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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 to differential bact vs viral conjunctivitis
Neurofibromatosis type2
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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

2. indications of audiometry in childrens
Prolactinoma
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
24h to 7d of birth

3. complete airway obstruction with FB
After 6m; breast mild provides iron until 6m.
Pho for forward bending; forward defect; common finding has no adverse physical effect
>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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

4. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
D for d; down syndrome and polyhydramnios
Thalassemia - congenital hemolytic anemia
Decreased UGT enzyme

5. sudden onset of fever - difficulty in breathing
Injury to lower roots of brachial plexus
Medical emergency; dimercaprol/edta
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
RSV - rhino and influenza

6. lens dislocation
Vaso-occlusive crisis; dx hb electrophoresis
Marfans - ehlers danlos - homocystinuria
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

7. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Pho for forward bending; forward defect; common finding has no adverse physical effect
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

8. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
RSV - rhino and influenza
Multiple telangiectesia - vasular lesion in CNS
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

9. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Atypical lymphocyte
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Marfans - ehlers danlos - homocystinuria

10. mech of botulism
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

11. sickle cell with symmetrical swelling of hands and feet
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
After 24h of abx therapy
Vaso-occlusive crisis; dx hb electrophoresis
Croup

12. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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)
Absence seizure; tx ethosuximide
Methylephenidate toxicity; cannot be stopped abruptly; taper

13. How to difference RSV and neonatal chlamydia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
No wheezing - no feever in chlamydia
Faciform RBC cause vascular occlusion
Marfans - ehlers danlos - homocystinuria

14. How to investigate delayed puberty
36 hours
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
Congenital rubella syndrome
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

15. language expectation from 2yo
Brown
ALL - alzheimers autism adhd depression seizure
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

16. microcytic - hypochromic anemia - hepatospelnomegaly
Injury to b/l glossopharyngeal. present in botulism
Facial portwine stain
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Thalassemia - congenital hemolytic anemia

17. Neonatal conjugated hyperbilirubinemia
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
Facial portwine stain
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Biliary atresia; tx surgery

18. pavlik harness
To make hip flexed and abducted position in DDH
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Biliary atresia; tx surgery
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

19. carditis and arthritis after rheumatic fever
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
If aortic root reaches 45 mm
Develops in 21 dasy

20. bromocriptine
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Prolactinoma
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

21. What is earliest sign of puberty?
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

22. Tx of FTT
Strep pneumonie; moraxella; h influenze
Diet modification to provide 110kc/kg/d
Herpes
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

23. deficinecy of 17 hydroxylase
Neurofibromatosis type2
After 6m; breast mild provides iron until 6m.
Increase of pregnenolone
Brown

24. mcCune albright`
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Lateral neck xray in epiglottitis show swollen epiglottis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Faciform RBC cause vascular occlusion

25. How to dx post uretheral valve
Fifth disease; febrile syndrome
Imaging study to r/o VUR
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

26. How long patient needs to be exposed to tick to get infected
Decreased UGT enzyme
36 hours
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

27. indications of VUR
Methylephenidate toxicity; cannot be stopped abruptly; taper
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Injury to b/l glossopharyngeal. present in botulism
Meconeum ileus; think about CF

28. iron supplement in child
No myoclonic activity in JME
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
After 6m; breast mild provides iron until 6m.
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

29. decreased mobility of tympanic membrane after otitis media
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

30. pneumonia in CF patient
14yrs
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Absence seizure; tx ethosuximide
Develops in 21 dasy

31. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Dactylitis; 2nd common is splenic seqestration
Increase of pregnenolone
HSP - look for symmetric skin lesions

32. target cell
Decreased UGT enzyme
Methylephenidate toxicity; cannot be stopped abruptly; taper
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
T for t ; thalassemia; inc serum iron and Iron binding

33. Tx of botulism
Multiple telangiectesia - vasular lesion in CNS
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Faciform RBC cause vascular occlusion
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

34. TTP pentad
No intervention; 90% foreign bodies pass without difficulty
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
After 6m; breast mild provides iron until 6m.
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

35. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Croup

36. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Facial portwine stain
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

37. Neonatal unconjugated hyperbilirubine
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Endocardial cushion defect (no separation between heart chambers)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Decreased UGT enzyme

38. Parvovirus
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Fifth disease; febrile syndrome
refuse

39. Tx of children constipation

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40. pumonary TB
No wheezing - no feever in chlamydia
D for d; down syndrome and polyhydramnios
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)
Facial portwine stain

41. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
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
Tx only symptomatic carrier

42. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Congenital rubella syndrome
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

43. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Croup
14yrs
No myoclonic activity in JME
Fifth disease; febrile syndrome

44. How to differentiate caput succedanueum and cephalohematoma
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
24-72 hours
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

45. cleft lip but no cleft palate
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Constitutional pubertal delay
Increase of pregnenolone
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

46. difference between structural disorder and flexible kyphosis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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
Wait until 6 months
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

47. viruses cause bronhioltitis
Pipercillin (zosyn) - ticarcillin
Increase of pregnenolone
RSV - rhino and influenza
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

48. adenovirus
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Develops in 21 dasy
T for t ; thalassemia; inc serum iron and Iron binding
URI

49. kallman syndrome
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

50. 3yo - febrile - left hip externally rotated
>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
Increase of pregnenolone
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH