A -day-old term breast-fed male appears icteric The physical examination reveals mild pallor and significant jaundice with a palpable liver 5 cm below the right rib margin His mother has a vague history of anemia and his older sister had prolonged neonatal jaundice The next logical step to evaluate the patient includes all of the following EXCEPT

Correct Answer: D

Rationale: Hemoglobin electrophoresis is not immediately necessary unless hemolytic anemia is suspected

Correct Answer: A

Rationale: The conjunctiva has the highest immune activity in the external eye due to its rich supply of immune cells, including mast cells and lymphocytes, which mediate allergic responses.

Correct Answer: D

Rationale: Alcohol use significantly increases suicide risk due to its disinhibiting effects and association with impulsive behavior.

Correct Answer: A

Rationale: Stereotypic movements include repetitive actions like eye blinking, head banging, and self-biting. Hand shaking is not typically classified as a stereotypic movement in this context.

Correct Answer: A

Rationale: Low pH (acidosis) with high PaCO2 and normal HCO3 indicates uncompensated respiratory acidosis due to hypoventilation.

Correct Answer: A

Rationale: Dilutional hyponatremia occurs in heart failure due to excessive water retention, leading to low sodium concentration. The body's compensatory mechanisms, including ADH release, exacerbate this condition.

Correct Answer: D

Rationale: Step 6 treatment for severe persistent asthma includes high-dose inhaled corticosteroids, long-acting beta-agonists, oral corticosteroids, and biologic agents like omalizumab for severe allergic asthma.

Correct Answer: A

Rationale: Renal tubular acidosis causes normal anion gap metabolic acidosis with hyperchloremia due to impaired bicarbonate reabsorption or acid secretion.

Correct Answer: A

Rationale: A large ASD typically does not produce an apical mid-diastolic rumble, as blood flow is not directed through the mitral valve in a manner that would cause turbulence.