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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. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
URI
Croup
Wait until 6 months

2. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Erb paralysis leading to diaphragmatic paralysis
Vaso-occlusive crisis; dx hb electrophoresis
Central isosexual precocious puberty; hypothalmaic hamartoma

3. spitting up - vomiting at night - weight stable
Imaging study to r/o VUR
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Pipercillin (zosyn) - ticarcillin
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

4. How to evaluate well appearing child just born in GBS pos mother?
Fifth disease; febrile syndrome
Tx only symptomatic carrier
Thalassemia - congenital hemolytic anemia
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

5. viruses cause bronhioltitis
URI
110 kcl/kg/day
RSV - rhino and influenza
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

6. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Constitutional pubertal delay
No myoclonic activity in JME

7. side effect of testosteron therapy
refuse
Decreases height - expensive; reserved for severe cases of delayed puberty
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

8. Tx of children constipation

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9. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
>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
After 6m; breast mild provides iron until 6m.

10. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Yes; but it will be less effective
Decreased UGT enzyme
To make hip flexed and abducted position in DDH

11. TTP pentad
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Do HIV testing at first
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
No; they are basic compound will be neutralized in an acidic environment of cellulitis

12. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
refuse
Vaso-occlusive crisis; dx hb electrophoresis

13. 18mo bilat breast enlargment - some pubic hair
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Benign permature thelarche; expectant management
INH 9m if INH resistant rifampin 6m in children and 4m in adults

14. flexible kyphosis
Vaso-occlusive crisis; dx hb electrophoresis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Pho for forward bending; forward defect; common finding has no adverse physical effect
After 24h of abx therapy

15. cat scratch disease
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Congenital rubella syndrome
Bartonella henselae; complication is suppuration of lymph node
Bladder dysfunction; UTI and renal dysfunctoin

16. association with infantile pyloric stenosis
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
Imaging study to r/o VUR
Congenital rubella syndrome
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

17. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
<2yrs - abd pain - diarrhoea - ARF
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

18. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Decreases height - expensive; reserved for severe cases of delayed puberty

19. duodenal atresia
Benign permature thelarche; expectant management
D for d; down syndrome and polyhydramnios
14yrs
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

20. Tx of FTT
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Neurofibromatosis type2
Diet modification to provide 110kc/kg/d

21. starring spells 10-20sec
No reticulocyte vs high reticulocyte
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
>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
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

22. How to investigate delayed puberty
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Faciform RBC cause vascular occlusion
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Do HIV testing at first

23. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

24. language expectation from 2yo
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

25. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
HSP - look for symmetric skin lesions
Lateral neck xray in epiglottitis show swollen epiglottis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

26. contraindications of MMR vaccine
Meconeum ileus; think about CF
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
INH 9m if INH resistant rifampin 6m in children and 4m in adults

27. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Penicillin G 4h before delivery
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

28. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
URI
Atypical lymphocyte
110 kcl/kg/day

29. defcicieny of 21 hydroxylase
Faciform RBC cause vascular occlusion
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Increase of progesteron/17oh progesterone
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

30. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Oral DMSA or EDTA IV
If aortic root reaches 45 mm
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

31. hypopigmented spots - family hx bilat deafness
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Neurofibromatosis type2
No wheezing - no feever in chlamydia

32. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Less than 5th percentile
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Mainly clinical; serology with initial ELISA - with western blot confirmation;

33. causes of FTT
Less than 5th percentile
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

34. sturge weber syndrome
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Diet modification to provide 110kc/kg/d
Facial portwine stain
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

35. pavlik harness
Vaso-occlusive crisis; dx hb electrophoresis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Dactylitis; 2nd common is splenic seqestration
To make hip flexed and abducted position in DDH

36. 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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

37. dx for turner
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

38. Tx of community acquired pneumonia
No reticulocyte vs high reticulocyte
Brown
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Central isosexual precocious puberty; hypothalmaic hamartoma

39. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Central isosexual precocious puberty; hypothalmaic hamartoma
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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

40. Febrile seizure
Dx US tx; correct serum electrolyte - pyloromyotom
Marfans - ehlers danlos - homocystinuria
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Endocardial cushion defect (no separation between heart chambers)

41. 12y - obese - hip pain - hip ext rotated
URI
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Injury to lower roots of brachial plexus
Increase of pregnenolone

42. most common complication of otitis media
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Rapid detection of RSV antigen in nasl
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

43. How to difference RSV and neonatal chlamydia
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
No wheezing - no feever in chlamydia
Meconeum ileus; think about CF
If aortic root reaches 45 mm

44. tick transmits RMSF
Black
Pho for forward bending; forward defect; common finding has no adverse physical effect
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

45. the recommended ca supplementation
Multiple telangiectesia - vasular lesion in CNS
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
No intervention; 90% foreign bodies pass without difficulty
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

46. How to dx keratitis?
Erb paralysis leading to diaphragmatic paralysis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Foreign body sensation - photophobia - corneal opacity tx abx

47. down syndrome with holocystolic mumur
Injury to b/l glossopharyngeal. present in botulism
Endocardial cushion defect (no separation between heart chambers)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

48. IM
Atypical lymphocyte
Diet modification to provide 110kc/kg/d
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

49. What is thumbprint sign
URI
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Lateral neck xray in epiglottitis show swollen epiglottis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

50. What is the calorie requirement of newborn?
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Pipercillin (zosyn) - ticarcillin
D for d; down syndrome and polyhydramnios
110 kcl/kg/day