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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. How to difference RSV and neonatal chlamydia
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No wheezing - no feever in chlamydia
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
ALL - alzheimers autism adhd depression seizure

2. target cell
Imaging study to r/o VUR
T for t ; thalassemia; inc serum iron and Iron binding
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

3. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Imaging study to r/o VUR
Atypical lymphocyte
Biliary atresia; tx surgery

4. carditis and arthritis after rheumatic fever
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
refuse
36 hours
Develops in 21 dasy

5. What is thumbprint sign
Foreign body sensation - photophobia - corneal opacity tx abx
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Lateral neck xray in epiglottitis show swollen epiglottis

6. centor criteria for bact pharyngitis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Increase of pregnenolone
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

7. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

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8. How to evaluate well appearing child just born in GBS pos mother?
Herpes
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Marfans - ehlers danlos - homocystinuria
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

9. lens dislocation
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Marfans - ehlers danlos - homocystinuria
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

10. lead >70
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Medical emergency; dimercaprol/edta

11. causes of FTT
Marfans - ehlers danlos - homocystinuria
Neurofibromatosis type2
>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
Decr calorie intake; decr calorie absorption;incr calorie demand

12. 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
Vaso-occlusive crisis; dx hb electrophoresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

13. pavlik harness
No wheezing - no feever in chlamydia
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
To make hip flexed and abducted position in DDH
T for t ; thalassemia; inc serum iron and Iron binding

14. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Facial portwine stain
24h to 7d of birth
T for t ; thalassemia; inc serum iron and Iron binding

15. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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
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
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

16. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Biliary atresia; tx surgery
Candidal diapar rash; tx clotrimazol
24h to 7d of birth

17. major depression
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Diet modification to provide 110kc/kg/d
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Atopic dermatitis; strong allergic/immunologic component; incr IgE

18. How to difference viral and bact pneumonia
Wait until 6 months
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Diet modification to provide 110kc/kg/d
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

19. Tx of community acquired pneumonia
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No intervention; 90% foreign bodies pass without difficulty
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

20. doing worse in school - lack of attention - starring speel
Lateral neck xray in epiglottitis show swollen epiglottis
Absence seizure; tx ethosuximide
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Faciform RBC cause vascular occlusion

21. patient with white plaques in mouth and lump in back
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Do HIV testing at first

22. can women with abnormal smear or genital get vaccine
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
If aortic root reaches 45 mm
Yes; but it will be less effective
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

23. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Multiple telangiectesia - vasular lesion in CNS
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

24. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Central isosexual precocious puberty; hypothalmaic hamartoma
Candidal diapar rash; tx clotrimazol
To make hip flexed and abducted position in DDH

25. acute otitis media-pathogen
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Strep pneumonie; moraxella; h influenze
110 kcl/kg/day
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

26. 21 hydroxylase
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Decr calorie intake; decr calorie absorption;incr calorie demand
24h to 7d of birth

27. When to give hpv vaccien
Vaso-occlusive crisis; dx hb electrophoresis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

28. What is earliest sign of puberty?
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Vaso-occlusive crisis; dx hb electrophoresis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Faciform RBC cause vascular occlusion

29. aplasic crisis
refuse
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Yes; but it will be less effective
Rapid detection of RSV antigen in nasl

30. flexible kyphosis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Pho for forward bending; forward defect; common finding has no adverse physical effect
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Candidal diapar rash; tx clotrimazol

31. differentiate between central and peripheral precocious puberty
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
Decr calorie intake; decr calorie absorption;incr calorie demand
Injury to lower roots of brachial plexus
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

32. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Benign permature thelarche; expectant management
Facial portwine stain

33. hypopigmented spots - family hx bilat deafness
Increase of progesteron/17oh progesterone
Neurofibromatosis type2
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

34. Nocturnal enuresis
Injury to b/l glossopharyngeal. present in botulism
If aortic root reaches 45 mm
HSP - look for symmetric skin lesions
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

35. How to dx acute angle closure glaucoma
Imaging study to r/o VUR
Pho for forward bending; forward defect; common finding has no adverse physical effect
Endocardial cushion defect (no separation between heart chambers)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

36. complete airway obstruction with FB
Marfans - ehlers danlos - homocystinuria
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Injury to lower roots of brachial plexus
>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. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Neurofibromatosis type2
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

38. When to do surgery for undescended testes
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Wait until 6 months
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Multiple telangiectesia - vasular lesion in CNS

39. iron supplement in child
After 6m; breast mild provides iron until 6m.
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
ALL - alzheimers autism adhd depression seizure
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

40. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
110 kcl/kg/day
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bartonella henselae; complication is suppuration of lymph node

41. Tx of children constipation

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42. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Prolactinoma
Fifth disease; febrile syndrome

43. Parvovirus
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
Fifth disease; febrile syndrome
Dx US tx; correct serum electrolyte - pyloromyotom

44. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

45. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Dx US tx; correct serum electrolyte - pyloromyotom
No intervention; 90% foreign bodies pass without difficulty
Prolactinoma

46. difference between breast milk and breafeeding jaundice
Absence seizure; tx ethosuximide
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
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
Lateral neck xray in epiglottitis show swollen epiglottis

47. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Congenital rubella syndrome
Brown
Constitutional pubertal delay

48. indications of audiometry in childrens
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

49. Febrile seizure
Less than 5th percentile
Dactylitis; 2nd common is splenic seqestration
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Increase of progesteron/17oh progesterone

50. How long anti-TB drugs given for TB meningitis?
Croup tx cool mist; racemic epi - corticosteroid
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Herpes
URI