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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. 18mo bilat breast enlargment - some pubic hair
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Benign permature thelarche; expectant management
Imaging study to r/o VUR
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

2. difference between rubeola (measles) and rulbella
Female - breech delivery - family history; tx referral to ortho
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
<2yrs - abd pain - diarrhoea - ARF
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

3. How to difference viral and bact pneumonia
1.5%
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
110 kcl/kg/day
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

4. cardiac manifestation of turner
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No reticulocyte vs high reticulocyte

5. down syndrome with holocystolic mumur
Increase of pregnenolone
Imaging study to r/o VUR
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Endocardial cushion defect (no separation between heart chambers)

6. acute abd pain - hx URI - lower extremity maculo papular rash
Faciform RBC cause vascular occlusion
Develops in 21 dasy
HSP - look for symmetric skin lesions
36 hours

7. How to differentiate caput succedanueum and cephalohematoma
<2yrs - abd pain - diarrhoea - ARF
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
24h to 7d of birth
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

8. What is thumbprint sign
Erb paralysis leading to diaphragmatic paralysis
Lateral neck xray in epiglottitis show swollen epiglottis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

9. Tx of community acquired pneumonia
Penicillin G 4h before delivery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
110 kcl/kg/day

10. side effect of testosteron therapy
To make hip flexed and abducted position in DDH
T for t ; thalassemia; inc serum iron and Iron binding
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Decreases height - expensive; reserved for severe cases of delayed puberty

11. lead 44-70
Between pregnenolone and 17oh pregnenolone
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Oral DMSA or EDTA IV
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

12. starring spells 10-20sec
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Pipercillin (zosyn) - ticarcillin
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

13. causes of FTT
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Decr calorie intake; decr calorie absorption;incr calorie demand
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)

14. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Increase of pregnenolone
Medical emergency; dimercaprol/edta
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

15. How long patient needs to be exposed to tick to get infected
Bartonella henselae; complication is suppuration of lymph node
No myoclonic activity in JME
Croup tx cool mist; racemic epi - corticosteroid
36 hours

16. What are the risk factors of developmental dysplais of hip
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Female - breech delivery - family history; tx referral to ortho
Imaging study to r/o VUR
Fifth disease; febrile syndrome

17. infant botulism
Herpes
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

18. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Erb paralysis leading to diaphragmatic paralysis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Lateral neck xray in epiglottitis show swollen epiglottis

19. Nocturnal enuresis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
110 kcl/kg/day
Candidal diapar rash; tx clotrimazol
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

20. What is the calorie requirement of newborn?
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
110 kcl/kg/day
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

21. horner syndrom
Vaso-occlusive crisis; dx hb electrophoresis
Injury to lower roots of brachial plexus
Neurofibromatosis type2
Risk of neurological dysfunction

22. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Injury to b/l glossopharyngeal. present in botulism
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
To make hip flexed and abducted position in DDH

23. contact lens keratitis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Brown
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

24. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

25. hypopigmented spots - family hx bilat deafness
Faciform RBC cause vascular occlusion
After 24h of abx therapy
Neurofibromatosis type2
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

26. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
24-72 hours
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Meconeum ileus; think about CF

27. 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
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
Candidal diapar rash; tx clotrimazol
Diet modification to provide 110kc/kg/d

28. major depression
Pho for forward bending; forward defect; common finding has no adverse physical effect
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

29. physiological jaundice
24h to 7d of birth
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Candidal diapar rash; tx clotrimazol
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

30. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
refuse
Tx only symptomatic carrier
Herpes

31. sturge weber syndrome
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Facial portwine stain
24-72 hours
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

32. What is the definition of delayed puberty?
Risk of neurological dysfunction
After 24h of abx therapy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

33. How to dx keratitis?
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Foreign body sensation - photophobia - corneal opacity tx abx

34. contraindications of DTap
Croup tx cool mist; racemic epi - corticosteroid
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Mainly clinical; serology with initial ELISA - with western blot confirmation;

35. pumonary TB
Penicillin G 4h before delivery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
RSV - rhino and influenza
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)

36. Tx of botulism
If aortic root reaches 45 mm
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

37. flexible kyphosis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Pho for forward bending; forward defect; common finding has no adverse physical effect
Bladder dysfunction; UTI and renal dysfunctoin

38. acute otitis media-pathogen
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Black
T for t ; thalassemia; inc serum iron and Iron binding
Strep pneumonie; moraxella; h influenze

39. HUS
Black
<2yrs - abd pain - diarrhoea - ARF
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Biliary atresia; tx surgery

40. deficinecy of 17 hydroxylase
Increase of pregnenolone
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

41. 3yo - febrile - left hip externally rotated
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Increase of pregnenolone

42. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Methylephenidate toxicity; cannot be stopped abruptly; taper
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

43. lead >70
Do HIV testing at first
If aortic root reaches 45 mm
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)
Medical emergency; dimercaprol/edta

44. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

45. When to do surgery for undescended testes
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Wait until 6 months
Endocardial cushion defect (no separation between heart chambers)
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

46. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Pho for forward bending; forward defect; common finding has no adverse physical effect
Oral DMSA or EDTA IV

47. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Decreased UGT enzyme

48. complication of lumbosacral meningocele
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Bladder dysfunction; UTI and renal dysfunctoin
1.5%
Dx US tx; correct serum electrolyte - pyloromyotom

49. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
refuse
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

50. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Meconeum ileus; think about CF
Vaso-occlusive crisis; dx hb electrophoresis
Wait until 6 months