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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 dx keratitis?
No reticulocyte vs high reticulocyte
Foreign body sensation - photophobia - corneal opacity tx abx
Wait until 6 months
Vaso-occlusive crisis; dx hb electrophoresis

2. most common complication of otitis media
Neurofibromatosis type2
110 kcl/kg/day
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

3. Tx of children constipation

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4. How to prevent GBS in neonate
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Central isosexual precocious puberty; hypothalmaic hamartoma
Penicillin G 4h before delivery

5. crying during urination. bacteriuria pyruria - rec episodes
36 hours
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Imaging study to r/o VUR
Risk of neurological dysfunction

6. complete airway obstruction with FB
Diet modification to provide 110kc/kg/d
Central isosexual precocious puberty; hypothalmaic hamartoma
>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
24-72 hours

7. bromocriptine
Atypical lymphocyte
Fifth disease; febrile syndrome
Prolactinoma
Injury to lower roots of brachial plexus

8. decreased mobility of tympanic membrane after otitis media
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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Dx US tx; correct serum electrolyte - pyloromyotom
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

9. mech of botulism
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Increase of progesteron/17oh progesterone
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Pipercillin (zosyn) - ticarcillin

10. horner syndrom
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Facial portwine stain
Injury to lower roots of brachial plexus

11. when bact conjunctivitis patient can go back to school
No wheezing - no feever in chlamydia
After 24h of abx therapy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

12. difference between diaper dermatitis and rash
Imaging study to r/o VUR
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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

13. lens dislocation
ALL - alzheimers autism adhd depression seizure
Benign permature thelarche; expectant management
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Marfans - ehlers danlos - homocystinuria

14. How to dx acute angle closure glaucoma
Atypical lymphocyte
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Between pregnenolone and 17oh pregnenolone
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

15. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Pipercillin (zosyn) - ticarcillin

16. spitting up - vomiting at night - weight stable
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Oral DMSA or EDTA IV
Rapid detection of RSV antigen in nasl
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

17. association with infantile pyloric stenosis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

18. aplasic crisis
Vaso-occlusive crisis; dx hb electrophoresis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Thalassemia - congenital hemolytic anemia

19. physiological jaundice
24h to 7d of birth
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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

20. 17 alpha hydroxylase
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Between pregnenolone and 17oh pregnenolone
<2yrs - abd pain - diarrhoea - ARF
Croup

21. if bone age lower than actual and puberty delayed
Croup
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Constitutional pubertal delay

22. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

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23. Tx of FTT
Diet modification to provide 110kc/kg/d
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

24. dx for DDH
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
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

25. contact lens keratitis
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
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

26. sickle cell with symmetrical swelling of hands and feet
Neurofibromatosis type2
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Vaso-occlusive crisis; dx hb electrophoresis
Herpes

27. Tx of community acquired pneumonia
Biliary atresia; tx surgery
Lateral neck xray in epiglottitis show swollen epiglottis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

28. contraindications of MMR vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

29. osler rendu weber syndrom
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Multiple telangiectesia - vasular lesion in CNS
Increase of progesteron/17oh progesterone

30. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Central isosexual precocious puberty; hypothalmaic hamartoma
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

31. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Penicillin G 4h before delivery

32. difference between structural disorder and flexible kyphosis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Injury to b/l glossopharyngeal. present in botulism
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

33. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
24-72 hours
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

34. 18mo bilat breast enlargment - some pubic hair
1.5%
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Benign permature thelarche; expectant management
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

35. down syndrome with holocystolic mumur
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Endocardial cushion defect (no separation between heart chambers)
If aortic root reaches 45 mm
Benign permature thelarche; expectant management

36. causes of FTT
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Foreign body sensation - photophobia - corneal opacity tx abx
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Develops in 21 dasy

37. How to differential bact vs viral conjunctivitis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

38. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Brown
Candidal diapar rash; tx clotrimazol
14yrs

39. is local anesthetics be used in cellulitis to reduce pain
Dx US tx; correct serum electrolyte - pyloromyotom
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
No; they are basic compound will be neutralized in an acidic environment of cellulitis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

40. deficinecy of 17 hydroxylase
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Bartonella henselae; complication is suppuration of lymph node
Meconeum ileus; think about CF
Increase of pregnenolone

41. can women with abnormal smear or genital get vaccine
Faciform RBC cause vascular occlusion
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Yes; but it will be less effective
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

42. 3yo - febrile - left hip externally rotated
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
No intervention; 90% foreign bodies pass without difficulty

43. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Strep pneumonie; moraxella; h influenze
After 6m; breast mild provides iron until 6m.
>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

44. infant botulism
Do HIV testing at first
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
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

45. complication of lumbosacral meningocele
Vaso-occlusive crisis; dx hb electrophoresis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Bladder dysfunction; UTI and renal dysfunctoin
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

46. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Pipercillin (zosyn) - ticarcillin
Increase of pregnenolone
Yes; but it will be less effective

47. kallman syndrome
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Risk of neurological dysfunction
36 hours
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

48. What is thumbprint sign
Vaso-occlusive crisis; dx hb electrophoresis
Lateral neck xray in epiglottitis show swollen epiglottis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
No wheezing - no feever in chlamydia

49. the risk of lyme after bitten by a tick
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
refuse
1.5%
T for t ; thalassemia; inc serum iron and Iron binding

50. how thalassemia die
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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Pipercillin (zosyn) - ticarcillin
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb