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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. viruses cause bronhioltitis
RSV - rhino and influenza
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Thalassemia - congenital hemolytic anemia
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

2. sturge weber syndrome
1.5%
Facial portwine stain
After 24h of abx therapy
<2yrs - abd pain - diarrhoea - ARF

3. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
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
No wheezing - no feever in chlamydia

4. target cell
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Endocardial cushion defect (no separation between heart chambers)
T for t ; thalassemia; inc serum iron and Iron binding

5. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

6. 12y - obese - hip pain - hip ext rotated
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
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
Benign permature thelarche; expectant management

7. iron supplement in child
Pho for forward bending; forward defect; common finding has no adverse physical effect
After 6m; breast mild provides iron until 6m.
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Facial portwine stain

8. tick transmits lyme
Oral DMSA or EDTA IV
If aortic root reaches 45 mm
Brown
36 hours

9. doing worse in school - lack of attention - starring speel
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Absence seizure; tx ethosuximide
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Injury to b/l glossopharyngeal. present in botulism

10. mcCune albright`
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Thalassemia - congenital hemolytic anemia

11. IM
Atypical lymphocyte
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
1.5%
refuse

12. Tx of children constipation

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13. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Methylephenidate toxicity; cannot be stopped abruptly; taper
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

14. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

15. lead 44-70
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Bartonella henselae; complication is suppuration of lymph node
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Oral DMSA or EDTA IV

16. non immune pregnant women exposed to rubella in first trimester
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Congenital rubella syndrome
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

17. 18mo bilat breast enlargment - some pubic hair
HSP - look for symmetric skin lesions
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
24-72 hours
Benign permature thelarche; expectant management

18. When to do aortic root surgery in marfans to prevent dissection?
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Candidal diapar rash; tx clotrimazol
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
If aortic root reaches 45 mm

19. tzanck
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Herpes
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

20. infant botulism
Brown
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

21. pumonary TB
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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)

22. complete airway obstruction with FB
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Atopic dermatitis; strong allergic/immunologic component; incr IgE
>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

23. Tx of botulism
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Risk of neurological dysfunction

24. deficinecy of 17 hydroxylase
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Increase of pregnenolone

25. Parvovirus
Fifth disease; febrile syndrome
Neurofibromatosis type2
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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

26. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
URI
Constitutional pubertal delay
Diet modification to provide 110kc/kg/d

27. the recommended ca supplementation
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Facial portwine stain
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Marfans - ehlers danlos - homocystinuria

28. low grade fever - cough - diffuse bilat ground glass opacities
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
TB - breastfeeding - asymptomatic hiv
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Thalassemia - congenital hemolytic anemia

29. failure to thrive
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Less than 5th percentile
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

30. How to investigate delayed puberty
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Vaso-occlusive crisis; dx hb electrophoresis

31. difference between breast milk and breafeeding jaundice
Croup tx cool mist; racemic epi - corticosteroid
Bladder dysfunction; UTI and renal dysfunctoin
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
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

32. When to give hpv vaccien
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Atypical lymphocyte
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
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

33. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
36 hours
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Candidal diapar rash; tx clotrimazol

34. How to dx acute angle closure glaucoma
Croup
Faciform RBC cause vascular occlusion
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

35. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Mainly clinical; serology with initial ELISA - with western blot confirmation;
RSV - rhino and influenza
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

36. How to prevent GBS in neonate
No myoclonic activity in JME
Less than 5th percentile
14yrs
Penicillin G 4h before delivery

37. How to dx RSV
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Rapid detection of RSV antigen in nasl
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Faciform RBC cause vascular occlusion

38. difference between structural disorder and flexible kyphosis
ALL - alzheimers autism adhd depression seizure
Do HIV testing at first
Marfans - ehlers danlos - homocystinuria
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

39. language delay
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
36 hours
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

40. When to give HRT in turner
14yrs
Between pregnenolone and 17oh pregnenolone
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

41. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
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
Penicillin G 4h before delivery

42. lens dislocation
Marfans - ehlers danlos - homocystinuria
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Strep pneumonie; moraxella; h influenze
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

43. physiological jaundice
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
24h to 7d of birth
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Black

44. sublottic narrowing
Dactylitis; 2nd common is splenic seqestration
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Croup tx cool mist; racemic epi - corticosteroid
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

45. contact lens keratitis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

46. can women with abnormal smear or genital get vaccine
Herpes
No reticulocyte vs high reticulocyte
Thalassemia - congenital hemolytic anemia
Yes; but it will be less effective

47. How to evaluate well appearing child just born in GBS pos mother?
Thalassemia - congenital hemolytic anemia
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Strep pneumonie; moraxella; h influenze
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

48. carditis and arthritis after rheumatic fever
Develops in 21 dasy
No wheezing - no feever in chlamydia
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Mainly clinical; serology with initial ELISA - with western blot confirmation;

49. impaired gag reflex
Croup tx cool mist; racemic epi - corticosteroid
Injury to b/l glossopharyngeal. present in botulism
Dactylitis; 2nd common is splenic seqestration
Neurofibromatosis type2

50. Infant with serum billlirubin >25
Risk of neurological dysfunction
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
No intervention; 90% foreign bodies pass without difficulty