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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. deficinecy of 17 hydroxylase
Imaging study to r/o VUR
Croup
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Increase of pregnenolone

2. lens dislocation
Herpes
No reticulocyte vs high reticulocyte
No intervention; 90% foreign bodies pass without difficulty
Marfans - ehlers danlos - homocystinuria

3. dx for DDH
Do HIV testing at first
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Dx US tx; correct serum electrolyte - pyloromyotom
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

4. tick transmits RMSF
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Black
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Benign permature thelarche; expectant management

5. How to evaluate well appearing child just born in GBS pos mother?
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
24-72 hours
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

6. difference between diaper dermatitis and rash
Facial portwine stain
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

7. adenovirus
Croup
14yrs
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
URI

8. cleft lip but no cleft palate
36 hours
Endocardial cushion defect (no separation between heart chambers)
Decreases height - expensive; reserved for severe cases of delayed puberty
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

9. How to investigate delayed puberty
Vaso-occlusive crisis; dx hb electrophoresis
RSV - rhino and influenza
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

10. How to dx RSV
Croup
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Rapid detection of RSV antigen in nasl
After 6m; breast mild provides iron until 6m.

11. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
ALL - alzheimers autism adhd depression seizure

12. Tx of FTT
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Diet modification to provide 110kc/kg/d
Female - breech delivery - family history; tx referral to ortho

13. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Dx US tx; correct serum electrolyte - pyloromyotom
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Candidal diapar rash; tx clotrimazol
Herpes

14. starring spells 10-20sec
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Female - breech delivery - family history; tx referral to ortho
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

15. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
24h to 7d of birth
Injury to b/l glossopharyngeal. present in botulism

16. carditis and arthritis after rheumatic fever
Decreases height - expensive; reserved for severe cases of delayed puberty
Develops in 21 dasy
Tx only symptomatic carrier
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

17. Parvovirus
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Bladder dysfunction; UTI and renal dysfunctoin
Female - breech delivery - family history; tx referral to ortho
Fifth disease; febrile syndrome

18. What are the risk factors of developmental dysplais of hip
Neurofibromatosis type2
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Female - breech delivery - family history; tx referral to ortho
Penicillin G 4h before delivery

19. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Lateral neck xray in epiglottitis show swollen epiglottis
Penicillin G 4h before delivery

20. failure to thrive
Less than 5th percentile
110 kcl/kg/day
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
14yrs

21. major depression
Benign permature thelarche; expectant management
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

22. centor criteria for bact pharyngitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Imaging study to r/o VUR
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

23. When to give HRT in turner
Yes; but it will be less effective
RSV - rhino and influenza
14yrs
Wait until 6 months

24. iron supplement in child
Croup
After 6m; breast mild provides iron until 6m.
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Injury to lower roots of brachial plexus

25. contraindications of DTap
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erb paralysis leading to diaphragmatic paralysis

26. How to prevent GBS in neonate
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Penicillin G 4h before delivery
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

27. target cell
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
T for t ; thalassemia; inc serum iron and Iron binding
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

28. how smoking contributes otitis media in children
Diet modification to provide 110kc/kg/d
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Medical emergency; dimercaprol/edta

29. When to do aortic root surgery in marfans to prevent dissection?
1.5%
If aortic root reaches 45 mm
110 kcl/kg/day
After 6m; breast mild provides iron until 6m.

30. coin in child's stomach
Rapid detection of RSV antigen in nasl
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
No intervention; 90% foreign bodies pass without difficulty
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

31. 3yo - never able to walk
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Constitutional pubertal delay
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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

32. patient with white plaques in mouth and lump in back
Thalassemia - congenital hemolytic anemia
Methylephenidate toxicity; cannot be stopped abruptly; taper
Do HIV testing at first
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

33. flexible kyphosis
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
Brown
Bladder dysfunction; UTI and renal dysfunctoin
Pho for forward bending; forward defect; common finding has no adverse physical effect

34. indications of audiometry in childrens
Candidal diapar rash; tx clotrimazol
Increase of pregnenolone
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Meconeum ileus; think about CF

35. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Dx US tx; correct serum electrolyte - pyloromyotom
Facial portwine stain
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

36. sudden onset of fever - difficulty in breathing
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Risk of neurological dysfunction

37. contact lens keratitis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

38. difference between breast milk and breafeeding jaundice
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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
Develops in 21 dasy

39. 18mo bilat breast enlargment - some pubic hair
T for t ; thalassemia; inc serum iron and Iron binding
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Benign permature thelarche; expectant management
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

40. viruses cause bronhioltitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
RSV - rhino and influenza

41. How to dx acute angle closure glaucoma
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
HSP - look for symmetric skin lesions

42. When erythema chronicum migrans develops after tick bite
24-72 hours
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Decr calorie intake; decr calorie absorption;incr calorie demand
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

43. spitting up - vomiting at night - weight stable
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

44. TTP pentad
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
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

45. aplasic crisis
HSP - look for symmetric skin lesions
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
14yrs

46. What is thumbprint sign
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Increase of pregnenolone
Lateral neck xray in epiglottitis show swollen epiglottis

47. low grade fever - cough - diffuse bilat ground glass opacities
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
After 6m; breast mild provides iron until 6m.
Erb paralysis leading to diaphragmatic paralysis

48. when bact conjunctivitis patient can go back to school
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
1.5%
After 24h of abx therapy

49. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
Oral DMSA or EDTA IV

50. nuchal rigidity - fever - sore throat - headache - dioriented
Oral DMSA or EDTA IV
After 6m; breast mild provides iron until 6m.
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Dactylitis; 2nd common is splenic seqestration