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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. When to bevioral and enviromental measure in led intoxication?
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
D for d; down syndrome and polyhydramnios
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

2. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Absence seizure; tx ethosuximide
Decreased UGT enzyme

3. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

4. penicillin effective against pseudomonas
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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
TB - breastfeeding - asymptomatic hiv
Pipercillin (zosyn) - ticarcillin

5. When to give hpv vaccien
Medical emergency; dimercaprol/edta
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
Erb paralysis leading to diaphragmatic paralysis
D for d; down syndrome and polyhydramnios

6. what conditions are not contraindicated
Imaging study to r/o VUR
>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
TB - breastfeeding - asymptomatic hiv
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

7. impaired gag reflex
Black
Injury to b/l glossopharyngeal. present in botulism
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Atypical lymphocyte

8. How to dx endopthalmitis
Bladder dysfunction; UTI and renal dysfunctoin
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Thalassemia - congenital hemolytic anemia

9. how thalassemia die
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
No myoclonic activity in JME

10. spitting up - vomiting at night - weight stable
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
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Biliary atresia; tx surgery
Penicillin G 4h before delivery

11. cleft lip but no cleft palate
Dx US tx; correct serum electrolyte - pyloromyotom
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Rapid detection of RSV antigen in nasl
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

12. contact lens keratitis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
1.5%
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Black

13. IM
Atypical lymphocyte
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No; they are basic compound will be neutralized in an acidic environment of cellulitis

14. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Decreases height - expensive; reserved for severe cases of delayed puberty
Atypical lymphocyte
TB - breastfeeding - asymptomatic hiv

15. How to difference RSV and neonatal chlamydia
To make hip flexed and abducted position in DDH
Pho for forward bending; forward defect; common finding has no adverse physical effect
No wheezing - no feever in chlamydia
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

16. When erythema chronicum migrans develops after tick bite
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
24-72 hours
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

17. contraindications of DTap
If aortic root reaches 45 mm
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

18. centor criteria for bact pharyngitis
Lateral neck xray in epiglottitis show swollen epiglottis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
<2yrs - abd pain - diarrhoea - ARF
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

19. sturge weber syndrome
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Methylephenidate toxicity; cannot be stopped abruptly; taper
Facial portwine stain
1.5%

20. 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
Endocardial cushion defect (no separation between heart chambers)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Vaso-occlusive crisis; dx hb electrophoresis

21. TTP pentad
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Bartonella henselae; complication is suppuration of lymph node
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

22. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Methylephenidate toxicity; cannot be stopped abruptly; taper
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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

23. pavlik harness
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
To make hip flexed and abducted position in DDH
Central isosexual precocious puberty; hypothalmaic hamartoma
Biliary atresia; tx surgery

24. When to do surgery for undescended testes
No myoclonic activity in JME
Wait until 6 months
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

25. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Biliary atresia; tx surgery
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

26. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Facial portwine stain
Meconeum ileus; think about CF
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
TB - breastfeeding - asymptomatic hiv

27. thumb sign
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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Meconeum ileus; think about CF

28. How to dx acute angle closure glaucoma
After 6m; breast mild provides iron until 6m.
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

29. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Oral DMSA or EDTA IV

30. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Lateral neck xray in epiglottitis show swollen epiglottis
Foreign body sensation - photophobia - corneal opacity tx abx

31. major depression
Pho for forward bending; forward defect; common finding has no adverse physical effect
Wait until 6 months
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

32. What is the definition of delayed puberty?
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Candidal diapar rash; tx clotrimazol
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

33. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Develops in 21 dasy
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

34. doing worse in school - lack of attention - starring speel
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
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
Absence seizure; tx ethosuximide
1.5%

35. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Injury to b/l glossopharyngeal. present in botulism
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

36. contraindications of MMR vaccine
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decreases height - expensive; reserved for severe cases of delayed puberty

37. patient with white plaques in mouth and lump in back
Do HIV testing at first
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
URI
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

38. HUS
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
<2yrs - abd pain - diarrhoea - ARF
Diet modification to provide 110kc/kg/d
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

39. lead 44-70
Croup tx cool mist; racemic epi - corticosteroid
Oral DMSA or EDTA IV
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
ALL - alzheimers autism adhd depression seizure

40. cardiac manifestation of turner
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Between pregnenolone and 17oh pregnenolone
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Atypical lymphocyte

41. lens dislocation
Benign permature thelarche; expectant management
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
TB - breastfeeding - asymptomatic hiv
Marfans - ehlers danlos - homocystinuria

42. acute otitis externa

43. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

44. How to differential bact vs viral conjunctivitis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Mainly clinical; serology with initial ELISA - with western blot confirmation;
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

45. lead >70
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
T for t ; thalassemia; inc serum iron and Iron binding
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Medical emergency; dimercaprol/edta

46. What is the most common initial symptom in sickle cell
Decreased UGT enzyme
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Dactylitis; 2nd common is splenic seqestration
To make hip flexed and abducted position in DDH

47. language delay
After 6m; breast mild provides iron until 6m.
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Imaging study to r/o VUR

48. 21 hydroxylase
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
After 24h of abx therapy
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

49. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Dactylitis; 2nd common is splenic seqestration
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

50. pumonary TB
To make hip flexed and abducted position in DDH
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
24h to 7d of birth