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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
Oral DMSA or EDTA IV
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No intervention; 90% foreign bodies pass without difficulty

2. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
No myoclonic activity in JME
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Atopic dermatitis; strong allergic/immunologic component; incr IgE

3. decreased mobility of tympanic membrane after otitis media
RSV - rhino and influenza
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

4. giardiasis
Decreased UGT enzyme
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Less than 5th percentile
Tx only symptomatic carrier

5. contact lens keratitis
Congenital rubella syndrome
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Neurofibromatosis type2

6. deficinecy of 17 hydroxylase
Imaging study to r/o VUR
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Increase of pregnenolone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

7. centor criteria for bact pharyngitis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

8. difference between structural disorder and flexible kyphosis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
24-72 hours
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Bartonella henselae; complication is suppuration of lymph node

9. iron supplement in child
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
>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
Bladder dysfunction; UTI and renal dysfunctoin
After 6m; breast mild provides iron until 6m.

10. What is the calorie requirement of newborn?
Brown
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Croup
110 kcl/kg/day

11. When to do surgery for undescended testes
Erb paralysis leading to diaphragmatic paralysis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Wait until 6 months
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

12. language expectation from 2yo
Faciform RBC cause vascular occlusion
If aortic root reaches 45 mm
Bladder dysfunction; UTI and renal dysfunctoin
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

13. tick transmits RMSF
Black
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

14. 12y - obese - hip pain - hip ext rotated
Lateral neck xray in epiglottitis show swollen epiglottis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Imaging study to r/o VUR
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

15. 21 hydroxylase
Thalassemia - congenital hemolytic anemia
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
24h to 7d of birth
Strep pneumonie; moraxella; h influenze

16. complication of lumbosacral meningocele
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Bladder dysfunction; UTI and renal dysfunctoin
Injury to lower roots of brachial plexus

17. IM
After 6m; breast mild provides iron until 6m.
Atypical lymphocyte
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

18. How to dx endopthalmitis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Dactylitis; 2nd common is splenic seqestration
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

19. infantile hypertrophic pyloric stenosis
After 24h of abx therapy
Dx US tx; correct serum electrolyte - pyloromyotom
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Develops in 21 dasy

20. When erythema chronicum migrans develops after tick bite
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
24-72 hours
Medical emergency; dimercaprol/edta
HSP - look for symmetric skin lesions

21. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Female - breech delivery - family history; tx referral to ortho

22. How to investigate delayed puberty
36 hours
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Endocardial cushion defect (no separation between heart chambers)
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

23. Tx of botulism
Meconeum ileus; think about CF
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
1.5%
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)

24. How to dx RSV
Rapid detection of RSV antigen in nasl
Strep pneumonie; moraxella; h influenze
Benign permature thelarche; expectant management
After 6m; breast mild provides iron until 6m.

25. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Central isosexual precocious puberty; hypothalmaic hamartoma
Absence seizure; tx ethosuximide
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

26. mech of botulism
Herpes
Atypical lymphocyte
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Constitutional pubertal delay

27. When to do aortic root surgery in marfans to prevent dissection?
Central isosexual precocious puberty; hypothalmaic hamartoma
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
If aortic root reaches 45 mm

28. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Candidal diapar rash; tx clotrimazol
Develops in 21 dasy

29. adenovirus
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Pho for forward bending; forward defect; common finding has no adverse physical effect
URI

30. 18mo bilat breast enlargment - some pubic hair
Decreased UGT enzyme
Benign permature thelarche; expectant management
Imaging study to r/o VUR
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

31. How to differential bact vs viral conjunctivitis
Croup tx cool mist; racemic epi - corticosteroid
Meconeum ileus; think about CF
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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

32. coin in child's stomach
RSV - rhino and influenza
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
No intervention; 90% foreign bodies pass without difficulty
Bladder dysfunction; UTI and renal dysfunctoin

33. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

34. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
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
Black
Croup
Bladder dysfunction; UTI and renal dysfunctoin

35. penicillin effective against pseudomonas
No wheezing - no feever in chlamydia
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Risk of neurological dysfunction
Pipercillin (zosyn) - ticarcillin

36. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Marfans - ehlers danlos - homocystinuria
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

37. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Endocardial cushion defect (no separation between heart chambers)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Methylephenidate toxicity; cannot be stopped abruptly; taper
D for d; down syndrome and polyhydramnios

38. How to difference viral and bact pneumonia
Central isosexual precocious puberty; hypothalmaic hamartoma
Atypical lymphocyte
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

39. hypopigmented spots - family hx bilat deafness
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Neurofibromatosis type2
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

40. if bone age lower than actual and puberty delayed
Faciform RBC cause vascular occlusion
Constitutional pubertal delay
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

41. 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
Brown
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

42. physiological jaundice
No wheezing - no feever in chlamydia
24h to 7d of birth
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
<2yrs - abd pain - diarrhoea - ARF

43. TTP pentad
Dactylitis; 2nd common is splenic seqestration
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Candidal diapar rash; tx clotrimazol
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

44. patient with white plaques in mouth and lump in back
URI
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
Do HIV testing at first
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

45. side effect of testosteron therapy
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Decreases height - expensive; reserved for severe cases of delayed puberty
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
TB - breastfeeding - asymptomatic hiv

46. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
RSV - rhino and influenza
Congenital rubella syndrome

47. Tx of bact conjunctivitis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Congenital rubella syndrome
Diet modification to provide 110kc/kg/d
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

48. What is the definition of delayed puberty?
Penicillin G 4h before delivery
URI
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

49. Neonatal unconjugated hyperbilirubine
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Strep pneumonie; moraxella; h influenze
Decreased UGT enzyme
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

50. pumonary TB
Herpes
Between pregnenolone and 17oh pregnenolone
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)
ALL - alzheimers autism adhd depression seizure