A 29-year-old woman, who is 8 weeks pregnant, presents to the obstetrics clinic for her first prenatal visit. She has a history of hypothyroidism diagnosed three years ago and has been on levothyroxine 100 mcg daily. She confirms adherence to her medication. Laboratory tests reveal a TSH level of 4.8 mIU/L (reference range for pregnancy: 0.1–2.5 mIU/L in the first trimester) with normal free T4 levels. Which of the following is the next step in the management of her hypothyroidism during pregnancy?

A 28-year-old pregnant woman, at 20 weeks of gestation, presents to the emergency department with progressive fatigue, drooping eyelids, and intermittent double vision that worsens by the evening and improves with rest. She works as a teacher and reports difficulty chewing food, speaking clearly, and occasional difficulty swallowing. Her pregnancy has been uneventful so far, but she is concerned about how her symptoms might affect her ability to carry her pregnancy to term. On examination: Bilateral ptosis is noted, worsening with sustained effort. Limb weakness is more pronounced proximally than distally. Reflexes are normal, and sensory examination is intact. Ice pack test is positive, and symptoms transiently improve with edrophonium administration. She has been diagnosed with myasthenia gravis (MG) and is seeking guidance on managing her condition during pregnancy. All of the following is true concerning this patient’s disorder during pregnancy EXCEPT

A 28-year-old woman presents to the emergency room with complaints of worsening fatigue and intermittent double vision. These symptoms have been progressively worsening over the last one month. She works as a teacher and the symptoms increase the longer she works on the black board, worse by the evening but relieved with rest. She has also noted drooping of her eyelids, which seems to worsen with prolonged working at the school. A detailed review of systems reveals some difficulty eating, change in voice quality, and weakness in chewing food. Physical examination discloses bilateral ptosis of both eyes that worsens when the patient is asked to actively keep her eyelids elevated. She has limb and trunk weakness in a proximal greater than distal distribution. Her symptoms markedly improved after edrophonium administration. Ice pack test turned out to be positive. Which of the following is the most significant emergency department complication of this disorder?

A 28-year-old woman presents to the emergency room with complaints of shortness of breath and intermittent double vision. While her shortness of breath started two days ago, her double vision has been progressively worsening over the last one month. She works as a teacher and the symptoms increase the longer she works on the black board, worse by the evening but relieved with rest. She has also noted drooping of her eyelids, which seems to worsen with prolonged working at the school. A detailed review of systems reveals some difficulty eating, change in voice quality, and weakness in chewing food. Physical examination discloses bilateral ptosis of both eyes that worsens when the patient is asked to actively keep her eyelids elevated. Her lung examination revealed bilateral wheezing and tachypnea. She has limb and trunk weakness in a proximal greater than distal distribution. Her symptoms markedly improved after edrophonium administration. Ice pack test turned out to be positive. Of the following, which is the most effective agent to treat this disorder?

A 28-year-old woman presents to the emergency room with complaints of shortness of breath and intermittent double vision. While her shortness of breath started two days ago, her double vision has been progressively worsening over the last one month. She works as a teacher and the symptoms increase the longer she works on the black board, worse by the evening but relieved with rest. She has also noted drooping of her eyelids, which seems to worsen with prolonged working at the school. A detailed review of systems reveals some difficulty eating, change in voice quality, and weakness in chewing food. Physical examination discloses bilateral ptosis of both eyes that worsens when the patient is asked to actively keep her eyelids elevated. Her lung examination revealed bilateral wheezing and tachypnea. She has limb and trunk weakness in a proximal greater than distal distribution. Her symptoms markedly improved after edrophonium administration. Ice pack test turned out to be positive. The first screening antibody in this disorder should be which of the following?

A 28-year-old woman presents to the emergency room with complaints of shortness of breath and intermittent double vision. While her shortness of breath started two days ago, her double vision has been progressively worsening over the last one month. She works as a teacher and the symptoms increase the longer she works on the black board, worse by the evening but relieved with rest. She has also noted drooping of her eyelids, which seems to worsen with prolonged working at the school. A detailed review of systems reveals some difficulty eating, difficulty chewing food and change in voice quality. Physical examination discloses bilateral ptosis of both eyes that worsens when the patient is asked to actively keep her eyelids elevated. Her lung examination revealed bilateral wheezing and tachypnea. She has limb and trunk weakness in a proximal greater than distal distribution. Her symptoms markedly improved after edrophonium administration. Ice pack test turned out to be positive. Which of the following is the most common presenting sign in this disease?

A 32-year-old woman visits her obstetrician for her first prenatal appointment at 10 weeks of gestation. She reports that she has continued taking valproic acid for her epilepsy but is concerned after reading about its potential risks during pregnancy. She has not taken any folic acid supplements and reports no significant health issues so far. The obstetrician explains that valproic acid is a known teratogen, particularly during the critical window of fetal heart development. During which gestational weeks is the fetal heart most susceptible to teratogens?

A 3-month-old male infant is brought to the pediatric clinic by his parents due to persistent tilting of his head to the right side since birth. The parents noticed that the baby prefers to look to the left and has difficulty turning his head to the right. They are also concerned about a small lump in his neck and slight flattening of the back of his head on the right side. The baby was born full-term via vaginal delivery after a prolonged labor. The pregnancy was otherwise uneventful. No complications were noted at birth, and the baby has been feeding and developing well. There is no family history of neck or musculoskeletal abnormalities. On examination, the infant’s head is tilted to the right with the chin rotated to the left. A firm, non-tender, 2 cm mass is palpated along the right sternocleidomastoid (SCM) muscle. Passive range of motion of the neck is limited, with resistance to rotation toward the right side. There is mild right-sided plagiocephaly noted, with flattening of the occiput on the right side. What is the first-line treatment for this condition?

A 2-month-old male infant is brought to the pediatric clinic by his parents due to persistent tilting of his head to the right side since birth. The parents noticed that the baby prefers to look to the left and has difficulty turning his head to the right. They are also concerned about a small lump in his neck and slight flattening of the back of his head on the right side. The baby was born full-term via vaginal delivery after a prolonged labor. The pregnancy was otherwise uneventful. No complications were noted at birth, and the baby has been feeding and developing well. There is no family history of neck or musculoskeletal abnormalities. On examination, the infant’s head is tilted to the right with the chin rotated to the left. A firm, non-tender, 2 cm mass is palpated along the right sternocleidomastoid (SCM) muscle. Passive range of motion of the neck is limited, with resistance to rotation toward the right side. There is mild right-sided plagiocephaly noted, with flattening of the occiput on the right side. What is the most likely diagnosis?

A male infant is delivered at 30 weeks of gestation via emergency cesarean section due to severe preeclampsia in the mother. The birth weight is 1200 grams, and Apgar scores are 6 at 1 minute and 8 at 5 minutes. The infant is admitted to the neonatal intensive care unit (NICU) for respiratory support and further monitoring. On day 3 of life, the infant develops episodes of apnea and bradycardia. Physical examination reveals a tense fontanelle, and the infant appears lethargic. No seizures are observed. Concerned about potential neurological complications, the NICU team orders a cranial ultrasound. Cranial ultrasound reveals intraventricular hemorrhage (IVH), classified as Grade III based on the presence of blood in the ventricles and moderate ventricular enlargement. What is the primary management goal in a preterm infant diagnosed with Grade III intraventricular hemorrhage?