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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. bromocriptine
Diet modification to provide 110kc/kg/d
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Prolactinoma

2. iron supplement in child
After 6m; breast mild provides iron until 6m.
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
110 kcl/kg/day

3. When to give hpv vaccien
Marfans - ehlers danlos - homocystinuria
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Atypical lymphocyte
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

4. What are the risk factors of developmental dysplais of hip
Croup
Female - breech delivery - family history; tx referral to ortho
24h to 7d of birth
Fifth disease; febrile syndrome

5. How to dx endopthalmitis
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
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
36 hours
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

6. When to give HRT in turner
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
<2yrs - abd pain - diarrhoea - ARF
Neurofibromatosis type2
14yrs

7. How to difference RSV and neonatal chlamydia
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Increase of progesteron/17oh progesterone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No wheezing - no feever in chlamydia

8. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
After 24h of abx therapy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Candidal diapar rash; tx clotrimazol
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

9. How to differentiate croup vs epiglotitis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
No wheezing - no feever in chlamydia

10. When to bevioral and enviromental measure in led intoxication?
Marfans - ehlers danlos - homocystinuria
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
RSV - rhino and influenza
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

11. Neonatal unconjugated hyperbilirubine
Decreased UGT enzyme
Erb paralysis leading to diaphragmatic paralysis
36 hours
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

12. How to dx RSV
Rapid detection of RSV antigen in nasl
Wait until 6 months
Risk of neurological dysfunction
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

13. is local anesthetics be used in cellulitis to reduce pain
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Absence seizure; tx ethosuximide
No myoclonic activity in JME
No reticulocyte vs high reticulocyte

14. viruses cause bronhioltitis
RSV - rhino and influenza
Atopic dermatitis; strong allergic/immunologic component; incr IgE
ALL - alzheimers autism adhd depression seizure
HSP - look for symmetric skin lesions

15. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Atypical lymphocyte
Croup
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

16. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

17. acute otitis externa

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18. How long anti-TB drugs given for TB meningitis?
Facial portwine stain
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

19. the recommended ca supplementation
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Faciform RBC cause vascular occlusion
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

20. cat scratch disease
36 hours
Bartonella henselae; complication is suppuration of lymph node
Increase of progesteron/17oh progesterone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

21. doing worse in school - lack of attention - starring speel
Foreign body sensation - photophobia - corneal opacity tx abx
Decreased UGT enzyme
Absence seizure; tx ethosuximide
Prolactinoma

22. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and 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

23. penicillin effective against pseudomonas
1.5%
Pipercillin (zosyn) - ticarcillin
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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

24. giardiasis
110 kcl/kg/day
Tx only symptomatic carrier
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

25. difference between structural disorder and flexible kyphosis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Endocardial cushion defect (no separation between heart chambers)
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

26. How to prevent GBS in neonate
14yrs
Erb paralysis leading to diaphragmatic paralysis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Penicillin G 4h before delivery

27. pavlik harness
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
24h to 7d of birth
To make hip flexed and abducted position in DDH

28. lead >70
Medical emergency; dimercaprol/edta
Less than 5th percentile
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

29. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Injury to lower roots of brachial plexus
Decreased UGT enzyme
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

30. When to do aortic root surgery in marfans to prevent dissection?
Increase of progesteron/17oh progesterone
Mainly clinical; serology with initial ELISA - with western blot confirmation;
If aortic root reaches 45 mm
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

31. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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)
Faciform RBC cause vascular occlusion

32. splenic infarction in sickle cell
Medical emergency; dimercaprol/edta
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
refuse
Faciform RBC cause vascular occlusion

33. How to differential bact vs viral conjunctivitis
If aortic root reaches 45 mm
No myoclonic activity in JME
Faciform RBC cause vascular occlusion
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

34. mech of botulism
Pipercillin (zosyn) - ticarcillin
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Decr calorie intake; decr calorie absorption;incr calorie demand

35. pumonary TB
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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)
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

36. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
refuse
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

37. acute otitis media-pathogen
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Croup tx cool mist; racemic epi - corticosteroid
Strep pneumonie; moraxella; h influenze

38. adenovirus
Neurofibromatosis type2
Develops in 21 dasy
Atypical lymphocyte
URI

39. causes of FTT
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

40. cardiac manifestation of turner
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Prolactinoma
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Dactylitis; 2nd common is splenic seqestration

41. impaired gag reflex
Multiple telangiectesia - vasular lesion in CNS
Injury to b/l glossopharyngeal. present in botulism
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Atypical lymphocyte

42. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
D for d; down syndrome and polyhydramnios

43. deficinecy of 17 hydroxylase
Bladder dysfunction; UTI and renal dysfunctoin
Increase of pregnenolone
Vaso-occlusive crisis; dx hb electrophoresis
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. causes of FTT
Neurofibromatosis type2
Decr calorie intake; decr calorie absorption;incr calorie demand
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
After 6m; breast mild provides iron until 6m.

45. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Croup tx cool mist; racemic epi - corticosteroid
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

46. the risk of lyme after bitten by a tick
1.5%
Dx US tx; correct serum electrolyte - pyloromyotom
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

47. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
After 6m; breast mild provides iron until 6m.

48. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Methylephenidate toxicity; cannot be stopped abruptly; taper
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Marfans - ehlers danlos - homocystinuria

49. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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

50. Infant with serum billlirubin >25
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Risk of neurological dysfunction
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
No; they are basic compound will be neutralized in an acidic environment of cellulitis