Nokea
While participating in sports, it is not uncommon for people to be subjected to sudden rotational injuries that result in the abrupt rotation of the cerebral cortex around the more fixed midbrain structures. This can interrupt input and outflow from the reticular activating system and result in what clinical phenomenon?
- A. Epidural hematoma
- B. Uncal herniation
- C. Concussion
- D. Contrecoup injury
Correct Answer: C
Rationale: Step 1: Sudden rotational injuries can disrupt brain function.
Step 2: Abrupt rotation of the cerebral cortex can affect the reticular activating system.
Step 3: Disruption of the reticular activating system can lead to altered consciousness.
Step 4: Altered consciousness is a hallmark of a concussion.
Therefore, the correct answer is C: Concussion. Other choices are incorrect because an epidural hematoma involves bleeding between the skull and dura (A), uncal herniation involves brain shifting through tentorium (B), and contrecoup injury occurs opposite the site of impact (D).
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The AGACNP is evaluating a patient who reportedly fell down a flight of steps. Her history is significant for several emergency room visits, but she denies any significant medical conditions. Some documentation in her chart indicates that she may have been subjected to physical abuse. Today she presents with a periorbital ecchymosis of the left eye and swelling in the left side of the face. Her neurologic examination is within normal limits. Which head imaging study would be most useful in assessing for findings consistent with a history of abuse?
- A. Radiographs
- B. CT scan without contrast
- C. MRI
- D. PET scan
Correct Answer: B
Rationale: The correct answer is B: CT scan without contrast. A CT scan is the most useful imaging study in assessing for findings consistent with a history of abuse in this patient. CT scan is preferred for acute trauma to the head as it provides detailed images of the brain, skull, and facial bones. It can detect acute hemorrhages, fractures, or other signs of trauma. In this case, the patient's presentation with periorbital ecchymosis and facial swelling raises suspicion for traumatic injury, which can be assessed effectively with a CT scan.
Radiographs (choice A) are not as sensitive as CT scans in detecting subtle fractures or soft tissue injuries in the head and face. MRI (choice C) is not typically used in acute trauma assessment and may not provide timely information needed in this case. PET scan (choice D) is not indicated for evaluating traumatic head injuries and is more commonly used for assessing metabolic and functional activity in the body.
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. Oligohydramnios, which is low levels of amniotic fluid, can lead to reduced cushioning in the uterus, allowing the fetus to assume abnormal positions like shoulder presentation. Macerated fetus (choice A) is related to prolonged fetal death, not shoulder presentation. Postdates pregnancy (choice B) may increase the risk of complications but is not a direct cause of shoulder presentation. Placenta abruption (choice D) is the premature separation of the placenta, which can lead to fetal distress but is not specifically linked to shoulder presentation.
Delivery of breech with an extended head is accomplished through
- A. Burns Marshall maneuver
- B. Lovset maneuver
- C. Mauriceau-Smellie-Veit
- D. McRobert’s maneuver
Correct Answer: C
Rationale: The correct answer is C: Mauriceau-Smellie-Veit maneuver for delivery of breech with an extended head. This maneuver involves flexing the head while still in the vagina to allow for easier delivery. The Burns Marshall maneuver (A) is for impacted fetal shoulders, Lovset maneuver (B) is for shoulder dystocia, and McRobert's maneuver (D) is for shoulder dystocia as well. The Mauriceau-Smellie-Veit maneuver is specifically designed for delivering a breech with an extended head, making it the correct choice in this scenario.
Secondary postpartum haemorrhage mostly occurs between the 8th-14th day postpartumly and can extend up to the first 46 days following delivery.
- A. TRUE
- B. FALSE
- C. Rarely True
- D. Sometimes True
Correct Answer: A
Rationale: The correct answer is A because secondary postpartum hemorrhage typically occurs between the 8th-14th day postpartum and can extend up to 6 weeks after delivery. This timeframe aligns with the physiological changes and healing process after childbirth.
Choice B is incorrect because it contradicts the established timeframe for secondary postpartum hemorrhage.
Choice C is incorrect as secondary postpartum hemorrhage is not rare but rather a recognized complication that can occur after childbirth.
Choice D is incorrect as secondary postpartum hemorrhage does not happen sporadically, but rather follows a defined timeframe based on postpartum physiological changes.
What are common complications of multiple gestations?
- A. Premature labor
- B. Twin-to-twin transfusion syndrome
- C. Preeclampsia
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D: All of the above. Multiple gestations are at higher risk for complications such as premature labor, where contractions start before 37 weeks, leading to preterm birth. Twin-to-twin transfusion syndrome can occur in identical twins sharing a placenta, causing unequal blood flow. Preeclampsia, characterized by high blood pressure and organ damage, is more common in multiple pregnancies. Therefore, all choices A, B, and C are correct as they are common complications associated with multiple gestations.