A 6-month-old infant presents to clinic with a 1-day history of diarrhea. No emesis has occurred. The infant appears about 3-5% dehydrated.
The initial management should include which of the following?
Correct Answer A:
Oral rehydration therapy is the preferable treatment for mild to moderate dehydration. The World Health Organization (WHO) rehydration solution contains 90 milliequivalents of sodium per liter, 20 milliequvalents of potassium per liter, and 20 g of glucose per liter.
B. Intraosseous access is obtained when intravenous access cannot be obtained.
C. Lumbar puncture is performed and antibiotics are given when sepsis is suspected.
D. Fruit juice may exacerbate diarrhea.
E. This patient does not require inpatient care at this time.
A one-year-old boy is brought to the office by his mother for his routine health check-up. She informs you that she has just been diagnosed with hypercholesterolemia. Her fasting serum total cholesterol concentration was 6.7 mmol/L and her LDL-cholesterol concentration was 3.37 mmol/L. A special diet has been recommended for her; however, she is very concerned about the risk of hypercholesterolemia for her son.
The most appropriate management at this time is to:
Correct Answer B:
The mother, whose age is unspecified, but is likely less than 60 years old, has no major risk factors for cardiac disease and her cholesterol levels are not elevated enough to trigger concern for a familial hypercholesterolemia. For these reasons, her child does not require any immediate attention but should wait until roughly two years old when his diet is free of breast milk and other sources of high fat content that infants often require.
Which one of the following topical agents used in the treatment of acne vulgaris is principally an antibacterial agent?
Correct Answer C:
Tretinoin, adapalene, and tazarotene are all retinoids and are primarily comedolytic and anti-comedogenic agents. Salicylic acid has a keratolytic effect and can be useful as a peeling agent. Benzoyl peroxide is an antibacterial and is therefore most useful in treating inflammatory papules and pustules.
A newborn male has a skin eruption on his forehead, nose, and cheeks. The lesions are mostly closed comedones with a few open comedones, papules, and pustules. No significant erythema is seen.
Which one of the following is the most likely diagnosis?
Correct Answer E:
Acne neonatorum occurs in up to 20% of newborns. It typically consists of closed comedones on the forehead, nose, and cheeks, and is thought to result from stimulation of sebaceous glands by maternal and infant androgens. Parents should be counseled that lesions usually resolve spontaneously within 4 months without scarring. Findings in erythema toxicum neonatorum include papules, pustules, and erythema. Candida and herpes lesions usually present with vesiculopustular lesions in the neonatal period. Milia consists of 1- to 2-mm pearly keratin plugs without erythema, and may occur on the trunk and limbs.
A 15-year-old boy visits his pediatrician with a chief complaint of chronic acne of moderate stage. He denies any allergies and currently takes no oral medications. He denies using any scented soaps, eats healthy meals and exercises regularly. He has tried topical benzoyl peroxide with no results.
What is the next step in treating his acne?
Moderate acne not responsive to basic topical treatments like benzoyl peroxide should be treated with oral antibiotics such as minocycline.
A) and B) Benzamycin and Benzaclin are topical and his acne needs oral medication since his acne has been categorized by a physician as being in the moderate state.
D) Cephalexin is more specific for skin infections such as dermatitis and cellulitis, and less specific for acne.
E) Accutane is reserved for severe cases of acne that are unresponsive to oral antibiotics. Female patients will also have to use birth control when taking Accutane.
Treatment of acne:
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