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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Erb paralysis leading to diaphragmatic paralysis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

2. How long patient needs to be exposed to tick to get infected
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Decr calorie intake; decr calorie absorption;incr calorie demand
D for d; down syndrome and polyhydramnios
36 hours

3. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
HSP - look for symmetric skin lesions
Biliary atresia; tx surgery
Thalassemia - congenital hemolytic anemia

4. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
No reticulocyte vs high reticulocyte
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Do HIV testing at first

5. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Feeding jauding due to lack of feeding; 1st week; tx support; milk jaundice due to milk; afer 7d; lack of glucoronidase; incre unconjugate biill tx; interrupt feeding resume
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

6. cleft lip but no cleft palate
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
URI
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

7. How to dx post uretheral valve
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

8. microcytic - hypochromic anemia - hepatospelnomegaly
Pho for forward bending; forward defect; common finding has no adverse physical effect
Decreased UGT enzyme
Herpes
Thalassemia - congenital hemolytic anemia

9. what conditions are not contraindicated
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
TB - breastfeeding - asymptomatic hiv
Decreased UGT enzyme

10. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Injury to lower roots of brachial plexus
Decr calorie intake; decr calorie absorption;incr calorie demand
T for t ; thalassemia; inc serum iron and Iron binding

11. How long anti-TB drugs given for TB meningitis?
Endocardial cushion defect (no separation between heart chambers)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

12. causes of acute anemia
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Strep pneumonie; moraxella; h influenze
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Faciform RBC cause vascular occlusion

13. red oozing rash on cheek - scaly - dry
Multiple telangiectesia - vasular lesion in CNS
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Rash involves crural folds - has hx of antibiotic tx - due to decrease in normal bact flora - tx clotrimazaol; dermatitis; opposite - no hx abx; tx zinc oxide
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

14. 3yo - never able to walk
1.5%
Order CK to r/o muscular dystrphies; duchene- defect in dystrophin gene; 10-20 times increased serum CK; LDH and aldolase also hight; dx electromyograpy and bx
Absence seizure; tx ethosuximide
Increase of pregnenolone

15. How to prevent GBS in neonate
Rapid detection of RSV antigen in nasl
Penicillin G 4h before delivery
After 6m; breast mild provides iron until 6m.
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

16. How to differential bact vs viral conjunctivitis
Rash involves crural folds - has hx of antibiotic tx - due to decrease in normal bact flora - tx clotrimazaol; dermatitis; opposite - no hx abx; tx zinc oxide
Bact: staph - strep - moraxell - h influenzae; eye redness - mucopurulent disch - thick - viral/allergic: adnovirus - asso with fever - URI - watery disch - severe bacterial infection lead to keratitis
Facial portwine stain
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

17. cat scratch disease
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
D for d; down syndrome and polyhydramnios
Bartonella henselae; complication is suppuration of lymph node

18. sudden onset of fever - difficulty in breathing
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
24h to 7d of birth

19. Infant with serum billlirubin >25
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Risk of neurological dysfunction
36 hours
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

20. differentiate between central and peripheral precocious puberty
refuse
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Erb paralysis leading to diaphragmatic paralysis
After 6m; breast mild provides iron until 6m.

21. Febrile seizure
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Mainly clinical; serology with initial ELISA - with western blot confirmation;
24h to 7d of birth
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

22. Neonatal unconjugated hyperbilirubine
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
T for t ; thalassemia; inc serum iron and Iron binding
After 24h of abx therapy
Decreased UGT enzyme

23. bromocriptine
Prolactinoma
Feeding jauding due to lack of feeding; 1st week; tx support; milk jaundice due to milk; afer 7d; lack of glucoronidase; incre unconjugate biill tx; interrupt feeding resume
Lateral neck xray in epiglottitis show swollen epiglottis
Rapid detection of RSV antigen in nasl

24. acute otitis media-pathogen
Neurofibromatosis type2
Facial portwine stain
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Strep pneumonie; moraxella; h influenze

25. lead >70
Decreases height - expensive; reserved for severe cases of delayed puberty
Medical emergency; dimercaprol/edta
1.5%
Do HIV testing at first

26. 17 alpha hydroxylase
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Between pregnenolone and 17oh pregnenolone
Rash involves crural folds - has hx of antibiotic tx - due to decrease in normal bact flora - tx clotrimazaol; dermatitis; opposite - no hx abx; tx zinc oxide

27. difference between structural disorder and flexible kyphosis
RSV - rhino and influenza
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Strep pneumonie; moraxella; h influenze

28. Tx of community acquired pneumonia
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Facial portwine stain

29. How to differentiate croup vs epiglotitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

30. crying during urination. bacteriuria pyruria - rec episodes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
To make hip flexed and abducted position in DDH
Order CK to r/o muscular dystrphies; duchene- defect in dystrophin gene; 10-20 times increased serum CK; LDH and aldolase also hight; dx electromyograpy and bx
Imaging study to r/o VUR

31. low grade fever - cough - diffuse bilat ground glass opacities
Croup
Risk of neurological dysfunction
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

32. Tx of botulism
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No reticulocyte vs high reticulocyte

33. aplasic crisis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
T for t ; thalassemia; inc serum iron and Iron binding
24h to 7d of birth

34. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Wait until 6 months
36 hours
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

35. spitting up - vomiting at night - weight stable
Fifth disease; febrile syndrome
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
TB - breastfeeding - asymptomatic hiv

36. What are the risk factors of developmental dysplais of hip
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Candidal diapar rash; tx clotrimazol
Female - breech delivery - family history; tx referral to ortho
24-72 hours

37. sickle cell with symmetrical swelling of hands and feet
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Develops in 21 dasy
Feeding jauding due to lack of feeding; 1st week; tx support; milk jaundice due to milk; afer 7d; lack of glucoronidase; incre unconjugate biill tx; interrupt feeding resume
Vaso-occlusive crisis; dx hb electrophoresis

38. defcicieny of 21 hydroxylase
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Increase of progesteron/17oh progesterone
Constitutional pubertal delay
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

39. dx of lyme
Black
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

40. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Do HIV testing at first
Increase of progesteron/17oh progesterone

41. cardiac manifestation of turner
TB - breastfeeding - asymptomatic hiv
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Medical emergency; dimercaprol/edta
Wait until 6 months

42. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Sydenhams chorea - 1-8m after rheumatic fever; may not recall h/o sore throat; tx oral penicillinX10d if allergic erythromycin; prophylaxis until adulthood; if motor function severely compromised - give haloperidol - valproic - phenobarbital
Central isosexual precocious puberty; hypothalmaic hamartoma

43. target cell
Dactylitis; 2nd common is splenic seqestration
T for t ; thalassemia; inc serum iron and Iron binding
36 hours
Between pregnenolone and 17oh pregnenolone

44. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Faciform RBC cause vascular occlusion
Croup tx cool mist; racemic epi - corticosteroid
Croup

45. difference between breast milk and breafeeding jaundice
Dactylitis; 2nd common is splenic seqestration
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Feeding jauding due to lack of feeding; 1st week; tx support; milk jaundice due to milk; afer 7d; lack of glucoronidase; incre unconjugate biill tx; interrupt feeding resume

46. tick transmits RMSF
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Black
36 hours
D for d; down syndrome and polyhydramnios

47. When to do surgery for undescended testes
Wait until 6 months
Injury to b/l glossopharyngeal. present in botulism
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
No myoclonic activity in JME

48. down syndrome has inreased risk of developing
Black
No wheezing - no feever in chlamydia
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
ALL - alzheimers autism adhd depression seizure

49. Tx of children constipation

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50. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
>1yr ; heimlich maneuver-series of 5 abdominal thrust with child sitting/standing; <1yr blows on the back with heel of hand alternating with chest thrust
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

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USMLE Step3 Pediatrics

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