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Free STEP3 Exam Braindumps (page: 85)

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While working in the emergency room you see a 14-month-old boy brought in with apparent leg pain. His parents tell you that he has recently been learning to walk and that this injury is the result of a fall.
You obtain the following x-ray



What is your interpretation of the x-ray?

  1. dislocation of the ankle
  2. a "chip" fracture of the proximal tibia
  3. a spiral fracture of the distal tibia
  4. a buckle fracture involving the distal tibia and fibula
  5. a transverse fracture of the distal tibia

Answer(s): C

Explanation:

The x-ray provided shows a nondisplaced spiral fracture of the distal tibia. This is also known as a toddler's fracture. This fracture can occur when the toddler begins to walk and twists on a planted leg. This torque can result in a spiral fracture of the planted tibia. There usually is no dislocation of the ankle joint and minimal displacement of the fracture. A chip fracture of the metaphysis is a common fracture seen in abused infants and is commonly termed as a "bucket-handle" or "corner" fracture. A buckle fracture is a common accidental fracture seen in falls from a height.



While working in the emergency room you see a 14-month-old boy brought in with apparent leg pain. His parents tell you that he has recently been learning to walk and that this injury is the result of a fall.
You obtain the following x-ray



What is the mechanism that likely resulted in this injury?

  1. twisting on a planted leg while learning to walk
  2. forced rotation of the leg by another person (child abuse)
  3. fall from a piece of furniture or stairs
  4. inversion of the ankle
  5. motor vehicle accident while not restrained in a car seat

Answer(s): A

Explanation:

The x-ray provided shows a nondisplaced spiral fracture of the distal tibia. This is also known as a toddler's fracture. This fracture can occur when the toddler begins to walk and twists on a planted leg. This torque can result in a spiral fracture of the planted tibia. There usually is no dislocation of the ankle joint and minimal displacement of the fracture. A chip fracture of the metaphysis is a common fracture seen in abused infants and is commonly termed as a "bucket-handle" or "corner" fracture. A buckle fracture is a common accidental fracture seen in falls from a height.



A 16-year-old sexually active woman is being seen in the emergency department. She is complaining of vaginal discharge. She has a temperature of 99.5°F, but is otherwise well. On pelvic examination, you see a mucopurulent cervical discharge with scant blood. Samples of the discharge are sent to the laboratory for culture. There are no cervical ulcers noted. She does not have any medical allergies.

Which of the following is the most common sexually transmitted infection in adolescents?

  1. herpes simplex virus (HSV)
  2. chlamydia
  3. gonorrhea
  4. human immunodeficiency virus (HIV)
  5. syphilis

Answer(s): B

Explanation:

This young woman has cervicitis, but without evidence of pelvic inflammatory disease (PID). Chlamydia is the most common bacterial cause of sexually transmitted diseases in the United States and the most likely etiology of this patient's infection. Gonorrhea would be the next most likely cause and, frequently, there will be coinfection with the two pathogens. The simplest outpatient treatment for these two would be a single 1- g oral dose of azithromycin and a 125-mg IM dose of ceftriaxone. This regimen will ensure complete compliance, which is crucial. Treatment of her sexual partners would also be recommended. Another cause of cervicitis is trichomoniasis, for which metronidazole, either for 1 week of 500 mg bid or a single 2- g oral dose, would be recommended therapy. Of the suggested answers, option Ais the only one which would cover the two most common infectious agents.



A 16-year-old sexually active woman is being seen in the emergency department. She is complaining of vaginal discharge. She has a temperature of 99.5°F, but is otherwise well. On pelvic examination, you see a mucopurulent cervical discharge with scant blood. Samples of the discharge are sent to the laboratory for culture. There are no cervical ulcers noted. She does not have any medical allergies.

For this patient, what is the most appropriate regimen for initial therapy?

  1. azithromycin (Zithromax) 1 g orally once and ceftriaxone (Rocephin) 125 mg intramuscular (IM) once
  2. amoxicillin/clavulanic acid (Augmentin) 500 mg orally twice a day for 7 days and ceftriaxone 125 mg IM once
  3. metronidazole (Flagyl) 500 mg orally twice a day for 7 days and amoxicillin/clavulanic acid 500 mg orally twice a day for 7 days
  4. ceftriaxone 125 mg IM once
  5. azithromycin 1 g orally once and metronidazole 500 mg orally for 7 days

Answer(s): A

Explanation:

This young woman has cervicitis, but without evidence of pelvic inflammatory disease (PID). Chlamydia is the most common bacterial cause of sexually transmitted diseases in the United States and the most likely etiology of this patient's infection. Gonorrhea would be the next most likely cause and, frequently, there will be coinfection with the two pathogens. The simplest outpatient treatment for these two would be a single 1- g oral dose of azithromycin and a 125-mg IM dose of ceftriaxone. This regimen will ensure complete compliance, which is crucial. Treatment of her sexual partners would also be recommended. Another cause of cervicitis is trichomoniasis, for which metronidazole, either for 1 week of 500 mg bid or a single 2- g oral dose, would be recommended therapy. Of the suggested answers, option Ais the only one which would cover the two most common infectious agents.






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