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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. acute otitis externa

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2. acute otitis media-pathogen
36 hours
If aortic root reaches 45 mm
Strep pneumonie; moraxella; h influenze
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

3. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Do HIV testing at first
Prolactinoma
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

4. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Decr calorie intake; decr calorie absorption;incr calorie demand
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
Oral DMSA or EDTA IV
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

5. infantile hypertrophic pyloric stenosis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Pipercillin (zosyn) - ticarcillin
Prolactinoma
Dx US tx; correct serum electrolyte - pyloromyotom

6. difference between breast milk and breafeeding jaundice
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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

7. congenital adrenal hyperplasi
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

8. mech of botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Increase of progesteron/17oh progesterone
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

9. doing worse in school - lack of attention - starring speel
Constitutional pubertal delay
Absence seizure; tx ethosuximide
T for t ; thalassemia; inc serum iron and Iron binding
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

10. indications of VUR
Yes; but it will be less effective
24h to 7d of birth
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

11. How to evaluate well appearing child just born in GBS pos mother?
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Between pregnenolone and 17oh pregnenolone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

12. causes of acute anemia
Atypical lymphocyte
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
refuse
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

13. the recommended ca supplementation
Diet modification to provide 110kc/kg/d
Endocardial cushion defect (no separation between heart chambers)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

14. What is the definition of delayed puberty?
Neurofibromatosis type2
Constitutional pubertal delay
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

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

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16. most common complication of otitis media
Biliary atresia; tx surgery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Wait until 6 months

17. IM
Pipercillin (zosyn) - ticarcillin
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Facial portwine stain
Atypical lymphocyte

18. osler rendu weber syndrom
No reticulocyte vs high reticulocyte
Multiple telangiectesia - vasular lesion in CNS
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

19. What is the calorie requirement of newborn?
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
110 kcl/kg/day
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

20. iron supplement in child
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)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
After 6m; breast mild provides iron until 6m.
Rapid detection of RSV antigen in nasl

21. 3yo - never able to walk
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
Foreign body sensation - photophobia - corneal opacity tx abx
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

22. When erythema chronicum migrans develops after tick bite
24-72 hours
>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
Pho for forward bending; forward defect; common finding has no adverse physical effect
INH 9m if INH resistant rifampin 6m in children and 4m in adults

23. cat scratch disease
Constitutional pubertal delay
To make hip flexed and abducted position in DDH
Neurofibromatosis type2
Bartonella henselae; complication is suppuration of lymph node

24. physiological jaundice
Bladder dysfunction; UTI and renal dysfunctoin
Methylephenidate toxicity; cannot be stopped abruptly; taper
Wait until 6 months
24h to 7d of birth

25. 18mo bilat breast enlargment - some pubic hair
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Benign permature thelarche; expectant management

26. 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
Candidal diapar rash; tx clotrimazol
14yrs
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

27. crying during urination. bacteriuria pyruria - rec episodes
Decreased UGT enzyme
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Imaging study to r/o VUR

28. low grade fever - cough - diffuse bilat ground glass opacities
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Pho for forward bending; forward defect; common finding has no adverse physical effect
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
D for d; down syndrome and polyhydramnios

29. microcytic - hypochromic anemia - hepatospelnomegaly
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Thalassemia - congenital hemolytic anemia
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

30. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
INH 9m if INH resistant rifampin 6m in children and 4m in adults

31. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
After 6m; breast mild provides iron until 6m.
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)
Methylephenidate toxicity; cannot be stopped abruptly; taper

32. indications of audiometry in childrens
HSP - look for symmetric skin lesions
URI
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

33. How to differentiate caput succedanueum and cephalohematoma
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
If aortic root reaches 45 mm
Mainly clinical; serology with initial ELISA - with western blot confirmation;

34. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Risk of neurological dysfunction
Increase of pregnenolone
Facial portwine stain

35. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
No myoclonic activity in JME
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

36. dx for DDH
Central isosexual precocious puberty; hypothalmaic hamartoma
Methylephenidate toxicity; cannot be stopped abruptly; taper
Less than 5th percentile
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

37. target cell
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
T for t ; thalassemia; inc serum iron and Iron binding
Bladder dysfunction; UTI and renal dysfunctoin

38. How to differentiate croup vs epiglotitis
Decr calorie intake; decr calorie absorption;incr calorie demand
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
URI
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

39. tick transmits lyme
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
URI
Brown
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

40. kallman syndrome
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Congenital rubella syndrome

41. How to prevent GBS in neonate
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Congenital rubella syndrome
Penicillin G 4h before delivery
Multiple telangiectesia - vasular lesion in CNS

42. How to investigate delayed puberty
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
TB - breastfeeding - asymptomatic hiv
Candidal diapar rash; tx clotrimazol
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

43. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
After 24h of abx therapy
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

44. the risk of lyme after bitten by a tick
110 kcl/kg/day
Wait until 6 months
Do HIV testing at first
1.5%

45. side effect of testosteron therapy
Strep pneumonie; moraxella; h influenze
Decreases height - expensive; reserved for severe cases of delayed puberty
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

46. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Multiple telangiectesia - vasular lesion in CNS
HSP - look for symmetric skin lesions

47. How to dx endopthalmitis
No myoclonic activity in JME
Endocardial cushion defect (no separation between heart chambers)
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Decr calorie intake; decr calorie absorption;incr calorie demand

48. nuchal rigidity - fever - sore throat - headache - dioriented
Risk of neurological dysfunction
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

49. 3yo - febrile - left hip externally rotated
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
No reticulocyte vs high reticulocyte
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

50. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
refuse
No intervention; 90% foreign bodies pass without difficulty
Croup