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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. Nocturnal enuresis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
After 6m; breast mild provides iron until 6m.

2. mech of botulism
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

3. low grade fever - cough - diffuse bilat ground glass opacities
Increase of pregnenolone
Develops in 21 dasy
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

4. dx of lyme
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
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pipercillin (zosyn) - ticarcillin

5. Tx of FTT
After 6m; breast mild provides iron until 6m.
Injury to b/l glossopharyngeal. present in botulism
Diet modification to provide 110kc/kg/d
Wait until 6 months

6. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Brown

7. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Decreased UGT enzyme
Medical emergency; dimercaprol/edta

8. pumonary TB
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Vaso-occlusive crisis; dx hb electrophoresis
Decreases height - expensive; reserved for severe cases of delayed puberty
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)

9. tick transmits lyme
Pipercillin (zosyn) - ticarcillin
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Brown
D for d; down syndrome and polyhydramnios

10. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Injury to b/l glossopharyngeal. present in botulism
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Bladder dysfunction; UTI and renal dysfunctoin

11. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
24h to 7d of birth
Pipercillin (zosyn) - ticarcillin

12. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

13. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Candidal diapar rash; tx clotrimazol
No reticulocyte vs high reticulocyte
No wheezing - no feever in chlamydia

14. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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
Develops in 21 dasy

15. 3yo - febrile - left hip externally rotated
Atypical lymphocyte
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

16. decreased mobility of tympanic membrane after otitis media
Atopic dermatitis; strong allergic/immunologic component; incr IgE
<2yrs - abd pain - diarrhoea - ARF
Meconeum ileus; think about CF
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

17. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Strep pneumonie; moraxella; h influenze

18. how thalassemia die
HSP - look for symmetric skin lesions
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Erb paralysis leading to diaphragmatic paralysis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

19. nuchal rigidity - fever - sore throat - headache - dioriented
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Increase of pregnenolone
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

20. How to investigate delayed puberty
Injury to b/l glossopharyngeal. present in botulism
Do HIV testing at first
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Rapid detection of RSV antigen in nasl

21. 12y - obese - hip pain - hip ext rotated
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Constitutional pubertal delay

22. contraindications of DTap
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Dactylitis; 2nd common is splenic seqestration
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Marfans - ehlers danlos - homocystinuria

23. Infant with serum billlirubin >25
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Decreases height - expensive; reserved for severe cases of delayed puberty
Strep pneumonie; moraxella; h influenze
Risk of neurological dysfunction

24. How to differential bact vs viral conjunctivitis
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

25. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Fifth disease; febrile syndrome
Increase of progesteron/17oh progesterone
Pipercillin (zosyn) - ticarcillin

26. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Meconeum ileus; think about CF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Tx only symptomatic carrier

27. sublottic narrowing
Wait until 6 months
Imaging study to r/o VUR
Croup tx cool mist; racemic epi - corticosteroid
Bladder dysfunction; UTI and renal dysfunctoin

28. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

29. adrenal tumor
ALL - alzheimers autism adhd depression seizure
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Biliary atresia; tx surgery
Diet modification to provide 110kc/kg/d

30. failure to thrive
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
Pho for forward bending; forward defect; common finding has no adverse physical effect
Less than 5th percentile

31. Tx of botulism
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
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Decr calorie intake; decr calorie absorption;incr calorie demand

32. TTP pentad
Rapid detection of RSV antigen in nasl
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

33. what conditions are not contraindicated
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
TB - breastfeeding - asymptomatic hiv
Pipercillin (zosyn) - ticarcillin

34. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Foreign body sensation - photophobia - corneal opacity tx abx
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Wait until 6 months

35. non immune pregnant women exposed to rubella in first trimester
Biliary atresia; tx surgery
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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)
Congenital rubella syndrome

36. 21 hydroxylase
TB - breastfeeding - asymptomatic hiv
Fifth disease; febrile syndrome
Injury to b/l glossopharyngeal. present in botulism
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

37. hypopigmented spots - family hx bilat deafness
24h to 7d of birth
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Neurofibromatosis type2

38. if bone age lower than actual and puberty delayed
Wait until 6 months
Pipercillin (zosyn) - ticarcillin
TB - breastfeeding - asymptomatic hiv
Constitutional pubertal delay

39. impaired gag reflex
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
Injury to b/l glossopharyngeal. present in botulism

40. horner syndrom
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Injury to lower roots of brachial plexus
No wheezing - no feever in chlamydia
Do HIV testing at first

41. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Constitutional pubertal delay
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Decreased UGT enzyme

42. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Atypical lymphocyte
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

43. adenovirus
URI
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Methylephenidate toxicity; cannot be stopped abruptly; taper
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

44. is local anesthetics be used in cellulitis to reduce pain
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
No; they are basic compound will be neutralized in an acidic environment of cellulitis
After 6m; breast mild provides iron until 6m.
refuse

45. Neonatal unconjugated hyperbilirubine
Pho for forward bending; forward defect; common finding has no adverse physical effect
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Erb paralysis leading to diaphragmatic paralysis
Decreased UGT enzyme

46. defcicieny of 21 hydroxylase
refuse
24h to 7d of birth
Female - breech delivery - family history; tx referral to ortho
Increase of progesteron/17oh progesterone

47. echymoses with low platelet <30k
Biliary atresia; tx surgery
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Atypical lymphocyte
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

48. can women with abnormal smear or genital get vaccine
Between pregnenolone and 17oh pregnenolone
Yes; but it will be less effective
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Fifth disease; febrile syndrome

49. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Meconeum ileus; think about CF
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Increase of progesteron/17oh progesterone

50. mcCune albright`
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Bartonella henselae; complication is suppuration of lymph node
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts