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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The earliest onset of cephalohematoma is
- A. Six hours postnatally
- B. Twelve hours postnatally
- C. Eighteen hours postnatally
- D. Immediately after birth
Correct Answer: A
Rationale: The correct answer is A: Six hours postnatally. Cephalohematoma is a collection of blood between a baby's skull and the periosteum. It typically appears several hours after birth due to trauma during delivery, causing bleeding under the periosteum. This allows time for the blood to accumulate and form a distinct swelling, making the onset around six hours postnatally. Choices B, C, and D are incorrect as they do not align with the typical timeline for the development of cephalohematoma.
The main feature of Hyperemesis gravidarum is
- A. Pallor or cyanosis of mucous membrane
- B. Inability to eat or retain food all through
- C. Weakness because of severe state of shock
- D. Smaller fundal height compared to dates
Correct Answer: B
Rationale: Step 1: Hyperemesis gravidarum is characterized by severe nausea and vomiting during pregnancy.
Step 2: Inability to eat or retain food all through is a hallmark feature due to excessive vomiting.
Step 3: This leads to dehydration, electrolyte imbalances, and weight loss.
Step 4: Pallor, cyanosis, weakness, and smaller fundal height are not specific to hyperemesis gravidarum.
Summary: Choice B is correct as it directly relates to the primary symptom of excessive vomiting in hyperemesis gravidarum, while the other choices are not specific to this condition.
A specific clinical feature of respiratory distress syndrome includes
- A. Grunting on inspiration
- B. Grunting on expiration
- C. Flaring of the nostrils
- D. Neonatal tachycardia
Correct Answer: B
Rationale: The correct answer is B: Grunting on expiration. In respiratory distress syndrome, the infant may exhibit grunting on expiration due to the difficulty in maintaining lung inflation during exhalation. This is a compensatory mechanism to increase functional residual capacity. Grunting on inspiration (choice A) may be seen in other respiratory conditions. Flaring of the nostrils (choice C) is a sign of increased work of breathing but is not specific to respiratory distress syndrome. Neonatal tachycardia (choice D) can be a nonspecific sign of distress and is not a specific feature of respiratory distress syndrome.
Lester R. is a 58-year-old male who is being evaluated for nocturia. He reports that he has to get up 2 to 3 times nightly to void. Additional assessment reveals urinary urgency and appreciable post-void dribbling. A digital rectal examination reveals a normal-sized prostate with no appreciable hypertrophy. The best approach to this patient includes
- A. Administration of the American Urological Association (AUA) Symptom Scale
- B. Laboratory assessment to include a PSA
- C. Ordering a prostate ultrasound
- D. Assessment of nonprostate causes of nocturia
Correct Answer: D
Rationale: The correct answer is D: Assessment of nonprostate causes of nocturia. In this case, the patient's symptoms of nocturia, urinary urgency, and post-void dribbling are not indicative of prostate enlargement. Given that the digital rectal examination revealed a normal-sized prostate with no hypertrophy, it is essential to explore other potential causes of nocturia in this patient. By assessing non-prostate causes of nocturia, such as diabetes, urinary tract infection, medication side effects, or sleep disorders, a more accurate diagnosis and appropriate treatment plan can be developed. This approach will lead to better patient outcomes compared to focusing solely on prostate-related evaluations.
Option A: Administration of the AUA Symptom Scale is not the best approach in this case because the patient's symptoms are not primarily related to prostate enlargement.
Option B: Laboratory assessment to include a PSA is not necessary since the digital rectal examination already indicated a normal-sized prostate with no appreciable hypertrophy.
Option C: Ordering a
R. S. is a 66-year-old female with Cushings syndrome due to an ACTH-producing pituitary tumor. The tumor is readily isolated by imaging, and the patient had an uneventful surgery. When seeing her in follow-up, the AGACNP anticipates
- A. Rapid reversal of symptoms, with good pituitary function
- B. Transient rebound release of remaining pituitary hormones
- C. Markedly improved dexamethasone suppression test
- D. Hyponatremia and compensatory SIADH
Correct Answer: B
Rationale: The correct answer is B: Transient rebound release of remaining pituitary hormones. After surgical removal of the ACTH-producing pituitary tumor in Cushing's syndrome, there may be a transient rebound release of remaining pituitary hormones due to relief of negative feedback from the tumor. This can lead to a temporary increase in pituitary hormone levels before normalization.
Rationale:
1. Rapid reversal of symptoms with good pituitary function (Choice A) is less likely as it takes time for the pituitary gland to recover and resume normal hormone production post-surgery.
2. Markedly improved dexamethasone suppression test (Choice C) is not expected immediately after surgery as it may take time for the hypothalamic-pituitary-adrenal axis to normalize.
3. Hyponatremia and compensatory SIADH (Choice D) are unlikely post-operatively in Cushing's syndrome as removal of the ACTH-producing tumor should lead to normalization of