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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. infantile hypertrophic pyloric stenosis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Dx US tx; correct serum electrolyte - pyloromyotom
TB - breastfeeding - asymptomatic hiv

2. How to investigate delayed puberty
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Injury to lower roots of brachial plexus

3. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

4. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Wait until 6 months
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

5. How to dx post uretheral valve
Facial portwine stain
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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
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

6. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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)
Prolactinoma
Decr calorie intake; decr calorie absorption;incr calorie demand

7. splenic infarction in sickle cell
Meconeum ileus; think about CF
Do HIV testing at first
Faciform RBC cause vascular occlusion
<2yrs - abd pain - diarrhoea - ARF

8. sublottic narrowing
URI
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Croup tx cool mist; racemic epi - corticosteroid
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

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

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10. flexible kyphosis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Pho for forward bending; forward defect; common finding has no adverse physical effect
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Yes; but it will be less effective

11. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Penicillin G 4h before delivery
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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. when bact conjunctivitis patient can go back to school
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Female - breech delivery - family history; tx referral to ortho
After 24h of abx therapy
Between pregnenolone and 17oh pregnenolone

13. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
1.5%
Imaging study to r/o VUR
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

14. lead >70
Tx only symptomatic carrier
No reticulocyte vs high reticulocyte
Female - breech delivery - family history; tx referral to ortho
Medical emergency; dimercaprol/edta

15. adenovirus
refuse
URI
Croup
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

16. tick transmits RMSF
Black
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

17. tick transmits lyme
Brown
Decreases height - expensive; reserved for severe cases of delayed puberty
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Herpes

18. What is the calorie requirement of newborn?
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
110 kcl/kg/day
After 24h of abx therapy
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

19. bromocriptine
Prolactinoma
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Tx only symptomatic carrier
Injury to b/l glossopharyngeal. present in botulism

20. impaired gag reflex
Lateral neck xray in epiglottitis show swollen epiglottis
Injury to b/l glossopharyngeal. present in botulism
refuse
Constitutional pubertal delay

21. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Faciform RBC cause vascular occlusion
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Methylephenidate toxicity; cannot be stopped abruptly; taper

22. How to differential bact vs viral conjunctivitis
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
Absence seizure; tx ethosuximide
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

23. centor criteria for bact pharyngitis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Marfans - ehlers danlos - homocystinuria
Do HIV testing at first

24. defcicieny of 21 hydroxylase
Imaging study to r/o VUR
Pipercillin (zosyn) - ticarcillin
Increase of progesteron/17oh progesterone
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

25. how thalassemia die
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Methylephenidate toxicity; cannot be stopped abruptly; taper
Dx US tx; correct serum electrolyte - pyloromyotom
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

26. carditis and arthritis after rheumatic fever
Increase of pregnenolone
Develops in 21 dasy
Foreign body sensation - photophobia - corneal opacity tx abx
HSP - look for symmetric skin lesions

27. TTP pentad
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Decreased UGT enzyme

28. is local anesthetics be used in cellulitis to reduce pain
RSV - rhino and influenza
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Endocardial cushion defect (no separation between heart chambers)
Rapid detection of RSV antigen in nasl

29. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Penicillin G 4h before delivery
Female - breech delivery - family history; tx referral to ortho
Erb paralysis leading to diaphragmatic paralysis

30. dx for DDH
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Endocardial cushion defect (no separation between heart chambers)
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

31. When erythema chronicum migrans develops after tick bite
24-72 hours
Thalassemia - congenital hemolytic anemia
Imaging study to r/o VUR
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

32. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
>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
Decr calorie intake; decr calorie absorption;incr calorie demand
Constitutional pubertal delay

33. HUS
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
<2yrs - abd pain - diarrhoea - ARF
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Herpes

34. How to evaluate well appearing child just born in GBS pos mother?
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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Constitutional pubertal delay

35. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Tx only symptomatic carrier
Imaging study to r/o VUR
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

36. doing worse in school - lack of attention - starring speel
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Absence seizure; tx ethosuximide
Marfans - ehlers danlos - homocystinuria

37. pavlik harness
Mainly clinical; serology with initial ELISA - with western blot confirmation;
D for d; down syndrome and polyhydramnios
To make hip flexed and abducted position in DDH
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

38. cat scratch disease
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Bartonella henselae; complication is suppuration of lymph node
Pho for forward bending; forward defect; common finding has no adverse physical effect
After 6m; breast mild provides iron until 6m.

39. cardiac manifestation of turner
Foreign body sensation - photophobia - corneal opacity tx abx
Develops in 21 dasy
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No; they are basic compound will be neutralized in an acidic environment of cellulitis

40. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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 wheezing - no feever in chlamydia
Brown
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

41. pneumonia in CF patient
No intervention; 90% foreign bodies pass without difficulty
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Bladder dysfunction; UTI and renal dysfunctoin
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

42. red oozing rash on cheek - scaly - dry
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Croup tx cool mist; racemic epi - corticosteroid

43. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Decr calorie intake; decr calorie absorption;incr calorie demand
Brown
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

44. When to do aortic root surgery in marfans to prevent dissection?
Benign permature thelarche; expectant management
If aortic root reaches 45 mm
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Neurofibromatosis type2

45. thumb sign
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Decreased UGT enzyme
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

46. indications of audiometry in childrens
No myoclonic activity in JME
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
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

47. When to give hpv vaccien
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
Erb paralysis leading to diaphragmatic paralysis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
If aortic root reaches 45 mm

48. How long anti-TB drugs given for TB meningitis?
After 24h of abx therapy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

49. How to dx RSV
Rapid detection of RSV antigen in nasl
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

50. When to do surgery for undescended testes
Wait until 6 months
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
Diet modification to provide 110kc/kg/d
Biliary atresia; tx surgery