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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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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. defcicieny of 21 hydroxylase
Herpes
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
Increase of progesteron/17oh progesterone
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

2. down syndrome with holocystolic mumur
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Do HIV testing at first
No myoclonic activity in JME
Endocardial cushion defect (no separation between heart chambers)

3. coin in child's stomach
Central isosexual precocious puberty; hypothalmaic hamartoma
No myoclonic activity in JME
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
No intervention; 90% foreign bodies pass without difficulty

4. Neonatal unconjugated hyperbilirubine
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Bartonella henselae; complication is suppuration of lymph node
Decreased UGT enzyme
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

5. pumonary TB
Atopic dermatitis; strong allergic/immunologic component; incr IgE
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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)
No reticulocyte vs high reticulocyte

6. When to give hpv vaccien
Tx only symptomatic carrier
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Prolactinoma
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

7. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

8. How to difference RSV and neonatal chlamydia
Meconeum ileus; think about CF
T for t ; thalassemia; inc serum iron and Iron binding
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No wheezing - no feever in chlamydia

9. 21 hydroxylase
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Benign permature thelarche; expectant management
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

10. indications of audiometry in childrens
Methylephenidate toxicity; cannot be stopped abruptly; taper
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
24h to 7d of birth

11. pavlik harness
Risk of neurological dysfunction
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
To make hip flexed and abducted position in DDH
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

12. lead 44-70
Dx US tx; correct serum electrolyte - pyloromyotom
Foreign body sensation - photophobia - corneal opacity tx abx
Oral DMSA or EDTA IV
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

13. osler rendu weber syndrom
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
Multiple telangiectesia - vasular lesion in CNS
No wheezing - no feever in chlamydia

14. 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
Lateral neck xray in epiglottitis show swollen epiglottis
Imaging study to r/o VUR
No reticulocyte vs high reticulocyte

15. centor criteria for bact pharyngitis
Increase of pregnenolone
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

16. echymoses with low platelet <30k
Do HIV testing at first
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Injury to b/l glossopharyngeal. present in botulism
Female - breech delivery - family history; tx referral to ortho

17. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Pipercillin (zosyn) - ticarcillin
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
Medical emergency; dimercaprol/edta
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

18. How to dx RSV
Lateral neck xray in epiglottitis show swollen epiglottis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Rapid detection of RSV antigen in nasl

19. IM
Atypical lymphocyte
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

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

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21. major depression
No wheezing - no feever in chlamydia
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

22. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Benign permature thelarche; expectant management
24h to 7d of birth
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
36 hours

23. thumb sign
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Pho for forward bending; forward defect; common finding has no adverse physical effect
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

24. cardiac manifestation of turner
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Strep pneumonie; moraxella; h influenze
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

25. dx for turner
Erb paralysis leading to diaphragmatic paralysis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
INH 9m if INH resistant rifampin 6m in children and 4m in adults

26. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Bartonella henselae; complication is suppuration of lymph node
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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. sturge weber syndrome
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
24h to 7d of birth
Bladder dysfunction; UTI and renal dysfunctoin
Facial portwine stain

28. Tx of FTT
Diet modification to provide 110kc/kg/d
INH 9m if INH resistant rifampin 6m in children and 4m in adults
14yrs
Herpes

29. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
TB - breastfeeding - asymptomatic hiv
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

30. How to differentiate croup vs epiglotitis
Medical emergency; dimercaprol/edta
No myoclonic activity in JME
No wheezing - no feever in chlamydia
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

31. sudden onset of fever - difficulty in breathing
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Less than 5th percentile
Strep pneumonie; moraxella; h influenze

32. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Benign permature thelarche; expectant management
<2yrs - abd pain - diarrhoea - ARF
Central isosexual precocious puberty; hypothalmaic hamartoma

33. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Vaso-occlusive crisis; dx hb electrophoresis
Erb paralysis leading to diaphragmatic paralysis

34. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
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
110 kcl/kg/day
Strep pneumonie; moraxella; h influenze
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

35. How to dx endopthalmitis
Develops in 21 dasy
Candidal diapar rash; tx clotrimazol
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

36. barking cough - inspiratory stridor - hoarsenes - p/w few days after 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
Croup
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

37. difference between rubeola (measles) and rulbella
Lateral neck xray in epiglottitis show swollen epiglottis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
D for d; down syndrome and polyhydramnios
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

38. is local anesthetics be used in cellulitis to reduce pain
Do HIV testing at first
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
<2yrs - abd pain - diarrhoea - ARF
No; they are basic compound will be neutralized in an acidic environment of cellulitis

39. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
refuse
Vaso-occlusive crisis; dx hb electrophoresis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

40. sickle cell with symmetrical swelling of hands and feet
Constitutional pubertal delay
D for d; down syndrome and polyhydramnios
Methylephenidate toxicity; cannot be stopped abruptly; taper
Vaso-occlusive crisis; dx hb electrophoresis

41. How to evaluate well appearing child just born in GBS pos mother?
Erb paralysis leading to diaphragmatic paralysis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

42. 18mo bilat breast enlargment - some pubic hair
Diet modification to provide 110kc/kg/d
Benign permature thelarche; expectant management
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

43. tzanck
Herpes
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
Dactylitis; 2nd common is splenic seqestration
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

44. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Less than 5th percentile

45. When to give HRT in turner
D for d; down syndrome and polyhydramnios
14yrs
Croup
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

46. What is thumbprint sign
Penicillin G 4h before delivery
Methylephenidate toxicity; cannot be stopped abruptly; taper
Lateral neck xray in epiglottitis show swollen epiglottis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

47. penicillin effective against pseudomonas
Constitutional pubertal delay
Pipercillin (zosyn) - ticarcillin
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No reticulocyte vs high reticulocyte

48. splenic infarction in sickle cell
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Increase of progesteron/17oh progesterone
Faciform RBC cause vascular occlusion
Foreign body sensation - photophobia - corneal opacity tx abx

49. bromocriptine
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Prolactinoma
Injury to b/l glossopharyngeal. present in botulism
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

50. causes of acute anemia
Strep pneumonie; moraxella; h influenze
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
URI
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

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USMLE Step3 Pediatrics

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