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Uterine Rupture โ a catastrophic obstetric emergency. Classic signs (mnemonic: ABCDE of rupture):
- Abdominal pain โ sudden, severe, tearing/ripping (contractions may cease)
- Bleeding (intraperitoneal โ minimal external bleeding)
- Cessing of contractions (previously regular contractions stop)
- Disappearing presenting part (head recedes from pelvis into abdomen)
- Emergency fetal distress (sudden prolonged bradycardia)
Additional: Maternal shock (tachycardia, hypotension), loss of uterine contour, tender abdomen.
Risk factors:
- Previous uterine scar (LSCS, myomectomy)
- Grand multiparity
- Prolonged obstructed labor
- Oxytocin misuse
- Instrumental delivery
Management: Call crash team โ IV access ร 2, fluids, crossmatch โ Immediate laparotomy โ Primary repair or hysterectomy depending on extent โ Deliver baby (perinatal mortality 50โ75% in complete rupture).
Incidence of rupture in scarred uterus: \(\approx 0.5{-}1\%\) with LSCS scar (higher with classical CS scar \(\approx 4{-}9\%\)).
Wilms' Tumor (Nephroblastoma) โ most common renal malignancy in children (peak age 3โ4 years).
Classic presentation:
- Asymptomatic abdominal mass (discovered by parent/during bath)
- Painless gross hematuria
- Hypertension (renin secretion)
- Child appears well (unlike neuroblastoma โ ill-appearing)
Important physical examination note: DO NOT palpate the abdominal mass repeatedly โ risk of tumor capsule rupture and metastatic seeding.
Associations:
- WAGR syndrome: Wilms' + Aniridia + Genitourinary anomalies + mental Retardation (WT1 gene mutation)
- Beckwith-Wiedemann syndrome
- Hemihypertrophy
Staging and Treatment:
| Stage | Description | Survival |
|---|---|---|
| I | Confined to kidney, completely resected | ~95% |
| IIโIII | Regional extension | ~85โ90% |
| IV | Hematogenous mets (lung, liver) | ~75% |
Treatment: Nephrectomy + chemotherapy (actinomycin D, vincristine) ยฑ radiotherapy. Wilms' has excellent prognosis โ one of most curable solid tumors.
The sentence acknowledges Boswell as the first great modern biographer, but suggests a similar claim could be made for Johnson. The blank must refer to the same distinction โ being first in time or importance.
- Partisanship โ means bias or strong support for one side; irrelevant here.
- Omniscience โ means all-knowing; not the subject of the sentence.
- Precedence โ means the state of coming before others. If Johnson also wrote a biography earlier, a claim of precedence (being first) could be made for him too. This fits perfectly.
- Opportunism โ means taking selfish advantage of situations; unrelated.
Correct Answer: C — Precedence. The sentence questions who truly came first as a great modern biographer.
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