Approach to diarrhea (pediatrics) Quiz: Ace Your Exams
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A 15-year-old girl presents to the primary care office for diarrhea. She reports episodes of diarrhea most days of the week for the last three months as well as abdominal bloating and occasional crampy abdominal pain. Some weeks, the symptoms are more frequent than other weeks. She has been feeling fatigued the last two weeks. The abdominal symptoms are not clearly related to consumption of milk products. Past medical history is significant only for seasonal allergies. There has been no recent travel, interaction with animals, new medications, or consumption of untreated water or undercooked meat or poultry. Temperature is 37.0°C (98.6°F), pulse is 70/min, respiratory rate is 18/min, and blood pressure is 110/70 mmHg. Weight is 107 lb (48.5 kg), which is seven pounds less than at her well check six months ago. Cardiopulmonary examination is within normal limits. The abdomen is soft and non-tender, with slight distension. Laboratory studies reveal a hemoglobin of 11.6 g/dL. White count, platelets, and complete metabolic panel are normal. Inflammatory markers, stool culture, and ova & parasite testing are negative. Which of the following is the best next step for making a diagnosis?
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