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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. tuberous sclerosis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
>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
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

2. cleft lip but no cleft palate
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Diet modification to provide 110kc/kg/d
Marfans - ehlers danlos - homocystinuria

3. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

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4. Neonatal conjugated hyperbilirubinemia
No intervention; 90% foreign bodies pass without difficulty
Foreign body sensation - photophobia - corneal opacity tx abx
Strep pneumonie; moraxella; h influenze
Biliary atresia; tx surgery

5. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Mainly clinical; serology with initial ELISA - with western blot confirmation;
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

6. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Wait until 6 months
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
<2yrs - abd pain - diarrhoea - ARF

7. How to dx RSV
Meconeum ileus; think about CF
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Oral DMSA or EDTA IV
Rapid detection of RSV antigen in nasl

8. 17 alpha hydroxylase
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
Meconeum ileus; think about CF
Between pregnenolone and 17oh pregnenolone

9. infantile hypertrophic pyloric stenosis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Dx US tx; correct serum electrolyte - pyloromyotom
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

10. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

11. lens dislocation
Tx only symptomatic carrier
Marfans - ehlers danlos - homocystinuria
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

12. centor criteria for bact pharyngitis
Black
110 kcl/kg/day
Pho for forward bending; forward defect; common finding has no adverse physical effect
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

13. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
D for d; down syndrome and polyhydramnios
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
TB - breastfeeding - asymptomatic hiv

14. giardiasis
24-72 hours
Tx only symptomatic carrier
Pho for forward bending; forward defect; common finding has no adverse physical effect
Croup tx cool mist; racemic epi - corticosteroid

15. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Multiple telangiectesia - vasular lesion in CNS
>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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

16. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Methylephenidate toxicity; cannot be stopped abruptly; taper
After 6m; breast mild provides iron until 6m.
Increase of pregnenolone

17. 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
Faciform RBC cause vascular occlusion
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Less than 5th percentile

18. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

19. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Prolactinoma
Imaging study to r/o VUR
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

20. dx of lyme
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Rapid detection of RSV antigen in nasl

21. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Vaso-occlusive crisis; dx hb electrophoresis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
RSV - rhino and influenza
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

22. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Wait until 6 months
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

23. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
If aortic root reaches 45 mm
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

24. How to differentiate croup vs epiglotitis
Tx only symptomatic carrier
Prolactinoma
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

25. Tx of children constipation

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26. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Fifth disease; febrile syndrome
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

27. How to evaluate well appearing child just born in GBS pos mother?
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
After 6m; breast mild provides iron until 6m.
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

28. red oozing rash on cheek - scaly - dry
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
110 kcl/kg/day
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Do HIV testing at first

29. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Fifth disease; febrile syndrome
Pipercillin (zosyn) - ticarcillin
Risk of neurological dysfunction

30. osler rendu weber syndrom
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Multiple telangiectesia - vasular lesion in CNS
Tx only symptomatic carrier

31. coin in child's stomach
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
1.5%
No intervention; 90% foreign bodies pass without difficulty

32. defcicieny of 21 hydroxylase
No reticulocyte vs high reticulocyte
ALL - alzheimers autism adhd depression seizure
Increase of progesteron/17oh progesterone
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

33. hypopigmented spots - family hx bilat deafness
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Faciform RBC cause vascular occlusion
Decr calorie intake; decr calorie absorption;incr calorie demand
Neurofibromatosis type2

34. patient with white plaques in mouth and lump in back
Do HIV testing at first
Decreased UGT enzyme
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)
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

35. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Thalassemia - congenital hemolytic anemia
ALL - alzheimers autism adhd depression seizure

36. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
If aortic root reaches 45 mm
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

37. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
D for d; down syndrome and polyhydramnios
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Erb paralysis leading to diaphragmatic paralysis

38. difference between rubeola (measles) and rulbella
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

39. sudden onset of fever - difficulty in breathing
TB - breastfeeding - asymptomatic hiv
Herpes
Erb paralysis leading to diaphragmatic paralysis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

40. benefits of antibiotic therapy in acute pharyngitis?
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

41. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Central isosexual precocious puberty; hypothalmaic hamartoma
Croup
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Penicillin G 4h before delivery

42. aplasic crisis
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Benign permature thelarche; expectant management

43. What is thumbprint sign
Rapid detection of RSV antigen in nasl
Lateral neck xray in epiglottitis show swollen epiglottis
HSP - look for symmetric skin lesions
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

44. causes of FTT
Yes; but it will be less effective
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Rapid detection of RSV antigen in nasl

45. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
No intervention; 90% foreign bodies pass without difficulty
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

46. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

47. Tx of botulism
ALL - alzheimers autism adhd depression seizure
Pho for forward bending; forward defect; common finding has no adverse physical effect
Benign permature thelarche; expectant management
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

48. most common complication of otitis media
Fifth disease; febrile syndrome
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
<2yrs - abd pain - diarrhoea - ARF
Medical emergency; dimercaprol/edta

49. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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

50. Tx of community acquired pneumonia
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
refuse