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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. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

2. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Brown
Decreased UGT enzyme
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

3. adenovirus
Croup
URI
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

4. mcCune albright`
T for t ; thalassemia; inc serum iron and Iron binding
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

5. When to give hpv vaccien
Develops in 21 dasy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

6. lead 44-70
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
No intervention; 90% foreign bodies pass without difficulty
Oral DMSA or EDTA IV
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

7. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
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
Absence seizure; tx ethosuximide
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

8. What is thumbprint sign
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Endocardial cushion defect (no separation between heart chambers)
Lateral neck xray in epiglottitis show swollen epiglottis
Increase of progesteron/17oh progesterone

9. How to dx RSV
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Rapid detection of RSV antigen in nasl
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

10. microcytic - hypochromic anemia - hepatospelnomegaly
Wait until 6 months
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Thalassemia - congenital hemolytic anemia
1.5%

11. kallman syndrome
Less than 5th percentile
Facial portwine stain
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

12. causes of FTT
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

13. infant botulism
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Absence seizure; tx ethosuximide
>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
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

14. centor criteria for bact pharyngitis
14yrs
Marfans - ehlers danlos - homocystinuria
Diet modification to provide 110kc/kg/d
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

15. sublottic narrowing
INH 9m if INH resistant rifampin 6m in children and 4m in adults
refuse
Strep pneumonie; moraxella; h influenze
Croup tx cool mist; racemic epi - corticosteroid

16. Tx of bact conjunctivitis
Absence seizure; tx ethosuximide
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
TB - breastfeeding - asymptomatic hiv

17. dx for DDH
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Bladder dysfunction; UTI and renal dysfunctoin
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

18. When to bevioral and enviromental measure in led intoxication?
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

19. How to dx post uretheral valve
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

20. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
To make hip flexed and abducted position in DDH

21. non immune pregnant women exposed to rubella in first trimester
Fifth disease; febrile syndrome
Congenital rubella syndrome
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Mainly clinical; serology with initial ELISA - with western blot confirmation;

22. 3yo - febrile - left hip externally rotated
Imaging study to r/o VUR
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Multiple telangiectesia - vasular lesion in CNS

23. flexible kyphosis
Vaso-occlusive crisis; dx hb electrophoresis
Injury to lower roots of brachial plexus
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Pho for forward bending; forward defect; common finding has no adverse physical effect

24. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Croup
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

25. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Develops in 21 dasy

26. differentiate between central and peripheral precocious puberty
Endocardial cushion defect (no separation between heart chambers)
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
To make hip flexed and abducted position in DDH
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

27. How to differential bact vs viral conjunctivitis
Diet modification to provide 110kc/kg/d
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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

28. TTP pentad
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

29. duodenal atresia
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Methylephenidate toxicity; cannot be stopped abruptly; taper
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
D for d; down syndrome and polyhydramnios

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

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31. osler rendu weber syndrom
Imaging study to r/o VUR
Multiple telangiectesia - vasular lesion in CNS
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

32. 3yo - never able to walk
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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
Candidal diapar rash; tx clotrimazol

33. Nocturnal enuresis
Dx US tx; correct serum electrolyte - pyloromyotom
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

34. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Less than 5th percentile
Black

35. is local anesthetics be used in cellulitis to reduce pain
Lateral neck xray in epiglottitis show swollen epiglottis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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

36. tzanck
36 hours
Increase of pregnenolone
Herpes
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

37. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Imaging study to r/o VUR
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

38. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

39. tick transmits RMSF
Black
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
HSP - look for symmetric skin lesions
Bladder dysfunction; UTI and renal dysfunctoin

40. HUS
Increase of progesteron/17oh progesterone
refuse
Methylephenidate toxicity; cannot be stopped abruptly; taper
<2yrs - abd pain - diarrhoea - ARF

41. down syndrome has inreased risk of developing
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Tx only symptomatic carrier
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
ALL - alzheimers autism adhd depression seizure

42. What is the calorie requirement of newborn?
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
If aortic root reaches 45 mm
110 kcl/kg/day

43. How to investigate delayed puberty
RSV - rhino and influenza
Imaging study to r/o VUR
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

44. difference between structural disorder and flexible kyphosis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Marfans - ehlers danlos - homocystinuria
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

45. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Medical emergency; dimercaprol/edta

46. 17 alpha hydroxylase
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Between pregnenolone and 17oh pregnenolone
Increase of progesteron/17oh progesterone
Injury to lower roots of brachial plexus

47. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Tx only symptomatic carrier
Biliary atresia; tx surgery

48. physiological jaundice
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
24h to 7d of birth
No reticulocyte vs high reticulocyte

49. down syndrome with holocystolic mumur
24h to 7d of birth
Endocardial cushion defect (no separation between heart chambers)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Medical emergency; dimercaprol/edta

50. When erythema chronicum migrans develops after tick bite
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
24-72 hours