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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. acute abd pain - hx URI - lower extremity maculo papular rash
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
HSP - look for symmetric skin lesions
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

2. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Facial portwine stain
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

3. TTP pentad
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
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

4. the recommended ca supplementation
Herpes
D for d; down syndrome and polyhydramnios
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Vaso-occlusive crisis; dx hb electrophoresis

5. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Bladder dysfunction; UTI and renal dysfunctoin
Croup
Biliary atresia; tx surgery

6. How to prevent GBS in neonate
URI
Injury to b/l glossopharyngeal. present in botulism
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Penicillin G 4h before delivery

7. contact lens keratitis
110 kcl/kg/day
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

8. is local anesthetics be used in cellulitis to reduce pain
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
No; they are basic compound will be neutralized in an acidic environment of cellulitis

9. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Croup
Croup tx cool mist; racemic epi - corticosteroid
Diet modification to provide 110kc/kg/d

10. bromocriptine
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Prolactinoma

11. mech of botulism
Injury to lower roots of brachial plexus
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Neurofibromatosis type2
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

12. giardiasis
Tx only symptomatic carrier
Congenital rubella syndrome
URI
Croup

13. 17 alpha hydroxylase
HSP - look for symmetric skin lesions
Between pregnenolone and 17oh pregnenolone
Pho for forward bending; forward defect; common finding has no adverse physical effect
Imaging study to r/o VUR

14. the risk of lyme after bitten by a tick
1.5%
URI
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

15. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Benign permature thelarche; expectant management
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erb paralysis leading to diaphragmatic paralysis

16. physiological jaundice
Oral DMSA or EDTA IV
24h to 7d of birth
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Methylephenidate toxicity; cannot be stopped abruptly; taper

17. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Aferbrile pneumnia - c. trachomatic - mycoplasma - ureasplams - cmv - rsv; look for onset - if 2-19w - can be chlamydia if asso conjunctivitis dx; cx of nasal secretion - chlamydia pcr
After 6m; breast mild provides iron until 6m.
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

18. 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
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
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Absence seizure; tx ethosuximide

19. Parvovirus
Develops in 21 dasy
Pho for forward bending; forward defect; common finding has no adverse physical effect
110 kcl/kg/day
Fifth disease; febrile syndrome

20. Tx of community acquired pneumonia
Multiple telangiectesia - vasular lesion in CNS
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Absence seizure; tx ethosuximide

21. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Black
Between pregnenolone and 17oh pregnenolone
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

22. What is the calorie requirement of newborn?
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Croup
Injury to b/l glossopharyngeal. present in botulism
110 kcl/kg/day

23. non immune pregnant women exposed to rubella in first trimester
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Congenital rubella syndrome

24. How to differential bact vs viral conjunctivitis
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
Vaso-occlusive crisis; dx hb electrophoresis
T for t ; thalassemia; inc serum iron and Iron binding
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

25. pumonary TB
Diet modification to provide 110kc/kg/d
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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)

26. 21 hydroxylase
Injury to b/l glossopharyngeal. present in botulism
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

27. How to dx endopthalmitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
No reticulocyte vs high reticulocyte
Decr calorie intake; decr calorie absorption;incr calorie demand

28. starring spells 10-20sec
Multiple telangiectesia - vasular lesion in CNS
Do HIV testing at first
Decreased UGT enzyme
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

29. HUS
Fifth disease; febrile syndrome
Female - breech delivery - family history; tx referral to ortho
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
<2yrs - abd pain - diarrhoea - ARF

30. When to bevioral and enviromental measure in led intoxication?
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Increase of progesteron/17oh progesterone
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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

31. horner syndrom
Injury to lower roots of brachial plexus
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Pho for forward bending; forward defect; common finding has no adverse physical effect
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

32. dx for DDH
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Do HIV testing at first
Lateral neck xray in epiglottitis show swollen epiglottis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

33. When to give hpv vaccien
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Black
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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

34. Febrile seizure
Penicillin G 4h before delivery
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

35. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Develops in 21 dasy
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Neurofibromatosis type2

36. low grade fever - cough - diffuse bilat ground glass opacities
14yrs
Aferbrile pneumnia - c. trachomatic - mycoplasma - ureasplams - cmv - rsv; look for onset - if 2-19w - can be chlamydia if asso conjunctivitis dx; cx of nasal secretion - chlamydia pcr
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

37. 12y - obese - hip pain - hip ext rotated
Erb paralysis leading to diaphragmatic paralysis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

38. When to do aortic root surgery in marfans to prevent dissection?
Develops in 21 dasy
Croup
If aortic root reaches 45 mm
To make hip flexed and abducted position in DDH

39. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
36 hours
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

40. penicillin effective against pseudomonas
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
No wheezing - no feever in chlamydia
Pipercillin (zosyn) - ticarcillin
Lateral neck xray in epiglottitis show swollen epiglottis

41. osler rendu weber syndrom
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
No intervention; 90% foreign bodies pass without difficulty
Multiple telangiectesia - vasular lesion in CNS
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

42. tzanck
<2yrs - abd pain - diarrhoea - ARF
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)
Herpes

43. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Biliary atresia; tx surgery
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

44. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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

45. spitting up - vomiting at night - weight stable
Vaso-occlusive crisis; dx hb electrophoresis
ALL - alzheimers autism adhd depression seizure
24h to 7d of birth
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

46. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Aferbrile pneumnia - c. trachomatic - mycoplasma - ureasplams - cmv - rsv; look for onset - if 2-19w - can be chlamydia if asso conjunctivitis dx; cx of nasal secretion - chlamydia pcr
Increase of pregnenolone

47. How to investigate delayed puberty
Pipercillin (zosyn) - ticarcillin
Medical emergency; dimercaprol/edta
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

48. How long patient needs to be exposed to tick to get infected
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Tx only symptomatic carrier
36 hours
If aortic root reaches 45 mm

49. major depression
Pipercillin (zosyn) - ticarcillin
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

50. nuchal rigidity - fever - sore throat - headache - dioriented
Croup tx cool mist; racemic epi - corticosteroid
Erb paralysis leading to diaphragmatic paralysis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults