Everyone who got this question right is a cop. ༼⌐■ل͟■༽
If NBME asks about a kid with suspicious rash under his nose + lightheaded/dumber in class, that kid's huffing glue
Inhalant abuse could be done with glue, paint thinners, fuel, nitrous oxide, or alkyl nitrites. Usually in high-school aged kids. Inhalants are 'downers' so whatever intoxication effects there are should be depressant and fully resolve within 30 min. to a couple hours. Patients may look drunk when intoxicated with inhalants, but usually quickly resolve. A characteristic "glue sniffer's rash" around the nose and mouth is sometimes seen after prolonged use.
A Teen with injection of both conjunctiva = weed could also be abusing other drugs Is 12 years old and four months just too old and too long of a time for it to be impetigo? I narrowed it down to these two and guessed but... I wasn't sure I could eliminate it.
The gold stippling could simply be mucosal due to injury from the inhalant that has scabbed over. For whatever reason NBME loves kids huffing, this is a classic presentation.
Atopic dermatitis: Type 1 hypersensitivity rxn. Pruritic eruption commonly on skin flexures. Appears on face in infancy and then in antecubital fossa in children and adults. Associated with other atopic disease (asthma, allergic rhinitis, food allergies); aug. serum IgE. (FA2020 p. 477)
Impetigo: Bacterial infx on skin. Very superficial skin infx. Usually from S aureus or S pyogenes. HIGHLY CONTAGIOUS. Honey colored crusting. (FA2020 p. 479)