[sona]

A 14-year-old boy is brought to the physician by his mother because of a 3-month history of severe blemishes on his face and back that have been increasing in number. His mother has bought many over-the-counter medications for the acne, but he has not used any of them. Physical examination shows multiple pustules. Which of the following is the most appropriate next step?

A Ask the patient if he is concerned about the appearance of his skin

B Obtain a dietary history

C
)
Suggest a new nonprescription medication

D
)
Provide a prescription for a topical antibiotic

E
)
Recommend a consultation with a dermatologist





what is the answer plz ?

 

[aktorque]

A) Ask the patient if he is concerned about the appearance of his skin.

You should ask directly to the pt about his concern regarding his medical problem. This scenario looks like that the mom really is worrying about her kids appearance. You should not take any actions (tx, referral, etc) b4 px say something.

 

[patelMD]

A) Ask the patient if he is concerned about the appearance of his skin.

You should ask directly to the pt about his concern regarding his medical problem. This scenario looks like that the mom really is worrying about her kids appearance. You should not take any actions (tx, referral, etc) b4 px say something.

But he's only 14? But then again, it is always ''what the patient wants'' :notsure:

 

[Mondoshawan]

confusing

That is confusing - because you would certainly do A, B and D! I guess the question is which you would do first, and so I would go with A as well: involving the patient in his own medical treatment is always a good idea, whether the patient is 4 years old or 40. It increases compliance with treatment and I would think probably allows us to get a better history from them.

We can exclude C because his mother has already tried many non-prescription medications, and "severe blemishes" could mean a cystic acne that will leave both physical and psychological scars if left untreated.

We can exclude E because we have not reached the limits of any generalist's scope of practice, and because of the "never refer on the USMLE" rule of thumb.

 

[Mondoshawan]

...But then again, it is always ''what the patient wants'' ...

I'd like to change that maxim to: "It's never what the patient doesn't want," which seems a more accurate description of the autonomy of an adolescent patient...