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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. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Diet modification to provide 110kc/kg/d
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

2. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

3. pavlik harness
To make hip flexed and abducted position in DDH
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Risk of neurological dysfunction

4. carditis and arthritis after rheumatic fever
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Develops in 21 dasy
Pho for forward bending; forward defect; common finding has no adverse physical effect
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

5. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
14yrs
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Meconeum ileus; think about CF
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

6. How to dx post uretheral valve
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

7. benefits of antibiotic therapy in acute pharyngitis?
Central isosexual precocious puberty; hypothalmaic hamartoma
refuse
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

8. when bact conjunctivitis patient can go back to school
Vaso-occlusive crisis; dx hb electrophoresis
Pipercillin (zosyn) - ticarcillin
After 24h of abx therapy
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

9. causes of FTT
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

10. Neonatal unconjugated hyperbilirubine
Biliary atresia; tx surgery
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Decreased UGT enzyme
Dx US tx; correct serum electrolyte - pyloromyotom

11. kallman syndrome
Strep pneumonie; moraxella; h influenze
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
RSV - rhino and influenza
Faciform RBC cause vascular occlusion

12. is local anesthetics be used in cellulitis to reduce pain
No wheezing - no feever in chlamydia
Vaso-occlusive crisis; dx hb electrophoresis
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)
No; they are basic compound will be neutralized in an acidic environment of cellulitis

13. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Congenital rubella syndrome
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

14. 18mo bilat breast enlargment - some pubic hair
Fifth disease; febrile syndrome
Benign permature thelarche; expectant management
>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
Multiple telangiectesia - vasular lesion in CNS

15. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

16. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Decreases height - expensive; reserved for severe cases of delayed puberty
If aortic root reaches 45 mm

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

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18. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Candidal diapar rash; tx clotrimazol

19. can women with abnormal smear or genital get vaccine
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Yes; but it will be less effective
After 24h of abx therapy
Meconeum ileus; think about CF

20. the recommended ca supplementation
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Methylephenidate toxicity; cannot be stopped abruptly; taper

21. adrenal tumor
Bartonella henselae; complication is suppuration of lymph node
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Neurofibromatosis type2
Marfans - ehlers danlos - homocystinuria

22. 3yo - never able to walk
No intervention; 90% foreign bodies pass without difficulty
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

23. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Croup tx cool mist; racemic epi - corticosteroid
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Injury to b/l glossopharyngeal. present in botulism

24. major depression
Croup tx cool mist; racemic epi - corticosteroid
After 6m; breast mild provides iron until 6m.
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

25. pneumonia in CF patient
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Facial portwine stain
Tx only symptomatic carrier
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

26. What is the most common initial symptom in sickle cell
Methylephenidate toxicity; cannot be stopped abruptly; taper
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Dactylitis; 2nd common is splenic seqestration
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

27. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Multiple telangiectesia - vasular lesion in CNS
Medical emergency; dimercaprol/edta
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

28. mcCune albright`
Brown
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Foreign body sensation - photophobia - corneal opacity tx abx
After 6m; breast mild provides iron until 6m.

29. Neonatal conjugated hyperbilirubinemia
Imaging study to r/o VUR
Croup tx cool mist; racemic epi - corticosteroid
Bartonella henselae; complication is suppuration of lymph node
Biliary atresia; tx surgery

30. bromocriptine
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Pipercillin (zosyn) - ticarcillin
Prolactinoma
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)

31. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
14yrs
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

32. 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
Dactylitis; 2nd common is splenic seqestration
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

33. how thalassemia die
refuse
Imaging study to r/o VUR
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

34. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Diet modification to provide 110kc/kg/d
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

35. deficinecy of 17 hydroxylase
Oral DMSA or EDTA IV
Decreased UGT enzyme
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Increase of pregnenolone

36. tick transmits RMSF
Black
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Congenital rubella syndrome

37. When erythema chronicum migrans develops after tick bite
Female - breech delivery - family history; tx referral to ortho
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
24-72 hours
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

38. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
After 6m; breast mild provides iron until 6m.
Croup

39. congenital adrenal hyperplasi
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

40. physiological jaundice
24h to 7d of birth
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
Congenital rubella syndrome
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

41. duodenal atresia
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
>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
D for d; down syndrome and polyhydramnios
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

42. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
No wheezing - no feever in chlamydia
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

43. How to investigate delayed puberty
After 24h of abx therapy
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

44. spitting up - vomiting at night - weight stable
Strep pneumonie; moraxella; h influenze
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Endocardial cushion defect (no separation between heart chambers)
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

45. difference between structural disorder and flexible kyphosis
RSV - rhino and influenza
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Diet modification to provide 110kc/kg/d
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

46. pumonary TB
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)
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

47. Parents can _____ vaccine
refuse
Absence seizure; tx ethosuximide
Injury to lower roots of brachial plexus
Tx only symptomatic carrier

48. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Yes; but it will be less effective
Pipercillin (zosyn) - ticarcillin
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

49. When to give HRT in turner
<2yrs - abd pain - diarrhoea - ARF
T for t ; thalassemia; inc serum iron and Iron binding
>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
14yrs

50. indications of audiometry in childrens
Pho for forward bending; forward defect; common finding has no adverse physical effect
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
RSV - rhino and influenza