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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.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Facial portwine stain
Increase of progesteron/17oh progesterone
Mainly clinical; serology with initial ELISA - with western blot confirmation;

2. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

3. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Vaso-occlusive crisis; dx hb electrophoresis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

4. TB prophylaxis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Decr calorie intake; decr calorie absorption;incr calorie demand
INH 9m if INH resistant rifampin 6m in children and 4m in adults

5. When to give hpv vaccien
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Marfans - ehlers danlos - homocystinuria
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
Bartonella henselae; complication is suppuration of lymph node

6. patient with white plaques in mouth and lump in back
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Do HIV testing at first

7. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
24h to 7d of birth
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Strep pneumonie; moraxella; h influenze

8. doing worse in school - lack of attention - starring speel
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Meconeum ileus; think about CF
Absence seizure; tx ethosuximide

9. down syndrome has inreased risk of developing
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Between pregnenolone and 17oh pregnenolone
ALL - alzheimers autism adhd depression seizure

10. lens dislocation
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Marfans - ehlers danlos - homocystinuria
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

11. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Diet modification to provide 110kc/kg/d
URI
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

12. hypopigmented spots - family hx bilat deafness
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Neurofibromatosis type2
Vaso-occlusive crisis; dx hb electrophoresis

13. the recommended ca supplementation
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Marfans - ehlers danlos - homocystinuria
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Rapid detection of RSV antigen in nasl

14. dx for turner
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Croup tx cool mist; racemic epi - corticosteroid
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Faciform RBC cause vascular occlusion

15. adenovirus
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Decr calorie intake; decr calorie absorption;incr calorie demand
URI
Increase of progesteron/17oh progesterone

16. association with infantile pyloric stenosis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Bladder dysfunction; UTI and renal dysfunctoin
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

17. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
HSP - look for symmetric skin lesions
Croup
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

18. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Less than 5th percentile
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

19. What is thumbprint sign
Risk of neurological dysfunction
Lateral neck xray in epiglottitis show swollen epiglottis
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

20. How long patient needs to be exposed to tick to get infected
HSP - look for symmetric skin lesions
Herpes
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
36 hours

21. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
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
Medical emergency; dimercaprol/edta
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

22. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Croup tx cool mist; racemic epi - corticosteroid
Endocardial cushion defect (no separation between heart chambers)
Erb paralysis leading to diaphragmatic paralysis

23. 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)
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Less than 5th percentile

24. pavlik harness
Between pregnenolone and 17oh pregnenolone
To make hip flexed and abducted position in DDH
Wait until 6 months
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

25. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Risk of neurological dysfunction
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

26. duodenal atresia
D for d; down syndrome and polyhydramnios
Meconeum ileus; think about CF
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Wait until 6 months

27. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

28. Parents can _____ vaccine
refuse
24-72 hours
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

29. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
TB - breastfeeding - asymptomatic hiv
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

30. difference between structural disorder and flexible kyphosis
Absence seizure; tx ethosuximide
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Rapid detection of RSV antigen in nasl

31. cat scratch disease
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Bartonella henselae; complication is suppuration of lymph node
1.5%

32. cardiac manifestation of turner
HSP - look for symmetric skin lesions
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Biliary atresia; tx surgery
Risk of neurological dysfunction

33. tick transmits lyme
Brown
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Erb paralysis leading to diaphragmatic paralysis
Marfans - ehlers danlos - homocystinuria

34. side effect of testosteron therapy
Rapid detection of RSV antigen in nasl
Decreases height - expensive; reserved for severe cases of delayed puberty
Faciform RBC cause vascular occlusion
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

35. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Multiple telangiectesia - vasular lesion in CNS
Diet modification to provide 110kc/kg/d
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

36. coin in child's stomach
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No intervention; 90% foreign bodies pass without difficulty
Methylephenidate toxicity; cannot be stopped abruptly; taper
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

37. iron supplement in child
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)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
After 6m; breast mild provides iron until 6m.

38. 3yo - febrile - left hip externally rotated
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)
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Penicillin G 4h before delivery
Brown

39. dx of lyme
Erb paralysis leading to diaphragmatic paralysis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

40. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Vaso-occlusive crisis; dx hb electrophoresis

41. IM
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Atypical lymphocyte
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Pho for forward bending; forward defect; common finding has no adverse physical effect

42. How to dx RSV
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Rapid detection of RSV antigen in nasl
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

43. splenic infarction in sickle cell
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
Faciform RBC cause vascular occlusion
No intervention; 90% foreign bodies pass without difficulty

44. sturge weber syndrome
Do HIV testing at first
Facial portwine stain
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

45. acute otitis externa

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46. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
24h to 7d of birth
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
Benign permature thelarche; expectant management

47. how smoking contributes otitis media in children
Female - breech delivery - family history; tx referral to ortho
Thalassemia - congenital hemolytic anemia
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Multiple telangiectesia - vasular lesion in CNS

48. carditis and arthritis after rheumatic fever
Less than 5th percentile
Bladder dysfunction; UTI and renal dysfunctoin
Marfans - ehlers danlos - homocystinuria
Develops in 21 dasy

49. differentiate between central and peripheral precocious puberty
Prolactinoma
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
INH 9m if INH resistant rifampin 6m in children and 4m in adults
No myoclonic activity in JME

50. What are the risk factors of developmental dysplais of hip
Dx US tx; correct serum electrolyte - pyloromyotom
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Female - breech delivery - family history; tx referral to ortho