Which one of the following clinical features indicates neonatal intracranial injury?

Correct Answer: C

Rationale: Rationale for choice C: 1. Excessive molding or abnormal stretching of the fetal head can indicate neonatal intracranial injury due to the trauma during birth. 2. This feature suggests possible compression or trauma to the baby's head during delivery. 3. It may lead to intracranial hemorrhage or other injuries, requiring close monitoring and medical intervention. Summary of other choices: A. An oedematous swelling resolving in 48 hours is likely a normal finding (cephalohematoma) and not specific to intracranial injury. B. Notable bleeding between the epicranial aponeurosis & periosteum may indicate cephalohematoma or caput succedaneum, not necessarily intracranial injury. D. Peripheral cyanosis is related to oxygenation and circulation, not specific to intracranial injury.

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: C

Rationale: The correct answer is C: Oligohydramnios. Shoulder presentation occurs when the baby presents shoulder-first rather than head-first during birth. Oligohydramnios, a condition characterized by low levels of amniotic fluid, can lead to decreased uterine space, increasing the chances of abnormal fetal positioning. Macerated fetus (A) is associated with fetal decomposition, not shoulder presentation. Postdates pregnancy (B) is linked to increased risk of macrosomia but not shoulder presentation. Placenta abruption (D) is a separation of the placenta from the uterus, not a direct cause of shoulder presentation.

Correct Answer: D

Rationale: The correct answer is D because placenta praevia can lead to severe bleeding during childbirth, posing high risks to both the mother and the baby. This condition occurs when the placenta partially or completely covers the cervix, leading to bleeding as the cervix dilates during labor. Choice A is incorrect because bleeding in placenta praevia is not related to the segment preparing for labor. Choice B is incorrect as bleeding is primarily due to the abnormal placement of the placenta, not from pathological processes. Choice C is incorrect as bleeding can occur before 37 weeks in cases of placenta praevia.

Correct Answer: B

Rationale: The correct answer is B: Oligohydramnios. Oligohydramnios leads to reduced volume of amniotic fluid, which can result in poor fetal movements and inadequate cushioning for the fetus. This can increase the likelihood of abnormal fetal positions like shoulder presentation. Other choices are incorrect because: A: A sub-septate uterus is a structural uterine abnormality and not directly related to shoulder presentation. C: Prematurity may lead to preterm labor but is not specifically associated with shoulder presentation. D: Multiple pregnancy can increase the risk of malpresentation but is not a direct maternal cause of shoulder presentation.

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: Depression. Psychosis during puerperium commonly manifests as postpartum depression, characterized by feelings of extreme sadness, anxiety, and fatigue. This is due to hormonal changes and stress associated with childbirth. Mania (choice A) and bipolar disorder (choice B) are less common during this period. Infection (choice D) is not a typical manifestation of psychosis during puerperium. Overall, postpartum depression is the most prevalent and well-documented form of psychosis in the postpartum period.

Correct Answer: B

Rationale: It is important to monitor blood pressure in pregnant women to detect preeclampsia, a serious condition that can lead to complications for both the mother and the baby. Preeclampsia is characterized by high blood pressure and protein in the urine, and early detection is crucial for timely intervention. Regular monitoring allows healthcare providers to identify and manage preeclampsia promptly, reducing the risk of severe complications such as eclampsia and organ damage. Anemia, preterm labor, and gestational diabetes are important aspects of prenatal care but are not directly related to the need for regular blood pressure monitoring in pregnant women.

Correct Answer: C

Rationale: The correct answer is C: Transmural myocardial infarction. Subtotal plaque disruption leads to vasoconstriction, platelet activation, and embolization, causing complete occlusion of a coronary artery. This results in ischemia of the entire thickness of the myocardial wall, leading to transmural myocardial infarction. Endothelial cell dysfunction (A) is an early event in atherosclerosis but does not directly result from subtotal plaque disruption. Prinzmetal's angina (B) is caused by transient coronary artery spasm rather than plaque disruption. Non-ST elevation myocardial infarction (D) involves incomplete blockage of a coronary artery and typically does not result from subtotal plaque disruption.