Nokea
In True cephalopelvic disproportion
- A. Half of the patients will need an operative delivery
- B. The problem may be overcome during labor
- C. Operative delivery is unnecessary
- D. Operative delivery will be needed
Correct Answer: D
Rationale: In True cephalopelvic disproportion, the baby's head is too large to pass through the mother's pelvis. This condition often requires operative delivery (C-section) as a vaginal birth is not possible. Choice D is correct because operative delivery is indeed needed to safely deliver the baby. Choice A is incorrect as not all patients with cephalopelvic disproportion will necessarily require operative delivery. Choice B is also incorrect as the issue cannot generally be overcome during labor due to physical constraints. Choice C is incorrect as operative delivery is usually necessary in cases of true cephalopelvic disproportion to prevent complications.
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The AGACNP is counseling a patient about various methods of tumor biopsy. Which of the following is not an accurate statement?
- A. Incisional biopsy is preferred to excisional biopsy when possible
- B. Core needle biopsy has a higher rate of false positive than does fine needle aspiration
- C. Fine needle aspiration does not allow grading of tumors
- D. Core needle and incisional biopsies are virtually identical in terms of false results
Correct Answer: C
Rationale: Correct Answer: C - Fine needle aspiration does not allow grading of tumors.
Rationale:
1. Fine needle aspiration (FNA) collects cells for cytology evaluation, not tissue for grading.
2. Grading requires evaluation of tissue architecture, which is not possible with FNA.
3. FNA is useful for diagnosis but not for determining tumor grade.
Summary:
A: Incorrect - Excisional biopsy is preferred over incisional biopsy to obtain the entire tumor for diagnosis and grading.
B: Incorrect - Core needle biopsy has a lower false positive rate compared to fine needle aspiration.
D: Incorrect - Core needle and incisional biopsies differ in the amount of tissue sampled and potential for false results.
Vaginal delivery is possible in
- A. Brow presentation
- B. Face presentation
- C. Shoulder presentation
- D. Unstable lie
Correct Answer: B
Rationale: The correct answer is B: Face presentation. Vaginal delivery is possible in face presentation as the baby's head is extended, allowing for descent through the birth canal. Brow presentation (A) and shoulder presentation (C) may require cesarean delivery due to the atypical presentation of the baby. Unstable lie (D) refers to the baby being in a transverse position, which also necessitates a cesarean section. Face presentation is the only option where vaginal delivery may be possible due to the extended position of the baby's head.
T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation?
- A. A temperature of 101.5°F
- B. A leukocyte count of 18,000/µL
- C. A palpable gallbladder
- D. A positive Murphy’s sign
Correct Answer: A
Rationale: The correct answer is A: A temperature of 101.5°F. A fever indicates an inflammatory response, which could be due to a complication like cholecystitis or cholangitis. Elevated leukocyte count (choice B) supports infection but is not as specific as a fever. Palpable gallbladder (choice C) may suggest inflammation but not necessarily a complication. A positive Murphy's sign (choice D) is indicative of gallbladder inflammation but does not directly indicate a complication requiring surgical evaluation.
Placenta praevia is also referred to as unavoidable haemorrhage because
- A. Bleeding results as the segment prepares for true labour
- B. Bleeding results from pathological processes of the placenta
- C. Bleeding always occurs after a gestation of 37 complete weeks
- D. Of the high morbidity and mortality rate to the mother and neonate
Correct Answer: D
Rationale: The correct answer is D because placenta praevia can lead to life-threatening bleeding during labor due to the placenta partially or completely covering the cervix. This condition poses a high risk of morbidity and mortality to both the mother and the baby.
A: Incorrect. Bleeding in placenta praevia is not related to the segment preparing for labor.
B: Incorrect. While bleeding is due to placental issues, it is specifically due to the placenta's abnormal positioning, not a pathological process.
C: Incorrect. Bleeding can occur before 37 weeks in cases of placenta praevia, and the timing of bleeding is not linked to gestational age.
The commonest causative organism of pyelonephritis is
- A. Streptococcus faecalis
- B. Proteus vulgaris
- C. Staphylococcus pyogene
- D. Escherichia coli
Correct Answer: D
Rationale: The correct answer is D: Escherichia coli. E. coli is the most common causative organism of pyelonephritis due to its prevalence in the gastrointestinal tract. It has specific virulence factors that enable it to ascend the urinary tract and cause infection. Streptococcus faecalis, Proteus vulgaris, and Staphylococcus pyogene are less commonly associated with pyelonephritis compared to E. coli.