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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. iron supplement in child
After 6m; breast mild provides iron until 6m.
36 hours
Develops in 21 dasy
Absence seizure; tx ethosuximide

2. red oozing rash on cheek - scaly - dry
36 hours
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Neurofibromatosis type2

3. When to do surgery for undescended testes
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Brown
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Wait until 6 months

4. dx of lyme
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Faciform RBC cause vascular occlusion
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

5. What is the definition of delayed puberty?
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

6. Tx of children constipation

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7. Tx of FTT
Diet modification to provide 110kc/kg/d
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Thalassemia - congenital hemolytic anemia
Do HIV testing at first

8. failure to thrive
Multiple telangiectesia - vasular lesion in CNS
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Diet modification to provide 110kc/kg/d
Less than 5th percentile

9. acute otitis externa

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10. doing worse in school - lack of attention - starring speel
Medical emergency; dimercaprol/edta
URI
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
Absence seizure; tx ethosuximide

11. splenic infarction in sickle cell
refuse
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)
Faciform RBC cause vascular occlusion
Tx only symptomatic carrier

12. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Develops in 21 dasy
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

13. causes of FTT
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Decr calorie intake; decr calorie absorption;incr calorie demand
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

14. tzanck
Herpes
Dactylitis; 2nd common is splenic seqestration
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Croup tx cool mist; racemic epi - corticosteroid

15. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Vaso-occlusive crisis; dx hb electrophoresis
Diet modification to provide 110kc/kg/d

16. lens dislocation
URI
Marfans - ehlers danlos - homocystinuria
Endocardial cushion defect (no separation between heart chambers)
Injury to lower roots of brachial plexus

17. language expectation from 2yo
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
After 6m; breast mild provides iron until 6m.
Vaso-occlusive crisis; dx hb electrophoresis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

18. tick transmits lyme
Vaso-occlusive crisis; dx hb electrophoresis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Brown
INH 9m if INH resistant rifampin 6m in children and 4m in adults

19. bromocriptine
If aortic root reaches 45 mm
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Prolactinoma
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

20. IM
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Atypical lymphocyte
TB - breastfeeding - asymptomatic hiv

21. physiological jaundice
Congenital rubella syndrome
Wait until 6 months
24h to 7d of birth
After 6m; breast mild provides iron until 6m.

22. contact lens keratitis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Decr calorie intake; decr calorie absorption;incr calorie demand
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

23. When to give hpv vaccien
Penicillin G 4h before delivery
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
Faciform RBC cause vascular occlusion
Yes; but it will be less effective

24. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
<2yrs - abd pain - diarrhoea - ARF
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
TB - breastfeeding - asymptomatic hiv
Candidal diapar rash; tx clotrimazol

25. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Between pregnenolone and 17oh pregnenolone
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Absence seizure; tx ethosuximide

26. What is the calorie requirement of newborn?
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
After 24h of abx therapy
110 kcl/kg/day
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

27. acute otitis media-pathogen
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Absence seizure; tx ethosuximide
Croup
Strep pneumonie; moraxella; h influenze

28. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Atypical lymphocyte
Methylephenidate toxicity; cannot be stopped abruptly; taper
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

29. Parents can _____ vaccine
refuse
Absence seizure; tx ethosuximide
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

30. benefits of antibiotic therapy in acute pharyngitis?
<2yrs - abd pain - diarrhoea - ARF
To make hip flexed and abducted position in DDH
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

31. TTP pentad
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

32. sudden onset of fever - difficulty in breathing
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

33. pavlik harness
To make hip flexed and abducted position in DDH
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

34. 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
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Meconeum ileus; think about CF
<2yrs - abd pain - diarrhoea - ARF

35. Neonatal conjugated hyperbilirubinemia
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Croup tx cool mist; racemic epi - corticosteroid
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Biliary atresia; tx surgery

36. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Croup
Constitutional pubertal delay
No reticulocyte vs high reticulocyte
Faciform RBC cause vascular occlusion

37. How to investigate delayed puberty
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Yes; but it will be less effective

38. patient with white plaques in mouth and lump in back
Do HIV testing at first
Multiple telangiectesia - vasular lesion in CNS
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

39. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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)
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Atypical lymphocyte

40. viruses cause bronhioltitis
Rapid detection of RSV antigen in nasl
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
RSV - rhino and influenza
Injury to lower roots of brachial plexus

41. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
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
T for t ; thalassemia; inc serum iron and Iron binding

42. spitting up - vomiting at night - weight stable
Absence seizure; tx ethosuximide
Endocardial cushion defect (no separation between heart chambers)
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

43. What are the risk factors of developmental dysplais of hip
>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
Female - breech delivery - family history; tx referral to ortho
Decreased UGT enzyme
Less than 5th percentile

44. low grade fever - cough - diffuse bilat ground glass opacities
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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

45. sublottic narrowing
Black
Develops in 21 dasy
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)
Croup tx cool mist; racemic epi - corticosteroid

46. down syndrome with holocystolic mumur
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Endocardial cushion defect (no separation between heart chambers)
T for t ; thalassemia; inc serum iron and Iron binding
Absence seizure; tx ethosuximide

47. Infant with serum billlirubin >25
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Oral DMSA or EDTA IV
Risk of neurological dysfunction

48. flexible kyphosis
Prolactinoma
Marfans - ehlers danlos - homocystinuria
Fifth disease; febrile syndrome
Pho for forward bending; forward defect; common finding has no adverse physical effect

49. How to dx keratitis?
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Foreign body sensation - photophobia - corneal opacity tx abx
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
Less than 5th percentile

50. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Neurofibromatosis type2
Rapid detection of RSV antigen in nasl
110 kcl/kg/day