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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. sudden onset of fever - difficulty in breathing
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Increase of progesteron/17oh progesterone
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

2. cardiac manifestation of turner
Female - breech delivery - family history; tx referral to ortho
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Croup tx cool mist; racemic epi - corticosteroid
Penicillin G 4h before delivery

3. Tx of children constipation

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4. sturge weber syndrome
ALL - alzheimers autism adhd depression seizure
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Facial portwine stain
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

5. causes of FTT
No intervention; 90% foreign bodies pass without difficulty
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
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

6. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
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
Risk of neurological dysfunction
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

7. duodenal atresia
D for d; down syndrome and polyhydramnios
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Injury to lower roots of brachial plexus
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

8. differentiate between central and peripheral precocious puberty
Marfans - ehlers danlos - homocystinuria
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Croup
Decr calorie intake; decr calorie absorption;incr calorie demand

9. acute abd pain - hx URI - lower extremity maculo papular rash
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
14yrs
HSP - look for symmetric skin lesions
D for d; down syndrome and polyhydramnios

10. how smoking contributes otitis media in children
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
After 24h of abx therapy

11. mcCune albright`
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Foreign body sensation - photophobia - corneal opacity tx abx
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

12. what conditions are not contraindicated
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
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
TB - breastfeeding - asymptomatic hiv

13. difference between diaper dermatitis and rash
Methylephenidate toxicity; cannot be stopped abruptly; taper
Fifth disease; febrile syndrome
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

14. acute otitis externa

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15. IM
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Pipercillin (zosyn) - ticarcillin
Atypical lymphocyte
Less than 5th percentile

16. How to investigate delayed puberty
Increase of pregnenolone
Benign permature thelarche; expectant management
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Wait until 6 months

17. low grade fever - cough - diffuse bilat ground glass opacities
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Atopic dermatitis; strong allergic/immunologic component; incr IgE

18. When to give hpv vaccien
Develops in 21 dasy
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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
No reticulocyte vs high reticulocyte

19. 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)
Vaso-occlusive crisis; dx hb electrophoresis
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
After 6m; breast mild provides iron until 6m.

20. mech of botulism
Methylephenidate toxicity; cannot be stopped abruptly; taper
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

21. non immune pregnant women exposed to rubella in first trimester
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Congenital rubella syndrome
URI

22. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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)
Croup
Wait until 6 months

23. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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
Meconeum ileus; think about CF
If aortic root reaches 45 mm

24. nuchal rigidity - fever - sore throat - headache - dioriented
TB - breastfeeding - asymptomatic hiv
refuse
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
URI

25. deficinecy of 17 hydroxylase
No intervention; 90% foreign bodies pass without difficulty
Increase of pregnenolone
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Biliary atresia; tx surgery

26. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Rapid detection of RSV antigen in nasl

27. contraindications of MMR vaccine
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Injury to b/l glossopharyngeal. present in botulism

28. target cell
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
No wheezing - no feever in chlamydia
T for t ; thalassemia; inc serum iron and Iron binding
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

29. How to dx acute angle closure glaucoma
Vaso-occlusive crisis; dx hb electrophoresis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

30. kallman syndrome
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Injury to lower roots of brachial plexus
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

31. doing worse in school - lack of attention - starring speel
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
14yrs
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Absence seizure; tx ethosuximide

32. Parvovirus
Fifth disease; febrile syndrome
Medical emergency; dimercaprol/edta
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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

33. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
No intervention; 90% foreign bodies pass without difficulty
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Diet modification to provide 110kc/kg/d

34. lens dislocation
Pipercillin (zosyn) - ticarcillin
Marfans - ehlers danlos - homocystinuria
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Foreign body sensation - photophobia - corneal opacity tx abx

35. When to do aortic root surgery in marfans to prevent dissection?
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
If aortic root reaches 45 mm
Rapid detection of RSV antigen in nasl
Decr calorie intake; decr calorie absorption;incr calorie demand

36. how thalassemia die
Vaso-occlusive crisis; dx hb electrophoresis
Yes; but it will be less effective
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

37. Infant with serum billlirubin >25
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Risk of neurological dysfunction
RSV - rhino and influenza

38. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

39. 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
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
Penicillin G 4h before delivery
>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

40. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Tx only symptomatic carrier
After 6m; breast mild provides iron until 6m.
TB - breastfeeding - asymptomatic hiv

41. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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
Congenital rubella syndrome
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

42. 21 hydroxylase
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
HSP - look for symmetric skin lesions
Bladder dysfunction; UTI and renal dysfunctoin
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

43. centor criteria for bact pharyngitis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

44. contact lens keratitis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Croup
Thalassemia - congenital hemolytic anemia
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

45. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Rapid detection of RSV antigen in nasl
After 6m; breast mild provides iron until 6m.
Methylephenidate toxicity; cannot be stopped abruptly; taper

46. bromocriptine
Thalassemia - congenital hemolytic anemia
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Prolactinoma

47. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Prolactinoma
Faciform RBC cause vascular occlusion
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

48. tick transmits lyme
Brown
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Congenital rubella syndrome

49. Tx of FTT
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Diet modification to provide 110kc/kg/d
Pho for forward bending; forward defect; common finding has no adverse physical effect
Develops in 21 dasy

50. congenital adrenal hyperplasi
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace