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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
Increase of pregnenolone
Neurofibromatosis type2
Biliary atresia; tx surgery
To make hip flexed and abducted position in DDH

2. 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)
HSP - look for symmetric skin lesions
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 pregnenolone and 17oh pregnenolone

3. How to prevent GBS in neonate
Penicillin G 4h before delivery
<2yrs - abd pain - diarrhoea - ARF
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
24h to 7d of birth

4. low grade fever - cough - diffuse bilat ground glass opacities
Injury to b/l glossopharyngeal. present in botulism
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

5. acute otitis externa

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6. 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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Thalassemia - congenital hemolytic anemia
Dactylitis; 2nd common is splenic seqestration

7. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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
HSP - look for symmetric skin lesions
Female - breech delivery - family history; tx referral to ortho

8. association with infantile pyloric stenosis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

9. patient with white plaques in mouth and lump in back
Injury to b/l glossopharyngeal. present in botulism
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Do HIV testing at first

10. when bact conjunctivitis patient can go back to school
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
After 24h of abx therapy
Increase of progesteron/17oh progesterone
Candidal diapar rash; tx clotrimazol

11. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Absence seizure; tx ethosuximide
Lateral neck xray in epiglottitis show swollen epiglottis
Erb paralysis leading to diaphragmatic paralysis

12. pneumonia in CF patient
Fifth disease; febrile syndrome
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Injury to lower roots of brachial plexus
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

13. the risk of lyme after bitten by a tick
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
After 24h of abx therapy
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
1.5%

14. tick transmits RMSF
Black
No myoclonic activity in JME
Bartonella henselae; complication is suppuration of lymph node
After 6m; breast mild provides iron until 6m.

15. How to dx RSV
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Rapid detection of RSV antigen in nasl
After 24h of abx therapy
Risk of neurological dysfunction

16. difference between diaper dermatitis and rash
Central isosexual precocious puberty; hypothalmaic hamartoma
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
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

17. side effect of testosteron therapy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decreases height - expensive; reserved for severe cases of delayed puberty
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

18. What are the risk factors of developmental dysplais of hip
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Female - breech delivery - family history; tx referral to ortho
Less than 5th percentile
TB - breastfeeding - asymptomatic hiv

19. language delay
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

20. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Faciform RBC cause vascular occlusion
Dactylitis; 2nd common is splenic seqestration
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Erb paralysis leading to diaphragmatic paralysis

21. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Wait until 6 months
Oral DMSA or EDTA IV
Methylephenidate toxicity; cannot be stopped abruptly; taper

22. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
No myoclonic activity in JME
Vaso-occlusive crisis; dx hb electrophoresis

23. splenic infarction in sickle cell
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Meconeum ileus; think about CF
Faciform RBC cause vascular occlusion
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

24. centor criteria for bact pharyngitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Marfans - ehlers danlos - homocystinuria
No reticulocyte vs high reticulocyte

25. indications of VUR
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
URI
Rapid detection of RSV antigen in nasl
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

26. Tx of children constipation

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27. language expectation from 2yo
Imaging study to r/o VUR
Multiple telangiectesia - vasular lesion in CNS
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
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

28. benefits of antibiotic therapy in acute pharyngitis?
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Congenital rubella syndrome

29. What is the calorie requirement of newborn?
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Female - breech delivery - family history; tx referral to ortho
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
110 kcl/kg/day

30. When to bevioral and enviromental measure in led intoxication?
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

31. How long patient needs to be exposed to tick to get infected
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
36 hours
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

32. mech of botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Imaging study to r/o VUR
>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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

33. red oozing rash on cheek - scaly - dry
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Candidal diapar rash; tx clotrimazol

34. deficinecy of 17 hydroxylase
Increase of pregnenolone
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Croup

35. When to do surgery for undescended testes
Yes; but it will be less effective
14yrs
Between pregnenolone and 17oh pregnenolone
Wait until 6 months

36. When erythema chronicum migrans develops after tick bite
Decreased UGT enzyme
24-72 hours
No myoclonic activity in JME
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

37. 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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

38. When to do aortic root surgery in marfans to prevent dissection?
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
If aortic root reaches 45 mm
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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

39. Tx of botulism
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
TB - breastfeeding - asymptomatic hiv
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

40. How to differentiate caput succedanueum and cephalohematoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
refuse
Benign permature thelarche; expectant management
Injury to lower roots of brachial plexus

41. How to dx endopthalmitis
>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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Neurofibromatosis type2
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

42. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Increase of progesteron/17oh progesterone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
110 kcl/kg/day
Croup

43. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
Decreased UGT enzyme
Candidal diapar rash; tx clotrimazol
Methylephenidate toxicity; cannot be stopped abruptly; taper

44. echymoses with low platelet <30k
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

45. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Croup tx cool mist; racemic epi - corticosteroid
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Croup

46. Parents can _____ vaccine
refuse
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Faciform RBC cause vascular occlusion
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

47. how smoking contributes otitis media in children
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

48. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

49. spitting up - vomiting at night - weight stable
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
INH 9m if INH resistant rifampin 6m in children and 4m in adults

50. tzanck
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Herpes
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes