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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. 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
If aortic root reaches 45 mm
Decreased UGT enzyme
RSV - rhino and influenza

2. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
After 24h of abx therapy
Biliary atresia; tx 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

3. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

4. the recommended ca supplementation
Thalassemia - congenital hemolytic anemia
Increase of progesteron/17oh progesterone
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Atopic dermatitis; strong allergic/immunologic component; incr IgE

5. if bone age lower than actual and puberty delayed
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Constitutional pubertal delay
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

6. When to give hpv vaccien
Neurofibromatosis type2
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
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
Congenital rubella syndrome

7. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
D for d; down syndrome and polyhydramnios
No wheezing - no feever in chlamydia

8. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Black
<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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

9. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Central isosexual precocious puberty; hypothalmaic hamartoma

10. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
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
Wait until 6 months
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

11. Neonatal conjugated hyperbilirubinemia
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
Biliary atresia; tx surgery
Pho for forward bending; forward defect; common finding has no adverse physical effect
24h to 7d of birth

12. red oozing rash on cheek - scaly - dry
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
After 24h of abx therapy
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

13. When to bevioral and enviromental measure in led intoxication?
Atypical lymphocyte
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Do HIV testing at first

14. How to differential bact vs viral conjunctivitis
Dx US tx; correct serum electrolyte - pyloromyotom
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

15. decreased mobility of tympanic membrane after otitis media
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
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

16. defcicieny of 21 hydroxylase
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
1.5%
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Increase of progesteron/17oh progesterone

17. sudden onset of fever - difficulty in breathing
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Bartonella henselae; complication is suppuration of lymph node
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Biliary atresia; tx surgery

18. How to differentiate caput succedanueum and cephalohematoma
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Endocardial cushion defect (no separation between heart chambers)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

19. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Candidal diapar rash; tx clotrimazol

20. horner syndrom
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Injury to lower roots of brachial plexus
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

21. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Multiple telangiectesia - vasular lesion in CNS
Meconeum ileus; think about CF
T for t ; thalassemia; inc serum iron and Iron binding

22. 3yo - febrile - left hip externally rotated
Facial portwine stain
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Candidal diapar rash; tx clotrimazol
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

23. adenovirus
Injury to b/l glossopharyngeal. present in botulism
URI
Constitutional pubertal delay
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

24. How to prevent GBS in neonate
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Penicillin G 4h before delivery
Dactylitis; 2nd common is splenic seqestration

25. infant botulism
RSV - rhino and influenza
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

26. difference between breast milk and breafeeding jaundice
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
Decr calorie intake; decr calorie absorption;incr calorie demand
Thalassemia - congenital hemolytic anemia
Risk of neurological dysfunction

27. iron supplement in child
14yrs
Medical emergency; dimercaprol/edta
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
After 6m; breast mild provides iron until 6m.

28. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Foreign body sensation - photophobia - corneal opacity tx abx
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

29. lead >70
Medical emergency; dimercaprol/edta
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Increase of pregnenolone

30. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Increase of pregnenolone

31. language delay
Candidal diapar rash; tx clotrimazol
Multiple telangiectesia - vasular lesion in CNS
HSP - look for symmetric skin lesions
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

32. acute abd pain - hx URI - lower extremity maculo papular rash
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
HSP - look for symmetric skin lesions
Multiple telangiectesia - vasular lesion in CNS
Fifth disease; febrile syndrome

33. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Benign permature thelarche; expectant management

34. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

35. How long patient needs to be exposed to tick to get infected
36 hours
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Fifth disease; febrile syndrome
Marfans - ehlers danlos - homocystinuria

36. HUS
Risk of neurological dysfunction
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
<2yrs - abd pain - diarrhoea - ARF

37. target cell
Bladder dysfunction; UTI and renal dysfunctoin
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
T for t ; thalassemia; inc serum iron and Iron binding
Thalassemia - congenital hemolytic anemia

38. is local anesthetics be used in cellulitis to reduce pain
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

39. how thalassemia die
Bartonella henselae; complication is suppuration of lymph node
Dactylitis; 2nd common is splenic seqestration
Increase of pregnenolone
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

40. physiological jaundice
HSP - look for symmetric skin lesions
Prolactinoma
Increase of progesteron/17oh progesterone
24h to 7d of birth

41. causes of acute anemia
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
ALL - alzheimers autism adhd depression seizure
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

42. hypopigmented spots - family hx bilat deafness
Increase of pregnenolone
Meconeum ileus; think about CF
Neurofibromatosis type2
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

43. aplasic crisis
14yrs
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Wait until 6 months
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

44. nuchal rigidity - fever - sore throat - headache - dioriented
No wheezing - no feever in chlamydia
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Develops in 21 dasy
INH 9m if INH resistant rifampin 6m in children and 4m in adults

45. benefits of antibiotic therapy in acute pharyngitis?
Penicillin G 4h before delivery
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Imaging study to r/o VUR

46. 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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Dx US tx; correct serum electrolyte - pyloromyotom
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

47. indications of audiometry in childrens
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Benign permature thelarche; expectant management
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

48. tick transmits RMSF
After 24h of abx therapy
Black
Faciform RBC cause vascular occlusion
Benign permature thelarche; expectant management

49. complete airway obstruction with FB
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Croup tx cool mist; racemic epi - corticosteroid
>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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

50. How to dx post uretheral valve
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
No reticulocyte vs high reticulocyte
Develops in 21 dasy