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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. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
After 24h of abx therapy

2. acute otitis externa

3. is local anesthetics be used in cellulitis to reduce pain
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

4. When to bevioral and enviromental measure in led intoxication?
URI
Thalassemia - congenital hemolytic anemia
No; they are basic compound will be neutralized in an acidic environment of cellulitis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

5. nuchal rigidity - fever - sore throat - headache - dioriented
Tx only symptomatic carrier
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Endocardial cushion defect (no separation between heart chambers)
Decreases height - expensive; reserved for severe cases of delayed puberty

6. adrenal tumor
Dx US tx; correct serum electrolyte - pyloromyotom
refuse
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
T for t ; thalassemia; inc serum iron and Iron binding

7. Tx of community acquired pneumonia
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Wait until 6 months
Oral DMSA or EDTA IV

8. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
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

9. physiological jaundice
24-72 hours
24h to 7d of birth
Benign permature thelarche; expectant management
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

10. sudden onset of fever - difficulty in breathing
36 hours
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

11. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No wheezing - no feever in chlamydia
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

12. mech of botulism
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
Imaging study to r/o VUR
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

13. IM
Injury to b/l glossopharyngeal. present in botulism
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Dactylitis; 2nd common is splenic seqestration
Atypical lymphocyte

14. giardiasis
Tx only symptomatic carrier
After 24h of abx therapy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

15. impaired gag reflex
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Injury to b/l glossopharyngeal. present in botulism
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

16. non immune pregnant women exposed to rubella in first trimester
Do HIV testing at first
Congenital rubella syndrome
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

17. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Faciform RBC cause vascular occlusion

18. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Prolactinoma
Increase of progesteron/17oh progesterone

19. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Candidal diapar rash; tx clotrimazol
36 hours
Tx only symptomatic carrier

20. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

21. lead 44-70
No myoclonic activity in JME
Oral DMSA or EDTA IV
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

22. Infant with serum billlirubin >25
Risk of neurological dysfunction
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
To make hip flexed and abducted position in DDH
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

23. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Black
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
Wait until 6 months

24. Tx of FTT
Diet modification to provide 110kc/kg/d
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
1.5%

25. patient with white plaques in mouth and lump in back
Constitutional pubertal delay
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Do HIV testing at first

26. acute abd pain - hx URI - lower extremity maculo papular rash
Decr calorie intake; decr calorie absorption;incr calorie demand
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
HSP - look for symmetric skin lesions
Vaso-occlusive crisis; dx hb electrophoresis

27. tick transmits lyme
Brown
110 kcl/kg/day
Increase of progesteron/17oh progesterone
<2yrs - abd pain - diarrhoea - ARF

28. How to evaluate well appearing child just born in GBS pos mother?
Strep pneumonie; moraxella; h influenze
>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
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

29. tick transmits RMSF
Black
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Biliary atresia; tx surgery
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

30. adenovirus
Injury to lower roots of brachial plexus
URI
Develops in 21 dasy
Less than 5th percentile

31. TB prophylaxis
Brown
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
INH 9m if INH resistant rifampin 6m in children and 4m in adults

32. contraindications of MMR vaccine
ALL - alzheimers autism adhd depression seizure
Facial portwine stain
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

33. complete airway obstruction with FB
After 6m; breast mild provides iron until 6m.
>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
No wheezing - no feever in chlamydia
Dactylitis; 2nd common is splenic seqestration

34. osler rendu weber syndrom
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Multiple telangiectesia - vasular lesion in CNS
T for t ; thalassemia; inc serum iron and Iron binding
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

35. coin in child's stomach
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
110 kcl/kg/day
No intervention; 90% foreign bodies pass without difficulty
Penicillin G 4h before delivery

36. How to dx post uretheral valve
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Foreign body sensation - photophobia - corneal opacity tx abx
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

37. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Injury to lower roots of brachial plexus
Meconeum ileus; think about CF
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

38. language delay
Penicillin G 4h before delivery
Develops in 21 dasy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

39. splenic infarction in sickle cell
Yes; but it will be less effective
Faciform RBC cause vascular occlusion
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
No reticulocyte vs high reticulocyte

40. indications of audiometry in childrens
After 6m; breast mild provides iron until 6m.
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
24-72 hours

41. how thalassemia die
Female - breech delivery - family history; tx referral to ortho
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

42. difference between structural disorder and flexible kyphosis
Erb paralysis leading to diaphragmatic paralysis
Decr calorie intake; decr calorie absorption;incr calorie demand
Dx US tx; correct serum electrolyte - pyloromyotom
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

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

44. differentiate between central and peripheral precocious puberty
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

45. down syndrome with holocystolic mumur
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Endocardial cushion defect (no separation between heart chambers)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
110 kcl/kg/day

46. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
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

47. duodenal atresia
Oral DMSA or EDTA IV
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
D for d; down syndrome and polyhydramnios
24-72 hours

48. 18mo bilat breast enlargment - some pubic hair
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Benign permature thelarche; expectant management
After 24h of abx therapy
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

49. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Methylephenidate toxicity; cannot be stopped abruptly; taper
Prolactinoma
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

50. causes of FTT
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Do HIV testing at first