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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. TTP pentad
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
No reticulocyte vs high reticulocyte
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
No wheezing - no feever in chlamydia

2. viruses cause bronhioltitis
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
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Candidal diapar rash; tx clotrimazol
RSV - rhino and influenza

3. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
URI
Endocardial cushion defect (no separation between heart chambers)
HSP - look for symmetric skin lesions

4. congenital adrenal hyperplasi
Injury to b/l glossopharyngeal. present in botulism
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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)
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

5. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Methylephenidate toxicity; cannot be stopped abruptly; taper

6. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Diet modification to provide 110kc/kg/d
Increase of progesteron/17oh progesterone

7. How long patient needs to be exposed to tick to get infected
36 hours
Croup tx cool mist; racemic epi - corticosteroid
No intervention; 90% foreign bodies pass without difficulty
Pipercillin (zosyn) - ticarcillin

8. How to dx acute angle closure glaucoma
Decr calorie intake; decr calorie absorption;incr calorie demand
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Risk of neurological dysfunction

9. adenovirus
Injury to lower roots of brachial plexus
URI
TB - breastfeeding - asymptomatic hiv
To make hip flexed and abducted position in DDH

10. How to evaluate well appearing child just born in GBS pos mother?
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
<2yrs - abd pain - diarrhoea - ARF
Biliary atresia; tx surgery

11. infant botulism
Tx only symptomatic carrier
Congenital rubella syndrome
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Dactylitis; 2nd common is splenic seqestration

12. osler rendu weber syndrom
1.5%
Multiple telangiectesia - vasular lesion in CNS
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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

13. low grade fever - cough - diffuse bilat ground glass opacities
Increase of progesteron/17oh progesterone
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No wheezing - no feever in chlamydia

14. patient with white plaques in mouth and lump in back
Do HIV testing at first
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Absence seizure; tx ethosuximide
Atypical lymphocyte

15. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Black
Foreign body sensation - photophobia - corneal opacity tx abx
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

16. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
No; they are basic compound will be neutralized in an acidic environment of cellulitis

17. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Atypical lymphocyte
Neurofibromatosis type2
Mainly clinical; serology with initial ELISA - with western blot confirmation;

18. duodenal atresia
D for d; down syndrome and polyhydramnios
No myoclonic activity in JME
Do HIV testing at first
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

19. coin in child's stomach
Diet modification to provide 110kc/kg/d
If aortic root reaches 45 mm
No intervention; 90% foreign bodies pass without difficulty
Faciform RBC cause vascular occlusion

20. When to bevioral and enviromental measure in led intoxication?
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Endocardial cushion defect (no separation between heart chambers)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

21. splenic infarction in sickle cell
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Atypical lymphocyte
Faciform RBC cause vascular occlusion
Rapid detection of RSV antigen in nasl

22. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Increase of progesteron/17oh progesterone
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
Dactylitis; 2nd common is splenic seqestration
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

23. 3yo - never able to walk
24h to 7d of birth
Dactylitis; 2nd common is splenic seqestration
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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

24. How to dx post uretheral valve
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Bartonella henselae; complication is suppuration of lymph node

25. 3yo - febrile - left hip externally rotated
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Yes; but it will be less effective
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

26. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
110 kcl/kg/day
No myoclonic activity in JME
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Multiple telangiectesia - vasular lesion in CNS

27. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No reticulocyte vs high reticulocyte
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Candidal diapar rash; tx clotrimazol

28. Neonatal conjugated hyperbilirubinemia
RSV - rhino and influenza
Less than 5th percentile
Biliary atresia; tx surgery
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

29. Parents can _____ vaccine
Medical emergency; dimercaprol/edta
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
refuse
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

30. crying during urination. bacteriuria pyruria - rec episodes
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Imaging study to r/o VUR
Decreased UGT enzyme

31. How to dx endopthalmitis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
<2yrs - abd pain - diarrhoea - ARF
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

32. How long anti-TB drugs given for TB meningitis?
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

33. starring spells 10-20sec
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Imaging study to r/o VUR

34. deficinecy of 17 hydroxylase
refuse
Thalassemia - congenital hemolytic anemia
Increase of pregnenolone
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

35. thumb sign
>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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
No reticulocyte vs high reticulocyte
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)

36. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
No; they are basic compound will be neutralized in an acidic environment of cellulitis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Candidal diapar rash; tx clotrimazol
Foreign body sensation - photophobia - corneal opacity tx abx

37. benefits of antibiotic therapy in acute pharyngitis?
RSV - rhino and influenza
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Constitutional pubertal delay

38. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Atypical lymphocyte
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Candidal diapar rash; tx clotrimazol

39. difference between breast milk and breafeeding jaundice
Yes; but it will be less effective
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

40. impaired gag reflex
Develops in 21 dasy
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Injury to b/l glossopharyngeal. present in botulism
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

41. pumonary TB
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)
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Vaso-occlusive crisis; dx hb electrophoresis

42. How to differentiate caput succedanueum and cephalohematoma
ALL - alzheimers autism adhd depression seizure
Neurofibromatosis type2
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

43. How to difference viral and bact pneumonia
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
>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. pavlik harness
To make hip flexed and abducted position in DDH
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Biliary atresia; tx surgery

45. acute otitis externa

46. target cell
HSP - look for symmetric skin lesions
T for t ; thalassemia; inc serum iron and Iron binding
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

47. sickle cell with symmetrical swelling of hands and feet
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
No reticulocyte vs high reticulocyte
Vaso-occlusive crisis; dx hb electrophoresis

48. How to differentiate croup vs epiglotitis
24h to 7d of birth
RSV - rhino and influenza
TB - breastfeeding - asymptomatic hiv
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

49. red oozing rash on cheek - scaly - dry
URI
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

50. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Facial portwine stain
HSP - look for symmetric skin lesions
No wheezing - no feever in chlamydia