Nokea
The engaging diameter in a face presentation is
- A. Sub-mento vertical diameter
- B. Sub-mento bregmatic diameter
- C. Mento vertical diameter
- D. Sub-occipito bregmatic diameter
Correct Answer: A
Rationale: The engaging diameter in a face presentation is the sub-mento vertical diameter. This is the correct answer because it represents the distance from the tip of the chin (mentum) to the highest point on the skull (vertex), which is the most critical diameter for the face to descend through the pelvis during childbirth.
Choice B (Sub-mento bregmatic diameter) is incorrect because it represents the distance from the tip of the chin to the anterior fontanelle, not the highest point on the skull.
Choice C (Mento vertical diameter) is incorrect because it refers to the distance from the chin to the base of the skull, not the highest point on the skull.
Choice D (Sub-occipito bregmatic diameter) is incorrect because it represents the distance from the base of the skull to the anterior fontanelle, not involving the chin.
You may also like to solve these questions
Vaginal birth after caesarean section is known as
- A. Spontaneous vaginal delivery
- B. Trial of scar
- C. Spontaneous vertex delivery
- D. Trial of birth
Correct Answer: B
Rationale: The correct answer is B: Trial of scar. This term specifically refers to the process of attempting a vaginal birth after a previous caesarean section. It involves monitoring the previous cesarean scar for any signs of complications during labor.
A: Spontaneous vaginal delivery refers to giving birth vaginally without any previous cesarean section.
C: Spontaneous vertex delivery simply describes the position of the baby's head during birth.
D: Trial of birth is not a commonly used term in obstetrics and does not specifically relate to VBAC.
A neonate of a smear-negative mother just before birth receives BCG as usual.
- A. TRUE
- B. FALSE
- C. -
- D. -
Correct Answer: A
Rationale: The correct answer is A because BCG vaccination is recommended for newborns regardless of maternal smear status to prevent tuberculosis. The neonate is at risk of TB exposure postnatally and needs protection. Maternal smear status does not affect the indication for BCG in the newborn. Choice B is incorrect because withholding BCG in this case would leave the neonate vulnerable to TB. Choices C and D are not applicable as they do not provide any information.
Janet is a 54-year-old female who is in the ICU following hepatic resection due to metastatic disease. She is expected to move to a general medical floor today. Morning labs are as follows serum bilirubin approximately 2 gdL, albumin 3.1 gdL, and prothrombin time 20 seconds. AST and ALT are 85 and 99 respectively. The appropriate response would be to
- A. Cancel the transfer and keep her in the ICU
- B. Infuse albumin and fresh frozen plasma
- C. Repeat the labs the next day
- D. Prepare for reoperation
Correct Answer: D
Rationale: The correct answer is D: Prepare for reoperation. Given the patient's elevated AST and ALT levels after hepatic resection, along with abnormal prothrombin time and low albumin, there is concern for liver dysfunction. This indicates a potential complication post-surgery, such as hepatic insufficiency or failure, necessitating reoperation for further evaluation and management. Cancelling the transfer (A) would delay necessary intervention. Infusing albumin and fresh frozen plasma (B) would address only the symptoms but not the underlying cause. Repeating labs the next day (C) would not address the urgency of the situation.
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.
A cause of shoulder presentation is
- A. Macerated fetus
- B. Postdates pregnancy
- C. Oligohydramnios
- D. Placenta abruption
Correct Answer: C
Rationale: The correct answer is C: Oligohydramnios. Shoulder presentation occurs when the baby presents shoulder-first rather than head-first during birth. Oligohydramnios, a condition characterized by low levels of amniotic fluid, can lead to decreased uterine space, increasing the chances of abnormal fetal positioning. Macerated fetus (A) is associated with fetal decomposition, not shoulder presentation. Postdates pregnancy (B) is linked to increased risk of macrosomia but not shoulder presentation. Placenta abruption (D) is a separation of the placenta from the uterus, not a direct cause of shoulder presentation.