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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.
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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. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Oral DMSA or EDTA IV
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

2. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
>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
Candidal diapar rash; tx clotrimazol
Meconeum ileus; think about CF

3. 3yo - never able to walk
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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
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
Marfans - ehlers danlos - homocystinuria

4. kallman syndrome
Faciform RBC cause vascular occlusion
After 24h of abx therapy
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

5. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Erb paralysis leading to diaphragmatic paralysis
After 6m; breast mild provides iron until 6m.

6. most common complication of otitis media
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Strep pneumonie; moraxella; h influenze
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

7. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
URI
Herpes
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

8. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
refuse
Biliary atresia; tx surgery
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

9. cat scratch disease
Prolactinoma
Croup tx cool mist; racemic epi - corticosteroid
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Bartonella henselae; complication is suppuration of lymph node

10. mcCune albright`
Croup
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
T for t ; thalassemia; inc serum iron and Iron binding

11. 12y - obese - hip pain - hip ext rotated
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
D for d; down syndrome and polyhydramnios

12. What is earliest sign of puberty?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
T for t ; thalassemia; inc serum iron and Iron binding
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

13. dx for turner
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Thalassemia - congenital hemolytic anemia

14. penicillin effective against pseudomonas
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Pipercillin (zosyn) - ticarcillin
Dx US tx; correct serum electrolyte - pyloromyotom
Dactylitis; 2nd common is splenic seqestration

15. differentiate between central and peripheral precocious puberty
Female - breech delivery - family history; tx referral to ortho
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

16. splenic infarction in sickle cell
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Faciform RBC cause vascular occlusion
Penicillin G 4h before delivery
<2yrs - abd pain - diarrhoea - ARF

17. What is the most common initial symptom in sickle cell
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Dactylitis; 2nd common is splenic seqestration
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

18. difference between rubeola (measles) and rulbella
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Female - breech delivery - family history; tx referral to ortho
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

19. How to prevent GBS in neonate
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Penicillin G 4h before delivery
Imaging study to r/o VUR

20. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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 seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
No reticulocyte vs high reticulocyte

21. difference between diaper dermatitis and rash
Meconeum ileus; think about CF
Marfans - ehlers danlos - homocystinuria
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

22. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Do HIV testing at first
24-72 hours
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

23. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
No intervention; 90% foreign bodies pass without difficulty
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

24. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Imaging study to r/o VUR
Atypical lymphocyte

25. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Methylephenidate toxicity; cannot be stopped abruptly; taper
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

26. Parvovirus
Fifth disease; febrile syndrome
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Injury to b/l glossopharyngeal. present in botulism
Injury to lower roots of brachial plexus

27. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Marfans - ehlers danlos - homocystinuria
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Develops in 21 dasy

28. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

29. difference between breast milk and breafeeding jaundice
Black
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)
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
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

30. Tx of community acquired pneumonia
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Wait until 6 months
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

31. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
After 6m; breast mild provides iron until 6m.
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

32. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

33. echymoses with low platelet <30k
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)
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
No wheezing - no feever in chlamydia

34. Neonatal conjugated hyperbilirubinemia
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Biliary atresia; tx surgery
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

35. How to dx endopthalmitis
Dactylitis; 2nd common is splenic seqestration
Diet modification to provide 110kc/kg/d
Prolactinoma
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

36. What is the calorie requirement of newborn?
Dactylitis; 2nd common is splenic seqestration
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
110 kcl/kg/day

37. adrenal tumor
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

38. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Congenital rubella syndrome

39. lens dislocation
Marfans - ehlers danlos - homocystinuria
Methylephenidate toxicity; cannot be stopped abruptly; taper
Brown
Strep pneumonie; moraxella; h influenze

40. the risk of lyme after bitten by a tick
Fifth disease; febrile syndrome
Increase of progesteron/17oh progesterone
1.5%
Black

41. mech of botulism
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
After 24h of abx therapy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

42. deficinecy of 17 hydroxylase
Increase of pregnenolone
D for d; down syndrome and polyhydramnios
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

43. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Female - breech delivery - family history; tx referral to ortho
36 hours

44. microcytic - hypochromic anemia - hepatospelnomegaly
Pho for forward bending; forward defect; common finding has no adverse physical effect
Benign permature thelarche; expectant management
Thalassemia - congenital hemolytic anemia
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

45. complete airway obstruction with FB
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
>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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

46. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
T for t ; thalassemia; inc serum iron and Iron binding
Meconeum ileus; think about CF
No intervention; 90% foreign bodies pass without difficulty
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

47. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Candidal diapar rash; tx clotrimazol
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

48. 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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decreased UGT enzyme

49. pumonary TB
No reticulocyte vs high reticulocyte
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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)
Wait until 6 months

50. acute otitis externa