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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. pneumonia in CF patient
INH 9m if INH resistant rifampin 6m in children and 4m in adults
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Oral DMSA or EDTA IV

2. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Imaging study to r/o VUR

3. infant botulism
Decr calorie intake; decr calorie absorption;incr calorie demand
Herpes
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

4. crying during urination. bacteriuria pyruria - rec episodes
Strep pneumonie; moraxella; h influenze
Imaging study to r/o VUR
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

5. When to give HRT in turner
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
14yrs
Benign permature thelarche; expectant management
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

6. low grade fever - cough - diffuse bilat ground glass opacities
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Meconeum ileus; think about CF
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Penicillin G 4h before delivery

7. sturge weber syndrome
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Increase of progesteron/17oh progesterone
Facial portwine stain
Marfans - ehlers danlos - homocystinuria

8. indications of VUR
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Congenital rubella syndrome

9. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
If aortic root reaches 45 mm
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
After 6m; breast mild provides iron until 6m.

10. splenic infarction in sickle cell
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Faciform RBC cause vascular occlusion
ALL - alzheimers autism adhd depression seizure
Female - breech delivery - family history; tx referral to ortho

11. nuchal rigidity - fever - sore throat - headache - dioriented
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Prolactinoma
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

12. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

13. 12y - obese - hip pain - hip ext rotated
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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

14. when bact conjunctivitis patient can go back to school
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Decreases height - expensive; reserved for severe cases of delayed puberty
Bladder dysfunction; UTI and renal dysfunctoin
After 24h of abx therapy

15. dx for DDH
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
HSP - look for symmetric skin lesions

16. Tx of botulism
<2yrs - abd pain - diarrhoea - ARF
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
24h to 7d of birth
No intervention; 90% foreign bodies pass without difficulty

17. lead >70
Meconeum ileus; think about CF
refuse
Decr calorie intake; decr calorie absorption;incr calorie demand
Medical emergency; dimercaprol/edta

18. Parvovirus
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Fifth disease; febrile syndrome
refuse
T for t ; thalassemia; inc serum iron and Iron binding

19. acute otitis media-pathogen
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Strep pneumonie; moraxella; h influenze

20. aplasic crisis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

21. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Dactylitis; 2nd common is splenic seqestration
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Croup tx cool mist; racemic epi - corticosteroid

22. patient with white plaques in mouth and lump in back
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Do HIV testing at first
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No; they are basic compound will be neutralized in an acidic environment of cellulitis

23. tzanck
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
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
Herpes

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

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25. causes of FTT
No wheezing - no feever in chlamydia
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Less than 5th percentile

26. language expectation from 2yo
Do HIV testing at first
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Develops in 21 dasy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

27. difference between breast milk and breafeeding jaundice
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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
Decreased UGT enzyme
Increase of pregnenolone

28. tick transmits RMSF
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Black
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
TB - breastfeeding - asymptomatic hiv

29. failure to thrive
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Meconeum ileus; think about CF
Less than 5th percentile

30. infantile hypertrophic pyloric stenosis
Croup tx cool mist; racemic epi - corticosteroid
Dx US tx; correct serum electrolyte - pyloromyotom
24-72 hours
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

31. dx for turner
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

32. dx of lyme
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
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
Pipercillin (zosyn) - ticarcillin
Mainly clinical; serology with initial ELISA - with western blot confirmation;

33. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Absence seizure; tx ethosuximide
No reticulocyte vs high reticulocyte
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

34. What is the most common initial symptom in sickle cell
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
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
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)

35. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
Central isosexual precocious puberty; hypothalmaic hamartoma
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

36. What is thumbprint sign
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
Lateral neck xray in epiglottitis show swollen epiglottis
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 distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

37. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Candidal diapar rash; tx clotrimazol
Diet modification to provide 110kc/kg/d
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

38. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Rapid detection of RSV antigen in nasl
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
Do HIV testing at first

39. Neonatal unconjugated hyperbilirubine
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Decreased UGT enzyme
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

40. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
Absence seizure; tx ethosuximide
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

41. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Medical emergency; dimercaprol/edta
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

42. 3yo - never able to walk
Meconeum ileus; think about CF
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
24h to 7d of birth

43. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Biliary atresia; tx surgery

44. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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
Prolactinoma

45. What is the definition of delayed puberty?
Injury to lower roots of brachial plexus
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
Tx only symptomatic carrier

46. difference between diaper dermatitis and rash
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Wait until 6 months
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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

47. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

48. difference between rubeola (measles) and rulbella
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

49. What is earliest sign of puberty?
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
No reticulocyte vs high reticulocyte
Meconeum ileus; think about CF

50. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy