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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. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Foreign body sensation - photophobia - corneal opacity tx abx
Central isosexual precocious puberty; hypothalmaic hamartoma
Absence seizure; tx ethosuximide
No myoclonic activity in JME

2. iron supplement in child
After 6m; breast mild provides iron until 6m.
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

3. differentiate between central and peripheral precocious puberty
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Pipercillin (zosyn) - ticarcillin
Decreased UGT enzyme
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

4. acute abd pain - hx URI - lower extremity maculo papular rash
Thalassemia - congenital hemolytic anemia
HSP - look for symmetric skin lesions
TB - breastfeeding - asymptomatic hiv
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

5. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
<2yrs - abd pain - diarrhoea - ARF
TB - breastfeeding - asymptomatic hiv
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

6. giardiasis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Tx only symptomatic carrier
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

7. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Facial portwine stain
No intervention; 90% foreign bodies pass without difficulty
Erb paralysis leading to diaphragmatic paralysis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

8. doing worse in school - lack of attention - starring speel
RSV - rhino and influenza
Absence seizure; tx ethosuximide
Constitutional pubertal delay
Faciform RBC cause vascular occlusion

9. lead 44-70
Faciform RBC cause vascular occlusion
Croup
Oral DMSA or EDTA IV
Facial portwine stain

10. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No wheezing - no feever in chlamydia
D for d; down syndrome and polyhydramnios
No myoclonic activity in JME

11. pumonary TB
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)
Pho for forward bending; forward defect; common finding has no adverse physical effect
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

12. Tx of FTT
24h to 7d of birth
D for d; down syndrome and polyhydramnios
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Diet modification to provide 110kc/kg/d

13. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Fifth disease; febrile syndrome
Pipercillin (zosyn) - ticarcillin
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

14. When to do surgery for undescended testes
Brown
Risk of neurological dysfunction
refuse
Wait until 6 months

15. What is earliest sign of puberty?
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Pho for forward bending; forward defect; common finding has no adverse physical effect
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
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

16. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Facial portwine stain
Less than 5th percentile
To make hip flexed and abducted position in DDH

17. Tx of bact conjunctivitis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
14yrs
Neurofibromatosis type2

18. the risk of lyme after bitten by a tick
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
1.5%
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

19. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Less than 5th percentile
Biliary atresia; tx surgery
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

20. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

21. HUS
Facial portwine stain
Meconeum ileus; think about CF
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
<2yrs - abd pain - diarrhoea - ARF

22. cleft lip but no cleft palate
<2yrs - abd pain - diarrhoea - ARF
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Methylephenidate toxicity; cannot be stopped abruptly; taper
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

23. major depression
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Female - breech delivery - family history; tx referral to ortho

24. causes of acute anemia
Rapid detection of RSV antigen in nasl
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Oral DMSA or EDTA IV

25. failure to thrive
RSV - rhino and influenza
Absence seizure; tx ethosuximide
Less than 5th percentile
Croup

26. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
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
Develops in 21 dasy

27. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

28. complication of lumbosacral meningocele
Lateral neck xray in epiglottitis show swollen epiglottis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Bladder dysfunction; UTI and renal dysfunctoin
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

29. starring spells 10-20sec
36 hours
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

30. kallman syndrome
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
URI
Croup tx cool mist; racemic epi - corticosteroid
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

31. how thalassemia die
After 24h of abx therapy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Central isosexual precocious puberty; hypothalmaic hamartoma

32. Parvovirus
Fifth disease; febrile syndrome
110 kcl/kg/day
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Constitutional pubertal delay

33. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Faciform RBC cause vascular occlusion

34. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Imaging study to r/o VUR
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Croup

35. What is the calorie requirement of newborn?
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
110 kcl/kg/day
Imaging study to r/o VUR

36. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Dactylitis; 2nd common is splenic seqestration
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

37. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

38. red oozing rash on cheek - scaly - dry
RSV - rhino and influenza
Dx US tx; correct serum electrolyte - pyloromyotom
Meconeum ileus; think about CF
Atopic dermatitis; strong allergic/immunologic component; incr IgE

39. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Diet modification to provide 110kc/kg/d
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
refuse

40. tuberous sclerosis
To make hip flexed and abducted position in DDH
Dactylitis; 2nd common is splenic seqestration
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Tx only symptomatic carrier

41. 12y - obese - hip pain - hip ext rotated
36 hours
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Female - breech delivery - family history; tx referral to ortho

42. pneumonia in CF patient
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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)
Erb paralysis leading to diaphragmatic paralysis

43. viruses cause bronhioltitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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)
Medical emergency; dimercaprol/edta
RSV - rhino and influenza

44. microcytic - hypochromic anemia - hepatospelnomegaly
Facial portwine stain
Faciform RBC cause vascular occlusion
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Thalassemia - congenital hemolytic anemia

45. target cell
T for t ; thalassemia; inc serum iron and Iron binding
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

46. sturge weber syndrome
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Facial portwine stain
Injury to b/l glossopharyngeal. present in botulism
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

47. how smoking contributes otitis media in children
Erb paralysis leading to diaphragmatic paralysis
Thalassemia - congenital hemolytic anemia
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

48. aplasic crisis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Central isosexual precocious puberty; hypothalmaic hamartoma
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

49. Tx of community acquired pneumonia
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Central isosexual precocious puberty; hypothalmaic hamartoma

50. spitting up - vomiting at night - weight stable
Herpes
No myoclonic activity in JME
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart