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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. echymoses with low platelet <30k
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Neurofibromatosis type2
Meconeum ileus; think about CF

2. How to dx endopthalmitis
Penicillin G 4h before delivery
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Meconeum ileus; think about CF

3. can women with abnormal smear or genital get vaccine
Bartonella henselae; complication is suppuration of lymph node
Injury to lower roots of brachial plexus
Female - breech delivery - family history; tx referral to ortho
Yes; but it will be less effective

4. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Pho for forward bending; forward defect; common finding has no adverse physical effect
Wait until 6 months

5. differentiate between central and peripheral precocious puberty
Absence seizure; tx ethosuximide
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Marfans - ehlers danlos - homocystinuria
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

6. starring spells 10-20sec
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
After 6m; breast mild provides iron until 6m.
RSV - rhino and influenza
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

7. causes of FTT
Prolactinoma
Decr calorie intake; decr calorie absorption;incr calorie demand
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
Wait until 6 months

8. When erythema chronicum migrans develops after tick bite
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
24-72 hours
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

9. How to differentiate croup vs epiglotitis
<2yrs - abd pain - diarrhoea - ARF
Rapid detection of RSV antigen in nasl
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

10. Tx of children constipation

11. kallman syndrome
Faciform RBC cause vascular occlusion
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Pho for forward bending; forward defect; common finding has no adverse physical effect
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

12. How long anti-TB drugs given for TB meningitis?
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Congenital rubella syndrome
INH 9m if INH resistant rifampin 6m in children and 4m in adults

13. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
>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
Dactylitis; 2nd common is splenic seqestration
Candidal diapar rash; tx clotrimazol
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

14. dx of lyme
Increase of progesteron/17oh progesterone
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Between pregnenolone and 17oh pregnenolone
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

15. iron supplement in child
After 6m; breast mild provides iron until 6m.
Pipercillin (zosyn) - ticarcillin
Less than 5th percentile
Vaso-occlusive crisis; dx hb electrophoresis

16. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

17. adenovirus
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)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
>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

18. How to evaluate well appearing child just born in GBS pos mother?
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
To make hip flexed and abducted position in DDH

19. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Bladder dysfunction; UTI and renal dysfunctoin
Prolactinoma
Atopic dermatitis; strong allergic/immunologic component; incr IgE

20. crying during urination. bacteriuria pyruria - rec episodes
110 kcl/kg/day
Imaging study to r/o VUR
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Develops in 21 dasy

21. language expectation from 2yo
Less than 5th percentile
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

22. Parents can _____ vaccine
To make hip flexed and abducted position in DDH
refuse
Brown
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

23. mcCune albright`
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Marfans - ehlers danlos - homocystinuria

24. sublottic narrowing
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Croup tx cool mist; racemic epi - corticosteroid

25. coin in child's stomach
No wheezing - no feever in chlamydia
RSV - rhino and influenza
Constitutional pubertal delay
No intervention; 90% foreign bodies pass without difficulty

26. lead 44-70
Oral DMSA or EDTA IV
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Do HIV testing at first
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

27. most common complication of otitis media
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Biliary atresia; tx surgery

28. pneumonia in CF patient
36 hours
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Croup tx cool mist; racemic epi - corticosteroid

29. acute otitis externa

30. physiological jaundice
Wait until 6 months
Meconeum ileus; think about CF
24h to 7d of birth
Candidal diapar rash; tx clotrimazol

31. down syndrome with holocystolic mumur
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Endocardial cushion defect (no separation between heart chambers)
Pipercillin (zosyn) - ticarcillin
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

32. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
D for d; down syndrome and polyhydramnios
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

33. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
To make hip flexed and abducted position in DDH
INH 9m if INH resistant rifampin 6m in children and 4m in adults
If aortic root reaches 45 mm

34. the recommended ca supplementation
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Risk of neurological dysfunction

35. 18mo bilat breast enlargment - some pubic hair
Candidal diapar rash; tx clotrimazol
Croup tx cool mist; racemic epi - corticosteroid
Medical emergency; dimercaprol/edta
Benign permature thelarche; expectant management

36. association with infantile pyloric stenosis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
TB - breastfeeding - asymptomatic hiv
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Strep pneumonie; moraxella; h influenze

37. horner syndrom
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Injury to lower roots of brachial plexus
If aortic root reaches 45 mm

38. how thalassemia die
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Croup

39. Neonatal conjugated hyperbilirubinemia
Tx only symptomatic carrier
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Biliary atresia; tx surgery

40. Nocturnal enuresis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
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

41. How to prevent GBS in neonate
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Penicillin G 4h before delivery
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No intervention; 90% foreign bodies pass without difficulty

42. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Injury to lower roots of brachial plexus
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Brown

43. Febrile seizure
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

44. low grade fever - cough - diffuse bilat ground glass opacities
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Dactylitis; 2nd common is splenic seqestration
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

45. failure to thrive
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Less than 5th percentile
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

46. How to differentiate caput succedanueum and cephalohematoma
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Central isosexual precocious puberty; hypothalmaic hamartoma
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

47. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
24-72 hours
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
No myoclonic activity in JME

48. What is earliest sign of puberty?
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
24-72 hours
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Develops in 21 dasy

49. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Increase of pregnenolone
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
ALL - alzheimers autism adhd depression seizure

50. complication of lumbosacral meningocele
14yrs
Increase of progesteron/17oh progesterone
Tx only symptomatic carrier
Bladder dysfunction; UTI and renal dysfunctoin