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

2. lens dislocation
Faciform RBC cause vascular occlusion
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Foreign body sensation - photophobia - corneal opacity tx abx
Marfans - ehlers danlos - homocystinuria

3. When to give hpv vaccien
Less than 5th percentile
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
Dactylitis; 2nd common is splenic seqestration
Brown

4. mcCune albright`
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
T for t ; thalassemia; inc serum iron and Iron binding

5. language expectation from 2yo
Absence seizure; tx ethosuximide
No wheezing - no feever in chlamydia
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Congenital rubella syndrome

6. 18mo bilat breast enlargment - some pubic hair
Female - breech delivery - family history; tx referral to ortho
Croup tx cool mist; racemic epi - corticosteroid
Benign permature thelarche; expectant management
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

7. adenovirus
URI
Risk of neurological dysfunction
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
RSV - rhino and influenza

8. What is earliest sign of puberty?
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

9. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Methylephenidate toxicity; cannot be stopped abruptly; taper
36 hours
Imaging study to r/o VUR

10. How to differentiate croup vs epiglotitis
Diet modification to provide 110kc/kg/d
Facial portwine stain
Lateral neck xray in epiglottitis show swollen epiglottis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

11. acute otitis media-pathogen
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Strep pneumonie; moraxella; h influenze
Develops in 21 dasy
110 kcl/kg/day

12. patient with white plaques in mouth and lump in back
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
T for t ; thalassemia; inc serum iron and Iron binding
Benign permature thelarche; expectant management
Do HIV testing at first

13. Tx of botulism
Do HIV testing at first
No intervention; 90% foreign bodies pass without difficulty
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
ALL - alzheimers autism adhd depression seizure

14. hypopigmented spots - family hx bilat deafness
Less than 5th percentile
Neurofibromatosis type2
Croup
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

15. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
36 hours
If aortic root reaches 45 mm
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

16. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
36 hours
Thalassemia - congenital hemolytic anemia
14yrs

17. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
24h to 7d of birth
Benign permature thelarche; expectant management
Lateral neck xray in epiglottitis show swollen epiglottis

18. Tx of FTT
Diet modification to provide 110kc/kg/d
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
24-72 hours
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

19. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
14yrs
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Female - breech delivery - family history; tx referral to ortho
Erb paralysis leading to diaphragmatic paralysis

20. thumb sign
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
24h to 7d of birth
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

21. side effect of testosteron therapy
Lateral neck xray in epiglottitis show swollen epiglottis
Decreases height - expensive; reserved for severe cases of delayed puberty
Absence seizure; tx ethosuximide
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

22. down syndrome with holocystolic mumur
Yes; but it will be less effective
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Endocardial cushion defect (no separation between heart chambers)
Rapid detection of RSV antigen in nasl

23. doing worse in school - lack of attention - starring speel
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
Absence seizure; tx ethosuximide
Thalassemia - congenital hemolytic anemia
24-72 hours

24. HUS
Do HIV testing at first
Multiple telangiectesia - vasular lesion in CNS
D for d; down syndrome and polyhydramnios
<2yrs - abd pain - diarrhoea - ARF

25. 21 hydroxylase
>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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
TB - breastfeeding - asymptomatic hiv

26. dx for turner
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

27. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
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
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

28. When to do surgery for undescended testes
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Wait until 6 months
INH 9m if INH resistant rifampin 6m in children and 4m in adults
>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

29. 3yo - febrile - left hip externally rotated
URI
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
36 hours
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

30. horner syndrom
24h to 7d of birth
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Decreases height - expensive; reserved for severe cases of delayed puberty
Injury to lower roots of brachial plexus

31. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

32. cat scratch disease
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Pipercillin (zosyn) - ticarcillin
Bartonella henselae; complication is suppuration of lymph node

33. indications of audiometry in childrens
Pipercillin (zosyn) - ticarcillin
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Strep pneumonie; moraxella; h influenze
Facial portwine stain

34. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Rapid detection of RSV antigen in nasl
<2yrs - abd pain - diarrhoea - ARF
Meconeum ileus; think about CF
Candidal diapar rash; tx clotrimazol

35. dx of lyme
Marfans - ehlers danlos - homocystinuria
Mainly clinical; serology with initial ELISA - with western blot confirmation;
After 24h of abx therapy
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

36. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
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
HSP - look for symmetric skin lesions
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

37. cleft lip but no cleft palate
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Thalassemia - congenital hemolytic anemia

38. nuchal rigidity - fever - sore throat - headache - dioriented
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

39. viruses cause bronhioltitis
Croup tx cool mist; racemic epi - corticosteroid
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
RSV - rhino and influenza
Foreign body sensation - photophobia - corneal opacity tx abx

40. causes of FTT
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
No myoclonic activity in JME
Diet modification to provide 110kc/kg/d

41. Tx of children constipation

42. Febrile seizure
Dx US tx; correct serum electrolyte - pyloromyotom
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Wait until 6 months

43. Neonatal unconjugated hyperbilirubine
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Injury to lower roots of brachial plexus
Decreased UGT enzyme
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

44. Parents can _____ vaccine
refuse
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

45. What is the definition of delayed puberty?
Prolactinoma
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

46. How to differential bact vs viral conjunctivitis
>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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Croup tx cool mist; racemic epi - corticosteroid
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

47. acute otitis externa

48. major depression
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Atopic dermatitis; strong allergic/immunologic component; incr IgE
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Between pregnenolone and 17oh pregnenolone

49. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Meconeum ileus; think about CF
If aortic root reaches 45 mm

50. differentiate between central and peripheral precocious puberty
Strep pneumonie; moraxella; h influenze
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Develops in 21 dasy