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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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Answer 50 questions in 15 minutes.
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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. bromocriptine
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Prolactinoma
Decreased UGT enzyme
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

2. differentiate between central and peripheral precocious puberty
Medical emergency; dimercaprol/edta
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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
T for t ; thalassemia; inc serum iron and Iron binding

3. Neonatal unconjugated hyperbilirubine
14yrs
Decreased UGT enzyme
Multiple telangiectesia - vasular lesion in CNS
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

4. 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
Croup
Medical emergency; dimercaprol/edta
Decr calorie intake; decr calorie absorption;incr calorie demand

5. What is the most common initial symptom in sickle cell
Neurofibromatosis type2
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Dactylitis; 2nd common is splenic seqestration

6. infant botulism
Imaging study to r/o VUR
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
<2yrs - abd pain - diarrhoea - ARF

7. 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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Imaging study to r/o VUR
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

8. causes of acute anemia
110 kcl/kg/day
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
URI

9. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
T for t ; thalassemia; inc serum iron and Iron binding
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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

10. 18mo bilat breast enlargment - some pubic hair
Oral DMSA or EDTA IV
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Lateral neck xray in epiglottitis show swollen epiglottis
Benign permature thelarche; expectant management

11. the recommended ca supplementation
Rapid detection of RSV antigen in nasl
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

12. echymoses with low platelet <30k
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Strep pneumonie; moraxella; h influenze
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

13. adenovirus
URI
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
After 24h of abx therapy
TB - breastfeeding - asymptomatic hiv

14. benefits of antibiotic therapy in acute pharyngitis?
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

15. How to prevent GBS in neonate
refuse
Penicillin G 4h before delivery
Strep pneumonie; moraxella; h influenze
Methylephenidate toxicity; cannot be stopped abruptly; taper

16. carditis and arthritis after rheumatic fever
Benign permature thelarche; expectant management
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Develops in 21 dasy
Dactylitis; 2nd common is splenic seqestration

17. What are the risk factors of developmental dysplais of hip
Develops in 21 dasy
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
Female - breech delivery - family history; tx referral to ortho
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

18. When to give hpv vaccien
refuse
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
1.5%
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

19. horner syndrom
After 6m; breast mild provides iron until 6m.
Diet modification to provide 110kc/kg/d
Vaso-occlusive crisis; dx hb electrophoresis
Injury to lower roots of brachial plexus

20. How to differential bact vs viral conjunctivitis
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
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
Do HIV testing at first
Bartonella henselae; complication is suppuration of lymph node

21. How long anti-TB drugs given for TB meningitis?
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Absence seizure; tx ethosuximide
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

22. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Bladder dysfunction; UTI and renal dysfunctoin
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

23. What is thumbprint sign
110 kcl/kg/day
Absence seizure; tx ethosuximide
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Lateral neck xray in epiglottitis show swollen epiglottis

24. How to investigate 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
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Wait until 6 months
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

25. contraindications of MMR vaccine
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Female - breech delivery - family history; tx referral to ortho
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

26. lens dislocation
Marfans - ehlers danlos - homocystinuria
refuse
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Prolactinoma

27. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Imaging study to r/o VUR
Dx US tx; correct serum electrolyte - pyloromyotom

28. complete airway obstruction with FB
>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
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

29. sudden onset of fever - difficulty in breathing
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Meconeum ileus; think about CF
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

30. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Absence seizure; tx ethosuximide
Croup

31. centor criteria for bact pharyngitis
No myoclonic activity in JME
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Yes; but it will be less effective
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

32. How to evaluate well appearing child just born in GBS pos mother?
Faciform RBC cause vascular occlusion
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

33. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
<2yrs - abd pain - diarrhoea - ARF
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)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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

34. how thalassemia die
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Oral DMSA or EDTA IV
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

35. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

36. microcytic - hypochromic anemia - hepatospelnomegaly
No reticulocyte vs high reticulocyte
ALL - alzheimers autism adhd depression seizure
Less than 5th percentile
Thalassemia - congenital hemolytic anemia

37. TB prophylaxis
To make hip flexed and abducted position in DDH
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Wait until 6 months
INH 9m if INH resistant rifampin 6m in children and 4m in adults

38. pumonary TB
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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)
Meconeum ileus; think about CF

39. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Meconeum ileus; think about CF
Herpes

40. contact lens keratitis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Penicillin G 4h before delivery
Tx only symptomatic carrier
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

41. infantile hypertrophic pyloric stenosis
Biliary atresia; tx surgery
Erb paralysis leading to diaphragmatic paralysis
Dx US tx; correct serum electrolyte - pyloromyotom
Injury to b/l glossopharyngeal. present in botulism

42. When to do surgery for undescended testes
Decreases height - expensive; reserved for severe cases of delayed puberty
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Wait until 6 months
Faciform RBC cause vascular occlusion

43. 12y - obese - hip pain - hip ext rotated
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

44. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Dx US tx; correct serum electrolyte - pyloromyotom
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

45. sublottic narrowing
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No reticulocyte vs high reticulocyte
Croup tx cool mist; racemic epi - corticosteroid
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

46. sickle cell with symmetrical swelling of hands and feet
Medical emergency; dimercaprol/edta
Benign permature thelarche; expectant management
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Vaso-occlusive crisis; dx hb electrophoresis

47. How to differentiate croup vs epiglotitis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
1.5%

48. 3yo - never able to walk
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Increase of progesteron/17oh progesterone
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
T for t ; thalassemia; inc serum iron and Iron binding

49. major depression
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)
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
refuse
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

50. IM
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Atypical lymphocyte
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Thalassemia - congenital hemolytic anemia

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USMLE Step3 Pediatrics

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