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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. TB prophylaxis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Fifth disease; febrile syndrome
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Vaso-occlusive crisis; dx hb electrophoresis

2. horner syndrom
>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
Wait until 6 months
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Injury to lower roots of brachial plexus

3. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Black
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. benefits of antibiotic therapy in acute pharyngitis?
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
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

5. aplasic crisis
36 hours
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
D for d; down syndrome and polyhydramnios

6. is local anesthetics be used in cellulitis to reduce pain
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Dx US tx; correct serum electrolyte - pyloromyotom

7. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Decreased UGT enzyme
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

8. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Diet modification to provide 110kc/kg/d
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
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

9. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

10. Neonatal unconjugated hyperbilirubine
Rapid detection of RSV antigen in nasl
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Decreased UGT enzyme
refuse

11. sublottic narrowing
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Congenital rubella syndrome
Croup tx cool mist; racemic epi - corticosteroid
T for t ; thalassemia; inc serum iron and Iron binding

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

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13. congenital adrenal hyperplasi
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No intervention; 90% foreign bodies pass without difficulty

14. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Brown
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

15. crying during urination. bacteriuria pyruria - rec episodes
Imaging study to r/o VUR
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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
Candidal diapar rash; tx clotrimazol

16. carditis and arthritis after rheumatic fever
T for t ; thalassemia; inc serum iron and Iron binding
Marfans - ehlers danlos - homocystinuria
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
Develops in 21 dasy

17. 3yo - never able to walk
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
Endocardial cushion defect (no separation between heart chambers)
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

18. when bact conjunctivitis patient can go back to school
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Oral DMSA or EDTA IV
After 24h of abx therapy
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

19. dx of lyme
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
Facial portwine stain
1.5%
Mainly clinical; serology with initial ELISA - with western blot confirmation;

20. cat scratch disease
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Pho for forward bending; forward defect; common finding has no adverse physical effect
Biliary atresia; tx surgery
Bartonella henselae; complication is suppuration of lymph node

21. defcicieny of 21 hydroxylase
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Increase of progesteron/17oh progesterone
Benign permature thelarche; expectant management
No reticulocyte vs high reticulocyte

22. How to differential bact vs viral conjunctivitis
Rapid detection of RSV antigen in nasl
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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
Wait until 6 months

23. acute otitis externa

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24. Tx of FTT
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Endocardial cushion defect (no separation between heart chambers)
Less than 5th percentile
Diet modification to provide 110kc/kg/d

25. 12y - obese - hip pain - hip ext rotated
After 6m; breast mild provides iron until 6m.
Pipercillin (zosyn) - ticarcillin
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

26. cleft lip but no cleft palate
Increase of progesteron/17oh progesterone
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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)

27. centor criteria for bact pharyngitis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Croup tx cool mist; racemic epi - corticosteroid
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

28. How to evaluate well appearing child just born in GBS pos mother?
Rapid detection of RSV antigen in nasl
Neurofibromatosis type2
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

29. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
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
Thalassemia - congenital hemolytic anemia
36 hours

30. language delay
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Increase of progesteron/17oh progesterone

31. When to bevioral and enviromental measure in led intoxication?
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Wait until 6 months
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

32. failure to thrive
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Less than 5th percentile
Constitutional pubertal delay

33. hypopigmented spots - family hx bilat deafness
Rapid detection of RSV antigen in nasl
Neurofibromatosis type2
Endocardial cushion defect (no separation between heart chambers)
Candidal diapar rash; tx clotrimazol

34. lead >70
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Medical emergency; dimercaprol/edta
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

35. iron supplement in child
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Fifth disease; febrile syndrome
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
After 6m; breast mild provides iron until 6m.

36. infant botulism
Constitutional pubertal delay
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Marfans - ehlers danlos - homocystinuria
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

37. Febrile seizure
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Increase of pregnenolone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

38. differentiate between central and peripheral precocious puberty
Candidal diapar rash; tx clotrimazol
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

39. red oozing rash on cheek - scaly - dry
No reticulocyte vs high reticulocyte
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Faciform RBC cause vascular occlusion

40. difference between diaper dermatitis and rash
Croup
Central isosexual precocious puberty; hypothalmaic hamartoma
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

41. kallman syndrome
refuse
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Biliary atresia; tx surgery
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

42. Neonatal conjugated hyperbilirubinemia
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Injury to b/l glossopharyngeal. present in botulism
Biliary atresia; tx surgery
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

43. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Bladder dysfunction; UTI and renal dysfunctoin
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Foreign body sensation - photophobia - corneal opacity tx abx

44. indications of audiometry in childrens
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Medical emergency; dimercaprol/edta
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
110 kcl/kg/day

45. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
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
To make hip flexed and abducted position in DDH
Faciform RBC cause vascular occlusion

46. penicillin effective against pseudomonas
Do HIV testing at first
Pipercillin (zosyn) - ticarcillin
Multiple telangiectesia - vasular lesion in CNS
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

47. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
D for d; down syndrome and polyhydramnios
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Do HIV testing at first

48. adenovirus
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
URI
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

49. echymoses with low platelet <30k
<2yrs - abd pain - diarrhoea - ARF
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Penicillin G 4h before delivery
Dx US tx; correct serum electrolyte - pyloromyotom

50. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Medical emergency; dimercaprol/edta
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