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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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Match each statement with the correct term.
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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. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

2. How to dx RSV
Dactylitis; 2nd common is splenic seqestration
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
Rapid detection of RSV antigen in nasl
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

3. sublottic narrowing
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Female - breech delivery - family history; tx referral to ortho
Croup tx cool mist; racemic epi - corticosteroid
Decr calorie intake; decr calorie absorption;incr calorie demand

4. difference between diaper dermatitis and rash
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
Wait until 6 months
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

5. viruses cause bronhioltitis
24-72 hours
RSV - rhino and influenza
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

6. tuberous sclerosis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Bartonella henselae; complication is suppuration of lymph node
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

7. infantile hypertrophic pyloric stenosis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
Dx US tx; correct serum electrolyte - pyloromyotom

8. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Neurofibromatosis type2
Vaso-occlusive crisis; dx hb electrophoresis
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

9. tzanck
Dx US tx; correct serum electrolyte - pyloromyotom
RSV - rhino and influenza
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Herpes

10. what conditions are not contraindicated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
TB - breastfeeding - asymptomatic hiv
24-72 hours

11. giardiasis
Wait until 6 months
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Benign permature thelarche; expectant management
Tx only symptomatic carrier

12. difference between breast milk and breafeeding jaundice
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No myoclonic activity in JME
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

13. language expectation from 2yo
Less than 5th percentile
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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

14. horner syndrom
If aortic root reaches 45 mm
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
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to lower roots of brachial plexus

15. deficinecy of 17 hydroxylase
Increase of pregnenolone
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Endocardial cushion defect (no separation between heart chambers)

16. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
ALL - alzheimers autism adhd depression seizure
Injury to lower roots of brachial plexus

17. the risk of lyme after bitten by a tick
Increase of progesteron/17oh progesterone
Yes; but it will be less effective
1.5%
Candidal diapar rash; tx clotrimazol

18. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Thalassemia - congenital hemolytic anemia
Dx US tx; correct serum electrolyte - pyloromyotom
Methylephenidate toxicity; cannot be stopped abruptly; taper
Decr calorie intake; decr calorie absorption;incr calorie demand

19. How to investigate delayed puberty
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
Prolactinoma
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

20. 18mo bilat breast enlargment - some pubic hair
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Benign permature thelarche; expectant management

21. How to dx endopthalmitis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Between pregnenolone and 17oh pregnenolone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Wait until 6 months

22. duodenal atresia
Decreased UGT enzyme
Dactylitis; 2nd common is splenic seqestration
Penicillin G 4h before delivery
D for d; down syndrome and polyhydramnios

23. splenic infarction in sickle cell
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Faciform RBC cause vascular occlusion
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

24. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Fifth disease; febrile syndrome
RSV - rhino and influenza
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

25. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
24h to 7d of birth
Dactylitis; 2nd common is splenic seqestration
Bartonella henselae; complication is suppuration of lymph node

26. tick transmits lyme
Brown
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
RSV - rhino and influenza

27. Tx of FTT
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Diet modification to provide 110kc/kg/d
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

28. How long anti-TB drugs given for TB meningitis?
Increase of pregnenolone
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
T for t ; thalassemia; inc serum iron and Iron binding
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

29. bromocriptine
After 6m; breast mild provides iron until 6m.
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Prolactinoma
Croup tx cool mist; racemic epi - corticosteroid

30. mcCune albright`
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
RSV - rhino and influenza
Herpes

31. patient with white plaques in mouth and lump in back
Do HIV testing at first
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No; they are basic compound will be neutralized in an acidic environment of cellulitis
No myoclonic activity in JME

32. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

33. sickle cell with symmetrical swelling of hands and feet
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Herpes
Prolactinoma
Vaso-occlusive crisis; dx hb electrophoresis

34. if bone age lower than actual and puberty delayed
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)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Constitutional pubertal delay

35. What is thumbprint sign
Female - breech delivery - family history; tx referral to ortho
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Lateral neck xray in epiglottitis show swollen epiglottis
Tx only symptomatic carrier

36. 3yo - never able to walk
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
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
D for d; down syndrome and polyhydramnios
Increase of pregnenolone

37. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

38. How to dx keratitis?
Pipercillin (zosyn) - ticarcillin
Foreign body sensation - photophobia - corneal opacity tx abx
Faciform RBC cause vascular occlusion
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

39. penicillin effective against pseudomonas
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Brown
Pipercillin (zosyn) - ticarcillin

40. centor criteria for bact pharyngitis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Do HIV testing at first
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

41. 3yo - febrile - left hip externally rotated
Decreases height - expensive; reserved for severe cases of delayed puberty
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
36 hours
No reticulocyte vs high reticulocyte

42. contraindications of MMR vaccine
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

43. Febrile seizure
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

44. pumonary TB
Do HIV testing at first
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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)

45. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Pho for forward bending; forward defect; common finding has no adverse physical effect
Dactylitis; 2nd common is splenic seqestration
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

46. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
After 24h of abx therapy
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

47. is local anesthetics be used in cellulitis to reduce pain
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Increase of pregnenolone
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Prolactinoma

48. spitting up - vomiting at night - weight stable
Oral DMSA or EDTA IV
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Mainly clinical; serology with initial ELISA - with western blot confirmation;

49. lead >70
Risk of neurological dysfunction
Medical emergency; dimercaprol/edta
Facial portwine stain
Methylephenidate toxicity; cannot be stopped abruptly; taper

50. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Between pregnenolone and 17oh pregnenolone
Medical emergency; dimercaprol/edta
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

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USMLE Step3 Pediatrics

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