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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. patient with white plaques in mouth and lump in back
Facial portwine stain
Do HIV testing at first
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

2. When to give HRT in turner
24h to 7d of birth
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Facial portwine stain
14yrs

3. When erythema chronicum migrans develops after tick bite
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
24-72 hours
Methylephenidate toxicity; cannot be stopped abruptly; taper
Medical emergency; dimercaprol/edta

4. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Tx only symptomatic carrier
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Erb paralysis leading to diaphragmatic paralysis
Black

5. dx of lyme
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Bartonella henselae; complication is suppuration of lymph node
Mainly clinical; serology with initial ELISA - with western blot confirmation;

6. indications of VUR
Oral DMSA or EDTA IV
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

7. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Oral DMSA or EDTA IV
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Medical emergency; dimercaprol/edta

8. When to do aortic root surgery in marfans to prevent dissection?
After 6m; breast mild provides iron until 6m.
Pho for forward bending; forward defect; common finding has no adverse physical effect
If aortic root reaches 45 mm
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

9. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Tx only symptomatic carrier
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

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

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11. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Foreign body sensation - photophobia - corneal opacity tx abx
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Bladder dysfunction; UTI and renal dysfunctoin

12. difference between structural disorder and flexible kyphosis
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Pipercillin (zosyn) - ticarcillin

13. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
14yrs
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
Yes; but it will be less effective
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

14. the recommended ca supplementation
Meconeum ileus; think about CF
Faciform RBC cause vascular occlusion
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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

15. red oozing rash on cheek - scaly - dry
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Faciform RBC cause vascular occlusion
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Atopic dermatitis; strong allergic/immunologic component; incr IgE

16. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
After 24h of abx therapy
Erb paralysis leading to diaphragmatic paralysis
Oral DMSA or EDTA IV

17. thumb sign
Develops in 21 dasy
ALL - alzheimers autism adhd depression seizure
Bladder dysfunction; UTI and renal dysfunctoin
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

18. tick transmits RMSF
Increase of progesteron/17oh progesterone
RSV - rhino and influenza
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Black

19. tick transmits lyme
Do HIV testing at first
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Brown
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

20. decreased mobility of tympanic membrane after otitis media
After 24h of abx therapy
ALL - alzheimers autism adhd depression seizure
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

21. How to dx acute angle closure glaucoma
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
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
>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
Atypical lymphocyte

22. How to prevent GBS in neonate
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)
Penicillin G 4h before delivery
24h to 7d of birth
24-72 hours

23. dx for turner
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Decr calorie intake; decr calorie absorption;incr calorie demand
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

24. failure to thrive
Facial portwine stain
Less than 5th percentile
Increase of progesteron/17oh progesterone
Between pregnenolone and 17oh pregnenolone

25. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
After 24h of abx therapy
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

26. Parents can _____ vaccine
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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
refuse

27. indications of audiometry in childrens
Female - breech delivery - family history; tx referral to ortho
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Diet modification to provide 110kc/kg/d
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

28. How to evaluate well appearing child just born in GBS pos mother?
RSV - rhino and influenza
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Bladder dysfunction; UTI and renal dysfunctoin
Less than 5th percentile

29. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
HSP - look for symmetric skin lesions
<2yrs - abd pain - diarrhoea - ARF
Decreases height - expensive; reserved for severe cases of delayed puberty

30. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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

31. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Erb paralysis leading to diaphragmatic paralysis
Medical emergency; dimercaprol/edta
36 hours
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

32. cleft lip but no cleft palate
Oral DMSA or EDTA IV
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
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

33. pumonary TB
ALL - alzheimers autism adhd depression seizure
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)
After 24h of abx therapy
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

34. pneumonia in CF patient
Faciform RBC cause vascular occlusion
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)
Marfans - ehlers danlos - homocystinuria

35. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
RSV - rhino and influenza
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Central isosexual precocious puberty; hypothalmaic hamartoma
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

36. Tx of FTT
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Constitutional pubertal delay
Faciform RBC cause vascular occlusion
Diet modification to provide 110kc/kg/d

37. TTP pentad
Meconeum ileus; think about CF
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Endocardial cushion defect (no separation between heart chambers)
Herpes

38. How to dx keratitis?
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Oral DMSA or EDTA IV
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Foreign body sensation - photophobia - corneal opacity tx abx

39. giardiasis
Tx only symptomatic carrier
Black
24h to 7d of birth
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

40. crying during urination. bacteriuria pyruria - rec episodes
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
After 24h of abx therapy
Oral DMSA or EDTA IV
Imaging study to r/o VUR

41. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Dactylitis; 2nd common is splenic seqestration
Injury to b/l glossopharyngeal. present in botulism
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

42. How long anti-TB drugs given for TB meningitis?
Vaso-occlusive crisis; dx hb electrophoresis
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Herpes
After 24h of abx therapy

43. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
No reticulocyte vs high reticulocyte

44. language delay
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
To make hip flexed and abducted position in DDH

45. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

46. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

47. benefits of antibiotic therapy in acute pharyngitis?
No intervention; 90% foreign bodies pass without difficulty
TB - breastfeeding - asymptomatic hiv
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

48. 18mo bilat breast enlargment - some pubic hair
HSP - look for symmetric skin lesions
Brown
Benign permature thelarche; expectant management
No reticulocyte vs high reticulocyte

49. horner syndrom
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
14yrs
Decreased UGT enzyme
Injury to lower roots of brachial plexus

50. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Rapid detection of RSV antigen in nasl
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene