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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. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Central isosexual precocious puberty; hypothalmaic hamartoma
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
TB - breastfeeding - asymptomatic hiv
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

2. pavlik harness
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
Congenital rubella syndrome
HSP - look for symmetric skin lesions
To make hip flexed and abducted position in DDH

3. Tx of FTT
Between pregnenolone and 17oh pregnenolone
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Diet modification to provide 110kc/kg/d

4. sickle cell with symmetrical swelling of hands and feet
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Brown
Vaso-occlusive crisis; dx hb electrophoresis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

5. mech of botulism
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Diet modification to provide 110kc/kg/d

6. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Lateral neck xray in epiglottitis show swollen epiglottis
Croup
After 24h of abx therapy
Fifth disease; febrile syndrome

7. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
110 kcl/kg/day

8. centor criteria for bact pharyngitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

9. osler rendu weber syndrom
Risk of neurological dysfunction
Multiple telangiectesia - vasular lesion in CNS
Neurofibromatosis type2
Injury to lower roots of brachial plexus

10. cardiac manifestation of turner
HSP - look for symmetric skin lesions
Methylephenidate toxicity; cannot be stopped abruptly; taper
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Injury to lower roots of brachial plexus

11. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Tx only symptomatic carrier
Erb paralysis leading to diaphragmatic paralysis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

12. Parents can _____ vaccine
refuse
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Bartonella henselae; complication is suppuration of lymph node
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

13. language expectation from 2yo
Constitutional pubertal delay
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
14yrs
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

14. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Congenital rubella syndrome
D for d; down syndrome and polyhydramnios

15. dx for DDH
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Thalassemia - congenital hemolytic anemia

16. Nocturnal enuresis
After 6m; breast mild provides iron until 6m.
Atypical lymphocyte
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

17. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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
TB - breastfeeding - asymptomatic hiv

18. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Constitutional pubertal delay
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

19. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
RSV - rhino and influenza
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

20. down syndrome has inreased risk of developing
Diet modification to provide 110kc/kg/d
ALL - alzheimers autism adhd depression seizure
Dx US tx; correct serum electrolyte - pyloromyotom
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

21. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
14yrs
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

22. bromocriptine
<2yrs - abd pain - diarrhoea - ARF
Foreign body sensation - photophobia - corneal opacity tx abx
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Prolactinoma

23. benefits of antibiotic therapy in acute pharyngitis?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Erb paralysis leading to diaphragmatic paralysis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
1.5%

24. acute otitis externa

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25. HUS
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)
<2yrs - abd pain - diarrhoea - ARF
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
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

26. impaired gag reflex
T for t ; thalassemia; inc serum iron and Iron binding
Thalassemia - congenital hemolytic anemia
Injury to b/l glossopharyngeal. present in botulism
Fifth disease; febrile syndrome

27. cat scratch disease
Imaging study to r/o VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Bartonella henselae; complication is suppuration of lymph node
Vaso-occlusive crisis; dx hb electrophoresis

28. spitting up - vomiting at night - weight stable
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
refuse

29. sublottic narrowing
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Between pregnenolone and 17oh pregnenolone
Croup tx cool mist; racemic epi - corticosteroid
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

30. doing worse in school - lack of attention - starring speel
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
If aortic root reaches 45 mm
Absence seizure; tx ethosuximide
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

31. Neonatal unconjugated hyperbilirubine
No intervention; 90% foreign bodies pass without difficulty
Decreased UGT enzyme
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

32. crying during urination. bacteriuria pyruria - rec episodes
Less than 5th percentile
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Imaging study to r/o VUR
Rapid detection of RSV antigen in nasl

33. if bone age lower than actual and puberty delayed
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Imaging study to r/o VUR
Constitutional pubertal delay
Yes; but it will be less effective

34. Infant with serum billlirubin >25
>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
Risk of neurological dysfunction
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

35. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Atypical lymphocyte
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Decreases height - expensive; reserved for severe cases of delayed puberty

36. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
<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)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

37. defcicieny of 21 hydroxylase
Erb paralysis leading to diaphragmatic paralysis
After 24h of abx therapy
24-72 hours
Increase of progesteron/17oh progesterone

38. infantile hypertrophic pyloric stenosis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
24-72 hours
Facial portwine stain
Dx US tx; correct serum electrolyte - pyloromyotom

39. patient with white plaques in mouth and lump in back
Do HIV testing at first
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Lateral neck xray in epiglottitis show swollen epiglottis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

40. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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
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)
D for d; down syndrome and polyhydramnios

41. TB prophylaxis
36 hours
1.5%
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

42. tzanck
Brown
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Herpes
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

43. How to investigate delayed puberty
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

44. Neonatal conjugated hyperbilirubinemia
Do HIV testing at first
Biliary atresia; tx surgery
Vaso-occlusive crisis; dx hb electrophoresis
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

45. down syndrome with holocystolic mumur
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Absence seizure; tx ethosuximide
Endocardial cushion defect (no separation between heart chambers)
Black

46. When to give hpv vaccien
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Thalassemia - congenital hemolytic anemia
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
Brown

47. What is the calorie requirement of newborn?
Meconeum ileus; think about CF
Neurofibromatosis type2
110 kcl/kg/day
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

48. Tx of children constipation

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49. viruses cause bronhioltitis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
RSV - rhino and influenza
Endocardial cushion defect (no separation between heart chambers)
Injury to b/l glossopharyngeal. present in botulism

50. giardiasis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
No myoclonic activity in JME
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Tx only symptomatic carrier

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USMLE Step3 Pediatrics

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