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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. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

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

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3. 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)
Croup tx cool mist; racemic epi - corticosteroid
Medical emergency; dimercaprol/edta
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

4. target cell
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
T for t ; thalassemia; inc serum iron and Iron binding
Foreign body sensation - photophobia - corneal opacity tx abx
Herpes

5. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
After 6m; breast mild provides iron until 6m.
Erb paralysis leading to diaphragmatic paralysis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

6. tick transmits RMSF
Black
RSV - rhino and influenza
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

7. most common complication of otitis media
Biliary atresia; tx surgery
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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

8. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Black
Meconeum ileus; think about CF
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

9. pavlik harness
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
110 kcl/kg/day
To make hip flexed and abducted position in DDH
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

10. non immune pregnant women exposed to rubella in first trimester
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Congenital rubella syndrome

11. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
TB - breastfeeding - asymptomatic hiv
Imaging study to r/o VUR
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

12. doing worse in school - lack of attention - starring speel
T for t ; thalassemia; inc serum iron and Iron binding
Absence seizure; tx ethosuximide
Yes; but it will be less effective
URI

13. How to dx keratitis?
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Foreign body sensation - photophobia - corneal opacity tx abx
ALL - alzheimers autism adhd depression seizure

14. coin in child's stomach
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
No intervention; 90% foreign bodies pass without difficulty
14yrs
Rapid detection of RSV antigen in nasl

15. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Croup
URI
If aortic root reaches 45 mm

16. complete airway obstruction with FB
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
>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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Facial portwine stain

17. deficinecy of 17 hydroxylase
Prolactinoma
TB - breastfeeding - asymptomatic hiv
Increase of pregnenolone
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

18. lead >70
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Diet modification to provide 110kc/kg/d
Medical emergency; dimercaprol/edta

19. How to dx post uretheral valve
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Congenital rubella syndrome
<2yrs - abd pain - diarrhoea - ARF

20. side effect of testosteron therapy
Medical emergency; dimercaprol/edta
T for t ; thalassemia; inc serum iron and Iron binding
Decreases height - expensive; reserved for severe cases of delayed puberty
Multiple telangiectesia - vasular lesion in CNS

21. Nocturnal enuresis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
RSV - rhino and influenza
URI
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

22. IM
Atypical lymphocyte
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
To make hip flexed and abducted position in DDH

23. decreased mobility of tympanic membrane after otitis media
URI
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
If aortic root reaches 45 mm
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

24. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Bartonella henselae; complication is suppuration of lymph node
Facial portwine stain
Diet modification to provide 110kc/kg/d

25. TTP pentad
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Foreign body sensation - photophobia - corneal opacity tx abx
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

26. cardiac manifestation of turner
To make hip flexed and abducted position in DDH
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decr calorie intake; decr calorie absorption;incr calorie demand

27. acute abd pain - hx URI - lower extremity maculo papular rash
Bladder dysfunction; UTI and renal dysfunctoin
HSP - look for symmetric skin lesions
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

28. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
refuse
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Biliary atresia; tx surgery

29. How to dx endopthalmitis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

30. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
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
Vaso-occlusive crisis; dx hb electrophoresis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

31. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Pipercillin (zosyn) - ticarcillin
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

32. viruses cause bronhioltitis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Lateral neck xray in epiglottitis show swollen epiglottis
Less than 5th percentile
RSV - rhino and influenza

33. 21 hydroxylase
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Endocardial cushion defect (no separation between heart chambers)

34. duodenal atresia
Absence seizure; tx ethosuximide
Decreased UGT enzyme
D for d; down syndrome and polyhydramnios
24h to 7d of birth

35. Tx of bact conjunctivitis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Wait until 6 months
TB - breastfeeding - asymptomatic hiv
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

36. difference between diaper dermatitis and rash
Brown
Increase of pregnenolone
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
Vaso-occlusive crisis; dx hb electrophoresis

37. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
If aortic root reaches 45 mm
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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

38. How to dx acute angle closure glaucoma
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

39. lead 44-70
Foreign body sensation - photophobia - corneal opacity tx abx
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
D for d; down syndrome and polyhydramnios
Oral DMSA or EDTA IV

40. adenovirus
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Fifth disease; febrile syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
URI

41. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Tx only symptomatic carrier
URI
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

42. splenic infarction in sickle cell
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)
Dactylitis; 2nd common is splenic seqestration
Faciform RBC cause vascular occlusion
Black

43. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

44. When to give HRT in turner
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
14yrs
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Injury to b/l glossopharyngeal. present in botulism

45. HUS
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No myoclonic activity in JME
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<2yrs - abd pain - diarrhoea - ARF

46. dx of lyme
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Mainly clinical; serology with initial ELISA - with western blot confirmation;
36 hours

47. When erythema chronicum migrans develops after tick bite
T for t ; thalassemia; inc serum iron and Iron binding
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Meconeum ileus; think about CF
24-72 hours

48. iron supplement in child
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
After 6m; breast mild provides iron until 6m.
<2yrs - abd pain - diarrhoea - ARF
Decr calorie intake; decr calorie absorption;incr calorie demand

49. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Benign permature thelarche; expectant management
<2yrs - abd pain - diarrhoea - ARF

50. mcCune albright`
Injury to lower roots of brachial plexus
No myoclonic activity in JME
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts