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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. Tx of botulism
Neurofibromatosis type2
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

2. bromocriptine
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Increase of pregnenolone
Prolactinoma

3. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
To make hip flexed and abducted position in DDH
Bladder dysfunction; UTI and renal dysfunctoin
Central isosexual precocious puberty; hypothalmaic hamartoma
Injury to lower roots of brachial plexus

4. How to prevent GBS in neonate
Penicillin G 4h before delivery
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Less than 5th percentile
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

5. difference between breast milk and breafeeding jaundice
HSP - look for symmetric skin lesions
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

6. cardiac manifestation of turner
Foreign body sensation - photophobia - corneal opacity tx abx
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

7. How to dx RSV
Rapid detection of RSV antigen in nasl
Congenital rubella syndrome
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Atypical lymphocyte

8. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Black

9. mcCune albright`
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
Thalassemia - congenital hemolytic anemia
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

10. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Candidal diapar rash; tx clotrimazol

11. Neonatal unconjugated hyperbilirubine
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Decreased UGT enzyme
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

12. contraindications of DTap
Thalassemia - congenital hemolytic anemia
Black
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Candidal diapar rash; tx clotrimazol

13. lens dislocation
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Marfans - ehlers danlos - homocystinuria
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

14. aplasic crisis
Bladder dysfunction; UTI and renal dysfunctoin
Rapid detection of RSV antigen in nasl
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
RSV - rhino and influenza

15. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Fifth disease; febrile syndrome
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

16. when bact conjunctivitis patient can go back to school
Vaso-occlusive crisis; dx hb electrophoresis
After 24h of abx therapy
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Imaging study to r/o VUR

17. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Yes; but it will be less effective
Risk of neurological dysfunction
Methylephenidate toxicity; cannot be stopped abruptly; taper

18. red oozing rash on cheek - scaly - dry
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Fifth disease; febrile syndrome
Atopic dermatitis; strong allergic/immunologic component; incr IgE

19. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
If aortic root reaches 45 mm
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Herpes

20. flexible kyphosis
Oral DMSA or EDTA IV
Pho for forward bending; forward defect; common finding has no adverse physical effect
D for d; down syndrome and polyhydramnios
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

21. TB prophylaxis
1.5%
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Black

22. 12y - obese - hip pain - hip ext rotated
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No wheezing - no feever in chlamydia
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)

23. Tx of children constipation

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24. When erythema chronicum migrans develops after tick bite
Absence seizure; tx ethosuximide
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
24-72 hours
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

25. tick transmits RMSF
Black
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Central isosexual precocious puberty; hypothalmaic hamartoma
Facial portwine stain

26. decreased mobility of tympanic membrane after otitis media
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Decreases height - expensive; reserved for severe cases of delayed puberty
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Central isosexual precocious puberty; hypothalmaic hamartoma

27. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
After 24h of abx therapy
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

28. indications of VUR
Dx US tx; correct serum electrolyte - pyloromyotom
Wait until 6 months
Increase of pregnenolone
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

29. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Brown
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

30. What is earliest sign of puberty?
Strep pneumonie; moraxella; h influenze
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Candidal diapar rash; tx clotrimazol

31. lead >70
Less than 5th percentile
Black
Medical emergency; dimercaprol/edta
1.5%

32. nuchal rigidity - fever - sore throat - headache - dioriented
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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

33. crying during urination. bacteriuria pyruria - rec episodes
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Imaging study to r/o VUR

34. coin in child's stomach
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
After 24h of abx therapy
No intervention; 90% foreign bodies pass without difficulty
After 6m; breast mild provides iron until 6m.

35. pavlik harness
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
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Fifth disease; febrile syndrome
To make hip flexed and abducted position in DDH

36. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Rapid detection of RSV antigen in nasl
No intervention; 90% foreign bodies pass without difficulty
No reticulocyte vs high reticulocyte

37. tick transmits lyme
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
24h to 7d of birth
Brown

38. dx of lyme
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
24h to 7d of birth
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

39. sturge weber syndrome
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Bladder dysfunction; UTI and renal dysfunctoin
Facial portwine stain

40. language expectation from 2yo
If aortic root reaches 45 mm
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Increase of progesteron/17oh progesterone

41. failure to thrive
Strep pneumonie; moraxella; h influenze
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Less than 5th percentile
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

42. When to do surgery for undescended testes
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
24h to 7d of birth
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Wait until 6 months

43. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Congenital rubella syndrome
Vaso-occlusive crisis; dx hb electrophoresis

44. Febrile seizure
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Increase of progesteron/17oh progesterone
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

45. viruses cause bronhioltitis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
RSV - rhino and influenza
Develops in 21 dasy
Increase of progesteron/17oh progesterone

46. causes of acute anemia
Risk of neurological dysfunction
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

47. major depression
Less than 5th percentile
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Risk of neurological dysfunction

48. if bone age lower than actual and puberty delayed
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
Constitutional pubertal delay
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

49. tuberous sclerosis
24-72 hours
Tx only symptomatic carrier
Prolactinoma
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

50. How to differential bact vs viral conjunctivitis
refuse
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
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
Decreased UGT enzyme