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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. is local anesthetics be used in cellulitis to reduce pain
Erb paralysis leading to diaphragmatic paralysis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

2. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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)
Neurofibromatosis type2
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

3. When erythema chronicum migrans develops after tick bite
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
HSP - look for symmetric skin lesions
24-72 hours
Constitutional pubertal delay

4. language expectation from 2yo
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Penicillin G 4h before delivery
Medical emergency; dimercaprol/edta

5. tuberous sclerosis
Vaso-occlusive crisis; dx hb electrophoresis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

6. congenital adrenal hyperplasi
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No; they are basic compound will be neutralized in an acidic environment of cellulitis

7. How to difference RSV and neonatal chlamydia
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
Vaso-occlusive crisis; dx hb electrophoresis
No wheezing - no feever in chlamydia
Oral DMSA or EDTA IV

8. 17 alpha hydroxylase
Erb paralysis leading to diaphragmatic paralysis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Croup tx cool mist; racemic epi - corticosteroid
Between pregnenolone and 17oh pregnenolone

9. complication of lumbosacral meningocele
Brown
Faciform RBC cause vascular occlusion
Bladder dysfunction; UTI and renal dysfunctoin
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

10. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Injury to lower roots of brachial plexus
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Methylephenidate toxicity; cannot be stopped abruptly; taper
<2yrs - abd pain - diarrhoea - ARF

11. Infant with serum billlirubin >25
Do HIV testing at first
Risk of neurological dysfunction
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
Fifth disease; febrile syndrome

12. Febrile seizure
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Methylephenidate toxicity; cannot be stopped abruptly; taper
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

13. impaired gag reflex
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Injury to b/l glossopharyngeal. present in botulism
Wait until 6 months
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

14. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Endocardial cushion defect (no separation between heart chambers)
Faciform RBC cause vascular occlusion

15. difference between diaper dermatitis and rash
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
Bartonella henselae; complication is suppuration of lymph node
Erb paralysis leading to diaphragmatic paralysis
If aortic root reaches 45 mm

16. How to dx RSV
Rapid detection of RSV antigen in nasl
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Develops in 21 dasy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

17. horner syndrom
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Injury to lower roots of brachial plexus
1.5%
TB - breastfeeding - asymptomatic hiv

18. mech of botulism
Meconeum ileus; think about CF
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

19. What is thumbprint sign
D for d; down syndrome and polyhydramnios
Lateral neck xray in epiglottitis show swollen epiglottis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Neurofibromatosis type2

20. iron supplement in child
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Lateral neck xray in epiglottitis show swollen epiglottis
After 6m; breast mild provides iron until 6m.

21. How to differentiate caput succedanueum and cephalohematoma
Oral DMSA or EDTA IV
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

22. Tx of FTT
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Bladder dysfunction; UTI and renal dysfunctoin
Diet modification to provide 110kc/kg/d
Dactylitis; 2nd common is splenic seqestration

23. adrenal tumor
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
To make hip flexed and abducted position in DDH
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

24. infantile hypertrophic pyloric stenosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
HSP - look for symmetric skin lesions
Dx US tx; correct serum electrolyte - pyloromyotom

25. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Erb paralysis leading to diaphragmatic paralysis
Candidal diapar rash; tx clotrimazol
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

26. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Dactylitis; 2nd common is splenic seqestration
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

27. What is the calorie requirement of newborn?
Benign permature thelarche; expectant management
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Facial portwine stain
110 kcl/kg/day

28. difference between breast milk and breafeeding jaundice
Lateral neck xray in epiglottitis show swollen epiglottis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
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

29. When to bevioral and enviromental measure in led intoxication?
ALL - alzheimers autism adhd depression seizure
Meconeum ileus; think about CF
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

30. acute abd pain - hx URI - lower extremity maculo papular rash
Central isosexual precocious puberty; hypothalmaic hamartoma
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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
HSP - look for symmetric skin lesions

31. Nocturnal enuresis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Prolactinoma
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

32. acute otitis media-pathogen
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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Strep pneumonie; moraxella; h influenze
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

33. Parents can _____ vaccine
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
No reticulocyte vs high reticulocyte
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
refuse

34. pumonary TB
RSV - rhino and influenza
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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

35. Tx of community acquired pneumonia
Constitutional pubertal delay
Lateral neck xray in epiglottitis show swollen epiglottis
Wait until 6 months
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

36. crying during urination. bacteriuria pyruria - rec episodes
Biliary atresia; tx surgery
Imaging study to r/o VUR
Croup tx cool mist; racemic epi - corticosteroid
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

37. How to dx acute angle closure glaucoma
24h to 7d of birth
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
HSP - look for symmetric skin lesions

38. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Wait until 6 months
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

39. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Imaging study to r/o VUR

40. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
1.5%

41. How to dx keratitis?
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Foreign body sensation - photophobia - corneal opacity tx abx

42. microcytic - hypochromic anemia - hepatospelnomegaly
1.5%
<2yrs - abd pain - diarrhoea - ARF
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Thalassemia - congenital hemolytic anemia

43. language delay
If aortic root reaches 45 mm
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

44. sturge weber syndrome
Dactylitis; 2nd common is splenic seqestration
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
Facial portwine stain
Injury to lower roots of brachial plexus

45. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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
Wait until 6 months
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. penicillin effective against pseudomonas
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
No intervention; 90% foreign bodies pass without difficulty
Pipercillin (zosyn) - ticarcillin
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

47. coin in child's stomach
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
No intervention; 90% foreign bodies pass without difficulty
Foreign body sensation - photophobia - corneal opacity tx abx
Bartonella henselae; complication is suppuration of lymph node

48. 3yo - febrile - left hip externally rotated
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Increase of progesteron/17oh progesterone
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

49. acute otitis externa

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50. How to differential bact vs viral conjunctivitis
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure