El comercio minorista en ciudades patrimoniales

Anne 35 Ramos, genie anne

Question 35. A 19 y/o G1P0, 6 weeks pregnant, develops vaginal spotting after undergoing a unilateral salpingo-oophorectomy for an ovarian mass. The spotting was most likely due to a lack of which hormone?

a. human placental lactogen

b. human chorionic gonadotroponin c. estrogen

d. progesterone Answer: D

Rationale: Ovulation ceases during pregnancy and the maturation of new follicles is suspended. Ordinarily only a single corpus luteum can be found in pregnant women. This functions maximally during the first 6 to 7 weeks of

pregnancy - 45 weeks post-ovulstion snd thereafter

contribute relativeley little to progesterone production. This observations have been confirmed by surgical removal of the corpus luteum before 7 week to 5 weeks post-ovulation- which results in a rapid fall of maternal serum progesterone and spontaneous abortion. (Csapo and co-workers, 1973) Reference: William obstetrics,23e, chapter 5: maternal physiology

35 Ramos, Genie Anne

Question 36. Dextrorotation of the uterus is due to:

a. presence of the rectosigmoid on the left b. hydronephrosis of the kidney on the right c. preference of the baby to move to the right d. presence of the appendix on the right

Answer: A

Rationale: By the end of 12 weeks, the uterus has become too large to remian entirely within the pelvis. As the uterus continues to enlargen it contacts the anterior abdominal wall, displaces the intestines laterally and superiorly, and

continues to rise, ultimately reachinh almost to the liver. With ascent of uterus to pelvis, it usually undergoes rotation to the right. This dextrorotation likely is caused by the rectosigmoid on the left side of the pelvis. As the uterus rises, tension is exerted on the brad and round ligaments.

Reference: William obstetrics,23e, chapter 5: maternal physiology

35 Ramos, Genie Anne

Question 37. The elevated patches of tissue present on the ovaries that bleed easily during pregnancy are:

a. endometriotic implants b. adhesions

c. decidual reaction d. corpus lutem Answer: C

Rationale: A decidual reaction on and beneath the surface of the ovaries is common in pregnancy and is usually observed at ceserean delivery. These elevated patches of tissue bleed easily and may on first glance resemble freshly torn

adhesions.

Reference: William obstetrics,23e, chapter 5: maternal physiology

36. Yu, Philip Philip Andrew S. Yu Section B

36. Dextrorotation of the uterus is due to:

a. Presence of the rectosigmoid on the left b. Hydronephrosis of the kidney on the right c. Preference of the baby to move on the right d. Presence of the appendix on the right

ANSWER: A. Presence of the rectosigmoid on the left Rationalization : Because of unequal dilatation may result from a cushioning provided by the left ureter by the sigmoid colon as the consequence.

37. The elevated patches of tissues on the ovaries that bleed easily during pregnancy are:

a. Endometriotic implants c. Decidual Reaction

b. Adhesions d. Corpus

luteum

ANSWER: C . Decidual Reaction

Rationalization: A decidual reaction on and beneath the surface of the ovaries, similar to that found in the

endometrial stroma, is common in pregnancy and usually observed at Caesarian Section deliveries. These elevated patches of tissue bleed easily and may on first glance resemble freshly torn adhesions.

38. The following inflammatory markers are increased in pregnancy, EXCEPT:

a. Leukocyte alkaline phosphatase c. Monocytes b. Erythrocyte Sedimentation Rate d. C-Reactive protein

ANSWER: C. Monocytes

Rationalization: Leukocyte alkaline phosphatase, which are used to evaluate myeloproliferative disorders, are increased during early pregnancy. Erythrocyte Sedimentation Rate is increased in normal pregnancy because of elevated plasma globins and fibrinogen. C-reactive protein, an acute phase reactant rises rapidly in response to tissue trauma or inflammation.

Reference: Williams Obstetrics 23rd Edition

38. Nazareno,

Christine 38. NAZARENO, CHRISTINE

The following inflammatory markers are increased in pregnancy except:

•Leukocyte alkaline phosphatase

•Erythrocyte sedimentation rate

•Monocytes

•C-reactive proteins Answer: Monocytes Rationalization:

Beginning quite early in pregnancy, the activity of leukocyte alkaline phosphatase is increased. Such elevated activity is

not peculiar to pregnancy but occurs in a wide variety of conditions, including most inflammatory states.

The concentration of C-reactive protein, an acute-phase serum reactant, rises rapidly to 1000-fold in response to tissue trauma or inflammation. Watts and colleagues (1991) measure C-reactive protein sequentially diring 81 normal pregnancies to establish normative values. Median C-reactive protein values during pregnancy were higher than values for nonpregnant women, and these values were evaluated further in labor.

Another marker of inflammation, the erythrocyte

sedimentation rate is increased in normal pregnancy because of elevated plasma globulins and fibrinogen.

Source: William’s Obstetrics 22nd edition, pp. 131 39. NAZARENO, CHRISTINE

The consequence of an elevated diaphragm in pregnancy is:

•Increased diaphragmatic excursion

•Decreased functional residual capacity and residual volume

•Increased tidal volume

•Decrease in peak expiratory flow rates

Answer: Decreased functional residual capacity and residual volume

Rationalization:

During pregnancy, diaphragmatic excursion is actually greater than when non-pregnant. The respiratory rate changed a bit, but the tidal volume, minute ventilator

volume, and minute oxygen uptake increase significantly as pregnancy advances. These events happen during normal pregnancy, but the direct consequence of an elevated diaphragm during pregnancy is the decrease in functional residual capacity and residual volume of air.

