A 6-year-old presents with his parents, with a chief complaint of a 3 day history of sore throat, intermittent frontal headache and fever with a 1 day history of a non pruritic fine, raised rash, without N, V, D or C. He is able to take fluids without difficulty but has diminished appetite. The parents report that other children in their son’s kindergarten class have been sick with similar signs and symptoms. A rapid strep screen is positive. Clinical evaluation is consistent with scarlet fever. The child has no drug allergies.

Which of the following is the most appropriate intervention?

A. IM penicillin

B. Oralamoxicillin

C. Topical triamcinolone

D. No specific therapy is needed.

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A 50 yo woman presents with a 6-month history of intermittent RUQ abdominal pain, bloating and nausea, particularly after eating fatty food, describing the discomfort as sharp, occasionally radiating to the right shoulder, usually lasting around 45 mins, and accompanied by eructation. She is currently without distress, stating that, “I cut back on food that I know bothers my stomach. Physical exam reveals, BMI=35, no jaundice, mild RUQ abdominal tenderness and negative Murphy’s sign.

Which of the following is the next step in her care?

A. Provide a 1-month trial of proton pump inhibitor (PPI) therapy.

B. Refer to surgery for further evaluation.

C. Order a RUQ ab for abdominal ultrasound and hepatic enzymes.

D. Obtain serum H. pylori testing.

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An 18-month-old toddler presents for a sick visit with a chief complaint of recent onset of fever and skin lesions. Which of the following is most consistent with the presentation of measles (rubeola)?

A. A 3-day history of anterior cervical lymphadenopathy, significant sore throat, fever with a 1-day history of a fine erythematous skin eruption.

B. A 3-day history of fever, mild nasal congestion,

and crankiness followed by resolution of elevated temperature and eruption of a fine pink rash

C. A 3-day history of cough, conjunctivitis with clear eye discharge, mild sore throat without exudate, diffuse lymphadenopathy and fever, followed by a new onset diffuse maculopapular rash

D. A 2-day history of fever, mild sore throat, posterior cervical lymphadenopathy, and maculopapular skin lesions.

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