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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. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Central isosexual precocious puberty; hypothalmaic hamartoma
Decreased UGT enzyme

2. difference between rubeola (measles) and rulbella
Bladder dysfunction; UTI and renal dysfunctoin
No wheezing - no feever in chlamydia
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Wait until 6 months

3. penicillin effective against pseudomonas
refuse
Pipercillin (zosyn) - ticarcillin
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
RSV - rhino and influenza

4. deficinecy of 17 hydroxylase
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Increase of pregnenolone
Bladder dysfunction; UTI and renal dysfunctoin
Tx only symptomatic carrier

5. pavlik harness
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Absence seizure; tx ethosuximide
To make hip flexed and abducted position in DDH
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

6. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Less than 5th percentile
Absence seizure; tx ethosuximide
Facial portwine stain

7. difference between structural disorder and flexible kyphosis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Atypical lymphocyte
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

8. complication of lumbosacral meningocele
1.5%
No reticulocyte vs high reticulocyte
Bladder dysfunction; UTI and renal dysfunctoin
Yes; but it will be less effective

9. viruses cause bronhioltitis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
24h to 7d of birth
RSV - rhino and influenza
No wheezing - no feever in chlamydia

10. duodenal atresia
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
>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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

11. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Thalassemia - congenital hemolytic anemia
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

12. Tx of bact conjunctivitis
TB - breastfeeding - asymptomatic hiv
Decr calorie intake; decr calorie absorption;incr calorie demand
Foreign body sensation - photophobia - corneal opacity tx abx
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

13. target cell
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
T for t ; thalassemia; inc serum iron and Iron binding
Do HIV testing at first
No myoclonic activity in JME

14. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
No reticulocyte vs high reticulocyte
Black
Bartonella henselae; complication is suppuration of lymph node

15. carditis and arthritis after rheumatic fever
TB - breastfeeding - asymptomatic hiv
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Develops in 21 dasy
Vaso-occlusive crisis; dx hb electrophoresis

16. infant botulism
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

17. failure to thrive
Less than 5th percentile
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
Injury to b/l glossopharyngeal. present in botulism
Vaso-occlusive crisis; dx hb electrophoresis

18. What are the risk factors of developmental dysplais of hip
Bartonella henselae; complication is suppuration of lymph node
Between pregnenolone and 17oh pregnenolone
Female - breech delivery - family history; tx referral to ortho
110 kcl/kg/day

19. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
To make hip flexed and abducted position in DDH
Pipercillin (zosyn) - ticarcillin
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

20. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
To make hip flexed and abducted position in DDH
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

21. dx for turner
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)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Croup tx cool mist; racemic epi - corticosteroid
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

22. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Rapid detection of RSV antigen in nasl
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

23. difference between breast milk and breafeeding jaundice
Prolactinoma
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

24. nuchal rigidity - fever - sore throat - headache - dioriented
Candidal diapar rash; tx clotrimazol
Methylephenidate toxicity; cannot be stopped abruptly; taper
Dactylitis; 2nd common is splenic seqestration
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

25. the risk of lyme after bitten by a tick
1.5%
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
To make hip flexed and abducted position in DDH
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

26. tick transmits lyme
Brown
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Black
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

27. non immune pregnant women exposed to rubella in first trimester
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
No reticulocyte vs high reticulocyte
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Congenital rubella syndrome

28. physiological jaundice
Facial portwine stain
RSV - rhino and influenza
24h to 7d of birth
Benign permature thelarche; expectant management

29. 17 alpha hydroxylase
TB - breastfeeding - asymptomatic hiv
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
RSV - rhino and influenza
Between pregnenolone and 17oh pregnenolone

30. echymoses with low platelet <30k
URI
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

31. most common complication of otitis media
Pho for forward bending; forward defect; common finding has no adverse physical effect
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
>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

32. how thalassemia die
Atypical lymphocyte
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

33. tick transmits RMSF
Black
T for t ; thalassemia; inc serum iron and Iron binding
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No myoclonic activity in JME

34. sublottic narrowing
Methylephenidate toxicity; cannot be stopped abruptly; taper
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Croup tx cool mist; racemic epi - corticosteroid
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

35. How to differentiate croup vs epiglotitis
Imaging study to r/o VUR
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
If aortic root reaches 45 mm
Biliary atresia; tx surgery

36. Tx of botulism
Pipercillin (zosyn) - ticarcillin
Atypical lymphocyte
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

37. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Brown
Lateral neck xray in epiglottitis show swollen epiglottis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

38. congenital adrenal hyperplasi
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
TB - breastfeeding - asymptomatic hiv
Tx only symptomatic carrier

39. causes of acute anemia
To make hip flexed and abducted position in DDH
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No wheezing - no feever in chlamydia

40. doing worse in school - lack of attention - starring speel
Facial portwine stain
Diet modification to provide 110kc/kg/d
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Absence seizure; tx ethosuximide

41. impaired gag reflex
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Foreign body sensation - photophobia - corneal opacity tx abx
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Injury to b/l glossopharyngeal. present in botulism

42. 12y - obese - hip pain - hip ext rotated
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
T for t ; thalassemia; inc serum iron and Iron binding
Herpes
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

43. bromocriptine
Erb paralysis leading to diaphragmatic paralysis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Prolactinoma
>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

44. how smoking contributes otitis media in children
Faciform RBC cause vascular occlusion
Pho for forward bending; forward defect; common finding has no adverse physical effect
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

45. pneumonia in CF patient
Candidal diapar rash; tx clotrimazol
URI
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

46. How to prevent GBS in neonate
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
Tx only symptomatic carrier
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Penicillin G 4h before delivery

47. causes of FTT
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

48. What is the calorie requirement of newborn?
Prolactinoma
Increase of pregnenolone
110 kcl/kg/day
Central isosexual precocious puberty; hypothalmaic hamartoma

49. lead >70
Central isosexual precocious puberty; hypothalmaic hamartoma
Medical emergency; dimercaprol/edta
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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

50. mech of botulism
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
No myoclonic activity in JME