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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. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Injury to lower roots of brachial plexus
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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

2. down syndrome has inreased risk of developing
Wait until 6 months
ALL - alzheimers autism adhd depression seizure
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Central isosexual precocious puberty; hypothalmaic hamartoma

3. indications of VUR
Thalassemia - congenital hemolytic anemia
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No; they are basic compound will be neutralized in an acidic environment of cellulitis

4. sturge weber 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
Facial portwine stain
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Neurofibromatosis type2

5. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Foreign body sensation - photophobia - corneal opacity tx abx
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Diet modification to provide 110kc/kg/d

6. 18mo bilat breast enlargment - some pubic hair
Central isosexual precocious puberty; hypothalmaic hamartoma
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Benign permature thelarche; expectant management
Prolactinoma

7. Tx of community acquired pneumonia
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
<2yrs - abd pain - diarrhoea - ARF

8. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Tx only symptomatic carrier
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

9. Neonatal conjugated hyperbilirubinemia
Oral DMSA or EDTA IV
24h to 7d of birth
No myoclonic activity in JME
Biliary atresia; tx surgery

10. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Multiple telangiectesia - vasular lesion in CNS
Atypical lymphocyte
URI

11. low grade fever - cough - diffuse bilat ground glass opacities
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

12. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
T for t ; thalassemia; inc serum iron and Iron binding
Croup

13. How to evaluate well appearing child just born in GBS pos mother?
Wait until 6 months
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Decreases height - expensive; reserved for severe cases of delayed puberty
URI

14. Tx of botulism
After 24h of abx therapy
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

15. osler rendu weber syndrom
After 6m; breast mild provides iron until 6m.
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Multiple telangiectesia - vasular lesion in CNS
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

16. mcCune albright`
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
No reticulocyte vs high reticulocyte
Congenital rubella syndrome

17. IM
Atypical lymphocyte
URI
Croup
14yrs

18. decreased mobility of tympanic membrane after otitis media
Oral DMSA or EDTA IV
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
14yrs
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

19. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Risk of neurological dysfunction
24h to 7d of birth

20. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Erb paralysis leading to diaphragmatic paralysis
TB - breastfeeding - asymptomatic hiv

21. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
36 hours
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

22. pavlik harness
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
To make hip flexed and abducted position in DDH
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

23. How to differentiate croup vs epiglotitis
Absence seizure; tx ethosuximide
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Dactylitis; 2nd common is splenic seqestration

24. What is earliest sign of puberty?
110 kcl/kg/day
Central isosexual precocious puberty; hypothalmaic hamartoma
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

25. Parvovirus
Pipercillin (zosyn) - ticarcillin
Fifth disease; febrile syndrome
Increase of progesteron/17oh progesterone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

26. infant botulism
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)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
36 hours
Increase of progesteron/17oh progesterone

27. How to prevent GBS in neonate
Penicillin G 4h before delivery
T for t ; thalassemia; inc serum iron and Iron binding
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Decreased UGT enzyme

28. association with infantile pyloric stenosis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

29. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Foreign body sensation - photophobia - corneal opacity tx abx
Pipercillin (zosyn) - ticarcillin

30. 17 alpha hydroxylase
24h to 7d of birth
Between pregnenolone and 17oh pregnenolone
Mainly clinical; serology with initial ELISA - with western blot confirmation;
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

31. cat scratch disease
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
After 24h of abx therapy
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)
Bartonella henselae; complication is suppuration of lymph node

32. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Candidal diapar rash; tx clotrimazol
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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

33. 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
Black
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

34. splenic infarction in sickle cell
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Faciform RBC cause vascular occlusion
24h to 7d of birth
Prolactinoma

35. Neonatal unconjugated hyperbilirubine
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Decreased UGT enzyme
Facial portwine stain
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

36. Infant with serum billlirubin >25
Risk of neurological dysfunction
Decr calorie intake; decr calorie absorption;incr calorie demand
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Faciform RBC cause vascular occlusion

37. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Decreased UGT enzyme
Injury to lower roots of brachial plexus
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

38. sublottic narrowing
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Injury to lower roots of brachial plexus
Croup tx cool mist; racemic epi - corticosteroid
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

39. 3yo - febrile - left hip externally rotated
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Fifth disease; febrile syndrome
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

40. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Penicillin G 4h before delivery
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

41. how thalassemia die
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decreases height - expensive; reserved for severe cases of delayed puberty

42. When to do surgery for undescended testes
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Facial portwine stain
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Wait until 6 months

43. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Herpes
Yes; but it will be less effective
1.5%
No reticulocyte vs high reticulocyte

44. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
If aortic root reaches 45 mm
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

45. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Female - breech delivery - family history; tx referral to ortho
Erb paralysis leading to diaphragmatic paralysis
>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. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Lateral neck xray in epiglottitis show swollen epiglottis
Croup
Less than 5th percentile

47. causes of FTT
Yes; but it will be less effective
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
>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
Decr calorie intake; decr calorie absorption;incr calorie demand

48. How to differential bact vs viral conjunctivitis
Prolactinoma
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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
Strep pneumonie; moraxella; h influenze

49. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Dactylitis; 2nd common is splenic seqestration
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

50. causes of FTT
Congenital rubella syndrome
Between pregnenolone and 17oh pregnenolone
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Erb paralysis leading to diaphragmatic paralysis