Source: William’s Obstetrics 22nd edition, pp. 136 40. NAZARENO, CHRISTINE

A pregnant woman who fails to excrete concentrated urine after withholding fluids for approximately 18 hours means:

•The woman has renal damage

•The kidneys are normal by excreting mobilized extracellular fluid of relatively low osmolality

•The kidneys are compensating for the lack of fluid intake

•The contents of the urine are filtered by a diseased kidney

Answer: The kidneys are normal by excreting mobilized extracellular fluid of relatively low osmolality

Rationalization:

In early pregnancy, the glomerular filtration rate increases as much as 50%, while the renal plasma flow is increased much greater during the beginning of the second trimester. This is may be due to the relaxin and neuronal nitric oxide synthase – which are responsible for the increased glomerular filtration and plasma flow during pregnancy.

During the day, pregnant women tend to accumulate water in the form of dependent edema, and at night, while recumbent, they mobilize this fluid and excrete it via the kidneys. This reversal of the usual nonpregnant diurnal pattern of urinary flow causes nocturia and the urine is more dilute than in the non-pregnant state. Failure of a pregnant woman to excrete concentrated urine after witholding fluids for approximately 18 hours does not sfifnify renal damage. In dactm the kidney in these circumstances functions perfectly normally by

excreting mobilized extracellular fluid of relatively low osmolality.

Source: William’s Obstetrics 22nd edition, pp. 138

39. Pataunia,

Josan 39. The consequence of an elevated diaphragm in pregnancy is?

m. Increased diaphragmatic excursion

n. Decreased functional residual capacity and residual volume

o. Increased tidal volume

p. Decreased in peak expiratory flow rates ANSWER: B

RATIONALE:

Increased diaphragmatic excursion is brought about by growth of the uterine mass that interferes with the range of motion of the diaphragm and with the expansion of the lungs and breathing movements.

Decreased functional residual capacity and residual volume is a result of the upward pressure exerted by the abdominal contents.

Increased tidal volume significantly enhances as

pregnancy advances. It, together with resting minute ventilation, is caused by several factors such as

enhanced respiratory drive due to stimulatory effects of progesterone, low expiratory reserve volume, and

compensated respiratory alkalosis.

Peak expiratory flow rates decline progressively as gestation advances.

REFERRENCE:

Sumpaico, Textbook of Obstetrics, 3^rd Edition, pages 234-235

Williams Obstetrics 23^rd Edition, page 121.

40. A pregnant woman who fails to excrete concentrated urine after withholding fluids for approximately 18hours means:

i. The woman has renal damage

j. The kidneys are normal by excreting mobilized extracellular fluid of relatively low osmolality

k. The kidneys are compensating for the lack of fluid intake

l. The contents of the urine are filtered by a diseased kidney

ANSWER: B RATIONALE:

Pregnancy is associated with enhanced

production of nitric oxide which, in recent studies, is implicated to be an important mediator of the renal hyperfiltration during pregnancy.

REFERRENCE:

Sumpaico, Textbook of Obstetrics, 3^rd Edition, page 236.

41. A pregnant woman may experience an increase in the incidence of:

m. Tooth decay n. Gingivitis o. Heartburn p. All of the above

ANSWER: C RATIONALE:

Most evidence indicates that pregnancy does not incite tooth decay.

Gingivitis which is characterized by spongy

swollen hyperaemic gums, is notable during pregnancy

due to increased vascularity of the gums caused by the increased in estrogen level.

Heartburn (pyrosis) is common in pregnancy which is the manifestation of esophageal regurgitation or reflux of acidic secretions which is caused by a

decreased lower esophageal sphincter tone contributed by progesterone secretion in pregnancy. In addition, intraesophageal pressures are lower and intragastric pressures higher in pregnant women.

REFERRENCE:

Sumpaico, Textbook of Obstetrics, 3^rd edition, page 236-237.

Williams Obstetrics 23^rd Edition, page 125.

40. Lameda,

Randall M. 40. LAMEDA, RANDALL M.

A pregnant woman who fails to excrete concentrated urine after withholding fluids for approximately 18 hours mean:

a. the woman has renal damage

b. the kidneys are normal by excreting mobilized extracellular fluid of relatively low osmolality

c. the kidney are compensating for the lack of fluid intake d. the contents of the urine are filtered by a diseased kidney Answer: b

Rationale:Normal pregnancy is associated with an appreciable increase in extracellular water, and postpartum diuresis is a physiological reversal of this process. This regularly occurs between the second and fifth days and corresponds with loss of residual pregnancy hypervolemia. In preeclampsia, both retention of fluid antepartum and diuresis postpartum may be greatly increased

Reference: Williams Obstetrics, 23edition, Chapter 30: The Puerperium

41.LAMEDA, RANDALL M.

A pregnant woman may experience an increase in the incidence of:

a. tooth decay b. gingivitis c. heartburn

d. all of the above Answer: c

Rationale:

Pyrosis (heartburn) is common during pregnancy and is most likely caused by reflux of acidic secretions into the lower esophagus (see Chap. 49, Reflux Esophagitis). Although the altered position of the stomach probably contributes to its frequent occurrence, lower esophageal sphincter tone also is decreased. In addition, intraesophageal pressures are lower and intragastric pressures higher in pregnant women. At the same time, esophageal peristalsis has lower wave speed and lower amplitude (Ulmsten and Sundström, 1978).

Reference: Williams Obstetrics, 23edition Chapter 5: Maternal Physiology