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USMLE Step3 Pediatrics

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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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. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

2. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Less than 5th percentile
Yes; but it will be less effective

3. pavlik harness
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
Decreases height - expensive; reserved for severe cases of delayed puberty
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
To make hip flexed and abducted position in DDH

4. defcicieny of 21 hydroxylase
RSV - rhino and influenza
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Increase of progesteron/17oh progesterone
Bladder dysfunction; UTI and renal dysfunctoin

5. infant botulism
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

6. sudden onset of fever - difficulty in breathing
No wheezing - no feever in chlamydia
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

7. 18mo bilat breast enlargment - some pubic hair
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Benign permature thelarche; expectant management
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

8. cleft lip but no cleft palate
No intervention; 90% foreign bodies pass without difficulty
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

9. is local anesthetics be used in cellulitis to reduce pain
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No; they are basic compound will be neutralized in an acidic environment of cellulitis
No wheezing - no feever in chlamydia
Between pregnenolone and 17oh pregnenolone

10. down syndrome has inreased risk of developing
Between pregnenolone and 17oh pregnenolone
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
ALL - alzheimers autism adhd depression seizure
Endocardial cushion defect (no separation between heart chambers)

11. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
HSP - look for symmetric skin lesions
No wheezing - no feever in chlamydia
Bartonella henselae; complication is suppuration of lymph node

12. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Diet modification to provide 110kc/kg/d

13. When erythema chronicum migrans develops after tick bite
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Do HIV testing at first
24-72 hours
To make hip flexed and abducted position in DDH

14. pumonary TB
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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)
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

15. Neonatal conjugated hyperbilirubinemia
Meconeum ileus; think about CF
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Biliary atresia; tx surgery
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

16. deficinecy of 17 hydroxylase
Constitutional pubertal delay
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
No intervention; 90% foreign bodies pass without difficulty
Increase of pregnenolone

17. dx for DDH
Bartonella henselae; complication is suppuration of lymph node
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

18. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
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
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

19. viruses cause bronhioltitis
Dx US tx; correct serum electrolyte - pyloromyotom
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
RSV - rhino and influenza
Decreases height - expensive; reserved for severe cases of delayed puberty

20. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
24h to 7d of birth
Meconeum ileus; think about CF
No wheezing - no feever in chlamydia
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

21. hypopigmented spots - family hx bilat deafness
Yes; but it will be less effective
Neurofibromatosis type2
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

22. How to differentiate croup vs epiglotitis
Medical emergency; dimercaprol/edta
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

23. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Congenital rubella syndrome
Candidal diapar rash; tx clotrimazol
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
Meconeum ileus; think about CF

24. How to difference viral and bact pneumonia
No reticulocyte vs high reticulocyte
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Central isosexual precocious puberty; hypothalmaic hamartoma
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

25. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Decreases height - expensive; reserved for severe cases of delayed puberty
Facial portwine stain

26. contraindications of DTap
Imaging study to r/o VUR
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

27. difference between rubeola (measles) and rulbella
T for t ; thalassemia; inc serum iron and Iron binding
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Facial portwine stain

28. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Develops in 21 dasy
Pho for forward bending; forward defect; common finding has no adverse physical effect
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

29. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Meconeum ileus; think about CF
Less than 5th percentile
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

30. echymoses with low platelet <30k
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
No wheezing - no feever in chlamydia
RSV - rhino and influenza

31. red oozing rash on cheek - scaly - dry
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

32. benefits of antibiotic therapy in acute pharyngitis?
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Benign permature thelarche; expectant management
Risk of neurological dysfunction

33. 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
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
24h to 7d of birth
Facial portwine stain

34. lead 44-70
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Herpes
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
Oral DMSA or EDTA IV

35. how smoking contributes otitis media in children
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Erb paralysis leading to diaphragmatic paralysis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
RSV - rhino and influenza

36. major depression
110 kcl/kg/day
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<2yrs - abd pain - diarrhoea - ARF

37. aplasic crisis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
No myoclonic activity in JME
Develops in 21 dasy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

38. cardiac manifestation of turner
Risk of neurological dysfunction
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Atopic dermatitis; strong allergic/immunologic component; incr IgE

39. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

40. non immune pregnant women exposed to rubella in first trimester
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Medical emergency; dimercaprol/edta
Congenital rubella syndrome
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

41. When to give HRT in turner
14yrs
<2yrs - abd pain - diarrhoea - ARF
Injury to b/l glossopharyngeal. present in botulism
Mainly clinical; serology with initial ELISA - with western blot confirmation;

42. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

43. 3yo - febrile - left hip externally rotated
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Medical emergency; dimercaprol/edta
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

44. TTP pentad
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)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

45. association with infantile pyloric stenosis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

46. HUS
36 hours
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
<2yrs - abd pain - diarrhoea - ARF

47. When to give hpv vaccien
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
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

48. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Biliary atresia; tx surgery
Imaging study to r/o VUR

49. the risk of lyme after bitten by a tick
1.5%
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

50. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Tx only symptomatic carrier
URI