Which of the following is INCORRECT regarding the possible causes of GORD in pregnancy?

Correct Answer: B

Rationale: In early pregnancy, gastrointestinal issues like Gastroesophageal Reflux Disease (GORD) can arise due to physiological changes. The correct answer, B) Increased gastric motility, is incorrect because in pregnancy, there is actually a decrease in gastric motility, leading to delayed gastric emptying. This delay can exacerbate GORD symptoms by allowing more time for gastric contents to reflux into the esophagus. A) relaxation of the lower esophageal sphincter is a common cause of GORD in pregnancy as hormonal changes can lead to decreased tone in the sphincter, allowing for reflux. C) Expansion of the uterus and pressure on the stomach can also contribute to GORD by displacing the stomach and altering its position, which can affect the function of the lower esophageal sphincter. D) The blunted lower esophageal sphincter response to stimuli like a protein-rich meal can further aggravate reflux symptoms in pregnancy. Educationally, understanding the physiological changes in pregnancy that contribute to complications like GORD is crucial for healthcare professionals to provide effective care and management for pregnant individuals. By knowing the correct and incorrect causes of GORD in pregnancy, healthcare providers can tailor interventions to alleviate symptoms and improve maternal well-being during this critical period.

Correct Answer: B

Rationale: B is incorrect because larger breast size does not lead to greater protein binding. The size of the breast does not affect the protein binding capacity of breastmilk. Protein binding is influenced by the drug's chemical properties and the composition of breastmilk, not by the size of the breast. A is correct because the molecular size of the drug can affect its transfer into breastmilk. Smaller molecules are more likely to pass through the mammary gland into breastmilk, while larger molecules may be excluded. C is correct because the pH of breast milk is indeed slightly more acidic than maternal plasma. This difference in pH can affect the ionization of drugs and their ability to transfer into breastmilk. D is correct because the lipophilicity of the drug plays a significant role in its transfer into breastmilk. Lipophilic drugs are more likely to pass through the cell membranes of the mammary gland and into breastmilk, while hydrophilic drugs may be excluded. In summary, B is incorrect because breast size does not influence protein binding in breastmilk. A, C, and D are correct because the molecular size, pH, and lipophilicity of the drug are all important factors that can influence drug transfer into breastmilk.

Correct Answer: C

Rationale: Phenytoin interferes with folate metabolism by decreasing the activity of methionine synthase, making choice C correct. Methionine synthase is an enzyme that plays a crucial role in the conversion of homocysteine to methionine, a process that requires folate as a cofactor. By inhibiting the activity of methionine synthase, phenytoin indirectly impairs the conversion of homocysteine to methionine, leading to a decrease in methionine levels and subsequent disruption of DNA methylation and synthesis. Choice A is incorrect because phenytoin does not increase folate absorption. In fact, phenytoin has been shown to decrease folate levels due to its interference with folate metabolism. Choice B is also incorrect because phenytoin does not increase the activity of MTHFR (methylenetetrahydrofolate reductase), an enzyme involved in folate metabolism. Phenytoin's effects on folate metabolism predominantly involve methionine synthase. Choice D is incorrect because phenytoin does not increase the activity of methionine synthase. As mentioned earlier, phenytoin actually decreases the activity of methionine synthase, leading to impaired folate metabolism and methylation processes.

Correct Answer: A

Rationale: Ginger is the correct answer because it has traditionally been used as an antiemetic for nausea and vomiting, especially during pregnancy. Ginger contains active compounds such as gingerol and shogaol that have been shown to help reduce nausea and vomiting by acting on the gastrointestinal system. Studies have supported the effectiveness of ginger in alleviating pregnancy-related nausea. Garlic is not the correct answer as it is not commonly used as an antiemetic. While garlic has many health benefits, it is not typically used specifically for nausea and vomiting. Ginkgo biloba is also not the correct answer. Ginkgo biloba is often used for cognitive function and circulation but is not known for its antiemetic properties. In fact, ginkgo biloba has been associated with side effects such as nausea and gastrointestinal upset in some individuals. Green tea is not the correct answer either. While green tea is a popular beverage with many health benefits, it is not typically used as an antiemetic. In some cases, green tea may actually worsen nausea due to its caffeine content. In conclusion, ginger is the best choice among the options provided as it has a long history of use as an antiemetic agent, especially in cases of pregnancy-related nausea and vomiting.

Correct Answer: C

Rationale: Magnesium sulfate is commonly used in obstetrics to prevent seizures in women with preeclampsia or eclampsia, as well as to stop preterm labor. The desired outcome related to the administration of magnesium sulfate is to decrease blood pressure (Choice C). Magnesium sulfate has vasodilatory effects which help to lower blood pressure in women with preeclampsia or eclampsia, reducing the risk of complications such as stroke or organ damage. Choice A (Increased contractions) is incorrect because magnesium sulfate is actually used to stop preterm labor by relaxing the uterine muscles and preventing contractions. It is a tocolytic agent, not a uterotonic. Choice B (Respiratory rate above 18) is incorrect because magnesium sulfate can actually depress the respiratory system, leading to respiratory depression or even respiratory arrest in high doses. Therefore, it is important to monitor the respiratory rate closely when administering magnesium sulfate. Choice D (Increased uterine tone) is incorrect because, as mentioned earlier, magnesium sulfate is a tocolytic agent that relaxes the uterine muscles to prevent preterm labor. It does not increase uterine tone. In fact, it is used to delay delivery to allow for the administration of corticosteroids to improve fetal lung maturity.