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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. Tx of children constipation

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2. bromocriptine
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
To make hip flexed and abducted position in DDH
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
Prolactinoma

3. How to prevent GBS in neonate
RSV - rhino and influenza
Penicillin G 4h before delivery
Pipercillin (zosyn) - ticarcillin
INH 9m if INH resistant rifampin 6m in children and 4m in adults

4. What is earliest sign of puberty?
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
If aortic root reaches 45 mm
To make hip flexed and abducted position in DDH

5. tick transmits lyme
Meconeum ileus; think about CF
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Brown
Black

6. indications of VUR
Strep pneumonie; moraxella; h influenze
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Croup tx cool mist; racemic epi - corticosteroid
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

7. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Erb paralysis leading to diaphragmatic paralysis
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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

8. centor criteria for bact pharyngitis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Increase of progesteron/17oh progesterone

9. tick transmits RMSF
Faciform RBC cause vascular occlusion
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Black
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

10. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Do HIV testing at first
Dactylitis; 2nd common is splenic seqestration
Croup
36 hours

11. mcCune albright`
Increase of pregnenolone
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Rapid detection of RSV antigen in nasl
Methylephenidate toxicity; cannot be stopped abruptly; taper

12. penicillin effective against pseudomonas
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Pipercillin (zosyn) - ticarcillin
INH 9m if INH resistant rifampin 6m in children and 4m in adults
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

13. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Less than 5th percentile
Black

14. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Bladder dysfunction; UTI and renal dysfunctoin
Pipercillin (zosyn) - ticarcillin
Meconeum ileus; think about CF
Increase of progesteron/17oh progesterone

15. causes of acute anemia
Lateral neck xray in epiglottitis show swollen epiglottis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
T for t ; thalassemia; inc serum iron and Iron binding
After 24h of abx therapy

16. How to dx post uretheral valve
36 hours
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Diet modification to provide 110kc/kg/d
Constitutional pubertal delay

17. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Croup

18. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Atypical lymphocyte
Vaso-occlusive crisis; dx hb electrophoresis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

19. the risk of lyme after bitten by a tick
No intervention; 90% foreign bodies pass without difficulty
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
24h to 7d of birth
1.5%

20. Tx of botulism
Between pregnenolone and 17oh pregnenolone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

21. contraindications of MMR vaccine
Croup
Faciform RBC cause vascular occlusion
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

22. difference between diaper dermatitis and rash
Marfans - ehlers danlos - homocystinuria
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
Less than 5th percentile
Strep pneumonie; moraxella; h influenze

23. when bact conjunctivitis patient can go back to school
Decreased UGT enzyme
After 24h of abx therapy
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
D for d; down syndrome and polyhydramnios

24. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
HSP - look for symmetric skin lesions

25. aplasic crisis
Dactylitis; 2nd common is splenic seqestration
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
After 24h of abx therapy

26. kallman syndrome
Rapid detection of RSV antigen in nasl
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

27. What is the calorie requirement of newborn?
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Endocardial cushion defect (no separation between heart chambers)
110 kcl/kg/day

28. down syndrome has inreased risk of developing
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
ALL - alzheimers autism adhd depression seizure
36 hours
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

29. viruses cause bronhioltitis
RSV - rhino and influenza
Biliary atresia; tx surgery
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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

30. Neonatal conjugated hyperbilirubinemia
T for t ; thalassemia; inc serum iron and Iron binding
Strep pneumonie; moraxella; h influenze
Biliary atresia; tx surgery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

31. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Vaso-occlusive crisis; dx hb electrophoresis
Neurofibromatosis type2
After 6m; breast mild provides iron until 6m.

32. indications of audiometry in childrens
URI
Medical emergency; dimercaprol/edta
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

33. thumb sign
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

34. sudden onset of fever - difficulty in breathing
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
TB - breastfeeding - asymptomatic hiv
Absence seizure; tx ethosuximide
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

35. deficinecy of 17 hydroxylase
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Increase of pregnenolone
Develops in 21 dasy
No intervention; 90% foreign bodies pass without difficulty

36. tuberous sclerosis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Central isosexual precocious puberty; hypothalmaic hamartoma
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

37. spitting up - vomiting at night - weight stable
Benign permature thelarche; expectant management
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

38. lead >70
1.5%
Methylephenidate toxicity; cannot be stopped abruptly; taper
Neurofibromatosis type2
Medical emergency; dimercaprol/edta

39. Parents can _____ vaccine
Less than 5th percentile
Oral DMSA or EDTA IV
Congenital rubella syndrome
refuse

40. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
14yrs
T for t ; thalassemia; inc serum iron and Iron binding
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

41. How to evaluate well appearing child just born in GBS pos mother?
Bladder dysfunction; UTI and renal dysfunctoin
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Risk of neurological dysfunction
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

42. complete airway obstruction with FB
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Decr calorie intake; decr calorie absorption;incr calorie demand
>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
Do HIV testing at first

43. dx of lyme
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Tx only symptomatic carrier
Mainly clinical; serology with initial ELISA - with western blot confirmation;
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

44. language expectation from 2yo
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
After 24h of abx therapy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

45. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Fifth disease; febrile syndrome
Risk of neurological dysfunction

46. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Injury to b/l glossopharyngeal. present in botulism
<2yrs - abd pain - diarrhoea - ARF
No myoclonic activity in JME

47. When erythema chronicum migrans develops after tick bite
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
24-72 hours
>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
Mainly clinical; serology with initial ELISA - with western blot confirmation;

48. Parvovirus
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
1.5%
Fifth disease; febrile syndrome
Foreign body sensation - photophobia - corneal opacity tx abx

49. 3yo - never able to walk
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
HSP - look for symmetric skin lesions
<2yrs - abd pain - diarrhoea - ARF

50. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Do HIV testing at first
Erb paralysis leading to diaphragmatic paralysis
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
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