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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. dx for turner
24-72 hours
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

2. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
24-72 hours
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Absence seizure; tx ethosuximide

3. coin in child's stomach
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
No wheezing - no feever in chlamydia
No intervention; 90% foreign bodies pass without difficulty
<2yrs - abd pain - diarrhoea - ARF

4. deficinecy of 17 hydroxylase
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Increase of pregnenolone
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
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

5. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Wait until 6 months
Marfans - ehlers danlos - homocystinuria
24h to 7d of birth

6. 12y - obese - hip pain - hip ext rotated
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

7. How to dx endopthalmitis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
24h to 7d of birth
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

8. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
If aortic root reaches 45 mm
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

9. defcicieny of 21 hydroxylase
D for d; down syndrome and polyhydramnios
Rapid detection of RSV antigen in nasl
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Increase of progesteron/17oh progesterone

10. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

11. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Increase of progesteron/17oh progesterone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

12. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

13. hypopigmented spots - family hx bilat deafness
Injury to b/l glossopharyngeal. present in botulism
Neurofibromatosis type2
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Female - breech delivery - family history; tx referral to ortho

14. How to differentiate caput succedanueum and cephalohematoma
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Foreign body sensation - photophobia - corneal opacity tx abx
Fifth disease; febrile syndrome

15. indications of audiometry in childrens
Increase of pregnenolone
Erb paralysis leading to diaphragmatic paralysis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

16. Febrile seizure
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
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Central isosexual precocious puberty; hypothalmaic hamartoma

17. cardiac manifestation of turner
Increase of progesteron/17oh progesterone
TB - breastfeeding - asymptomatic hiv
After 24h of abx therapy
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

18. congenital adrenal hyperplasi
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Penicillin G 4h before delivery

19. How to difference viral and bact pneumonia
Herpes
Meconeum ileus; think about CF
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Neurofibromatosis type2

20. When to bevioral and enviromental measure in led intoxication?
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)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Benign permature thelarche; expectant management
Constitutional pubertal delay

21. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Pipercillin (zosyn) - ticarcillin
Central isosexual precocious puberty; hypothalmaic hamartoma
24-72 hours
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

22. differentiate between central and peripheral precocious puberty
24-72 hours
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-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Absence seizure; tx ethosuximide

23. mech of botulism
Biliary atresia; tx surgery
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
36 hours

24. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Absence seizure; tx ethosuximide
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

25. difference between diaper dermatitis and rash
Herpes
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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

26. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
36 hours
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

27. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Croup
Rapid detection of RSV antigen in nasl
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Lateral neck xray in epiglottitis show swollen epiglottis

28. HUS
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
<2yrs - abd pain - diarrhoea - ARF
Absence seizure; tx ethosuximide
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

29. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Injury to b/l glossopharyngeal. present in botulism
Congenital rubella syndrome
T for t ; thalassemia; inc serum iron and Iron binding
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

30. 21 hydroxylase
refuse
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
T for t ; thalassemia; inc serum iron and Iron binding

31. lead 44-70
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Oral DMSA or EDTA IV
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Multiple telangiectesia - vasular lesion in CNS

32. carditis and arthritis after rheumatic fever
Wait until 6 months
24h to 7d of birth
Develops in 21 dasy
Methylephenidate toxicity; cannot be stopped abruptly; taper

33. tick transmits lyme
Increase of pregnenolone
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Rapid detection of RSV antigen in nasl
Brown

34. acute otitis externa

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35. language delay
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Increase of progesteron/17oh progesterone
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Congenital rubella syndrome

36. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Bartonella henselae; complication is suppuration of lymph node
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

37. crying during urination. bacteriuria pyruria - rec episodes
110 kcl/kg/day
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Erb paralysis leading to diaphragmatic paralysis
Imaging study to r/o VUR

38. what conditions are not contraindicated
Injury to b/l glossopharyngeal. present in botulism
1.5%
TB - breastfeeding - asymptomatic hiv
No myoclonic activity in JME

39. the risk of lyme after bitten by a tick
Benign permature thelarche; expectant management
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Endocardial cushion defect (no separation between heart chambers)
1.5%

40. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Meconeum ileus; think about CF
Decr calorie intake; decr calorie absorption;incr calorie demand

41. tzanck
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Herpes
Foreign body sensation - photophobia - corneal opacity tx abx

42. flexible kyphosis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Pho for forward bending; forward defect; common finding has no adverse physical effect
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Decreased UGT enzyme

43. can women with abnormal smear or genital get vaccine
Decreases height - expensive; reserved for severe cases of delayed puberty
To make hip flexed and abducted position in DDH
Yes; but it will be less effective
Develops in 21 dasy

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

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45. Tx of botulism
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

46. down syndrome with holocystolic mumur
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)
Benign permature thelarche; expectant management
Endocardial cushion defect (no separation between heart chambers)
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

47. failure to thrive
Yes; but it will be less effective
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Increase of progesteron/17oh progesterone
Less than 5th percentile

48. physiological jaundice
24h to 7d of birth
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Dx US tx; correct serum electrolyte - pyloromyotom
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

49. causes of FTT
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
ALL - alzheimers autism adhd depression seizure
Decr calorie intake; decr calorie absorption;incr calorie demand
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

50. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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
Rapid detection of RSV antigen in nasl