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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. contraindications of MMR vaccine
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Multiple telangiectesia - vasular lesion in CNS
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

2. sudden onset of fever - difficulty in breathing
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Rapid detection of RSV antigen in nasl
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

3. 12y - obese - hip pain - hip ext rotated
Atypical lymphocyte
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Rapid detection of RSV antigen in nasl
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

4. TTP pentad
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
24h to 7d of birth
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

5. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Tx only symptomatic carrier
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

6. Nocturnal enuresis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Candidal diapar rash; tx clotrimazol
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

7. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Less than 5th percentile
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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

8. most common complication of otitis media
ALL - alzheimers autism adhd depression seizure
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Neurofibromatosis type2
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

9. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
110 kcl/kg/day
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

10. echymoses with low platelet <30k
24-72 hours
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

11. decreased mobility of tympanic membrane after otitis media
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Pho for forward bending; forward defect; common finding has no adverse physical effect
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

12. contact lens keratitis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
No intervention; 90% foreign bodies pass without difficulty

13. How to prevent GBS in neonate
Herpes
Penicillin G 4h before delivery
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

14. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Female - breech delivery - family history; tx referral to ortho
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
24-72 hours

15. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Candidal diapar rash; tx clotrimazol
Central isosexual precocious puberty; hypothalmaic hamartoma
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

16. 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)
Pho for forward bending; forward defect; common finding has no adverse physical effect
Mainly clinical; serology with initial ELISA - with western blot confirmation;
D for d; down syndrome and polyhydramnios

17. physiological jaundice
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
24h to 7d of birth
Constitutional pubertal delay

18. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Faciform RBC cause vascular occlusion
Facial portwine stain
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

19. sturge weber syndrome
Facial portwine stain
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No reticulocyte vs high reticulocyte
Pho for forward bending; forward defect; common finding has no adverse physical effect

20. How to difference RSV and neonatal chlamydia
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
No wheezing - no feever in chlamydia
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

21. 3yo - never able to walk
1.5%
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
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
Between pregnenolone and 17oh pregnenolone

22. causes of FTT
TB - breastfeeding - asymptomatic hiv
<2yrs - abd pain - diarrhoea - ARF
Decr calorie intake; decr calorie absorption;incr calorie demand
Decreased UGT enzyme

23. tick transmits lyme
Brown
Injury to b/l glossopharyngeal. present in botulism
Oral DMSA or EDTA IV
Facial portwine stain

24. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Facial portwine stain
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

25. How to dx keratitis?
Decreased UGT enzyme
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Foreign body sensation - photophobia - corneal opacity tx abx
Decr calorie intake; decr calorie absorption;incr calorie demand

26. mech of botulism
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

27. difference between diaper dermatitis and rash
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
T for t ; thalassemia; inc serum iron and Iron binding
Wait until 6 months
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

28. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Tx only symptomatic carrier
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
T for t ; thalassemia; inc serum iron and Iron binding

29. hypopigmented spots - family hx bilat deafness
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Bartonella henselae; complication is suppuration of lymph node
Neurofibromatosis type2
No intervention; 90% foreign bodies pass without difficulty

30. What are the risk factors of developmental dysplais of hip
URI
>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
Female - breech delivery - family history; tx referral to ortho
Erb paralysis leading to diaphragmatic paralysis

31. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Injury to b/l glossopharyngeal. present in botulism
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

32. down syndrome with holocystolic mumur
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Lateral neck xray in epiglottitis show swollen epiglottis
Endocardial cushion defect (no separation between heart chambers)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

33. viruses cause bronhioltitis
RSV - rhino and influenza
Penicillin G 4h before delivery
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
14yrs

34. When to do aortic root surgery in marfans to prevent dissection?
Pipercillin (zosyn) - ticarcillin
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
If aortic root reaches 45 mm
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

35. dx for turner
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Dx US tx; correct serum electrolyte - pyloromyotom
Medical emergency; dimercaprol/edta
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

36. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Croup
Imaging study to r/o VUR
Atopic dermatitis; strong allergic/immunologic component; incr IgE

37. failure to thrive
Less than 5th percentile
Strep pneumonie; moraxella; h influenze
Neurofibromatosis type2
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

38. patient with white plaques in mouth and lump in back
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Do HIV testing at first
Atypical lymphocyte

39. duodenal atresia
ALL - alzheimers autism adhd depression seizure
Brown
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
D for d; down syndrome and polyhydramnios

40. tzanck
Meconeum ileus; think about CF
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Herpes
No myoclonic activity in JME

41. microcytic - hypochromic anemia - hepatospelnomegaly
Erb paralysis leading to diaphragmatic paralysis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Thalassemia - congenital hemolytic anemia
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

42. language expectation from 2yo
Facial portwine stain
Penicillin G 4h before delivery
14yrs
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

43. When to do surgery for undescended testes
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Foreign body sensation - photophobia - corneal opacity tx abx
Wait until 6 months
Pipercillin (zosyn) - ticarcillin

44. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
RSV - rhino and influenza
No reticulocyte vs high reticulocyte
Female - breech delivery - family history; tx referral to ortho

45. pavlik harness
Herpes
After 24h of abx therapy
To make hip flexed and abducted position in DDH
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

46. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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)
Vaso-occlusive crisis; dx hb electrophoresis
Dactylitis; 2nd common is splenic seqestration
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

47. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
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)
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
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

48. How to differentiate croup vs epiglotitis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Increase of pregnenolone
Faciform RBC cause vascular occlusion
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

49. Tx of community acquired pneumonia
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

50. causes of FTT
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
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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products