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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. mech of botulism
Tx only symptomatic carrier
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)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

2. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

3. adenovirus
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Croup
URI
Biliary atresia; tx surgery

4. How to dx endopthalmitis
T for t ; thalassemia; inc serum iron and Iron binding
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Injury to lower roots of brachial plexus
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

5. microcytic - hypochromic anemia - hepatospelnomegaly
Oral DMSA or EDTA IV
Constitutional pubertal delay
Foreign body sensation - photophobia - corneal opacity tx abx
Thalassemia - congenital hemolytic anemia

6. infantile hypertrophic pyloric stenosis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Dx US tx; correct serum electrolyte - pyloromyotom
Neurofibromatosis type2
Strep pneumonie; moraxella; h influenze

7. How to differentiate caput succedanueum and cephalohematoma
Injury to lower roots of brachial plexus
Constitutional pubertal delay
TB - breastfeeding - asymptomatic hiv
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

8. Febrile seizure
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

9. Tx of botulism
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
HSP - look for symmetric skin lesions
Oral DMSA or EDTA IV
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

10. 3yo - febrile - left hip externally rotated
refuse
Bartonella henselae; complication is suppuration of lymph node
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
<2yrs - abd pain - diarrhoea - ARF

11. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Endocardial cushion defect (no separation between heart chambers)
Candidal diapar rash; tx clotrimazol

12. hypopigmented spots - family hx bilat deafness
No wheezing - no feever in chlamydia
Dactylitis; 2nd common is splenic seqestration
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Neurofibromatosis type2

13. When to do aortic root surgery in marfans to prevent dissection?
Meconeum ileus; think about CF
Increase of pregnenolone
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
If aortic root reaches 45 mm

14. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Bladder dysfunction; UTI and renal dysfunctoin
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Methylephenidate toxicity; cannot be stopped abruptly; taper
ALL - alzheimers autism adhd depression seizure

15. spitting up - vomiting at night - weight stable
Marfans - ehlers danlos - homocystinuria
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Foreign body sensation - photophobia - corneal opacity tx abx

16. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Pipercillin (zosyn) - ticarcillin
36 hours
Imaging study to r/o VUR
Croup

17. How to dx acute angle closure glaucoma
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Marfans - ehlers danlos - homocystinuria
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Multiple telangiectesia - vasular lesion in CNS

18. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Oral DMSA or EDTA IV
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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

19. How to difference RSV and neonatal chlamydia
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
No wheezing - no feever in chlamydia
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Female - breech delivery - family history; tx referral to ortho

20. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

21. complete airway obstruction with FB
Constitutional pubertal delay
Female - breech delivery - family history; tx referral to ortho
Mainly clinical; serology with initial ELISA - with western blot confirmation;
>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

22. What is earliest sign of 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)
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Medical emergency; dimercaprol/edta
Develops in 21 dasy

23. sublottic narrowing
Injury to b/l glossopharyngeal. present in botulism
Tx only symptomatic carrier
Croup tx cool mist; racemic epi - corticosteroid
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

24. what conditions are not contraindicated
24-72 hours
Increase of pregnenolone
HSP - look for symmetric skin lesions
TB - breastfeeding - asymptomatic hiv

25. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decr calorie intake; decr calorie absorption;incr calorie demand
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

26. dx of lyme
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

27. difference between breast milk and breafeeding jaundice
HSP - look for symmetric skin lesions
Faciform RBC cause vascular occlusion
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
After 24h of abx therapy

28. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
1.5%
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

29. Infant with serum billlirubin >25
Increase of progesteron/17oh progesterone
Imaging study to r/o VUR
Bartonella henselae; complication is suppuration of lymph node
Risk of neurological dysfunction

30. aplasic crisis
Foreign body sensation - photophobia - corneal opacity tx abx
Faciform RBC cause vascular occlusion
ALL - alzheimers autism adhd depression seizure
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

31. duodenal atresia
D for d; down syndrome and polyhydramnios
Croup tx cool mist; racemic epi - corticosteroid
36 hours
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

32. association with infantile pyloric stenosis
Absence seizure; tx ethosuximide
Penicillin G 4h before delivery
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Foreign body sensation - photophobia - corneal opacity tx abx

33. When erythema chronicum migrans develops after tick bite
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Decr calorie intake; decr calorie absorption;incr calorie demand
24-72 hours
Candidal diapar rash; tx clotrimazol

34. What is the calorie requirement of newborn?
110 kcl/kg/day
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

35. nuchal rigidity - fever - sore throat - headache - dioriented
To make hip flexed and abducted position in DDH
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Brown

36. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

37. TB prophylaxis
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
Decreased UGT enzyme
D for d; down syndrome and polyhydramnios
INH 9m if INH resistant rifampin 6m in children and 4m in adults

38. failure to thrive
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Less than 5th percentile

39. language expectation from 2yo
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

40. Tx of community acquired pneumonia
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
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
1.5%

41. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Decreased UGT enzyme

42. How to evaluate well appearing child just born in GBS pos mother?
Atypical lymphocyte
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
24-72 hours
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

43. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
If aortic root reaches 45 mm

44. acute otitis externa

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45. tick transmits lyme
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No intervention; 90% foreign bodies pass without difficulty
Between pregnenolone and 17oh pregnenolone
Brown

46. 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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Diet modification to provide 110kc/kg/d

47. sudden onset of fever - difficulty in breathing
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

48. acute abd pain - hx URI - lower extremity maculo papular rash
Facial portwine stain
HSP - look for symmetric skin lesions
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
>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

49. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Increase of progesteron/17oh progesterone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

50. indications of VUR
Do HIV testing at first
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No reticulocyte vs high reticulocyte
After 6m; breast mild provides iron until 6m.