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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. horner syndrom
Injury to lower roots of brachial plexus
If aortic root reaches 45 mm
Herpes
After 24h of abx therapy

2. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

3. defcicieny of 21 hydroxylase
RSV - rhino and influenza
Develops in 21 dasy
Erb paralysis leading to diaphragmatic paralysis
Increase of progesteron/17oh progesterone

4. dx for DDH
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Dactylitis; 2nd common is splenic seqestration
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

5. carditis and arthritis after rheumatic fever
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Lateral neck xray in epiglottitis show swollen epiglottis
Marfans - ehlers danlos - homocystinuria
Develops in 21 dasy

6. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Croup tx cool mist; racemic epi - corticosteroid

7. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
1.5%
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

8. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
>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
Neurofibromatosis type2
After 24h of abx therapy

9. IM
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Atypical lymphocyte

10. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Atypical lymphocyte
Develops in 21 dasy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

11. infantile hypertrophic pyloric stenosis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Dx US tx; correct serum electrolyte - pyloromyotom
Medical emergency; dimercaprol/edta
To make hip flexed and abducted position in DDH

12. pavlik harness
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Diet modification to provide 110kc/kg/d
To make hip flexed and abducted position in DDH
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

13. adrenal tumor
Injury to b/l glossopharyngeal. present in botulism
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Meconeum ileus; think about CF
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

14. How to difference viral and bact pneumonia
Central isosexual precocious puberty; hypothalmaic hamartoma
Biliary atresia; tx surgery
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

15. difference between diaper dermatitis and rash
To make hip flexed and abducted position in DDH
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Imaging study to r/o VUR

16. tick transmits lyme
Tx only symptomatic carrier
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Brown
Increase of pregnenolone

17. infant botulism
To make hip flexed and abducted position in DDH
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Pipercillin (zosyn) - ticarcillin

18. How to dx RSV
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
Decreased UGT enzyme
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

19. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

20. coin in child's stomach
Rapid detection of RSV antigen in nasl
No intervention; 90% foreign bodies pass without difficulty
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
HSP - look for symmetric skin lesions

21. splenic infarction in sickle cell
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Faciform RBC cause vascular occlusion
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

22. When to bevioral and enviromental measure in led intoxication?
36 hours
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
Strep pneumonie; moraxella; h influenze
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

23. acute otitis media-pathogen
Black
Oral DMSA or EDTA IV
Penicillin G 4h before delivery
Strep pneumonie; moraxella; h influenze

24. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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
Herpes
Decr calorie intake; decr calorie absorption;incr calorie demand

25. How to investigate delayed puberty
No myoclonic activity in JME
Fifth disease; febrile syndrome
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Atypical lymphocyte

26. down syndrome has inreased risk of developing
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
ALL - alzheimers autism adhd depression seizure
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

27. 12y - obese - hip pain - hip ext rotated
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
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

28. decreased mobility of tympanic membrane after otitis media
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Biliary atresia; tx surgery
36 hours
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

29. language delay
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Facial portwine stain

30. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Black
Biliary atresia; tx surgery
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

31. How long patient needs to be exposed to tick to get infected
36 hours
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Bladder dysfunction; UTI and renal dysfunctoin
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

32. tzanck
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
36 hours
Herpes
Decreased UGT enzyme

33. How to differential bact vs viral conjunctivitis
No wheezing - no feever in chlamydia
Black
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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

34. acute abd pain - hx URI - lower extremity maculo papular rash
Meconeum ileus; think about CF
Black
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
HSP - look for symmetric skin lesions

35. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Pipercillin (zosyn) - ticarcillin
Candidal diapar rash; tx clotrimazol

36. contact lens keratitis
Marfans - ehlers danlos - homocystinuria
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Decreases height - expensive; reserved for severe cases of delayed puberty
Imaging study to r/o VUR

37. When to give HRT in turner
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Dactylitis; 2nd common is splenic seqestration
If aortic root reaches 45 mm
14yrs

38. giardiasis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
No intervention; 90% foreign bodies pass without difficulty
Tx only symptomatic carrier
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

39. TB prophylaxis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
INH 9m if INH resistant rifampin 6m in children and 4m in adults

40. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Imaging study to r/o VUR
Decreases height - expensive; reserved for severe cases of delayed puberty
Erb paralysis leading to diaphragmatic paralysis

41. down syndrome with holocystolic mumur
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
Diet modification to provide 110kc/kg/d
Endocardial cushion defect (no separation between heart chambers)
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

42. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
No wheezing - no feever in chlamydia

43. starring spells 10-20sec
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
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

44. tuberous sclerosis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Increase of pregnenolone

45. Neonatal unconjugated hyperbilirubine
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Wait until 6 months
Decreased UGT enzyme
>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

46. the risk of lyme after bitten by a tick
Tx only symptomatic carrier
1.5%
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

47. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Meconeum ileus; think about CF
Facial portwine stain

48. hypopigmented spots - family hx bilat deafness
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Neurofibromatosis type2

49. lead 44-70
24-72 hours
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Oral DMSA or EDTA IV
Risk of neurological dysfunction

50. Tx of children constipation

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USMLE Step3 Pediatrics

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