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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.
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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. what conditions are not contraindicated
Constitutional pubertal delay
After 24h of abx therapy
TB - breastfeeding - asymptomatic hiv
>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

2. mech of botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Oral DMSA or EDTA IV
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

3. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Oral DMSA or EDTA IV

4. physiological jaundice
refuse
24h to 7d of birth
Diet modification to provide 110kc/kg/d
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

5. How to differentiate croup vs epiglotitis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Meconeum ileus; think about CF

6. thumb sign
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Brown
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

7. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Dactylitis; 2nd common is splenic seqestration
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

8. microcytic - hypochromic anemia - hepatospelnomegaly
Increase of pregnenolone
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Thalassemia - congenital hemolytic anemia
Bladder dysfunction; UTI and renal dysfunctoin

9. difference between rubeola (measles) and rulbella
Biliary atresia; tx surgery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
No; they are basic compound will be neutralized in an acidic environment of cellulitis

10. How to dx keratitis?
Neurofibromatosis type2
Foreign body sensation - photophobia - corneal opacity tx abx
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

11. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
No intervention; 90% foreign bodies pass without difficulty
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

12. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
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)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Pipercillin (zosyn) - ticarcillin

13. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Marfans - ehlers danlos - homocystinuria
Between pregnenolone and 17oh pregnenolone

14. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

15. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
No reticulocyte vs high reticulocyte
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
RSV - rhino and influenza
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

16. What is the most common initial symptom in sickle cell
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
If aortic root reaches 45 mm
Dactylitis; 2nd common is splenic seqestration
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

17. IM
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Less than 5th percentile
Atypical lymphocyte
Croup tx cool mist; racemic epi - corticosteroid

18. nuchal rigidity - fever - sore throat - headache - dioriented
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Female - breech delivery - family history; tx referral to ortho
Between pregnenolone and 17oh pregnenolone

19. What is earliest sign of puberty?
Brown
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
No; they are basic compound will be neutralized in an acidic environment of cellulitis

20. pumonary TB
Develops in 21 dasy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Constitutional pubertal delay
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)

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

22. How to evaluate well appearing child just born in GBS pos mother?
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Rapid detection of RSV antigen in nasl
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

23. failure to thrive
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Less than 5th percentile
Risk of neurological dysfunction
To make hip flexed and abducted position in DDH

24. iron supplement in child
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
After 6m; breast mild provides iron until 6m.
Foreign body sensation - photophobia - corneal opacity tx abx
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

25. lead 44-70
Oral DMSA or EDTA IV
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Multiple telangiectesia - vasular lesion in CNS
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

26. Febrile seizure
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
D for d; down syndrome and polyhydramnios
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

27. Infant with serum billlirubin >25
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
After 24h of abx therapy
refuse
Risk of neurological dysfunction

28. 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
Injury to b/l glossopharyngeal. present in botulism
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Do HIV testing at first

29. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Imaging study to r/o VUR
Central isosexual precocious puberty; hypothalmaic hamartoma

30. language expectation from 2yo
INH 9m if INH resistant rifampin 6m in children and 4m in adults
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
No wheezing - no feever in chlamydia

31. side effect of testosteron therapy
Develops in 21 dasy
T for t ; thalassemia; inc serum iron and Iron binding
Decreases height - expensive; reserved for severe cases of delayed puberty
Fifth disease; febrile syndrome

32. When to do surgery for undescended testes
Imaging study to r/o VUR
Wait until 6 months
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Increase of progesteron/17oh progesterone

33. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Dactylitis; 2nd common is splenic seqestration

34. contraindications of DTap
Bladder dysfunction; UTI and renal dysfunctoin
ALL - alzheimers autism adhd depression seizure
Increase of progesteron/17oh progesterone
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

35. infant botulism
Biliary atresia; tx surgery
Facial portwine stain
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Croup

36. 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
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No reticulocyte vs high reticulocyte
Facial portwine stain

37. viruses cause bronhioltitis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
RSV - rhino and influenza
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

38. indications of audiometry in childrens
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Diet modification to provide 110kc/kg/d
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Thalassemia - congenital hemolytic anemia

39. lead >70
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Medical emergency; dimercaprol/edta
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

40. contact lens keratitis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

41. red oozing rash on cheek - scaly - dry
Absence seizure; tx ethosuximide
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Benign permature thelarche; expectant management

42. tick transmits lyme
Brown
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Endocardial cushion defect (no separation between heart chambers)
Tx only symptomatic carrier

43. adrenal tumor
Risk of neurological dysfunction
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Less than 5th percentile
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

44. How to dx RSV
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
Rapid detection of RSV antigen in nasl
Increase of progesteron/17oh progesterone
Endocardial cushion defect (no separation between heart chambers)

45. How long patient needs to be exposed to tick to get infected
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Wait until 6 months
36 hours
Female - breech delivery - family history; tx referral to ortho

46. Parents can _____ vaccine
ALL - alzheimers autism adhd depression seizure
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
Black
refuse

47. When to give HRT in turner
Pho for forward bending; forward defect; common finding has no adverse physical effect
14yrs
Congenital rubella syndrome
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

48. dx for turner
Dactylitis; 2nd common is splenic seqestration
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

49. splenic infarction in sickle cell
Croup
HSP - look for symmetric skin lesions
Faciform RBC cause vascular occlusion
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

50. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Benign permature thelarche; expectant management
1.5%
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts