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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. sudden onset of fever - difficulty in breathing
HSP - look for symmetric skin lesions
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

2. if bone age lower than actual and puberty delayed
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
Bartonella henselae; complication is suppuration of lymph node
Increase of pregnenolone
Constitutional pubertal delay

3. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Erb paralysis leading to diaphragmatic paralysis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

4. pumonary TB
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)
To make hip flexed and abducted position in DDH
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

5. nuchal rigidity - fever - sore throat - headache - dioriented
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

6. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Brown
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Yes; but it will be less effective

7. Parvovirus
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Fifth disease; febrile syndrome
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
>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

8. When erythema chronicum migrans develops after tick bite
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
24-72 hours
Decreased UGT enzyme
D for d; down syndrome and polyhydramnios

9. pavlik harness
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
No reticulocyte vs high reticulocyte
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
To make hip flexed and abducted position in DDH

10. physiological jaundice
RSV - rhino and influenza
24h to 7d of birth
Endocardial cushion defect (no separation between heart chambers)
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

11. acute otitis media-pathogen
Black
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
Strep pneumonie; moraxella; h influenze
No reticulocyte vs high reticulocyte

12. association with infantile pyloric stenosis
Absence seizure; tx ethosuximide
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Bladder dysfunction; UTI and renal dysfunctoin

13. How to difference viral and bact pneumonia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
36 hours
Injury to lower roots of brachial plexus

14. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Yes; but it will be less effective
Less than 5th percentile
refuse

15. mcCune albright`
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

16. IM
Atypical lymphocyte
No myoclonic activity in JME
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Penicillin G 4h before delivery

17. How to dx RSV
URI
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Rapid detection of RSV antigen in nasl
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

18. difference between rubeola (measles) and rulbella
<2yrs - abd pain - diarrhoea - ARF
Decreases height - expensive; reserved for severe cases of delayed puberty
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

19. when bact conjunctivitis patient can go back to school
Congenital rubella syndrome
After 24h of abx therapy
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
If aortic root reaches 45 mm

20. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
TB - breastfeeding - asymptomatic hiv
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

21. Febrile seizure
Bladder dysfunction; UTI and renal dysfunctoin
HSP - look for symmetric skin lesions
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

22. What are the risk factors of developmental dysplais of hip
Do HIV testing at first
Female - breech delivery - family history; tx referral to ortho
Penicillin G 4h before delivery
Dx US tx; correct serum electrolyte - pyloromyotom

23. down syndrome with holocystolic mumur
No reticulocyte vs high reticulocyte
Endocardial cushion defect (no separation between heart chambers)
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

24. patient with white plaques in mouth and lump in back
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Do HIV testing at first
Prolactinoma
Decreases height - expensive; reserved for severe cases of delayed puberty

25. benefits of antibiotic therapy in acute pharyngitis?
Do HIV testing at first
Yes; but it will be less effective
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Imaging study to r/o VUR

26. centor criteria for bact pharyngitis
Do HIV testing at first
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
T for t ; thalassemia; inc serum iron and Iron binding

27. dx of lyme
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Pho for forward bending; forward defect; common finding has no adverse physical effect
Mainly clinical; serology with initial ELISA - with western blot confirmation;

28. decreased mobility of tympanic membrane after otitis media
HSP - look for symmetric skin lesions
Rapid detection of RSV antigen in nasl
refuse
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

29. infant botulism
URI
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Diet modification to provide 110kc/kg/d
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

30. How to dx keratitis?
No reticulocyte vs high reticulocyte
Foreign body sensation - photophobia - corneal opacity tx abx
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

31. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

32. crying during urination. bacteriuria pyruria - rec episodes
110 kcl/kg/day
Tx only symptomatic carrier
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Imaging study to r/o VUR

33. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Increase of pregnenolone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

34. Tx of botulism
HSP - look for symmetric skin lesions
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Vaso-occlusive crisis; dx hb electrophoresis
RSV - rhino and influenza

35. lead >70
Risk of neurological dysfunction
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
Medical emergency; dimercaprol/edta
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

36. tzanck
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
<2yrs - abd pain - diarrhoea - ARF
To make hip flexed and abducted position in DDH
Herpes

37. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Injury to lower roots of brachial plexus
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

38. adrenal tumor
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Less than 5th percentile
Bartonella henselae; complication is suppuration of lymph node
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

39. How to dx endopthalmitis
Dx US tx; correct serum electrolyte - pyloromyotom
Neurofibromatosis type2
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Constitutional pubertal delay

40. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Atopic dermatitis; strong allergic/immunologic component; incr IgE
110 kcl/kg/day

41. What is the most common initial symptom in sickle cell
Tx only symptomatic carrier
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Biliary atresia; tx surgery
Dactylitis; 2nd common is splenic seqestration

42. aplasic crisis
Imaging study to r/o VUR
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

43. When to give hpv vaccien
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
D for d; down syndrome and polyhydramnios
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
24h to 7d of birth

44. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
No reticulocyte vs high reticulocyte
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

45. TTP pentad
Injury to b/l glossopharyngeal. present in botulism
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
No; they are basic compound will be neutralized in an acidic environment of cellulitis

46. side effect of testosteron therapy
URI
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Injury to lower roots of brachial plexus
Decreases height - expensive; reserved for severe cases of delayed puberty

47. 21 hydroxylase
No intervention; 90% foreign bodies pass without difficulty
Do HIV testing at first
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Endocardial cushion defect (no separation between heart chambers)

48. tick transmits RMSF
Less than 5th percentile
Black
Thalassemia - congenital hemolytic anemia
Yes; but it will be less effective

49. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
No reticulocyte vs high reticulocyte
Multiple telangiectesia - vasular lesion in CNS
Meconeum ileus; think about CF
Wait until 6 months

50. acute abd pain - hx URI - lower extremity maculo papular rash
RSV - rhino and influenza
HSP - look for symmetric skin lesions
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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