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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.
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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. What is earliest sign of puberty?
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Prolactinoma
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

2. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
After 24h of abx therapy
Erb paralysis leading to diaphragmatic paralysis
Endocardial cushion defect (no separation between heart chambers)

3. indications of audiometry in childrens
RSV - rhino and influenza
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Meconeum ileus; think about CF
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

4. sublottic narrowing
Do HIV testing at first
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Croup tx cool mist; racemic epi - corticosteroid
Constitutional pubertal delay

5. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bladder dysfunction; UTI and renal dysfunctoin
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

6. language delay
Injury to b/l glossopharyngeal. present in botulism
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

7. When erythema chronicum migrans develops after tick bite
24-72 hours
After 6m; breast mild provides iron until 6m.
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

8. target cell
T for t ; thalassemia; inc serum iron and Iron binding
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Multiple telangiectesia - vasular lesion in CNS

9. When to give HRT in turner
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
14yrs
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

10. tick transmits RMSF
Medical emergency; dimercaprol/edta
Black
1.5%
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

11. causes of acute anemia
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Oral DMSA or EDTA IV

12. What is the definition of delayed puberty?
ALL - alzheimers autism adhd depression seizure
14yrs
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

13. viruses cause bronhioltitis
Facial portwine stain
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
RSV - rhino and influenza
14yrs

14. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Strep pneumonie; moraxella; h influenze
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

15. How to difference RSV and neonatal chlamydia
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
No wheezing - no feever in chlamydia
Medical emergency; dimercaprol/edta
T for t ; thalassemia; inc serum iron and Iron binding

16. What is thumbprint sign
If aortic root reaches 45 mm
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Lateral neck xray in epiglottitis show swollen epiglottis
Decr calorie intake; decr calorie absorption;incr calorie demand

17. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
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
Dactylitis; 2nd common is splenic seqestration
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

18. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Wait until 6 months
TB - breastfeeding - asymptomatic hiv
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

19. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Marfans - ehlers danlos - homocystinuria
No intervention; 90% foreign bodies pass without difficulty
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

20. How to differentiate caput succedanueum and cephalohematoma
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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)

21. lens dislocation
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Erb paralysis leading to diaphragmatic paralysis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Marfans - ehlers danlos - homocystinuria

22. infant botulism
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Bartonella henselae; complication is suppuration of lymph node
Methylephenidate toxicity; cannot be stopped abruptly; taper
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

23. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
No wheezing - no feever in chlamydia
Faciform RBC cause vascular occlusion
Atypical lymphocyte

24. bromocriptine
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
D for d; down syndrome and polyhydramnios
Prolactinoma

25. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
T for t ; thalassemia; inc serum iron and Iron binding

26. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
URI
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

27. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Less than 5th percentile

28. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Meconeum ileus; think about CF
Croup tx cool mist; racemic epi - corticosteroid
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Candidal diapar rash; tx clotrimazol

29. How to dx endopthalmitis
Strep pneumonie; moraxella; h influenze
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Methylephenidate toxicity; cannot be stopped abruptly; taper

30. tzanck
Herpes
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Bladder dysfunction; UTI and renal dysfunctoin
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

31. How to dx acute angle closure glaucoma
Do HIV testing at first
TB - breastfeeding - asymptomatic hiv
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
>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

32. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
1.5%
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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

33. How to investigate delayed puberty
HSP - look for symmetric skin lesions
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

34. HUS
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
<2yrs - abd pain - diarrhoea - ARF
Oral DMSA or EDTA IV
14yrs

35. dx for turner
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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

36. horner syndrom
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
36 hours
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Injury to lower roots of brachial plexus

37. cleft lip but no cleft palate
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
24-72 hours
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

38. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Dactylitis; 2nd common is splenic seqestration
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Risk of neurological dysfunction

39. nuchal rigidity - fever - sore throat - headache - dioriented
<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
Oral DMSA or EDTA IV
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

40. How to differentiate croup vs epiglotitis
<2yrs - abd pain - diarrhoea - ARF
Croup
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Increase of progesteron/17oh progesterone

41. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
RSV - rhino and influenza
Imaging study to r/o VUR
No myoclonic activity in JME
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)

42. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
If aortic root reaches 45 mm
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

43. 18mo bilat breast enlargment - some pubic hair
Dx US tx; correct serum electrolyte - pyloromyotom
Benign permature thelarche; expectant management
Female - breech delivery - family history; tx referral to ortho
Injury to b/l glossopharyngeal. present in botulism

44. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Dx US tx; correct serum electrolyte - pyloromyotom
Erb paralysis leading to diaphragmatic paralysis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

45. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Multiple telangiectesia - vasular lesion in CNS
Croup
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

46. complete airway obstruction with FB
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Lateral neck xray in epiglottitis show swollen epiglottis
Between pregnenolone and 17oh pregnenolone
>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

47. Tx of bact conjunctivitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

48. lead 44-70
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
<2yrs - abd pain - diarrhoea - ARF
Decr calorie intake; decr calorie absorption;incr calorie demand
Oral DMSA or EDTA IV

49. causes of FTT
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Decr calorie intake; decr calorie absorption;incr calorie demand
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

50. difference between diaper dermatitis and rash
TB - breastfeeding - asymptomatic hiv
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Decr calorie intake; decr calorie absorption;incr calorie demand