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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. How to differential bact vs viral conjunctivitis
Injury to lower roots of brachial plexus
Foreign body sensation - photophobia - corneal opacity tx abx
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
Decr calorie intake; decr calorie absorption;incr calorie demand

2. congenital adrenal hyperplasi
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Increase of progesteron/17oh progesterone
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

3. lens dislocation
After 24h of abx therapy
Female - breech delivery - family history; tx referral to ortho
Marfans - ehlers danlos - homocystinuria
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

4. How to dx post uretheral valve
Develops in 21 dasy
No wheezing - no feever in chlamydia
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Wait until 6 months

5. cleft lip but no cleft palate
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Oral DMSA or EDTA IV
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

6. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

7. side effect of testosteron therapy
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
Decreases height - expensive; reserved for severe cases of delayed puberty
<2yrs - abd pain - diarrhoea - ARF
1.5%

8. coin in child's stomach
Develops in 21 dasy
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Pipercillin (zosyn) - ticarcillin
No intervention; 90% foreign bodies pass without difficulty

9. viruses cause bronhioltitis
Injury to lower roots of brachial plexus
RSV - rhino and influenza
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
No wheezing - no feever in chlamydia

10. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Female - breech delivery - family history; tx referral to ortho
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
HSP - look for symmetric skin lesions

11. hypopigmented spots - family hx bilat deafness
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Neurofibromatosis type2
After 24h of abx therapy

12. complete airway obstruction with FB
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Benign permature thelarche; expectant management
>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 wheezing - no feever in chlamydia

13. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Croup tx cool mist; racemic epi - corticosteroid
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

14. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
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
Pipercillin (zosyn) - ticarcillin
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

15. differentiate between central and peripheral precocious puberty
Prolactinoma
Decreased UGT enzyme
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Vaso-occlusive crisis; dx hb electrophoresis

16. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Pipercillin (zosyn) - ticarcillin
Injury to lower roots of brachial plexus
HSP - look for symmetric skin lesions

17. infant botulism
Bartonella henselae; complication is suppuration of lymph node
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

18. indications of audiometry in childrens
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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
No wheezing - no feever in chlamydia

19. bromocriptine
URI
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Prolactinoma
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

20. 3yo - febrile - left hip externally rotated
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Methylephenidate toxicity; cannot be stopped abruptly; taper

21. horner syndrom
Injury to b/l glossopharyngeal. present in botulism
Injury to lower roots of brachial plexus
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Croup

22. giardiasis
Tx only symptomatic carrier
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
No myoclonic activity in JME
Endocardial cushion defect (no separation between heart chambers)

23. TTP pentad
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Tx only symptomatic carrier
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

24. How long anti-TB drugs given for TB meningitis?
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Facial portwine stain
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Methylephenidate toxicity; cannot be stopped abruptly; taper

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

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26. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Vaso-occlusive crisis; dx hb electrophoresis
No myoclonic activity in JME

27. Infant with serum billlirubin >25
Increase of pregnenolone
Risk of neurological dysfunction
After 24h of abx therapy
No wheezing - no feever in chlamydia

28. 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)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
To make hip flexed and abducted position in DDH

29. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
No reticulocyte vs high reticulocyte
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

30. indications of VUR
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Risk of neurological dysfunction

31. Nocturnal enuresis
Medical emergency; dimercaprol/edta
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
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

32. difference between breast milk and breafeeding jaundice
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
URI
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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

33. physiological jaundice
24h to 7d of birth
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Endocardial cushion defect (no separation between heart chambers)
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

34. thumb sign
HSP - look for symmetric skin lesions
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
1.5%

35. echymoses with low platelet <30k
HSP - look for symmetric skin lesions
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

36. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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

37. doing worse in school - lack of attention - starring speel
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Absence seizure; tx ethosuximide
HSP - look for symmetric skin lesions

38. how smoking contributes otitis media in children
Female - breech delivery - family history; tx referral to ortho
Candidal diapar rash; tx clotrimazol
Between pregnenolone and 17oh pregnenolone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

39. mech of botulism
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
refuse
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

40. acute otitis externa

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41. When to give hpv vaccien
No intervention; 90% foreign bodies pass without difficulty
Bartonella henselae; complication is suppuration of lymph node
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
24h to 7d of birth

42. spitting up - vomiting at night - weight stable
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Pipercillin (zosyn) - ticarcillin
Atypical lymphocyte
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

43. low grade fever - cough - diffuse bilat ground glass opacities
<2yrs - abd pain - diarrhoea - ARF
Absence seizure; tx ethosuximide
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

44. difference between rubeola (measles) and rulbella
Central isosexual precocious puberty; hypothalmaic hamartoma
Croup
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

45. When to do surgery for undescended testes
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Wait until 6 months
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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)

46. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Neurofibromatosis type2
24-72 hours
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

47. osler rendu weber syndrom
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Multiple telangiectesia - vasular lesion in CNS
T for t ; thalassemia; inc serum iron and Iron binding
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

48. sublottic narrowing
Endocardial cushion defect (no separation between heart chambers)
Croup tx cool mist; racemic epi - corticosteroid
Bladder dysfunction; UTI and renal dysfunctoin
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

49. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
No myoclonic activity in JME
Dactylitis; 2nd common is splenic seqestration

50. 3yo - never able to walk
Decreases height - expensive; reserved for severe cases of delayed puberty
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
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace