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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. adrenal tumor
Pho for forward bending; forward defect; common finding has no adverse physical effect
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Rapid detection of RSV antigen in nasl

2. How to dx RSV
No myoclonic activity in JME
Rapid detection of RSV antigen in nasl
T for t ; thalassemia; inc serum iron and Iron binding
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

3. the recommended ca supplementation
T for t ; thalassemia; inc serum iron and Iron binding
24h to 7d of birth
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Diet modification to provide 110kc/kg/d

4. cat scratch disease
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Bartonella henselae; complication is suppuration of lymph node
Imaging study to r/o VUR
Croup tx cool mist; racemic epi - corticosteroid

5. TTP pentad
Constitutional pubertal delay
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

6. language expectation from 2yo
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
14yrs

7. physiological jaundice
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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
After 24h of abx therapy
24h to 7d of birth

8. microcytic - hypochromic anemia - hepatospelnomegaly
Increase of progesteron/17oh progesterone
Thalassemia - congenital hemolytic anemia
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Absence seizure; tx ethosuximide

9. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
>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
Constitutional pubertal delay

10. tick transmits RMSF
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Absence seizure; tx ethosuximide
Black

11. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Strep pneumonie; moraxella; h influenze
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

12. How to dx keratitis?
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Brown
Foreign body sensation - photophobia - corneal opacity tx abx
refuse

13. viruses cause bronhioltitis
T for t ; thalassemia; inc serum iron and Iron binding
RSV - rhino and influenza
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Black

14. contraindications of MMR vaccine
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
No wheezing - no feever in chlamydia

15. the risk of lyme after bitten by a tick
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
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Dx US tx; correct serum electrolyte - pyloromyotom
1.5%

16. 3yo - never able to walk
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
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
Develops in 21 dasy
Less than 5th percentile

17. How long patient needs to be exposed to tick to get infected
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
After 6m; breast mild provides iron until 6m.
36 hours

18. How to dx post uretheral valve
Tx only symptomatic carrier
Medical emergency; dimercaprol/edta
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
RSV - rhino and influenza

19. echymoses with low platelet <30k
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Penicillin G 4h before delivery
Thalassemia - congenital hemolytic anemia
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

20. sturge weber syndrome
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Facial portwine stain
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

21. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Methylephenidate toxicity; cannot be stopped abruptly; taper

22. When to give hpv vaccien
Biliary atresia; tx surgery
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

23. What is the definition of delayed puberty?
ALL - alzheimers autism adhd depression seizure
Fifth disease; febrile syndrome
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

24. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

25. acute otitis media-pathogen
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Strep pneumonie; moraxella; h influenze
Marfans - ehlers danlos - homocystinuria
Develops in 21 dasy

26. Infant with serum billlirubin >25
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Risk of neurological dysfunction
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

27. cardiac manifestation of turner
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Vaso-occlusive crisis; dx hb electrophoresis
refuse

28. 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
Congenital rubella syndrome
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

29. complete airway obstruction with FB
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
>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
Marfans - ehlers danlos - homocystinuria

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

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31. Nocturnal enuresis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

32. language delay
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
refuse
Oral DMSA or EDTA IV
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

33. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Imaging study to r/o VUR
No wheezing - no feever in chlamydia
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

34. How to dx acute angle closure glaucoma
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Brown
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

35. causes of FTT
1.5%
Risk of neurological dysfunction
Dactylitis; 2nd common is splenic seqestration
Decr calorie intake; decr calorie absorption;incr calorie demand

36. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Yes; but it will be less effective
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

37. Tx of bact conjunctivitis
Benign permature thelarche; expectant management
Strep pneumonie; moraxella; h influenze
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

38. penicillin effective against pseudomonas
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Tx only symptomatic carrier
Injury to lower roots of brachial plexus
Pipercillin (zosyn) - ticarcillin

39. Tx of children constipation

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40. tick transmits lyme
Brown
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Marfans - ehlers danlos - homocystinuria
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

41. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Meconeum ileus; think about CF
Atopic dermatitis; strong allergic/immunologic component; incr IgE

42. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
>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
Risk of neurological dysfunction
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

43. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Constitutional pubertal delay

44. infant botulism
Increase of progesteron/17oh progesterone
Croup tx cool mist; racemic epi - corticosteroid
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Meconeum ileus; think about CF

45. major depression
Constitutional pubertal delay
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
No reticulocyte vs high reticulocyte
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

46. aplasic crisis
TB - breastfeeding - asymptomatic hiv
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Imaging study to r/o VUR
Yes; but it will be less effective

47. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Wait until 6 months
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Erb paralysis leading to diaphragmatic paralysis

48. benefits of antibiotic therapy in acute pharyngitis?
Risk of neurological dysfunction
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

49. impaired gag reflex
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to b/l glossopharyngeal. present in botulism
Female - breech delivery - family history; tx referral to ortho
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

50. How to differentiate croup vs epiglotitis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Dx US tx; correct serum electrolyte - pyloromyotom
URI
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y