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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. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

2. can women with abnormal smear or genital get vaccine
Oral DMSA or EDTA IV
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Yes; but it will be less effective
Increase of progesteron/17oh progesterone

3. physiological jaundice
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

4. down syndrome has inreased risk of developing
Yes; but it will be less effective
Injury to lower roots of brachial plexus
ALL - alzheimers autism adhd depression seizure
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

5. What is thumbprint sign
Risk of neurological dysfunction
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Lateral neck xray in epiglottitis show swollen epiglottis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

6. sudden onset of fever - difficulty in breathing
Vaso-occlusive crisis; dx hb electrophoresis
Absence seizure; tx ethosuximide
Lateral neck xray in epiglottitis show swollen epiglottis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

7. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Tx only symptomatic carrier
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
Constitutional pubertal delay

8. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
If aortic root reaches 45 mm

9. How long anti-TB drugs given for TB meningitis?
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Benign permature thelarche; expectant management
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

10. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
URI

11. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Fifth disease; febrile syndrome
Pho for forward bending; forward defect; common finding has no adverse physical effect
Wait until 6 months
Croup

12. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

13. down syndrome with holocystolic mumur
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Endocardial cushion defect (no separation between heart chambers)
36 hours

14. Febrile seizure
No wheezing - no feever in chlamydia
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

15. Parvovirus
Fifth disease; febrile syndrome
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
1.5%
Medical emergency; dimercaprol/edta

16. osler rendu weber syndrom
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Multiple telangiectesia - vasular lesion in CNS
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

17. the recommended ca supplementation
>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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
refuse
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

18. association with infantile pyloric stenosis
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
110 kcl/kg/day
No; they are basic compound will be neutralized in an acidic environment of cellulitis

19. target cell
Develops in 21 dasy
T for t ; thalassemia; inc serum iron and Iron binding
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Facial portwine stain

20. acute abd pain - hx URI - lower extremity maculo papular rash
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Decreased UGT enzyme
HSP - look for symmetric skin lesions
Foreign body sensation - photophobia - corneal opacity tx abx

21. when bact conjunctivitis patient can go back to school
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Yes; but it will be less effective
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
After 24h of abx therapy

22. patient with white plaques in mouth and lump in back
Do HIV testing at first
refuse
Pipercillin (zosyn) - ticarcillin
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

23. Nocturnal enuresis
Atypical lymphocyte
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Pho for forward bending; forward defect; common finding has no adverse physical effect
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

24. carditis and arthritis after rheumatic fever
Croup
No intervention; 90% foreign bodies pass without difficulty
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Develops in 21 dasy

25. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

26. language delay
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Tx only symptomatic carrier
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Constitutional pubertal delay

27. IM
Croup tx cool mist; racemic epi - corticosteroid
Erb paralysis leading to diaphragmatic paralysis
Atypical lymphocyte
Injury to b/l glossopharyngeal. present in botulism

28. tick transmits lyme
Brown
Absence seizure; tx ethosuximide
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

29. non immune pregnant women exposed to rubella in first trimester
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Dx US tx; correct serum electrolyte - pyloromyotom
Yes; but it will be less effective
Congenital rubella syndrome

30. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Multiple telangiectesia - vasular lesion in CNS

31. iron supplement in child
After 6m; breast mild provides iron until 6m.
Diet modification to provide 110kc/kg/d
Yes; but it will be less effective
>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

32. starring spells 10-20sec
Bladder dysfunction; UTI and renal dysfunctoin
If aortic root reaches 45 mm
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

33. horner syndrom
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Injury to lower roots of brachial plexus
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Yes; but it will be less effective

34. is local anesthetics be used in cellulitis to reduce pain
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Diet modification to provide 110kc/kg/d

35. How to differential bact vs viral conjunctivitis
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
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

36. When to do aortic root surgery in marfans to prevent dissection?
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Increase of pregnenolone
If aortic root reaches 45 mm
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

37. 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)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Prolactinoma
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

38. How to dx RSV
Decreases height - expensive; reserved for severe cases of delayed puberty
Rapid detection of RSV antigen in nasl
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

39. the risk of lyme after bitten by a tick
1.5%
Diet modification to provide 110kc/kg/d
After 6m; breast mild provides iron until 6m.
Constitutional pubertal delay

40. lens dislocation
Marfans - ehlers danlos - homocystinuria
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
HSP - look for symmetric skin lesions
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

41. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
No intervention; 90% foreign bodies pass without difficulty

42. mcCune albright`
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
24-72 hours
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

43. side effect of testosteron therapy
Between pregnenolone and 17oh pregnenolone
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Decreases height - expensive; reserved for severe cases of delayed puberty
TB - breastfeeding - asymptomatic hiv

44. How to differentiate croup vs epiglotitis
Increase of pregnenolone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

45. viruses cause bronhioltitis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
RSV - rhino and influenza
Lateral neck xray in epiglottitis show swollen epiglottis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

46. thumb sign
Do HIV testing at first
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

47. lead >70
Yes; but it will be less effective
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Medical emergency; dimercaprol/edta
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

48. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Strep pneumonie; moraxella; h influenze
T for t ; thalassemia; inc serum iron and Iron binding
Oral DMSA or EDTA IV

49. cleft lip but no cleft palate
D for d; down syndrome and polyhydramnios
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE

50. flexible kyphosis
Biliary atresia; tx surgery
Herpes
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