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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. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

2. tuberous sclerosis
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

3. When to give hpv vaccien
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

4. Nocturnal enuresis
Brown
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Pipercillin (zosyn) - ticarcillin

5. lead 44-70
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Oral DMSA or EDTA IV
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

6. cleft lip but no cleft palate
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

7. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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

8. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Croup

9. thumb sign
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Multiple telangiectesia - vasular lesion in CNS
After 24h of abx therapy
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

10. nuchal rigidity - fever - sore throat - headache - dioriented
Injury to lower roots of brachial plexus
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Multiple telangiectesia - vasular lesion in CNS
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

11. adrenal tumor
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
No reticulocyte vs high reticulocyte

12. Infant with serum billlirubin >25
Between pregnenolone and 17oh pregnenolone
Croup tx cool mist; racemic epi - corticosteroid
Risk of neurological dysfunction
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

13. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Dactylitis; 2nd common is splenic seqestration
Croup
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

14. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
No intervention; 90% foreign bodies pass without difficulty
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

15. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Absence seizure; tx ethosuximide
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

16. pumonary TB
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)
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

17. cardiac manifestation of turner
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
24h to 7d of birth
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

18. acute otitis externa

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19. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Marfans - ehlers danlos - homocystinuria
TB - breastfeeding - asymptomatic hiv
14yrs

20. 17 alpha hydroxylase
TB - breastfeeding - asymptomatic hiv
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Between pregnenolone and 17oh pregnenolone
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

21. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
D for d; down syndrome and polyhydramnios
Croup
Herpes
Wait until 6 months

22. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Decreases height - expensive; reserved for severe cases of delayed puberty
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

23. dx of lyme
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Multiple telangiectesia - vasular lesion in CNS
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Mainly clinical; serology with initial ELISA - with western blot confirmation;

24. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
RSV - rhino and influenza
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

25. lens dislocation
refuse
Decr calorie intake; decr calorie absorption;incr calorie demand
Marfans - ehlers danlos - homocystinuria
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

26. When to do surgery for undescended testes
Wait until 6 months
Female - breech delivery - family history; tx referral to ortho
Atypical lymphocyte
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

27. How to difference viral and bact pneumonia
TB - breastfeeding - asymptomatic hiv
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Vaso-occlusive crisis; dx hb electrophoresis

28. infantile hypertrophic pyloric stenosis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Dx US tx; correct serum electrolyte - pyloromyotom
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

29. 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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Benign permature thelarche; expectant management

30. Tx of bact conjunctivitis
Prolactinoma
Imaging study to r/o VUR
ALL - alzheimers autism adhd depression seizure
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

31. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Multiple telangiectesia - vasular lesion in CNS
Thalassemia - congenital hemolytic anemia

32. centor criteria for bact pharyngitis
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
No intervention; 90% foreign bodies pass without difficulty
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Central isosexual precocious puberty; hypothalmaic hamartoma

33. TB prophylaxis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
INH 9m if INH resistant rifampin 6m in children and 4m in adults
24-72 hours

34. When to do aortic root surgery in marfans to prevent dissection?
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Bartonella henselae; complication is suppuration of lymph node
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
If aortic root reaches 45 mm

35. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
After 6m; breast mild provides iron until 6m.

36. How to difference RSV and neonatal chlamydia
Oral DMSA or EDTA IV
Multiple telangiectesia - vasular lesion in CNS
No wheezing - no feever in chlamydia
Pho for forward bending; forward defect; common finding has no adverse physical effect

37. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
No wheezing - no feever in chlamydia
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

38. When erythema chronicum migrans develops after tick bite
No reticulocyte vs high reticulocyte
24-72 hours
ALL - alzheimers autism adhd depression seizure
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

39. sudden onset of fever - difficulty in breathing
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

40. mcCune albright`
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
T for t ; thalassemia; inc serum iron and Iron binding
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

41. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
Tx only symptomatic carrier
Atypical lymphocyte
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

42. physiological jaundice
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Injury to lower roots of brachial plexus
URI
24h to 7d of birth

43. is local anesthetics be used in cellulitis to reduce pain
Prolactinoma
Biliary atresia; tx surgery
No; they are basic compound will be neutralized in an acidic environment of cellulitis
14yrs

44. complication of lumbosacral meningocele
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Bladder dysfunction; UTI and renal dysfunctoin
No intervention; 90% foreign bodies pass without difficulty
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

45. IM
Atypical lymphocyte
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Thalassemia - congenital hemolytic anemia
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

46. flexible kyphosis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Brown
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Pho for forward bending; forward defect; common finding has no adverse physical effect

47. how thalassemia die
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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Wait until 6 months
Lateral neck xray in epiglottitis show swollen epiglottis

48. Tx of children constipation

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49. language expectation from 2yo
Bartonella henselae; complication is suppuration of lymph node
ALL - alzheimers autism adhd depression seizure
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Develops in 21 dasy

50. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
No; they are basic compound will be neutralized in an acidic environment of cellulitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery