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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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1. infantile hypertrophic pyloric stenosis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
To make hip flexed and abducted position in DDH
Dx US tx; correct serum electrolyte - pyloromyotom
Fifth disease; febrile syndrome

2. How to dx post uretheral valve
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Strep pneumonie; moraxella; h influenze
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

3. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Faciform RBC cause vascular occlusion
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

4. Parents can _____ vaccine
refuse
No reticulocyte vs high reticulocyte
Tx only symptomatic carrier
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

5. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Methylephenidate toxicity; cannot be stopped abruptly; taper
24h to 7d of birth
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

6. cat scratch disease
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Bartonella henselae; complication is suppuration of lymph node
Atypical lymphocyte
1.5%

7. when bact conjunctivitis patient can go back to school
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
To make hip flexed and abducted position in DDH
After 24h of abx therapy
Dactylitis; 2nd common is splenic seqestration

8. tuberous sclerosis
Increase of pregnenolone
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Croup
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

9. pneumonia in CF patient
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
110 kcl/kg/day

10. Parvovirus
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Fifth disease; febrile syndrome
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

11. Tx of bact conjunctivitis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Marfans - ehlers danlos - homocystinuria
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

12. difference between breast milk and breafeeding jaundice
HSP - look for symmetric skin lesions
Medical emergency; dimercaprol/edta
Risk of neurological dysfunction
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

13. echymoses with low platelet <30k
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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Decreased UGT enzyme
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

14. benefits of antibiotic therapy in acute pharyngitis?
Thalassemia - congenital hemolytic anemia
Multiple telangiectesia - vasular lesion in CNS
Pipercillin (zosyn) - ticarcillin
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

15. How to investigate delayed puberty
Medical emergency; dimercaprol/edta
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
Pipercillin (zosyn) - ticarcillin
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

16. How to difference viral and bact pneumonia
Medical emergency; dimercaprol/edta
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

17. How to dx RSV
Rapid detection of RSV antigen in nasl
If aortic root reaches 45 mm
Develops in 21 dasy
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

18. contact lens keratitis
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
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
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

19. iron supplement in child
Strep pneumonie; moraxella; h influenze
1.5%
Pipercillin (zosyn) - ticarcillin
After 6m; breast mild provides iron until 6m.

20. dx for DDH
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Biliary atresia; tx surgery
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
TB - breastfeeding - asymptomatic hiv

21. Infant with serum billlirubin >25
After 24h of abx therapy
URI
Risk of neurological dysfunction
No myoclonic activity in JME

22. aplasic crisis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Decreased UGT enzyme
HSP - look for symmetric skin lesions

23. What is the calorie requirement of newborn?
36 hours
110 kcl/kg/day
Risk of neurological dysfunction
Diet modification to provide 110kc/kg/d

24. flexible kyphosis
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
Medical emergency; dimercaprol/edta
Dactylitis; 2nd common is splenic seqestration
Pho for forward bending; forward defect; common finding has no adverse physical effect

25. 12y - obese - hip pain - hip ext rotated
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
Mainly clinical; serology with initial ELISA - with western blot confirmation;
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Strep pneumonie; moraxella; h influenze

26. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Injury to lower roots of brachial plexus
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

27. What is thumbprint sign
Pipercillin (zosyn) - ticarcillin
Medical emergency; dimercaprol/edta
Lateral neck xray in epiglottitis show swollen epiglottis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

28. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Multiple telangiectesia - vasular lesion in CNS
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

29. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Central isosexual precocious puberty; hypothalmaic hamartoma
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Decr calorie intake; decr calorie absorption;incr calorie demand
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

30. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
110 kcl/kg/day
Erb paralysis leading to diaphragmatic paralysis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

31. side effect of testosteron therapy
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Decreases height - expensive; reserved for severe cases of delayed puberty
Endocardial cushion defect (no separation between heart chambers)
Facial portwine stain

32. When to bevioral and enviromental measure in led intoxication?
Diet modification to provide 110kc/kg/d
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

33. what conditions are not contraindicated
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Imaging study to r/o VUR
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
TB - breastfeeding - asymptomatic hiv

34. physiological jaundice
Benign permature thelarche; expectant management
24h to 7d of birth
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Congenital rubella syndrome

35. the recommended ca supplementation
No intervention; 90% foreign bodies pass without difficulty
14yrs
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
1.5%

36. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Medical emergency; dimercaprol/edta

37. down syndrome has inreased risk of developing
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
ALL - alzheimers autism adhd depression seizure

38. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Penicillin G 4h before delivery
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

39. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Decreases height - expensive; reserved for severe cases of delayed puberty
Meconeum ileus; think about CF
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Penicillin G 4h before delivery

40. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
T for t ; thalassemia; inc serum iron and Iron binding
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Vaso-occlusive crisis; dx hb electrophoresis

41. defcicieny of 21 hydroxylase
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Decreased UGT enzyme
Increase of progesteron/17oh progesterone
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

42. down syndrome with holocystolic mumur
After 6m; breast mild provides iron until 6m.
Endocardial cushion defect (no separation between heart chambers)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

43. adrenal tumor
Pipercillin (zosyn) - ticarcillin
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
36 hours

44. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Increase of progesteron/17oh progesterone
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

45. 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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
1.5%
INH 9m if INH resistant rifampin 6m in children and 4m in adults

46. sturge weber syndrome
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
After 24h of abx therapy
Facial portwine stain
Vaso-occlusive crisis; dx hb electrophoresis

47. TTP pentad
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
After 6m; breast mild provides iron until 6m.
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

48. How long patient needs to be exposed to tick to get infected
36 hours
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

49. lead >70
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Prolactinoma
Medical emergency; dimercaprol/edta
110 kcl/kg/day

50. complete airway obstruction with FB
Candidal diapar rash; tx clotrimazol
>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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Do HIV testing at first

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USMLE Step3 Pediatrics

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