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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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1. lens dislocation
Facial portwine stain
Marfans - ehlers danlos - homocystinuria
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Croup tx cool mist; racemic epi - corticosteroid

2. Neonatal unconjugated hyperbilirubine
Central isosexual precocious puberty; hypothalmaic hamartoma
Decreased UGT enzyme
Croup tx cool mist; racemic epi - corticosteroid
TB - breastfeeding - asymptomatic hiv

3. pneumonia in CF patient
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
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

4. contact lens keratitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
refuse
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

5. mcCune albright`
Congenital rubella syndrome
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

6. echymoses with low platelet <30k
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Marfans - ehlers danlos - homocystinuria
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
TB - breastfeeding - asymptomatic hiv

7. can women with abnormal smear or genital get vaccine
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
Foreign body sensation - photophobia - corneal opacity tx abx
Yes; but it will be less effective
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

8. What are the risk factors of developmental dysplais of hip
Bartonella henselae; complication is suppuration of lymph node
Female - breech delivery - family history; tx referral to ortho
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

9. tick transmits lyme
Brown
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Penicillin G 4h before delivery
If aortic root reaches 45 mm

10. causes of FTT
Herpes
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Dactylitis; 2nd common is splenic seqestration
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

11. acute otitis externa

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12. acute abd pain - hx URI - lower extremity maculo papular rash
14yrs
Erb paralysis leading to diaphragmatic paralysis
HSP - look for symmetric skin lesions
Foreign body sensation - photophobia - corneal opacity tx abx

13. duodenal atresia
Bladder dysfunction; UTI and renal dysfunctoin
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
D for d; down syndrome and polyhydramnios

14. difference between rubeola (measles) and rulbella
1.5%
TB - breastfeeding - asymptomatic hiv
Thalassemia - congenital hemolytic anemia
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

15. impaired gag reflex
Bartonella henselae; complication is suppuration of lymph node
36 hours
Injury to b/l glossopharyngeal. present in botulism
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

16. When erythema chronicum migrans develops after tick bite
Pipercillin (zosyn) - ticarcillin
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Dactylitis; 2nd common is splenic seqestration
24-72 hours

17. splenic infarction in sickle cell
<2yrs - abd pain - diarrhoea - ARF
Faciform RBC cause vascular occlusion
ALL - alzheimers autism adhd depression seizure
Prolactinoma

18. difference between breast milk and breafeeding jaundice
Decr calorie intake; decr calorie absorption;incr calorie demand
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
Do HIV testing at first
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

19. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
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
<2yrs - abd pain - diarrhoea - ARF
Erb paralysis leading to diaphragmatic paralysis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

20. When to give HRT in turner
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
14yrs
1.5%

21. pavlik harness
To make hip flexed and abducted position in DDH
URI
Increase of progesteron/17oh progesterone
Risk of neurological dysfunction

22. Parents can _____ vaccine
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Mainly clinical; serology with initial ELISA - with western blot confirmation;
refuse
T for t ; thalassemia; inc serum iron and Iron binding

23. association with infantile pyloric stenosis
Herpes
Bartonella henselae; complication is suppuration of lymph node
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Risk of neurological dysfunction

24. aplasic crisis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

25. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
ALL - alzheimers autism adhd depression seizure
Methylephenidate toxicity; cannot be stopped abruptly; taper
Croup
Do HIV testing at first

26. cat scratch disease
Multiple telangiectesia - vasular lesion in CNS
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bartonella henselae; complication is suppuration of lymph node
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

27. How to differentiate caput succedanueum and cephalohematoma
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Atypical lymphocyte
>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

28. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

29. infant botulism
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Constitutional pubertal delay
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

30. iron supplement in child
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Do HIV testing at first
After 6m; breast mild provides iron until 6m.
24h to 7d of birth

31. 18mo bilat breast enlargment - some pubic hair
Increase of progesteron/17oh progesterone
Benign permature thelarche; expectant management
Risk of neurological dysfunction
Decr calorie intake; decr calorie absorption;incr calorie demand

32. thumb sign
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Croup
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

33. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Black
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Injury to lower roots of brachial plexus

34. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

35. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Erb paralysis leading to diaphragmatic paralysis
Methylephenidate toxicity; cannot be stopped abruptly; taper
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Facial portwine stain

36. benefits of antibiotic therapy in acute pharyngitis?
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Herpes

37. When to do aortic root surgery in marfans to prevent dissection?
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Constitutional pubertal delay
If aortic root reaches 45 mm
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

38. how thalassemia die
Imaging study to r/o VUR
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Injury to lower roots of brachial plexus
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

39. How to investigate delayed puberty
110 kcl/kg/day
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

40. mech of botulism
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Pho for forward bending; forward defect; common finding has no adverse physical effect
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

41. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Diet modification to provide 110kc/kg/d
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

42. Tx of bact conjunctivitis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Dx US tx; correct serum electrolyte - pyloromyotom
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

43. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Bladder dysfunction; UTI and renal dysfunctoin
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

44. if bone age lower than actual and puberty delayed
ALL - alzheimers autism adhd depression seizure
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Constitutional pubertal delay

45. 17 alpha hydroxylase
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
Between pregnenolone and 17oh pregnenolone
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

46. How to dx RSV
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Herpes
Rapid detection of RSV antigen in nasl

47. carditis and arthritis after rheumatic fever
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Develops in 21 dasy
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

48. coin in child's stomach
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No intervention; 90% foreign bodies pass without difficulty
HSP - look for symmetric skin lesions

49. physiological jaundice
24h to 7d of birth
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Dx US tx; correct serum electrolyte - pyloromyotom

50. low grade fever - cough - diffuse bilat ground glass opacities
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

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USMLE Step3 Pediatrics

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