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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. What is the most common initial symptom in sickle cell
14yrs
Dactylitis; 2nd common is splenic seqestration
Marfans - ehlers danlos - homocystinuria
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

2. target cell
Benign permature thelarche; expectant management
Pipercillin (zosyn) - ticarcillin
T for t ; thalassemia; inc serum iron and Iron binding
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

3. centor criteria for bact pharyngitis
Faciform RBC cause vascular occlusion
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
After 6m; breast mild provides iron until 6m.

4. How to dx acute angle closure glaucoma
Lateral neck xray in epiglottitis show swollen epiglottis
No reticulocyte vs high reticulocyte
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

5. Tx of children constipation

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6. When to do aortic root surgery in marfans to prevent dissection?
RSV - rhino and influenza
If aortic root reaches 45 mm
D for d; down syndrome and polyhydramnios
Prolactinoma

7. how smoking contributes otitis media in children
Black
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Injury to lower roots of brachial plexus
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

8. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
No wheezing - no feever in chlamydia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Methylephenidate toxicity; cannot be stopped abruptly; taper
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

9. low grade fever - cough - diffuse bilat ground glass opacities
INH 9m if INH resistant rifampin 6m in children and 4m in adults
RSV - rhino and influenza
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

10. 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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Vaso-occlusive crisis; dx hb electrophoresis

11. major depression
Vaso-occlusive crisis; dx hb electrophoresis
Imaging study to r/o VUR
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Injury to b/l glossopharyngeal. present in botulism

12. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Candidal diapar rash; tx clotrimazol
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Diet modification to provide 110kc/kg/d
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

13. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
To make hip flexed and abducted position in DDH
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Erb paralysis leading to diaphragmatic paralysis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

14. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Decreases height - expensive; reserved for severe cases of delayed puberty

15. How to difference viral and bact pneumonia
Facial portwine stain
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Fifth disease; febrile syndrome
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

16. Parents can _____ vaccine
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
If aortic root reaches 45 mm
INH 9m if INH resistant rifampin 6m in children and 4m in adults
refuse

17. How to dx RSV
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Rapid detection of RSV antigen in nasl
Dx US tx; correct serum electrolyte - pyloromyotom
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

18. sudden onset of fever - difficulty in breathing
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Oral DMSA or EDTA IV
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

19. Parvovirus
Fifth disease; febrile syndrome
Congenital rubella syndrome
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
14yrs

20. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Risk of neurological dysfunction
Croup tx cool mist; racemic epi - corticosteroid
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Croup

21. contraindications of MMR vaccine
No wheezing - no feever in chlamydia
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
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

22. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
D for d; down syndrome and polyhydramnios
Croup

23. causes of FTT
Risk of neurological dysfunction
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Multiple telangiectesia - vasular lesion in CNS

24. 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
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

25. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Develops in 21 dasy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

26. deficinecy of 17 hydroxylase
URI
Increase of pregnenolone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

27. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

28. language delay
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Tx only symptomatic carrier
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

29. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Increase of pregnenolone
Constitutional pubertal delay
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

30. viruses cause bronhioltitis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
RSV - rhino and influenza

31. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
D for d; down syndrome and polyhydramnios
Herpes
Candidal diapar rash; tx clotrimazol
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

32. lens dislocation
Bladder dysfunction; UTI and renal dysfunctoin
Marfans - ehlers danlos - homocystinuria
Less than 5th percentile
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

33. bromocriptine
Multiple telangiectesia - vasular lesion in CNS
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Prolactinoma
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

34. IM
Decreases height - expensive; reserved for severe cases of delayed puberty
Atypical lymphocyte
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Female - breech delivery - family history; tx referral to ortho

35. difference between breast milk and breafeeding jaundice
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Bartonella henselae; complication is suppuration of lymph node
Diet modification to provide 110kc/kg/d
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

36. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Yes; but it will be less effective
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

37. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Methylephenidate toxicity; cannot be stopped abruptly; taper
Strep pneumonie; moraxella; h influenze

38. pneumonia in CF patient
Fifth disease; febrile syndrome
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
>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. carditis and arthritis after rheumatic fever
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Develops in 21 dasy
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

40. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
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
No wheezing - no feever in chlamydia
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

41. giardiasis
Pipercillin (zosyn) - ticarcillin
Tx only symptomatic carrier
1.5%
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

42. if bone age lower than actual and puberty delayed
Decreased UGT enzyme
Constitutional pubertal delay
Vaso-occlusive crisis; dx hb electrophoresis
Risk of neurological dysfunction

43. difference between rubeola (measles) and rulbella
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Bartonella henselae; complication is suppuration of lymph node
Multiple telangiectesia - vasular lesion in CNS
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

44. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Decreased UGT enzyme
T for t ; thalassemia; inc serum iron and Iron binding

45. adrenal tumor
Vaso-occlusive crisis; dx hb electrophoresis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

46. How to differentiate caput succedanueum and cephalohematoma
If aortic root reaches 45 mm
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Marfans - ehlers danlos - homocystinuria

47. difference between diaper dermatitis and rash
Faciform RBC cause vascular occlusion
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
Benign permature thelarche; expectant management
No reticulocyte vs high reticulocyte

48. dx for DDH
Candidal diapar rash; tx clotrimazol
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Decr calorie intake; decr calorie absorption;incr calorie demand

49. lead >70
Medical emergency; dimercaprol/edta
36 hours
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
1.5%

50. dx of lyme
No intervention; 90% foreign bodies pass without difficulty
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
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Risk of neurological dysfunction