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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. When erythema chronicum migrans develops after tick bite
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
24-72 hours
Medical emergency; dimercaprol/edta
No; they are basic compound will be neutralized in an acidic environment of cellulitis

2. what conditions are not contraindicated
Faciform RBC cause vascular occlusion
Dactylitis; 2nd common is splenic seqestration
Methylephenidate toxicity; cannot be stopped abruptly; taper
TB - breastfeeding - asymptomatic hiv

3. lead >70
Decreases height - expensive; reserved for severe cases of delayed puberty
Medical emergency; dimercaprol/edta
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

4. splenic infarction in sickle cell
URI
Faciform RBC cause vascular occlusion
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
Mainly clinical; serology with initial ELISA - with western blot confirmation;

5. Parents can _____ vaccine
Bartonella henselae; complication is suppuration of lymph node
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
refuse
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

6. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
110 kcl/kg/day
Erb paralysis leading to diaphragmatic paralysis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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

7. lens dislocation
Marfans - ehlers danlos - homocystinuria
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
Prolactinoma
Meconeum ileus; think about CF

8. How to dx post uretheral valve
Methylephenidate toxicity; cannot be stopped abruptly; taper
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Neurofibromatosis type2
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

9. contact lens keratitis
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
Increase of pregnenolone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

10. side effect of testosteron therapy
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
<2yrs - abd pain - diarrhoea - ARF
Rapid detection of RSV antigen in nasl
Decreases height - expensive; reserved for severe cases of delayed puberty

11. lead 44-70
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
Oral DMSA or EDTA IV
After 24h of abx therapy
Thalassemia - congenital hemolytic anemia

12. 17 alpha hydroxylase
Yes; but it will be less effective
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
24h to 7d of birth
Between pregnenolone and 17oh pregnenolone

13. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Wait until 6 months
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

14. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Pipercillin (zosyn) - ticarcillin

15. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Marfans - ehlers danlos - homocystinuria
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Imaging study to r/o VUR

16. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Dactylitis; 2nd common is splenic seqestration
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

17. How to investigate delayed puberty
Increase of progesteron/17oh progesterone
No myoclonic activity in JME
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

18. viruses cause bronhioltitis
RSV - rhino and influenza
Lateral neck xray in epiglottitis show swollen epiglottis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Injury to lower roots of brachial plexus

19. congenital adrenal hyperplasi
Foreign body sensation - photophobia - corneal opacity tx abx
110 kcl/kg/day
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

20. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Herpes
If aortic root reaches 45 mm
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

21. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Neurofibromatosis type2
URI
Increase of pregnenolone

22. indications of audiometry in childrens
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)
Wait until 6 months
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

23. How to evaluate well appearing child just born in GBS pos mother?
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Methylephenidate toxicity; cannot be stopped abruptly; taper
T for t ; thalassemia; inc serum iron and Iron binding
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

24. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Black
Central isosexual precocious puberty; hypothalmaic hamartoma
Less than 5th percentile

25. When to bevioral and enviromental measure in led intoxication?
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

26. the recommended ca supplementation
Erb paralysis leading to diaphragmatic paralysis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
TB - breastfeeding - asymptomatic hiv
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

27. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Faciform RBC cause vascular occlusion
Candidal diapar rash; tx clotrimazol
Medical emergency; dimercaprol/edta
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

28. How to dx keratitis?
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
No intervention; 90% foreign bodies pass without difficulty
Neurofibromatosis type2
Foreign body sensation - photophobia - corneal opacity tx abx

29. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Erb paralysis leading to diaphragmatic paralysis
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

30. How to differentiate croup vs epiglotitis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
ALL - alzheimers autism adhd depression seizure
1.5%
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

31. penicillin effective against pseudomonas
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
If aortic root reaches 45 mm
Pipercillin (zosyn) - ticarcillin
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

32. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
TB - breastfeeding - asymptomatic hiv
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

33. How to dx acute angle closure glaucoma
Thalassemia - congenital hemolytic anemia
24h to 7d of birth
Bartonella henselae; complication is suppuration of lymph node
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

34. How to dx RSV
Rapid detection of RSV antigen in nasl
Constitutional pubertal delay
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

35. Infant with serum billlirubin >25
T for t ; thalassemia; inc serum iron and Iron binding
Risk of neurological dysfunction
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
INH 9m if INH resistant rifampin 6m in children and 4m in adults

36. iron supplement in child
After 6m; breast mild provides iron until 6m.
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Black

37. sudden onset of fever - difficulty in breathing
Yes; but it will be less effective
Croup
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

38. difference between rubeola (measles) and rulbella
Strep pneumonie; moraxella; h influenze
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

39. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Tx only symptomatic carrier
URI

40. doing worse in school - lack of attention - starring speel
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Injury to lower roots of brachial plexus
Increase of pregnenolone
Absence seizure; tx ethosuximide

41. How to difference RSV and neonatal chlamydia
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Black
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No wheezing - no feever in chlamydia

42. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
No; they are basic compound will be neutralized in an acidic environment of cellulitis
No reticulocyte vs high reticulocyte
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

43. 3yo - never able to walk
After 24h of abx therapy
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
To make hip flexed and abducted position in DDH

44. acute abd pain - hx URI - lower extremity maculo papular rash
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Between pregnenolone and 17oh pregnenolone
HSP - look for symmetric skin lesions
Female - breech delivery - family history; tx referral to ortho

45. Febrile seizure
Absence seizure; tx ethosuximide
36 hours
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Rapid detection of RSV antigen in nasl

46. How to dx endopthalmitis
Less than 5th percentile
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Oral DMSA or EDTA IV

47. target cell
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
T for t ; thalassemia; inc serum iron and Iron binding

48. spitting up - vomiting at night - weight stable
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Decr calorie intake; decr calorie absorption;incr calorie demand
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

49. What are the risk factors of developmental dysplais of hip
Constitutional pubertal delay
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Female - breech delivery - family history; tx referral to ortho
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

50. physiological jaundice
Atypical lymphocyte
24h to 7d of birth
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Tx only symptomatic carrier