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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. How to dx RSV
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
110 kcl/kg/day
Rapid detection of RSV antigen in nasl
To make hip flexed and abducted position in DDH

2. cat scratch disease
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Bartonella henselae; complication is suppuration of lymph node
Develops in 21 dasy
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

3. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Less than 5th percentile
Decreases height - expensive; reserved for severe cases of delayed puberty

4. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Decreases height - expensive; reserved for severe cases of delayed puberty
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Dactylitis; 2nd common is splenic seqestration

5. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Croup
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

6. acute otitis externa

7. splenic infarction in sickle cell
Biliary atresia; tx surgery
Neurofibromatosis type2
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Faciform RBC cause vascular occlusion

8. decreased mobility of tympanic membrane after otitis media
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
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
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

9. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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

10. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
24-72 hours
36 hours
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

11. down syndrome has inreased risk of developing
URI
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
ALL - alzheimers autism adhd depression seizure

12. Tx of FTT
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Diet modification to provide 110kc/kg/d
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

13. pavlik harness
Absence seizure; tx ethosuximide
To make hip flexed and abducted position in DDH
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Decreases height - expensive; reserved for severe cases of delayed puberty

14. differentiate between central and peripheral precocious puberty
1.5%
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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)

15. Tx of children constipation

16. what conditions are not contraindicated
T for t ; thalassemia; inc serum iron and Iron binding
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
TB - breastfeeding - asymptomatic hiv
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

17. contact lens keratitis
Candidal diapar rash; tx clotrimazol
Rapid detection of RSV antigen in nasl
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

18. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Croup
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
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

19. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Oral DMSA or EDTA IV
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

20. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Female - breech delivery - family history; tx referral to ortho
Neurofibromatosis type2
Injury to b/l glossopharyngeal. present in botulism

21. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Methylephenidate toxicity; cannot be stopped abruptly; taper
Erb paralysis leading to diaphragmatic paralysis
Central isosexual precocious puberty; hypothalmaic hamartoma

22. Tx of bact conjunctivitis
URI
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Benign permature thelarche; expectant management

23. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Croup
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

24. How to dx acute angle closure glaucoma
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

25. difference between diaper dermatitis and rash
To make hip flexed and abducted position in DDH
Dactylitis; 2nd common is splenic seqestration
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

26. sudden onset of fever - difficulty in breathing
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Central isosexual precocious puberty; hypothalmaic hamartoma
Increase of progesteron/17oh progesterone

27. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Erb paralysis leading to diaphragmatic paralysis
Yes; but it will be less effective
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

28. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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

29. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Between pregnenolone and 17oh pregnenolone
Tx only symptomatic carrier
Rapid detection of RSV antigen in nasl

30. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Pho for forward bending; forward defect; common finding has no adverse physical effect
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Neurofibromatosis type2

31. 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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
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
36 hours

32. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
No wheezing - no feever in chlamydia
Croup
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

33. kallman syndrome
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Constitutional pubertal delay
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No intervention; 90% foreign bodies pass without difficulty

34. cardiac manifestation of turner
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Less than 5th percentile

35. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Central isosexual precocious puberty; hypothalmaic hamartoma
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

36. iron supplement in child
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Vaso-occlusive crisis; dx hb electrophoresis
After 6m; breast mild provides iron until 6m.

37. difference between breast milk and breafeeding jaundice
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
<2yrs - abd pain - diarrhoea - ARF
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

38. how thalassemia die
Herpes
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No reticulocyte vs high reticulocyte
After 6m; breast mild provides iron until 6m.

39. pumonary TB
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
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)
Do HIV testing at first

40. When erythema chronicum migrans develops after tick bite
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
24-72 hours
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

41. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Absence seizure; tx ethosuximide

42. tzanck
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Herpes
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

43. lead >70
Medical emergency; dimercaprol/edta
Foreign body sensation - photophobia - corneal opacity tx abx
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Herpes

44. deficinecy of 17 hydroxylase
Less than 5th percentile
Constitutional pubertal delay
Increase of pregnenolone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

45. IM
Atypical lymphocyte
Injury to b/l glossopharyngeal. present in botulism
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No myoclonic activity in JME

46. tick transmits RMSF
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
Black

47. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
If aortic root reaches 45 mm
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Thalassemia - congenital hemolytic anemia

48. most common complication of otitis media
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
After 6m; breast mild provides iron until 6m.

49. Tx of botulism
Bladder dysfunction; UTI and renal dysfunctoin
<2yrs - abd pain - diarrhoea - ARF
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Croup

50. when bact conjunctivitis patient can go back to school
Constitutional pubertal delay
After 24h of abx therapy
Diet modification to provide 110kc/kg/d
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products