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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 evaluate well appearing child just born in GBS pos mother?
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Biliary atresia; tx surgery

2. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Risk of neurological dysfunction
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Develops in 21 dasy

3. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
36 hours
Biliary atresia; tx surgery
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

4. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

5. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Prolactinoma
Meconeum ileus; think about CF

6. How to differentiate croup vs epiglotitis
No myoclonic activity in JME
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Congenital rubella syndrome

7. How to dx acute angle closure glaucoma
Do HIV testing at first
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

8. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
1.5%
Mainly clinical; serology with initial ELISA - with western blot confirmation;
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

9. tzanck
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
Herpes
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
refuse

10. When to do surgery for undescended testes
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Wait until 6 months
Female - breech delivery - family history; tx referral to ortho
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

11. indications of audiometry in childrens
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

12. What is the calorie requirement of newborn?
Injury to b/l glossopharyngeal. present in botulism
110 kcl/kg/day
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

13. duodenal atresia
Methylephenidate toxicity; cannot be stopped abruptly; taper
D for d; down syndrome and polyhydramnios
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Biliary atresia; tx surgery

14. How long patient needs to be exposed to tick to get infected
Oral DMSA or EDTA IV
Pipercillin (zosyn) - ticarcillin
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
36 hours

15. if bone age lower than actual and puberty delayed
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
Yes; but it will be less effective
Brown
Constitutional pubertal delay

16. giardiasis
Tx only symptomatic carrier
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
If aortic root reaches 45 mm
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

17. How to dx RSV
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
ALL - alzheimers autism adhd depression seizure
Rapid detection of RSV antigen in nasl

18. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Foreign body sensation - photophobia - corneal opacity tx abx
24-72 hours
Decr calorie intake; decr calorie absorption;incr calorie demand
Methylephenidate toxicity; cannot be stopped abruptly; taper

19. the recommended ca supplementation
Penicillin G 4h before delivery
110 kcl/kg/day
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Decr calorie intake; decr calorie absorption;incr calorie demand

20. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

21. What is thumbprint sign
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Lateral neck xray in epiglottitis show swollen epiglottis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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

22. what conditions are not contraindicated
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
TB - breastfeeding - asymptomatic hiv
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

23. Tx of children constipation

24. echymoses with low platelet <30k
After 6m; breast mild provides iron until 6m.
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
No intervention; 90% foreign bodies pass without difficulty
14yrs

25. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Lateral neck xray in epiglottitis show swollen epiglottis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
RSV - rhino and influenza
Central isosexual precocious puberty; hypothalmaic hamartoma

26. kallman syndrome
Neurofibromatosis type2
Decr calorie intake; decr calorie absorption;incr calorie demand
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

27. sickle cell with symmetrical swelling of hands and feet
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
110 kcl/kg/day
Risk of neurological dysfunction
Vaso-occlusive crisis; dx hb electrophoresis

28. mcCune albright`
Decreases height - expensive; reserved for severe cases of delayed puberty
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Rapid detection of RSV antigen in nasl

29. How to dx post uretheral valve
Pipercillin (zosyn) - ticarcillin
Atypical lymphocyte
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

30. Parvovirus
Fifth disease; febrile syndrome
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
Erb paralysis leading to diaphragmatic paralysis

31. When to do aortic root surgery in marfans to prevent dissection?
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
If aortic root reaches 45 mm
1.5%
Bartonella henselae; complication is suppuration of lymph node

32. sturge weber syndrome
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
24-72 hours
Facial portwine stain

33. red oozing rash on cheek - scaly - dry
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Bladder dysfunction; UTI and renal dysfunctoin
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Atopic dermatitis; strong allergic/immunologic component; incr IgE

34. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Endocardial cushion defect (no separation between heart chambers)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

35. Nocturnal enuresis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

36. Tx of FTT
Less than 5th percentile
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Diet modification to provide 110kc/kg/d
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

37. when bact conjunctivitis patient can go back to school
To make hip flexed and abducted position in DDH
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
After 24h of abx therapy
Atypical lymphocyte

38. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Absence seizure; tx ethosuximide
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
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

39. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Dactylitis; 2nd common is splenic seqestration
Erb paralysis leading to diaphragmatic paralysis
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)
Croup

40. When erythema chronicum migrans develops after tick bite
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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
24-72 hours
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

41. How to difference viral and bact pneumonia
URI
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

42. Tx of bact conjunctivitis
RSV - rhino and influenza
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Vaso-occlusive crisis; dx hb electrophoresis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

43. cleft lip but no cleft palate
Female - breech delivery - family history; tx referral to ortho
<2yrs - abd pain - diarrhoea - ARF
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Yes; but it will be less effective

44. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
No myoclonic activity in JME
Candidal diapar rash; tx clotrimazol
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

45. What is earliest sign of puberty?
Central isosexual precocious puberty; hypothalmaic hamartoma
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

46. causes of FTT
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Neurofibromatosis type2
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

47. deficinecy of 17 hydroxylase
Central isosexual precocious puberty; hypothalmaic hamartoma
Increase of pregnenolone
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
Diet modification to provide 110kc/kg/d

48. complete airway obstruction with FB
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Tx only symptomatic carrier
>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

49. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Bartonella henselae; complication is suppuration of lymph node
Increase of progesteron/17oh progesterone
After 6m; breast mild provides iron until 6m.

50. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Marfans - ehlers danlos - homocystinuria
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry