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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. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Wait until 6 months
No intervention; 90% foreign bodies pass without difficulty

2. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Do HIV testing at first
Penicillin G 4h before delivery
Meconeum ileus; think about CF
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

3. echymoses with low platelet <30k
Wait until 6 months
Faciform RBC cause vascular occlusion
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

4. How to differential bact vs viral conjunctivitis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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
Meconeum ileus; think about CF
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

5. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
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
To make hip flexed and abducted position in DDH
RSV - rhino and influenza

6. How to difference RSV and neonatal chlamydia
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No wheezing - no feever in chlamydia
Injury to b/l glossopharyngeal. present in botulism
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

7. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Medical emergency; dimercaprol/edta
Croup

8. tuberous sclerosis
Rapid detection of RSV antigen in nasl
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
14yrs
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

9. tick transmits lyme
Brown
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

10. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Pho for forward bending; forward defect; common finding has no adverse physical effect
Medical emergency; dimercaprol/edta

11. When erythema chronicum migrans develops after tick bite
Prolactinoma
Marfans - ehlers danlos - homocystinuria
24-72 hours
Pho for forward bending; forward defect; common finding has no adverse physical effect

12. contraindications of MMR vaccine
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Constitutional pubertal delay
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
ALL - alzheimers autism adhd depression seizure

13. language delay
Injury to lower roots of brachial plexus
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Black
Increase of progesteron/17oh progesterone

14. giardiasis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Tx only symptomatic carrier
Methylephenidate toxicity; cannot be stopped abruptly; taper
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

15. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
24h to 7d of birth
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Candidal diapar rash; tx clotrimazol
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

16. 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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Strep pneumonie; moraxella; h influenze
Methylephenidate toxicity; cannot be stopped abruptly; taper

17. 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)
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Brown

18. impaired gag reflex
Methylephenidate toxicity; cannot be stopped abruptly; taper
Thalassemia - congenital hemolytic anemia
Injury to b/l glossopharyngeal. present in botulism
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

19. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Erb paralysis leading to diaphragmatic paralysis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Black

20. Febrile seizure
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
1.5%
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Congenital rubella syndrome

21. coin in child's stomach
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
No intervention; 90% foreign bodies pass without difficulty
36 hours
RSV - rhino and influenza

22. cat scratch disease
RSV - rhino and influenza
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bartonella henselae; complication is suppuration of lymph node

23. kallman syndrome
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
After 24h of abx therapy
Decr calorie intake; decr calorie absorption;incr calorie demand

24. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Increase of pregnenolone
Decr calorie intake; decr calorie absorption;incr calorie demand
Black

25. infantile hypertrophic pyloric stenosis
Brown
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Dx US tx; correct serum electrolyte - pyloromyotom
Develops in 21 dasy

26. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
No reticulocyte vs high reticulocyte
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

27. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Rapid detection of RSV antigen in nasl
Dactylitis; 2nd common is splenic seqestration
Do HIV testing at first

28. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Bladder dysfunction; UTI and renal dysfunctoin
Diet modification to provide 110kc/kg/d
TB - breastfeeding - asymptomatic hiv

29. non immune pregnant women exposed to rubella in first trimester
Lateral neck xray in epiglottitis show swollen epiglottis
Faciform RBC cause vascular occlusion
Congenital rubella syndrome
T for t ; thalassemia; inc serum iron and Iron binding

30. How long anti-TB drugs given for TB meningitis?
Constitutional pubertal delay
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

31. How to prevent GBS in neonate
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Decreased UGT enzyme
Central isosexual precocious puberty; hypothalmaic hamartoma
Penicillin G 4h before delivery

32. difference between diaper dermatitis and rash
Decr calorie intake; decr calorie absorption;incr calorie demand
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
Bladder dysfunction; UTI and renal dysfunctoin
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

33. duodenal atresia
No; they are basic compound will be neutralized in an acidic environment of cellulitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Pipercillin (zosyn) - ticarcillin
D for d; down syndrome and polyhydramnios

34. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Female - breech delivery - family history; tx referral to ortho
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Medical emergency; dimercaprol/edta

35. the risk of lyme after bitten by a tick
1.5%
Prolactinoma
Increase of pregnenolone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

36. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Oral DMSA or EDTA IV
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

37. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
To make hip flexed and abducted position in DDH

38. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Croup tx cool mist; racemic epi - corticosteroid
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

39. is local anesthetics be used in cellulitis to reduce pain
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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)
refuse

40. when bact conjunctivitis patient can go back to school
Medical emergency; dimercaprol/edta
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
After 24h of abx therapy
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

41. tick transmits RMSF
Imaging study to r/o VUR
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Black
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

42. pavlik harness
To make hip flexed and abducted position in DDH
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Marfans - ehlers danlos - homocystinuria
Dactylitis; 2nd common is splenic seqestration

43. hypopigmented spots - family hx bilat deafness
RSV - rhino and influenza
Neurofibromatosis type2
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Less than 5th percentile

44. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
24-72 hours
>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
No myoclonic activity in JME

45. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Atopic dermatitis; strong allergic/immunologic component; incr IgE

46. nuchal rigidity - fever - sore throat - headache - dioriented
Injury to b/l glossopharyngeal. present in botulism
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

47. TB prophylaxis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
>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

48. Tx of children constipation

49. How to evaluate well appearing child just born in GBS pos mother?
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Atypical lymphocyte
110 kcl/kg/day

50. major depression
Dx US tx; correct serum electrolyte - pyloromyotom
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -