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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. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Black
Methylephenidate toxicity; cannot be stopped abruptly; taper
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

2. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erb paralysis leading to diaphragmatic paralysis
Bartonella henselae; complication is suppuration of lymph node
<2yrs - abd pain - diarrhoea - ARF

3. penicillin effective against pseudomonas
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Pipercillin (zosyn) - ticarcillin
After 24h of abx therapy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

4. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Endocardial cushion defect (no separation between heart chambers)
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

5. flexible kyphosis
Meconeum ileus; think about CF
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pho for forward bending; forward defect; common finding has no adverse physical effect
Biliary atresia; tx surgery

6. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
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
Croup tx cool mist; racemic epi - corticosteroid
Atopic dermatitis; strong allergic/immunologic component; incr IgE

7. infant botulism
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
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
Decreases height - expensive; reserved for severe cases of delayed puberty

8. language delay
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Decreased UGT enzyme
24-72 hours
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

9. duodenal atresia
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
D for d; down syndrome and polyhydramnios
Decreased UGT enzyme
refuse

10. When erythema chronicum migrans develops after tick bite
24-72 hours
Lateral neck xray in epiglottitis show swollen epiglottis
Risk of neurological dysfunction
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

11. How long patient needs to be exposed to tick to get infected
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
36 hours
Decr calorie intake; decr calorie absorption;incr calorie demand
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

12. cat scratch disease
Croup
Absence seizure; tx ethosuximide
Bartonella henselae; complication is suppuration of lymph node
Injury to lower roots of brachial plexus

13. acute abd pain - hx URI - lower extremity maculo papular rash
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
No wheezing - no feever in chlamydia
HSP - look for symmetric skin lesions
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

14. low grade fever - cough - diffuse bilat ground glass opacities
No wheezing - no feever in chlamydia
Penicillin G 4h before delivery
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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

15. complication of lumbosacral meningocele
Dx US tx; correct serum electrolyte - pyloromyotom
Brown
Bladder dysfunction; UTI and renal dysfunctoin
Wait until 6 months

16. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
To make hip flexed and abducted position in DDH
Bartonella henselae; complication is suppuration of lymph node
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

17. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Bartonella henselae; complication is suppuration of lymph node
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
No; they are basic compound will be neutralized in an acidic environment of cellulitis

18. bromocriptine
Prolactinoma
Decr calorie intake; decr calorie absorption;incr calorie demand
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

19. Parvovirus
Increase of progesteron/17oh progesterone
Constitutional pubertal delay
Fifth disease; febrile syndrome
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

20. How to prevent GBS in neonate
Penicillin G 4h before delivery
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

21. pumonary TB
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

22. Neonatal unconjugated hyperbilirubine
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Methylephenidate toxicity; cannot be stopped abruptly; taper
Decreased UGT enzyme

23. iron supplement in child
Brown
Develops in 21 dasy
After 6m; breast mild provides iron until 6m.
Croup tx cool mist; racemic epi - corticosteroid

24. doing worse in school - lack of attention - starring speel
After 6m; breast mild provides iron until 6m.
Injury to b/l glossopharyngeal. present in botulism
Absence seizure; tx ethosuximide
36 hours

25. mech of botulism
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Vaso-occlusive crisis; dx hb electrophoresis

26. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
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
14yrs
Faciform RBC cause vascular occlusion

27. the risk of lyme after bitten by a tick
Erb paralysis leading to diaphragmatic paralysis
1.5%
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Risk of neurological dysfunction

28. osler rendu weber syndrom
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
Rapid detection of RSV antigen in nasl
If aortic root reaches 45 mm
Multiple telangiectesia - vasular lesion in CNS

29. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
<2yrs - abd pain - diarrhoea - ARF
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

30. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Tx only symptomatic carrier

31. dx for DDH
Foreign body sensation - photophobia - corneal opacity tx abx
Wait until 6 months
Marfans - ehlers danlos - homocystinuria
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

32. 3yo - febrile - left hip externally rotated
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Decreased UGT enzyme
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
INH 9m if INH resistant rifampin 6m in children and 4m in adults

33. When to do surgery for undescended testes
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Wait until 6 months
INH 9m if INH resistant rifampin 6m in children and 4m in adults
After 6m; breast mild provides iron until 6m.

34. complete airway obstruction with FB
Less than 5th percentile
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
Central isosexual precocious puberty; hypothalmaic hamartoma
>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

35. sickle cell with symmetrical swelling of hands and feet
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Injury to lower roots of brachial plexus
Tx only symptomatic carrier
Vaso-occlusive crisis; dx hb electrophoresis

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

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37. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Foreign body sensation - photophobia - corneal opacity tx abx
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

38. indications of audiometry in childrens
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Methylephenidate toxicity; cannot be stopped abruptly; taper

39. failure to thrive
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Less than 5th percentile

40. tzanck
Dx US tx; correct serum electrolyte - pyloromyotom
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Herpes
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

41. causes of FTT
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Neurofibromatosis type2
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

42. association with infantile pyloric stenosis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Increase of pregnenolone
Decr calorie intake; decr calorie absorption;incr calorie demand

43. viruses cause bronhioltitis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Congenital rubella syndrome
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
RSV - rhino and influenza

44. What is thumbprint sign
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Lateral neck xray in epiglottitis show swollen epiglottis
Injury to b/l glossopharyngeal. present in botulism
Pipercillin (zosyn) - ticarcillin

45. Tx of FTT
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Absence seizure; tx ethosuximide
Increase of pregnenolone
Diet modification to provide 110kc/kg/d

46. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

47. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Black
Absence seizure; tx ethosuximide

48. aplasic crisis
Rapid detection of RSV antigen in nasl
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Tx only symptomatic carrier
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

49. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
D for d; down syndrome and polyhydramnios
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

50. down syndrome has inreased risk of developing
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
Thalassemia - congenital hemolytic anemia
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
ALL - alzheimers autism adhd depression seizure