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Staff Nurse Exam Question Answers- April 2018  ESIC Staff Nurse Exam Model Question Answers-2019


1. Before endotracheal intubation some facts about trachea a nurse has to understand and all the following are true regarding trachea except
  1. It is about 13 cm long
  2. It bifurcates into two major bronchi
  3. It starts at te level of 7th cervical vertebra
  4. It ends at the level of sternal angle of Louis







2. Contraindication for expectant regime in placenta praevia are all except
  1. Bleeding at 36 wks
  2. Profuse bleeding
  3. Baby dead
  4. Congenital anomaly of foetus








3. Active foetal movement felt by the mother is
  1. Quickening
  2. Lightening
  3. Ballotment
  4. Softening






4. Commonest type of Genito urinary fistulae
  1. Vescico vaginal
  2. Utero vaginal
  3. Vescico uterine
  4. Urethro vaginal







5. Mr. Mukthar Ahamad is undergoing chest physiotherapy after CABG. Which of the following levels of prevention it illustrates?
  1. Primordial
  2. Primary
  3. Secondary
  4. Tertiary







6. Lower esophageal sphincter tone is high in
  1. Achalasia Cardia
  2. Diffuse Esophageal Spasm
  3. Nut Cracker Esophagus
  4. Ineffective Esophageal motility







7. Puberty menorrhagia is managed by
  1. Danazol
  2. Progestogens
  3. Oestrogens
  4. D&C




8. Contraceptive failure is calculated by
  1. Pearl Index
  2. Pincus Index
  3. Russel Index
  4. Reids Index







9. Commonest malignancy of maxillary sinus is
  1. Squmous cell carcinoma
  2. Adeno carcinoma
  3. Adenoid cystic carcinoma
  4. Rhabdomyosarcoma







10.Most common post operative psychiatric condition is
  1. Depression
  2. Schizophrenia
  3. Mania
  4. Delirium









11. Electro convulsive therapy was first introduced by
  1. Moniz and Lima
  2. Cerletti and Bini
  3. Fraud and Jung
  4. Meduna and Paracelsus







12. The following are true about retraction except
  1. Muscle fibres permanently shortened
  2. Progressive and intense during 1st stage
  3. Special property of upper uterine segment
  4. Effects haemostasis after separation of placenta





13. Delusion is a disorder of
  1. Perception
  2. Thought
  3. Orientation
  4. Memory







14. Simpson grading is used to assess the completeness of surgical removal of
  1. Gliomas
  2. Meningiomas
  3. Pituitary adenomas
  4. Vestibular schwannomas






15. Cardiac failure is most likely in pregnancy at

  1. 32 Wks
  2. 1st Stage of labour
  3. III Stage of labour
  4. D:-4th Stage of labour







16. The test used to detect hip instability is
  1. Barlow's test
  2. Weber test
  3. Phalan test
  4. Alen test






17. The commonest gynaecological cause of retention urine
  1. Vaginal operations
  2. Ovarian tumours
  3. Cervical fibroid
  4. Haemato colpos







18. Softening of cervix during pregnancy is
  1. Osiander's sign
  2. Goodell's sign
  3. Chadwick's sign
  4. Chvostek's sign







19. Commonest false localizing sign in raised intracranial pressure is
  1. Oculomotor nerve palsy
  2. Abducent nerve palsy
  3. Facial nerve palsy
  4. Papilloedema






20. A patient treated for infertility with clomiphene presents with sudden onset of abdominal pain and distension
with ascites. Probable cause is
  1. Uterine rupture
  2. Ectopic pregnancy
  3. Multi fetal pregnancy
  4. Hyper stimulation syndrome






21. A group of related ideas or statements is called
  1. theory
  2. conceptual framework
  3. philosophy
  4. paradigm






22. Bleeding in the first trimester with no uterine contraction or pain and dilatation of cervix indicates
  1. Threatened abortion
  2. Complete abortion
  3. missed abortion
  4. inevitable abortion






23. Bacillus cereus food poisoning is commonly associated with the consumption of
  1. green beans
  2. fried rice
  3. Bottled honey
  4. Baked potato






24. A scale that cannot be used to assess a subject for a mood disorder is
  1. Edinburgh inventory
  2. Hamilton rating scale
  3. Wakefield questionnaire
  4. Beck inventory






25. when there is a possibility of locked twins being born ?
  1. First twin has cephalic and the second twin has breech presentation
  2. Fraternal twins
  3. First twin has breech and the second twin has cephalic presentation
  4. Dichorionic diamniotic twins






26. An immovable joint is called
  1. Synarthrosis
  2. Amphiarthrosis
  3. Diarthrosis
  4. Polyarthritis






27. In the diagnostic atatement "Excess fluid volume related to decreased venous return as manifested by lower extremity edema (swelling ) " the etiolog of the problem is :
  1. Edema
  2. Excess fluid volume
  3. Decreased venous return
  4. Idiopathic






28. Which of the below is NOT a function of the fibrous skeleton of the heart?
  1. Forms a structural foundation for the heart valves
  2. Conducts the impulses from atria to ventricles
  3. Prevents overstretching of the valves
  4. Acts as a point of insertion for cardiac muscle fibres






29. The microorganism that is usually a part of the normal vaginal flora but can cause meningitis in newborns is :
  1. Candida albicans
  2. Group B streptococci
  3. Staphylococcus epidermidis
  4. Corynebacterium species






30. Proton pump in stomach is an example for :
  1. Simple diffusion
  2. Facilitated diffusion
  3. Secondary active gransport
  4. Primary active transport






31. Voluntary rejection of unacceptable thoughts or feeelings from conscious awareness is called :
  1. Substitution
  2. sublimation
  3. Symbolisation
  4. Suppression






32. The professional value of nursing that describes the right toself-determination is called :
  1. Integrity
  2. Autonomy
  3. Dignity
  4. Altruism






33. Which of the following is NOT a part of the secondary prevention of mental illness ?
  1. Early detection
  2. Rehabilitation
  3. Crisis stabilisation
  4. Screening






34. Introduction of solid foods along with brreast feeding is called
  1. Scheduled feeding
  2. Demand feeding
  3. Complementary feeding
  4. Conditional feeding






35. Pseudo hyphae are seen in :
  1. Penicillium
  2. Aspergillus
  3. Candida
  4. Mucor






36. Naegele's rule is used to calculate :
  1. Amniotic fluid
  2. Cervical dilatation
  3. Gestational age
  4. Expected date of delivery






37. The test that is most specific for myocardial damage is:
  1. Myoglobin
  2. Troponin I
  3. Creatinine kinase
  4. CK-mb






38. The first level in the healthcare system is:
  1. Secondary health care
  2. Primary health care
  3. Primordial health care
  4. Tertiary health care






39. Respiratory rate multiplied by tidal volume gives :
  1. Total lung capacity
  2. Maximum voluntary ventilation
  3. Minute volume
  4. Expiratory reserve volume






40. Fine downy hair, normally found abundantly in premature babies, is called :
  1. Vernix
  2. Lanugo
  3. Caput
  4. Naevi






41. In a patient taking high doses of acetaminophen over a prolonged period, the parameter tob e monitored regularly is:
  1. Kidney function
  2. Liver function
  3. GI irritation
  4. Prothrombin time






42. Depolarisation in a nerve action potential is due to :
  1. Opening of potassium channels
  2. opening of calcium channels
  3. Opening of sodium channels
  4. Closing of sodium channels






43. The action of the sympathetic system in the walls of airways is called :
  1. Bronchodilatation
  2. Increased gas exchange
  3. Bronchoconstriction
  4. Increased secretion






44. Which of the following is true with regards to pregnancy-induced hypertension ?
  1. There is raised BP before 20 weeks' gestation
  2. Proteinuria is usually present
  3. It is also called as gestationalhypertension
  4. Visual disturbances are always present






45. The most common cause of retinal detachment is:
  1. Degenerative changes in the retina or vitreous
  2. Brain tumors
  3. Trauma
  4. Diabetes mellitus






46. The term MRSA in bacteriology stands for:
  1. Multidrug Resistant Staphylococcus aureus
  2. Methicillin Resistant Streptococcus anginosus
  3. Methicillin Reactive Staphylococcus aureus
  4. Methicillin Resistant Staphylococcus aureus






47. The document that gives nurses the authority to carr out specific actions under certain circumstances, often when a physician is not immediately available, is called :
  1. Discharge summary
  2. Standing order
  3. Prescription
  4. Concept map






48. The genera that needs pyridoxal for growth is:
  1. Granulicatella
  2. Pedi coccus
  3. Aero coccus
  4. Enterococcus






49. Which surgical procedure has the highest incidence of ureteric injury ?
  1. vaginal hysterectomy
  2. werthimes hysterectomy
  3. abdominal hysterectomy
  4. anterior colporrhaphy






50. Normal intracranial pressure in adults is
  1. 1-7 mm Hg
  2. 7-15 mm Hg
  3. 15-25 mm Hg
  4. 20-30 mm Hg






51. Which type of hallucinations are common in schizophrenia ?
  1. Olfactory
  2. Tactile
  3. Auditory
  4. Visual






52. Puberty menorrhagia is managed by
  1. Danazol
  2. Progestogens
  3. Oestrogens
  4. D & C






53. Tincture of iodine is :
  1. Alcoholic solution of Iodine
  2. Solution of Iodine in aqueous KI
  3. Aqueous solution of Iodine
  4. Aqueous solution of KI






54. A thin fibrous ring present at the margin of the chorionic plate is:
  1. Placenta marginata
  2. Placenta circumvallate
  3. Placenta succentrata
  4. velamentous insertion






55. All of the following are included in electromagnetic spectrum except
  1. Visible light
  2. gamma rays
  3. Beta rays
  4. X-rays






56. External jugular vein drains into which ofthe following vein :
  1. Facial vein
  2. Brachiocephalic vein
  3. Subclavian vein
  4. Internal jugular vein






57. Contraceptive failure is calculated by
  1. Russel index
  2. Pincus index
  3. Pearl index
  4. Reids index






58. Normal serum bilirubin level is
  1. 1-2 mg %
  2. 0.1 - 0.7 mg%
  3. 0.2 - 0.8 mg%
  4. 0.4 - 1.2mg %






59. In a normal average infant, how much more will be the growth of body length compared to the body length at birth ?
  1. 20 %
  2. 50 %
  3. 75%
  4. 10 %






60. Which of the following is NOT assimilated by eukaryotic cells ?
  1. Lactate
  2. Nitrogen
  3. Glucose
  4. Sulphate






61. An unattractive man selects expensive , stylish clothes to draw attention to himself. The defense mechanism exemplified here is :
  1. Compensation
  2. Conversion
  3. Denial
  4. Dissociation






62. Which of the following is the mortality indicator ?
  1. Prevalence rate
  2. Crude death rate 
  3. Incidence rate
  4. Morbidity rate






