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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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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. side effect of testosteron therapy
No reticulocyte vs high reticulocyte
Decreases height - expensive; reserved for severe cases of delayed puberty
RSV - rhino and influenza
After 6m; breast mild provides iron until 6m.

2. complication of lumbosacral meningocele
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Bladder dysfunction; UTI and renal dysfunctoin
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

3. tick transmits lyme
Croup tx cool mist; racemic epi - corticosteroid
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Brown
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

4. osler rendu weber syndrom
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Multiple telangiectesia - vasular lesion in CNS
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Absence seizure; tx ethosuximide

5. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Penicillin G 4h before delivery

6. deficinecy of 17 hydroxylase
14yrs
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Increase of pregnenolone
>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

7. contact lens keratitis
Faciform RBC cause vascular occlusion
Medical emergency; dimercaprol/edta
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
36 hours

8. Tx of FTT
Diet modification to provide 110kc/kg/d
Vaso-occlusive crisis; dx hb electrophoresis
Oral DMSA or EDTA IV
No myoclonic activity in JME

9. infantile hypertrophic pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Lateral neck xray in epiglottitis show swollen epiglottis
Between pregnenolone and 17oh pregnenolone
Dx US tx; correct serum electrolyte - pyloromyotom

10. How to differentiate croup vs epiglotitis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
ALL - alzheimers autism adhd depression seizure

11. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Oral DMSA or EDTA IV
24-72 hours
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

12. 18mo bilat breast enlargment - some pubic hair
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Between pregnenolone and 17oh pregnenolone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Benign permature thelarche; expectant management

13. dx for DDH
No myoclonic activity in JME
Decreased UGT enzyme
Absence seizure; tx ethosuximide
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

14. Tx of botulism
Penicillin G 4h before delivery
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Strep pneumonie; moraxella; h influenze
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

15. pneumonia in CF patient
After 6m; breast mild provides iron until 6m.
Pipercillin (zosyn) - ticarcillin
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
refuse

16. Tx of children constipation

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17. association with infantile pyloric stenosis
24-72 hours
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

18. sturge weber syndrome
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Facial portwine stain
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Decreased UGT enzyme

19. HUS
<2yrs - abd pain - diarrhoea - ARF
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Injury to lower roots of brachial plexus
Endocardial cushion defect (no separation between heart chambers)

20. acute otitis media-pathogen
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Strep pneumonie; moraxella; h influenze
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

21. Nocturnal enuresis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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

22. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Tx only symptomatic carrier
Increase of progesteron/17oh progesterone
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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

23. benefits of antibiotic therapy in acute pharyngitis?
Less than 5th percentile
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

24. How to dx RSV
HSP - look for symmetric skin lesions
Rapid detection of RSV antigen in nasl
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Dx US tx; correct serum electrolyte - pyloromyotom

25. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

26. sublottic narrowing
Brown
Croup tx cool mist; racemic epi - corticosteroid
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
14yrs

27. tick transmits RMSF
Black
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Do HIV testing at first
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

28. IM
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Atypical lymphocyte
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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

29. How to investigate delayed puberty
Faciform RBC cause vascular occlusion
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

30. sickle cell with symmetrical swelling of hands and feet
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Wait until 6 months
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Vaso-occlusive crisis; dx hb electrophoresis

31. iron supplement in child
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
After 6m; breast mild provides iron until 6m.
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

32. viruses cause bronhioltitis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Injury to b/l glossopharyngeal. present in botulism
RSV - rhino and influenza
14yrs

33. indications of audiometry in childrens
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Benign permature thelarche; expectant management
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
After 24h of abx therapy

34. 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
Between pregnenolone and 17oh pregnenolone
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Imaging study to r/o VUR

35. complete airway obstruction with FB
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
>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
Croup tx cool mist; racemic epi - corticosteroid

36. Parents can _____ vaccine
If aortic root reaches 45 mm
refuse
TB - breastfeeding - asymptomatic hiv
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

37. pavlik harness
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
To make hip flexed and abducted position in DDH
Dactylitis; 2nd common is splenic seqestration
Pipercillin (zosyn) - ticarcillin

38. low grade fever - cough - diffuse bilat ground glass opacities
Female - breech delivery - family history; tx referral to ortho
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Wait until 6 months
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

39. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Multiple telangiectesia - vasular lesion in CNS
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
After 6m; breast mild provides iron until 6m.

40. When to give HRT in turner
Central isosexual precocious puberty; hypothalmaic hamartoma
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
14yrs
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

41. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Do HIV testing at first
Croup
Oral DMSA or EDTA IV

42. How to evaluate well appearing child just born in GBS pos mother?
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Increase of progesteron/17oh progesterone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Develops in 21 dasy

43. can women with abnormal smear or genital get vaccine
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Atypical lymphocyte
No intervention; 90% foreign bodies pass without difficulty
Yes; but it will be less effective

44. microcytic - hypochromic anemia - hepatospelnomegaly
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Female - breech delivery - family history; tx referral to ortho
Thalassemia - congenital hemolytic anemia
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

45. difference between structural disorder and flexible kyphosis
No myoclonic activity in JME
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

46. failure to thrive
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Injury to lower roots of brachial plexus
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Less than 5th percentile

47. What is the definition of delayed puberty?
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

48. lead 44-70
Neurofibromatosis type2
Croup
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Oral DMSA or EDTA IV

49. TB prophylaxis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

50. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response