. Martin, age 13, just started taking amoxicillin for otitis media.
His mother said that he woke up this morning with a rash on his
trunk. What is your first action? . Correct Answer Stop the
amoxicillin.
A 10-year-old male in 5th grade presents to the pediatric office
with his mother complaining of itchy and red eyes for 1 day.
The patient complains of watery drainage in both eyes,
associated with repetitive itching. On physical exam, he has no
fever or constitutional symptoms. His vision is normal, with no
decrease in extraocular movements. The patient has a sibling
that just started day care recently. He also has bilateral
preauricular lymph nodes that are inflamed. What is the patient's
diagnosis? Correct Answer Viral conjunctivitis.
A 16-year-old male presents to your office. He was sent by an
orthopedist. He has recently had surgical fixation of a humerus
fracture. The patient has been going to physical therapy and has
been developing a rash on his arm after therapy that disappears
shortly after returning home. He does not have the rash prior to
therapy. The patient denies fevers and chills, and his incision is
well healed, with no signs of infection. Of note, the patient has
been experiencing more hand edema than the average patient
and has had edema wraps used at the end of therapy to help with
his swelling. The wraps are made of a synthetic plastic material.
The rash the patient gets is erythematous and blotchy, not raised;
it is on the operative upper extremity. What is the most likely
diagnosis? Correct Answer Contact dermatitis.
,A 20-year-old male presents to your primary care clinic. This
patient is a college student. He complains of fatigue, sore throat,
and low-grade fever for 3 days. On physical exam, he has a
temperature of 100.7°F. His ear exam is normal. His nose and
throat exam shows mild erythema of the nasal mucosa and
edematous, enlarged tonsils bilaterally, with erythema of the
pharyngeal wall and tonsillar exudates. He has inflamed
posterior cervical lymph nodes. He has a mild nonproductive
cough and clear lung exam. What is his most likely diagnosis?
Correct Answer Mononucleosis.
A 22-year-old African American female presents to your family
practice office complaining of progressive skin discoloration.
She is adopted and has no known family history of skin
problems. The patient notes nonpalpable patches of skin loss and
blanching of her forehead and both hands and feet. It has
developed over a period of 6 months and appears to have
stopped. It is not pruritic, and there is no erythema or sign of
infectious etiology. What is the most likely diagnosis? Correct
Answer Vitiligo.
A 22-year-old college student presents to your urgent care clinic
complaining of a rash. She was recently on spring break and
spent every night in the hot tub at her hotel. On physical exam,
she has multiple small areas of 1- to 2-mm erythematous
pustules that are present mostly where her bathing suit covered
her buttocks. What is the most likely pathogen causing these
lesions Correct Answer Pseudomonas aeruginosa.
A 25-year-old client who plays in a band complains that he finds
it difficult to understand his fellow musicians at the end of a
,night of performing, a problem that is compounded by the noisy
environment of the club. These symptoms are most
characteristic of which of the following? Correct Answer
Sensorineural loss.
A 25-year-old male presents with "bleeding in my eye" for 1
day. He awoke this morning with a dark area of redness in his
eye. He has no visual loss or changes. He denies constitutional
symptoms, pruritus, drainage, or recent trauma. The redness
presents on physical exam as a dark red area in the patient's
sclera of the right eye only and takes up less than 50% of the
eye. The patient's remaining sclera is clear and white. He also
notes he was drinking alcohol last night and vomited afterward.
What is the best treatment? Correct Answer Reassurance that
this lesion will resolve without any treatment in 2 to 4 weeks.
A 27-year-old female comes in to your primary care office
complaining of a perioral rash. The patient noticed burning
around her lips a couple days ago that quickly went away. She
awoke from sleep yesterday and noticed a group of vesicles with
erythematous bases where the burning had been before. There is
no burning today. She is afebrile and has no difficulty eating or
swallowing. What test would confirm her diagnosis? Correct
Answer Tzanck smear.
A 3-year-old patient presents to your pediatric office with her
mother. She has recently been started in day care. Her mother
noted slight perioral erythema on the right side of the patient's
mouth prior to bed last night. The patient awoke today with 3
small, superficial, honey-colored vesicles where the erythema
was last night. The patient has no surrounding erythema. She
, had no difficulty eating this morning and is active and energetic
and doesn't appear lethargic or fatigued. She is also afebrile.
How would you treat this child? Correct Answer Local
debridement and mupirocin for 5 days.
A 4-year-old male presents to your pediatric clinic with his
mother complaining of an itchy rash, mostly between his
fingers. This has been going on for multiple days and has been
getting worse. The patient recently started at a new day care. On
physical exam, the patient is afebrile and has multiple small (1-2
mm) red papules in sets of 3 located in the web spaces between
his fingers. He also has signs of excoriation. What is the
treatment for this problem? Correct Answer Permethrin lotion
for the patient and also his family members.
A 44-year-old banker comes to your office for evaluation of a
pulsating headache over the left temporal region, and he rates
the pain as an 8 on a scale of 1 to 10. The pain has been constant
for the past several hours and is accompanied by nausea and
sensitivity to light. He has had frequent, though less severe,
headaches for many years, and they are usually relieved by over-
the-counter medicines. He is unclear as to a precipitating event
but notes that he has had visual disturbances before each
headache and he has been under a lot of stress in his job. Based
on this description, what is the most likely diagnosis of this type
of headache? Correct Answer Migraine.
A 6-year-old female presents to your pediatric office with her
mother complaining of right ear pain for 3 days. This pain
resolved with Tylenol. The patient has also had noted fevers of
101.3°F over the last 2 nights. The patient had a nonproductive
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