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1. A 25-year-old woman, gravida 1, para 1, aborta 0, gave birth to a newborn who is hypotonic with a large protruding tongue and brachycephaly. The newborn has a single palmar crease bilaterally and short, broad hands with a curved fifth digit. These features best support a clinical diagnosis of which one of the following?

A) Turner syndrome.
B) Trisomy 21.
C) Congenital hypothyroidism.
D) Fetal alcohol syndrome.
E) Prader-Willi syndrome.

2. A 72-year-old man presents to your clinic accompanied by his 70-year-old husband. The patient reports that, over the last several months, his libido has been very low. Which one of the following would be the best next step?

A) Assess for depression
B) Prescribe testosterone
C) Refer for couple's counselling
D) Order serum testosterone levels
E) Interview the couple together

3. A 58-year-old woman presents to your office with refractory bipolar I disorder. She is on the following medications: lithium carbonate, valproic acid, and olanzapine. She also takes acetaminophen for osteoarthritis and pantoprazole for gastroesophageal reflux. Lately, she has noticed she bruises very easily. Laboratory work displays a platelet count of 70 × 10#/L (normal 130-400). Which one of the following is most likely to induce this side effect?

A) Acetaminophen
B) Lithium carbonate
C) Olanzapine
D) Pantoprazole
E) Valproic acid

4. A 37-year-old man comes to the office for follow-up of his opioid use disorder. He receives opioid agonist treatment, including some take-home doses. At this follow-up visit, he reports some nonprescription opioid use since his last visit. Which one of the following is the best next step?

A) Taper the dosage of the opioid agonist
B) Slowly taper and discontinue the opioid agonist
C) Discontinue take-home doses
D) Prescribe a cannabinoid
E) Increase the frequency of follow-up visits

5. 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.

問題與答案：