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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. language delay
Benign permature thelarche; expectant management
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

2. 12y - obese - hip pain - hip ext rotated
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Fifth disease; febrile syndrome
To make hip flexed and abducted position in DDH
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

3. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Erb paralysis leading to diaphragmatic paralysis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
TB - breastfeeding - asymptomatic hiv

4. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

5. How to differentiate croup vs epiglotitis
Herpes
Injury to lower roots of brachial plexus
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

6. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
No myoclonic activity in JME
Medical emergency; dimercaprol/edta
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

7. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
T for t ; thalassemia; inc serum iron and Iron binding
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
D for d; down syndrome and polyhydramnios

8. if bone age lower than actual and puberty delayed
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Constitutional pubertal delay
Foreign body sensation - photophobia - corneal opacity tx abx

9. Tx of botulism
Risk of neurological dysfunction
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

10. dx of lyme
Female - breech delivery - family history; tx referral to ortho
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Mainly clinical; serology with initial ELISA - with western blot confirmation;

11. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

12. Febrile seizure
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Central isosexual precocious puberty; hypothalmaic hamartoma
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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

13. complication of lumbosacral meningocele
Meconeum ileus; think about CF
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Bladder dysfunction; UTI and renal dysfunctoin
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

14. lens dislocation
Marfans - ehlers danlos - homocystinuria
<2yrs - abd pain - diarrhoea - ARF
ALL - alzheimers autism adhd depression seizure
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

15. How to evaluate well appearing child just born in GBS pos mother?
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Vaso-occlusive crisis; dx hb electrophoresis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

16. Nocturnal enuresis
T for t ; thalassemia; inc serum iron and Iron binding
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Facial portwine stain

17. difference between diaper dermatitis and rash
Pipercillin (zosyn) - ticarcillin
Methylephenidate toxicity; cannot be stopped abruptly; taper
Congenital rubella syndrome
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

18. congenital adrenal hyperplasi
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No myoclonic activity in JME
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Pho for forward bending; forward defect; common finding has no adverse physical effect

19. most common complication of otitis media
Pho for forward bending; forward defect; common finding has no adverse physical effect
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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

20. When erythema chronicum migrans develops after tick bite
To make hip flexed and abducted position in DDH
Pho for forward bending; forward defect; common finding has no adverse physical effect
After 24h of abx therapy
24-72 hours

21. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
24-72 hours
14yrs

22. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
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
Female - breech delivery - family history; tx referral to ortho

23. dx for DDH
Marfans - ehlers danlos - homocystinuria
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Congenital rubella syndrome
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

24. 21 hydroxylase
Dx US tx; correct serum electrolyte - pyloromyotom
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Imaging study to r/o VUR
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

25. contraindications of MMR vaccine
24h to 7d of birth
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

26. causes of FTT
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

27. sublottic narrowing
Biliary atresia; tx surgery
Female - breech delivery - family history; tx referral to ortho
Croup tx cool mist; racemic epi - corticosteroid
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

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

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29. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Increase of progesteron/17oh progesterone
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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. how thalassemia die
Risk of neurological dysfunction
Endocardial cushion defect (no separation between heart chambers)
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decreases height - expensive; reserved for severe cases of delayed puberty

31. What are the risk factors of developmental dysplais of hip
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Biliary atresia; tx surgery
Female - breech delivery - family history; tx referral to ortho
Marfans - ehlers danlos - homocystinuria

32. osler rendu weber syndrom
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Multiple telangiectesia - vasular lesion in CNS
If aortic root reaches 45 mm

33. splenic infarction in sickle cell
Decreased UGT enzyme
Strep pneumonie; moraxella; h influenze
Faciform RBC cause vascular occlusion
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

34. major depression
Pipercillin (zosyn) - ticarcillin
Biliary atresia; tx surgery
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

35. How to difference RSV and neonatal chlamydia
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Croup
No wheezing - no feever in chlamydia

36. Tx of FTT
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Diet modification to provide 110kc/kg/d
1.5%
Multiple telangiectesia - vasular lesion in CNS

37. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Erb paralysis leading to diaphragmatic paralysis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Oral DMSA or EDTA IV

38. TTP pentad
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
If aortic root reaches 45 mm
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Wait until 6 months

39. centor criteria for bact pharyngitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Injury to b/l glossopharyngeal. present in botulism
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

40. kallman syndrome
Benign permature thelarche; expectant management
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

41. acute abd pain - hx URI - lower extremity maculo papular rash
Biliary atresia; tx surgery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
HSP - look for symmetric skin lesions
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

42. down syndrome has inreased risk of developing
Imaging study to r/o VUR
ALL - alzheimers autism adhd depression seizure
Foreign body sensation - photophobia - corneal opacity tx abx
Rapid detection of RSV antigen in nasl

43. non immune pregnant women exposed to rubella in first trimester
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Congenital rubella syndrome
Rapid detection of RSV antigen in nasl
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

44. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

45. acute otitis externa

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46. How to prevent GBS in neonate
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
Penicillin G 4h before delivery
Multiple telangiectesia - vasular lesion in CNS
Less than 5th percentile

47. How long patient needs to be exposed to tick to get infected
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
INH 9m if INH resistant rifampin 6m in children and 4m in adults
36 hours

48. What is thumbprint sign
Central isosexual precocious puberty; hypothalmaic hamartoma
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
Lateral neck xray in epiglottitis show swollen epiglottis
Develops in 21 dasy

49. tick transmits lyme
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Brown
Develops in 21 dasy
Tx only symptomatic carrier

50. 3yo - never able to walk
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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
Prolactinoma