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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. indications of audiometry in childrens
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Croup

2. How to evaluate well appearing child just born in GBS pos mother?
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Lateral neck xray in epiglottitis show swollen epiglottis

3. viruses cause bronhioltitis
Facial portwine stain
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
INH 9m if INH resistant rifampin 6m in children and 4m in adults
RSV - rhino and influenza

4. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Croup
Meconeum ileus; think about CF

5. bromocriptine
Tx only symptomatic carrier
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Prolactinoma
URI

6. When to give hpv vaccien
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

7. if bone age lower than actual and puberty delayed
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Constitutional pubertal delay
Pipercillin (zosyn) - ticarcillin

8. 12y - obese - hip pain - hip ext rotated
Biliary atresia; tx surgery
To make hip flexed and abducted position in DDH
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

9. pavlik harness
Lateral neck xray in epiglottitis show swollen epiglottis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
To make hip flexed and abducted position in DDH
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

10. impaired gag reflex
No reticulocyte vs high reticulocyte
Tx only symptomatic carrier
Injury to b/l glossopharyngeal. present in botulism
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

11. the recommended ca supplementation
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
URI
14yrs
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

12. Tx of FTT
Diet modification to provide 110kc/kg/d
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

13. 18mo bilat breast enlargment - some pubic hair
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Benign permature thelarche; expectant management

14. How to differentiate caput succedanueum and cephalohematoma
Facial portwine stain
Oral DMSA or EDTA IV
No intervention; 90% foreign bodies pass without difficulty
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

15. how smoking contributes otitis media in children
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

16. What is thumbprint sign
1.5%
RSV - rhino and influenza
Lateral neck xray in epiglottitis show swollen epiglottis
To make hip flexed and abducted position in DDH

17. down syndrome has inreased risk of developing
After 24h of abx therapy
refuse
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
ALL - alzheimers autism adhd depression seizure

18. doing worse in school - lack of attention - starring speel
After 24h of abx therapy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Absence seizure; tx ethosuximide
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

19. How to dx keratitis?
Female - breech delivery - family history; tx referral to ortho
TB - breastfeeding - asymptomatic hiv
Foreign body sensation - photophobia - corneal opacity tx abx
Constitutional pubertal delay

20. Parents can _____ vaccine
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
refuse

21. language delay
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Marfans - ehlers danlos - homocystinuria
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

22. What is the most common initial symptom in sickle cell
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Dactylitis; 2nd common is splenic seqestration

23. How to differentiate croup vs epiglotitis
Oral DMSA or EDTA IV
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

24. causes of FTT
Decreases height - expensive; reserved for severe cases of delayed puberty
Prolactinoma
Decr calorie intake; decr calorie absorption;incr calorie demand
No wheezing - no feever in chlamydia

25. How long patient needs to be exposed to tick to get infected
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Strep pneumonie; moraxella; h influenze
36 hours
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

26. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
URI

27. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
1.5%
Brown

28. cardiac manifestation of turner
Yes; but it will be less effective
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Penicillin G 4h before delivery
Multiple telangiectesia - vasular lesion in CNS

29. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Injury to b/l glossopharyngeal. present in botulism
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

30. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

31. pumonary TB
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Prolactinoma
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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)

32. carditis and arthritis after rheumatic fever
Develops in 21 dasy
24-72 hours
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

33. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
HSP - look for symmetric skin lesions
Strep pneumonie; moraxella; h influenze

34. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
After 6m; breast mild provides iron until 6m.
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

35. How to dx endopthalmitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
After 24h of abx therapy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

36. dx for DDH
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
T for t ; thalassemia; inc serum iron and Iron binding
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

37. 3yo - febrile - left hip externally rotated
Strep pneumonie; moraxella; h influenze
TB - breastfeeding - asymptomatic hiv
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

38. IM
14yrs
Atypical lymphocyte
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
Decr calorie intake; decr calorie absorption;incr calorie demand

39. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Strep pneumonie; moraxella; h influenze
Imaging study to r/o VUR

40. duodenal atresia
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
D for d; down syndrome and polyhydramnios
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

41. lead 44-70
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Benign permature thelarche; expectant management
Oral DMSA or EDTA IV

42. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
HSP - look for symmetric skin lesions
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

43. Infant with serum billlirubin >25
No intervention; 90% foreign bodies pass without difficulty
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Risk of neurological dysfunction
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

44. echymoses with low platelet <30k
Between pregnenolone and 17oh pregnenolone
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

45. major depression
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Endocardial cushion defect (no separation between heart chambers)
Bartonella henselae; complication is suppuration of lymph node
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

46. failure to thrive
Less than 5th percentile
Croup
Decr calorie intake; decr calorie absorption;incr calorie demand
Injury to lower roots of brachial plexus

47. What are the risk factors of developmental dysplais of hip
Wait until 6 months
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
Female - breech delivery - family history; tx referral to ortho
Decreased UGT enzyme

48. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
No wheezing - no feever in chlamydia
>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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Methylephenidate toxicity; cannot be stopped abruptly; taper

49. How long anti-TB drugs given for TB meningitis?
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Pho for forward bending; forward defect; common finding has no adverse physical effect
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

50. association with infantile pyloric stenosis
Lateral neck xray in epiglottitis show swollen epiglottis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Decresed visio - sudden onset - seeing halos around light - headache - eye pain