63. Neuroleptic drugs are also known as :
  1. Hypnotics
  2. Antiepileptics
  3. antidepressants
  4. Antipsychotics






64. When a person's blood pressure drops, the kidneys respond by :
  1. Secreting renin
  2. Increasing urine output
  3. Slowing the release of ADH
  4. Producing aldosterone






65. Which is NOT a high risk factor that might affect workers in a construction company ?
  1. Traumatic injuries
  2. Allergic diseases
  3. Malnutrition
  4. Chest disease






66. The normal order of events taking place during thesecond stage of labour is :
  1. Descent → flexion → crowning → extension → internal rotation
  2. descent → flexion → internal rotation → extension → crowning
  3. Descent → internal rotation → crowning → extension → flexion
  4. Descent → flexion → internal rotation → crowning → extension






67. Which of the following is NOT a component of HELLP syndrome ?
  1. Bleeding pervaginum
  2. Low platelet count
  3. Elevated liver enzymes
  4. Hemolysis






68. Poor skin turgor in neonates and infants indicates :
  1. Hypoglycemia
  2. Hypertonia
  3. Dehydration
  4. Hypocalcemia






69. Which of the following is NOT a sign of respiratory distress ?
  1. Nasal flaring
  2. Changing of posture to ease breathing
  3. Speaking complete sentences
  4. Cyanosis






70. Which of the following is the  true statement about the H zone of the sarcomere ?
  1. It contains thin filaments only
  2. It contains thick filaments only
  3. It is devoid of thck or thin filaments
  4. It contains thick and thin filaments lying side by side






71. Srub typhus is caused by :
  1. Rickettsia prowazekii
  2. Orientia tsutsugamushi
  3. Rickettsia akari
  4. Rickettsia typhi






72. Which of the following is a confirmed indication of pregnancy ?
  1. Nausea and vomiting
  2. Amennorrhea
  3. Fetal heart in ultra-sonogram
  4. Beta HCG in urine






73. The minimally invasive technique by which thin, insulated lead wire with electrodes (neurostimulator) is surgically implanted in the brain is called :
  1. Functional MRI
  2. Transcranial magnetic stimulation
  3. Deep brain stimulation
  4. Electroconvulsive therapy






74. The "Adam's Apple " is formed by :
  1. Hyoid bone
  2. Thyroid cartilage
  3. Epiglottis
  4. Cricoid cartilage






75. The meaning of remission is :
  1. the person is clinically cured
  2. the severity of disease increases
  3. The disease is present, but the person does not experience symptoms
  4. The symptoms reappear






76. Lactational amenorrhoea acts as a contraceptive method by :
  1. Preventing implantation
  2. Preventing ovulation
  3. Preventing sprem entry
  4. Spermicidal action






77. The test used for the diagnosis of trichomoniasis is :
  1. Specific serologic test
  2. Ova and parasite fecal smear
  3. Enzyme-linked immunoassay (ELISA) test of serum
  4. Wet mount of vaginal fluid






78. The third phase of body's adaptation to stress is :
  1. Resistance
  2. Exhaustion
  3. Rebound
  4. Reaction






79. . Tuberculosis is caused by polluted:
Air
Water
Food
Fomites.






80. Polio is transmitted through:
  1. Water
  2. Air
  3. Food
  4. Insects






81. A person with no sign of disease but may transmit, it is called:
  1. A resistant person
  2. Immune person
  3. A carrier person
  4. An allergic person.






82. For eye examination the instrument used is:
  1. Stethoscope
  2. Otoscope
  3. Opthalmoscope
  4. Percussion hammer






83. Thyroid gland is present in:
  1. Chest
  2. Abdomen
  3. Neck
  4. Back






84. Who is regarded as “Father of Medicine”?
  1. Paracelsus
  2. Aristotle
  3. Galen
  4. Hippocrates






85. Dehydration is caused in the human body due to:
  1. Less of vitamins
  2. Loss of water
  3. Loss of Salt
  4. Loss of minerals.






86. All these are sterilized by chemicals except:
  1. Scissors
  2. Endoscopes
  3. Gauze
  4. Cables





87. B.C.G. vaccine is given to protect the child against:
  1. Diphtheria
  2. Tetanus
  3. Typhoid
  4. Tuberculosis






88. Protein deficiency disease is known as:
  1. Kwashiorkar
  2. Cushing’s disease
  3. Gaucher’s disease
  4. None of these above





89. Bone deformation can occur due to lack of:
  1. Calcium
  2. Phosphorus
  3. Vitamin D
  4. All of these






90. Vitamin ‘D’ deficiency may result in:
  1. Rickets
  2. Beriberi
  3. Scurvey
  4. Night blindness






91. Which is not cancer:
  1. Leukaemia
  2. Glaucoma
  3. Carcinoma
  4. Sarcoma






92. Vitamin essential for coagulation of blood is:
  1. B
  2. D
  3. K
  4. A

















The Question Paper with Answer of ESIC Staff Nurse Examination conducted  on 26/02/2019 and 27/02/2019 is published on 03/03/2019. Nurse Examination conducted  on 26/02/2019 and 27/02/2019 is published on 03/03/2019.

In the first decades of the 18th century in the Dutch Republic, Daniel Gabriel Fahrenheit[7] made two revolutionary breakthroughs in the history of thermometry. He invented the mercury-in-glass thermometer (first widely used, accurate, practical thermometer)[2][1] and Fahrenheit scale (first standardized temperature scale to be widely used).[2]
In 1714, Dutch[7] scientist and inventor Daniel Gabriel Fahrenheit invented the first reliable thermometer, using mercury instead of alcohol and water mixtures. In 1724, he proposed a temperature scale which now (slightly adjusted) bears his name. He could do this because he manufactured thermometers, using mercury (which has a high coefficient of expansion) for the first time, and the quality of his production could provide a finer scale and greater reproducibility, leading to its general adoption. In 1742, Anders Celsius (1701–1744) proposed a scale with zero at the boiling point and 100 degrees at the freezing point of water,[17] though the scale which now bears his name has them the other way around.[18
Era of precision thermometry
See also: Precision thermometry, Fahrenheit scale, Celsius scale, Mercury-in-glass thermometer (mercury thermometer), Medical thermometer, Clinical thermometer, Pyrometer, and Infrared thermometer

Daniel Gabriel Fahrenheit, the originator of the era of precision thermometry.[14] He invented the mercury-in-glass thermometer (first widely used, accurate, practical thermometer)[1][15][16] and Fahrenheit scale (first standardized temperature scale to be widely used).

A medical mercury-in-glass maximum thermometer.
In 1714, Dutch[7] scientist and inventor Daniel Gabriel Fahrenheit invented the first reliable thermometer, using mercury instead of alcohol and water mixtures. In 1724, he proposed a temperature scale which now (slightly adjusted) bears his name. He could do this because he manufactured thermometers, using mercury (which has a high coefficient of expansion) for the first time, and the quality of his production could provide a finer scale and greater reproducibility, leading to its general adoption. In 1742, Anders Celsius (1701–1744) proposed a scale with zero at the boiling point and 100 degrees at the freezing point of water,[17] though the scale which now bears his name has them the other way around.[18] French entomologist René Antoine Ferchault de Réaumur invented an alcohol thermometer and, temperature scale in 1730, that ultimately proved to be less reliable than Fahrenheit's mercury thermometer.

The first physician to use thermometer measurements in clinical practice was Herman Boerhaave (1668–1738).[19] In 1866, Sir Thomas Clifford Allbutt (1836–1925) invented a clinical thermometer that produced a body temperature reading in five minutes as opposed to twenty.[20] In 1999, Dr. Francesco Pompei of the Exergen Corporation introduced the world's first temporal artery thermometer, a non-invasive temperature sensor which scans the forehead in about two seconds and provides a medically accurate body temperature.[21][22]






Abstract
The human placenta is a villous hemochorial structure. It is attached to the uterine wall and establishes connection between the mother and the fetus through the umbilical cord and thus plays a critical role in maternal fetal transfer. It is developed from two sources: fetal chorion frondosum and maternal decidua basalis. Various abnormal conditions have been reported with the placenta and the placental chorioangioma is one of them. Chorioangioma of placenta is the commonest benign tumor of the placenta. It consists of a benign angioma arising from the chorionic tissue. It has been found to be associated with many serious complications such as nonimmune hydrops, congenital abnormalities, hemolytic anemia, polyhydramnios, IUGR, and IUFD.

Keywords
chorioangiomafetusplacentapolyhydramniosvilli
Chapter and author infoShow +
1. Introduction
The human placenta is discoid in shape and is a villous hemochorial structure [1, 2]. The placenta is attached to the uterine wall and establishes connection between the mother and the fetus through the umbilical cord and thus plays a critical role in maternal fetal transfer [2]. It has a complex synthetic capacity and plays a role in the immunologic acceptance of fetal allograft [2].

2. Development
The placenta is developed from two sources. The principal component is fetal which develops from the chorion frondosum, and the maternal component consists of decidua basalis (Figure 1) [2]. The fertilized ovum converts into a morula and further differentiates into a blastocyst. The outer layer of the blastocyst proliferates to form the primary trophoblastic cell mass which infiltrates the endometrial lining. By the 7th post-ovulatory day, the trophoblast differentiates into two layers: an inner layer of clear mononuclear cells with well-defined limiting membranes called cytotrophoblast and the outer layer of multinucleated cells with no intercellular membrane called syncytiotrophoblasts [1]. By 10th to 13th post-ovulatory days, a series of intercommunicating spaces or lacunae develop in the rapidly enlarging and dividing trophoblastic cell mass.


Figure 1.
Decidual structure differentiating into decidua basalis, capsularis, and parietalis.
The lacunae become confluent, and as the trophoblastic cell erodes the maternal vessels, they become filled with blood to form intervillous spaces. Between the lacunae spaces, there are columns having a central core of cytotrophoblasts surrounded by syncytiotrophoblasts. These form the framework for the development of villi later. From these pillars, branching sprouts appear. Those columns extent as far as the decidua and a mesenchymal core develops in them to form extraembryonic mesenchyme, which forms the villus vessels. In due course, these vessels establish continuity with those developing from the body stalk and inner chorionic mesenchyme. The distal part of the columns is not invaded by the mesenchyme but only serves to anchor it to the basal plate [1, 3]. These cells proliferate and spread laterally separating the syncytiotrophoblasts into two layers, the definitive syncytium on the fetal aspect and the peripheral syncytium on the decidual side which eventually degenerates and is replaced by a fibrinoid material and is known as Nitabuch’s layer.

With deeper blastocyst invasion into the decidua, the extravillous cytotrophoblasts give rise to solid primary villi composed of a cytotrophoblast core covered by syncytium. The most deeply implanted portion of these villi forms placenta (Figure 2). Beginning on the 12th day after fertilization, chorionic villi can first be distinguished and form secondary villi. After angiogenesis begins in the mesenchymal cores, it results into tertiary villi.


Figure 2.
Development of placenta.
By approximately the 17th day, fetal blood vessels are functional, and a placental circulation is established. The placenta is a vascularized villus structure by the 21st day. The fetal-placental circulation is completed when embryonic blood vessels are connected with chorionic vessels. Groups of cytotrophoblasts also grow into the lumen of the spiral arteries extending as far as the decidual myometrial junction. These cells destroy the muscular and the elastic layer of the vessel wall and get replaced by a fibrinoid material which is derived from the maternal blood and proteins secreted by the trophoblastic cells. This primary invasion dilates the spiral arteriolar wall and thus augments blood flow to the placenta [1, 3]. There is a secondary invasion of trophoblast between 12 and 16 weeks extending up to radial arteries within the myometrium. Thus, spiral arteries are converted to large bore uteroplacental arteries. The net effect is funneling of the arteries that reduce the pressure of the blood to 70–80 mm Hg before it reaches the intervillous space. It thus increases the blood flow.

The placental septa appear by 12 weeks protruding into the intervillous spaces from the basal plate and divide the placenta into 15–20 lobes. Until the end of the 16th week, the placenta grows both in thickness and circumference due to growth of the chorionic villi with accompanying expansion of the intervillous space and with continuous arborization and formation of fresh villi [2].

In the first trimester, the villi are large and have a mantle of trophoblasts consisting of an inner layer of cytotrophoblasts and an outer layer of syncytiotrophoblasts with the stroma of small fetal vessels. During the second trimester, the villi are smaller, the mantle is less regular and the cytotrophoblasts less numerous, and the stroma with more collagen. The fetal vessels become larger and more toward the periphery of the villus. In the third trimester, the villi are much smaller in diameter, and the cytotrophoblasts are irregular and thinned out. The fetal vessels are dilated and lie just below the thinned out trophoblasts.

The placenta, at term, is almost a circular disc with a diameter of 15–20 cm and a thickness of about 3 cm at its center [2]. It feels spongy and weighs about 500 g, the proportion to the weight of the baby being roughly 1:??6 at term and occupies about 30% of the uterine wall. It presents two surfaces, fetal and maternal, and a peripheral margin (Figure 3) [2].

The fetal surface is covered by the smooth and glistening amnion with the umbilical cord attached at or near its center [2].

The maternal surface is rough and spongy. It consists of 15–20 lobes or cotyledons which are limited by fissures. Each fissure is occupied by the decidual septum which is derived from the basal plate [2].


Figure 3.
Placenta at term.
The placenta consists of two plates. The chorionic plate lies internally. It is lined by the amniotic membrane. The umbilical cord is attached to this plate. The basal plate lies to the maternal aspect. Between the two plates lies the intervillous space containing the stem villi with their branches, the space being filled with maternal blood. A mature placenta has a volume of about 500 mL of blood, 350 mL being occupied in the villi system and 150 mL lying in the intervillous space [2].

3. Functions
Transfer of nutrients and waste products between the mother and the fetus. In this respect, it attributes to the following functions:

Respiratory

Excretory

Nutritive

Endocrine function: placenta is an endocrine gland. It produces both steroid and peptide hormones (like progesterone, estriol, human chorionic gonadotropin, and human placental lactogen) to maintain pregnancy and support fetal growth.

Barrier function: placenta acts as a protective mechanism.

Immunological function: maternal antibodies are taken into the syncytiotrophoblasts by pinocytosis and subsequently transferred to fetal capillaries and thus fetus acquires passive immunity (Figure 4).


Figure 4.
Blood supply of placenta.
4. Abnormalities of placenta
4.1. Placenta succenturiata
The accessory lobe is developed from the activated villi on the chorionic leave, may be placed at varying distances from the main placental margin. A leash of vessels connecting the main to the small lobe traverses through the membranes (Figure 5). In cases of absence of communicating blood vessels, it is called placenta spuria. The incidence of placenta succenturiata is about 3%. If the succenturiate lobe is retained, the following birth of the placenta may lead to:

Postpartum hemorrhage which may be primary or secondary

Subinvolution

Uterine sepsis

Polyp formation


Figure 5.
Placental abnormalities.
Treatment: Whenever the diagnosis of missing lobe is made, exploration of the uterus and removal of the lobe under general anesthesia is to be done.

4.2. Velamentous placenta
Normally, the umbilical cord inserts into the middle of the placenta as it develops. In velamentous cord insertion, the umbilical cord inserts into the fetal membranes (chorioamniotic membranes) and then travels within the membranes to the placenta (between the amnion and the chorion). The exposed vessels are not protected by Wharton's jelly and hence are vulnerable to rupture (Figure 5). Rupture is especially likely if the vessels are near the cervix, in which case they may rupture in early labor, likely resulting in a stillbirth. Once it is diagnosed, baby should be delivered by cesarean section.

4.3. Battledore placenta
Umbilical cord may be attached in the center, off center, on the edge, or in the membranes of the placenta. Battledore placenta is a placenta in which the umbilical cord is attached at the placental margin. The shortest distance between the cord insertion and the placental edge is within 2 cm. The incidence of the battledore placenta is 7–9% in singleton pregnancies and 24–33% in twin pregnancies [4, 5]. Complications associated with the battledore placenta are:

fetal distress

intrauterine growth restriction

preterm labor

decreased birth weight of baby and placenta

4.4. Placenta extrachorialis
It can be:

Circumvallate placenta: the fetal surface is divided into a central depressed zone surrounded by a thickened white ring which is usually complete. The ring is situated at varying distances from the margin of the placenta and is composed of a double fold of amnion and chorion with degenerated decidua (vera) and fibrin in between. Vessels radiate from the cord insertion as far as the ring and then disappear from view.

Placenta marginata: a thin fibrous ring is present at the margin of the chorionic plate where the fetal vessels appear to terminate.

There is increased chance of:

Abortion

Hydrorrhea gravidarum

Antepartum hemorrhage

Growth retardation of the baby

Preterm delivery

Retained placenta or membranes

4.5. Morbidly adherent placenta
Morbidly adherent placenta, which includes placenta accreta, increta, and percreta, implies an abnormal implantation of the placenta into the uterine wall (Figure 6). The incidence of placenta accreta has increased significantly over the past several decades, with the main risk factors including prior cesarean section and placental previa. Sonographic markers of placenta accreta can be present as early as the first trimester and include a low uterine implantation of a gestational sac, multiple vascular lacunae within the placenta, loss of the normal hypoechoic retroplacental zone, and abnormality of the uterine serosa-bladder interface, among others.

Placenta accreta is an extremely rare form in which the placenta is directly anchored to the myometrium partially or completely without any intervening decidua. The probable cause is due to the absence of decidua basalis and poor development of the fibrinoid layer.

Placenta increta: The placenta invades whole thickness of myometrium.

Placenta percreta: The placenta penetrates whole of the myometrium and may reach up to the peritoneum or bladder.


Figure 6.
Morbidly adherent placenta (A: Accrete, B: Increta, C: Percreta).
4.6. Gestational trophoblastic disease/neoplasm
Gestational trophoblastic disease is divided into molar and nonmolar tumors. Nonmolar tumors are grouped as gestational trophoblastic neoplasia. It is classified as:

Hydatidiform mole

Complete

Partial

Gestational trophoblastic neoplasia

Invasive mole

Choriocarcinoma

Placental site trophoblastic tumor

Epithelioid trophoblastic tumor

4.7. Chorioangioma of placenta
Placental chorioangioma is the commonest benign tumor of the placenta. Its incidence is around 1% when examined microscopically and is seen more frequently in multiple pregnancies and in female babies [6]. Chorioangiomas that are clinically evident are less common with an incidence between 1:3500 and 1:9000 births [6]. It is believed to arise by 16th day of fertilization, although there is no documentation of the tumor in the first trimester [7]. In the majority of cases, it is small or microscopic and of no clinical significance. If it increases in size >5 cm, then it may be associated with serious maternal and fetal complications (Figure 7) [6].


Figure 7.
Chorioangioma of placenta.
The pathogenesis of these neoplasms is controversial; however, they can originate from any part of the placenta excluding the trophoblastic tissues [8]. Three histological patterns of chorioangiomas have been described: angiomatous, cellular, and degenerate [9];

The angiomatous is the most common, with numerous small areas of endothelial tissue, capillaries, and blood vessels surrounded by placental stroma.

The cellular pattern has abundant endothelial cells within a loose stroma.

The degenerate pattern has calcification, necrosis, or hyalinization.

These lesions are sometimes classified as placental hamartomas rather than true neoplasia [10]. There is no malignant potential.

Large tumors probably act as arteriovenous shunts and cause complications. Maternal complications are preeclampsia, preterm labor, placental abruption, polyhydramnios, and postpartum hemorrhage [11]. The correlation of chorioangioma with hydramnios and preterm delivery is found to be significant among the various reported clinical complications. Fetal congestive heart failure may develop because of the increased blood flow through the low resistance vascular channels in the chorioangioma acting as an arteriovenous shunt. Other associated fetal complications are nonimmune hydrops, fetal demise, hemolytic anemia, congenital anomalies, fetal thrombocytopenia, cardiomegaly, intrauterine growth restriction, and neonatal death [12].

Antenatal ultrasound examination has made diagnosis and follow up possible before delivery. In the present case, the placental tumor was not diagnosed in the ultrasound documentation rather polyhydramnios was reported. Doppler ultrasound examination is the gold standard in primary diagnosis of hemangioma. But unfortunately, we could not conduct Doppler USG in the present case as delivery was imminent. Magnetic resonance imaging (MRI) is used only in suspicious cases, while the computed tomography (CT) technique has a limited role in the diagnosis of the placental angioma, mainly because of the high radiation risk and poor tissue differentiation.

Chorioangioma with complications before fetal viability requires interventions. Alcohol injection, laser coagulation of feeding vessels, and microcoil embolization of the feeding vessels are described for women with fetal complications like hydrops [13, 14]. Large chorioangioma associated with polyhydramnios leads to high perinatal morbidity and mortality. Polyhydramnios is treated with therapeutic amniocentesis and maternal indomethacin therapy [12]. Steroid administration for acceleration of fetal lung maturity before 34?weeks is indicated. If complications appear late in pregnancy, delivery is the choice. A recent literature review concluded that further studies are needed to refine the appropriate selection criteria that will justify the risk of invasive in utero therapy for chorioangiomas [15].
                                                                                                                          . .
António Caetano de Abreu Freire Egas Moniz (1874 –  1955), known as Egas Moniz (Portuguese: ) was a Portuguese neurologist and the developer of cerebral angiography. He is regarded as one of the founders of modern psychosurgery, having developed the surgical procedure leucotomy—known better today as lobotomy—for which he became the first Portuguese national to receive a Nobel Prize in 1949 (shared with Walter Rudolf Hess).
Ladislas Joseph Meduna (1896 – 1964), the Hungarian psychiatrist and neuropathologist, chemically induced grand mal epileptic seizures as treatment for schizophrenia. It is the basis for modern convulsive therapy.
Paracelsus Paracelsus
German-Swiss physician wrote a clinical description of syphilis, in which he maintained that the disease could be successfully treated by carefully measured doses of mercury compounds taken internally. He stated that the “miners’ disease” (silicosis) resulted from inhaling metal vapours  He was the first to declare that, if given in small doses, “what makes a man ill also cures him”—an anticipation of the modern practice of homeopathy. Paracelsus is said to have cured many persons in the plague-stricken town of Stertzing in the summer of 1534 by administering orally a pill made of bread containing a minute amount of the patient’s excreta he had removed on a needle point.

Paracelsus was the first to connect goitre with minerals, especially lead, in drinking water. He prepared and used new chemical remedies, including those containing mercury, sulfur, iron, and copper sulfate, thus uniting medicine with chemistry. Paracelsus, in fact, contributed substantially to the rise of modern medicine, including psychiatric treatment.
The Simpson grade of meningioma resection


was described in 1957 and correlated the degree of surgical resection completeness with symptomatic recurrence 1.

Although the type of resection still plays a part in the likelihood of symptomatic recurrence, other factors (such as the MIB-1 index) are also important, particularly in grades I - III 2.

grade I
complete removal including resection of underlying bone and associated dura
9% symptomatic recurrence at 10 years
grade II
complete removal and coagulation of dural attachment
19% symptomatic recurrence at 10 years
grade III
complete removal w/o resection of dura or coagulation
29% symptomatic recurrence at 10 years
grade IV
subtotal resection
44% symptomatic recurrence at 10 years
grade V
simple decompression with or without biopsy
100% symptomatic recurrence at 10 years (small sample in original paper)
What is Ovarian Hyperstimulation Syndrome?

Ovarian hyperstimulation syndrome (OHSS) is an excessive response to taking the medicines (especially injectable gonadotropins) used to make eggs grow. Rarely, OHSS can result from taking other medications, such as clomiphene citrate or gonadotropin-releasing hormone.

Women with OHSS have a large number of growing follicles along with high estradiol levels. This leads to fluid leaking into the abdomen (belly), which can cause bloating, nausea, and swelling of the abdomen. When OHSS is severe, blood clots, shortness of breath, abdominal pain, dehydration, and vomiting are possible. Rare deaths are reported.
Identical twins
Identical twins are also called monozygotic twins, meaning one fertilized egg. They occur when one egg is fertilized by one sperm as usual, but the egg splits in two shortly afterward. Each half then grows into a baby.

Because they originally came from the same egg and sperm, 100 percent of their chromosomes are identical. This means they’re the same sex and have the same genetic characteristics, like hair and eye color.

However, things in their environment, such as how much room they each had in the womb, can cause slight differences in their appearance.

Fraternal twins
The other name for fraternal twins is dizygotic twins, meaning two fertilized eggs. They’re the result of the mother releasing two eggs at the same time with each egg being fertilized by a different sperm.

Because they come from different eggs and sperm, they only share about 50 percent of their chromosomes like any other siblings. This means they can be the same or different sexes and aren’t identical.


The Wakefield Questionnaire for Depression
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Naegele’s rule

Naegele’s rule involves a simple calculation: Add seven days to the first day of your LMP and then subtract three months.

For example, if your LMP was November 1, 2017:

Add seven days (November 8, 2017).
Subtract three months (August 8, 2017).
Change the year, if necessary (to the year 2018, in this case).
In this example, the due date would be August 8, 2018.
Lung volumes and lung capacities refer to the volume of air in the lungs at different phases of the respiratory cycle.

The average total lung capacity of an adult human male is about 6 litres of air.

Tidal breathing is normal, resting breathing; the tidal volume is the volume of air that is inhaled or exhaled in only a single such breath.

The average human respiratory rate is 30-60 breaths per minute at birth,[1] decreasing to 12-20 breaths per minute in adults.[2]
Placenta succenturiata
There is an accessory lobe which is developed from the activated villi on the chorionic leaf, may be placed at varying distances from the main placental margin. A leash of vessels connecting the main to the small lobe traverses through the membranes. In cases of absence of communicating blood vessels, it is called placenta spuria. The incidence of placenta succenturiata is about 3%. If the succenturiate lobe is retained, the following birth of the placenta may lead to: Postpartum hemorrhage which may be primary or secondary
Velamentous cord insertion
The umbilical cord is inserted in the fetal membranes. In normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac.
Risk to the baby is very low. It can increase the risk of preterm birth of a small-for-gestational-age baby, low Apgar score, and a stay in the neonatal intensive care unit (NICU) after birth
A gamma ray, or gamma radiation (symbol  χ  ), is a penetrating form of electromagnetic radiation arising from the radioactive decay of atomic nuclei. It consists of the shortest wavelength electromagnetic waves and so imparts the highest photon energy.
Gamma rays are ionizing radiation and are thus biologically hazardous. Due to their high penetration power, they can damage bone marrow and internal organs. Unlike alpha and beta rays, they pass easily through the body and thus pose a formidable radiation protection challenge, requiring shielding made from dense materials such as lead or concrete.
A beta particle, also called beta ray or beta radiation (symbol ß), is a high-energy, high-speed electron or positron emitted by the radioactive decay of an atomic nucleus during the process of beta decay. There are two forms of beta decay, ß- decay and ß+ decay, which produce electrons and positrons respectively.
X-rays are a form of electromagnetic radiation, similar to visible light. Unlike light, however, x-rays have higher energy and can pass through most objects, including the body. Medical x-rays are used to generate images of tissues and structures inside the body.
Alpha particles, also called alpha rays or alpha radiation, consist of two protons and two neutrons bound together into a particle identical to a helium-4 nucleus. They are generally produced in the process of alpha decay, but may also be produced in other ways.
Composition: 2 protons, 2 neutrons
Definition. A eukaryotic cell contains membrane-bound organelles such as a nucleus, mitochondria, and an endoplasmic reticulum. Organisms based on the eukaryotic cell include protozoa, fungi, plants, and animals. These organisms are grouped into the biological domain Eukaryota.
HELLP syndrome,
Features:- hemolysis, elevated liver enzyme levels, and low platelet levels. It is a life-threatening condition complicating pregnancy. Risk factors, maternal age of older than 34 years, multiparity, and European descent
Thrombocytopenia occurs due to consumption of platelets due to a coagulation cascade due to adhesion of platelets to a damaged endothelium. Multiorgan microvascular injury and hepatic necrosis cause liver dysfunction. Placental maternal vascular supply lesions occur. May lead to small for gestational age fetus.
H zone
It is the region of a striated muscle fibre that contains only thick (myosin) filaments. The H zone appears as a lighter band in the middle of the dark A band at the centre of a sarcomere.
Breastfeeding as a Contraceptive Method (Lactational ...
The Lactational Amenorrhea Method

The method uses three measures of a woman's fertility: 1) the return of her menstrual period, 2) her patterns of breastfeeding, and 3) the time postpartum.
The contraceptive effect of the lactational amenorrhoea method is a result of increased levels of prolactin. When prolactin levels increase, the production and secretion of gonadotrophin releasing hormone are inhibited and a reduction of gonadotropin-releasing hormone from the hypothalamus during lactation suppress ovulation. This leads to a reduction in luteinizing hormone (LH) release and inhibition of follicular maturation.

This contraceptive method is useful to a woman who is still amenorrhoeic, and who is not feeding her baby with supplements, for up to 6 months after delivery.
98% protection from pregnancy.

Kwashiorkor
Corrected by eating more protein and more calories overall, especially if treatment is started early.

Calories in the form of carbohydrates, sugars, and fats. Once these calories provide energy, foods with proteins are given. Foods must be introduced and calories should be increased slowly. The body may need to adjust to the increased intake.
Long-term vitamin and mineral supplementation to the diet is recommended

Complications of kwashiorkor
Even with treatment, children who have had kwashiorkor may never reach their full growth and height potential. If treatment comes too late, a child may have permanent physical and mental disabilities.
If left untreated, the condition can lead to coma, shock, or death.

Protein can be found in foods like : seafood, eggs, lean, meat, beans, peas, nuts, seeds.

Children and older adults, the two groups who most commonly experience kwashiorkor as a result of abuse or neglect, will display typical symptoms of the condition. The most visible symptoms are swelling of the ankles, feet, and belly. In some cases of abuse or neglect, these symptoms may also accompany other signs of mistreatment, such as bruising and broken bones.


Rickets
is a condition that results in weak or soft bones in children. Symptoms include bowed legs, stunted growth, bone pain, large forehead, and trouble sleeping. Complications may include bone fractures, muscle spasms, an abnormally curved spine, or intellectual disability.

The most common cause of rickets is a vitamin D deficiency. This can result from eating a diet without enough vitamin D, dark skin, too little sun exposure, exclusive breastfeeding without vitamin D supplementation, celiac disease, and certain genetic conditions. Other factors may include not enough calcium or phosphorus. The underlying mechanism involves insufficient calcification of the growth plate. Diagnosis is generally based on blood tests finding a low calcium, low phosphorus, and a high alkaline phosphatase together with X-rays.

Prevention for exclusively breastfed babies is vitamin D supplements. Otherwise, treatment depends on the underlying cause. If due to a lack of vitamin D, treatment is usually with vitamin D and calcium. This generally results in improvements within a few weeks. Bone deformities may also improve over time. Occasionally surgery may be done to correct bone deformities. Genetic forms of the disease typically require specialized treatment.
Gaucher (go-SHAY) disease
is the result of a buildup of certain fatty substances in certain organs, particularly spleen and liver. This causes these organs to enlarge and can affect their function.
The fatty substances in bone tissue, weakens the bone and increases the risk of fractures. If the bone marrow is affected, it can interfere with blood's ability to clot.
An enzyme that breaks down these fatty substances doesn't work properly in people with Gaucher disease. Treatment often includes enzyme replacement therapy.
An inherited disorder, Gaucher disease is most common in Jewish people of Eastern and Central European descent (Ashkenazi). Symptoms can appear at any age.
Symptoms
Abdominal complaints. Because the liver and especially the spleen can enlarge dramatically, the abdomen can become painfully distended.
Skeletal abnormalities. Gaucher disease can weaken bone, increasing the risk of painful fractures. It can also interfere with the blood supply to bones, which can cause portions of the bone to die.
Blood disorders. A decrease in healthy red blood cells (anemia) can result in severe fatigue. Gaucher disease also affects the cells responsible for clotting, which can cause easy bruising and nosebleeds.
More rarely, Gaucher disease affects the brain, which can cause abnormal eye movements, muscle rigidity, swallowing difficulties and seizures.