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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. difference between diaper dermatitis and rash
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Imaging study to r/o VUR
After 6m; breast mild provides iron until 6m.
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

2. Tx of bact 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
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

3. What is thumbprint sign
Meconeum ileus; think about CF
Lateral neck xray in epiglottitis show swollen epiglottis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Pipercillin (zosyn) - ticarcillin

4. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No wheezing - no feever in chlamydia

5. contraindications of DTap
No reticulocyte vs high reticulocyte
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Constitutional pubertal delay
Benign permature thelarche; expectant management

6. crying during urination. bacteriuria pyruria - rec episodes
No reticulocyte vs high reticulocyte
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Imaging study to r/o VUR
Croup tx cool mist; racemic epi - corticosteroid

7. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Neurofibromatosis type2
No myoclonic activity in JME
Wait until 6 months

8. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Mainly clinical; serology with initial ELISA - with western blot confirmation;

9. bromocriptine
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Prolactinoma
Rapid detection of RSV antigen in nasl
Increase of pregnenolone

10. congenital adrenal hyperplasi
After 6m; breast mild provides iron until 6m.
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Pipercillin (zosyn) - ticarcillin

11. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Pipercillin (zosyn) - ticarcillin
Increase of pregnenolone
refuse

12. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Foreign body sensation - photophobia - corneal opacity tx abx
Dactylitis; 2nd common is splenic seqestration
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

13. is local anesthetics be used in cellulitis to reduce pain
Increase of progesteron/17oh progesterone
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No; they are basic compound will be neutralized in an acidic environment of cellulitis

14. spitting up - vomiting at night - weight stable
Bartonella henselae; complication is suppuration of lymph node
Wait until 6 months
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Female - breech delivery - family history; tx referral to ortho

15. major depression
refuse
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Candidal diapar rash; tx clotrimazol
Absence seizure; tx ethosuximide

16. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Diet modification to provide 110kc/kg/d
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

17. contact lens keratitis
>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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

18. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Croup
Benign permature thelarche; expectant management
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

19. coin in child's stomach
<2yrs - abd pain - diarrhoea - ARF
No intervention; 90% foreign bodies pass without difficulty
Medical emergency; dimercaprol/edta
Bladder dysfunction; UTI and renal dysfunctoin

20. aplasic crisis
Strep pneumonie; moraxella; h influenze
Thalassemia - congenital hemolytic anemia
Penicillin G 4h before delivery
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

21. How to dx post uretheral valve
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Pho for forward bending; forward defect; common finding has no adverse physical effect
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Diet modification to provide 110kc/kg/d

22. sudden onset of fever - difficulty in breathing
Marfans - ehlers danlos - homocystinuria
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

23. How to differentiate caput succedanueum and cephalohematoma
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Yes; but it will be less effective
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
1.5%

24. doing worse in school - lack of attention - starring speel
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Absence seizure; tx ethosuximide

25. How to dx acute angle closure glaucoma
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Strep pneumonie; moraxella; h influenze
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

26. physiological jaundice
24h to 7d of birth
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
1.5%
Fifth disease; febrile syndrome

27. tuberous sclerosis
<2yrs - abd pain - diarrhoea - ARF
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)
14yrs
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

28. language delay
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Central isosexual precocious puberty; hypothalmaic hamartoma
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
>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

29. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Bladder dysfunction; UTI and renal dysfunctoin
Less than 5th percentile
Decreases height - expensive; reserved for severe cases of delayed puberty

30. Tx of community acquired pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Risk of neurological dysfunction

31. How to dx endopthalmitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

32. indications of VUR
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Absence seizure; tx ethosuximide
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

33. tick transmits RMSF
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Black
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
HSP - look for symmetric skin lesions

34. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Injury to b/l glossopharyngeal. present in botulism
Candidal diapar rash; tx clotrimazol
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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

35. TTP pentad
Dactylitis; 2nd common is splenic seqestration
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

36. sickle cell with symmetrical swelling of hands and feet
Bladder dysfunction; UTI and renal dysfunctoin
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Vaso-occlusive crisis; dx hb electrophoresis

37. What is the most common initial symptom in sickle cell
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
HSP - look for symmetric skin lesions
Dactylitis; 2nd common is splenic seqestration

38. down syndrome has inreased risk of developing
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
No reticulocyte vs high reticulocyte
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
ALL - alzheimers autism adhd depression seizure

39. 21 hydroxylase
Tx only symptomatic carrier
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Pho for forward bending; forward defect; common finding has no adverse physical effect

40. differentiate between central and peripheral precocious puberty
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Meconeum ileus; think about CF

41. lead 44-70
Yes; but it will be less effective
Medical emergency; dimercaprol/edta
Oral DMSA or EDTA IV
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

42. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
14yrs

43. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

44. non immune pregnant women exposed to rubella in first trimester
Female - breech delivery - family history; tx referral to ortho
Tx only symptomatic carrier
Congenital rubella syndrome
Endocardial cushion defect (no separation between heart chambers)

45. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Methylephenidate toxicity; cannot be stopped abruptly; taper
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Black

46. giardiasis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Herpes
Rapid detection of RSV antigen in nasl
Tx only symptomatic carrier

47. sublottic narrowing
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
110 kcl/kg/day
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Croup tx cool mist; racemic epi - corticosteroid

48. deficinecy of 17 hydroxylase
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Dactylitis; 2nd common is splenic seqestration
Decr calorie intake; decr calorie absorption;incr calorie demand
Increase of pregnenolone

49. horner syndrom
36 hours
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Injury to lower roots of brachial plexus
>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

50. TB prophylaxis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
INH 9m if INH resistant rifampin 6m in children and 4m in adults