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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. horner syndrom
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Injury to lower roots of brachial plexus
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
D for d; down syndrome and polyhydramnios

2. Nocturnal enuresis
No myoclonic activity in JME
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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

3. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Decreased UGT enzyme
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

4. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Pho for forward bending; forward defect; common finding has no adverse physical effect

5. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
>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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

6. When to do surgery for undescended testes
Wait until 6 months
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
24-72 hours
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

7. How long patient needs to be exposed to tick to get infected
Wait until 6 months
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
36 hours

8. physiological jaundice
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
24h to 7d of birth
Rapid detection of RSV antigen in nasl

9. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
D for d; down syndrome and polyhydramnios
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

10. adrenal tumor
No reticulocyte vs high reticulocyte
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
No intervention; 90% foreign bodies pass without difficulty
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

11. indications of audiometry in childrens
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Meconeum ileus; think about CF
Less than 5th percentile

12. acute otitis externa

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13. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Develops in 21 dasy
No reticulocyte vs high reticulocyte
D for d; down syndrome and polyhydramnios

14. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Increase of progesteron/17oh progesterone

15. decreased mobility of tympanic membrane after otitis media
Congenital rubella syndrome
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
TB - breastfeeding - asymptomatic hiv

16. Tx of community acquired pneumonia
Lateral neck xray in epiglottitis show swollen epiglottis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Black
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

17. most common complication of otitis media
Fifth disease; febrile syndrome
HSP - look for symmetric skin lesions
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

18. How long anti-TB drugs given for TB meningitis?
Brown
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

19. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Multiple telangiectesia - vasular lesion in CNS
Brown

20. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
To make hip flexed and abducted position in DDH
D for d; down syndrome and polyhydramnios

21. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Meconeum ileus; think about CF

22. When to give HRT in turner
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Marfans - ehlers danlos - homocystinuria
14yrs
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

23. differentiate between central and peripheral precocious puberty
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

24. contraindications of DTap
24-72 hours
36 hours
Pipercillin (zosyn) - ticarcillin
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

25. pavlik harness
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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
To make hip flexed and abducted position in DDH

26. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Thalassemia - congenital hemolytic anemia
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Pho for forward bending; forward defect; common finding has no adverse physical effect
Methylephenidate toxicity; cannot be stopped abruptly; taper

27. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
URI
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Dx US tx; correct serum electrolyte - pyloromyotom
Croup

28. indications of VUR
Thalassemia - congenital hemolytic anemia
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
36 hours

29. How to dx keratitis?
Marfans - ehlers danlos - homocystinuria
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

30. Infant with serum billlirubin >25
Risk of neurological dysfunction
Injury to lower roots of brachial plexus
Atopic dermatitis; strong allergic/immunologic component; incr IgE
After 6m; breast mild provides iron until 6m.

31. contact lens keratitis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

32. pumonary TB
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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)
Brown
If aortic root reaches 45 mm

33. duodenal atresia
Increase of progesteron/17oh progesterone
D for d; down syndrome and polyhydramnios
Endocardial cushion defect (no separation between heart chambers)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

34. causes of FTT
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Decr calorie intake; decr calorie absorption;incr calorie demand
Decreases height - expensive; reserved for severe cases of delayed puberty
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

35. Tx of FTT
Diet modification to provide 110kc/kg/d
Lateral neck xray in epiglottitis show swollen epiglottis
Less than 5th percentile
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

36. difference between breast milk and breafeeding jaundice
refuse
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Atypical lymphocyte
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. difference between diaper dermatitis and rash
Atypical lymphocyte
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
Herpes
If aortic root reaches 45 mm

38. giardiasis
Pho for forward bending; forward defect; common finding has no adverse physical effect
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
Tx only symptomatic carrier
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

39. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Methylephenidate toxicity; cannot be stopped abruptly; taper
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
>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

40. deficinecy of 17 hydroxylase
Increase of pregnenolone
If aortic root reaches 45 mm
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Absence seizure; tx ethosuximide

41. doing worse in school - lack of attention - starring speel
Herpes
Absence seizure; tx ethosuximide
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

42. centor criteria for bact pharyngitis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

43. HUS
<2yrs - abd pain - diarrhoea - ARF
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

44. thumb sign
Croup tx cool mist; racemic epi - corticosteroid
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Congenital rubella syndrome
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

45. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
refuse
To make hip flexed and abducted position in DDH
Penicillin G 4h before delivery

46. microcytic - hypochromic anemia - hepatospelnomegaly
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Thalassemia - congenital hemolytic anemia
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Croup

47. non immune pregnant women exposed to rubella in first trimester
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Congenital rubella syndrome
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

48. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Biliary atresia; tx surgery
Wait until 6 months

49. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Biliary atresia; tx surgery
Congenital rubella syndrome

50. carditis and arthritis after rheumatic fever
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
After 24h of abx therapy
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Develops in 21 dasy