Educational objective: Failure of neural tube closure at 4 weeks gestation results in neural tube defects (NTDs). First trimester use of valproate is a significant risk factor for NTDs, but periconceptional folate (vitamin 89) supplementation reduces this risk.

A newborn is examined in the delivery room shortly after being born vaginally to a 38-year-old woman. The mother had intermittent prenatal care, and the pregnancy was complicated by bipolar disorder and chronic hypertension. Interview of the mother reveals pressured and tangential speech. She states, "I take my prescribed meds when I remember," and then adds, "I have a good memory, and I took the meds most of the time throughout the pregnancy." She claims to have smoked cigarettes occasionally but then changes the subject when asked if other substances were used during pregnancy. Examination of the neonate shows a nondysmorphic face and a mass overlying the lower spine that is covered with a patch of hair.

A 32-year-old man undergoes evaluation for episodes of paroxysmal supraventricular tachycardia. An electrophysiology study reveals focal atrial tachycardia that originates in the crista terminalis of the right atrium. Radiofrequency ablation is planned to destroy the ectopic focus and treat the arrhythmia.

Educational objective: Subfalcine herniation occurs when the cingulate gyrus is displaced under the falx cerebri. Subfalcine herniation may compress the ipsilateral anterior cerebral artery, resulting in ischemia and contralateral leg weakness.

Answer D (correct answer): The American College of Physicians and many other organizations recommend against P.:hY.sician treatment of friends or familY. except in emergencies. There are a number of reasons for this. Patients may not fully disclose personal health issues to a friend or family member. Treating friends or family without a full assessment can !ead to medical errors. Friends and family may not follow-up appropriately as they normally would. The situation described in the question is common in actual practice. Most physicians handle this by assisting their friend or family member in obtaining a formal assessment by a colleague.

A physician is approached by a female friend she has known since childhood. Her friend says she has had a "cold" for the past two days. She does not have time for a complete examination. She asks for a prescription for antibiotics because in the past "that's the only thing that works."

A physician is approached by a female friend she has known since childhood. Her friend says she has had a "cold" for the past two days. She does not have time for a complete examination. She asks for a prescription for antibiotics because in the past "that's…