An 18-month-old boy has received 5 days of amoxicillin for otitis media. He continues to have fever, and on physical examination, the right tympanic membrane is bulging with purulent fluid behind it.Which of the following is the best antibiotic to use?
Answer(s): A
Patients with persistent otitis media after 5 days of amoxicillin likely have resistant S. pneumoniae, or a beta-lactamase-positive M. catarrhalis or H. influenzae. Cephalexin, erythromycin, dicloxacillin, and penicillin would not cover the beta-lactamase-positive organisms. Some would recommend that the patient would benefit from a higher dose of the amoxicillin component in the combination antibiotic to provide better coverage for resistant S.
A 13-year-old boy presents for evaluation of short stature. His growth chart from ages 2 through 12 years is shown in Figure. His growth in the first 2 years of life was typically at the 25th percentile. He has been healthy, has a good appetite, and is doing well in school. He lives with his parents and is an only child. His parents' heights are both at the 50th percentile. His father states that he grew several inches after he completed high school. A complete physical examination is normal. His Tanner stage is
Constitutional delay is a normal pattern of growth, characterized by a relatively late pubertal growth spurt. It is recognized most commonly in boys. Patients typically show a moderate degree of short stature in early to middle childhood. The growth pattern is often similar to one or both parents. Final adult height is within the expected genetic potential. The children are otherwise well. Familial short stature is also a normal growth pattern in a short but otherwise normal family. One or both parents are typically 12 standard deviations below mean height for adults. The growth pattern parallels the normal growth curve at a percentile consistent with genetic potential. Deprivational dwarfism is due to psychosocial factors. It typically presents at a younger age, and weight is affected more than the height so that these children are not proportionately small. Hypothyroidism can affect growth but would cause a decrease in growth velocity when it occurred.The patient's height curve would flatten out, instead of paralleling the normal curves. Short stature from growth hormone deficiency typically presents by 3 years.
A 13-year-old boy presents for evaluation of short stature. His growth chart from ages 2 through 12 years is shown in Figure. His growth in the first 2 years of life was typically at the 25th percentile. He has been healthy, has a good appetite, and is doing well in school. He lives with his parents and is an only child. His parents' heights are both at the 50th percentile. His father states that he grew several inches after he completed high school. A complete physical examination is normal. His Tanner stage is I Which of the following tests is the most appropriate next step in the care of this patient?
Answer(s): E
Given that this is a classic case of constitutional growth delay, no diagnostic studies are indicated. Close monitoring of growth would be indicated. A bone age, if performed, would be less than chronologic age, demonstrating the growth potential for the patient. Cranial imaging would be indicated if the patient had evidence for onset of secondary hypopituitarism
A 12-year-old girl presents with chest pain when she plays basketball. The pain is substernal, is associated with dyspnea, and occurs after she has been playing vigorously. The pain does not radiate. The pain and dyspnea resolve with rest. She does not have palpitations or any lightheadedness associated with the pain. She does not have pain or dyspnea at other times. There is no history of early cardiac deaths or unexplained deaths of young people in her family. Her physical examination is normal, except for a grade 2/6 systolic vibratory murmur heard at the left lower sternal border.Which of the following is the most likely cause of her symptoms?
Answer(s): B
Chest pain in adolescents is a common problem. It is rarely associated with serious illness. In this patient, the onset with exercise, resolution with rest, and a family history of asthma, exercise-induced asthma is the most likely cause. Angina is a rare cause of chest pain in adolescents, and with a normal cardiac examination and no family history of cardiac disease, this is unlikely. Costochondritis is a common cause of chest pain but typically has an insidious onset and does not resolve with rest. Esophagitis is a common cause of chest pain but is typically impacted by eating, not exercise. Mitral valve prolapse can cause chest pain, although most pediatric patients with mitral valve prolapse are asymptomatic. On examination, they often have a systolic click.
A 12-year-old girl presents with chest pain when she plays basketball. The pain is substernal, is associated with dyspnea, and occurs after she has been playing vigorously. The pain does not radiate. The pain and dyspnea resolve with rest. She does not have palpitations or any lightheadedness associated with the pain. She does not have pain or dyspnea at other times. There is no history of early cardiac deaths or unexplained deaths of young people in her family. Her physical examination is normal, except for a grade 2/6 systolic vibratory murmur heard at the left lower sternal border.The same patient now complains of palpitations and dizziness with the chest pain. Which of the following tests should be ordered for this patient?
In a patient with symptoms and signs consistent with exercise-induced asthma, a therapeutic trial of inhaled albuterol is the first line of therapy and diagnosis. If there is evidence of cardiac disease on history or physical examination, then one should proceed with the indicated tests. Pulmonary function tests could be used to confirm the diagnosis and are used in cases in which the diagnosis is uncertain or if patients fail the therapeutic trial.
Post your Comments and Discuss USMLE STEP2 exam prep with other Community members:
Our website is free, but we have to fight against AI bots and content theft. We're sorry for the inconvenience caused by these security measures. You can access the rest of the STEP2 content, but please register or login to continue.