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1. You are examining a newborn in the delivery room. He was born at full term by spontaneous vaginal delivery.
On examination, he is active, and his vital signs are within normal range. His head circumference is at the third percentile, with height and weight at the 10th percentile. Auscultation of his chest is clear with normal cardiovascular examination findings. The abdomen is protuberant with a liver edge palpable at 4 cm below the costal margin and mild splenomegaly. Which one of the following is the most likely diagnosis?

A) Cephalic molding
B) Lipid storage disease
C) Cystic fibrosis
D) Congenital viral infection
E) Trisomy 21

2. A 26-year-old woman, gravida 2, para 1, presents with a positive pregnancy test. Her previous pregnancy was associated with preeclampsia, and she delivered a 1000 g boy at 34 weeks' gestation. Her blood pressure is 130
/86 mm Hg. Which one of the following is the best recommendation for this pregnancy?

A) Prophylactic labetalol.
B) Amniocentesis for karyotyping.
C) Complete bed rest starting at 20 weeks' gestation.
D) Genetic assessment and counseling.
E) Accurate dating by ultrasound.

3. A 1-week-old boy born at full term is brought by his parents to the office with a 2-day history of eye swelling and watery discharge. This morning, the discharge became thick and yellow. On physical exam, he is afebrile and fussy with bilateral eyelid edema, purulent discharge, and erythematous conjunctivae. After taking appropriate cultures of the eyes, which one of the following is the best next step?

A) Admit the patient and start antibiotic therapy
B) Recommend lacrimal sac massage
C) Reassure the parents and prescribe a topical antibiotic
D) Advise warm compresses every 2 to 3 hours until discharge is cleared
E) Prescribe an oral antibiotic and reassess in 48 hours

4. A 26-year-old man presents to your office with fever, chills, and malaise. Aside from an episode of dysuria 8 weeks ago, which spontaneously resolved, he has been healthy. On examination, his left wrist and right ankle are tender. There is a cluster of vesiculopustular lesions on his right hand. Which one of the following is the most likely diagnosis?

A) Reactive arthritis
B) Varicella
C) Rheumatoid arthritis
D) Disseminated gonococcemia
E) Primary HIV infection syndrome

5. A 62-year-old man (wealthy philanthropist) with emphysema from smoking and a 21-year-old woman (elementary teacher) with cystic fibrosis are both compatible matches for a lung transplant. Which criterion determines organ allocation?

A) The patient has family members who rely on them for income.
B) The patient's value and contributions to society.
C) The date the patient was placed on the waiting list.
D) The clinical severity of the patient's pulmonary disease.
E) Whether the underlying condition is due to self-induced illness.

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