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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. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Candidal diapar rash; tx clotrimazol

2. complete airway obstruction with FB
Pipercillin (zosyn) - ticarcillin
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
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

3. 18mo bilat breast enlargment - some pubic hair
Marfans - ehlers danlos - homocystinuria
Benign permature thelarche; expectant management
Absence seizure; tx ethosuximide
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

4. language expectation from 2yo
Endocardial cushion defect (no separation between heart chambers)
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Black
After 6m; breast mild provides iron until 6m.

5. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
ALL - alzheimers autism adhd depression seizure
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

6. decreased mobility of tympanic membrane after otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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

7. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Candidal diapar rash; tx clotrimazol
Croup
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

8. What are the risk factors of developmental dysplais of hip
Erb paralysis leading to diaphragmatic paralysis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
24-72 hours
Female - breech delivery - family history; tx referral to ortho

9. splenic infarction in sickle cell
HSP - look for symmetric skin lesions
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
Faciform RBC cause vascular occlusion
Croup tx cool mist; racemic epi - corticosteroid

10. viruses cause bronhioltitis
RSV - rhino and influenza
Pho for forward bending; forward defect; common finding has no adverse physical effect
After 24h of abx therapy
Yes; but it will be less effective

11. 3yo - never able to walk
Tx only symptomatic carrier
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

12. failure to thrive
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Atypical lymphocyte
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
Less than 5th percentile

13. contact lens keratitis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
URI

14. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Rapid detection of RSV antigen in nasl
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Benign permature thelarche; expectant management

15. What is the definition of delayed puberty?
To make hip flexed and abducted position in DDH
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
24-72 hours
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

16. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Injury to b/l glossopharyngeal. present in botulism
Rapid detection of RSV antigen in nasl
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

17. pneumonia in CF patient
Croup
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Lateral neck xray in epiglottitis show swollen epiglottis
24-72 hours

18. non immune pregnant women exposed to rubella in first trimester
Strep pneumonie; moraxella; h influenze
Penicillin G 4h before delivery
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Congenital rubella syndrome

19. What is the most common initial symptom in sickle cell
Diet modification to provide 110kc/kg/d
Dactylitis; 2nd common is splenic seqestration
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

20. coin in child's stomach
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
<2yrs - abd pain - diarrhoea - ARF
No intervention; 90% foreign bodies pass without difficulty

21. indications of VUR
Rapid detection of RSV antigen in nasl
No; they are basic compound will be neutralized in an acidic environment of cellulitis
If aortic root reaches 45 mm
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

22. can women with abnormal smear or genital get vaccine
Wait until 6 months
Yes; but it will be less effective
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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

23. target cell
T for t ; thalassemia; inc serum iron and Iron binding
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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

24. How to dx post uretheral valve
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
D for d; down syndrome and polyhydramnios
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

25. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Bartonella henselae; complication is suppuration of lymph node
Erb paralysis leading to diaphragmatic paralysis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

26. microcytic - hypochromic anemia - hepatospelnomegaly
Neurofibromatosis type2
Thalassemia - congenital hemolytic anemia
ALL - alzheimers autism adhd depression seizure
Dx US tx; correct serum electrolyte - pyloromyotom

27. How long patient needs to be exposed to tick to get infected
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Dactylitis; 2nd common is splenic seqestration
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
36 hours

28. difference between diaper dermatitis and rash
Black
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
Vaso-occlusive crisis; dx hb electrophoresis

29. tick transmits lyme
Decreased UGT enzyme
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Brown
No intervention; 90% foreign bodies pass without difficulty

30. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Methylephenidate toxicity; cannot be stopped abruptly; taper
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Fifth disease; febrile syndrome

31. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Imaging study to r/o VUR
TB - breastfeeding - asymptomatic hiv
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

32. How to prevent GBS in neonate
Penicillin G 4h before delivery
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Strep pneumonie; moraxella; h influenze
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

33. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Diet modification to provide 110kc/kg/d
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Fifth disease; febrile syndrome

34. contraindications of MMR vaccine
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

35. lead >70
Medical emergency; dimercaprol/edta
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Marfans - ehlers danlos - homocystinuria
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

36. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Rapid detection of RSV antigen in nasl
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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)

37. the risk of lyme after bitten by a tick
1.5%
Pipercillin (zosyn) - ticarcillin
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

38. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Erb paralysis leading to diaphragmatic paralysis
T for t ; thalassemia; inc serum iron and Iron binding
Dx US tx; correct serum electrolyte - pyloromyotom

39. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
>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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

40. how smoking contributes otitis media in children
After 24h of abx therapy
Endocardial cushion defect (no separation between heart chambers)
Yes; but it will be less effective
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

41. Tx of FTT
Diet modification to provide 110kc/kg/d
Lateral neck xray in epiglottitis show swollen epiglottis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

42. down syndrome has inreased risk of developing
Herpes
ALL - alzheimers autism adhd depression seizure
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

43. How to differentiate caput succedanueum and cephalohematoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Oral DMSA or EDTA IV
No myoclonic activity in JME
Absence seizure; tx ethosuximide

44. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Penicillin G 4h before delivery

45. dx for turner
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Foreign body sensation - photophobia - corneal opacity tx abx

46. What is the calorie requirement of newborn?
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
110 kcl/kg/day
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
Brown

47. Infant with serum billlirubin >25
Risk of neurological dysfunction
Foreign body sensation - photophobia - corneal opacity tx abx
Increase of pregnenolone
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

48. Nocturnal enuresis
Constitutional pubertal delay
<2yrs - abd pain - diarrhoea - ARF
Atopic dermatitis; strong allergic/immunologic component; incr IgE
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

49. tick transmits RMSF
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Black
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

50. dx for DDH
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination