peads 2 - usmle_steps

[ArchivalUser]

4. An 8-year-old boy is brought to the office because of a 5-day history of fever, coryza and cough that coincides with an epidemic of influenza in the community. Today he is unable to walk because of pain in the calves. His mother has been giving him acetaminophen for fever and pain. Physical examination shows a temperature of 38.3°C (101.0°F). He is alert, interactive and well-hydrated. He has clear rhinorrhea, mild pharyngeal erythema and a clear chest. His calves are tender to palpation. Strength cannot be tested because of pain. Neurologic examination, including deep tendon reflexes, is normal. Which of the following is the most appropriate therapy?

A) Acetaminophen, orally, as needed
B) Amantadine, orally
C) Immune globulin, intravenously
D) Influenza virus vaccine, intramuscularly
E) Prednisone, orally

[ArchivalUser]

6. A 3-year-old African-American boy who is a new patient is brought to the office by his grandmother. She says, "He was OK until this afternoon, when he suddenly developed a fever. He's been spitting a lot. He keeps his mouth open and he refuses to lie down. He won't eat." You learn that the child has received only one set of vaccinations at the age of 2 months. Vital signs are: temperature 39.4°C (103.0°F), pulse 110/min, respirations 24/min and blood pressure 110/70 mm Hg. On physical examination the child sits in a tripod position and salivation is evident. Which of the following is the most appropriate next step?

A) Administration of cefotaxime, intravenously
B) Complete blood count and blood culture
C) Determination of arterial blood gas values
D) Immediate otorhinolaryngology consultation
E) Lateral neck x-ray film

[ArchivalUser]

A) Acetaminophen, orally, as needed

[ArchivalUser]

C) Determination of arterial blood gas values

[ArchivalUser]

E....C

[ArchivalUser]

A and C