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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. difference between diaper dermatitis and rash
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
14yrs
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

2. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Increase of pregnenolone
Thalassemia - congenital hemolytic anemia

3. sublottic narrowing
Tx only symptomatic carrier
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
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Croup tx cool mist; racemic epi - corticosteroid

4. congenital adrenal hyperplasi
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Medical emergency; dimercaprol/edta
No intervention; 90% foreign bodies pass without difficulty
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

5. 3yo - febrile - left hip externally rotated
Develops in 21 dasy
Bladder dysfunction; UTI and renal dysfunctoin
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

6. how thalassemia die
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No myoclonic activity in JME
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

7. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Benign permature thelarche; expectant management
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
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

8. contraindications of DTap
Vaso-occlusive crisis; dx hb electrophoresis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

9. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
After 24h of abx therapy
Constitutional pubertal delay
Strep pneumonie; moraxella; h influenze

10. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Dactylitis; 2nd common is splenic seqestration
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

11. doing worse in school - lack of attention - starring speel
Black
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Absence seizure; tx ethosuximide
Injury to b/l glossopharyngeal. present in botulism

12. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Congenital rubella syndrome
Faciform RBC cause vascular occlusion
Meconeum ileus; think about CF
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

13. spitting up - vomiting at night - weight stable
refuse
Meconeum ileus; think about CF
GERD - try thickened formula if no improvement - H2 antagonists - last resort 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

14. cat scratch disease
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Bartonella henselae; complication is suppuration of lymph node
Oral DMSA or EDTA IV
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)

15. iron supplement in child
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
After 6m; breast mild provides iron until 6m.

16. complication of lumbosacral meningocele
Rapid detection of RSV antigen in nasl
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
HSP - look for symmetric skin lesions
Bladder dysfunction; UTI and renal dysfunctoin

17. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Croup
HSP - look for symmetric skin lesions
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

18. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
refuse
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Biliary atresia; tx surgery

19. 17 alpha hydroxylase
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Between pregnenolone and 17oh pregnenolone
Brown

20. Tx of bact conjunctivitis
24h to 7d of birth
RSV - rhino and influenza
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

21. How long anti-TB drugs given for TB meningitis?
Central isosexual precocious puberty; hypothalmaic hamartoma
Atopic dermatitis; strong allergic/immunologic component; incr IgE
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
INH 9m if INH resistant rifampin 6m in children and 4m in adults

22. Febrile seizure
Diet modification to provide 110kc/kg/d
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Decr calorie intake; decr calorie absorption;incr calorie demand
Increase of pregnenolone

23. Infant with serum billlirubin >25
Risk of neurological dysfunction
110 kcl/kg/day
Dactylitis; 2nd common is splenic seqestration
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

24. if bone age lower than actual and puberty delayed
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Constitutional pubertal delay
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
TB - breastfeeding - asymptomatic hiv

25. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Candidal diapar rash; tx clotrimazol
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
refuse

26. horner syndrom
refuse
24h to 7d of birth
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Injury to lower roots of brachial plexus

27. tuberous sclerosis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Medical emergency; dimercaprol/edta
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

28. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
No myoclonic activity in JME
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

29. sudden onset of fever - difficulty in breathing
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Erb paralysis leading to diaphragmatic paralysis

30. Neonatal unconjugated hyperbilirubine
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Decreased UGT enzyme
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

31. lead 44-70
Oral DMSA or EDTA IV
36 hours
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Do HIV testing at first

32. bromocriptine
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Wait until 6 months
Prolactinoma
Atypical lymphocyte

33. How to differentiate caput succedanueum and cephalohematoma
Diet modification to provide 110kc/kg/d
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No wheezing - no feever in chlamydia

34. dx for DDH
Medical emergency; dimercaprol/edta
Imaging study to r/o VUR
Do HIV testing at first
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

35. pavlik harness
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Bartonella henselae; complication is suppuration of lymph node
To make hip flexed and abducted position in DDH
Erb paralysis leading to diaphragmatic paralysis

36. Parvovirus
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Rapid detection of RSV antigen in nasl
Vaso-occlusive crisis; dx hb electrophoresis
Fifth disease; febrile syndrome

37. What is the definition of delayed puberty?
Herpes
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
24h to 7d of birth

38. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
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
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Marfans - ehlers danlos - homocystinuria

39. How to prevent GBS in neonate
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Penicillin G 4h before delivery
Congenital rubella syndrome
Injury to b/l glossopharyngeal. present in botulism

40. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

41. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Bladder dysfunction; UTI and renal dysfunctoin
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

42. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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
Injury to lower roots of brachial plexus

43. thumb sign
Central isosexual precocious puberty; hypothalmaic hamartoma
After 6m; breast mild provides iron until 6m.
TB - breastfeeding - asymptomatic hiv
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

44. red oozing rash on cheek - scaly - dry
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Female - breech delivery - family history; tx referral to ortho
D for d; down syndrome and polyhydramnios

45. association with infantile pyloric stenosis
Rapid detection of RSV antigen in nasl
Neurofibromatosis type2
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

46. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Candidal diapar rash; tx clotrimazol

47. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
HSP - look for symmetric skin lesions
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Biliary atresia; tx surgery

48. When to do surgery for undescended testes
T for t ; thalassemia; inc serum iron and Iron binding
Strep pneumonie; moraxella; h influenze
Wait until 6 months
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

49. When erythema chronicum migrans develops after tick bite
Mainly clinical; serology with initial ELISA - with western blot confirmation;
110 kcl/kg/day
24-72 hours
Less than 5th percentile

50. What is earliest sign of puberty?
T for t ; thalassemia; inc serum iron and Iron binding
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation