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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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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. When erythema chronicum migrans develops after tick bite
Methylephenidate toxicity; cannot be stopped abruptly; taper
Decreases height - expensive; reserved for severe cases of delayed puberty
24-72 hours
Croup tx cool mist; racemic epi - corticosteroid

2. How to dx RSV
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Rapid detection of RSV antigen in nasl
TB - breastfeeding - asymptomatic hiv
D for d; down syndrome and polyhydramnios

3. indications of audiometry in childrens
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
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
Dx US tx; correct serum electrolyte - pyloromyotom

4. Tx of community acquired pneumonia
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
110 kcl/kg/day

5. Parents can _____ vaccine
refuse
Foreign body sensation - photophobia - corneal opacity tx abx
Risk of neurological dysfunction
T for t ; thalassemia; inc serum iron and Iron binding

6. HUS
<2yrs - abd pain - diarrhoea - ARF
Foreign body sensation - photophobia - corneal opacity tx abx
Do HIV testing at first
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

7. How to prevent GBS in neonate
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Penicillin G 4h before delivery
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Meconeum ileus; think about CF

8. infantile hypertrophic pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Dx US tx; correct serum electrolyte - pyloromyotom
Develops in 21 dasy
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

9. crying during urination. bacteriuria pyruria - rec episodes
ALL - alzheimers autism adhd depression seizure
URI
Imaging study to r/o VUR
Brown

10. the risk of lyme after bitten by a tick
Injury to b/l glossopharyngeal. present in botulism
1.5%
Candidal diapar rash; tx clotrimazol
Methylephenidate toxicity; cannot be stopped abruptly; taper

11. lead 44-70
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Oral DMSA or EDTA IV

12. When to do aortic root surgery in marfans to prevent dissection?
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Oral DMSA or EDTA IV
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
If aortic root reaches 45 mm

13. language expectation from 2yo
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Endocardial cushion defect (no separation between heart chambers)
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
T for t ; thalassemia; inc serum iron and Iron binding

14. acute otitis media-pathogen
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
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Strep pneumonie; moraxella; h influenze

15. causes of acute anemia
Medical emergency; dimercaprol/edta
Methylephenidate toxicity; cannot be stopped abruptly; taper
Strep pneumonie; moraxella; h influenze
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

16. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No myoclonic activity in JME
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

17. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Increase of pregnenolone
Medical emergency; dimercaprol/edta
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

18. defcicieny of 21 hydroxylase
Absence seizure; tx ethosuximide
Increase of progesteron/17oh progesterone
Injury to lower roots of brachial plexus
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

19. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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
Central isosexual precocious puberty; hypothalmaic hamartoma

20. 21 hydroxylase
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
RSV - rhino and influenza
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

21. complete airway obstruction with FB
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Do HIV testing at first
>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
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

22. What is the definition of delayed puberty?
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Congenital rubella syndrome
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

23. What is earliest sign of puberty?
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Decr calorie intake; decr calorie absorption;incr calorie demand
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

24. sturge weber syndrome
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Atypical lymphocyte
Facial portwine stain
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

25. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
14yrs
Facial portwine stain

26. complication of lumbosacral meningocele
24-72 hours
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Bladder dysfunction; UTI and renal dysfunctoin
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

27. How to investigate delayed puberty
Croup tx cool mist; racemic epi - corticosteroid
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Strep pneumonie; moraxella; h influenze
Increase of progesteron/17oh progesterone

28. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
No myoclonic activity in JME
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

29. when bact conjunctivitis patient can go back to school
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Meconeum ileus; think about CF
If aortic root reaches 45 mm
After 24h of abx therapy

30. mech of botulism
Foreign body sensation - photophobia - corneal opacity tx abx
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

31. horner syndrom
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
After 24h of abx therapy
Between pregnenolone and 17oh pregnenolone
Injury to lower roots of brachial plexus

32. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Female - breech delivery - family history; tx referral to ortho
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

33. dx for DDH
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
After 24h of abx therapy
Vaso-occlusive crisis; dx hb electrophoresis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

34. difference between structural disorder and flexible kyphosis
Herpes
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Increase of pregnenolone
No reticulocyte vs high reticulocyte

35. hypopigmented spots - family hx bilat deafness
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Yes; but it will be less effective
Neurofibromatosis type2

36. Infant with serum billlirubin >25
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
Risk of neurological dysfunction
Strep pneumonie; moraxella; h influenze
Dactylitis; 2nd common is splenic seqestration

37. pumonary TB
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)
Candidal diapar rash; tx clotrimazol
Tx only symptomatic carrier
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

38. coin in child's stomach
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
No intervention; 90% foreign bodies pass without difficulty

39. acute abd pain - hx URI - lower extremity maculo papular rash
Croup tx cool mist; racemic epi - corticosteroid
Strep pneumonie; moraxella; h influenze
HSP - look for symmetric skin lesions
Dx US tx; correct serum electrolyte - pyloromyotom

40. association with infantile pyloric stenosis
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
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

41. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
ALL - alzheimers autism adhd depression seizure
Croup tx cool mist; racemic epi - corticosteroid
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

42. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Neurofibromatosis type2

43. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Less than 5th percentile

44. When to bevioral and enviromental measure in led intoxication?
Medical emergency; dimercaprol/edta
Yes; but it will be less effective
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

45. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Female - breech delivery - family history; tx referral to ortho
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

46. microcytic - hypochromic anemia - hepatospelnomegaly
36 hours
Thalassemia - congenital hemolytic anemia
Congenital rubella syndrome
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

47. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Increase of progesteron/17oh progesterone

48. 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
Faciform RBC cause vascular occlusion
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

49. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Injury to b/l glossopharyngeal. present in botulism
No reticulocyte vs high reticulocyte
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Foreign body sensation - photophobia - corneal opacity tx abx

50. congenital adrenal hyperplasi
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
refuse
Injury to lower roots of brachial plexus

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USMLE Step3 Pediatrics

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