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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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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 to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Rapid detection of RSV antigen in nasl
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

2. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
>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
36 hours

3. causes of acute anemia
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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

4. non immune pregnant women exposed to rubella in first trimester
Tx only symptomatic carrier
Black
Congenital rubella syndrome
Pipercillin (zosyn) - ticarcillin

5. How to investigate delayed puberty
Penicillin G 4h before delivery
Brown
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

6. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Endocardial cushion defect (no separation between heart chambers)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Meconeum ileus; think about CF

7. acute abd pain - hx URI - lower extremity maculo papular rash
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
HSP - look for symmetric skin lesions
Wait until 6 months
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

8. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Between pregnenolone and 17oh pregnenolone
Decr calorie intake; decr calorie absorption;incr calorie demand
Female - breech delivery - family history; tx referral to ortho

9. centor criteria for bact pharyngitis
Congenital rubella syndrome
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Faciform RBC cause vascular occlusion

10. What is the calorie requirement of newborn?
Biliary atresia; tx surgery
110 kcl/kg/day
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

11. viruses cause bronhioltitis
Atypical lymphocyte
RSV - rhino and influenza
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Endocardial cushion defect (no separation between heart chambers)

12. How to evaluate well appearing child just born in GBS pos mother?
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Thalassemia - congenital hemolytic anemia
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

13. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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

14. difference between diaper dermatitis and rash
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Between pregnenolone and 17oh pregnenolone
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
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

15. low grade fever - cough - diffuse bilat ground glass opacities
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

16. indications of audiometry in childrens
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Do HIV testing at first

17. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Congenital rubella syndrome
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

18. infantile hypertrophic pyloric stenosis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Dx US tx; correct serum electrolyte - pyloromyotom
Risk of neurological dysfunction

19. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
24h to 7d of birth
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

20. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

21. sickle cell with symmetrical swelling of hands and feet
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Vaso-occlusive crisis; dx hb electrophoresis

22. When to give hpv vaccien
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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. defcicieny of 21 hydroxylase
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Develops in 21 dasy
Increase of progesteron/17oh progesterone
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

24. tuberous sclerosis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Herpes
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

25. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Meconeum ileus; think about CF
Mainly clinical; serology with initial ELISA - with western blot confirmation;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

26. most common complication of otitis media
Pipercillin (zosyn) - ticarcillin
No reticulocyte vs high reticulocyte
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

27. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

28. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Croup tx cool mist; racemic epi - corticosteroid
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

29. hypopigmented spots - family hx bilat deafness
Increase of progesteron/17oh progesterone
24-72 hours
Less than 5th percentile
Neurofibromatosis type2

30. language expectation from 2yo
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Between pregnenolone and 17oh pregnenolone
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Strep pneumonie; moraxella; h influenze

31. adenovirus
Imaging study to r/o VUR
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
No myoclonic activity in JME
URI

32. pneumonia in CF patient
Bladder dysfunction; UTI and renal dysfunctoin
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
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

33. cleft lip but no cleft palate
Develops in 21 dasy
Croup tx cool mist; racemic epi - corticosteroid
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

34. iron supplement in child
ALL - alzheimers autism adhd depression seizure
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
refuse
After 6m; breast mild provides iron until 6m.

35. failure to thrive
TB - breastfeeding - asymptomatic hiv
Less than 5th percentile
Bladder dysfunction; UTI and renal dysfunctoin
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

36. contact lens keratitis
Foreign body sensation - photophobia - corneal opacity tx abx
Erb paralysis leading to diaphragmatic paralysis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

37. tick transmits lyme
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
refuse
Brown

38. bromocriptine
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Neurofibromatosis type2
Methylephenidate toxicity; cannot be stopped abruptly; taper
Prolactinoma

39. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
>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
Increase of pregnenolone

40. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Brown
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
ALL - alzheimers autism adhd depression seizure
Increase of pregnenolone

41. How to differential bact vs viral conjunctivitis
Croup tx cool mist; racemic epi - corticosteroid
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Facial portwine stain
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

42. What is the definition of delayed puberty?
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
ALL - alzheimers autism adhd depression seizure

43. contraindications of MMR vaccine
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
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
Medical emergency; dimercaprol/edta
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

44. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Female - breech delivery - family history; tx referral to ortho
14yrs
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

45. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
No myoclonic activity in JME
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

46. indications of VUR
36 hours
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Facial portwine stain
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

47. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Strep pneumonie; moraxella; h influenze
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Prolactinoma

48. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Candidal diapar rash; tx clotrimazol
Between pregnenolone and 17oh pregnenolone

49. tick transmits RMSF
Female - breech delivery - family history; tx referral to ortho
Yes; but it will be less effective
Black
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

50. How to differentiate caput succedanueum and cephalohematoma
Herpes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
After 24h of abx therapy
refuse