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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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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. down syndrome has inreased risk of developing
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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
ALL - alzheimers autism adhd depression seizure
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

2. tick transmits lyme
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Brown

3. 3yo - never able to walk
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
INH 9m if INH resistant rifampin 6m in children and 4m in adults
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
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

4. difference between structural disorder and flexible kyphosis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
After 6m; breast mild provides iron until 6m.
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

5. down syndrome with holocystolic mumur
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Endocardial cushion defect (no separation between heart chambers)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

6. cardiac manifestation of turner
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decr calorie intake; decr calorie absorption;incr calorie demand
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

7. mcCune albright`
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Decreased UGT enzyme
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

8. How to dx acute angle closure glaucoma
Benign permature thelarche; expectant management
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Erb paralysis leading to diaphragmatic paralysis

9. How to dx RSV
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Rapid detection of RSV antigen in nasl
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

10. splenic infarction in sickle cell
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
<2yrs - abd pain - diarrhoea - ARF
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Faciform RBC cause vascular occlusion

11. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
1.5%
Thalassemia - congenital hemolytic anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

12. Tx of FTT
Diet modification to provide 110kc/kg/d
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

13. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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)

14. lens dislocation
Marfans - ehlers danlos - homocystinuria
Absence seizure; tx ethosuximide
Methylephenidate toxicity; cannot be stopped abruptly; taper
Between pregnenolone and 17oh pregnenolone

15. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Croup tx cool mist; racemic epi - corticosteroid
Decreases height - expensive; reserved for severe cases of delayed puberty
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

16. what conditions are not contraindicated
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
TB - breastfeeding - asymptomatic hiv
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Imaging study to r/o VUR

17. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
36 hours
Pipercillin (zosyn) - ticarcillin
No myoclonic activity in JME
Atopic dermatitis; strong allergic/immunologic component; incr IgE

18. centor criteria for bact pharyngitis
Decreased UGT enzyme
Herpes
Constitutional pubertal delay
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

19. When erythema chronicum migrans develops after tick bite
Multiple telangiectesia - vasular lesion in CNS
Candidal diapar rash; tx clotrimazol
24h to 7d of birth
24-72 hours

20. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
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)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

21. contraindications of MMR vaccine
Thalassemia - congenital hemolytic anemia
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

22. How to difference RSV and neonatal chlamydia
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
No wheezing - no feever in chlamydia
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)
Endocardial cushion defect (no separation between heart chambers)

23. How long anti-TB drugs given for TB meningitis?
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No; they are basic compound will be neutralized in an acidic environment of cellulitis

24. if bone age lower than actual and puberty delayed
Black
Bartonella henselae; complication is suppuration of lymph node
Constitutional pubertal delay
110 kcl/kg/day

25. How to dx endopthalmitis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
URI
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Pipercillin (zosyn) - ticarcillin

26. osler rendu weber syndrom
Erb paralysis leading to diaphragmatic paralysis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Multiple telangiectesia - vasular lesion in CNS
Injury to lower roots of brachial plexus

27. defcicieny of 21 hydroxylase
Faciform RBC cause vascular occlusion
Between pregnenolone and 17oh pregnenolone
Increase of progesteron/17oh progesterone
After 24h of abx therapy

28. doing worse in school - lack of attention - starring speel
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Erb paralysis leading to diaphragmatic paralysis
Absence seizure; tx ethosuximide
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

29. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Imaging study to r/o VUR
If aortic root reaches 45 mm
Strep pneumonie; moraxella; h influenze

30. Febrile seizure
Imaging study to r/o VUR
Black
1.5%
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

31. Parents can _____ vaccine
Female - breech delivery - family history; tx referral to ortho
URI
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
refuse

32. 3yo - febrile - left hip externally rotated
1.5%
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

33. TTP pentad
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
URI
Dx US tx; correct serum electrolyte - pyloromyotom
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

34. the recommended ca supplementation
To make hip flexed and abducted position in DDH
Penicillin G 4h before delivery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Lateral neck xray in epiglottitis show swollen epiglottis

35. IM
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Female - breech delivery - family history; tx referral to ortho
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Atypical lymphocyte

36. duodenal atresia
To make hip flexed and abducted position in DDH
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
D for d; down syndrome and polyhydramnios
Oral DMSA or EDTA IV

37. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Develops in 21 dasy
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

38. pavlik harness
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
To make hip flexed and abducted position in DDH

39. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Do HIV testing at first
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
Increase of pregnenolone
After 24h of abx therapy

40. viruses cause bronhioltitis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
RSV - rhino and influenza

41. iron supplement in child
Risk of neurological dysfunction
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
1.5%
After 6m; breast mild provides iron until 6m.

42. horner syndrom
After 6m; breast mild provides iron until 6m.
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Neurofibromatosis type2
Injury to lower roots of brachial plexus

43. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
ALL - alzheimers autism adhd depression seizure
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)
Medical emergency; dimercaprol/edta

44. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
T for t ; thalassemia; inc serum iron and Iron binding
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

45. What is thumbprint sign
Foreign body sensation - photophobia - corneal opacity tx abx
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
Lateral neck xray in epiglottitis show swollen epiglottis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

46. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Less than 5th percentile
Meconeum ileus; think about CF
No reticulocyte vs high reticulocyte

47. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Croup tx cool mist; racemic epi - corticosteroid
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

48. nuchal rigidity - fever - sore throat - headache - dioriented
Croup tx cool mist; racemic epi - corticosteroid
If aortic root reaches 45 mm
<2yrs - abd pain - diarrhoea - ARF
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

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
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Central isosexual precocious puberty; hypothalmaic hamartoma

50. complete airway obstruction with FB
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
>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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

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USMLE Step3 Pediatrics

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