Nokea
What are the risks of a VBAC (vaginal birth after cesarean)?
- A. Uterine rupture
- B. Postpartum hemorrhage
- C. Placenta previa
- D. All of the above
Correct Answer: A
Rationale: The correct answer is A: Uterine rupture. This is the most significant risk associated with VBAC, where the scar from the previous cesarean section may tear during labor. This can lead to severe complications for both the mother and baby. Postpartum hemorrhage (B) and placenta previa (C) are potential risks in any pregnancy but are not specifically increased in VBAC. Therefore, the correct answer is A, as it directly relates to the unique risk of VBAC.
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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.
A patient with chronic hepatic encephalopathy is being discharged home. Discharge teaching centers upon long-term management strategies to prevent ammonia accumulation. Teaching for this patient includes instruction about
- A. Lactulose taken 20 g PO daily
- B. Spironolactone taken 100 mg PO daily
- C. Protein intake of 50 g daily
- D. Zolpidem taken 10 mg PO qhs.
Correct Answer: C
Rationale: The correct answer is C: Protein intake of 50 g daily. In hepatic encephalopathy, reducing protein intake is crucial to prevent ammonia accumulation. Protein breakdown in the body leads to ammonia production, which worsens encephalopathy symptoms. Limiting protein intake to 50g daily helps decrease ammonia formation. Lactulose (choice A) is used to reduce ammonia absorption in the gut. Spironolactone (choice B) is a diuretic used to treat fluid retention in liver disease. Zolpidem (choice D) is a sedative and not related to managing ammonia accumulation in hepatic encephalopathy. Therefore, choices A, B, and D are incorrect for long-term management of ammonia accumulation in hepatic encephalopathy.
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: B
Rationale: The correct answer is B: Infuse albumin and fresh frozen plasma. Given Janet's post-hepatic resection status and abnormal lab values indicating liver dysfunction (elevated bilirubin, low albumin, prolonged prothrombin time, elevated AST and ALT), she is at risk for coagulopathy and hypoalbuminemia. Infusing albumin can help improve her oncotic pressure and fluid balance, while fresh frozen plasma can replenish clotting factors to address the prolonged prothrombin time. This intervention aims to stabilize her condition before transferring to the general medical floor.
Canceling the transfer (Choice A) is not necessary if appropriate interventions can be taken. Repeating labs the next day (Choice C) delays potentially needed treatments. Preparing for reoperation (Choice D) is not indicated based on the information provided.
Effects of preeclampsia on the reproductive system include
- A. Development of infarcts and placental abruption
- B. Lowered vaginal discharge pH and haemorrhage
- C. Congestive cardiac failure and fetal hypoxia
- D. Poor placental anchorage and severe infarction
Correct Answer: D
Rationale: The correct answer is D because preeclampsia can lead to poor placental anchorage, which results in reduced blood flow to the placenta, leading to severe infarction. This can cause adverse effects on the fetus and the mother. Choice A is incorrect because infarcts and placental abruption are not specific effects of preeclampsia on the reproductive system. Choice B is incorrect because lowered vaginal discharge pH and hemorrhage are not typical effects of preeclampsia. Choice C is incorrect because congestive cardiac failure and fetal hypoxia are not direct effects of preeclampsia on the reproductive system.
A medical/obstetric predisposing factor to puerperal sepsis includes
- A. Delivery by unskilled birth attendants
- B. Emergency cesarean section
- C. Poor personal hygiene
- D. Delay in care seeking
Correct Answer: B
Rationale: The correct answer is B: Emergency cesarean section. Emergency cesarean sections can increase the risk of puerperal sepsis due to the urgency of the procedure, which may lead to inadequate sterilization or contamination. Other choices are less directly associated with puerperal sepsis: A may increase the risk of infection, but not specifically puerperal sepsis. C relates to general hygiene practices and D focuses on delays in seeking care, which may affect treatment outcomes but are not direct predisposing factors to puerperal sepsis.