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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. dx for turner
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Injury to lower roots of brachial plexus
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

2. How to difference RSV and neonatal chlamydia
Do HIV testing at first
No wheezing - no feever in chlamydia
Between pregnenolone and 17oh pregnenolone
Candidal diapar rash; tx clotrimazol

3. pavlik harness
36 hours
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
To make hip flexed and abducted position in DDH

4. tuberous sclerosis
URI
24h to 7d of birth
D for d; down syndrome and polyhydramnios
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

5. complete airway obstruction with FB
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
>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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

6. splenic infarction in sickle cell
Oral DMSA or EDTA IV
Benign permature thelarche; expectant management
Faciform RBC cause vascular occlusion
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

7. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Erb paralysis leading to diaphragmatic paralysis
HSP - look for symmetric skin lesions

8. differentiate between central and peripheral precocious puberty
110 kcl/kg/day
Pipercillin (zosyn) - ticarcillin
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

9. coin in child's stomach
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Imaging study to r/o VUR
refuse
No intervention; 90% foreign bodies pass without difficulty

10. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Black
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
No reticulocyte vs high reticulocyte
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

11. sudden onset of fever - difficulty in breathing
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
Pipercillin (zosyn) - ticarcillin
D for d; down syndrome and polyhydramnios
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

12. How to evaluate well appearing child just born in GBS pos mother?
Brown
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Croup

13. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
URI
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
No reticulocyte vs high reticulocyte

14. target cell
To make hip flexed and abducted position in DDH
T for t ; thalassemia; inc serum iron and Iron binding
Endocardial cushion defect (no separation between heart chambers)
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

15. How to dx acute angle closure glaucoma
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
No wheezing - no feever in chlamydia
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Faciform RBC cause vascular occlusion

16. the risk of lyme after bitten by a tick
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
Congenital rubella syndrome
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
1.5%

17. acute abd pain - hx URI - lower extremity maculo papular rash
URI
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Absence seizure; tx ethosuximide
HSP - look for symmetric skin lesions

18. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Croup
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Mainly clinical; serology with initial ELISA - with western blot confirmation;

19. benefits of antibiotic therapy in acute pharyngitis?
Strep pneumonie; moraxella; h influenze
Constitutional pubertal delay
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

20. osler rendu weber syndrom
Increase of pregnenolone
Penicillin G 4h before delivery
Pipercillin (zosyn) - ticarcillin
Multiple telangiectesia - vasular lesion in CNS

21. flexible kyphosis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Injury to lower roots of brachial plexus
Pho for forward bending; forward defect; common finding has no adverse physical effect
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

22. what conditions are not contraindicated
Croup tx cool mist; racemic epi - corticosteroid
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
INH 9m if INH resistant rifampin 6m in children and 4m in adults
TB - breastfeeding - asymptomatic hiv

23. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Decr calorie intake; decr calorie absorption;incr calorie demand
Absence seizure; tx ethosuximide
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

24. How to investigate delayed puberty
Tx only symptomatic carrier
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Facial portwine stain
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

25. cardiac manifestation of turner
24-72 hours
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Pho for forward bending; forward defect; common finding has no adverse physical effect
Neurofibromatosis type2

26. iron supplement in child
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
After 6m; breast mild provides iron until 6m.
No reticulocyte vs high reticulocyte
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

27. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Candidal diapar rash; tx clotrimazol
Black
Methylephenidate toxicity; cannot be stopped abruptly; taper

28. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

29. tick transmits RMSF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Black
Risk of neurological dysfunction
Multiple telangiectesia - vasular lesion in CNS

30. When to do surgery for undescended testes
Wait until 6 months
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
No reticulocyte vs high reticulocyte
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

31. How to difference viral and bact pneumonia
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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Rapid detection of RSV antigen in nasl

32. 12y - obese - hip pain - hip ext rotated
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
110 kcl/kg/day
Thalassemia - congenital hemolytic anemia

33. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Lateral neck xray in epiglottitis show swollen epiglottis

34. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
After 24h of abx therapy
Dactylitis; 2nd common is splenic seqestration

35. giardiasis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Tx only symptomatic carrier
Endocardial cushion defect (no separation between heart chambers)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

36. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Female - breech delivery - family history; tx referral to ortho
If aortic root reaches 45 mm

37. patient with white plaques in mouth and lump in back
Herpes
Do HIV testing at first
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Marfans - ehlers danlos - homocystinuria

38. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Fifth disease; febrile syndrome
Bartonella henselae; complication is suppuration of lymph node
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

39. When erythema chronicum migrans develops after tick bite
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
ALL - alzheimers autism adhd depression seizure
24-72 hours

40. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Penicillin G 4h before delivery

41. How long anti-TB drugs given for TB meningitis?
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Lateral neck xray in epiglottitis show swollen epiglottis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

42. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
HSP - look for symmetric skin lesions
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Methylephenidate toxicity; cannot be stopped abruptly; taper

43. contraindications of MMR vaccine
No reticulocyte vs high reticulocyte
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
INH 9m if INH resistant rifampin 6m in children and 4m in adults

44. how smoking contributes otitis media in children
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

45. microcytic - hypochromic anemia - hepatospelnomegaly
Methylephenidate toxicity; cannot be stopped abruptly; taper
Thalassemia - congenital hemolytic anemia
Female - breech delivery - family history; tx referral to ortho
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

46. aplasic crisis
Risk of neurological dysfunction
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
110 kcl/kg/day
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

47. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Candidal diapar rash; tx clotrimazol
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

48. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
refuse
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

49. mcCune albright`
Congenital rubella syndrome
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Dx US tx; correct serum electrolyte - pyloromyotom
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

50. if bone age lower than actual and puberty delayed
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Do HIV testing at first
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Constitutional pubertal delay