Discussion in 'AIIMS Nov 2013' started by Guest, May 10, 2010.

  1. smarty.

    smarty. Guest

    Q. coagulative necrosis is seen in ;;
    2 sarcoidosis;;
    3 gangrene;;
    4cryptcoccal inf

    answer is gangrene as it is a type of necrosis due to ischemia similar to the infarcation which is an example of coagulative necrosis

    tuberculosis and cyptococcal infections cause caseous necrosis of infectious etiology
    sarcoidosis have non necrotising granulomas

    1dura matter in ant fossa;;
    2int nasal cavity;;
    3maxillary sinus lining;;
    4ethmoidal cells

    Anterior ethmoidal artery supplies the mucous lining of anterior ethmoid air cells, upper anterior part of nasal cavity, skin of nose and the duramater in anterior fossa

    answer is maxillary sinus lining

    gestational diabetes melitus-which of the following is not usually seen ;;
    1past h/o macrosmic baby;;
    2cong malformations;;
    4 polyhydramnios;;

    Complications and sequelae of Gestational diabetes include:

    * Hyperinsulinaemia
    * Hyperglycaemia
    * Polyhydramnios
    * Birth hypoxia
    * Macrosomia
    * Dystocia
    * Perinatal morbidity
    * Placental hypertrophy
    * Intrauterine growth retardation
    * Intrauterine death
    Gestational diabetes

    Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life.

    Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.
    A 2008 study completed in the U.S. found that more American women are entering pregnancy with preexisting diabetes. In fact the rate of diabetes in expectant mothers has more than doubled in the past 6 years.[10] This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential that the children of diabetic mothers will also become diabetic in the future.

    Middle superior alveolar nerve is a branch of :
    a) palatine branch of maxillary
    b) nasal branch of maxillary
    c) infraorbital nerve
    d)mandibular nerve

    Ans c) infraorbital nerve
    Gray’s 40th 699


    • The maxillary nerve is a sensory division of the trigeminal nerve.
    • Most of the branches from the maxillary nerve arise in the pterygopalatine fossa.
    • It gives rise to the zygomatic and infraorbital nerves that pass into the orbit through the inferior orbital fissure and two others that pass through the pterygopalatine ganglion without synapsing and are distributed to the nose, palate and pharynx.

    Zygomatic nerve

    • The zygomatic nerve is located close to the base of the lateral wall of the orbit. It soon divides into two branches, the zygomaticotemporal and the zygomaticofacial nerves, which run for only a short distance in the orbit before passing onto the face through the lateral wall of the orbit.
    • They may either enter separate canals within the zygomatic bone or the zygomatic nerve itself may enter the bone before dividing.

    • The zygomaticotemporal nerve exits the zygomatic bone on its medial surface, and pierces the temporal fascia to supply the skin over the temple.
    • It also gives a branch to the lacrimal nerve which may carry parasympathetic fibres to the lacrimal gland .

    • The zygomaticofacial nerve leaves the zygomatic bone on its lateral surface to supply skin overlying the prominence of the cheek.

    Infraorbital nerve

    • The infraorbital nerve initially lies in the infraorbital groove on the floor of the orbit.
    • As it approaches the rim of the orbit it runs into the infraorbital canal through which it passes to emerge onto the face at the infraorbital foramen.
    • The infraorbital nerve supplies the skin of the lower eyelid, possibly the conjunctiva, and skin over the upper jaw, and also provides the middle and anterior superior alveolar nerves.

    Ovarian pathology referred to
    a) Gluteal region.
    b) Ant thigh
    c) Medial part of thigh.
    d) back of thigh

    Ans medial part of thigh
    Gray’s anatomy 40th ed

    • The ovarian plexuses consist of postganglionic sympathetic, parasympathetic and visceral afferent fibres.
    • The efferent sympathetic fibres are derived from the tenth and eleventh thoracic spinal segments and are probably vasoconstrictor, whereas the parasympathetic fibres, from the inferior hypogastric plexuses, are probably vasodilator.
    • The nerves accompany the ovarian artery to the ovary and uterine tube.
    • The upper part of the ovarian plexus is formed from branches of the renal and aortic plexuses, and the lower part is reinforced from the superior and inferior hypogastric plexuses.
    • Autonomic fibres do not reach the ovarian follicles and are not required for ovulation.

