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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.
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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. what conditions are not contraindicated
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Brown
Black
TB - breastfeeding - asymptomatic hiv

2. What is the most common initial symptom in sickle cell
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Croup tx cool mist; racemic epi - corticosteroid
Lateral neck xray in epiglottitis show swollen epiglottis
Dactylitis; 2nd common is splenic seqestration

3. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
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
Imaging study to r/o VUR
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

4. HUS
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
<2yrs - abd pain - diarrhoea - ARF
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Neurofibromatosis type2

5. mcCune albright`
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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

6. How long anti-TB drugs given for TB meningitis?
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Candidal diapar rash; tx clotrimazol

7. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
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
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)
Dx US tx; correct serum electrolyte - pyloromyotom
No myoclonic activity in JME

8. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
D for d; down syndrome and polyhydramnios
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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

9. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Female - breech delivery - family history; tx referral to ortho
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

10. Tx of children constipation

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11. cleft lip but no cleft palate
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
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

12. How to differentiate croup vs epiglotitis
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
Marfans - ehlers danlos - homocystinuria
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

13. side effect of testosteron therapy
Oral DMSA or EDTA IV
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decreases height - expensive; reserved for severe cases of delayed puberty
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

14. contraindications of DTap
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

15. is local anesthetics be used in cellulitis to reduce pain
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Strep pneumonie; moraxella; h influenze

16. deficinecy of 17 hydroxylase
Increase of pregnenolone
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Thalassemia - congenital hemolytic anemia

17. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
1.5%
Do HIV testing at first
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

18. dx of lyme
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Mainly clinical; serology with initial ELISA - with western blot confirmation;
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
D for d; down syndrome and polyhydramnios

19. adenovirus
Rapid detection of RSV antigen in nasl
URI
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Croup

20. indications of VUR
Wait until 6 months
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Atopic dermatitis; strong allergic/immunologic component; incr IgE

21. causes of acute anemia
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

22. lead 44-70
Constitutional pubertal delay
Oral DMSA or EDTA IV
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

23. lead >70
After 24h of abx therapy
Medical emergency; dimercaprol/edta
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

24. TTP pentad
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Decreases height - expensive; reserved for severe cases of delayed puberty
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

25. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
1.5%
Neurofibromatosis type2
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

26. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Croup tx cool mist; racemic epi - corticosteroid
No intervention; 90% foreign bodies pass without difficulty

27. tick transmits lyme
Brown
D for d; down syndrome and polyhydramnios
Meconeum ileus; think about CF
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

28. pneumonia in CF patient
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Constitutional pubertal delay
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

29. down syndrome has inreased risk of developing
Meconeum ileus; think about CF
1.5%
Strep pneumonie; moraxella; h influenze
ALL - alzheimers autism adhd depression seizure

30. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

31. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
T for t ; thalassemia; inc serum iron and Iron binding
>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
Croup tx cool mist; racemic epi - corticosteroid

32. How to dx post uretheral valve
Injury to b/l glossopharyngeal. present in botulism
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

33. physiological jaundice
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
24h to 7d of birth

34. 12y - obese - hip pain - hip ext rotated
Central isosexual precocious puberty; hypothalmaic hamartoma
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Thalassemia - congenital hemolytic anemia
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

35. when bact conjunctivitis patient can go back to school
Croup tx cool mist; racemic epi - corticosteroid
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Wait until 6 months
After 24h of abx therapy

36. Parvovirus
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
Wait until 6 months
Fifth disease; febrile syndrome
24-72 hours

37. dx for DDH
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Congenital rubella syndrome
D for d; down syndrome and polyhydramnios
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

38. tuberous sclerosis
Thalassemia - congenital hemolytic anemia
D for d; down syndrome and polyhydramnios
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Brown

39. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Increase of progesteron/17oh progesterone
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

40. dx for turner
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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

41. How to difference viral and bact pneumonia
Increase of progesteron/17oh progesterone
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Absence seizure; tx ethosuximide

42. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
No wheezing - no feever in chlamydia
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

43. tick transmits RMSF
Pipercillin (zosyn) - ticarcillin
Black
Increase of progesteron/17oh progesterone
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

44. 3yo - febrile - left hip externally rotated
Meconeum ileus; think about CF
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
<2yrs - abd pain - diarrhoea - ARF

45. contraindications of MMR vaccine
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
<2yrs - abd pain - diarrhoea - ARF

46. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Atypical lymphocyte
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
TB - breastfeeding - asymptomatic hiv

47. causes of FTT
Lateral neck xray in epiglottitis show swollen epiglottis
110 kcl/kg/day
Candidal diapar rash; tx clotrimazol
Decr calorie intake; decr calorie absorption;incr calorie demand

48. contact lens keratitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

49. Neonatal unconjugated hyperbilirubine
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Decreased UGT enzyme

50. adrenal tumor
Meconeum ileus; think about CF
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Penicillin G 4h before delivery