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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. down syndrome has inreased risk of developing
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
ALL - alzheimers autism adhd depression seizure
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

2. flexible kyphosis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Pho for forward bending; forward defect; common finding has no adverse physical effect
Female - breech delivery - family history; tx referral to ortho
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

3. echymoses with low platelet <30k
Between pregnenolone and 17oh pregnenolone
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Less than 5th percentile
1.5%

4. lead >70
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
To make hip flexed and abducted position in DDH
Medical emergency; dimercaprol/edta
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

5. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
Medical emergency; dimercaprol/edta

6. Tx of botulism
Facial portwine stain
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Vaso-occlusive crisis; dx hb electrophoresis

7. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Medical emergency; dimercaprol/edta

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

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9. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Prolactinoma
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

10. causes of acute anemia
Tx only symptomatic carrier
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

11. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Lateral neck xray in epiglottitis show swollen epiglottis
Between pregnenolone and 17oh pregnenolone
Endocardial cushion defect (no separation between heart chambers)

12. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Benign permature thelarche; expectant management
Foreign body sensation - photophobia - corneal opacity tx abx
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

13. cardiac manifestation of turner
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Oral DMSA or EDTA IV
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

14. congenital adrenal hyperplasi
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Increase of progesteron/17oh progesterone
Decr calorie intake; decr calorie absorption;incr calorie demand

15. How to dx acute angle closure glaucoma
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Methylephenidate toxicity; cannot be stopped abruptly; taper
URI
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

16. failure to thrive
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Dx US tx; correct serum electrolyte - pyloromyotom
Less than 5th percentile
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

17. Tx of community acquired pneumonia
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Do HIV testing at first
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

18. kallman syndrome
No wheezing - no feever in chlamydia
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

19. When erythema chronicum migrans develops after tick bite
24-72 hours
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

20. Neonatal unconjugated hyperbilirubine
After 6m; breast mild provides iron until 6m.
Decreased UGT enzyme
Do HIV testing at first
Thalassemia - congenital hemolytic anemia

21. sudden onset of fever - difficulty in breathing
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
No intervention; 90% foreign bodies pass without difficulty
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

22. non immune pregnant women exposed to rubella in first trimester
Neurofibromatosis type2
If aortic root reaches 45 mm
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Congenital rubella syndrome

23. differentiate between central and peripheral precocious puberty
To make hip flexed and abducted position in DDH
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

24. contact lens keratitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Bartonella henselae; complication is suppuration of lymph node
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

25. language delay
ALL - alzheimers autism adhd depression seizure
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

26. carditis and arthritis after rheumatic fever
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)
110 kcl/kg/day
14yrs
Develops in 21 dasy

27. When to bevioral and enviromental measure in led intoxication?
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
Yes; but it will be less effective
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

28. Nocturnal enuresis
ALL - alzheimers autism adhd depression seizure
Atopic dermatitis; strong allergic/immunologic component; incr IgE
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

29. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Thalassemia - congenital hemolytic anemia
Oral DMSA or EDTA IV
Croup
Benign permature thelarche; expectant management

30. how thalassemia die
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
ALL - alzheimers autism adhd depression seizure

31. When to give hpv vaccien
Between pregnenolone and 17oh pregnenolone
To make hip flexed and abducted position in DDH
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
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

32. microcytic - hypochromic anemia - hepatospelnomegaly
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Thalassemia - congenital hemolytic anemia
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

33. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
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)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

34. crying during urination. bacteriuria pyruria - rec episodes
Erb paralysis leading to diaphragmatic paralysis
Imaging study to r/o VUR
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

35. side effect of testosteron therapy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Facial portwine stain
Decreases height - expensive; reserved for severe cases of delayed puberty
INH 9m if INH resistant rifampin 6m in children and 4m in adults

36. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Increase of progesteron/17oh progesterone
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

37. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
110 kcl/kg/day
14yrs
Bartonella henselae; complication is suppuration of lymph node

38. Tx of FTT
URI
Croup
Diet modification to provide 110kc/kg/d
Atypical lymphocyte

39. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
110 kcl/kg/day
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No myoclonic activity in JME

40. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Oral DMSA or EDTA IV
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

41. difference between breast milk and breafeeding jaundice
Increase of progesteron/17oh progesterone
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
Candidal diapar rash; tx clotrimazol
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)

42. How to evaluate well appearing child just born in GBS pos mother?
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

43. dx for turner
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
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Candidal diapar rash; tx clotrimazol
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

44. contraindications of MMR vaccine
Female - breech delivery - family history; tx referral to ortho
Less than 5th percentile
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Oral DMSA or EDTA IV

45. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
No reticulocyte vs high reticulocyte
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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

46. lead 44-70
Oral DMSA or EDTA IV
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Medical emergency; dimercaprol/edta
Endocardial cushion defect (no separation between heart chambers)

47. duodenal atresia
No; they are basic compound will be neutralized in an acidic environment of cellulitis
D for d; down syndrome and polyhydramnios
Facial portwine stain
Risk of neurological dysfunction

48. cleft lip but no cleft palate
14yrs
Methylephenidate toxicity; cannot be stopped abruptly; taper
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

49. tzanck
Herpes
Biliary atresia; tx surgery
Brown
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

50. physiological jaundice
24h to 7d of birth
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace