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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. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Multiple telangiectesia - vasular lesion in CNS
1.5%
Methylephenidate toxicity; cannot be stopped abruptly; taper

2. tick transmits lyme
Do HIV testing at first
No wheezing - no feever in chlamydia
Brown
Vaso-occlusive crisis; dx hb electrophoresis

3. physiological jaundice
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
24h to 7d of birth
14yrs
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

4. starring spells 10-20sec
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
No wheezing - no feever in chlamydia
Vaso-occlusive crisis; dx hb electrophoresis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

5. indications of audiometry in childrens
Bartonella henselae; complication is suppuration of lymph node
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Dactylitis; 2nd common is splenic seqestration
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

6. dx of lyme
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Dactylitis; 2nd common is splenic seqestration
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Mainly clinical; serology with initial ELISA - with western blot confirmation;

7. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
<2yrs - abd pain - diarrhoea - ARF
Facial portwine stain
No intervention; 90% foreign bodies pass without difficulty

8. contraindications of MMR vaccine
Dactylitis; 2nd common is splenic seqestration
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

9. osler rendu weber syndrom
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Methylephenidate toxicity; cannot be stopped abruptly; taper
Multiple telangiectesia - vasular lesion in CNS
No; they are basic compound will be neutralized in an acidic environment of cellulitis

10. What is the most common initial symptom in sickle cell
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
Dactylitis; 2nd common is splenic seqestration
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

11. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Central isosexual precocious puberty; hypothalmaic hamartoma
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

12. How to difference viral and bact pneumonia
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
24-72 hours
Facial portwine stain
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

13. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Congenital rubella syndrome
refuse
<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

14. Febrile seizure
If aortic root reaches 45 mm
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
HSP - look for symmetric skin lesions
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

15. What is the definition of delayed puberty?
No myoclonic activity in JME
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

16. thumb sign
Penicillin G 4h before delivery
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
1.5%
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

17. 3yo - never able to walk
Decreased UGT enzyme
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

18. indications of VUR
Dx US tx; correct serum electrolyte - pyloromyotom
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

19. acute otitis media-pathogen
Less than 5th percentile
Strep pneumonie; moraxella; h influenze
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Multiple telangiectesia - vasular lesion in CNS

20. When to do aortic root surgery in marfans to prevent dissection?
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
If aortic root reaches 45 mm
Bartonella henselae; complication is suppuration of lymph node
Penicillin G 4h before delivery

21. iron supplement in child
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
After 6m; breast mild provides iron until 6m.
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

22. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Neurofibromatosis type2
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
refuse

23. down syndrome with holocystolic mumur
D for d; down syndrome and polyhydramnios
Endocardial cushion defect (no separation between heart chambers)
>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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

24. patient with white plaques in mouth and lump in back
Do HIV testing at first
Strep pneumonie; moraxella; h influenze
Erb paralysis leading to diaphragmatic paralysis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

25. contact lens keratitis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
1.5%
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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

26. How long patient needs to be exposed to tick to get infected
Decreases height - expensive; reserved for severe cases of delayed puberty
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
36 hours

27. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
If aortic root reaches 45 mm
Bladder dysfunction; UTI and renal dysfunctoin
Central isosexual precocious puberty; hypothalmaic hamartoma

28. duodenal atresia
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
To make hip flexed and abducted position in DDH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
D for d; down syndrome and polyhydramnios

29. cardiac manifestation of turner
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
<2yrs - abd pain - diarrhoea - ARF
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Herpes

30. difference between rubeola (measles) and rulbella
Dx US tx; correct serum electrolyte - pyloromyotom
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Vaso-occlusive crisis; dx hb electrophoresis

31. How to differentiate caput succedanueum and cephalohematoma
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Decr calorie intake; decr calorie absorption;incr calorie demand
Injury to b/l glossopharyngeal. present in botulism

32. echymoses with low platelet <30k
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Imaging study to r/o VUR
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

33. Tx of botulism
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Central isosexual precocious puberty; hypothalmaic hamartoma
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

34. hypopigmented spots - family hx bilat deafness
Prolactinoma
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Tx only symptomatic carrier
Neurofibromatosis type2

35. sudden onset of fever - difficulty in breathing
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
110 kcl/kg/day

36. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Croup
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Pho for forward bending; forward defect; common finding has no adverse physical effect

37. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Congenital rubella syndrome
Decreased UGT enzyme
Imaging study to r/o VUR

38. tuberous sclerosis
Develops in 21 dasy
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Pho for forward bending; forward defect; common finding has no adverse physical effect

39. difference between breast milk and breafeeding jaundice
Fifth disease; febrile syndrome
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
1.5%
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

40. causes of acute anemia
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Do HIV testing at first

41. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Increase of progesteron/17oh progesterone
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

42. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Lateral neck xray in epiglottitis show swollen epiglottis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Dactylitis; 2nd common is splenic seqestration

43. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Diet modification to provide 110kc/kg/d
Penicillin G 4h before delivery
Congenital rubella syndrome

44. contraindications of DTap
Bartonella henselae; complication is suppuration of lymph node
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

45. mech of botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Penicillin G 4h before delivery

46. cat scratch disease
Strep pneumonie; moraxella; h influenze
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Congenital rubella syndrome
Bartonella henselae; complication is suppuration of lymph node

47. horner syndrom
Croup tx cool mist; racemic epi - corticosteroid
Injury to lower roots of brachial plexus
Black
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

48. giardiasis
Tx only symptomatic carrier
110 kcl/kg/day
Female - breech delivery - family history; tx referral to ortho
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

49. association with infantile pyloric stenosis
No reticulocyte vs high reticulocyte
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
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. target cell
Female - breech delivery - family history; tx referral to ortho
Prolactinoma
Rapid detection of RSV antigen in nasl
T for t ; thalassemia; inc serum iron and Iron binding