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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. defcicieny of 21 hydroxylase
Meconeum ileus; think about CF
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Increase of progesteron/17oh progesterone
Dactylitis; 2nd common is splenic seqestration

2. flexible kyphosis
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
Pho for forward bending; forward defect; common finding has no adverse physical effect
No reticulocyte vs high reticulocyte
Medical emergency; dimercaprol/edta

3. tzanck
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Herpes
Pipercillin (zosyn) - ticarcillin
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

4. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Foreign body sensation - photophobia - corneal opacity tx abx
Between pregnenolone and 17oh pregnenolone
Pipercillin (zosyn) - ticarcillin

5. low grade fever - cough - diffuse bilat ground glass opacities
1.5%
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Fifth disease; febrile syndrome

6. adenovirus
Rapid detection of RSV antigen in nasl
URI
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Female - breech delivery - family history; tx referral to ortho

7. patient with white plaques in mouth and lump in back
<2yrs - abd pain - diarrhoea - ARF
Vaso-occlusive crisis; dx hb electrophoresis
Do HIV testing at first
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

8. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Methylephenidate toxicity; cannot be stopped abruptly; taper
Candidal diapar rash; tx clotrimazol

9. difference between breast milk and breafeeding jaundice
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
After 24h of abx therapy

10. decreased mobility of tympanic membrane after otitis media
36 hours
Dactylitis; 2nd common is splenic seqestration
Thalassemia - congenital hemolytic anemia
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

11. major depression
Tx only symptomatic carrier
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

12. mcCune albright`
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Penicillin G 4h before delivery
14yrs
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

13. target cell
T for t ; thalassemia; inc serum iron and Iron binding
Less than 5th percentile
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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

14. acute abd pain - hx URI - lower extremity maculo papular rash
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Injury to lower roots of brachial plexus
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
HSP - look for symmetric skin lesions

15. benefits of antibiotic therapy in acute pharyngitis?
Erb paralysis leading to diaphragmatic paralysis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Faciform RBC cause vascular occlusion

16. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Do HIV testing at first
Pho for forward bending; forward defect; common finding has no adverse physical effect
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

17. 18mo bilat breast enlargment - some pubic hair
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Increase of progesteron/17oh progesterone
Benign permature thelarche; expectant management
Pipercillin (zosyn) - ticarcillin

18. centor criteria for bact pharyngitis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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

19. osler rendu weber syndrom
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
Increase of pregnenolone
Multiple telangiectesia - vasular lesion in CNS
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

20. duodenal atresia
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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)
Decreases height - expensive; reserved for severe cases of delayed puberty
D for d; down syndrome and polyhydramnios

21. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Black

22. how thalassemia die
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
No wheezing - no feever in chlamydia
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Central isosexual precocious puberty; hypothalmaic hamartoma

23. acute otitis media-pathogen
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Benign permature thelarche; expectant management
Strep pneumonie; moraxella; h influenze
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

24. HUS
<2yrs - abd pain - diarrhoea - ARF
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Meconeum ileus; think about CF

25. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Croup
Decr calorie intake; decr calorie absorption;incr calorie demand
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. congenital adrenal hyperplasi
To make hip flexed and abducted position in DDH
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Female - breech delivery - family history; tx referral to ortho

27. How to difference RSV and neonatal chlamydia
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
No wheezing - no feever in chlamydia
ALL - alzheimers autism adhd depression seizure
Facial portwine stain

28. lens dislocation
Oral DMSA or EDTA IV
Pho for forward bending; forward defect; common finding has no adverse physical effect
Marfans - ehlers danlos - homocystinuria
Endocardial cushion defect (no separation between heart chambers)

29. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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
Fifth disease; febrile syndrome

30. lead >70
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Medical emergency; dimercaprol/edta
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

31. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Facial portwine stain
Endocardial cushion defect (no separation between heart chambers)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

32. How to dx RSV
No intervention; 90% foreign bodies pass without difficulty
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Rapid detection of RSV antigen in nasl

33. pneumonia in CF patient
After 6m; breast mild provides iron until 6m.
Imaging study to r/o VUR
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Injury to lower roots of brachial plexus

34. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Strep pneumonie; moraxella; h influenze
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

35. How to difference viral and bact pneumonia
24h to 7d of birth
No reticulocyte vs high reticulocyte
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

36. 21 hydroxylase
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Prolactinoma

37. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Penicillin G 4h before delivery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

38. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Diet modification to provide 110kc/kg/d

39. IM
After 6m; breast mild provides iron until 6m.
14yrs
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Atypical lymphocyte

40. Parvovirus
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
Fifth disease; febrile 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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

41. physiological jaundice
Erb paralysis leading to diaphragmatic paralysis
24h to 7d of birth
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Benign permature thelarche; expectant management

42. sturge weber syndrome
Dx US tx; correct serum electrolyte - pyloromyotom
Facial portwine stain
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

43. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Brown

44. what conditions are not contraindicated
Decreases height - expensive; reserved for severe cases of delayed puberty
Multiple telangiectesia - vasular lesion in CNS
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
TB - breastfeeding - asymptomatic hiv

45. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
After 6m; breast mild provides iron until 6m.
Do HIV testing at first
Pipercillin (zosyn) - ticarcillin

46. cat scratch disease
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Candidal diapar rash; tx clotrimazol
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Bartonella henselae; complication is suppuration of lymph node

47. What is thumbprint sign
Strep pneumonie; moraxella; h influenze
Injury to b/l glossopharyngeal. present in botulism
Lateral neck xray in epiglottitis show swollen epiglottis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

48. starring spells 10-20sec
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Bladder dysfunction; UTI and renal dysfunctoin

49. When to do surgery for undescended testes
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Croup
24h to 7d of birth
Wait until 6 months

50. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
After 6m; breast mild provides iron until 6m.
Croup