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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. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Neurofibromatosis type2
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
1.5%

2. echymoses with low platelet <30k
1.5%
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

3. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Candidal diapar rash; tx clotrimazol
Prolactinoma
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

4. how smoking contributes otitis media in children
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Erb paralysis leading to diaphragmatic paralysis

5. adenovirus
Multiple telangiectesia - vasular lesion in CNS
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
URI
Rapid detection of RSV antigen in nasl

6. infantile hypertrophic pyloric stenosis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Dx US tx; correct serum electrolyte - pyloromyotom
Strep pneumonie; moraxella; h influenze

7. Infant with serum billlirubin >25
Develops in 21 dasy
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Risk of neurological dysfunction
Constitutional pubertal delay

8. lead 44-70
Oral DMSA or EDTA IV
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
To make hip flexed and abducted position in DDH
No intervention; 90% foreign bodies pass without difficulty

9. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Faciform RBC cause vascular occlusion
refuse

10. 18mo bilat breast enlargment - some pubic hair
After 6m; breast mild provides iron until 6m.
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Absence seizure; tx ethosuximide
Benign permature thelarche; expectant management

11. difference between rubeola (measles) and rulbella
After 24h of abx therapy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Brown

12. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Absence seizure; tx ethosuximide
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Imaging study to r/o VUR

13. What is thumbprint sign
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Lateral neck xray in epiglottitis show swollen epiglottis
INH 9m if INH resistant rifampin 6m in children and 4m in adults

14. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Marfans - ehlers danlos - homocystinuria
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
24h to 7d of birth

15. How to dx endopthalmitis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Yes; but it will be less effective
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

16. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

17. dx of lyme
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Mainly clinical; serology with initial ELISA - with western blot confirmation;
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

18. sudden onset of fever - difficulty in breathing
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Lateral neck xray in epiglottitis show swollen epiglottis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

19. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
No reticulocyte vs high reticulocyte

20. acute otitis externa

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21. TB prophylaxis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Imaging study to r/o VUR
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

22. lead >70
Medical emergency; dimercaprol/edta
If aortic root reaches 45 mm
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

23. Parvovirus
D for d; down syndrome and polyhydramnios
24-72 hours
Fifth disease; febrile syndrome
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

24. causes of acute anemia
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
TB - breastfeeding - asymptomatic hiv
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

25. How to investigate delayed puberty
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

26. aplasic crisis
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)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
No reticulocyte vs high reticulocyte
24-72 hours

27. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Endocardial cushion defect (no separation between heart chambers)
Facial portwine stain
Do HIV testing at first

28. mcCune albright`
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

29. complete airway obstruction with FB
>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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Erb paralysis leading to diaphragmatic paralysis

30. complication of lumbosacral meningocele
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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Bladder dysfunction; UTI and renal dysfunctoin
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

31. splenic infarction in sickle cell
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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Faciform RBC cause vascular occlusion
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

32. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
To make hip flexed and abducted position in DDH
Risk of neurological dysfunction

33. Tx of botulism
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Penicillin G 4h before delivery
Foreign body sensation - photophobia - corneal opacity tx abx

34. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
24h to 7d of birth
D for d; down syndrome and polyhydramnios

35. 17 alpha hydroxylase
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Diet modification to provide 110kc/kg/d
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Between pregnenolone and 17oh pregnenolone

36. How to difference viral and bact pneumonia
Female - breech delivery - family history; tx referral to ortho
No wheezing - no feever in chlamydia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

37. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Methylephenidate toxicity; cannot be stopped abruptly; taper
Wait until 6 months
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

38. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Brown
Pho for forward bending; forward defect; common finding has no adverse physical effect
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

39. What is the calorie requirement of newborn?
1.5%
Rapid detection of RSV antigen in nasl
Multiple telangiectesia - vasular lesion in CNS
110 kcl/kg/day

40. What is earliest sign of puberty?
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

41. tick transmits lyme
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Brown
RSV - rhino and influenza
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

42. centor criteria for bact pharyngitis
14yrs
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
T for t ; thalassemia; inc serum iron and Iron binding

43. bromocriptine
Prolactinoma
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

44. How to dx RSV
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
110 kcl/kg/day
Rapid detection of RSV antigen in nasl
Decreases height - expensive; reserved for severe cases of delayed puberty

45. target cell
To make hip flexed and abducted position in DDH
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
T for t ; thalassemia; inc serum iron and Iron binding
Increase of progesteron/17oh progesterone

46. failure to thrive
Prolactinoma
Central isosexual precocious puberty; hypothalmaic hamartoma
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Less than 5th percentile

47. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Black
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
24-72 hours

48. 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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Pho for forward bending; forward defect; common finding has no adverse physical effect

49. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
If aortic root reaches 45 mm
Croup
Atopic dermatitis; strong allergic/immunologic component; incr IgE

50. causes of FTT
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Injury to lower roots of brachial plexus