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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

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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. how thalassemia die
Develops in 21 dasy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
24h to 7d of birth

2. impaired gag reflex
Bartonella henselae; complication is suppuration of lymph node
Injury to b/l glossopharyngeal. present in botulism
Decreases height - expensive; reserved for severe cases of delayed puberty
Imaging study to r/o VUR

3. doing worse in school - lack of attention - starring speel
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Absence seizure; tx ethosuximide
No intervention; 90% foreign bodies pass without difficulty

4. failure to thrive
Less than 5th percentile
Oral DMSA or EDTA IV
Biliary atresia; tx surgery
Injury to lower roots of brachial plexus

5. tuberous sclerosis
Methylephenidate toxicity; cannot be stopped abruptly; taper
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Neurofibromatosis type2

6. 3yo - febrile - left hip externally rotated
Increase of progesteron/17oh progesterone
Vaso-occlusive crisis; dx hb electrophoresis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

7. How to dx keratitis?
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
URI
Foreign body sensation - photophobia - corneal opacity tx abx
Marfans - ehlers danlos - homocystinuria

8. down syndrome with holocystolic mumur
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Endocardial cushion defect (no separation between heart chambers)
Croup tx cool mist; racemic epi - corticosteroid
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

9. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
URI
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

10. What is earliest sign of puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Benign permature thelarche; expectant management
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

11. TB prophylaxis
Endocardial cushion defect (no separation between heart chambers)
If aortic root reaches 45 mm
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Neurofibromatosis type2

12. How to difference RSV and neonatal chlamydia
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No myoclonic activity in JME
No wheezing - no feever in chlamydia
Meconeum ileus; think about CF

13. causes of FTT
110 kcl/kg/day
Endocardial cushion defect (no separation between heart chambers)
Decr calorie intake; decr calorie absorption;incr calorie demand
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

14. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Thalassemia - congenital hemolytic anemia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
RSV - rhino and influenza

15. 21 hydroxylase
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Marfans - ehlers danlos - homocystinuria

16. infantile hypertrophic pyloric stenosis
Oral DMSA or EDTA IV
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Bartonella henselae; complication is suppuration of lymph node
Dx US tx; correct serum electrolyte - pyloromyotom

17. 17 alpha hydroxylase
Increase of progesteron/17oh progesterone
36 hours
TB - breastfeeding - asymptomatic hiv
Between pregnenolone and 17oh pregnenolone

18. tick transmits RMSF
Pho for forward bending; forward defect; common finding has no adverse physical effect
Tx only symptomatic carrier
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
Black

19. dx of lyme
24-72 hours
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Lateral neck xray in epiglottitis show swollen epiglottis

20. dx for DDH
Neurofibromatosis type2
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

21. mcCune albright`
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

22. starring spells 10-20sec
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Do HIV testing at first
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

23. How to differential bact vs viral conjunctivitis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
Croup

24. benefits of antibiotic therapy in acute pharyngitis?
24-72 hours
Bladder dysfunction; UTI and renal dysfunctoin
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Foreign body sensation - photophobia - corneal opacity tx abx

25. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
After 24h of abx therapy

26. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
No; they are basic compound will be neutralized in an acidic environment of cellulitis
14yrs

27. causes of acute anemia
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Multiple telangiectesia - vasular lesion in CNS
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Imaging study to r/o VUR

28. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Increase of progesteron/17oh progesterone
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

29. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Endocardial cushion defect (no separation between heart chambers)
Bladder dysfunction; UTI and renal dysfunctoin
Croup
Methylephenidate toxicity; cannot be stopped abruptly; taper

30. 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)
24h to 7d of birth
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

31. the recommended ca supplementation
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
refuse
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

32. microcytic - hypochromic anemia - hepatospelnomegaly
<2yrs - abd pain - diarrhoea - ARF
Bartonella henselae; complication is suppuration of lymph node
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Thalassemia - congenital hemolytic anemia

33. nuchal rigidity - fever - sore throat - headache - dioriented
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Dx US tx; correct serum electrolyte - pyloromyotom

34. When to do surgery for undescended testes
Wait until 6 months
Prolactinoma
Methylephenidate toxicity; cannot be stopped abruptly; taper
After 6m; breast mild provides iron until 6m.

35. defcicieny of 21 hydroxylase
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Increase of progesteron/17oh progesterone

36. What is the calorie requirement of newborn?
Wait until 6 months
Vaso-occlusive crisis; dx hb electrophoresis
110 kcl/kg/day
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

37. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Central isosexual precocious puberty; hypothalmaic hamartoma
Diet modification to provide 110kc/kg/d

38. Infant with serum billlirubin >25
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Risk of neurological dysfunction
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

39. acute abd pain - hx URI - lower extremity maculo papular rash
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Wait until 6 months
HSP - look for symmetric skin lesions
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

40. When to do aortic root surgery in marfans to prevent dissection?
INH 9m if INH resistant rifampin 6m in children and 4m in adults
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
Fifth disease; febrile syndrome
If aortic root reaches 45 mm

41. 18mo bilat breast enlargment - some pubic hair
Marfans - ehlers danlos - homocystinuria
Benign permature thelarche; expectant management
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

42. How to prevent GBS in neonate
refuse
Diet modification to provide 110kc/kg/d
Rapid detection of RSV antigen in nasl
Penicillin G 4h before delivery

43. pneumonia in CF patient
Bartonella henselae; complication is suppuration of lymph node
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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
Strep pneumonie; moraxella; h influenze

44. can women with abnormal smear or genital get vaccine
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
Yes; but it will be less effective
Foreign body sensation - photophobia - corneal opacity tx abx
Wait until 6 months

45. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

46. pavlik harness
24-72 hours
Fifth disease; febrile syndrome
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
To make hip flexed and abducted position in DDH

47. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Atypical lymphocyte
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Facial portwine stain
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

48. What is the definition of delayed puberty?
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Marfans - ehlers danlos - homocystinuria

49. echymoses with low platelet <30k
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
After 24h of abx therapy
Pipercillin (zosyn) - ticarcillin
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

50. difference between structural disorder and flexible kyphosis
Dactylitis; 2nd common is splenic seqestration
Oral DMSA or EDTA IV
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Fifth disease; febrile syndrome

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USMLE Step3 Pediatrics

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