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Chorioamnionitis (intra-amniotic infection) occurs when bacteria ascend into the amniotic cavity, often after prolonged rupture of membranes. Risk factors include prolonged rupture, multiple digital exams, and preterm labor. Clinical features include maternal fever, uterine tenderness, maternal/fetal tachycardia, and malodorous amniotic fluid. Placenta previa presents with painless vaginal bleeding without fever or tenderness. Placental abruption presents with painful bleeding and uterine hypertonicity, not infection. Vasa previa presents with painless vaginal bleeding and fetal distress due to rupture of fetal vessels. Management of chorioamnionitis requires broad-spectrum antibiotics (ampicillin, gentamicin, ± clindamycin) and expedited delivery, usually vaginal if feasible. Delay increases risk of sepsis and neonatal complications.

Hereditary hemochromatosis is an autosomal recessive disorder, most often due to HFE gene mutations, leading to excessive intestinal iron absorption. Excess iron deposits in multiple organs, causing cirrhosis, diabetes (“bronze diabetes”), cardiomyopathy, arthropathy, and hyperpigmentation. Labs show elevated ferritin, high transferrin saturation, and increased serum iron. Wilson disease involves copper accumulation with Kayser–Fleischer rings and neurologic symptoms. Alpha-1 antitrypsin deficiency causes emphysema and liver disease but not diabetes or hyperpigmentation. Autoimmune hepatitis presents with elevated liver enzymes, hypergammaglobulinemia, and autoantibodies (ANA, SMA). Diagnosis of hemochromatosis is confirmed with HFE testing or liver biopsy. Treatment involves regular phlebotomy or iron chelation. Early detection prevents irreversible organ damage.

Delusional disorder is characterized by ≥1 delusion lasting ≥1 month, in the absence of other psychotic symptoms such as hallucinations, disorganized speech, or grossly impaired functioning. Functioning outside of delusional content is relatively preserved. This patient’s belief that coworkers are plotting against him represents a persecutory-type delusion. Schizophrenia requires ≥6 months of symptoms with ≥2 psychotic features (delusions, hallucinations, disorganized speech, disorganized behavior, or negative symptoms). Schizophreniform disorder is similar but lasts 1–6 months. Brief psychotic disorder lasts <1 month and often follows a stressor. Management of delusional disorder includes antipsychotic medication and psychotherapy, though patients often have limited insight and resist treatment. Prognosis is better than schizophrenia but relapses are common.

Klinefelter syndrome (47,XXY) is caused by nondisjunction leading to an extra X chromosome in males. Clinical features include tall stature, gynecomastia, small firm testes, infertility, and decreased facial and body hair. Hypogonadism is due to seminiferous tubule dysgenesis, leading to decreased inhibin B and increased FSH/LH. Testosterone is low, and estradiol is elevated. Turner syndrome (45,XO) occurs in females with short stature, webbed neck, and streak ovaries. Androgen insensitivity syndrome presents in genetic males (46,XY) with female external genitalia due to androgen receptor defect. Noonan syndrome presents with short stature and congenital heart defects. Klinefelter syndrome is diagnosed by karyotyping. Management includes testosterone replacement and fertility counseling.

Placental abruption occurs when the placenta prematurely separates from the uterine wall. It presents with painful vaginal bleeding, uterine tenderness, hypertonicity, and nonreassuring fetal heart patterns (late decelerations due to hypoxia). Risk factors include hypertension, trauma, smoking, and cocaine use. Placenta previa causes painless third-trimester bleeding with a normal, soft uterus. Vasa previa presents with painless bleeding and fetal distress after rupture of membranes due to fetal vessel rupture. Uterine rupture presents with painful bleeding, abnormal uterine contour, and loss of fetal station, often in women with prior cesarean or uterine surgery. Management of abruption depends on maternal and fetal status; unstable cases require immediate delivery, typically by cesarean. Complications include DIC and fetal demise.