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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.
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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. splenic infarction in sickle cell
36 hours
Faciform RBC cause vascular occlusion
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

2. differentiate between central and peripheral precocious puberty
Benign permature thelarche; expectant management
Injury to lower roots of brachial plexus
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

3. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
24h to 7d of birth
Biliary atresia; tx surgery
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

4. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
RSV - rhino and influenza
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
No myoclonic activity in JME

5. How to difference RSV and neonatal chlamydia
Congenital rubella syndrome
Wait until 6 months
No wheezing - no feever in chlamydia
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

6. cleft lip but no cleft palate
Benign permature thelarche; expectant management
Croup
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Dx US tx; correct serum electrolyte - pyloromyotom

7. When erythema chronicum migrans develops after tick bite
24-72 hours
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
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

8. mech of botulism
Brown
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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
Lateral neck xray in epiglottitis show swollen epiglottis

9. decreased mobility of tympanic membrane after otitis media
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

10. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Rapid detection of RSV antigen in nasl

11. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Constitutional pubertal delay
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

12. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

13. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Bartonella henselae; complication is suppuration of lymph node
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Erb paralysis leading to diaphragmatic paralysis
Do HIV testing at first

14. How to investigate delayed puberty
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Rapid detection of RSV antigen in nasl
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Croup tx cool mist; racemic epi - corticosteroid

15. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
No reticulocyte vs high reticulocyte
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
No myoclonic activity in JME

16. major depression
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
T for t ; thalassemia; inc serum iron and Iron binding
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

17. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Neurofibromatosis type2
Meconeum ileus; think about CF

18. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

19. defcicieny of 21 hydroxylase
Wait until 6 months
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Increase of progesteron/17oh progesterone
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

20. hypopigmented spots - family hx bilat deafness
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Imaging study to r/o VUR
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Neurofibromatosis type2

21. the risk of lyme after bitten by a tick
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
1.5%
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

22. Tx of FTT
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Diet modification to provide 110kc/kg/d
ALL - alzheimers autism adhd depression seizure
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

23. pumonary TB
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)
Risk of neurological dysfunction
Strep pneumonie; moraxella; h influenze
Develops in 21 dasy

24. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Benign permature thelarche; expectant management
Erb paralysis leading to diaphragmatic paralysis

25. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

26. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Do HIV testing at first
Thalassemia - congenital hemolytic anemia
Bartonella henselae; complication is suppuration of lymph node

27. duodenal atresia
D for d; down syndrome and polyhydramnios
URI
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
TB - breastfeeding - asymptomatic hiv

28. adenovirus
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Fifth disease; febrile syndrome
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
URI

29. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
TB - breastfeeding - asymptomatic hiv
Less than 5th percentile
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

30. tick transmits RMSF
Bartonella henselae; complication is suppuration of lymph node
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Injury to b/l glossopharyngeal. present in botulism
Black

31. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Brown
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

32. How to dx acute angle closure glaucoma
Marfans - ehlers danlos - homocystinuria
Tx only symptomatic carrier
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

33. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
No myoclonic activity in JME
Neurofibromatosis type2

34. How to dx endopthalmitis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

35. Febrile seizure
Methylephenidate toxicity; cannot be stopped abruptly; taper
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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

36. mcCune albright`
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

37. acute otitis externa

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38. What are the risk factors of developmental dysplais of hip
Marfans - ehlers danlos - homocystinuria
Develops in 21 dasy
No reticulocyte vs high reticulocyte
Female - breech delivery - family history; tx referral to ortho

39. failure to thrive
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Less than 5th percentile
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

40. can women with abnormal smear or genital get vaccine
Constitutional pubertal delay
Yes; but it will be less effective
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

41. crying during urination. bacteriuria pyruria - rec episodes
Dx US tx; correct serum electrolyte - pyloromyotom
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Imaging study to r/o VUR
Brown

42. osler rendu weber syndrom
Injury to lower roots of brachial plexus
Multiple telangiectesia - vasular lesion in CNS
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Methylephenidate toxicity; cannot be stopped abruptly; taper

43. is local anesthetics be used in cellulitis to reduce pain
Do HIV testing at first
T for t ; thalassemia; inc serum iron and Iron binding
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
No; they are basic compound will be neutralized in an acidic environment of cellulitis

44. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
No intervention; 90% foreign bodies pass without difficulty
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Medical emergency; dimercaprol/edta

45. low grade fever - cough - diffuse bilat ground glass opacities
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No myoclonic activity in JME
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

46. horner syndrom
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Injury to lower roots of brachial plexus
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Injury to b/l glossopharyngeal. present in botulism

47. causes of FTT
Atypical lymphocyte
Decr calorie intake; decr calorie absorption;incr calorie demand
110 kcl/kg/day
Constitutional pubertal delay

48. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

49. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Methylephenidate toxicity; cannot be stopped abruptly; taper
Oral DMSA or EDTA IV

50. infantile hypertrophic pyloric stenosis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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
Dx US tx; correct serum electrolyte - pyloromyotom
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications