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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. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Vaso-occlusive crisis; dx hb electrophoresis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Oral DMSA or EDTA IV

2. sturge weber syndrome
Facial portwine stain
TB - breastfeeding - asymptomatic hiv
Yes; but it will be less effective
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

3. is local anesthetics be used in cellulitis to reduce pain
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Less than 5th percentile
Lateral neck xray in epiglottitis show swollen epiglottis
No; they are basic compound will be neutralized in an acidic environment of cellulitis

4. duodenal atresia
D for d; down syndrome and polyhydramnios
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
Develops in 21 dasy

5. language expectation from 2yo
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Strep pneumonie; moraxella; h influenze

6. can women with abnormal smear or genital get vaccine
Diet modification to provide 110kc/kg/d
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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

7. aplasic crisis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
RSV - rhino and influenza

8. How to differentiate caput succedanueum and cephalohematoma
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Pipercillin (zosyn) - ticarcillin
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Decr calorie intake; decr calorie absorption;incr calorie demand

9. When to bevioral and enviromental measure in led intoxication?
Between pregnenolone and 17oh pregnenolone
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No; they are basic compound will be neutralized in an acidic environment of cellulitis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

10. Infant with serum billlirubin >25
No myoclonic activity in JME
Risk of neurological dysfunction
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Do HIV testing at first

11. TTP pentad
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Injury to lower roots of brachial plexus
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

12. What is earliest sign of puberty?
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

13. 3yo - febrile - left hip externally rotated
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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)
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

14. How to dx acute angle closure glaucoma
Pipercillin (zosyn) - ticarcillin
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Brown
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

15. acute otitis media-pathogen
Brown
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Strep pneumonie; moraxella; h influenze
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

16. difference between rubeola (measles) and rulbella
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No intervention; 90% foreign bodies pass without difficulty

17. bromocriptine
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No reticulocyte vs high reticulocyte
Prolactinoma
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

18. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Croup
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Less than 5th percentile

19. what conditions are not contraindicated
110 kcl/kg/day
After 24h of abx therapy
TB - breastfeeding - asymptomatic hiv
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

20. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

21. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Injury to b/l glossopharyngeal. present in botulism
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Brown

22. How to dx keratitis?
Female - breech delivery - family history; tx referral to ortho
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to b/l glossopharyngeal. present in botulism
Black

23. tuberous sclerosis
1.5%
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
D for d; down syndrome and polyhydramnios
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

24. What is the calorie requirement of newborn?
Erb paralysis leading to diaphragmatic paralysis
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
110 kcl/kg/day
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

25. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Injury to b/l glossopharyngeal. present in botulism
Pho for forward bending; forward defect; common finding has no adverse physical effect
Bladder dysfunction; UTI and renal dysfunctoin

26. cat scratch disease
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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
Bartonella henselae; complication is suppuration of lymph node

27. IM
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
refuse
Atypical lymphocyte

28. dx for turner
ALL - alzheimers autism adhd depression seizure
T for t ; thalassemia; inc serum iron and Iron binding
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Decreased UGT enzyme

29. Parvovirus
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
36 hours
Fifth disease; febrile syndrome
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

30. lens dislocation
Marfans - ehlers danlos - homocystinuria
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Benign permature thelarche; expectant management
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

31. contraindications of DTap
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
110 kcl/kg/day
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

32. difference between structural disorder and flexible kyphosis
Atypical lymphocyte
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
RSV - rhino and influenza
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

33. When to give HRT in turner
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
14yrs
Black

34. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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
Lateral neck xray in epiglottitis show swollen epiglottis
Endocardial cushion defect (no separation between heart chambers)

35. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
After 6m; breast mild provides iron until 6m.
Prolactinoma

36. physiological jaundice
24h to 7d of birth
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

37. carditis and arthritis after rheumatic fever
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
110 kcl/kg/day
Develops in 21 dasy
Atypical lymphocyte

38. spitting up - vomiting at night - weight stable
Marfans - ehlers danlos - homocystinuria
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
If aortic root reaches 45 mm
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

39. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
D for d; down syndrome and polyhydramnios
URI
Meconeum ileus; think about CF
36 hours

40. adrenal tumor
24-72 hours
Methylephenidate toxicity; cannot be stopped abruptly; taper
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

41. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Tx only symptomatic carrier
Marfans - ehlers danlos - homocystinuria
Atopic dermatitis; strong allergic/immunologic component; incr IgE

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

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43. adenovirus
No intervention; 90% foreign bodies pass without difficulty
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
URI
Endocardial cushion defect (no separation between heart chambers)

44. target cell
RSV - rhino and influenza
Develops in 21 dasy
T for t ; thalassemia; inc serum iron and Iron binding
TB - breastfeeding - asymptomatic hiv

45. penicillin effective against pseudomonas
ALL - alzheimers autism adhd depression seizure
>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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Pipercillin (zosyn) - ticarcillin

46. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Medical emergency; dimercaprol/edta
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

47. Tx of FTT
Bartonella henselae; complication is suppuration of lymph node
110 kcl/kg/day
Diet modification to provide 110kc/kg/d
Rapid detection of RSV antigen in nasl

48. low grade fever - cough - diffuse bilat ground glass opacities
Dx US tx; correct serum electrolyte - pyloromyotom
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No intervention; 90% foreign bodies pass without difficulty
Medical emergency; dimercaprol/edta

49. viruses cause bronhioltitis
RSV - rhino and influenza
If aortic root reaches 45 mm
Multiple telangiectesia - vasular lesion in CNS
Female - breech delivery - family history; tx referral to ortho

50. acute otitis externa

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