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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. microcytic - hypochromic anemia - hepatospelnomegaly
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Thalassemia - congenital hemolytic anemia
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

2. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Erb paralysis leading to diaphragmatic paralysis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

3. defcicieny of 21 hydroxylase
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Facial portwine stain
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Increase of progesteron/17oh progesterone

4. tick transmits lyme
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Brown
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

5. is local anesthetics be used in cellulitis to reduce pain
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
No; they are basic compound will be neutralized in an acidic environment of cellulitis

6. cat scratch disease
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
Between pregnenolone and 17oh pregnenolone
Risk of neurological dysfunction
Bartonella henselae; complication is suppuration of lymph node

7. iron supplement in child
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Decreases height - expensive; reserved for severe cases of delayed puberty
After 6m; breast mild provides iron until 6m.
Imaging study to r/o VUR

8. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
ALL - alzheimers autism adhd depression seizure
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

9. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Neurofibromatosis type2
14yrs
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

10. lead 44-70
Oral DMSA or EDTA IV
Decreased UGT enzyme
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

11. What is the calorie requirement of newborn?
No intervention; 90% foreign bodies pass without difficulty
Dactylitis; 2nd common is splenic seqestration
110 kcl/kg/day
D for d; down syndrome and polyhydramnios

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

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13. hypopigmented spots - family hx bilat deafness
Meconeum ileus; think about CF
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Neurofibromatosis type2
RSV - rhino and influenza

14. centor criteria for bact pharyngitis
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
No reticulocyte vs high reticulocyte
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

15. infant botulism
Female - breech delivery - family history; tx referral to ortho
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

16. How to dx endopthalmitis
Yes; but it will be less effective
No wheezing - no feever in chlamydia
Pipercillin (zosyn) - ticarcillin
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

17. down syndrome with holocystolic mumur
Benign permature thelarche; expectant management
Endocardial cushion defect (no separation between heart chambers)
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

18. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Yes; but it will be less effective

19. flexible kyphosis
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
Pho for forward bending; forward defect; common finding has no adverse physical effect
Strep pneumonie; moraxella; h influenze

20. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Thalassemia - congenital hemolytic anemia

21. most common complication of otitis media
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Dx US tx; correct serum electrolyte - pyloromyotom
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

22. difference between breast milk and breafeeding jaundice
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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

23. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Multiple telangiectesia - vasular lesion in CNS
Less than 5th percentile
Lateral neck xray in epiglottitis show swollen epiglottis

24. pumonary TB
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
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)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

25. physiological jaundice
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
24h to 7d of birth
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

26. dx of lyme
Congenital rubella syndrome
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Mainly clinical; serology with initial ELISA - with western blot confirmation;

27. benefits of antibiotic therapy in acute pharyngitis?
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Bladder dysfunction; UTI and renal dysfunctoin
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

28. When to do surgery for undescended testes
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Lateral neck xray in epiglottitis show swollen epiglottis
Wait until 6 months
Decreases height - expensive; reserved for severe cases of delayed puberty

29. Tx of botulism
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Oral DMSA or EDTA IV
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

30. causes of acute anemia
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
36 hours
Biliary atresia; tx surgery

31. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
No wheezing - no feever in chlamydia
Central isosexual precocious puberty; hypothalmaic hamartoma
refuse
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

32. difference between structural disorder and flexible kyphosis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Between pregnenolone and 17oh pregnenolone

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
Facial portwine stain
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

34. the risk of lyme after bitten by a tick
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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)
1.5%

35. crying during urination. bacteriuria pyruria - rec episodes
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
36 hours
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Imaging study to r/o VUR

36. horner syndrom
Facial portwine stain
Injury to lower roots of brachial plexus
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Herpes

37. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No; they are basic compound will be neutralized in an acidic environment of cellulitis
No myoclonic activity in JME
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Diet modification to provide 110kc/kg/d

38. difference between rubeola (measles) and rulbella
ALL - alzheimers autism adhd depression seizure
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Diet modification to provide 110kc/kg/d
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

39. tuberous sclerosis
After 6m; breast mild provides iron until 6m.
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Candidal diapar rash; tx clotrimazol
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

40. causes of FTT
Increase of progesteron/17oh progesterone
Decr calorie intake; decr calorie absorption;incr calorie demand
After 24h of abx therapy
Do HIV testing at first

41. Parents can _____ vaccine
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
refuse
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

42. tick transmits RMSF
Black
T for t ; thalassemia; inc serum iron and Iron binding
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

43. Neonatal conjugated hyperbilirubinemia
Bartonella henselae; complication is suppuration of lymph node
Bladder dysfunction; UTI and renal dysfunctoin
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Biliary atresia; tx surgery

44. TTP pentad
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
No intervention; 90% foreign bodies pass without difficulty
No myoclonic activity in JME
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

45. dx for turner
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
24-72 hours
Faciform RBC cause vascular occlusion
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

46. How to investigate delayed puberty
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Fifth disease; febrile syndrome
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Meconeum ileus; think about CF

47. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Strep pneumonie; moraxella; h influenze
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
Develops in 21 dasy

48. the recommended ca supplementation
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Risk of neurological dysfunction
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

49. contraindications of MMR vaccine
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Increase of progesteron/17oh progesterone
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

50. How long anti-TB drugs given for TB meningitis?
To make hip flexed and abducted position in DDH
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Herpes
Dx US tx; correct serum electrolyte - pyloromyotom