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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. How to difference viral and bact pneumonia
Increase of progesteron/17oh progesterone
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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
Croup

2. HUS
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
<2yrs - abd pain - diarrhoea - ARF
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Strep pneumonie; moraxella; h influenze

3. How to evaluate well appearing child just born in GBS pos mother?
Brown
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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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)

4. IM
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Atypical lymphocyte

5. centor criteria for bact pharyngitis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

6. Tx of FTT
Diet modification to provide 110kc/kg/d
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Constitutional pubertal delay
To make hip flexed and abducted position in DDH

7. When to do surgery for undescended testes
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
HSP - look for symmetric skin lesions
Yes; but it will be less effective
Wait until 6 months

8. giardiasis
Brown
Tx only symptomatic carrier
After 24h of abx therapy
Black

9. cleft lip but no cleft palate
RSV - rhino and influenza
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
No wheezing - no feever in chlamydia
After 6m; breast mild provides iron until 6m.

10. Infant with serum billlirubin >25
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Risk of neurological dysfunction
24h to 7d of birth

11. can women with abnormal smear or genital get vaccine
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Atypical lymphocyte
Yes; but it will be less effective
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

12. causes of FTT
Between pregnenolone and 17oh pregnenolone
Decr calorie intake; decr calorie absorption;incr calorie demand
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Biliary atresia; tx surgery

13. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
RSV - rhino and influenza
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

14. decreased mobility of tympanic membrane after otitis media
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Tx only symptomatic carrier

15. How to difference RSV and neonatal chlamydia
D for d; down syndrome and polyhydramnios
No wheezing - no feever in chlamydia
110 kcl/kg/day
Absence seizure; tx ethosuximide

16. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Croup
Brown
Wait until 6 months

17. 17 alpha hydroxylase
Thalassemia - congenital hemolytic anemia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Between pregnenolone and 17oh pregnenolone

18. crying during urination. bacteriuria pyruria - rec episodes
Decreased UGT enzyme
Decreases height - expensive; reserved for severe cases of delayed puberty
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
Imaging study to r/o VUR

19. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Neurofibromatosis type2
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

20. What is the definition of delayed puberty?
Prolactinoma
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
RSV - rhino and influenza

21. if bone age lower than actual and puberty delayed
Pipercillin (zosyn) - ticarcillin
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Constitutional pubertal delay

22. How to dx post uretheral valve
Multiple telangiectesia - vasular lesion in CNS
Methylephenidate toxicity; cannot be stopped abruptly; taper
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Marfans - ehlers danlos - homocystinuria

23. how smoking contributes otitis media in children
ALL - alzheimers autism adhd depression seizure
Decr calorie intake; decr calorie absorption;incr calorie demand
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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

24. sublottic narrowing
Atypical lymphocyte
Multiple telangiectesia - vasular lesion in CNS
Croup tx cool mist; racemic epi - corticosteroid
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

25. When to do aortic root surgery in marfans to prevent dissection?
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
No; they are basic compound will be neutralized in an acidic environment of cellulitis
If aortic root reaches 45 mm

26. most common complication of otitis media
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
Constitutional pubertal delay
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

27. osler rendu weber syndrom
To make hip flexed and abducted position in DDH
Thalassemia - congenital hemolytic anemia
Multiple telangiectesia - vasular lesion in CNS
Faciform RBC cause vascular occlusion

28. When to give hpv vaccien
refuse
No reticulocyte vs high reticulocyte
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
<2yrs - abd pain - diarrhoea - ARF

29. sudden onset of fever - difficulty in breathing
TB - breastfeeding - asymptomatic hiv
Central isosexual precocious puberty; hypothalmaic hamartoma
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

30. nuchal rigidity - fever - sore throat - headache - dioriented
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)
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Bartonella henselae; complication is suppuration of lymph node

31. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Marfans - ehlers danlos - homocystinuria

32. acute otitis externa

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33. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Rapid detection of RSV antigen in nasl
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Yes; but it will be less effective

34. Parents can _____ vaccine
Strep pneumonie; moraxella; h influenze
24-72 hours
refuse
RSV - rhino and influenza

35. carditis and arthritis after rheumatic fever
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)
Between pregnenolone and 17oh pregnenolone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Develops in 21 dasy

36. How long patient needs to be exposed to tick to get infected
Mainly clinical; serology with initial ELISA - with western blot confirmation;
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
36 hours

37. mech of botulism
After 24h of abx therapy
14yrs
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Methylephenidate toxicity; cannot be stopped abruptly; taper

38. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
If aortic root reaches 45 mm
Penicillin G 4h before delivery
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
No intervention; 90% foreign bodies pass without difficulty

39. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Atypical lymphocyte
14yrs

40. sturge weber syndrome
Facial portwine stain
HSP - look for symmetric skin lesions
D for d; down syndrome and polyhydramnios
Dactylitis; 2nd common is splenic seqestration

41. is local anesthetics be used in cellulitis to reduce pain
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Injury to lower roots of brachial plexus
Oral DMSA or EDTA IV

42. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Risk of neurological dysfunction
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Candidal diapar rash; tx clotrimazol
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

43. iron supplement in child
Dactylitis; 2nd common is splenic seqestration
After 6m; breast mild provides iron until 6m.
RSV - rhino and influenza
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

44. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
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
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
To make hip flexed and abducted position in DDH

45. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Rapid detection of RSV antigen in nasl

46. Parvovirus
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)
Fifth disease; febrile syndrome
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
Oral DMSA or EDTA IV

47. What is thumbprint sign
36 hours
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Lateral neck xray in epiglottitis show swollen epiglottis

48. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
>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
Injury to lower roots of brachial plexus
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)
Methylephenidate toxicity; cannot be stopped abruptly; taper

49. When to give HRT in turner
Dx US tx; correct serum electrolyte - pyloromyotom
After 6m; breast mild provides iron until 6m.
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
14yrs

50. side effect of testosteron therapy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Decreases height - expensive; reserved for severe cases of delayed puberty
<2yrs - abd pain - diarrhoea - ARF