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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. How to dx endopthalmitis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
110 kcl/kg/day
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

2. Febrile seizure
No reticulocyte vs high reticulocyte
Strep pneumonie; moraxella; h influenze
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Between pregnenolone and 17oh pregnenolone

3. horner syndrom
Strep pneumonie; moraxella; h influenze
Foreign body sensation - photophobia - corneal opacity tx abx
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Injury to lower roots of brachial plexus

4. 3yo - febrile - left hip externally rotated
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Croup tx cool mist; racemic epi - corticosteroid

5. acute otitis media-pathogen
Constitutional pubertal delay
refuse
Herpes
Strep pneumonie; moraxella; h influenze

6. How long patient needs to be exposed to tick to get infected
36 hours
14yrs
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
URI

7. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
URI
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

8. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Imaging study to r/o VUR
Brown
Atypical lymphocyte

9. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Decreased UGT enzyme
14yrs
No wheezing - no feever in chlamydia
No reticulocyte vs high reticulocyte

10. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
No wheezing - no feever in chlamydia
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

11. when bact conjunctivitis patient can go back to school
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
After 24h of abx therapy
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

12. mcCune albright`
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

13. What is the definition of delayed puberty?
Injury to lower roots of brachial plexus
Female - breech delivery - family history; tx referral to ortho
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

14. What is the most common initial symptom in sickle cell
INH 9m if INH resistant rifampin 6m in children and 4m in adults
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Dactylitis; 2nd common is splenic seqestration
<2yrs - abd pain - diarrhoea - ARF

15. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
Black
Biliary atresia; tx surgery
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

16. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Penicillin G 4h before delivery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

17. iron supplement in child
After 6m; breast mild provides iron until 6m.
Congenital rubella syndrome
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

18. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Fifth disease; febrile syndrome
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
>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. dx for 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
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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

20. what conditions are not contraindicated
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
TB - breastfeeding - asymptomatic hiv
Biliary atresia; tx surgery
Bladder dysfunction; UTI and renal dysfunctoin

21. target cell
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
T for t ; thalassemia; inc serum iron and Iron binding

22. 3yo - never able to walk
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
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
Biliary atresia; tx surgery
Atopic dermatitis; strong allergic/immunologic component; incr IgE

23. dx of lyme
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pipercillin (zosyn) - ticarcillin
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

24. bromocriptine
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Absence seizure; tx ethosuximide
URI
Prolactinoma

25. deficinecy of 17 hydroxylase
Do HIV testing at first
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Methylephenidate toxicity; cannot be stopped abruptly; taper
Increase of pregnenolone

26. TTP pentad
Bladder dysfunction; UTI and renal dysfunctoin
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Increase of progesteron/17oh progesterone

27. decreased mobility of tympanic membrane after otitis media
Bladder dysfunction; UTI and renal dysfunctoin
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Multiple telangiectesia - vasular lesion in CNS
36 hours

28. How to dx keratitis?
14yrs
After 6m; breast mild provides iron until 6m.
Foreign body sensation - photophobia - corneal opacity tx abx
Multiple telangiectesia - vasular lesion in CNS

29. acute abd pain - hx URI - lower extremity maculo papular rash
Decr calorie intake; decr calorie absorption;incr calorie demand
HSP - look for symmetric skin lesions
No reticulocyte vs high reticulocyte
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

30. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Pipercillin (zosyn) - ticarcillin
No myoclonic activity in JME
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

31. 17 alpha hydroxylase
Methylephenidate toxicity; cannot be stopped abruptly; taper
Between pregnenolone and 17oh pregnenolone
RSV - rhino and influenza
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

32. duodenal atresia
Rapid detection of RSV antigen in nasl
D for d; down syndrome and polyhydramnios
110 kcl/kg/day
Strep pneumonie; moraxella; h influenze

33. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Wait until 6 months

34. Tx of children constipation

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35. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erb paralysis leading to diaphragmatic paralysis
Yes; but it will be less effective

36. spitting up - vomiting at night - weight stable
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Atopic dermatitis; strong allergic/immunologic component; incr IgE
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

37. association with infantile pyloric stenosis
Diet modification to provide 110kc/kg/d
Less than 5th percentile
Penicillin G 4h before delivery
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

38. benefits of antibiotic therapy in acute pharyngitis?
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

39. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Absence seizure; tx ethosuximide
HSP - look for symmetric skin lesions
Herpes

40. causes of FTT
Erb paralysis leading to diaphragmatic paralysis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Croup tx cool mist; racemic epi - corticosteroid

41. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Yes; but it will be less effective
Foreign body sensation - photophobia - corneal opacity tx abx

42. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

43. How to differential bact vs viral conjunctivitis
Increase of progesteron/17oh progesterone
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
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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

44. tick transmits RMSF
Black
Vaso-occlusive crisis; dx hb electrophoresis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Prolactinoma

45. Tx of bact conjunctivitis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No wheezing - no feever in chlamydia
Risk of neurological dysfunction
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

46. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
After 24h of abx therapy
Increase of pregnenolone

47. HUS
<2yrs - abd pain - diarrhoea - ARF
Thalassemia - congenital hemolytic anemia
Rapid detection of RSV antigen in nasl
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

48. How to investigate delayed puberty
Injury to lower roots of brachial plexus
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
URI
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

49. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Pho for forward bending; forward defect; common finding has no adverse physical effect
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

50. down syndrome with holocystolic mumur
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Endocardial cushion defect (no separation between heart chambers)
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