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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. 3yo - never able to walk
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
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
Increase of progesteron/17oh progesterone
D for d; down syndrome and polyhydramnios

2. mcCune albright`
To make hip flexed and abducted position in DDH
Fifth disease; febrile syndrome
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

3. How long patient needs to be exposed to tick to get infected
Neurofibromatosis type2
36 hours
Multiple telangiectesia - vasular lesion in CNS
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

4. carditis and arthritis after rheumatic fever
ALL - alzheimers autism adhd depression seizure
Develops in 21 dasy
Brown
After 6m; breast mild provides iron until 6m.

5. HUS
Female - breech delivery - family history; tx referral to ortho
<2yrs - abd pain - diarrhoea - ARF
Neurofibromatosis type2
T for t ; thalassemia; inc serum iron and Iron binding

6. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
RSV - rhino and influenza
Penicillin G 4h before delivery
After 24h of abx therapy

7. difference between rubeola (measles) and rulbella
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Decreases height - expensive; reserved for severe cases of delayed puberty
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

8. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

9. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No reticulocyte vs high reticulocyte
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

10. When to bevioral and enviromental measure in led intoxication?
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

11. is local anesthetics be used in cellulitis to reduce pain
Black
Do HIV testing at first
D for d; down syndrome and polyhydramnios
No; they are basic compound will be neutralized in an acidic environment of cellulitis

12. hypopigmented spots - family hx bilat deafness
TB - breastfeeding - asymptomatic hiv
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Vaso-occlusive crisis; dx hb electrophoresis
Neurofibromatosis type2

13. cardiac manifestation of turner
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Injury to lower roots of brachial plexus
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

14. cleft lip but no cleft palate
Central isosexual precocious puberty; hypothalmaic hamartoma
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Brown

15. low grade fever - cough - diffuse bilat ground glass opacities
Tx only symptomatic carrier
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
>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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

16. difference between breast milk and breafeeding jaundice
Vaso-occlusive crisis; dx hb electrophoresis
14yrs
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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

17. the recommended ca supplementation
36 hours
Lateral neck xray in epiglottitis show swollen epiglottis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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

18. association with infantile pyloric stenosis
Penicillin G 4h before delivery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

19. benefits of antibiotic therapy in acute pharyngitis?
Dactylitis; 2nd common is splenic seqestration
No intervention; 90% foreign bodies pass without difficulty
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

20. adrenal tumor
No; they are basic compound will be neutralized in an acidic environment of cellulitis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Black
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

21. giardiasis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
After 24h of abx therapy
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Tx only symptomatic carrier

22. When to give hpv vaccien
Do HIV testing at first
Candidal diapar rash; tx clotrimazol
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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

23. What is the definition of delayed puberty?
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Tx only symptomatic carrier
Injury to lower roots of brachial plexus

24. down syndrome has inreased risk of developing
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
ALL - alzheimers autism adhd depression seizure
Oral DMSA or EDTA IV

25. tick transmits lyme
Meconeum ileus; think about CF
Brown
Croup tx cool mist; racemic epi - corticosteroid
1.5%

26. flexible kyphosis
Do HIV testing at first
Pho for forward bending; forward defect; common finding has no adverse physical effect
<2yrs - abd pain - diarrhoea - ARF
>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

27. kallman syndrome
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Constitutional pubertal delay
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

28. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
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
Do HIV testing at first
D for d; down syndrome and polyhydramnios

29. duodenal atresia
Decr calorie intake; decr calorie absorption;incr calorie demand
D for d; down syndrome and polyhydramnios
T for t ; thalassemia; inc serum iron and Iron binding
No intervention; 90% foreign bodies pass without difficulty

30. contraindications of DTap
Injury to lower roots of brachial plexus
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Develops in 21 dasy

31. TB prophylaxis
Injury to b/l glossopharyngeal. present in botulism
INH 9m if INH resistant rifampin 6m in children and 4m in adults
To make hip flexed and abducted position in DDH
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

32. complete airway obstruction with FB
Candidal diapar rash; tx clotrimazol
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
>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
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

33. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Biliary atresia; tx surgery

34. red oozing rash on cheek - scaly - dry
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Penicillin G 4h before delivery
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

35. acute abd pain - hx URI - lower extremity maculo papular rash
Penicillin G 4h before delivery
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Diet modification to provide 110kc/kg/d
HSP - look for symmetric skin lesions

36. 3yo - febrile - left hip externally rotated
Neurofibromatosis type2
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
No intervention; 90% foreign bodies pass without difficulty
Thalassemia - congenital hemolytic anemia

37. Tx of children constipation

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38. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Less than 5th percentile
Injury to lower roots of brachial plexus
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

39. infantile hypertrophic pyloric stenosis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Dx US tx; correct serum electrolyte - pyloromyotom
24-72 hours

40. tzanck
Herpes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
14yrs

41. viruses cause bronhioltitis
Benign permature thelarche; expectant management
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Female - breech delivery - family history; tx referral to ortho
RSV - rhino and influenza

42. can women with abnormal smear or genital get vaccine
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Yes; but it will be less effective

43. indications of VUR
Diet modification to provide 110kc/kg/d
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
refuse

44. Parents can _____ vaccine
Dx US tx; correct serum electrolyte - pyloromyotom
refuse
Constitutional pubertal delay
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

45. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Yes; but it will be less effective
Dx US tx; correct serum electrolyte - pyloromyotom
D for d; down syndrome and polyhydramnios

46. How to difference RSV and neonatal chlamydia
Between pregnenolone and 17oh pregnenolone
No wheezing - no feever in chlamydia
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

47. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Decreases height - expensive; reserved for severe cases of delayed puberty
Injury to b/l glossopharyngeal. present in botulism

48. TTP pentad
Biliary atresia; tx surgery
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

49. aplasic crisis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

50. Parvovirus
Injury to lower roots of brachial plexus
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Fifth disease; febrile syndrome
No wheezing - no feever in chlamydia