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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. pavlik harness
To make hip flexed and abducted position in DDH
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
36 hours
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

2. Tx of FTT
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Do HIV testing at first
Diet modification to provide 110kc/kg/d
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

3. infant botulism
Imaging study to r/o VUR
Black
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

4. How to differentiate croup vs epiglotitis
Meconeum ileus; think about CF
After 6m; breast mild provides iron until 6m.
Multiple telangiectesia - vasular lesion in CNS
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

5. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Bartonella henselae; complication is suppuration of lymph node
Erb paralysis leading to diaphragmatic paralysis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Decr calorie intake; decr calorie absorption;incr calorie demand

6. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
TB - breastfeeding - asymptomatic hiv
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

7. sturge weber syndrome
Facial portwine stain
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
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)
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

8. When erythema chronicum migrans develops after tick bite
24-72 hours
Prolactinoma
Increase of pregnenolone
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

9. mcCune albright`
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Decreases height - expensive; reserved for severe cases of delayed puberty
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

10. How long patient needs to be exposed to tick to get infected
Absence seizure; tx ethosuximide
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Meconeum ileus; think about CF
36 hours

11. tzanck
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
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
Herpes
T for t ; thalassemia; inc serum iron and Iron binding

12. most common complication of otitis media
To make hip flexed and abducted position in DDH
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Faciform RBC cause vascular occlusion
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

13. How long anti-TB drugs given for TB meningitis?
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Oral DMSA or EDTA IV
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Pho for forward bending; forward defect; common finding has no adverse physical effect

14. lead 44-70
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Female - breech delivery - family history; tx referral to ortho
Oral DMSA or EDTA IV
Dactylitis; 2nd common is splenic seqestration

15. cardiac manifestation of turner
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Injury to lower roots of brachial plexus
Croup
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

16. complication of lumbosacral meningocele
No intervention; 90% foreign bodies pass without difficulty
Bladder dysfunction; UTI and renal dysfunctoin
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

17. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
RSV - rhino and influenza
Do HIV testing at first
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

18. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
24-72 hours
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
1.5%

19. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Fifth disease; febrile syndrome
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

20. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
No wheezing - no feever in chlamydia
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

21. patient with white plaques in mouth and lump in back
Injury to b/l glossopharyngeal. present in botulism
Oral DMSA or EDTA IV
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
Do HIV testing at first

22. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

23. down syndrome with holocystolic mumur
No myoclonic activity in JME
Foreign body sensation - photophobia - corneal opacity tx abx
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Endocardial cushion defect (no separation between heart chambers)

24. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Decreased UGT enzyme
RSV - rhino and influenza
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

25. physiological jaundice
RSV - rhino and influenza
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
24h to 7d of birth

26. 3yo - never able to walk
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Vaso-occlusive crisis; dx hb electrophoresis
RSV - rhino and influenza
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

27. Tx of community acquired pneumonia
No intervention; 90% foreign bodies pass without difficulty
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Foreign body sensation - photophobia - corneal opacity tx abx

28. 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
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Less than 5th percentile

29. tick transmits RMSF
If aortic root reaches 45 mm
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Imaging study to r/o VUR
Black

30. 18mo bilat breast enlargment - some pubic hair
After 6m; breast mild provides iron until 6m.
Benign permature thelarche; expectant management
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Increase of pregnenolone

31. How to investigate delayed puberty
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Between pregnenolone and 17oh pregnenolone
Black

32. Febrile seizure
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
After 6m; breast mild provides iron until 6m.

33. How to prevent GBS in neonate
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Herpes
Female - breech delivery - family history; tx referral to ortho
Penicillin G 4h before delivery

34. Tx of botulism
Decreases height - expensive; reserved for severe cases of delayed puberty
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

35. flexible kyphosis
After 24h of abx therapy
Marfans - ehlers danlos - homocystinuria
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Pho for forward bending; forward defect; common finding has no adverse physical effect

36. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Diet modification to provide 110kc/kg/d
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

37. lead >70
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Medical emergency; dimercaprol/edta
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

38. aplasic crisis
Risk of neurological dysfunction
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
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

39. sickle cell with symmetrical swelling of hands and feet
After 24h of abx therapy
Vaso-occlusive crisis; dx hb electrophoresis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

40. causes of FTT
Injury to b/l glossopharyngeal. present in botulism
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

41. red oozing rash on cheek - scaly - dry
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Brown

42. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
1.5%
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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

43. if bone age lower than actual and puberty delayed
Develops in 21 dasy
Constitutional pubertal delay
Imaging study to r/o VUR
Croup

44. adrenal tumor
Foreign body sensation - photophobia - corneal opacity tx abx
Risk of neurological dysfunction
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

45. giardiasis
Thalassemia - congenital hemolytic anemia
Less than 5th percentile
Tx only symptomatic carrier
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

46. tick transmits lyme
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Brown
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

47. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Decr calorie intake; decr calorie absorption;incr calorie demand
refuse

48. crying during urination. bacteriuria pyruria - rec episodes
TB - breastfeeding - asymptomatic hiv
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Imaging study to r/o VUR
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

49. contraindications of MMR vaccine
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Oral DMSA or EDTA IV
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

50. nuchal rigidity - fever - sore throat - headache - dioriented
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
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Atypical lymphocyte
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults