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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. language delay
Penicillin G 4h before delivery
Lateral neck xray in epiglottitis show swollen epiglottis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

2. Febrile seizure
Decreases height - expensive; reserved for severe cases of delayed puberty
After 6m; breast mild provides iron until 6m.
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

3. lens dislocation
Marfans - ehlers danlos - homocystinuria
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Female - breech delivery - family history; tx referral to ortho
No myoclonic activity in JME

4. When to do surgery for undescended testes
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Wait until 6 months
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

5. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Benign permature thelarche; expectant management
<2yrs - abd pain - diarrhoea - ARF
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

6. What are the risk factors of developmental dysplais of hip
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Wait until 6 months
Female - breech delivery - family history; tx referral to ortho
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

7. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Dactylitis; 2nd common is splenic seqestration
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No wheezing - no feever in chlamydia
No myoclonic activity in JME

8. tzanck
Lateral neck xray in epiglottitis show swollen epiglottis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Herpes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

9. doing worse in school - lack of attention - starring speel
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Croup tx cool mist; racemic epi - corticosteroid
Decreased UGT enzyme
Absence seizure; tx ethosuximide

10. can women with abnormal smear or genital get vaccine
Tx only symptomatic carrier
Yes; but it will be less effective
To make hip flexed and abducted position in DDH
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

11. contact lens keratitis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Imaging study to r/o VUR

12. 12y - obese - hip pain - hip ext rotated
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Facial portwine stain
Meconeum ileus; think about CF

13. sturge weber syndrome
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Lateral neck xray in epiglottitis show swollen epiglottis
14yrs
Facial portwine stain

14. difference between rubeola (measles) and rulbella
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
No wheezing - no feever in chlamydia
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

15. duodenal atresia
Injury to lower roots of brachial plexus
D for d; down syndrome and polyhydramnios
Methylephenidate toxicity; cannot be stopped abruptly; taper
Faciform RBC cause vascular occlusion

16. Nocturnal enuresis
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
110 kcl/kg/day

17. 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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Increase of progesteron/17oh progesterone
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

18. 18mo bilat breast enlargment - some pubic hair
Absence seizure; tx ethosuximide
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
After 6m; breast mild provides iron until 6m.
Benign permature thelarche; expectant management

19. When to give hpv vaccien
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
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Facial portwine stain
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

20. cat scratch disease
Fifth disease; febrile syndrome
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
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
Bartonella henselae; complication is suppuration of lymph node

21. impaired gag reflex
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Injury to b/l glossopharyngeal. present in botulism
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

22. cleft lip but no cleft palate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

23. acute abd pain - hx URI - lower extremity maculo papular rash
Risk of neurological dysfunction
D for d; down syndrome and polyhydramnios
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
HSP - look for symmetric skin lesions

24. What is earliest sign of puberty?
Strep pneumonie; moraxella; h influenze
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Fifth disease; febrile syndrome
Croup

25. How to prevent GBS in neonate
Erb paralysis leading to diaphragmatic paralysis
No myoclonic activity in JME
Penicillin G 4h before delivery
Thalassemia - congenital hemolytic anemia

26. difference between diaper dermatitis and rash
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
1.5%
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

27. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Do HIV testing at first

28. lead 44-70
Between pregnenolone and 17oh pregnenolone
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
After 24h of abx therapy
Oral DMSA or EDTA IV

29. how smoking contributes otitis media in children
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

30. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
>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
Fifth disease; febrile syndrome
Erb paralysis leading to diaphragmatic paralysis

31. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Dx US tx; correct serum electrolyte - pyloromyotom
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Methylephenidate toxicity; cannot be stopped abruptly; taper

32. complication of lumbosacral meningocele
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Bladder dysfunction; UTI and renal dysfunctoin
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

33. patient with white plaques in mouth and lump in back
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Do HIV testing at first
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Strep pneumonie; moraxella; h influenze

34. low grade fever - cough - diffuse bilat ground glass opacities
Meconeum ileus; think about CF
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Risk of neurological dysfunction

35. kallman syndrome
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

36. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
24h to 7d of birth
Imaging study to r/o VUR
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

37. spitting up - vomiting at night - weight stable
Oral DMSA or EDTA IV
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Increase of progesteron/17oh progesterone
Candidal diapar rash; tx clotrimazol

38. infantile hypertrophic pyloric stenosis
110 kcl/kg/day
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Dx US tx; correct serum electrolyte - pyloromyotom

39. physiological jaundice
24h to 7d of birth
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Bartonella henselae; complication is suppuration of lymph node

40. indications of VUR
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

41. mech of botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
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
Strep pneumonie; moraxella; h influenze

42. How to dx RSV
No myoclonic activity in JME
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Rapid detection of RSV antigen in nasl
Facial portwine stain

43. microcytic - hypochromic anemia - hepatospelnomegaly
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Thalassemia - congenital hemolytic anemia
>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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

44. association with infantile pyloric stenosis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Penicillin G 4h before delivery
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
INH 9m if INH resistant rifampin 6m in children and 4m in adults

45. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

46. pumonary TB
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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)
Multiple telangiectesia - vasular lesion in CNS
Prolactinoma

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

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48. When to bevioral and enviromental measure in led intoxication?
Benign permature thelarche; expectant management
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

49. 3yo - never able to walk
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
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
Marfans - ehlers danlos - homocystinuria
Diet modification to provide 110kc/kg/d

50. horner syndrom
Meconeum ileus; think about CF
Brown
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Injury to lower roots of brachial plexus