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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. when bact conjunctivitis patient can go back to school
24h to 7d of birth
Injury to lower roots of brachial plexus
To make hip flexed and abducted position in DDH
After 24h of abx therapy

2. adenovirus
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
URI
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

3. acute otitis media-pathogen
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Strep pneumonie; moraxella; h influenze
Croup
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

4. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Strep pneumonie; moraxella; h influenze
Marfans - ehlers danlos - homocystinuria
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

5. What is earliest sign of puberty?
After 6m; breast mild provides iron until 6m.
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Facial portwine stain
refuse

6. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Meconeum ileus; think about CF
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

7. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Decr calorie intake; decr calorie absorption;incr calorie demand

8. Febrile seizure
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

9. When erythema chronicum migrans develops after tick bite
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
24-72 hours
Decreases height - expensive; reserved for severe cases of delayed puberty
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

10. 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
Develops in 21 dasy
URI
Dx US tx; correct serum electrolyte - pyloromyotom

11. sturge weber syndrome
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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)
Facial portwine stain
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

12. pumonary TB
Marfans - ehlers danlos - homocystinuria
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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)

13. mcCune albright`
D for d; down syndrome and polyhydramnios
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Atopic dermatitis; strong allergic/immunologic component; incr IgE
24-72 hours

14. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Benign permature thelarche; expectant management
Croup
INH 9m if INH resistant rifampin 6m in children and 4m in adults

15. tuberous sclerosis
Endocardial cushion defect (no separation between heart chambers)
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Decr calorie intake; decr calorie absorption;incr calorie demand
Methylephenidate toxicity; cannot be stopped abruptly; taper

16. How to difference RSV and neonatal chlamydia
Constitutional pubertal delay
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Decr calorie intake; decr calorie absorption;incr calorie demand
No wheezing - no feever in chlamydia

17. When to bevioral and enviromental measure in led intoxication?
Atypical lymphocyte
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

18. How to prevent GBS in neonate
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Penicillin G 4h before delivery
Pipercillin (zosyn) - ticarcillin

19. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Vaso-occlusive crisis; dx hb electrophoresis
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

20. tick transmits RMSF
<2yrs - abd pain - diarrhoea - ARF
Develops in 21 dasy
After 24h of abx therapy
Black

21. dx for turner
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)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Increase of pregnenolone
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

22. patient with white plaques in mouth and lump in back
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Decreased UGT enzyme
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Do HIV testing at first

23. 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
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Female - breech delivery - family history; tx referral to ortho

24. causes of FTT
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
Decr calorie intake; decr calorie absorption;incr calorie demand
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

25. infantile hypertrophic pyloric stenosis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
No wheezing - no feever in chlamydia
Dx US tx; correct serum electrolyte - pyloromyotom

26. nuchal rigidity - fever - sore throat - headache - dioriented
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Medical emergency; dimercaprol/edta

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

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28. causes of FTT
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
INH 9m if INH resistant rifampin 6m in children and 4m in adults

29. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No reticulocyte vs high reticulocyte

30. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Croup tx cool mist; racemic epi - corticosteroid
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Central isosexual precocious puberty; hypothalmaic hamartoma
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

31. indications of VUR
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Dactylitis; 2nd common is splenic seqestration
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

32. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Yes; but it will be less effective
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

33. tick transmits lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Brown
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

34. low grade fever - cough - diffuse bilat ground glass opacities
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Vaso-occlusive crisis; dx hb electrophoresis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

35. tzanck
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Faciform RBC cause vascular occlusion
Herpes
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

36. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
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
Tx only symptomatic carrier
Erb paralysis leading to diaphragmatic paralysis

37. can women with abnormal smear or genital get vaccine
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
24-72 hours
Yes; but it will be less effective

38. target cell
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
<2yrs - abd pain - diarrhoea - ARF
Between pregnenolone and 17oh pregnenolone
T for t ; thalassemia; inc serum iron and Iron binding

39. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Imaging study to r/o VUR
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

40. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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
No myoclonic activity in JME

41. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Methylephenidate toxicity; cannot be stopped abruptly; taper
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Herpes

42. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Bladder dysfunction; UTI and renal dysfunctoin
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

43. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
URI
Erb paralysis leading to diaphragmatic paralysis
36 hours

44. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Dactylitis; 2nd common is splenic seqestration
Do HIV testing at first

45. cleft lip but no cleft palate
Bartonella henselae; complication is suppuration of lymph node
Multiple telangiectesia - vasular lesion in CNS
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

46. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
No myoclonic activity in JME
Decreases height - expensive; reserved for severe cases of delayed puberty
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Croup

47. down syndrome with holocystolic mumur
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
Endocardial cushion defect (no separation between heart chambers)
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Dx US tx; correct serum electrolyte - pyloromyotom

48. Neonatal conjugated hyperbilirubinemia
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Yes; but it will be less effective
No reticulocyte vs high reticulocyte
Biliary atresia; tx surgery

49. How to dx RSV
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
If aortic root reaches 45 mm
Rapid detection of RSV antigen in nasl
Mainly clinical; serology with initial ELISA - with western blot confirmation;

50. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Erb paralysis leading to diaphragmatic paralysis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb