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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. difference between diaper dermatitis and rash
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

2. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Bartonella henselae; complication is suppuration of lymph node
Increase of pregnenolone

3. What is the definition of delayed puberty?
Bartonella henselae; complication is suppuration of lymph node
Tx only symptomatic carrier
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

4. adenovirus
Bladder dysfunction; UTI and renal dysfunctoin
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
URI
Vaso-occlusive crisis; dx hb electrophoresis

5. lens dislocation
Marfans - ehlers danlos - homocystinuria
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Meconeum ileus; think about CF
Bartonella henselae; complication is suppuration of lymph node

6. tick transmits lyme
Brown
Increase of progesteron/17oh progesterone
14yrs
Marfans - ehlers danlos - homocystinuria

7. How to differentiate croup vs epiglotitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
36 hours
Decr calorie intake; decr calorie absorption;incr calorie demand
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

8. Parvovirus
Fifth disease; febrile syndrome
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
Injury to lower roots of brachial plexus
T for t ; thalassemia; inc serum iron and Iron binding

9. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Candidal diapar rash; tx clotrimazol
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

10. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
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
RSV - rhino and influenza
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

11. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Decreased UGT enzyme
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

12. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Increase of pregnenolone
24h to 7d of birth
Central isosexual precocious puberty; hypothalmaic hamartoma

13. sudden onset of fever - difficulty in breathing
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Croup
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

14. Neonatal unconjugated hyperbilirubine
24-72 hours
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Decreased UGT enzyme
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

15. mech of botulism
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Decreased UGT enzyme
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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

16. carditis and arthritis after rheumatic fever
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Develops in 21 dasy

17. Tx of bact conjunctivitis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

18. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Endocardial cushion defect (no separation between heart chambers)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

19. kallman syndrome
After 6m; breast mild provides iron until 6m.
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

20. language expectation from 2yo
Fifth disease; febrile syndrome
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Herpes
1.5%

21. When to give hpv vaccien
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

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

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23. acute otitis externa

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24. How to investigate delayed puberty
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
No reticulocyte vs high reticulocyte
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

25. tick transmits RMSF
Black
Croup
Injury to b/l glossopharyngeal. present in botulism
URI

26. low grade fever - cough - diffuse bilat ground glass opacities
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Endocardial cushion defect (no separation between heart chambers)

27. dx of lyme
URI
Erb paralysis leading to diaphragmatic paralysis
Wait until 6 months
Mainly clinical; serology with initial ELISA - with western blot confirmation;

28. iron supplement in child
Develops in 21 dasy
Brown
Meconeum ileus; think about CF
After 6m; breast mild provides iron until 6m.

29. the recommended ca supplementation
Endocardial cushion defect (no separation between heart chambers)
No wheezing - no feever in chlamydia
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

30. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Medical emergency; dimercaprol/edta
Risk of neurological dysfunction

31. patient with white plaques in mouth and lump in back
Biliary atresia; tx surgery
Erb paralysis leading to diaphragmatic paralysis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Do HIV testing at first

32. Parents can _____ vaccine
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to lower roots of brachial plexus
Facial portwine stain
refuse

33. complication of lumbosacral meningocele
Diet modification to provide 110kc/kg/d
Brown
Decreases height - expensive; reserved for severe cases of delayed puberty
Bladder dysfunction; UTI and renal dysfunctoin

34. 17 alpha hydroxylase
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
Atypical lymphocyte
Injury to lower roots of brachial plexus
Between pregnenolone and 17oh pregnenolone

35. tuberous sclerosis
<2yrs - abd pain - diarrhoea - ARF
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

36. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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

37. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
24h to 7d of birth
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

38. if bone age lower than actual and puberty delayed
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Constitutional pubertal delay
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Strep pneumonie; moraxella; h influenze

39. difference between structural disorder and flexible kyphosis
Less than 5th percentile
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
To make hip flexed and abducted position in DDH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

40. osler rendu weber syndrom
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Yes; but it will be less effective
Multiple telangiectesia - vasular lesion in CNS

41. When to do aortic root surgery in marfans to prevent dissection?
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
If aortic root reaches 45 mm
Endocardial cushion defect (no separation between heart chambers)
Herpes

42. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Atypical lymphocyte
Diet modification to provide 110kc/kg/d
Tx only symptomatic carrier

43. dx for DDH
Croup
1.5%
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

44. When to give HRT in turner
24-72 hours
14yrs
TB - breastfeeding - asymptomatic hiv
Congenital rubella syndrome

45. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Methylephenidate toxicity; cannot be stopped abruptly; taper
URI

46. viruses cause bronhioltitis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
RSV - rhino and influenza
No wheezing - no feever in chlamydia
INH 9m if INH resistant rifampin 6m in children and 4m in adults

47. contraindications of MMR vaccine
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Female - breech delivery - family history; tx referral to ortho
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

48. thumb sign
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Injury to lower roots of brachial plexus
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Brown

49. sickle cell with symmetrical swelling of hands and feet
refuse
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Vaso-occlusive crisis; dx hb electrophoresis
Risk of neurological dysfunction

50. difference between breast milk and breafeeding jaundice
Methylephenidate toxicity; cannot be stopped abruptly; taper
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
Multiple telangiectesia - vasular lesion in CNS
Facial portwine stain