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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 viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Oral DMSA or EDTA IV
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Marfans - ehlers danlos - homocystinuria

2. difference between rubeola (measles) and rulbella
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) -
HSP - look for symmetric skin lesions
Endocardial cushion defect (no separation between heart chambers)

3. How to dx acute angle closure glaucoma
14yrs
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Dx US tx; correct serum electrolyte - pyloromyotom
Atopic dermatitis; strong allergic/immunologic component; incr IgE

4. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
refuse
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Strep pneumonie; moraxella; h influenze

5. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Oral DMSA or EDTA IV
Herpes
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

6. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Pipercillin (zosyn) - ticarcillin
1.5%
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

7. sublottic narrowing
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Penicillin G 4h before delivery
Croup tx cool mist; racemic epi - corticosteroid
No reticulocyte vs high reticulocyte

8. how thalassemia die
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
No wheezing - no feever in chlamydia
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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

9. dx for DDH
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Imaging study to r/o VUR
Bladder dysfunction; UTI and renal dysfunctoin
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

10. coin in child's stomach
Female - breech delivery - family history; tx referral to ortho
No intervention; 90% foreign bodies pass without difficulty
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
T for t ; thalassemia; inc serum iron and Iron binding

11. lead >70
Medical emergency; dimercaprol/edta
Diet modification to provide 110kc/kg/d
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Dx US tx; correct serum electrolyte - pyloromyotom

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

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13. TB prophylaxis
ALL - alzheimers autism adhd depression seizure
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

14. acute otitis externa

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15. adenovirus
URI
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

16. Febrile seizure
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

17. How to dx keratitis?
36 hours
D for d; down syndrome and polyhydramnios
Foreign body sensation - photophobia - corneal opacity tx abx
Bartonella henselae; complication is suppuration of lymph node

18. difference between breast milk and breafeeding jaundice
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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
No wheezing - no feever in chlamydia

19. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
To make hip flexed and abducted position in DDH

20. patient with white plaques in mouth and lump in back
Less than 5th percentile
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Do HIV testing at first
Rapid detection of RSV antigen in nasl

21. Tx of FTT
Diet modification to provide 110kc/kg/d
Injury to lower roots of brachial plexus
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Rapid detection of RSV antigen in nasl

22. causes of acute anemia
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No wheezing - no feever in chlamydia
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

23. tuberous sclerosis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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
RSV - rhino and influenza

24. How to dx RSV
Rapid detection of RSV antigen in nasl
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Yes; but it will be less effective

25. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Injury to lower roots of brachial plexus
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

26. centor criteria for bact pharyngitis
Imaging study to r/o VUR
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
INH 9m if INH resistant rifampin 6m in children and 4m in adults

27. benefits of antibiotic therapy in acute pharyngitis?
Congenital rubella syndrome
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Dactylitis; 2nd common is splenic seqestration
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

28. complete airway obstruction with FB
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
>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
Endocardial cushion defect (no separation between heart chambers)
Tx only symptomatic carrier

29. mech of botulism
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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

30. deficinecy of 17 hydroxylase
No intervention; 90% foreign bodies pass without difficulty
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Increase of pregnenolone

31. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
D for d; down syndrome and polyhydramnios
Prolactinoma
No intervention; 90% foreign bodies pass without difficulty

32. How long patient needs to be exposed to tick to get infected
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
36 hours

33. bromocriptine
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Erb paralysis leading to diaphragmatic paralysis
Develops in 21 dasy
Prolactinoma

34. How to difference RSV and neonatal chlamydia
Facial portwine stain
Less than 5th percentile
Rapid detection of RSV antigen in nasl
No wheezing - no feever in chlamydia

35. the risk of lyme after bitten by a tick
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
1.5%
Dactylitis; 2nd common is splenic seqestration

36. How long anti-TB drugs given for TB meningitis?
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
After 24h of abx therapy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

37. IM
Dactylitis; 2nd common is splenic seqestration
Atypical lymphocyte
Erb paralysis leading to diaphragmatic paralysis
Facial portwine stain

38. 3yo - febrile - left hip externally rotated
Constitutional pubertal delay
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

39. target cell
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
T for t ; thalassemia; inc serum iron and Iron binding
After 24h of abx therapy
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

40. 12y - obese - hip pain - hip ext rotated
Croup tx cool mist; racemic epi - corticosteroid
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Penicillin G 4h before delivery
Tx only symptomatic carrier

41. How to prevent GBS in neonate
Lateral neck xray in epiglottitis show swollen epiglottis
Penicillin G 4h before delivery
Increase of progesteron/17oh progesterone
Rapid detection of RSV antigen in nasl

42. Tx of children constipation

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43. sturge weber syndrome
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Facial portwine stain
Neurofibromatosis type2
Benign permature thelarche; expectant management

44. How to differentiate croup vs epiglotitis
Central isosexual precocious puberty; hypothalmaic hamartoma
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Constitutional pubertal delay

45. language delay
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Fifth disease; febrile syndrome
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

46. echymoses with low platelet <30k
Congenital rubella syndrome
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Prolactinoma
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

47. How to dx endopthalmitis
Brown
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) -
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

48. Infant with serum billlirubin >25
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
After 6m; breast mild provides iron until 6m.
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Risk of neurological dysfunction

49. acute otitis media-pathogen
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Strep pneumonie; moraxella; h influenze
Between pregnenolone and 17oh pregnenolone

50. defcicieny of 21 hydroxylase
<2yrs - abd pain - diarrhoea - ARF
Increase of progesteron/17oh progesterone
Marfans - ehlers danlos - homocystinuria
Risk of neurological dysfunction