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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 dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Decreased UGT enzyme
Multiple telangiectesia - vasular lesion in CNS

2. Parvovirus
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
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Fifth disease; febrile syndrome
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

3. echymoses with low platelet <30k
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

4. acute otitis externa

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5. How to prevent GBS in neonate
Multiple telangiectesia - vasular lesion in CNS
14yrs
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Penicillin G 4h before delivery

6. How to differentiate caput succedanueum and cephalohematoma
Wait until 6 months
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
URI

7. decreased mobility of tympanic membrane after otitis media
Bartonella henselae; complication is suppuration of lymph node
Pho for forward bending; forward defect; common finding has no adverse physical effect
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

8. difference between structural disorder and flexible kyphosis
Benign permature thelarche; expectant management
Between pregnenolone and 17oh pregnenolone
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
T for t ; thalassemia; inc serum iron and Iron binding

9. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Dactylitis; 2nd common is splenic seqestration

10. How to dx post uretheral valve
Risk of neurological dysfunction
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

11. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Congenital rubella syndrome
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

12. When to do aortic root surgery in marfans to prevent dissection?
Endocardial cushion defect (no separation between heart chambers)
Faciform RBC cause vascular occlusion
If aortic root reaches 45 mm
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

13. What is the most common initial symptom in sickle cell
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Dactylitis; 2nd common is splenic seqestration
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

14. pneumonia in CF patient
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

15. cat scratch disease
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Bartonella henselae; complication is suppuration of lymph node
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

16. infant botulism
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Endocardial cushion defect (no separation between heart chambers)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

17. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Do HIV testing at first
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
Wait until 6 months
No reticulocyte vs high reticulocyte

18. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
24h to 7d of birth
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Atopic dermatitis; strong allergic/immunologic component; incr IgE

19. Tx of community acquired pneumonia
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
14yrs

20. contraindications of MMR vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
After 24h of abx therapy
Constitutional pubertal delay

21. bromocriptine
Prolactinoma
1.5%
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

22. TB prophylaxis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Bladder dysfunction; UTI and renal dysfunctoin
Methylephenidate toxicity; cannot be stopped abruptly; taper
INH 9m if INH resistant rifampin 6m in children and 4m in adults

23. adenovirus
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
URI
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Risk of neurological dysfunction

24. How to differentiate croup vs epiglotitis
Black
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

25. Tx of bact conjunctivitis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Vaso-occlusive crisis; dx hb electrophoresis

26. can women with abnormal smear or genital get vaccine
Diet modification to provide 110kc/kg/d
Fifth disease; febrile syndrome
Less than 5th percentile
Yes; but it will be less effective

27. complete airway obstruction with FB
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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)
>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
Decreases height - expensive; reserved for severe cases of delayed puberty

28. adrenal tumor
No myoclonic activity in JME
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Oral DMSA or EDTA IV
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

29. mech of botulism
Yes; but it will be less effective
Penicillin G 4h before delivery
No intervention; 90% foreign bodies pass without difficulty
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

30. Neonatal conjugated hyperbilirubinemia
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Biliary atresia; tx surgery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

31. iron supplement in child
14yrs
>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
After 6m; breast mild provides iron until 6m.
Tx only symptomatic carrier

32. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
RSV - rhino and influenza
HSP - look for symmetric skin lesions

33. When to bevioral and enviromental measure in led intoxication?
No wheezing - no feever in chlamydia
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Endocardial cushion defect (no separation between heart chambers)
Diet modification to provide 110kc/kg/d

34. target cell
Erb paralysis leading to diaphragmatic paralysis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
T for t ; thalassemia; inc serum iron and Iron binding

35. How long anti-TB drugs given for TB meningitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Between pregnenolone and 17oh pregnenolone

36. splenic infarction in sickle cell
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Methylephenidate toxicity; cannot be stopped abruptly; taper
Faciform RBC cause vascular occlusion

37. defcicieny of 21 hydroxylase
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Increase of progesteron/17oh progesterone
Pho for forward bending; forward defect; common finding has no adverse physical effect

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

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39. difference between rubeola (measles) and rulbella
Between pregnenolone and 17oh pregnenolone
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

40. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Benign permature thelarche; expectant management
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Croup tx cool mist; racemic epi - corticosteroid

41. osler rendu weber syndrom
Biliary atresia; tx surgery
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Multiple telangiectesia - vasular lesion in CNS
Increase of pregnenolone

42. sturge weber syndrome
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Neurofibromatosis type2
Facial portwine stain

43. horner syndrom
>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
After 24h of abx therapy
Injury to lower roots of brachial plexus
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

44. 12y - obese - hip pain - hip ext rotated
Foreign body sensation - photophobia - corneal opacity tx abx
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Methylephenidate toxicity; cannot be stopped abruptly; taper
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

45. lens dislocation
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Risk of neurological dysfunction
Marfans - ehlers danlos - homocystinuria
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

46. HUS
Croup
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
<2yrs - abd pain - diarrhoea - ARF
Penicillin G 4h before delivery

47. tick transmits lyme
Strep pneumonie; moraxella; h influenze
Endocardial cushion defect (no separation between heart chambers)
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
Brown

48. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

49. How to difference viral and bact pneumonia
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Dx US tx; correct serum electrolyte - pyloromyotom

50. if bone age lower than actual and puberty delayed
24-72 hours
refuse
After 24h of abx therapy
Constitutional pubertal delay