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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. hypopigmented spots - family hx bilat deafness
Croup
Neurofibromatosis type2
No reticulocyte vs high reticulocyte
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

2. When to do aortic root surgery in marfans to prevent dissection?
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Diet modification to provide 110kc/kg/d
refuse
If aortic root reaches 45 mm

3. causes of acute anemia
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Injury to b/l glossopharyngeal. present in botulism

4. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Develops in 21 dasy
Thalassemia - congenital hemolytic anemia
<2yrs - abd pain - diarrhoea - ARF

5. How to differential bact vs viral conjunctivitis
Endocardial cushion defect (no separation between heart chambers)
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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
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

6. horner syndrom
Injury to lower roots of brachial plexus
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

7. lead >70
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Medical emergency; dimercaprol/edta

8. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

9. can women with abnormal smear or genital get vaccine
Central isosexual precocious puberty; hypothalmaic hamartoma
Diet modification to provide 110kc/kg/d
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Yes; but it will be less effective

10. Nocturnal enuresis
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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Dx US tx; correct serum electrolyte - pyloromyotom

11. complete airway obstruction with FB
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Do HIV testing at first
Medical emergency; dimercaprol/edta
>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. side effect of testosteron therapy
24h to 7d of birth
Thalassemia - congenital hemolytic anemia
Decreases height - expensive; reserved for severe cases of delayed puberty
Brown

13. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
RSV - rhino and influenza
Less than 5th percentile
1.5%

14. microcytic - hypochromic anemia - hepatospelnomegaly
ALL - alzheimers autism adhd depression seizure
Thalassemia - congenital hemolytic anemia
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

15. the risk of lyme after bitten by a tick
Atopic dermatitis; strong allergic/immunologic component; incr IgE
1.5%
Bladder dysfunction; UTI and renal dysfunctoin
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

16. contraindications of DTap
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
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
After 24h of abx therapy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

17. impaired gag reflex
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Injury to b/l glossopharyngeal. present in botulism

18. acute otitis externa

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19. lens dislocation
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Marfans - ehlers danlos - homocystinuria

20. down syndrome with holocystolic mumur
Yes; but it will be less effective
24-72 hours
Endocardial cushion defect (no separation between heart chambers)
Croup

21. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Increase of progesteron/17oh progesterone
Pipercillin (zosyn) - ticarcillin
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

22. How to dx acute angle closure glaucoma
24-72 hours
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

23. target cell
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
T for t ; thalassemia; inc serum iron and Iron binding
Diet modification to provide 110kc/kg/d
Central isosexual precocious puberty; hypothalmaic hamartoma

24. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
T for t ; thalassemia; inc serum iron and Iron binding
If aortic root reaches 45 mm
Benign permature thelarche; expectant management

25. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
No intervention; 90% foreign bodies pass without difficulty
Faciform RBC cause vascular occlusion
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

26. thumb sign
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
HSP - look for symmetric skin lesions
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

27. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
TB - breastfeeding - asymptomatic hiv
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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

28. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
<2yrs - abd pain - diarrhoea - ARF
No wheezing - no feever in chlamydia
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

29. doing worse in school - lack of attention - starring speel
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Endocardial cushion defect (no separation between heart chambers)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Absence seizure; tx ethosuximide

30. When to give HRT in turner
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
14yrs
Lateral neck xray in epiglottitis show swollen epiglottis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

31. iron supplement in child
After 6m; breast mild provides iron until 6m.
Increase of pregnenolone
Oral DMSA or EDTA IV
No intervention; 90% foreign bodies pass without difficulty

32. sublottic narrowing
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Croup tx cool mist; racemic epi - corticosteroid
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Atopic dermatitis; strong allergic/immunologic component; incr IgE

33. What is the calorie requirement of newborn?
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
refuse
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
110 kcl/kg/day

34. indications of audiometry in childrens
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

35. physiological jaundice
Erb paralysis leading to diaphragmatic paralysis
24h to 7d of birth
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Brown

36. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Dx US tx; correct serum electrolyte - pyloromyotom
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

37. Febrile seizure
Imaging study to r/o VUR
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

38. 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
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
No myoclonic activity in JME
Thalassemia - congenital hemolytic anemia

39. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Diet modification to provide 110kc/kg/d
HSP - look for symmetric skin lesions
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

40. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Develops in 21 dasy
Rapid detection of RSV antigen in nasl
Meconeum ileus; think about CF

41. 3yo - never able to walk
Central isosexual precocious puberty; hypothalmaic hamartoma
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
Lateral neck xray in epiglottitis show swollen epiglottis
ALL - alzheimers autism adhd depression seizure

42. HUS
<2yrs - abd pain - diarrhoea - ARF
>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
After 24h of abx therapy
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

43. difference between structural disorder and flexible kyphosis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Herpes
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

44. causes of FTT
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Penicillin G 4h before delivery
Decr calorie intake; decr calorie absorption;incr calorie demand
1.5%

45. giardiasis
Penicillin G 4h before delivery
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Tx only symptomatic carrier

46. 3yo - febrile - left hip externally rotated
Neurofibromatosis type2
No wheezing - no feever in chlamydia
Croup
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

47. contact lens keratitis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

48. splenic infarction in sickle cell
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Faciform RBC cause vascular occlusion
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Meconeum ileus; think about CF

49. pneumonia in CF patient
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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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

50. red oozing rash on cheek - scaly - dry
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE