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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. How to dx endopthalmitis
Absence seizure; tx ethosuximide
Pho for forward bending; forward defect; common finding has no adverse physical effect
Biliary atresia; tx surgery
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

2. coin in child's stomach
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
No intervention; 90% foreign bodies pass without difficulty

3. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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

4. physiological jaundice
Candidal diapar rash; tx clotrimazol
Pho for forward bending; forward defect; common finding has no adverse physical effect
24h to 7d of birth
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

5. tzanck
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Thalassemia - congenital hemolytic anemia
Herpes
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

6. impaired gag reflex
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)
Faciform RBC cause vascular occlusion
Injury to b/l glossopharyngeal. present in botulism
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

7. failure to thrive
1.5%
Central isosexual precocious puberty; hypothalmaic hamartoma
Less than 5th percentile
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

8. Tx of community acquired pneumonia
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Imaging study to r/o VUR

9. sturge weber syndrome
Facial portwine stain
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
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
URI

10. decreased mobility of tympanic membrane after otitis media
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Marfans - ehlers danlos - homocystinuria
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

11. carditis and arthritis after rheumatic fever
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Bartonella henselae; complication is suppuration of lymph node
Develops in 21 dasy
TB - breastfeeding - asymptomatic hiv

12. contraindications of MMR vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Foreign body sensation - photophobia - corneal opacity tx abx
Benign permature thelarche; expectant management
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

13. the risk of lyme after bitten by a tick
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Herpes
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
1.5%

14. causes of FTT
14yrs
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Bartonella henselae; complication is suppuration of lymph node
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

15. What is the calorie requirement of newborn?
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Facial portwine stain
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
110 kcl/kg/day

16. indications of audiometry in childrens
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
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
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

17. TTP pentad
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Decr calorie intake; decr calorie absorption;incr calorie demand

18. tick transmits lyme
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Brown
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

19. horner syndrom
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Methylephenidate toxicity; cannot be stopped abruptly; taper
Injury to lower roots of brachial plexus
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

20. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Injury to lower roots of brachial plexus
Erb paralysis leading to diaphragmatic paralysis

21. How to difference viral and bact pneumonia
To make hip flexed and abducted position in DDH
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

22. 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)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Endocardial cushion defect (no separation between heart chambers)
RSV - rhino and influenza

23. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Marfans - ehlers danlos - homocystinuria
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

24. red oozing rash on cheek - scaly - dry
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No myoclonic activity in JME
RSV - rhino and influenza

25. low grade fever - cough - diffuse bilat ground glass opacities
No intervention; 90% foreign bodies pass without difficulty
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

26. dx of lyme
Strep pneumonie; moraxella; h influenze
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

27. centor criteria for bact pharyngitis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
>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
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

28. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
No wheezing - no feever in chlamydia
HSP - look for symmetric skin lesions
Brown

29. down syndrome has inreased risk of developing
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Black
ALL - alzheimers autism adhd depression seizure
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

30. What is thumbprint sign
Increase of pregnenolone
Injury to lower roots of brachial plexus
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Lateral neck xray in epiglottitis show swollen epiglottis

31. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
No; they are basic compound will be neutralized in an acidic environment of cellulitis

32. Tx of bact conjunctivitis
Thalassemia - congenital hemolytic anemia
Vaso-occlusive crisis; dx hb electrophoresis
Increase of pregnenolone
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

33. Tx of FTT
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
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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Diet modification to provide 110kc/kg/d

34. acute otitis externa

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35. lead >70
Medical emergency; dimercaprol/edta
Yes; but it will be less effective
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
Penicillin G 4h before delivery

36. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Atypical lymphocyte
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

37. association with infantile pyloric stenosis
URI
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

38. Febrile seizure
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE

39. down syndrome with holocystolic mumur
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Endocardial cushion defect (no separation between heart chambers)
Imaging study to r/o VUR

40. sudden onset of fever - difficulty in breathing
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Congenital rubella syndrome
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

41. microcytic - hypochromic anemia - hepatospelnomegaly
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Thalassemia - congenital hemolytic anemia
No intervention; 90% foreign bodies pass without difficulty
Yes; but it will be less effective

42. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Tx only symptomatic carrier
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

43. When erythema chronicum migrans develops after tick bite
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
24-72 hours
HSP - look for symmetric skin lesions
Methylephenidate toxicity; cannot be stopped abruptly; taper

44. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Increase of pregnenolone
Methylephenidate toxicity; cannot be stopped abruptly; taper

45. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Bartonella henselae; complication is suppuration of lymph node
Injury to b/l glossopharyngeal. present in botulism
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

46. penicillin effective against pseudomonas
Thalassemia - congenital hemolytic anemia
Tx only symptomatic carrier
Pipercillin (zosyn) - ticarcillin
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

47. contraindications of DTap
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Strep pneumonie; moraxella; h influenze

48. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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)
1.5%
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

49. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
TB - breastfeeding - asymptomatic hiv
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Increase of pregnenolone

50. infantile hypertrophic pyloric stenosis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Dx US tx; correct serum electrolyte - pyloromyotom
To make hip flexed and abducted position in DDH
Do HIV testing at first