Answer：(D)

The correct answer is D. By the third week of development, hematopoiesis begins in the blood islands of the yolk sac. Beginning at 1 month of development and continuing until the 7th month, blood elements are also formed in the liver (choice B) and the liver is the dominant source of hematopoiesis. However, you should be aware that many other sites in the body after about 2 to 4 months are sites of some hematopoiesis, including spleen (choice B) and lymphatic organs (choice C). These sites may continue to produce some blood cells up to the peripartum period.

Answer：(D)

The correct unswer is D. This is Gardner's syndrome, which is a familial polyposis that presents with extra-intestinal manifestations including extra-intestinal manifestations including epidermal inclusion cysts, osteomas, desmoid tumors, and dental abnormalities.
Turcot syndrome is associated with CNS tumors.
FAP is the broader term that this falls under, but because of the smaller number of polyps ( Juvenile polyposis usually presents with bleeding and iron deficiency anemia.
HNPCC would not explain anything else besides the polyps, so it is not the right answer here.

Answer：(B)

The correct answer is B. The Moro or startle reflex can be elicited in the infant by any startling event, such as making a loud noise or changing the baby’s position (e.g.， holding the infant supine in one’s arms and dropping the baby's head slightly but suddenly). This reflex consists of extension and abduction of the arms with fingers spread, followed by flexion and adduction of the arms. This is a normal reflex that appears during gestation and will normally disappear between 3-6 months. A summary of development reflexes is shown below:

Answer：(C)

The correct answer is C. While this patient's two prior miscarriages may have been a coincidence, her presentation is concerning for an underlying disorder contributing to recurrent pregnancy losses. The VDRL test is often administered to pregnant patients and has a high sensitivity for syphilis. However, the specificity of this test is somewhat low and the diagnosis should be confirmed with the FTA-ABS test Antiphospholipid antibody syndrome (APS) is a common cause of a false positive VDRL in women of this age group. APS can promote arterial and venous thromboses and a resultant tendency toward spontaneous abortions Thrombocytopenia and a prolonged PTT are also common findings in affected patients. While further testing should probably be performed to confirm the diagnosis, this patient should be started on low molecular weight heparin (LMWH) to reduce the nskto her current pregnancy.
(Choice A) Benzathine penicillin is unnecessary as this patient is unlikely to have syphilis since the FTA-ABS is negative Her false positive VDRL is likely secondary to APS.
(Choice B) This patient does not have a bacterial infection that would benefit from the addition of azithromycin
(Choice D) The role of corticosteroids in APS is controversial and currently not the standard of care.