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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. pavlik harness
Brown
To make hip flexed and abducted position in DDH
HSP - look for symmetric skin lesions
Risk of neurological dysfunction

2. tzanck
Foreign body sensation - photophobia - corneal opacity tx abx
Do HIV testing at first
Herpes
>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. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
Herpes
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
Strep pneumonie; moraxella; h influenze

4. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Decr calorie intake; decr calorie absorption;incr calorie demand
Less than 5th percentile
Strep pneumonie; moraxella; h influenze

5. red oozing rash on cheek - scaly - dry
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

6. IM
24-72 hours
Atypical lymphocyte
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

7. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Between pregnenolone and 17oh pregnenolone
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

8. How to dx acute angle closure glaucoma
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Brown
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

9. deficinecy of 17 hydroxylase
<2yrs - abd pain - diarrhoea - ARF
Increase of pregnenolone
Diet modification to provide 110kc/kg/d
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

10. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
1.5%
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

11. cleft lip but no cleft palate
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Facial portwine stain
refuse

12. language expectation from 2yo
24h to 7d of birth
Yes; but it will be less effective
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

13. Neonatal conjugated hyperbilirubinemia
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Biliary atresia; tx surgery
Less than 5th percentile
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

14. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Candidal diapar rash; tx clotrimazol
Decr calorie intake; decr calorie absorption;incr calorie demand
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

15. Parents can _____ vaccine
Benign permature thelarche; expectant management
TB - breastfeeding - asymptomatic hiv
refuse
Medical emergency; dimercaprol/edta

16. cat scratch disease
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
Fifth disease; febrile syndrome
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

17. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Risk of neurological dysfunction
36 hours
1.5%

18. viruses cause bronhioltitis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Meconeum ileus; think about CF
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
RSV - rhino and influenza

19. iron supplement in child
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
After 6m; breast mild provides iron until 6m.
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

20. When erythema chronicum migrans develops after tick bite
Imaging study to r/o VUR
24h to 7d of birth
24-72 hours
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

21. When to do aortic root surgery in marfans to prevent dissection?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
If aortic root reaches 45 mm

22. 3yo - febrile - left hip externally rotated
Wait until 6 months
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
refuse

23. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Do HIV testing at first

24. difference between rubeola (measles) and rulbella
110 kcl/kg/day
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

25. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Strep pneumonie; moraxella; h influenze
Atypical lymphocyte
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

26. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
1.5%
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

27. HUS
<2yrs - abd pain - diarrhoea - ARF
Atypical lymphocyte
Medical emergency; dimercaprol/edta
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

28. splenic infarction in sickle cell
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Faciform RBC cause vascular occlusion
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Mainly clinical; serology with initial ELISA - with western blot confirmation;

29. How to evaluate well appearing child just born in GBS pos mother?
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Atypical lymphocyte
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

30. tick transmits RMSF
Black
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

31. microcytic - hypochromic anemia - hepatospelnomegaly
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No reticulocyte vs high reticulocyte
Thalassemia - congenital hemolytic anemia
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

32. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Rapid detection of RSV antigen in nasl
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

33. centor criteria for bact pharyngitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Pipercillin (zosyn) - ticarcillin

34. 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)
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Do HIV testing at first
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

35. down syndrome with holocystolic mumur
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
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
Endocardial cushion defect (no separation between heart chambers)

36. most common complication of otitis media
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
No wheezing - no feever in chlamydia

37. sturge weber syndrome
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Facial portwine stain
Methylephenidate toxicity; cannot be stopped abruptly; taper
Pipercillin (zosyn) - ticarcillin

38. How to dx RSV
24h to 7d of birth
Rapid detection of RSV antigen in nasl
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

39. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No intervention; 90% foreign bodies pass without difficulty
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Injury to b/l glossopharyngeal. present in botulism

40. When to do surgery for undescended testes
Wait until 6 months
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
RSV - rhino and influenza
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

41. duodenal atresia
D for d; down syndrome and polyhydramnios
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
1.5%

42. When to give hpv vaccien
Croup
Benign permature thelarche; expectant management
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

43. 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
No myoclonic activity in JME
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Absence seizure; tx ethosuximide

44. What are the risk factors of developmental dysplais of hip
Vaso-occlusive crisis; dx hb electrophoresis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Female - breech delivery - family history; tx referral to ortho
Dactylitis; 2nd common is splenic seqestration

45. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Endocardial cushion defect (no separation between heart chambers)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

46. What is the calorie requirement of newborn?
Dactylitis; 2nd common is splenic seqestration
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
110 kcl/kg/day
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

47. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Central isosexual precocious puberty; hypothalmaic hamartoma
Mainly clinical; serology with initial ELISA - with western blot confirmation;
URI

48. aplasic crisis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Risk of neurological dysfunction
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
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

49. tick transmits lyme
Brown
Absence seizure; tx ethosuximide
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

50. benefits of antibiotic therapy in acute pharyngitis?
Yes; but it will be less effective
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
After 24h of abx therapy
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications