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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. cleft lip but no cleft palate
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Multiple telangiectesia - vasular lesion in CNS
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

2. complication of lumbosacral meningocele
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Bladder dysfunction; UTI and renal dysfunctoin
Lateral neck xray in epiglottitis show swollen epiglottis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

3. How to dx post uretheral valve
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
HSP - look for symmetric skin lesions
If aortic root reaches 45 mm
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

4. major depression
After 6m; breast mild provides iron until 6m.
Prolactinoma
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Dactylitis; 2nd common is splenic seqestration

5. giardiasis
ALL - alzheimers autism adhd depression seizure
Diet modification to provide 110kc/kg/d
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Tx only symptomatic carrier

6. can women with abnormal smear or genital get vaccine
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
Yes; but it will be less effective
36 hours
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

7. indications of audiometry in childrens
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
ALL - alzheimers autism adhd depression seizure
Wait until 6 months

8. causes of acute anemia
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Yes; but it will be less effective

9. 3yo - febrile - left hip externally rotated
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
RSV - rhino and influenza
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

10. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Pho for forward bending; forward defect; common finding has no adverse physical effect
Herpes
Meconeum ileus; think about CF

11. complete airway obstruction with FB
Multiple telangiectesia - vasular lesion in CNS
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
>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
Diet modification to provide 110kc/kg/d

12. When to do surgery for undescended testes
Wait until 6 months
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Candidal diapar rash; tx clotrimazol
Dx US tx; correct serum electrolyte - pyloromyotom

13. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Tx only symptomatic carrier

14. How to difference RSV and neonatal chlamydia
Female - breech delivery - family history; tx referral to ortho
Develops in 21 dasy
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
No wheezing - no feever in chlamydia

15. How to evaluate well appearing child just born in GBS pos mother?
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
<2yrs - abd pain - diarrhoea - ARF
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Tx only symptomatic carrier

16. acute abd pain - hx URI - lower extremity maculo papular rash
Pho for forward bending; forward defect; common finding has no adverse physical effect
Decreases height - expensive; reserved for severe cases of delayed puberty
Constitutional pubertal delay
HSP - look for symmetric skin lesions

17. congenital adrenal hyperplasi
No intervention; 90% foreign bodies pass without difficulty
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Strep pneumonie; moraxella; h influenze
Endocardial cushion defect (no separation between heart chambers)

18. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
TB - breastfeeding - asymptomatic hiv
HSP - look for symmetric skin lesions

19. starring spells 10-20sec
After 24h of abx therapy
No myoclonic activity in JME
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Medical emergency; dimercaprol/edta

20. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Pipercillin (zosyn) - ticarcillin
Yes; but it will be less effective
Croup
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

21. carditis and arthritis after rheumatic fever
Wait until 6 months
No reticulocyte vs high reticulocyte
Develops in 21 dasy
Bladder dysfunction; UTI and renal dysfunctoin

22. crying during urination. bacteriuria pyruria - rec episodes
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)
110 kcl/kg/day
Imaging study to r/o VUR
Do HIV testing at first

23. non immune pregnant women exposed to rubella in first trimester
Yes; but it will be less effective
Female - breech delivery - family history; tx referral to ortho
Increase of progesteron/17oh progesterone
Congenital rubella syndrome

24. kallman syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
TB - breastfeeding - asymptomatic hiv
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

25. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Bladder dysfunction; UTI and renal dysfunctoin

26. HUS
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Imaging study to r/o VUR
Croup tx cool mist; racemic epi - corticosteroid
<2yrs - abd pain - diarrhoea - ARF

27. lead 44-70
Penicillin G 4h before delivery
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Oral DMSA or EDTA IV
24h to 7d of birth

28. horner syndrom
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Foreign body sensation - photophobia - corneal opacity tx abx
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Injury to lower roots of brachial plexus

29. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Mainly clinical; serology with initial ELISA - with western blot confirmation;

30. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Croup tx cool mist; racemic epi - corticosteroid
Decreases height - expensive; reserved for severe cases of delayed puberty
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

31. sickle cell with symmetrical swelling of hands and feet
Black
Foreign body sensation - photophobia - corneal opacity tx abx
Vaso-occlusive crisis; dx hb electrophoresis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

32. How to dx keratitis?
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Multiple telangiectesia - vasular lesion in CNS
110 kcl/kg/day
Foreign body sensation - photophobia - corneal opacity tx abx

33. Infant with serum billlirubin >25
Increase of progesteron/17oh progesterone
Risk of neurological dysfunction
Erb paralysis leading to diaphragmatic paralysis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

34. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
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
Herpes
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No myoclonic activity in JME

35. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Pipercillin (zosyn) - ticarcillin
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Meconeum ileus; think about CF

36. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Central isosexual precocious puberty; hypothalmaic hamartoma

37. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Less than 5th percentile
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

38. infant botulism
Central isosexual precocious puberty; hypothalmaic hamartoma
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

39. Tx of FTT
After 24h of abx therapy
Imaging study to r/o VUR
36 hours
Diet modification to provide 110kc/kg/d

40. dx for DDH
36 hours
No wheezing - no feever in chlamydia
Female - breech delivery - family history; tx referral to ortho
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

41. red oozing rash on cheek - scaly - dry
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Tx only symptomatic carrier
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

42. low grade fever - cough - diffuse bilat ground glass opacities
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Bladder dysfunction; UTI and renal dysfunctoin
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

43. patient with white plaques in mouth and lump in back
Bartonella henselae; complication is suppuration of lymph node
Do HIV testing at first
Increase of progesteron/17oh progesterone
Faciform RBC cause vascular occlusion

44. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

45. adrenal tumor
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Lateral neck xray in epiglottitis show swollen epiglottis
No wheezing - no feever in chlamydia
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

46. How to prevent GBS in neonate
Injury to lower roots of brachial plexus
Penicillin G 4h before delivery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

47. lead >70
Medical emergency; dimercaprol/edta
Pho for forward bending; forward defect; common finding has no adverse physical effect
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
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

48. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Central isosexual precocious puberty; hypothalmaic hamartoma

49. What is the definition of delayed puberty?
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
URI
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

50. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Benign permature thelarche; expectant management