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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. What is earliest sign of puberty?
Do HIV testing at first
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
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

2. target cell
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
T for t ; thalassemia; inc serum iron and Iron binding
24-72 hours
Rapid detection of RSV antigen in nasl

3. language delay
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
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
>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

4. Tx of children constipation

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5. complete airway obstruction with FB
>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
HSP - look for symmetric skin lesions
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

6. 18mo bilat breast enlargment - some pubic hair
24-72 hours
Benign permature thelarche; expectant management
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Lateral neck xray in epiglottitis show swollen epiglottis

7. How to prevent GBS in neonate
Penicillin G 4h before delivery
Black
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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

8. Parents can _____ vaccine
refuse
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
24h to 7d of birth
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

9. cat scratch disease
Absence seizure; tx ethosuximide
Bartonella henselae; complication is suppuration of lymph node
Constitutional pubertal delay
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

10. down syndrome with holocystolic mumur
To make hip flexed and abducted position in DDH
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Endocardial cushion defect (no separation between heart chambers)

11. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Prolactinoma
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

12. difference between breast milk and breafeeding jaundice
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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

13. causes of FTT
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
If aortic root reaches 45 mm

14. Tx of bact conjunctivitis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Prolactinoma
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
14yrs

15. When to bevioral and enviromental measure in led intoxication?
Imaging study to r/o VUR
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

16. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Risk of neurological dysfunction
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

17. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

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18. decreased mobility of tympanic membrane after otitis media
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
>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

19. bromocriptine
Medical emergency; dimercaprol/edta
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
Black
Prolactinoma

20. Parvovirus
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Fifth disease; febrile syndrome

21. the recommended ca supplementation
Dx US tx; correct serum electrolyte - pyloromyotom
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Yes; but it will be less effective
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

22. what conditions are not contraindicated
Strep pneumonie; moraxella; h influenze
TB - breastfeeding - asymptomatic hiv
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Croup

23. deficinecy of 17 hydroxylase
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Constitutional pubertal delay
Increase of pregnenolone

24. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Decreases height - expensive; reserved for severe cases of delayed puberty
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

25. red oozing rash on cheek - scaly - dry
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Diet modification to provide 110kc/kg/d
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

26. microcytic - hypochromic anemia - hepatospelnomegaly
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Penicillin G 4h before delivery
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Thalassemia - congenital hemolytic anemia

27. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

28. How to dx post uretheral valve
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
Diet modification to provide 110kc/kg/d
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

29. indications of VUR
ALL - alzheimers autism adhd depression seizure
Atypical lymphocyte
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Increase of progesteron/17oh progesterone

30. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Central isosexual precocious puberty; hypothalmaic hamartoma
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

31. How long anti-TB drugs given for TB meningitis?
14yrs
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Bartonella henselae; complication is suppuration of lymph node

32. TB prophylaxis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Prolactinoma
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

33. defcicieny of 21 hydroxylase
Pho for forward bending; forward defect; common finding has no adverse physical effect
After 24h of abx therapy
Fifth disease; febrile syndrome
Increase of progesteron/17oh progesterone

34. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
To make hip flexed and abducted position in DDH

35. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
URI
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

36. mech of botulism
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Decr calorie intake; decr calorie absorption;incr calorie demand
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

37. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Central isosexual precocious puberty; hypothalmaic hamartoma
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

38. When to do aortic root surgery in marfans to prevent dissection?
Decreased UGT enzyme
24-72 hours
If aortic root reaches 45 mm
Imaging study to r/o VUR

39. When to give HRT in turner
Decr calorie intake; decr calorie absorption;incr calorie demand
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
14yrs

40. most common complication of otitis media
Candidal diapar rash; tx clotrimazol
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Penicillin G 4h before delivery
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

41. penicillin effective against pseudomonas
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Pipercillin (zosyn) - ticarcillin

42. side effect of testosteron therapy
Atypical lymphocyte
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Decreases height - expensive; reserved for severe cases of delayed puberty
>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

43. How to differential bact vs viral conjunctivitis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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

44. When to give hpv vaccien
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
No wheezing - no feever in chlamydia
Central isosexual precocious puberty; hypothalmaic hamartoma
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

45. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Erb paralysis leading to diaphragmatic paralysis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

46. indications of audiometry in childrens
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Diet modification to provide 110kc/kg/d
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Dactylitis; 2nd common is splenic seqestration

47. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Strep pneumonie; moraxella; h influenze
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
After 24h of abx therapy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

48. down syndrome has inreased risk of developing
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
ALL - alzheimers autism adhd depression seizure
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

49. How to dx acute angle closure glaucoma
110 kcl/kg/day
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
INH 9m if INH resistant rifampin 6m in children and 4m in adults

50. flexible kyphosis
Prolactinoma
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Pho for forward bending; forward defect; common finding has no adverse physical effect
INH 9m if INH resistant rifampin 6m in children and 4m in adults