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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
14yrs
Strep pneumonie; moraxella; h influenze
Meconeum ileus; think about CF

2. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Neurofibromatosis type2
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

3. splenic infarction in sickle cell
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Faciform RBC cause vascular occlusion
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Atopic dermatitis; strong allergic/immunologic component; incr IgE

4. How to dx endopthalmitis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
HSP - look for symmetric skin lesions
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

5. duodenal atresia
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
D for d; down syndrome and polyhydramnios
110 kcl/kg/day
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

6. 3yo - never able to walk
Erb paralysis leading to diaphragmatic paralysis
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
HSP - look for symmetric skin lesions
Rapid detection of RSV antigen in nasl

7. Parvovirus
TB - breastfeeding - asymptomatic hiv
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Fifth disease; febrile syndrome
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

8. How long patient needs to be exposed to tick to get infected
36 hours
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
Yes; but it will be less effective
Dx US tx; correct serum electrolyte - pyloromyotom

9. Tx of children constipation

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10. Nocturnal enuresis
Constitutional pubertal delay
Endocardial cushion defect (no separation between heart chambers)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

11. defcicieny of 21 hydroxylase
Congenital rubella syndrome
Increase of progesteron/17oh progesterone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Erb paralysis leading to diaphragmatic paralysis

12. What are the risk factors of developmental dysplais of hip
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Female - breech delivery - family history; tx referral to ortho
Biliary atresia; tx surgery

13. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Imaging study to r/o VUR
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
14yrs

14. iron supplement in child
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Brown
After 6m; breast mild provides iron until 6m.

15. pavlik harness
Erb paralysis leading to diaphragmatic paralysis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
To make hip flexed and abducted position in DDH
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

16. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Endocardial cushion defect (no separation between heart chambers)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Medical emergency; dimercaprol/edta

17. 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)
D for d; down syndrome and polyhydramnios
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
Female - breech delivery - family history; tx referral to ortho

18. tzanck
Dactylitis; 2nd common is splenic seqestration
Herpes
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

19. What is thumbprint sign
D for d; down syndrome and polyhydramnios
Decreases height - expensive; reserved for severe cases of delayed puberty
Lateral neck xray in epiglottitis show swollen epiglottis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

20. causes of acute anemia
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Injury to b/l glossopharyngeal. present in botulism

21. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
24-72 hours
T for t ; thalassemia; inc serum iron and Iron binding
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
No myoclonic activity in JME

22. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Decreased UGT enzyme
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

23. benefits of antibiotic therapy in acute pharyngitis?
Increase of progesteron/17oh progesterone
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Increase of pregnenolone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

24. red oozing rash on cheek - scaly - dry
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Strep pneumonie; moraxella; h influenze

25. aplasic crisis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Fifth disease; febrile syndrome

26. What is the calorie requirement of newborn?
Endocardial cushion defect (no separation between heart chambers)
Medical emergency; dimercaprol/edta
110 kcl/kg/day
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

27. sturge weber syndrome
ALL - alzheimers autism adhd depression seizure
Facial portwine stain
36 hours
Mainly clinical; serology with initial ELISA - with western blot confirmation;

28. How to dx RSV
After 6m; breast mild provides iron until 6m.
Penicillin G 4h before delivery
Risk of neurological dysfunction
Rapid detection of RSV antigen in nasl

29. mech of botulism
Yes; but it will be less effective
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Less than 5th percentile
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

30. horner syndrom
ALL - alzheimers autism adhd depression seizure
Less than 5th percentile
Injury to lower roots of brachial plexus
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

31. the recommended ca supplementation
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Herpes
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

32. centor criteria for bact pharyngitis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Multiple telangiectesia - vasular lesion in CNS

33. Tx of bact conjunctivitis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

34. complete airway obstruction with FB
Develops in 21 dasy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Multiple telangiectesia - vasular lesion in CNS
>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

35. How to evaluate well appearing child just born in GBS pos mother?
Penicillin G 4h before delivery
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

36. adenovirus
URI
After 24h of abx therapy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No wheezing - no feever in chlamydia

37. When to bevioral and enviromental measure in led intoxication?
Vaso-occlusive crisis; dx hb electrophoresis
Foreign body sensation - photophobia - corneal opacity tx abx
Develops in 21 dasy
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

38. What is the definition of delayed puberty?
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Black
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

39. sudden onset of fever - difficulty in breathing
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Yes; but it will be less effective
Faciform RBC cause vascular occlusion
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

40. acute abd pain - hx URI - lower extremity maculo papular rash
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
HSP - look for symmetric skin lesions
Candidal diapar rash; tx clotrimazol
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

41. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Facial portwine stain
Bladder dysfunction; UTI and renal dysfunctoin
Less than 5th percentile

42. dx for turner
Wait until 6 months
If aortic root reaches 45 mm
Medical emergency; dimercaprol/edta
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

43. Neonatal conjugated hyperbilirubinemia
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Penicillin G 4h before delivery
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Biliary atresia; tx surgery

44. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Bartonella henselae; complication is suppuration of lymph node
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

45. How to investigate delayed puberty
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
URI
HSP - look for symmetric skin lesions
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

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

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47. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Bladder dysfunction; UTI and renal dysfunctoin
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

48. how thalassemia die
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
1.5%
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

49. what conditions are not contraindicated
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
TB - breastfeeding - asymptomatic hiv
Develops in 21 dasy
D for d; down syndrome and polyhydramnios

50. target cell
Endocardial cushion defect (no separation between heart chambers)
TB - breastfeeding - asymptomatic hiv
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
T for t ; thalassemia; inc serum iron and Iron binding