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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. the risk of lyme after bitten by a tick
Mainly clinical; serology with initial ELISA - with western blot confirmation;
<2yrs - abd pain - diarrhoea - ARF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
1.5%

2. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Diet modification to provide 110kc/kg/d
RSV - rhino and influenza

3. Tx of children constipation

4. hypopigmented spots - family hx bilat deafness
Yes; but it will be less effective
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Less than 5th percentile
Neurofibromatosis type2

5. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Facial portwine stain
Croup tx cool mist; racemic epi - corticosteroid
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

6. sturge weber syndrome
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Facial portwine stain
Candidal diapar rash; tx clotrimazol
Between pregnenolone and 17oh pregnenolone

7. causes of FTT
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Decr calorie intake; decr calorie absorption;incr calorie demand
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Tx only symptomatic carrier

8. if bone age lower than actual and puberty delayed
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Constitutional pubertal delay

9. Neonatal unconjugated hyperbilirubine
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Wait until 6 months
Decreased UGT enzyme

10. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
T for t ; thalassemia; inc serum iron and Iron binding
14yrs
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

11. lens dislocation
36 hours
Marfans - ehlers danlos - homocystinuria
Herpes
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

12. mcCune albright`
<2yrs - abd pain - diarrhoea - ARF
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

13. differentiate between central and peripheral precocious puberty
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Increase of progesteron/17oh progesterone
Absence seizure; tx ethosuximide

14. IM
Yes; but it will be less effective
Atypical lymphocyte
No myoclonic activity in JME
Faciform RBC cause vascular occlusion

15. physiological jaundice
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
D for d; down syndrome and polyhydramnios
24h to 7d of birth
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

16. How to dx keratitis?
Medical emergency; dimercaprol/edta
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Foreign body sensation - photophobia - corneal opacity tx abx

17. What is the calorie requirement of newborn?
Bartonella henselae; complication is suppuration of lymph node
110 kcl/kg/day
After 24h of abx therapy
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

18. target cell
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
T for t ; thalassemia; inc serum iron and Iron binding
Congenital rubella syndrome

19. aplasic crisis
Neurofibromatosis type2
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Facial portwine stain

20. cardiac manifestation of turner
To make hip flexed and abducted position in DDH
<2yrs - abd pain - diarrhoea - ARF
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Croup tx cool mist; racemic epi - corticosteroid

21. crying during urination. bacteriuria pyruria - rec episodes
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Imaging study to r/o VUR
Biliary atresia; tx surgery

22. side effect of testosteron therapy
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Decreases height - expensive; reserved for severe cases of delayed puberty
refuse

23. 21 hydroxylase
ALL - alzheimers autism adhd depression seizure
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Methylephenidate toxicity; cannot be stopped abruptly; taper
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

24. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
To make hip flexed and abducted position in DDH
Penicillin G 4h before delivery

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

26. When to give HRT in turner
After 6m; breast mild provides iron until 6m.
ALL - alzheimers autism adhd depression seizure
14yrs
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

27. infant botulism
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
>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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

28. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Dx US tx; correct serum electrolyte - pyloromyotom
No reticulocyte vs high reticulocyte

29. lead >70
Multiple telangiectesia - vasular lesion in CNS
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Medical emergency; dimercaprol/edta

30. Parents can _____ vaccine
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
refuse
Do HIV testing at first
Congenital rubella syndrome

31. pneumonia in CF patient
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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. How to difference viral and bact pneumonia
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Atypical lymphocyte
refuse
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

33. low grade fever - cough - diffuse bilat ground glass opacities
Female - breech delivery - family history; tx referral to ortho
To make hip flexed and abducted position in DDH
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

34. sudden onset of fever - difficulty in breathing
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Wait until 6 months
D for d; down syndrome and polyhydramnios

35. the recommended ca supplementation
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
URI
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

36. complication of lumbosacral meningocele
Candidal diapar rash; tx clotrimazol
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Bladder dysfunction; UTI and renal dysfunctoin
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

37. tzanck
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Injury to lower roots of brachial plexus
RSV - rhino and influenza
Herpes

38. adrenal tumor
Do HIV testing at first
Black
Thalassemia - congenital hemolytic anemia
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

39. How to differentiate caput succedanueum and cephalohematoma
T for t ; thalassemia; inc serum iron and Iron binding
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
RSV - rhino and influenza
Imaging study to r/o VUR

40. major depression
Female - breech delivery - family history; tx referral to ortho
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
ALL - alzheimers autism adhd depression seizure

41. contraindications of MMR vaccine
refuse
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

42. Nocturnal enuresis
Decr calorie intake; decr calorie absorption;incr calorie demand
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
RSV - rhino and influenza
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

43. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
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
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

44. bromocriptine
Injury to b/l glossopharyngeal. present in botulism
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Prolactinoma
No wheezing - no feever in chlamydia

45. Tx of botulism
Bladder dysfunction; UTI and renal dysfunctoin
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No wheezing - no feever in chlamydia
Absence seizure; tx ethosuximide

46. when bact conjunctivitis patient can go back to school
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Between pregnenolone and 17oh pregnenolone
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
After 24h of abx therapy

47. adenovirus
To make hip flexed and abducted position in DDH
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
URI
Biliary atresia; tx surgery

48. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
110 kcl/kg/day
Vaso-occlusive crisis; dx hb electrophoresis

49. What is earliest sign of puberty?
Herpes
Faciform RBC cause vascular occlusion
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Decr calorie intake; decr calorie absorption;incr calorie demand

50. difference between structural disorder and flexible kyphosis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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