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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. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

2. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Diet modification to provide 110kc/kg/d
<2yrs - abd pain - diarrhoea - ARF

3. Febrile seizure
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Atypical lymphocyte
Endocardial cushion defect (no separation between heart chambers)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

4. how thalassemia die
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Benign permature thelarche; expectant management
To make hip flexed and abducted position in DDH
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

5. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
After 24h of abx therapy
Female - breech delivery - family history; tx referral to ortho

6. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
INH 9m if INH resistant rifampin 6m in children and 4m in adults
No myoclonic activity in JME
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

7. complete airway obstruction with FB
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
>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
Bladder dysfunction; UTI and renal dysfunctoin
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

8. What are the risk factors of developmental dysplais of hip
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Wait until 6 months
Female - breech delivery - family history; tx referral to ortho
Bladder dysfunction; UTI and renal dysfunctoin

9. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Endocardial cushion defect (no separation between heart chambers)
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

10. mech of botulism
Decr calorie intake; decr calorie absorption;incr calorie demand
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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
>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

11. contraindications of MMR vaccine
No intervention; 90% foreign bodies pass without difficulty
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
14yrs
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

12. Parvovirus
Fifth disease; febrile syndrome
Absence seizure; tx ethosuximide
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

13. How to dx RSV
Decreased UGT enzyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Rapid detection of RSV antigen in nasl
Tx only symptomatic carrier

14. dx for DDH
Lateral neck xray in epiglottitis show swollen epiglottis
Erb paralysis leading to diaphragmatic paralysis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
RSV - rhino and influenza

15. difference between rubeola (measles) and rulbella
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Foreign body sensation - photophobia - corneal opacity tx abx
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

16. When to give HRT in turner
Increase of progesteron/17oh progesterone
14yrs
Decreases height - expensive; reserved for severe cases of delayed puberty
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

17. contact lens keratitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
URI
After 6m; breast mild provides iron until 6m.

18. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
No myoclonic activity in JME
Facial portwine stain
Bartonella henselae; complication is suppuration of lymph node
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

19. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Benign permature thelarche; expectant management
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
24h to 7d of birth

20. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Penicillin G 4h before delivery
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

21. 12y - obese - hip pain - hip ext rotated
Croup
Medical emergency; dimercaprol/edta
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

22. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
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

23. difference between diaper dermatitis and rash
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Lateral neck xray in epiglottitis show swollen epiglottis
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

24. congenital adrenal hyperplasi
Congenital rubella syndrome
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Brown
Wait until 6 months

25. sturge weber syndrome
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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
Facial portwine stain
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

26. lead 44-70
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
14yrs
Oral DMSA or EDTA IV
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

27. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Candidal diapar rash; tx clotrimazol
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
T for t ; thalassemia; inc serum iron and Iron binding

28. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
HSP - look for symmetric skin lesions
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

29. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Decreased UGT enzyme
Injury to b/l glossopharyngeal. present in botulism
Risk of neurological dysfunction

30. kallman syndrome
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Increase of pregnenolone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

31. When to give hpv vaccien
T for t ; thalassemia; inc serum iron and Iron binding
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
TB - breastfeeding - asymptomatic hiv
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

32. How to differential bact vs viral conjunctivitis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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

33. cat scratch disease
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Bartonella henselae; complication is suppuration of lymph node
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

34. How to investigate delayed puberty
HSP - look for symmetric skin lesions
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

35. When to do surgery for undescended testes
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Wait until 6 months

36. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

37. How to prevent GBS in neonate
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
Risk of neurological dysfunction
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Penicillin G 4h before delivery

38. differentiate between central and peripheral precocious puberty
Fifth disease; febrile syndrome
36 hours
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

39. When erythema chronicum migrans develops after tick bite
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Do HIV testing at first
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
24-72 hours

40. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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
RSV - rhino and influenza
Thalassemia - congenital hemolytic anemia

41. viruses cause bronhioltitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Prolactinoma
RSV - rhino and influenza
Atopic dermatitis; strong allergic/immunologic component; incr IgE

42. side effect of testosteron therapy
Methylephenidate toxicity; cannot be stopped abruptly; taper
Decreases height - expensive; reserved for severe cases of delayed puberty
Develops in 21 dasy
T for t ; thalassemia; inc serum iron and Iron binding

43. How to evaluate well appearing child just born in GBS pos mother?
Constitutional pubertal delay
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

44. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Bartonella henselae; complication is suppuration of lymph node
Marfans - ehlers danlos - homocystinuria

45. centor criteria for bact pharyngitis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Between pregnenolone and 17oh pregnenolone
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

46. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
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 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
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

47. giardiasis
Tx only symptomatic carrier
Central isosexual precocious puberty; hypothalmaic hamartoma
T for t ; thalassemia; inc serum iron and Iron binding
Facial portwine stain

48. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Tx only symptomatic carrier
Do HIV testing at first

49. hypopigmented spots - family hx bilat deafness
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Neurofibromatosis type2
Decreased UGT enzyme
Endocardial cushion defect (no separation between heart chambers)

50. cleft lip but no cleft palate
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Hypopigmented macule - glial proliferation - organ haramtomas/cysts