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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. mech of botulism
Decreases height - expensive; reserved for severe cases of delayed puberty
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

2. Neonatal conjugated hyperbilirubinemia
No myoclonic activity in JME
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Biliary atresia; tx surgery
Injury to lower roots of brachial plexus

3. patient with white plaques in mouth and lump in back
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Bartonella henselae; complication is suppuration of lymph node
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Do HIV testing at first

4. When to do surgery for undescended testes
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Vaso-occlusive crisis; dx hb electrophoresis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Wait until 6 months

5. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Penicillin G 4h before delivery
Methylephenidate toxicity; cannot be stopped abruptly; taper
Decreases height - expensive; reserved for severe cases of delayed puberty

6. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
ALL - alzheimers autism adhd depression seizure
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Bladder dysfunction; UTI and renal dysfunctoin
Croup

7. dx for DDH
Candidal diapar rash; tx clotrimazol
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Wait until 6 months
<2yrs - abd pain - diarrhoea - ARF

8. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Congenital rubella syndrome
Dx US tx; correct serum electrolyte - pyloromyotom

9. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Fifth disease; febrile syndrome
Atypical lymphocyte
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

10. IM
Injury to b/l glossopharyngeal. present in botulism
Atypical lymphocyte
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

11. 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)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Endocardial cushion defect (no separation between heart chambers)
Dx US tx; correct serum electrolyte - pyloromyotom

12. cat scratch disease
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;
Bartonella henselae; complication is suppuration of lymph node
Yes; but it will be less effective

13. When to do aortic root surgery in marfans to prevent dissection?
D for d; down syndrome and polyhydramnios
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Vaso-occlusive crisis; dx hb electrophoresis
If aortic root reaches 45 mm

14. How to difference viral and bact pneumonia
Herpes
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Fifth disease; febrile syndrome
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

15. thumb sign
Thalassemia - congenital hemolytic anemia
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

16. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

17. failure to thrive
Diet modification to provide 110kc/kg/d
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Less than 5th percentile
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

18. tzanck
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Herpes
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

19. sturge weber syndrome
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Facial portwine stain
Tx only symptomatic carrier
Erb paralysis leading to diaphragmatic paralysis

20. carditis and arthritis after rheumatic fever
Medical emergency; dimercaprol/edta
Develops in 21 dasy
Thalassemia - congenital hemolytic anemia
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

21. How to dx endopthalmitis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Lateral neck xray in epiglottitis show swollen epiglottis
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

22. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Diet modification to provide 110kc/kg/d
Atopic dermatitis; strong allergic/immunologic component; incr IgE

23. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to lower roots of brachial plexus
After 6m; breast mild provides iron until 6m.
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

24. Tx of FTT
Wait until 6 months
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Dactylitis; 2nd common is splenic seqestration
Diet modification to provide 110kc/kg/d

25. kallman syndrome
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
HSP - look for symmetric skin lesions
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

26. nuchal rigidity - fever - sore throat - headache - dioriented
Benign permature thelarche; expectant management
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

27. benefits of antibiotic therapy in acute pharyngitis?
Rapid detection of RSV antigen in nasl
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
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
Endocardial cushion defect (no separation between heart chambers)

28. the risk of lyme after bitten by a tick
1.5%
Diet modification to provide 110kc/kg/d
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
Pipercillin (zosyn) - ticarcillin

29. how thalassemia die
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
After 24h of abx therapy
HSP - look for symmetric skin lesions

30. What is the calorie requirement of newborn?
Decreases height - expensive; reserved for severe cases of delayed puberty
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
110 kcl/kg/day

31. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Increase of pregnenolone
Herpes
Injury to lower roots of brachial plexus
Candidal diapar rash; tx clotrimazol

32. echymoses with low platelet <30k
No reticulocyte vs high reticulocyte
>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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

33. giardiasis
Central isosexual precocious puberty; hypothalmaic hamartoma
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Tx only symptomatic carrier
HSP - look for symmetric skin lesions

34. Tx of bact conjunctivitis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
RSV - rhino and influenza
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

35. What is the most common initial symptom in sickle cell
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Dactylitis; 2nd common is splenic seqestration
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

36. How to differentiate caput succedanueum and cephalohematoma
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Congenital rubella syndrome

37. can women with abnormal smear or genital get vaccine
Between pregnenolone and 17oh pregnenolone
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Yes; but it will be less effective
Oral DMSA or EDTA IV

38. tuberous sclerosis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Croup
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

39. What is thumbprint sign
Decreased UGT enzyme
Lateral neck xray in epiglottitis show swollen epiglottis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
24h to 7d of birth

40. lens dislocation
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Erb paralysis leading to diaphragmatic paralysis
Marfans - ehlers danlos - homocystinuria
Strep pneumonie; moraxella; h influenze

41. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Meconeum ileus; think about CF
Pipercillin (zosyn) - ticarcillin

42. tick transmits lyme
Brown
Atypical lymphocyte
ALL - alzheimers autism adhd depression seizure
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

43. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
<2yrs - abd pain - diarrhoea - ARF
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

44. physiological jaundice
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Bladder dysfunction; UTI and renal dysfunctoin
24h to 7d of birth
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

45. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Absence seizure; tx ethosuximide
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

46. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Black
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

47. causes of acute anemia
ALL - alzheimers autism adhd depression seizure
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

48. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Faciform RBC cause vascular occlusion
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

49. How to evaluate well appearing child just born in GBS pos mother?
No myoclonic activity in JME
Yes; but it will be less effective
D for d; down syndrome and polyhydramnios
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

50. How to prevent GBS in neonate
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
D for d; down syndrome and polyhydramnios
Penicillin G 4h before delivery
ALL - alzheimers autism adhd depression seizure