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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. When to give hpv vaccien
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
Penicillin G 4h before delivery
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

2. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Absence seizure; tx ethosuximide
Injury to b/l glossopharyngeal. present in botulism
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

3. failure to thrive
Pipercillin (zosyn) - ticarcillin
Multiple telangiectesia - vasular lesion in CNS
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Less than 5th percentile

4. bromocriptine
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Prolactinoma
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Do HIV testing at first

5. sturge weber syndrome
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
Facial portwine stain
Croup tx cool mist; racemic epi - corticosteroid
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

6. how smoking contributes otitis media in children
24h to 7d of birth
RSV - rhino and influenza
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

7. nuchal rigidity - fever - sore throat - headache - dioriented
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Brown

8. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Congenital rubella syndrome

9. When to do surgery for undescended testes
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
D for d; down syndrome and polyhydramnios
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Wait until 6 months

10. Tx of botulism
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Methylephenidate toxicity; cannot be stopped abruptly; taper

11. osler rendu weber syndrom
Herpes
Imaging study to r/o VUR
Multiple telangiectesia - vasular lesion in CNS
Fifth disease; febrile syndrome

12. IM
URI
Candidal diapar rash; tx clotrimazol
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Atypical lymphocyte

13. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
TB - breastfeeding - asymptomatic hiv
Female - breech delivery - family history; tx referral to ortho
Decreases height - expensive; reserved for severe cases of delayed puberty

14. Tx of children constipation

15. How to difference viral and bact pneumonia
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
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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

16. association with infantile pyloric stenosis
Oral DMSA or EDTA IV
Develops in 21 dasy
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

17. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
1.5%
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
TB - breastfeeding - asymptomatic hiv

18. Tx of bact conjunctivitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Candidal diapar rash; tx clotrimazol
Oral DMSA or EDTA IV
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

19. dx for turner
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Black
Biliary atresia; tx surgery
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

20. 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
Decr calorie intake; decr calorie absorption;incr calorie demand
HSP - look for symmetric skin lesions
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

21. adrenal tumor
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Herpes
Candidal diapar rash; tx clotrimazol
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

22. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
After 24h of abx therapy
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Prolactinoma

23. coin in child's stomach
After 6m; breast mild provides iron until 6m.
URI
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
No intervention; 90% foreign bodies pass without difficulty

24. if bone age lower than actual and puberty delayed
refuse
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Constitutional pubertal delay
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

25. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
No myoclonic activity in JME
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

26. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Rapid detection of RSV antigen in nasl
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

27. How long anti-TB drugs given for TB meningitis?
Benign permature thelarche; expectant management
Central isosexual precocious puberty; hypothalmaic hamartoma
>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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

28. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Marfans - ehlers danlos - homocystinuria
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Candidal diapar rash; tx clotrimazol
Decr calorie intake; decr calorie absorption;incr calorie demand

29. 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
<2yrs - abd pain - diarrhoea - ARF
RSV - rhino and influenza
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

30. Parvovirus
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Fifth disease; febrile syndrome
Benign permature thelarche; expectant management
>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

31. pavlik harness
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
To make hip flexed and abducted position in DDH
Absence seizure; tx ethosuximide

32. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Oral DMSA or EDTA IV
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
After 6m; breast mild provides iron until 6m.
Erb paralysis leading to diaphragmatic paralysis

33. differentiate between central and peripheral precocious puberty
ALL - alzheimers autism adhd depression seizure
Wait until 6 months
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Medical emergency; dimercaprol/edta

34. contact lens keratitis
Strep pneumonie; moraxella; h influenze
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Oral DMSA or EDTA IV

35. HUS
<2yrs - abd pain - diarrhoea - ARF
Pipercillin (zosyn) - ticarcillin
Croup tx cool mist; racemic epi - corticosteroid
Biliary atresia; tx surgery

36. down syndrome has inreased risk of developing
Bladder dysfunction; UTI and renal dysfunctoin
ALL - alzheimers autism adhd depression seizure
Pipercillin (zosyn) - ticarcillin
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

37. 17 alpha hydroxylase
Medical emergency; dimercaprol/edta
Between pregnenolone and 17oh pregnenolone
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
Dactylitis; 2nd common is splenic seqestration

38. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

39. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
24-72 hours
Increase of progesteron/17oh progesterone
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

40. contraindications of DTap
Candidal diapar rash; tx clotrimazol
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Yes; but it will be less effective

41. 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
refuse
Increase of pregnenolone
Atypical lymphocyte

42. How to differentiate croup vs epiglotitis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Penicillin G 4h before delivery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

43. difference between diaper dermatitis and rash
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
Pipercillin (zosyn) - ticarcillin
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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

44. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

45. How to differential bact vs viral conjunctivitis
Central isosexual precocious puberty; hypothalmaic hamartoma
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No intervention; 90% foreign bodies pass without difficulty
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

46. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
D for d; down syndrome and polyhydramnios
Candidal diapar rash; tx clotrimazol
ALL - alzheimers autism adhd depression seizure

47. indications of VUR
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Oral DMSA or EDTA IV

48. complete airway obstruction with FB
Bartonella henselae; complication is suppuration of lymph node
Candidal diapar rash; tx clotrimazol
>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
No wheezing - no feever in chlamydia

49. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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

50. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Female - breech delivery - family history; tx referral to ortho
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination