Nokea
The presenting diameter in brow presentation is
- A. Submentobregmatic
- B. Suboccipitofrontal
- C. Occipitalfrontal
- D. Mentovertical
Correct Answer: A
Rationale: The presenting diameter in brow presentation is the submentobregmatic diameter. This is because in brow presentation, the fetal head is partially extended, causing the forehead (bregma) to be the presenting part. The submentobregmatic diameter is the distance between the chin (mentum) and the highest point of the forehead (bregma). This diameter is crucial for successful delivery in brow presentation as it is the smallest diameter that must pass through the maternal pelvis.
Summary of other choices:
B: Suboccipitofrontal - This diameter is not relevant in brow presentation as it involves the back of the head.
C: Occipitalfrontal - This diameter is the distance between the back of the head and the forehead, also not relevant in brow presentation.
D: Mentovertical - This diameter is the distance between the chin and the vertex of the head, not the forehead.
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When counseling a patient about his surgical options for an ulcer that has been refractory to medical therapy, the AGACNP advises the patient that he will need
- A. Lifelong vitamin D replacement
- B. Excision of the ulcer, which produces an 80% cure rate
- C. To eat much smaller, more frequent meals
- D. Some form of vagotomy
Correct Answer: D
Rationale: Correct Answer: D. Some form of vagotomy
Rationale:
1. Vagotomy is a surgical procedure that involves cutting the vagus nerve to reduce acid production in the stomach, which can help in treating ulcers.
2. Vagotomy is often recommended when ulcers are refractory to medical therapy, making it an appropriate surgical option.
3. Lifelong vitamin D replacement (A) is not typically necessary for ulcer treatment. Excision of the ulcer (B) is not a common treatment and does not address the underlying cause. Eating smaller meals (C) may help manage symptoms but is not a surgical option for refractory ulcers.
The AGACNP is counseling a patient about various methods of tumor biopsy. Which of the following is not an accurate statement?
- A. Incisional biopsy is preferred to excisional biopsy when possible
- B. Core needle biopsy has a higher rate of false positive than does fine needle aspiration
- C. Fine needle aspiration does not allow grading of tumors
- D. Core needle and incisional biopsies are virtually identical in terms of false results
Correct Answer: C
Rationale: Correct Answer: C - Fine needle aspiration does not allow grading of tumors.
Rationale:
1. Fine needle aspiration (FNA) collects cells for cytology evaluation, not tissue for grading.
2. Grading requires evaluation of tissue architecture, which is not possible with FNA.
3. FNA is useful for diagnosis but not for determining tumor grade.
Summary:
A: Incorrect - Excisional biopsy is preferred over incisional biopsy to obtain the entire tumor for diagnosis and grading.
B: Incorrect - Core needle biopsy has a lower false positive rate compared to fine needle aspiration.
D: Incorrect - Core needle and incisional biopsies differ in the amount of tissue sampled and potential for false results.
There are no other abnormal findings. This suggests that Mr. Thornton
- A. Is having anterior wall ischemia
- B. Is having an anterior wall infarction
- C. Has a history of anterior wall NSTEMI
- D. Has a history of anterior wall STEMI
Correct Answer: B
Rationale: The correct answer is B because the absence of any other abnormal findings suggests that Mr. Thornton is currently experiencing an anterior wall infarction. This is indicated by the localized area of myocardial necrosis due to prolonged ischemia. Option A is incorrect because ischemia would typically present with reversible changes rather than necrosis. Option C is incorrect as NSTEMI would show some abnormal findings. Option D is incorrect as STEMI would show more significant ECG changes and enzyme elevation. In summary, the absence of other abnormalities points towards an acute event like an anterior wall infarction.
In True cephalopelvic disproportion
- A. Half of the patients will need an operative delivery
- B. The problem may be overcome during labor
- C. Operative delivery is unnecessary
- D. Operative delivery will be needed
Correct Answer: D
Rationale: In True cephalopelvic disproportion, the baby's head is too large to pass through the mother's pelvis. This condition often requires operative delivery (C-section) as a vaginal birth is not possible. Choice D is correct because operative delivery is indeed needed to safely deliver the baby. Choice A is incorrect as not all patients with cephalopelvic disproportion will necessarily require operative delivery. Choice B is also incorrect as the issue cannot generally be overcome during labor due to physical constraints. Choice C is incorrect as operative delivery is usually necessary in cases of true cephalopelvic disproportion to prevent complications.
Complete uterine rupture: b) Define complete uterine rupture
- A. Rupture involving only the serosa
- B. Rupture involving the entire uterine layers
- C. A tear without uterine contractions
- D. None of the above
Correct Answer: B
Rationale: Complete uterine rupture involves a full-thickness disruption of all uterine layers, including the serosa, myometrium, and endometrium. This leads to a complete separation of the uterine wall, potentially resulting in severe bleeding and fetal distress. Choice A is incorrect as it only involves the outermost layer of the uterus. Choice C is incorrect as uterine contractions are usually present during uterine rupture. Choice D is incorrect as the correct definition of complete uterine rupture involves the entire uterine layers being affected.