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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. TB prophylaxis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

2. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Benign permature thelarche; expectant management
Atypical lymphocyte

3. giardiasis
Tx only symptomatic carrier
Faciform RBC cause vascular occlusion
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Increase of progesteron/17oh progesterone

4. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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

5. carditis and arthritis after rheumatic fever
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Develops in 21 dasy

6. cleft lip but no cleft palate
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Decreases height - expensive; reserved for severe cases of delayed puberty
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

7. 21 hydroxylase
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
36 hours

8. association with infantile pyloric stenosis
Female - breech delivery - family history; tx referral to ortho
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Black
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

9. cardiac manifestation of turner
Herpes
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
<2yrs - abd pain - diarrhoea - ARF
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

10. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
T for t ; thalassemia; inc serum iron and Iron binding
Wait until 6 months
Congenital rubella syndrome

11. When to give HRT in turner
Faciform RBC cause vascular occlusion
INH 9m if INH resistant rifampin 6m in children and 4m in adults
14yrs
1.5%

12. Febrile seizure
Absence seizure; tx ethosuximide
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

13. deficinecy of 17 hydroxylase
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Prolactinoma
Increase of pregnenolone
>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

14. How to differential bact vs viral conjunctivitis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Lateral neck xray in epiglottitis show swollen epiglottis
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
<2yrs - abd pain - diarrhoea - ARF

15. 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
Tx only symptomatic carrier
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
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

16. how smoking contributes otitis media in children
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Increase of progesteron/17oh progesterone
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

17. dx of lyme
Between pregnenolone and 17oh pregnenolone
Thalassemia - congenital hemolytic anemia
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

18. physiological jaundice
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
24h to 7d of birth
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

19. sickle cell with symmetrical swelling of hands and feet
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Vaso-occlusive crisis; dx hb electrophoresis
Imaging study to r/o VUR
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

20. failure to thrive
Less than 5th percentile
After 24h of abx therapy
Dactylitis; 2nd common is splenic seqestration
Penicillin G 4h before delivery

21. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Neurofibromatosis type2
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
RSV - rhino and influenza

22. contact lens keratitis
No intervention; 90% foreign bodies pass without difficulty
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Risk of neurological dysfunction
Medical emergency; dimercaprol/edta

23. Infant with serum billlirubin >25
Risk of neurological dysfunction
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Decreased UGT enzyme
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

24. Parvovirus
Fifth disease; febrile syndrome
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Croup tx cool mist; racemic epi - corticosteroid

25. if bone age lower than actual and puberty delayed
24h to 7d of birth
Constitutional pubertal delay
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
D for d; down syndrome and polyhydramnios

26. Tx of community acquired pneumonia
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Injury to b/l glossopharyngeal. present in botulism
Thalassemia - congenital hemolytic anemia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

27. What is thumbprint sign
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Lateral neck xray in epiglottitis show swollen epiglottis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

28. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No myoclonic activity in JME

29. When to do aortic root surgery in marfans to prevent dissection?
Croup tx cool mist; racemic epi - corticosteroid
If aortic root reaches 45 mm
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

30. Tx of bact conjunctivitis
24-72 hours
Pipercillin (zosyn) - ticarcillin
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

31. down syndrome with holocystolic mumur
Pipercillin (zosyn) - ticarcillin
Endocardial cushion defect (no separation between heart chambers)
Female - breech delivery - family history; tx referral to ortho
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)

32. aplasic crisis
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Endocardial cushion defect (no separation between heart chambers)

33. causes of FTT
Tx only symptomatic carrier
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
<2yrs - abd pain - diarrhoea - ARF
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

34. How to dx endopthalmitis
Thalassemia - congenital hemolytic anemia
Bartonella henselae; complication is suppuration of lymph node
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

35. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Biliary atresia; tx surgery
Central isosexual precocious puberty; hypothalmaic hamartoma
Marfans - ehlers danlos - homocystinuria
Facial portwine stain

36. cat scratch disease
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
Bartonella henselae; complication is suppuration of lymph node
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

37. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Brown
<2yrs - abd pain - diarrhoea - ARF
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

38. What is the definition of delayed puberty?
After 6m; breast mild provides iron until 6m.
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

39. congenital adrenal hyperplasi
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Bladder dysfunction; UTI and renal dysfunctoin
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

40. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Meconeum ileus; think about CF
Yes; but it will be less effective

41. How to dx keratitis?
Pipercillin (zosyn) - ticarcillin
Foreign body sensation - photophobia - corneal opacity tx abx
Atypical lymphocyte
Risk of neurological dysfunction

42. adenovirus
URI
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Neurofibromatosis type2
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

43. 12y - obese - hip pain - hip ext rotated
Do HIV testing at first
After 6m; breast mild provides iron until 6m.
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Decreases height - expensive; reserved for severe cases of delayed puberty

44. lens dislocation
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
No reticulocyte vs high reticulocyte
Marfans - ehlers danlos - homocystinuria

45. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Atopic dermatitis; strong allergic/immunologic component; incr IgE
refuse
To make hip flexed and abducted position in DDH

46. the risk of lyme after bitten by a tick
>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
Decr calorie intake; decr calorie absorption;incr calorie demand
1.5%
Foreign body sensation - photophobia - corneal opacity tx abx

47. patient with white plaques in mouth and lump in back
Do HIV testing at first
Rapid detection of RSV antigen in nasl
24-72 hours
T for t ; thalassemia; inc serum iron and Iron binding

48. microcytic - hypochromic anemia - hepatospelnomegaly
Pho for forward bending; forward defect; common finding has no adverse physical effect
Thalassemia - congenital hemolytic anemia
1.5%
D for d; down syndrome and polyhydramnios

49. When to do surgery for undescended testes
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Penicillin G 4h before delivery
Wait until 6 months
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

50. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Meconeum ileus; think about CF
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI