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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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Answer 50 questions in 15 minutes.
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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. When erythema chronicum migrans develops after tick bite
24-72 hours
Croup
No reticulocyte vs high reticulocyte
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

2. lens dislocation
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Marfans - ehlers danlos - homocystinuria
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

3. when bact conjunctivitis patient can go back to school
Increase of progesteron/17oh progesterone
Bladder dysfunction; UTI and renal dysfunctoin
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
After 24h of abx therapy

4. down syndrome has inreased risk of developing
Strep pneumonie; moraxella; h influenze
Biliary atresia; tx surgery
Diet modification to provide 110kc/kg/d
ALL - alzheimers autism adhd depression seizure

5. carditis and arthritis after rheumatic fever
Develops in 21 dasy
If aortic root reaches 45 mm
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

6. flexible kyphosis
TB - breastfeeding - asymptomatic hiv
Medical emergency; dimercaprol/edta
Increase of pregnenolone
Pho for forward bending; forward defect; common finding has no adverse physical effect

7. bromocriptine
Prolactinoma
Pho for forward bending; forward defect; common finding has no adverse physical effect
Absence seizure; tx ethosuximide
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

8. iron supplement in child
After 6m; breast mild provides iron until 6m.
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
14yrs
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

9. sudden onset of fever - difficulty in breathing
T for t ; thalassemia; inc serum iron and Iron binding
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

10. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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
Faciform RBC cause vascular occlusion
Imaging study to r/o VUR

11. dx for DDH
RSV - rhino and influenza
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

12. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Central isosexual precocious puberty; hypothalmaic hamartoma
Croup
No myoclonic activity in JME

13. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

14. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Between pregnenolone and 17oh pregnenolone
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

15. pavlik harness
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Decr calorie intake; decr calorie absorption;incr calorie demand
To make hip flexed and abducted position in DDH
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

16. What are the risk factors of developmental dysplais of hip
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Female - breech delivery - family history; tx referral to ortho

17. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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
Do HIV testing at first
Croup tx cool mist; racemic epi - corticosteroid

18. When to bevioral and enviromental measure in led intoxication?
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
INH 9m if INH resistant rifampin 6m in children and 4m in adults
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Bartonella henselae; complication is suppuration of lymph node

19. mcCune albright`
D for d; down syndrome and polyhydramnios
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

20. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Less than 5th percentile
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
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

21. What is the definition of delayed puberty?
Congenital rubella syndrome
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

22. centor criteria for bact pharyngitis
Fifth disease; febrile syndrome
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Methylephenidate toxicity; cannot be stopped abruptly; taper

23. how smoking contributes otitis media in children
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Thalassemia - congenital hemolytic anemia
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

24. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No intervention; 90% foreign bodies pass without difficulty
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Imaging study to r/o VUR

25. IM
No wheezing - no feever in chlamydia
Imaging study to r/o VUR
Atypical lymphocyte
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

26. How to difference RSV and neonatal chlamydia
HSP - look for symmetric skin lesions
Medical emergency; dimercaprol/edta
Vaso-occlusive crisis; dx hb electrophoresis
No wheezing - no feever in chlamydia

27. How long patient needs to be exposed to tick to get infected
After 6m; breast mild provides iron until 6m.
Penicillin G 4h before delivery
36 hours
Decreases height - expensive; reserved for severe cases of delayed puberty

28. if bone age lower than actual and puberty delayed
After 24h of abx therapy
Constitutional pubertal delay
Congenital rubella syndrome
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

29. 17 alpha hydroxylase
Mainly clinical; serology with initial ELISA - with western blot confirmation;
URI
HSP - look for symmetric skin lesions
Between pregnenolone and 17oh pregnenolone

30. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Croup
After 24h of abx therapy
Bladder dysfunction; UTI and renal dysfunctoin

31. 12y - obese - hip pain - hip ext rotated
Methylephenidate toxicity; cannot be stopped abruptly; taper
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Brown
Herpes

32. complete airway obstruction with FB
>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
Dx US tx; correct serum electrolyte - pyloromyotom
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Faciform RBC cause vascular occlusion

33. the risk of lyme after bitten by a tick
1.5%
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Rapid detection of RSV antigen in nasl

34. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Rapid detection of RSV antigen in nasl
Meconeum ileus; think about CF
Endocardial cushion defect (no separation between heart chambers)

35. tick transmits lyme
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
1.5%
Brown
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

36. Tx of children constipation

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37. cardiac manifestation of turner
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

38. side effect of testosteron therapy
14yrs
URI
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Decreases height - expensive; reserved for severe cases of delayed puberty

39. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
D for d; down syndrome and polyhydramnios
Bladder dysfunction; UTI and renal dysfunctoin
No reticulocyte vs high reticulocyte
If aortic root reaches 45 mm

40. target cell
24-72 hours
T for t ; thalassemia; inc serum iron and Iron binding
110 kcl/kg/day
Yes; but it will be less effective

41. low grade fever - cough - diffuse bilat ground glass opacities
Bartonella henselae; complication is suppuration of lymph node
Croup
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Foreign body sensation - photophobia - corneal opacity tx abx

42. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
110 kcl/kg/day
No reticulocyte vs high reticulocyte

43. patient with white plaques in mouth and lump in back
Erb paralysis leading to diaphragmatic paralysis
Do HIV testing at first
Dx US tx; correct serum electrolyte - pyloromyotom
After 6m; breast mild provides iron until 6m.

44. language delay
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to b/l glossopharyngeal. present in botulism
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Increase of pregnenolone

45. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

46. starring spells 10-20sec
Imaging study to r/o VUR
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Strep pneumonie; moraxella; h influenze
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

47. sublottic narrowing
14yrs
After 6m; breast mild provides iron until 6m.
Decr calorie intake; decr calorie absorption;incr calorie demand
Croup tx cool mist; racemic epi - corticosteroid

48. decreased mobility of tympanic membrane after otitis media
Biliary atresia; tx surgery
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) -
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

49. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Rapid detection of RSV antigen in nasl
Between pregnenolone and 17oh pregnenolone
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

50. How to dx post uretheral valve
refuse
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

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USMLE Step3 Pediatrics

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