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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. TB prophylaxis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
INH 9m if INH resistant rifampin 6m in children and 4m in adults

2. TTP pentad
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
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Marfans - ehlers danlos - homocystinuria
Prolactinoma

3. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Faciform RBC cause vascular occlusion

4. When erythema chronicum migrans develops after tick bite
Rapid detection of RSV antigen in nasl
Faciform RBC cause vascular occlusion
24-72 hours
No intervention; 90% foreign bodies pass without difficulty

5. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Pho for forward bending; forward defect; common finding has no adverse physical effect
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
To make hip flexed and abducted position in DDH

6. acute otitis media-pathogen
Croup
Strep pneumonie; moraxella; h influenze
After 6m; breast mild provides iron until 6m.
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

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

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8. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
No reticulocyte vs high reticulocyte
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

9. red oozing rash on cheek - scaly - dry
Brown
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Diet modification to provide 110kc/kg/d
1.5%

10. When to do aortic root surgery in marfans to prevent dissection?
Risk of neurological dysfunction
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Multiple telangiectesia - vasular lesion in CNS
If aortic root reaches 45 mm

11. How to difference viral and bact pneumonia
No reticulocyte vs high reticulocyte
Vaso-occlusive crisis; dx hb electrophoresis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

12. How to dx endopthalmitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
T for t ; thalassemia; inc serum iron and Iron binding

13. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
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
Vaso-occlusive crisis; dx hb electrophoresis
Develops in 21 dasy

14. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Yes; but it will be less effective
Tx only symptomatic carrier

15. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Bartonella henselae; complication is suppuration of lymph node
Decreased UGT enzyme
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

16. Neonatal unconjugated hyperbilirubine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
36 hours
Decreased UGT enzyme
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

17. When to bevioral and enviromental measure in led intoxication?
Develops in 21 dasy
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Wait until 6 months

18. How to investigate delayed puberty
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
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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

19. down syndrome with holocystolic mumur
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Endocardial cushion defect (no separation between heart chambers)
Tx only symptomatic carrier
Decreases height - expensive; reserved for severe cases of delayed puberty

20. Tx of botulism
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
24h to 7d of birth

21. tick transmits RMSF
T for t ; thalassemia; inc serum iron and Iron binding
Black
Wait until 6 months
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

22. How to prevent GBS in neonate
Decreases height - expensive; reserved for severe cases of delayed puberty
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Penicillin G 4h before delivery
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

23. spitting up - vomiting at night - weight stable
Thalassemia - congenital hemolytic anemia
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Croup tx cool mist; racemic epi - corticosteroid

24. 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
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

25. kallman syndrome
Faciform RBC cause vascular occlusion
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
110 kcl/kg/day
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

26. How to dx acute angle closure glaucoma
Central isosexual precocious puberty; hypothalmaic hamartoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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

27. defcicieny of 21 hydroxylase
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Rapid detection of RSV antigen in nasl
Increase of progesteron/17oh progesterone
Thalassemia - congenital hemolytic anemia

28. Tx of community acquired pneumonia
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 pregnenolone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

29. IM
Atypical lymphocyte
ALL - alzheimers autism adhd depression seizure
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

30. language delay
Faciform RBC cause vascular occlusion
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

31. adrenal tumor
Croup
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
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

32. splenic infarction in sickle cell
Neurofibromatosis type2
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Faciform RBC cause vascular occlusion
Decreased UGT enzyme

33. hypopigmented spots - family hx bilat deafness
Yes; but it will be less effective
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Neurofibromatosis type2
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

34. low grade fever - cough - diffuse bilat ground glass opacities
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No reticulocyte vs high reticulocyte
Fifth disease; febrile syndrome

35. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decreases height - expensive; reserved for severe cases of delayed puberty
Black
INH 9m if INH resistant rifampin 6m in children and 4m in adults

36. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Erb paralysis leading to diaphragmatic paralysis
URI
Methylephenidate toxicity; cannot be stopped abruptly; taper
Biliary atresia; tx surgery

37. bromocriptine
No wheezing - no feever in chlamydia
Biliary atresia; tx surgery
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Prolactinoma

38. pneumonia in CF patient
110 kcl/kg/day
1.5%
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
>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

39. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
After 24h of abx therapy
Tx only symptomatic carrier

40. Parents can _____ vaccine
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
refuse
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
No myoclonic activity in JME

41. target cell
INH 9m if INH resistant rifampin 6m in children and 4m in adults
T for t ; thalassemia; inc serum iron and Iron binding
Erb paralysis leading to diaphragmatic paralysis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

42. aplasic crisis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Candidal diapar rash; tx clotrimazol
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

43. contact lens keratitis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

44. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Facial portwine stain
Prolactinoma
ALL - alzheimers autism adhd depression seizure

45. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

46. flexible kyphosis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Meconeum ileus; think about CF
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Pho for forward bending; forward defect; common finding has no adverse physical effect

47. 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)
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Develops in 21 dasy

48. 12y - obese - hip pain - hip ext rotated
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Black
Penicillin G 4h before delivery
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

49. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Increase of progesteron/17oh progesterone
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

50. giardiasis
Tx only symptomatic carrier
Candidal diapar rash; tx clotrimazol
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
RSV - rhino and influenza

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USMLE Step3 Pediatrics

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