Which of the following is an indication for forceps delivery?

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: B

Rationale: Step 1: Post-splenectomy, platelet count typically drops temporarily, leading to a risk of bleeding. Step 2: To compensate, the body increases hemoglobin (Hgb) levels to maintain oxygen-carrying capacity. Step 3: Therefore, on postoperative day 2, an increased Hgb level is expected. Summary: A is incorrect because MCV is not typically affected in this scenario. C is incorrect because platelet count usually decreases post-splenectomy. D is incorrect as albumin levels are not directly impacted by splenectomy for ITP.

Correct Answer: A

Rationale: The correct answer is A because BCG vaccination is recommended for newborns regardless of maternal smear status to prevent tuberculosis. The neonate is at risk of TB exposure postnatally and needs protection. Maternal smear status does not affect the indication for BCG in the newborn. Choice B is incorrect because withholding BCG in this case would leave the neonate vulnerable to TB. Choices C and D are not applicable as they do not provide any information.

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: 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: A

Rationale: The correct answer is A: Avoidance of elective surgery and nonessential medications. This is the initial management for a patient with thrombocytopenia and abnormal bleeding time, possibly indicating immune thrombocytopenic purpura (ITP). Avoiding surgery and medications that can worsen thrombocytopenia is crucial to prevent bleeding complications. Prednisone (B) is not the first-line treatment for ITP, especially without confirming the diagnosis. Monoclonal antibody therapy (C) such as rituximab is usually reserved for refractory cases. Splenectomy (D) is considered only if other treatments fail as a last resort.

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: 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.