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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. lead >70
URI
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Wait until 6 months
Medical emergency; dimercaprol/edta

2. is local anesthetics be used in cellulitis to reduce pain
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Diet modification to provide 110kc/kg/d
1.5%

3. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Rapid detection of RSV antigen in nasl
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Tx only symptomatic carrier

4. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
No myoclonic activity in JME
110 kcl/kg/day

5. adrenal tumor
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Between pregnenolone and 17oh pregnenolone

6. centor criteria for bact pharyngitis
Decreased UGT enzyme
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Benign permature thelarche; expectant management

7. Febrile seizure
Do HIV testing at first
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

8. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
24h to 7d of birth
Increase of progesteron/17oh progesterone
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Central isosexual precocious puberty; hypothalmaic hamartoma

9. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Methylephenidate toxicity; cannot be stopped abruptly; taper

10. How to evaluate well appearing child just born in GBS pos mother?
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Less than 5th percentile
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

11. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
refuse

12. kallman syndrome
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

13. infantile hypertrophic pyloric stenosis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Dx US tx; correct serum electrolyte - pyloromyotom
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

14. if bone age lower than actual and puberty delayed
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Constitutional pubertal delay
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

15. sickle cell with symmetrical swelling of hands and feet
Endocardial cushion defect (no separation between heart chambers)
Wait until 6 months
Vaso-occlusive crisis; dx hb electrophoresis
Pipercillin (zosyn) - ticarcillin

16. When to do aortic root surgery in marfans to prevent dissection?
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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Diet modification to provide 110kc/kg/d
If aortic root reaches 45 mm

17. Nocturnal enuresis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Faciform RBC cause vascular occlusion

18. Parents can _____ vaccine
Penicillin G 4h before delivery
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
refuse

19. tuberous sclerosis
Thalassemia - congenital hemolytic anemia
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Atypical lymphocyte

20. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Facial portwine stain
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
14yrs

21. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
refuse
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
D for d; down syndrome and polyhydramnios

22. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
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
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

23. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Decreased UGT enzyme
No intervention; 90% foreign bodies pass without difficulty
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

24. How to dx endopthalmitis
Candidal diapar rash; tx clotrimazol
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
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)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

25. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Decr calorie intake; decr calorie absorption;incr calorie demand
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No myoclonic activity in JME
Increase of pregnenolone

26. side effect of testosteron therapy
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)
Decreases height - expensive; reserved for severe cases of delayed puberty
Rapid detection of RSV antigen in nasl
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

27. how thalassemia die
110 kcl/kg/day
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

28. contraindications of MMR vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Candidal diapar rash; tx clotrimazol

29. starring spells 10-20sec
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Atypical lymphocyte
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Facial portwine stain

30. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Faciform RBC cause vascular occlusion
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
INH 9m if INH resistant rifampin 6m in children and 4m in adults

31. giardiasis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Tx only symptomatic carrier
Erb paralysis leading to diaphragmatic paralysis

32. tick transmits lyme
Biliary atresia; tx surgery
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Brown
Female - breech delivery - family history; tx referral to ortho

33. pavlik harness
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Tx only symptomatic carrier
To make hip flexed and abducted position in DDH

34. How long patient needs to be exposed to tick to get infected
Oral DMSA or EDTA IV
36 hours
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
Strep pneumonie; moraxella; h influenze

35. failure to thrive
Erb paralysis leading to diaphragmatic paralysis
Tx only symptomatic carrier
1.5%
Less than 5th percentile

36. iron supplement in child
After 6m; breast mild provides iron until 6m.
RSV - rhino and influenza
Faciform RBC cause vascular occlusion
<2yrs - abd pain - diarrhoea - ARF

37. When to bevioral and enviromental measure in led intoxication?
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Central isosexual precocious puberty; hypothalmaic hamartoma
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

38. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Marfans - ehlers danlos - homocystinuria
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Do HIV testing at first

39. sturge weber syndrome
Facial portwine stain
>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
Neurofibromatosis type2
Absence seizure; tx ethosuximide

40. Neonatal conjugated hyperbilirubinemia
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Biliary atresia; tx surgery
Bladder dysfunction; UTI and renal dysfunctoin
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

41. indications of VUR
36 hours
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Central isosexual precocious puberty; hypothalmaic hamartoma
Black

42. How to dx acute angle closure glaucoma
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Multiple telangiectesia - vasular lesion in CNS
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

43. down syndrome with holocystolic mumur
Between pregnenolone and 17oh pregnenolone
Oral DMSA or EDTA IV
Endocardial cushion defect (no separation between heart chambers)
Increase of pregnenolone

44. congenital adrenal hyperplasi
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Increase of pregnenolone
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

45. How to prevent GBS in neonate
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Decr calorie intake; decr calorie absorption;incr calorie demand
To make hip flexed and abducted position in DDH
Penicillin G 4h before delivery

46. causes of acute anemia
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

47. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
T for t ; thalassemia; inc serum iron and Iron binding
After 24h of abx therapy
Vaso-occlusive crisis; dx hb electrophoresis

48. How to differentiate caput succedanueum and cephalohematoma
Injury to b/l glossopharyngeal. present in botulism
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Imaging study to r/o VUR
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

49. 12y - obese - hip pain - hip ext rotated
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

50. coin in child's stomach
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
TB - breastfeeding - asymptomatic hiv
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No intervention; 90% foreign bodies pass without difficulty