Which of the following is NOT a source of pain in labour?

Correct Answer: B

Rationale: Step 1: Uterine contractions are a physiological process in labor causing pain due to muscle contractions. Step 2: Cervical dilatation involves the opening of the cervix, which can cause pain and discomfort. Step 3: Pelvic floor stretching occurs as the baby moves through the birth canal, leading to pain. Step 4: Socio-cultural norms do not directly cause physical pain in labor, making choice B the correct answer. Other choices directly relate to physical processes causing pain.

Correct Answer: D

Rationale: The correct answer is D: Prevent excessive traction being applied. This is because in a breech delivery, excessive traction can lead to complications such as fetal injuries or umbilical cord prolapse. The midwife should avoid pulling on the baby's legs or body to prevent undue stress on the baby. The other choices are incorrect because: A: Ascertain the fetal wellbeing in utero - this is typically done through other means such as fetal monitoring. B: Allow enough room for the fetus to pass - this should be done by ensuring proper positioning and allowing natural descent. C: Allow gravitating descent of the fetus - this is not a recommended practice as it can cause complications.

Correct Answer: A

Rationale: Rationale for choice A: Calcium channel antagonists are the treatment of choice for achalasia as they help relax the lower esophageal sphincter, improving swallowing. This is a non-invasive option that can provide symptom relief for many patients. Summary for other choices: B: Intrasphincter botulinum injection is a temporary solution and not considered the treatment of choice. C: Pneumatic dilation is another option for achalasia but is typically used if calcium channel antagonists are ineffective. D: Myotomy and partial fundoplication is a more invasive surgical option and usually considered if other treatments fail.

Correct Answer: B

Rationale: Step 1: TB can be transmitted through respiratory droplets, not just during labor. Step 2: Mother with active TB can transmit the bacteria to the child during childbirth. Step 3: Therefore, the statement that mother-to-child transmission never occurs during labor is false. Summary: Choice B is correct because TB transmission can occur during labor, making Choice A incorrect. Choices C and D are irrelevant.

Correct Answer: B

Rationale: The correct answer is B: Rotational injury. Flexion-distraction injuries of the thoracolumbar spine are often caused by rotational forces that occur during accidents such as motor vehicle collisions or falls. These forces lead to the spine being twisted, causing separation of the vertebrae. Blunt trauma (A) can cause various spinal injuries but is not specific to flexion-distraction injuries. Seat belts (C) are designed to prevent spinal injuries by restraining the body during a collision. Gunshot wounds (D) can cause spinal cord injuries but are not commonly associated with flexion-distraction injuries of the thoracolumbar spine.

Correct Answer: D

Rationale: The correct answer is D because deep transverse arrest refers to a situation where the fetal head fails to rotate and descend in the pelvis due to the occiput and sinciput being at the same level. This leads to a prolonged labor. Choice A is incorrect because flexion can be inadequate in deep transverse arrest. Choice B is incorrect because it is not solely caused by uterine contractions but rather fetal malposition. Choice C is incorrect because a well-curved sacrum is not a defining factor in deep transverse arrest.

Correct Answer: A

Rationale: Neonatal injury to nerve roots C8 & T1 leads to Klumpke's palsy due to damage to the lower brachial plexus. This results in weakness of the hand and forearm muscles. Erb's palsy is from injury to C5-C6 roots causing upper brachial plexus damage. Phrenic injury affects the diaphragm due to C3-C5 roots. Radial palsy involves the radial nerve, typically from injury at the spiral groove of the humerus. Therefore, the correct answer is A as it directly correlates with the specific nerve roots affected in Klumpke's palsy.

Correct Answer: A

Rationale: In face presentation, the face is an ill-fitting presenting part, leading to obstructed labor. The face has larger diameters, making it difficult to pass through the birth canal. This differs from vertex delivery where the head can mold to fit. Caput succedaneum is swelling of the soft tissues on the baby's head and does not directly cause obstructed labor.

Correct Answer: B

Rationale: Step-by-step rationale for why choice B is correct: 1. The ACCF/AHA recommends cardiac consultation before an operation for patients on antiplatelet therapy to assess the risk of bleeding versus thrombotic events. 2. Cardiac consultation helps determine the necessity of continuing, modifying, or stopping antiplatelet therapy. 3. This individualized approach ensures optimal perioperative management based on the patient's cardiovascular risk profile. 4. Choice A is incorrect as stopping antiplatelet therapy for 10 days can increase the risk of thrombotic events. 5. Choice C is incorrect as it oversimplifies the decision-making process without considering the patient's specific risks. 6. Choice D is incorrect because initiating antiplatelet therapy in all high-risk cardiac procedures may not be necessary for every patient.