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A 6-Year-Old Boy Is Brought to the Office for a Routine

question 21

Multiple Choice

A 6-year-old boy is brought to the office for a routine health maintenance examination. Several "dark spots" on his trunk have been increasing in number and now appear to be spreading. The skin lesions are not painful or pruritic. The patient has no chronic medical conditions and takes no medications. He has reached all developmental milestones and is in the first grade. Maternal family history is noncontributory. The parents are divorced and paternal history is unknown. Blood pressure is 98/64 mm Hg and pulse is 100/min. The patient is at the 25th and 50th percentile for height and weight, respectively. Examination shows an alert, active boy. Pupils are equal and reactive bilaterally. Cranial nerves II-XII are intact. Cardiac examination reveals a regular rate and rhythm; no murmurs are auscultated. The abdomen is soft and has no palpable masses. Scattered 1×2 cm, hyperpigmented macules are seen over the trunk, left arm, and right thigh, as shown in the exhibit, and numerous 2×3 mm, hyperpigmented macules are seen in the bilateral inguinal creases. The patellar and Achilles deep tendon reflexes are 2/4 bilaterally. Muscle bulk and tone are normal in all extremities. Which of the following is the best next step in management of this patient?

Definitions:

Rolling Technique

A method used in various crafts or activities, such as cooking or physical therapy, involving the movement of rolling for efficiency or effectiveness.

Bias

A systematic error or unfair influence leading to incorrect conclusions or misrepresentations in data collection, analysis, or interpretation.

Shuffled

The process of randomly mixing or rearranging items, such as data points or playing cards, to ensure randomness.

Ordinary Deck

Refers to a standard deck of playing cards including 52 cards divided into four suits, used in a wide variety of card games.