You are caring for a 17-year-old girl who has end-stage renal disease. She is receiving dialysis at the hospital
3 times a week. She requests medical assistance in dying (MAID). Which of the following is the best next step?

• A.Inform the patient that she will need parental consent to be assessed for MAID.
• B.Explain to the patient that she is not terminally ill.
• C.Refer the patient to a psychiatrist.
• D.Suggest a trial of home dialysis.
• E.Explore the reasons for the patient's request for MAID.

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A 29-year-old woman presents to the sexually transmitted infection clinic with concerns regarding a copious vaginal discharge. Ten percent potassium hydroxide was used to confirm the diagnosis of which one of the following?

• A.Chlamydia trachomatis.
• B.Trichomonas vaginalis.
• C.Gonorrhea.
• D.Group B streptococcus.
• E.Bacterial vaginosis.

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You are called to attend an 18-year-old woman, gravida 2, para 1, aborta 0, who is in precipitous labour. She did not realize she was pregnant and has not had any prenatal care. After the delivery, you examine the newborn boy; he is vigorous, and it appears that he was born at full term. Physical examination findings of the newborn are normal. Review of the prenatal record from the mother's last pregnancy shows the following:
* HIV: Negative
* Hepatitis B surface antibody: Positive
* Hepatitis C: Negative
* Syphilis serology: Negative
The mother's previous child was placed in foster care. The mother is withdrawn and uncommunicative after delivery. Which one of the following is the best next step?

• A.Administer hepatitis B vaccine to the newborn
• B.Initiate feeding with donor breast milk
• C.Collect urine from the newborn for a drug screen
• D.Recommend immediate skin-to-skin care

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A 27-year-old man with a bowel obstruction secondary to a terminal ileum stricture has been on various medications since he was diagnosed with Crohn disease 8 years ago. You recommend a bowel resection, but he refuses this option because he is fearful of short bowel syndrome. He states that the only surgical procedure he will undergo is a bypass of the diseased segment so that the affected bowel will heal. You know that this is the wrong operation. Which one of the following is the best next step?

• A.Obtain a formal competency assessment.
• B.Transfer care to a colleague that you know is receptive to the patient's request.
• C.Administer a high dose of intravenous steroids for trial.
• D.Decline to do the bypass but carefully explain why.
• E.Get consent for exploratory laparotomy and do a resection.

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A 4-month-old boy is brought to the office by his parents to ask about the rotavirus vaccine. They would like to avoid the possibility of the infant coming down with gastroenteritis. Their older child was hospitalized with gastroenteritis at age 10 months. They have a friend who had intussusception after getting the rotavirus immunization, and they are worried about a possible link to the vaccine. Which one of the following is the most appropriate response?

• A.The vaccine is recommended as the risk of intussusception is extremely low.
• B.The risk of intussusception is markedly increased after vaccination but is offset by a decrease in severe diarrhea.
• C.Intussusception is an easily treatable condition.
• D.Intussusception only occurs in 1- to 3-year-old children, so any risk to the infant is minimal.
• E.Rotavirus infection is generally self-limited, so routine vaccination is not encouraged unless there are comorbidities.

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