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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. is local anesthetics be used in cellulitis to reduce pain
Less than 5th percentile
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bladder dysfunction; UTI and renal dysfunctoin

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

3. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
24h to 7d of birth

4. What is thumbprint sign
If aortic root reaches 45 mm
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Lateral neck xray in epiglottitis show swollen epiglottis
Injury to b/l glossopharyngeal. present in botulism

5. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Congenital rubella syndrome
Diet modification to provide 110kc/kg/d
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

6. the recommended ca supplementation
Increase of pregnenolone
Herpes
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Absence seizure; tx ethosuximide

7. difference between rubeola (measles) and rulbella
Pipercillin (zosyn) - ticarcillin
RSV - rhino and influenza
110 kcl/kg/day
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

8. major depression
Congenital rubella syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

9. penicillin effective against pseudomonas
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Female - breech delivery - family history; tx referral to ortho
Risk of neurological dysfunction
Pipercillin (zosyn) - ticarcillin

10. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
36 hours
Increase of pregnenolone
Biliary atresia; tx surgery

11. 21 hydroxylase
Black
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

12. acute abd pain - hx URI - lower extremity maculo papular rash
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
T for t ; thalassemia; inc serum iron and Iron binding
HSP - look for symmetric skin lesions

13. dx of lyme
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pho for forward bending; forward defect; common finding has no adverse physical effect
Injury to b/l glossopharyngeal. present in botulism

14. When to give hpv vaccien
Rapid detection of RSV antigen in nasl
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Female - breech delivery - family history; tx referral to ortho
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

15. 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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Atypical lymphocyte

16. osler rendu weber syndrom
RSV - rhino and influenza
24-72 hours
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Multiple telangiectesia - vasular lesion in CNS

17. patient with white plaques in mouth and lump in back
Erb paralysis leading to diaphragmatic paralysis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Do HIV testing at first
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

18. What is earliest sign of puberty?
Black
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Croup tx cool mist; racemic epi - corticosteroid

19. Infant with serum billlirubin >25
Thalassemia - congenital hemolytic anemia
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Risk of neurological dysfunction
No reticulocyte vs high reticulocyte

20. IM
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Atypical lymphocyte
Candidal diapar rash; tx clotrimazol
After 6m; breast mild provides iron until 6m.

21. tzanck
ALL - alzheimers autism adhd depression seizure
24-72 hours
Herpes
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

22. thumb sign
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

23. Tx of community acquired pneumonia
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
No reticulocyte vs high reticulocyte
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

24. horner syndrom
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Injury to lower roots of brachial plexus
Brown

25. indications of audiometry in childrens
Vaso-occlusive crisis; dx hb electrophoresis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
After 6m; breast mild provides iron until 6m.
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

26. acute otitis externa

27. hypopigmented spots - family hx bilat deafness
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Neurofibromatosis type2
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

28. impaired gag reflex
URI
Pho for forward bending; forward defect; common finding has no adverse physical effect
Wait until 6 months
Injury to b/l glossopharyngeal. present in botulism

29. sturge weber syndrome
Pipercillin (zosyn) - ticarcillin
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Facial portwine stain
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

30. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

31. red oozing rash on cheek - scaly - dry
14yrs
T for t ; thalassemia; inc serum iron and Iron binding
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

32. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Biliary atresia; tx surgery
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

33. How to prevent GBS in neonate
Penicillin G 4h before delivery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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

34. sublottic narrowing
Injury to b/l glossopharyngeal. present in botulism
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Croup tx cool mist; racemic epi - corticosteroid
Endocardial cushion defect (no separation between heart chambers)

35. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Thalassemia - congenital hemolytic anemia
Injury to b/l glossopharyngeal. present in botulism

36. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Increase of pregnenolone
110 kcl/kg/day
Increase of progesteron/17oh progesterone

37. low grade fever - cough - diffuse bilat ground glass opacities
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
After 24h of abx therapy
1.5%

38. difference between diaper dermatitis and rash
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
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
Facial portwine stain

39. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Fifth disease; febrile syndrome

40. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Erb paralysis leading to diaphragmatic paralysis
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

41. aplasic crisis
14yrs
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

42. adenovirus
Endocardial cushion defect (no separation between heart chambers)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
URI
Thalassemia - congenital hemolytic anemia

43. When to bevioral and enviromental measure in led intoxication?
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Marfans - ehlers danlos - homocystinuria
>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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

44. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Pho for forward bending; forward defect; common finding has no adverse physical effect
No reticulocyte vs high reticulocyte
Decr calorie intake; decr calorie absorption;incr calorie demand
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

45. coin in child's stomach
36 hours
No intervention; 90% foreign bodies pass without difficulty
Erb paralysis leading to diaphragmatic paralysis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

46. duodenal atresia
Constitutional pubertal delay
D for d; down syndrome and polyhydramnios
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

47. How to dx keratitis?
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
Foreign body sensation - photophobia - corneal opacity tx abx
Between pregnenolone and 17oh pregnenolone
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

48. cardiac manifestation of turner
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

49. How to differentiate caput succedanueum and cephalohematoma
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
No intervention; 90% foreign bodies pass without difficulty
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
RSV - rhino and influenza

50. When to give HRT in turner
Atopic dermatitis; strong allergic/immunologic component; incr IgE
>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
14yrs
Decresed visio - sudden onset - seeing halos around light - headache - eye pain