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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. major depression
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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)
To make hip flexed and abducted position in DDH
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

2. When to give HRT in turner
14yrs
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
>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

3. association with infantile pyloric stenosis
Croup tx cool mist; racemic epi - corticosteroid
Benign permature thelarche; expectant management
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

4. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Pho for forward bending; forward defect; common finding has no adverse physical effect
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
No wheezing - no feever in chlamydia

5. nuchal rigidity - fever - sore throat - headache - dioriented
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Injury to lower roots of brachial plexus
Female - breech delivery - family history; tx referral to ortho

6. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Prolactinoma
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

7. benefits of antibiotic therapy in acute pharyngitis?
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Constitutional pubertal delay
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

8. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Injury to lower roots of brachial plexus
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Do HIV testing at first

9. How to difference RSV and neonatal chlamydia
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)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
No wheezing - no feever in chlamydia
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

10. How to dx acute angle closure glaucoma
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Vaso-occlusive crisis; dx hb electrophoresis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

11. down syndrome with holocystolic mumur
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
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Endocardial cushion defect (no separation between heart chambers)
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

12. Tx of children constipation

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13. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No intervention; 90% foreign bodies pass without difficulty
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Erb paralysis leading to diaphragmatic paralysis

14. 12y - obese - hip pain - hip ext rotated
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Risk of neurological dysfunction
No intervention; 90% foreign bodies pass without difficulty

15. complication of lumbosacral meningocele
Rapid detection of RSV antigen in nasl
Strep pneumonie; moraxella; h influenze
Biliary atresia; tx surgery
Bladder dysfunction; UTI and renal dysfunctoin

16. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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
Medical emergency; dimercaprol/edta
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

17. Tx of bact conjunctivitis
Increase of progesteron/17oh progesterone
Erb paralysis leading to diaphragmatic paralysis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

18. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Biliary atresia; tx surgery
Methylephenidate toxicity; cannot be stopped abruptly; taper
Injury to lower roots of brachial plexus
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

19. pneumonia in CF patient
Decr calorie intake; decr calorie absorption;incr calorie demand
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Strep pneumonie; moraxella; h influenze

20. tuberous sclerosis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
No wheezing - no feever in chlamydia

21. pumonary TB
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)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Between pregnenolone and 17oh pregnenolone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

22. physiological jaundice
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
24h to 7d of birth
Croup
If aortic root reaches 45 mm

23. tzanck
Herpes
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Injury to lower roots of brachial plexus
Meconeum ileus; think about CF

24. iron supplement in child
Tx only symptomatic carrier
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
After 6m; breast mild provides iron until 6m.

25. cleft lip but no cleft palate
Faciform RBC cause vascular occlusion
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Less than 5th percentile

26. contraindications of MMR vaccine
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
After 24h of abx therapy
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

27. dx for turner
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No myoclonic activity in JME
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

28. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
To make hip flexed and abducted position in DDH
Constitutional pubertal delay
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

29. Nocturnal enuresis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
After 6m; breast mild provides iron until 6m.
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

30. starring spells 10-20sec
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
D for d; down syndrome and polyhydramnios
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

31. hypopigmented spots - family hx bilat deafness
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Neurofibromatosis type2
Central isosexual precocious puberty; hypothalmaic hamartoma
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

32. What is thumbprint sign
Endocardial cushion defect (no separation between heart chambers)
Lateral neck xray in epiglottitis show swollen epiglottis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
110 kcl/kg/day

33. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Less than 5th percentile
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
No intervention; 90% foreign bodies pass without difficulty

34. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
110 kcl/kg/day
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

35. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Decreases height - expensive; reserved for severe cases of delayed puberty
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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

36. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Less than 5th percentile
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

37. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Increase of progesteron/17oh progesterone

38. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
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
Strep pneumonie; moraxella; h influenze
Croup
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

39. Neonatal conjugated hyperbilirubinemia
No wheezing - no feever in chlamydia
Oral DMSA or EDTA IV
Biliary atresia; tx surgery
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

40. spitting up - vomiting at night - weight stable
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Meconeum ileus; think about CF
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Develops in 21 dasy

41. tick transmits RMSF
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
Black
Faciform RBC cause vascular occlusion
Injury to b/l glossopharyngeal. present in botulism

42. 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
Injury to b/l glossopharyngeal. present in botulism
Methylephenidate toxicity; cannot be stopped abruptly; taper
No; they are basic compound will be neutralized in an acidic environment of cellulitis

43. language expectation from 2yo
Endocardial cushion defect (no separation between heart chambers)
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Diet modification to provide 110kc/kg/d
Rapid detection of RSV antigen in nasl

44. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Rapid detection of RSV antigen in nasl
No myoclonic activity in JME
Decreases height - expensive; reserved for severe cases of delayed puberty

45. How long patient needs to be exposed to tick to get infected
Decreased UGT enzyme
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
TB - breastfeeding - asymptomatic hiv
36 hours

46. IM
Medical emergency; dimercaprol/edta
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Atypical lymphocyte
Faciform RBC cause vascular occlusion

47. causes of FTT
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
RSV - rhino and influenza
Diet modification to provide 110kc/kg/d

48. bromocriptine
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Prolactinoma
After 6m; breast mild provides iron until 6m.

49. HUS
Yes; but it will be less effective
<2yrs - abd pain - diarrhoea - ARF
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
No intervention; 90% foreign bodies pass without difficulty

50. How to differentiate caput succedanueum and cephalohematoma
Between pregnenolone and 17oh pregnenolone
refuse
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Injury to b/l glossopharyngeal. present in botulism