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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. differentiate between central and peripheral precocious puberty
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Absence seizure; tx ethosuximide
No reticulocyte vs high reticulocyte
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

2. spitting up - vomiting at night - weight stable
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Endocardial cushion defect (no separation between heart chambers)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

3. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Bladder dysfunction; UTI and renal dysfunctoin
Oral DMSA or EDTA IV
Croup
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

4. coin in child's stomach
Croup
No intervention; 90% foreign bodies pass without difficulty
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
ALL - alzheimers autism adhd depression seizure

5. 21 hydroxylase
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Neurofibromatosis type2
No intervention; 90% foreign bodies pass without difficulty
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

6. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decreases height - expensive; reserved for severe cases of delayed puberty
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
Black

7. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Meconeum ileus; think about CF
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

8. infantile hypertrophic pyloric stenosis
Strep pneumonie; moraxella; h influenze
Multiple telangiectesia - vasular lesion in CNS
Dx US tx; correct serum electrolyte - pyloromyotom
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

9. How to investigate delayed puberty
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)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Benign permature thelarche; expectant management

10. congenital adrenal hyperplasi
Imaging study to r/o VUR
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
After 24h of abx therapy

11. cardiac manifestation of turner
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Thalassemia - congenital hemolytic anemia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Less than 5th percentile

12. tick transmits lyme
Atypical lymphocyte
Brown
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Croup

13. 17 alpha hydroxylase
Prolactinoma
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)
Between pregnenolone and 17oh pregnenolone
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

14. tuberous sclerosis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Herpes
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

15. tzanck
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
TB - breastfeeding - asymptomatic hiv
Herpes
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

16. patient with white plaques in mouth and lump in back
Do HIV testing at first
36 hours
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
14yrs

17. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
ALL - alzheimers autism adhd depression seizure
D for d; down syndrome and polyhydramnios
Oral DMSA or EDTA IV

18. if bone age lower than actual and puberty delayed
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
<2yrs - abd pain - diarrhoea - ARF
Constitutional pubertal delay

19. What are the risk factors of developmental dysplais of hip
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Female - breech delivery - family history; tx referral to ortho
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

20. How to differentiate croup vs epiglotitis
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Increase of pregnenolone
Tx only symptomatic carrier

21. How to difference RSV and neonatal chlamydia
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
No wheezing - no feever in chlamydia
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Mainly clinical; serology with initial ELISA - with western blot confirmation;

22. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
T for t ; thalassemia; inc serum iron and Iron binding
Do HIV testing at first
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

23. lens dislocation
Marfans - ehlers danlos - homocystinuria
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Candidal diapar rash; tx clotrimazol
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

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

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25. How to differential bact vs viral conjunctivitis
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
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

26. starring spells 10-20sec
Endocardial cushion defect (no separation between heart chambers)
Increase of pregnenolone
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

27. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Injury to lower roots of brachial plexus
Oral DMSA or EDTA IV

28. down syndrome has inreased risk of developing
Brown
ALL - alzheimers autism adhd depression seizure
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

29. defcicieny of 21 hydroxylase
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Increase of progesteron/17oh progesterone
24h to 7d of birth

30. down syndrome with holocystolic mumur
Benign permature thelarche; expectant management
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Endocardial cushion defect (no separation between heart chambers)

31. dx of lyme
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
After 24h of abx therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Mainly clinical; serology with initial ELISA - with western blot confirmation;

32. can women with abnormal smear or genital get vaccine
Brown
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Yes; but it will be less effective

33. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Oral DMSA or EDTA IV
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

34. sickle cell with symmetrical swelling of hands and feet
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Decreases height - expensive; reserved for severe cases of delayed puberty
Vaso-occlusive crisis; dx hb electrophoresis
Methylephenidate toxicity; cannot be stopped abruptly; taper

35. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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
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
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

36. echymoses with low platelet <30k
Herpes
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)
Endocardial cushion defect (no separation between heart chambers)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

37. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

38. difference between diaper dermatitis and rash
Dactylitis; 2nd common is splenic seqestration
Pipercillin (zosyn) - ticarcillin
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

39. carditis and arthritis after rheumatic fever
Neurofibromatosis type2
Erb paralysis leading to diaphragmatic paralysis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Develops in 21 dasy

40. How long patient needs to be exposed to tick to get infected
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Biliary atresia; tx surgery
Dx US tx; correct serum electrolyte - pyloromyotom
36 hours

41. difference between rubeola (measles) and rulbella
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Develops in 21 dasy
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Wait until 6 months

42. cleft lip but no cleft palate
Develops in 21 dasy
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)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

43. most common complication of otitis media
Congenital rubella syndrome
No myoclonic activity in JME
Decreased UGT enzyme
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

44. lead 44-70
Oral DMSA or EDTA IV
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
TB - breastfeeding - asymptomatic hiv
Croup tx cool mist; racemic epi - corticosteroid

45. 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
Decr calorie intake; decr calorie absorption;incr calorie demand
Facial portwine stain
Biliary atresia; tx surgery

46. What is the calorie requirement of newborn?
Congenital rubella syndrome
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
110 kcl/kg/day
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

47. target cell
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)
T for t ; thalassemia; inc serum iron and Iron binding
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

48. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
After 24h of abx therapy
Facial portwine stain
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

49. IM
Atypical lymphocyte
No myoclonic activity in JME
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

50. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Injury to b/l glossopharyngeal. present in botulism
If aortic root reaches 45 mm
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO