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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. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Decr calorie intake; decr calorie absorption;incr calorie demand
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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

2. side effect of testosteron therapy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
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
Decreases height - expensive; reserved for severe cases of delayed puberty

3. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Injury to b/l glossopharyngeal. present in botulism
Pipercillin (zosyn) - ticarcillin
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Central isosexual precocious puberty; hypothalmaic hamartoma

4. contact lens keratitis
14yrs
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Lateral neck xray in epiglottitis show swollen epiglottis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

5. acute otitis externa

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6. decreased mobility of tympanic membrane after otitis media
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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
Prolactinoma
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

7. lead 44-70
Croup
Lateral neck xray in epiglottitis show swollen epiglottis
Strep pneumonie; moraxella; h influenze
Oral DMSA or EDTA IV

8. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Foreign body sensation - photophobia - corneal opacity tx abx
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

9. Tx of community acquired pneumonia
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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
1.5%
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

10. the risk of lyme after bitten by a tick
Between pregnenolone and 17oh pregnenolone
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
1.5%
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

11. What are the risk factors of developmental dysplais of hip
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Female - breech delivery - family history; tx referral to ortho
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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

12. pavlik harness
No intervention; 90% foreign bodies pass without difficulty
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
To make hip flexed and abducted position in DDH

13. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Central isosexual precocious puberty; hypothalmaic hamartoma
Croup
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No reticulocyte vs high reticulocyte

14. red oozing rash on cheek - scaly - dry
Penicillin G 4h before delivery
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

15. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
No myoclonic activity in JME
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
Candidal diapar rash; tx clotrimazol
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

16. target cell
1.5%
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
T for t ; thalassemia; inc serum iron and Iron binding

17. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Wait until 6 months
Neurofibromatosis type2

18. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Erb paralysis leading to diaphragmatic paralysis
Croup
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

19. sudden onset of fever - difficulty in breathing
Atypical lymphocyte
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Erb paralysis leading to diaphragmatic paralysis

20. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Erb paralysis leading to diaphragmatic paralysis
Decreases height - expensive; reserved for severe cases of delayed puberty

21. Tx of children constipation

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22. viruses cause bronhioltitis
Foreign body sensation - photophobia - corneal opacity tx abx
Increase of progesteron/17oh progesterone
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
RSV - rhino and influenza

23. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
No wheezing - no feever in chlamydia
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

24. 18mo bilat breast enlargment - some pubic hair
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; they are basic compound will be neutralized in an acidic environment of cellulitis
Benign permature thelarche; expectant management
No wheezing - no feever in chlamydia

25. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
<2yrs - abd pain - diarrhoea - ARF
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

26. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Thalassemia - congenital hemolytic anemia
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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

27. Nocturnal enuresis
24h to 7d of birth
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Brown
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

28. Infant with serum billlirubin >25
No intervention; 90% foreign bodies pass without difficulty
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
Risk of neurological dysfunction
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

29. duodenal atresia
D for d; down syndrome and polyhydramnios
>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
Benign permature thelarche; expectant management
After 24h of abx therapy

30. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Lateral neck xray in epiglottitis show swollen epiglottis
Croup tx cool mist; racemic epi - corticosteroid

31. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Herpes
Croup

32. deficinecy of 17 hydroxylase
RSV - rhino and influenza
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
After 6m; breast mild provides iron until 6m.
Increase of pregnenolone

33. adenovirus
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
URI
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

34. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Between pregnenolone and 17oh pregnenolone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Erb paralysis leading to diaphragmatic paralysis

35. dx for turner
If aortic root reaches 45 mm
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
>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

36. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

37. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Facial portwine stain
Croup tx cool mist; racemic epi - corticosteroid
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

38. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

39. How to dx endopthalmitis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erb paralysis leading to diaphragmatic paralysis

40. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
14yrs
After 24h of abx therapy

41. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Croup
Female - breech delivery - family history; tx referral to ortho
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

42. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
After 6m; breast mild provides iron until 6m.
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
INH 9m if INH resistant rifampin 6m in children and 4m in adults

43. difference between breast milk and breafeeding jaundice
No myoclonic activity in JME
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

44. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
No reticulocyte vs high reticulocyte
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

45. How to dx post uretheral valve
Injury to b/l glossopharyngeal. present in botulism
Bladder dysfunction; UTI and renal dysfunctoin
Croup tx cool mist; racemic epi - corticosteroid
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

46. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
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
No reticulocyte vs high reticulocyte
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

47. infant botulism
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Marfans - ehlers danlos - homocystinuria
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

48. What is earliest sign of puberty?
Between pregnenolone and 17oh pregnenolone
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Benign permature thelarche; expectant management

49. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Faciform RBC cause vascular occlusion
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

50. Febrile seizure
Risk of neurological dysfunction
Decr calorie intake; decr calorie absorption;incr calorie demand
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis