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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. pneumonia in CF patient
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Between pregnenolone and 17oh pregnenolone
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

2. How to dx endopthalmitis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Decreased UGT enzyme
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

3. What are the risk factors of developmental dysplais of hip
Strep pneumonie; moraxella; h influenze
Female - breech delivery - family history; tx referral to ortho
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
1.5%

4. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Facial portwine stain
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Candidal diapar rash; tx clotrimazol

5. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Increase of progesteron/17oh progesterone
Between pregnenolone and 17oh pregnenolone
Oral DMSA or EDTA IV

6. hypopigmented spots - family hx bilat deafness
Develops in 21 dasy
Penicillin G 4h before delivery
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Neurofibromatosis type2

7. How to differential bact vs viral conjunctivitis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
Prolactinoma

8. Parvovirus
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Less than 5th percentile
Benign permature thelarche; expectant management
Fifth disease; febrile syndrome

9. down syndrome has inreased risk of developing
Vaso-occlusive crisis; dx hb electrophoresis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
ALL - alzheimers autism adhd depression seizure
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

10. 17 alpha hydroxylase
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Between pregnenolone and 17oh pregnenolone
36 hours
Less than 5th percentile

11. When to give HRT in turner
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
14yrs
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

12. dx for DDH
>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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Prolactinoma
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

13. contraindications of DTap
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

14. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Meconeum ileus; think about CF

15. kallman syndrome
Neurofibromatosis type2
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No myoclonic activity in JME

16. starring spells 10-20sec
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

17. tick transmits RMSF
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Black
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Foreign body sensation - photophobia - corneal opacity tx abx

18. mcCune albright`
Lateral neck xray in epiglottitis show swollen epiglottis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

19. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Bladder dysfunction; UTI and renal dysfunctoin

20. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Neurofibromatosis type2
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
If aortic root reaches 45 mm

21. adrenal tumor
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

22. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Croup tx cool mist; racemic epi - corticosteroid

23. 12y - obese - hip pain - hip ext rotated
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
1.5%
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

24. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
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
Central isosexual precocious puberty; hypothalmaic hamartoma
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

25. tuberous sclerosis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

26. target cell
Meconeum ileus; think about CF
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
T for t ; thalassemia; inc serum iron and Iron binding
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

27. tzanck
Herpes
Bartonella henselae; complication is suppuration of lymph node
ALL - alzheimers autism adhd depression seizure
Medical emergency; dimercaprol/edta

28. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

29. HUS
Bladder dysfunction; UTI and renal dysfunctoin
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
<2yrs - abd pain - diarrhoea - ARF

30. aplasic crisis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

31. How to differentiate caput succedanueum and cephalohematoma
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
Tx only symptomatic carrier
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Diet modification to provide 110kc/kg/d

32. when bact conjunctivitis patient can go back to school
Vaso-occlusive crisis; dx hb electrophoresis
After 24h of abx therapy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Imaging study to r/o VUR

33. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

34. 18mo bilat breast enlargment - some pubic hair
Central isosexual precocious puberty; hypothalmaic hamartoma
Benign permature thelarche; expectant management
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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

35. microcytic - hypochromic anemia - hepatospelnomegaly
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Thalassemia - congenital hemolytic anemia
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

36. pavlik harness
Fifth disease; febrile syndrome
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
To make hip flexed and abducted position in DDH
24-72 hours

37. acute otitis externa

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38. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No; they are basic compound will be neutralized in an acidic environment of cellulitis

39. acute otitis media-pathogen
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Strep pneumonie; moraxella; h influenze
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

40. centor criteria for bact pharyngitis
1.5%
refuse
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Female - breech delivery - family history; tx referral to ortho

41. cleft lip but no cleft palate
Absence seizure; tx ethosuximide
Methylephenidate toxicity; cannot be stopped abruptly; taper
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
After 6m; breast mild provides iron until 6m.

42. difference between structural disorder and flexible kyphosis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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

43. When to give hpv vaccien
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
RSV - rhino and influenza
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Bartonella henselae; complication is suppuration of lymph node

44. splenic infarction in sickle cell
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Multiple telangiectesia - vasular lesion in CNS
Faciform RBC cause vascular occlusion

45. How to prevent GBS in neonate
Penicillin G 4h before delivery
Develops in 21 dasy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

46. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
D for d; down syndrome and polyhydramnios
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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
14yrs

47. How to dx RSV
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Absence seizure; tx ethosuximide
Rapid detection of RSV antigen in nasl
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

48. decreased mobility of tympanic membrane after otitis media
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
After 24h of abx therapy

49. low grade fever - cough - diffuse bilat ground glass opacities
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Decreases height - expensive; reserved for severe cases of delayed puberty

50. How to investigate delayed puberty
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
After 6m; breast mild provides iron until 6m.
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng