Nokea
In obstructed labor, edema of the vulva presents early due to
- A. Prolonged effort of the mother to push the baby
- B. Pressure applied on cervix by the presenting part
- C. An ill-fitting presenting part pressing on the cervix
- D. Large presenting diameters stretching the vulva
Correct Answer: B
Rationale: The correct answer is B because pressure applied on the cervix by the presenting part in obstructed labor leads to edema of the vulva. This pressure causes obstruction of blood and lymphatic flow in the area, resulting in swelling and edema. Prolonged effort by the mother (choice A) would not directly cause vulvar edema. An ill-fitting presenting part (choice C) may contribute to obstruction but does not explain the mechanism of edema. Large presenting diameters (choice D) stretching the vulva would not directly cause edema without pressure on the cervix.
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A general principle in surgical oncology is that the best approach to curative surgery in a fixed tumor requires
- A. En bloc resection
- B. Adjuvant therapies
- C. Neoadjuvant therapies
- D. Elective lymph node dissection
Correct Answer: D
Rationale: The correct answer is D: Elective lymph node dissection. This is because elective lymph node dissection helps to remove potentially cancerous lymph nodes, aiding in staging and ensuring complete tumor removal, thus improving the chances of curative surgery. En bloc resection (A) is important but may not always be feasible in fixed tumors. Adjuvant therapies (B) are used after surgery, not as the primary approach. Neoadjuvant therapies (C) are given before surgery to shrink tumors, not specifically for fixed tumors.
During neonatal resuscitation, dry wiping is aimed at
- A. Preventing hypothermia and facilitating tactile stimulation
- B. Preventing hemorrhage and clearing of the airway
- C. Preventing infection and facilitating tactile stimulation
- D. Improving the appearance and preventing infection
Correct Answer: A
Rationale: The correct answer is A: Preventing hypothermia and facilitating tactile stimulation. Dry wiping during neonatal resuscitation helps prevent hypothermia by removing wetness from the baby's skin. It also facilitates tactile stimulation, which can help stimulate the baby's breathing.
Summary:
B: Preventing hemorrhage and clearing of the airway - Dry wiping does not prevent hemorrhage or clear the airway directly.
C: Preventing infection and facilitating tactile stimulation - While dry wiping can help prevent infection, its primary aim during neonatal resuscitation is to prevent hypothermia.
D: Improving the appearance and preventing infection - Dry wiping is not done for cosmetic reasons; its main purpose is to prevent hypothermia.
Delivery of breech with an extended head is accomplished through
- A. Burns Marshall maneuver
- B. Lovset maneuver
- C. Mauriceau-Smellie-Veit
- D. McRobert’s maneuver
Correct Answer: C
Rationale: The correct answer is C: Mauriceau-Smellie-Veit maneuver for delivery of breech with an extended head. This maneuver involves flexing the head while still in the vagina to allow for easier delivery. The Burns Marshall maneuver (A) is for impacted fetal shoulders, Lovset maneuver (B) is for shoulder dystocia, and McRobert's maneuver (D) is for shoulder dystocia as well. The Mauriceau-Smellie-Veit maneuver is specifically designed for delivering a breech with an extended head, making it the correct choice in this scenario.
S. R. is a 51-year-old male patient who is being evaluated for fatigue. Over the last few months he has noticed a marked decrease in activity tolerance. Physical examination reveals a variety of ecchymoses of unknown origin. The CBC is significant for a Hgb of 10.1 gdL, an MCV of 72 fL and a platelet count of 65,000L the remainder of the CBC is normal. Coagulation studies are normal, but bleeding time is prolonged. The AGACNP recognizes that initial management of this patient will include
- A. Avoidance of elective surgery and nonessential medications
- B. Prednisone 60 mg daily until platelets normal
- C. Monoclonal antibody therapy such as rituximab
- D. Splenectomy
Correct Answer: A
Rationale: The correct answer is A: Avoidance of elective surgery and nonessential medications. This is the initial management for a patient with thrombocytopenia and abnormal bleeding time, possibly indicating immune thrombocytopenic purpura (ITP). Avoiding surgery and medications that can worsen thrombocytopenia is crucial to prevent bleeding complications. Prednisone (B) is not the first-line treatment for ITP, especially without confirming the diagnosis. Monoclonal antibody therapy (C) such as rituximab is usually reserved for refractory cases. Splenectomy (D) is considered only if other treatments fail as a last resort.
The complication that is associated with hyperemesis gravidarum is
- A. Wernicke’s encephalopathy
- B. Sheehan’s syndrome
- C. Maurice encephalitis
- D. Antepartum bleeding
Correct Answer: A
Rationale: The correct answer is A: Wernicke's encephalopathy. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy. Wernicke's encephalopathy is a neurological complication due to thiamine deficiency, which can occur in severe cases of vomiting, leading to impaired brain function. Sheehan's syndrome is a complication of postpartum pituitary necrosis. Maurice encephalitis is a fictional term not related to this context. Antepartum bleeding is not a typical complication of hyperemesis gravidarum. Therefore, the correct answer is A due to the potential neurological impact of severe vomiting on thiamine levels.