Icterus gravis and hydrops fetalis are conditions highly associated with:

Correct Answer: A

Rationale: The correct answer is A: Rhesus D incompatibility. Icterus gravis (severe jaundice) and hydrops fetalis (abnormal accumulation of fluid) are both conditions commonly associated with Rhesus D incompatibility between a mother and her fetus. This occurs when the mother is Rh-negative and the fetus is Rh-positive, leading to maternal antibodies attacking the fetal red blood cells, resulting in severe hemolytic anemia and subsequent complications. Explanation for why other choices are incorrect: B: ABO incompatibility typically leads to less severe jaundice and hemolytic disease compared to Rhesus D incompatibility. C: Physiological jaundice is a common and benign condition in newborns caused by the immaturity of the liver, not by blood type incompatibility. D: Instant perinatal death is not specifically associated with these conditions, but rather with other serious complications during childbirth.

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.

Correct Answer: C

Rationale: The correct answer is C: Precipitate labor. Precipitate labor refers to a rapid labor and delivery process. It is matched with the statement in column A because it is associated with a sudden and quick progression of labor, leading to a rapid delivery of the baby. The other choices are incorrect because: A: Colicky uterus - This term is not related to rapid labor but rather refers to uterine contractions that are painful and intermittent. B: Constriction ring dystocia - This term describes a condition where there is a tight band around the uterus, causing difficulty in the delivery process, which is different from the rapid progression seen in precipitate labor. D: Cervical dystocia - This term refers to a condition where there are issues with the dilation or effacement of the cervix, not directly related to the speed of labor as in precipitate labor.

Correct Answer: D

Rationale: The correct answer is D: Prepare for reoperation. Given the patient's elevated AST and ALT levels after hepatic resection, along with abnormal prothrombin time and low albumin, there is concern for liver dysfunction. This indicates a potential complication post-surgery, such as hepatic insufficiency or failure, necessitating reoperation for further evaluation and management. Cancelling the transfer (A) would delay necessary intervention. Infusing albumin and fresh frozen plasma (B) would address only the symptoms but not the underlying cause. Repeating labs the next day (C) would not address the urgency of the situation.

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 engaging diameter in a face presentation is the sub-mento vertical diameter. This is the correct answer because it represents the distance from the tip of the chin (mentum) to the highest point on the skull (vertex), which is the most critical diameter for the face to descend through the pelvis during childbirth. Choice B (Sub-mento bregmatic diameter) is incorrect because it represents the distance from the tip of the chin to the anterior fontanelle, not the highest point on the skull. Choice C (Mento vertical diameter) is incorrect because it refers to the distance from the chin to the base of the skull, not the highest point on the skull. Choice D (Sub-occipito bregmatic diameter) is incorrect because it represents the distance from the base of the skull to the anterior fontanelle, not involving the chin.

Correct Answer: B

Rationale: The correct answer is B: Occipito posterior position. Forceps delivery may be indicated in this situation to help rotate the baby's head and facilitate delivery. Occipito posterior position can lead to prolonged labor and fetal distress, making forceps delivery necessary for a safe delivery. Incorrect choices: A: Cephalopelvic disproportion is not an indication for forceps delivery as it refers to mismatch between the size of the baby's head and the mother's pelvis. C: Breech presentation typically requires a different approach such as cesarean section rather than forceps delivery. D: Placenta abruption, a medical emergency, would not be managed with forceps delivery but rather require immediate intervention to prevent harm to both the mother and baby.

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.