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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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1. IM
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Atypical lymphocyte
ALL - alzheimers autism adhd depression seizure
Croup tx cool mist; racemic epi - corticosteroid

2. infantile hypertrophic pyloric stenosis
Prolactinoma
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Dx US tx; correct serum electrolyte - pyloromyotom
No myoclonic activity in JME

3. Parents can _____ vaccine
RSV - rhino and influenza
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
>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
refuse

4. tick transmits lyme
Absence seizure; tx ethosuximide
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
>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
Brown

5. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
After 24h of abx therapy
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

6. pneumonia in CF patient
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Imaging study to r/o VUR
Medical emergency; dimercaprol/edta
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

7. adrenal tumor
Foreign body sensation - photophobia - corneal opacity tx abx
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
After 6m; breast mild provides iron until 6m.
Pho for forward bending; forward defect; common finding has no adverse physical effect

8. What are the risk factors of developmental dysplais of hip
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Pipercillin (zosyn) - ticarcillin
Female - breech delivery - family history; tx referral to ortho
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

9. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bladder dysfunction; UTI and renal dysfunctoin
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

10. dx of lyme
Do HIV testing at first
Penicillin G 4h before delivery
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Injury to lower roots of brachial plexus

11. acute abd pain - hx URI - lower extremity maculo papular rash
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
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
>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
HSP - look for symmetric skin lesions

12. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Atypical lymphocyte
Candidal diapar rash; tx clotrimazol

13. How to investigate delayed puberty
36 hours
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

14. contraindications of DTap
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Vaso-occlusive crisis; dx hb electrophoresis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
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

15. down syndrome with holocystolic mumur
Atypical lymphocyte
Endocardial cushion defect (no separation between heart chambers)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

16. causes of FTT
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Prolactinoma

17. When to bevioral and enviromental measure in led intoxication?
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

18. How to difference viral and bact pneumonia
Penicillin G 4h before delivery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Foreign body sensation - photophobia - corneal opacity tx abx

19. sturge weber syndrome
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Facial portwine stain
36 hours

20. flexible kyphosis
Congenital rubella syndrome
Pho for forward bending; forward defect; common finding has no adverse physical effect
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Atopic dermatitis; strong allergic/immunologic component; incr IgE

21. difference between rubeola (measles) and rulbella
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

22. What is thumbprint sign
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Biliary atresia; tx surgery
After 24h of abx therapy
Lateral neck xray in epiglottitis show swollen epiglottis

23. 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
Fifth disease; febrile syndrome
Develops in 21 dasy
24h to 7d of birth

24. defcicieny of 21 hydroxylase
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Increase of progesteron/17oh progesterone
Bladder dysfunction; UTI and renal dysfunctoin
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

25. Nocturnal enuresis
24h to 7d of birth
>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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

26. When to do surgery for undescended testes
Neurofibromatosis type2
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Wait until 6 months
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

27. How to dx RSV
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
Rapid detection of RSV antigen in nasl
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

28. hypopigmented spots - family hx bilat deafness
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Atopic dermatitis; strong allergic/immunologic component; incr IgE
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Neurofibromatosis type2

29. how smoking contributes otitis media in children
D for d; down syndrome and polyhydramnios
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Foreign body sensation - photophobia - corneal opacity tx abx

30. difference between breast milk and breafeeding jaundice
Pipercillin (zosyn) - ticarcillin
Oral DMSA or EDTA IV
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
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

31. Tx of FTT
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Diet modification to provide 110kc/kg/d
Brown
Oral DMSA or EDTA IV

32. 17 alpha hydroxylase
Vaso-occlusive crisis; dx hb electrophoresis
Do HIV testing at first
Faciform RBC cause vascular occlusion
Between pregnenolone and 17oh pregnenolone

33. 3yo - never able to walk
HSP - look for symmetric skin lesions
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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
Dx US tx; correct serum electrolyte - pyloromyotom

34. tzanck
Marfans - ehlers danlos - homocystinuria
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
Herpes

35. pumonary TB
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)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

36. major depression
Central isosexual precocious puberty; hypothalmaic hamartoma
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Facial portwine stain
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

37. lens dislocation
After 24h of abx therapy
Dactylitis; 2nd common is splenic seqestration
Marfans - ehlers danlos - homocystinuria
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

38. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
24h to 7d of birth
Imaging study to r/o VUR
Penicillin G 4h before delivery

39. How to difference RSV and neonatal chlamydia
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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)
No wheezing - no feever in chlamydia

40. dx for DDH
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Tx only symptomatic carrier

41. physiological jaundice
Between pregnenolone and 17oh pregnenolone
Bladder dysfunction; UTI and renal dysfunctoin
24h to 7d of birth
Facial portwine stain

42. carditis and arthritis after rheumatic fever
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
After 6m; breast mild provides iron until 6m.
Develops in 21 dasy

43. Tx of bact conjunctivitis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

44. 21 hydroxylase
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Erb paralysis leading to diaphragmatic paralysis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

45. 18mo bilat breast enlargment - some pubic hair
After 24h of abx therapy
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)
Benign permature thelarche; expectant management
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

46. infant botulism
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Herpes
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

47. difference between diaper dermatitis and rash
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Methylephenidate toxicity; cannot be stopped abruptly; taper
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

48. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Strep pneumonie; moraxella; h influenze
Constitutional pubertal delay

49. the recommended ca supplementation
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
If aortic root reaches 45 mm
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

50. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
>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
Faciform RBC cause vascular occlusion
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

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USMLE Step3 Pediatrics

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