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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. 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
Lateral neck xray in epiglottitis show swollen epiglottis
Medical emergency; dimercaprol/edta
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

2. Tx of FTT
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Risk of neurological dysfunction
If aortic root reaches 45 mm
Diet modification to provide 110kc/kg/d

3. target cell
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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
T for t ; thalassemia; inc serum iron and Iron binding
Vaso-occlusive crisis; dx hb electrophoresis

4. When erythema chronicum migrans develops after tick bite
24-72 hours
Bartonella henselae; complication is suppuration of lymph node
Yes; but it will be less effective
ALL - alzheimers autism adhd depression seizure

5. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
1.5%
No reticulocyte vs high reticulocyte
Increase of progesteron/17oh progesterone

6. When to give HRT in turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Penicillin G 4h before delivery
T for t ; thalassemia; inc serum iron and Iron binding
14yrs

7. failure to thrive
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
Yes; but it will be less effective
RSV - rhino and influenza
Less than 5th percentile

8. Nocturnal enuresis
Medical emergency; dimercaprol/edta
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Atypical lymphocyte
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

9. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Female - breech delivery - family history; tx referral to ortho
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

10. giardiasis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Tx only symptomatic carrier
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

11. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Atypical lymphocyte
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

12. What is thumbprint sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Lateral neck xray in epiglottitis show swollen epiglottis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

13. mech of botulism
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Vaso-occlusive crisis; dx hb electrophoresis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Decreased UGT enzyme

14. causes of FTT
Methylephenidate toxicity; cannot be stopped abruptly; taper
Decr calorie intake; decr calorie absorption;incr calorie demand
Decreased UGT enzyme
No myoclonic activity in JME

15. When to do surgery for undescended testes
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Wait until 6 months
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

16. Tx of bact conjunctivitis
24h to 7d of birth
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No wheezing - no feever in chlamydia
Dx US tx; correct serum electrolyte - pyloromyotom

17. penicillin effective against pseudomonas
Bladder dysfunction; UTI and renal dysfunctoin
Less than 5th percentile
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Pipercillin (zosyn) - ticarcillin

18. carditis and arthritis after rheumatic fever
Croup tx cool mist; racemic epi - corticosteroid
Develops in 21 dasy
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Less than 5th percentile

19. How to dx RSV
Rapid detection of RSV antigen in nasl
Methylephenidate toxicity; cannot be stopped abruptly; taper
Bartonella henselae; complication is suppuration of lymph node
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

20. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
T for t ; thalassemia; inc serum iron and Iron binding

21. microcytic - hypochromic anemia - hepatospelnomegaly
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Thalassemia - congenital hemolytic anemia
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

22. non immune pregnant women exposed to rubella in first trimester
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Candidal diapar rash; tx clotrimazol
Black
Congenital rubella syndrome

23. How to dx acute angle closure glaucoma
Multiple telangiectesia - vasular lesion in CNS
No myoclonic activity in JME
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Facial portwine stain

24. horner syndrom
Injury to lower roots of brachial plexus
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Injury to b/l glossopharyngeal. present in botulism
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)

25. causes of FTT
Pho for forward bending; forward defect; common finding has no adverse physical effect
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
To make hip flexed and abducted position in DDH
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

26. Parents can _____ vaccine
Oral DMSA or EDTA IV
refuse
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Lateral neck xray in epiglottitis show swollen epiglottis

27. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Endocardial cushion defect (no separation between heart chambers)
Do HIV testing at first
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

28. Infant with serum billlirubin >25
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Risk of neurological dysfunction
Increase of progesteron/17oh progesterone
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

29. complete airway obstruction with FB
Rapid detection of RSV antigen in nasl
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
>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
24-72 hours

30. How to difference RSV and neonatal chlamydia
Faciform RBC cause vascular occlusion
No wheezing - no feever in chlamydia
D for d; down syndrome and polyhydramnios
Yes; but it will be less effective

31. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
ALL - alzheimers autism adhd depression seizure

32. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
>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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Develops in 21 dasy

33. contraindications of MMR vaccine
Tx only symptomatic carrier
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

34. coin in child's stomach
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Do HIV testing at first
Central isosexual precocious puberty; hypothalmaic hamartoma
No intervention; 90% foreign bodies pass without difficulty

35. acute abd pain - hx URI - lower extremity maculo papular rash
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erb paralysis leading to diaphragmatic paralysis
HSP - look for symmetric skin lesions
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

36. complication of lumbosacral meningocele
To make hip flexed and abducted position in DDH
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
Bladder dysfunction; UTI and renal dysfunctoin

37. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Croup
HSP - look for symmetric skin lesions
Foreign body sensation - photophobia - corneal opacity tx abx

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

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39. dx of lyme
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Less than 5th percentile

40. adrenal tumor
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

41. How to evaluate well appearing child just born in GBS pos mother?
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
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
RSV - rhino and influenza

42. splenic infarction in sickle cell
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
After 24h of abx therapy
Faciform RBC cause vascular occlusion
To make hip flexed and abducted position in DDH

43. What is the calorie requirement of newborn?
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Dactylitis; 2nd common is splenic seqestration
110 kcl/kg/day
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

44. duodenal atresia
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Foreign body sensation - photophobia - corneal opacity tx abx
Biliary atresia; tx surgery
D for d; down syndrome and polyhydramnios

45. Febrile seizure
Meconeum ileus; think about CF
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Rapid detection of RSV antigen in nasl
HSP - look for symmetric skin lesions

46. When to give hpv vaccien
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

47. contact lens keratitis
Thalassemia - congenital hemolytic anemia
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Increase of pregnenolone
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

48. How to dx endopthalmitis
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) -
Endocardial cushion defect (no separation between heart chambers)
Less than 5th percentile

49. nuchal rigidity - fever - sore throat - headache - dioriented
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Dactylitis; 2nd common is splenic seqestration
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

50. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Prolactinoma
Bartonella henselae; complication is suppuration of lymph node
Biliary atresia; tx surgery