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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. When erythema chronicum migrans develops after tick bite
Prolactinoma
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
24-72 hours
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

2. horner syndrom
Injury to lower roots of brachial plexus
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

3. difference between rubeola (measles) and rulbella
Injury to lower roots of brachial plexus
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
D for d; down syndrome and polyhydramnios
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

4. contraindications of MMR vaccine
Female - breech delivery - family history; tx referral to ortho
Risk of neurological dysfunction
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Decr calorie intake; decr calorie absorption;incr calorie demand

5. spitting up - vomiting at night - weight stable
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Central isosexual precocious puberty; hypothalmaic hamartoma
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

6. How long patient needs to be exposed to tick to get infected
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
36 hours
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
ALL - alzheimers autism adhd depression seizure

7. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Candidal diapar rash; tx clotrimazol
Fifth disease; febrile syndrome

8. language expectation from 2yo
Female - breech delivery - family history; tx referral to ortho
Prolactinoma
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

9. the recommended ca supplementation
Facial portwine stain
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

10. benefits of antibiotic therapy in acute pharyngitis?
Wait until 6 months
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Tx only symptomatic carrier

11. What is the definition of delayed puberty?
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Herpes
refuse
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

12. Parents can _____ vaccine
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
refuse

13. down syndrome has inreased risk of developing
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Less than 5th percentile
ALL - alzheimers autism adhd depression seizure
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

14. Tx of children constipation

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15. starring spells 10-20sec
Multiple telangiectesia - vasular lesion in CNS
D for d; down syndrome and polyhydramnios
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Faciform RBC cause vascular occlusion

16. cleft lip but no cleft palate
Facial portwine stain
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
HSP - look for symmetric skin lesions
Absence seizure; tx ethosuximide

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

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18. pavlik harness
To make hip flexed and abducted position in DDH
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Methylephenidate toxicity; cannot be stopped abruptly; taper
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

19. How to dx keratitis?
Bladder dysfunction; UTI and renal dysfunctoin
No reticulocyte vs high reticulocyte
No myoclonic activity in JME
Foreign body sensation - photophobia - corneal opacity tx abx

20. adenovirus
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
URI
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

21. When to give hpv vaccien
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
Atypical lymphocyte
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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)

22. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Diet modification to provide 110kc/kg/d
Increase of progesteron/17oh progesterone

23. indications of VUR
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Multiple telangiectesia - vasular lesion in CNS
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Bladder dysfunction; UTI and renal dysfunctoin

24. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Diet modification to provide 110kc/kg/d
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
RSV - rhino and influenza
36 hours

25. 21 hydroxylase
refuse
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Strep pneumonie; moraxella; h influenze
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

26. association with infantile pyloric stenosis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Female - breech delivery - family history; tx referral to ortho
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

27. How to differentiate croup vs epiglotitis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

28. osler rendu weber syndrom
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Facial portwine stain
Multiple telangiectesia - vasular lesion in CNS

29. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Facial portwine stain
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

30. how thalassemia die
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Increase of pregnenolone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

31. dx of lyme
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
>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
Mainly clinical; serology with initial ELISA - with western blot confirmation;
No; they are basic compound will be neutralized in an acidic environment of cellulitis

32. What is earliest sign of puberty?
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Bartonella henselae; complication is suppuration of lymph node
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
If aortic root reaches 45 mm

33. Infant with serum billlirubin >25
Risk of neurological dysfunction
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
HSP - look for symmetric skin lesions

34. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Facial portwine stain
Atypical lymphocyte
36 hours

35. Tx of bact conjunctivitis
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

36. target cell
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
T for t ; thalassemia; inc serum iron and Iron binding
Congenital rubella syndrome
Black

37. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

38. HUS
Black
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
Dactylitis; 2nd common is splenic seqestration

39. tzanck
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Multiple telangiectesia - vasular lesion in CNS
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Herpes

40. TTP pentad
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

41. complete airway obstruction with FB
Croup
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
>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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

42. When to do aortic root surgery in marfans to prevent dissection?
No; they are basic compound will be neutralized in an acidic environment of cellulitis
RSV - rhino and influenza
Pipercillin (zosyn) - ticarcillin
If aortic root reaches 45 mm

43. iron supplement in child
After 6m; breast mild provides iron until 6m.
Black
Oral DMSA or EDTA IV
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

44. pumonary TB
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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)
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

45. low grade fever - cough - diffuse bilat ground glass opacities
Decreases height - expensive; reserved for severe cases of delayed puberty
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Oral DMSA or EDTA IV
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

46. When to give HRT in turner
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
After 24h of abx therapy
14yrs
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

47. difference between diaper dermatitis and rash
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
24-72 hours
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
D for d; down syndrome and polyhydramnios

48. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

49. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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
To make hip flexed and abducted position in DDH
Bartonella henselae; complication is suppuration of lymph node

50. carditis and arthritis after rheumatic fever
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
ALL - alzheimers autism adhd depression seizure
Develops in 21 dasy