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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. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Decreases height - expensive; reserved for severe cases of delayed puberty
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

2. association with infantile pyloric stenosis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
24-72 hours
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

3. is local anesthetics be used in cellulitis to reduce pain
Female - breech delivery - family history; tx referral to ortho
Risk of neurological dysfunction
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
No; they are basic compound will be neutralized in an acidic environment of cellulitis

4. sickle cell with symmetrical swelling of hands and feet
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Benign permature thelarche; expectant management
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Vaso-occlusive crisis; dx hb electrophoresis

5. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
TB - breastfeeding - asymptomatic hiv
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

6. mcCune albright`
Increase of progesteron/17oh progesterone
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

7. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Pho for forward bending; forward defect; common finding has no adverse physical effect
Atypical lymphocyte
Facial portwine stain

8. HUS
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Decreased UGT enzyme
<2yrs - abd pain - diarrhoea - ARF

9. IM
Increase of pregnenolone
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Atypical lymphocyte
Wait until 6 months

10. iron supplement in child
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
After 6m; breast mild provides iron until 6m.
Tx only symptomatic carrier
Central isosexual precocious puberty; hypothalmaic hamartoma

11. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Biliary atresia; tx surgery
Thalassemia - congenital hemolytic anemia
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

12. How to evaluate well appearing child just born in GBS pos mother?
ALL - alzheimers autism adhd depression seizure
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
RSV - rhino and influenza

13. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Herpes
HSP - look for symmetric skin lesions

14. Tx of bact conjunctivitis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

15. spitting up - vomiting at night - weight stable
Diet modification to provide 110kc/kg/d
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Endocardial cushion defect (no separation between heart chambers)
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

16. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Bladder dysfunction; UTI and renal dysfunctoin
Central isosexual precocious puberty; hypothalmaic hamartoma
Herpes
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

17. failure to thrive
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Less than 5th percentile
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

18. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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. 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
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Pho for forward bending; forward defect; common finding has no adverse physical effect
<2yrs - abd pain - diarrhoea - ARF

20. microcytic - hypochromic anemia - hepatospelnomegaly
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
Decr calorie intake; decr calorie absorption;incr calorie demand
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Thalassemia - congenital hemolytic anemia

21. 21 hydroxylase
Lateral neck xray in epiglottitis show swollen epiglottis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

22. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Decr calorie intake; decr calorie absorption;incr calorie demand
Bladder dysfunction; UTI and renal dysfunctoin
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Do HIV testing at first

23. causes of FTT
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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Methylephenidate toxicity; cannot be stopped abruptly; taper
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

24. carditis and arthritis after rheumatic fever
Bladder dysfunction; UTI and renal dysfunctoin
Thalassemia - congenital hemolytic anemia
Develops in 21 dasy
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

25. dx of lyme
Endocardial cushion defect (no separation between heart chambers)
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Mainly clinical; serology with initial ELISA - with western blot confirmation;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

26. cat scratch disease
Between pregnenolone and 17oh pregnenolone
Constitutional pubertal delay
Erb paralysis leading to diaphragmatic paralysis
Bartonella henselae; complication is suppuration of lymph node

27. bromocriptine
Prolactinoma
Diet modification to provide 110kc/kg/d
Meconeum ileus; think about CF
Biliary atresia; tx surgery

28. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
110 kcl/kg/day
Prolactinoma
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)

29. How to differentiate caput succedanueum and cephalohematoma
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Foreign body sensation - photophobia - corneal opacity tx abx
Herpes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

30. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

31. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
<2yrs - abd pain - diarrhoea - ARF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Black

32. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Central isosexual precocious puberty; hypothalmaic hamartoma
No myoclonic activity in JME

33. lead >70
<2yrs - abd pain - diarrhoea - ARF
Medical emergency; dimercaprol/edta
Erb paralysis leading to diaphragmatic paralysis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

34. How to differential bact vs viral conjunctivitis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
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
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
36 hours

35. What are the risk factors of developmental dysplais of hip
HSP - look for symmetric skin lesions
Female - breech delivery - family history; tx referral to ortho
Injury to lower roots of brachial plexus
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

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

37. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Meconeum ileus; think about CF
Increase of progesteron/17oh progesterone
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

38. viruses cause bronhioltitis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
RSV - rhino and influenza

39. causes of FTT
Less than 5th percentile
Decr calorie intake; decr calorie absorption;incr calorie demand
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

40. kallman syndrome
Multiple telangiectesia - vasular lesion in CNS
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
TB - breastfeeding - asymptomatic hiv
Constitutional pubertal delay

41. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Tx only symptomatic carrier
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

42. osler rendu weber syndrom
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Tx only symptomatic carrier
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Multiple telangiectesia - vasular lesion in CNS

43. 18mo bilat breast enlargment - some pubic hair
RSV - rhino and influenza
TB - breastfeeding - asymptomatic hiv
Benign permature thelarche; expectant management
After 24h of abx therapy

44. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Do HIV testing at first
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Decreases height - expensive; reserved for severe cases of delayed puberty
Diet modification to provide 110kc/kg/d

45. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Rapid detection of RSV antigen in nasl
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Benign permature thelarche; expectant management

46. What is earliest sign of puberty?
Decreased UGT enzyme
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Develops in 21 dasy

47. starring spells 10-20sec
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
No myoclonic activity in JME
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

48. decreased mobility of tympanic membrane after otitis media
<2yrs - abd pain - diarrhoea - ARF
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

49. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Benign permature thelarche; expectant management
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

50. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
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
Erb paralysis leading to diaphragmatic paralysis
Dactylitis; 2nd common is splenic seqestration
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery