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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. indications of audiometry in childrens
Fifth disease; febrile syndrome
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Between pregnenolone and 17oh pregnenolone

2. hypopigmented spots - family hx bilat deafness
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Neurofibromatosis type2
Black
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

3. acute otitis externa

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4. physiological jaundice
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Prolactinoma
24h to 7d of birth

5. duodenal atresia
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
14yrs
D for d; down syndrome and polyhydramnios
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

6. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Dactylitis; 2nd common is splenic seqestration
Marfans - ehlers danlos - homocystinuria

7. the risk of lyme after bitten by a tick
Endocardial cushion defect (no separation between heart chambers)
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
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
1.5%

8. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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
D for d; down syndrome and polyhydramnios
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

9. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Do HIV testing at first
Facial portwine stain
Foreign body sensation - photophobia - corneal opacity tx abx

10. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Multiple telangiectesia - vasular lesion in CNS
36 hours

11. How long patient needs to be exposed to tick to get infected
Methylephenidate toxicity; cannot be stopped abruptly; taper
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
HSP - look for symmetric skin lesions
36 hours

12. When to give hpv vaccien
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
Neurofibromatosis type2
Develops in 21 dasy
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

13. complete airway obstruction with FB
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
>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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Pho for forward bending; forward defect; common finding has no adverse physical effect

14. is local anesthetics be used in cellulitis to reduce pain
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Multiple telangiectesia - vasular lesion in CNS
24h to 7d of birth

15. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
TB - breastfeeding - asymptomatic hiv
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

16. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Methylephenidate toxicity; cannot be stopped abruptly; taper
24h to 7d of birth
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

17. tuberous sclerosis
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

18. How to dx keratitis?
Less than 5th percentile
Erb paralysis leading to diaphragmatic paralysis
Between pregnenolone and 17oh pregnenolone
Foreign body sensation - photophobia - corneal opacity tx abx

19. 21 hydroxylase
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
ALL - alzheimers autism adhd depression seizure
36 hours

20. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Bladder dysfunction; UTI and renal dysfunctoin
Constitutional pubertal delay
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

21. the recommended ca supplementation
Neurofibromatosis type2
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

22. osler rendu weber syndrom
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Penicillin G 4h before delivery
Multiple telangiectesia - vasular lesion in CNS

23. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Decreased UGT enzyme
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

24. Infant with serum billlirubin >25
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Penicillin G 4h before delivery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Risk of neurological dysfunction

25. infant botulism
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

26. contraindications of MMR vaccine
Do HIV testing at first
Congenital rubella syndrome
Marfans - ehlers danlos - homocystinuria
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

27. How to dx acute angle closure glaucoma
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
Do HIV testing at first
No reticulocyte vs high reticulocyte
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

28. can women with abnormal smear or genital get vaccine
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Yes; but it will be less effective
>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. congenital adrenal hyperplasi
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
T for t ; thalassemia; inc serum iron and Iron binding
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Bladder dysfunction; UTI and renal dysfunctoin

30. tzanck
HSP - look for symmetric skin lesions
Herpes
If aortic root reaches 45 mm
Medical emergency; dimercaprol/edta

31. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Herpes
RSV - rhino and influenza
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

32. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
ALL - alzheimers autism adhd depression seizure
Multiple telangiectesia - vasular lesion in CNS
No myoclonic activity in JME

33. What is earliest sign of puberty?
Decreased UGT enzyme
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

34. tick transmits lyme
Constitutional pubertal delay
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Brown
Benign permature thelarche; expectant management

35. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
No reticulocyte vs high reticulocyte
No myoclonic activity in JME
Herpes

36. How to differential bact vs viral conjunctivitis
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
No myoclonic activity in JME
Facial portwine stain
Dx US tx; correct serum electrolyte - pyloromyotom

37. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
No myoclonic activity in JME
Candidal diapar rash; tx clotrimazol
Vaso-occlusive crisis; dx hb electrophoresis

38. crying during urination. bacteriuria pyruria - rec episodes
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Brown
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Imaging study to r/o VUR

39. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Imaging study to r/o VUR
Meconeum ileus; think about CF
Facial portwine stain
No reticulocyte vs high reticulocyte

40. Tx of botulism
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Develops in 21 dasy
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

41. cleft lip but no cleft palate
URI
36 hours
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

42. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Oral DMSA or EDTA IV
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

43. causes of FTT
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Decr calorie intake; decr calorie absorption;incr calorie demand
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
T for t ; thalassemia; inc serum iron and Iron binding

44. failure to thrive
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Less than 5th percentile
INH 9m if INH resistant rifampin 6m in children and 4m in adults

45. nuchal rigidity - fever - sore throat - headache - dioriented
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
Erb paralysis leading to diaphragmatic paralysis
36 hours
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

46. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Central isosexual precocious puberty; hypothalmaic hamartoma
Injury to b/l glossopharyngeal. present in botulism
Herpes

47. How to dx RSV
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Do HIV testing at first
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Rapid detection of RSV antigen in nasl

48. decreased mobility of tympanic membrane after otitis media
Bladder dysfunction; UTI and renal dysfunctoin
Fifth disease; febrile syndrome
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

49. What is the most common initial symptom in sickle cell
>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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Dactylitis; 2nd common is splenic seqestration
Injury to b/l glossopharyngeal. present in botulism

50. low grade fever - cough - diffuse bilat ground glass opacities
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Vaso-occlusive crisis; dx hb electrophoresis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Constitutional pubertal delay