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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. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
After 6m; breast mild provides iron until 6m.
Lateral neck xray in epiglottitis show swollen epiglottis
Pho for forward bending; forward defect; common finding has no adverse physical effect

2. sudden onset of fever - difficulty in breathing
Constitutional pubertal delay
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Croup tx cool mist; racemic epi - corticosteroid
Brown

3. What is earliest sign of puberty?
URI
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

4. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Facial portwine stain
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

5. How to difference viral and bact pneumonia
Injury to b/l glossopharyngeal. present in botulism
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Vaso-occlusive crisis; dx hb electrophoresis
Bartonella henselae; complication is suppuration of lymph node

6. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Erb paralysis leading to diaphragmatic paralysis
>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

7. contact lens keratitis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Decr calorie intake; decr calorie absorption;incr calorie demand
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

8. 3yo - never able to walk
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

9. patient with white plaques in mouth and lump in back
Do HIV testing at first
Wait until 6 months
Thalassemia - congenital hemolytic anemia
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

10. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
24h to 7d of birth
110 kcl/kg/day

11. How to dx post uretheral valve
T for t ; thalassemia; inc serum iron and Iron binding
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Absence seizure; tx ethosuximide
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

12. 3yo - febrile - left hip externally rotated
Central isosexual precocious puberty; hypothalmaic hamartoma
Croup
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

13. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Dx US tx; correct serum electrolyte - pyloromyotom

14. mcCune albright`
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Biliary atresia; tx surgery
Penicillin G 4h before delivery

15. can women with abnormal smear or genital get vaccine
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)
Yes; but it will be less effective
Meconeum ileus; think about CF
Develops in 21 dasy

16. tick transmits lyme
To make hip flexed and abducted position in DDH
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Brown
Facial portwine stain

17. aplasic crisis
Central isosexual precocious puberty; hypothalmaic hamartoma
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Croup tx cool mist; racemic epi - corticosteroid
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

18. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Risk of neurological dysfunction
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
After 6m; breast mild provides iron until 6m.

19. sickle cell with symmetrical swelling of hands and feet
Congenital rubella syndrome
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
refuse
Vaso-occlusive crisis; dx hb electrophoresis

20. how smoking contributes otitis media in children
Foreign body sensation - photophobia - corneal opacity tx abx
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
1.5%

21. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Candidal diapar rash; tx clotrimazol
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Foreign body sensation - photophobia - corneal opacity tx abx

22. What is thumbprint sign
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Biliary atresia; tx surgery
Lateral neck xray in epiglottitis show swollen epiglottis

23. duodenal atresia
Meconeum ileus; think about CF
Increase of pregnenolone
Penicillin G 4h before delivery
D for d; down syndrome and polyhydramnios

24. microcytic - hypochromic anemia - hepatospelnomegaly
Croup
Thalassemia - congenital hemolytic anemia
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

25. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Wait until 6 months

26. thumb sign
After 6m; breast mild provides iron until 6m.
Biliary atresia; tx surgery
Do HIV testing at first
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

27. What is the definition of delayed puberty?
Croup
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
<2yrs - abd pain - diarrhoea - ARF
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

28. association with infantile pyloric stenosis
Foreign body sensation - photophobia - corneal opacity tx abx
Medical emergency; dimercaprol/edta
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
No; they are basic compound will be neutralized in an acidic environment of cellulitis

29. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Bartonella henselae; complication is suppuration of lymph node

30. infantile hypertrophic pyloric stenosis
Central isosexual precocious puberty; hypothalmaic hamartoma
Dx US tx; correct serum electrolyte - pyloromyotom
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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

31. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
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
Do HIV testing at first
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

32. down syndrome has inreased risk of developing
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
After 6m; breast mild provides iron until 6m.
ALL - alzheimers autism adhd depression seizure
Female - breech delivery - family history; tx referral to ortho

33. viruses cause bronhioltitis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
RSV - rhino and influenza

34. causes of FTT
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Bladder dysfunction; UTI and renal dysfunctoin
Meconeum ileus; think about CF
Decr calorie intake; decr calorie absorption;incr calorie demand

35. lead 44-70
Oral DMSA or EDTA IV
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
After 24h of abx therapy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

36. IM
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Multiple telangiectesia - vasular lesion in CNS
Atypical lymphocyte
Bartonella henselae; complication is suppuration of lymph node

37. decreased mobility of tympanic membrane after otitis media
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Croup
Decreases height - expensive; reserved for severe cases of delayed puberty
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

38. the recommended ca supplementation
If aortic root reaches 45 mm
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

39. When to do aortic root surgery in marfans to prevent dissection?
>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
Increase of pregnenolone
Dactylitis; 2nd common is splenic seqestration
If aortic root reaches 45 mm

40. tuberous sclerosis
D for d; down syndrome and polyhydramnios
Foreign body sensation - photophobia - corneal opacity tx abx
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Meconeum ileus; think about CF

41. dx of lyme
To make hip flexed and abducted position in DDH
Medical emergency; dimercaprol/edta
Mainly clinical; serology with initial ELISA - with western blot confirmation;
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

42. low grade fever - cough - diffuse bilat ground glass opacities
<2yrs - abd pain - diarrhoea - ARF
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Lateral neck xray in epiglottitis show swollen epiglottis
Faciform RBC cause vascular occlusion

43. How to prevent GBS in neonate
No reticulocyte vs high reticulocyte
Croup
Less than 5th percentile
Penicillin G 4h before delivery

44. barking cough - inspiratory stridor - hoarsenes - p/w few days after 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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Croup
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

45. acute otitis externa

46. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Develops in 21 dasy
Oral DMSA or EDTA IV
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)

47. the risk of lyme after bitten by a tick
Prolactinoma
Tx only symptomatic carrier
Decr calorie intake; decr calorie absorption;incr calorie demand
1.5%

48. infant botulism
No intervention; 90% foreign bodies pass without difficulty
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Multiple telangiectesia - vasular lesion in CNS
INH 9m if INH resistant rifampin 6m in children and 4m in adults

49. tzanck
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Female - breech delivery - family history; tx referral to ortho
Herpes
Atypical lymphocyte

50. How to dx keratitis?
TB - breastfeeding - asymptomatic hiv
Meconeum ileus; think about CF
Foreign body sensation - photophobia - corneal opacity tx abx
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace