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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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Answer 50 questions in 15 minutes.
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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. 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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
refuse

2. dx for turner
Bartonella henselae; complication is suppuration of lymph node
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Yes; but it will be less effective

3. cleft lip but no cleft palate
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Brown
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Neurofibromatosis type2

4. difference between rubeola (measles) and rulbella
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

5. major depression
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
URI
24-72 hours

6. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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
Meconeum ileus; think about CF
Methylephenidate toxicity; cannot be stopped abruptly; taper

7. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
24h to 7d of birth

8. indications of VUR
ALL - alzheimers autism adhd depression seizure
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Erb paralysis leading to diaphragmatic paralysis
Marfans - ehlers danlos - homocystinuria

9. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Constitutional pubertal delay
Decreased UGT enzyme
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

10. lead 44-70
Diet modification to provide 110kc/kg/d
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Oral DMSA or EDTA IV

11. giardiasis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
No wheezing - no feever in chlamydia
Tx only symptomatic carrier

12. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Imaging study to r/o VUR
Decreased UGT enzyme
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

13. tick transmits RMSF
Decreases height - expensive; reserved for severe cases of delayed puberty
Black
Wait until 6 months
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

14. indications of audiometry in childrens
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Dactylitis; 2nd common is splenic seqestration
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

15. causes of FTT
HSP - look for symmetric skin lesions
No wheezing - no feever in chlamydia
Absence seizure; tx ethosuximide
Decr calorie intake; decr calorie absorption;incr calorie demand

16. Nocturnal enuresis
Increase of pregnenolone
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

17. How to dx keratitis?
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
Foreign body sensation - photophobia - corneal opacity tx abx
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Bladder dysfunction; UTI and renal dysfunctoin

18. How to investigate delayed puberty
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Risk of neurological dysfunction
14yrs

19. splenic infarction in sickle cell
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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
Faciform RBC cause vascular occlusion
Marfans - ehlers danlos - homocystinuria

20. How to prevent GBS in neonate
Vaso-occlusive crisis; dx hb electrophoresis
Penicillin G 4h before delivery
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

21. causes of FTT
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Dx US tx; correct serum electrolyte - pyloromyotom
D for d; down syndrome and polyhydramnios

22. dx for DDH
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Multiple telangiectesia - vasular lesion in CNS

23. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Herpes
Medical emergency; dimercaprol/edta
No reticulocyte vs high reticulocyte
Decr calorie intake; decr calorie absorption;incr calorie demand

24. complete airway obstruction with FB
Erb paralysis leading to diaphragmatic paralysis
>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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Facial portwine stain

25. How long patient needs to be exposed to tick to get infected
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
14yrs
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
36 hours

26. When to give HRT in turner
14yrs
Croup tx cool mist; racemic epi - corticosteroid
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Tx only symptomatic carrier

27. red oozing rash on cheek - scaly - dry
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
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)
Strep pneumonie; moraxella; h influenze

28. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Injury to lower roots of brachial plexus
Bartonella henselae; complication is suppuration of lymph node

29. acute otitis media-pathogen
No myoclonic activity in JME
Croup
Strep pneumonie; moraxella; h influenze
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

30. impaired gag reflex
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Injury to b/l glossopharyngeal. present in botulism
Erb paralysis leading to diaphragmatic paralysis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

31. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
After 24h of abx therapy
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

32. sturge weber syndrome
To make hip flexed and abducted position in DDH
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Facial portwine stain

33. how smoking contributes otitis media in children
>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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

34. physiological jaundice
24h to 7d of birth
Fifth disease; febrile syndrome
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Brown

35. when bact conjunctivitis patient can go back to school
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
Dx US tx; correct serum electrolyte - pyloromyotom
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
After 24h of abx therapy

36. Tx of children constipation

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37. What is the most common initial symptom in sickle cell
Herpes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
If aortic root reaches 45 mm
Dactylitis; 2nd common is splenic seqestration

38. is local anesthetics be used in cellulitis to reduce pain
110 kcl/kg/day
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Dx US tx; correct serum electrolyte - pyloromyotom
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

39. How to differentiate caput succedanueum and cephalohematoma
Biliary atresia; tx surgery
No myoclonic activity in JME
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

40. differentiate between central and peripheral precocious puberty
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
TB - breastfeeding - asymptomatic hiv
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

41. When to do surgery for undescended testes
Croup
Constitutional pubertal delay
Erb paralysis leading to diaphragmatic paralysis
Wait until 6 months

42. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Multiple telangiectesia - vasular lesion in CNS
Pipercillin (zosyn) - ticarcillin
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

43. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
After 24h of abx therapy
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Mainly clinical; serology with initial ELISA - with western blot confirmation;

44. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bartonella henselae; complication is suppuration of lymph node
Medical emergency; dimercaprol/edta

45. tick transmits lyme
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Brown
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

46. What are the risk factors of developmental dysplais of hip
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
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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Female - breech delivery - family history; tx referral to ortho

47. pumonary TB
Decreases height - expensive; reserved for severe cases of delayed puberty
Marfans - ehlers danlos - homocystinuria
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)
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

48. Infant with serum billlirubin >25
If aortic root reaches 45 mm
<2yrs - abd pain - diarrhoea - ARF
Endocardial cushion defect (no separation between heart chambers)
Risk of neurological dysfunction

49. acute otitis externa

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50. mcCune albright`
Injury to b/l glossopharyngeal. present in botulism
To make hip flexed and abducted position in DDH
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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

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USMLE Step3 Pediatrics

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