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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. doing worse in school - lack of attention - starring speel
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No myoclonic activity in JME
After 6m; breast mild provides iron until 6m.
Absence seizure; tx ethosuximide

2. 17 alpha hydroxylase
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
After 24h of abx therapy
Between pregnenolone and 17oh pregnenolone

3. When erythema chronicum migrans develops after tick bite
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
24-72 hours
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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

4. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Develops in 21 dasy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Injury to lower roots of brachial plexus

5. lens dislocation
Wait until 6 months
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
36 hours
Marfans - ehlers danlos - homocystinuria

6. cleft lip but no cleft palate
Absence seizure; tx ethosuximide
Pipercillin (zosyn) - ticarcillin
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
<2yrs - abd pain - diarrhoea - ARF

7. side effect of testosteron therapy
Do HIV testing at first
Croup tx cool mist; racemic epi - corticosteroid
Decreases height - expensive; reserved for severe cases of delayed puberty
Rapid detection of RSV antigen in nasl

8. differentiate between central and peripheral precocious puberty
No intervention; 90% foreign bodies pass without difficulty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Constitutional pubertal delay
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

9. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Decreased UGT enzyme
To make hip flexed and abducted position in DDH
Methylephenidate toxicity; cannot be stopped abruptly; taper

10. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
ALL - alzheimers autism adhd depression seizure
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Between pregnenolone and 17oh pregnenolone

11. lead 44-70
Oral DMSA or EDTA IV
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

12. cat scratch disease
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Bartonella henselae; complication is suppuration of lymph node

13. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
If aortic root reaches 45 mm
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

14. non immune pregnant women exposed to rubella in first trimester
Benign permature thelarche; expectant management
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Risk of neurological dysfunction
Congenital rubella syndrome

15. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Diet modification to provide 110kc/kg/d
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

16. carditis and arthritis after rheumatic fever
Oral DMSA or EDTA IV
36 hours
Develops in 21 dasy
Increase of progesteron/17oh progesterone

17. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Bladder dysfunction; UTI and renal dysfunctoin
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)
If aortic root reaches 45 mm

18. pneumonia in CF patient
<2yrs - abd pain - diarrhoea - ARF
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

19. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
110 kcl/kg/day
Bartonella henselae; complication is suppuration of lymph node

20. sublottic narrowing
Imaging study to r/o VUR
Croup tx cool mist; racemic epi - corticosteroid
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

21. IM
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Bladder dysfunction; UTI and renal dysfunctoin
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Atypical lymphocyte

22. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
URI
Benign permature thelarche; expectant management
No reticulocyte vs high reticulocyte
Biliary atresia; tx surgery

23. When to give hpv vaccien
Constitutional pubertal delay
Penicillin G 4h before delivery
Rapid detection of RSV antigen in nasl
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. Febrile seizure
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

25. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Neurofibromatosis type2
Vaso-occlusive crisis; dx hb electrophoresis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

26. What is the calorie requirement of newborn?
110 kcl/kg/day
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Risk of neurological dysfunction
RSV - rhino and influenza

27. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pho for forward bending; forward defect; common finding has no adverse physical effect
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

28. Infant with serum billlirubin >25
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Decreases height - expensive; reserved for severe cases of delayed puberty
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
Risk of neurological dysfunction

29. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
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
Meconeum ileus; think about CF
Injury to b/l glossopharyngeal. present in botulism

30. How to difference viral and bact pneumonia
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

31. failure to thrive
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Rapid detection of RSV antigen in nasl
Less than 5th percentile
Pho for forward bending; forward defect; common finding has no adverse physical effect

32. When to do aortic root surgery in marfans to prevent dissection?
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
If aortic root reaches 45 mm

33. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Croup tx cool mist; racemic epi - corticosteroid

34. infant botulism
Risk of neurological dysfunction
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Erb paralysis leading to diaphragmatic paralysis
HSP - look for symmetric skin lesions

35. physiological jaundice
24h to 7d of birth
24-72 hours
Dactylitis; 2nd common is splenic seqestration
No myoclonic activity in JME

36. Tx of FTT
Yes; but it will be less effective
36 hours
Diet modification to provide 110kc/kg/d
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

37. sturge weber syndrome
Female - breech delivery - family history; tx referral to ortho
Facial portwine stain
refuse
Risk of neurological dysfunction

38. Nocturnal enuresis
Increase of pregnenolone
Prolactinoma
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
URI

39. Neonatal unconjugated hyperbilirubine
ALL - alzheimers autism adhd depression seizure
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Decreased UGT enzyme
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

40. aplasic crisis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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

41. lead >70
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Foreign body sensation - photophobia - corneal opacity tx abx
ALL - alzheimers autism adhd depression seizure
Medical emergency; dimercaprol/edta

42. How to differentiate caput succedanueum and cephalohematoma
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
D for d; down syndrome and polyhydramnios
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

43. down syndrome has inreased risk of developing
24h to 7d of birth
ALL - alzheimers autism adhd depression seizure
Strep pneumonie; moraxella; h influenze
Black

44. most common complication of otitis media
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Wait until 6 months
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

45. What is earliest sign of puberty?
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

46. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Constitutional pubertal delay
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

47. language delay
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

48. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Biliary atresia; tx surgery
36 hours
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

49. How to prevent GBS in neonate
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Penicillin G 4h before delivery
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

50. microcytic - hypochromic anemia - hepatospelnomegaly
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
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Thalassemia - congenital hemolytic anemia
URI