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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. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Constitutional pubertal delay
Faciform RBC cause vascular occlusion

2. contraindications of DTap
Wait until 6 months
URI
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

3. lead >70
Tx only symptomatic carrier
Medical emergency; dimercaprol/edta
Candidal diapar rash; tx clotrimazol
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

4. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
RSV - rhino and influenza
Do HIV testing at first
Meconeum ileus; think about CF
Lateral neck xray in epiglottitis show swollen epiglottis

5. What is the calorie requirement of newborn?
110 kcl/kg/day
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Diet modification to provide 110kc/kg/d

6. sudden onset of fever - difficulty in breathing
Dx US tx; correct serum electrolyte - pyloromyotom
D for d; down syndrome and polyhydramnios
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Absence seizure; tx ethosuximide

7. echymoses with low platelet <30k
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
110 kcl/kg/day
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

8. Tx of bact conjunctivitis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
Decreases height - expensive; reserved for severe cases of delayed puberty
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

9. infantile hypertrophic pyloric stenosis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Dx US tx; correct serum electrolyte - pyloromyotom
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
14yrs

10. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Black
Croup tx cool mist; racemic epi - corticosteroid

11. When to bevioral and enviromental measure in led intoxication?
Decreased UGT enzyme
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Neurofibromatosis type2
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

12. Neonatal conjugated hyperbilirubinemia
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Biliary atresia; tx surgery
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

13. Tx of FTT
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Diet modification to provide 110kc/kg/d
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

14. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Multiple telangiectesia - vasular lesion in CNS
Croup tx cool mist; racemic epi - corticosteroid
D for d; down syndrome and polyhydramnios
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

15. difference between breast milk and breafeeding jaundice
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Develops in 21 dasy
Thalassemia - congenital hemolytic anemia
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

16. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
After 6m; breast mild provides iron until 6m.
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
110 kcl/kg/day

17. Parvovirus
Bartonella henselae; complication is suppuration of lymph node
Tx only symptomatic carrier
Neurofibromatosis type2
Fifth disease; febrile syndrome

18. if bone age lower than actual and puberty delayed
Marfans - ehlers danlos - homocystinuria
ALL - alzheimers autism adhd depression seizure
Constitutional pubertal delay
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

19. indications of audiometry in childrens
Less than 5th percentile
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
TB - breastfeeding - asymptomatic hiv

20. starring spells 10-20sec
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
14yrs
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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

21. complete airway obstruction with FB
>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
Thalassemia - congenital hemolytic anemia
Meconeum ileus; think about CF
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

22. Infant with serum billlirubin >25
Strep pneumonie; moraxella; h influenze
Risk of neurological dysfunction
refuse
>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

23. deficinecy of 17 hydroxylase
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Foreign body sensation - photophobia - corneal opacity tx abx
Increase of pregnenolone

24. IM
Pipercillin (zosyn) - ticarcillin
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
24-72 hours
Atypical lymphocyte

25. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Central isosexual precocious puberty; hypothalmaic hamartoma
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

26. What is earliest sign of puberty?
Decreases height - expensive; reserved for severe cases of delayed puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
36 hours
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

27. difference between structural disorder and flexible kyphosis
RSV - rhino and influenza
Decreases height - expensive; reserved for severe cases of delayed puberty
After 6m; breast mild provides iron until 6m.
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

28. How to evaluate well appearing child just born in GBS pos mother?
Injury to lower roots of brachial plexus
Marfans - ehlers danlos - homocystinuria
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

29. How long patient needs to be exposed to tick to get infected
Dactylitis; 2nd common is splenic seqestration
36 hours
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

30. 3yo - never able to walk
Pipercillin (zosyn) - ticarcillin
HSP - look for symmetric skin lesions
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

31. impaired gag reflex
Marfans - ehlers danlos - homocystinuria
Erb paralysis leading to diaphragmatic paralysis
Injury to b/l glossopharyngeal. present in botulism
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

32. red oozing rash on cheek - scaly - dry
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
T for t ; thalassemia; inc serum iron and Iron binding
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Atopic dermatitis; strong allergic/immunologic component; incr IgE

33. HUS
<2yrs - abd pain - diarrhoea - ARF
After 24h of abx therapy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Croup tx cool mist; racemic epi - corticosteroid

34. language delay
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Lateral neck xray in epiglottitis show swollen epiglottis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

35. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Constitutional pubertal delay
<2yrs - abd pain - diarrhoea - ARF
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

36. flexible kyphosis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Pho for forward bending; forward defect; common finding has no adverse physical effect
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Injury to b/l glossopharyngeal. present in botulism

37. iron supplement in child
Constitutional pubertal delay
Increase of pregnenolone
Absence seizure; tx ethosuximide
After 6m; breast mild provides iron until 6m.

38. When to give hpv vaccien
Croup tx cool mist; racemic epi - corticosteroid
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
Bartonella henselae; complication is suppuration of lymph node
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

39. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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

40. pavlik harness
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
No wheezing - no feever in chlamydia
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
To make hip flexed and abducted position in DDH

41. acute otitis media-pathogen
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Strep pneumonie; moraxella; h influenze
Endocardial cushion defect (no separation between heart chambers)

42. pumonary TB
Meconeum ileus; think about CF
Dx US tx; correct serum electrolyte - pyloromyotom
Medical emergency; dimercaprol/edta
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)

43. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
No; they are basic compound will be neutralized in an acidic environment of cellulitis
24h to 7d of birth

44. duodenal atresia
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Female - breech delivery - family history; tx referral to ortho
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
D for d; down syndrome and polyhydramnios

45. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

46. How to differentiate croup vs epiglotitis
After 6m; breast mild provides iron until 6m.
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Rapid detection of RSV antigen in nasl

47. failure to thrive
Less than 5th percentile
refuse
If aortic root reaches 45 mm
>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

48. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Central isosexual precocious puberty; hypothalmaic hamartoma
Fifth disease; febrile syndrome
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

49. low grade fever - cough - diffuse bilat ground glass opacities
Benign permature thelarche; expectant management
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
36 hours

50. When erythema chronicum migrans develops after tick bite
Decreased UGT enzyme
Endocardial cushion defect (no separation between heart chambers)
refuse
24-72 hours