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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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Answer 50 questions in 15 minutes.
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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. flexible kyphosis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Pho for forward bending; forward defect; common finding has no adverse physical effect
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Less than 5th percentile

2. decreased mobility of tympanic membrane after otitis media
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

3. Febrile seizure
Facial portwine stain
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Atypical lymphocyte
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

4. acute otitis externa

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5. pumonary TB
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)
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
Between pregnenolone and 17oh pregnenolone
Mainly clinical; serology with initial ELISA - with western blot confirmation;

6. how smoking contributes otitis media in children
Rapid detection of RSV antigen in nasl
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
36 hours
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

7. How to prevent GBS in neonate
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Penicillin G 4h before delivery
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

8. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
To make hip flexed and abducted position in DDH
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
T for t ; thalassemia; inc serum iron and Iron binding

9. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Injury to lower roots of brachial plexus
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
T for t ; thalassemia; inc serum iron and Iron binding

10. defcicieny of 21 hydroxylase
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Marfans - ehlers danlos - homocystinuria
Benign permature thelarche; expectant management
Increase of progesteron/17oh progesterone

11. sturge weber syndrome
Neurofibromatosis type2
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Facial portwine stain
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

12. indications of VUR
14yrs
TB - breastfeeding - asymptomatic hiv
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

13. red oozing rash on cheek - scaly - dry
Female - breech delivery - family history; tx referral to ortho
>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
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

14. How to difference RSV and neonatal chlamydia
Constitutional pubertal delay
Penicillin G 4h before delivery
No wheezing - no feever in chlamydia
Oral DMSA or EDTA IV

15. the risk of lyme after bitten by a tick
1.5%
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Less than 5th percentile
Erb paralysis leading to diaphragmatic paralysis

16. coin in child's stomach
Rapid detection of RSV antigen in nasl
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
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
No intervention; 90% foreign bodies pass without difficulty

17. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
>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
Develops in 21 dasy
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

18. causes of FTT
Wait until 6 months
36 hours
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Decr calorie intake; decr calorie absorption;incr calorie demand

19. dx of lyme
Candidal diapar rash; tx clotrimazol
110 kcl/kg/day
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

20. carditis and arthritis after rheumatic fever
Develops in 21 dasy
D for d; down syndrome and polyhydramnios
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

21. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
14yrs
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

22. tick transmits lyme
refuse
Brown
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Pho for forward bending; forward defect; common finding has no adverse physical effect

23. down syndrome has inreased risk of developing
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
ALL - alzheimers autism adhd depression seizure
Facial portwine stain
Medical emergency; dimercaprol/edta

24. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Neurofibromatosis type2
110 kcl/kg/day
Risk of neurological dysfunction
Meconeum ileus; think about CF

25. crying during urination. bacteriuria pyruria - rec episodes
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Imaging study to r/o VUR
Do HIV testing at first

26. complete airway obstruction with FB
Between pregnenolone and 17oh pregnenolone
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)
URI
>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

27. How to dx RSV
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Rapid detection of RSV antigen in nasl
Meconeum ileus; think about CF
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

28. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Benign permature thelarche; expectant management
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

29. How long anti-TB drugs given for TB meningitis?
URI
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Marfans - ehlers danlos - homocystinuria
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

30. When to do surgery for undescended testes
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Wait until 6 months

31. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

32. What is the calorie requirement of newborn?
TB - breastfeeding - asymptomatic hiv
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
110 kcl/kg/day
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

33. difference between diaper dermatitis and rash
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
Bladder dysfunction; UTI and renal dysfunctoin
refuse
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

34. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
TB - breastfeeding - asymptomatic hiv
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Decr calorie intake; decr calorie absorption;incr calorie demand

35. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Endocardial cushion defect (no separation between heart chambers)
<2yrs - abd pain - diarrhoea - ARF

36. 17 alpha hydroxylase
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Between pregnenolone and 17oh pregnenolone
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

37. can women with abnormal smear or genital get vaccine
Penicillin G 4h before delivery
No reticulocyte vs high reticulocyte
Yes; but it will be less effective
INH 9m if INH resistant rifampin 6m in children and 4m in adults

38. What are the risk factors of developmental dysplais of hip
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Female - breech delivery - family history; tx referral to ortho
Foreign body sensation - photophobia - corneal opacity tx abx
Imaging study to r/o VUR

39. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Tx only symptomatic carrier
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Multiple telangiectesia - vasular lesion in CNS

40. association with infantile pyloric stenosis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Brown
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Imaging study to r/o VUR

41. Parvovirus
Marfans - ehlers danlos - homocystinuria
Fifth disease; febrile syndrome
Between pregnenolone and 17oh pregnenolone
Lateral neck xray in epiglottitis show swollen epiglottis

42. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No reticulocyte vs high reticulocyte
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
Diet modification to provide 110kc/kg/d

43. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
36 hours
No myoclonic activity in JME
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Imaging study to r/o VUR

44. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Bladder dysfunction; UTI and renal dysfunctoin
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
T for t ; thalassemia; inc serum iron and Iron binding

45. mech of botulism
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
>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

46. How to differentiate caput succedanueum and cephalohematoma
No wheezing - no feever in chlamydia
Yes; but it will be less effective
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Rapid detection of RSV antigen in nasl

47. How to difference viral and bact pneumonia
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Oral DMSA or EDTA IV
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

48. difference between breast milk and breafeeding jaundice
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
D for d; down syndrome and polyhydramnios
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
HSP - look for symmetric skin lesions

49. starring spells 10-20sec
Black
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

50. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
110 kcl/kg/day
Central isosexual precocious puberty; hypothalmaic hamartoma
Dactylitis; 2nd common is splenic seqestration
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

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USMLE Step3 Pediatrics

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