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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. language expectation from 2yo
Risk of neurological dysfunction
Diet modification to provide 110kc/kg/d
Decreases height - expensive; reserved for severe cases of delayed puberty
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

2. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
14yrs
URI
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

3. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Diet modification to provide 110kc/kg/d
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Candidal diapar rash; tx clotrimazol
Pipercillin (zosyn) - ticarcillin

4. bromocriptine
Meconeum ileus; think about CF
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
URI
Prolactinoma

5. pumonary TB
Penicillin G 4h before delivery
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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)
Foreign body sensation - photophobia - corneal opacity tx abx

6. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Lateral neck xray in epiglottitis show swollen epiglottis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

7. causes of FTT
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

8. pavlik harness
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
No wheezing - no feever in chlamydia
Between pregnenolone and 17oh pregnenolone
To make hip flexed and abducted position in DDH

9. failure to thrive
Develops in 21 dasy
Lateral neck xray in epiglottitis show swollen epiglottis
Less than 5th percentile
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

10. difference between breast milk and breafeeding jaundice
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Multiple telangiectesia - vasular lesion in CNS

11. differentiate between central and peripheral precocious puberty
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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

12. 21 hydroxylase
Increase of pregnenolone
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

13. physiological jaundice
24h to 7d of birth
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Absence seizure; tx ethosuximide

14. spitting up - vomiting at night - weight stable
HSP - look for symmetric skin lesions
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
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
Medical emergency; dimercaprol/edta

15. How to dx endopthalmitis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Decreased UGT enzyme
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

16. What are the risk factors of developmental dysplais of hip
Bartonella henselae; complication is suppuration of lymph node
Mainly clinical; serology with initial ELISA - with western blot confirmation;
TB - breastfeeding - asymptomatic hiv
Female - breech delivery - family history; tx referral to ortho

17. splenic infarction in sickle cell
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Constitutional pubertal delay
Faciform RBC cause vascular occlusion

18. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Do HIV testing at first
Benign permature thelarche; expectant management

19. indications of VUR
T for t ; thalassemia; inc serum iron and Iron binding
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Less than 5th percentile
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

20. centor criteria for bact pharyngitis
110 kcl/kg/day
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
D for d; down syndrome and polyhydramnios
Between pregnenolone and 17oh pregnenolone

21. When to do surgery for undescended testes
Wait until 6 months
Fifth disease; febrile syndrome
Faciform RBC cause vascular occlusion
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

22. difference between diaper dermatitis and rash
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
Atypical lymphocyte
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
110 kcl/kg/day

23. dx for turner
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
Foreign body sensation - photophobia - corneal opacity tx abx
Constitutional pubertal delay
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

24. contraindications of MMR vaccine
24-72 hours
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
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

25. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Dx US tx; correct serum electrolyte - pyloromyotom

26. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Dactylitis; 2nd common is splenic seqestration
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

27. How to investigate delayed puberty
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Candidal diapar rash; tx clotrimazol
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

28. lead >70
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
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
Medical emergency; dimercaprol/edta
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

29. sublottic narrowing
No myoclonic activity in JME
Endocardial cushion defect (no separation between heart chambers)
Croup tx cool mist; racemic epi - corticosteroid
T for t ; thalassemia; inc serum iron and Iron binding

30. What is thumbprint sign
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Lateral neck xray in epiglottitis show swollen epiglottis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Foreign body sensation - photophobia - corneal opacity tx abx

31. language delay
Decreased UGT enzyme
24-72 hours
Constitutional pubertal delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

32. down syndrome with holocystolic mumur
Central isosexual precocious puberty; hypothalmaic hamartoma
Endocardial cushion defect (no separation between heart chambers)
Meconeum ileus; think about CF
INH 9m if INH resistant rifampin 6m in children and 4m in adults

33. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Less than 5th percentile
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

34. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
After 24h of abx therapy
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Facial portwine stain

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

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36. red oozing rash on cheek - scaly - dry
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No wheezing - no feever in chlamydia

37. How to dx acute angle closure glaucoma
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Bartonella henselae; complication is suppuration of lymph node
Decreases height - expensive; reserved for severe cases of delayed puberty

38. TB prophylaxis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
INH 9m if INH resistant rifampin 6m in children and 4m in adults
No wheezing - no feever in chlamydia
Multiple telangiectesia - vasular lesion in CNS

39. horner syndrom
1.5%
Herpes
Injury to lower roots of brachial plexus
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

40. penicillin effective against pseudomonas
Croup tx cool mist; racemic epi - corticosteroid
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Pipercillin (zosyn) - ticarcillin
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)

41. lens dislocation
Absence seizure; tx ethosuximide
Marfans - ehlers danlos - homocystinuria
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

42. viruses cause bronhioltitis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Yes; but it will be less effective
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
RSV - rhino and influenza

43. if bone age lower than actual and puberty delayed
URI
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Constitutional pubertal delay

44. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Neurofibromatosis type2
24-72 hours

45. How to evaluate well appearing child just born in GBS pos mother?
Tx only symptomatic carrier
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
refuse
<2yrs - abd pain - diarrhoea - ARF

46. target cell
No myoclonic activity in JME
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Risk of neurological dysfunction
T for t ; thalassemia; inc serum iron and Iron binding

47. non immune pregnant women exposed to rubella in first trimester
ALL - alzheimers autism adhd depression seizure
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
Congenital rubella syndrome

48. major depression
Biliary atresia; tx surgery
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
36 hours

49. Tx of community acquired pneumonia
ALL - alzheimers autism adhd depression seizure
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
36 hours
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

50. cleft lip but no cleft palate
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
36 hours
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes