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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. 18mo bilat breast enlargment - some pubic hair
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
Benign permature thelarche; expectant management
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

2. tick transmits RMSF
Black
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Female - breech delivery - family history; tx referral to ortho

3. When to do surgery for undescended testes
Wait until 6 months
Injury to b/l glossopharyngeal. present in botulism
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Congenital rubella syndrome

4. most common complication of otitis media
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Brown
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

5. complete airway obstruction with FB
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
>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
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Female - breech delivery - family history; tx referral to ortho

6. echymoses with low platelet <30k
1.5%
Herpes
24h to 7d of birth
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

7. contraindications of DTap
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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
refuse
Croup

8. How long anti-TB drugs given for TB meningitis?
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Brown
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

9. Parents can _____ vaccine
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
refuse
HSP - look for symmetric skin lesions
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

10. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Facial portwine stain
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Methylephenidate toxicity; cannot be stopped abruptly; taper
Imaging study to r/o VUR

11. How long patient needs to be exposed to tick to get infected
14yrs
Dx US tx; correct serum electrolyte - pyloromyotom
After 6m; breast mild provides iron until 6m.
36 hours

12. giardiasis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Tx only symptomatic carrier
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

13. 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
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
Decreases height - expensive; reserved for severe cases of delayed puberty
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

14. Tx of community acquired pneumonia
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Methylephenidate toxicity; cannot be stopped abruptly; taper
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

15. 3yo - never able to walk
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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
Biliary atresia; tx surgery

16. What is earliest sign of puberty?
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
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

17. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
After 24h of abx therapy
14yrs

18. Infant with serum billlirubin >25
After 24h of abx therapy
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Risk of neurological dysfunction
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

19. Nocturnal enuresis
Increase of progesteron/17oh progesterone
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

20. When erythema chronicum migrans develops after tick bite
Less than 5th percentile
24-72 hours
URI
Herpes

21. What is the most common initial symptom in sickle cell
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
If aortic root reaches 45 mm
Increase of pregnenolone
Dactylitis; 2nd common is splenic seqestration

22. how smoking contributes otitis media in children
<2yrs - abd pain - diarrhoea - ARF
Penicillin G 4h before delivery
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

23. Tx of botulism
Endocardial cushion defect (no separation between heart chambers)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

24. 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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

25. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
1.5%
Croup
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

26. association with infantile pyloric stenosis
HSP - look for symmetric skin lesions
Methylephenidate toxicity; cannot be stopped abruptly; taper
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

27. IM
Atypical lymphocyte
Bladder dysfunction; UTI and renal dysfunctoin
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

28. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
INH 9m if INH resistant rifampin 6m in children and 4m in adults
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

29. 21 hydroxylase
After 6m; breast mild provides iron until 6m.
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Absence seizure; tx ethosuximide
Prolactinoma

30. HUS
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Dx US tx; correct serum electrolyte - pyloromyotom
<2yrs - abd pain - diarrhoea - ARF

31. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
1.5%
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Herpes

32. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
24h to 7d of birth
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

33. down syndrome with holocystolic mumur
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Endocardial cushion defect (no separation between heart chambers)
D for d; down syndrome and polyhydramnios

34. Neonatal unconjugated hyperbilirubine
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Decreased UGT enzyme
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

35. causes of FTT
RSV - rhino and influenza
Decr calorie intake; decr calorie absorption;incr calorie demand
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
Increase of pregnenolone

36. difference between diaper dermatitis and rash
Do HIV testing at first
<2yrs - abd pain - diarrhoea - ARF
TB - breastfeeding - asymptomatic hiv
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

37. non immune pregnant women exposed to rubella in first trimester
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Congenital rubella syndrome
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

38. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
After 6m; breast mild provides iron until 6m.
Erb paralysis leading to diaphragmatic paralysis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

39. sturge weber syndrome
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Fifth disease; febrile syndrome
Increase of progesteron/17oh progesterone
Facial portwine stain

40. crying during urination. bacteriuria pyruria - rec episodes
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
Imaging study to r/o VUR
Penicillin G 4h before delivery
Oral DMSA or EDTA IV

41. pumonary TB
Brown
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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)
Marfans - ehlers danlos - homocystinuria

42. infantile hypertrophic pyloric stenosis
Benign permature thelarche; expectant management
Dx US tx; correct serum electrolyte - pyloromyotom
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Atopic dermatitis; strong allergic/immunologic component; incr IgE

43. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Faciform RBC cause vascular occlusion

44. pavlik harness
To make hip flexed and abducted position in DDH
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Wait until 6 months
Endocardial cushion defect (no separation between heart chambers)

45. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Atypical lymphocyte
Risk of neurological dysfunction

46. Parvovirus
Fifth disease; febrile syndrome
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Meconeum ileus; think about CF
No reticulocyte vs high reticulocyte

47. acute abd pain - hx URI - lower extremity maculo papular rash
To make hip flexed and abducted position in DDH
HSP - look for symmetric skin lesions
Increase of progesteron/17oh progesterone
24-72 hours

48. 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
Thalassemia - congenital hemolytic anemia
Candidal diapar rash; tx clotrimazol
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

49. Tx of FTT
Diet modification to provide 110kc/kg/d
No wheezing - no feever in chlamydia
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

50. kallman syndrome
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Brown
Croup tx cool mist; racemic epi - corticosteroid