USMLE rx and UWORLD Qs repro

She reports that her "water broke" about an hour ago while at home she appears to be in distress with contractions occurring every 4 minutes. Her temperature is 37.4° C (99.3° F), blood pressure is 133/70 mmHg, pulse is 92/min, and respiratory rate is 20/min. She is fully dilated and effaced. The baby is vertex and at -2 station. During delivery, the umbilical cord avulses from the placenta, after which the placenta is manually extracted in pieces. Bleeding is difficult to control despite uterine massage and the administration of uterotonics. The physician records approximately 1000 milliliters of blood loss. There are first-degree genital lacerations. The uterus is soft above the level of the umbilicus. Which of the following is the most likely explanation for the patient's prolonged bleeding?

Retained placental tissue is most liekly etiology. Placenta accreta is a disorder that exists on a spectrum of abnormal placental attachment disorders that can cause excessive postpartum bleeding if a vaginal delivery is attempted. Other important causes of postpartum bleeding include uterine atony, genital tract trauma, and coagulopathies.

During inguinal hernia repair. what structure must the surgeon be careful with that lies superiorly to the surface of the spermatic cord? What is it responsible for?

The ilioinguinal nerve arises from L1, passes through the inguinal ligament, and lies on top of the spermatic cord. It supplies cutaneous sensation to the scrotum/labia and medial aspect of the thigh and is in part responsible for the cremasteric reflex.

A G2P2 woman has given birth prematurely to her second child. The neonate has gross hepatosplenomegaly and ascites, as well as peripheral edema and purpura. The placenta is pale, thickened, and enlarged. Antibody screening for cytomegalovirus and toxoplasmosis agents are negative. The child dies soon after birth. What do you suspect?

When an Rh-negative mother who was previously sensitized to Rh antigen carries another Rh-positive child, hemolytic disease of the newborn occurs as a result of destruction of fetal RBCs by the mother's antibodies. This causes the presentation of hydrops fetalis.

pt has ab pain and Laboratory tests indicate that her β-human chorionic gonadotropin (β-hCG) level is 200,000 mIU/mL. Ultrasonography reveals numerous vesicles without any fetal parts in the uterus. Which of the following is the most likely karyotype of the uterine contents

A complete mole occurs when a haploid sperm replicates with an empty egg; it has a karyotype of 46,XX or 46,XY. A partial mole occurs when the ovum is fertilized with two sperm such that the karyotype is 69,XXY, 69,XYY, or 69,XXX.

A 20 y.o male has frequent urination, burning on urination, and low back pain for the past few days. The patient reports being sexually active with multiple partners over the past year with inconsistent condom use temperature is 38.6° C (101.5° F), blood pressure 128/72 mm Hg, pulse is 83/min, and respiratory rate is 16/min. A digital rectal examination is abnormal. A T2 sagittal MRI of the pelvis has been ordered. MRI is most likely to show inflammation of which of the following anatomic structures? What sxs are associated with it?

Acute prostatitis is a condition characterized by infection of the prostate which leads to an enlarged prostate, dysuria, urinary urgency, and low back pain. In older men, it is most commonly due to the bacteria E. coli, and in younger men it is due to either C. trachomatis or N. gonorrhoeae. I guessed bladder but you would not feel the bladder on DRE.

24-year-old woman, G1P0 sharp pains in her lower abdominal area for the past day and spotting. transvaginal ultrasound showed an empty uterus and no adnexal masses. Increasing BHcG over a couple days. She admits to having ca chlamydia infection when she was younger. Which of the following is a major risk factor related to this patient's condition? What are other risk factors (3)?

Ectopic pregnancy presents with sharp lower abdominal pain, amenorrhea, vaginal spotting, and lack of an observable intrauterine gestational sac by the time β-hCG has reached 2000 mIU/mL. Major risk factors include salpingitis (pelvic inflammatory disease), prior tubal surgery, endometriosis, and altered tubal motility. Salpingitis (pelvic inflammatory disease) may cause tubal scarring and adhesions, which commonly result in chronic pelvic pain, infertility, and increased risk for ectopic pregnancy

What is the mechanism of RH hemolytic disease of the newborn?

First pregnancy: mother exposed to fetal blood(often during delivery) formation of maternal anti-D IgG. Subsequent pregnancies: anti-D IgG crosses the placenta attacks fetal RBCs hemolysis in thef etus

Patient's with crytporchidism are at increased risk for developing which of the following conditions?

Germ cell tumors

How does RH hemolytic disease of the newborn present? What disease do you differentiate it from? How does that present?

Hydropsfetalis, jaundice shortly after birth, kernicterus. ABO hemolytic disease of the newborn. Presents with Mild jaundice in the neonate within 24 hours of birth. Unlike RhHDN ,can occur in first born babies and is usually less severe

If a parent wanted their child on a certain contraceptive, What should you do?

In accordance with the shared-decision making approach, information should be obtained directly from minor patients provided that they are able to understand their medical history and articulate their wishes

A 74-year-old man comes to the physician because of increased urinary frequency along with difficulty starting and stopping urination. he wakes up multiple times throughout the night when he hurries to the bathroom, yet he is unable to urinate. Describe the MOA of the drug would help him.

Inhibition of an enzyme that catalyzes a reduction reaction on steroid molecules First-line treatment of benign prostatic hyperplasia (BPH) is with α1-antagonists, which cause smooth muscle relaxation and offer symptomatic relief. Finasteride is another common treatment for BPH that inhibits 5α-reductase to decrease the synthesis of dihydrotestosterone (DHT). DHT is the stimulus for the prostate stromal hyperplasia seen in BPH.

What is the most common cause of postpartum hemorrage? If it was related to this, what would you expect in regards to presentation and measure to stop it?

Lack of effective uterine contraction. Uterine atony is the most common cause of postpartum hemorrhage. Although uterine atony can present similarly with a soft uterus on exam, this patient's lack of response to uterine massage and uterotonics makes this diagnosis less likely. Furthermore, the history of a placenta delivered in pieces raises suspicion for another diagnosis

what 3 things are people with undescended testicles at increased risk for developing?

Patients with cryptorchidism have an increased risk for development of testicular cancer, testicular torsion, and subfertility, even if the testicles are surgically descended.