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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. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
36 hours
Injury to lower roots of brachial plexus
Faciform RBC cause vascular occlusion

2. sturge weber syndrome
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Medical emergency; dimercaprol/edta
Facial portwine stain
<2yrs - abd pain - diarrhoea - ARF

3. failure to thrive
24-72 hours
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Less than 5th percentile
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

4. nuchal rigidity - fever - sore throat - headache - dioriented
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Diet modification to provide 110kc/kg/d
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

5. tick transmits RMSF
To make hip flexed and abducted position in DDH
Black
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

6. 3yo - febrile - left hip externally rotated
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
No myoclonic activity in JME
No wheezing - no feever in chlamydia

7. kallman syndrome
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)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Strep pneumonie; moraxella; h influenze
Constitutional pubertal delay

8. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
1.5%
Female - breech delivery - family history; tx referral to ortho
Methylephenidate toxicity; cannot be stopped abruptly; taper
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

9. complete airway obstruction with FB
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
>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
Marfans - ehlers danlos - homocystinuria

10. congenital adrenal hyperplasi
Vaso-occlusive crisis; dx hb electrophoresis
Biliary atresia; tx surgery
24-72 hours
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

11. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
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
No reticulocyte vs high reticulocyte
Croup tx cool mist; racemic epi - corticosteroid
Diet modification to provide 110kc/kg/d

12. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Female - breech delivery - family history; tx referral to ortho
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
24-72 hours

13. What are the risk factors of developmental dysplais of hip
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Decreases height - expensive; reserved for severe cases of delayed puberty
Dx US tx; correct serum electrolyte - pyloromyotom
Female - breech delivery - family history; tx referral to ortho

14. difference between structural disorder and flexible kyphosis
After 24h of abx therapy
INH 9m if INH resistant rifampin 6m in children and 4m in adults
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

15. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
14yrs
Strep pneumonie; moraxella; h influenze

16. physiological jaundice
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
<2yrs - abd pain - diarrhoea - ARF
24h to 7d of birth
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

17. aplasic crisis
Prolactinoma
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Facial portwine stain

18. How long anti-TB drugs given for TB meningitis?
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Multiple telangiectesia - vasular lesion in CNS
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

19. What is the calorie requirement of newborn?
Benign permature thelarche; expectant management
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Vaso-occlusive crisis; dx hb electrophoresis
110 kcl/kg/day

20. how smoking contributes otitis media in children
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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
After 6m; breast mild provides iron until 6m.
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

21. difference between breast milk and breafeeding jaundice
Foreign body sensation - photophobia - corneal opacity tx abx
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
14yrs
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

22. How to prevent GBS in neonate
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Penicillin G 4h before delivery

23. adrenal tumor
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Injury to lower roots of brachial plexus
Atypical lymphocyte

24. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
1.5%

25. cleft lip but no cleft palate
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

26. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
After 6m; breast mild provides iron until 6m.
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
Marfans - ehlers danlos - homocystinuria

27. lens dislocation
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
1.5%
Marfans - ehlers danlos - homocystinuria

28. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
RSV - rhino and influenza
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Injury to lower roots of brachial plexus

29. hypopigmented spots - family hx bilat deafness
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
TB - breastfeeding - asymptomatic hiv
Neurofibromatosis type2

30. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Facial portwine stain

31. is local anesthetics be used in cellulitis to reduce pain
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Female - breech delivery - family history; tx referral to ortho
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

32. How to differentiate croup vs epiglotitis
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Injury to b/l glossopharyngeal. present in botulism

33. When to do aortic root surgery in marfans to prevent dissection?
Faciform RBC cause vascular occlusion
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
If aortic root reaches 45 mm
Strep pneumonie; moraxella; h influenze

34. dx for DDH
HSP - look for symmetric skin lesions
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
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

35. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
TB - breastfeeding - asymptomatic hiv
Between pregnenolone and 17oh pregnenolone
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

36. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Pipercillin (zosyn) - ticarcillin
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

37. difference between diaper dermatitis and rash
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
TB - breastfeeding - asymptomatic hiv
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

38. contact lens keratitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
To make hip flexed and abducted position in DDH

39. Tx of community acquired pneumonia
Decr calorie intake; decr calorie absorption;incr calorie demand
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Biliary atresia; tx surgery

40. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Decreases height - expensive; reserved for severe cases of delayed puberty
Pho for forward bending; forward defect; common finding has no adverse physical effect
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

41. echymoses with low platelet <30k
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Imaging study to r/o VUR
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

42. Neonatal conjugated hyperbilirubinemia
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
If aortic root reaches 45 mm
Central isosexual precocious puberty; hypothalmaic hamartoma
Biliary atresia; tx surgery

43. cardiac manifestation of turner
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)
Tx only symptomatic carrier
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

44. How to evaluate well appearing child just born in GBS pos mother?
Decreased UGT enzyme
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
24h to 7d of birth

45. Tx of bact conjunctivitis
Risk of neurological dysfunction
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Central isosexual precocious puberty; hypothalmaic hamartoma

46. red oozing rash on cheek - scaly - dry
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No intervention; 90% foreign bodies pass without difficulty
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

47. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Injury to lower roots of brachial plexus
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

48. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
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
Central isosexual precocious puberty; hypothalmaic hamartoma
Lateral neck xray in epiglottitis show swollen epiglottis
No myoclonic activity in JME

49. lead >70
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
Medical emergency; dimercaprol/edta
Congenital rubella syndrome
Develops in 21 dasy

50. acute abd pain - hx URI - lower extremity maculo papular rash
Brown
HSP - look for symmetric skin lesions
Less than 5th percentile
Injury to lower roots of brachial plexus