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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. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Dx US tx; correct serum electrolyte - pyloromyotom
Pho for forward bending; forward defect; common finding has no adverse physical effect

2. language delay
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)
To make hip flexed and abducted position in DDH
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Vaso-occlusive crisis; dx hb electrophoresis

3. acute otitis externa

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4. doing worse in school - lack of attention - starring speel
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Absence seizure; tx ethosuximide
Croup
>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

5. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Penicillin G 4h before delivery
Diet modification to provide 110kc/kg/d
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

6. difference between diaper dermatitis and rash
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Between pregnenolone and 17oh pregnenolone

7. sublottic narrowing
Penicillin G 4h before delivery
Croup tx cool mist; racemic epi - corticosteroid
Bladder dysfunction; UTI and renal dysfunctoin
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

8. Tx of botulism
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Black
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

9. What is thumbprint sign
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
No intervention; 90% foreign bodies pass without difficulty
Lateral neck xray in epiglottitis show swollen epiglottis

10. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Injury to b/l glossopharyngeal. present in botulism
Constitutional pubertal delay
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

11. when bact conjunctivitis patient can go back to school
Bladder dysfunction; UTI and renal dysfunctoin
Candidal diapar rash; tx clotrimazol
After 24h of abx therapy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

12. giardiasis
Medical emergency; dimercaprol/edta
14yrs
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Tx only symptomatic carrier

13. osler rendu weber syndrom
110 kcl/kg/day
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Multiple telangiectesia - vasular lesion in CNS
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

14. congenital adrenal hyperplasi
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Biliary atresia; tx surgery
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Foreign body sensation - photophobia - corneal opacity tx abx

15. dx for DDH
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Increase of pregnenolone
Croup tx cool mist; racemic epi - corticosteroid

16. Tx of children constipation

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17. What is the most common initial symptom in sickle cell
36 hours
Dactylitis; 2nd common is splenic seqestration
Pho for forward bending; forward defect; common finding has no adverse physical effect
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)

18. centor criteria for bact pharyngitis
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
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
ALL - alzheimers autism adhd depression seizure
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

19. how thalassemia die
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

20. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Brown
No myoclonic activity in JME
INH 9m if INH resistant rifampin 6m in children and 4m in adults
No reticulocyte vs high reticulocyte

21. How to differential bact vs viral conjunctivitis
Dx US tx; correct serum electrolyte - pyloromyotom
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Tx only symptomatic carrier
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

22. How to prevent GBS in neonate
<2yrs - abd pain - diarrhoea - ARF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
After 6m; breast mild provides iron until 6m.
Penicillin G 4h before delivery

23. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Erb paralysis leading to diaphragmatic paralysis
Increase of progesteron/17oh progesterone
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

24. association with infantile pyloric stenosis
HSP - look for symmetric skin lesions
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Mainly clinical; serology with initial ELISA - with western blot confirmation;

25. lead >70
Decreased UGT enzyme
Medical emergency; dimercaprol/edta
Benign permature thelarche; expectant management
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

26. what conditions are not contraindicated
Marfans - ehlers danlos - homocystinuria
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
TB - breastfeeding - asymptomatic hiv
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

27. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Congenital rubella syndrome
No reticulocyte vs high reticulocyte
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

28. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Bladder dysfunction; UTI and renal dysfunctoin
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No intervention; 90% foreign bodies pass without difficulty

29. tick transmits RMSF
Black
No intervention; 90% foreign bodies pass without difficulty
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

30. What is the calorie requirement of newborn?
Facial portwine stain
110 kcl/kg/day
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

31. What is the definition of delayed puberty?
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

32. Tx of community acquired pneumonia
Prolactinoma
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Wait until 6 months
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

33. difference between breast milk and breafeeding jaundice
Dx US tx; correct serum electrolyte - pyloromyotom
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Biliary atresia; tx surgery
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

34. coin in child's stomach
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Multiple telangiectesia - vasular lesion in CNS
No intervention; 90% foreign bodies pass without difficulty

35. Tx of bact conjunctivitis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
refuse

36. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
24-72 hours
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Do HIV testing at first

37. When to do aortic root surgery in marfans to prevent dissection?
No; they are basic compound will be neutralized in an acidic environment of cellulitis
If aortic root reaches 45 mm
Constitutional pubertal delay
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

38. if bone age lower than actual and puberty delayed
RSV - rhino and influenza
Risk of neurological dysfunction
Constitutional pubertal delay
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

39. red oozing rash on cheek - scaly - dry
110 kcl/kg/day
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
1.5%
Atopic dermatitis; strong allergic/immunologic component; incr IgE

40. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
24-72 hours
Methylephenidate toxicity; cannot be stopped abruptly; taper
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

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

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42. TB prophylaxis
Dx US tx; correct serum electrolyte - pyloromyotom
Vaso-occlusive crisis; dx hb electrophoresis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Tx only symptomatic carrier

43. 12y - obese - hip pain - hip ext rotated
No intervention; 90% foreign bodies pass without difficulty
Dactylitis; 2nd common is splenic seqestration
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
24-72 hours

44. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
HSP - look for symmetric skin lesions
Diet modification to provide 110kc/kg/d

45. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Black
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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. When to give HRT in turner
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Foreign body sensation - photophobia - corneal opacity tx abx
URI
14yrs

47. duodenal atresia
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
D for d; down syndrome and polyhydramnios
Decreases height - expensive; reserved for severe cases of delayed puberty

48. 21 hydroxylase
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Atypical lymphocyte
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

49. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Dactylitis; 2nd common is splenic seqestration
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Fifth disease; febrile syndrome

50. contact lens keratitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Thalassemia - congenital hemolytic anemia
Faciform RBC cause vascular occlusion
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients