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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. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
After 6m; breast mild provides iron until 6m.
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
14yrs

2. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

3. the risk of lyme after bitten by a tick
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
1.5%
Decr calorie intake; decr calorie absorption;incr calorie demand
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

4. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Brown
No intervention; 90% foreign bodies pass without difficulty
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

5. physiological jaundice
24h to 7d of birth
Central isosexual precocious puberty; hypothalmaic hamartoma
Oral DMSA or EDTA IV
Tx only symptomatic carrier

6. horner syndrom
24-72 hours
Imaging study to r/o VUR
Benign permature thelarche; expectant management
Injury to lower roots of brachial plexus

7. thumb sign
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

8. How to dx post uretheral valve
Yes; but it will be less effective
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Central isosexual precocious puberty; hypothalmaic hamartoma

9. lead 44-70
T for t ; thalassemia; inc serum iron and Iron binding
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Oral DMSA or EDTA IV
ALL - alzheimers autism adhd depression seizure

10. target cell
Develops in 21 dasy
Penicillin G 4h before delivery
T for t ; thalassemia; inc serum iron and Iron binding
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

11. pneumonia in CF patient
Central isosexual precocious puberty; hypothalmaic hamartoma
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

12. cleft lip but no cleft palate
110 kcl/kg/day
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
TB - breastfeeding - asymptomatic hiv
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

13. low grade fever - cough - diffuse bilat ground glass opacities
110 kcl/kg/day
HSP - look for symmetric skin lesions
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

14. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Decr calorie intake; decr calorie absorption;incr calorie demand
Central isosexual precocious puberty; hypothalmaic hamartoma
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

15. nuchal rigidity - fever - sore throat - headache - dioriented
24h to 7d of birth
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
110 kcl/kg/day

16. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Develops in 21 dasy
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

17. cat scratch disease
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Bartonella henselae; complication is suppuration of lymph node
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)
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

18. how thalassemia die
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
RSV - rhino and influenza
To make hip flexed and abducted position in DDH

19. flexible kyphosis
Wait until 6 months
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
Pho for forward bending; forward defect; common finding has no adverse physical effect
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

20. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Medical emergency; dimercaprol/edta
URI
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

21. tick transmits RMSF
Biliary atresia; tx surgery
Black
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

22. lens dislocation
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Marfans - ehlers danlos - homocystinuria
ALL - alzheimers autism adhd depression seizure

23. Parvovirus
Risk of neurological dysfunction
Fifth disease; febrile syndrome
24h to 7d of birth
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

24. When to do aortic root surgery in marfans to prevent dissection?
Yes; but it will be less effective
If aortic root reaches 45 mm
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Fifth disease; febrile syndrome

25. 3yo - never able to walk
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Brown
Vaso-occlusive crisis; dx hb electrophoresis
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

26. indications of VUR
<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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
If aortic root reaches 45 mm

27. What is the calorie requirement of newborn?
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Female - breech delivery - family history; tx referral to ortho
Increase of pregnenolone
110 kcl/kg/day

28. difference between structural disorder and flexible kyphosis
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
Tx only symptomatic carrier
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

29. When erythema chronicum migrans develops after tick bite
24-72 hours
Oral DMSA or EDTA IV
Prolactinoma
Meconeum ileus; think about CF

30. pavlik harness
Between pregnenolone and 17oh pregnenolone
Penicillin G 4h before delivery
Strep pneumonie; moraxella; h influenze
To make hip flexed and abducted position in DDH

31. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Dx US tx; correct serum electrolyte - pyloromyotom
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

32. tick transmits lyme
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
To make hip flexed and abducted position in DDH
Brown
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

33. causes of acute anemia
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Injury to lower roots of brachial plexus
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
RSV - rhino and influenza

34. How to investigate delayed puberty
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
ALL - alzheimers autism adhd depression seizure
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

35. hypopigmented spots - family hx bilat deafness
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
Rapid detection of RSV antigen in nasl
Endocardial cushion defect (no separation between heart chambers)
Neurofibromatosis type2

36. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Dx US tx; correct serum electrolyte - pyloromyotom
Black
No reticulocyte vs high reticulocyte
Bartonella henselae; complication is suppuration of lymph node

37. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
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

38. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Black
RSV - rhino and influenza
Decreased UGT enzyme

39. What are the risk factors of developmental dysplais of hip
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Female - breech delivery - family history; tx referral to ortho
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Lateral neck xray in epiglottitis show swollen epiglottis

40. TB prophylaxis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Atopic dermatitis; strong allergic/immunologic component; incr IgE

41. patient with white plaques in mouth and lump in back
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
14yrs
36 hours

42. How to differentiate caput succedanueum and cephalohematoma
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Between pregnenolone and 17oh pregnenolone
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

43. kallman syndrome
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

44. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Multiple telangiectesia - vasular lesion in CNS
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

45. When to bevioral and enviromental measure in led intoxication?
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
110 kcl/kg/day
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Multiple telangiectesia - vasular lesion in CNS

46. infant botulism
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Candidal diapar rash; tx clotrimazol

47. Neonatal conjugated hyperbilirubinemia
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Absence seizure; tx ethosuximide
Biliary atresia; tx surgery
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

48. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Methylephenidate toxicity; cannot be stopped abruptly; taper

49. How long patient needs to be exposed to tick to get infected
Fifth disease; febrile syndrome
36 hours
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

50. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
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
Vaso-occlusive crisis; dx hb electrophoresis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality