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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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
Constitutional pubertal delay
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Erb paralysis leading to diaphragmatic paralysis

2. TTP pentad
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Strep pneumonie; moraxella; h influenze
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

3. language delay
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

4. dx for turner
Foreign body sensation - photophobia - corneal opacity tx abx
URI
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
ALL - alzheimers autism adhd depression seizure

5. lead 44-70
Croup tx cool mist; racemic epi - corticosteroid
Oral DMSA or EDTA IV
Bartonella henselae; complication is suppuration of lymph node
HSP - look for symmetric skin lesions

6. How to dx 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)
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to b/l glossopharyngeal. present in botulism
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

7. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Central isosexual precocious puberty; hypothalmaic hamartoma
Do HIV testing at first
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

8. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
D for d; down syndrome and polyhydramnios
Facial portwine stain
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

9. What is the definition of delayed puberty?
Foreign body sensation - photophobia - corneal opacity tx abx
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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

10. 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
Decreases height - expensive; reserved for severe cases of delayed puberty
36 hours
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

11. Neonatal conjugated hyperbilirubinemia
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Biliary atresia; tx surgery
Black
Wait until 6 months

12. How to dx post uretheral valve
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Less than 5th percentile

13. How to dx endopthalmitis
Wait until 6 months
Benign permature thelarche; expectant management
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

14. Infant with serum billlirubin >25
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Risk of neurological dysfunction

15. Tx of bact conjunctivitis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Thalassemia - congenital hemolytic anemia
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

16. bromocriptine
Decr calorie intake; decr calorie absorption;incr calorie demand
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Atypical lymphocyte
Prolactinoma

17. the risk of lyme after bitten by a tick
1.5%
Tx only symptomatic carrier
Brown
Bladder dysfunction; UTI and renal dysfunctoin

18. horner syndrom
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Injury to lower roots of brachial plexus

19. Tx of FTT
Decreased UGT enzyme
Develops in 21 dasy
Diet modification to provide 110kc/kg/d
Croup tx cool mist; racemic epi - corticosteroid

20. contraindications of DTap
Dx US tx; correct serum electrolyte - pyloromyotom
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

21. Parvovirus
Fifth disease; febrile syndrome
Pipercillin (zosyn) - ticarcillin
No intervention; 90% foreign bodies pass without difficulty
Black

22. 12y - obese - hip pain - hip ext rotated
Central isosexual precocious puberty; hypothalmaic hamartoma
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
36 hours
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

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

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24. flexible kyphosis
Neurofibromatosis type2
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Pho for forward bending; forward defect; common finding has no adverse physical effect
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

25. adrenal tumor
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Constitutional pubertal delay

26. giardiasis
No reticulocyte vs high reticulocyte
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Tx only symptomatic carrier

27. Febrile seizure
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

28. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Bladder dysfunction; UTI and renal dysfunctoin
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Biliary atresia; tx surgery

29. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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
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

30. Tx of botulism
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Constitutional pubertal delay
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

31. How to differentiate croup vs epiglotitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Diet modification to provide 110kc/kg/d
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

32. 21 hydroxylase
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
refuse
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

33. Tx of community acquired pneumonia
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
24h to 7d of birth
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
refuse

34. physiological jaundice
Tx only symptomatic carrier
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
24h to 7d of birth

35. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<2yrs - abd pain - diarrhoea - ARF
Erb paralysis leading to diaphragmatic paralysis

36. coin in child's stomach
110 kcl/kg/day
No intervention; 90% foreign bodies pass without difficulty
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Faciform RBC cause vascular occlusion

37. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
HSP - look for symmetric skin lesions
Injury to lower roots of brachial plexus
Meconeum ileus; think about CF
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

38. aplasic crisis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Yes; but it will be less effective
Marfans - ehlers danlos - homocystinuria

39. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
<2yrs - abd pain - diarrhoea - ARF
Dactylitis; 2nd common is splenic seqestration

40. 3yo - never able to walk
No myoclonic activity in JME
1.5%
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
Benign permature thelarche; expectant management

41. How to difference RSV and neonatal chlamydia
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Absence seizure; tx ethosuximide
No wheezing - no feever in chlamydia
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

42. spitting up - vomiting at night - weight stable
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Pho for forward bending; forward defect; common finding has no adverse physical effect
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Do HIV testing at first

43. difference between diaper dermatitis and rash
If aortic root reaches 45 mm
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

44. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

45. difference between breast milk and breafeeding jaundice
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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
Congenital rubella syndrome

46. causes of acute anemia
Black
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

47. How long anti-TB drugs given for TB meningitis?
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Oral DMSA or EDTA IV
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

48. What are the risk factors of developmental dysplais of hip
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Female - breech delivery - family history; tx referral to ortho
Decr calorie intake; decr calorie absorption;incr calorie demand
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

49. How to prevent GBS in neonate
Marfans - ehlers danlos - homocystinuria
Penicillin G 4h before delivery
<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

50. hypopigmented spots - family hx bilat deafness
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Neurofibromatosis type2
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery