Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except

Correct Answer: D

Rationale: The correct answer is D: Serotonin. Serotonin is not a primary chemical mediator of hepatic encephalopathy. The main chemical mediators involved in hepatic encephalopathy are A: Gamma-aminobutyric acid (GABA), B: Ammonia, and C: False neurotransmitters. GABA plays a role in inhibiting neurotransmission, ammonia is a key factor in the pathogenesis of hepatic encephalopathy, and false neurotransmitters are produced due to altered amino acid metabolism in the liver. Serotonin is not a key player in the development of hepatic encephalopathy, hence it is the correct answer.

Correct Answer: A

Rationale: The correct answer is A: Wernicke's encephalopathy. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy. Wernicke's encephalopathy is a neurological complication due to thiamine deficiency, which can occur in severe cases of vomiting, leading to impaired brain function. Sheehan's syndrome is a complication of postpartum pituitary necrosis. Maurice encephalitis is a fictional term not related to this context. Antepartum bleeding is not a typical complication of hyperemesis gravidarum. Therefore, the correct answer is A due to the potential neurological impact of severe vomiting on thiamine levels.

Correct Answer: D

Rationale: The correct answer is D, "All of the above." Postpartum hemorrhage can be caused by uterine atony, which is the failure of the uterus to contract after delivery; retained placenta, where parts of the placenta remain in the uterus; and vaginal trauma, such as tears or lacerations during delivery. Each of these factors can contribute to excessive bleeding after childbirth. Therefore, selecting all the choices is necessary to encompass the main causes of postpartum hemorrhage.

Correct Answer: B

Rationale: The correct answer is B because pressure applied on the cervix by the presenting part in obstructed labor leads to edema of the vulva. This pressure causes obstruction of blood and lymphatic flow in the area, resulting in swelling and edema. Prolonged effort by the mother (choice A) would not directly cause vulvar edema. An ill-fitting presenting part (choice C) may contribute to obstruction but does not explain the mechanism of edema. Large presenting diameters (choice D) stretching the vulva would not directly cause edema without pressure on the cervix.

Correct Answer: C

Rationale: The correct answer is C: Extraplacental haemorrhage. Incidental antepartum haemorrhage refers to bleeding from a source other than the placenta, such as the cervix or vagina, before delivery. Intraplacental haemorrhage (choice A) refers to bleeding within the placenta itself, not outside it. Intrapartum haemorrhage (choice B) occurs during labor and delivery, not before. Preterm haemorrhage (choice D) is not a specific term used to describe antepartum bleeding. Therefore, the correct term for antepartum bleeding from a non-placental source is extraplacental haemorrhage.

Correct Answer: A

Rationale: The correct answer is A: Prescribe anti-nausea medication. This is the most appropriate choice to manage hyperemesis gravidarum, a severe form of morning sickness. Anti-nausea medication can help alleviate symptoms and prevent dehydration. Choice B (Recommend bed rest) may not directly address the nausea and vomiting associated with hyperemesis gravidarum. Choice C (Suggest a high-protein diet) and D (Advise on exercise) may not be effective in managing the condition or providing immediate relief from symptoms. Anti-nausea medication is the most evidence-based approach to support a woman with hyperemesis gravidarum.

Correct Answer: A

Rationale: The correct answer is A: Persistent vomiting or nausea. Hyperemesis gravidarum is a severe form of morning sickness characterized by persistent vomiting and nausea during pregnancy. This is the main clinical feature due to hormonal changes and increased sensitivity to certain odors. Choice B is incorrect as sight-related problems are not a typical feature of hyperemesis gravidarum. Choice C is incorrect as persistent diarrhea is not a defining feature of this condition. Choice D is incorrect as frequency or urgency of micturition is not a primary symptom of hyperemesis gravidarum.

Correct Answer: C

Rationale: The correct answer is C: A rupture of the uterine wall confined to the tissue. Extra-peritoneal uterine rupture refers to a rupture that does not breach the peritoneal cavity, keeping the damage confined to the uterine tissue only. This is distinct from intra-peritoneal rupture which involves the peritoneum (choice B) and complete rupture of all uterine layers (choice D). Choice A is incorrect as it does not specify the location of the tear, and it does not necessarily imply that there is no organ damage.

Correct Answer: C

Rationale: Rationale: Face to pubis delivery occurs when the fetal face presents towards the mother's pubic bone during birth. Choice C is correct because a 45˚ anterior rotation of the occiput is needed for this positioning. This allows the fetal face to be directed towards the mother's pubis for a successful face to pubis delivery. Choices A and D are incorrect as they mention incorrect angles of rotation. Choice B is incorrect as a persistent occipito posterior position would result in a face to sacrum delivery, not face to pubis.