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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. difference between diaper dermatitis and rash
Vaso-occlusive crisis; dx hb electrophoresis
refuse
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
<2yrs - abd pain - diarrhoea - ARF

2. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Decr calorie intake; decr calorie absorption;incr calorie demand
Mainly clinical; serology with initial ELISA - with western blot confirmation;
URI

3. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
No reticulocyte vs high reticulocyte

4. acute otitis externa

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5. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
After 6m; breast mild provides iron until 6m.
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

6. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Congenital rubella syndrome
No myoclonic activity in JME
Injury to b/l glossopharyngeal. present in botulism

7. What is thumbprint sign
Decreased UGT enzyme
Wait until 6 months
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Lateral neck xray in epiglottitis show swollen epiglottis

8. Tx of community acquired pneumonia
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Oral DMSA or EDTA IV
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

9. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Black
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

10. Neonatal conjugated hyperbilirubinemia
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Biliary atresia; tx surgery
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

11. side effect of testosteron therapy
Injury to lower roots of brachial plexus
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
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
Decreases height - expensive; reserved for severe cases of delayed puberty

12. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
URI
Dactylitis; 2nd common is splenic seqestration
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

13. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Croup tx cool mist; racemic epi - corticosteroid
Lateral neck xray in epiglottitis show swollen epiglottis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

14. bromocriptine
RSV - rhino and influenza
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Prolactinoma
Central isosexual precocious puberty; hypothalmaic hamartoma

15. lead >70
<2yrs - abd pain - diarrhoea - ARF
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Medical emergency; dimercaprol/edta

16. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

17. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
T for t ; thalassemia; inc serum iron and Iron binding

18. lens dislocation
Marfans - ehlers danlos - homocystinuria
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Biliary atresia; tx surgery
24h to 7d of birth

19. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Neurofibromatosis type2
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

20. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
TB - breastfeeding - asymptomatic hiv
Dx US tx; correct serum electrolyte - pyloromyotom

21. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Decreases height - expensive; reserved for severe cases of delayed puberty
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
T for t ; thalassemia; inc serum iron and Iron binding

22. When to give hpv vaccien
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
Risk of neurological dysfunction
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Candidal diapar rash; tx clotrimazol

23. cleft lip but no cleft palate
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No myoclonic activity in JME
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

24. 17 alpha hydroxylase
Absence seizure; tx ethosuximide
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Between pregnenolone and 17oh pregnenolone
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

25. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Central isosexual precocious puberty; hypothalmaic hamartoma
Pipercillin (zosyn) - ticarcillin

26. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

27. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Pipercillin (zosyn) - ticarcillin
Croup
Constitutional pubertal delay

28. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Increase of progesteron/17oh progesterone
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

29. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
Vaso-occlusive crisis; dx hb electrophoresis

30. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
TB - breastfeeding - asymptomatic hiv

31. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bartonella henselae; complication is suppuration of lymph node

32. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Thalassemia - congenital hemolytic anemia
refuse
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

33. viruses cause bronhioltitis
RSV - rhino and influenza
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No intervention; 90% foreign bodies pass without difficulty
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

34. How to dx post uretheral valve
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Medical emergency; dimercaprol/edta
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

35. the risk of lyme after bitten by a tick
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Decreases height - expensive; reserved for severe cases of delayed puberty
1.5%
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

36. low grade fever - cough - diffuse bilat ground glass opacities
Prolactinoma
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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

37. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Increase of pregnenolone
Bartonella henselae; complication is suppuration of lymph node
Between pregnenolone and 17oh pregnenolone

38. red oozing rash on cheek - scaly - dry
Meconeum ileus; think about CF
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No myoclonic activity in JME
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

39. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No reticulocyte vs high reticulocyte
Strep pneumonie; moraxella; h influenze

40. Neonatal unconjugated hyperbilirubine
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Decreased UGT enzyme
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

41. can women with abnormal smear or genital get vaccine
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
Yes; but it will be less effective
After 24h of abx therapy
Decreases height - expensive; reserved for severe cases of delayed puberty

42. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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

43. carditis and arthritis after rheumatic fever
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
RSV - rhino and influenza
Develops in 21 dasy
Diet modification to provide 110kc/kg/d

44. When to do surgery for undescended testes
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Wait until 6 months
36 hours
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

45. What is earliest sign of puberty?
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
refuse
Black
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

46. infant botulism
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
After 6m; breast mild provides iron until 6m.

47. causes of acute anemia
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
If aortic root reaches 45 mm

48. down syndrome with holocystolic mumur
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Endocardial cushion defect (no separation between heart chambers)
HSP - look for symmetric skin lesions

49. How to dx RSV
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Rapid detection of RSV antigen in nasl
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

50. dx for DDH
Imaging study to r/o VUR
Dx US tx; correct serum electrolyte - pyloromyotom
Mainly clinical; serology with initial ELISA - with western blot confirmation;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;