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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. How long patient needs to be exposed to tick to get infected
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
36 hours

2. target cell
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Absence seizure; tx ethosuximide
T for t ; thalassemia; inc serum iron and Iron binding

3. complete airway obstruction with FB
Constitutional pubertal delay
After 6m; breast mild provides iron until 6m.
>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
After 24h of abx therapy

4. How to difference viral and bact pneumonia
Yes; but it will be less effective
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Less than 5th percentile
Methylephenidate toxicity; cannot be stopped abruptly; taper

5. if bone age lower than actual and puberty delayed
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
No wheezing - no feever in chlamydia
Constitutional pubertal delay

6. duodenal atresia
Candidal diapar rash; tx clotrimazol
110 kcl/kg/day
D for d; down syndrome and polyhydramnios
Herpes

7. lead >70
Medical emergency; dimercaprol/edta
Increase of pregnenolone
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Absence seizure; tx ethosuximide

8. Tx of children constipation

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9. Tx of botulism
Yes; but it will be less effective
Croup tx cool mist; racemic epi - corticosteroid
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

10. difference between rubeola (measles) and rulbella
>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
No intervention; 90% foreign bodies pass without difficulty
Brown
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

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

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12. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Croup
Imaging study to r/o VUR

13. congenital adrenal hyperplasi
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Pho for forward bending; forward defect; common finding has no adverse physical effect
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Decreases height - expensive; reserved for severe cases of delayed puberty

14. kallman syndrome
Marfans - ehlers danlos - homocystinuria
Penicillin G 4h before delivery
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
36 hours

15. 17 alpha hydroxylase
Meconeum ileus; think about CF
Faciform RBC cause vascular occlusion
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Between pregnenolone and 17oh pregnenolone

16. Febrile seizure
Injury to b/l glossopharyngeal. present in botulism
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

17. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
Absence seizure; tx ethosuximide
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

18. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
After 24h of abx therapy
Erb paralysis leading to diaphragmatic paralysis
Congenital rubella syndrome

19. Parvovirus
Endocardial cushion defect (no separation between heart chambers)
Fifth disease; febrile syndrome
Mainly clinical; serology with initial ELISA - with western blot confirmation;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

20. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Medical emergency; dimercaprol/edta

21. When to do aortic root surgery in marfans to prevent dissection?
No intervention; 90% foreign bodies pass without difficulty
If aortic root reaches 45 mm
Atypical lymphocyte
Croup

22. 12y - obese - hip pain - hip ext rotated
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Marfans - ehlers danlos - homocystinuria
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Less than 5th percentile

23. How to difference RSV and neonatal chlamydia
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No wheezing - no feever in chlamydia
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Benign permature thelarche; expectant management

24. sturge weber syndrome
Prolactinoma
Facial portwine stain
Pipercillin (zosyn) - ticarcillin
Yes; but it will be less effective

25. complication of lumbosacral meningocele
HSP - look for symmetric skin lesions
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Facial portwine stain
Bladder dysfunction; UTI and renal dysfunctoin

26. cat scratch disease
Herpes
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
Bartonella henselae; complication is suppuration of lymph node
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

27. cardiac manifestation of turner
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Medical emergency; dimercaprol/edta

28. sudden onset of fever - difficulty in breathing
D for d; down syndrome and polyhydramnios
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
T for t ; thalassemia; inc serum iron and Iron binding
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

29. HUS
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
<2yrs - abd pain - diarrhoea - ARF
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

30. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Rapid detection of RSV antigen in nasl
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

31. When to do surgery for undescended testes
Wait until 6 months
110 kcl/kg/day
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

32. hypopigmented spots - family hx bilat deafness
After 6m; breast mild provides iron until 6m.
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Neurofibromatosis type2
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

33. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Dactylitis; 2nd common is splenic seqestration

34. What is the calorie requirement of newborn?
Facial portwine stain
110 kcl/kg/day
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

35. down syndrome has inreased risk of developing
If aortic root reaches 45 mm
ALL - alzheimers autism adhd depression seizure
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Croup

36. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Wait until 6 months

37. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Black
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

38. bromocriptine
Prolactinoma
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Erb paralysis leading to diaphragmatic paralysis
Less than 5th percentile

39. Parents can _____ vaccine
URI
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Less than 5th percentile
refuse

40. pavlik harness
To make hip flexed and abducted position in DDH
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

41. the risk of lyme after bitten by a tick
1.5%
refuse
Benign permature thelarche; expectant management
T for t ; thalassemia; inc serum iron and Iron binding

42. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
No myoclonic activity in JME
Dx US tx; correct serum electrolyte - pyloromyotom
Imaging study to r/o VUR

43. pneumonia in CF patient
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)
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

44. How to differential bact vs viral conjunctivitis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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
Medical emergency; dimercaprol/edta
Between pregnenolone and 17oh pregnenolone

45. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Rapid detection of RSV antigen in nasl
Thalassemia - congenital hemolytic anemia

46. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Pho for forward bending; forward defect; common finding has no adverse physical effect

47. What is earliest sign of puberty?
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Benign permature thelarche; expectant management

48. benefits of antibiotic therapy in acute pharyngitis?
Central isosexual precocious puberty; hypothalmaic hamartoma
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

49. difference between breast milk and breafeeding jaundice
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
HSP - look for symmetric skin lesions
No wheezing - no feever in chlamydia
Constitutional pubertal delay

50. 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)
36 hours
24-72 hours
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

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USMLE Step3 Pediatrics

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