Test 17

Question 1

Patient confidentiality

Answer 1

Developing rapport and trust is particularly important in treatment of the adolescent patient. When a parent raises concerns, assessment should include interviewing the patient alone.

Question 2

Child and adolescent mental health

Answer 2

Depressed children and adolescents may display irritable rather than depressed mood. Initial evaluation of all children and adolescents with depression should include careful suicidal risk assessment.

Question 3

Melasma

Answer 3

Melasma presents as irregularly shaped, hyperpigmented macules on the face. It occurs more commonly in women, especially during pregnancy. Management involves minimizing sun exposure and using a broad-spectrum sunscreen that blocks both UVA and UVB radiation.

Question 4

Groin hernias

Answer 4

Inguinal hernias in children typically present with a nontender, reducible groin mass. Without prompt surgical correction, the mass can become incarcerated and lead to complications such as bowel ischemia or testicular atrophy.

Question 5

Acute pancreatitis

Answer 5

Infected pancreatic necrosis should be considered in patients with acute pancreatitis who have persistent abdominal pain or have initial improvement followed by clinical deterioration (leukocytosis, fever). CT scan showing gas within pancreatic necrosis is diagnostic. Management includes IV abx.