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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. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

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2. How to dx post uretheral valve
Multiple telangiectesia - vasular lesion in CNS
Risk of neurological dysfunction
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Croup tx cool mist; racemic epi - corticosteroid

3. bromocriptine
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Atopic dermatitis; strong allergic/immunologic component; incr IgE
To make hip flexed and abducted position in DDH
Prolactinoma

4. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Lateral neck xray in epiglottitis show swollen epiglottis
If aortic root reaches 45 mm
Brown

5. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Penicillin G 4h before delivery
HSP - look for symmetric skin lesions
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

6. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Croup
Fifth disease; febrile syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

7. mcCune albright`
Absence seizure; tx ethosuximide
Increase of progesteron/17oh progesterone
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

8. duodenal atresia
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Strep pneumonie; moraxella; h influenze
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
D for d; down syndrome and polyhydramnios

9. lead >70
Absence seizure; tx ethosuximide
Methylephenidate toxicity; cannot be stopped abruptly; taper
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Medical emergency; dimercaprol/edta

10. Tx of children constipation

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11. association with infantile pyloric stenosis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Decreases height - expensive; reserved for severe cases of delayed puberty
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

12. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

13. difference between diaper dermatitis and rash
Marfans - ehlers danlos - homocystinuria
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
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
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

14. complication of lumbosacral meningocele
Imaging study to r/o VUR
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
ALL - alzheimers autism adhd depression seizure
Bladder dysfunction; UTI and renal dysfunctoin

15. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
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)
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

16. acute otitis media-pathogen
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No intervention; 90% foreign bodies pass without difficulty
Female - breech delivery - family history; tx referral to ortho
Strep pneumonie; moraxella; h influenze

17. Tx of FTT
Diet modification to provide 110kc/kg/d
Decr calorie intake; decr calorie absorption;incr calorie demand
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)
No; they are basic compound will be neutralized in an acidic environment of cellulitis

18. what conditions are not contraindicated
Endocardial cushion defect (no separation between heart chambers)
After 6m; breast mild provides iron until 6m.
TB - breastfeeding - asymptomatic hiv
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

19. tuberous sclerosis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

20. TTP pentad
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Oral DMSA or EDTA IV

21. low grade fever - cough - diffuse bilat ground glass opacities
Injury to b/l glossopharyngeal. present in botulism
Marfans - ehlers danlos - homocystinuria
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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

22. pneumonia in CF patient
Endocardial cushion defect (no separation between heart chambers)
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Between pregnenolone and 17oh pregnenolone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

23. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Medical emergency; dimercaprol/edta
Erb paralysis leading to diaphragmatic paralysis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

24. How to dx keratitis?
No intervention; 90% foreign bodies pass without difficulty
Tx only symptomatic carrier
Foreign body sensation - photophobia - corneal opacity tx abx
Fifth disease; febrile syndrome

25. mech of botulism
Multiple telangiectesia - vasular lesion in CNS
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Injury to b/l glossopharyngeal. present in botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

26. What are the risk factors of developmental dysplais of hip
Dx US tx; correct serum electrolyte - pyloromyotom
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Female - breech delivery - family history; tx referral to ortho

27. When to give HRT in turner
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
Dx US tx; correct serum electrolyte - pyloromyotom
14yrs

28. adenovirus
Fifth disease; febrile syndrome
URI
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
No myoclonic activity in JME

29. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Do HIV testing at first
24h to 7d of birth

30. starring spells 10-20sec
Vaso-occlusive crisis; dx hb electrophoresis
Strep pneumonie; moraxella; h influenze
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

31. What is the most common initial symptom in sickle cell
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Dactylitis; 2nd common is splenic seqestration
>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. tick transmits RMSF
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Black
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

33. aplasic crisis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

34. IM
Neurofibromatosis type2
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Atypical lymphocyte

35. splenic infarction in sickle cell
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Faciform RBC cause vascular occlusion
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Croup tx cool mist; racemic epi - corticosteroid

36. when bact conjunctivitis patient can go back to school
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
After 24h of abx therapy
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

37. target cell
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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
Yes; but it will be less effective

38. major depression
Decreases height - expensive; reserved for severe cases of delayed puberty
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Faciform RBC cause vascular occlusion
Biliary atresia; tx surgery

39. centor criteria for bact pharyngitis
Risk of neurological dysfunction
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

40. carditis and arthritis after rheumatic fever
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Develops in 21 dasy
36 hours
1.5%

41. How to dx RSV
Methylephenidate toxicity; cannot be stopped abruptly; taper
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Rapid detection of RSV antigen in nasl
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

42. Tx of community acquired pneumonia
Constitutional pubertal delay
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

43. benefits of antibiotic therapy in acute pharyngitis?
Tx only symptomatic carrier
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Candidal diapar rash; tx clotrimazol
Increase of pregnenolone

44. How to differentiate caput succedanueum and cephalohematoma
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Black
URI

45. defcicieny of 21 hydroxylase
Rapid detection of RSV antigen in nasl
Increase of progesteron/17oh progesterone
Penicillin G 4h before delivery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

46. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
No intervention; 90% foreign bodies pass without difficulty
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Endocardial cushion defect (no separation between heart chambers)

47. kallman syndrome
Lateral neck xray in epiglottitis show swollen epiglottis
D for d; down syndrome and polyhydramnios
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
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)

48. 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
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Bladder dysfunction; UTI and renal dysfunctoin
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

49. 17 alpha hydroxylase
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
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
Do HIV testing at first
Between pregnenolone and 17oh pregnenolone

50. What is the calorie requirement of newborn?
110 kcl/kg/day
Marfans - ehlers danlos - homocystinuria
Croup tx cool mist; racemic epi - corticosteroid
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products