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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.
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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. acute otitis externa

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2. 3yo - febrile - left hip externally rotated
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Between pregnenolone and 17oh pregnenolone
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

3. congenital adrenal hyperplasi
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
T for t ; thalassemia; inc serum iron and Iron binding
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

4. pumonary TB
Facial portwine stain
Endocardial cushion defect (no separation between heart chambers)
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)
14yrs

5. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
24-72 hours

6. contact lens keratitis
Decreased UGT enzyme
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

7. deficinecy of 17 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Increase of pregnenolone

8. coin in child's stomach
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
No intervention; 90% foreign bodies pass without difficulty
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

9. red oozing rash on cheek - scaly - dry
Methylephenidate toxicity; cannot be stopped abruptly; taper
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

10. What are the risk factors of developmental dysplais of hip
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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
Female - breech delivery - family history; tx referral to ortho
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

11. What is the calorie requirement of newborn?
Diet modification to provide 110kc/kg/d
<2yrs - abd pain - diarrhoea - ARF
110 kcl/kg/day
Develops in 21 dasy

12. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Atypical lymphocyte
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Neurofibromatosis type2

13. difference between diaper dermatitis and rash
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Candidal diapar rash; tx clotrimazol
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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

14. Infant with serum billlirubin >25
Risk of neurological dysfunction
refuse
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Increase of pregnenolone

15. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Thalassemia - congenital hemolytic anemia
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

16. defcicieny of 21 hydroxylase
Methylephenidate toxicity; cannot be stopped abruptly; taper
Increase of progesteron/17oh progesterone
Croup tx cool mist; racemic epi - corticosteroid
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

17. 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
Brown
After 6m; breast mild provides iron until 6m.
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

18. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
After 6m; breast mild provides iron until 6m.

19. Neonatal conjugated hyperbilirubinemia
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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
T for t ; thalassemia; inc serum iron and Iron binding

20. dx for turner
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
After 6m; breast mild provides iron until 6m.
24h to 7d of birth
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

21. can women with abnormal smear or genital get vaccine
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Increase of progesteron/17oh progesterone
HSP - look for symmetric skin lesions
Yes; but it will be less effective

22. How to differential bact vs viral conjunctivitis
Atypical lymphocyte
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Do HIV testing at first

23. doing worse in school - lack of attention - starring speel
Congenital rubella syndrome
1.5%
Constitutional pubertal delay
Absence seizure; tx ethosuximide

24. Tx of bact conjunctivitis
If aortic root reaches 45 mm
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

25. viruses cause bronhioltitis
Injury to b/l glossopharyngeal. present in botulism
RSV - rhino and influenza
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

26. benefits of antibiotic therapy in acute pharyngitis?
Develops in 21 dasy
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
T for t ; thalassemia; inc serum iron and Iron binding
Strep pneumonie; moraxella; h influenze

27. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Endocardial cushion defect (no separation between heart chambers)
Risk of neurological dysfunction

28. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Decreased UGT enzyme
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
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

29. When to give HRT in turner
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Strep pneumonie; moraxella; h influenze
Endocardial cushion defect (no separation between heart chambers)
14yrs

30. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Strep pneumonie; moraxella; h influenze
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
Develops in 21 dasy

31. difference between rubeola (measles) and rulbella
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Wait until 6 months

32. How to dx keratitis?
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Foreign body sensation - photophobia - corneal opacity tx abx
Dactylitis; 2nd common is splenic seqestration
Injury to lower roots of brachial plexus

33. hypopigmented spots - family hx bilat deafness
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
No myoclonic activity in JME
Absence seizure; tx ethosuximide
Neurofibromatosis type2

34. duodenal atresia
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)
Strep pneumonie; moraxella; h influenze
D for d; down syndrome and polyhydramnios
Less than 5th percentile

35. lens dislocation
Marfans - ehlers danlos - homocystinuria
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Less than 5th percentile

36. if bone age lower than actual and puberty delayed
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Constitutional pubertal delay
TB - breastfeeding - asymptomatic hiv

37. down syndrome with holocystolic mumur
RSV - rhino and influenza
Injury to b/l glossopharyngeal. present in botulism
Medical emergency; dimercaprol/edta
Endocardial cushion defect (no separation between heart chambers)

38. dx for DDH
Candidal diapar rash; tx clotrimazol
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Pipercillin (zosyn) - ticarcillin
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

39. horner syndrom
Injury to lower roots of brachial plexus
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Do HIV testing at first
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

40. indications of VUR
After 24h of abx therapy
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

41. tick transmits RMSF
24h to 7d of birth
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Vaso-occlusive crisis; dx hb electrophoresis
Black

42. lead >70
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Medical emergency; dimercaprol/edta
Erb paralysis leading to diaphragmatic paralysis

43. giardiasis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
<2yrs - abd pain - diarrhoea - ARF
Tx only symptomatic carrier

44. infant botulism
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Candidal diapar rash; tx clotrimazol
D for d; down syndrome and polyhydramnios

45. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Croup
Erb paralysis leading to diaphragmatic paralysis

46. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Dx US tx; correct serum electrolyte - pyloromyotom
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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

47. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
HSP - look for symmetric skin lesions

48. Tx of children constipation

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49. lead 44-70
No wheezing - no feever in chlamydia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Decreases height - expensive; reserved for severe cases of delayed puberty
Oral DMSA or EDTA IV

50. the recommended ca supplementation
RSV - rhino and influenza
Oral DMSA or EDTA IV
Imaging study to r/o VUR
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

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USMLE Step3 Pediatrics

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