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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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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. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
TB - breastfeeding - asymptomatic hiv
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

2. when bact conjunctivitis patient can go back to school
If aortic root reaches 45 mm
After 24h of abx therapy
Decr calorie intake; decr calorie absorption;incr calorie demand
Increase of progesteron/17oh progesterone

3. carditis and arthritis after rheumatic fever
Methylephenidate toxicity; cannot be stopped abruptly; taper
Bartonella henselae; complication is suppuration of lymph node
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Develops in 21 dasy

4. non immune pregnant women exposed to rubella in first trimester
Develops in 21 dasy
Congenital rubella syndrome
Diet modification to provide 110kc/kg/d
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

5. What are the risk factors of developmental dysplais of hip
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Decreased UGT enzyme
Female - breech delivery - family history; tx referral to ortho
Atopic dermatitis; strong allergic/immunologic component; incr IgE

6. difference between structural disorder and flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
No reticulocyte vs high reticulocyte
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

7. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
No myoclonic activity in JME
Black
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

8. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
HSP - look for symmetric skin lesions
Decreases height - expensive; reserved for severe cases of delayed puberty
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

9. How to prevent GBS in neonate
Penicillin G 4h before delivery
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Erb paralysis leading to diaphragmatic paralysis
No wheezing - no feever in chlamydia

10. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

11. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Injury to lower roots of brachial plexus
Develops in 21 dasy
Meconeum ileus; think about CF

12. giardiasis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Dactylitis; 2nd common is splenic seqestration
Wait until 6 months
Tx only symptomatic carrier

13. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Meconeum ileus; think about CF

14. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
If aortic root reaches 45 mm
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
Increase of progesteron/17oh progesterone

15. patient with white plaques in mouth and lump in back
Dx US tx; correct serum electrolyte - pyloromyotom
Do HIV testing at first
If aortic root reaches 45 mm
<2yrs - abd pain - diarrhoea - ARF

16. How to dx post uretheral valve
Faciform RBC cause vascular occlusion
Female - breech delivery - family history; tx referral to ortho
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

17. pumonary TB
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Thalassemia - congenital hemolytic anemia
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
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)

18. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Increase of pregnenolone
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Risk of neurological dysfunction

19. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Penicillin G 4h before 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

20. When to do surgery for undescended testes
Wait until 6 months
Do HIV testing at first
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

21. TTP pentad
Croup
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

22. side effect of testosteron therapy
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Vaso-occlusive crisis; dx hb electrophoresis
Decreases height - expensive; reserved for severe cases of delayed puberty
Constitutional pubertal delay

23. difference between rubeola (measles) and rulbella
Benign permature thelarche; expectant management
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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

24. cardiac manifestation of turner
Absence seizure; tx ethosuximide
Risk of neurological dysfunction
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

25. How long patient needs to be exposed to tick to get infected
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Yes; but it will be less effective
36 hours
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

26. aplasic crisis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Congenital rubella syndrome

27. When to give HRT in turner
Methylephenidate toxicity; cannot be stopped abruptly; taper
14yrs
>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
URI

28. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
No intervention; 90% foreign bodies pass without difficulty
Medical emergency; dimercaprol/edta

29. adrenal tumor
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Methylephenidate toxicity; cannot be stopped abruptly; taper

30. 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
Yes; but it will be less effective
refuse
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

31. 21 hydroxylase
Wait until 6 months
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
D for d; down syndrome and polyhydramnios
Bladder dysfunction; UTI and renal dysfunctoin

32. When erythema chronicum migrans develops after tick bite
24-72 hours
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

33. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
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)
No myoclonic activity in JME
36 hours

34. mech of botulism
Risk of neurological dysfunction
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
To make hip flexed and abducted position in DDH
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

35. 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
Between pregnenolone and 17oh pregnenolone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

36. Parents can _____ vaccine
refuse
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

37. TB prophylaxis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
refuse
Brown
INH 9m if INH resistant rifampin 6m in children and 4m in adults

38. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
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)
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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

39. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Pho for forward bending; forward defect; common finding has no adverse physical effect

40. how thalassemia die
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Thalassemia - congenital hemolytic anemia
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

41. How to differentiate croup vs epiglotitis
<2yrs - abd pain - diarrhoea - ARF
Dactylitis; 2nd common is splenic seqestration
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Atopic dermatitis; strong allergic/immunologic component; incr IgE

42. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
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
Constitutional pubertal delay
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

43. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Fifth disease; febrile syndrome
Risk of neurological dysfunction

44. tzanck
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
Tx only symptomatic carrier
No myoclonic activity in JME
Herpes

45. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
TB - breastfeeding - asymptomatic hiv
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No myoclonic activity in JME
Methylephenidate toxicity; cannot be stopped abruptly; taper

46. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Benign permature thelarche; expectant management
Develops in 21 dasy
Absence seizure; tx ethosuximide

47. pavlik harness
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
To make hip flexed and abducted position in DDH

48. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
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)
Penicillin G 4h before delivery

49. red oozing rash on cheek - scaly - dry
Dx US tx; correct serum electrolyte - pyloromyotom
URI
Tx only symptomatic carrier
Atopic dermatitis; strong allergic/immunologic component; incr IgE

50. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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
Central isosexual precocious puberty; hypothalmaic hamartoma
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

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USMLE Step3 Pediatrics

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