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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. cat scratch disease
Strep pneumonie; moraxella; h influenze
Dx US tx; correct serum electrolyte - pyloromyotom
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bartonella henselae; complication is suppuration of lymph node

2. doing worse in school - lack of attention - starring speel
No myoclonic activity in JME
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Absence seizure; tx ethosuximide

3. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Rapid detection of RSV antigen in nasl
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Penicillin G 4h before delivery

4. indications of audiometry in childrens
Endocardial cushion defect (no separation between heart chambers)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Diet modification to provide 110kc/kg/d
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

5. microcytic - hypochromic anemia - hepatospelnomegaly
Endocardial cushion defect (no separation between heart chambers)
Decreased UGT enzyme
Fifth disease; febrile syndrome
Thalassemia - congenital hemolytic anemia

6. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Pho for forward bending; forward defect; common finding has no adverse physical effect
<2yrs - abd pain - diarrhoea - ARF
Decreases height - expensive; reserved for severe cases of delayed puberty

7. tzanck
Herpes
Tx only symptomatic carrier
Croup
HSP - look for symmetric skin lesions

8. 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)
Absence seizure; tx ethosuximide
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

9. difference between diaper dermatitis and rash
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Bladder dysfunction; UTI and renal dysfunctoin
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
Candidal diapar rash; tx clotrimazol

10. dx for turner
Injury to b/l glossopharyngeal. present in botulism
Penicillin G 4h before delivery
Marfans - ehlers danlos - homocystinuria
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

11. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Foreign body sensation - photophobia - corneal opacity tx abx
After 24h of abx therapy

12. tick transmits RMSF
Less than 5th percentile
Black
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

13. lens dislocation
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Marfans - ehlers danlos - homocystinuria
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Dactylitis; 2nd common is splenic seqestration

14. aplasic crisis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
No wheezing - no feever in chlamydia
ALL - alzheimers autism adhd depression seizure

15. mech of botulism
Croup tx cool mist; racemic epi - corticosteroid
Risk of neurological dysfunction
Benign permature thelarche; expectant management
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

16. acute otitis media-pathogen
Pipercillin (zosyn) - ticarcillin
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Decreased UGT enzyme
Strep pneumonie; moraxella; h influenze

17. is local anesthetics be used in cellulitis to reduce pain
No reticulocyte vs high reticulocyte
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)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No; they are basic compound will be neutralized in an acidic environment of cellulitis

18. mcCune albright`
Risk of neurological dysfunction
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

19. What is earliest sign of puberty?
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Injury to lower roots of brachial plexus
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

20. sublottic narrowing
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Croup tx cool mist; racemic epi - corticosteroid
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

21. TB prophylaxis
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
Tx only symptomatic carrier
INH 9m if INH resistant rifampin 6m in children and 4m in adults

22. How long anti-TB drugs given for TB meningitis?
refuse
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

23. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Imaging study to r/o VUR
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

24. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Candidal diapar rash; tx clotrimazol
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

25. osler rendu weber syndrom
<2yrs - abd pain - diarrhoea - ARF
Multiple telangiectesia - vasular lesion in CNS
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
If aortic root reaches 45 mm

26. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
110 kcl/kg/day

27. decreased mobility of tympanic membrane after otitis media
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Congenital rubella syndrome
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

28. 17 alpha hydroxylase
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Between pregnenolone and 17oh pregnenolone
Central isosexual precocious puberty; hypothalmaic hamartoma
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

29. causes of FTT
After 24h of abx therapy
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

30. Tx of children constipation

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31. 3yo - febrile - left hip externally rotated
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Decreased UGT enzyme

32. How to difference RSV and neonatal chlamydia
Injury to lower roots of brachial plexus
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
No wheezing - no feever in chlamydia
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

33. how thalassemia die
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Congenital rubella syndrome
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

34. 21 hydroxylase
No intervention; 90% foreign bodies pass without difficulty
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

35. What is the definition of delayed puberty?
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Endocardial cushion defect (no separation between heart chambers)

36. iron supplement in child
After 6m; breast mild provides iron until 6m.
RSV - rhino and influenza
To make hip flexed and abducted position in DDH
Tx only symptomatic carrier

37. association with infantile pyloric stenosis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Atypical lymphocyte
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

38. What is thumbprint sign
Marfans - ehlers danlos - homocystinuria
36 hours
Lateral neck xray in epiglottitis show swollen epiglottis
Wait until 6 months

39. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
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
No reticulocyte vs high reticulocyte
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
INH 9m if INH resistant rifampin 6m in children and 4m in adults

40. can women with abnormal smear or genital get vaccine
refuse
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
>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
Yes; but it will be less effective

41. starring spells 10-20sec
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Herpes
Female - breech delivery - family history; tx referral to ortho
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

42. tick transmits lyme
Dactylitis; 2nd common is splenic seqestration
<2yrs - abd pain - diarrhoea - ARF
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)
Brown

43. crying during urination. bacteriuria pyruria - rec episodes
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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)
Imaging study to r/o VUR
Meconeum ileus; think about CF

44. How to dx endopthalmitis
Decreased UGT enzyme
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

45. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
T for t ; thalassemia; inc serum iron and Iron binding
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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

46. How to difference viral and bact pneumonia
Vaso-occlusive crisis; dx hb electrophoresis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

47. sickle cell with symmetrical swelling of hands and feet
Faciform RBC cause vascular occlusion
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Vaso-occlusive crisis; dx hb electrophoresis
Endocardial cushion defect (no separation between heart chambers)

48. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Increase of progesteron/17oh progesterone

49. How to dx post uretheral valve
Wait until 6 months
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

50. penicillin effective against pseudomonas
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Pipercillin (zosyn) - ticarcillin
No intervention; 90% foreign bodies pass without difficulty
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro