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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. causes of FTT
<2yrs - abd pain - diarrhoea - ARF
Congenital rubella syndrome
Decr calorie intake; decr calorie absorption;incr calorie demand
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

2. flexible kyphosis
Erb paralysis leading to diaphragmatic paralysis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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)
Pho for forward bending; forward defect; common finding has no adverse physical effect

3. centor criteria for bact pharyngitis
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
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Black
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

4. What are the risk factors of developmental dysplais of hip
ALL - alzheimers autism adhd depression seizure
refuse
Female - breech delivery - family history; tx referral to ortho
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

5. What is the definition of delayed puberty?
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
<2yrs - abd pain - diarrhoea - ARF
Oral DMSA or EDTA IV

6. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Bladder dysfunction; UTI and renal dysfunctoin
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No myoclonic activity in JME

7. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Erb paralysis leading to diaphragmatic paralysis
Multiple telangiectesia - vasular lesion in CNS

8. congenital adrenal hyperplasi
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

9. side effect of testosteron therapy
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Decreases height - expensive; reserved for severe cases of delayed puberty
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
Fifth disease; febrile syndrome

10. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Central isosexual precocious puberty; hypothalmaic hamartoma
Decreases height - expensive; reserved for severe cases of delayed puberty
Dactylitis; 2nd common is splenic seqestration

11. 21 hydroxylase
URI
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

12. IM
HSP - look for symmetric skin lesions
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Atypical lymphocyte
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

13. sickle cell with symmetrical swelling of hands and feet
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Herpes
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
Vaso-occlusive crisis; dx hb electrophoresis

14. 3yo - never able to walk
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
14yrs
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
Injury to lower roots of brachial plexus

15. osler rendu weber syndrom
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Multiple telangiectesia - vasular lesion in CNS
Do HIV testing at first
Erb paralysis leading to diaphragmatic paralysis

16. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

17. mcCune albright`
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Develops in 21 dasy

18. starring spells 10-20sec
Increase of pregnenolone
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

19. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Endocardial cushion defect (no separation between heart chambers)
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

20. What is the calorie requirement of newborn?
110 kcl/kg/day
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Increase of progesteron/17oh progesterone
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

21. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
No myoclonic activity in JME
Croup tx cool mist; racemic epi - corticosteroid
Thalassemia - congenital hemolytic anemia

22. dx for DDH
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Vaso-occlusive crisis; dx hb electrophoresis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

23. major depression
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

24. Nocturnal enuresis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Congenital rubella syndrome
T for t ; thalassemia; inc serum iron and Iron binding
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

25. horner syndrom
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Injury to lower roots of brachial plexus
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

26. tzanck
Rapid detection of RSV antigen in nasl
Herpes
Methylephenidate toxicity; cannot be stopped abruptly; taper
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

27. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
24-72 hours
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Injury to b/l glossopharyngeal. present in botulism

28. Tx of FTT
Methylephenidate toxicity; cannot be stopped abruptly; taper
Diet modification to provide 110kc/kg/d
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

29. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Atopic dermatitis; strong allergic/immunologic component; incr IgE
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Decreases height - expensive; reserved for severe cases of delayed puberty

30. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

31. low grade fever - cough - diffuse bilat ground glass opacities
URI
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

32. tick transmits lyme
Atypical lymphocyte
Brown
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

33. When to give HRT in turner
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Bartonella henselae; complication is suppuration of lymph node
14yrs
Increase of pregnenolone

34. How to differentiate caput succedanueum and cephalohematoma
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Penicillin G 4h before delivery

35. spitting up - vomiting at night - weight stable
Croup tx cool mist; racemic epi - corticosteroid
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Do HIV testing at first

36. TTP pentad
Herpes
T for t ; thalassemia; inc serum iron and Iron binding
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

37. sudden onset of fever - difficulty in breathing
Multiple telangiectesia - vasular lesion in CNS
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Candidal diapar rash; tx clotrimazol
Less than 5th percentile

38. difference between breast milk and breafeeding jaundice
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
Rapid detection of RSV antigen in nasl
Develops in 21 dasy
Methylephenidate toxicity; cannot be stopped abruptly; taper

39. cleft lip but no cleft palate
Atypical lymphocyte
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

40. What is thumbprint sign
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Injury to b/l glossopharyngeal. present in botulism
D for d; down syndrome and polyhydramnios
Lateral neck xray in epiglottitis show swollen epiglottis

41. cardiac manifestation of turner
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Pho for forward bending; forward defect; common finding has no adverse physical effect
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
1.5%

42. How to prevent GBS in neonate
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;
Penicillin G 4h before delivery
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

43. Infant with serum billlirubin >25
Herpes
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Risk of neurological dysfunction
Neurofibromatosis type2

44. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Dactylitis; 2nd common is splenic seqestration

45. acute otitis externa

46. Tx of botulism
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Constitutional pubertal delay
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

47. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
No reticulocyte vs high reticulocyte

48. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
1.5%
Medical emergency; dimercaprol/edta

49. infantile hypertrophic pyloric stenosis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Dx US tx; correct serum electrolyte - pyloromyotom
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

50. language expectation from 2yo
<2yrs - abd pain - diarrhoea - ARF
Candidal diapar rash; tx clotrimazol
Brown
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry