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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. association with infantile pyloric stenosis
24-72 hours
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
ALL - alzheimers autism adhd depression seizure

2. 21 hydroxylase
36 hours
RSV - rhino and influenza
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

3. if bone age lower than actual and puberty delayed
Rapid detection of RSV antigen in nasl
Constitutional pubertal delay
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
24h to 7d of birth

4. dx for DDH
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Penicillin G 4h before delivery
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

5. acute otitis externa

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6. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

7. TTP pentad
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
14yrs

8. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Facial portwine stain
To make hip flexed and abducted position in DDH
Biliary atresia; tx surgery

9. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Injury to lower roots of brachial plexus
>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

10. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Black
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Endocardial cushion defect (no separation between heart chambers)

11. when bact conjunctivitis patient can go back to school
Increase of progesteron/17oh progesterone
Lateral neck xray in epiglottitis show swollen epiglottis
Fifth disease; febrile syndrome
After 24h of abx therapy

12. language delay
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Congenital rubella syndrome
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

13. side effect of testosteron therapy
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Decreases height - expensive; reserved for severe cases of delayed puberty
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
T for t ; thalassemia; inc serum iron and Iron binding

14. how thalassemia die
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Female - breech delivery - family history; tx referral to ortho
Brown
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

15. difference between diaper dermatitis and rash
>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
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
D for d; down syndrome and polyhydramnios

16. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Decreases height - expensive; reserved for severe cases of delayed puberty
No intervention; 90% foreign bodies pass without difficulty
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

17. acute abd pain - hx URI - lower extremity maculo papular rash
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Less than 5th percentile
HSP - look for symmetric skin lesions
Neurofibromatosis type2

18. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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
Mainly clinical; serology with initial ELISA - with western blot confirmation;

19. is local anesthetics be used in cellulitis to reduce pain
Decreases height - expensive; reserved for severe cases of delayed puberty
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Wait until 6 months
Atopic dermatitis; strong allergic/immunologic component; incr IgE

20. sturge weber syndrome
Endocardial cushion defect (no separation between heart chambers)
Facial portwine stain
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

21. microcytic - hypochromic anemia - hepatospelnomegaly
>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
Thalassemia - congenital hemolytic anemia
Increase of progesteron/17oh progesterone
Imaging study to r/o VUR

22. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
24h to 7d of birth
Dx US tx; correct serum electrolyte - pyloromyotom
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

23. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Herpes
Meconeum ileus; think about CF

24. Nocturnal enuresis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Foreign body sensation - photophobia - corneal opacity tx abx
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

25. osler rendu weber syndrom
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Marfans - ehlers danlos - homocystinuria
Multiple telangiectesia - vasular lesion in CNS

26. tuberous sclerosis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
To make hip flexed and abducted position in DDH
Faciform RBC cause vascular occlusion
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

27. sudden onset of fever - difficulty in breathing
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
HSP - look for symmetric skin lesions
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

28. the risk of lyme after bitten by a tick
Vaso-occlusive crisis; dx hb electrophoresis
1.5%
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

29. difference between structural disorder and flexible kyphosis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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
T for t ; thalassemia; inc serum iron and Iron binding

30. causes of FTT
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Decr calorie intake; decr calorie absorption;incr calorie demand
Risk of neurological dysfunction

31. 3yo - never able to walk
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
24-72 hours
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

32. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Croup tx cool mist; racemic epi - corticosteroid

33. benefits of antibiotic therapy in acute pharyngitis?
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Rapid detection of RSV antigen in nasl
Female - breech delivery - family history; tx referral to ortho
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

34. adenovirus
Croup tx cool mist; racemic epi - corticosteroid
URI
14yrs
Vaso-occlusive crisis; dx hb electrophoresis

35. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Atypical lymphocyte
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

36. duodenal atresia
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Endocardial cushion defect (no separation between heart chambers)
D for d; down syndrome and polyhydramnios
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

37. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Strep pneumonie; moraxella; h influenze
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

38. 18mo bilat breast enlargment - some pubic hair
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Benign permature thelarche; expectant management
Decreases height - expensive; reserved for severe cases of delayed puberty

39. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Meconeum ileus; think about CF
36 hours
Erb paralysis leading to diaphragmatic paralysis

40. pavlik harness
TB - breastfeeding - asymptomatic hiv
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
To make hip flexed and abducted position in DDH

41. dx for turner
No intervention; 90% foreign bodies pass without difficulty
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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

42. Tx of children constipation

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43. IM
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Atypical lymphocyte
After 24h of abx therapy

44. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Herpes
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
TB - breastfeeding - asymptomatic hiv

45. low grade fever - cough - diffuse bilat ground glass opacities
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Faciform RBC cause vascular occlusion
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Biliary atresia; tx surgery

46. carditis and arthritis after rheumatic fever
Injury to b/l glossopharyngeal. present in botulism
Develops in 21 dasy
Congenital rubella syndrome
Penicillin G 4h before delivery

47. doing worse in school - lack of attention - starring speel
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erb paralysis leading to diaphragmatic paralysis
Absence seizure; tx ethosuximide
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

48. How to differentiate caput succedanueum and cephalohematoma
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Decreases height - expensive; reserved for severe cases of delayed puberty
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

49. When to do surgery for undescended testes
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Facial portwine stain
Increase of progesteron/17oh progesterone
Wait until 6 months

50. Neonatal conjugated hyperbilirubinemia
Methylephenidate toxicity; cannot be stopped abruptly; taper
Herpes
Less than 5th percentile
Biliary atresia; tx surgery