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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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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. 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
Oral DMSA or EDTA IV
Foreign body sensation - photophobia - corneal opacity tx abx
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

2. contraindications of MMR vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Biliary atresia; tx surgery
Female - breech delivery - family history; tx referral to ortho
>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. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Decr calorie intake; decr calorie absorption;incr calorie demand
Central isosexual precocious puberty; hypothalmaic hamartoma
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

4. pneumonia in CF patient
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Decreases height - expensive; reserved for severe cases of delayed puberty
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Fifth disease; febrile syndrome

5. 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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Dx US tx; correct serum electrolyte - pyloromyotom

6. HUS
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
<2yrs - abd pain - diarrhoea - ARF

7. How to dx endopthalmitis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Multiple telangiectesia - vasular lesion in CNS
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

8. major depression
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
URI
24h to 7d of birth

9. How long patient needs to be exposed to tick to get infected
HSP - look for symmetric skin lesions
36 hours
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
110 kcl/kg/day

10. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Decreases height - expensive; reserved for severe cases of delayed puberty
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Croup

11. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
24h to 7d of birth
Pipercillin (zosyn) - ticarcillin

12. acute otitis media-pathogen
24h to 7d of birth
Strep pneumonie; moraxella; h influenze
To make hip flexed and abducted position in DDH
Tx only symptomatic carrier

13. sudden onset of fever - difficulty in breathing
TB - breastfeeding - asymptomatic hiv
Increase of pregnenolone
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

14. causes of FTT
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
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
Decr calorie intake; decr calorie absorption;incr calorie demand

15. viruses cause bronhioltitis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
RSV - rhino and influenza
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
No; they are basic compound will be neutralized in an acidic environment of cellulitis

16. sturge weber syndrome
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Facial portwine stain
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Benign permature thelarche; expectant management

17. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
110 kcl/kg/day
D for d; down syndrome and polyhydramnios
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

18. When to bevioral and enviromental measure in led intoxication?
Decreases height - expensive; reserved for severe cases of delayed puberty
Mainly clinical; serology with initial ELISA - with western blot confirmation;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Yes; but it will be less effective

19. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Foreign body sensation - photophobia - corneal opacity tx abx
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Develops in 21 dasy

20. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Brown
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
24h to 7d of birth

21. duodenal atresia
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
D for d; down syndrome and polyhydramnios
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

22. When erythema chronicum migrans develops after tick bite
24-72 hours
Dx US tx; correct serum electrolyte - pyloromyotom
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Yes; but it will be less effective

23. complication of lumbosacral meningocele
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
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Bladder dysfunction; UTI and renal dysfunctoin
Female - breech delivery - family history; tx referral to ortho

24. What are the risk factors of developmental dysplais of hip
Risk of neurological dysfunction
Female - breech delivery - family history; tx referral to ortho
Injury to b/l glossopharyngeal. present in botulism
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

25. What is earliest sign of puberty?
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
<2yrs - abd pain - diarrhoea - ARF

26. dx for turner
Herpes
Diet modification to provide 110kc/kg/d
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Develops in 21 dasy

27. tick transmits lyme
Increase of progesteron/17oh progesterone
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Brown

28. sickle cell with symmetrical swelling of hands and feet
Decr calorie intake; decr calorie absorption;incr calorie demand
Vaso-occlusive crisis; dx hb electrophoresis
Tx only symptomatic carrier
Foreign body sensation - photophobia - corneal opacity tx abx

29. How to difference RSV and neonatal chlamydia
Facial portwine stain
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
INH 9m if INH resistant rifampin 6m in children and 4m in adults
No wheezing - no feever in chlamydia

30. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Bartonella henselae; complication is suppuration of lymph node
Erb paralysis leading to diaphragmatic paralysis

31. patient with white plaques in mouth and lump in back
Do HIV testing at first
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

32. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
RSV - rhino and influenza
Absence seizure; tx ethosuximide
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

33. 12y - obese - hip pain - hip ext rotated
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Brown
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

34. giardiasis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
TB - breastfeeding - asymptomatic hiv
Tx only symptomatic carrier
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

35. microcytic - hypochromic anemia - hepatospelnomegaly
Increase of progesteron/17oh progesterone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Thalassemia - congenital hemolytic anemia

36. cleft lip but no cleft palate
Vaso-occlusive crisis; dx hb electrophoresis
Faciform RBC cause vascular occlusion
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Benign permature thelarche; expectant management

37. lead 44-70
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Oral DMSA or EDTA IV
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

38. Parents can _____ vaccine
Between pregnenolone and 17oh pregnenolone
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
refuse
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

39. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Foreign body sensation - photophobia - corneal opacity tx abx
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 myoclonic activity in JME

40. When to do surgery for undescended testes
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Marfans - ehlers danlos - homocystinuria
Wait until 6 months
No; they are basic compound will be neutralized in an acidic environment of cellulitis

41. spitting up - vomiting at night - weight stable
24-72 hours
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
ALL - alzheimers autism adhd depression seizure
Neurofibromatosis type2

42. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Brown
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
After 24h of abx therapy

43. TTP pentad
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
1.5%
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

44. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
No myoclonic activity in JME
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
URI
Brown

45. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Biliary atresia; tx surgery
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

46. How to differential bact vs viral conjunctivitis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
36 hours
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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. When to give hpv vaccien
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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
24-72 hours
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

48. Febrile seizure
Black
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
After 24h of abx therapy
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

49. horner syndrom
<2yrs - abd pain - diarrhoea - ARF
Injury to lower roots of brachial plexus
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Diet modification to provide 110kc/kg/d

50. thumb sign
TB - breastfeeding - asymptomatic hiv
Wait until 6 months
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

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USMLE Step3 Pediatrics

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