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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
14yrs
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

2. iron supplement in child
After 6m; breast mild provides iron until 6m.
Female - breech delivery - family history; tx referral to ortho
Herpes
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

3. tick transmits RMSF
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Lateral neck xray in epiglottitis show swollen epiglottis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Black

4. causes of FTT
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
If aortic root reaches 45 mm

5. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

6. How to investigate delayed puberty
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
TB - breastfeeding - asymptomatic hiv
No; they are basic compound will be neutralized in an acidic environment of cellulitis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

7. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Black
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

8. when bact conjunctivitis patient can go back to school
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Neurofibromatosis type2
After 24h of abx therapy

9. How to dx acute angle closure glaucoma
Multiple telangiectesia - vasular lesion in CNS
Erb paralysis leading to diaphragmatic paralysis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

10. Neonatal conjugated hyperbilirubinemia
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Biliary atresia; tx surgery
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

11. TTP pentad
Rapid detection of RSV antigen in nasl
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Marfans - ehlers danlos - homocystinuria
24-72 hours

12. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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
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

13. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
HSP - look for symmetric skin lesions
Constitutional pubertal delay
Prolactinoma

14. infantile hypertrophic pyloric stenosis
Herpes
Neurofibromatosis type2
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Dx US tx; correct serum electrolyte - pyloromyotom

15. How to dx endopthalmitis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
refuse
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

16. pavlik harness
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
RSV - rhino and influenza
Medical emergency; dimercaprol/edta
To make hip flexed and abducted position in DDH

17. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Decreases height - expensive; reserved for severe cases of delayed puberty

18. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
>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
Injury to b/l glossopharyngeal. present in botulism
No; they are basic compound will be neutralized in an acidic environment of cellulitis

19. causes of FTT
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
If aortic root reaches 45 mm
Decr calorie intake; decr calorie absorption;incr calorie demand
Herpes

20. carditis and arthritis after rheumatic fever
Black
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Develops in 21 dasy

21. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No reticulocyte vs high reticulocyte
TB - breastfeeding - asymptomatic hiv
Absence seizure; tx ethosuximide

22. doing worse in school - lack of attention - starring speel
T for t ; thalassemia; inc serum iron and Iron binding
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Absence seizure; tx ethosuximide

23. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Increase of pregnenolone
refuse
Less than 5th percentile

24. low grade fever - cough - diffuse bilat ground glass opacities
Thalassemia - congenital hemolytic anemia
Croup tx cool mist; racemic epi - corticosteroid
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

25. the recommended ca supplementation
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

26. how smoking contributes otitis media in children
Meconeum ileus; think about CF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
No; they are basic compound will be neutralized in an acidic environment of cellulitis
After 6m; breast mild provides iron until 6m.

27. congenital adrenal hyperplasi
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

28. pneumonia in CF patient
RSV - rhino and influenza
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

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

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30. infant botulism
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
Increase of progesteron/17oh progesterone
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

31. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
TB - breastfeeding - asymptomatic hiv
Erb paralysis leading to diaphragmatic paralysis
Black
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

32. 3yo - never able to walk
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Increase of progesteron/17oh progesterone
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
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

33. sturge weber syndrome
Fifth disease; febrile syndrome
ALL - alzheimers autism adhd depression seizure
Facial portwine stain
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

34. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
No wheezing - no feever in chlamydia
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

35. defcicieny of 21 hydroxylase
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
T for t ; thalassemia; inc serum iron and Iron binding
Increase of progesteron/17oh progesterone

36. Tx of bact conjunctivitis
ALL - alzheimers autism adhd depression seizure
Dx US tx; correct serum electrolyte - pyloromyotom
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

37. Parvovirus
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Croup tx cool mist; racemic epi - corticosteroid
Fifth disease; febrile syndrome
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

38. How to differential bact vs viral conjunctivitis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
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

39. tick transmits lyme
Brown
Absence seizure; tx ethosuximide
TB - breastfeeding - asymptomatic hiv
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

40. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
HSP - look for symmetric skin lesions
Central isosexual precocious puberty; hypothalmaic hamartoma
Neurofibromatosis type2
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

41. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
refuse
Croup
Marfans - ehlers danlos - homocystinuria

42. lead >70
Medical emergency; dimercaprol/edta
Prolactinoma
Atypical lymphocyte
Biliary atresia; tx surgery

43. complete airway obstruction with FB
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
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
>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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

44. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
No myoclonic activity in JME
Increase of pregnenolone
Brown

45. 17 alpha hydroxylase
Multiple telangiectesia - vasular lesion in CNS
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Between pregnenolone and 17oh pregnenolone
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

46. sudden onset of fever - difficulty in breathing
Pipercillin (zosyn) - ticarcillin
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Injury to b/l glossopharyngeal. present in botulism

47. physiological jaundice
Do HIV testing at first
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
24h to 7d of birth
URI

48. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Faciform RBC cause vascular occlusion

49. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Develops in 21 dasy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
110 kcl/kg/day

50. acute abd pain - hx URI - lower extremity maculo papular rash
Foreign body sensation - photophobia - corneal opacity tx abx
HSP - look for symmetric skin lesions
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Mainly clinical; serology with initial ELISA - with western blot confirmation;