    • Sensory fibres accompany the sympathetic nerves, and so ovarian pain can be periumbilical.
    • It is often perceived in the right or left iliac fossa due to local inflammation.
    • Ovarian pain can also be perceived on the medial side of the thigh in the cutaneous distribution of the obturator nerve, presumably because the ovary lies close to the obturator nerve in the ovarian fossa, and so any inflammation of the ovary or peritoneum in the ovarian fossa may affect the obturator nerve.

    Apoptosis is an important process for organogenesis and tissue remodelling in various normal and pathological conditions. In the apoptotic pathway, caspases play central roles, and have been studied extensively in the past decade, while their roles in renal development and organogenesis have not been elucidated yet. To reveal the roles of caspases in renal development, we have examined their activities and apoptosis in microdissected metanephroi. In the developing kidney, apoptotic cells showed expression of caspase-3, and inhibition of either caspase-3 or caspase-9 attenuated growth of metanephroi, indicating that the mitochondrial pathway of apoptosis plays major roles in kidney development. In addition, several growth factors are known to be involved in kidney organogenesis, such as hepatocyte growth factor. We currently are examining the roles of these growth factors and their signal transduction system; their roles in kidney organogenesis should be determined in the future.

    berry aneurysms - cause
    a. degeneration of internal elastic lamina
    b. degeneration of media / muscle cell layer
    c. deposition of mucoid material in media
    d. low grade inflammation of vessel wall

    ANS--degeneration of media / muscle cell layer
    Most saccular or intracranial berry aneurysms were once thought to be congenital in origin, arising from focal defects in the media and gradually developing over a period of years as arterial pressure first weakens and subsequently balloons out the vessel wall.
    Recent studies have found scant evidence for congenital, developmental, or inherited weakness of the arterial wall. Although genetic conditions are associated with increased risk of aneurysm development (see Associated conditions), most intracranial aneurysms probably result from hemodynamically induced degenerative vascular injury. The occurrence, growth, thrombosis, and even rupture of intracranial saccular aneurysms can be explained by abnormal hemodynamic shear stresses on the walls of large cerebral arteries, particularly at bifurcation points.

    Less common causes of saccular aneurysms include trauma, infection, tumor, drug abuse (cocaine), and high-flow states associated with AVMs or fistulae
  2. sudha.

    sudha. Guest

    65 yr old man with history of back pain since 3 months,ESR is raised,marked stiffness on examination.on x-ray syndesmophytes present ,likely diagnosis:

    aankylosing spondylitis
    b)degen osteoarthritis of spine
    c)ankylosing hypesostosis
    d)lumbar canal stenosis



    IN ankylosing hypesostosis,(DISH),doesnt have associartion with HLA.Routine biochem studuies and ESR are normal in ankylosing hypesostosis while its raised in ankylosing spondylitis and osteoarthritis

    SYNDESMOPHYTES are typical feature of ankylosing spondylytis

    if istead of syndesmophytes there are osteophytes ,then it may be osteoarthristis spine
  3. srivasan.

    srivasan. Guest

    Q. Woman with placenta praevia bleeds.What is most likely to occur after delivery?
    a)lack of menstrual cycle
    c)diabetes insipidus
    d)cushings disease



    pituitary causes of amenorrhea
    infarction-sheehan syndrome

    sheehan syndrome is consequence of severe and prolonged hypotension on pituitary gland that enlarges during is usually associated with history of major obstetric hemorrage
  4. srivasan.

    srivasan. Guest

    Q. cardiovascular manifestation of AIDS includes all EXCEPT:
    a)aortic aneurysm
    b)cardiac tamponade
    C)recurrent arterial emboli



    Nonbacterial thrombotic endocarditis (or marantic endocarditis) involves large, friable, sterile vegetations that form on the cardiac valves. These lesions have been associated with disseminated intravascular coagulation and systemic embolization.

    * In the early HIV epidemic, several case series suggested a high incidence of this uncommon disorder; however, few cases have since been reported, and almost none have been found in prospective series.

    *Marantic endocarditis should be suspected in any patient with systemic embolization, but should be considered rare in AIDS patients.

    Ref - Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine 8th : CHAPTER 67 – Cardiovascular Abnormalities in HIV-Infected Individuals.
  5. srivasan.

    srivasan. Guest

    Which of the following is not true about Lyme disease?
    a. Borrelia burgdorferi proliferates locally and produces cytokines
    b. PMNs seen CSF is suggestive of meningeal involvement
    c. Persistent infection despite good humoral response
    d. Intrathecal IgA is specific for diagnosis


    THE t-cell mediated immune response may have dual response in immune protection and pathogenesis of lyme borreliosis.both Th1 -type and TH-2 type cytokine are induced by T lymphocytes,monocyte by B.burgdoferui lipoprotein in vitro and are detected in synovial fluid ,csf and cardiac lesions of patients

    J Infect Dis. 1990 Jun;161(6):1203-9.

    Evaluation of the intrathecal antibody response to Borrelia burgdorferi as a diagnostic test for Lyme neuroborreliosis.
    Steere AC, Berardi VP, Weeks KE, Logigian EL, Ackermann R.

    Division of Rheumatology/Immunology, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111.

    The intrathecal antibody response to Borrelia burgdorferi was evaluated in American and West German patients with Lyme neuroborreliosis. By an antibody capture enzyme immunoassay, 12 (92%) of 13 patients from the USA with Lyme meningitis were found to have intrathecal antibody production to B. burgdorferi, usually of multiple isotypes, most commonly IgA. Of 12 patients with putative late central nervous system manifestations of Lyme disease, 5 (42%) had local production of IgG or IgA spirochetal antibody, but cerebrospinal fluid (CSF) abnormalities could not be demonstrated in 6 patients with late peripheral nervous system manifestations of the disorder. Compared with American patients, 30 European patients with neuroborreliosis had significantly higher CSF:serum ratios of specific antibody both early and late in the illness. .Intrathecal antibody determinations are the most specific diagnostic test currently available for Lyme neuroborreliosis, but local antibody production in CSF is an inconsistent finding in American patients with late neurologic manifestations of the disorder.
  6. kavya.

    kavya. Guest

    Laboratory Studies
    Laboratory diagnosis: According to US Centers for Disease Control and Prevention surveillance criteria, patients presenting with a clinical picture compatible with early LYME DISEASE (ie, erythema migrans, constitutional flulike symptoms) and a history of exposure to an area in which tick exposure is likely do not require laboratory confirmation of the disease before receiving treatment. Erythema migrans is the only manifestation of LD in the United States that allows clinical diagnosis in the absence of laboratory confirmation.
    Serologic testing: Serologic testing typically involves enzyme-linked immunosorbent assay (ELISA) or immunofluorescence assay (IFA). If results from either of these tests are positive or indeterminate, Western blotting should be performed to confirm LD.
    Seroconversion can take as long as 6-8 weeks after a tick bite. The false-negative rate for ELISA is 32% in early disease. Vaccination with the LD vaccine and a variety of diseases, including Rocky Mountain spotted fever, syphilis, systemic lupus erythematosus, and rheumatoid arthritis, can cause false-positive results. Late disease is tentatively diagnosed when at least 1 objective clinical manifestation of disseminated disease is present and is supported by ELISA or IFA results. These tests have 89% sensitivity but only 72% specificity for detecting LD.
    A positive result on Western blotting after ELISA or IFA is an indication for treatment. Likewise, a negative result is highly suggestive of a false-positive ELISA finding, and therapy is not indicated.
    Inadequate antibiotic therapy for early LD can suppress the antibody response, potentially yielding a false-negative result on ELISA, IFA, or Western blotting. Serum concentrations of immunoglobulin M (IgM) antibodies usually peak 6-8 weeks after infection and disappear within 4-6 months, although levels sometimes remain elevated for several months or years. IgM titers are useful in evaluating early disease and are considered positive if 2 of the 8 most common bands associated with early disease (ie, 18, 21, 28, 37, 41, 45, 58, or 93 kd) are present.
    In patients with a high probability of having early LD, IgM testing is 96% specific and 93% predictive. Immunoglobulin G (IgG) antibodies are typically detectable within 6-8 weeks after infection, peak within 4-6 months, and remain elevated indefinitely. In late-stage disease (>4-6 wk after infection), IgG results are more useful than IgM results and are considered diagnostic if 5 of 10 IgG bands common in late disease (ie, 18, 21, 28, 30, 39, 41, 45, 58, 66, or 93 kd) are present. Careful consideration of both IgG and IgM antibodies is essential because the IgG response may be negative in as many as 50% of patients (particularly those with early disease), whereas a persistence of IgM antibodies can lead to false-positive findings in patients infected for more than 1 month who subsequently receive effective treatment. Of note, serologic results can remain positive years after adequate treatment and cannot be used to distinguish active from inactive disease.
    CSF evaluation
    If a clinical diagnosis of neuroborreliosis is suspected, lumbar puncture is considered essential to evaluate the presence of specific antibodies to B burgdorferi.
    Although CSF cultures are positive in less than 10% of patients with apparent meningitis, intrathecal antibodies and a lymphocytic pleocytosis (approximately 100 cells/µL) are present in more than 80%. Patients with meningitis typically have elevated protein concentrations (>50 mg/dL) but normal glucose levels (45-80 mg/dL). Oligoclonal bands specific for B burgdorferi may be present.
    Ongoing controversy surrounds the diagnosis of neurologic LD. One of the most important concepts to understand is that a positive LD serology in CSF does not mean that the person has neuroborreliosis. It could represent evidence of a previous infection or simply reflect potential leakage of serum antibodies across the blood-brain barrier.
    Intrathecal anti-Borrelia antibody production is typically seen within 3-6 weeks of infection.
    Anti-Borrelia antibody CSF-to-serum index has recently shown a 97% specificity and 75% sensitivity for the diagnosis of neuroborreliosis CSF-to-serum index greater than 1.0 suggests synthesis of antibody in the CNS.
    Recent publications propose that 4 of the following 5 criteria should be present in order to diagnose neuroborreliosis:
    No past history of neuroborreliosis
    CSF anti-B burgdorferi antibodies
    Positive anti-B burgdorferi antibody index
    Favorable clinical outcome after proper antibiotic therapy
    Absence of alternative diagnosis
    Advanced techniques
    LD multiplex polymerase chain reaction (PCR)
    Lyme multiplex PCR has not been standardized; therefore, it is not currently used in routine testing.
    PCR is used to detect B burgdorferi DNA in the blood, CSF, urine, or synovial fluid within weeks of infection.
    The result is positive in approximately 30% of patients with active LD.
    A notable disadvantage of PCR testing is the likelihood of false-negative results because of a sparsity of spirochetes in infected tissues. Likewise, inexperience with the PCR technique can yield false-positive findings when care is not taken to prevent contamination and when incorrect primers are used in preparing the specimen.
    Although most PCR results become negative within 2 weeks of antimicrobial therapy, results can remain positive for years after apparent cure.
    One of the most compelling uses of PCR may be in confirming persistent or recurrent disease because a positive result is highly specific for exposure to B burgdorferi.
    LD urine antigen testing: This test has not been studied sufficiently. It has not been proven reliable or accurate and therefore should not be used as a diagnostic tool.
    Flow cytometric borreliacidal antibody test: This test is used to detect highly specific borreliacidal antibodies that formed after exposure to B burgdorferi. The specificity of borreliacidal antibody test results far exceeds those of ELISA. One study of 572 patients showed a specificity of greater than 99%, although its sensitivity is marginal, at 72%. Although borreliacidal antibodies are detectable in the serum soon after infection, the number of antibodies increases with the duration and severity of illness; therefore, borreliacidal antibody testing is most useful in late disease. It should not be performed in patients who recently received antimicrobial therapy.

