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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 dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

2. difference between breast milk and breafeeding jaundice
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
Congenital rubella syndrome
No; they are basic compound will be neutralized in an acidic environment of cellulitis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

3. sturge weber syndrome
Thalassemia - congenital hemolytic anemia
Facial portwine stain
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Congenital rubella syndrome

4. indications of VUR
Penicillin G 4h before delivery
Develops in 21 dasy
Lateral neck xray in epiglottitis show swollen epiglottis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

5. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Between pregnenolone and 17oh pregnenolone
Do HIV testing at first
Dactylitis; 2nd common is splenic seqestration

6. What are the risk factors of developmental dysplais of hip
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Atopic dermatitis; strong allergic/immunologic component; incr IgE
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Female - breech delivery - family history; tx referral to ortho

7. Neonatal unconjugated hyperbilirubine
No intervention; 90% foreign bodies pass without difficulty
T for t ; thalassemia; inc serum iron and Iron binding
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Decreased UGT enzyme

8. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
If aortic root reaches 45 mm
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
Croup

9. tick transmits lyme
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Brown
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

10. contraindications of DTap
T for t ; thalassemia; inc serum iron and Iron binding
Fifth disease; febrile syndrome
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

11. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
No wheezing - no feever in chlamydia
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
D for d; down syndrome and polyhydramnios

12. down syndrome has inreased risk of developing
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
ALL - alzheimers autism adhd depression seizure
Develops in 21 dasy
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

13. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Methylephenidate toxicity; cannot be stopped abruptly; taper
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

14. Nocturnal enuresis
Croup tx cool mist; racemic epi - corticosteroid
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Oral DMSA or EDTA IV
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

15. lead 44-70
No myoclonic activity in JME
Atypical lymphocyte
Do HIV testing at first
Oral DMSA or EDTA IV

16. Febrile seizure
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Bartonella henselae; complication is suppuration of lymph node

17. How to prevent GBS in neonate
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Penicillin G 4h before delivery
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Medical emergency; dimercaprol/edta

18. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Diet modification to provide 110kc/kg/d
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Atypical lymphocyte

19. when bact conjunctivitis patient can go back to school
Tx only symptomatic carrier
Pipercillin (zosyn) - ticarcillin
After 24h of abx therapy
URI

20. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
After 6m; breast mild provides iron until 6m.
To make hip flexed and abducted position in DDH
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

21. How to difference RSV and neonatal chlamydia
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
No wheezing - no feever in chlamydia
36 hours

22. complication of lumbosacral meningocele
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
After 24h of abx therapy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Bladder dysfunction; UTI and renal dysfunctoin

23. 17 alpha hydroxylase
Absence seizure; tx ethosuximide
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
If aortic root reaches 45 mm
Between pregnenolone and 17oh pregnenolone

24. Tx of bact conjunctivitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Develops in 21 dasy
Endocardial cushion defect (no separation between heart chambers)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

25. osler rendu weber syndrom
110 kcl/kg/day
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Multiple telangiectesia - vasular lesion in CNS

26. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
24-72 hours
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No reticulocyte vs high reticulocyte
Pho for forward bending; forward defect; common finding has no adverse physical effect

27. causes of FTT
Strep pneumonie; moraxella; h influenze
Decr calorie intake; decr calorie absorption;incr calorie demand
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Prolactinoma

28. 3yo - febrile - left hip externally rotated
TB - breastfeeding - asymptomatic hiv
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Meconeum ileus; think about CF

29. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
>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
Thalassemia - congenital hemolytic anemia
No; they are basic compound will be neutralized in an acidic environment of cellulitis

30. nuchal rigidity - fever - sore throat - headache - dioriented
Methylephenidate toxicity; cannot be stopped abruptly; taper
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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

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

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32. How to differentiate caput succedanueum and cephalohematoma
Between pregnenolone and 17oh pregnenolone
36 hours
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

33. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Candidal diapar rash; tx clotrimazol
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

34. contact lens keratitis
T for t ; thalassemia; inc serum iron and Iron binding
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

35. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

36. Parvovirus
Fifth disease; febrile syndrome
Dx US tx; correct serum electrolyte - pyloromyotom
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Croup

37. When to give hpv vaccien
Black
Between pregnenolone and 17oh pregnenolone
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
Marfans - ehlers danlos - homocystinuria

38. When to do aortic root surgery in marfans to prevent dissection?
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
If aortic root reaches 45 mm
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

39. tick transmits RMSF
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Constitutional pubertal delay
Black
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

40. How long anti-TB drugs given for TB meningitis?
Medical emergency; dimercaprol/edta
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

41. coin in child's stomach
14yrs
Dactylitis; 2nd common is splenic seqestration
No intervention; 90% foreign bodies pass without difficulty
No myoclonic activity in JME

42. echymoses with low platelet <30k
Herpes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Central isosexual precocious puberty; hypothalmaic hamartoma

43. How to difference viral and bact pneumonia
Herpes
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Dx US tx; correct serum electrolyte - pyloromyotom

44. starring spells 10-20sec
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Develops in 21 dasy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

45. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
To make hip flexed and abducted position in DDH
refuse

46. difference between structural disorder and flexible kyphosis
No wheezing - no feever in chlamydia
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No; they are basic compound will be neutralized in an acidic environment of cellulitis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

47. What is the calorie requirement of newborn?
Benign permature thelarche; expectant management
110 kcl/kg/day
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

48. acute otitis externa

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49. mech of botulism
Fifth disease; febrile syndrome
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

50. How to dx keratitis?
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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
Foreign body sensation - photophobia - corneal opacity tx abx
Prolactinoma