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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. When to give HRT in turner
14yrs
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Dactylitis; 2nd common is splenic seqestration
Decreases height - expensive; reserved for severe cases of delayed puberty

2. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
Benign permature thelarche; expectant management
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

3. horner syndrom
Injury to lower roots of brachial plexus
Pho for forward bending; forward defect; common finding has no adverse physical effect
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
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

4. bromocriptine
Oral DMSA or EDTA IV
Pipercillin (zosyn) - ticarcillin
Bartonella henselae; complication is suppuration of lymph node
Prolactinoma

5. starring spells 10-20sec
Erb paralysis leading to diaphragmatic paralysis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Risk of neurological dysfunction

6. how smoking contributes otitis media in children
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Increase of pregnenolone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

7. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Prolactinoma
Candidal diapar rash; tx clotrimazol
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Croup tx cool mist; racemic epi - corticosteroid

8. 12y - obese - hip pain - hip ext rotated
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

9. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Croup tx cool mist; racemic epi - corticosteroid

10. How to dx acute angle closure glaucoma
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Between pregnenolone and 17oh pregnenolone
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

11. IM
Decreases height - expensive; reserved for severe cases of delayed puberty
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Atypical lymphocyte
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

12. differentiate between central and peripheral precocious puberty
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
After 24h of abx therapy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

13. benefits of antibiotic therapy in acute pharyngitis?
Between pregnenolone and 17oh pregnenolone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Fifth disease; febrile syndrome
Wait until 6 months

14. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Meconeum ileus; think about CF
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

15. What is the most common initial symptom in sickle cell
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Dactylitis; 2nd common is splenic seqestration
No myoclonic activity in JME

16. 17 alpha hydroxylase
To make hip flexed and abducted position in DDH
Between pregnenolone and 17oh pregnenolone
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

17. deficinecy of 17 hydroxylase
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Strep pneumonie; moraxella; h influenze
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Increase of pregnenolone

18. When to give hpv vaccien
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
No myoclonic activity in JME
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
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

19. Parents can _____ vaccine
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Central isosexual precocious puberty; hypothalmaic hamartoma
refuse
Prolactinoma

20. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Croup tx cool mist; racemic epi - corticosteroid

21. Febrile seizure
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)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
1.5%
Congenital rubella syndrome

22. pumonary TB
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
After 6m; breast mild provides iron until 6m.
Diet modification to provide 110kc/kg/d
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)

23. physiological jaundice
Methylephenidate toxicity; cannot be stopped abruptly; taper
24h to 7d of birth
If aortic root reaches 45 mm
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

24. side effect of testosteron therapy
Neurofibromatosis type2
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
Decreases height - expensive; reserved for severe cases of delayed puberty
Dactylitis; 2nd common is splenic seqestration

25. crying during urination. bacteriuria pyruria - rec episodes
Multiple telangiectesia - vasular lesion in CNS
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Benign permature thelarche; expectant management
Imaging study to r/o VUR

26. lead 44-70
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Oral DMSA or EDTA IV
Atypical lymphocyte
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

27. doing worse in school - lack of attention - starring speel
Develops in 21 dasy
Diet modification to provide 110kc/kg/d
Absence seizure; tx ethosuximide
ALL - alzheimers autism adhd depression seizure

28. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
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)
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Constitutional pubertal delay

29. spitting up - vomiting at night - weight stable
Atypical lymphocyte
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Tx only symptomatic carrier
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

30. decreased mobility of tympanic membrane after otitis media
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Croup tx cool mist; racemic epi - corticosteroid
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

31. duodenal atresia
No reticulocyte vs high reticulocyte
Do HIV testing at first
D for d; down syndrome and polyhydramnios
No intervention; 90% foreign bodies pass without difficulty

32. difference between breast milk and breafeeding jaundice
Vaso-occlusive crisis; dx hb electrophoresis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
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
No reticulocyte vs high reticulocyte

33. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

34. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
24-72 hours
Central isosexual precocious puberty; hypothalmaic hamartoma

35. what conditions are not contraindicated
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
TB - breastfeeding - asymptomatic hiv
Wait until 6 months

36. coin in child's stomach
Bartonella henselae; complication is suppuration of lymph node
24-72 hours
No intervention; 90% foreign bodies pass without difficulty
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

37. infantile hypertrophic pyloric stenosis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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
Dx US tx; correct serum electrolyte - pyloromyotom
Biliary atresia; tx surgery

38. How to differentiate caput succedanueum and cephalohematoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Constitutional pubertal delay
Increase of pregnenolone
Mainly clinical; serology with initial ELISA - with western blot confirmation;

39. giardiasis
Meconeum ileus; think about CF
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Tx only symptomatic carrier
Wait until 6 months

40. Nocturnal enuresis
No wheezing - no feever in chlamydia
Dx US tx; correct serum electrolyte - pyloromyotom
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

41. Tx of bact conjunctivitis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Prolactinoma
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

42. most common complication of otitis media
Candidal diapar rash; tx clotrimazol
Croup tx cool mist; racemic epi - corticosteroid
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Risk of neurological dysfunction

43. How to differential bact vs viral conjunctivitis
Between pregnenolone and 17oh pregnenolone
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
TB - breastfeeding - asymptomatic hiv
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

44. defcicieny of 21 hydroxylase
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Increase of progesteron/17oh progesterone
Imaging study to r/o VUR
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

45. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Strep pneumonie; moraxella; h influenze
Decreases height - expensive; reserved for severe cases of delayed puberty
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

46. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Tx only symptomatic carrier
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Atypical lymphocyte

47. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
T for t ; thalassemia; inc serum iron and Iron binding
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
INH 9m if INH resistant rifampin 6m in children and 4m in adults

48. Tx of children constipation

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49. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

50. complete airway obstruction with FB
Oral DMSA or EDTA IV
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
After 6m; breast mild provides iron until 6m.
>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