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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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Biliary atresia; tx surgery
To make hip flexed and abducted position in DDH
Rapid detection of RSV antigen in nasl

2. acute abd pain - hx URI - lower extremity maculo papular rash
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Dx US tx; correct serum electrolyte - pyloromyotom
HSP - look for symmetric skin lesions

3. How to dx RSV
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Bartonella henselae; complication is suppuration of lymph node
Female - breech delivery - family history; tx referral to ortho
Rapid detection of RSV antigen in nasl

4. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Black
Herpes
To make hip flexed and abducted position in DDH

5. cat scratch disease
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Bartonella henselae; complication is suppuration of lymph node

6. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Decr calorie intake; decr calorie absorption;incr calorie demand
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Atopic dermatitis; strong allergic/immunologic component; incr IgE

7. When to do surgery for undescended testes
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Medical emergency; dimercaprol/edta
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Wait until 6 months

8. Tx of children constipation

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9. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
110 kcl/kg/day
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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
Injury to lower roots of brachial plexus

10. How long patient needs to be exposed to tick to get infected
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
36 hours
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

11. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Fifth disease; febrile syndrome
URI

12. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
refuse
Strep pneumonie; moraxella; h influenze

13. aplasic crisis
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
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
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

14. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Central isosexual precocious puberty; hypothalmaic hamartoma
Methylephenidate toxicity; cannot be stopped abruptly; taper
Bladder dysfunction; UTI and renal dysfunctoin
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

15. dx for DDH
>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
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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

16. decreased mobility of tympanic membrane after otitis media
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
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Atypical lymphocyte

17. Parvovirus
Fifth disease; febrile syndrome
To make hip flexed and abducted position in DDH
Marfans - ehlers danlos - homocystinuria
URI

18. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Vaso-occlusive crisis; dx hb electrophoresis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

19. Infant with serum billlirubin >25
Facial portwine stain
Female - breech delivery - family history; tx referral to ortho
Risk of neurological dysfunction
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

20. When to give hpv vaccien
Meconeum ileus; think about CF
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
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

21. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Strep pneumonie; moraxella; h influenze
Congenital rubella syndrome
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

22. What is earliest sign of puberty?
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No myoclonic activity in JME
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Risk of neurological dysfunction

23. What is thumbprint sign
Vaso-occlusive crisis; dx hb electrophoresis
Yes; but it will be less effective
Bladder dysfunction; UTI and renal dysfunctoin
Lateral neck xray in epiglottitis show swollen epiglottis

24. How to prevent GBS in neonate
Black
Penicillin G 4h before delivery
No reticulocyte vs high reticulocyte
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

25. sickle cell with symmetrical swelling of hands and feet
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Imaging study to r/o VUR
Risk of neurological dysfunction
Vaso-occlusive crisis; dx hb electrophoresis

26. 21 hydroxylase
Biliary atresia; tx surgery
TB - breastfeeding - asymptomatic hiv
Bladder dysfunction; UTI and renal dysfunctoin
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

27. What are the risk factors of developmental dysplais of hip
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
D for d; down syndrome and polyhydramnios
Tx only symptomatic carrier
Female - breech delivery - family history; tx referral to ortho

28. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Atypical lymphocyte
24h to 7d of birth

29. nuchal rigidity - fever - sore throat - headache - dioriented
Decreases height - expensive; reserved for severe cases of delayed puberty
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Do HIV testing at first

30. How to dx endopthalmitis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
ALL - alzheimers autism adhd depression seizure
Yes; but it will be less effective

31. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
110 kcl/kg/day

32. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Central isosexual precocious puberty; hypothalmaic hamartoma

33. cardiac manifestation of turner
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
14yrs
Methylephenidate toxicity; cannot be stopped abruptly; taper
Croup tx cool mist; racemic epi - corticosteroid

34. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Do HIV testing at first
Meconeum ileus; think about CF
T for t ; thalassemia; inc serum iron and Iron binding

35. the risk of lyme after bitten by a tick
1.5%
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

36. how smoking contributes otitis media in children
Risk of neurological dysfunction
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

37. indications of audiometry in childrens
Herpes
Increase of progesteron/17oh progesterone
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
To make hip flexed and abducted position in DDH

38. complete airway obstruction with FB
No reticulocyte vs high reticulocyte
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
>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
Faciform RBC cause vascular occlusion

39. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
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
Black
36 hours

40. impaired gag reflex
Benign permature thelarche; expectant management
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Injury to b/l glossopharyngeal. present in botulism
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

41. down syndrome with holocystolic mumur
Injury to b/l glossopharyngeal. present in botulism
Tx only symptomatic carrier
Yes; but it will be less effective
Endocardial cushion defect (no separation between heart chambers)

42. when bact conjunctivitis patient can go back to school
Increase of pregnenolone
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
After 24h of abx therapy
Prolactinoma

43. adrenal tumor
24h to 7d of birth
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

44. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
<2yrs - abd pain - diarrhoea - ARF
Lateral neck xray in epiglottitis show swollen epiglottis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Decreases height - expensive; reserved for severe cases of delayed puberty

45. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
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

46. mech of botulism
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Constitutional pubertal delay
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

47. 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)
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Black

48. How to dx post uretheral valve
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Yes; but it will be less effective

49. dx for turner
RSV - rhino and influenza
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Dactylitis; 2nd common is splenic seqestration

50. acute otitis media-pathogen
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Biliary atresia; tx surgery
Strep pneumonie; moraxella; h influenze
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection