In which form of hypospadias should circumcision be deferred in order to preserve the prepuce for later surgical repair?

Correct Answer: A

Rationale: The correct answer is A: Ventral displacement. In ventral displacement hypospadias, the urethral opening is located on the underside of the penis, making it necessary to defer circumcision to preserve the prepuce for later surgical repair. Preserving the prepuce in this case is important for reconstructive surgery to correct the hypospadias. Choices B, C, and D do not require deferring circumcision as the location of the urethral opening does not impact the need for prepuce preservation for future surgical repair.

Correct Answer: A

Rationale: The correct answer is A: Fetal macrosomia. Prolonged pregnancy increases the risk of fetal macrosomia due to continued fetal growth beyond the normal term. This can lead to complications during delivery, such as shoulder dystocia and birth injuries. Placental dysfunction and cesarean section are possible outcomes of prolonged pregnancy but are not directly associated with fetal risks in this context. Shoulder dystocia is a potential complication of fetal macrosomia but is not a direct fetal risk of prolonged pregnancy.

Correct Answer: A

Rationale: The correct answer is A: Radiographs. Radiographs, specifically skull X-rays, are most useful in assessing for findings consistent with a history of abuse in this case. Radiographs can detect fractures, such as skull fractures or facial bone fractures, which are common in cases of physical abuse. These fractures may not always be clinically evident but can be identified on X-rays. Explanation of other choices: B: CT scan without contrast - While a CT scan can provide detailed imaging of the head, it may not be necessary in this case as the patient's neurologic examination is within normal limits. Also, radiographs are more cost-effective and can detect fractures effectively. C: MRI - MRI is not typically used as the first-line imaging modality for suspected head trauma due to its cost and time-consuming nature. Radiographs are more appropriate for initial evaluation. D: PET scan - PET scans are used to detect metabolic activity in tissues and are not typically indicated for assessing acute traumatic injuries like fractures associated with

Correct Answer: C

Rationale: The correct answer is C: Protein intake of 50 g daily. In hepatic encephalopathy, reducing protein intake is crucial to prevent ammonia accumulation. Protein breakdown in the body leads to ammonia production, which worsens encephalopathy symptoms. Limiting protein intake to 50g daily helps decrease ammonia formation. Lactulose (choice A) is used to reduce ammonia absorption in the gut. Spironolactone (choice B) is a diuretic used to treat fluid retention in liver disease. Zolpidem (choice D) is a sedative and not related to managing ammonia accumulation in hepatic encephalopathy. Therefore, choices A, B, and D are incorrect for long-term management of ammonia accumulation in hepatic encephalopathy.

Correct Answer: B

Rationale: The correct answer is B. It is important to manage medications appropriately preoperatively to minimize complications. Metoprolol, a beta blocker, should be continued up until the day of surgery to prevent rebound hypertension or tachycardia. Metformin should be held on the day of surgery to avoid potential lactic acidosis due to its effects on kidney function. Warfarin should be discontinued 5-7 days before surgery to reduce the risk of bleeding. Vitamin E can increase bleeding risk and should be discontinued. Choice A is incorrect as not all medications should be taken until the morning of surgery. Choice C is incorrect as warfarin should be held earlier than 5 days before surgery. Choice D is incorrect as metformin should be held on the day of surgery, regardless of blood sugar levels, to prevent lactic acidosis.

Correct Answer: B

Rationale: The correct answer is B: Emergency cesarean section. Emergency cesarean sections can increase the risk of puerperal sepsis due to the urgency of the procedure, which may lead to inadequate sterilization or contamination. Other choices are less directly associated with puerperal sepsis: A may increase the risk of infection, but not specifically puerperal sepsis. C relates to general hygiene practices and D focuses on delays in seeking care, which may affect treatment outcomes but are not direct predisposing factors to puerperal sepsis.

Correct Answer: A

Rationale: The correct answer is A: Uterine rupture. This is the most significant risk associated with VBAC, where the scar from the previous cesarean section may tear during labor. This can lead to severe complications for both the mother and baby. Postpartum hemorrhage (B) and placenta previa (C) are potential risks in any pregnancy but are not specifically increased in VBAC. Therefore, the correct answer is A, as it directly relates to the unique risk of VBAC.

Correct Answer: B

Rationale: The correct answer is B: Face presentation. Vaginal delivery is possible in face presentation as the fetus is in a position where the face is presenting first, allowing for delivery. In this presentation, the chin is usually tucked onto the chest, making it easier for the baby's head to pass through the birth canal. A: Brow presentation is incorrect because it indicates the baby's head is extended slightly, making it more difficult for vaginal delivery. C: Shoulder presentation is incorrect as it can lead to a shoulder dystocia, making vaginal delivery dangerous and difficult. D: Unstable lie is incorrect because it refers to the baby being in a transverse position, making vaginal delivery impossible without intervention.

Correct Answer: A

Rationale: The correct answer is A because uterine rupture can lead to severe complications such as hemorrhage from blood vessels tearing, uterine atony causing failure of the uterus to contract, infection due to exposure of internal tissues, and peritonitis from inflammation of the abdominal lining. Choices B and C are incorrect as they list complications that are not directly associated with uterine rupture. Preterm labor, cord prolapse, uterine prolapse, fetal distress, placental abruption are potential consequences of other obstetric complications but not specifically uterine rupture. Therefore, choice A is the most appropriate answer given the context of uterine rupture.