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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. differentiate between central and peripheral precocious puberty
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Diet modification to provide 110kc/kg/d

2. difference between breast milk and breafeeding jaundice
Risk of neurological dysfunction
TB - breastfeeding - asymptomatic hiv
URI
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

3. 3yo - never able to walk
Benign permature thelarche; expectant management
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
After 24h of abx therapy
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

4. how smoking contributes otitis media in children
Black
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Increase of pregnenolone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

5. How to differentiate caput succedanueum and cephalohematoma
Tx only symptomatic carrier
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No; they are basic compound will be neutralized in an acidic environment of cellulitis

6. defcicieny of 21 hydroxylase
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Increase of progesteron/17oh progesterone
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

7. contraindications of DTap
Biliary atresia; tx surgery
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
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

8. language expectation from 2yo
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Bladder dysfunction; UTI and renal dysfunctoin
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

9. Tx of FTT
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Diet modification to provide 110kc/kg/d
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

10. How to difference viral and bact pneumonia
Meconeum ileus; think about CF
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
D for d; down syndrome and polyhydramnios

11. How long patient needs to be exposed to tick to get infected
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Bladder dysfunction; UTI and renal dysfunctoin
Croup
36 hours

12. tuberous sclerosis
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
Bartonella henselae; complication is suppuration of lymph node
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

13. When erythema chronicum migrans develops after tick bite
36 hours
refuse
Diet modification to provide 110kc/kg/d
24-72 hours

14. pavlik harness
TB - breastfeeding - asymptomatic hiv
Oral DMSA or EDTA IV
To make hip flexed and abducted position in DDH
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

15. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
24h to 7d of birth
HSP - look for symmetric skin lesions

16. HUS
ALL - alzheimers autism adhd depression seizure
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
<2yrs - abd pain - diarrhoea - ARF
Atypical lymphocyte

17. duodenal atresia
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Central isosexual precocious puberty; hypothalmaic hamartoma
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
D for d; down syndrome and polyhydramnios

18. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Dx US tx; correct serum electrolyte - pyloromyotom
RSV - rhino and influenza
Mainly clinical; serology with initial ELISA - with western blot confirmation;

19. What is the most common initial symptom in sickle cell
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Dactylitis; 2nd common is splenic seqestration
Brown
No; they are basic compound will be neutralized in an acidic environment of cellulitis

20. how thalassemia die
Pho for forward bending; forward defect; common finding has no adverse physical effect
RSV - rhino and influenza
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

21. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
Decr calorie intake; decr calorie absorption;incr calorie demand
Prolactinoma
Imaging study to r/o VUR

22. What is thumbprint sign
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Lateral neck xray in epiglottitis show swollen epiglottis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

23. tzanck
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Faciform RBC cause vascular occlusion
Croup
Herpes

24. Infant with serum billlirubin >25
Risk of neurological dysfunction
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Strep pneumonie; moraxella; h influenze

25. splenic infarction in sickle cell
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Faciform RBC cause vascular occlusion

26. How to dx keratitis?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Foreign body sensation - photophobia - corneal opacity tx abx
Black

27. How to dx post uretheral valve
URI
14yrs
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

28. lead >70
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Medical emergency; dimercaprol/edta
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

29. lens dislocation
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Marfans - ehlers danlos - homocystinuria
Meconeum ileus; think about CF
1.5%

30. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Vaso-occlusive crisis; dx hb electrophoresis
Female - breech delivery - family history; tx referral to ortho
refuse
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

31. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Candidal diapar rash; tx clotrimazol
Facial portwine stain
Foreign body sensation - photophobia - corneal opacity tx abx

32. 12y - obese - hip pain - hip ext rotated
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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

33. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
No reticulocyte vs high reticulocyte
Methylephenidate toxicity; cannot be stopped abruptly; taper
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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

34. difference between rubeola (measles) and rulbella
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)
Congenital rubella syndrome
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

35. What is earliest sign of puberty?
Penicillin G 4h before delivery
Do HIV testing at first
T for t ; thalassemia; inc serum iron and Iron binding
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

36. physiological jaundice
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
24h to 7d of birth

37. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Injury to b/l glossopharyngeal. present in botulism
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
24-72 hours

38. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Oral DMSA or EDTA IV
Benign permature thelarche; expectant management
ALL - alzheimers autism adhd depression seizure

39. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
No reticulocyte vs high reticulocyte
TB - breastfeeding - asymptomatic hiv
INH 9m if INH resistant rifampin 6m in children and 4m in adults

40. benefits of antibiotic therapy in acute pharyngitis?
Tx only symptomatic carrier
Constitutional pubertal delay
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

41. TTP pentad
Wait until 6 months
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
No wheezing - no feever in chlamydia

42. sickle cell with symmetrical swelling of hands and feet
Develops in 21 dasy
Vaso-occlusive crisis; dx hb electrophoresis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Dactylitis; 2nd common is splenic seqestration

43. adrenal tumor
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
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Pho for forward bending; forward defect; common finding has no adverse physical effect
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

44. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Methylephenidate toxicity; cannot be stopped abruptly; taper

45. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Oral DMSA or EDTA IV
To make hip flexed and abducted position in DDH

46. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

47. How to differentiate croup vs epiglotitis
T for t ; thalassemia; inc serum iron and Iron binding
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Central isosexual precocious puberty; hypothalmaic hamartoma
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

48. How to differential bact vs viral conjunctivitis
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
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Herpes

49. causes of FTT
No myoclonic activity in JME
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
110 kcl/kg/day
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

50. When to give hpv vaccien
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
Increase of progesteron/17oh progesterone
To make hip flexed and abducted position in DDH
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