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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. starring spells 10-20sec
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Foreign body sensation - photophobia - corneal opacity tx abx
Bartonella henselae; complication is suppuration of lymph node

2. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No myoclonic activity in JME
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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

3. When to give hpv vaccien
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
T for t ; thalassemia; inc serum iron and Iron binding
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
1.5%

4. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
TB - breastfeeding - asymptomatic hiv
Imaging study to r/o VUR

5. when bact conjunctivitis patient can go back to school
Endocardial cushion defect (no separation between heart chambers)
Faciform RBC cause vascular occlusion
14yrs
After 24h of abx therapy

6. When to bevioral and enviromental measure in led intoxication?
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Atypical lymphocyte
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

7. 3yo - never able to walk
Do HIV testing at first
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Bartonella henselae; complication is suppuration of lymph node

8. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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
RSV - rhino and influenza
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

9. spitting up - vomiting at night - weight stable
After 6m; breast mild provides iron until 6m.
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Decreases height - expensive; reserved for severe cases of delayed puberty
Fifth disease; febrile syndrome

10. contraindications of MMR vaccine
No wheezing - no feever in chlamydia
110 kcl/kg/day
Absence seizure; tx ethosuximide
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

11. aplasic crisis
Fifth disease; febrile syndrome
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Imaging study to r/o VUR

12. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
refuse

13. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Injury to b/l glossopharyngeal. present in botulism
Yes; but it will be less effective
No wheezing - no feever in chlamydia

14. defcicieny of 21 hydroxylase
Facial portwine stain
No myoclonic activity in JME
Increase of progesteron/17oh progesterone
Injury to b/l glossopharyngeal. present in botulism

15. flexible kyphosis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Do HIV testing at first
Pho for forward bending; forward defect; common finding has no adverse physical effect
110 kcl/kg/day

16. viruses cause bronhioltitis
RSV - rhino and influenza
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Brown

17. 17 alpha hydroxylase
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Decr calorie intake; decr calorie absorption;incr calorie demand
Between pregnenolone and 17oh pregnenolone

18. Neonatal conjugated hyperbilirubinemia
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Atypical lymphocyte
Biliary atresia; tx surgery

19. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Less than 5th percentile
Brown

20. How to differentiate caput succedanueum and cephalohematoma
Foreign body sensation - photophobia - corneal opacity tx abx
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

21. tzanck
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Herpes

22. major depression
URI
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Imaging study to r/o VUR

23. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Lateral neck xray in epiglottitis show swollen epiglottis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Croup

24. adenovirus
URI
<2yrs - abd pain - diarrhoea - ARF
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

25. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Brown
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

26. When erythema chronicum migrans develops after tick bite
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Vaso-occlusive crisis; dx hb electrophoresis
After 6m; breast mild provides iron until 6m.
24-72 hours

27. When to give HRT in turner
1.5%
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
14yrs
ALL - alzheimers autism adhd depression seizure

28. How to dx keratitis?
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Foreign body sensation - photophobia - corneal opacity tx abx
Strep pneumonie; moraxella; h influenze
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

29. Tx of children constipation

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30. deficinecy of 17 hydroxylase
Do HIV testing at first
1.5%
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Increase of pregnenolone

31. 21 hydroxylase
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Central isosexual precocious puberty; hypothalmaic hamartoma
Injury to lower roots of brachial plexus
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

32. What is the definition of delayed puberty?
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Prolactinoma
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

33. the recommended ca supplementation
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
24-72 hours
Atopic dermatitis; strong allergic/immunologic component; incr IgE
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

34. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Central isosexual precocious puberty; hypothalmaic hamartoma
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

35. How to dx RSV
Rapid detection of RSV antigen in nasl
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
No myoclonic activity in JME
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

36. crying during urination. bacteriuria pyruria - rec episodes
To make hip flexed and abducted position in DDH
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
If aortic root reaches 45 mm
Imaging study to r/o VUR

37. patient with white plaques in mouth and lump in back
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Do HIV testing at first
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

38. thumb sign
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Injury to lower roots of brachial plexus

39. differentiate between central and peripheral precocious puberty
Yes; but it will be less effective
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Strep pneumonie; moraxella; h influenze

40. iron supplement in child
After 6m; breast mild provides iron until 6m.
To make hip flexed and abducted position in DDH
Croup
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

41. tick transmits RMSF
Black
<2yrs - abd pain - diarrhoea - ARF
Less than 5th percentile
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

42. What is the most common initial symptom in sickle cell
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Neurofibromatosis type2
HSP - look for symmetric skin lesions
Dactylitis; 2nd common is splenic seqestration

43. penicillin effective against pseudomonas
Develops in 21 dasy
Pipercillin (zosyn) - ticarcillin
Increase of pregnenolone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

44. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

45. How to dx endopthalmitis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Between pregnenolone and 17oh pregnenolone
>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

46. TTP pentad
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

47. sturge weber syndrome
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Facial portwine stain
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Pho for forward bending; forward defect; common finding has no adverse physical effect

48. How long anti-TB drugs given for TB meningitis?
Less than 5th percentile
To make hip flexed and abducted position in DDH
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

49. dx for turner
Increase of progesteron/17oh progesterone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
After 24h of abx therapy

50. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Increase of pregnenolone
Meconeum ileus; think about CF
Congenital rubella syndrome
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops