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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. Nocturnal enuresis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Atopic dermatitis; strong allergic/immunologic component; incr IgE

2. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
No myoclonic activity in JME
Thalassemia - congenital hemolytic anemia
Medical emergency; dimercaprol/edta

3. infantile hypertrophic pyloric stenosis
Bladder dysfunction; UTI and renal dysfunctoin
Croup
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Dx US tx; correct serum electrolyte - pyloromyotom

4. indications of VUR
No wheezing - no feever in chlamydia
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Between pregnenolone and 17oh pregnenolone
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

5. target cell
T for t ; thalassemia; inc serum iron and Iron binding
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

6. nuchal rigidity - fever - sore throat - headache - dioriented
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Candidal diapar rash; tx clotrimazol
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
1.5%

7. association with infantile pyloric stenosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
36 hours
Erb paralysis leading to diaphragmatic paralysis

8. flexible kyphosis
Wait until 6 months
Pho for forward bending; forward defect; common finding has no adverse physical effect
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

9. coin in child's stomach
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
No intervention; 90% foreign bodies pass without difficulty
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

10. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Congenital rubella syndrome
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

11. When to give HRT in turner
Develops in 21 dasy
Thalassemia - congenital hemolytic anemia
14yrs
Rapid detection of RSV antigen in nasl

12. When to do aortic root surgery in marfans to prevent dissection?
14yrs
If aortic root reaches 45 mm
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
24-72 hours

13. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
ALL - alzheimers autism adhd depression seizure
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

14. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Vaso-occlusive crisis; dx hb electrophoresis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

15. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Develops in 21 dasy
36 hours
Meconeum ileus; think about CF
Herpes

16. Tx of botulism
Increase of pregnenolone
Constitutional pubertal delay
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

17. doing worse in school - lack of attention - starring speel
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Bartonella henselae; complication is suppuration of lymph node
Less than 5th percentile
Absence seizure; tx ethosuximide

18. language expectation from 2yo
Decreased UGT enzyme
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
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)
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

19. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Brown
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

20. the risk of lyme after bitten by a tick
Biliary atresia; tx surgery
No myoclonic activity in JME
1.5%
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

21. patient with white plaques in mouth and lump in back
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Do HIV testing at first
No intervention; 90% foreign bodies pass without difficulty
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

22. acute abd pain - hx URI - lower extremity maculo papular rash
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
HSP - look for symmetric skin lesions
Increase of progesteron/17oh progesterone
Absence seizure; tx ethosuximide

23. complete airway obstruction with FB
After 6m; breast mild provides iron until 6m.
Dx US tx; correct serum electrolyte - pyloromyotom
No; they are basic compound will be neutralized in an acidic environment of cellulitis
>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

24. duodenal atresia
D for d; down syndrome and polyhydramnios
URI
14yrs
Methylephenidate toxicity; cannot be stopped abruptly; taper

25. lead 44-70
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Oral DMSA or EDTA IV
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

26. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Decreases height - expensive; reserved for severe cases of delayed puberty
Diet modification to provide 110kc/kg/d
If aortic root reaches 45 mm

27. HUS
<2yrs - abd pain - diarrhoea - ARF
36 hours
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
110 kcl/kg/day

28. How to differentiate croup vs epiglotitis
HSP - look for symmetric skin lesions
Croup tx cool mist; racemic epi - corticosteroid
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Erb paralysis leading to diaphragmatic paralysis

29. pavlik harness
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Croup tx cool mist; racemic epi - corticosteroid
To make hip flexed and abducted position in DDH

30. tick transmits lyme
<2yrs - abd pain - diarrhoea - ARF
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Prolactinoma
Brown

31. Febrile seizure
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Injury to b/l glossopharyngeal. present in botulism
24-72 hours
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

32. Parvovirus
Fifth disease; febrile syndrome
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Candidal diapar rash; tx clotrimazol

33. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Meconeum ileus; think about CF
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

34. causes of FTT
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Increase of progesteron/17oh progesterone

35. tuberous sclerosis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Bartonella henselae; complication is suppuration of lymph node
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

36. How to differentiate caput succedanueum and cephalohematoma
Absence seizure; tx ethosuximide
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Constitutional pubertal delay

37. dx for turner
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

38. thumb sign
>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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
14yrs
Faciform RBC cause vascular occlusion

39. cat scratch disease
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
Faciform RBC cause vascular occlusion
To make hip flexed and abducted position in DDH
Bartonella henselae; complication is suppuration of lymph node

40. adrenal tumor
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
110 kcl/kg/day
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

41. How to investigate delayed puberty
Mainly clinical; serology with initial ELISA - with western blot confirmation;
1.5%
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Tx only symptomatic carrier

42. What is the definition of delayed puberty?
Benign permature thelarche; expectant management
Bladder dysfunction; UTI and renal dysfunctoin
Facial portwine stain
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

43. How long anti-TB drugs given for TB meningitis?
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

44. language delay
36 hours
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

45. Parents can _____ vaccine
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
refuse
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Decr calorie intake; decr calorie absorption;incr calorie demand

46. defcicieny of 21 hydroxylase
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
To make hip flexed and abducted position in DDH
Increase of progesteron/17oh progesterone

47. tzanck
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Herpes
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

48. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
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)
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Develops in 21 dasy
Erb paralysis leading to diaphragmatic paralysis

49. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

50. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Between pregnenolone and 17oh pregnenolone
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Bartonella henselae; complication is suppuration of lymph node