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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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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. penicillin effective against pseudomonas
1.5%
No wheezing - no feever in chlamydia
Pipercillin (zosyn) - ticarcillin
Lateral neck xray in epiglottitis show swollen epiglottis

2. congenital adrenal hyperplasi
Black
Injury to b/l glossopharyngeal. present in botulism
Decreased UGT enzyme
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

3. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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

4. difference between rubeola (measles) and rulbella
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

5. How to dx RSV
Yes; but it will be less effective
refuse
Rapid detection of RSV antigen in nasl
Do HIV testing at first

6. is local anesthetics be used in cellulitis to reduce pain
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
<2yrs - abd pain - diarrhoea - ARF
Dx US tx; correct serum electrolyte - pyloromyotom
No; they are basic compound will be neutralized in an acidic environment of cellulitis

7. mech of botulism
14yrs
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
>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
Pho for forward bending; forward defect; common finding has no adverse physical effect

8. What is the definition of delayed puberty?
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

9. How long patient needs to be exposed to tick to get infected
Methylephenidate toxicity; cannot be stopped abruptly; taper
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
36 hours

10. TTP pentad
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Endocardial cushion defect (no separation between heart chambers)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

11. Tx of community acquired pneumonia
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Biliary atresia; tx surgery
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

12. tick transmits lyme
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Endocardial cushion defect (no separation between heart chambers)
Benign permature thelarche; expectant management
Brown

13. side effect of testosteron therapy
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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Decreases height - expensive; reserved for severe cases of delayed puberty
TB - breastfeeding - asymptomatic hiv

14. Parvovirus
To make hip flexed and abducted position in DDH
Fifth disease; febrile syndrome
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Atypical lymphocyte

15. difference between diaper dermatitis and rash
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
36 hours
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

16. when bact conjunctivitis patient can go back to school
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
After 24h of abx therapy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

17. How to differentiate croup vs epiglotitis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

18. What is thumbprint sign
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Lateral neck xray in epiglottitis show swollen epiglottis
Yes; but it will be less effective

19. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
No reticulocyte vs high reticulocyte
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Croup tx cool mist; racemic epi - corticosteroid

20. tick transmits RMSF
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Black
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

21. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
refuse
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

22. How long anti-TB drugs given for TB meningitis?
Strep pneumonie; moraxella; h influenze
Facial portwine stain
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

23. red oozing rash on cheek - scaly - dry
Bladder dysfunction; UTI and renal dysfunctoin
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Atopic dermatitis; strong allergic/immunologic component; incr IgE

24. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

25. 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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Dactylitis; 2nd common is splenic seqestration
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

26. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
No wheezing - no feever in chlamydia
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

27. how smoking contributes otitis media in children
Congenital rubella syndrome
Atypical lymphocyte
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

28. dx for DDH
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Faciform RBC cause vascular occlusion
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

29. causes of FTT
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Yes; but it will be less effective
1.5%

30. patient with white plaques in mouth and lump in back
Do HIV testing at first
Strep pneumonie; moraxella; h influenze
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

31. Tx of bact conjunctivitis
After 6m; breast mild provides iron until 6m.
Decr calorie intake; decr calorie absorption;incr calorie demand
110 kcl/kg/day
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

32. 21 hydroxylase
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
If aortic root reaches 45 mm

33. decreased mobility of tympanic membrane after otitis media
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Marfans - ehlers danlos - homocystinuria
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

34. failure to thrive
Injury to b/l glossopharyngeal. present in botulism
After 24h of abx therapy
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Less than 5th percentile

35. tzanck
Herpes
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Risk of neurological dysfunction

36. echymoses with low platelet <30k
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Bladder dysfunction; UTI and renal dysfunctoin
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

37. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Decr calorie intake; decr calorie absorption;incr calorie demand
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
URI

38. Febrile seizure
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

39. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
No myoclonic activity in JME

40. Tx of botulism
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Atypical lymphocyte
Constitutional pubertal delay

41. what conditions are not contraindicated
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
TB - breastfeeding - asymptomatic hiv
Congenital rubella syndrome
Marfans - ehlers danlos - homocystinuria

42. starring spells 10-20sec
24h to 7d of birth
>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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

43. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Do HIV testing at first
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Meconeum ileus; think about CF

44. infant botulism
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

45. indications of VUR
Risk of neurological dysfunction
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

46. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
No intervention; 90% foreign bodies pass without difficulty
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

47. complication of lumbosacral meningocele
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Facial portwine stain
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Bladder dysfunction; UTI and renal dysfunctoin

48. crying during urination. bacteriuria pyruria - rec episodes
Endocardial cushion defect (no separation between heart chambers)
Imaging study to r/o VUR
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Wait until 6 months

49. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Erb paralysis leading to diaphragmatic paralysis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

50. Tx of children constipation

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USMLE Step3 Pediatrics

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