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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.
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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. Neonatal unconjugated hyperbilirubine
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Decreased UGT enzyme
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Strep pneumonie; moraxella; h influenze

2. What is the most common initial symptom in sickle cell
URI
Dactylitis; 2nd common is splenic seqestration
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
If aortic root reaches 45 mm

3. causes of acute anemia
36 hours
Decreased UGT enzyme
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

4. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Increase of pregnenolone
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Benign permature thelarche; expectant management

5. lead >70
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Medical emergency; dimercaprol/edta

6. How to differentiate croup vs epiglotitis
Between pregnenolone and 17oh pregnenolone
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Penicillin G 4h before delivery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

7. How to prevent GBS in neonate
Penicillin G 4h before delivery
ALL - alzheimers autism adhd depression seizure
Biliary atresia; tx surgery
24-72 hours

8. 12y - obese - hip pain - hip ext rotated
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Methylephenidate toxicity; cannot be stopped abruptly; taper
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Congenital rubella syndrome

9. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Imaging study to r/o VUR
Bladder dysfunction; UTI and renal dysfunctoin

10. adrenal tumor
Diet modification to provide 110kc/kg/d
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

11. How to difference viral and bact pneumonia
Neurofibromatosis type2
36 hours
No wheezing - no feever in chlamydia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

12. down syndrome with holocystolic mumur
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Endocardial cushion defect (no separation between heart chambers)
RSV - rhino and influenza

13. indications of audiometry in childrens
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

14. bromocriptine
Medical emergency; dimercaprol/edta
Rapid detection of RSV antigen in nasl
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Prolactinoma

15. 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)
Prolactinoma
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

16. How to evaluate well appearing child just born in GBS pos mother?
Penicillin G 4h before delivery
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
URI
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

17. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Develops in 21 dasy
Lateral neck xray in epiglottitis show swollen epiglottis
Erb paralysis leading to diaphragmatic paralysis

18. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
24h to 7d of birth
HSP - look for symmetric skin lesions
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

19. IM
Faciform RBC cause vascular occlusion
Atypical lymphocyte
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

20. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Bladder dysfunction; UTI and renal dysfunctoin
Increase of pregnenolone
TB - breastfeeding - asymptomatic hiv

21. sudden onset of fever - difficulty in breathing
Lateral neck xray in epiglottitis show swollen epiglottis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Female - breech delivery - family history; tx referral to ortho
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

22. complication of lumbosacral meningocele
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
Bladder dysfunction; UTI and renal dysfunctoin
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
Croup

23. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Bartonella henselae; complication is suppuration of lymph node

24. dx for DDH
Pho for forward bending; forward defect; common finding has no adverse physical effect
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

25. causes of FTT
Brown
Decr calorie intake; decr calorie absorption;incr calorie demand
Croup
Develops in 21 dasy

26. How to dx endopthalmitis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
No wheezing - no feever in chlamydia
110 kcl/kg/day

27. differentiate between central and peripheral precocious puberty
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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)

28. contact lens keratitis
Prolactinoma
Candidal diapar rash; tx clotrimazol
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

29. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Decr calorie intake; decr calorie absorption;incr calorie demand
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Candidal diapar rash; tx clotrimazol

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

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31. Neonatal conjugated hyperbilirubinemia
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
Risk of neurological dysfunction
HSP - look for symmetric skin lesions
Biliary atresia; tx surgery

32. Nocturnal enuresis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Wait until 6 months
No reticulocyte vs high reticulocyte
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

33. When erythema chronicum migrans develops after tick bite
Medical emergency; dimercaprol/edta
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
24-72 hours
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

34. difference between breast milk and breafeeding jaundice
Pipercillin (zosyn) - ticarcillin
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
No wheezing - no feever in chlamydia
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

35. low grade fever - cough - diffuse bilat ground glass opacities
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Do HIV testing at first

36. osler rendu weber syndrom
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Multiple telangiectesia - vasular lesion in CNS
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

37. iron supplement in child
After 6m; breast mild provides iron until 6m.
ALL - alzheimers autism adhd depression seizure
1.5%
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

38. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Absence seizure; tx ethosuximide
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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

39. viruses cause bronhioltitis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
RSV - rhino and influenza

40. How long anti-TB drugs given for TB meningitis?
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Marfans - ehlers danlos - homocystinuria
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

41. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Diet modification to provide 110kc/kg/d
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

42. complete airway obstruction with FB
>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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Less than 5th percentile
Dx US tx; correct serum electrolyte - pyloromyotom

43. the recommended ca supplementation
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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

44. Parents can _____ vaccine
Central isosexual precocious puberty; hypothalmaic hamartoma
refuse
Atypical lymphocyte
Decreases height - expensive; reserved for severe cases of delayed puberty

45. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Herpes
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Oral DMSA or EDTA IV

46. what conditions are not contraindicated
Thalassemia - congenital hemolytic anemia
TB - breastfeeding - asymptomatic hiv
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

47. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
24h to 7d of birth
Brown
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

48. acute otitis externa

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49. coin in child's stomach
Vaso-occlusive crisis; dx hb electrophoresis
Injury to lower roots of brachial plexus
No intervention; 90% foreign bodies pass without difficulty
Benign permature thelarche; expectant management

50. What is earliest sign of puberty?
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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

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USMLE Step3 Pediatrics

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