    Imaging Studies
    MRIs show abnormalities in approximately 15-20% of patients in the United States who have neurologic manifestations of LD.
    Punctate lesions of the periventricular white matter are common and resemble changes seen in demyelinating or inflammatory disorders. In an attempt to differentiate radiological manifestations of neuroborreliosis and multiple sclerosis, a recent study proposed that occult brain tissue damage (seen by brain magnetization transfer and diffusion tensor magnetic resonance) are not common in neuroborreliosis, as opposed to multiple sclerosis.
    Space-occupying lesions have also been reported as a rare manifestation.
    In European patients with CSF-confirmed LD, imaging findings have suggested that microvasculitis and macrovasculitis in the CNS may be responsible for neurologic sequelae and the MRI changes seen in patients with neuroborreliosis.
    Functional brain imaging, such as single-photon emission CT scanning, may contribute to the diagnosis of chronic neurologic LD.

    Other Tests
    Electrophysiologic studies: Abnormal results are often consistent with axonal degeneration in patients presenting with peripheral neuropathy in stage 3 disease.
  7. Growin.

    Growin. Guest

    emedicine Radiology

    Clinically, DISH is often referred to as senile ankylosing spondylitis because there are similarities in appearance between the 2 conditions; however, DISH and ankylosing spondylitis differ in their age of onset.

    The etiology of diffuse idiopathic skeletal hyperostosis (DISH) is uncertain. Glucose metabolism imbalance (diabetes), dyslipidemia, and hyperuricemia have been implicated.4 DISH diagnostic criteria include the following :

    •Flowing calcifications and ossifications along the anterolateral aspect of at least 4 contiguous vertebral bodies, with or without osteophytes
    •Preservation of disk height in the involved areas and an absence of excessive disk disease
    •Absence of bony ankylosis of facet joints and absence of sacroiliac erosion, sclerosis, or bony fusion, although narrowing and sclerosis of facet joints are acceptable6 Unlike ankylosing spondylitis, DISH does not involve the sacroiliac joint. DISH is also distinct from marginal osteophytes that form in response to degenerative disk disease. Patients with DISH infrequently demonstrate disk height reduction or vacuum changes.

    Lower thoracic spine involvement is typical of DISH, but the lumbar and cervical spine also can be affected. The left side of the spine typically is spared or less involved, which probably is attributable to the pulsating aorta. Forestier disease includes many extra-axial features, such as ossification of other ligaments and tendons, as well as subcutaneous calcification.

    •Most patients present with a stiff back, although nonspecific back pain may be associated with diffuse idiopathic skeletal hyperostosis (DISH). Rarely, kyphosis is present. Dysphagia occasionally is attributed to prominent osteophytes in the cervical spine.8 •Chronic pneumonia has been reported secondary to the obstruction of a bronchus. Fibrobullous changes have been reported, but they are probably secondary to the mechanical deformity of the thorax rather than to an intrinsic relationship (as found in ankylosing spondylitis). •Hyperextension vertebral fractures and atlantoaxial subluxation have been reported. •Stridor, nocturnal dyspnea, and vocal cord paralysis have been noted. •Compression of the inferior vena cava has been attributed to DISH. •Neurologic manifestations (secondary to spinal canal stenosis), heterotopic ossification, and metabolic causes (manifesting as paresthesia, gait disturbance, hyporeflexia) can be seen. •Increased risk of heterotopic bone formation after hip surgery has been questioned. •Soft-tissue calcification, as in surgical scars, has been noted. •Association with hyperostosis frontalis interna and OPLL has been mentioned.

    Diffuse idiopathic skeletal hyperostosis (DISH) occurs more commonly in males (65%) than in females (35%).

    Diffuse idiopathic skeletal hyperostosis (DISH) occurs most often in persons aged 50-75 years.

    Clinical symptoms include back stiffness with restricted motion. Complaints are intermittent; stiffness is worse in the morning and is relieved with mild activity. Symptoms are worsened when the patient sits for a length of time or when the weather is wet and cold. The lower thoracic area most commonly is involved. In the later stages, signs of spinal stenosis may be noted.

    Although advanced disease is the most common clinical feature in patients, various symptoms have been attributed to florid ossification, including dysphagia, stridor, chronic pneumonia, and vascular compression.

    Radiography of the thoracic and lumbar spine usually is sufficient for diagnosing diffuse idiopathic skeletal hyperostosis (DISH). Occasionally, computed tomography (CT) scanning may be performed to evaluate complications, such as fracture, or symptoms caused by pressure effects on the trachea, esophagus, and veins. Bone scanning and magnetic resonance imaging (MRI) do not play a significant role in the diagnosis of DISH.

    Radiographs of the spine typically demonstrate thoracic spinal involvement; however, diffuse idiopathic skeletal hyperostosis (DISH) can also affect the lumbar and cervical spine. DISH is distinguished by the presence of flowing syndesmophytes along, but separated from, the anterior aspect of the vertebral bodies, involving at least 4 levels. The disease begins as fine ossification, 1- to 2-mm thick, but ossification may thicken to as much as 20 mm as the disease progresses.

    Radiographic findings in DISH include the following extra-axial features:
    •Skull - Ossification of the nuchal ligaments
    Enthesopathy at the ischial tuberosities
    Ossification of the sacrotuberous ligament
    Ossification of the symphysis pubis
    •Lower extremities
    Ossification of the quadriceps and infrapatellar tendons
    Ossification of the Achilles tendon and the plantar aponeurosis
    •Upper extremities - Ossification of the triceps tendon
    •Skin - Subcutaneous calcification

    The hallmark of DISH is ossification occurring along the anterior aspect of the vertebral bodies but remaining separate from the vertebrae. Osteophytes of degenerative spinal disease usually occur along the anterolateral aspect. The location of the ossification distinguishes DISH from OPLL.
  8. guru.

    guru. Guest

    which of the following is usually NOT seen in gestational diabetes mellitus?
    a)previous macrosomic baby


    In diabetics, polyhydramnios is more common if the diabetes is poorly-controlled and/or the baby is macrosomic

    Polyhydramnios is the presence of excessive amniotic fluid surrounding the unborn infant.


    Amniotic fluid is a clear, slightly yellowish liquid that surrounds the unborn baby (fetus) during pregnancy. It is contained in the amniotic sac.

    While in the womb, the baby floats in the amniotic fluid. Amniotic fluid surrounds and cushions the infant throughout development. The amount of amniotic fluid is greatest at around 34 weeks into the pregnancy (gestation).

    The amniotic fluid constantly moves (circulates) as the baby swallows and "inhales" the fluid, and then releases or "exhales" the fluid through urine.

    The amniotic fluid helps:

    The developing baby move in the womb, which allows for proper bone growth
    The lungs to develop properly
    Keep a relatively constant temperature around the baby, protecting from heat loss
    Protect the baby from outside injury by cushioning sudden blows or movements

    Polyhydramnios can occur if the fetus does not swallow and absorb amniotic fluid in normal amounts. This can happen due to:

    Gastrointestinal disorders, such as duodenal atresia, esophageal atresia, gastroschisis, and diaphragmatic hernia
    Brain and nervous system (neurological) problems, such as anencephaly and myotonic dystrophy
    A variety of other causes, such as poorly controlled diabetes, achondroplasia,Beckwith-Wiedemann syndrome
    Polyhydramnios may also be related to increased fluid production
    , which occurs with:

    Certain fetal lung disorders
    Multiple gestation (for example, twins or triplets)
    Hydrops fetalis
    Sometimes, no specific cause for polyhydramnios is found.

    What to Expect at Your Office Visit

    This condition is discovered during pregnancy. You may have noticed that your belly is getting large very quickly. You doctor or nurse measures the size of your uterus at every visit.

    If your uterus is growing faster than expected, or it is larger than normal for your baby's gestational age, the doctor or nurse may:

    Have you come back sooner than normal to re-measure
    Perform an ultrasound
    If the health care provider finds a fetal abnormality (birth defect), you may need an amniocentesis to test for a genetic defect.

    Women with polyhydramnios are also more likely to go into labor early. Mild polyhydramnios that shows up in the later part of pregnancy does not often cause serious problems. More severe polyhydramnios may be treated with medications or by having extra fluid removed.

    The baby will be delivered in a hospital with specialists who can provide immediate evaluation and treatment.

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