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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. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Bladder dysfunction; UTI and renal dysfunctoin
Candidal diapar rash; tx clotrimazol
Thalassemia - congenital hemolytic anemia

2. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
TB - breastfeeding - asymptomatic hiv
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

3. How to prevent GBS in neonate
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Penicillin G 4h before delivery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Constitutional pubertal delay

4. physiological jaundice
HSP - look for symmetric skin lesions
24h to 7d of birth
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

5. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Less than 5th percentile

6. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

7. nuchal rigidity - fever - sore throat - headache - dioriented
No; they are basic compound will be neutralized in an acidic environment of cellulitis
refuse
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

8. 21 hydroxylase
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Methylephenidate toxicity; cannot be stopped abruptly; taper
Female - breech delivery - family history; tx referral to ortho
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

9. 18mo bilat breast enlargment - some pubic hair
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Benign permature thelarche; expectant management
Thalassemia - congenital hemolytic anemia
No wheezing - no feever in chlamydia

10. adenovirus
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
URI
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

11. sudden onset of fever - difficulty in breathing
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Less than 5th percentile
110 kcl/kg/day
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

12. HUS
Medical emergency; dimercaprol/edta
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
<2yrs - abd pain - diarrhoea - ARF

13. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Injury to b/l glossopharyngeal. present in botulism
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No myoclonic activity in JME

14. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
refuse
Black
Female - breech delivery - family history; tx referral to ortho

15. tick transmits RMSF
Black
Vaso-occlusive crisis; dx hb electrophoresis
Lateral neck xray in epiglottitis show swollen epiglottis
Constitutional pubertal delay

16. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Risk of neurological dysfunction
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Strep pneumonie; moraxella; h influenze

17. failure to thrive
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
Less than 5th percentile
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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

18. difference between rubeola (measles) and rulbella
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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
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 erythema chronicum migrans develops after tick bite
Pho for forward bending; forward defect; common finding has no adverse physical effect
24-72 hours
T for t ; thalassemia; inc serum iron and Iron binding
Injury to lower roots of brachial plexus

20. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
Constitutional pubertal delay

21. differentiate between central and peripheral precocious puberty
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Rapid detection of RSV antigen in nasl

22. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Pipercillin (zosyn) - ticarcillin

23. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Meconeum ileus; think about CF
Candidal diapar rash; tx clotrimazol

24. osler rendu weber syndrom
refuse
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Multiple telangiectesia - vasular lesion in CNS
Candidal diapar rash; tx clotrimazol

25. crying during urination. bacteriuria pyruria - rec episodes
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
Imaging study to r/o VUR
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

26. hypopigmented spots - family hx bilat deafness
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Neurofibromatosis type2

27. What is the definition of delayed puberty?
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
24-72 hours

28. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Thalassemia - congenital hemolytic anemia

29. When to do surgery for undescended testes
ALL - alzheimers autism adhd depression seizure
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Wait until 6 months

30. down syndrome with holocystolic mumur
Decr calorie intake; decr calorie absorption;incr calorie demand
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Endocardial cushion defect (no separation between heart chambers)
Facial portwine stain

31. indications of audiometry in childrens
Dx US tx; correct serum electrolyte - pyloromyotom
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Medical emergency; dimercaprol/edta
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

32. complication of lumbosacral meningocele
Multiple telangiectesia - vasular lesion in CNS
Bladder dysfunction; UTI and renal dysfunctoin
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
T for t ; thalassemia; inc serum iron and Iron binding

33. association with infantile pyloric stenosis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
No intervention; 90% foreign bodies pass without difficulty
Injury to b/l glossopharyngeal. present in botulism
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

34. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
RSV - rhino and influenza
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Central isosexual precocious puberty; hypothalmaic hamartoma

35. How to dx RSV
Rapid detection of RSV antigen in nasl
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
After 24h of abx therapy
Endocardial cushion defect (no separation between heart chambers)

36. horner syndrom
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Injury to lower roots of brachial plexus
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
No myoclonic activity in JME

37. contraindications of DTap
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Dx US tx; correct serum electrolyte - pyloromyotom
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

38. 3yo - never able to walk
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Injury to lower roots of brachial plexus

39. language expectation from 2yo
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)
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Develops in 21 dasy

40. sturge weber syndrome
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Female - breech delivery - family history; tx referral to ortho
Facial portwine stain
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

41. viruses cause bronhioltitis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Meconeum ileus; think about CF
T for t ; thalassemia; inc serum iron and Iron binding
RSV - rhino and influenza

42. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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 intervention; 90% foreign bodies pass without difficulty
refuse

43. Tx of community acquired pneumonia
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

44. contraindications of MMR vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Herpes
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

45. How to difference RSV and neonatal chlamydia
Imaging study to r/o VUR
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Decr calorie intake; decr calorie absorption;incr calorie demand
No wheezing - no feever in chlamydia

46. Febrile seizure
Increase of pregnenolone
Injury to b/l glossopharyngeal. present in botulism
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

47. doing worse in school - lack of attention - starring speel
D for d; down syndrome and polyhydramnios
Absence seizure; tx ethosuximide
Between pregnenolone and 17oh pregnenolone
Increase of pregnenolone

48. Parvovirus
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Fifth disease; febrile syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

49. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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)

50. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
1.5%
Croup