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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.
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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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
24-72 hours
Black
RSV - rhino and influenza

2. How to differential bact vs viral conjunctivitis
Erb paralysis leading to diaphragmatic paralysis
Wait until 6 months
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
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

3. tick transmits lyme
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Brown
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
Dx US tx; correct serum electrolyte - pyloromyotom

4. patient with white plaques in mouth and lump in back
1.5%
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Do HIV testing at first
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

5. How long patient needs to be exposed to tick to get infected
Brown
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
36 hours

6. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

7. Tx of community acquired pneumonia
Bartonella henselae; complication is suppuration of lymph node
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

8. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

9. giardiasis
Tx only symptomatic carrier
Congenital rubella syndrome
URI
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

10. microcytic - hypochromic anemia - hepatospelnomegaly
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Thalassemia - congenital hemolytic anemia
Yes; but it will be less effective
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

11. indications of VUR
Dx US tx; correct serum electrolyte - pyloromyotom
If aortic root reaches 45 mm
Bartonella henselae; complication is suppuration of lymph node
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

12. indications of audiometry in childrens
Lateral neck xray in epiglottitis show swollen epiglottis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

13. difference between breast milk and breafeeding jaundice
Constitutional pubertal delay
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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
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

14. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

15. Tx of FTT
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Diet modification to provide 110kc/kg/d
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

16. adenovirus
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Croup tx cool mist; racemic epi - corticosteroid
URI
Congenital rubella syndrome

17. acute otitis media-pathogen
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Strep pneumonie; moraxella; h influenze
No myoclonic activity in JME
Wait until 6 months

18. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

19. How to differentiate croup vs epiglotitis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
After 6m; breast mild provides iron until 6m.
Foreign body sensation - photophobia - corneal opacity tx abx

20. starring spells 10-20sec
Increase of pregnenolone
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

21. crying during urination. bacteriuria pyruria - rec episodes
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Imaging study to r/o VUR
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Foreign body sensation - photophobia - corneal opacity tx abx

22. causes of acute anemia
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Increase of pregnenolone

23. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

24. adrenal tumor
Strep pneumonie; moraxella; h influenze
Bladder dysfunction; UTI and renal dysfunctoin
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

25. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
1.5%
Multiple telangiectesia - vasular lesion in CNS

26. down syndrome has inreased risk of developing
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
24-72 hours
Vaso-occlusive crisis; dx hb electrophoresis
ALL - alzheimers autism adhd depression seizure

27. IM
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Less than 5th percentile
Atypical lymphocyte
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

28. How to difference viral and bact pneumonia
Yes; but it will be less effective
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Facial portwine stain
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

29. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
No intervention; 90% foreign bodies pass without difficulty
14yrs
Herpes

30. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
No reticulocyte vs high reticulocyte
Constitutional pubertal delay
Mainly clinical; serology with initial ELISA - with western blot confirmation;

31. non immune pregnant women exposed to rubella in first trimester
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Congenital rubella syndrome
URI

32. 18mo bilat breast enlargment - some pubic hair
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
To make hip flexed and abducted position in DDH
Benign permature thelarche; expectant management

33. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Constitutional pubertal delay
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

34. lens dislocation
Thalassemia - congenital hemolytic anemia
Marfans - ehlers danlos - homocystinuria
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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)

35. What is the calorie requirement of newborn?
110 kcl/kg/day
Atypical lymphocyte
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

36. association with infantile pyloric stenosis
Bartonella henselae; complication is suppuration of lymph node
RSV - rhino and influenza
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Black

37. sudden onset of fever - difficulty in breathing
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Decreased UGT enzyme
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

38. What is the definition of delayed puberty?
Fifth disease; febrile syndrome
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Facial portwine stain
Brown

39. difference between structural disorder and flexible kyphosis
Biliary atresia; tx surgery
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
refuse
Endocardial cushion defect (no separation between heart chambers)

40. When to give HRT in turner
14yrs
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Central isosexual precocious puberty; hypothalmaic hamartoma
TB - breastfeeding - asymptomatic hiv

41. cleft lip but no cleft palate
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Medical emergency; dimercaprol/edta
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

42. How to prevent GBS in neonate
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Penicillin G 4h before delivery
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

43. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Neurofibromatosis type2
No myoclonic activity in JME
>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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

44. How to dx post uretheral valve
TB - breastfeeding - asymptomatic hiv
Penicillin G 4h before delivery
Decreased UGT enzyme
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

45. failure to thrive
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Less than 5th percentile
Benign permature thelarche; expectant management

46. Tx of bact conjunctivitis
Methylephenidate toxicity; cannot be stopped abruptly; taper
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
To make hip flexed and abducted position in DDH
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

47. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
No reticulocyte vs high reticulocyte
Rapid detection of RSV antigen in nasl
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

48. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Foreign body sensation - photophobia - corneal opacity tx abx
Develops in 21 dasy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

49. the risk of lyme after bitten by a tick
1.5%
Lateral neck xray in epiglottitis show swollen epiglottis
RSV - rhino and influenza
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

50. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Meconeum ileus; think about CF
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Biliary atresia; tx surgery