The correct statement about shoulder dystocia is

Correct Answer: A

Rationale: The correct statement about shoulder dystocia is A: It’s an impaction of the anterior shoulder after delivery of the head. This is accurate as shoulder dystocia occurs when the anterior shoulder becomes impacted behind the maternal pubic symphysis. This can lead to difficulty delivering the shoulders after the head is delivered. B is incorrect as shoulder dystocia involves the anterior shoulder, not the posterior. C is incorrect as shoulder dystocia is not related to compound presentation. D is incorrect as shoulder dystocia is an obstetric emergency that requires prompt intervention to prevent complications for both the mother and the baby.

Correct Answer: B

Rationale: The correct answer is B (GCS of 3 to 8 and hypotension) because hypotension is not a specific indication for intracranial pressure (ICP) monitoring according to the Brain Trauma Foundation guidelines. The rationale is that hypotension is a systemic issue affecting overall perfusion, whereas ICP monitoring is specifically for assessing intracranial dynamics. A, C, and D are incorrect choices because they all involve conditions that could potentially indicate increased intracranial pressure and the need for monitoring. A) Abnormal head CT indicates structural brain injury, C) age > 40 is a risk factor for poor outcomes after traumatic brain injury, and D) bradycardia can be a sign of increased ICP affecting brainstem function. Therefore, these conditions warrant ICP monitoring according to guidelines.

Correct Answer: B

Rationale: The correct answer is B. Ordering hepatic ultrasound annually to follow progression is the appropriate response for hepatic hemangiomas. Biopsy is not recommended due to the risk of bleeding. Surgery is usually not required unless there are complications. Documenting the finding is important but does not address the need for monitoring. Ultrasound allows for non-invasive monitoring of the hemangiomas over time to assess for growth or complications, guiding further management if needed.

Correct Answer: D

Rationale: The correct answer is D because virilizing adrenal tumors are more likely to be malignant in children. This is due to the fact that virilizing tumors can be associated with conditions like adrenocortical carcinoma, which is a malignant tumor. In contrast, feminizing adrenal tumors are not always carcinomas (choice A) and are not the most common type of adrenal tumor (choice B). Additionally, virilizing tumors in women can be localized to different parts of the adrenal gland, not just the cortex (choice C). Therefore, choice D is the most accurate statement among the options provided.

Correct Answer: D

Rationale: The correct answer is D, postpartum eclampsia. In amniotic fluid embolism, convulsions are often mistaken for postpartum eclampsia due to similar symptoms such as seizures and altered mental status. Postpartum eclampsia occurs after delivery, usually within 48 hours, while antepartum eclampsia occurs before delivery. Presence of stroke and pre-existing epilepsy are not directly related to convulsions in amniotic fluid embolism. Thus, D is the correct choice as it closely resembles the presentation of convulsions in amniotic fluid embolism.

Correct Answer: A

Rationale: The correct answer is A because inflammatory polyps are indeed considered precancerous, meaning they have the potential to develop into cancer over time. By having regular colonoscopies every 3 to 5 years, any new polyps can be detected early and removed before they have a chance to become malignant. This approach helps in preventing the progression of polyps to cancerous lesions, thus reducing the risk of developing colon cancer. Choice B is incorrect because while family history is a risk factor for colon cancer, the presence of inflammatory polyps in Mr. Costigan should not be overlooked or solely attributed to family history. Choice C is incorrect because all polyps have the potential to become cancerous, including inflammatory polyps. Ignoring their presence can lead to missed opportunities for early intervention. Choice D is incorrect because at this stage, the primary focus should be on surveillance and prevention through regular colonoscopies, rather than jumping into discussions about aggressive treatment options.

Correct Answer: D

Rationale: The correct answer is D: Compound. In compound presentation, a hand or foot is alongside the presenting part, usually the head. This can complicate the delivery process. A: Footling presentation means the foot presents first. B: Transverse presentation is when the baby is lying sideways. C: Cephalic presentation is normal, with the head presenting first. In this scenario, D is the correct answer as it specifically describes the situation where a hand or foot is alongside the presenting part.

Correct Answer: C

Rationale: The correct answer is C: Compound. When a hand or foot lies alongside the presenting part during childbirth, it is called a compound presentation. This can be a complication as it increases the risk of the presenting part not fitting through the birth canal properly. A: Footling presentation occurs when the baby's foot or feet are the first to emerge from the birth canal. B: Transverse presentation is when the baby is lying sideways in the uterus. D: Cephalic presentation is the ideal position for vaginal delivery, with the baby's head down and ready to be born.

Correct Answer: C

Rationale: The correct answer is C: Truncus arteriosus. In this condition, there is a single large vessel arising from the heart that gives rise to the systemic, pulmonary, and coronary arteries. This results in mixing of oxygenated and deoxygenated blood, leading to severe cyanosis and inadequate oxygenation of the body, causing immediate death after birth. A: Pulmonary stenosis and B: Aortic coarctation typically do not cause immediate death after birth. D: Ductus arteriosus is a normal fetal structure that closes shortly after birth and its presence would not directly cause immediate death.