Nokea
The major causative organism of urinary tract infection during puerperium is:
- A. Staphylococcus pyogenes
- B. Anaerobic streptococci
- C. Clostridium welchii
- D. Escherichia coli
Correct Answer: D
Rationale: The correct answer is D: Escherichia coli. During puerperium, the most common causative organism of urinary tract infection is E. coli. This is because E. coli is a normal flora in the gastrointestinal tract and can ascend to the urinary tract due to factors like hormonal changes, reduced bladder tone, and trauma during delivery. Staphylococcus pyogenes (Choice A), Anaerobic streptococci (Choice B), and Clostridium welchii (Choice C) are not typically associated with urinary tract infections during puerperium. Staphylococcus pyogenes is more commonly known for causing skin infections, Anaerobic streptococci are not commonly implicated in urinary tract infections, and Clostridium welchii is associated with gas gangrene, not urinary tract infections.
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Traumatic diaphragmatic hernias present in both acute and chronic forms. Patients with a more chronic form are most likely to be present with
- A. Respiratory insufficiency
- B. Sepsis
- C. Bowel obstruction
- D. Anemia
Correct Answer: A
Rationale: The correct answer is A: Respiratory insufficiency. Chronic traumatic diaphragmatic hernias can lead to gradual compromise of respiratory function due to herniation of abdominal contents into the chest cavity, causing compression of the lungs and reduced lung capacity. This results in symptoms such as dyspnea, cough, and chest pain. Sepsis (B) is more commonly associated with acute traumatic diaphragmatic hernias. Bowel obstruction (C) is a possible complication but typically presents with acute symptoms like abdominal pain and distension. Anemia (D) is not a common presentation of diaphragmatic hernias.
In myelodysplastic syndromes, the primary indications for splenectomy include
- A. Major hemolysis unresponsive to medical management
- B. Severe symptoms of massive splenomegaly
- C. Sustained leukocyte elevation above 30,000 cells/µL
- D. Portal hypertension
Correct Answer: D
Rationale: The correct answer is D: Portal hypertension. In myelodysplastic syndromes, splenectomy is indicated primarily for portal hypertension due to extramedullary hematopoiesjson in the spleen, leading to increased blood flow and pressure in the portal vein. This can alleviate symptoms such as ascites and variceal bleeding. Choices A, B, and C are incorrect as major hemolysis, massive splenomegaly, and sustained leukocyte elevation are not primary indications for splenectomy in myelodysplastic syndromes.
Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except
- A. Gamma-aminobutyric acid (GABA)
- B. Ammonia
- C. False neurotransmitters
- D. Serotonin
Correct Answer: B
Rationale: The correct answer is B: Ammonia. Ammonia is a primary chemical mediator of hepatic encephalopathy. In patients with chronic liver disease, the liver's ability to detoxify ammonia is compromised, leading to its accumulation in the bloodstream and subsequent neurotoxic effects causing encephalopathy. Gamma-aminobutyric acid (GABA), false neurotransmitters, and serotonin are all implicated in the pathophysiology of hepatic encephalopathy. GABA is involved in neurotransmission, false neurotransmitters are substances that disrupt normal neurotransmission, and serotonin levels are altered in hepatic encephalopathy.
The type of heat loss that is prevented by keeping the NBU temperature warm & warm wrapping of the neonates is
- A. Convection
- B. Conduction
- C. Evaporation
- D. Radiation
Correct Answer: B
Rationale: The correct answer is B: Conduction. Conduction is the transfer of heat through direct contact. By keeping the neonatal unit warm and wrapping neonates in warm blankets, heat loss through direct contact with surfaces is minimized. Convection involves heat transfer through air or fluid movement, not relevant in this scenario. Evaporation is the process of heat loss through moisture evaporation from the skin, not applicable here. Radiation is heat transfer through electromagnetic waves, which can be prevented by warm wrapping but not the primary focus in this context.
A condition of trial of scar is
- A. Estimated fetal weight of less than 3600g
- B. Availability of a level one hospital nearby
- C. Not more than two previous caesarean section scars
- D. An adequate pelvis with true conjugate 10.5cm
Correct Answer: C
Rationale: The correct answer is C: Not more than two previous caesarean section scars. This is because a trial of scar refers to a trial of labor in a woman who has had previous cesarean sections. The guideline typically recommends that a trial of scar should be considered in women with no more than two previous cesarean section scars to reduce the risk of uterine rupture. Choices A, B, and D are incorrect because the estimated fetal weight, availability of a level one hospital, and pelvis size are not specific criteria used to determine eligibility for a trial of scar.