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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. how thalassemia die
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)
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Injury to b/l glossopharyngeal. present in botulism
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

2. sickle cell with symmetrical swelling of hands and feet
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Vaso-occlusive crisis; dx hb electrophoresis
Oral DMSA or EDTA IV
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

3. 12y - obese - hip pain - hip ext rotated
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Mainly clinical; serology with initial ELISA - with western blot confirmation;
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
T for t ; thalassemia; inc serum iron and Iron binding

4. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
1.5%
D for d; down syndrome and polyhydramnios
refuse
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

5. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Fifth disease; febrile syndrome
Benign permature thelarche; expectant management

6. down syndrome with holocystolic mumur
HSP - look for symmetric skin lesions
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Endocardial cushion defect (no separation between heart chambers)
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

7. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Marfans - ehlers danlos - homocystinuria
Meconeum ileus; think about CF
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

8. adrenal tumor
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Constitutional pubertal delay
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

9. tick transmits lyme
Prolactinoma
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Erb paralysis leading to diaphragmatic paralysis
Brown

10. adenovirus
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
URI
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
No myoclonic activity in JME

11. echymoses with low platelet <30k
Foreign body sensation - photophobia - corneal opacity tx abx
Black
No reticulocyte vs high reticulocyte
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

12. nuchal rigidity - fever - sore throat - headache - dioriented
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
24h to 7d of birth
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

13. Parvovirus
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Croup tx cool mist; racemic epi - corticosteroid
Fifth disease; febrile syndrome

14. difference between structural disorder and flexible kyphosis
Fifth disease; febrile syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Pipercillin (zosyn) - ticarcillin
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

15. How to differentiate croup vs epiglotitis
Marfans - ehlers danlos - homocystinuria
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Atypical lymphocyte

16. Tx of FTT
Fifth disease; febrile syndrome
Central isosexual precocious puberty; hypothalmaic hamartoma
Diet modification to provide 110kc/kg/d
Increase of progesteron/17oh progesterone

17. Neonatal conjugated hyperbilirubinemia
Increase of progesteron/17oh progesterone
Biliary atresia; tx surgery
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
110 kcl/kg/day

18. What is the calorie requirement of newborn?
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
110 kcl/kg/day
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

19. carditis and arthritis after rheumatic fever
Develops in 21 dasy
>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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

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

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21. cardiac manifestation of turner
Benign permature thelarche; expectant management
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Tx only symptomatic carrier
Foreign body sensation - photophobia - corneal opacity tx abx

22. When to do surgery for undescended testes
D for d; down syndrome and polyhydramnios
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Wait until 6 months
Foreign body sensation - photophobia - corneal opacity tx abx

23. lens dislocation
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
No wheezing - no feever in chlamydia
Marfans - ehlers danlos - homocystinuria
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

24. benefits of antibiotic therapy in acute pharyngitis?
Tx only symptomatic carrier
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

25. acute otitis media-pathogen
D for d; down syndrome and polyhydramnios
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
Strep pneumonie; moraxella; h influenze
Wait until 6 months

26. complication of lumbosacral meningocele
Black
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Croup tx cool mist; racemic epi - corticosteroid
Bladder dysfunction; UTI and renal dysfunctoin

27. splenic infarction in sickle cell
Dx US tx; correct serum electrolyte - pyloromyotom
Faciform RBC cause vascular occlusion
Bladder dysfunction; UTI and renal dysfunctoin
refuse

28. if bone age lower than actual and puberty delayed
Between pregnenolone and 17oh pregnenolone
Facial portwine stain
Constitutional pubertal delay
Injury to b/l glossopharyngeal. present in botulism

29. duodenal atresia
D for d; down syndrome and polyhydramnios
Foreign body sensation - photophobia - corneal opacity tx abx
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
1.5%

30. How to dx endopthalmitis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Fifth disease; febrile syndrome
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

31. difference between breast milk and breafeeding jaundice
Strep pneumonie; moraxella; h influenze
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
After 24h of abx therapy
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

32. complete airway obstruction with FB
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
>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
Diet modification to provide 110kc/kg/d
No; they are basic compound will be neutralized in an acidic environment of cellulitis

33. How to dx post uretheral valve
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

34. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
14yrs
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

35. acute otitis externa

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36. sublottic narrowing
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Decreased UGT enzyme
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Croup tx cool mist; racemic epi - corticosteroid

37. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
No reticulocyte vs high reticulocyte
>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
Less than 5th percentile

38. low grade fever - cough - diffuse bilat ground glass opacities
To make hip flexed and abducted position in DDH
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

39. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Female - breech delivery - family history; tx referral to ortho
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
URI
Do HIV testing at first

40. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Black
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Faciform RBC cause vascular occlusion

41. aplasic crisis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
<2yrs - abd pain - diarrhoea - ARF
Imaging study to r/o VUR
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

42. How to dx acute angle closure glaucoma
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
No wheezing - no feever in chlamydia
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
<2yrs - abd pain - diarrhoea - ARF

43. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
TB - breastfeeding - asymptomatic hiv
Dx US tx; correct serum electrolyte - pyloromyotom
Diet modification to provide 110kc/kg/d

44. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Dx US tx; correct serum electrolyte - pyloromyotom
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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Erb paralysis leading to diaphragmatic paralysis

45. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Endocardial cushion defect (no separation between heart chambers)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Wait until 6 months

46. how smoking contributes otitis media in children
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Oral DMSA or EDTA IV
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)

47. How long patient needs to be exposed to tick to get infected
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Absence seizure; tx ethosuximide
36 hours
RSV - rhino and influenza

48. causes of FTT
TB - breastfeeding - asymptomatic hiv
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
>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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

49. contraindications of DTap
Pipercillin (zosyn) - ticarcillin
24-72 hours
Constitutional pubertal delay
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

50. hypopigmented spots - family hx bilat deafness
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Neurofibromatosis type2
Facial portwine stain
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

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USMLE Step3 Pediatrics

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