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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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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. Tx of botulism
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Pho for forward bending; forward defect; common finding has no adverse physical effect
Benign permature thelarche; expectant management

2. bromocriptine
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Injury to b/l glossopharyngeal. present in botulism
If aortic root reaches 45 mm
Prolactinoma

3. Parvovirus
Injury to lower roots of brachial plexus
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decr calorie intake; decr calorie absorption;incr calorie demand
Fifth disease; febrile syndrome

4. difference between structural disorder and flexible kyphosis
Female - breech delivery - family history; tx referral to ortho
Dx US tx; correct serum electrolyte - pyloromyotom
Pipercillin (zosyn) - ticarcillin
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

5. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Benign permature thelarche; expectant management
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

6. How to evaluate well appearing child just born in GBS pos mother?
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Decr calorie intake; decr calorie absorption;incr calorie demand

7. Neonatal unconjugated hyperbilirubine
Benign permature thelarche; expectant management
Decreased UGT enzyme
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
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

8. When to do aortic root surgery in marfans to prevent dissection?
Foreign body sensation - photophobia - corneal opacity tx abx
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
If aortic root reaches 45 mm

9. kallman syndrome
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

10. How to prevent GBS in neonate
Penicillin G 4h before delivery
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
No reticulocyte vs high reticulocyte
No myoclonic activity in JME

11. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
To make hip flexed and abducted position in DDH
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

12. How long patient needs to be exposed to tick to get infected
Pipercillin (zosyn) - ticarcillin
1.5%
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
36 hours

13. dx of lyme
Erb paralysis leading to diaphragmatic paralysis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Dactylitis; 2nd common is splenic seqestration
Tx only symptomatic carrier

14. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Marfans - ehlers danlos - homocystinuria
Pho for forward bending; forward defect; common finding has no adverse physical effect
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

15. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Injury to lower roots of brachial plexus
Thalassemia - congenital hemolytic anemia
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
Biliary atresia; tx surgery

16. failure to thrive
Less than 5th percentile
Erb paralysis leading to diaphragmatic paralysis
Constitutional pubertal delay
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

17. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
14yrs
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Meconeum ileus; think about CF
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

18. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Diet modification to provide 110kc/kg/d
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
Increase of progesteron/17oh progesterone
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

19. mech of botulism
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Atypical lymphocyte
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

20. 3yo - never able to walk
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
Benign permature thelarche; expectant management
Develops in 21 dasy
After 24h of abx therapy

21. 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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Croup tx cool mist; racemic epi - corticosteroid
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

22. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Benign permature thelarche; expectant management
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

23. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Diet modification to provide 110kc/kg/d

24. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
To make hip flexed and abducted position in DDH
Tx only symptomatic carrier
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

25. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Black
Penicillin G 4h before delivery
Constitutional pubertal delay

26. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

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27. can women with abnormal smear or genital get vaccine
Decr calorie intake; decr calorie absorption;incr calorie demand
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Imaging study to r/o VUR
Yes; but it will be less effective

28. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
36 hours
Develops in 21 dasy
Fifth disease; febrile syndrome

29. Febrile seizure
Candidal diapar rash; tx clotrimazol
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
URI

30. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Foreign body sensation - photophobia - corneal opacity tx abx
Thalassemia - congenital hemolytic anemia
Erb paralysis leading to diaphragmatic paralysis

31. indications of audiometry in childrens
Strep pneumonie; moraxella; h influenze
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

32. adrenal tumor
Dactylitis; 2nd common is splenic seqestration
Do HIV testing at first
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

33. language delay
Biliary atresia; tx surgery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

34. tick transmits lyme
Neurofibromatosis type2
Decreases height - expensive; reserved for severe cases of delayed puberty
Faciform RBC cause vascular occlusion
Brown

35. hypopigmented spots - family hx bilat deafness
Thalassemia - congenital hemolytic anemia
Neurofibromatosis type2
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

36. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Central isosexual precocious puberty; hypothalmaic hamartoma

37. crying during urination. bacteriuria pyruria - rec episodes
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Dactylitis; 2nd common is splenic seqestration
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Imaging study to r/o VUR

38. physiological jaundice
Dactylitis; 2nd common is splenic seqestration
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
HSP - look for symmetric skin lesions
24h to 7d of birth

39. penicillin effective against pseudomonas
Rapid detection of RSV antigen in nasl
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Pipercillin (zosyn) - ticarcillin
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

40. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Absence seizure; tx ethosuximide
No reticulocyte vs high reticulocyte
Increase of progesteron/17oh progesterone
No wheezing - no feever in chlamydia

41. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Absence seizure; tx ethosuximide
Benign permature thelarche; expectant management
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

42. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
RSV - rhino and influenza
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

43. 3yo - febrile - left hip externally rotated
Diet modification to provide 110kc/kg/d
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

44. complete airway obstruction with FB
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
>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
Biliary atresia; tx surgery
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

45. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

46. What is the calorie requirement of newborn?
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Methylephenidate toxicity; cannot be stopped abruptly; taper
110 kcl/kg/day
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

47. target cell
T for t ; thalassemia; inc serum iron and Iron binding
Methylephenidate toxicity; cannot be stopped abruptly; taper
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Injury to b/l glossopharyngeal. present in botulism

48. giardiasis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Tx only symptomatic carrier
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

49. pumonary TB
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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)
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Pho for forward bending; forward defect; common finding has no adverse physical effect

50. causes of FTT
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
Bladder dysfunction; UTI and renal dysfunctoin
Decr calorie intake; decr calorie absorption;incr calorie demand
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

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USMLE Step3 Pediatrics

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