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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. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Constitutional pubertal delay
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Herpes

2. 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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

3. 17 alpha hydroxylase
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Between pregnenolone and 17oh pregnenolone
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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

4. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
<2yrs - abd pain - diarrhoea - ARF
Increase of pregnenolone

5. How to dx RSV
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Constitutional pubertal delay
Rapid detection of RSV antigen in nasl
Medical emergency; dimercaprol/edta

6. the recommended ca supplementation
Atypical lymphocyte
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

7. 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)
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Candidal diapar rash; tx clotrimazol
Between pregnenolone and 17oh pregnenolone

8. kallman syndrome
Black
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
RSV - rhino and influenza

9. TTP pentad
110 kcl/kg/day
Foreign body sensation - photophobia - corneal opacity tx abx
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

10. pneumonia in CF patient
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
ALL - alzheimers autism adhd depression seizure
Dx US tx; correct serum electrolyte - pyloromyotom
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

11. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Injury to b/l glossopharyngeal. present in botulism
Foreign body sensation - photophobia - corneal opacity tx abx

12. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Candidal diapar rash; tx clotrimazol
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

13. How to dx endopthalmitis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Medical emergency; dimercaprol/edta

14. centor criteria for bact pharyngitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

15. how thalassemia die
URI
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Less than 5th percentile
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

16. When to do aortic root surgery in marfans to prevent dissection?
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Tx only symptomatic carrier
If aortic root reaches 45 mm
No reticulocyte vs high reticulocyte

17. if bone age lower than actual and puberty delayed
Foreign body sensation - photophobia - corneal opacity tx abx
36 hours
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Constitutional pubertal delay

18. contraindications of DTap
Bladder dysfunction; UTI and renal dysfunctoin
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
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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

19. Tx of FTT
Diet modification to provide 110kc/kg/d
24-72 hours
ALL - alzheimers autism adhd depression seizure
If aortic root reaches 45 mm

20. How long patient needs to be exposed to tick to get infected
36 hours
Black
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

21. how smoking contributes otitis media in children
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
refuse

22. TB prophylaxis
No myoclonic activity in JME
Yes; but it will be less effective
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

23. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No myoclonic activity in JME
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

24. How to dx keratitis?
Fifth disease; febrile syndrome
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Foreign body sensation - photophobia - corneal opacity tx abx
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

25. When to give hpv vaccien
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Endocardial cushion defect (no separation between heart chambers)
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

26. When to bevioral and enviromental measure in led intoxication?
Wait until 6 months
<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
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)

27. giardiasis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Tx only symptomatic carrier
Congenital rubella syndrome
24h to 7d of birth

28. infantile hypertrophic pyloric stenosis
Erb paralysis leading to diaphragmatic paralysis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Dx US tx; correct serum electrolyte - pyloromyotom

29. What is the definition of delayed puberty?
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
TB - breastfeeding - asymptomatic hiv
RSV - rhino and influenza

30. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No intervention; 90% foreign bodies pass without difficulty
Dactylitis; 2nd common is splenic seqestration

31. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Faciform RBC cause vascular occlusion
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

32. Tx of bact conjunctivitis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Yes; but it will be less effective
Bartonella henselae; complication is suppuration of lymph node

33. acute abd pain - hx URI - lower extremity maculo papular rash
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
HSP - look for symmetric skin lesions
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
1.5%

34. IM
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Atypical lymphocyte
Congenital rubella syndrome
Injury to lower roots of brachial plexus

35. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
TB - breastfeeding - asymptomatic hiv
Decreases height - expensive; reserved for severe cases of delayed puberty
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

36. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

37. splenic infarction in sickle cell
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
Faciform RBC cause vascular occlusion
Increase of pregnenolone
36 hours

38. What is earliest sign of puberty?
Central isosexual precocious puberty; hypothalmaic hamartoma
Marfans - ehlers danlos - homocystinuria
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

39. deficinecy of 17 hydroxylase
After 6m; breast mild provides iron until 6m.
Increase of pregnenolone
Penicillin G 4h before delivery
ALL - alzheimers autism adhd depression seizure

40. mcCune albright`
Pipercillin (zosyn) - ticarcillin
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

41. Tx of children constipation

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42. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Foreign body sensation - photophobia - corneal opacity tx abx
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
No wheezing - no feever in chlamydia

43. lead >70
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Wait until 6 months
Medical emergency; dimercaprol/edta
Benign permature thelarche; expectant management

44. How to differentiate croup vs epiglotitis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Croup tx cool mist; racemic epi - corticosteroid
TB - breastfeeding - asymptomatic hiv
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

45. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Meconeum ileus; think about CF

46. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
TB - breastfeeding - asymptomatic hiv

47. viruses cause bronhioltitis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
RSV - rhino and influenza
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Congenital rubella syndrome

48. physiological jaundice
24h to 7d of birth
Erb paralysis leading to diaphragmatic paralysis
ALL - alzheimers autism adhd depression seizure
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

49. dx for DDH
Less than 5th percentile
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Endocardial cushion defect (no separation between heart chambers)
<2yrs - abd pain - diarrhoea - ARF

50. How long anti-TB drugs given for TB meningitis?
D for d; down syndrome and polyhydramnios
Develops in 21 dasy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery