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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. how smoking contributes otitis media in children
ALL - alzheimers autism adhd depression seizure
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No intervention; 90% foreign bodies pass without difficulty

2. sudden onset of fever - difficulty in breathing
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

3. pavlik harness
To make hip flexed and abducted position in DDH
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

4. failure to thrive
Benign permature thelarche; expectant management
Less than 5th percentile
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
Dactylitis; 2nd common is splenic seqestration

5. Infant with serum billlirubin >25
Fifth disease; febrile syndrome
36 hours
Risk of neurological dysfunction
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

6. How to dx endopthalmitis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Medical emergency; dimercaprol/edta
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

7. difference between rubeola (measles) and rulbella
Yes; but it will be less effective
No myoclonic activity in JME
Absence seizure; tx ethosuximide
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

8. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Brown
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
ALL - alzheimers autism adhd depression seizure

9. penicillin effective against pseudomonas
<2yrs - abd pain - diarrhoea - ARF
Pipercillin (zosyn) - ticarcillin
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

10. physiological jaundice
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
No reticulocyte vs high reticulocyte
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
24h to 7d of birth

11. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
ALL - alzheimers autism adhd depression seizure
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

12. 12y - obese - hip pain - hip ext rotated
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

13. infant botulism
Oral DMSA or EDTA IV
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

14. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Decreased UGT enzyme
Methylephenidate toxicity; cannot be stopped abruptly; taper
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

15. What is thumbprint sign
Constitutional pubertal delay
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Methylephenidate toxicity; cannot be stopped abruptly; taper
Lateral neck xray in epiglottitis show swollen epiglottis

16. dx for DDH
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
refuse
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Between pregnenolone and 17oh pregnenolone

17. How to difference viral and bact pneumonia
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
RSV - rhino and influenza
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

18. congenital adrenal hyperplasi
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Decreased UGT enzyme
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Foreign body sensation - photophobia - corneal opacity tx abx

19. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
110 kcl/kg/day
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Injury to lower roots of brachial plexus

20. When erythema chronicum migrans develops after tick bite
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Croup tx cool mist; racemic epi - corticosteroid
24-72 hours

21. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Increase of progesteron/17oh progesterone

22. difference between structural disorder and flexible kyphosis
Increase of pregnenolone
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Erb paralysis leading to diaphragmatic paralysis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

23. lens dislocation
Marfans - ehlers danlos - homocystinuria
Vaso-occlusive crisis; dx hb electrophoresis
>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

24. spitting up - vomiting at night - weight stable
Neurofibromatosis type2
TB - breastfeeding - asymptomatic hiv
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

25. infantile hypertrophic pyloric stenosis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Do HIV testing at first
Dx US tx; correct serum electrolyte - pyloromyotom
14yrs

26. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
To make hip flexed and abducted position in DDH
Bartonella henselae; complication is suppuration of lymph node

27. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neurofibromatosis type2
Central isosexual precocious puberty; hypothalmaic hamartoma
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

28. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Female - breech delivery - family history; tx referral to ortho
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
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Develops in 21 dasy

29. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Female - breech delivery - family history; tx referral to ortho
ALL - alzheimers autism adhd depression seizure

30. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Decreased UGT enzyme
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)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

31. association with infantile pyloric stenosis
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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

32. adenovirus
Injury to b/l glossopharyngeal. present in botulism
Bartonella henselae; complication is suppuration of lymph node
>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
URI

33. when bact conjunctivitis patient can go back to school
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Pipercillin (zosyn) - ticarcillin
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
After 24h of abx therapy

34. giardiasis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Tx only symptomatic carrier
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
>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

35. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Tx only symptomatic carrier
HSP - look for symmetric skin lesions

36. When to give hpv vaccien
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
No myoclonic activity in JME
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)

37. 18mo bilat breast enlargment - some pubic hair
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Benign permature thelarche; expectant management
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
refuse

38. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

39. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Injury to lower roots of brachial plexus
110 kcl/kg/day
Erb paralysis leading to diaphragmatic paralysis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

40. can women with abnormal smear or genital get vaccine
No myoclonic activity in JME
Less than 5th percentile
Yes; but it will be less effective
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

41. 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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

42. horner syndrom
D for d; down syndrome and polyhydramnios
Diet modification to provide 110kc/kg/d
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Injury to lower roots of brachial plexus

43. indications of VUR
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Congenital rubella syndrome
Herpes
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

44. bromocriptine
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Prolactinoma
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Endocardial cushion defect (no separation between heart chambers)

45. When to give HRT in turner
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Croup
Pipercillin (zosyn) - ticarcillin
14yrs

46. causes of FTT
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
To make hip flexed and abducted position in DDH
14yrs
Decr calorie intake; decr calorie absorption;incr calorie demand

47. contraindications of MMR vaccine
Penicillin G 4h before delivery
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

48. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Pho for forward bending; forward defect; common finding has no adverse physical effect

49. differentiate between central and peripheral precocious puberty
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
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
Erb paralysis leading to diaphragmatic paralysis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

50. impaired gag reflex
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Constitutional pubertal delay
Injury to b/l glossopharyngeal. present in botulism