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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. When to do aortic root surgery in marfans to prevent dissection?
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
If aortic root reaches 45 mm
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Methylephenidate toxicity; cannot be stopped abruptly; taper

2. complication of lumbosacral meningocele
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
Bladder dysfunction; UTI and renal dysfunctoin
Herpes

3. language delay
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
36 hours
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

4. spitting up - vomiting at night - weight stable
refuse
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
No reticulocyte vs high reticulocyte
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

5. deficinecy of 17 hydroxylase
Increase of pregnenolone
Pho for forward bending; forward defect; common finding has no adverse physical effect
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

6. target cell
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Less than 5th percentile
Brown
T for t ; thalassemia; inc serum iron and Iron binding

7. acute abd pain - hx URI - lower extremity maculo papular rash
Constitutional pubertal delay
HSP - look for symmetric skin lesions
Strep pneumonie; moraxella; h influenze
T for t ; thalassemia; inc serum iron and Iron binding

8. indications of audiometry in childrens
Strep pneumonie; moraxella; h influenze
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Fifth disease; febrile syndrome
Erb paralysis leading to diaphragmatic paralysis

9. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
36 hours
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
D for d; down syndrome and polyhydramnios

10. Parents can _____ vaccine
Rapid detection of RSV antigen in nasl
Methylephenidate toxicity; cannot be stopped abruptly; taper
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
refuse

11. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
No intervention; 90% foreign bodies pass without difficulty
No reticulocyte vs high reticulocyte

12. congenital adrenal hyperplasi
Develops in 21 dasy
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No reticulocyte vs high reticulocyte

13. the risk of lyme after bitten by a tick
1.5%
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Less than 5th percentile
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

14. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Pho for forward bending; forward defect; common finding has no adverse physical effect
Erb paralysis leading to diaphragmatic paralysis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

15. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

16. benefits of antibiotic therapy in acute pharyngitis?
Oral DMSA or EDTA IV
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

17. tuberous sclerosis
Black
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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
Atypical lymphocyte

18. dx for DDH
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Central isosexual precocious puberty; hypothalmaic hamartoma

19. 21 hydroxylase
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

20. sickle cell with symmetrical swelling of hands and feet
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Vaso-occlusive crisis; dx hb electrophoresis
24-72 hours

21. physiological jaundice
If aortic root reaches 45 mm
HSP - look for symmetric skin lesions
24h to 7d of birth
Pho for forward bending; forward defect; common finding has no adverse physical effect

22. Tx of community acquired pneumonia
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Atypical lymphocyte
Female - breech delivery - family history; tx referral to ortho
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

23. pumonary TB
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
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)

24. down syndrome with holocystolic mumur
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
Dx US tx; correct serum electrolyte - pyloromyotom
Meconeum ileus; think about CF
Endocardial cushion defect (no separation between heart chambers)

25. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Congenital rubella syndrome
Do HIV testing at first
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

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

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27. How long anti-TB drugs given for TB meningitis?
Decreases height - expensive; reserved for severe cases of delayed puberty
Bartonella henselae; complication is suppuration of lymph node
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

28. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
<2yrs - abd pain - diarrhoea - ARF

29. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
No; they are basic compound will be neutralized in an acidic environment of cellulitis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Methylephenidate toxicity; cannot be stopped abruptly; taper

30. Parvovirus
Fifth disease; febrile syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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

31. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
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
Risk of neurological dysfunction
Candidal diapar rash; tx clotrimazol
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

32. Tx of bact conjunctivitis
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Neurofibromatosis type2
TB - breastfeeding - asymptomatic hiv

33. most common complication of otitis media
Decr calorie intake; decr calorie absorption;incr calorie demand
Yes; but it will be less effective
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Congenital rubella syndrome

34. How to differentiate caput succedanueum and cephalohematoma
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Develops in 21 dasy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
T for t ; thalassemia; inc serum iron and Iron binding

35. How to dx RSV
Rapid detection of RSV antigen in nasl
No wheezing - no feever in chlamydia
Diet modification to provide 110kc/kg/d
<2yrs - abd pain - diarrhoea - ARF

36. 17 alpha hydroxylase
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
D for d; down syndrome and polyhydramnios
Between pregnenolone and 17oh pregnenolone

37. giardiasis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Medical emergency; dimercaprol/edta
After 24h of abx therapy
Tx only symptomatic carrier

38. Tx of FTT
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Diet modification to provide 110kc/kg/d
Wait until 6 months
Endocardial cushion defect (no separation between heart chambers)

39. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Penicillin G 4h before delivery
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

40. splenic infarction in sickle cell
Faciform RBC cause vascular occlusion
Pipercillin (zosyn) - ticarcillin
Pho for forward bending; forward defect; common finding has no adverse physical effect
Strep pneumonie; moraxella; h influenze

41. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Meconeum ileus; think about CF
Yes; but it will be less effective
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

42. causes of FTT
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Decr calorie intake; decr calorie absorption;incr calorie demand
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

43. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Increase of pregnenolone
RSV - rhino and influenza

44. hypopigmented spots - family hx bilat deafness
Endocardial cushion defect (no separation between heart chambers)
Neurofibromatosis type2
Herpes
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

45. adrenal tumor
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
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
To make hip flexed and abducted position in DDH
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

46. Tx of botulism
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
URI
<2yrs - abd pain - diarrhoea - ARF
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

47. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
D for d; down syndrome and polyhydramnios
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Increase of progesteron/17oh progesterone

48. penicillin effective against pseudomonas
Candidal diapar rash; tx clotrimazol
Pipercillin (zosyn) - ticarcillin
Endocardial cushion defect (no separation between heart chambers)
Decreases height - expensive; reserved for severe cases of delayed puberty

49. Infant with serum billlirubin >25
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Risk of neurological dysfunction
Black
Less than 5th percentile

50. infantile hypertrophic pyloric stenosis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Oral DMSA or EDTA IV
Dx US tx; correct serum electrolyte - pyloromyotom
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)