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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. Tx of children constipation

2. dx of lyme
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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
Mainly clinical; serology with initial ELISA - with western blot confirmation;

3. difference between breast milk and breafeeding jaundice
Thalassemia - congenital hemolytic anemia
Absence seizure; tx ethosuximide
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
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

4. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
HSP - look for symmetric skin lesions
Female - breech delivery - family history; tx referral to ortho
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

5. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
HSP - look for symmetric skin lesions
Atopic dermatitis; strong allergic/immunologic component; incr IgE

6. causes of FTT
Congenital rubella syndrome
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Dx US tx; correct serum electrolyte - pyloromyotom

7. When to give hpv vaccien
No reticulocyte vs high reticulocyte
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Develops in 21 dasy
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

8. dx for DDH
Central isosexual precocious puberty; hypothalmaic hamartoma
Develops in 21 dasy
Marfans - ehlers danlos - homocystinuria
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

9. HUS
Congenital rubella syndrome
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
<2yrs - abd pain - diarrhoea - ARF

10. down syndrome with holocystolic mumur
No reticulocyte vs high reticulocyte
Endocardial cushion defect (no separation between heart chambers)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

11. target cell
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
T for t ; thalassemia; inc serum iron and Iron binding
Oral DMSA or EDTA IV
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

12. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Injury to lower roots of brachial plexus
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
14yrs
Candidal diapar rash; tx clotrimazol

13. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Foreign body sensation - photophobia - corneal opacity tx abx
Yes; but it will be less effective

14. How to evaluate well appearing child just born in GBS pos mother?
Congenital rubella syndrome
No reticulocyte vs high reticulocyte
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Benign permature thelarche; expectant management

15. How to differentiate croup vs epiglotitis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

16. Parents can _____ vaccine
Methylephenidate toxicity; cannot be stopped abruptly; taper
After 24h of abx therapy
refuse
Fifth disease; febrile syndrome

17. TTP pentad
Facial portwine stain
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

18. penicillin effective against pseudomonas
Erb paralysis leading to diaphragmatic paralysis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Pipercillin (zosyn) - ticarcillin
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

19. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
No wheezing - no feever in chlamydia
Medical emergency; dimercaprol/edta

20. contraindications of MMR vaccine
RSV - rhino and influenza
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

21. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
INH 9m if INH resistant rifampin 6m in children and 4m in adults
<2yrs - abd pain - diarrhoea - ARF
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

22. Infant with serum billlirubin >25
Bartonella henselae; complication is suppuration of lymph node
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Fifth disease; febrile syndrome
Risk of neurological dysfunction

23. Tx of community acquired pneumonia
Croup tx cool mist; racemic epi - corticosteroid
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Bladder dysfunction; UTI and renal dysfunctoin
36 hours

24. benefits of antibiotic therapy in acute pharyngitis?
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
<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
refuse

25. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

26. viruses cause bronhioltitis
RSV - rhino and influenza
Thalassemia - congenital hemolytic anemia
Facial portwine stain
Croup tx cool mist; racemic epi - corticosteroid

27. low grade fever - cough - diffuse bilat ground glass opacities
Atopic dermatitis; strong allergic/immunologic component; incr IgE
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No; they are basic compound will be neutralized in an acidic environment of cellulitis

28. how smoking contributes otitis media in children
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Lateral neck xray in epiglottitis show swollen epiglottis
Penicillin G 4h before delivery
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

29. 21 hydroxylase
Do HIV testing at first
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Increase of progesteron/17oh progesterone

30. 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
Constitutional pubertal delay
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

31. sturge weber syndrome
Congenital rubella syndrome
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Facial portwine stain
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

32. pumonary TB
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)
To make hip flexed and abducted position in DDH
INH 9m if INH resistant rifampin 6m in children and 4m in adults
RSV - rhino and influenza

33. acute otitis media-pathogen
Rapid detection of RSV antigen in nasl
Strep pneumonie; moraxella; h influenze
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Black

34. Tx of botulism
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Benign permature thelarche; expectant management
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

35. What is earliest sign of puberty?
Facial portwine stain
Between pregnenolone and 17oh pregnenolone
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Thalassemia - congenital hemolytic anemia

36. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Injury to lower roots of brachial plexus
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

37. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Develops in 21 dasy

38. how thalassemia die
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
After 6m; breast mild provides iron until 6m.
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

39. red oozing rash on cheek - scaly - dry
T for t ; thalassemia; inc serum iron and Iron binding
Atypical lymphocyte
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

40. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

41. How to differentiate caput succedanueum and cephalohematoma
Erb paralysis leading to diaphragmatic paralysis
24h to 7d of birth
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

42. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Imaging study to r/o VUR

43. spitting up - vomiting at night - weight stable
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
>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

44. When to do surgery for undescended testes
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Wait until 6 months

45. difference between rubeola (measles) and rulbella
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Penicillin G 4h before delivery
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

46. osler rendu weber syndrom
refuse
Yes; but it will be less effective
Foreign body sensation - photophobia - corneal opacity tx abx
Multiple telangiectesia - vasular lesion in CNS

47. What are the risk factors of developmental dysplais of hip
After 6m; breast mild provides iron until 6m.
Female - breech delivery - family history; tx referral to ortho
Rapid detection of RSV antigen in nasl
Decreased UGT enzyme

48. How to difference viral and bact pneumonia
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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;

49. pneumonia in CF patient
36 hours
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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
Multiple telangiectesia - vasular lesion in CNS

50. When to do aortic root surgery in marfans to prevent dissection?
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
If aortic root reaches 45 mm
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram