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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. What is the calorie requirement of newborn?
Penicillin G 4h before delivery
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
110 kcl/kg/day
Diet modification to provide 110kc/kg/d

2. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No intervention; 90% foreign bodies pass without difficulty
110 kcl/kg/day
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

3. Neonatal unconjugated hyperbilirubine
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Decreased UGT enzyme
No intervention; 90% foreign bodies pass without difficulty

4. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
RSV - rhino and influenza
Do HIV testing at first
Thalassemia - congenital hemolytic anemia
Central isosexual precocious puberty; hypothalmaic hamartoma

5. lead 44-70
Decreased UGT enzyme
Foreign body sensation - photophobia - corneal opacity tx abx
Oral DMSA or EDTA IV
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

6. crying during urination. bacteriuria pyruria - rec episodes
No reticulocyte vs high reticulocyte
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Imaging study to r/o VUR
D for d; down syndrome and polyhydramnios

7. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Brown
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

8. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Vaso-occlusive crisis; dx hb electrophoresis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Dactylitis; 2nd common is splenic seqestration
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

9. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Croup

10. What is the definition of delayed puberty?
Increase of pregnenolone
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;
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

11. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Congenital rubella syndrome
Dactylitis; 2nd common is splenic seqestration
D for d; down syndrome and polyhydramnios

12. adrenal tumor
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
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

13. language expectation from 2yo
No wheezing - no feever in chlamydia
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

14. acute otitis media-pathogen
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Less than 5th percentile
Strep pneumonie; moraxella; h influenze
<2yrs - abd pain - diarrhoea - ARF

15. IM
Methylephenidate toxicity; cannot be stopped abruptly; taper
Rapid detection of RSV antigen in nasl
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Atypical lymphocyte

16. When to bevioral and enviromental measure in led intoxication?
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

17. horner syndrom
Injury to lower roots of brachial plexus
Do HIV testing at first
Bartonella henselae; complication is suppuration of lymph node
Biliary atresia; tx surgery

18. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
1.5%
To make hip flexed and abducted position in DDH
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

19. impaired gag reflex
Facial portwine stain
Fifth disease; febrile syndrome
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Injury to b/l glossopharyngeal. present in botulism

20. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Do HIV testing at first
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
Vaso-occlusive crisis; dx hb electrophoresis

21. contact lens keratitis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Decreased UGT enzyme
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Between pregnenolone and 17oh pregnenolone

22. 3yo - never able to walk
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Bladder dysfunction; UTI and renal dysfunctoin
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

23. duodenal atresia
D for d; down syndrome and polyhydramnios
Bartonella henselae; complication is suppuration of lymph node
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

24. cat scratch disease
Pipercillin (zosyn) - ticarcillin
Congenital rubella syndrome
Bartonella henselae; complication is suppuration of lymph node
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

25. When to do aortic root surgery in marfans to prevent dissection?
Faciform RBC cause vascular occlusion
If aortic root reaches 45 mm
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

26. spitting up - vomiting at night - weight stable
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

27. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Croup
Between pregnenolone and 17oh pregnenolone
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

28. adenovirus
Develops in 21 dasy
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
URI
D for d; down syndrome and polyhydramnios

29. benefits of antibiotic therapy in acute pharyngitis?
Injury to lower roots of brachial plexus
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

30. acute abd pain - hx URI - lower extremity maculo papular rash
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
HSP - look for symmetric skin lesions

31. infant botulism
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

32. How to differential bact vs viral conjunctivitis
Risk of neurological dysfunction
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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
14yrs

33. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Meconeum ileus; think about CF
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

34. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Dactylitis; 2nd common is splenic seqestration
Prolactinoma
Tx only symptomatic carrier

35. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Rapid detection of RSV antigen in nasl
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

36. tick transmits RMSF
Black
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Croup tx cool mist; racemic epi - corticosteroid

37. viruses cause bronhioltitis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
RSV - rhino and influenza
HSP - look for symmetric skin lesions

38. causes of acute anemia
Tx only symptomatic carrier
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
Facial portwine stain
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

39. when bact conjunctivitis patient can go back to school
Do HIV testing at first
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
After 24h of abx therapy
No reticulocyte vs high reticulocyte

40. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
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
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Croup

41. iron supplement in child
Dx US tx; correct serum electrolyte - pyloromyotom
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
After 6m; breast mild provides iron until 6m.
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

42. When to give HRT in turner
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Increase of progesteron/17oh progesterone
14yrs

43. How to differentiate caput succedanueum and cephalohematoma
If aortic root reaches 45 mm
Wait until 6 months
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

44. mcCune albright`
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Erb paralysis leading to diaphragmatic paralysis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

45. 18mo bilat breast enlargment - some pubic hair
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Injury to lower roots of brachial plexus
Benign permature thelarche; expectant management
Dactylitis; 2nd common is splenic seqestration

46. low grade fever - cough - diffuse bilat ground glass opacities
Brown
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Meconeum ileus; think about CF

47. causes of FTT
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
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)
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

48. difference between rubeola (measles) and rulbella
No myoclonic activity in JME
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
If aortic root reaches 45 mm
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

49. the recommended ca supplementation
Biliary atresia; tx surgery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

50. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness