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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. most common complication of otitis media
Black
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
<2yrs - abd pain - diarrhoea - ARF

2. the recommended ca supplementation
D for d; down syndrome and polyhydramnios
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Decreases height - expensive; reserved for severe cases of delayed puberty

3. aplasic crisis
Fifth disease; febrile syndrome
Medical emergency; dimercaprol/edta
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
24-72 hours

4. osler rendu weber syndrom
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Multiple telangiectesia - vasular lesion in CNS
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Between pregnenolone and 17oh pregnenolone

5. language delay
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Less than 5th percentile

6. dx for DDH
Female - breech delivery - family history; tx referral to ortho
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
ALL - alzheimers autism adhd depression seizure
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

7. dx of lyme
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
To make hip flexed and abducted position in DDH
Meconeum ileus; think about CF
Mainly clinical; serology with initial ELISA - with western blot confirmation;

8. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
After 24h of abx therapy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

9. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
24h to 7d of birth
TB - breastfeeding - asymptomatic hiv
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

10. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Facial portwine stain
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

11. sublottic narrowing
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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Croup tx cool mist; racemic epi - corticosteroid

12. patient with white plaques in mouth and lump in back
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Do HIV testing at first
Bladder dysfunction; UTI and renal dysfunctoin
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

13. down syndrome with holocystolic mumur
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Pipercillin (zosyn) - ticarcillin
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
Endocardial cushion defect (no separation between heart chambers)

14. tzanck
Herpes
Do HIV testing at first
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

15. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Female - breech delivery - family history; tx referral to ortho
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Congenital rubella syndrome

16. How to difference viral and bact pneumonia
After 6m; breast mild provides iron until 6m.
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Foreign body sensation - photophobia - corneal opacity tx abx

17. physiological jaundice
Endocardial cushion defect (no separation between heart chambers)
24h to 7d of birth
<2yrs - abd pain - diarrhoea - ARF
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

18. duodenal atresia
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Brown
D for d; down syndrome and polyhydramnios
Develops in 21 dasy

19. contact lens keratitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Candidal diapar rash; tx clotrimazol

20. 18mo bilat breast enlargment - some pubic hair
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Benign permature thelarche; expectant management
Multiple telangiectesia - vasular lesion in CNS

21. tick transmits RMSF
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Black
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

22. infantile hypertrophic pyloric stenosis
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

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

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24. What are the risk factors of developmental dysplais of hip
Dx US tx; correct serum electrolyte - pyloromyotom
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Atypical lymphocyte
Female - breech delivery - family history; tx referral to ortho

25. centor criteria for bact pharyngitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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

26. 21 hydroxylase
Facial portwine stain
refuse
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

27. What is the most common initial symptom in sickle cell
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Dactylitis; 2nd common is splenic seqestration
No wheezing - no feever in chlamydia
D for d; down syndrome and polyhydramnios

28. infant botulism
Brown
Facial portwine stain
Rapid detection of RSV antigen in nasl
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

29. lead >70
Strep pneumonie; moraxella; h influenze
Do HIV testing at first
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Medical emergency; dimercaprol/edta

30. bromocriptine
Oral DMSA or EDTA IV
24-72 hours
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Prolactinoma

31. When to do aortic root surgery in marfans to prevent dissection?
After 24h of abx therapy
Facial portwine stain
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
If aortic root reaches 45 mm

32. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

33. TB prophylaxis
Decreased UGT enzyme
Foreign body sensation - photophobia - corneal opacity tx abx
Benign permature thelarche; expectant management
INH 9m if INH resistant rifampin 6m in children and 4m in adults

34. the risk of lyme after bitten by a tick
Bladder dysfunction; UTI and renal dysfunctoin
1.5%
<2yrs - abd pain - diarrhoea - ARF
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

35. Parvovirus
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Croup tx cool mist; racemic epi - corticosteroid
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Fifth disease; febrile syndrome

36. complete airway obstruction with FB
>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
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

37. How to differential bact vs viral conjunctivitis
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
Risk of neurological dysfunction
Wait until 6 months
Increase of progesteron/17oh progesterone

38. Neonatal conjugated hyperbilirubinemia
Atypical lymphocyte
Less than 5th percentile
Yes; but it will be less effective
Biliary atresia; tx surgery

39. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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

40. starring spells 10-20sec
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Penicillin G 4h before delivery
Constitutional pubertal delay
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

41. impaired gag reflex
ALL - alzheimers autism adhd depression seizure
No intervention; 90% foreign bodies pass without difficulty
Thalassemia - congenital hemolytic anemia
Injury to b/l glossopharyngeal. present in botulism

42. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Biliary atresia; tx surgery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

43. language expectation from 2yo
refuse
Develops in 21 dasy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
No myoclonic activity in JME

44. mech of botulism
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
Female - breech delivery - family history; tx referral to ortho
>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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

45. cleft lip but no cleft palate
Rapid detection of RSV antigen in nasl
T for t ; thalassemia; inc serum iron and Iron binding
Brown
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

46. How to dx acute angle closure glaucoma
Benign permature thelarche; expectant management
Bladder dysfunction; UTI and renal dysfunctoin
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
1.5%

47. What is earliest sign of puberty?
Pho for forward bending; forward defect; common finding has no adverse physical effect
Erb paralysis leading to diaphragmatic paralysis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
No myoclonic activity in JME

48. deficinecy of 17 hydroxylase
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Pipercillin (zosyn) - ticarcillin
Increase of pregnenolone
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

49. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Do HIV testing at first
Candidal diapar rash; tx clotrimazol
Meconeum ileus; think about CF
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

50. contraindications of MMR vaccine
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
RSV - rhino and influenza