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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. difference between diaper dermatitis and rash
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Methylephenidate toxicity; cannot be stopped abruptly; taper
TB - breastfeeding - asymptomatic hiv
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

2. deficinecy of 17 hydroxylase
Rapid detection of RSV antigen in nasl
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Increase of pregnenolone

3. dx of lyme
Congenital rubella syndrome
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Methylephenidate toxicity; cannot be stopped abruptly; taper
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

4. adenovirus
Injury to b/l glossopharyngeal. present in botulism
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
URI

5. mech of botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
No myoclonic activity in JME
RSV - rhino and influenza

6. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Between pregnenolone and 17oh pregnenolone
Yes; but it will be less effective

7. side effect of testosteron therapy
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

8. contraindications of DTap
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Brown
Benign permature thelarche; expectant management

9. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Diet modification to provide 110kc/kg/d
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Lateral neck xray in epiglottitis show swollen epiglottis

10. most common complication of otitis media
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
If aortic root reaches 45 mm
Marfans - ehlers danlos - homocystinuria

11. How to dx acute angle closure glaucoma
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Neurofibromatosis type2
Decr calorie intake; decr calorie absorption;incr calorie demand
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

12. dx for turner
Decreases height - expensive; reserved for severe cases of delayed puberty
After 24h of abx therapy
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
14yrs

13. congenital adrenal hyperplasi
refuse
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

14. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Constitutional pubertal delay
D for d; down syndrome and polyhydramnios
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

15. When to do surgery for undescended testes
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Wait until 6 months
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

16. cleft lip but no cleft palate
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Decreases height - expensive; reserved for severe cases of delayed puberty
1.5%

17. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Candidal diapar rash; tx clotrimazol
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

18. patient with white plaques in mouth and lump in back
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
Do HIV testing at first
Develops in 21 dasy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

19. How to differentiate caput succedanueum and cephalohematoma
Dx US tx; correct serum electrolyte - pyloromyotom
110 kcl/kg/day
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

20. difference between breast milk and breafeeding jaundice
D for d; down syndrome and polyhydramnios
ALL - alzheimers autism adhd depression seizure
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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

21. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Medical emergency; dimercaprol/edta
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

22. tick transmits lyme
Dx US tx; correct serum electrolyte - pyloromyotom
14yrs
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Brown

23. IM
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
24h to 7d of birth
Atypical lymphocyte
Meconeum ileus; think about CF

24. impaired gag reflex
Multiple telangiectesia - vasular lesion in CNS
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Constitutional pubertal delay
Injury to b/l glossopharyngeal. present in botulism

25. How to differential bact vs viral conjunctivitis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Female - breech delivery - family history; tx referral to ortho

26. complete airway obstruction with FB
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
>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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Central isosexual precocious puberty; hypothalmaic hamartoma

27. 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
No intervention; 90% foreign bodies pass without difficulty
Brown
No myoclonic activity in JME

28. Febrile seizure
Erb paralysis leading to diaphragmatic paralysis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Wait until 6 months
Methylephenidate toxicity; cannot be stopped abruptly; taper

29. When erythema chronicum migrans develops after tick bite
Fifth disease; febrile syndrome
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
24-72 hours

30. Neonatal unconjugated hyperbilirubine
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Decreased UGT enzyme
Dx US tx; correct serum electrolyte - pyloromyotom
Yes; but it will be less effective

31. the risk of lyme after bitten by a tick
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
1.5%
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

32. viruses cause bronhioltitis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
RSV - rhino and influenza
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

33. if bone age lower than actual and puberty delayed
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
URI
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Constitutional pubertal delay

34. How to prevent GBS in neonate
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
After 6m; breast mild provides iron until 6m.
Penicillin G 4h before delivery

35. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Congenital rubella syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

36. dx for DDH
24-72 hours
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

37. echymoses with low platelet <30k
After 6m; breast mild provides iron until 6m.
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Faciform RBC cause vascular occlusion
RSV - rhino and influenza

38. What is the definition of delayed puberty?
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

39. is local anesthetics be used in cellulitis to reduce pain
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
TB - breastfeeding - asymptomatic hiv
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bladder dysfunction; UTI and renal dysfunctoin

40. What is the calorie requirement of newborn?
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
110 kcl/kg/day
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

41. When to bevioral and enviromental measure in led intoxication?
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Dactylitis; 2nd common is splenic seqestration
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
URI

42. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Endocardial cushion defect (no separation between heart chambers)
Facial portwine stain

43. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

44. tick transmits RMSF
36 hours
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Black
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

45. pavlik harness
Absence seizure; tx ethosuximide
To make hip flexed and abducted position in DDH
No myoclonic activity in JME
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

46. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Fifth disease; febrile syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

47. adrenal tumor
Brown
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Yes; but it will be less effective
Neurofibromatosis type2

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

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49. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Black
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

50. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Bartonella henselae; complication is suppuration of lymph node
No wheezing - no feever in chlamydia