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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
Increase of progesteron/17oh progesterone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Candidal diapar rash; tx clotrimazol
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

2. patient with white plaques in mouth and lump in back
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Dactylitis; 2nd common is splenic seqestration
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Do HIV testing at first

3. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Croup tx cool mist; racemic epi - corticosteroid
Decreases height - expensive; reserved for severe cases of delayed puberty

4. spitting up - vomiting at night - weight stable
Constitutional pubertal delay
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
After 24h of abx therapy
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

5. echymoses with low platelet <30k
Thalassemia - congenital hemolytic anemia
Tx only symptomatic carrier
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

6. nuchal rigidity - fever - sore throat - headache - dioriented
Endocardial cushion defect (no separation between heart chambers)
Female - breech delivery - family history; tx referral to ortho
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

7. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
>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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

8. Infant with serum billlirubin >25
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Risk of neurological dysfunction
No; they are basic compound will be neutralized in an acidic environment of cellulitis

9. starring spells 10-20sec
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)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
No intervention; 90% foreign bodies pass without difficulty
Prolactinoma

10. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Tx only symptomatic carrier
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

11. sturge weber syndrome
Facial portwine stain
Oral DMSA or EDTA IV
Dx US tx; correct serum electrolyte - pyloromyotom
Risk of neurological dysfunction

12. can women with abnormal smear or genital get vaccine
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
Benign permature thelarche; expectant management
Black
Yes; but it will be less effective

13. Tx of children constipation

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14. How to differential bact vs viral conjunctivitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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
Decr calorie intake; decr calorie absorption;incr calorie demand

15. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Rapid detection of RSV antigen in nasl

16. When to give HRT in turner
No wheezing - no feever in chlamydia
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Dx US tx; correct serum electrolyte - pyloromyotom
14yrs

17. IM
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Atypical lymphocyte
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Candidal diapar rash; tx clotrimazol

18. failure to thrive
Pipercillin (zosyn) - ticarcillin
Less than 5th percentile
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Benign permature thelarche; expectant management

19. difference between breast milk and breafeeding jaundice
Decr calorie intake; decr calorie absorption;incr calorie demand
110 kcl/kg/day
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
RSV - rhino and influenza

20. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Prolactinoma
Candidal diapar rash; tx clotrimazol

21. lead 44-70
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Oral DMSA or EDTA IV
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Bladder dysfunction; UTI and renal dysfunctoin

22. tick transmits lyme
ALL - alzheimers autism adhd depression seizure
Brown
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

23. acute abd pain - hx URI - lower extremity maculo papular rash
Bladder dysfunction; UTI and renal dysfunctoin
HSP - look for symmetric skin lesions
Central isosexual precocious puberty; hypothalmaic hamartoma
Prolactinoma

24. When to do aortic root surgery in marfans to prevent dissection?
Brown
If aortic root reaches 45 mm
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No myoclonic activity in JME

25. lens dislocation
Do HIV testing at first
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Marfans - ehlers danlos - homocystinuria
Croup

26. microcytic - hypochromic anemia - hepatospelnomegaly
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Thalassemia - congenital hemolytic anemia
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

27. How to dx RSV
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Rapid detection of RSV antigen in nasl
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

28. Parvovirus
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Endocardial cushion defect (no separation between heart chambers)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Fifth disease; febrile syndrome

29. infant botulism
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Facial portwine stain
HSP - look for symmetric skin lesions
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

30. deficinecy of 17 hydroxylase
Increase of pregnenolone
Prolactinoma
Between pregnenolone and 17oh pregnenolone
Atopic dermatitis; strong allergic/immunologic component; incr IgE

31. How long anti-TB drugs given for TB meningitis?
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Medical emergency; dimercaprol/edta
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

32. language delay
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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

33. congenital adrenal hyperplasi
Croup
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

34. pneumonia in CF patient
Decreases height - expensive; reserved for severe cases of delayed puberty
Female - breech delivery - family history; tx referral to ortho
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

35. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Less than 5th percentile
Facial portwine stain
Develops in 21 dasy

36. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Neurofibromatosis type2
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

37. contraindications of MMR vaccine
Decreased UGT enzyme
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
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
Brown

38. defcicieny of 21 hydroxylase
110 kcl/kg/day
Increase of progesteron/17oh progesterone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

39. giardiasis
36 hours
D for d; down syndrome and polyhydramnios
Tx only symptomatic carrier
RSV - rhino and influenza

40. benefits of antibiotic therapy in acute pharyngitis?
Congenital rubella syndrome
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Diet modification to provide 110kc/kg/d
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

41. adrenal tumor
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Biliary atresia; tx surgery
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

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

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43. lead >70
Tx only symptomatic carrier
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Medical emergency; dimercaprol/edta
Marfans - ehlers danlos - homocystinuria

44. How to dx endopthalmitis
Candidal diapar rash; tx clotrimazol
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Pho for forward bending; forward defect; common finding has no adverse physical effect

45. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Dactylitis; 2nd common is splenic seqestration
Strep pneumonie; moraxella; h influenze

46. When erythema chronicum migrans develops after tick bite
24-72 hours
Marfans - ehlers danlos - homocystinuria
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

47. physiological jaundice
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
24h to 7d of birth
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
No; they are basic compound will be neutralized in an acidic environment of cellulitis

48. When to bevioral and enviromental measure in led intoxication?
HSP - look for symmetric skin lesions
Female - breech delivery - family history; tx referral to ortho
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

49. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Croup
Strep pneumonie; moraxella; h influenze
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

50. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
refuse
HSP - look for symmetric skin lesions