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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. congenital adrenal hyperplasi
Oral DMSA or EDTA IV
T for t ; thalassemia; inc serum iron and Iron binding
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
24h to 7d of birth

2. complication of lumbosacral meningocele
Rapid detection of RSV antigen in nasl
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
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
Bladder dysfunction; UTI and renal dysfunctoin

3. bromocriptine
No reticulocyte vs high reticulocyte
Prolactinoma
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
refuse

4. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
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
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
No myoclonic activity in JME

5. echymoses with low platelet <30k
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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
24h to 7d of birth
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

6. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

7. mcCune albright`
Croup tx cool mist; racemic epi - corticosteroid
Decr calorie intake; decr calorie absorption;incr calorie demand
Facial portwine stain
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

8. differentiate between central and peripheral precocious puberty
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
14yrs

9. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Increase of pregnenolone
Endocardial cushion defect (no separation between heart chambers)
Methylephenidate toxicity; cannot be stopped abruptly; taper
Central isosexual precocious puberty; hypothalmaic hamartoma

10. HUS
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Wait until 6 months
Vaso-occlusive crisis; dx hb electrophoresis
<2yrs - abd pain - diarrhoea - ARF

11. tzanck
Herpes
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
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
No reticulocyte vs high reticulocyte

12. the recommended ca supplementation
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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
>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

13. How to difference RSV and neonatal chlamydia
Imaging study to r/o VUR
Increase of progesteron/17oh progesterone
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
No wheezing - no feever in chlamydia

14. Nocturnal enuresis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Absence seizure; tx ethosuximide
Female - breech delivery - family history; tx referral to ortho

15. 3yo - febrile - left hip externally rotated
Neurofibromatosis type2
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Female - breech delivery - family history; tx referral to ortho
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

16. crying during urination. bacteriuria pyruria - rec episodes
Injury to b/l glossopharyngeal. present in botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Imaging study to r/o VUR
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

17. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
HSP - look for symmetric skin lesions

18. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No reticulocyte vs high reticulocyte
Develops in 21 dasy
Imaging study to r/o VUR

19. adenovirus
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
URI
No intervention; 90% foreign bodies pass without difficulty
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

20. sickle cell with symmetrical swelling of hands and feet
Oral DMSA or EDTA IV
Vaso-occlusive crisis; dx hb electrophoresis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Croup

21. When erythema chronicum migrans develops after tick bite
24-72 hours
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
14yrs
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

22. splenic infarction in sickle cell
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Faciform RBC cause vascular occlusion
Tx only symptomatic carrier
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

23. how thalassemia die
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No intervention; 90% foreign bodies pass without difficulty

24. tick transmits RMSF
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
T for t ; thalassemia; inc serum iron and Iron binding
Black
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

25. language expectation from 2yo
After 6m; breast mild provides iron until 6m.
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No intervention; 90% foreign bodies pass without difficulty

26. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Meconeum ileus; think about CF
Increase of pregnenolone
Injury to b/l glossopharyngeal. present in botulism

27. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

28. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Meconeum ileus; think about CF
refuse
Medical emergency; dimercaprol/edta

29. difference between rubeola (measles) and rulbella
Prolactinoma
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Benign permature thelarche; expectant management
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

30. cleft lip but no cleft palate
No intervention; 90% foreign bodies pass without difficulty
Atypical lymphocyte
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

31. How long anti-TB drugs given for TB meningitis?
Diet modification to provide 110kc/kg/d
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Biliary atresia; tx surgery
Black

32. decreased mobility of tympanic membrane after otitis media
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Dactylitis; 2nd common is splenic seqestration

33. dx of lyme
Atypical lymphocyte
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

34. red oozing rash on cheek - scaly - dry
Wait until 6 months
Yes; but it will be less effective
Herpes
Atopic dermatitis; strong allergic/immunologic component; incr IgE

35. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Black
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

36. How to prevent GBS in neonate
Penicillin G 4h before delivery
Neurofibromatosis type2
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Female - breech delivery - family history; tx referral to ortho

37. How to investigate delayed puberty
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Brown
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

38. viruses cause bronhioltitis
RSV - rhino and influenza
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Black
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

39. What is the most common initial symptom in sickle cell
Decreases height - expensive; reserved for severe cases of delayed puberty
Dactylitis; 2nd common is splenic seqestration
Bladder dysfunction; UTI and renal dysfunctoin
Mainly clinical; serology with initial ELISA - with western blot confirmation;

40. difference between diaper dermatitis and rash
Imaging study to r/o VUR
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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

41. sublottic narrowing
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
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
Croup tx cool mist; racemic epi - corticosteroid
Increase of pregnenolone

42. language delay
RSV - rhino and influenza
Bartonella henselae; complication is suppuration of lymph node
Tx only symptomatic carrier
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

43. pumonary TB
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Yes; but it will be less effective
refuse
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)

44. How to dx acute angle closure glaucoma
No wheezing - no feever in chlamydia
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Dx US tx; correct serum electrolyte - pyloromyotom
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

45. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Imaging study to r/o VUR
Penicillin G 4h before delivery
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

46. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Congenital rubella syndrome
Vaso-occlusive crisis; dx hb electrophoresis
Prolactinoma
Erb paralysis leading to diaphragmatic paralysis

47. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Central isosexual precocious puberty; hypothalmaic hamartoma
Decreases height - expensive; reserved for severe cases of delayed puberty
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

48. mech of botulism
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

49. if bone age lower than actual and puberty delayed
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Constitutional pubertal delay
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

50. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Atypical lymphocyte
After 24h of abx therapy
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis