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Free STEP3 Exam Braindumps (page: 91)

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A 4-year-old is brought to your office by his mother for evaluation. She is concerned because the child has been spiking fevers and pulling on his left ear. Your examination reveals a bulging and erythematous tympanic membrane (TM).

Which of the following is most likely to be the cause of his illness?

  1. Haemophilus influenzae, type B (HIB)
  2. Moraxella catarrhalis
  3. Mycoplasma pneumoniae
  4. GAS
  5. S. pneumoniae

Answer(s): E

Explanation:

The most common cause of otitis media in children is pneumococcus (S. pneumoniae). This is also the most common cause of sinusitis and pneumonia. Otitis media is usually seen in conjunction with an upper respiratory tract infection. Pressure from extensive use of antimicrobials has resulted in a dramatic increase in penicillin resistance in pneumococcus. Amoxicillin remains the recommended initial antibiotic of choice for the treatment of otitis media in children. In an effort to reduce the incidence of antibiotic resistance, and because of the high spontaneous cure rate of otitis media, many authorities are advocating withholding antimicrobial treatment unless symptoms persist for several days in spite of symptomatic treatment.



A 4-year-old is brought to your office by his mother for evaluation. She is concerned because the child has been spiking fevers and pulling on his left ear. Your examination reveals a bulging and erythematous tympanic membrane (TM).

You determine that the child should receive antibiotics. The initial antibiotic of choice should be?

  1. amoxicillin
  2. azithromycin (Zithromax)
  3. erythromycin
  4. trimethoprim/sulfamethoxazole (Septra)
  5. tetracycline

Answer(s): A

Explanation:

The most common cause of otitis media in children is pneumococcus (S. pneumoniae). This is also the most common cause of sinusitis and pneumonia. Otitis media is usually seen in conjunction with an upper respiratory tract infection. Pressure from extensive use of antimicrobials has resulted in a dramatic increase in penicillin resistance in pneumococcus. Amoxicillin remains the recommended initial antibiotic of choice for the treatment of otitis media in children. In an effort to reduce the incidence of antibiotic resistance, and because of the high spontaneous cure rate of otitis media, many authorities are advocating withholding antimicrobial treatment unless symptoms persist for several days in spite of symptomatic treatment.



Which of the following has a carrier state that is not considered contagious?

  1. E. coli
  2. HSV
  3. Chlamydia trachomatis
  4. GAS
  5. RSV

Answer(s): D

Explanation:

GAS pharyngitis ("strep throat") is a common cause of tonsillitis requiring antibiotics. GAS continues to be very susceptible to penicillin, which still remains the treatment of choice. Occasionally, children will have a persistently positive throat culture for GAS and are considered carriers. This carrier state is not a risk for rheumatic disease and is felt not to be contagious to others. The presence of E. coli in the intestinal tract is considered colonization and not carrier state. An example of an enteric bacterium which does have a carrier state would be Salmonella typhi (typhoid fever).



You are working in the emergency department and are called to perform a lumbar puncture on a 3- month- old infant who presented with fever and lethargy. The spinal fluid that you obtain is turbid. The laboratory reports that there are 200 WBCs and 5 RBCs per high-power field (HPF). Ninety-five percent of the WBCs in the spinal fluid are neutrophils.

Which of the following is the most probable cause of this illness?

  1. GBS
  2. HSV
  3. GAS
  4. S. pneumoniae
  5. coli

Answer(s): D

Explanation:

In children over 1 month of age, the most common causes of bacterial meningitis are S. pneumoniae and Neisseria meningitidis. HIB was also a frequent cause of this disease prior to the widespread use of the HIB vaccine. GBS, E. coli, and HSV would be more common causes of CNS infections in neonates. (McMillin et al., 1999, Chap. 142) Nonpolio enteroviruses are the most common causes of aseptic meningitis in childhood. There are approximately 65 nonpolio enteroviruses, including the Coxsackieviruses, echoviruses, and enteroviruses. Children are the main susceptible population and transmission is from child to child, via fecal-oral or oraloral (respiratory) contact. Meningitis may result from viremic spread of the virus. Treatment of this is supportive.






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