An 8-year-old boy is brought to your office with the complaint of abdominal pain. The pain is worse during the week and seems to be less prominent during the weekends and during the summer. The patient’s growth and development are normal. The physical examination is unremarkable. Laboratory screening, including stool for occult blood, complete blood count, urinalysis, and chemistry panel, yields normal results. Which of the following is the best next step in the care of this patient?
a. Perform an upper GI series
b. Perform CT of the abdomen
c. Administer a trial of H2 blockers
d. Observe the patient and reassure the patient and family
e. Recommend a lactose-free diet
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is d; Observe the patient and reassure the patient and family.
Recurrent abdominal pain is a common complaint occurring in at least 10% of school-age children. In children older than 2 years, less than 10% of cases have an identifiable organic cause. Management of these children is difficult and frustrating for the physician and the family. Excessive testing and treatments are contraindicated. A thorough history and physical examination, including growth parameters, are frequently helpful in separating organic from nonorganic causes of abdominal pain. Any signs or symptoms of organic causes should be pursued. If nothing in the history or physical examination is found, as is likely in the case described, reassurance of the children and family members is indicated. Close follow-up for new or changing symptoms as well as further reassurance to the family is important.