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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. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Croup tx cool mist; racemic epi - corticosteroid
Croup
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

2. benefits of antibiotic therapy in acute pharyngitis?
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
>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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

3. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Methylephenidate toxicity; cannot be stopped abruptly; taper

4. dx for turner
Facial portwine stain
Candidal diapar rash; tx clotrimazol
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

5. IM
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Atypical lymphocyte
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Wait until 6 months

6. How long anti-TB drugs given for TB meningitis?
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Injury to b/l glossopharyngeal. present in botulism
Strep pneumonie; moraxella; h influenze
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

7. complication of lumbosacral meningocele
Bartonella henselae; complication is suppuration of lymph node
Between pregnenolone and 17oh pregnenolone
Imaging study to r/o VUR
Bladder dysfunction; UTI and renal dysfunctoin

8. the risk of lyme after bitten by a tick
Absence seizure; tx ethosuximide
1.5%
Injury to b/l glossopharyngeal. present in botulism
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

9. language expectation from 2yo
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

10. complete airway obstruction with FB
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Pipercillin (zosyn) - ticarcillin
>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
Decreased UGT enzyme

11. When to bevioral and enviromental measure in led intoxication?
<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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

12. side effect of testosteron therapy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Penicillin G 4h before delivery
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

13. When to give HRT in turner
14yrs
Oral DMSA or EDTA IV
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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

14. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Less than 5th percentile
Candidal diapar rash; tx clotrimazol
>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

15. difference between rubeola (measles) and rulbella
Congenital rubella syndrome
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
URI
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

16. mcCune albright`
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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
Neurofibromatosis type2

17. Infant with serum billlirubin >25
Risk of neurological dysfunction
Decr calorie intake; decr calorie absorption;incr calorie demand
Increase of pregnenolone
Oral DMSA or EDTA IV

18. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Thalassemia - congenital hemolytic anemia
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
refuse
Pho for forward bending; forward defect; common finding has no adverse physical effect

19. down syndrome has inreased risk of developing
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Diet modification to provide 110kc/kg/d
ALL - alzheimers autism adhd depression seizure
Absence seizure; tx ethosuximide

20. lens dislocation
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Increase of pregnenolone
Marfans - ehlers danlos - homocystinuria

21. How to prevent GBS in neonate
Do HIV testing at first
Croup
Penicillin G 4h before delivery
Increase of pregnenolone

22. TB prophylaxis
T for t ; thalassemia; inc serum iron and Iron binding
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Atopic dermatitis; strong allergic/immunologic component; incr IgE

23. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

24. failure to thrive
Less than 5th percentile
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

25. carditis and arthritis after rheumatic fever
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Black
Pho for forward bending; forward defect; common finding has no adverse physical effect
Develops in 21 dasy

26. coin in child's stomach
T for t ; thalassemia; inc serum iron and Iron binding
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
No intervention; 90% foreign bodies pass without difficulty
Multiple telangiectesia - vasular lesion in CNS

27. what conditions are not contraindicated
Absence seizure; tx ethosuximide
TB - breastfeeding - asymptomatic hiv
Prolactinoma
>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

28. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
110 kcl/kg/day
Medical emergency; dimercaprol/edta

29. TTP pentad
HSP - look for symmetric skin lesions
Medical emergency; dimercaprol/edta
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

30. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No intervention; 90% foreign bodies pass without difficulty
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

31. decreased mobility of tympanic membrane after otitis media
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
D for d; down syndrome and polyhydramnios

32. can women with abnormal smear or genital get vaccine
T for t ; thalassemia; inc serum iron and Iron binding
URI
Atypical lymphocyte
Yes; but it will be less effective

33. How to investigate delayed puberty
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
36 hours
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
refuse

34. pneumonia in CF patient
Female - breech delivery - family history; tx referral to ortho
No myoclonic activity in JME
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
ALL - alzheimers autism adhd depression seizure

35. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Bartonella henselae; complication is suppuration of lymph node
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

36. congenital adrenal hyperplasi
Meconeum ileus; think about CF
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Decreased UGT enzyme
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

37. osler rendu weber syndrom
Yes; but it will be less effective
Pho for forward bending; forward defect; common finding has no adverse physical effect
Multiple telangiectesia - vasular lesion in CNS
Dactylitis; 2nd common is splenic seqestration

38. How to dx endopthalmitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

39. How to evaluate well appearing child just born in GBS pos mother?
14yrs
Faciform RBC cause vascular occlusion
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

40. When to give hpv vaccien
ALL - alzheimers autism adhd depression seizure
Dactylitis; 2nd common is splenic seqestration
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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
No myoclonic activity in JME

42. major depression
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
No intervention; 90% foreign bodies pass without difficulty
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
<2yrs - abd pain - diarrhoea - ARF

43. pumonary TB
Injury to lower roots of brachial plexus
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)
1.5%
Croup

44. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Risk of neurological dysfunction
Decreases height - expensive; reserved for severe cases of delayed puberty
<2yrs - abd pain - diarrhoea - ARF
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

45. flexible kyphosis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
D for d; down syndrome and polyhydramnios
To make hip flexed and abducted position in DDH
Pho for forward bending; forward defect; common finding has no adverse physical effect

46. kallman syndrome
To make hip flexed and abducted position in DDH
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

47. most common complication of otitis media
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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
Lateral neck xray in epiglottitis show swollen epiglottis

48. How to difference viral and bact pneumonia
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Constitutional pubertal delay
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Facial portwine stain

49. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Strep pneumonie; moraxella; h influenze

50. indications of audiometry in childrens
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Decreased UGT enzyme
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -