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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.
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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. contact lens keratitis
T for t ; thalassemia; inc serum iron and Iron binding
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Increase of pregnenolone
36 hours

2. Neonatal conjugated hyperbilirubinemia
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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

3. adenovirus
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Pho for forward bending; forward defect; common finding has no adverse physical effect
URI
If aortic root reaches 45 mm

4. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Foreign body sensation - photophobia - corneal opacity tx abx
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

5. How to difference viral and bact pneumonia
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
To make hip flexed and abducted position in DDH
After 24h of abx therapy
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

6. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Croup tx cool mist; racemic epi - corticosteroid
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No reticulocyte vs high reticulocyte

7. benefits of antibiotic therapy in acute pharyngitis?
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
No intervention; 90% foreign bodies pass without difficulty
After 6m; breast mild provides iron until 6m.

8. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Do HIV testing at first
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

9. infantile hypertrophic pyloric stenosis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Dx US tx; correct serum electrolyte - pyloromyotom
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

10. How to dx acute angle closure glaucoma
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Faciform RBC cause vascular occlusion
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
No wheezing - no feever in chlamydia

11. congenital adrenal hyperplasi
Yes; but it will be less effective
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

12. 17 alpha hydroxylase
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Between pregnenolone and 17oh pregnenolone
Decreased UGT enzyme
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

13. dx of lyme
>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
Benign permature thelarche; expectant management
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Mainly clinical; serology with initial ELISA - with western blot confirmation;

14. pumonary TB
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)
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Benign permature thelarche; expectant management
Absence seizure; tx ethosuximide

15. cat scratch disease
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Absence seizure; tx ethosuximide
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Bartonella henselae; complication is suppuration of lymph node

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

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17. TB prophylaxis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

18. Neonatal unconjugated hyperbilirubine
36 hours
Prolactinoma
110 kcl/kg/day
Decreased UGT enzyme

19. impaired gag reflex
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Injury to b/l glossopharyngeal. present in botulism
Candidal diapar rash; tx clotrimazol
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

20. when bact conjunctivitis patient can go back to school
Prolactinoma
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Thalassemia - congenital hemolytic anemia
After 24h of abx therapy

21. What is the calorie requirement of newborn?
Bladder dysfunction; UTI and renal dysfunctoin
No; they are basic compound will be neutralized in an acidic environment of cellulitis
110 kcl/kg/day
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

22. 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
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
Pho for forward bending; forward defect; common finding has no adverse physical effect
Faciform RBC cause vascular occlusion

23. Parvovirus
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Fifth disease; febrile syndrome
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

24. How to differential bact vs viral conjunctivitis
Marfans - ehlers danlos - homocystinuria
Foreign body sensation - photophobia - corneal opacity tx abx
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

25. How to investigate delayed puberty
Dx US tx; correct serum electrolyte - pyloromyotom
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Congenital rubella syndrome

26. What are the risk factors of developmental dysplais of hip
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Female - breech delivery - family history; tx referral to ortho

27. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Lateral neck xray in epiglottitis show swollen epiglottis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Diet modification to provide 110kc/kg/d

28. complication of lumbosacral meningocele
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Erb paralysis leading to diaphragmatic paralysis
No wheezing - no feever in chlamydia
Bladder dysfunction; UTI and renal dysfunctoin

29. can women with abnormal smear or genital get vaccine
TB - breastfeeding - asymptomatic hiv
Yes; but it will be less effective
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Decreased UGT enzyme

30. splenic infarction in sickle cell
Multiple telangiectesia - vasular lesion in CNS
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Faciform RBC cause vascular occlusion
Strep pneumonie; moraxella; h influenze

31. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Endocardial cushion defect (no separation between heart chambers)

32. sickle cell with symmetrical swelling of hands and feet
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Vaso-occlusive crisis; dx hb electrophoresis
Injury to lower roots of brachial plexus
Oral DMSA or EDTA IV

33. side effect of testosteron therapy
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Decreases height - expensive; reserved for severe cases of delayed puberty

34. major depression
ALL - alzheimers autism adhd depression seizure
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Decreased UGT enzyme
Absence seizure; tx ethosuximide

35. HUS
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
To make hip flexed and abducted position in DDH
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
<2yrs - abd pain - diarrhoea - ARF

36. tick transmits lyme
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Biliary atresia; tx surgery
Brown
If aortic root reaches 45 mm

37. 18mo bilat breast enlargment - some pubic hair
Prolactinoma
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
<2yrs - abd pain - diarrhoea - ARF
Benign permature thelarche; expectant management

38. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Herpes

39. aplasic crisis
HSP - look for symmetric skin lesions
Constitutional pubertal delay
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

40. tick transmits RMSF
36 hours
Black
Injury to b/l glossopharyngeal. present in botulism
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

41. How to evaluate well appearing child just born in GBS pos mother?
Oral DMSA or EDTA IV
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

42. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Risk of neurological dysfunction
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

43. pneumonia in CF patient
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

44. difference between breast milk and breafeeding jaundice
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
Medical emergency; dimercaprol/edta
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Benign permature thelarche; expectant management

45. How long anti-TB drugs given for TB meningitis?
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Between pregnenolone and 17oh pregnenolone
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

46. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Benign permature thelarche; expectant management

47. failure to thrive
Less than 5th percentile
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Yes; but it will be less effective
Prolactinoma

48. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Black
No myoclonic activity in JME
Dx US tx; correct serum electrolyte - pyloromyotom

49. When to do aortic root surgery in marfans to prevent dissection?
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
After 6m; breast mild provides iron until 6m.
Decreased UGT enzyme
If aortic root reaches 45 mm

50. adrenal tumor
Rapid detection of RSV antigen in nasl
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Diet modification to provide 110kc/kg/d
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)