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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. What is the definition of delayed puberty?
110 kcl/kg/day
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Diet modification to provide 110kc/kg/d

2. the risk of lyme after bitten by a tick
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)
HSP - look for symmetric skin lesions
1.5%
Central isosexual precocious puberty; hypothalmaic hamartoma

3. tuberous sclerosis
Increase of progesteron/17oh progesterone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
D for d; down syndrome and polyhydramnios
<2yrs - abd pain - diarrhoea - ARF

4. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Rapid detection of RSV antigen in nasl
Central isosexual precocious puberty; hypothalmaic hamartoma
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

5. thumb sign
Atypical lymphocyte
Candidal diapar rash; tx clotrimazol
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

6. lens dislocation
Dx US tx; correct serum electrolyte - pyloromyotom
Marfans - ehlers danlos - homocystinuria
To make hip flexed and abducted position in DDH
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

7. cleft lip but no cleft palate
ALL - alzheimers autism adhd depression seizure
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Penicillin G 4h before delivery
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

8. contraindications of MMR vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Faciform RBC cause vascular occlusion
Bladder dysfunction; UTI and renal dysfunctoin
Develops in 21 dasy

9. 17 alpha hydroxylase
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
No intervention; 90% foreign bodies pass without difficulty
Between pregnenolone and 17oh pregnenolone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

10. What are the risk factors of developmental dysplais of hip
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
Female - breech delivery - family history; tx referral to ortho
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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

11. Tx of community acquired pneumonia
Faciform RBC cause vascular occlusion
Herpes
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

12. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
1.5%

13. 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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

14. patient with white plaques in mouth and lump in back
Do HIV testing at first
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

15. pneumonia in CF patient
ALL - alzheimers autism adhd depression seizure
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Risk of neurological dysfunction
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

16. What is the calorie requirement of newborn?
110 kcl/kg/day
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
14yrs
24h to 7d of birth

17. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Neurofibromatosis type2
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Fifth disease; febrile syndrome

18. difference between breast milk and breafeeding jaundice
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
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

19. side effect of testosteron therapy
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Decreases height - expensive; reserved for severe cases of delayed puberty
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

20. How to dx RSV
Rapid detection of RSV antigen in nasl
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

21. When to give hpv vaccien
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
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

22. nuchal rigidity - fever - sore throat - headache - dioriented
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

23. red oozing rash on cheek - scaly - dry
Central isosexual precocious puberty; hypothalmaic hamartoma
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Atopic dermatitis; strong allergic/immunologic component; incr IgE

24. what conditions are not contraindicated
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
TB - breastfeeding - asymptomatic hiv

25. pumonary TB
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Penicillin G 4h before delivery
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)
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

26. TB prophylaxis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Candidal diapar rash; tx clotrimazol
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
INH 9m if INH resistant rifampin 6m in children and 4m in adults

27. 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
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
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

28. infantile hypertrophic pyloric stenosis
Yes; but it will be less effective
Dx US tx; correct serum electrolyte - pyloromyotom
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Atypical lymphocyte

29. How long patient needs to be exposed to tick to get infected
Foreign body sensation - photophobia - corneal opacity tx abx
Croup tx cool mist; racemic epi - corticosteroid
36 hours
After 6m; breast mild provides iron until 6m.

30. When to do surgery for undescended testes
>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
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Wait until 6 months
INH 9m if INH resistant rifampin 6m in children and 4m in adults

31. IM
Atypical lymphocyte
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
After 24h of abx therapy

32. difference between structural disorder and flexible kyphosis
Benign permature thelarche; expectant management
Brown
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

33. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Facial portwine stain
Candidal diapar rash; tx clotrimazol
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Black

34. difference between diaper dermatitis and rash
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
Less than 5th percentile
Black
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

35. the recommended ca supplementation
Tx only symptomatic carrier
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Herpes
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

36. causes of FTT
Methylephenidate toxicity; cannot be stopped abruptly; taper
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
1.5%
Decr calorie intake; decr calorie absorption;incr calorie demand

37. Neonatal conjugated hyperbilirubinemia
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Biliary atresia; tx surgery

38. acute otitis media-pathogen
Increase of pregnenolone
Marfans - ehlers danlos - homocystinuria
Faciform RBC cause vascular occlusion
Strep pneumonie; moraxella; h influenze

39. 12y - obese - hip pain - hip ext rotated
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Biliary atresia; tx surgery

40. adenovirus
No; they are basic compound will be neutralized in an acidic environment of cellulitis
URI
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

41. 3yo - never able to walk
Prolactinoma
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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
Injury to lower roots of brachial plexus

42. physiological jaundice
24h to 7d of birth
TB - breastfeeding - asymptomatic hiv
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Oral DMSA or EDTA IV

43. echymoses with low platelet <30k
Thalassemia - congenital hemolytic anemia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Less than 5th percentile
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

44. crying during urination. bacteriuria pyruria - rec episodes
Neurofibromatosis type2
After 6m; breast mild provides iron until 6m.
Imaging study to r/o VUR
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

45. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
If aortic root reaches 45 mm
After 24h of abx therapy
Atypical lymphocyte

46. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Dactylitis; 2nd common is splenic seqestration
Medical emergency; dimercaprol/edta
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

47. complication of lumbosacral meningocele
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Bladder dysfunction; UTI and renal dysfunctoin
To make hip flexed and abducted position in DDH
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

48. most common complication of otitis media
Tx only symptomatic carrier
Decreased UGT enzyme
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

49. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Absence seizure; tx ethosuximide
Develops in 21 dasy
No; they are basic compound will be neutralized in an acidic environment of cellulitis

50. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
After 6m; breast mild provides iron until 6m.