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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 FTT
ALL - alzheimers autism adhd depression seizure
Between pregnenolone and 17oh pregnenolone
1.5%
Diet modification to provide 110kc/kg/d

2. indications of audiometry in childrens
After 24h of abx therapy
Atypical lymphocyte
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

3. adenovirus
URI
Increase of progesteron/17oh progesterone
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Dactylitis; 2nd common is splenic seqestration

4. Neonatal unconjugated hyperbilirubine
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Decreased UGT enzyme
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

5. duodenal atresia
Injury to b/l glossopharyngeal. present in botulism
Thalassemia - congenital hemolytic anemia
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
D for d; down syndrome and polyhydramnios

6. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
No reticulocyte vs high reticulocyte
Decreases height - expensive; reserved for severe cases of delayed puberty
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

7. microcytic - hypochromic anemia - hepatospelnomegaly
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
Thalassemia - congenital hemolytic anemia
Neurofibromatosis type2
Penicillin G 4h before delivery

8. failure to thrive
No myoclonic activity in JME
Less than 5th percentile
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

9. How to differentiate caput succedanueum and cephalohematoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No myoclonic activity in JME
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Candidal diapar rash; tx clotrimazol

10. Tx of community acquired pneumonia
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Rapid detection of RSV antigen in nasl
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

11. sudden onset of fever - difficulty in breathing
Decreased UGT enzyme
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

12. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

13. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
refuse
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

14. pavlik harness
Croup tx cool mist; racemic epi - corticosteroid
Fifth disease; febrile syndrome
To make hip flexed and abducted position in DDH
refuse

15. dx of lyme
Risk of neurological dysfunction
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Dx US tx; correct serum electrolyte - pyloromyotom

16. Neonatal conjugated hyperbilirubinemia
HSP - look for symmetric skin lesions
Central isosexual precocious puberty; hypothalmaic hamartoma
Biliary atresia; tx surgery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

17. IM
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Atypical lymphocyte
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Lateral neck xray in epiglottitis show swollen epiglottis

18. How to dx keratitis?
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
HSP - look for symmetric skin lesions
Foreign body sensation - photophobia - corneal opacity tx abx
Black

19. mech of botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
HSP - look for symmetric skin lesions
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Risk of neurological dysfunction

20. tick transmits RMSF
No wheezing - no feever in chlamydia
If aortic root reaches 45 mm
Black
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

21. cat scratch disease
Increase of pregnenolone
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bartonella henselae; complication is suppuration of lymph node

22. spitting up - vomiting at night - weight stable
URI
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
No myoclonic activity in JME

23. non immune pregnant women exposed to rubella in first trimester
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Facial portwine stain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Congenital rubella syndrome

24. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Thalassemia - congenital hemolytic anemia
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Injury to lower roots of brachial plexus

25. How to prevent GBS in neonate
If aortic root reaches 45 mm
14yrs
Penicillin G 4h before delivery
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

26. doing worse in school - lack of attention - starring speel
If aortic root reaches 45 mm
Absence seizure; tx ethosuximide
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

27. tick transmits lyme
Prolactinoma
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Wait until 6 months
Brown

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

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29. When erythema chronicum migrans develops after tick bite
After 6m; breast mild provides iron until 6m.
24-72 hours
Diet modification to provide 110kc/kg/d
Medical emergency; dimercaprol/edta

30. red oozing rash on cheek - scaly - dry
Do HIV testing at first
Imaging study to r/o VUR
Increase of pregnenolone
Atopic dermatitis; strong allergic/immunologic component; incr IgE

31. What are the risk factors of developmental dysplais of hip
Methylephenidate toxicity; cannot be stopped abruptly; taper
Croup
<2yrs - abd pain - diarrhoea - ARF
Female - breech delivery - family history; tx referral to ortho

32. giardiasis
Erb paralysis leading to diaphragmatic paralysis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Tx only symptomatic carrier
Strep pneumonie; moraxella; h influenze

33. causes of FTT
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

34. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Croup
Lateral neck xray in epiglottitis show swollen epiglottis
No; they are basic compound will be neutralized in an acidic environment of cellulitis

35. down syndrome with holocystolic mumur
HSP - look for symmetric skin lesions
Endocardial cushion defect (no separation between heart chambers)
110 kcl/kg/day
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

36. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Rapid detection of RSV antigen in nasl
Central isosexual precocious puberty; hypothalmaic hamartoma
Lateral neck xray in epiglottitis show swollen epiglottis

37. How to differential bact vs viral conjunctivitis
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
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
Injury to b/l glossopharyngeal. present in botulism
No reticulocyte vs high reticulocyte

38. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
No; they are basic compound will be neutralized in an acidic environment of cellulitis
RSV - rhino and influenza

39. pumonary TB
Black
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
<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)

40. language expectation from 2yo
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Injury to lower roots of brachial plexus
Biliary atresia; tx surgery

41. language delay
Marfans - ehlers danlos - homocystinuria
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
T for t ; thalassemia; inc serum iron and Iron binding
36 hours

42. 12y - obese - hip pain - hip ext rotated
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)
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Wait until 6 months

43. Tx of botulism
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No myoclonic activity in JME
Penicillin G 4h before delivery

44. how thalassemia die
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Candidal diapar rash; tx clotrimazol
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

45. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
URI
Wait until 6 months

46. How to dx post uretheral valve
Thalassemia - congenital hemolytic anemia
Female - breech delivery - family history; tx referral to ortho
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

47. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Between pregnenolone and 17oh pregnenolone
Atypical lymphocyte
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

48. complication of lumbosacral meningocele
Methylephenidate toxicity; cannot be stopped abruptly; taper
Congenital rubella syndrome
After 6m; breast mild provides iron until 6m.
Bladder dysfunction; UTI and renal dysfunctoin

49. hypopigmented spots - family hx bilat deafness
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
24-72 hours
Neurofibromatosis type2
Thalassemia - congenital hemolytic anemia

50. dx for DDH
Thalassemia - congenital hemolytic anemia
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry