PERINATOLOGY • Vol 24 • No. 1 • May–Aug 2023 • 53 Self-assessment Quiz Answers Quiz 1. a,b,c,d Pregnant women with gestational diabetes are at an increased risk of fetal macrosomia, which is in turn a risk factor for shoulder dystocia. During vaginal delivery, the anterior shoulder of the fetus gets stuck against the mother’s pubic symphysis. Most of the times, the anterior shoulder is relieved by the delivery of the posterior arm. During the process, the humerus gets fractured. Gestational age and advanced maternal age are related to shoulder dystocia, when the patient is past the due date (> 40 wk). Maternal smoking is not shown to be related to this condition. 2. b,c,d Management of an AHE during pregnancy presents a challenge. On the one hand, it is important to lower blood pressure to prevent a hypertensive emergency (eg, hypertensive encephalopathy and cardiac decompensation damage to major organs). Extreme hypertension may cause placental abruption. Lowering blood pressure too much may lead to underperfusion of the placenta and fetal distress. The goal of antihypertensive therapy during an acute episode is not to lower blood pressure to normotensive levels but rather to a mild-tomoderate hypertensive level (150/95 mmHg is a good target blood pressure). 3. a,e Placental abruption is characterized by vaginal bleeding, abdominal pain, and uterine contractions (or increased uterine tone). Fetal distress is seen in more than 50% of cases. The bleeding during abruption is not bloody mucus, but rather frank blood that is often dark red. Abruption can lead to pregnancy loss. It has to be diagnosed at the earliest, treated aggressively, and monitored promptly. 4. a,b Pseudoseizures refer to attacks that are superficially similar to tonic–clonic seizures but are related to hysterical conversion or malingering. Pseudoseizures can be differentiated from true seizures with the help of EEG studies and serum prolactin level. They both return to normal levels after pseudoseizures. True tonic–clonic seizures are generalized seizures characterized by loss of consciousness or sleep following attacks. Tongue biting and loss of sphincter control are common during true seizures. 5. a,b,c,d Most cases of acute pharyngotonsillitis are caused by viruses such as rhinoviruses, coronaviruses, and parainfluenza viruses. Beta-hemolytic streptococci account for about 15% to 30% of cases. Fever, anorexia, throat pain, and purulent exudates are the combination of clinical features. Occasionally, scarlatiniform rash may appear. The condition can be diagnosed using rapid strep test and culture tests. They are highly sensitive (95%) but not very specific.
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