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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. tick transmits lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Benign permature thelarche; expectant management
Brown
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

2. is local anesthetics be used in cellulitis to reduce pain
Brown
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

3. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Prolactinoma
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

4. Tx of community acquired pneumonia
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
RSV - rhino and influenza

5. major depression
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

6. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Injury to lower roots of brachial plexus
Penicillin G 4h before delivery

7. Tx of bact conjunctivitis
Dactylitis; 2nd common is splenic seqestration
Yes; but it will be less effective
Brown
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

8. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Endocardial cushion defect (no separation between heart chambers)
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
Thalassemia - congenital hemolytic anemia

9. Parents can _____ vaccine
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
refuse

10. How to dx RSV
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Female - breech delivery - family history; tx referral to ortho
Lateral neck xray in epiglottitis show swollen epiglottis
Rapid detection of RSV antigen in nasl

11. 3yo - febrile - left hip externally rotated
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Rapid detection of RSV antigen in nasl
Between pregnenolone and 17oh pregnenolone

12. How to difference RSV and neonatal chlamydia
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
No wheezing - no feever in chlamydia
Increase of pregnenolone

13. indications of VUR
If aortic root reaches 45 mm
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

14. duodenal atresia
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Vaso-occlusive crisis; dx hb electrophoresis
D for d; down syndrome and polyhydramnios
Candidal diapar rash; tx clotrimazol

15. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Risk of neurological dysfunction
After 6m; breast mild provides iron until 6m.

16. contraindications of DTap
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)
Endocardial cushion defect (no separation between heart chambers)
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

17. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Erb paralysis leading to diaphragmatic paralysis
Increase of progesteron/17oh progesterone
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

18. down syndrome has inreased risk of developing
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
ALL - alzheimers autism adhd depression seizure
Herpes
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

19. 18mo bilat breast enlargment - some pubic hair
ALL - alzheimers autism adhd depression seizure
Benign permature thelarche; expectant management
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

20. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Atopic dermatitis; strong allergic/immunologic component; incr IgE
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

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

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22. failure to thrive
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Croup
Less than 5th percentile
Mainly clinical; serology with initial ELISA - with western blot confirmation;

23. 3yo - never able to walk
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
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

24. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
1.5%
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
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

25. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
To make hip flexed and abducted position in DDH
Tx only symptomatic carrier
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

26. Infant with serum billlirubin >25
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Risk of neurological dysfunction
URI

27. thumb sign
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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Injury to b/l glossopharyngeal. present in botulism
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

28. giardiasis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Tx only symptomatic carrier
Fifth disease; febrile syndrome
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

29. sublottic narrowing
36 hours
Croup tx cool mist; racemic epi - corticosteroid
Less than 5th percentile
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

30. spitting up - vomiting at night - weight stable
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

31. How to differentiate caput succedanueum and cephalohematoma
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
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
>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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

32. decreased mobility of tympanic membrane after otitis media
Brown
1.5%
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

33. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Endocardial cushion defect (no separation between heart chambers)

34. bromocriptine
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Oral DMSA or EDTA IV
Prolactinoma

35. side effect of testosteron therapy
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
No reticulocyte vs high reticulocyte
Decreases height - expensive; reserved for severe cases of delayed puberty
Neurofibromatosis type2

36. When to bevioral and enviromental measure in led intoxication?
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Croup
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

37. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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)

38. How to differentiate croup vs epiglotitis
Rapid detection of RSV antigen in nasl
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
36 hours
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

39. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
RSV - rhino and influenza
Risk of neurological dysfunction
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

40. difference between breast milk and breafeeding jaundice
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
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Mainly clinical; serology with initial ELISA - with western blot confirmation;
If aortic root reaches 45 mm

41. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
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
14yrs
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Central isosexual precocious puberty; hypothalmaic hamartoma

42. tick transmits RMSF
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Black
No myoclonic activity in JME

43. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
No myoclonic activity in JME
Facial portwine stain
Constitutional pubertal delay

44. How long patient needs to be exposed to tick to get infected
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
36 hours
Increase of pregnenolone
Foreign body sensation - photophobia - corneal opacity tx abx

45. When erythema chronicum migrans develops after tick bite
Vaso-occlusive crisis; dx hb electrophoresis
Decreased UGT enzyme
24-72 hours
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

46. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Increase of progesteron/17oh progesterone
No myoclonic activity in JME
Prolactinoma
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

47. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
24h to 7d of birth
Absence seizure; tx ethosuximide
Faciform RBC cause vascular occlusion

48. microcytic - hypochromic anemia - hepatospelnomegaly
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Thalassemia - congenital hemolytic anemia
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Less than 5th percentile

49. association with infantile pyloric stenosis
Pipercillin (zosyn) - ticarcillin
Risk of neurological dysfunction
Herpes
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

50. pavlik harness
To make hip flexed and abducted position in DDH
>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
No intervention; 90% foreign bodies pass without difficulty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality