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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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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. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Central isosexual precocious puberty; hypothalmaic hamartoma

2. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Foreign body sensation - photophobia - corneal opacity tx abx
<2yrs - abd pain - diarrhoea - ARF
No reticulocyte vs high reticulocyte
No myoclonic activity in JME

3. When erythema chronicum migrans develops after tick bite
24-72 hours
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

4. sturge weber syndrome
1.5%
Between pregnenolone and 17oh pregnenolone
Facial portwine stain
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

5. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No myoclonic activity in JME
Pho for forward bending; forward defect; common finding has no adverse physical effect
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

6. most common complication of otitis media
Lateral neck xray in epiglottitis show swollen epiglottis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

7. How long anti-TB drugs given for TB meningitis?
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Black
Endocardial cushion defect (no separation between heart chambers)
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

8. microcytic - hypochromic anemia - hepatospelnomegaly
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Thalassemia - congenital hemolytic anemia
>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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

9. 18mo bilat breast enlargment - some pubic hair
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Benign permature thelarche; expectant management
Atypical lymphocyte

10. When to bevioral and enviromental measure in led intoxication?
Bladder dysfunction; UTI and renal dysfunctoin
Increase of pregnenolone
Candidal diapar rash; tx clotrimazol
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

11. duodenal atresia
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
D for d; down syndrome and polyhydramnios
ALL - alzheimers autism adhd depression seizure
Atopic dermatitis; strong allergic/immunologic component; incr IgE

12. red oozing rash on cheek - scaly - dry
1.5%
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Atopic dermatitis; strong allergic/immunologic component; incr IgE
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

13. 21 hydroxylase
T for t ; thalassemia; inc serum iron and Iron binding
Increase of progesteron/17oh progesterone
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Injury to b/l glossopharyngeal. present in botulism

14. How to dx endopthalmitis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Yes; but it will be less effective
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

15. contact lens keratitis
No reticulocyte vs high reticulocyte
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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

16. How to dx keratitis?
D for d; down syndrome and polyhydramnios
To make hip flexed and abducted position in DDH
Foreign body sensation - photophobia - corneal opacity tx abx
Marfans - ehlers danlos - homocystinuria

17. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Central isosexual precocious puberty; hypothalmaic hamartoma
No myoclonic activity in JME

18. is local anesthetics be used in cellulitis to reduce pain
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Absence seizure; tx ethosuximide
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

19. lens dislocation
14yrs
Marfans - ehlers danlos - homocystinuria
Tx only symptomatic carrier
Candidal diapar rash; tx clotrimazol

20. 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
Decreases height - expensive; reserved for severe cases of delayed puberty
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Risk of neurological dysfunction

21. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
ALL - alzheimers autism adhd depression seizure
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

22. How to differentiate caput succedanueum and cephalohematoma
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Constitutional pubertal delay
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

23. infant botulism
Multiple telangiectesia - vasular lesion in CNS
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

24. When to do surgery for undescended testes
Wait until 6 months
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Imaging study to r/o VUR

25. 3yo - febrile - left hip externally rotated
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Endocardial cushion defect (no separation between heart chambers)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

26. Febrile seizure
No intervention; 90% foreign bodies pass without difficulty
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Female - breech delivery - family history; tx referral to ortho
Less than 5th percentile

27. crying during urination. bacteriuria pyruria - rec episodes
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Imaging study to r/o VUR
Endocardial cushion defect (no separation between heart chambers)

28. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Dactylitis; 2nd common is splenic seqestration
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Erb paralysis leading to diaphragmatic paralysis

29. What is earliest sign of puberty?
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Female - breech delivery - family history; tx referral to ortho
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

30. Tx of FTT
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Foreign body sensation - photophobia - corneal opacity tx abx
Pipercillin (zosyn) - ticarcillin
Diet modification to provide 110kc/kg/d

31. decreased mobility of tympanic membrane after otitis media
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
>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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
After 24h of abx therapy

32. tick transmits RMSF
Atypical lymphocyte
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Black
TB - breastfeeding - asymptomatic hiv

33. centor criteria for bact pharyngitis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
No intervention; 90% foreign bodies pass without difficulty
Diet modification to provide 110kc/kg/d
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

34. dx for turner
Rapid detection of RSV antigen in nasl
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
HSP - look for symmetric skin lesions
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

35. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Between pregnenolone and 17oh pregnenolone
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

36. osler rendu weber syndrom
Female - breech delivery - family history; tx referral to ortho
Multiple telangiectesia - vasular lesion in CNS
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
Dx US tx; correct serum electrolyte - pyloromyotom

37. language delay
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Increase of pregnenolone

38. IM
ALL - alzheimers autism adhd depression seizure
Herpes
Atypical lymphocyte
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

39. difference between diaper dermatitis and rash
Bartonella henselae; complication is suppuration of lymph node
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
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
Tx only symptomatic carrier

40. down syndrome has inreased risk of developing
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
ALL - alzheimers autism adhd depression seizure
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Decreased UGT enzyme

41. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
If aortic root reaches 45 mm
Do HIV testing at first
Candidal diapar rash; tx clotrimazol
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

42. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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
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)
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

43. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Wait until 6 months
Bladder dysfunction; UTI and renal dysfunctoin

44. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Fifth disease; febrile syndrome
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

45. What are the risk factors of developmental dysplais of hip
Lateral neck xray in epiglottitis show swollen epiglottis
Female - breech delivery - family history; tx referral to ortho
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No myoclonic activity in JME

46. contraindications of MMR vaccine
Do HIV testing at first
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Increase of pregnenolone
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

47. pumonary TB
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
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)
Thalassemia - congenital hemolytic anemia

48. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Neurofibromatosis type2
Herpes

49. how smoking contributes otitis media in children
Less than 5th percentile
D for d; down syndrome and polyhydramnios
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

50. How to dx acute angle closure glaucoma
Bladder dysfunction; UTI and renal dysfunctoin
Marfans - ehlers danlos - homocystinuria
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

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USMLE Step3 Pediatrics

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