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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. 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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

2. How to dx keratitis?
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Foreign body sensation - photophobia - corneal opacity tx abx

3. what conditions are not contraindicated
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Pho for forward bending; forward defect; common finding has no adverse physical effect
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
TB - breastfeeding - asymptomatic hiv

4. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
No myoclonic activity in JME
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
T for t ; thalassemia; inc serum iron and Iron binding

5. When to give HRT in turner
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
14yrs
Imaging study to r/o VUR
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

6. carditis and arthritis after rheumatic fever
Develops in 21 dasy
No wheezing - no feever in chlamydia
URI
Injury to b/l glossopharyngeal. present in botulism

7. When to give hpv vaccien
36 hours
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
Female - breech delivery - family history; tx referral to ortho
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

8. is local anesthetics be used in cellulitis to reduce pain
110 kcl/kg/day
Rapid detection of RSV antigen in nasl
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
No; they are basic compound will be neutralized in an acidic environment of cellulitis

9. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
URI

10. microcytic - hypochromic anemia - hepatospelnomegaly
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Thalassemia - congenital hemolytic anemia
Decreases height - expensive; reserved for severe cases of delayed puberty
Strep pneumonie; moraxella; h influenze

11. how smoking contributes otitis media in children
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
<2yrs - abd pain - diarrhoea - ARF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

12. HUS
<2yrs - abd pain - diarrhoea - ARF
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
24h to 7d of birth
Atopic dermatitis; strong allergic/immunologic component; incr IgE

13. doing worse in school - lack of attention - starring speel
Vaso-occlusive crisis; dx hb electrophoresis
Absence seizure; tx ethosuximide
Brown
Decreases height - expensive; reserved for severe cases of delayed puberty

14. giardiasis
Faciform RBC cause vascular occlusion
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Tx only symptomatic carrier

15. patient with white plaques in mouth and lump in back
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Do HIV testing at first
Dx US tx; correct serum electrolyte - pyloromyotom
Atopic dermatitis; strong allergic/immunologic component; incr IgE

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

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17. aplasic crisis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
RSV - rhino and influenza
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

18. can women with abnormal smear or genital get vaccine
No reticulocyte vs high reticulocyte
Croup tx cool mist; racemic epi - corticosteroid
Yes; but it will be less effective
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

19. cat scratch disease
Fifth disease; febrile syndrome
T for t ; thalassemia; inc serum iron and Iron binding
Absence seizure; tx ethosuximide
Bartonella henselae; complication is suppuration of lymph node

20. lead 44-70
Oral DMSA or EDTA IV
<2yrs - abd pain - diarrhoea - ARF
Dx US tx; correct serum electrolyte - pyloromyotom
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

21. Infant with serum billlirubin >25
Bartonella henselae; complication is suppuration of lymph node
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Risk of neurological dysfunction

22. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

23. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
To make hip flexed and abducted position in DDH
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

24. difference between rubeola (measles) and rulbella
No reticulocyte vs high reticulocyte
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Central isosexual precocious puberty; hypothalmaic hamartoma

25. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
>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
refuse
Black

26. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
110 kcl/kg/day
Pho for forward bending; forward defect; common finding has no adverse physical effect

27. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Constitutional pubertal delay
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

28. sickle cell with symmetrical swelling of hands and feet
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) -
Vaso-occlusive crisis; dx hb electrophoresis
Candidal diapar rash; tx clotrimazol

29. contact lens keratitis
Herpes
Injury to b/l glossopharyngeal. present in botulism
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
TB - breastfeeding - asymptomatic hiv

30. the risk of lyme after bitten by a tick
1.5%
Decreases height - expensive; reserved for severe cases of delayed puberty
Bartonella henselae; complication is suppuration of lymph node
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

31. How to dx post uretheral valve
1.5%
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

32. thumb sign
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Methylephenidate toxicity; cannot be stopped abruptly; taper

33. Tx of FTT
Marfans - ehlers danlos - homocystinuria
Diet modification to provide 110kc/kg/d
Congenital rubella syndrome
<2yrs - abd pain - diarrhoea - ARF

34. down syndrome has inreased risk of developing
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
ALL - alzheimers autism adhd depression seizure
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

35. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

36. hypopigmented spots - family hx bilat deafness
Strep pneumonie; moraxella; h influenze
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Neurofibromatosis type2

37. 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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

38. contraindications of MMR vaccine
After 6m; breast mild provides iron until 6m.
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

39. IM
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Croup
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Atypical lymphocyte

40. mech of botulism
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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

41. tzanck
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Herpes
If aortic root reaches 45 mm
>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

42. tick transmits lyme
Candidal diapar rash; tx clotrimazol
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Brown

43. cardiac manifestation of turner
>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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
110 kcl/kg/day
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

44. difference between structural disorder and flexible kyphosis
Dactylitis; 2nd common is splenic seqestration
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Pho for forward bending; forward defect; common finding has no adverse physical effect
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

45. dx for DDH
Between pregnenolone and 17oh pregnenolone
Dx US tx; correct serum electrolyte - pyloromyotom
24h to 7d of birth
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

46. What is the most common initial symptom in sickle cell
Yes; but it will be less effective
Dactylitis; 2nd common is splenic seqestration
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Prolactinoma

47. flexible kyphosis
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Pho for forward bending; forward defect; common finding has no adverse physical effect
24-72 hours

48. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Lateral neck xray in epiglottitis show swollen epiglottis
Between pregnenolone and 17oh pregnenolone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

49. acute abd pain - hx URI - lower extremity maculo papular rash
TB - breastfeeding - asymptomatic hiv
Lateral neck xray in epiglottitis show swollen epiglottis
HSP - look for symmetric skin lesions
No reticulocyte vs high reticulocyte

50. sublottic narrowing
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
14yrs
Croup tx cool mist; racemic epi - corticosteroid
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)