A 5-year-old boy is seen for evaluation of a rash. He has a history of atopic dermatitis that is typically well controlled. He reports falling on the playground and skinning his knee 4 days ago. This morning, he awoke to find redness, swelling, and tenderness surrounding the abrasion. The boy’s mother is a physician, and his younger sister has been treated for several skin abscesses in the past. The boy appears well and has age-appropriate vital signs with no fever. He has a 2×1–cm shallow abrasion overlying his left patella with approximately 3 cm of surrounding erythema and edema. The area is tender, with no focal fluctuance. He has full range of motion of his knee. He has several enlarged, nontender lymph nodes at the left inguinal canal. The remainder of his physical examination findings are normal.
what is the MOST appropriate treatment with explanation
A. amoxicillin
B. cephalexin
C. clindamycin
D. doxycycline A 20-month-old, previously healthy boy is being evaluated for poor weight gain for 4 to 5 months, and watery diarrhea, bloating, and poor appetite for 3 weeks. He currently passes stools 4 to 6 times daily, wakes up with stool in his diaper, and has a significant diaper rash. He has had no vomiting or hematochezia. The boy prefers to drink whole milk (generally 20 oz/day) and water. He does not eat many sugary foods and does not drink juice. His father has lactose intolerance and his older brother has type 1 diabetes. The boy’s physical examination findings demonstrate a weight of 10 kg (7th percentile), length of 87 cm (54th percentile), and weight/length less than the 1st percentile. He appears tired and has thin extremities. His abdomen is soft, moderately distended, and nontender, without mass or organomegaly. Moderate diaper dermatitis is present.
Stool testing shows the following results:
Laboratory Test
Result
Fecal ova and parasite examination
Negative
Giardia antigen
Negative
Fecal bacterial culture
Negative
Fecal fat
43% (reference range <20%)
Pancreatic elastase
>500 μg/g (reference range >200)
Fecal occult blood
Negative
Fecal white blood cells
Negative
Of the following, the MOST likely cause of this boy’s diarrhea is
A. celiac disease
B. functional diarrhea
C. Shwachman Diamond syndrome
D. ulcerative colitis
