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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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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. How to dx RSV
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Absence seizure; tx ethosuximide
Rapid detection of RSV antigen in nasl

2. difference between rubeola (measles) and rulbella
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Tx only symptomatic carrier
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Injury to lower roots of brachial plexus

3. dx for DDH
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
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Female - breech delivery - family history; tx referral to ortho
Candidal diapar rash; tx clotrimazol

4. the recommended ca supplementation
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

5. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Candidal diapar rash; tx clotrimazol
24-72 hours

6. most common complication of otitis media
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
HSP - look for symmetric skin lesions
Strep pneumonie; moraxella; h influenze

7. How to difference RSV and neonatal chlamydia
Benign permature thelarche; expectant management
Congenital rubella syndrome
No wheezing - no feever in chlamydia
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

8. difference between structural disorder and flexible kyphosis
Strep pneumonie; moraxella; h influenze
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
>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

9. When to do aortic root surgery in marfans to prevent dissection?
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Methylephenidate toxicity; cannot be stopped abruptly; taper
Croup
If aortic root reaches 45 mm

10. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Multiple telangiectesia - vasular lesion in CNS
Meconeum ileus; think about CF
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

11. when bact conjunctivitis patient can go back to school
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
After 24h of abx therapy
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
URI

12. sublottic narrowing
Diet modification to provide 110kc/kg/d
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Develops in 21 dasy
Croup tx cool mist; racemic epi - corticosteroid

13. kallman syndrome
Rapid detection of RSV antigen in nasl
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Fifth disease; febrile syndrome

14. Neonatal conjugated hyperbilirubinemia
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
36 hours
Biliary atresia; tx surgery

15. is local anesthetics be used in cellulitis to reduce pain
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Candidal diapar rash; tx clotrimazol

16. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Croup tx cool mist; racemic epi - corticosteroid
Erb paralysis leading to diaphragmatic paralysis

17. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Croup tx cool mist; racemic epi - corticosteroid
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
<2yrs - abd pain - diarrhoea - ARF

18. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
HSP - look for symmetric skin lesions
URI
RSV - rhino and influenza

19. deficinecy of 17 hydroxylase
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Increase of pregnenolone

20. mech of botulism
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Candidal diapar rash; tx clotrimazol
TB - breastfeeding - asymptomatic hiv
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

21. crying during urination. bacteriuria pyruria - rec episodes
Decreased UGT enzyme
Imaging study to r/o VUR
Erb paralysis leading to diaphragmatic paralysis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

22. coin in child's stomach
Methylephenidate toxicity; cannot be stopped abruptly; taper
Central isosexual precocious puberty; hypothalmaic hamartoma
>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 intervention; 90% foreign bodies pass without difficulty

23. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Wait until 6 months
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Central isosexual precocious puberty; hypothalmaic hamartoma
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

24. mcCune albright`
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Do HIV testing at first
Imaging study to r/o VUR
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

25. spitting up - vomiting at night - weight stable
Dactylitis; 2nd common is splenic seqestration
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

26. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
<2yrs - abd pain - diarrhoea - ARF
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Decreases height - expensive; reserved for severe cases of delayed puberty

27. Parvovirus
Erb paralysis leading to diaphragmatic paralysis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Fifth disease; febrile syndrome

28. lead >70
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Medical emergency; dimercaprol/edta
Increase of pregnenolone

29. sturge weber syndrome
Vaso-occlusive crisis; dx hb electrophoresis
Facial portwine stain
Dactylitis; 2nd common is splenic seqestration
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

30. sudden onset of fever - difficulty in breathing
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
ALL - alzheimers autism adhd depression seizure
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Erb paralysis leading to diaphragmatic paralysis

31. impaired gag reflex
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Fifth disease; febrile syndrome
Injury to b/l glossopharyngeal. present in botulism
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

32. When to give HRT in turner
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
14yrs
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Herpes

33. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Decr calorie intake; decr calorie absorption;incr calorie demand
No reticulocyte vs high reticulocyte
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Candidal diapar rash; tx clotrimazol

34. patient with white plaques in mouth and lump in back
Diet modification to provide 110kc/kg/d
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
Faciform RBC cause vascular occlusion
Do HIV testing at first

35. acute otitis externa

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36. pumonary TB
Candidal diapar rash; tx clotrimazol
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
INH 9m if INH resistant rifampin 6m in children and 4m in adults
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)

37. Nocturnal enuresis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
24-72 hours
Black

38. failure to thrive
Less than 5th percentile
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Tx only symptomatic carrier
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

39. Neonatal unconjugated hyperbilirubine
Croup tx cool mist; racemic epi - corticosteroid
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Decreased UGT enzyme

40. infantile hypertrophic pyloric stenosis
Decreased UGT enzyme
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Marfans - ehlers danlos - homocystinuria
Dx US tx; correct serum electrolyte - pyloromyotom

41. HUS
<2yrs - abd pain - diarrhoea - ARF
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

42. Tx of bact conjunctivitis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Develops in 21 dasy
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
1.5%

43. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Herpes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

44. causes of FTT
Endocardial cushion defect (no separation between heart chambers)
Decr calorie intake; decr calorie absorption;incr calorie demand
110 kcl/kg/day
Multiple telangiectesia - vasular lesion in CNS

45. pavlik harness
Diet modification to provide 110kc/kg/d
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
To make hip flexed and abducted position in DDH
If aortic root reaches 45 mm

46. starring spells 10-20sec
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
No intervention; 90% foreign bodies pass without difficulty
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Foreign body sensation - photophobia - corneal opacity tx abx

47. splenic infarction in sickle cell
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Risk of neurological dysfunction
Faciform RBC cause vascular occlusion

48. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

49. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Black
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

50. tick transmits lyme
Brown
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

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USMLE Step3 Pediatrics

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