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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. TTP pentad
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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
Fifth disease; febrile syndrome
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

2. difference between diaper dermatitis and rash
Increase of pregnenolone
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
Marfans - ehlers danlos - homocystinuria
Increase of progesteron/17oh progesterone

3. 3yo - never able to walk
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
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
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

4. sturge weber syndrome
No reticulocyte vs high reticulocyte
No; they are basic compound will be neutralized in an acidic environment of cellulitis
>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
Facial portwine stain

5. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Central isosexual precocious puberty; hypothalmaic hamartoma
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Penicillin G 4h before delivery

6. 21 hydroxylase
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

7. aplasic crisis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Increase of pregnenolone
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

8. causes of FTT
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Decreased UGT enzyme
24-72 hours
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

9. duodenal atresia
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
Biliary atresia; tx surgery
Neurofibromatosis type2
D for d; down syndrome and polyhydramnios

10. sublottic narrowing
Meconeum ileus; think about CF
Croup tx cool mist; racemic epi - corticosteroid
After 6m; breast mild provides iron until 6m.
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

11. acute otitis externa

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12. flexible kyphosis
ALL - alzheimers autism adhd depression seizure
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Pho for forward bending; forward defect; common finding has no adverse physical effect

13. red oozing rash on cheek - scaly - dry
Constitutional pubertal delay
Atopic dermatitis; strong allergic/immunologic component; incr IgE
If aortic root reaches 45 mm
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

14. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
T for t ; thalassemia; inc serum iron and Iron binding
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
Multiple telangiectesia - vasular lesion in CNS

15. spitting up - vomiting at night - weight stable
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
Medical emergency; dimercaprol/edta
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
24-72 hours

16. most common complication of otitis media
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Bartonella henselae; complication is suppuration of lymph node
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

17. How to differentiate caput succedanueum and cephalohematoma
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Injury to lower roots of brachial plexus
Central isosexual precocious puberty; hypothalmaic hamartoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

18. down syndrome has inreased risk of developing
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
ALL - alzheimers autism adhd depression seizure
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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

19. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Develops in 21 dasy
Prolactinoma
HSP - look for symmetric skin lesions

20. mech of botulism
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

21. major depression
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Between pregnenolone and 17oh pregnenolone
36 hours

22. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
INH 9m if INH resistant rifampin 6m in children and 4m in adults

23. the recommended ca supplementation
Increase of pregnenolone
D for d; down syndrome and polyhydramnios
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

24. How to evaluate well appearing child just born in GBS pos mother?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Benign permature thelarche; expectant management
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Injury to lower roots of brachial plexus

25. the risk of lyme after bitten by a tick
Congenital rubella syndrome
No intervention; 90% foreign bodies pass without difficulty
1.5%
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

26. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Neurofibromatosis type2
Yes; but it will be less effective

27. non immune pregnant women exposed to rubella in first trimester
Dx US tx; correct serum electrolyte - pyloromyotom
Congenital rubella syndrome
No wheezing - no feever in chlamydia
Lateral neck xray in epiglottitis show swollen epiglottis

28. deficinecy of 17 hydroxylase
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Increase of 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
Lateral neck xray in epiglottitis show swollen epiglottis

29. down syndrome with holocystolic mumur
Croup
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Endocardial cushion defect (no separation between heart chambers)

30. physiological jaundice
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
24h to 7d of birth
Meconeum ileus; think about CF
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

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

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32. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
110 kcl/kg/day
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

33. tick transmits RMSF
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Black
<2yrs - abd pain - diarrhoea - ARF
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

34. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

35. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
Prolactinoma
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

36. adenovirus
No intervention; 90% foreign bodies pass without difficulty
Croup tx cool mist; racemic epi - corticosteroid
Strep pneumonie; moraxella; h influenze
URI

37. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Bladder dysfunction; UTI and renal dysfunctoin
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

38. failure to thrive
14yrs
Less than 5th percentile
If aortic root reaches 45 mm
Yes; but it will be less effective

39. How to differential bact vs viral conjunctivitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Marfans - ehlers danlos - homocystinuria
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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

40. How to dx acute angle closure glaucoma
Prolactinoma
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

41. pumonary TB
TB - breastfeeding - asymptomatic hiv
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)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

42. pneumonia in CF patient
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Erb paralysis leading to diaphragmatic paralysis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

43. horner syndrom
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Injury to lower roots of brachial plexus
Fifth disease; febrile syndrome
Herpes

44. low grade fever - cough - diffuse bilat ground glass opacities
Absence seizure; tx ethosuximide
Tx only symptomatic carrier
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
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

45. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Mainly clinical; serology with initial ELISA - with western blot confirmation;
After 6m; breast mild provides iron until 6m.
Candidal diapar rash; tx clotrimazol
Strep pneumonie; moraxella; h influenze

46. When to do aortic root surgery in marfans to prevent dissection?
Facial portwine stain
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
If aortic root reaches 45 mm
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

47. splenic infarction in sickle cell
T for t ; thalassemia; inc serum iron and Iron binding
Oral DMSA or EDTA IV
Faciform RBC cause vascular occlusion
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

48. acute abd pain - hx URI - lower extremity maculo papular rash
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
HSP - look for symmetric skin lesions
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

49. HUS
Faciform RBC cause vascular occlusion
<2yrs - abd pain - diarrhoea - ARF
Multiple telangiectesia - vasular lesion in CNS
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

50. 3yo - febrile - left hip externally rotated
TB - breastfeeding - asymptomatic hiv
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -