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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. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Between pregnenolone and 17oh pregnenolone
Constitutional pubertal delay
To make hip flexed and abducted position in DDH

2. What are the risk factors of developmental dysplais of hip
Do HIV testing at first
Between pregnenolone and 17oh pregnenolone
Female - breech delivery - family history; tx referral to ortho
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

3. tzanck
Herpes
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
HSP - look for symmetric skin lesions
Central isosexual precocious puberty; hypothalmaic hamartoma

4. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Thalassemia - congenital hemolytic anemia
Vaso-occlusive crisis; dx hb electrophoresis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Meconeum ileus; think about CF

5. viruses cause bronhioltitis
RSV - rhino and influenza
Increase of progesteron/17oh progesterone
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

6. Infant with serum billlirubin >25
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Increase of progesteron/17oh progesterone
Oral DMSA or EDTA IV
Risk of neurological dysfunction

7. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
ALL - alzheimers autism adhd depression seizure
refuse
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

8. down syndrome with holocystolic mumur
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Endocardial cushion defect (no separation between heart chambers)
Multiple telangiectesia - vasular lesion in CNS

9. contraindications of DTap
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
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

10. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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

11. acute otitis externa

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12. difference between diaper dermatitis and rash
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
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
Female - breech delivery - family history; tx referral to ortho
Less than 5th percentile

13. Febrile seizure
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Develops in 21 dasy
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

14. deficinecy of 17 hydroxylase
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Increase of pregnenolone
TB - breastfeeding - asymptomatic hiv
If aortic root reaches 45 mm

15. indications of audiometry in childrens
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Croup tx cool mist; racemic epi - corticosteroid

16. What is the definition of delayed puberty?
Facial portwine stain
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

17. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Less than 5th percentile
INH 9m if INH resistant rifampin 6m in children and 4m in adults
1.5%
Methylephenidate toxicity; cannot be stopped abruptly; taper

18. difference between structural disorder and flexible kyphosis
Croup
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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
Risk of neurological dysfunction

19. difference between rubeola (measles) and rulbella
Fifth disease; febrile syndrome
Lateral neck xray in epiglottitis show swollen epiglottis
Vaso-occlusive crisis; dx hb electrophoresis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

20. causes of acute anemia
D for d; down syndrome and polyhydramnios
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Thalassemia - congenital hemolytic anemia

21. lead >70
Medical emergency; dimercaprol/edta
ALL - alzheimers autism adhd depression seizure
Erb paralysis leading to diaphragmatic paralysis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

22. When erythema chronicum migrans develops after tick bite
Female - breech delivery - family history; tx referral to ortho
No reticulocyte vs high reticulocyte
24-72 hours
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

23. How to differential bact vs viral conjunctivitis
ALL - alzheimers autism adhd depression seizure
Bartonella henselae; complication is suppuration of lymph node
Risk of neurological dysfunction
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

24. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
To make hip flexed and abducted position in DDH
Central isosexual precocious puberty; hypothalmaic hamartoma
ALL - alzheimers autism adhd depression seizure

25. dx of lyme
110 kcl/kg/day
No intervention; 90% foreign bodies pass without difficulty
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Medical emergency; dimercaprol/edta

26. thumb sign
Biliary atresia; tx surgery
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No wheezing - no feever in chlamydia
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

27. complete airway obstruction with FB
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
Foreign body sensation - photophobia - corneal opacity tx abx
>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
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

28. contact lens keratitis
TB - breastfeeding - asymptomatic hiv
Absence seizure; tx ethosuximide
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)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

29. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Facial portwine stain
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Dx US tx; correct serum electrolyte - pyloromyotom

30. what conditions are not contraindicated
URI
TB - breastfeeding - asymptomatic hiv
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

31. How to difference viral and bact pneumonia
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Central isosexual precocious puberty; hypothalmaic hamartoma
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

32. cat scratch disease
Endocardial cushion defect (no separation between heart chambers)
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bartonella henselae; complication is suppuration of lymph node

33. How to dx post uretheral valve
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Dx US tx; correct serum electrolyte - pyloromyotom
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

34. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
refuse
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Foreign body sensation - photophobia - corneal opacity tx abx

35. Nocturnal enuresis
Marfans - ehlers danlos - homocystinuria
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Injury to b/l glossopharyngeal. present in botulism
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

36. TTP pentad
110 kcl/kg/day
ALL - alzheimers autism adhd depression seizure
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
T for t ; thalassemia; inc serum iron and Iron binding

37. 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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Rapid detection of RSV antigen in nasl

38. the risk of lyme after bitten by a tick
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
1.5%

39. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Strep pneumonie; moraxella; h influenze
Increase of pregnenolone

40. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
24h to 7d of birth
ALL - alzheimers autism adhd depression seizure
Less than 5th percentile

41. Tx of community acquired pneumonia
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Imaging study to r/o VUR
Mainly clinical; serology with initial ELISA - with western blot confirmation;

42. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Medical emergency; dimercaprol/edta
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Congenital rubella syndrome

43. pneumonia in CF patient
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Lateral neck xray in epiglottitis show swollen epiglottis
Meconeum ileus; think about CF

44. infant botulism
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
36 hours
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Penicillin G 4h before delivery

45. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

46. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Atopic dermatitis; strong allergic/immunologic component; incr IgE
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Risk of neurological dysfunction

47. coin in child's stomach
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
No intervention; 90% foreign bodies pass without difficulty
Medical emergency; dimercaprol/edta
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

48. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
14yrs
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Bladder dysfunction; UTI and renal dysfunctoin

49. horner syndrom
No myoclonic activity in JME
Vaso-occlusive crisis; dx hb electrophoresis
Injury to lower roots of brachial plexus
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

50. What is the calorie requirement of newborn?
Dactylitis; 2nd common is splenic seqestration
24h to 7d of birth
110 kcl/kg/day
Imaging study to r/o VUR