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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. Parvovirus
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Fifth disease; febrile syndrome
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Faciform RBC cause vascular occlusion

2. thumb sign
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Strep pneumonie; moraxella; h influenze

3. Tx of botulism
1.5%
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

4. when bact conjunctivitis patient can go back to school
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)
Fifth disease; febrile syndrome
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
After 24h of abx therapy

5. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Multiple telangiectesia - vasular lesion in CNS
No reticulocyte vs high reticulocyte

6. Tx of community acquired pneumonia
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Vaso-occlusive crisis; dx hb electrophoresis
Absence seizure; tx ethosuximide

7. HUS
<2yrs - abd pain - diarrhoea - ARF
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
HSP - look for symmetric skin lesions

8. tick transmits RMSF
No intervention; 90% foreign bodies pass without difficulty
Pho for forward bending; forward defect; common finding has no adverse physical effect
Black
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

9. red oozing rash on cheek - scaly - dry
<2yrs - abd pain - diarrhoea - ARF
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

10. physiological jaundice
24h to 7d of birth
Risk of neurological dysfunction
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

11. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Meconeum ileus; think about CF
No myoclonic activity in JME

12. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Strep pneumonie; moraxella; h influenze
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Candidal diapar rash; tx clotrimazol
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

13. contraindications of DTap
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Neurofibromatosis type2
Multiple telangiectesia - vasular lesion in CNS

14. pneumonia in CF patient
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Prolactinoma
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

15. What is the most common initial symptom in sickle cell
Dx US tx; correct serum electrolyte - pyloromyotom
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Dactylitis; 2nd common is splenic seqestration
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

16. penicillin effective against pseudomonas
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
14yrs
Absence seizure; tx ethosuximide
Pipercillin (zosyn) - ticarcillin

17. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
<2yrs - abd pain - diarrhoea - ARF
Diet modification to provide 110kc/kg/d
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Meconeum ileus; think about CF

18. lens dislocation
D for d; down syndrome and polyhydramnios
Marfans - ehlers danlos - homocystinuria
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

19. spitting up - vomiting at night - weight stable
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
URI
To make hip flexed and abducted position in DDH
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

20. is local anesthetics be used in cellulitis to reduce pain
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
36 hours
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

21. How to prevent GBS in neonate
Medical emergency; dimercaprol/edta
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Penicillin G 4h before delivery
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

22. cleft lip but no cleft palate
Meconeum ileus; think about CF
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

23. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Herpes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Do HIV testing at first

24. indications of audiometry in childrens
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Marfans - ehlers danlos - homocystinuria
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

25. sublottic narrowing
Facial portwine stain
Croup tx cool mist; racemic epi - corticosteroid
After 24h of abx therapy
Injury to b/l glossopharyngeal. present in botulism

26. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
To make hip flexed and abducted position in DDH
Increase of pregnenolone
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

27. Neonatal conjugated hyperbilirubinemia
Risk of neurological dysfunction
Biliary atresia; tx surgery
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
T for t ; thalassemia; inc serum iron and Iron binding

28. failure to thrive
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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
Less than 5th percentile

29. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Black
After 24h of abx therapy
Candidal diapar rash; tx clotrimazol

30. the recommended ca supplementation
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Biliary atresia; tx surgery

31. lead 44-70
Oral DMSA or EDTA IV
Bladder dysfunction; UTI and renal dysfunctoin
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
Candidal diapar rash; tx clotrimazol

32. What is the definition of delayed puberty?
Prolactinoma
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
No; they are basic compound will be neutralized in an acidic environment of cellulitis

33. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Increase of progesteron/17oh progesterone
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
Decr calorie intake; decr calorie absorption;incr calorie demand

34. cardiac manifestation of turner
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Absence seizure; tx ethosuximide
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bartonella henselae; complication is suppuration of lymph node

35. can women with abnormal smear or genital get vaccine
Do HIV testing at first
Yes; but it will be less effective
1.5%
Female - breech delivery - family history; tx referral to ortho

36. contraindications of MMR vaccine
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Medical emergency; dimercaprol/edta

37. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Methylephenidate toxicity; cannot be stopped abruptly; taper
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
Black

38. dx for turner
Pipercillin (zosyn) - ticarcillin
Risk of neurological dysfunction
Diet modification to provide 110kc/kg/d
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

39. How to difference viral and bact pneumonia
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
No reticulocyte vs high reticulocyte
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Fifth disease; febrile syndrome

40. bromocriptine
Prolactinoma
Between pregnenolone and 17oh pregnenolone
36 hours
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

41. coin in child's stomach
After 24h of abx therapy
Croup tx cool mist; racemic epi - corticosteroid
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No intervention; 90% foreign bodies pass without difficulty

42. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pipercillin (zosyn) - ticarcillin

43. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Risk of neurological dysfunction
Decreases height - expensive; reserved for severe cases of delayed puberty
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

44. mech of botulism
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
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

45. dx for DDH
Faciform RBC cause vascular occlusion
Strep pneumonie; moraxella; h influenze
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Bladder dysfunction; UTI and renal dysfunctoin

46. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Pho for forward bending; forward defect; common finding has no adverse physical effect
Marfans - ehlers danlos - homocystinuria
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

47. pumonary TB
Erb paralysis leading to diaphragmatic paralysis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
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)

48. lead >70
Meconeum ileus; think about CF
Medical emergency; dimercaprol/edta
Wait until 6 months
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

49. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Multiple telangiectesia - vasular lesion in CNS
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

50. microcytic - hypochromic anemia - hepatospelnomegaly
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Thalassemia - congenital hemolytic anemia
Croup tx cool mist; racemic epi - corticosteroid