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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. pavlik harness
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
To make hip flexed and abducted position in DDH
Neurofibromatosis type2
Benign permature thelarche; expectant management

2. TTP pentad
Vaso-occlusive crisis; dx hb electrophoresis
Constitutional pubertal delay
No intervention; 90% foreign bodies pass without difficulty
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

3. bromocriptine
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Penicillin G 4h before delivery
Prolactinoma

4. How to differential bact vs viral conjunctivitis
Develops in 21 dasy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Methylephenidate toxicity; cannot be stopped abruptly; taper
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

5. complication of lumbosacral meningocele
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Bladder dysfunction; UTI and renal dysfunctoin
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

6. Parents can _____ vaccine
Penicillin G 4h before delivery
refuse
No wheezing - no feever in chlamydia
Black

7. What is earliest sign of puberty?
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

8. low grade fever - cough - diffuse bilat ground glass opacities
Croup tx cool mist; racemic epi - corticosteroid
1.5%
refuse
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

9. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Croup tx cool mist; racemic epi - corticosteroid

10. decreased mobility of tympanic membrane after otitis media
After 6m; breast mild provides iron until 6m.
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

11. Tx of bact conjunctivitis
Between pregnenolone and 17oh pregnenolone
Imaging study to r/o VUR
36 hours
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

12. Infant with serum billlirubin >25
Medical emergency; dimercaprol/edta
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Risk of neurological dysfunction
Develops in 21 dasy

13. How long anti-TB drugs given for TB meningitis?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Decreased UGT enzyme
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

14. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
After 24h of abx therapy
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
110 kcl/kg/day

15. cat scratch disease
<2yrs - abd pain - diarrhoea - ARF
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Bartonella henselae; complication is suppuration of lymph node

16. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Croup
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Constitutional pubertal delay

17. if bone age lower than actual and puberty delayed
Atypical lymphocyte
Constitutional pubertal delay
Decr calorie intake; decr calorie absorption;incr calorie demand
HSP - look for symmetric skin lesions

18. target cell
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
T for t ; thalassemia; inc serum iron and Iron binding

19. Febrile seizure
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
36 hours
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

20. deficinecy of 17 hydroxylase
Decr calorie intake; decr calorie absorption;incr calorie demand
Increase of pregnenolone
To make hip flexed and abducted position in DDH
Risk of neurological dysfunction

21. acute otitis media-pathogen
Medical emergency; dimercaprol/edta
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Central isosexual precocious puberty; hypothalmaic hamartoma
Strep pneumonie; moraxella; h influenze

22. contraindications of MMR vaccine
Lateral neck xray in epiglottitis show swollen epiglottis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

23. patient with white plaques in mouth and lump in back
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Biliary atresia; tx surgery
Imaging study to r/o VUR
Do HIV testing at first

24. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Prolactinoma
Central isosexual precocious puberty; hypothalmaic hamartoma
T for t ; thalassemia; inc serum iron and Iron binding
Dx US tx; correct serum electrolyte - pyloromyotom

25. spitting up - vomiting at night - weight stable
No wheezing - no feever in chlamydia
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Strep pneumonie; moraxella; h influenze

26. HUS
<2yrs - abd pain - diarrhoea - ARF
Candidal diapar rash; tx clotrimazol
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Risk of neurological dysfunction

27. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
To make hip flexed and abducted position in DDH
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

28. duodenal atresia
D for d; down syndrome and polyhydramnios
Congenital rubella syndrome
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

29. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Congenital rubella syndrome
No reticulocyte vs high reticulocyte

30. how smoking contributes otitis media in children
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

31. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
To make hip flexed and abducted position in DDH

32. congenital adrenal hyperplasi
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Decreased UGT enzyme
Injury to b/l glossopharyngeal. present in botulism

33. benefits of antibiotic therapy in acute pharyngitis?
Absence seizure; tx ethosuximide
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

34. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Dactylitis; 2nd common is splenic seqestration
Meconeum ileus; think about CF
D for d; down syndrome and polyhydramnios
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

35. When to do surgery for undescended testes
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
1.5%
Injury to lower roots of brachial plexus
Wait until 6 months

36. tick transmits RMSF
Black
No intervention; 90% foreign bodies pass without difficulty
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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

37. impaired gag reflex
TB - breastfeeding - asymptomatic hiv
Constitutional pubertal delay
Injury to b/l glossopharyngeal. present in botulism
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

38. when bact conjunctivitis patient can go back to school
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
After 24h of abx therapy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

39. lens dislocation
Marfans - ehlers danlos - homocystinuria
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Candidal diapar rash; tx clotrimazol
T for t ; thalassemia; inc serum iron and Iron binding

40. carditis and arthritis after rheumatic fever
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Develops in 21 dasy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Congenital rubella syndrome

41. viruses cause bronhioltitis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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
RSV - rhino and influenza

42. 3yo - never able to walk
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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
Injury to b/l glossopharyngeal. present in botulism
Croup tx cool mist; racemic epi - corticosteroid

43. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Erb paralysis leading to diaphragmatic paralysis
Imaging study to r/o VUR
Strep pneumonie; moraxella; h influenze

44. causes of FTT
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
D for d; down syndrome and polyhydramnios
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
110 kcl/kg/day

45. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Pho for forward bending; forward defect; common finding has no adverse physical effect
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

46. nuchal rigidity - fever - sore throat - headache - dioriented
Brown
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Injury to b/l glossopharyngeal. present in botulism
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

47. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Strep pneumonie; moraxella; h influenze
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Multiple telangiectesia - vasular lesion in CNS

48. adenovirus
Risk of neurological dysfunction
Diet modification to provide 110kc/kg/d
No intervention; 90% foreign bodies pass without difficulty
URI

49. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Risk of neurological dysfunction

50. What are the risk factors of developmental dysplais of hip
14yrs
Female - breech delivery - family history; tx referral to ortho
Do HIV testing at first
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

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USMLE Step3 Pediatrics

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