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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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Risk of neurological dysfunction
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Neurofibromatosis type2

2. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Congenital rubella syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

3. tzanck
Atypical lymphocyte
Herpes
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Atopic dermatitis; strong allergic/immunologic component; incr IgE

4. echymoses with low platelet <30k
Meconeum ileus; think about CF
To make hip flexed and abducted position in DDH
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Biliary atresia; tx surgery

5. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

6. 3yo - never able to walk
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Herpes
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

7. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
refuse
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

8. defcicieny of 21 hydroxylase
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
Increase of progesteron/17oh progesterone
Oral DMSA or EDTA IV
Less than 5th percentile

9. splenic infarction in sickle cell
Bladder dysfunction; UTI and renal dysfunctoin
Faciform RBC cause vascular occlusion
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Endocardial cushion defect (no separation between heart chambers)

10. How to dx RSV
Rapid detection of RSV antigen in nasl
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
After 24h of abx therapy

11. patient with white plaques in mouth and lump in back
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Do HIV testing at first
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Injury to lower roots of brachial plexus

12. tuberous sclerosis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Decr calorie intake; decr calorie absorption;incr calorie demand
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

13. the risk of lyme after bitten by a tick
110 kcl/kg/day
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Yes; but it will be less effective
1.5%

14. is local anesthetics be used in cellulitis to reduce pain
Prolactinoma
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
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

15. association with infantile pyloric stenosis
refuse
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
24h to 7d of birth

16. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Decreases height - expensive; reserved for severe cases of delayed puberty

17. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No reticulocyte vs high reticulocyte
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

18. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
T for t ; thalassemia; inc serum iron and Iron binding

19. major depression
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Constitutional pubertal delay
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

20. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Rapid detection of RSV antigen in nasl

21. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Develops in 21 dasy
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

22. infantile hypertrophic pyloric stenosis
URI
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Dx US tx; correct serum electrolyte - pyloromyotom
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

23. thumb sign
RSV - rhino and influenza
Penicillin G 4h before delivery
T for t ; thalassemia; inc serum iron and Iron binding
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

24. How to difference RSV and neonatal chlamydia
Imaging study to r/o VUR
Do HIV testing at first
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
No wheezing - no feever in chlamydia

25. How to evaluate well appearing child just born in GBS pos mother?
After 6m; breast mild provides iron until 6m.
Prolactinoma
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

26. lead >70
Do HIV testing at first
<2yrs - abd pain - diarrhoea - ARF
Medical emergency; dimercaprol/edta
14yrs

27. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Facial portwine stain
After 6m; breast mild provides iron until 6m.
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

28. acute otitis media-pathogen
RSV - rhino and influenza
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Strep pneumonie; moraxella; h influenze
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

29. How to differentiate caput succedanueum and cephalohematoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Oral DMSA or EDTA IV
Yes; but it will be less effective

30. differentiate between central and peripheral precocious puberty
Injury to lower roots of brachial plexus
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

31. Tx of botulism
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Mainly clinical; serology with initial ELISA - with western blot confirmation;
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

32. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Constitutional pubertal delay

33. When erythema chronicum migrans develops after tick bite
24-72 hours
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Dactylitis; 2nd common is splenic seqestration
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

34. How long patient needs to be exposed to tick to get infected
No reticulocyte vs high reticulocyte
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
36 hours

35. HUS
Increase of pregnenolone
No intervention; 90% foreign bodies pass without difficulty
<2yrs - abd pain - diarrhoea - ARF
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

36. bromocriptine
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Brown
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Prolactinoma

37. lens dislocation
14yrs
Marfans - ehlers danlos - homocystinuria
Decreased UGT enzyme
T for t ; thalassemia; inc serum iron and Iron binding

38. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Dactylitis; 2nd common is splenic seqestration
No myoclonic activity in JME
Pipercillin (zosyn) - ticarcillin
1.5%

39. complete airway obstruction with FB
After 6m; breast mild provides iron until 6m.
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
>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

40. How long anti-TB drugs given for TB meningitis?
1.5%
HSP - look for symmetric skin lesions
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Foreign body sensation - photophobia - corneal opacity tx abx

41. indications of audiometry in childrens
Congenital rubella syndrome
Constitutional pubertal delay
Biliary atresia; tx surgery
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

42. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Dx US tx; correct serum electrolyte - pyloromyotom
Yes; but it will be less effective

43. When to bevioral and enviromental measure in led intoxication?
Rapid detection of RSV antigen in nasl
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Bartonella henselae; complication is suppuration of lymph node

44. What is the calorie requirement of newborn?
Decreases height - expensive; reserved for severe cases of delayed puberty
No intervention; 90% foreign bodies pass without difficulty
Lateral neck xray in epiglottitis show swollen epiglottis
110 kcl/kg/day

45. adrenal tumor
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
D for d; down syndrome and polyhydramnios
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

46. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Marfans - ehlers danlos - homocystinuria
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
HSP - look for symmetric skin lesions

47. what conditions are not contraindicated
Penicillin G 4h before delivery
TB - breastfeeding - asymptomatic hiv
refuse
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

48. congenital adrenal hyperplasi
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
14yrs
URI
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

49. duodenal atresia
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
D for d; down syndrome and polyhydramnios

50. What is thumbprint sign
Pho for forward bending; forward defect; common finding has no adverse physical effect
Female - breech delivery - family history; tx referral to ortho
Injury to lower roots of brachial plexus
Lateral neck xray in epiglottitis show swollen epiglottis