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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. echymoses with low platelet <30k
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Benign permature thelarche; expectant management
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

2. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
ALL - alzheimers autism adhd depression seizure
Black
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

3. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
24-72 hours
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No reticulocyte vs high reticulocyte

4. low grade fever - cough - diffuse bilat ground glass opacities
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Vaso-occlusive crisis; dx hb electrophoresis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Multiple telangiectesia - vasular lesion in CNS

5. What is the calorie requirement of newborn?
ALL - alzheimers autism adhd depression seizure
HSP - look for symmetric skin lesions
Injury to b/l glossopharyngeal. present in botulism
110 kcl/kg/day

6. Infant with serum billlirubin >25
Risk of neurological dysfunction
To make hip flexed and abducted position in DDH
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

7. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Croup
Female - breech delivery - family history; tx referral to ortho
<2yrs - abd pain - diarrhoea - ARF

8. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Multiple telangiectesia - vasular lesion in CNS
Bartonella henselae; complication is suppuration of lymph node
After 24h of abx therapy

9. How to dx post uretheral valve
Bladder dysfunction; UTI and renal dysfunctoin
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Thalassemia - congenital hemolytic anemia

10. How to prevent GBS in neonate
Central isosexual precocious puberty; hypothalmaic hamartoma
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Tx only symptomatic carrier
Penicillin G 4h before delivery

11. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Neurofibromatosis type2
Absence seizure; tx ethosuximide
Thalassemia - congenital hemolytic anemia

12. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Increase of progesteron/17oh progesterone
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Meconeum ileus; think about CF
Methylephenidate toxicity; cannot be stopped abruptly; taper

13. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

14. How long anti-TB drugs given for TB meningitis?
24-72 hours
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Female - breech delivery - family history; tx referral to ortho
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

15. red oozing rash on cheek - scaly - dry
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Mainly clinical; serology with initial ELISA - with western blot confirmation;

16. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Oral DMSA or EDTA IV
Methylephenidate toxicity; cannot be stopped abruptly; taper
Atypical lymphocyte

17. What is the definition of delayed puberty?
Wait until 6 months
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Pho for forward bending; forward defect; common finding has no adverse physical effect

18. impaired gag reflex
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Meconeum ileus; think about CF
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Injury to b/l glossopharyngeal. present in botulism

19. the recommended ca supplementation
Injury to b/l glossopharyngeal. present in botulism
Foreign body sensation - photophobia - corneal opacity tx abx
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
T for t ; thalassemia; inc serum iron and Iron binding

20. adrenal tumor
Croup
Diet modification to provide 110kc/kg/d
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Decr calorie intake; decr calorie absorption;incr calorie demand

21. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Bartonella henselae; complication is suppuration of lymph node

22. indications of audiometry in childrens
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Herpes
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
INH 9m if INH resistant rifampin 6m in children and 4m in adults

23. congenital adrenal hyperplasi
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

24. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Herpes

25. iron supplement in child
Do HIV testing at first
Tx only symptomatic carrier
Black
After 6m; breast mild provides iron until 6m.

26. deficinecy of 17 hydroxylase
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
T for t ; thalassemia; inc serum iron and Iron binding
Increase of pregnenolone
Multiple telangiectesia - vasular lesion in CNS

27. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
36 hours
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Penicillin G 4h before delivery

28. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Neurofibromatosis type2
Meconeum ileus; think about CF
Dactylitis; 2nd common is splenic seqestration

29. 3yo - febrile - left hip externally rotated
Congenital rubella syndrome
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Croup

30. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Rapid detection of RSV antigen in nasl
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

31. down syndrome with holocystolic mumur
Meconeum ileus; think about CF
Endocardial cushion defect (no separation between heart chambers)
TB - breastfeeding - asymptomatic hiv
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

32. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
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
Less than 5th percentile
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

33. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

34. Tx of bact conjunctivitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Herpes
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

35. When to do aortic root surgery in marfans to prevent dissection?
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Fifth disease; febrile syndrome
If aortic root reaches 45 mm
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

36. What is earliest sign of puberty?
To make hip flexed and abducted position in DDH
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Foreign body sensation - photophobia - corneal opacity tx abx
1.5%

37. when bact conjunctivitis patient can go back to school
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
After 24h of abx therapy
Brown
Decr calorie intake; decr calorie absorption;incr calorie demand

38. major depression
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Tx only symptomatic carrier
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

39. starring spells 10-20sec
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
Dactylitis; 2nd common is splenic seqestration
HSP - look for symmetric skin lesions
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

40. adenovirus
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
URI
Female - breech delivery - family history; tx referral to ortho
Endocardial cushion defect (no separation between heart chambers)

41. carditis and arthritis after rheumatic fever
If aortic root reaches 45 mm
Develops in 21 dasy
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

42. 3yo - never able to walk
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

43. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
To make hip flexed and abducted position in DDH
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

44. contraindications of DTap
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Herpes
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Increase of progesteron/17oh progesterone

45. How to difference viral and bact pneumonia
Imaging study to r/o VUR
RSV - rhino and influenza
Marfans - ehlers danlos - homocystinuria
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

46. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Central isosexual precocious puberty; hypothalmaic hamartoma
After 24h of abx therapy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

47. acute otitis externa

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48. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Increase of pregnenolone
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

49. How to investigate delayed puberty
Strep pneumonie; moraxella; h influenze
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Decreased UGT enzyme
Less than 5th percentile

50. IM
Herpes
Atypical lymphocyte
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
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