Nokea
The CORRECT statement with regards to face to pubis delivery is
- A. It results due to a 135˚ anterior rotation of the occiput
- B. It results due to a persistent occipito posterior position
- C. It results due to a 45˚ anterior rotation of the occiput
- D. It results due to a 45˚ anterior rotation of the sinciput
Correct Answer: C
Rationale: Rationale:
Face to pubis delivery occurs when the fetal face presents towards the mother's pubic bone during birth. Choice C is correct because a 45˚ anterior rotation of the occiput is needed for this positioning. This allows the fetal face to be directed towards the mother's pubis for a successful face to pubis delivery. Choices A and D are incorrect as they mention incorrect angles of rotation. Choice B is incorrect as a persistent occipito posterior position would result in a face to sacrum delivery, not face to pubis.
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In the preoperative assessment of a patient for the likelihood of postoperative risk, ascorbic acid deficiency, anemia, and volume contraction are all risk factors for
- A. Prolonged intubation
- B. Thromboembolism
- C. Delayed wound healing
- D. Atelectasis
Correct Answer: D
Rationale: Step-by-step rationale for why choice D (Atelectasis) is correct:
1. Ascorbic acid deficiency can lead to impaired lung function, increasing the risk of atelectasis.
2. Anemia can cause decreased oxygen-carrying capacity, contributing to atelectasis.
3. Volume contraction can lead to reduced lung expansion, further predisposing to atelectasis.
Summary:
- Choice A (Prolonged intubation): Intubation duration is more related to respiratory complications, not directly linked to the mentioned risk factors.
- Choice B (Thromboembolism): Risk factors like immobility and hypercoagulability are more relevant to thromboembolism.
- Choice C (Delayed wound healing): More associated with factors like malnutrition and impaired immune function rather than the mentioned risk factors.
Incidental antepartum haemorrhage is also referred to as
- A. Intraplacental haemorrhage
- B. Intrapartum haemorrhage
- C. Extraplacental haemorrhage
- D. Preterm haemorrhage
Correct Answer: C
Rationale: The correct answer is C: Extraplacental haemorrhage. Incidental antepartum haemorrhage refers to bleeding from a source other than the placenta, such as the cervix or vagina, before delivery. Intraplacental haemorrhage (choice A) refers to bleeding within the placenta itself, not outside it. Intrapartum haemorrhage (choice B) occurs during labor and delivery, not before. Preterm haemorrhage (choice D) is not a specific term used to describe antepartum bleeding. Therefore, the correct term for antepartum bleeding from a non-placental source is extraplacental haemorrhage.
Ms. OReilly is a 69-year-old patient who is having a bowel resection for a malignant tumor of the right colon. She has several chronic medical conditions and takes numerous daily medications, including metoprolol 100 mg daily, warfarin 5 mg daily, vitamin E 200 units daily, and metformin 1000 mg bid. Which of the following regimens is the most appropriate approach to managing her medications preoperatively?
- A. All medications should be taken up to and including the morning of surgery
- B. The beta blocker may be taken up until the day of surgery, metformin should be held the day of surgery, and the remaining medications should be d/c’d 5–7 days before surgery
- C. Warfarin should be held 5 days before surgery; all other medications may be taken through the morning of surgery
- D. Metformin should be held if the morning blood sugar is < 200 mg/dL; all other medications except warfarin may be given the day of surgery
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. Metformin should be held if the morning blood sugar is < 200 mg/dL to reduce the risk of lactic acidosis postoperatively.
2. Warfarin should be held 5 days before surgery to prevent excessive bleeding during the procedure.
3. Beta blocker (metoprolol) can be continued on the day of surgery to prevent rebound hypertension.
4. Vitamin E can be continued as it does not have significant interactions or adverse effects in this scenario.
Summary:
- Choice A is incorrect as it does not address the need to hold metformin and warfarin appropriately.
- Choice B is incorrect as it discontinues medications too early and does not address metformin management.
- Choice C is incorrect as it only addresses warfarin and does not consider metformin or other medications.
- Choice D is the most appropriate approach as it addresses the specific considerations for each medication based on their effects and interactions.
Bruised and oedematous appearance of the uterus, associated with placenta abruption, is collectively referred to as
- A. Wernicke’s encephalopathy
- B. Uterine prolapse
- C. Couvelaire uterus
- D. Asherman’s syndrome
Correct Answer: C
Rationale: The correct answer is C, Couvelaire uterus. This condition is characterized by a bruised and edematous appearance of the uterus due to severe placental abruption. The rationale is that a Couvelaire uterus specifically refers to this presentation, while the other choices do not.
A: Wernicke's encephalopathy is a neurological disorder caused by thiamine deficiency.
B: Uterine prolapse is the descent or herniation of the uterus into or beyond the vagina.
D: Asherman's syndrome involves intrauterine adhesions leading to menstrual irregularities.
The progression of coronary artery plaque formation can lead to a variety of pathologic conditions. When subtotal plaque disruption occurs resulting in vasoconstriction, platelet activation, and embolization, it most commonly causes which clinical phenomenon?
- A. Endothelial cell dysfunction
- B. Prinzmetal’s angina
- C. Transmural myocardial infarction
- D. Non-ST elevation myocardial infarction
Correct Answer: C
Rationale: The correct answer is C: Transmural myocardial infarction. Subtotal plaque disruption leads to vasoconstriction, platelet activation, and embolization, causing complete occlusion of a coronary artery. This results in ischemia of the entire thickness of the myocardial wall, leading to transmural myocardial infarction. Endothelial cell dysfunction (A) is an early event in atherosclerosis but does not directly result from subtotal plaque disruption. Prinzmetal's angina (B) is caused by transient coronary artery spasm rather than plaque disruption. Non-ST elevation myocardial infarction (D) involves incomplete blockage of a coronary artery and typically does not result from subtotal plaque disruption.