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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. complete airway obstruction with FB
Imaging study to r/o VUR
Constitutional pubertal delay
Herpes
>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

2. TTP pentad
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
refuse
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

3. contact lens keratitis
Pho for forward bending; forward defect; common finding has no adverse physical effect
No myoclonic activity in JME
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

4. tuberous sclerosis
Dx US tx; correct serum electrolyte - pyloromyotom
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

5. patient with white plaques in mouth and lump in back
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Do HIV testing at first
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

6. deficinecy of 17 hydroxylase
T for t ; thalassemia; inc serum iron and Iron binding
Increase of pregnenolone
Medical emergency; dimercaprol/edta
Multiple telangiectesia - vasular lesion in CNS

7. crying during urination. bacteriuria pyruria - rec episodes
Increase of progesteron/17oh progesterone
RSV - rhino and influenza
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Imaging study to r/o VUR

8. major depression
Herpes
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Dactylitis; 2nd common is splenic seqestration
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

9. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Penicillin G 4h before delivery

10. lead >70
Medical emergency; dimercaprol/edta
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
36 hours
Less than 5th percentile

11. When to give hpv vaccien
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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Tx only symptomatic carrier
Biliary atresia; tx surgery

12. target cell
T for t ; thalassemia; inc serum iron and Iron binding
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
>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

13. How to differential bact vs viral conjunctivitis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Bladder dysfunction; UTI and renal dysfunctoin
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
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

14. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
T for t ; thalassemia; inc serum iron and Iron binding
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Endocardial cushion defect (no separation between heart chambers)

15. lens dislocation
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Meconeum ileus; think about CF
Marfans - ehlers danlos - homocystinuria

16. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
24-72 hours
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Brown

17. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
T for t ; thalassemia; inc serum iron and Iron binding
Yes; but it will be less effective
Dactylitis; 2nd common is splenic seqestration

18. How to difference viral and bact pneumonia
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Injury to b/l glossopharyngeal. present in botulism
No wheezing - no feever in chlamydia

19. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Erb paralysis leading to diaphragmatic paralysis
Faciform RBC cause vascular occlusion

20. association with infantile pyloric stenosis
Bartonella henselae; complication is suppuration of lymph node
Wait until 6 months
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

21. flexible kyphosis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Pho for forward bending; forward defect; common finding has no adverse physical effect
Croup
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

22. iron supplement in child
No; they are basic compound will be neutralized in an acidic environment of cellulitis
After 6m; breast mild provides iron until 6m.
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

23. benefits of antibiotic therapy in acute pharyngitis?
>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
Oral DMSA or EDTA IV
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

24. How to differentiate caput succedanueum and cephalohematoma
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

25. When to do aortic root surgery in marfans to prevent dissection?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
If aortic root reaches 45 mm
Tx only symptomatic carrier

26. giardiasis
refuse
Tx only symptomatic carrier
Bladder dysfunction; UTI and renal dysfunctoin
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

27. How to investigate delayed puberty
ALL - alzheimers autism adhd depression seizure
Facial portwine stain
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

28. dx of lyme
Biliary atresia; tx surgery
D for d; down syndrome and polyhydramnios
Mainly clinical; serology with initial ELISA - with western blot confirmation;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

29. Tx of children constipation

30. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Brown
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. horner syndrom
Female - breech delivery - family history; tx referral to ortho
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Injury to lower roots of brachial plexus
Between pregnenolone and 17oh pregnenolone

32. 12y - obese - hip pain - hip ext rotated
Atypical lymphocyte
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

33. 3yo - never able to walk
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
Risk of neurological dysfunction
1.5%
D for d; down syndrome and polyhydramnios

34. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

35. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Injury to lower roots of brachial plexus
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
>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

36. adrenal tumor
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

37. sickle cell with symmetrical swelling of hands and feet
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Vaso-occlusive crisis; dx hb electrophoresis
Do HIV testing at first
Dx US tx; correct serum electrolyte - pyloromyotom

38. low grade fever - cough - diffuse bilat ground glass opacities
Congenital rubella syndrome
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
After 6m; breast mild provides iron until 6m.
14yrs

39. What is earliest sign of puberty?
Decreases height - expensive; reserved for severe cases of delayed puberty
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Endocardial cushion defect (no separation between heart chambers)
Pipercillin (zosyn) - ticarcillin

40. When to give HRT in turner
14yrs
Absence seizure; tx ethosuximide
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
Central isosexual precocious puberty; hypothalmaic hamartoma

41. difference between breast milk and breafeeding jaundice
Brown
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

42. Neonatal unconjugated hyperbilirubine
Neurofibromatosis type2
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Decreased UGT enzyme
Foreign body sensation - photophobia - corneal opacity tx abx

43. cleft lip but no cleft palate
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
ALL - alzheimers autism adhd depression seizure
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

44. difference between diaper dermatitis and rash
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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Imaging study to r/o VUR

45. differentiate between central and peripheral precocious puberty
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Foreign body sensation - photophobia - corneal opacity tx abx

46. Neonatal conjugated hyperbilirubinemia
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
24h to 7d of birth
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Biliary atresia; tx surgery

47. How to differentiate croup vs epiglotitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

48. When to do surgery for undescended testes
1.5%
Wait until 6 months
Tx only symptomatic carrier
Biliary atresia; tx surgery

49. tzanck
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
>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
Herpes
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

50. causes of acute anemia
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Pipercillin (zosyn) - ticarcillin
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis