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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 erythema chronicum migrans develops after tick bite
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
24-72 hours
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

2. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

3. How to differentiate croup vs epiglotitis
Increase of progesteron/17oh progesterone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

4. Infant with serum billlirubin >25
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Vaso-occlusive crisis; dx hb electrophoresis
Risk of neurological dysfunction
Thalassemia - congenital hemolytic anemia

5. patient with white plaques in mouth and lump in back
Bladder dysfunction; UTI and renal dysfunctoin
Risk of neurological dysfunction
Do HIV testing at first
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

6. cardiac manifestation of turner
Dx US tx; correct serum electrolyte - pyloromyotom
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Dactylitis; 2nd common is splenic seqestration
No reticulocyte vs high reticulocyte

7. difference between rubeola (measles) and rulbella
Pipercillin (zosyn) - ticarcillin
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Medical emergency; dimercaprol/edta
Atypical lymphocyte

8. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

9. 12y - obese - hip pain - hip ext rotated
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No wheezing - no feever in chlamydia

10. How to dx RSV
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Meconeum ileus; think about CF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Rapid detection of RSV antigen in nasl

11. viruses cause bronhioltitis
Decr calorie intake; decr calorie absorption;incr calorie demand
Risk of neurological dysfunction
Rapid detection of RSV antigen in nasl
RSV - rhino and influenza

12. How to dx post uretheral valve
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

13. pumonary TB
Do HIV testing at first
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Herpes
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)

14. lead >70
D for d; down syndrome and polyhydramnios
Medical emergency; dimercaprol/edta
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
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

15. What are the risk factors of developmental dysplais of hip
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
ALL - alzheimers autism adhd depression seizure
Black
Female - breech delivery - family history; tx referral to ortho

16. spitting up - vomiting at night - weight stable
Central isosexual precocious puberty; hypothalmaic hamartoma
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

17. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Decreases height - expensive; reserved for severe cases of delayed puberty
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Absence seizure; tx ethosuximide

18. the risk of lyme after bitten by a tick
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Bladder dysfunction; UTI and renal dysfunctoin
1.5%
Oral DMSA or EDTA IV

19. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Decreased UGT enzyme
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
14yrs

20. physiological jaundice
Injury to b/l glossopharyngeal. present in botulism
24h to 7d of birth
T for t ; thalassemia; inc serum iron and Iron binding
Between pregnenolone and 17oh pregnenolone

21. defcicieny of 21 hydroxylase
Croup tx cool mist; racemic epi - corticosteroid
Increase of progesteron/17oh progesterone
TB - breastfeeding - asymptomatic hiv
Black

22. How to prevent GBS in neonate
Penicillin G 4h before delivery
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Methylephenidate toxicity; cannot be stopped abruptly; taper
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

23. failure to thrive
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Less than 5th percentile
24h to 7d of birth

24. infantile hypertrophic pyloric stenosis
Yes; but it will be less effective
Dx US tx; correct serum electrolyte - pyloromyotom
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pho for forward bending; forward defect; common finding has no adverse physical effect

25. hypopigmented spots - family hx bilat deafness
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Neurofibromatosis type2
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Meconeum ileus; think about CF

26. acute otitis externa

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27. giardiasis
Marfans - ehlers danlos - homocystinuria
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)
Tx only symptomatic carrier
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

28. starring spells 10-20sec
Central isosexual precocious puberty; hypothalmaic hamartoma
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
TB - breastfeeding - asymptomatic hiv
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

29. infant botulism
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Increase of pregnenolone

30. down syndrome has inreased risk of developing
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
ALL - alzheimers autism adhd depression seizure
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Absence seizure; tx ethosuximide

31. pavlik harness
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
To make hip flexed and abducted position in DDH
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

32. Tx of community acquired pneumonia
Facial portwine stain
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Rapid detection of RSV antigen in nasl
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

33. sickle cell with symmetrical swelling of hands and feet
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Oral DMSA or EDTA IV
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Vaso-occlusive crisis; dx hb electrophoresis

34. Parvovirus
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Fifth disease; febrile syndrome
Do HIV testing at first

35. most common complication of otitis media
Endocardial cushion defect (no separation between heart chambers)
Atypical lymphocyte
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

36. indications of VUR
Constitutional pubertal delay
Bladder dysfunction; UTI and renal dysfunctoin
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

37. tzanck
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Herpes
Decr calorie intake; decr calorie absorption;incr calorie demand
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

38. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Faciform RBC cause vascular occlusion
Black

39. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

40. Tx of bact conjunctivitis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
14yrs
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

41. HUS
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
<2yrs - abd pain - diarrhoea - ARF
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

42. contraindications of MMR vaccine
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Yes; but it will be less effective
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

43. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Medical emergency; dimercaprol/edta
Decr calorie intake; decr calorie absorption;incr calorie demand
No myoclonic activity in JME
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

44. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Increase of pregnenolone
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Black

45. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No intervention; 90% foreign bodies pass without difficulty
Neurofibromatosis type2
Erb paralysis leading to diaphragmatic paralysis

46. carditis and arthritis after rheumatic fever
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Constitutional pubertal delay
Develops in 21 dasy
Benign permature thelarche; expectant management

47. dx for DDH
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

48. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
No reticulocyte vs high reticulocyte

49. tick transmits RMSF
Less than 5th percentile
Black
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Injury to lower roots of brachial plexus

50. if bone age lower than actual and puberty delayed
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Dactylitis; 2nd common is splenic seqestration
Constitutional pubertal delay
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy