Nokea
Prior to taking a patient for an emergency cesarean section, it is MOST important to assess that:
- A. A signed informed consent has been given
- B. A Foley’s catheter has been inserted
- C. An intravenous line has been started
- D. The perineal area has been shaved adequately
Correct Answer: C
Rationale: The correct answer is C because establishing an intravenous line is essential for immediate access to administer fluids, medications, and blood products during the emergency cesarean section. This step ensures that the patient's vital signs can be supported, and any emergent interventions can be readily delivered.
A: While informed consent is important, in an emergency situation, the priority is to ensure the patient's immediate medical needs are met.
B: Inserting a Foley's catheter may be necessary during the procedure, but it is not the most critical assessment prior to the cesarean section.
D: Shaving the perineal area is not a priority in an emergency situation and may be done during the preparation for surgery.
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Flexion-distraction injuries of the thoracolumbar spine are most commonly caused by
- A. Blunt trauma
- B. Rotational injury
- C. Seat belts
- D. Gunshot wounds
Correct Answer: B
Rationale: The correct answer is B: Rotational injury. Flexion-distraction injuries of the thoracolumbar spine are often caused by rotational forces that occur during accidents such as motor vehicle collisions or falls. These forces lead to the spine being twisted, causing separation of the vertebrae. Blunt trauma (A) can cause various spinal injuries but is not specific to flexion-distraction injuries. Seat belts (C) are designed to prevent spinal injuries by restraining the body during a collision. Gunshot wounds (D) can cause spinal cord injuries but are not commonly associated with flexion-distraction injuries of the thoracolumbar spine.
When counseling a patient about treatment modalities for achalasia, the AGACNP advised that which of the following is the treatment of choice?
- A. Calcium channel antagonists
- B. Intrasphincter botulinum injection
- C. Pneumatic dilation
- D. Myotomy and partial fundoplication
Correct Answer: A
Rationale: Rationale for choice A: Calcium channel antagonists are the treatment of choice for achalasia as they help relax the lower esophageal sphincter, improving swallowing. This is a non-invasive option that can provide symptom relief for many patients.
Summary for other choices:
B: Intrasphincter botulinum injection is a temporary solution and not considered the treatment of choice.
C: Pneumatic dilation is another option for achalasia but is typically used if calcium channel antagonists are ineffective.
D: Myotomy and partial fundoplication is a more invasive surgical option and usually considered if other treatments fail.
The fetal head retracting against the perineum is a
- A. Gaskin sign
- B. Turtle sign
- C. Klumpke sign
- D. Chignon sign
Correct Answer: B
Rationale: The correct answer is B: Turtle sign. This sign refers to the fetal head retracting against the perineum during delivery. It indicates shoulder dystocia, a complication where the baby's shoulders get stuck after the head is delivered. This can lead to serious complications for both the baby and the mother if not managed promptly.
A: Gaskin sign is incorrect as it refers to a position where the mother is on her hands and knees during labor.
C: Klumpke sign is incorrect as it is a neurological condition affecting the lower arm and hand.
D: Chignon sign is incorrect as it is not a recognized medical term related to childbirth.
Which of the following is NOT a source of pain in labour?
- A. Uterine contractions
- B. Socio-cultural norms
- C. Cervical dilatation
- D. Pelvic floor stretching
Correct Answer: B
Rationale: Step 1: Uterine contractions are a physiological process in labor causing pain due to muscle contractions.
Step 2: Cervical dilatation involves the opening of the cervix, which can cause pain and discomfort.
Step 3: Pelvic floor stretching occurs as the baby moves through the birth canal, leading to pain.
Step 4: Socio-cultural norms do not directly cause physical pain in labor, making choice B the correct answer. Other choices directly relate to physical processes causing pain.
The main diagnostic feature of puerperal pyrexia is
- A. Fever ≥ 38°C for three consecutive occasions
- B. Fever ≥ 38°C for three days continuously
- C. Fever ≥ 38°C for three weeks continuously
- D. Fever ≥ 38°C for six days occasionally
Correct Answer: A
Rationale: The correct answer is A: Fever ≥ 38°C for three consecutive occasions. Puerperal pyrexia is defined as fever occurring after childbirth. The key diagnostic feature is the presence of fever (≥ 38°C) on three consecutive occasions, indicating a persistent infection. Choice B is incorrect because it doesn't specify the need for consecutive occasions. Choice C is incorrect as it extends the duration of fever to three weeks, which is too long for typical puerperal pyrexia. Choice D is incorrect as it mentions "occasionally" instead of "consecutively," which is not indicative of a consistent fever pattern seen in puerperal pyrexia.