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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. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Less than 5th percentile
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

2. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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

3. Neonatal conjugated hyperbilirubinemia
Do HIV testing at first
To make hip flexed and abducted position in DDH
<2yrs - abd pain - diarrhoea - ARF
Biliary atresia; tx surgery

4. lead 44-70
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Dactylitis; 2nd common is splenic seqestration
Oral DMSA or EDTA IV
Between pregnenolone and 17oh pregnenolone

5. patient with white plaques in mouth and lump in back
Do HIV testing at first
Erb paralysis leading to diaphragmatic paralysis
Oral DMSA or EDTA IV
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

6. what conditions are not contraindicated
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
TB - breastfeeding - asymptomatic hiv
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Increase of progesteron/17oh progesterone

7. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Injury to lower roots of brachial plexus

8. Neonatal unconjugated hyperbilirubine
Absence seizure; tx ethosuximide
Thalassemia - congenital hemolytic anemia
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Decreased UGT enzyme

9. When to do aortic root surgery in marfans to prevent dissection?
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
If aortic root reaches 45 mm
refuse

10. cleft lip but no cleft palate
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Prolactinoma
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

11. How to prevent GBS in neonate
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Injury to b/l glossopharyngeal. present in botulism
Penicillin G 4h before delivery
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

12. How to difference RSV and neonatal chlamydia
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
No wheezing - no feever in chlamydia
Benign permature thelarche; expectant management
Injury to lower roots of brachial plexus

13. How to investigate delayed puberty
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

14. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Endocardial cushion defect (no separation between heart chambers)
Croup
Dx US tx; correct serum electrolyte - pyloromyotom
No myoclonic activity in JME

15. TB prophylaxis
Marfans - ehlers danlos - homocystinuria
Rapid detection of RSV antigen in nasl
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

16. 17 alpha hydroxylase
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Between pregnenolone and 17oh pregnenolone
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

17. decreased mobility of tympanic membrane after otitis media
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Herpes
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

18. duodenal atresia
D for d; down syndrome and polyhydramnios
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Rapid detection of RSV antigen in nasl
Absence seizure; tx ethosuximide

19. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Benign permature thelarche; expectant management
Decreases height - expensive; reserved for severe cases of delayed puberty
No wheezing - no feever in chlamydia
No myoclonic activity in JME

20. thumb sign
Strep pneumonie; moraxella; h influenze
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

21. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

22. How to differentiate croup vs epiglotitis
If aortic root reaches 45 mm
36 hours
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
ALL - alzheimers autism adhd depression seizure

23. horner syndrom
Yes; but it will be less effective
Injury to lower roots of brachial plexus
Wait until 6 months
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

24. 3yo - never able to walk
Constitutional pubertal delay
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No reticulocyte vs high reticulocyte
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

25. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
After 24h of abx therapy
After 6m; breast mild provides iron until 6m.

26. adenovirus
Constitutional pubertal delay
URI
Pho for forward bending; forward defect; common finding has no adverse physical effect
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

27. down syndrome has inreased risk of developing
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
ALL - alzheimers autism adhd depression seizure

28. aplasic crisis
Increase of pregnenolone
Lateral neck xray in epiglottitis show swollen epiglottis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
24-72 hours

29. dx for DDH
TB - breastfeeding - asymptomatic hiv
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Bartonella henselae; complication is suppuration of lymph node
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

30. Infant with serum billlirubin >25
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Risk of neurological dysfunction
1.5%
Endocardial cushion defect (no separation between heart chambers)

31. causes of FTT
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Benign permature thelarche; expectant management
Increase of progesteron/17oh progesterone

32. physiological jaundice
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Absence seizure; tx ethosuximide
24h to 7d of birth
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

33. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Faciform RBC cause vascular occlusion
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Decreases height - expensive; reserved for severe cases of delayed puberty

34. coin in child's stomach
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
No wheezing - no feever in chlamydia
>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

35. osler rendu weber syndrom
Erb paralysis leading to diaphragmatic paralysis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Multiple telangiectesia - vasular lesion in CNS

36. contraindications of MMR vaccine
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Do HIV testing at first
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. non immune pregnant women exposed to rubella in first trimester
HSP - look for symmetric skin lesions
Congenital rubella syndrome
D for d; down syndrome and polyhydramnios
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

38. failure to thrive
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Less than 5th percentile

39. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Neurofibromatosis type2
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

40. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Fifth disease; febrile syndrome

41. carditis and arthritis after rheumatic fever
>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
Yes; but it will be less effective
Develops in 21 dasy
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

42. how smoking contributes otitis media in children
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

43. the recommended ca supplementation
Multiple telangiectesia - vasular lesion in CNS
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

44. low grade fever - cough - diffuse bilat ground glass opacities
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Oral DMSA or EDTA IV
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

45. nuchal rigidity - fever - sore throat - headache - dioriented
Absence seizure; tx ethosuximide
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Penicillin G 4h before delivery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

46. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Endocardial cushion defect (no separation between heart chambers)

47. complication of lumbosacral meningocele
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Bladder dysfunction; UTI and renal dysfunctoin
Between pregnenolone and 17oh pregnenolone

48. cardiac manifestation of turner
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

49. Tx of community acquired pneumonia
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

50. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
D for d; down syndrome and polyhydramnios