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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. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
>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

2. difference between rubeola (measles) and rulbella
Risk of neurological dysfunction
Oral DMSA or EDTA IV
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Yes; but it will be less effective

3. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
D for d; down syndrome and polyhydramnios
Bladder dysfunction; UTI and renal dysfunctoin
Imaging study to r/o VUR

4. Parvovirus
Constitutional pubertal delay
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Congenital rubella syndrome
Fifth disease; febrile syndrome

5. acute otitis media-pathogen
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Vaso-occlusive crisis; dx hb electrophoresis
Strep pneumonie; moraxella; h influenze
Constitutional pubertal delay

6. 18mo bilat breast enlargment - some pubic hair
Increase of pregnenolone
Benign permature thelarche; expectant management
36 hours
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

7. benefits of antibiotic therapy in acute pharyngitis?
1.5%
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

8. 3yo - febrile - left hip externally rotated
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
36 hours
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

9. complication of lumbosacral meningocele
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
36 hours
Bladder dysfunction; UTI and renal dysfunctoin
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

10. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Congenital rubella syndrome

11. What is earliest sign of puberty?
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Injury to b/l glossopharyngeal. present in botulism
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
36 hours

12. lens dislocation
<2yrs - abd pain - diarrhoea - ARF
Marfans - ehlers danlos - homocystinuria
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

13. starring spells 10-20sec
Between pregnenolone and 17oh pregnenolone
Neurofibromatosis type2
refuse
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

14. How to differentiate caput succedanueum and cephalohematoma
Increase of progesteron/17oh progesterone
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
After 24h of abx therapy
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

15. penicillin effective against pseudomonas
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Erb paralysis leading to diaphragmatic paralysis
Pipercillin (zosyn) - ticarcillin
No reticulocyte vs high reticulocyte

16. 17 alpha hydroxylase
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Risk of neurological dysfunction
Between pregnenolone and 17oh pregnenolone

17. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Dx US tx; correct serum electrolyte - pyloromyotom
Candidal diapar rash; tx clotrimazol
D for d; down syndrome and polyhydramnios

18. IM
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Herpes
Brown
Atypical lymphocyte

19. difference between diaper dermatitis and rash
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Brown
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
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

20. tuberous sclerosis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

21. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

22. the recommended ca supplementation
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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

23. patient with white plaques in mouth and lump in back
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Do HIV testing at first
24h to 7d of birth
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

24. duodenal atresia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
D for d; down syndrome and polyhydramnios
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

25. down syndrome has inreased risk of developing
Risk of neurological dysfunction
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
ALL - alzheimers autism adhd depression seizure
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

26. mcCune albright`
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
No intervention; 90% foreign bodies pass without difficulty
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
24-72 hours

27. contact lens keratitis
Brown
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
24-72 hours

28. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Herpes
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

29. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Dx US tx; correct serum electrolyte - pyloromyotom
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

30. How to differential bact vs viral conjunctivitis
URI
Do HIV testing at first
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
Decr calorie intake; decr calorie absorption;incr calorie demand

31. cleft lip but no cleft palate
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Pho for forward bending; forward defect; common finding has no adverse physical effect

32. pumonary TB
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Bartonella henselae; complication is suppuration of lymph node
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)
14yrs

33. Infant with serum billlirubin >25
110 kcl/kg/day
D for d; down syndrome and polyhydramnios
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Risk of neurological dysfunction

34. down syndrome with holocystolic mumur
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Endocardial cushion defect (no separation between heart chambers)
Croup

35. sublottic narrowing
>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
Croup tx cool mist; racemic epi - corticosteroid
D for d; down syndrome and polyhydramnios
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

36. When to give hpv vaccien
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE

37. physiological jaundice
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
Diet modification to provide 110kc/kg/d
24h to 7d of birth
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

38. red oozing rash on cheek - scaly - dry
Black
Croup tx cool mist; racemic epi - corticosteroid
Pho for forward bending; forward defect; common finding has no adverse physical effect
Atopic dermatitis; strong allergic/immunologic component; incr IgE

39. What is thumbprint sign
Pipercillin (zosyn) - ticarcillin
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)
Lateral neck xray in epiglottitis show swollen epiglottis

40. aplasic crisis
24-72 hours
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
refuse
TB - breastfeeding - asymptomatic hiv

41. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Fifth disease; febrile syndrome
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

42. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Central isosexual precocious puberty; hypothalmaic hamartoma

43. adenovirus
Faciform RBC cause vascular occlusion
URI
Pho for forward bending; forward defect; common finding has no adverse physical effect
Dx US tx; correct serum electrolyte - pyloromyotom

44. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Marfans - ehlers danlos - homocystinuria
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
Methylephenidate toxicity; cannot be stopped abruptly; taper

45. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Croup

46. association with infantile pyloric stenosis
24-72 hours
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Wait until 6 months
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

47. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Pipercillin (zosyn) - ticarcillin

48. causes of FTT
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Risk of neurological dysfunction
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Decreased UGT enzyme

49. Tx of FTT
TB - breastfeeding - asymptomatic hiv
Dactylitis; 2nd common is splenic seqestration
Brown
Diet modification to provide 110kc/kg/d

50. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
HSP - look for symmetric skin lesions
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

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USMLE Step3 Pediatrics

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