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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. decreased mobility of tympanic membrane after otitis media
Herpes
Increase of pregnenolone
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

2. coin in child's stomach
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Facial portwine stain
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
No intervention; 90% foreign bodies pass without difficulty

3. down syndrome has inreased risk of developing
24-72 hours
TB - breastfeeding - asymptomatic hiv
ALL - alzheimers autism adhd depression seizure
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

4. pneumonia in CF patient
HSP - look for symmetric skin lesions
110 kcl/kg/day
No intervention; 90% foreign bodies pass without difficulty
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

5. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

6. How to difference RSV and neonatal chlamydia
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
No wheezing - no feever in chlamydia
T for t ; thalassemia; inc serum iron and Iron binding
Atopic dermatitis; strong allergic/immunologic component; incr IgE

7. What is the calorie requirement of newborn?
Absence seizure; tx ethosuximide
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
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
110 kcl/kg/day

8. How to investigate delayed puberty
Faciform RBC cause vascular occlusion
D for d; down syndrome and polyhydramnios
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

9. doing worse in school - lack of attention - starring speel
Injury to lower roots of brachial plexus
Congenital rubella syndrome
Absence seizure; tx ethosuximide
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

10. What is earliest sign of puberty?
Decreased UGT enzyme
Biliary atresia; tx surgery
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

11. sturge weber syndrome
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Facial portwine stain
24h to 7d of birth
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)

12. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Congenital rubella syndrome
Wait until 6 months

13. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Pipercillin (zosyn) - ticarcillin

14. How to evaluate well appearing child just born in GBS pos mother?
After 6m; breast mild provides iron until 6m.
RSV - rhino and influenza
Prolactinoma
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

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

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16. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Neurofibromatosis type2
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

17. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
RSV - rhino and influenza
24h to 7d of birth
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

18. pavlik harness
Penicillin G 4h before delivery
No wheezing - no feever in chlamydia
To make hip flexed and abducted position in DDH
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

19. what conditions are not contraindicated
14yrs
Croup tx cool mist; racemic epi - corticosteroid
TB - breastfeeding - asymptomatic hiv
Endocardial cushion defect (no separation between heart chambers)

20. dx of lyme
Methylephenidate toxicity; cannot be stopped abruptly; taper
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No myoclonic activity in JME
Brown

21. indications of VUR
No reticulocyte vs high reticulocyte
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Tx only symptomatic carrier

22. Tx of community acquired pneumonia
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Constitutional pubertal delay
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

23. crying during urination. bacteriuria pyruria - rec episodes
Neurofibromatosis type2
Injury to b/l glossopharyngeal. present in botulism
Faciform RBC cause vascular occlusion
Imaging study to r/o VUR

24. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Endocardial cushion defect (no separation between heart chambers)
Strep pneumonie; moraxella; h influenze
No; they are basic compound will be neutralized in an acidic environment of cellulitis

25. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Prolactinoma
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
After 6m; breast mild provides iron until 6m.
Strep pneumonie; moraxella; h influenze

26. How to dx keratitis?
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Brown
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Foreign body sensation - photophobia - corneal opacity tx abx

27. When to give HRT in turner
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
14yrs
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

28. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Biliary atresia; tx surgery
Dactylitis; 2nd common is splenic seqestration
Thalassemia - congenital hemolytic anemia

29. mcCune albright`
Decreased UGT enzyme
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Do HIV testing at first

30. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
After 24h of abx therapy
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
After 6m; breast mild provides iron until 6m.

31. how thalassemia die
<2yrs - abd pain - diarrhoea - ARF
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
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
Do HIV testing at first

32. how smoking contributes otitis media in children
Croup tx cool mist; racemic epi - corticosteroid
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Do HIV testing at first

33. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
No myoclonic activity in JME
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Methylephenidate toxicity; cannot be stopped abruptly; taper

34. aplasic crisis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Facial portwine stain
Herpes
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

35. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Atypical lymphocyte
Brown

36. language expectation from 2yo
>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
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Imaging study to r/o VUR

37. lead >70
Increase of pregnenolone
Neurofibromatosis type2
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Medical emergency; dimercaprol/edta

38. carditis and arthritis after rheumatic fever
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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
Develops in 21 dasy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

39. How long patient needs to be exposed to tick to get infected
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
36 hours
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
D for d; down syndrome and polyhydramnios

40. iron supplement in child
Bartonella henselae; complication is suppuration of lymph node
Benign permature thelarche; expectant management
After 6m; breast mild provides iron until 6m.
Penicillin G 4h before delivery

41. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Oral DMSA or EDTA IV
14yrs
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

42. difference between structural disorder and flexible kyphosis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Pipercillin (zosyn) - ticarcillin
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Facial portwine stain

43. target cell
Rapid detection of RSV antigen in nasl
Wait until 6 months
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
T for t ; thalassemia; inc serum iron and Iron binding

44. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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
refuse
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

45. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Pipercillin (zosyn) - ticarcillin
Meconeum ileus; think about CF
Multiple telangiectesia - vasular lesion in CNS

46. viruses cause bronhioltitis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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
RSV - rhino and influenza
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

47. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
36 hours
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

48. How to differential bact vs viral conjunctivitis
Faciform RBC cause vascular occlusion
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
D for d; down syndrome and polyhydramnios
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

49. cleft lip but no cleft palate
Facial portwine stain
URI
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
1.5%

50. adenovirus
No wheezing - no feever in chlamydia
URI
Rapid detection of RSV antigen in nasl
Candidal diapar rash; tx clotrimazol