct answer is B: By altering immune development. The maternal microbiome plays a crucial role in shaping the fetal immune system during pregnancy. Microbes in the mother's body can influence the development of the fetus's immune system through various mechanisms, such as immune cells crossing the placenta. This interaction helps the fetus develop tolerance to maternal antigens.
Choice A (By increasing fetal weight) is incorrect because the maternal microbiome's influence is not primarily related to weight gain. Choice C (By reducing placental oxygen levels) is incorrect as it does not directly relate to the immune system development. Choice D (By enhancing amniotic fluid) is incorrect as the main influence is on the immune system rather than amniotic fluid enhancement.
A patient with suspected Cushings syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate
- A. Low ACTH and low cortisol
- B. Low ACTH and high cortisol
- C. High ACTH and low cortisol
- D. High ACTH and high cortisol
Correct Answer: A
Rationale: The correct answer is A: Low ACTH and low cortisol. In a patient with an adrenal tumor causing Cushing's syndrome, the tumor itself produces excess cortisol independently of ACTH regulation. Therefore, ACTH levels are low due to negative feedback from high cortisol levels. As a result, cortisol levels are high, while ACTH levels are low.
Explanation for other choices:
B: Low ACTH and high cortisol - This suggests primary adrenal insufficiency (Addison's disease), not Cushing's syndrome.
C: High ACTH and low cortisol - This suggests secondary adrenal insufficiency, not Cushing's syndrome.
D: High ACTH and high cortisol - This is contradictory and not physiologically possible in the context of an adrenal tumor causing Cushing's syndrome.
K. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms the remainder of the GI review of systems is negative. His medical history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that
- A. He will need endoscopy to evaluate the problem
- B. Chronic gastroparesis is a known complication of ulcer surgery
- C. Medication is unlikely to help, and he may need another surgery
- D. His symptoms occur in 5 to 10% of people after ulcer surgery
Correct Answer: C
Rationale: Rationale for Correct Answer (C):
1. The patient's symptoms of decreased capacity for intake and nausea after eating suggest gastroparesis, a common complication post-ulcer surgery.
2. Given the history of complicated peptic ulcer disease and prior surgery, medication may be ineffective, necessitating potential reoperation.
3. The AGACNP advises that another surgery may be needed, indicating that medication alone may not suffice to address the issue.
Summary of Incorrect Choices:
A: Endoscopy is not necessary at this point as the symptoms are likely indicative of a functional issue rather than a structural problem.
B: While gastroparesis can occur post-ulcer surgery, the patient's symptoms are more suggestive of gastroparesis rather than chronic gastroparesis as a known complication.
D: The frequency of occurrence of symptoms after ulcer surgery is not relevant to the current management of the patient's symptoms.
Neonatal injury to nerve roots C8 & T1 causes one of the following
- A. Klumpke’s palsy
- B. Erb’s palsy
- C. Phrenic injury
- D. Radial palsy
Correct Answer: A
Rationale: Neonatal injury to nerve roots C8 & T1 leads to Klumpke's palsy due to damage to the lower brachial plexus. This results in weakness of the hand and forearm muscles. Erb's palsy is from injury to C5-C6 roots causing upper brachial plexus damage. Phrenic injury affects the diaphragm due to C3-C5 roots. Radial palsy involves the radial nerve, typically from injury at the spiral groove of the humerus. Therefore, the correct answer is A as it directly correlates with the specific nerve roots affected in Klumpke's palsy.
What is a common cause of oligohydramnios during pregnancy?
- A. Maternal hypertension
- B. Multiple gestations
- C. Premature rupture of membranes
- D. Fetal macrosomia
Correct Answer: C
Rationale: The correct answer is C: Premature rupture of membranes. Oligohydramnios is a condition characterized by low levels of amniotic fluid which can be caused by the premature rupture of membranes, leading to the leakage of amniotic fluid. This condition can result in various complications such as fetal growth restriction and compression of the umbilical cord. Maternal hypertension (choice A) is not a direct cause of oligohydramnios. Multiple gestations (choice B) may lead to polyhydramnios (excessive amniotic fluid) rather than oligohydramnios. Fetal macrosomia (choice D) is associated with increased amniotic fluid levels rather than decreased levels seen in oligohydramnios.