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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. lens dislocation
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Marfans - ehlers danlos - homocystinuria
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

2. language delay
No intervention; 90% foreign bodies pass without difficulty
14yrs
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
<2yrs - abd pain - diarrhoea - ARF

3. indications of audiometry in childrens
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
HSP - look for symmetric skin lesions
Meconeum ileus; think about CF

4. causes of acute anemia
No intervention; 90% foreign bodies pass without difficulty
Rapid detection of RSV antigen in nasl
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

5. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
To make hip flexed and abducted position in DDH
ALL - alzheimers autism adhd depression seizure
Injury to lower roots of brachial plexus

6. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Methylephenidate toxicity; cannot be stopped abruptly; taper
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Herpes

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

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8. 17 alpha hydroxylase
Decreases height - expensive; reserved for severe cases of delayed puberty
Between pregnenolone and 17oh pregnenolone
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
Do HIV testing at first

9. is local anesthetics be used in cellulitis to reduce pain
1.5%
Wait until 6 months
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No; they are basic compound will be neutralized in an acidic environment of cellulitis

10. Infant with serum billlirubin >25
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Risk of neurological dysfunction
Biliary atresia; tx surgery
<2yrs - abd pain - diarrhoea - ARF

11. difference between diaper dermatitis and rash
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Less than 5th percentile
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
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

12. deficinecy of 17 hydroxylase
Increase of pregnenolone
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Biliary atresia; tx surgery

13. When to give HRT in turner
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
14yrs
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

14. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Foreign body sensation - photophobia - corneal opacity tx abx
Faciform RBC cause vascular occlusion
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

15. osler rendu weber syndrom
URI
Multiple telangiectesia - vasular lesion in CNS
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

16. how thalassemia die
Neurofibromatosis type2
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

17. physiological jaundice
Multiple telangiectesia - vasular lesion in CNS
24h to 7d of birth
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Female - breech delivery - family history; tx referral to ortho

18. acute otitis media-pathogen
Black
Strep pneumonie; moraxella; h influenze
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
HSP - look for symmetric skin lesions

19. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
refuse
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Facial portwine stain

20. aplasic crisis
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
URI
TB - breastfeeding - asymptomatic hiv
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

21. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
ALL - alzheimers autism adhd depression seizure
No myoclonic activity in JME
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

22. 21 hydroxylase
Atypical lymphocyte
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
No; they are basic compound will be neutralized in an acidic environment of cellulitis

23. if bone age lower than actual and puberty delayed
To make hip flexed and abducted position in DDH
Constitutional pubertal delay
Rapid detection of RSV antigen in nasl
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

24. difference between breast milk and breafeeding jaundice
Herpes
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Black
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

25. Nocturnal enuresis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Medical emergency; dimercaprol/edta
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

26. complete airway obstruction with FB
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
>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

27. acute otitis externa

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28. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Pho for forward bending; forward defect; common finding has no adverse physical effect
Less than 5th percentile
D for d; down syndrome and polyhydramnios

29. Neonatal unconjugated hyperbilirubine
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Decreased UGT enzyme
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Thalassemia - congenital hemolytic anemia

30. What are the risk factors of developmental dysplais of hip
Atypical lymphocyte
Female - breech delivery - family history; tx referral to ortho
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Rapid detection of RSV antigen in nasl

31. the recommended ca supplementation
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Central isosexual precocious puberty; hypothalmaic hamartoma
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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

32. carditis and arthritis after rheumatic fever
Develops in 21 dasy
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Injury to b/l glossopharyngeal. present in botulism

33. 3yo - febrile - left hip externally rotated
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Tx only symptomatic carrier
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Atopic dermatitis; strong allergic/immunologic component; incr IgE

34. adenovirus
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
URI
Neurofibromatosis type2
Oral DMSA or EDTA IV

35. How to dx RSV
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Rapid detection of RSV antigen in nasl
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Constitutional pubertal delay

36. association with infantile pyloric stenosis
Injury to lower roots of brachial plexus
Yes; but it will be less effective
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

37. viruses cause bronhioltitis
RSV - rhino and influenza
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Biliary atresia; tx surgery

38. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Decreased UGT enzyme
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

39. Tx of bact conjunctivitis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Croup
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

40. penicillin effective against pseudomonas
RSV - rhino and influenza
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Pipercillin (zosyn) - ticarcillin
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

41. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Mainly clinical; serology with initial ELISA - with western blot confirmation;
refuse
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

42. 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)
Meconeum ileus; think about CF
Endocardial cushion defect (no separation between heart chambers)
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

43. iron supplement in child
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
No; they are basic compound will be neutralized in an acidic environment of cellulitis
After 6m; breast mild provides iron until 6m.
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

44. microcytic - hypochromic anemia - hepatospelnomegaly
Decreased UGT enzyme
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)
Thalassemia - congenital hemolytic anemia

45. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Diet modification to provide 110kc/kg/d

46. complication of lumbosacral meningocele
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
Bladder dysfunction; UTI and renal dysfunctoin
Meconeum ileus; think about CF
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

47. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Brown
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

48. splenic infarction in sickle cell
Do HIV testing at first
Faciform RBC cause vascular occlusion
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
No wheezing - no feever in chlamydia

49. low grade fever - cough - diffuse bilat ground glass opacities
Black
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

50. How long patient needs to be exposed to tick to get infected
36 hours
Constitutional pubertal delay
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI