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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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Match each statement with the correct term.
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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. infant botulism
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

2. 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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
After 24h of abx therapy

3. complete airway obstruction with FB
Fifth disease; febrile 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
refuse
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

4. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
URI
Medical emergency; dimercaprol/edta

5. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

6. mech of botulism
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Faciform RBC cause vascular occlusion

7. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
110 kcl/kg/day
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
No myoclonic activity in JME

8. When to bevioral and enviromental measure in led intoxication?
HSP - look for symmetric skin lesions
RSV - rhino and influenza
Decreased UGT enzyme
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

9. TTP pentad
No reticulocyte vs high reticulocyte
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Pipercillin (zosyn) - ticarcillin

10. dx for DDH
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Less than 5th percentile
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

11. adenovirus
URI
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Injury to lower roots of brachial plexus
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

12. echymoses with low platelet <30k
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Faciform RBC cause vascular occlusion

13. language delay
Black
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Tx only symptomatic carrier
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

14. crying during urination. bacteriuria pyruria - rec episodes
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Imaging study to r/o VUR
Brown
Bartonella henselae; complication is suppuration of lymph node

15. major depression
Female - breech delivery - family history; tx referral to ortho
No wheezing - no feever in chlamydia
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

16. Neonatal unconjugated hyperbilirubine
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Decreased UGT enzyme
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

17. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Oral DMSA or EDTA IV
Meconeum ileus; think about CF
<2yrs - abd pain - diarrhoea - ARF
Decreased UGT enzyme

18. contraindications of MMR vaccine
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
>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
Female - breech delivery - family history; tx referral to ortho
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

19. Tx of FTT
INH 9m if INH resistant rifampin 6m in children and 4m in adults
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
Diet modification to provide 110kc/kg/d
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

20. sturge weber syndrome
Facial portwine stain
Absence seizure; tx ethosuximide
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

21. How to differentiate croup vs epiglotitis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Decr calorie intake; decr calorie absorption;incr calorie demand
Marfans - ehlers danlos - homocystinuria

22. thumb sign
Pho for forward bending; forward defect; common finding has no adverse physical effect
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

23. Tx of botulism
Candidal diapar rash; tx clotrimazol
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Brown
No reticulocyte vs high reticulocyte

24. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Marfans - ehlers danlos - homocystinuria
Lateral neck xray in epiglottitis show swollen epiglottis
Decreased UGT enzyme

25. iron supplement in child
Develops in 21 dasy
After 6m; breast mild provides iron until 6m.
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Meconeum ileus; think about CF

26. the recommended ca supplementation
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Candidal diapar rash; tx clotrimazol
Bladder dysfunction; UTI and renal dysfunctoin

27. What is the definition of delayed puberty?
No reticulocyte vs high reticulocyte
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

28. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Fifth disease; febrile syndrome
Strep pneumonie; moraxella; h influenze
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erb paralysis leading to diaphragmatic paralysis

29. pavlik harness
To make hip flexed and abducted position in DDH
ALL - alzheimers autism adhd depression seizure
Decreased UGT enzyme
Increase of progesteron/17oh progesterone

30. giardiasis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Faciform RBC cause vascular occlusion
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Tx only symptomatic carrier

31. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

32. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Develops in 21 dasy
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
If aortic root reaches 45 mm

33. complication of lumbosacral meningocele
Faciform RBC cause vascular occlusion
Bartonella henselae; complication is suppuration of lymph node
Bladder dysfunction; UTI and renal dysfunctoin
Rapid detection of RSV antigen in nasl

34. tick transmits lyme
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Brown

35. difference between diaper dermatitis and rash
URI
Pipercillin (zosyn) - ticarcillin
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

36. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Female - breech delivery - family history; tx referral to ortho
Do HIV testing at first

37. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Tx only symptomatic carrier
Meconeum ileus; think about CF
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

38. indications of VUR
110 kcl/kg/day
Do HIV testing at first
Facial portwine stain
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

39. How to dx endopthalmitis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

40. What is the most common initial symptom in sickle cell
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Congenital rubella syndrome
Dactylitis; 2nd common is splenic seqestration
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

41. differentiate between central and peripheral precocious puberty
Decr calorie intake; decr calorie absorption;incr calorie demand
Penicillin G 4h before delivery
Constitutional pubertal delay
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

42. tick transmits RMSF
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Black
Decr calorie intake; decr calorie absorption;incr calorie demand

43. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Develops in 21 dasy
URI

44. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Injury to b/l glossopharyngeal. present in botulism

45. pumonary TB
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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)

46. hypopigmented spots - family hx bilat deafness
Yes; but it will be less effective
RSV - rhino and influenza
Constitutional pubertal delay
Neurofibromatosis type2

47. splenic infarction in sickle cell
Biliary atresia; tx surgery
Faciform RBC cause vascular occlusion
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Candidal diapar rash; tx clotrimazol

48. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
Tx only symptomatic carrier
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

49. down syndrome has inreased risk of developing
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Increase of progesteron/17oh progesterone
Croup tx cool mist; racemic epi - corticosteroid
ALL - alzheimers autism adhd depression seizure

50. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
After 6m; breast mild provides iron until 6m.
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

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USMLE Step3 Pediatrics

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