Pregnancy, Childbirth, and Puerperium 1

Question 1

Answer 1

C

Question 2

Answer 2

BThis infant has congenital torticollis, which typically develops by 2 to 4 weeks of age. It is most commonly caused by birth trauma (eg, breech delivery) or malposition of the head in utero (eg, due to fetal macrosomia or oligohydramnios), both of which can result in sternocleidomastoid muscle (SCM) injury and fibrosis. Children with congenital torticollis may have additional musculoskeletal anomalies, including hip dysplasia, metatarsus adductus (ie, adduction of the forefoot), and talipes equinovarus (ie, clubfoot).
The diagnosis of congenital torticollis is made clinically. On physical examination, the head is tilted toward the affected side with the chin pointed away from the contracture. A soft-tissue mass may be palpable in the inferior one-third of the affected SCM. Plagiocephaly and facial asymmetry may be seen in severe cases. Most cases resolve with conservative therapy and stretching exercises.
(Choice A) Folate deficiency during the first trimester of pregnancy is associated with fetal neural tube defects (eg, spina bifida).
(Choice C) Defective collagen synthesis causes osteogenesis imperfecta (brittle bone disease). Patients with the lethal variety usually die in utero or in early infancy due to severe fractures, pulmonary failure, or intracerebral hemorrhage.
(Choice D) Alcohol consumption during pregnancy can cause fetal alcohol syndrome. Affected infants have poor growth, functional developmental deficits, and characteristic facial abnormalities including a smooth philtrum, thin vermilion border, and small palpebral fissures.
(Choice E) The majority of upper respiratory infections in pregnancy are benign. However, rubella, one of the TORCH infections, is transmitted by the respiratory route and can cause severe birth defects, including hearing loss, cataracts, and congenital heart defects.
Educational objective:
Congenital torticollis is typically noted by 2 to 4 weeks of age, after which the child prefers to hold the head tilted to one side. It is most commonly the result of malposition of the head in utero or birth trauma. Most cases resolve with conservative therapy and stretching exercises.

Question 3

Answer 3

D

Question 4

Answer 4

A

Question 5

Answer 5

A

Question 6

Answer 6

D

Question 7

Answer 7

C

Question 8

Answer 8

E

Question 9

Answer 9

D

Question 10

Answer 10

E

Question 11

Answer 11

E

Question 12

Answer 12

E

Question 13

Answer 13

E

Question 14

Answer 14

B

Question 15

Answer 15

E