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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. crying during urination. bacteriuria pyruria - rec episodes
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Diet modification to provide 110kc/kg/d
Imaging study to r/o VUR
Dactylitis; 2nd common is splenic seqestration

2. 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
14yrs
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

3. non immune pregnant women exposed to rubella in first trimester
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Rapid detection of RSV antigen in nasl
Congenital rubella syndrome
Lateral neck xray in epiglottitis show swollen epiglottis

4. HUS
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
1.5%
No intervention; 90% foreign bodies pass without difficulty
<2yrs - abd pain - diarrhoea - ARF

5. microcytic - hypochromic anemia - hepatospelnomegaly
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Thalassemia - congenital hemolytic anemia
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

6. How to difference RSV and neonatal chlamydia
Bartonella henselae; complication is suppuration of lymph node
No wheezing - no feever in chlamydia
After 6m; breast mild provides iron until 6m.
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

7. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
If aortic root reaches 45 mm
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

8. How to dx acute angle closure glaucoma
Black
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)
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

9. duodenal atresia
ALL - alzheimers autism adhd depression seizure
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
D for d; down syndrome and polyhydramnios

10. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

11. Tx of bact conjunctivitis
No myoclonic activity in JME
Increase of progesteron/17oh progesterone
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

12. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Congenital rubella syndrome
Medical emergency; dimercaprol/edta
Methylephenidate toxicity; cannot be stopped abruptly; taper

13. causes of acute anemia
No myoclonic activity in JME
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Atypical lymphocyte
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

14. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
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
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
Between pregnenolone and 17oh pregnenolone

15. defcicieny of 21 hydroxylase
No wheezing - no feever in chlamydia
Increase of progesteron/17oh progesterone
Congenital rubella syndrome
Injury to lower roots of brachial plexus

16. dx for turner
Wait until 6 months
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Diet modification to provide 110kc/kg/d
Injury to lower roots of brachial plexus

17. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
<2yrs - abd pain - diarrhoea - ARF
Erb paralysis leading to diaphragmatic paralysis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No myoclonic activity in JME

18. language expectation from 2yo
<2yrs - abd pain - diarrhoea - ARF
RSV - rhino and influenza
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

19. acute otitis externa

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20. How long patient needs to be exposed to tick to get infected
Develops in 21 dasy
<2yrs - abd pain - diarrhoea - ARF
36 hours
Dactylitis; 2nd common is splenic seqestration

21. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
24-72 hours
Marfans - ehlers danlos - homocystinuria
Foreign body sensation - photophobia - corneal opacity tx abx

22. down syndrome with holocystolic mumur
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Candidal diapar rash; tx clotrimazol
Endocardial cushion defect (no separation between heart chambers)
After 6m; breast mild provides iron until 6m.

23. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Meconeum ileus; think about CF
Lateral neck xray in epiglottitis show swollen epiglottis

24. doing worse in school - lack of attention - starring speel
Absence seizure; tx ethosuximide
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Constitutional pubertal delay
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

25. What is the definition of delayed puberty?
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Less than 5th percentile
Develops in 21 dasy

26. failure to thrive
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Less than 5th percentile
Imaging study to r/o VUR
Vaso-occlusive crisis; dx hb electrophoresis

27. pneumonia in CF patient
Wait until 6 months
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
24-72 hours
Injury to b/l glossopharyngeal. present in botulism

28. side effect of testosteron therapy
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Faciform RBC cause vascular occlusion
Facial portwine stain
Decreases height - expensive; reserved for severe cases of delayed puberty

29. acute otitis media-pathogen
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
URI
36 hours
Strep pneumonie; moraxella; h influenze

30. centor criteria for bact pharyngitis
Female - breech delivery - family history; tx referral to ortho
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

31. 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)
Endocardial cushion defect (no separation between heart chambers)
ALL - alzheimers autism adhd depression seizure
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

32. How to differentiate croup vs epiglotitis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

33. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Neurofibromatosis type2
Croup tx cool mist; racemic epi - corticosteroid
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

34. lens dislocation
No intervention; 90% foreign bodies pass without difficulty
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Rapid detection of RSV antigen in nasl
Marfans - ehlers danlos - homocystinuria

35. How to difference viral and bact pneumonia
24h to 7d of birth
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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
110 kcl/kg/day

36. When to do surgery for undescended testes
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
To make hip flexed and abducted position in DDH
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Wait until 6 months

37. most common complication of otitis media
1.5%
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
24h to 7d of birth

38. lead >70
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Thalassemia - congenital hemolytic anemia
Medical emergency; dimercaprol/edta

39. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
36 hours

40. Parents can _____ vaccine
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Absence seizure; tx ethosuximide
Injury to b/l glossopharyngeal. present in botulism
refuse

41. Nocturnal enuresis
Meconeum ileus; think about CF
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

42. can women with abnormal smear or genital get vaccine
110 kcl/kg/day
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Yes; but it will be less effective
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

43. Febrile seizure
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

44. indications of audiometry in childrens
Fifth disease; febrile syndrome
Central isosexual precocious puberty; hypothalmaic hamartoma
Diet modification to provide 110kc/kg/d
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

45. How to evaluate well appearing child just born in GBS pos mother?
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

46. complete airway obstruction with FB
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
>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
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

47. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

48. Parvovirus
Fifth disease; febrile syndrome
Diet modification to provide 110kc/kg/d
refuse
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

49. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

50. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Prolactinoma
Wait until 6 months
No intervention; 90% foreign bodies pass without difficulty