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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. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Injury to b/l glossopharyngeal. present in botulism
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Congenital rubella syndrome

2. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Methylephenidate toxicity; cannot be stopped abruptly; taper

3. IM
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Atypical lymphocyte
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

4. coin in child's stomach
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
No intervention; 90% foreign bodies pass without difficulty
After 24h of abx therapy
Oral DMSA or EDTA IV

5. the recommended ca supplementation
Methylephenidate toxicity; cannot be stopped abruptly; taper
Penicillin G 4h before delivery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Mainly clinical; serology with initial ELISA - with western blot confirmation;

6. 3yo - febrile - left hip externally rotated
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Decr calorie intake; decr calorie absorption;incr calorie demand
Lateral neck xray in epiglottitis show swollen epiglottis

7. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Increase of pregnenolone
Strep pneumonie; moraxella; h influenze

8. dx for DDH
Endocardial cushion defect (no separation between heart chambers)
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)
INH 9m if INH resistant rifampin 6m in children and 4m in adults
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

9. major depression
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Biliary atresia; tx surgery

10. penicillin effective against pseudomonas
Methylephenidate toxicity; cannot be stopped abruptly; taper
Pipercillin (zosyn) - ticarcillin
Bartonella henselae; complication is suppuration of lymph node
Candidal diapar rash; tx clotrimazol

11. flexible kyphosis
Marfans - ehlers danlos - homocystinuria
Oral DMSA or EDTA IV
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Pho for forward bending; forward defect; common finding has no adverse physical effect

12. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
24-72 hours
Candidal diapar rash; tx clotrimazol
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

13. bromocriptine
ALL - alzheimers autism adhd depression seizure
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Risk of neurological dysfunction
Prolactinoma

14. if bone age lower than actual and puberty delayed
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Constitutional pubertal delay

15. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Congenital rubella syndrome
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

16. How to difference RSV and neonatal chlamydia
Injury to lower roots of brachial plexus
No wheezing - no feever in chlamydia
Less than 5th percentile
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

17. cleft lip but no cleft palate
Dx US tx; correct serum electrolyte - pyloromyotom
36 hours
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Thalassemia - congenital hemolytic anemia

18. sturge weber syndrome
Facial portwine stain
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Vaso-occlusive crisis; dx hb electrophoresis

19. How to dx acute angle closure glaucoma
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
URI
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

20. decreased mobility of tympanic membrane after otitis media
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

21. mech of botulism
Yes; but it will be less effective
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Absence seizure; tx ethosuximide
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

22. difference between breast milk and breafeeding jaundice
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
Pho for forward bending; forward defect; common finding has no adverse physical effect
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

23. horner syndrom
Injury to lower roots of brachial plexus
Absence seizure; tx ethosuximide
Dactylitis; 2nd common is splenic seqestration
Between pregnenolone and 17oh pregnenolone

24. echymoses with low platelet <30k
TB - breastfeeding - asymptomatic hiv
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Rapid detection of RSV antigen in nasl
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

25. starring spells 10-20sec
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Yes; but it will be less effective

26. language expectation from 2yo
Candidal diapar rash; tx clotrimazol
Meconeum ileus; think about CF
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

27. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Marfans - ehlers danlos - homocystinuria
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

28. crying during urination. bacteriuria pyruria - rec episodes
Constitutional pubertal delay
Imaging study to r/o VUR
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

29. can women with abnormal smear or genital get vaccine
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
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)
Yes; but it will be less effective
Increase of progesteron/17oh progesterone

30. iron supplement in child
Methylephenidate toxicity; cannot be stopped abruptly; taper
Dx US tx; correct serum electrolyte - pyloromyotom
After 24h of abx therapy
After 6m; breast mild provides iron until 6m.

31. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Candidal diapar rash; tx clotrimazol
After 24h of abx therapy
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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

32. duodenal atresia
Biliary atresia; tx surgery
D for d; down syndrome and polyhydramnios
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
Pho for forward bending; forward defect; common finding has no adverse physical effect

33. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
>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
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

34. Tx of community acquired pneumonia
If aortic root reaches 45 mm
Herpes
Dx US tx; correct serum electrolyte - pyloromyotom
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

35. What is the definition of delayed puberty?
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

36. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Benign permature thelarche; expectant management
Thalassemia - congenital hemolytic anemia
Diet modification to provide 110kc/kg/d

37. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Methylephenidate toxicity; cannot be stopped abruptly; taper
Brown
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

38. thumb sign
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)
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

39. adrenal tumor
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Atypical lymphocyte
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

40. tick transmits lyme
Pho for forward bending; forward defect; common finding has no adverse physical effect
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
No wheezing - no feever in chlamydia
Brown

41. the risk of lyme after bitten by a tick
1.5%
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Prolactinoma
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

42. congenital adrenal hyperplasi
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
ALL - alzheimers autism adhd depression seizure
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

43. Tx of bact conjunctivitis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Benign permature thelarche; expectant management
No myoclonic activity in JME
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

44. splenic infarction in sickle cell
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Faciform RBC cause vascular occlusion
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

45. carditis and arthritis after rheumatic fever
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Risk of neurological dysfunction
HSP - look for symmetric skin lesions
Develops in 21 dasy

46. 12y - obese - hip pain - hip ext rotated
Herpes
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

47. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Rapid detection of RSV antigen in nasl
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

48. indications of VUR
Brown
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Black
Tx only symptomatic carrier

49. low grade fever - cough - diffuse bilat ground glass opacities
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Thalassemia - congenital hemolytic anemia

50. dx of lyme
To make hip flexed and abducted position in DDH
Mainly clinical; serology with initial ELISA - with western blot confirmation;
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No myoclonic activity in JME