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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. causes of FTT
Tx only symptomatic carrier
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Decr calorie intake; decr calorie absorption;incr calorie demand

2. down syndrome has inreased risk of developing
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
ALL - alzheimers autism adhd depression seizure
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

3. When to give HRT in turner
T for t ; thalassemia; inc serum iron and Iron binding
After 6m; breast mild provides iron until 6m.
14yrs
Less than 5th percentile

4. indications of VUR
Black
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Pipercillin (zosyn) - ticarcillin
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

5. How long patient needs to be exposed to tick to get infected
Yes; but it will be less effective
Between pregnenolone and 17oh pregnenolone
Erb paralysis leading to diaphragmatic paralysis
36 hours

6. When to give hpv vaccien
URI
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
Croup tx cool mist; racemic epi - corticosteroid
Vaso-occlusive crisis; dx hb electrophoresis

7. How to dx RSV
<2yrs - abd pain - diarrhoea - ARF
Lateral neck xray in epiglottitis show swollen epiglottis
URI
Rapid detection of RSV antigen in nasl

8. How to differential bact vs viral conjunctivitis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Bladder dysfunction; UTI and renal dysfunctoin
Facial portwine stain
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

9. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

10. difference between structural disorder and flexible kyphosis
Congenital rubella syndrome
<2yrs - abd pain - diarrhoea - ARF
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

11. How to differentiate caput succedanueum and cephalohematoma
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Female - breech delivery - family history; tx referral to ortho
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Herpes

12. side effect of testosteron therapy
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
24-72 hours
Decreases height - expensive; reserved for severe cases of delayed puberty

13. What are the risk factors of developmental dysplais of hip
No intervention; 90% foreign bodies pass without difficulty
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Female - breech delivery - family history; tx referral to ortho
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

14. lens dislocation
Marfans - ehlers danlos - homocystinuria
No reticulocyte vs high reticulocyte
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Imaging study to r/o VUR

15. adenovirus
Oral DMSA or EDTA IV
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
URI
Foreign body sensation - photophobia - corneal opacity tx abx

16. starring spells 10-20sec
Prolactinoma
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

17. 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
Dactylitis; 2nd common is splenic seqestration
Central isosexual precocious puberty; hypothalmaic hamartoma
Facial portwine stain

18. can women with abnormal smear or genital get vaccine
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Yes; but it will be less effective
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
>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

19. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Meconeum ileus; think about CF
Prolactinoma
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
Brown

20. How to differentiate croup vs epiglotitis
Facial portwine stain
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

21. TTP pentad
Benign permature thelarche; expectant management
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

22. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Bladder dysfunction; UTI and renal dysfunctoin
refuse

23. Neonatal conjugated hyperbilirubinemia
Rapid detection of RSV antigen in nasl
ALL - alzheimers autism adhd depression seizure
After 24h of abx therapy
Biliary atresia; tx surgery

24. language expectation from 2yo
Foreign body sensation - photophobia - corneal opacity tx abx
URI
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

25. bromocriptine
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
Prolactinoma
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

26. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Central isosexual precocious puberty; hypothalmaic hamartoma
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Strep pneumonie; moraxella; h influenze

27. mech of botulism
Oral DMSA or EDTA IV
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
No reticulocyte vs high reticulocyte
Decreased UGT enzyme

28. low grade fever - cough - diffuse bilat ground glass opacities
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Imaging study to r/o VUR
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

29. What is the definition of delayed puberty?
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
24-72 hours

30. difference between breast milk and breafeeding jaundice
Increase of pregnenolone
Decreases height - expensive; reserved for severe cases of delayed puberty
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
RSV - rhino and influenza

31. complete airway obstruction with FB
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
>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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

32. aplasic crisis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

33. adrenal tumor
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
RSV - rhino and influenza

34. 12y - obese - hip pain - hip ext rotated
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Rapid detection of RSV antigen in nasl

35. sudden onset of fever - difficulty in breathing
Injury to lower roots of brachial plexus
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Constitutional pubertal delay
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

36. carditis and arthritis after rheumatic fever
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
refuse
Develops in 21 dasy
>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

37. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Croup

38. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Diet modification to provide 110kc/kg/d
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

39. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Wait until 6 months
Oral DMSA or EDTA IV
Medical emergency; dimercaprol/edta

40. splenic infarction in sickle cell
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Herpes
Faciform RBC cause vascular occlusion
After 24h of abx therapy

41. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Croup

42. if bone age lower than actual and puberty delayed
Diet modification to provide 110kc/kg/d
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Constitutional pubertal delay
Benign permature thelarche; expectant management

43. down syndrome with holocystolic mumur
Erb paralysis leading to diaphragmatic paralysis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Endocardial cushion defect (no separation between heart chambers)
After 24h of abx therapy

44. cleft lip but no cleft palate
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

45. cardiac manifestation of turner
refuse
To make hip flexed and abducted position in DDH
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

46. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Central isosexual precocious puberty; hypothalmaic hamartoma
To make hip flexed and abducted position in DDH

47. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Brown
RSV - rhino and influenza
Dx US tx; correct serum electrolyte - pyloromyotom

48. osler rendu weber syndrom
ALL - alzheimers autism adhd depression seizure
Dx US tx; correct serum electrolyte - pyloromyotom
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
Multiple telangiectesia - vasular lesion in CNS

49. the risk of lyme after bitten by a tick
Croup
Thalassemia - congenital hemolytic anemia
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
1.5%

50. pneumonia in CF patient
Faciform RBC cause vascular occlusion
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone