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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. splenic infarction in sickle cell
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Faciform RBC cause vascular occlusion
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

2. carditis and arthritis after rheumatic fever
No; they are basic compound will be neutralized in an acidic environment of cellulitis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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)
Develops in 21 dasy

3. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
ALL - alzheimers autism adhd depression seizure

4. Tx of botulism
Medical emergency; dimercaprol/edta
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Penicillin G 4h before delivery

5. acute otitis externa

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6. how thalassemia die
refuse
Absence seizure; tx ethosuximide
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
TB - breastfeeding - asymptomatic hiv

7. sickle cell with symmetrical swelling of hands and feet
Strep pneumonie; moraxella; h influenze
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Vaso-occlusive crisis; dx hb electrophoresis
<2yrs - abd pain - diarrhoea - ARF

8. What is the calorie requirement of newborn?
Increase of pregnenolone
Candidal diapar rash; tx clotrimazol
110 kcl/kg/day
Decreases height - expensive; reserved for severe cases of delayed puberty

9. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

10. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Methylephenidate toxicity; cannot be stopped abruptly; taper
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
24h to 7d of birth

11. target cell
RSV - rhino and influenza
T for t ; thalassemia; inc serum iron and Iron binding
Atypical lymphocyte
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)

12. difference between breast milk and breafeeding jaundice
24h to 7d of birth
Meconeum ileus; think about CF
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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. difference between diaper dermatitis and rash
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
36 hours
Fifth disease; febrile syndrome
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

14. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Rapid detection of RSV antigen in nasl
Biliary atresia; tx surgery
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

15. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Marfans - ehlers danlos - homocystinuria
Mainly clinical; serology with initial ELISA - with western blot confirmation;

16. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Central isosexual precocious puberty; hypothalmaic hamartoma
Bladder dysfunction; UTI and renal dysfunctoin
Do HIV testing at first

17. horner syndrom
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
Risk of neurological dysfunction
Fifth disease; febrile syndrome
Injury to lower roots of brachial plexus

18. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Pipercillin (zosyn) - ticarcillin
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

19. down syndrome with holocystolic mumur
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Wait until 6 months
Endocardial cushion defect (no separation between heart chambers)

20. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Do HIV testing at first
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Pipercillin (zosyn) - ticarcillin

21. doing worse in school - lack of attention - starring speel
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Absence seizure; tx ethosuximide
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

22. 17 alpha hydroxylase
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Between pregnenolone and 17oh pregnenolone
Candidal diapar rash; tx clotrimazol
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

23. the risk of lyme after bitten by a tick
D for d; down syndrome and polyhydramnios
Central isosexual precocious puberty; hypothalmaic hamartoma
1.5%
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

24. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Methylephenidate toxicity; cannot be stopped abruptly; taper

25. the recommended ca supplementation
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

26. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
URI
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

27. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Atypical lymphocyte
Strep pneumonie; moraxella; h influenze
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

28. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Marfans - ehlers danlos - homocystinuria
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
Vaso-occlusive crisis; dx hb electrophoresis
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

29. What is earliest sign of puberty?
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
After 6m; breast mild provides iron until 6m.
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Dx US tx; correct serum electrolyte - pyloromyotom

30. HUS
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
<2yrs - abd pain - diarrhoea - ARF
24-72 hours

31. contraindications of DTap
TB - breastfeeding - asymptomatic hiv
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

32. red oozing rash on cheek - scaly - dry
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

33. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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
Develops in 21 dasy
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

34. what conditions are not contraindicated
Decreased UGT enzyme
14yrs
TB - breastfeeding - asymptomatic hiv
Atypical lymphocyte

35. lens dislocation
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Marfans - ehlers danlos - homocystinuria
Risk of neurological dysfunction
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

36. How to dx endopthalmitis
Foreign body sensation - photophobia - corneal opacity tx abx
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
No intervention; 90% foreign bodies pass without difficulty

37. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Tx only symptomatic carrier
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

38. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Strep pneumonie; moraxella; h influenze
Bladder dysfunction; UTI and renal dysfunctoin
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

39. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No intervention; 90% foreign bodies pass without difficulty

40. aplasic crisis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Dactylitis; 2nd common is splenic seqestration
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

41. How to differentiate caput succedanueum and cephalohematoma
Atypical lymphocyte
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
24-72 hours

42. nuchal rigidity - fever - sore throat - headache - dioriented
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
URI
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

43. How to dx RSV
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Prolactinoma
Rapid detection of RSV antigen in nasl
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

44. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Atypical lymphocyte
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
>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

45. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Female - breech delivery - family history; tx referral to ortho
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
No myoclonic activity in JME
Meconeum ileus; think about CF

46. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Oral DMSA or EDTA IV
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

47. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
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
24h to 7d of birth
Brown

48. duodenal atresia
Between pregnenolone and 17oh pregnenolone
Do HIV testing at first
D for d; down syndrome and polyhydramnios
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

49. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
D for d; down syndrome and polyhydramnios
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

50. contact lens keratitis
Female - breech delivery - family history; tx referral to ortho
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients