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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. causes of FTT
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
URI
Decr calorie intake; decr calorie absorption;incr calorie demand
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

2. How to dx keratitis?
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Foreign body sensation - photophobia - corneal opacity tx abx
Absence seizure; tx ethosuximide
Bartonella henselae; complication is suppuration of lymph node

3. When to give hpv vaccien
No reticulocyte vs high reticulocyte
36 hours
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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

4. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Constitutional pubertal delay
Fifth disease; febrile syndrome
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

5. How long patient needs to be exposed to tick to get infected
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
INH 9m if INH resistant rifampin 6m in children and 4m in adults
No myoclonic activity in JME
36 hours

6. mech of botulism
Prolactinoma
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Mainly clinical; serology with initial ELISA - with western blot confirmation;

7. bromocriptine
URI
Pho for forward bending; forward defect; common finding has no adverse physical effect
Vaso-occlusive crisis; dx hb electrophoresis
Prolactinoma

8. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Wait until 6 months
Meconeum ileus; think about CF
>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

9. indications of VUR
Injury to b/l glossopharyngeal. present in botulism
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Thalassemia - congenital hemolytic anemia

10. sickle cell with symmetrical swelling of hands and feet
Constitutional pubertal delay
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Medical emergency; dimercaprol/edta
Vaso-occlusive crisis; dx hb electrophoresis

11. TB prophylaxis
Central isosexual precocious puberty; hypothalmaic hamartoma
110 kcl/kg/day
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
INH 9m if INH resistant rifampin 6m in children and 4m in adults

12. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
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
Oral DMSA or EDTA IV
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

13. duodenal atresia
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
D for d; down syndrome and polyhydramnios
Methylephenidate toxicity; cannot be stopped abruptly; taper
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

14. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
>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
Female - breech delivery - family history; tx referral to ortho

15. complication of lumbosacral meningocele
Increase of pregnenolone
Bladder dysfunction; UTI and renal dysfunctoin
Develops in 21 dasy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

16. Tx of botulism
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Benign permature thelarche; expectant management
Fifth disease; febrile syndrome
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

17. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Pho for forward bending; forward defect; common finding has no adverse physical effect
No myoclonic activity in JME
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

18. How to dx post uretheral valve
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Biliary atresia; tx surgery
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

19. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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

20. When to do surgery for undescended testes
Neurofibromatosis type2
Benign permature thelarche; expectant management
Wait until 6 months
Rapid detection of RSV antigen in nasl

21. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
RSV - rhino and influenza
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
No reticulocyte vs high reticulocyte
Herpes

22. down syndrome has inreased risk of developing
RSV - rhino and influenza
110 kcl/kg/day
ALL - alzheimers autism adhd depression seizure
Injury to lower roots of brachial plexus

23. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Endocardial cushion defect (no separation between heart chambers)
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
No wheezing - no feever in chlamydia

24. difference between rubeola (measles) and rulbella
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

25. echymoses with low platelet <30k
Facial portwine stain
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
<2yrs - abd pain - diarrhoea - ARF
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

26. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Croup tx cool mist; racemic epi - corticosteroid
24-72 hours

27. cardiac manifestation of turner
Croup tx cool mist; racemic epi - corticosteroid
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

28. lens dislocation
No myoclonic activity in JME
Marfans - ehlers danlos - homocystinuria
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
Increase of pregnenolone

29. 17 alpha hydroxylase
Develops in 21 dasy
Risk of neurological dysfunction
Between pregnenolone and 17oh pregnenolone
Imaging study to r/o VUR

30. impaired gag reflex
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
24h to 7d of birth
Injury to b/l glossopharyngeal. present in botulism

31. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Atypical lymphocyte
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Prolactinoma

32. adenovirus
HSP - look for symmetric skin lesions
URI
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Atopic dermatitis; strong allergic/immunologic component; incr IgE

33. how thalassemia die
Dactylitis; 2nd common is splenic seqestration
URI
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Injury to b/l glossopharyngeal. present in botulism

34. Tx of bact conjunctivitis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Female - breech delivery - family history; tx referral to ortho
Herpes
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

35. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
To make hip flexed and abducted position in DDH
Multiple telangiectesia - vasular lesion in CNS
HSP - look for symmetric skin lesions

36. viruses cause bronhioltitis
RSV - rhino and influenza
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Injury to lower roots of brachial plexus
Black

37. centor criteria for bact pharyngitis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Bartonella henselae; complication is suppuration of lymph node
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

38. tuberous sclerosis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
T for t ; thalassemia; inc serum iron and Iron binding
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
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

39. acute abd pain - hx URI - lower extremity maculo papular rash
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
HSP - look for symmetric skin lesions
Between pregnenolone and 17oh pregnenolone
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

40. How to differentiate croup vs epiglotitis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

41. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

42. microcytic - hypochromic anemia - hepatospelnomegaly
Erb paralysis leading to diaphragmatic paralysis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Lateral neck xray in epiglottitis show swollen epiglottis
Thalassemia - congenital hemolytic anemia

43. How to prevent GBS in neonate
T for t ; thalassemia; inc serum iron and Iron binding
Between pregnenolone and 17oh pregnenolone
Penicillin G 4h before delivery
<2yrs - abd pain - diarrhoea - ARF

44. How to evaluate well appearing child just born in GBS pos mother?
Benign permature thelarche; expectant management
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

45. benefits of antibiotic therapy in acute pharyngitis?
Wait until 6 months
Herpes
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
No reticulocyte vs high reticulocyte

46. can women with abnormal smear or genital get vaccine
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Medical emergency; dimercaprol/edta
Yes; but it will be less effective

47. crying during urination. bacteriuria pyruria - rec episodes
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Imaging study to r/o VUR
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

48. 18mo bilat breast enlargment - some pubic hair
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
After 24h of abx therapy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Benign permature thelarche; expectant management

49. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Develops in 21 dasy
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

50. TTP pentad
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications