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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. osler rendu weber syndrom
refuse
Multiple telangiectesia - vasular lesion in CNS
Less than 5th percentile
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

2. most common complication of otitis media
Tx only symptomatic carrier
Bartonella henselae; complication is suppuration of lymph node
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

3. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Meconeum ileus; think about CF
Between pregnenolone and 17oh pregnenolone

4. How to dx RSV
Atypical lymphocyte
110 kcl/kg/day
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Rapid detection of RSV antigen in nasl

5. How long patient needs to be exposed to tick to get infected
Increase of pregnenolone
36 hours
Multiple telangiectesia - vasular lesion in CNS
Central isosexual precocious puberty; hypothalmaic hamartoma

6. When to do surgery for undescended testes
D for d; down syndrome and polyhydramnios
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Tx only symptomatic carrier
Wait until 6 months

7. red oozing rash on cheek - scaly - dry
HSP - look for symmetric skin lesions
Wait until 6 months
Multiple telangiectesia - vasular lesion in CNS
Atopic dermatitis; strong allergic/immunologic component; incr IgE

8. physiological jaundice
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Erb paralysis leading to diaphragmatic paralysis
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
24h to 7d of birth

9. benefits of antibiotic therapy in acute pharyngitis?
Faciform RBC cause vascular occlusion
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Vaso-occlusive crisis; dx hb electrophoresis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

10. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
24h to 7d of birth
Injury to b/l glossopharyngeal. present in botulism

11. difference between structural disorder and flexible kyphosis
TB - breastfeeding - asymptomatic hiv
No wheezing - no feever in chlamydia
D for d; down syndrome and polyhydramnios
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

12. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Medical emergency; dimercaprol/edta

13. low grade fever - cough - diffuse bilat ground glass opacities
Croup
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

14. the recommended ca supplementation
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

15. pneumonia in CF patient
URI
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Female - breech delivery - family history; tx referral to ortho

16. What is the definition of delayed puberty?
Congenital rubella syndrome
Neurofibromatosis type2
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

17. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Pipercillin (zosyn) - ticarcillin
Croup
Oral DMSA or EDTA IV

18. How to investigate delayed puberty
Decr calorie intake; decr calorie absorption;incr calorie demand
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Pipercillin (zosyn) - ticarcillin
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

19. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Erb paralysis leading to diaphragmatic paralysis
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
Develops in 21 dasy
Thalassemia - congenital hemolytic anemia

20. congenital adrenal hyperplasi
Wait until 6 months
Female - breech delivery - family history; tx referral to ortho
Candidal diapar rash; tx clotrimazol
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

21. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
>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

22. What is the calorie requirement of newborn?
110 kcl/kg/day
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
No wheezing - no feever in chlamydia

23. When to give hpv vaccien
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
Thalassemia - congenital hemolytic anemia
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
URI

24. How long anti-TB drugs given for TB meningitis?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Meconeum ileus; think about CF
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

25. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Wait until 6 months
Dx US tx; correct serum electrolyte - pyloromyotom
Multiple telangiectesia - vasular lesion in CNS

26. flexible kyphosis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
110 kcl/kg/day
Pho for forward bending; forward defect; common finding has no adverse physical effect

27. lead >70
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
24-72 hours
Medical emergency; dimercaprol/edta
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

28. differentiate between central and peripheral precocious puberty
No wheezing - no feever in chlamydia
Absence seizure; tx ethosuximide
Penicillin G 4h before delivery
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

29. infantile hypertrophic pyloric stenosis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Dx US tx; correct serum electrolyte - pyloromyotom
Atypical lymphocyte

30. dx for DDH
Multiple telangiectesia - vasular lesion in CNS
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
refuse

31. acute otitis media-pathogen
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Strep pneumonie; moraxella; h influenze
Bartonella henselae; complication is suppuration of lymph node
<2yrs - abd pain - diarrhoea - ARF

32. Infant with serum billlirubin >25
Bladder dysfunction; UTI and renal dysfunctoin
Risk of neurological dysfunction
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Erb paralysis leading to diaphragmatic paralysis

33. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Erb paralysis leading to diaphragmatic paralysis
D for d; down syndrome and polyhydramnios
Endocardial cushion defect (no separation between heart chambers)

34. How to dx acute angle closure glaucoma
RSV - rhino and influenza
Multiple telangiectesia - vasular lesion in CNS
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Brown

35. major depression
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
TB - breastfeeding - asymptomatic hiv

36. contraindications of MMR vaccine
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Meconeum ileus; think about CF
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
To make hip flexed and abducted position in DDH

37. What is the most common initial symptom in sickle cell
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
TB - breastfeeding - asymptomatic hiv
Biliary atresia; tx surgery
Dactylitis; 2nd common is splenic seqestration

38. down syndrome has inreased risk of developing
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
Candidal diapar rash; tx clotrimazol
ALL - alzheimers autism adhd depression seizure
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

39. tuberous sclerosis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Pho for forward bending; forward defect; common finding has no adverse physical effect
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

40. tick transmits RMSF
Oral DMSA or EDTA IV
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Black
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

41. contraindications of DTap
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Fifth disease; febrile syndrome
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

42. IM
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Wait until 6 months
Atypical lymphocyte
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

43. lead 44-70
Oral DMSA or EDTA IV
No myoclonic activity in JME
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

44. Tx of FTT
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Diet modification to provide 110kc/kg/d
Imaging study to r/o VUR
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

45. Febrile seizure
Female - breech delivery - family history; tx referral to ortho
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Strep pneumonie; moraxella; h influenze
Wait until 6 months

46. tick transmits lyme
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Brown

47. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

48. is local anesthetics be used in cellulitis to reduce pain
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
>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

49. When to give HRT in turner
Brown
14yrs
1.5%
36 hours

50. failure to thrive
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Less than 5th percentile
No wheezing - no feever in chlamydia
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime