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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. differentiate between central and peripheral precocious puberty
Faciform RBC cause vascular occlusion
Decreases height - expensive; reserved for severe cases of delayed puberty
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

2. Infant with serum billlirubin >25
Risk of neurological dysfunction
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Croup tx cool mist; racemic epi - corticosteroid
Increase of progesteron/17oh progesterone

3. coin in child's stomach
Pipercillin (zosyn) - ticarcillin
No intervention; 90% foreign bodies pass without difficulty
>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
Lateral neck xray in epiglottitis show swollen epiglottis

4. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Increase of pregnenolone

5. centor criteria for bact pharyngitis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Brown
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

6. What is the most common initial symptom in sickle cell
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Dactylitis; 2nd common is splenic seqestration
Imaging study to r/o VUR

7. How to difference viral and bact pneumonia
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Pho for forward bending; forward defect; common finding has no adverse physical effect
INH 9m if INH resistant rifampin 6m in children and 4m in adults

8. if bone age lower than actual and puberty delayed
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Constitutional pubertal delay
If aortic root reaches 45 mm
Mainly clinical; serology with initial ELISA - with western blot confirmation;

9. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
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)
Facial portwine stain
TB - breastfeeding - asymptomatic hiv

10. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
D for d; down syndrome and polyhydramnios
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Increase of pregnenolone

11. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Decreased UGT enzyme
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Croup

12. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Increase of pregnenolone
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
No; they are basic compound will be neutralized in an acidic environment of cellulitis

13. adrenal tumor
ALL - alzheimers autism adhd depression seizure
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Develops in 21 dasy
Decreases height - expensive; reserved for severe cases of delayed puberty

14. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Vaso-occlusive crisis; dx hb electrophoresis

15. When to do surgery for undescended testes
Croup tx cool mist; racemic epi - corticosteroid
Wait until 6 months
Foreign body sensation - photophobia - corneal opacity tx abx
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

16. lens dislocation
Marfans - ehlers danlos - homocystinuria
HSP - look for symmetric skin lesions
RSV - rhino and influenza
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

17. What is earliest sign of puberty?
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
Facial portwine stain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

18. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Thalassemia - congenital hemolytic anemia
Benign permature thelarche; expectant management

19. How to dx endopthalmitis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Fifth disease; febrile syndrome
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

20. cardiac manifestation of turner
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Diet modification to provide 110kc/kg/d
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
1.5%

21. causes of acute anemia
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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

22. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Croup tx cool mist; racemic epi - corticosteroid
No myoclonic activity in JME
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

23. when bact conjunctivitis patient can go back to school
Meconeum ileus; think about CF
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
After 24h of abx therapy
To make hip flexed and abducted position in DDH

24. acute otitis externa

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25. complete airway obstruction with FB
Prolactinoma
>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
24h to 7d of birth
T for t ; thalassemia; inc serum iron and Iron binding

26. How to dx acute angle closure glaucoma
Croup tx cool mist; racemic epi - corticosteroid
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Benign permature thelarche; expectant management

27. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Decr calorie intake; decr calorie absorption;incr calorie demand
Imaging study to r/o VUR
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

28. How to prevent GBS in neonate
Penicillin G 4h before delivery
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Lateral neck xray in epiglottitis show swollen epiglottis
T for t ; thalassemia; inc serum iron and Iron binding

29. non immune pregnant women exposed to rubella in first trimester
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Congenital rubella syndrome
ALL - alzheimers autism adhd depression seizure
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

30. 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
Increase of progesteron/17oh progesterone
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

31. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
No; they are basic compound will be neutralized in an acidic environment of cellulitis

32. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Tx only symptomatic carrier
No intervention; 90% foreign bodies pass without difficulty
Brown
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

33. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
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)
Croup tx cool mist; racemic epi - corticosteroid
To make hip flexed and abducted position in DDH
Methylephenidate toxicity; cannot be stopped abruptly; taper

34. decreased mobility of tympanic membrane after otitis media
Methylephenidate toxicity; cannot be stopped abruptly; taper
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Benign permature thelarche; expectant management
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 investigate delayed puberty
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Fifth disease; febrile syndrome
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

36. 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)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Lateral neck xray in epiglottitis show swollen epiglottis
refuse

37. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Decreases height - expensive; reserved for severe cases of delayed puberty
Vaso-occlusive crisis; dx hb electrophoresis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

38. crying during urination. bacteriuria pyruria - rec episodes
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Dactylitis; 2nd common is splenic seqestration
No wheezing - no feever in chlamydia
Imaging study to r/o VUR

39. failure to thrive
Between pregnenolone and 17oh pregnenolone
Less than 5th percentile
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

40. adenovirus
URI
Diet modification to provide 110kc/kg/d
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
refuse

41. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Croup tx cool mist; racemic epi - corticosteroid
Erb paralysis leading to diaphragmatic paralysis
24-72 hours
Develops in 21 dasy

42. the recommended ca supplementation
RSV - rhino and influenza
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Constitutional pubertal delay
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

43. viruses cause bronhioltitis
RSV - rhino and influenza
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
36 hours
Pho for forward bending; forward defect; common finding has no adverse physical effect

44. spitting up - vomiting at night - weight stable
Vaso-occlusive crisis; dx hb electrophoresis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

45. aplasic crisis
Dactylitis; 2nd common is splenic seqestration
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
T for t ; thalassemia; inc serum iron and Iron binding
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

46. bromocriptine
RSV - rhino and influenza
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)
Endocardial cushion defect (no separation between heart chambers)
Prolactinoma

47. Tx of children constipation

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48. difference between breast milk and breafeeding jaundice
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
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
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

49. Nocturnal enuresis
Foreign body sensation - photophobia - corneal opacity tx abx
Herpes
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

50. HUS
Strep pneumonie; moraxella; h influenze
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
<2yrs - abd pain - diarrhoea - ARF
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation