Nokea
Mechanism of labour in left Sacro-anterior position (breech):
- A. Flexion, internal rotation, extension, external rotation
- B. Descent, engagement, flexion, internal rotation
- C. Flexion, external rotation, descent, expulsion
- D. Extension, flexion, engagement, delivery
Correct Answer: A
Rationale: The mechanism includes flexion, internal rotation, and extension of the breech baby.
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The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kgday. The best approach to this patients management is to
- A. Continue the current regimen
- B. D/C the spironolactone and begin a loop diuretic
- C. Add a loop diuretic to the spironolactone
- D. Proceed to large-volume paracentesis Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?
Correct Answer: B
Rationale: The best approach to managing the patient with ascites who has responded to spironolactone with weight loss is to add a loop diuretic to the current regimen. Spironolactone is an aldosterone antagonist that primarily works on the distal convoluted tubule, while loop diuretics, such as furosemide, act on the thick ascending limb of the loop of Henle. Combining these two diuretics can result in a synergistic effect, increasing diuresis and reducing fluid retention in patients with ascites. This combination therapy is often used in patients who do not respond adequately to spironolactone alone, and it is considered a common strategy in the management of ascites due to cirrhosis. Therefore, adding a loop diuretic to the spironolactone regimen is the most appropriate next step to optimize diuresis and fluid management in this patient.
On vaginal examination, the findings characteristic of brow presentation include
- A. Presenting diameter is submento-vertical 11.5cm, head partially extended
- B. Back difficult to palpate, fetal heart heard on the same side as the limbs
- C. Presenting diameter is mento-vertical 13.5cm, head partially extended
- D. Presenting diameter is mento-vertical 13.5cm, head completely extended
Correct Answer: A
Rationale: The characteristic presenting diameter in brow presentation is submento-vertical, with the head partially extended.
In marginal cephalopelvic disproportion,
- A. All the patients will need an operative delivery.
- B. Half of the patients will need an operative delivery.
- C. The problem is always overcome during labor.
- D. The pelvis is too small for the fetus to pass through.
Correct Answer: C
Rationale: Marginal cephalopelvic disproportion can often be managed in labor without the need for a cesarean.
Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didnt want to go to the emergency room because he didnt want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes
- A. Proper cleansing and covering of the laceration, along with antibiotic therapy
- B. Local anesthesia, cleansing, and wound exploration for foreign bodies
- C. Local anesthesia, cleansing, and suture repair
- D. Cleansing, covering, antibiotic therapy, and tetanus prophylaxis
Correct Answer: D
Rationale: In this scenario, the patient presents with a jagged laceration on his forearm that is still open and requires sutures. The appropriate management for this patient involves local anesthesia to reduce pain, thorough cleansing of the wound to prevent infection, and wound exploration to assess for any foreign bodies that may be present. Suturing the wound is necessary to promote proper healing and reduce the risk of complications. Antibiotic therapy may be indicated if signs of infection are present, but it is not mentioned in the scenario as a primary management step. Tetanus prophylaxis should also be considered given the mechanism of injury involving a dirty object.
The presenting diameter in face presentation is
- A. Submento-vertical
- B. Mento-vertical
- C. Suboccipito-bregmatic
- D. Submento-bregmatic
Correct Answer: A
Rationale: In face presentation, the presenting diameter is submento-vertical.