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Free STEP3 Exam Braindumps (page: 93)

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A 4-year-old girl is brought in to the office by her mother. She developed chicken pox about 6 days ago. She appeared to be recovering well but mother became concerned because she was persistently scratching at several of the lesions and they were not healing. On examination, the child is afebrile and generally well appearing. On examination of her skin you see the following image



What would be the most appropriate treatment?

  1. topical triamcinolone 0.1% cream
  2. topical nystatin cream
  3. oral acyclovir
  4. oral cephalexin
  5. no treatment is necessary as this is a self-limited condition

Answer(s): D

Explanation:

The image provided shows a classic case of impetigo. This is a common skin infection of childhood. It frequently occurs following a case of chickenpox and is due to the child picking or scratching at the varicella lesions, resulting in a secondary bacterial infection. GAS infection is the most common cause of impetigo associated with varicella infections. It is markedly more prevalent than the next most common infectious agent, S. aureus. Tinea corporis, often due to T. rubrum, is also known as ringworm. It classically is a circular lesion with a red, raised border, and central clearing. Contact dermatitis, from exposure to an irritant such as poison ivy, often causes plaques of erythema and edema with superimposed vesicles. This is also frequently secondarily infected with GAS from scratching. Warts, caused by the human papilloma virus, do not typically appear as the lesions in the image. Of the options listed, oral cephalexin would be the most appropriate initial therapy. Most GAS isolates are sensitive to first-generation cephalosporins, such as cephalexin. Topical steroids are useful for inflammatory or allergic conditions, topical nystatin for a fungal infection (such as tinea corporis) and oral acyclovir can be used early in the course of a varicella infection



A well-appearing 6-year-old presents to your office with a chief complaint of bruising. The parents report that the child had a cold 2 weeks ago but completely recovered. The child is sitting on the examining table, in no distress, discussing her favorite cartoons. On examination, you find mucosal bleeding and bruises on the child's arms and chest. You order a complete blood count (CBC) that has the following results: WBC 12,000, hemoglobin 11 g/dL, and a platelet count of 45,000.

What is the most likely cause of this child's bleeding and bruising?

  1. immune thrombocytopenic purpura (ITP)
  2. Henoch-Schönlein purpura (HSP)
  3. Evans syndrome
  4. meningococcemia
  5. hemolytic uremic syndrome (HUS)

Answer(s): A

Explanation:

The hallmark of immune (also known as idiopathic) thrombocytopenia purpura (ITP) is the otherwise healthy appearing child with isolated thrombocytopenia. ITP is the most common cause of isolated thrombocytopenia in childhood. It occurs with equal frequency in both boys and girls. The presence of thrombocytopenia in a patient with otherwise normal cell lines, and a normal physical examination is enough to make the diagnosis, so further evaluation, such as a bone marrow biopsy, is unnecessary. Which children to treat and which treatment to use are areas of controversy in the management of ITP. Most acute ITP will resolve spontaneously, so many will recommend observation for children who appear well, are asymptomatic, and have platelet counts above 30,000. Platelet transfusions should be reserved only in the instance of ongoing or imminent bleeding. When a decision is made to treat, usually when the platelet count falls below 20,000, there are several options available. Treatment involves using IVIG, steroids, anti-D immunoglobulins, or combinations thereof. Combinations of medications may work synergistically. Prednisone is often used initially, as it can be given orally and is inexpensive. Typically, it will be tapered over 2 weeks to 3 months. By using combination therapy when needed, splenectomy can be avoided in the vast majority of cases. When it is necessary, it should be delayed, if at all possible, for at least a year after diagnosis.



A well-appearing 6-year-old presents to your office with a chief complaint of bruising. The parents report that the child had a cold 2 weeks ago but completely recovered. The child is sitting on the examining table, in no distress, discussing her favorite cartoons. On examination, you find mucosal bleeding and bruises on the child's arms and chest. You order a complete blood count (CBC) that has the following results: WBC 12,000, hemoglobin 11 g/dL, and a platelet count of 45,000.

After discussing various options with a regional pediatric hematologist and the patient's parents, your most appropriate initial management would be which of the following?

  1. a platelet transfusion at the regional children's hospital
  2. an IM dose of methylprednisolone as an outpatient
  3. reassurance to the parents with close outpatient follow-up
  4. intravenous immunoglobulin (IVIG) at the regional children's hospital
  5. bone marrow biopsy at the regional children's hospital

Answer(s): C

Explanation:

The hallmark of immune (also known as idiopathic) thrombocytopenia purpura (ITP) is the otherwise healthy appearing child with isolated thrombocytopenia. ITP is the most common cause of isolated thrombocytopenia in childhood. It occurs with equal frequency in both boys and girls. The presence of thrombocytopenia in a patient with otherwise normal cell lines, and a normal physical examination is enough to make the diagnosis, so further evaluation, such as a bone marrow biopsy, is unnecessary. Which children to treat and which treatment to use are areas of controversy in the management of ITP. Most acute ITP will resolve spontaneously, so many will recommend observation for children who appear well, are asymptomatic, and have platelet counts above 30,000. Platelet transfusions should be reserved only in the instance of ongoing or imminent bleeding. When a decision is made to treat, usually when the platelet count falls below 20,000, there are several options available. Treatment involves using IVIG, steroids, anti-D immunoglobulins, or combinations thereof. Combinations of medications may work synergistically. Prednisone is often used initially, as it can be given orally and is inexpensive. Typically, it will be tapered over 2 weeks to 3 months. By using combination therapy when needed, splenectomy can be avoided in the vast majority of cases. When it is necessary, it should be delayed, if at all possible, for at least a year after diagnosis.



A well-appearing 6-year-old presents to your office with a chief complaint of bruising. The parents report that the child had a cold 2 weeks ago but completely recovered. The child is sitting on the examining table, in no distress, discussing her favorite cartoons. On examination, you find mucosal bleeding and bruises on the child's arms and chest. You order a complete blood count (CBC) that has the following results: WBC 12,000, hemoglobin 11 g/dL, and a platelet count of 45,000.

Following your initial evaluation and treatment, you see the child for follow-up in 1 week. She continues to appear well but still has obvious purpura and her platelet count is now 17,000. All other cell lines are normal. Of the options listed below, what is your most appropriate management at this time?

  1. admission to the regional children's hospital for a platelet transfusion
  2. admission to the children's hospital for a splenectomy
  3. reassurance to the parents and close outpatient follow-up
  4. admission to the children's hospital for IVIG and steroids
  5. whole-blood transfusion with several hours of observation to ensure that there is no transfusion reaction

Answer(s): D

Explanation:

The hallmark of immune (also known as idiopathic) thrombocytopenia purpura (ITP) is the otherwise healthy appearing child with isolated thrombocytopenia. ITP is the most common cause of isolated thrombocytopenia in childhood. It occurs with equal frequency in both boys and girls. The presence of thrombocytopenia in a patient with otherwise normal cell lines, and a normal physical examination is enough to make the diagnosis, so further evaluation, such as a bone marrow biopsy, is unnecessary. Which children to treat and which treatment to use are areas of controversy in the management of ITP. Most acute ITP will resolve spontaneously, so many will recommend observation for children who appear well, are asymptomatic, and have platelet counts above 30,000. Platelet transfusions should be reserved only in the instance of ongoing or imminent bleeding. When a decision is made to treat, usually when the platelet count falls below 20,000, there are several options available. Treatment involves using IVIG, steroids, anti-D immunoglobulins, or combinations thereof. Combinations of medications may work synergistically. Prednisone is often used initially, as it can be given orally and is inexpensive. Typically, it will be tapered over 2 weeks to 3 months. By using combination therapy when needed, splenectomy can be avoided in the vast majority of cases. When it is necessary, it should be delayed, if at all possible, for at least a year after diagnosis.






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