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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. Tx of community acquired pneumonia
Erb paralysis leading to diaphragmatic paralysis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

2. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
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
Vaso-occlusive crisis; dx hb electrophoresis
Central isosexual precocious puberty; hypothalmaic hamartoma

3. tzanck
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Herpes
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

4. When to give HRT in turner
Yes; but it will be less effective
14yrs
Oral DMSA or EDTA IV
Mainly clinical; serology with initial ELISA - with western blot confirmation;

5. tick transmits lyme
Brown
Medical emergency; dimercaprol/edta
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
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

6. IM
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Tx only symptomatic carrier
Atypical lymphocyte

7. giardiasis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Tx only symptomatic carrier
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Between pregnenolone and 17oh pregnenolone

8. benefits of antibiotic therapy in acute pharyngitis?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

9. centor criteria for bact pharyngitis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Endocardial cushion defect (no separation between heart chambers)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Decreased UGT enzyme

10. mcCune albright`
Bartonella henselae; complication is suppuration of lymph node
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Croup
Herpes

11. tick transmits RMSF
Pipercillin (zosyn) - ticarcillin
No wheezing - no feever in chlamydia
Black
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

12. How to differential bact vs viral conjunctivitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Croup

13. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Pipercillin (zosyn) - ticarcillin
After 24h of abx therapy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

14. aplasic crisis
Increase of progesteron/17oh progesterone
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Tx only symptomatic carrier
refuse

15. osler rendu weber syndrom
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Female - breech delivery - family history; tx referral to ortho
Foreign body sensation - photophobia - corneal opacity tx abx
Multiple telangiectesia - vasular lesion in CNS

16. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

17. crying during urination. bacteriuria pyruria - rec episodes
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Prolactinoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Imaging study to r/o VUR

18. association with infantile pyloric stenosis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Bartonella henselae; complication is suppuration of lymph node
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

19. 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)
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Herpes
Injury to b/l glossopharyngeal. present in botulism

20. contraindications of MMR vaccine
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

21. Parents can _____ vaccine
Less than 5th percentile
Pipercillin (zosyn) - ticarcillin
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
refuse

22. side effect of testosteron therapy
24-72 hours
Fifth disease; febrile syndrome
Pho for forward bending; forward defect; common finding has no adverse physical effect
Decreases height - expensive; reserved for severe cases of delayed puberty

23. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Pipercillin (zosyn) - ticarcillin
Increase of pregnenolone

24. 12y - obese - hip pain - hip ext rotated
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
Pho for forward bending; forward defect; common finding has no adverse physical effect
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Increase of progesteron/17oh progesterone

25. target cell
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
T for t ; thalassemia; inc serum iron and Iron binding
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Do HIV testing at first

26. What is the most common initial symptom in sickle cell
Fifth disease; febrile syndrome
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Vaso-occlusive crisis; dx hb electrophoresis
Dactylitis; 2nd common is splenic seqestration

27. When to do surgery for undescended testes
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Absence seizure; tx ethosuximide
Decr calorie intake; decr calorie absorption;incr calorie demand
Wait until 6 months

28. How to differentiate caput succedanueum and cephalohematoma
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Mainly clinical; serology with initial ELISA - with western blot confirmation;

29. Febrile seizure
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
110 kcl/kg/day

30. sublottic narrowing
No wheezing - no feever in chlamydia
Croup tx cool mist; racemic epi - corticosteroid
Between pregnenolone and 17oh pregnenolone
If aortic root reaches 45 mm

31. Infant with serum billlirubin >25
Bartonella henselae; complication is suppuration of lymph node
Risk of neurological dysfunction
After 24h of abx therapy
14yrs

32. infant botulism
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No myoclonic activity in JME
Thalassemia - congenital hemolytic anemia
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

33. When erythema chronicum migrans develops after tick bite
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
24-72 hours
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)
Increase of pregnenolone

34. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

35. When to give hpv vaccien
Prolactinoma
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
Benign permature thelarche; expectant management
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

36. echymoses with low platelet <30k
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Oral DMSA or EDTA IV
Croup

37. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Herpes
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

38. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Marfans - ehlers danlos - homocystinuria
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

39. flexible kyphosis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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
Dx US tx; correct serum electrolyte - pyloromyotom

40. how thalassemia die
To make hip flexed and abducted position in DDH
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Medical emergency; dimercaprol/edta
Dx US tx; correct serum electrolyte - pyloromyotom

41. mech of botulism
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Meconeum ileus; think about CF
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

42. causes of FTT
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

43. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
No myoclonic activity in JME
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
1.5%

44. Tx of children constipation

45. difference between structural disorder and flexible kyphosis
ALL - alzheimers autism adhd depression seizure
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
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. 17 alpha hydroxylase
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Between pregnenolone and 17oh pregnenolone

47. impaired gag reflex
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Injury to b/l glossopharyngeal. present in botulism
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

48. Parvovirus
Fifth disease; febrile syndrome
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Atypical lymphocyte
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

49. What is the calorie requirement of newborn?
RSV - rhino and influenza
Marfans - ehlers danlos - homocystinuria
110 kcl/kg/day
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

50. complication of lumbosacral meningocele
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bladder dysfunction; UTI and renal dysfunctoin
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications