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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. Tx of bact conjunctivitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Pho for forward bending; forward defect; common finding has no adverse physical effect
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

2. thumb sign
Dactylitis; 2nd common is splenic seqestration
refuse
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

3. physiological jaundice
Tx only symptomatic carrier
Multiple telangiectesia - vasular lesion in CNS
24h to 7d of birth
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

4. bromocriptine
Biliary atresia; tx surgery
Prolactinoma
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

5. lens dislocation
Marfans - ehlers danlos - homocystinuria
Lateral neck xray in epiglottitis show swollen epiglottis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

6. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Dactylitis; 2nd common is splenic seqestration
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
14yrs

7. How to investigate delayed puberty
Increase of pregnenolone
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

8. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
No myoclonic activity in JME
Atopic dermatitis; strong allergic/immunologic component; incr IgE
HSP - look for symmetric skin lesions

9. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Do HIV testing at first
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

10. acute otitis externa

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11. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Rapid detection of RSV antigen in nasl
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
1.5%

12. patient with white plaques in mouth and lump in back
Do HIV testing at first
Multiple telangiectesia - vasular lesion in CNS
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
After 24h of abx therapy

13. dx for DDH
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
24-72 hours
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

14. difference between structural disorder and flexible kyphosis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Increase of progesteron/17oh progesterone
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

15. complete airway obstruction with FB
>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
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Pho for forward bending; forward defect; common finding has no adverse physical effect

16. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No reticulocyte vs high reticulocyte

17. What is the calorie requirement of newborn?
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
110 kcl/kg/day

18. How to dx post uretheral valve
ALL - alzheimers autism adhd depression seizure
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Imaging study to r/o VUR
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

19. acute otitis media-pathogen
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Diet modification to provide 110kc/kg/d
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Strep pneumonie; moraxella; h influenze

20. When to bevioral and enviromental measure in led intoxication?
Decr calorie intake; decr calorie absorption;incr calorie demand
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
To make hip flexed and abducted position in DDH
Oral DMSA or EDTA IV

21. 3yo - never able to walk
Benign permature thelarche; expectant management
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
Penicillin G 4h before delivery

22. 12y - obese - hip pain - hip ext rotated
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Constitutional pubertal delay
Female - breech delivery - family history; tx referral to ortho

23. How to dx endopthalmitis
RSV - rhino and influenza
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Increase of pregnenolone
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

24. non immune pregnant women exposed to rubella in first trimester
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Congenital rubella syndrome

25. tuberous sclerosis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Foreign body sensation - photophobia - corneal opacity tx abx

26. infant botulism
Oral DMSA or EDTA IV
Benign permature thelarche; expectant management
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Less than 5th percentile

27. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
24h to 7d of birth
Erb paralysis leading to diaphragmatic paralysis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

28. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Wait until 6 months
No reticulocyte vs high reticulocyte
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

29. contraindications of MMR vaccine
Croup tx cool mist; racemic epi - corticosteroid
Do HIV testing at first
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

30. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Candidal diapar rash; tx clotrimazol
refuse
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

31. tzanck
Benign permature thelarche; expectant management
Herpes
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
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

32. down syndrome with holocystolic mumur
Decreased UGT enzyme
Endocardial cushion defect (no separation between heart chambers)
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Facial portwine stain

33. target cell
Black
T for t ; thalassemia; inc serum iron and Iron binding
Between pregnenolone and 17oh pregnenolone
Risk of neurological dysfunction

34. When to give hpv vaccien
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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

35. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
24-72 hours
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

36. 17 alpha hydroxylase
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)
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
T for t ; thalassemia; inc serum iron and Iron binding
Between pregnenolone and 17oh pregnenolone

37. tick transmits lyme
Endocardial cushion defect (no separation between heart chambers)
Pho for forward bending; forward defect; common finding has no adverse physical effect
Brown
URI

38. sublottic narrowing
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Neurofibromatosis type2
Faciform RBC cause vascular occlusion
Croup tx cool mist; racemic epi - corticosteroid

39. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Increase of progesteron/17oh progesterone
14yrs

40. sickle cell with symmetrical swelling of hands and feet
Constitutional pubertal delay
110 kcl/kg/day
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Vaso-occlusive crisis; dx hb electrophoresis

41. How to dx keratitis?
Methylephenidate toxicity; cannot be stopped abruptly; taper
Foreign body sensation - photophobia - corneal opacity tx abx
RSV - rhino and influenza
INH 9m if INH resistant rifampin 6m in children and 4m in adults

42. causes of FTT
Imaging study to r/o VUR
If aortic root reaches 45 mm
Decr calorie intake; decr calorie absorption;incr calorie demand
Develops in 21 dasy

43. Tx of community acquired pneumonia
Dx US tx; correct serum electrolyte - pyloromyotom
No intervention; 90% foreign bodies pass without difficulty
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

44. When erythema chronicum migrans develops after tick bite
Wait until 6 months
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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
24-72 hours

45. How to difference viral and bact pneumonia
24h to 7d of birth
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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
After 6m; breast mild provides iron until 6m.

46. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
36 hours
No reticulocyte vs high reticulocyte
If aortic root reaches 45 mm
Meconeum ileus; think about CF

47. iron supplement in child
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
After 6m; breast mild provides iron until 6m.
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

48. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Croup
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

49. How to difference RSV and neonatal chlamydia
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Facial portwine stain
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
No wheezing - no feever in chlamydia

50. adenovirus
URI
>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
Develops in 21 dasy
No; they are basic compound will be neutralized in an acidic environment of cellulitis