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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. lead 44-70
No; they are basic compound will be neutralized in an acidic environment of cellulitis
14yrs
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Oral DMSA or EDTA IV

2. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Black
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Dx US tx; correct serum electrolyte - pyloromyotom

3. How to dx keratitis?
Facial portwine stain
Penicillin G 4h before delivery
Foreign body sensation - photophobia - corneal opacity tx abx
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

4. contraindications of MMR vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
T for t ; thalassemia; inc serum iron and Iron binding
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

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

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6. 3yo - febrile - left hip externally rotated
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Endocardial cushion defect (no separation between heart chambers)
Vaso-occlusive crisis; dx hb electrophoresis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

7. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Biliary atresia; tx surgery
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)
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

8. pumonary TB
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
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)
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

9. adenovirus
Dactylitis; 2nd common is splenic seqestration
Less than 5th percentile
URI
T for t ; thalassemia; inc serum iron and Iron binding

10. 12y - obese - hip pain - hip ext rotated
Neurofibromatosis type2
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

11. What is the most common initial symptom in sickle cell
RSV - rhino and influenza
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Dactylitis; 2nd common is splenic seqestration
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

12. defcicieny of 21 hydroxylase
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Biliary atresia; tx surgery
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Increase of progesteron/17oh progesterone

13. language delay
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Bladder dysfunction; UTI and renal dysfunctoin
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Marfans - ehlers danlos - homocystinuria

14. when bact conjunctivitis patient can go back to school
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
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
After 24h of abx therapy
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

15. failure to thrive
Less than 5th percentile
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Croup
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

16. How to dx post uretheral valve
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
refuse
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Candidal diapar rash; tx clotrimazol

17. Infant with serum billlirubin >25
Between pregnenolone and 17oh pregnenolone
110 kcl/kg/day
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
Risk of neurological dysfunction

18. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Diet modification to provide 110kc/kg/d
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

19. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Decr calorie intake; decr calorie absorption;incr calorie demand
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

20. infantile hypertrophic pyloric stenosis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Do HIV testing at first
Dx US tx; correct serum electrolyte - pyloromyotom
14yrs

21. How to prevent GBS in neonate
Foreign body sensation - photophobia - corneal opacity tx abx
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Penicillin G 4h before delivery
Medical emergency; dimercaprol/edta

22. low grade fever - cough - diffuse bilat ground glass opacities
refuse
Methylephenidate toxicity; cannot be stopped abruptly; taper
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

23. dx for DDH
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
Congenital rubella syndrome
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

24. 21 hydroxylase
Constitutional pubertal delay
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
1.5%
Faciform RBC cause vascular occlusion

25. spitting up - vomiting at night - weight stable
Diet modification to provide 110kc/kg/d
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bartonella henselae; complication is suppuration of lymph node

26. sturge weber syndrome
>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
24-72 hours
Facial portwine stain
RSV - rhino and influenza

27. What is the definition of delayed puberty?
14yrs
TB - breastfeeding - asymptomatic hiv
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
T for t ; thalassemia; inc serum iron and Iron binding

28. tuberous sclerosis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

29. adrenal tumor
>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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

30. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
<2yrs - abd pain - diarrhoea - ARF
Dx US tx; correct serum electrolyte - pyloromyotom
Biliary atresia; tx surgery

31. cleft lip but no cleft palate
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Dx US tx; correct serum electrolyte - pyloromyotom

32. starring spells 10-20sec
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
24h to 7d of birth
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

33. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Croup tx cool mist; racemic epi - corticosteroid
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Erb paralysis leading to diaphragmatic paralysis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

34. the recommended ca supplementation
TB - breastfeeding - asymptomatic hiv
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Pipercillin (zosyn) - ticarcillin

35. Tx of botulism
Imaging study to r/o VUR
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Absence seizure; tx ethosuximide

36. difference between structural disorder and flexible kyphosis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Fifth disease; febrile syndrome

37. How to evaluate well appearing child just born in GBS pos mother?
HSP - look for symmetric skin lesions
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No reticulocyte vs high reticulocyte
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

38. How to dx endopthalmitis
After 24h of abx therapy
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Neurofibromatosis type2

39. down syndrome has inreased risk of developing
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
ALL - alzheimers autism adhd depression seizure
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
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

40. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Erb paralysis leading to diaphragmatic paralysis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
ALL - alzheimers autism adhd depression seizure

41. nuchal rigidity - fever - sore throat - headache - dioriented
Absence seizure; tx ethosuximide
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

42. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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
Benign permature thelarche; expectant management

43. horner syndrom
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Injury to lower roots of brachial plexus
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 with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

44. lens dislocation
Meconeum ileus; think about CF
Facial portwine stain
Marfans - ehlers danlos - homocystinuria
1.5%

45. sudden onset of fever - difficulty in breathing
Atypical lymphocyte
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Central isosexual precocious puberty; hypothalmaic hamartoma

46. Tx of bact conjunctivitis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Congenital rubella syndrome

47. microcytic - hypochromic anemia - hepatospelnomegaly
Biliary atresia; tx surgery
36 hours
D for d; down syndrome and polyhydramnios
Thalassemia - congenital hemolytic anemia

48. Neonatal unconjugated hyperbilirubine
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
Decreased UGT enzyme
Strep pneumonie; moraxella; h influenze
Tx only symptomatic carrier

49. tick transmits RMSF
Black
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

50. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
<2yrs - abd pain - diarrhoea - ARF
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Croup
Decresed visio - sudden onset - seeing halos around light - headache - eye pain