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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.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. How to dx acute angle closure glaucoma
24h to 7d of birth
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

2. tzanck
Fifth disease; febrile syndrome
Imaging study to r/o VUR
Herpes
RSV - rhino and influenza

3. lead >70
Rapid detection of RSV antigen in nasl
Medical emergency; dimercaprol/edta
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

4. the recommended ca supplementation
110 kcl/kg/day
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Aferbrile pneumnia - c. trachomatic - mycoplasma - ureasplams - cmv - rsv; look for onset - if 2-19w - can be chlamydia if asso conjunctivitis dx; cx of nasal secretion - chlamydia pcr
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

5. When to bevioral and enviromental measure in led intoxication?
<2yrs - abd pain - diarrhoea - ARF
Female - breech delivery - family history; tx referral to ortho
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Biliary atresia; tx surgery

6. What is earliest sign of puberty?
No myoclonic activity in JME
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Brown

7. How long patient needs to be exposed to tick to get infected
36 hours
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

8. deficinecy of 17 hydroxylase
Increase of pregnenolone
Herpes
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Absence seizure; tx ethosuximide

9. adenovirus
Risk of neurological dysfunction
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Decr calorie intake; decr calorie absorption;incr calorie demand
URI

10. Tx of children constipation

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11. can women with abnormal smear or genital get vaccine
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Transmits thought sneezing -coughling - singing - speaking by microscopic aerosol containg the organism; keep patient in resp isoloation until non-infectious (3 sputum acid fast smear negative)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Yes; but it will be less effective

12. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Increase of progesteron/17oh progesterone
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

13. is local anesthetics be used in cellulitis to reduce pain
Imaging study to r/o VUR
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
36 hours
No; they are basic compound will be neutralized in an acidic environment of cellulitis

14. 17 alpha hydroxylase
Less than 5th percentile
Do HIV testing at first
RSV - rhino and influenza
Between pregnenolone and 17oh pregnenolone

15. 18mo bilat breast enlargment - some pubic hair
Erb paralysis leading to diaphragmatic paralysis
Penicillin G 4h before delivery
Benign permature thelarche; expectant management
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

16. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Bartonella henselae; complication is suppuration of lymph node
Penicillin G 4h before delivery

17. lens dislocation
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Marfans - ehlers danlos - homocystinuria
URI
Injury to b/l glossopharyngeal. present in botulism

18. What is the calorie requirement of newborn?
After 6m; breast mild provides iron until 6m.
Do HIV testing at first
110 kcl/kg/day
Constitutional pubertal delay

19. association with infantile pyloric stenosis
URI
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
refuse

20. pneumonia in CF patient
Bladder dysfunction; UTI and renal dysfunctoin
URI
Bartonella henselae; complication is suppuration of lymph node
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

21. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Faciform RBC cause vascular occlusion
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
24-72 hours

22. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Aferbrile pneumnia - c. trachomatic - mycoplasma - ureasplams - cmv - rsv; look for onset - if 2-19w - can be chlamydia if asso conjunctivitis dx; cx of nasal secretion - chlamydia pcr
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Thalassemia - congenital hemolytic anemia
36 hours

23. centor criteria for bact pharyngitis
24h to 7d of birth
Bladder dysfunction; UTI and renal dysfunctoin
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

24. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

25. complete airway obstruction with FB
No intervention; 90% foreign bodies pass without difficulty
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
>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

26. How to differentiate caput succedanueum and cephalohematoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Imaging study to r/o VUR
Oral DMSA or EDTA IV
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

27. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Meconeum ileus; think about CF
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

28. how thalassemia die
Multiple telangiectesia - vasular lesion in CNS
Benign permature thelarche; expectant management
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

29. low grade fever - cough - diffuse bilat ground glass opacities
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Marfans - ehlers danlos - homocystinuria
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

30. When to do surgery for undescended testes
Wait until 6 months
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
HSP - look for symmetric skin lesions
Aferbrile pneumnia - c. trachomatic - mycoplasma - ureasplams - cmv - rsv; look for onset - if 2-19w - can be chlamydia if asso conjunctivitis dx; cx of nasal secretion - chlamydia pcr

31. acute abd pain - hx URI - lower extremity maculo papular rash
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
HSP - look for symmetric skin lesions
Vaso-occlusive crisis; dx hb electrophoresis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

32. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Mainly clinical; serology with initial ELISA - with western blot confirmation;

33. contraindications of DTap
>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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
RSV - rhino and influenza

34. HUS
HSP - look for symmetric skin lesions
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
<2yrs - abd pain - diarrhoea - ARF
No; they are basic compound will be neutralized in an acidic environment of cellulitis

35. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Neurofibromatosis type2
Pipercillin (zosyn) - ticarcillin
Penicillin G 4h before delivery

36. cat scratch disease
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Bartonella henselae; complication is suppuration of lymph node
11-12yrs as late as 26yrs; hpv2 and hpv4 against strains 16 and 18 which casuse 70% of cervical ca; not live vaccines; give 0 1 6

37. Tx of community acquired pneumonia
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

38. viruses cause bronhioltitis
Erb paralysis leading to diaphragmatic paralysis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
RSV - rhino and influenza

39. How to investigate delayed puberty
Congenital rubella syndrome
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Injury to b/l glossopharyngeal. present in botulism
Constitutional pubertal delay

40. difference between breast milk and breafeeding jaundice
No reticulocyte vs high reticulocyte
Do HIV testing at first
Decr calorie intake; decr calorie absorption;incr calorie demand
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

41. crying during urination. bacteriuria pyruria - rec episodes
Injury to lower roots of brachial plexus
Imaging study to r/o VUR
Decreased UGT enzyme
Oral DMSA or EDTA IV

42. indications of VUR
No reticulocyte vs high reticulocyte
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

43. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
ALL - alzheimers autism adhd depression seizure
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

44. How to differential bact vs viral conjunctivitis
110 kcl/kg/day
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
Injury to b/l glossopharyngeal. present in botulism
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

45. infant botulism
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
110 kcl/kg/day

46. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
HSP - look for symmetric skin lesions
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
>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

47. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Endocardial cushion defect (no separation between heart chambers)
Mainly clinical; serology with initial ELISA - with western blot confirmation;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

48. TB prophylaxis
Pipercillin (zosyn) - ticarcillin
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
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

49. How to evaluate well appearing child just born in GBS pos mother?
Imaging study to r/o VUR
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Risk of neurological dysfunction
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

50. contraindications of MMR vaccine
Absence seizure; tx ethosuximide
Facial portwine stain
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Pho for forward bending; forward defect; common finding has no adverse physical effect