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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. How to difference viral and bact pneumonia
Croup
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

2. complete airway obstruction with FB
Penicillin G 4h before delivery
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
>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

3. horner syndrom
TB - breastfeeding - asymptomatic hiv
URI
Injury to lower roots of brachial plexus
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

4. difference between rubeola (measles) and rulbella
Erb paralysis leading to diaphragmatic paralysis
Yes; but it will be less effective
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

5. 18mo bilat breast enlargment - some pubic hair
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Herpes
Absence seizure; tx ethosuximide
Benign permature thelarche; expectant management

6. acute otitis externa

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7. iron supplement in child
After 6m; breast mild provides iron until 6m.
URI
24h to 7d of birth
No reticulocyte vs high reticulocyte

8. spitting up - vomiting at night - weight stable
Dactylitis; 2nd common is splenic seqestration
Congenital rubella syndrome
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
To make hip flexed and abducted position in DDH

9. patient with white plaques in mouth and lump in back
Croup tx cool mist; racemic epi - corticosteroid
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Do HIV testing at first
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

10. centor criteria for bact pharyngitis
Multiple telangiectesia - vasular lesion in CNS
Vaso-occlusive crisis; dx hb electrophoresis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

11. side effect of testosteron therapy
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Decreases height - expensive; reserved for severe cases of delayed puberty
Bladder dysfunction; UTI and renal dysfunctoin
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

12. Tx of FTT
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Diet modification to provide 110kc/kg/d
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Endocardial cushion defect (no separation between heart chambers)

13. giardiasis
Tx only symptomatic carrier
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Wait until 6 months
Congenital rubella syndrome

14. causes of FTT
Dactylitis; 2nd common is splenic seqestration
Tx only symptomatic carrier
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

15. When to bevioral and enviromental measure in led intoxication?
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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. pumonary TB
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)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
24h to 7d of birth
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

17. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

18. Tx of children constipation

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19. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Marfans - ehlers danlos - homocystinuria
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

20. dx for turner
Tx only symptomatic carrier
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Lateral neck xray in epiglottitis show swollen epiglottis

21. the recommended ca supplementation
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Neurofibromatosis type2
Congenital rubella syndrome
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

22. How to differential bact vs viral conjunctivitis
Croup
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

23. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
No wheezing - no feever in chlamydia
Croup
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

24. lead >70
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Medical emergency; dimercaprol/edta

25. down syndrome has inreased risk of developing
Atopic dermatitis; strong allergic/immunologic component; incr IgE
ALL - alzheimers autism adhd depression seizure
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Methylephenidate toxicity; cannot be stopped abruptly; taper

26. How to dx acute angle closure glaucoma
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

27. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Dx US tx; correct serum electrolyte - pyloromyotom
Candidal diapar rash; tx clotrimazol
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

28. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Faciform RBC cause vascular occlusion
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Black

29. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Meconeum ileus; think about CF
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

30. penicillin effective against pseudomonas
RSV - rhino and influenza
Pipercillin (zosyn) - ticarcillin
36 hours
Neurofibromatosis type2

31. tuberous sclerosis
Increase of pregnenolone
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

32. microcytic - hypochromic anemia - hepatospelnomegaly
Lateral neck xray in epiglottitis show swollen epiglottis
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
Thalassemia - congenital hemolytic anemia
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

33. How to dx RSV
Decr calorie intake; decr calorie absorption;incr calorie demand
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Rapid detection of RSV antigen in nasl
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

34. When to give hpv vaccien
Brown
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
14yrs
Decr calorie intake; decr calorie absorption;incr calorie demand

35. lens dislocation
Oral DMSA or EDTA IV
36 hours
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
Marfans - ehlers danlos - homocystinuria

36. How long anti-TB drugs given for TB meningitis?
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Decreased UGT enzyme
To make hip flexed and abducted position in DDH

37. tick transmits RMSF
T for t ; thalassemia; inc serum iron and Iron binding
Black
24-72 hours
Decreases height - expensive; reserved for severe cases of delayed puberty

38. When erythema chronicum migrans develops after tick bite
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Endocardial cushion defect (no separation between heart chambers)
24-72 hours
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

39. can women with abnormal smear or genital get vaccine
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
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
Yes; but it will be less effective
No; they are basic compound will be neutralized in an acidic environment of cellulitis

40. Neonatal unconjugated hyperbilirubine
URI
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Decreased UGT enzyme
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

41. aplasic crisis
Pipercillin (zosyn) - ticarcillin
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

42. causes of FTT
Strep pneumonie; moraxella; h influenze
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Decr calorie intake; decr calorie absorption;incr calorie demand
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

43. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
T for t ; thalassemia; inc serum iron and Iron binding
No intervention; 90% foreign bodies pass without difficulty
To make hip flexed and abducted position in DDH

44. association with infantile pyloric stenosis
Medical emergency; dimercaprol/edta
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
<2yrs - abd pain - diarrhoea - ARF

45. dx for DDH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

46. Parvovirus
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Increase of progesteron/17oh progesterone
Fifth disease; febrile syndrome
Central isosexual precocious puberty; hypothalmaic hamartoma

47. TTP pentad
To make hip flexed and abducted position in DDH
refuse
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
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

48. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Faciform RBC cause vascular occlusion
Absence seizure; tx ethosuximide
No intervention; 90% foreign bodies pass without difficulty

49. Infant with serum billlirubin >25
URI
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Risk of neurological dysfunction
Candidal diapar rash; tx clotrimazol

50. tzanck
Facial portwine stain
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Herpes
Do HIV testing at first