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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. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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
Black

2. acute otitis media-pathogen
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Strep pneumonie; moraxella; h influenze
Meconeum ileus; think about CF
Biliary atresia; tx surgery

3. penicillin effective against pseudomonas
Penicillin G 4h before delivery
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Pipercillin (zosyn) - ticarcillin
Pho for forward bending; forward defect; common finding has no adverse physical effect

4. sturge weber syndrome
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Fifth disease; febrile syndrome
Facial portwine stain

5. thumb sign
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Pipercillin (zosyn) - ticarcillin

6. tzanck
<2yrs - abd pain - diarrhoea - ARF
Herpes
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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

7. How to evaluate well appearing child just born in GBS pos mother?
Congenital rubella syndrome
>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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

8. How to investigate delayed puberty
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

9. doing worse in school - lack of attention - starring speel
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Absence seizure; tx ethosuximide
Methylephenidate toxicity; cannot be stopped abruptly; taper
Fifth disease; febrile syndrome

10. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Decreases height - expensive; reserved for severe cases of delayed puberty
Pho for forward bending; forward defect; common finding has no adverse physical effect
Injury to lower roots of brachial plexus
Methylephenidate toxicity; cannot be stopped abruptly; taper

11. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
After 24h of abx therapy
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

12. pneumonia in CF patient
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Bartonella henselae; complication is suppuration of lymph node

13. crying during urination. bacteriuria pyruria - rec episodes
Neurofibromatosis type2
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Imaging study to r/o VUR

14. carditis and arthritis after rheumatic fever
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
Develops in 21 dasy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Medical emergency; dimercaprol/edta

15. When to give HRT in turner
14yrs
T for t ; thalassemia; inc serum iron and Iron binding
Absence seizure; tx ethosuximide
Female - breech delivery - family history; tx referral to ortho

16. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
No intervention; 90% foreign bodies pass without difficulty
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

17. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Dx US tx; correct serum electrolyte - pyloromyotom
If aortic root reaches 45 mm
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

18. bromocriptine
Vaso-occlusive crisis; dx hb electrophoresis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Prolactinoma

19. how thalassemia die
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

20. physiological jaundice
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
24h to 7d of birth
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

21. down syndrome has inreased risk of developing
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
ALL - alzheimers autism adhd depression seizure
Bartonella henselae; complication is suppuration of lymph node
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

22. aplasic crisis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Candidal diapar rash; tx clotrimazol
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Constitutional pubertal delay

23. causes of FTT
Constitutional pubertal delay
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Croup tx cool mist; racemic epi - corticosteroid
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

24. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
After 6m; breast mild provides iron until 6m.
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
After 24h of abx therapy

25. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Absence seizure; tx ethosuximide
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

26. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Vaso-occlusive crisis; dx hb electrophoresis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

27. acute abd pain - hx URI - lower extremity maculo papular rash
If aortic root reaches 45 mm
14yrs
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
HSP - look for symmetric skin lesions

28. IM
Atypical lymphocyte
RSV - rhino and influenza
refuse
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

29. How to dx endopthalmitis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

30. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
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
Less than 5th percentile
INH 9m if INH resistant rifampin 6m in children and 4m in adults

31. pavlik harness
>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
Erb paralysis leading to diaphragmatic paralysis
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
To make hip flexed and abducted position in DDH

32. adrenal tumor
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
No myoclonic activity in JME
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

33. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Pipercillin (zosyn) - ticarcillin
Injury to lower roots of brachial plexus

34. Infant with serum billlirubin >25
refuse
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Risk of neurological dysfunction
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

35. lead 44-70
T for t ; thalassemia; inc serum iron and Iron binding
1.5%
Biliary atresia; tx surgery
Oral DMSA or EDTA IV

36. starring spells 10-20sec
Prolactinoma
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
RSV - rhino and influenza

37. acute otitis externa

38. complication of lumbosacral meningocele
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
RSV - rhino and influenza
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Bladder dysfunction; UTI and renal dysfunctoin

39. How to difference RSV and neonatal chlamydia
TB - breastfeeding - asymptomatic hiv
No intervention; 90% foreign bodies pass without difficulty
Endocardial cushion defect (no separation between heart chambers)
No wheezing - no feever in chlamydia

40. Nocturnal enuresis
ALL - alzheimers autism adhd depression seizure
Constitutional pubertal delay
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

41. infantile hypertrophic pyloric stenosis
If aortic root reaches 45 mm
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Dx US tx; correct serum electrolyte - pyloromyotom

42. horner syndrom
Injury to lower roots of brachial plexus
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Multiple telangiectesia - vasular lesion in CNS
Herpes

43. Neonatal conjugated hyperbilirubinemia
Multiple telangiectesia - vasular lesion in CNS
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Biliary atresia; tx surgery
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

44. failure to thrive
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Benign permature thelarche; expectant management
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Less than 5th percentile

45. kallman syndrome
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
RSV - rhino and influenza

46. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

47. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Pho for forward bending; forward defect; common finding has no adverse physical effect
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Marfans - ehlers danlos - homocystinuria
Endocardial cushion defect (no separation between heart chambers)

48. 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
Benign permature thelarche; expectant management
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Brown

49. adenovirus
URI
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

50. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Increase of progesteron/17oh progesterone
Medical emergency; dimercaprol/edta
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes