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Fetal Birth Injuries. 4th year neonatal course. Definition. The term birth injury is used to denote: avoidable and unavoidable. mechanical, hypoxic and ischemic ...
FETAL BIRTH INJURIES The followings are characters of Cephalohematoma, except: A. Appears after delivery. B. Limited to the borders of one cranial bone. C. Persist for few weeks. D. Soft and pits under pressure. Erb’s palsy include the followings, except: A. The upper limp at the side of the trunk. B. Internally rotated. C. The wrist is flexed. D. Weakness of the flexors of the wrist and fingers. Fetal birth injuries: A. Fracture skull is commonly associated with cephalhematoma. B. Sternomastoid injury occurs with excessive traction on the neck. C. Vertebral column injuries are most common with transverse lie. D. Fractures and dislocations of long bones are most common with vaginal breech delivery. E. Facial palsy most commonly occurs with face presentation. Fetal birth injuries: A. Do not occur with cesarean section. B. Facial palsy commonly turns into facial paralysis. C. Brachial plexus injury occurs with excessive traction on the neck. D. Complete recovery usually occurs with injuries of abdominal viscera. E. Pelvic caput is the second common type of fetal birth injuries. Fracture of the fetal skull: A. Is commonly related to difficult delivery. B. Is sometimes due to precipitate labor. C. Requires a CT scan. D. A linear fracture may be associated with cephalhematoma. E. The outcome of fracture base is usually favorable. Caput succedaneum: A. Is edema of the subcutaneous tissue of the fetal scalp. B. Disappears 2-3 hours after delivery. C. A cervical caput may be associated with rupture of membranes before full cervical dilatation. D. A pelvic caput is usually smaller than a cervical caput. E. An artificial caput should not overlie the occiput. Caput succedaneum: A. A cervical caput is commonly associated with excessive moulding. B. A pelvic caput may give a false impression about the degree of flexion. C. An artificial caput results from use of forceps for delivery. D. A cervical caput is commonly associated with intra cranial hemorrhage. E. Caput should be differentiated from cephalhematoma. Cephalhematoma: A. Is collection of blood under the skull. B. Appears at delivery. C. Is limited to the borders of one cranial bone. D. Persists for few days. E. Requires a CT scan. Cephalhematoma: A. May be caused by forceps delivery. B. May occur with delivery using the ventouse. C. May cause jaundice in the newborn. D. May cause neonatal hypoglycemia. E. Should be evacuated. Intracranial hemorrhage: A. Is sometimes due to intrauterine asphyxia. B. Is more common with preterm labor. C. The intra-ventricular type is related to traumatic delivery. D. With intra-cerebral hemorrhage, the anterior fontanelle is tense and bulging. E. Magnesium sulfate is sometimes required to prevent convulsions. Intracranial hemorrhage: A. CT is essential in diagnosis and follow up. B. Ultrasonography is essential in diagnosis and follow up. C. Lumbar puncture may be used for diagnosis. D. Lumbar puncture may be a part of the treatment. E. Vitamin k 10 mg IM is given to improve coagulation. Intracranial hemorrhage: A. The majority of etiological factors are preventable. B. Commonly causes asphyxia. C. Neurological manifestations are uncommon. D. Breast milk should be evacuated and given to the newborn by a dropper. E. Antibiotics are given to prevent pulmonary infection. Etiological factors of intracranial hemorrhage: A. Rapid compression and decompression of the fetal head. B. Cervical caput. C. Moulding. D. Excessive compression of the fetal head. E. Rh incompatibility. Sites of intracranial hemorrhage: A. Subdural. B. Subperiosteal. C. Subarachnoid. D. Intra-dural. E. Intracerebral. Shortly after vaginal delivery of an infant in an occiput posterior position, a vaguely demarcated edematous area over the midline of the skull was noted. This observed lesion is most likely: a) A cephalhematoma. b) A skull fracture. c) Caput succedaneum. d) A subdural hematoma. e) Subgaleal hematoma. Fetus and neonate 1- Cut-off value of cervical length at 24 weeks of gestation for prediction of preterm delivery is: A) 0.5cm. B) 1.5cm C) 2.5cm D) 3.5cm 2- Neonatal intraventricular hemorrhage, all are TRUE EXCEPT: A) is associated with prematurity B) The incidence is more in babies delivered by CS C) can be diagnosed by lumbar puncture D) may lead to hydrocephalus 3- Respiratory Distress Syndrome, all TRUE EXCEPT: A) is more common in the offspring of diabetic mothers B) is due to deficient levels of surfactant C) artificial surfactant can be administered via an endotracheal tube D) more common in term than preterm fetus 4- Preterm labour, all TRUE EXCEPT: A) is associated with an increased risk of breech presentation. B) is associated with uterine anomaly. C) is associated with genital tract infection. D) TOCOLYTIC THERAPY CAN ALWAYS POSTPONE DELIVERY. 5- Preterm delivery , all are TRUE EXCEPT: A) More likely in women with previous history of preterm delivery B) is more likely with multiple pregnancy. C) is more likely if the mother smokes cigarettes. D) is defined as the delivery of a baby weighing < 5 lb. 6- Post term pregnancy is more than ………….. days: A) 280 B) 287 C) 294 D) 300 7- A neonate with asymmetrical intrauterine growth restriction, all are true EXCEPT: A) Is more likely to develop hypoglycaemia than a normally grown neonate. B) Has increased liver glycogen storage. C) Is at increased risk of hypothermia. D) Has a body length that is less restricted than its body weight. 8- Causes of neonatal hypoglycaemia include only one of the following: A) cow milk allergy B) urea cycle defects C) glycine sensitivity D) infants of diabetic mothers 9- Hyaline membrane disease, all are not true EXCEPT: A) usually occurs within 12 hours of delivery B) usually occurs after Caeserean section C) has a better prognosis if steroids are given to the infant D) is more common in multiple pregnancies 10- Ritrodrine can cause one of the following: A) bradycardia B) heart block C) hypotension D) peripheral vasoconstriction 11- Which phrase best defines a teratogen? A) a life-support system that protects the fetus B) an agent that stimulates the formation of organs C) an abnormality in infants of alcoholic mothers D) an environmental factor that produces birth defects 12- A common characteristic of babies born to women who smoke during their pregnancies is: A) a missing arm or leg B) facial deformities and below-average intelligence C) restlessness and irritability D) lower birthweights 13- The Apgar primarily assesses a newborn's: A) psychological status B) reflexes C) physiological health D) responsivity to people 14- With regard to the Apgar Score, all are not true EXCEPT: A) heart rate < 100 beats per minute scores 0 B) grimace in response to stimulation scores 2 C) some flexion of extremities scores 1 D) gasping, weak cry scores 0 E) is normally recorded at 1 and 10 minutes 15- The following factors positively influence high birth weight: A) Maternal growth hormones. B) Prolonged pregnancy (294) days. C) Fetal hyperinsulinaemia. D) Primiparity E) Social class 16- Birthweight > 4.5 kg, all are true EXCEPT: A) is always due to poorly controlled diabetes. B) increases the risk of shoulder dystocia. C) is a contra-indication to vaginal delivery of a baby presenting by the breech. D) another large baby is likely in a subsequent pregnancy. 17- Cervical Incompetence, all are true EXCEPT: A) usually manifests itself in late miscarriage B) is treated with 2nd. trimester cervical cerclage C) usually causes ante-partum hemorrhage D)may present with premature rupture of membranes 18- In circlage operation stitch should be removed: A) after delivery B) at labour C) at 38 weeks D) at 28 weeks. 19- The following are recognized risk factors for preterm labour EXCEPT: A) Maternal employment B) Genital infection C) Low pre-pregnancy maternal weight D) Smoking 20- The following regimens will delay delivery in preterm labour EXCEPT: A) IV ritodrine B) Progesterone supplementation C) Nifedipine D) tndomethacin 21- The following are absolute contraindications to ritodrine EXCEPT: A) Cervical dilatation of 4 cm B) Ruptured membranes C) Hyperthyroidism D) Insulin-dependent diabetes 22- Signs of fetal postmaturity that may be noted prior to delivery include one of the following: A) oligohydramnios B) maternal edema C) clear amniotic fluid D) maternal weight loss 23- The postmaturity syndrome—the following do not apply EXCEPT: A) Increased incidence of placental abruption B) Meconium staining of membranes C) Body weight increased in relation to body length D) Fetal macrosomia 24- Of the conditions listed below, which one most accurately describes a risk for preterm labour and birth: A) Caucasian race B) Maternal age between 20 - 25 C) Bicornuate uterus D) One previous first-trimester miscarriage E) Singleton pregnancy 25- Bell’s palsy is dysfunction of A) Mandibular nerve B) Maxillary nerve C) Facial nerve D) Ophthalmic nerve 26- Match the following tocolytic agents with their mechanism of action. 1) Nifedipine 2) Terbutaline 3) Ethanol 4) Indomethacin 5) Magnesium sulfate A) Suppresses synthesis of endogenous prostaglandins B) Inhibits oxytocin release C) Stimulates cyclic AMP formation D) Inhibits calcium influx 27- History of preterm births may indicate all of the following EXCEPT: A) DES exposure B) Uterine anomaly C) Incompetent cervix D) Previous breech delivery 28- The predominant fetal pulmonary surfactant is: A) Sphingomyelin B) Phosphatidylcholine C) Phosphatidylserine D) Phosphatidylinositol E) Steroids 29- Maternal administration of steroids: A) Decreases the incidence and severity of hyaline membrane disease B) Is effective only in female fetuses C) Exerts its maximum effect after 32 weeks D) Carries unacceptable neonatal complications 30- Management of the neonate with a heart rate between 60 and 90 beats per minute (bpm) should include which of the following? A) Rubbing infant's back with a drying towel B) Placing infant under radiant heat source C) Suctioning the oropharynx and nose D) All of the above 31- The obstetrician encountering an infant suspected of having meconium aspiration should do all of the following except: A) Suction the oropharynx and nasopharynx immediately upon delivery of the head B) Insert a laryngoscope, irrespective of whether the baby is actively breathing C) Check the airway before inserting positive-pressure ventilation to avoid forcing meconium D) Complete delivery by cesarean section if that is mode of delivery, then suction the oropharynx and nasopharynx 32- Which of the following characterizes intraventricular hemorrhage? A) Occurs in 75% of infants weighing 1,000-1,800 g B) Occurs universally in infants under 28 weeks of gestation C) Most often originates in the subependymal layer of the peri ventricular matrix that overlies the head of the caudate nucleus D) Most commonly is associated with meconium aspiration 33- Erb-Duchenne upper arm palsy is due to injury of which cervical nerves? A) 1 and 2 B) 3 and 4 C) 5 and 6 D) 7 and 8 34- All of the following statements characterize hyaline membrane disease (HMD) except: A) Elevated respiratory rate (> 60/min) B) Expiratory grunting C) Nearly 100% incidence below 29-30 weeks D) Amelioration of acute HMD by intratracheal administrations of modified bovine surfactant 35- Of neonatal deaths not attributed to congenital malformations, what percentage result from preterm delivery? A) 40% B) 50% C) 75% D) 90% 36- Very low-birth-weight refers to infants weighing less than: A) 750 g B) 1000g C) 1.500 g D) 2,000 g 37- All of the following factors have been consistently associated with preterm delivery except: A) Previous first-trimester abortion B) Low socioeconomic status C) Non white race D) Smoking E) l.ow prepregnancy weight 38- A patient who has had a prior preterm birth presents for counseling. You should tell her that her risk of having a second preitrm delivery is approximately: A) 5%-10% B) 20%-40% C) 50%-75% D) Over 75% 39- Which of the following uterine abnormalities is associated with the highest incidence of preterm delivery? A) Unicornuate B) Complete bicornuate C) Arcuate D) Complete septum 40- All of the following have been associated with an increased risk of preterm delivery in a current pregnancy except: A) Placenta previa B) Oligohydramnios C) Hyperemesis gravidarum D) First -trimester bleeding E) Multiple gestation 41- Maternal complications of parenteral β-mimetic tocolytic therapy include: A) Hyperglycemia B) Hypokalemia C) Chest pain D) Hypotension E) All of the above 42- Which of the following statements correctly describes the use of magnesium sulfate as a tocolytic agent? A) Magnesium sulfate is the preferred tocolytic in patients with myasthenia gravis B) Serum magnesium levels correlate well with tocolytic effect C) Pulmonary edema has not been reported in patients receiving magnesium sulfate tocolysis D) Magnesium sulfate is the preferred tocolytic in patients with diabetes mellitus 43- Which of the following is an absolute contraindication to the administration of β-mimetic tocolytic agents? A) Chorioamnionitis B) Maternal chronic hypertension C) Maternal history of severe migraine headaches D) Multiple gestation 44- All of the following have been observed in association with indomethacin tocolysis except: A) Oligohydramnios B) Pulmonary hypertension in the neonate C) Constriction of the ductus arteriosus D) Fetal growth retardation 45- Fetal and neonatal complications associated with premature rupture of the membranes (PROM) include: A) Neonatal sepsis B) Pulmonary hypoplasia C) Cord prolapse D) Skeletal deformities E) All of the above 46- Characteristics of infants with the postmaturity syndrome include all of the following except: A) Skin maceration B) Brownish green disco lor a lion of the skin C) Increased subcutaneous fat deposits D) Failure of intrauterine growth 47- Prolonged pregnancy is associated with an increased incidence of all of the following except: A) Fetal hypoxia B) Macrosomia C) Meconium staining D) Polyhydraninios 48- If the last menstrual period was withdrawal bleeding following oral contraceptives. the expected date of confinement should be calculated later by at least: A) 2 weeks B) 4 weeks C) 6 weeks D) 8 weeks 49- Which of the following techniques for anteparturm fetal surveillance has been associated with the lowest false-negative rate in the prolonged pregnancy? A) Nonstress test B) Biophysical profile C) Contraction stress test D) Maternal assessment of fetal activity 50- All of the following tests are useful in antepartum surveillance of prolonged pregnancy except: A) Biophysical profile B) Nonstress test C) Contraction stress test D) Amniocentesis for meconium 51- A post-date or post-term pregnancy is defined as one which has reached: A) 40 weeks of gestation B) 41 weeks of gestation C) 42 weeks of gestation D) 43 weeks of gestation 52- In the prolonged pregnancy, the primary maternal risk is associated with: A) Preeclampsia B) Cesarean section C) Gestational diabetes D) Excessive weight gain 53- The possibility of RDS would be most reliably predicted by: A) U/S measurement of BPD B) U/S measurement of femur length C) Creatinine concentration in amniotic fluid > 2 D) L/S ratio in amniotic fluid < 2 E) Decrease of bilirubin in amniotic fluid (1)Faetal birth injures during breech delivery include the following EXCEPT: A) Fracture- dislocation of axis vertebra. B) Intra- cranial hemorrhage. C) Facial nerve palsy. D) Ruptured liver. (2)With excessive moulding, the vessel, most liable to injury, is: A) Superior Sagittal sinus. B) Inferior Sagittal sinus. C) Vein of Galen (Great cerebral). D) Straight sinus. (3)Fracture of the vault of the skull may be associated with: A) Subdural hemorrhage. B) Cephalhaematoma. C) Forceps delivery. D) All of the above. (4)Faetal birth injuries are caused by: A) Prematurity. B) Mal-presentations especially breech. C) Instrumental delivery. D) All of the above. (5)Subdural & subarachnoid hemorrhage are caused by the following EXCEPT: A) Prematurity. B) Breech delivery. C) Asphyxia. D) Forceps delivery. (6)Following faetal injuries are due to forceps delivery EXCEPT: A) Cranial & intracranial injuries. B) Facial nerve palsy. C) Erb's palsy. D) Klumpke's palsy. (7)In Erb's palsy the following is found EXCEPT: A) Injury to cervical nerves C 5& 6. B) Policeman tip position. C) Deviation of angle of mouth. D) Extension of elbow. (8)Excessive neck stretching may: A) Occur during breech delivery. B) Occur during forceps delivery. C) Result in Erb's paralysis. D) Result in sterno-mastoid hoematoma. E) All of the above. (9)A newborn, with asphyxia, drowsiness, convulsions & bulging anterior fontanelle, is provisionally, diagnosed as: A) Respiratory distress syndrome. B) Meconium aspiration. C) Intracranial hemorrhage. D) Fracture of the axis vertebera. (10)In cephalhaematoma the following is true EXCEPT: A) May follow vacuum extraction. B) There is stripping of periosteum with rupture of its vessels. C) Aspiration of blood is needed. D) May be a safety- valve for a concomitant fractured vault bone. (11)In active management of intracranial haemorrhage, in newborn, the following is true, EXCEPT: A) Resuscitation with minimal handling. B) Chloral hydrate, Magnesium sulphate 50% 1ml. C) Vit. K 10mgm I.M. to the mother during labour. D) Prophylactic antibiotics. E) Lumber puncture.
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