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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. How to differential bact vs viral conjunctivitis
Injury to lower roots of brachial plexus
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
Meconeum ileus; think about CF
Less than 5th percentile

2. 21 hydroxylase
Develops in 21 dasy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

3. acute abd pain - hx URI - lower extremity maculo papular rash
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
HSP - look for symmetric skin lesions
Pipercillin (zosyn) - ticarcillin
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

4. pavlik harness
Foreign body sensation - photophobia - corneal opacity tx abx
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Constitutional pubertal delay
To make hip flexed and abducted position in DDH

5. Parents can _____ vaccine
Herpes
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
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
refuse

6. When erythema chronicum migrans develops after tick bite
24-72 hours
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

7. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Decreases height - expensive; reserved for severe cases of delayed puberty
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

8. thumb sign
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
RSV - rhino and influenza
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

9. Tx of bact conjunctivitis
Atypical lymphocyte
Wait until 6 months
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

10. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Risk of neurological dysfunction
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

11. How long patient needs to be exposed to tick to get infected
Central isosexual precocious puberty; hypothalmaic hamartoma
To make hip flexed and abducted position in DDH
36 hours
Do HIV testing at first

12. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Bartonella henselae; complication is suppuration of lymph node
Wait until 6 months

13. when bact conjunctivitis patient can go back to school
Lateral neck xray in epiglottitis show swollen epiglottis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
After 24h of abx therapy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

14. bromocriptine
To make hip flexed and abducted position in DDH
Prolactinoma
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

15. physiological jaundice
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
24h to 7d of birth
No reticulocyte vs high reticulocyte

16. acute otitis externa

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17. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Benign permature thelarche; expectant management
24-72 hours
Methylephenidate toxicity; cannot be stopped abruptly; taper

18. sudden onset of fever - difficulty in breathing
URI
Vaso-occlusive crisis; dx hb electrophoresis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

19. Febrile seizure
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Injury to lower roots of brachial plexus
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

20. low grade fever - cough - diffuse bilat ground glass opacities
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Central isosexual precocious puberty; hypothalmaic hamartoma

21. dx for turner
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Vaso-occlusive crisis; dx hb electrophoresis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

22. congenital adrenal hyperplasi
After 24h of abx therapy
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Atopic dermatitis; strong allergic/immunologic component; incr IgE

23. what conditions are not contraindicated
Pipercillin (zosyn) - ticarcillin
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
TB - breastfeeding - asymptomatic hiv
No; they are basic compound will be neutralized in an acidic environment of cellulitis

24. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Yes; but it will be less effective
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)

25. microcytic - hypochromic anemia - hepatospelnomegaly
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Thalassemia - congenital hemolytic anemia
Bladder dysfunction; UTI and renal dysfunctoin
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

26. difference between structural disorder and flexible kyphosis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Facial portwine stain
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

27. cat scratch disease
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
24h to 7d of birth
Bartonella henselae; complication is suppuration of lymph node
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

28. carditis and arthritis after rheumatic fever
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Develops in 21 dasy
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
ALL - alzheimers autism adhd depression seizure

29. When to give HRT in turner
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
14yrs
No reticulocyte vs high reticulocyte

30. patient with white plaques in mouth and lump in back
Do HIV testing at first
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
24h to 7d of birth
No; they are basic compound will be neutralized in an acidic environment of cellulitis

31. language delay
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Thalassemia - congenital hemolytic anemia
>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

32. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
To make hip flexed and abducted position in DDH

33. crying during urination. bacteriuria pyruria - rec episodes
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
Imaging study to r/o VUR
T for t ; thalassemia; inc serum iron and Iron binding
After 24h of abx therapy

34. pneumonia in CF patient
If aortic root reaches 45 mm
Imaging study to r/o VUR
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Risk of neurological dysfunction

35. dx of lyme
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Mainly clinical; serology with initial ELISA - with western blot confirmation;

36. How to dx post uretheral valve
To make hip flexed and abducted position in DDH
If aortic root reaches 45 mm
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

37. tuberous sclerosis
1.5%
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Less than 5th percentile
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

38. tzanck
Develops in 21 dasy
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Herpes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

39. deficinecy of 17 hydroxylase
Decreases height - expensive; reserved for severe cases of delayed puberty
Methylephenidate toxicity; cannot be stopped abruptly; taper
Increase of pregnenolone
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

40. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
If aortic root reaches 45 mm

41. failure to thrive
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Less than 5th percentile
Marfans - ehlers danlos - homocystinuria
Multiple telangiectesia - vasular lesion in CNS

42. red oozing rash on cheek - scaly - dry
Thalassemia - congenital hemolytic anemia
Atopic dermatitis; strong allergic/immunologic component; incr IgE
RSV - rhino and influenza
24h to 7d of birth

43. sturge weber syndrome
Rapid detection of RSV antigen in nasl
Facial portwine stain
Thalassemia - congenital hemolytic anemia
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

44. aplasic crisis
HSP - look for symmetric skin lesions
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Croup

45. how thalassemia die
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Neurofibromatosis type2
Marfans - ehlers danlos - homocystinuria
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

46. Neonatal conjugated hyperbilirubinemia
Croup
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Biliary atresia; tx surgery
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

47. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Decreases height - expensive; reserved for severe cases of delayed puberty
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
If aortic root reaches 45 mm
Meconeum ileus; think about CF

48. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
HSP - look for symmetric skin lesions

49. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Methylephenidate toxicity; cannot be stopped abruptly; taper
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
No reticulocyte vs high reticulocyte
Mainly clinical; serology with initial ELISA - with western blot confirmation;

50. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Fifth disease; febrile syndrome
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults