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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. Tx of children constipation

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2. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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
No reticulocyte vs high reticulocyte

3. How to differentiate croup vs epiglotitis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Vaso-occlusive crisis; dx hb electrophoresis

4. TTP pentad
14yrs
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
36 hours

5. defcicieny of 21 hydroxylase
Less than 5th percentile
Increase of progesteron/17oh progesterone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
ALL - alzheimers autism adhd depression seizure

6. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Vaso-occlusive crisis; dx hb electrophoresis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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

7. hypopigmented spots - family hx bilat deafness
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Facial portwine stain
Neurofibromatosis type2
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

8. dx for turner
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Neurofibromatosis type2
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Herpes

9. How to dx acute angle closure glaucoma
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

10. target cell
T for t ; thalassemia; inc serum iron and Iron binding
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Brown

11. when bact conjunctivitis patient can go back to school
Multiple telangiectesia - vasular lesion in CNS
After 24h of abx therapy
Bartonella henselae; complication is suppuration of lymph node
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

12. How to dx RSV
Wait until 6 months
Rapid detection of RSV antigen in nasl
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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

13. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Decr calorie intake; decr calorie absorption;incr calorie demand
T for t ; thalassemia; inc serum iron and Iron binding
Benign permature thelarche; expectant management

14. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
D for d; down syndrome and polyhydramnios
36 hours
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

15. aplasic crisis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

16. IM
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Atypical lymphocyte
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

17. How to dx keratitis?
Between pregnenolone and 17oh pregnenolone
Foreign body sensation - photophobia - corneal opacity tx abx
Meconeum ileus; think about CF
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

18. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Increase of pregnenolone
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Central isosexual precocious puberty; hypothalmaic hamartoma

19. mech of botulism
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Decr calorie intake; decr calorie absorption;incr calorie demand
Oral DMSA or EDTA IV

20. 3yo - febrile - left hip externally rotated
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Medical emergency; dimercaprol/edta
Rapid detection of RSV antigen in nasl
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

21. 12y - obese - hip pain - hip ext rotated
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Biliary atresia; tx surgery
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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)

22. the risk of lyme after bitten by a tick
1.5%
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Croup tx cool mist; racemic epi - corticosteroid
Pipercillin (zosyn) - ticarcillin

23. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Erb paralysis leading to diaphragmatic paralysis
No myoclonic activity in JME
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

24. benefits of antibiotic therapy in acute pharyngitis?
URI
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
To make hip flexed and abducted position in DDH
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

25. What is thumbprint sign
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Lateral neck xray in epiglottitis show swollen epiglottis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Croup tx cool mist; racemic epi - corticosteroid

26. Tx of botulism
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

27. What is the definition of delayed puberty?
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

28. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
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
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

29. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
<2yrs - abd pain - diarrhoea - ARF
Pho for forward bending; forward defect; common finding has no adverse physical effect
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

30. How long anti-TB drugs given for TB meningitis?
Black
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Atypical lymphocyte

31. How to investigate delayed puberty
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Tx only symptomatic carrier
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

32. what conditions are not contraindicated
Foreign body sensation - photophobia - corneal opacity tx abx
Atypical lymphocyte
HSP - look for symmetric skin lesions
TB - breastfeeding - asymptomatic hiv

33. When to do surgery for undescended testes
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Wait until 6 months
Do HIV testing at first
Injury to b/l glossopharyngeal. present in botulism

34. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Candidal diapar rash; tx clotrimazol
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Vaso-occlusive crisis; dx hb electrophoresis

35. side effect of testosteron therapy
24-72 hours
Decreases height - expensive; reserved for severe cases of delayed puberty
36 hours
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

36. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
36 hours

37. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
No myoclonic activity in JME

38. cardiac manifestation of turner
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Absence seizure; tx ethosuximide

39. When erythema chronicum migrans develops after tick bite
24-72 hours
After 24h of abx therapy
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

40. low grade fever - cough - diffuse bilat ground glass opacities
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
No wheezing - no feever in chlamydia
Imaging study to r/o VUR
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

41. penicillin effective against pseudomonas
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Pipercillin (zosyn) - ticarcillin
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
No myoclonic activity in JME

42. When to give hpv vaccien
Diet modification to provide 110kc/kg/d
24h to 7d of birth
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

43. tick transmits RMSF
T for t ; thalassemia; inc serum iron and Iron binding
Bladder dysfunction; UTI and renal dysfunctoin
Black
Croup tx cool mist; racemic epi - corticosteroid

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

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45. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Increase of pregnenolone
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

46. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Injury to b/l glossopharyngeal. present in botulism
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Less than 5th percentile
Increase of pregnenolone

47. causes of FTT
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
ALL - alzheimers autism adhd depression seizure
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

48. tzanck
Thalassemia - congenital hemolytic anemia
Herpes
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
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

49. nuchal rigidity - fever - sore throat - headache - dioriented
Herpes
Increase of progesteron/17oh progesterone
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Black

50. the recommended ca supplementation
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb