A patient has been prescribed olanzapine 15 mg daily for acute manic episodes associated with bipolar I disorder. Four days after beginning treatment, he has a sudden onset of fever (39 degrees C, 102 degrees F), tachycardia, and tachypnea. Oxygen saturation at rest is 93% and he exhibits muscular rigidity and some alteration is mental status. The most likely cause of these symptoms is:
Read DetailsA 3-day-old developed a rash 1 day ago that has continued to spread. The perinatal history is unremarkable. On exam, she is well-appearing with macules, papules, and pustules 2-3mm in diameter generalized to her face, trunk and extremities. Which of the following is the most likely diagnosis?
Read DetailsA 13-year old boy presents for his annual physical. His is in the 98th percentile for weight and 50th percentile for height. On physical exam you note dark, velvety skin changes on his neck. You order a work up. His non-fasting glucose is 210 mg/dL and his hemoglobin A1c is 7%. What is the next best step?
Read DetailsA 12-year-old male has complained of right anterior thigh pain intermittently for the past 6 weeks. His mom reports no history of trauma but notes “he is limping more and more”. You note reluctance to walk at all, positioning of the right hip in an extreme external rotation and limited hip flexion on exam. You suspect:
Read DetailsA 10-year-old boy presents to the clinic for evaluation of a skin problem. He reports intense itching and skin crawling. His symptoms started a few days ago. He is now having trouble sleeping, as the pruritus seems to be worse when he lays down at night. On exam, you note lesions in the webs of his fingers and on the soles of his feet. Which of the following is the best treatment for the suspected condition?
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