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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. How to evaluate well appearing child just born in GBS pos mother?
14yrs
Erb paralysis leading to diaphragmatic paralysis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
HSP - look for symmetric skin lesions

2. acute abd pain - hx URI - lower extremity maculo papular rash
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Diet modification to provide 110kc/kg/d
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
HSP - look for symmetric skin lesions

3. indications of audiometry in childrens
T for t ; thalassemia; inc serum iron and Iron binding
Decreases height - expensive; reserved for severe cases of delayed puberty
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

4. aplasic crisis
Dactylitis; 2nd common is splenic seqestration
Endocardial cushion defect (no separation between heart chambers)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

5. cardiac manifestation of turner
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Penicillin G 4h before delivery
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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

6. HUS
Pho for forward bending; forward defect; common finding has no adverse physical effect
Injury to lower roots of brachial plexus
Atopic dermatitis; strong allergic/immunologic component; incr IgE
<2yrs - abd pain - diarrhoea - ARF

7. physiological jaundice
Develops in 21 dasy
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
24h to 7d of birth
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

8. complete airway obstruction with FB
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
>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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

9. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

10. How to differentiate caput succedanueum and cephalohematoma
Brown
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
Rapid detection of RSV antigen in nasl
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

11. the risk of lyme after bitten by a tick
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Croup tx cool mist; racemic epi - corticosteroid
1.5%
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

12. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Penicillin G 4h before delivery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
1.5%

13. can women with abnormal smear or genital get vaccine
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Vaso-occlusive crisis; dx hb electrophoresis
Yes; but it will be less effective
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

14. thumb sign
D for d; down syndrome and polyhydramnios
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Absence seizure; tx ethosuximide
Oral DMSA or EDTA IV

15. How to dx RSV
Rapid detection of RSV antigen in nasl
If aortic root reaches 45 mm
Faciform RBC cause vascular occlusion
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

16. dx of lyme
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
14yrs
Prolactinoma
Mainly clinical; serology with initial ELISA - with western blot confirmation;

17. congenital adrenal hyperplasi
Meconeum ileus; think about CF
Female - breech delivery - family history; tx referral to ortho
Faciform RBC cause vascular occlusion
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

18. failure to thrive
Less than 5th percentile
Injury to lower roots of brachial plexus
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
ALL - alzheimers autism adhd depression seizure

19. Tx of botulism
Central isosexual precocious puberty; hypothalmaic hamartoma
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Increase of progesteron/17oh progesterone

20. When to do surgery for undescended testes
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
URI
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Wait until 6 months

21. How long patient needs to be exposed to tick to get infected
Injury to lower roots of brachial plexus
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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
36 hours

22. patient with white plaques in mouth and lump in back
Penicillin G 4h before delivery
Do HIV testing at first
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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

23. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

24. the recommended ca supplementation
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Develops in 21 dasy
Diet modification to provide 110kc/kg/d

25. difference between diaper dermatitis and rash
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
Thalassemia - congenital hemolytic anemia

26. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Tx only symptomatic carrier
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

27. adenovirus
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
D for d; down syndrome and polyhydramnios
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
URI

28. How to dx post uretheral valve
refuse
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Biliary atresia; tx surgery
Pho for forward bending; forward defect; common finding has no adverse physical effect

29. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Endocardial cushion defect (no separation between heart chambers)
Injury to b/l glossopharyngeal. present in botulism
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

30. carditis and arthritis after rheumatic fever
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Develops in 21 dasy
Diet modification to provide 110kc/kg/d
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

31. infant botulism
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Develops in 21 dasy
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

32. side effect of testosteron therapy
Dx US tx; correct serum electrolyte - pyloromyotom
Decreases height - expensive; reserved for severe cases of delayed puberty
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)
URI

33. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

34. tick transmits lyme
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
Brown
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
ALL - alzheimers autism adhd depression seizure

35. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Bladder dysfunction; UTI and renal dysfunctoin
<2yrs - abd pain - diarrhoea - ARF
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

36. sickle cell with symmetrical swelling of hands and feet
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Vaso-occlusive crisis; dx hb electrophoresis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

37. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Pho for forward bending; forward defect; common finding has no adverse physical effect
Pipercillin (zosyn) - ticarcillin
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

38. decreased mobility of tympanic membrane after otitis media
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

39. cat scratch disease
D for d; down syndrome and polyhydramnios
Atypical lymphocyte
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
Bartonella henselae; complication is suppuration of lymph node

40. low grade fever - cough - diffuse bilat ground glass opacities
Black
Decreases height - expensive; reserved for severe cases of delayed puberty
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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

41. How to difference RSV and neonatal chlamydia
Dactylitis; 2nd common is splenic seqestration
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
RSV - rhino and influenza
No wheezing - no feever in chlamydia

42. mech of botulism
Marfans - ehlers danlos - homocystinuria
Medical emergency; dimercaprol/edta
refuse
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

43. What are the risk factors of developmental dysplais of hip
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Female - breech delivery - family history; tx referral to ortho
Facial portwine stain

44. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Erb paralysis leading to diaphragmatic paralysis
36 hours
Injury to b/l glossopharyngeal. present in botulism

45. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Bladder dysfunction; UTI and renal dysfunctoin
Central isosexual precocious puberty; hypothalmaic hamartoma
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

46. target cell
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
T for t ; thalassemia; inc serum iron and Iron binding
Risk of neurological dysfunction
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

47. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Methylephenidate toxicity; cannot be stopped abruptly; taper

48. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Central isosexual precocious puberty; hypothalmaic hamartoma
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

49. lead >70
Injury to lower roots of brachial plexus
Prolactinoma
Injury to b/l glossopharyngeal. present in botulism
Medical emergency; dimercaprol/edta

50. nuchal rigidity - fever - sore throat - headache - dioriented
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
HSP - look for symmetric skin lesions
Prolactinoma
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults