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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. iron supplement in child
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
After 6m; breast mild provides iron until 6m.
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

2. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Bartonella henselae; complication is suppuration of lymph node
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
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

3. pumonary TB
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
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)
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

4. dx of lyme
Black
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Lateral neck xray in epiglottitis show swollen epiglottis
14yrs

5. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Croup

6. contraindications of DTap
24h to 7d of birth
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
To make hip flexed and abducted position in DDH
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

7. HUS
Candidal diapar rash; tx clotrimazol
RSV - rhino and influenza
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
<2yrs - abd pain - diarrhoea - ARF

8. lead >70
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Medical emergency; dimercaprol/edta
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

9. lens dislocation
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
Marfans - ehlers danlos - homocystinuria
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

10. adenovirus
ALL - alzheimers autism adhd depression seizure
Injury to b/l glossopharyngeal. present in botulism
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
URI

11. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
After 24h of abx therapy
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
If aortic root reaches 45 mm
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

12. adrenal tumor
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

13. IM
110 kcl/kg/day
Faciform RBC cause vascular occlusion
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
Atypical lymphocyte

14. When erythema chronicum migrans develops after tick bite
Croup tx cool mist; racemic epi - corticosteroid
24-72 hours
Vaso-occlusive crisis; dx hb electrophoresis
Atopic dermatitis; strong allergic/immunologic component; incr IgE

15. tuberous sclerosis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Dactylitis; 2nd common is splenic seqestration
URI
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

16. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
24h to 7d of birth
Prolactinoma
Methylephenidate toxicity; cannot be stopped abruptly; taper

17. Neonatal conjugated hyperbilirubinemia
Vaso-occlusive crisis; dx hb electrophoresis
Biliary atresia; tx surgery
Pho for forward bending; forward defect; common finding has no adverse physical effect
D for d; down syndrome and polyhydramnios

18. Neonatal unconjugated hyperbilirubine
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
Decreased UGT enzyme
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

19. down syndrome with holocystolic mumur
ALL - alzheimers autism adhd depression seizure
Endocardial cushion defect (no separation between heart chambers)
URI
Do HIV testing at first

20. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Endocardial cushion defect (no separation between heart chambers)
Decr calorie intake; decr calorie absorption;incr calorie demand
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

21. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
<2yrs - abd pain - diarrhoea - ARF
Risk of neurological dysfunction
Candidal diapar rash; tx clotrimazol

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

23. How to difference RSV and neonatal chlamydia
Candidal diapar rash; tx clotrimazol
No wheezing - no feever in chlamydia
Between pregnenolone and 17oh pregnenolone
Rapid detection of RSV antigen in nasl

24. decreased mobility of tympanic membrane after otitis media
1.5%
Increase of progesteron/17oh progesterone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

25. flexible kyphosis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Croup
Pho for forward bending; forward defect; common finding has no adverse physical effect
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

26. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Croup tx cool mist; racemic epi - corticosteroid
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
Penicillin G 4h before delivery
Endocardial cushion defect (no separation between heart chambers)

27. Infant with serum billlirubin >25
Risk of neurological dysfunction
Croup
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Facial portwine stain

28. acute otitis media-pathogen
Lateral neck xray in epiglottitis show swollen epiglottis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Herpes
Strep pneumonie; moraxella; h influenze

29. patient with white plaques in mouth and lump in back
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Do HIV testing at first
Neurofibromatosis type2
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

30. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Between pregnenolone and 17oh pregnenolone
Female - breech delivery - family history; tx referral to ortho
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

31. major depression
Candidal diapar rash; tx clotrimazol
No wheezing - no feever in chlamydia
Penicillin G 4h before delivery
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

32. what conditions are not contraindicated
Candidal diapar rash; tx clotrimazol
TB - breastfeeding - asymptomatic hiv
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Marfans - ehlers danlos - homocystinuria

33. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Erb paralysis leading to diaphragmatic paralysis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
36 hours

34. Parents can _____ vaccine
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
refuse

35. causes of FTT
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Decr calorie intake; decr calorie absorption;incr calorie demand
Strep pneumonie; moraxella; h influenze

36. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
24h to 7d of birth
Risk of neurological dysfunction

37. deficinecy of 17 hydroxylase
24-72 hours
Increase of pregnenolone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Thalassemia - congenital hemolytic anemia

38. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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
Wait until 6 months

39. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

40. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Pipercillin (zosyn) - ticarcillin
Strep pneumonie; moraxella; h influenze

41. osler rendu weber syndrom
Facial portwine stain
Croup
Erb paralysis leading to diaphragmatic paralysis
Multiple telangiectesia - vasular lesion in CNS

42. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
24h to 7d of birth
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

43. How to differentiate croup vs epiglotitis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
T for t ; thalassemia; inc serum iron and Iron binding
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

44. What is the calorie requirement of newborn?
Tx only symptomatic carrier
110 kcl/kg/day
<2yrs - abd pain - diarrhoea - ARF
Mainly clinical; serology with initial ELISA - with western blot confirmation;

45. side effect of testosteron therapy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
No reticulocyte vs high reticulocyte
Do HIV testing at first
Decreases height - expensive; reserved for severe cases of delayed puberty

46. When to give hpv vaccien
After 24h of abx therapy
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
Penicillin G 4h before delivery
Decreases height - expensive; reserved for severe cases of delayed puberty

47. spitting up - vomiting at night - weight stable
Between pregnenolone and 17oh pregnenolone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
RSV - rhino and influenza

48. causes of acute anemia
Female - breech delivery - family history; tx referral to ortho
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

49. How to prevent GBS in neonate
Penicillin G 4h before delivery
Develops in 21 dasy
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

50. how thalassemia die
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Risk of neurological dysfunction
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure