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

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A 32-year-old woman presents to your outpatient clinic with concerns regarding a 6-month history of both a pulsatile buzzing sound in her ears and headaches. There is no history of hearing loss, vertigo, ear pain, or discharge from the ears. There is a long-standing history of prolonged exposure to occupational noise. She has a BMI of 32. Otoscopic examination is unremarkable, and there are no neck masses present. You determine that the buzzing sound is synchronous with her radial pulse. Which of the following investigations should be ordered next?

• A.Audiogram
• B.Magnetic resonance imaging of the brain
• C.Electroencephalography
• D.C-reactive protein

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A 60-year-old man is admitted to hospital, and lung cancer is diagnosed. When his family physician reviews the discharge summary, she reviews the patient's chart and finds a chest radiograph report from 1 year ago that mentions a suspicious nodule and recommends a computed tomography scan. The family physician recalls seeing this report and did not order the scan. Which one of the following is the family physician's best next step?

• A.Do not disclose at this time.
• B.Discipline the office staff for not bringing the report to her attention.
• C.Call the radiologist who issued the report and determine why the patient was not contacted directly.
• D.Communicate with the patient and arrange to disclose this information to him.
• E.Forward the report to the oncology team that will be treating him.

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A 1-month-old breastfed baby is brought to your office by his parents for his well-baby check-up. He was born at 32 weeks' gestation. Growth parameters at birth revealed head circumference, weight and length at the
50th percentile. Today, his weight is at the 10th percentile. Which one of the following is the most appropriate plan of action?

• A.Observe the infant while feeding.
• B.Order a sweat chloride test.
• C.Supplement with formula feeding.
• D.Obtain serology for celiac disease.
• E.Reassure the parents.

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A 76-year-old man is brought by his family to your clinic with new-onset urinary incontinence. They state that the patient is experiencing a slowly progressing cognitive decline marked by memory disturbance, apathy, and attentional problems. Examination reveals that the patient has a stooped, forward-leaning posture and a wide-based gait. Which one of the following is the most likely diagnosis?

• A.Parkinson disease
• B.Alzheimer disease
• C.Lewy body dementia
• D.Normal pressure hydrocephalus
• E.Frontotemporal dementia

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