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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. When to give HRT in turner
Herpes
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
14yrs
Atypical lymphocyte

2. TB prophylaxis
Rapid detection of RSV antigen in nasl
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Tx only symptomatic carrier
Pipercillin (zosyn) - ticarcillin

3. horner syndrom
24h to 7d of birth
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Injury to lower roots of brachial plexus

4. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Diet modification to provide 110kc/kg/d
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

5. What is the calorie requirement of newborn?
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
14yrs
110 kcl/kg/day
Bartonella henselae; complication is suppuration of lymph node

6. Infant with serum billlirubin >25
Between pregnenolone and 17oh pregnenolone
Risk of neurological dysfunction
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

7. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Tx only symptomatic carrier
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Croup

8. How to prevent GBS in neonate
Wait until 6 months
Dactylitis; 2nd common is splenic seqestration
Meconeum ileus; think about CF
Penicillin G 4h before delivery

9. acute abd pain - hx URI - lower extremity maculo papular rash
Between pregnenolone and 17oh pregnenolone
HSP - look for symmetric skin lesions
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Biliary atresia; tx surgery

10. microcytic - hypochromic anemia - hepatospelnomegaly
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
refuse
Marfans - ehlers danlos - homocystinuria
Thalassemia - congenital hemolytic anemia

11. Parvovirus
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
Fifth disease; febrile syndrome
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

12. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
TB - breastfeeding - asymptomatic hiv

13. when bact conjunctivitis patient can go back to school
Constitutional pubertal delay
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
RSV - rhino and influenza
After 24h of abx therapy

14. non immune pregnant women exposed to rubella in first trimester
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
If aortic root reaches 45 mm
Faciform RBC cause vascular occlusion
Congenital rubella syndrome

15. How to dx post uretheral valve
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

16. pumonary TB
Strep pneumonie; moraxella; h influenze
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)
Foreign body sensation - photophobia - corneal opacity tx abx
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

17. infantile hypertrophic pyloric stenosis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
110 kcl/kg/day
Dx US tx; correct serum electrolyte - pyloromyotom

18. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Atypical lymphocyte
Pipercillin (zosyn) - ticarcillin

19. Tx of community acquired pneumonia
Benign permature thelarche; expectant management
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
If aortic root reaches 45 mm
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

20. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Herpes
RSV - rhino and influenza
Biliary atresia; tx surgery

21. bromocriptine
After 6m; breast mild provides iron until 6m.
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Penicillin G 4h before delivery
Prolactinoma

22. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Develops in 21 dasy
Imaging study to r/o VUR
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

23. deficinecy of 17 hydroxylase
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Increase of pregnenolone

24. HUS
<2yrs - abd pain - diarrhoea - ARF
No reticulocyte vs high reticulocyte
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

25. congenital adrenal hyperplasi
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

26. language delay
Do HIV testing at first
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

27. When to give hpv vaccien
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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

28. down syndrome with holocystolic mumur
No intervention; 90% foreign bodies pass without difficulty
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Endocardial cushion defect (no separation between heart chambers)
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

29. Tx of FTT
Diet modification to provide 110kc/kg/d
Fifth disease; febrile syndrome
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
RSV - rhino and influenza

30. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

31. How to dx endopthalmitis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
36 hours
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

32. How to dx keratitis?
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Erb paralysis leading to diaphragmatic paralysis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Foreign body sensation - photophobia - corneal opacity tx abx

33. causes of acute anemia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Wait until 6 months

34. patient with white plaques in mouth and lump in back
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Pho for forward bending; forward defect; common finding has no adverse physical effect
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Do HIV testing at first

35. nuchal rigidity - fever - sore throat - headache - dioriented
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

36. contact lens keratitis
RSV - rhino and influenza
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

37. doing worse in school - lack of attention - starring speel
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Absence seizure; tx ethosuximide
Injury to lower roots of brachial plexus
Increase of pregnenolone

38. osler rendu weber syndrom
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Injury to b/l glossopharyngeal. present in botulism
Multiple telangiectesia - vasular lesion in CNS

39. infant botulism
RSV - rhino and influenza
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Bartonella henselae; complication is suppuration of lymph node
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

40. failure to thrive
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Less than 5th percentile
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bartonella henselae; complication is suppuration of lymph node

41. TTP pentad
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
RSV - rhino and influenza
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

42. echymoses with low platelet <30k
Benign permature thelarche; expectant management
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

43. How to dx acute angle closure glaucoma
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 least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

44. How to differential bact vs viral conjunctivitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

45. benefits of antibiotic therapy in acute pharyngitis?
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Methylephenidate toxicity; cannot be stopped abruptly; taper

46. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Rapid detection of RSV antigen in nasl
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

47. coin in child's stomach
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
No intervention; 90% foreign bodies pass without difficulty
1.5%

48. impaired gag reflex
Strep pneumonie; moraxella; h influenze
Injury to b/l glossopharyngeal. present in botulism
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

49. indications of audiometry in childrens
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

50. What are the risk factors of developmental dysplais of hip
Constitutional pubertal delay
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Female - breech delivery - family history; tx referral to ortho
Between pregnenolone and 17oh pregnenolone