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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. When to give hpv vaccien
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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

2. iron supplement in child
Diet modification to provide 110kc/kg/d
Biliary atresia; tx surgery
Faciform RBC cause vascular occlusion
After 6m; breast mild provides iron until 6m.

3. the risk of lyme after bitten by a tick
Injury to lower roots of brachial plexus
Candidal diapar rash; tx clotrimazol
1.5%
Fifth disease; febrile syndrome

4. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
No reticulocyte vs high reticulocyte
24h to 7d of birth
Dx US tx; correct serum electrolyte - pyloromyotom

5. if bone age lower than actual and puberty delayed
110 kcl/kg/day
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Constitutional pubertal delay

6. differentiate between central and peripheral precocious puberty
Absence seizure; tx ethosuximide
Develops in 21 dasy
Candidal diapar rash; tx clotrimazol
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

7. flexible kyphosis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Pho for forward bending; forward defect; common finding has no adverse physical effect
110 kcl/kg/day
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

8. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Fifth disease; febrile syndrome
Bartonella henselae; complication is suppuration of lymph node

9. Infant with serum billlirubin >25
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Decr calorie intake; decr calorie absorption;incr calorie demand
Risk of neurological dysfunction
Strep pneumonie; moraxella; h influenze

10. non immune pregnant women exposed to rubella in first trimester
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Congenital rubella syndrome
Decreased UGT enzyme

11. What are the risk factors of developmental dysplais of hip
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 -
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Female - breech delivery - family history; tx referral to ortho

12. 3yo - never able to walk
Central isosexual precocious puberty; hypothalmaic hamartoma
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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

13. How to differential bact vs viral conjunctivitis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
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
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

14. pavlik harness
To make hip flexed and abducted position in DDH
<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)
Medical emergency; dimercaprol/edta

15. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Tx only symptomatic carrier
24-72 hours
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

16. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

17. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Penicillin G 4h before delivery

18. thumb sign
1.5%
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
36 hours

19. TTP pentad
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Endocardial cushion defect (no separation between heart chambers)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Herpes

20. HUS
<2yrs - abd pain - diarrhoea - ARF
Injury to b/l glossopharyngeal. present in botulism
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
To make hip flexed and abducted position in DDH

21. dx for turner
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
D for d; down syndrome and polyhydramnios
Decreases height - expensive; reserved for severe cases of delayed puberty

22. How to dx acute angle closure glaucoma
Neurofibromatosis type2
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Decreased UGT enzyme

23. what conditions are not contraindicated
Biliary atresia; tx surgery
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Fifth disease; febrile syndrome
TB - breastfeeding - asymptomatic hiv

24. What is the definition of delayed puberty?
HSP - look for symmetric skin lesions
Methylephenidate toxicity; cannot be stopped abruptly; taper
Penicillin G 4h before delivery
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

25. tuberous sclerosis
Fifth disease; febrile syndrome
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Vaso-occlusive crisis; dx hb electrophoresis

26. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Faciform RBC cause vascular occlusion

27. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Croup
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

28. down syndrome has inreased risk of developing
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
ALL - alzheimers autism adhd depression seizure
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

29. How to dx keratitis?
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Foreign body sensation - photophobia - corneal opacity tx abx

30. can women with abnormal smear or genital get vaccine
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Atypical lymphocyte
Yes; but it will be less effective
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

31. horner syndrom
Candidal diapar rash; tx clotrimazol
Do HIV testing at first
Female - breech delivery - family history; tx referral to ortho
Injury to lower roots of brachial plexus

32. causes of acute anemia
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
D for d; down syndrome and polyhydramnios

33. How to differentiate caput succedanueum and cephalohematoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Constitutional pubertal delay
24h to 7d of birth
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

34. difference between diaper dermatitis and rash
Decr calorie intake; decr calorie absorption;incr calorie demand
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

35. TB prophylaxis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Risk of neurological dysfunction

36. osler rendu weber syndrom
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Lateral neck xray in epiglottitis show swollen epiglottis
Multiple telangiectesia - vasular lesion in CNS
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

37. association with infantile pyloric stenosis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Imaging study to r/o VUR
<2yrs - abd pain - diarrhoea - ARF

38. Neonatal conjugated hyperbilirubinemia
110 kcl/kg/day
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Biliary atresia; tx surgery
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

39. When to give HRT in turner
14yrs
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Multiple telangiectesia - vasular lesion in CNS
Benign permature thelarche; expectant management

40. How long patient needs to be exposed to tick to get infected
Tx only symptomatic carrier
36 hours
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

41. adenovirus
URI
Prolactinoma
Medical emergency; dimercaprol/edta
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

42. When to do aortic root surgery in marfans to prevent dissection?
No wheezing - no feever in chlamydia
TB - breastfeeding - asymptomatic hiv
If aortic root reaches 45 mm
Yes; but it will be less effective

43. Nocturnal enuresis
<2yrs - abd pain - diarrhoea - ARF
Pipercillin (zosyn) - ticarcillin
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)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

44. How to difference viral and bact pneumonia
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Decreases height - expensive; reserved for severe cases of delayed puberty
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

45. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
<2yrs - abd pain - diarrhoea - ARF
Oral DMSA or EDTA IV
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
No reticulocyte vs high reticulocyte

46. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
1.5%
Erb paralysis leading to diaphragmatic paralysis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
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

47. tick transmits lyme
Brown
Vaso-occlusive crisis; dx hb electrophoresis
Injury to b/l glossopharyngeal. present in botulism
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

48. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
<2yrs - abd pain - diarrhoea - ARF
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

49. contact lens keratitis
Lateral neck xray in epiglottitis show swollen epiglottis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

50. When to do surgery for undescended testes
Wait until 6 months
Imaging study to r/o VUR
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
Rapid detection of RSV antigen in nasl