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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. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Congenital rubella syndrome
Vaso-occlusive crisis; dx hb electrophoresis
Risk of neurological dysfunction
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. pumonary TB
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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)

3. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Foreign body sensation - photophobia - corneal opacity tx abx

4. if bone age lower than actual and puberty delayed
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
ALL - alzheimers autism adhd depression seizure
Constitutional pubertal delay

5. non immune pregnant women exposed to rubella in first trimester
1.5%
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Congenital rubella syndrome

6. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
ALL - alzheimers autism adhd depression seizure
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
No myoclonic activity in JME
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

7. crying during urination. bacteriuria pyruria - rec episodes
Biliary atresia; tx surgery
Imaging study to r/o VUR
Injury to lower roots of brachial plexus
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

8. How to differentiate caput succedanueum and cephalohematoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Fifth disease; febrile syndrome
Increase of pregnenolone
Faciform RBC cause vascular occlusion

9. bromocriptine
Imaging study to r/o VUR
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Prolactinoma

10. When to do surgery for undescended testes
Wait until 6 months
Decr calorie intake; decr calorie absorption;incr calorie demand
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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

11. what conditions are not contraindicated
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
TB - breastfeeding - asymptomatic hiv
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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. differentiate between central and peripheral precocious puberty
Central isosexual precocious puberty; hypothalmaic hamartoma
Congenital rubella syndrome
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
<2yrs - abd pain - diarrhoea - ARF

13. contact lens keratitis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Decr calorie intake; decr calorie absorption;incr calorie demand
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

14. side effect of testosteron therapy
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Decreases height - expensive; reserved for severe cases of delayed puberty
Oral DMSA or EDTA IV
Erb paralysis leading to diaphragmatic paralysis

15. tzanck
Pho for forward bending; forward defect; common finding has no adverse physical effect
After 6m; breast mild provides iron until 6m.
Herpes
Multiple telangiectesia - vasular lesion in CNS

16. Nocturnal enuresis
Between pregnenolone and 17oh pregnenolone
110 kcl/kg/day
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

17. how smoking contributes otitis media in children
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Decr calorie intake; decr calorie absorption;incr calorie demand
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

18. 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
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Foreign body sensation - photophobia - corneal opacity tx abx
Oral DMSA or EDTA IV

19. hypopigmented spots - family hx bilat deafness
<2yrs - abd pain - diarrhoea - ARF
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Neurofibromatosis type2
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

20. starring spells 10-20sec
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
After 24h of abx therapy

21. 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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
24-72 hours
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

22. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Marfans - ehlers danlos - homocystinuria
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Herpes

23. the risk of lyme after bitten by a tick
No myoclonic activity in JME
14yrs
Faciform RBC cause vascular occlusion
1.5%

24. Parents can _____ vaccine
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
refuse
Endocardial cushion defect (no separation between heart chambers)
Bartonella henselae; complication is suppuration of lymph node

25. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Medical emergency; dimercaprol/edta
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

26. What is earliest sign of puberty?
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Atopic dermatitis; strong allergic/immunologic component; incr IgE
If aortic root reaches 45 mm
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

27. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Bladder dysfunction; UTI and renal dysfunctoin
14yrs

28. red oozing rash on cheek - scaly - dry
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Central isosexual precocious puberty; hypothalmaic hamartoma
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

29. HUS
24h to 7d of birth
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
<2yrs - abd pain - diarrhoea - ARF
ALL - alzheimers autism adhd depression seizure

30. echymoses with low platelet <30k
Congenital rubella syndrome
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Imaging study to r/o VUR
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

31. pavlik harness
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
To make hip flexed and abducted position in DDH
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
<2yrs - abd pain - diarrhoea - ARF

32. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Wait until 6 months
Croup
<2yrs - abd pain - diarrhoea - ARF

33. How to differentiate croup vs epiglotitis
No wheezing - no feever in chlamydia
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

34. How to prevent GBS in neonate
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
Tx only symptomatic carrier
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Penicillin G 4h before delivery

35. viruses cause bronhioltitis
RSV - rhino and influenza
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

36. What is thumbprint sign
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Lateral neck xray in epiglottitis show swollen epiglottis
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

37. IM
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Penicillin G 4h before delivery
Atypical lymphocyte
Dx US tx; correct serum electrolyte - pyloromyotom

38. causes of FTT
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
D for d; down syndrome and polyhydramnios

39. When to do aortic root surgery in marfans to prevent dissection?
Endocardial cushion defect (no separation between heart chambers)
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
If aortic root reaches 45 mm
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

40. osler rendu weber syndrom
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Pipercillin (zosyn) - ticarcillin
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Multiple telangiectesia - vasular lesion in CNS

41. How to dx post uretheral valve
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
No reticulocyte vs high reticulocyte

42. infantile hypertrophic pyloric stenosis
Decr calorie intake; decr calorie absorption;incr calorie demand
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
Foreign body sensation - photophobia - corneal opacity tx abx
Dx US tx; correct serum electrolyte - pyloromyotom

43. What is the most common initial symptom in sickle cell
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Dactylitis; 2nd common is splenic seqestration

44. language delay
Neurofibromatosis type2
Injury to b/l glossopharyngeal. present in botulism
Methylephenidate toxicity; cannot be stopped abruptly; taper
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

45. failure to thrive
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Less than 5th percentile
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

46. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
>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
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

47. pneumonia in CF patient
Fifth disease; febrile syndrome
Oral DMSA or EDTA IV
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

48. difference between structural disorder and flexible kyphosis
Benign permature thelarche; expectant management
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
No wheezing - no feever in chlamydia
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

49. 3yo - never able to walk
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

50. major depression
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Benign permature thelarche; expectant management
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
D for d; down syndrome and polyhydramnios