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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. Tx of community acquired pneumonia
Dx US tx; correct serum electrolyte - pyloromyotom
Herpes
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
No intervention; 90% foreign bodies pass without difficulty

2. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
TB - breastfeeding - asymptomatic hiv
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Pho for forward bending; forward defect; common finding has no adverse physical effect

3. cat scratch disease
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Bartonella henselae; complication is suppuration of lymph node
To make hip flexed and abducted position in DDH
Develops in 21 dasy

4. most common complication of otitis media
Between pregnenolone and 17oh pregnenolone
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

5. lens dislocation
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Marfans - ehlers danlos - homocystinuria

6. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
To make hip flexed and abducted position in DDH
Decr calorie intake; decr calorie absorption;incr calorie demand
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

7. How to difference RSV and neonatal chlamydia
Mainly clinical; serology with initial ELISA - with western blot confirmation;
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Increase of progesteron/17oh progesterone
No wheezing - no feever in chlamydia

8. TB prophylaxis
No reticulocyte vs high reticulocyte
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
INH 9m if INH resistant rifampin 6m in children and 4m in adults

9. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Herpes
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

10. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Atypical lymphocyte
HSP - look for symmetric skin lesions
ALL - alzheimers autism adhd depression seizure

11. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Develops in 21 dasy
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

12. starring spells 10-20sec
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Multiple telangiectesia - vasular lesion in CNS
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

13. Nocturnal enuresis
No reticulocyte vs high reticulocyte
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Diet modification to provide 110kc/kg/d
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

14. microcytic - hypochromic anemia - hepatospelnomegaly
Oral DMSA or EDTA IV
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Thalassemia - congenital hemolytic anemia
Constitutional pubertal delay

15. Tx of botulism
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

16. causes of FTT
Brown
Decr calorie intake; decr calorie absorption;incr calorie demand
Dx US tx; correct serum electrolyte - pyloromyotom
Black

17. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Bladder dysfunction; UTI and renal dysfunctoin
HSP - look for symmetric skin lesions
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

18. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
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
<2yrs - abd pain - diarrhoea - ARF
URI
No reticulocyte vs high reticulocyte

19. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
After 24h of abx therapy

20. Tx of children constipation

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21. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Diet modification to provide 110kc/kg/d
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

22. difference between rubeola (measles) and rulbella
Faciform RBC cause vascular occlusion
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;
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

23. How to prevent GBS in neonate
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
24-72 hours
Penicillin G 4h before delivery
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

24. pumonary TB
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)
INH 9m if INH resistant rifampin 6m in children and 4m in adults
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
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

25. IM
Atypical lymphocyte
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

26. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Prolactinoma
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Injury to b/l glossopharyngeal. present in botulism

27. acute otitis externa

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28. 21 hydroxylase
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Fifth disease; febrile syndrome
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

29. language delay
Multiple telangiectesia - vasular lesion in CNS
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
After 6m; breast mild provides iron until 6m.
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

30. contraindications of MMR vaccine
Croup tx cool mist; racemic epi - corticosteroid
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

31. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No myoclonic activity in JME
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
D for d; down syndrome and polyhydramnios

32. carditis and arthritis after rheumatic fever
TB - breastfeeding - asymptomatic hiv
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Develops in 21 dasy

33. Infant with serum billlirubin >25
Risk of neurological dysfunction
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
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

34. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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
<2yrs - abd pain - diarrhoea - ARF

35. acute otitis media-pathogen
Multiple telangiectesia - vasular lesion in CNS
Strep pneumonie; moraxella; h influenze
Foreign body sensation - photophobia - corneal opacity tx abx
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

36. target cell
Faciform RBC cause vascular occlusion
T for t ; thalassemia; inc serum iron and Iron binding
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

37. lead 44-70
Atypical lymphocyte
Oral DMSA or EDTA IV
Brown
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

38. complete airway obstruction with FB
>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
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Risk of neurological dysfunction
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

39. 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
No wheezing - no feever in chlamydia
Between pregnenolone and 17oh pregnenolone
Facial portwine stain

40. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Marfans - ehlers danlos - homocystinuria
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Methylephenidate toxicity; cannot be stopped abruptly; taper
Imaging study to r/o VUR

41. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Pipercillin (zosyn) - ticarcillin
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Bladder dysfunction; UTI and renal dysfunctoin

42. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Less than 5th percentile
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

43. What is the calorie requirement of newborn?
Croup tx cool mist; racemic epi - corticosteroid
Meconeum ileus; think about CF
110 kcl/kg/day
TB - breastfeeding - asymptomatic hiv

44. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Rapid detection of RSV antigen in nasl
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Multiple telangiectesia - vasular lesion in CNS

45. TTP pentad
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
T for t ; thalassemia; inc serum iron and Iron binding
Strep pneumonie; moraxella; h influenze

46. splenic infarction in sickle cell
After 6m; breast mild provides iron until 6m.
No intervention; 90% foreign bodies pass without difficulty
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Faciform RBC cause vascular occlusion

47. cleft lip but no cleft palate
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)
Lateral neck xray in epiglottitis show swollen epiglottis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

48. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Imaging study to r/o VUR
Diet modification to provide 110kc/kg/d
Increase of pregnenolone
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

49. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Multiple telangiectesia - vasular lesion in CNS
Thalassemia - congenital hemolytic anemia

50. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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