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Question 1
A 15-year-old girl is brought to the pediatric emergency room by the lunchroom teacher, who observed her sitting alone and crying. On questioning, the teacher learned that the girl had taken five unidentified tablets after having had an argument with her mother about a boyfriend of whom the mother disapproved. Toxicology studies are negative, and physical examination is normal. Which of the following is the most appropriate course of action?
- Hospitalize the teenager on the adolescent ward
- Get a psychiatry consultation
- Get a social service consultation
- Arrange a family conference that includes the boyfriend
- Prescribe an antidepressant and arrange for a prompt clinic appointment
Question 2
A 15-year-old girl is seen in your clinic with a sprained ankle, which occurred the previous day while she was exercising in her room. You realize that you have not seen her for quite some time, and begin to expand your examination beyond the ankle. You find relatively minimal swelling on her right ankle. She has dental decay, especially of anterior teeth and a swollen, reddened, irritated uvula. She seems to be somewhat hirsute on her arms and legs, but has thinning of her hair of the head. She has a resting heart rate of 60 beats per minute, and her oral temperature is 96°F. Further questioning suggests that she has developed secondary amenorrhea. Which of the following is the most appropriate next step in the management of this girl?
- HIV testing
- Radiograph of ankle
- Thyroid function panel
- Comparison of current and past weights
- Pregnancy testing
Question 3
A 17-year-old sexually active girl comes to your office complaining of acne that is unresponsive to the usual treatment regimen. Physical examination reveals severe nodulocystic acne of her face and upper chest and back. You consider prescribing isotretinoin (Accutane), but you are concerned about side effects. Reviewing the literature, you find which of the following to be true about isotretinoin?
- Its efficacy can be profound and permanent
- It is not known to be a teratogen
- Most patients experience excessive tearing and salivation
- Severe arthritis necessitating cessation of the drug occurs in about 15% of patients
- Significant decrease in serum triglyceride levels are noted in 25% of patients
Good luck…
