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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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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. lens dislocation
URI
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Injury to b/l glossopharyngeal. present in botulism
Marfans - ehlers danlos - homocystinuria

2. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
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)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

3. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Constitutional pubertal delay
110 kcl/kg/day
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

4. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

5. dx of lyme
Croup tx cool mist; racemic epi - corticosteroid
Bladder dysfunction; UTI and renal dysfunctoin
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Mainly clinical; serology with initial ELISA - with western blot confirmation;

6. IM
Biliary atresia; tx surgery
Atypical lymphocyte
Penicillin G 4h before delivery
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

7. tick transmits RMSF
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)
Black
Candidal diapar rash; tx clotrimazol
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

8. mcCune albright`
Croup tx cool mist; racemic epi - corticosteroid
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Faciform RBC cause vascular occlusion
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

9. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
>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
Absence seizure; tx ethosuximide
Strep pneumonie; moraxella; h influenze

10. How to investigate delayed puberty
Congenital rubella syndrome
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

11. Neonatal unconjugated hyperbilirubine
After 24h of abx therapy
>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
Endocardial cushion defect (no separation between heart chambers)
Decreased UGT enzyme

12. causes of FTT
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

13. sturge weber syndrome
Facial portwine stain
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Foreign body sensation - photophobia - corneal opacity tx abx
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

14. down syndrome has inreased risk of developing
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
ALL - alzheimers autism adhd depression seizure

15. adrenal tumor
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Endocardial cushion defect (no separation between heart chambers)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

16. How to dx RSV
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
No wheezing - no feever in chlamydia
Rapid detection of RSV antigen in nasl
Sydenhams chorea - 1-8m after rheumatic fever; may not recall h/o sore throat; tx oral penicillinX10d if allergic erythromycin; prophylaxis until adulthood; if motor function severely compromised - give haloperidol - valproic - phenobarbital

17. Parents can _____ vaccine
refuse
Facial portwine stain
110 kcl/kg/day
Dx US tx; correct serum electrolyte - pyloromyotom

18. difference between breast milk and breafeeding jaundice
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
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
After 6m; breast mild provides iron until 6m.
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

19. TTP pentad
Benign permature thelarche; expectant management
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Increase of progesteron/17oh progesterone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

20. patient with white plaques in mouth and lump in back
Do HIV testing at first
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

21. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Decreases height - expensive; reserved for severe cases of delayed puberty
Sydenhams chorea - 1-8m after rheumatic fever; may not recall h/o sore throat; tx oral penicillinX10d if allergic erythromycin; prophylaxis until adulthood; if motor function severely compromised - give haloperidol - valproic - phenobarbital
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
RSV - rhino and influenza

22. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Wait until 6 months
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

23. microcytic - hypochromic anemia - hepatospelnomegaly
Risk of neurological dysfunction
Thalassemia - congenital hemolytic anemia
Facial portwine stain
1.5%

24. How to differential bact vs viral conjunctivitis
Wait until 6 months
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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
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

25. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Biliary atresia; tx surgery
RSV - rhino and influenza
Benign permature thelarche; expectant management

26. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Diet modification to provide 110kc/kg/d
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Croup

27. When to give hpv vaccien
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Vaso-occlusive crisis; dx hb electrophoresis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Decr calorie intake; decr calorie absorption;incr calorie demand
Black
Wait until 6 months

29. When to do surgery for undescended testes
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
No intervention; 90% foreign bodies pass without difficulty
Wait until 6 months
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

30. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Sydenhams chorea - 1-8m after rheumatic fever; may not recall h/o sore throat; tx oral penicillinX10d if allergic erythromycin; prophylaxis until adulthood; if motor function severely compromised - give haloperidol - valproic - phenobarbital
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Injury to lower roots of brachial plexus
Erb paralysis leading to diaphragmatic paralysis

31. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Croup tx cool mist; racemic epi - corticosteroid
Develops in 21 dasy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

32. dx for DDH
Decreased UGT enzyme
Increase of pregnenolone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Bladder dysfunction; UTI and renal dysfunctoin

33. crying during urination. bacteriuria pyruria - rec episodes
Pho for forward bending; forward defect; common finding has no adverse physical effect
T for t ; thalassemia; inc serum iron and Iron binding
Imaging study to r/o VUR
Biliary atresia; tx surgery

34. difference between rubeola (measles) and rulbella
TB - breastfeeding - asymptomatic hiv
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

35. How to prevent GBS in neonate
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Penicillin G 4h before delivery
No myoclonic activity in JME

36. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

37. infantile hypertrophic pyloric stenosis
Constitutional pubertal delay
Dx US tx; correct serum electrolyte - pyloromyotom
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

38. acute abd pain - hx URI - lower extremity maculo papular rash
Congenital rubella syndrome
HSP - look for symmetric skin lesions
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Endocardial cushion defect (no separation between heart chambers)

39. 3yo - never able to walk
Marfans - ehlers danlos - homocystinuria
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
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

40. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
refuse

41. failure to thrive
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Less than 5th percentile
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

42. difference between structural disorder and flexible kyphosis
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

43. duodenal atresia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
D for d; down syndrome and polyhydramnios
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Erb paralysis leading to diaphragmatic paralysis

44. causes of FTT
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
No intervention; 90% foreign bodies pass without difficulty
Decreases height - expensive; reserved for severe cases of delayed puberty
Decr calorie intake; decr calorie absorption;incr calorie demand

45. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Yes; but it will be less effective
110 kcl/kg/day
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
INH 9m if INH resistant rifampin 6m in children and 4m in adults

46. mech of botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

47. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Do HIV testing at first
Candidal diapar rash; tx clotrimazol
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

48. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
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)
Increase of pregnenolone
Injury to lower roots of brachial plexus

49. lead >70
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Imaging study to r/o VUR
Medical emergency; dimercaprol/edta
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

50. can women with abnormal smear or genital get vaccine
Candidal diapar rash; tx clotrimazol
Yes; but it will be less effective
Central isosexual precocious puberty; hypothalmaic hamartoma
Female - breech delivery - family history; tx referral to ortho

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USMLE Step3 Pediatrics

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