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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. adrenal tumor
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Facial portwine stain
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

2. How to differentiate caput succedanueum and cephalohematoma
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

3. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
14yrs
24h to 7d of birth
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

4. When to do aortic root surgery in marfans to prevent dissection?
Erb paralysis leading to diaphragmatic paralysis
If aortic root reaches 45 mm
Brown
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

5. How long patient needs to be exposed to tick to get infected
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
36 hours
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Black

6. lens dislocation
Increase of progesteron/17oh progesterone
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Marfans - ehlers danlos - homocystinuria
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

7. non immune pregnant women exposed to rubella in first trimester
Injury to b/l glossopharyngeal. present in botulism
1.5%
Congenital rubella syndrome
Lateral neck xray in epiglottitis show swollen epiglottis

8. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Diet modification to provide 110kc/kg/d
Dactylitis; 2nd common is splenic seqestration

9. pavlik harness
Wait until 6 months
After 24h of abx therapy
To make hip flexed and abducted position in DDH
HSP - look for symmetric skin lesions

10. Febrile seizure
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Decr calorie intake; decr calorie absorption;incr calorie demand
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

11. failure to thrive
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
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
Less than 5th percentile
Do HIV testing at first

12. duodenal atresia
Imaging study to r/o VUR
D for d; down syndrome and polyhydramnios
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Biliary atresia; tx surgery

13. What is the definition of delayed puberty?
Faciform RBC cause vascular occlusion
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Tx only symptomatic carrier

14. dx for turner
Bartonella henselae; complication is suppuration of lymph node
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
14yrs

15. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
110 kcl/kg/day
Erb paralysis leading to diaphragmatic paralysis

16. Tx of children constipation

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17. indications of VUR
Penicillin G 4h before delivery
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
T for t ; thalassemia; inc serum iron and Iron binding
24h to 7d of birth

18. When to do surgery for undescended testes
Wait until 6 months
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Constitutional pubertal delay
Medical emergency; dimercaprol/edta

19. When to bevioral and enviromental measure in led intoxication?
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
After 6m; breast mild provides iron until 6m.
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

20. infant botulism
110 kcl/kg/day
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

21. When erythema chronicum migrans develops after tick bite
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
24-72 hours
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

22. contact lens keratitis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Prolactinoma
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Atopic dermatitis; strong allergic/immunologic component; incr IgE

23. horner syndrom
Injury to lower roots of brachial plexus
Increase of pregnenolone
Mainly clinical; serology with initial ELISA - with western blot confirmation;
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

24. tuberous sclerosis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Dx US tx; correct serum electrolyte - pyloromyotom
Bladder dysfunction; UTI and renal dysfunctoin

25. TB prophylaxis
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
Diet modification to provide 110kc/kg/d
TB - breastfeeding - asymptomatic hiv

26. cardiac manifestation of turner
Between pregnenolone and 17oh pregnenolone
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Dx US tx; correct serum electrolyte - pyloromyotom
Imaging study to r/o VUR

27. How to prevent GBS in neonate
Penicillin G 4h before delivery
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Wait until 6 months

28. infantile hypertrophic pyloric stenosis
Medical emergency; dimercaprol/edta
Less than 5th percentile
Dx US tx; correct serum electrolyte - pyloromyotom
Atypical lymphocyte

29. differentiate between central and peripheral precocious puberty
No wheezing - no feever in chlamydia
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Congenital rubella syndrome
>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

30. language delay
Strep pneumonie; moraxella; h influenze
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
To make hip flexed and abducted position in DDH
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

31. congenital adrenal hyperplasi
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Do HIV testing at first
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

32. How to investigate delayed puberty
INH 9m if INH resistant rifampin 6m in children and 4m in adults
<2yrs - abd pain - diarrhoea - ARF
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

33. the recommended ca supplementation
After 6m; breast mild provides iron until 6m.
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Rapid detection of RSV antigen in nasl
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

34. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
After 6m; breast mild provides iron until 6m.
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
24-72 hours

35. 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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Herpes
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

36. Parvovirus
After 6m; breast mild provides iron until 6m.
Fifth disease; febrile syndrome
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

37. How to evaluate well appearing child just born in GBS pos mother?
D for d; down syndrome and polyhydramnios
URI
Decreased UGT enzyme
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

38. causes of acute anemia
D for d; down syndrome and polyhydramnios
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Injury to b/l glossopharyngeal. present in botulism
Tx only symptomatic carrier

39. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
ALL - alzheimers autism adhd depression seizure
Vaso-occlusive crisis; dx hb electrophoresis
24-72 hours

40. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No intervention; 90% foreign bodies pass without difficulty
Congenital rubella syndrome

41. dx of lyme
Pho for forward bending; forward defect; common finding has no adverse physical effect
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
24-72 hours

42. complete airway obstruction with FB
After 6m; breast mild provides iron until 6m.
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
>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

43. What is earliest sign of puberty?
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Decr calorie intake; decr calorie absorption;incr calorie demand
Do HIV testing at first

44. aplasic crisis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Injury to b/l glossopharyngeal. present in botulism

45. sublottic narrowing
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
No wheezing - no feever in chlamydia
Croup tx cool mist; racemic epi - corticosteroid
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

46. benefits of antibiotic therapy in acute pharyngitis?
Lateral neck xray in epiglottitis show swollen epiglottis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

47. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Decreases height - expensive; reserved for severe cases of delayed puberty

48. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Decreases height - expensive; reserved for severe cases of delayed puberty
No reticulocyte vs high reticulocyte
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

49. sickle cell with symmetrical swelling of hands and feet
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Vaso-occlusive crisis; dx hb electrophoresis
Bladder dysfunction; UTI and renal dysfunctoin
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

50. red oozing rash on cheek - scaly - dry
Central isosexual precocious puberty; hypothalmaic hamartoma
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Risk of neurological dysfunction
Atopic dermatitis; strong allergic/immunologic component; incr IgE