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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. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
24-72 hours
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
Croup tx cool mist; racemic epi - corticosteroid

2. difference between rubeola (measles) and rulbella
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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

3. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Croup
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Less than 5th percentile

4. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
Oral DMSA or EDTA IV
D for d; down syndrome and polyhydramnios
1.5%

5. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Between pregnenolone and 17oh pregnenolone
No wheezing - no feever in chlamydia

6. duodenal atresia
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Foreign body sensation - photophobia - corneal opacity tx abx
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
D for d; down syndrome and polyhydramnios

7. How to differentiate caput succedanueum and cephalohematoma
Lateral neck xray in epiglottitis show swollen epiglottis
Biliary atresia; tx surgery
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No reticulocyte vs high reticulocyte

8. mcCune albright`
Penicillin G 4h before delivery
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Rapid detection of RSV antigen in nasl
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

9. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Candidal diapar rash; tx clotrimazol
After 24h of abx therapy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

10. 3yo - never able to walk
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
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
Constitutional pubertal delay
Pho for forward bending; forward defect; common finding has no adverse physical effect

11. what conditions are not contraindicated
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Croup
TB - breastfeeding - asymptomatic hiv

12. 18mo bilat breast enlargment - some pubic hair
To make hip flexed and abducted position in DDH
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
110 kcl/kg/day
Benign permature thelarche; expectant management

13. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
24-72 hours

14. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Yes; but it will be less effective
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

15. When to give HRT in turner
110 kcl/kg/day
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
14yrs

16. What are the risk factors of developmental dysplais of hip
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Female - breech delivery - family history; tx referral to ortho
Atopic dermatitis; strong allergic/immunologic component; incr IgE

17. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

18. How to difference RSV and neonatal chlamydia
Foreign body sensation - photophobia - corneal opacity tx abx
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
No wheezing - no feever in chlamydia
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

19. down syndrome has inreased risk of developing
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
ALL - alzheimers autism adhd depression seizure
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

20. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No reticulocyte vs high reticulocyte
Strep pneumonie; moraxella; h influenze
D for d; down syndrome and polyhydramnios

21. 3yo - febrile - left hip externally rotated
Oral DMSA or EDTA IV
Injury to lower roots of brachial plexus
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

22. How to prevent GBS in neonate
Penicillin G 4h before delivery
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Fifth disease; febrile syndrome
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

23. differentiate between central and peripheral precocious puberty
Yes; but it will be less effective
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

24. iron supplement in child
Do HIV testing at first
Erb paralysis leading to diaphragmatic paralysis
After 6m; breast mild provides iron until 6m.
D for d; down syndrome and polyhydramnios

25. association with infantile pyloric stenosis
Bladder dysfunction; UTI and renal dysfunctoin
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
1.5%
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

26. lens dislocation
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
No reticulocyte vs high reticulocyte
Marfans - ehlers danlos - homocystinuria
Biliary atresia; tx surgery

27. can women with abnormal smear or genital get vaccine
110 kcl/kg/day
14yrs
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Yes; but it will be less effective

28. infantile hypertrophic pyloric stenosis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Methylephenidate toxicity; cannot be stopped abruptly; taper
Dx US tx; correct serum electrolyte - pyloromyotom
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

29. most common complication of otitis media
Dx US tx; correct serum electrolyte - pyloromyotom
Meconeum ileus; think about CF
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Benign permature thelarche; expectant management

30. Tx of FTT
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
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
Diet modification to provide 110kc/kg/d
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

31. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Prolactinoma
Erb paralysis leading to diaphragmatic paralysis

32. mech of botulism
Imaging study to r/o VUR
Prolactinoma
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

33. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
110 kcl/kg/day
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

34. carditis and arthritis after rheumatic fever
Develops in 21 dasy
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
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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

35. sturge weber syndrome
Facial portwine stain
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)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

36. giardiasis
Tx only symptomatic carrier
Candidal diapar rash; tx clotrimazol
T for t ; thalassemia; inc serum iron and Iron binding
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

37. What is the most common initial symptom in sickle cell
No reticulocyte vs high reticulocyte
Dactylitis; 2nd common is splenic seqestration
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Strep pneumonie; moraxella; h influenze

38. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Penicillin G 4h before delivery
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

39. patient with white plaques in mouth and lump in back
Yes; but it will be less effective
<2yrs - abd pain - diarrhoea - ARF
Do HIV testing at first
Decr calorie intake; decr calorie absorption;incr calorie demand

40. low grade fever - cough - diffuse bilat ground glass opacities
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 only symptomatic carrier
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
24h to 7d of birth

41. spitting up - vomiting at night - weight stable
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Dx US tx; correct serum electrolyte - pyloromyotom
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

42. How to evaluate well appearing child just born in GBS pos mother?
Dx US tx; correct serum electrolyte - pyloromyotom
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

43. the risk of lyme after bitten by a tick
Increase of progesteron/17oh progesterone
Penicillin G 4h before delivery
INH 9m if INH resistant rifampin 6m in children and 4m in adults
1.5%

44. tzanck
Herpes
Endocardial cushion defect (no separation between heart chambers)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Atypical lymphocyte

45. tick transmits lyme
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Herpes
Brown

46. When to do surgery for undescended testes
Pipercillin (zosyn) - ticarcillin
Wait until 6 months
No intervention; 90% foreign bodies pass without difficulty
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

47. hypopigmented spots - family hx bilat deafness
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Neurofibromatosis type2
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

48. pneumonia in CF patient
No wheezing - no feever in chlamydia
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
To make hip flexed and abducted position in DDH
Female - breech delivery - family history; tx referral to ortho

49. How to dx RSV
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
Absence seizure; tx ethosuximide
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Rapid detection of RSV antigen in nasl

50. pavlik harness
Thalassemia - congenital hemolytic anemia
To make hip flexed and abducted position in DDH
Risk of neurological dysfunction
Multiple telangiectesia - vasular lesion in CNS