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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. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
D for d; down syndrome and polyhydramnios

2. 17 alpha hydroxylase
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Between pregnenolone and 17oh pregnenolone
Strep pneumonie; moraxella; h influenze
36 hours

3. flexible kyphosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Pho for forward bending; forward defect; common finding has no adverse physical effect
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Central isosexual precocious puberty; hypothalmaic hamartoma

4. contraindications of DTap
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

5. microcytic - hypochromic anemia - hepatospelnomegaly
Meconeum ileus; think about CF
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
Thalassemia - congenital hemolytic anemia
Female - breech delivery - family history; tx referral to ortho

6. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Injury to b/l glossopharyngeal. present in botulism

7. dx for DDH
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

8. the risk of lyme after bitten by a tick
TB - breastfeeding - asymptomatic hiv
1.5%
Meconeum ileus; think about CF
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

9. How to dx RSV
Dx US tx; correct serum electrolyte - pyloromyotom
Atypical lymphocyte
Rapid detection of RSV antigen in nasl
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

10. giardiasis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Tx only symptomatic carrier
1.5%
Imaging study to r/o VUR

11. bromocriptine
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Prolactinoma
14yrs
Dactylitis; 2nd common is splenic seqestration

12. When to give HRT in turner
14yrs
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
HSP - look for symmetric skin lesions
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

13. kallman syndrome
14yrs
No wheezing - no feever in chlamydia
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

14. crying during urination. bacteriuria pyruria - rec episodes
refuse
Pipercillin (zosyn) - ticarcillin
Imaging study to r/o VUR
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

15. Parents can _____ vaccine
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
refuse
Female - breech delivery - family history; tx referral to ortho
Croup

16. Nocturnal enuresis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Pho for forward bending; forward defect; common finding has no adverse physical effect

17. causes of acute anemia
Benign permature thelarche; expectant management
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
refuse

18. What is thumbprint sign
Meconeum ileus; think about CF
Lateral neck xray in epiglottitis show swollen epiglottis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
After 6m; breast mild provides iron until 6m.

19. viruses cause bronhioltitis
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
RSV - rhino and influenza

20. IM
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Meconeum ileus; think about CF
Atypical lymphocyte

21. major depression
>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
Central isosexual precocious puberty; hypothalmaic hamartoma
Risk of neurological dysfunction
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

22. difference between rubeola (measles) and rulbella
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

23. iron supplement in child
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
After 6m; breast mild provides iron until 6m.
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
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

24. splenic infarction in sickle cell
Strep pneumonie; moraxella; h influenze
Endocardial cushion defect (no separation between heart chambers)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Faciform RBC cause vascular occlusion

25. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Faciform RBC cause vascular occlusion
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Strep pneumonie; moraxella; h influenze

26. complete airway obstruction with FB
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
>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
Bartonella henselae; complication is suppuration of lymph node
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

27. infant botulism
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Imaging study to r/o VUR
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

28. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
14yrs
Dactylitis; 2nd common is splenic seqestration
Methylephenidate toxicity; cannot be stopped abruptly; taper
No reticulocyte vs high reticulocyte

29. failure to thrive
Less than 5th percentile
Herpes
refuse
URI

30. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
1.5%
Female - breech delivery - family history; tx referral to ortho

31. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Central isosexual precocious puberty; hypothalmaic hamartoma
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Risk of neurological dysfunction

32. what conditions are not contraindicated
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
TB - breastfeeding - asymptomatic hiv

33. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
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
Atypical lymphocyte
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

34. physiological jaundice
24h to 7d of birth
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
Endocardial cushion defect (no separation between heart chambers)
Do HIV testing at first

35. contact lens keratitis
Diet modification to provide 110kc/kg/d
Biliary atresia; tx surgery
Endocardial cushion defect (no separation between heart chambers)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

36. How long patient needs to be exposed to tick to get infected
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
36 hours
After 6m; breast mild provides iron until 6m.

37. HUS
Multiple telangiectesia - vasular lesion in CNS
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
<2yrs - abd pain - diarrhoea - ARF
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

38. When to bevioral and enviromental measure in led intoxication?
Develops in 21 dasy
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
No wheezing - no feever in chlamydia
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

39. congenital adrenal hyperplasi
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Increase of progesteron/17oh progesterone
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

40. What is the calorie requirement of newborn?
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No myoclonic activity in JME
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
110 kcl/kg/day

41. nuchal rigidity - fever - sore throat - headache - dioriented
Candidal diapar rash; tx clotrimazol
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Decreased UGT enzyme

42. dx of lyme
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Tx only symptomatic carrier

43. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No wheezing - no feever in chlamydia
Central isosexual precocious puberty; hypothalmaic hamartoma
INH 9m if INH resistant rifampin 6m in children and 4m in adults

44. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Rapid detection of RSV antigen in nasl
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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. How to dx acute angle closure glaucoma
Risk of neurological dysfunction
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Atypical lymphocyte
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

46. Febrile seizure
Constitutional pubertal delay
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Erb paralysis leading to diaphragmatic paralysis
No reticulocyte vs high reticulocyte

47. Tx of bact conjunctivitis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Atypical lymphocyte
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

48. TB prophylaxis
To make hip flexed and abducted position in DDH
RSV - rhino and influenza
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
INH 9m if INH resistant rifampin 6m in children and 4m in adults

49. Tx of botulism
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)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

50. Parvovirus
No wheezing - no feever in chlamydia
Fifth disease; febrile syndrome
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
Thalassemia - congenital hemolytic anemia