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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. What is the most common initial symptom in sickle cell
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Dactylitis; 2nd common is splenic seqestration

2. How long patient needs to be exposed to tick to get infected
Methylephenidate toxicity; cannot be stopped abruptly; taper
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
36 hours
ALL - alzheimers autism adhd depression seizure

3. difference between structural disorder and flexible kyphosis
Herpes
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
<2yrs - abd pain - diarrhoea - ARF
Female - breech delivery - family history; tx referral to ortho

4. When to bevioral and enviromental measure in led intoxication?
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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

5. osler rendu weber syndrom
Increase of progesteron/17oh progesterone
Multiple telangiectesia - vasular lesion in CNS
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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

6. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Female - breech delivery - family history; tx referral to ortho

7. non immune pregnant women exposed to rubella in first trimester
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Congenital rubella syndrome
Risk of neurological dysfunction
Herpes

8. Neonatal conjugated hyperbilirubinemia
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Decreased UGT enzyme
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Biliary atresia; tx surgery

9. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

10. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
refuse

11. Febrile seizure
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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
No reticulocyte vs high reticulocyte

12. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Neurofibromatosis type2
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Pho for forward bending; forward defect; common finding has no adverse physical effect

13. How to evaluate well appearing child just born in GBS pos mother?
Tx only symptomatic carrier
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

14. acute otitis externa

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15. deficinecy of 17 hydroxylase
Increase of pregnenolone
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Between pregnenolone and 17oh pregnenolone
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

16. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Benign permature thelarche; expectant management
TB - breastfeeding - asymptomatic hiv
110 kcl/kg/day

17. cleft lip but no cleft palate
Decreased UGT enzyme
After 6m; breast mild provides iron until 6m.
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Black

18. decreased mobility of tympanic membrane after otitis media
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Strep pneumonie; moraxella; h influenze
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

19. starring spells 10-20sec
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

20. How to difference RSV and neonatal chlamydia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No wheezing - no feever in chlamydia
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Pho for forward bending; forward defect; common finding has no adverse physical effect

21. adenovirus
14yrs
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
URI
Atopic dermatitis; strong allergic/immunologic component; incr IgE

22. IM
Atypical lymphocyte
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Develops in 21 dasy
Pipercillin (zosyn) - ticarcillin

23. When to give hpv vaccien
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
Fifth disease; febrile syndrome
Croup tx cool mist; racemic epi - corticosteroid
D for d; down syndrome and polyhydramnios

24. When to do surgery for undescended testes
Wait until 6 months
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Penicillin G 4h before delivery
Strep pneumonie; moraxella; h influenze

25. giardiasis
T for t ; thalassemia; inc serum iron and Iron binding
Tx only symptomatic carrier
Medical emergency; dimercaprol/edta
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

26. How to difference viral and bact pneumonia
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Central isosexual precocious puberty; hypothalmaic hamartoma
No intervention; 90% foreign bodies pass without difficulty

27. congenital adrenal hyperplasi
Endocardial cushion defect (no separation between heart chambers)
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

28. contact lens keratitis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
TB - breastfeeding - asymptomatic hiv

29. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Diet modification to provide 110kc/kg/d
Oral DMSA or EDTA IV
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

30. Nocturnal enuresis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
After 24h of abx therapy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

31. How to dx endopthalmitis
Between pregnenolone and 17oh pregnenolone
Black
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

32. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
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)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

33. sudden onset of fever - difficulty in breathing
<2yrs - abd pain - diarrhoea - ARF
Diet modification to provide 110kc/kg/d
Imaging study to r/o VUR
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

34. How to prevent GBS in neonate
Penicillin G 4h before delivery
URI
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Between pregnenolone and 17oh pregnenolone

35. differentiate between central and peripheral precocious puberty
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Herpes

36. most common complication of otitis media
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

37. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

38. pavlik harness
Endocardial cushion defect (no separation between heart chambers)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Faciform RBC cause vascular occlusion
To make hip flexed and abducted position in DDH

39. target cell
Diet modification to provide 110kc/kg/d
T for t ; thalassemia; inc serum iron and Iron binding
Biliary atresia; tx surgery
Croup

40. 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
>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
Black
If aortic root reaches 45 mm

41. association with infantile pyloric stenosis
Vaso-occlusive crisis; dx hb electrophoresis
Methylephenidate toxicity; cannot be stopped abruptly; taper
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

42. lens dislocation
Marfans - ehlers danlos - homocystinuria
Between pregnenolone and 17oh pregnenolone
Atypical lymphocyte
No reticulocyte vs high reticulocyte

43. Tx of botulism
Imaging study to r/o VUR
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

44. difference between rubeola (measles) and rulbella
14yrs
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Bartonella henselae; complication is suppuration of lymph node
To make hip flexed and abducted position in DDH

45. centor criteria for bact pharyngitis
Strep pneumonie; moraxella; h influenze
No reticulocyte vs high reticulocyte
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

46. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
After 6m; breast mild provides iron until 6m.
Brown
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

47. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Increase of pregnenolone
Meconeum ileus; think about CF
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

48. How to differentiate croup vs epiglotitis
Facial portwine stain
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

49. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Increase of progesteron/17oh progesterone
Dx US tx; correct serum electrolyte - pyloromyotom
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

50. How to dx post uretheral valve
Pipercillin (zosyn) - ticarcillin
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

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USMLE Step3 Pediatrics

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