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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. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Foreign body sensation - photophobia - corneal opacity tx abx
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

2. difference between breast milk and breafeeding jaundice
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

3. How to dx keratitis?
110 kcl/kg/day
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Foreign body sensation - photophobia - corneal opacity tx abx
No reticulocyte vs high reticulocyte

4. How to prevent GBS in neonate
Wait until 6 months
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Penicillin G 4h before delivery
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

5. physiological jaundice
24h to 7d of birth
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Faciform RBC cause vascular occlusion

6. TTP pentad
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
No intervention; 90% foreign bodies pass without difficulty
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

7. 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
Risk of neurological dysfunction
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

8. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Absence seizure; tx ethosuximide

9. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Oral DMSA or EDTA IV

10. cleft lip but no cleft palate
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Foreign body sensation - photophobia - corneal opacity tx abx
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

11. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Croup

12. 12y - obese - hip pain - hip ext rotated
Tx only symptomatic carrier
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Benign permature thelarche; expectant management
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

13. echymoses with low platelet <30k
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

14. What are the risk factors of developmental dysplais of hip
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Female - breech delivery - family history; tx referral to ortho
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
After 6m; breast mild provides iron until 6m.

15. How to difference viral and bact pneumonia
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Biliary atresia; tx surgery
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Diet modification to provide 110kc/kg/d

16. difference between rubeola (measles) and rulbella
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
HSP - look for symmetric skin lesions

17. cardiac manifestation of turner
refuse
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Marfans - ehlers danlos - homocystinuria
Bartonella henselae; complication is suppuration of lymph node

18. horner syndrom
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Facial portwine stain
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Injury to lower roots of brachial plexus

19. 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
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

20. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Penicillin G 4h before delivery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Herpes

21. lead >70
D for d; down syndrome and polyhydramnios
Medical emergency; dimercaprol/edta
Vaso-occlusive crisis; dx hb electrophoresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

22. mech of botulism
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Increase of pregnenolone
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

23. How to dx post uretheral valve
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Wait until 6 months
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

24. HUS
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<2yrs - abd pain - diarrhoea - ARF
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

25. tzanck
Penicillin G 4h before delivery
Herpes
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

26. Tx of botulism
Female - breech delivery - family history; tx referral to ortho
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

27. Tx of community acquired pneumonia
14yrs
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

28. How to dx endopthalmitis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Biliary atresia; tx surgery
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Multiple telangiectesia - vasular lesion in CNS

29. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
14yrs
Central isosexual precocious puberty; hypothalmaic hamartoma
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Tx only symptomatic carrier

30. How to evaluate well appearing child just born in GBS pos mother?
No reticulocyte vs high reticulocyte
Vaso-occlusive crisis; dx hb electrophoresis
Do HIV testing at first
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

31. if bone age lower than actual and puberty delayed
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
Marfans - ehlers danlos - homocystinuria
Constitutional pubertal delay
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

32. how smoking contributes otitis media in children
Decreased UGT enzyme
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
1.5%

33. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
36 hours
Injury to lower roots of brachial plexus
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

34. How to dx acute angle closure glaucoma
No; they are basic compound will be neutralized in an acidic environment of cellulitis
refuse
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
After 6m; breast mild provides iron until 6m.

35. lead 44-70
No wheezing - no feever in chlamydia
Croup
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Oral DMSA or EDTA IV

36. acute otitis externa

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37. pumonary TB
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
RSV - rhino and influenza
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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)

38. Infant with serum billlirubin >25
Pipercillin (zosyn) - ticarcillin
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
Risk of neurological dysfunction
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

39. How to differential bact vs viral conjunctivitis
Injury to lower roots of brachial plexus
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
1.5%
Erb paralysis leading to diaphragmatic paralysis

40. When to give HRT in turner
14yrs
TB - breastfeeding - asymptomatic hiv
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

41. aplasic crisis
110 kcl/kg/day
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
36 hours
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

42. impaired gag reflex
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Develops in 21 dasy
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Injury to b/l glossopharyngeal. present in botulism

43. complete airway obstruction with FB
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
>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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Risk of neurological dysfunction

44. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
If aortic root reaches 45 mm
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

45. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
No intervention; 90% foreign bodies pass without difficulty
Central isosexual precocious puberty; hypothalmaic hamartoma

46. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Risk of neurological dysfunction
Croup tx cool mist; racemic epi - corticosteroid
Congenital rubella syndrome

47. sublottic narrowing
URI
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
24-72 hours
Croup tx cool mist; racemic epi - corticosteroid

48. microcytic - hypochromic anemia - hepatospelnomegaly
Decreased UGT enzyme
Imaging study to r/o VUR
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Thalassemia - congenital hemolytic anemia

49. thumb sign
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

50. starring spells 10-20sec
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Methylephenidate toxicity; cannot be stopped abruptly; taper
Female - breech delivery - family history; tx referral to ortho
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure