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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. Tx of botulism
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
Fifth disease; febrile syndrome
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

2. mcCune albright`
Facial portwine stain
Strep pneumonie; moraxella; h influenze
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Yes; but it will be less effective

3. echymoses with low platelet <30k
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

4. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Erb paralysis leading to diaphragmatic paralysis
Decreased UGT enzyme
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

5. deficinecy of 17 hydroxylase
Strep pneumonie; moraxella; h influenze
Increase of pregnenolone
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
After 6m; breast mild provides iron until 6m.

6. sturge weber 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)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Facial portwine stain
No intervention; 90% foreign bodies pass without difficulty

7. physiological jaundice
24h to 7d of birth
Between pregnenolone and 17oh pregnenolone
Rapid detection of RSV antigen in nasl
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

8. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Dactylitis; 2nd common is splenic seqestration
No reticulocyte vs high reticulocyte
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Bladder dysfunction; UTI and renal dysfunctoin

9. HUS
<2yrs - abd pain - diarrhoea - ARF
Oral DMSA or EDTA IV
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

10. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Central isosexual precocious puberty; hypothalmaic hamartoma
Oral DMSA or EDTA IV
Herpes

11. When to give HRT in turner
14yrs
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

12. What is the definition of delayed puberty?
Methylephenidate toxicity; cannot be stopped abruptly; taper
Injury to b/l glossopharyngeal. present in botulism
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

13. How to differential bact vs viral conjunctivitis
Prolactinoma
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Dx US tx; correct serum electrolyte - pyloromyotom
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

14. How to dx acute angle closure glaucoma
Wait until 6 months
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

15. acute abd pain - hx URI - lower extremity maculo papular rash
To make hip flexed and abducted position in DDH
HSP - look for symmetric skin lesions
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

16. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Multiple telangiectesia - vasular lesion in CNS
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
14yrs

17. failure to thrive
Less than 5th percentile
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

18. complete airway obstruction with FB
Marfans - ehlers danlos - homocystinuria
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
>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

19. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Increase of progesteron/17oh progesterone
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

20. giardiasis
Tx only symptomatic carrier
Prolactinoma
Erb paralysis leading to diaphragmatic paralysis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

21. How to dx keratitis?
After 6m; breast mild provides iron until 6m.
Foreign body sensation - photophobia - corneal opacity tx abx
No intervention; 90% foreign bodies pass without difficulty
Thalassemia - congenital hemolytic anemia

22. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Meconeum ileus; think about CF
Benign permature thelarche; expectant management
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

23. How to differentiate croup vs epiglotitis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Bladder dysfunction; UTI and renal dysfunctoin
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

24. sickle cell with symmetrical swelling of hands and feet
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
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
Vaso-occlusive crisis; dx hb electrophoresis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

25. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Congenital rubella syndrome
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

26. thumb sign
URI
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

27. most common complication of otitis media
Imaging study to r/o VUR
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

28. how smoking contributes otitis media in children
After 6m; breast mild provides iron until 6m.
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
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

29. pneumonia in CF patient
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Pipercillin (zosyn) - ticarcillin
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

30. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Croup
Medical emergency; dimercaprol/edta
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

31. How to differentiate caput succedanueum and cephalohematoma
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
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Pipercillin (zosyn) - ticarcillin

32. contact lens keratitis
Dx US tx; correct serum electrolyte - pyloromyotom
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Bladder dysfunction; UTI and renal dysfunctoin
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

33. when bact conjunctivitis patient can go back to school
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Foreign body sensation - photophobia - corneal opacity tx abx
After 24h of abx therapy
Candidal diapar rash; tx clotrimazol

34. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

35. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

36. What is thumbprint sign
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Lateral neck xray in epiglottitis show swollen epiglottis
Bladder dysfunction; UTI and renal dysfunctoin
Between pregnenolone and 17oh pregnenolone

37. kallman syndrome
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Do HIV testing at first
Injury to b/l glossopharyngeal. present in botulism
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

38. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
T for t ; thalassemia; inc serum iron and Iron binding

39. How to dx post uretheral valve
Croup tx cool mist; racemic epi - corticosteroid
Injury to lower roots of brachial plexus
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

40. the recommended ca supplementation
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)
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
URI
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

41. Neonatal unconjugated hyperbilirubine
Croup
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Injury to lower roots of brachial plexus
Decreased UGT enzyme

42. complication of lumbosacral meningocele
Diet modification to provide 110kc/kg/d
Multiple telangiectesia - vasular lesion in CNS
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Bladder dysfunction; UTI and renal dysfunctoin

43. TTP pentad
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Between pregnenolone and 17oh pregnenolone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
To make hip flexed and abducted position in DDH

44. down syndrome has inreased risk of developing
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
ALL - alzheimers autism adhd depression seizure

45. Nocturnal enuresis
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)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Endocardial cushion defect (no separation between heart chambers)

46. language delay
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Constitutional pubertal delay
Faciform RBC cause vascular occlusion

47. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
Tx only symptomatic carrier
Decreases height - expensive; reserved for severe cases of delayed puberty
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

48. tuberous sclerosis
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
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Between pregnenolone and 17oh pregnenolone
Herpes

49. sublottic narrowing
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Rapid detection of RSV antigen in nasl
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Croup tx cool mist; racemic epi - corticosteroid

50. Tx of children constipation