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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. lead 44-70
Oral DMSA or EDTA IV
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
After 6m; breast mild provides iron until 6m.
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

2. infantile hypertrophic pyloric stenosis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No wheezing - no feever in chlamydia
Dx US tx; correct serum electrolyte - pyloromyotom

3. When to do aortic root surgery in marfans to prevent dissection?
ALL - alzheimers autism adhd depression seizure
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
If aortic root reaches 45 mm
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

4. How to dx endopthalmitis
Injury to b/l glossopharyngeal. present in botulism
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

5. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Pipercillin (zosyn) - ticarcillin
Mainly clinical; serology with initial ELISA - with western blot confirmation;
To make hip flexed and abducted position in DDH

6. low grade fever - cough - diffuse bilat ground glass opacities
TB - breastfeeding - asymptomatic hiv
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
1.5%

7. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
ALL - alzheimers autism adhd depression seizure
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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

8. iron supplement in child
After 6m; breast mild provides iron until 6m.
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Constitutional pubertal delay

9. HUS
<2yrs - abd pain - diarrhoea - ARF
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Penicillin G 4h before delivery
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

10. viruses cause bronhioltitis
RSV - rhino and influenza
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Develops in 21 dasy
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

11. physiological jaundice
24h to 7d of birth
Atypical lymphocyte
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Do HIV testing at first

12. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Faciform RBC cause vascular occlusion
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

13. 21 hydroxylase
Rapid detection of RSV antigen in nasl
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
After 24h of abx therapy

14. difference between breast milk and breafeeding jaundice
Central isosexual precocious puberty; hypothalmaic hamartoma
24h to 7d of birth
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
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

15. How to dx acute angle closure glaucoma
Diet modification to provide 110kc/kg/d
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
Croup tx cool mist; racemic epi - corticosteroid
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

16. doing worse in school - lack of attention - starring speel
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Absence seizure; tx ethosuximide

17. tick transmits lyme
No myoclonic activity in JME
Brown
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

18. IM
Dactylitis; 2nd common is splenic seqestration
Endocardial cushion defect (no separation between heart chambers)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Atypical lymphocyte

19. causes of FTT
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Decr calorie intake; decr calorie absorption;incr calorie demand
Faciform RBC cause vascular occlusion

20. benefits of antibiotic therapy in acute pharyngitis?
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
After 6m; breast mild provides iron until 6m.
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

21. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
24h to 7d of birth
Croup
Imaging study to r/o VUR

22. mcCune albright`
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
Neurofibromatosis type2
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Strep pneumonie; moraxella; h influenze

23. bromocriptine
Prolactinoma
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Atypical lymphocyte
14yrs

24. Neonatal conjugated hyperbilirubinemia
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Biliary atresia; tx surgery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Facial portwine stain

25. lead >70
Erb paralysis leading to diaphragmatic paralysis
Medical emergency; dimercaprol/edta
Decreased UGT enzyme
Develops in 21 dasy

26. duodenal atresia
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Atypical lymphocyte
D for d; down syndrome and polyhydramnios

27. down syndrome has inreased risk of developing
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
ALL - alzheimers autism adhd depression seizure
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
Oral DMSA or EDTA IV

28. kallman syndrome
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Facial portwine stain
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

29. How to differentiate caput succedanueum and cephalohematoma
Decr calorie intake; decr calorie absorption;incr calorie demand
No intervention; 90% foreign bodies pass without difficulty
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Mainly clinical; serology with initial ELISA - with western blot confirmation;

30. Nocturnal enuresis
Between pregnenolone and 17oh pregnenolone
Decreases height - expensive; reserved for severe cases of delayed puberty
Black
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

31. carditis and arthritis after rheumatic fever
Female - breech delivery - family history; tx referral to ortho
Develops in 21 dasy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Methylephenidate toxicity; cannot be stopped abruptly; taper

32. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
To make hip flexed and abducted position in DDH
110 kcl/kg/day

33. How to prevent GBS in neonate
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
Penicillin G 4h before delivery

34. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Atopic dermatitis; strong allergic/immunologic component; incr IgE
ALL - alzheimers autism adhd depression seizure

35. What is the most common initial symptom in sickle cell
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Dactylitis; 2nd common is splenic seqestration
Endocardial cushion defect (no separation between heart chambers)

36. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
24-72 hours
Increase of pregnenolone
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

37. Parvovirus
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
D for d; down syndrome and polyhydramnios
Fifth disease; febrile syndrome
Yes; but it will be less effective

38. dx for turner
1.5%
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

39. TB prophylaxis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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
Wait until 6 months

40. Infant with serum billlirubin >25
Bladder dysfunction; UTI and renal dysfunctoin
Risk of neurological dysfunction
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Marfans - ehlers danlos - homocystinuria

41. Tx of FTT
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
No wheezing - no feever in chlamydia
Diet modification to provide 110kc/kg/d
Foreign body sensation - photophobia - corneal opacity tx abx

42. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Thalassemia - congenital hemolytic anemia
Bartonella henselae; complication is suppuration of lymph node
No intervention; 90% foreign bodies pass without difficulty

43. decreased mobility of tympanic membrane after otitis media
Decr calorie intake; decr calorie absorption;incr calorie demand
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
After 24h of abx therapy
Croup tx cool mist; racemic epi - corticosteroid

44. the risk of lyme after bitten by a tick
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Atypical lymphocyte
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
1.5%

45. Tx of botulism
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
ALL - alzheimers autism adhd depression seizure
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Foreign body sensation - photophobia - corneal opacity tx abx

46. How to dx post uretheral valve
Rapid detection of RSV antigen in nasl
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Mainly clinical; serology with initial ELISA - with western blot confirmation;

47. How to differentiate croup vs epiglotitis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Thalassemia - congenital hemolytic anemia

48. side effect of testosteron therapy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
To make hip flexed and abducted position in DDH
Erb paralysis leading to diaphragmatic paralysis
Decreases height - expensive; reserved for severe cases of delayed puberty

49. How to evaluate well appearing child just born in GBS pos mother?
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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Brown

50. indications of VUR
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Yes; but it will be less effective
Congenital rubella syndrome
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI