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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. sublottic narrowing
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Croup tx cool mist; racemic epi - corticosteroid
No intervention; 90% foreign bodies pass without difficulty
110 kcl/kg/day

2. tick transmits lyme
Brown
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
14yrs

3. viruses cause bronhioltitis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Herpes
Imaging study to r/o VUR
RSV - rhino and influenza

4. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
After 6m; breast mild provides iron until 6m.
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

5. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
After 24h of abx therapy
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
TB - breastfeeding - asymptomatic hiv

6. When erythema chronicum migrans develops after tick bite
Atypical lymphocyte
24-72 hours
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

7. How to dx endopthalmitis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Increase of progesteron/17oh progesterone

8. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Risk of neurological dysfunction
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

9. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Fifth disease; febrile syndrome
Penicillin G 4h before delivery
No reticulocyte vs high reticulocyte

10. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Neurofibromatosis type2
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No reticulocyte vs high reticulocyte

11. tuberous sclerosis
Yes; but it will be less effective
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No myoclonic activity in JME

12. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
No wheezing - no feever in chlamydia
<2yrs - abd pain - diarrhoea - ARF
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

13. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
14yrs
Meconeum ileus; think about CF

14. kallman syndrome
Erb paralysis leading to diaphragmatic paralysis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Tx only symptomatic carrier

15. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

16. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

17. duodenal atresia
24-72 hours
INH 9m if INH resistant rifampin 6m in children and 4m in adults
D for d; down syndrome and polyhydramnios
Rapid detection of RSV antigen in nasl

18. patient with white plaques in mouth and lump in back
Marfans - ehlers danlos - homocystinuria
Bladder dysfunction; UTI and renal dysfunctoin
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Do HIV testing at first

19. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Central isosexual precocious puberty; hypothalmaic hamartoma
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

20. sturge weber syndrome
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
No reticulocyte vs high reticulocyte
Facial portwine stain
<2yrs - abd pain - diarrhoea - ARF

21. dx of lyme
If aortic root reaches 45 mm
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Medical emergency; dimercaprol/edta

22. association with infantile pyloric stenosis
Black
Absence seizure; tx ethosuximide
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

23. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Female - breech delivery - family history; tx referral to ortho
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
Central isosexual precocious puberty; hypothalmaic hamartoma

24. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Decreased UGT enzyme
Imaging study to r/o VUR
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
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

25. mech of botulism
110 kcl/kg/day
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Meconeum ileus; think about CF
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

26. When to give HRT in turner
Increase of pregnenolone
Black
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
14yrs

27. contraindications of MMR vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
No reticulocyte vs high reticulocyte
Multiple telangiectesia - vasular lesion in CNS
Rapid detection of RSV antigen in nasl

28. tzanck
14yrs
Pipercillin (zosyn) - ticarcillin
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Herpes

29. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Congenital rubella syndrome
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

30. How to dx post uretheral valve
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
24-72 hours
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Decr calorie intake; decr calorie absorption;incr calorie demand

31. when bact conjunctivitis patient can go back to school
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
RSV - rhino and influenza
After 24h of abx therapy
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

32. What is the calorie requirement of newborn?
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
110 kcl/kg/day

33. defcicieny of 21 hydroxylase
Decreases height - expensive; reserved for severe cases of delayed puberty
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Increase of progesteron/17oh progesterone
Rapid detection of RSV antigen in nasl

34. complete airway obstruction with FB
>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
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)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Vaso-occlusive crisis; dx hb electrophoresis

35. Neonatal conjugated hyperbilirubinemia
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Biliary atresia; tx surgery
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Strep pneumonie; moraxella; h influenze

36. side effect of testosteron therapy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Congenital rubella syndrome
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Decreases height - expensive; reserved for severe cases of delayed puberty

37. starring spells 10-20sec
14yrs
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Central isosexual precocious puberty; hypothalmaic hamartoma
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

38. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Diet modification to provide 110kc/kg/d
Imaging study to r/o VUR

39. is local anesthetics be used in cellulitis to reduce pain
Wait until 6 months
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Dactylitis; 2nd common is splenic seqestration
Neurofibromatosis type2

40. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Meconeum ileus; think about CF
Yes; but it will be less effective
Thalassemia - congenital hemolytic anemia

41. How to investigate delayed puberty
No intervention; 90% foreign bodies pass without difficulty
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
D for d; down syndrome and polyhydramnios

42. differentiate between central and peripheral precocious puberty
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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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
Injury to b/l glossopharyngeal. present in botulism

43. 12y - obese - hip pain - hip ext rotated
Rapid detection of RSV antigen in nasl
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Decr calorie intake; decr calorie absorption;incr calorie demand

44. How to prevent GBS in neonate
To make hip flexed and abducted position in DDH
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Penicillin G 4h before delivery
Congenital rubella syndrome

45. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Decreases height - expensive; reserved for severe cases of delayed puberty

46. Tx of FTT
Develops in 21 dasy
110 kcl/kg/day
Diet modification to provide 110kc/kg/d
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

47. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
24-72 hours
24h to 7d of birth
Increase of progesteron/17oh progesterone
Central isosexual precocious puberty; hypothalmaic hamartoma

48. When to bevioral and enviromental measure in led intoxication?
Lateral neck xray in epiglottitis show swollen epiglottis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
ALL - alzheimers autism adhd depression seizure

49. decreased mobility of tympanic membrane after otitis media
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Dx US tx; correct serum electrolyte - pyloromyotom
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

50. pavlik harness
To make hip flexed and abducted position in DDH
After 6m; breast mild provides iron until 6m.
URI
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton