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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. if bone age lower than actual and puberty delayed
110 kcl/kg/day
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Constitutional pubertal delay

2. Tx of children constipation

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3. bromocriptine
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Prolactinoma
Strep pneumonie; moraxella; h influenze
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

4. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

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5. tuberous sclerosis
Between pregnenolone and 17oh pregnenolone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Risk of neurological dysfunction

6. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Imaging study to r/o VUR
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

7. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Biliary atresia; tx surgery
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

8. low grade fever - cough - diffuse bilat ground glass opacities
Croup
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Diet modification to provide 110kc/kg/d

9. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Female - breech delivery - family history; tx referral to ortho

10. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Atypical lymphocyte
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Erb paralysis leading to diaphragmatic paralysis

11. 21 hydroxylase
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
14yrs
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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

12. Tx of community acquired pneumonia
Herpes
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Vaso-occlusive crisis; dx hb electrophoresis
D for d; down syndrome and polyhydramnios

13. horner syndrom
Atypical lymphocyte
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Injury to lower roots of brachial plexus
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

14. Tx of FTT
<2yrs - abd pain - diarrhoea - ARF
Female - breech delivery - family history; tx referral to ortho
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Diet modification to provide 110kc/kg/d

15. Tx of bact conjunctivitis
Decreased UGT enzyme
Pho for forward bending; forward defect; common finding has no adverse physical effect
110 kcl/kg/day
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

16. red oozing rash on cheek - scaly - dry
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Diet modification to provide 110kc/kg/d
Atypical lymphocyte
Atopic dermatitis; strong allergic/immunologic component; incr IgE

17. centor criteria for bact pharyngitis
36 hours
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Tx only symptomatic carrier
Fifth disease; febrile syndrome

18. starring spells 10-20sec
Congenital rubella syndrome
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
D for d; down syndrome and polyhydramnios
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

19. causes of acute anemia
No myoclonic activity in JME
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Strep pneumonie; moraxella; h influenze
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

20. indications of VUR
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Neurofibromatosis type2
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

21. tick transmits lyme
24-72 hours
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Brown
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

22. difference between diaper dermatitis and rash
Benign permature thelarche; expectant management
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
refuse
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

23. difference between structural disorder and flexible kyphosis
>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
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

24. major depression
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
After 6m; breast mild provides iron until 6m.
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Between pregnenolone and 17oh pregnenolone

25. penicillin effective against pseudomonas
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
Biliary atresia; tx surgery
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Pipercillin (zosyn) - ticarcillin

26. Parents can _____ vaccine
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
refuse
Do HIV testing at first

27. viruses cause bronhioltitis
Dx US tx; correct serum electrolyte - pyloromyotom
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
RSV - rhino and influenza
Injury to b/l glossopharyngeal. present in botulism

28. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No intervention; 90% foreign bodies pass without difficulty
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

29. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Absence seizure; tx ethosuximide
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Constitutional pubertal delay

30. How to dx acute angle closure glaucoma
Tx only symptomatic carrier
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Decr calorie intake; decr calorie absorption;incr calorie demand

31. pavlik harness
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Pipercillin (zosyn) - ticarcillin
Increase of progesteron/17oh progesterone
To make hip flexed and abducted position in DDH

32. What is thumbprint sign
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
Bladder dysfunction; UTI and renal dysfunctoin
Diet modification to provide 110kc/kg/d
Lateral neck xray in epiglottitis show swollen epiglottis

33. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Methylephenidate toxicity; cannot be stopped abruptly; taper
Brown

34. sturge weber syndrome
Facial portwine stain
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

35. down syndrome has inreased risk of developing
No myoclonic activity in JME
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Female - breech delivery - family history; tx referral to ortho
ALL - alzheimers autism adhd depression seizure

36. impaired gag reflex
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Injury to b/l glossopharyngeal. present in botulism
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Bladder dysfunction; UTI and renal dysfunctoin

37. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
24h to 7d of birth
Croup tx cool mist; racemic epi - corticosteroid
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

38. 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
Bartonella henselae; complication is suppuration of lymph node
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
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

39. spitting up - vomiting at night - weight stable
To make hip flexed and abducted position in DDH
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
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) -

40. contraindications of DTap
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

41. HUS
<2yrs - abd pain - diarrhoea - ARF
If aortic root reaches 45 mm
Erb paralysis leading to diaphragmatic paralysis
Tx only symptomatic carrier

42. physiological jaundice
24h to 7d of birth
Bartonella henselae; complication is suppuration of lymph node
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Marfans - ehlers danlos - homocystinuria

43. differentiate between central and peripheral precocious puberty
Female - breech delivery - family history; tx referral to ortho
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Atopic dermatitis; strong allergic/immunologic component; incr IgE

44. complication of lumbosacral meningocele
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Bladder dysfunction; UTI and renal dysfunctoin
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

45. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Absence seizure; tx ethosuximide
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Central isosexual precocious puberty; hypothalmaic hamartoma
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

46. giardiasis
Tx only symptomatic carrier
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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

47. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Mainly clinical; serology with initial ELISA - with western blot confirmation;

48. causes of FTT
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Decr calorie intake; decr calorie absorption;incr calorie demand
Dx US tx; correct serum electrolyte - pyloromyotom

49. language expectation from 2yo
Meconeum ileus; think about CF
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Methylephenidate toxicity; cannot be stopped abruptly; taper
Less than 5th percentile

50. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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
Constitutional pubertal delay