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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. is local anesthetics be used in cellulitis to reduce pain
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
No; they are basic compound will be neutralized in an acidic environment of cellulitis

2. cat scratch disease
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
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
Bartonella henselae; complication is suppuration of lymph node

3. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
24-72 hours
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

4. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Marfans - ehlers danlos - homocystinuria
Thalassemia - congenital hemolytic anemia
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

5. Nocturnal enuresis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

6. starring spells 10-20sec
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

7. acute abd pain - hx URI - lower extremity maculo papular rash
Develops in 21 dasy
Foreign body sensation - photophobia - corneal opacity tx abx
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
HSP - look for symmetric skin lesions

8. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Congenital rubella syndrome
Croup
24h to 7d of birth
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

9. How to dx endopthalmitis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
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

10. thumb sign
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)
Dactylitis; 2nd common is splenic seqestration
D for d; down syndrome and polyhydramnios
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

11. mcCune albright`
Pho for forward bending; forward defect; common finding has no adverse physical effect
Prolactinoma
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

12. When erythema chronicum migrans develops after tick bite
Endocardial cushion defect (no separation between heart chambers)
Develops in 21 dasy
No wheezing - no feever in chlamydia
24-72 hours

13. centor criteria for bact pharyngitis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
No; they are basic compound will be neutralized in an acidic environment of cellulitis

14. tzanck
Medical emergency; dimercaprol/edta
Develops in 21 dasy
Croup tx cool mist; racemic epi - corticosteroid
Herpes

15. decreased mobility of tympanic membrane after otitis media
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Increase of progesteron/17oh progesterone
Decr calorie intake; decr calorie absorption;incr calorie demand

16. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
HSP - look for symmetric skin lesions
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
Candidal diapar rash; tx clotrimazol

17. acute otitis externa

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18. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Decr calorie intake; decr calorie absorption;incr calorie demand
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

19. How to dx keratitis?
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Foreign body sensation - photophobia - corneal opacity tx abx
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

20. side effect of testosteron therapy
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
refuse
Decreases height - expensive; reserved for severe cases of delayed puberty
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

21. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Strep pneumonie; moraxella; h influenze

22. aplasic crisis
Dx US tx; correct serum electrolyte - pyloromyotom
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
After 6m; breast mild provides iron until 6m.

23. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
36 hours
Congenital rubella syndrome
Erb paralysis leading to diaphragmatic paralysis

24. pumonary TB
Thalassemia - congenital hemolytic anemia
Benign permature thelarche; expectant management
Absence seizure; tx ethosuximide
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)

25. How to evaluate well appearing child just born in GBS pos mother?
Methylephenidate toxicity; cannot be stopped abruptly; taper
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
T for t ; thalassemia; inc serum iron and Iron binding

26. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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

27. spitting up - vomiting at night - weight stable
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
refuse
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

28. non immune pregnant women exposed to rubella in first trimester
Between pregnenolone and 17oh pregnenolone
24-72 hours
Black
Congenital rubella syndrome

29. Tx of FTT
If aortic root reaches 45 mm
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Faciform RBC cause vascular occlusion
Diet modification to provide 110kc/kg/d

30. flexible kyphosis
Methylephenidate toxicity; cannot be stopped abruptly; taper
Injury to b/l glossopharyngeal. present in botulism
Pho for forward bending; forward defect; common finding has no adverse physical effect
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

31. what conditions are not contraindicated
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Foreign body sensation - photophobia - corneal opacity tx abx
TB - breastfeeding - asymptomatic hiv
T for t ; thalassemia; inc serum iron and Iron binding

32. crying during urination. bacteriuria pyruria - rec episodes
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Imaging study to r/o VUR
No reticulocyte vs high reticulocyte
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

33. deficinecy of 17 hydroxylase
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)
Tx only symptomatic carrier
Increase of pregnenolone
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

34. cardiac manifestation of turner
T for t ; thalassemia; inc serum iron and Iron binding
24-72 hours
110 kcl/kg/day
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

35. difference between breast milk and breafeeding jaundice
No wheezing - no feever in chlamydia
Foreign body sensation - photophobia - corneal opacity tx abx
Yes; but it will be less effective
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

36. Parents can _____ vaccine
>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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
refuse

37. coin in child's stomach
URI
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
No intervention; 90% foreign bodies pass without difficulty
Decreased UGT enzyme

38. congenital adrenal hyperplasi
Herpes
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
D for d; down syndrome and polyhydramnios
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

39. pneumonia in CF patient
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Tx only symptomatic carrier

40. how smoking contributes otitis media in children
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Decreased UGT enzyme
INH 9m if INH resistant rifampin 6m in children and 4m in adults

41. sickle cell with symmetrical swelling of hands and feet
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
Vaso-occlusive crisis; dx hb electrophoresis
Increase of pregnenolone
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

42. giardiasis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Tx only symptomatic carrier
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

43. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
TB - breastfeeding - asymptomatic hiv
Diet modification to provide 110kc/kg/d
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
No myoclonic activity in JME

44. low grade fever - cough - diffuse bilat ground glass opacities
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

45. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Female - breech delivery - family history; tx referral to ortho
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

46. benefits of antibiotic therapy in acute pharyngitis?
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Mainly clinical; serology with initial ELISA - with western blot confirmation;

47. failure to thrive
Less than 5th percentile
HSP - look for symmetric skin lesions
No wheezing - no feever in chlamydia
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

48. HUS
<2yrs - abd pain - diarrhoea - ARF
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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
Injury to b/l glossopharyngeal. present in botulism

49. What is earliest sign of puberty?
Biliary atresia; tx surgery
Congenital rubella syndrome
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

50. causes of FTT
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Fifth disease; febrile syndrome
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA