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Which one of the following children should be referred immediately for

evaluation of speech delay?

A. A 12 month old who babbles but speaks no words

B. An 18 month old who does not understand action words

. A 2 year old who has a vocabulary of 2! words

". A 2 year old who is unable to follow three step directions

#. A ! year old who has a vocabulary of $% words.

A &' year old females presents with the inability to smell. (he is in good

health) and her only medical problem is osteoporosis) treated with

alendronate *+osama,-. (he says she has no sinus or nasal symptoms. A

physical e,amination is normal including an ear) nose) and throat

e,amination.

Which ond of the following would be most appropriate at this point?

a. "iscontinuing the alendronate

b. An antitissue transglutaminase antibody test

c. A serum vitamin " level

d. /0 of the brain

A $% year old male presents to your oce with erythroderma and fever. 3e

has not had a sore throat) rhinorrhea) cough) or urinary tract symptoms. 3is

current medications include lisinopril) atenolol) and allopurinol. 45 e,am) he

has a bp of 11%67% mm 3g) a pulse rate of 7% bpm) and a temp of !8.&

*1%1.$ +-. he skin is remarkable for marked erythema over 7%9 of the body)

with tenderness to touch. 3is mental status is clear and his neck is supple.

/ildly tender adenopathy is noted in the neck) a,illae) and groin. 3e has no

oral ulcerations or ocular symptoms.

A B shows a WB count of 1$)%%% with 2%9 eosinophils. A metabolic

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pro:le shows an A( *(;4- level of 1%% - level of 11%

/ and regular) and hispupils are miotic.

he most likely cause of his condition is@

a. organophosphate poisoning

b. scopolamine overdose

c. narcotics overdose

d. benodiaepine overdose.

A !$ year old primigravid schoolteacher awakens with a rash clinically

consistent with varicella early in the !8th week of her pregnancy. (he had a

negative varicella titer early