Delivery of breech with an extended head is accomplished through

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.

Correct Answer: C

Rationale: The correct answer is C: Gram negative infection. In sepsis, especially with a Gram negative infection, organ donation may pose a risk of transmitting the infection to the recipient. This can be life-threatening for the organ recipient. Renal failure (choice A), traumatic brain injury (choice B), and breast cancer (choice D) are not direct contraindications to organ donation. Renal failure may limit the suitability of certain organs, but it does not automatically disqualify a patient from donating other organs. Traumatic brain injury may impact brain donation but does not rule out other organ donation. Breast cancer may affect eligibility for certain organs but does not universally disqualify a patient from organ donation.

Correct Answer: C

Rationale: The correct answer is C: Protein intake of 50 g daily. In hepatic encephalopathy, reducing protein intake helps decrease ammonia production. Excessive ammonia leads to neurological symptoms. Lactulose (choice A) is correct for hepatic encephalopathy as it helps eliminate ammonia through the gut. Spironolactone (choice B) is a diuretic and not indicated for hepatic encephalopathy. Zolpidem (choice D) is a sleep aid and not relevant to managing ammonia accumulation. In summary, choice C is correct because it directly targets the underlying issue of ammonia accumulation in hepatic encephalopathy, while the other choices do not address this specific concern.

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.

Correct Answer: C

Rationale: The correct answer is C: Baseline cardiac catheterization. Given the presence of a new onset grade IIVI crescendo-decrescendo cardiac murmur, a baseline cardiac catheterization is necessary to assess the severity and etiology of the murmur. This procedure will provide crucial information on the structure and function of the heart, helping to determine the appropriate management plan. A: Annual or biannual serial echocardiography is not necessary as the patient is currently asymptomatic and echocardiography has already revealed mild aortic calcification. B: Modification of activity level is not the immediate priority as the patient is very active physically and not reporting any limitations to daily activities. D: Statin therapy is not indicated based solely on the presence of a new murmur without further assessment of cardiac function through cardiac catheterization.

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.

Correct Answer: C

Rationale: The correct answer is C: Couvelaire uterus. This condition refers to the bruised and edematous appearance of the uterus associated with placental abruption. Placental abruption occurs when the placenta separates from the uterine wall prematurely, leading to bleeding and a compromised blood supply to the uterus. The bruised appearance is due to blood infiltrating the myometrium. Explanation for other choices: A: Wernicke’s encephalopathy - This is a neurological disorder caused by thiamine deficiency, not related to uterine issues. B: Uterine prolapse - This is the descent or herniation of the uterus into or beyond the vaginal canal, not related to placental abruption. D: Asherman’s syndrome - This is characterized by intrauterine adhesions or scar tissue, typically a result of uterine surgery, not associated with placental abruption.

Correct Answer: D

Rationale: The correct answer is D because placenta praevia can lead to severe bleeding during childbirth, posing high risks to both the mother and the baby. This condition occurs when the placenta partially or completely covers the cervix, leading to bleeding as the cervix dilates during labor. Choice A is incorrect because bleeding in placenta praevia is not related to the segment preparing for labor. Choice B is incorrect as bleeding is primarily due to the abnormal placement of the placenta, not from pathological processes. Choice C is incorrect as bleeding can occur before 37 weeks in cases of placenta praevia.

Correct Answer: A

Rationale: The correct answer is A: TRUE. This is because BCG vaccination for newborns is recommended even if the mother is smear-negative for tuberculosis, as it helps protect the newborn from severe forms of TB. Smear status of the mother does not impact the need for BCG vaccination in the neonate. Choice B is incorrect as it falsely implies that BCG should not be given in this scenario. Choices C and D are not applicable as they do not provide any information.