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

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2. side effect of testosteron therapy
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Decreases height - expensive; reserved for severe cases of delayed puberty
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

3. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Candidal diapar rash; tx clotrimazol

4. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
URI
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

5. decreased mobility of tympanic membrane after otitis media
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
14yrs
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

6. How to dx RSV
Thalassemia - congenital hemolytic anemia
Rapid detection of RSV antigen in nasl
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Croup

7. down syndrome with holocystolic mumur
Decreases height - expensive; reserved for severe cases of delayed puberty
Endocardial cushion defect (no separation between heart chambers)
Constitutional pubertal delay
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

8. can women with abnormal smear or genital get vaccine
Bladder dysfunction; UTI and renal dysfunctoin
Between pregnenolone and 17oh pregnenolone
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Yes; but it will be less effective

9. nuchal rigidity - fever - sore throat - headache - dioriented
Absence seizure; tx ethosuximide
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
110 kcl/kg/day
Congenital rubella syndrome

10. How to difference RSV and neonatal chlamydia
INH 9m if INH resistant rifampin 6m in children and 4m in adults
No wheezing - no feever in chlamydia
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

11. How to prevent GBS in neonate
Foreign body sensation - photophobia - corneal opacity tx abx
Benign permature thelarche; expectant management
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Penicillin G 4h before delivery

12. low grade fever - cough - diffuse bilat ground glass opacities
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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
Dactylitis; 2nd common is splenic seqestration
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

13. when bact conjunctivitis patient can go back to school
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Candidal diapar rash; tx clotrimazol
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
After 24h of abx therapy

14. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Less than 5th percentile
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)
Black

15. How to dx post uretheral valve
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Decreased UGT enzyme
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

16. defcicieny of 21 hydroxylase
Brown
Increase of progesteron/17oh progesterone
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Injury to b/l glossopharyngeal. present in botulism

17. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Oral DMSA or EDTA IV
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

18. language delay
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
refuse
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

19. sudden onset of fever - difficulty in breathing
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Croup
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Develops in 21 dasy

20. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
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
T for t ; thalassemia; inc serum iron and Iron binding
Pipercillin (zosyn) - ticarcillin

21. indications of VUR
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
refuse
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

22. 3yo - febrile - left hip externally rotated
Tx only symptomatic carrier
Wait until 6 months
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

23. difference between structural disorder and flexible kyphosis
URI
Foreign body sensation - photophobia - corneal opacity tx abx
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Central isosexual precocious puberty; hypothalmaic hamartoma

24. difference between diaper dermatitis and rash
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
Central isosexual precocious puberty; hypothalmaic hamartoma
Dactylitis; 2nd common is splenic seqestration

25. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Croup tx cool mist; racemic epi - corticosteroid
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

26. bromocriptine
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
110 kcl/kg/day
Faciform RBC cause vascular occlusion
Prolactinoma

27. acute otitis media-pathogen
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
After 24h of abx therapy
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Strep pneumonie; moraxella; h influenze

28. infantile hypertrophic pyloric stenosis
24-72 hours
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
Dx US tx; correct serum electrolyte - pyloromyotom
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

29. How to dx keratitis?
Benign permature thelarche; expectant management
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Foreign body sensation - photophobia - corneal opacity tx abx

30. lens dislocation
Marfans - ehlers danlos - homocystinuria
Strep pneumonie; moraxella; h influenze
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Endocardial cushion defect (no separation between heart chambers)

31. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

32. congenital adrenal hyperplasi
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Facial portwine stain
Mainly clinical; serology with initial ELISA - with western blot confirmation;

33. When to bevioral and enviromental measure in led intoxication?
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Marfans - ehlers danlos - homocystinuria
Risk of neurological dysfunction
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

34. tzanck
Dactylitis; 2nd common is splenic seqestration
Medical emergency; dimercaprol/edta
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Herpes

35. difference between rubeola (measles) and rulbella
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

36. 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)
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Neurofibromatosis type2
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

37. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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)
RSV - rhino and influenza
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

38. deficinecy of 17 hydroxylase
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Increase of pregnenolone
Benign permature thelarche; expectant management
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

39. TB prophylaxis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

40. What is the calorie requirement of newborn?
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
If aortic root reaches 45 mm
110 kcl/kg/day

41. osler rendu weber syndrom
HSP - look for symmetric skin lesions
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Decreased UGT enzyme
Multiple telangiectesia - vasular lesion in CNS

42. adenovirus
Croup tx cool mist; racemic epi - corticosteroid
Candidal diapar rash; tx clotrimazol
URI
Decreased UGT enzyme

43. flexible kyphosis
Strep pneumonie; moraxella; h influenze
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
If aortic root reaches 45 mm
Pho for forward bending; forward defect; common finding has no adverse physical effect

44. infant botulism
Congenital rubella syndrome
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

45. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Marfans - ehlers danlos - homocystinuria

46. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Foreign body sensation - photophobia - corneal opacity tx abx
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
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

47. penicillin effective against pseudomonas
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Do HIV testing at first
Pipercillin (zosyn) - ticarcillin
Vaso-occlusive crisis; dx hb electrophoresis

48. tick transmits lyme
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
No myoclonic activity in JME
Brown
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

49. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Imaging study to r/o VUR
HSP - look for symmetric skin lesions
Dx US tx; correct serum electrolyte - pyloromyotom

50. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Neurofibromatosis type2