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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. Infant with serum billlirubin >25
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
RSV - rhino and influenza
Risk of neurological dysfunction
Neurofibromatosis type2

2. pneumonia in CF patient
URI
Do HIV testing at first
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Marfans - ehlers danlos - homocystinuria

3. how smoking contributes otitis media in children
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

4. difference between breast milk and breafeeding jaundice
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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
No reticulocyte vs high reticulocyte

5. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
refuse
Croup
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

6. can women with abnormal smear or genital get vaccine
Faciform RBC cause vascular occlusion
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Yes; but it will be less effective
TB - breastfeeding - asymptomatic hiv

7. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
36 hours
URI
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

8. How to difference viral and bact pneumonia
Female - breech delivery - family history; tx referral to ortho
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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
Rapid detection of RSV antigen in nasl

9. HUS
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Black
<2yrs - abd pain - diarrhoea - ARF
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

10. failure to thrive
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Methylephenidate toxicity; cannot be stopped abruptly; taper
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Less than 5th percentile

11. How to investigate delayed puberty
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
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
1.5%

12. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
T for t ; thalassemia; inc serum iron and Iron binding
Injury to b/l glossopharyngeal. present in botulism
Decreases height - expensive; reserved for severe cases of delayed puberty

13. what conditions are not contraindicated
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Yes; but it will be less effective
TB - breastfeeding - asymptomatic hiv
Less than 5th percentile

14. Febrile seizure
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

15. How to evaluate well appearing child just born in GBS pos mother?
Marfans - ehlers danlos - homocystinuria
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Risk of neurological dysfunction
1.5%

16. Parvovirus
Fifth disease; febrile syndrome
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Less than 5th percentile
Injury to b/l glossopharyngeal. present in botulism

17. infant botulism
Congenital rubella syndrome
Meconeum ileus; think about CF
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

18. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
D for d; down syndrome and polyhydramnios
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

19. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Pho for forward bending; forward defect; common finding has no adverse physical effect
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Rapid detection of RSV antigen in nasl

20. IM
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Atypical lymphocyte
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

21. target cell
T for t ; thalassemia; inc serum iron and Iron binding
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)
Tx only symptomatic carrier
Candidal diapar rash; tx clotrimazol

22. dx for turner
Do HIV testing at first
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Yes; but it will be less effective
No intervention; 90% foreign bodies pass without difficulty

23. What is the definition of delayed puberty?
No myoclonic activity in JME
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

24. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Develops in 21 dasy

25. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
1.5%
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

26. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Bartonella henselae; complication is suppuration of lymph node
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

27. How long patient needs to be exposed to tick to get infected
Benign permature thelarche; expectant management
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
36 hours
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

28. centor criteria for bact pharyngitis
Croup
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Facial portwine stain

29. pumonary TB
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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)
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

30. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Neurofibromatosis type2
Thalassemia - congenital hemolytic anemia
URI
No myoclonic activity in JME

31. dx of lyme
Biliary atresia; tx surgery
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No myoclonic activity in JME

32. patient with white plaques in mouth and lump in back
Injury to b/l glossopharyngeal. present in botulism
Do HIV testing at first
Bartonella henselae; complication is suppuration of lymph node
Pipercillin (zosyn) - ticarcillin

33. How to differential bact vs viral conjunctivitis
Congenital rubella syndrome
Rapid detection of RSV antigen in nasl
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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

34. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
HSP - look for symmetric skin lesions

35. starring spells 10-20sec
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Between pregnenolone and 17oh pregnenolone
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Decreased UGT enzyme

36. when bact conjunctivitis patient can go back to school
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
After 24h of abx therapy
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
No wheezing - no feever in chlamydia

37. How to dx RSV
Multiple telangiectesia - vasular lesion in CNS
Rapid detection of RSV antigen in nasl
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

38. How to prevent GBS in neonate
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Injury to lower roots of brachial plexus
Penicillin G 4h before delivery
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

39. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Brown
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Erb paralysis leading to diaphragmatic paralysis

40. Tx of children constipation

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41. how thalassemia die
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

42. What is earliest sign of puberty?
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Female - breech delivery - family history; tx referral to ortho
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

43. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Central isosexual precocious puberty; hypothalmaic hamartoma
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

44. contraindications of MMR vaccine
Methylephenidate toxicity; cannot be stopped abruptly; taper
Croup tx cool mist; racemic epi - corticosteroid
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

45. Neonatal conjugated hyperbilirubinemia
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
36 hours
Biliary atresia; tx surgery
After 6m; breast mild provides iron until 6m.

46. decreased mobility of tympanic membrane after otitis media
T for t ; thalassemia; inc serum iron and Iron binding
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Increase of progesteron/17oh progesterone
Female - breech delivery - family history; tx referral to ortho

47. When to bevioral and enviromental measure in led intoxication?
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Diet modification to provide 110kc/kg/d
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Penicillin G 4h before delivery

48. deficinecy of 17 hydroxylase
Increase of pregnenolone
Croup tx cool mist; racemic epi - corticosteroid
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
Tx only symptomatic carrier

49. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Decr calorie intake; decr calorie absorption;incr calorie demand
Absence seizure; tx ethosuximide
Diet modification to provide 110kc/kg/d

50. kallman syndrome
24-72 hours
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products