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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. When to do aortic root surgery in marfans to prevent dissection?
Brown
Atypical lymphocyte
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
If aortic root reaches 45 mm

2. dx for turner
Vaso-occlusive crisis; dx hb electrophoresis
Oral DMSA or EDTA IV
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

3. How to dx post uretheral valve
Decr calorie intake; decr calorie absorption;incr calorie demand
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
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)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

4. How to differentiate caput succedanueum and cephalohematoma
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Female - breech delivery - family history; tx referral to ortho
Atypical lymphocyte

5. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Marfans - ehlers danlos - homocystinuria
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Fifth disease; febrile syndrome

6. How long patient needs to be exposed to tick to get infected
Medical emergency; dimercaprol/edta
36 hours
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
110 kcl/kg/day

7. sturge weber syndrome
Facial portwine stain
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Fifth disease; febrile syndrome

8. 21 hydroxylase
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
RSV - rhino and influenza
Biliary atresia; tx surgery

9. dx for DDH
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
RSV - rhino and influenza
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

10. non immune pregnant women exposed to rubella in first trimester
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Penicillin G 4h before delivery
Congenital rubella syndrome
Do HIV testing at first

11. Tx of children constipation

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12. How to dx keratitis?
Methylephenidate toxicity; cannot be stopped abruptly; taper
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)
Foreign body sensation - photophobia - corneal opacity tx abx
Lateral neck xray in epiglottitis show swollen epiglottis

13. lens dislocation
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Marfans - ehlers danlos - homocystinuria
Decreased UGT enzyme

14. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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
Biliary atresia; tx surgery

15. lead 44-70
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Develops in 21 dasy
Oral DMSA or EDTA IV
Congenital rubella syndrome

16. doing worse in school - lack of attention - starring speel
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Absence seizure; tx ethosuximide

17. Febrile seizure
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
D for d; down syndrome and polyhydramnios

18. Nocturnal enuresis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
RSV - rhino and influenza
Biliary atresia; tx surgery

19. What is the calorie requirement of newborn?
HSP - look for symmetric skin lesions
110 kcl/kg/day
24-72 hours
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

20. failure to thrive
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
T for t ; thalassemia; inc serum iron and Iron binding
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Less than 5th percentile

21. echymoses with low platelet <30k
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

22. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erb paralysis leading to diaphragmatic paralysis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

23. complication of lumbosacral meningocele
14yrs
Bladder dysfunction; UTI and renal dysfunctoin
Decreases height - expensive; reserved for severe cases of delayed puberty
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

24. thumb sign
<2yrs - abd pain - diarrhoea - ARF
>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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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

25. 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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
To make hip flexed and abducted position in DDH
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

26. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Meconeum ileus; think about CF

27. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
<2yrs - abd pain - diarrhoea - ARF
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

28. cardiac manifestation of turner
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Less than 5th percentile
Lateral neck xray in epiglottitis show swollen epiglottis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

29. How to dx RSV
Rapid detection of RSV antigen in nasl
If aortic root reaches 45 mm
Penicillin G 4h before delivery
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

30. association with infantile pyloric stenosis
After 24h of abx therapy
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Dactylitis; 2nd common is splenic seqestration

31. impaired gag reflex
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Absence seizure; tx ethosuximide
Injury to b/l glossopharyngeal. present in botulism
After 24h of abx therapy

32. What is thumbprint sign
Decreased UGT enzyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Lateral neck xray in epiglottitis show swollen epiglottis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

33. centor criteria for bact pharyngitis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
ALL - alzheimers autism adhd depression seizure
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
To make hip flexed and abducted position in DDH

34. benefits of antibiotic therapy in acute pharyngitis?
Absence seizure; tx ethosuximide
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
36 hours
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

35. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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
Dx US tx; correct serum electrolyte - pyloromyotom
Oral DMSA or EDTA IV

36. Tx of FTT
Diet modification to provide 110kc/kg/d
Black
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
Decr calorie intake; decr calorie absorption;incr calorie demand

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

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38. is local anesthetics be used in cellulitis to reduce pain
Dactylitis; 2nd common is splenic seqestration
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Imaging study to r/o VUR

39. viruses cause bronhioltitis
Dactylitis; 2nd common is splenic seqestration
TB - breastfeeding - asymptomatic hiv
RSV - rhino and influenza
Marfans - ehlers danlos - homocystinuria

40. language delay
Congenital rubella syndrome
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Erb paralysis leading to diaphragmatic paralysis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

41. bromocriptine
Prolactinoma
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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

42. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Decreases height - expensive; reserved for severe cases of delayed puberty
Do HIV testing at first
No myoclonic activity in JME
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

43. HUS
<2yrs - abd pain - diarrhoea - ARF
Lateral neck xray in epiglottitis show swollen epiglottis
No reticulocyte vs high reticulocyte
Pipercillin (zosyn) - ticarcillin

44. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

45. indications of VUR
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
14yrs
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

46. causes of FTT
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Decr calorie intake; decr calorie absorption;incr calorie demand
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

47. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Female - breech delivery - family history; tx referral to ortho
Congenital rubella syndrome
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
Thalassemia - congenital hemolytic anemia

48. What are the risk factors of developmental dysplais of hip
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Female - breech delivery - family history; tx referral to ortho
Between pregnenolone and 17oh pregnenolone

49. how smoking contributes otitis media in children
110 kcl/kg/day
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
After 24h of abx therapy
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

50. cat scratch disease
Tx only symptomatic carrier
Bartonella henselae; complication is suppuration of lymph node
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Brown