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: C

Rationale: The correct answer is C: Oligohydramnios. Oligohydramnios, which is low levels of amniotic fluid, can lead to reduced cushioning in the uterus, allowing the fetus to assume abnormal positions like shoulder presentation. Macerated fetus (choice A) is related to prolonged fetal death, not shoulder presentation. Postdates pregnancy (choice B) may increase the risk of complications but is not a direct cause of shoulder presentation. Placenta abruption (choice D) is the premature separation of the placenta, which can lead to fetal distress but is not specifically linked to shoulder presentation.

Correct Answer: A

Rationale: The correct answer is A: Rhesus D incompatibility. Icterus gravis (severe jaundice) and hydrops fetalis (abnormal accumulation of fluid) are both conditions commonly associated with Rhesus D incompatibility between a mother and her fetus. This occurs when the mother is Rh-negative and the fetus is Rh-positive, leading to maternal antibodies attacking the fetal red blood cells, resulting in severe hemolytic anemia and subsequent complications. Explanation for why other choices are incorrect: B: ABO incompatibility typically leads to less severe jaundice and hemolytic disease compared to Rhesus D incompatibility. C: Physiological jaundice is a common and benign condition in newborns caused by the immaturity of the liver, not by blood type incompatibility. D: Instant perinatal death is not specifically associated with these conditions, but rather with other serious complications during childbirth.

Correct Answer: B

Rationale: The correct answer is B because pressure applied on the cervix by the presenting part in obstructed labor leads to edema of the vulva. This pressure causes obstruction of blood and lymphatic flow in the area, resulting in swelling and edema. Prolonged effort by the mother (choice A) would not directly cause vulvar edema. An ill-fitting presenting part (choice C) may contribute to obstruction but does not explain the mechanism of edema. Large presenting diameters (choice D) stretching the vulva would not directly cause edema without pressure on the cervix.

Correct Answer: B

Rationale: Postdatism refers to a pregnancy that extends beyond the normal gestation period of 280 days. The correct answer is B (294 days) as it is more than the standard 280-day term. Choice A (280 days) is the normal term, not postdatism. Choices C (290 days) and D (287 days) are also below the 294-day mark, making them incorrect for defining postdatism.

Correct Answer: D

Rationale: The correct answer is D: Elective lymph node dissection. This is because elective lymph node dissection helps to remove potentially cancerous lymph nodes, aiding in staging and ensuring complete tumor removal, thus improving the chances of curative surgery. En bloc resection (A) is important but may not always be feasible in fixed tumors. Adjuvant therapies (B) are used after surgery, not as the primary approach. Neoadjuvant therapies (C) are given before surgery to shrink tumors, not specifically for fixed tumors.

Correct Answer: D

Rationale: Step-by-step rationale for why choice D (Atelectasis) is correct: 1. Ascorbic acid deficiency can lead to impaired lung function, increasing the risk of atelectasis. 2. Anemia can cause decreased oxygen-carrying capacity, contributing to atelectasis. 3. Volume contraction can lead to reduced lung expansion, further predisposing to atelectasis. Summary: - Choice A (Prolonged intubation): Intubation duration is more related to respiratory complications, not directly linked to the mentioned risk factors. - Choice B (Thromboembolism): Risk factors like immobility and hypercoagulability are more relevant to thromboembolism. - Choice C (Delayed wound healing): More associated with factors like malnutrition and impaired immune function rather than the mentioned risk factors.

Correct Answer: B

Rationale: In uterine inversion, the fundus is the last part to be replaced due to its position being the deepest inside the vagina. The fundus is the upper portion of the uterus and is the last part to invert back into its normal position. The cervix, isthmus, and body are parts of the uterus that are more easily replaced during the process of uterine inversion. The fundus being the final part to be replaced ensures the uterus is fully restored to its correct orientation.

Correct Answer: A

Rationale: The correct answer is A: Acyclovir. The rationale is that sudden sensorineural hearing loss (SSHL) can sometimes be associated with viral infections, such as herpes simplex virus. Acyclovir is an antiviral medication that can potentially help treat the underlying viral infection causing SSHL. It is important to address the potential viral etiology before considering other treatments. Summary of other choices: B: Furosemide is a diuretic used to treat conditions like high blood pressure and edema, not SSHL. C: Warfarin is an anticoagulant used to prevent blood clots, not indicated for SSHL. D: Hyperbaric oxygen therapy is sometimes used for SSHL, but addressing any potential viral infection with Acyclovir would be a more appropriate initial step.