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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. What is the most common initial symptom in sickle cell
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Multiple telangiectesia - vasular lesion in CNS
Wait until 6 months
Dactylitis; 2nd common is splenic seqestration

2. Parvovirus
Fifth disease; febrile syndrome
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

3. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Constitutional pubertal delay
Methylephenidate toxicity; cannot be stopped abruptly; taper

4. What is thumbprint sign
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Lateral neck xray in epiglottitis show swollen epiglottis
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Foreign body sensation - photophobia - corneal opacity tx abx

5. penicillin effective against pseudomonas
Atopic dermatitis; strong allergic/immunologic component; incr IgE
24-72 hours
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pipercillin (zosyn) - ticarcillin

6. kallman syndrome
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
INH 9m if INH resistant rifampin 6m in children and 4m in adults
24-72 hours
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

7. What is the calorie requirement of newborn?
RSV - rhino and influenza
110 kcl/kg/day
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
After 6m; breast mild provides iron until 6m.

8. pneumonia in CF patient
Croup tx cool mist; racemic epi - corticosteroid
refuse
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
URI

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

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10. red oozing rash on cheek - scaly - dry
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

11. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
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
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Decr calorie intake; decr calorie absorption;incr calorie demand

12. sickle cell with symmetrical swelling of hands and feet
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Vaso-occlusive crisis; dx hb electrophoresis

13. how thalassemia die
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

14. pavlik harness
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Medical emergency; dimercaprol/edta
To make hip flexed and abducted position in DDH
Less than 5th percentile

15. the risk of lyme after bitten by a tick
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
After 6m; breast mild provides iron until 6m.
Fifth disease; febrile syndrome
1.5%

16. causes of FTT
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Strep pneumonie; moraxella; h influenze
Decr calorie intake; decr calorie absorption;incr calorie demand
Brown

17. What are the risk factors of developmental dysplais of hip
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Female - breech delivery - family history; tx referral to ortho
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Strep pneumonie; moraxella; h influenze

18. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
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
Facial portwine stain
ALL - alzheimers autism adhd depression seizure
Erb paralysis leading to diaphragmatic paralysis

19. How to difference viral and bact pneumonia
Biliary atresia; tx surgery
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
36 hours
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

20. complication of lumbosacral meningocele
Endocardial cushion defect (no separation between heart chambers)
Congenital rubella syndrome
Meconeum ileus; think about CF
Bladder dysfunction; UTI and renal dysfunctoin

21. Infant with serum billlirubin >25
T for t ; thalassemia; inc serum iron and Iron binding
Risk of neurological dysfunction
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Methylephenidate toxicity; cannot be stopped abruptly; taper

22. 3yo - never able to walk
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
Bartonella henselae; complication is suppuration of lymph node
Imaging study to r/o VUR
Increase of pregnenolone

23. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
Dactylitis; 2nd common is splenic seqestration
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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. failure to thrive
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)
Less than 5th percentile
Marfans - ehlers danlos - homocystinuria
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

25. can women with abnormal smear or genital get vaccine
Imaging study to r/o VUR
Yes; but it will be less effective
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Mainly clinical; serology with initial ELISA - with western blot confirmation;

26. cleft lip but no cleft palate
Rapid detection of RSV antigen in nasl
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
RSV - rhino and influenza
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

27. crying during urination. bacteriuria pyruria - rec episodes
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Develops in 21 dasy
Imaging study to r/o VUR

28. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
URI
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

29. impaired gag reflex
Increase of pregnenolone
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Injury to b/l glossopharyngeal. present in botulism

30. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Medical emergency; dimercaprol/edta

31. How to dx post uretheral valve
No reticulocyte vs high reticulocyte
Less than 5th percentile
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

32. dx for turner
Develops in 21 dasy
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
ALL - alzheimers autism adhd depression seizure
Imaging study to r/o VUR

33. contact lens keratitis
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
Candidal diapar rash; tx clotrimazol
Croup tx cool mist; racemic epi - corticosteroid

34. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Brown
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Constitutional pubertal delay

35. pumonary TB
Decr calorie intake; decr calorie absorption;incr calorie demand
Croup
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 intervention; 90% foreign bodies pass without difficulty

36. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

37. 17 alpha hydroxylase
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Between pregnenolone and 17oh pregnenolone
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Injury to lower roots of brachial plexus

38. How long anti-TB drugs given for TB meningitis?
refuse
Develops in 21 dasy
After 24h of abx therapy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

39. lead >70
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
D for d; down syndrome and polyhydramnios
Medical emergency; dimercaprol/edta
Croup tx cool mist; racemic epi - corticosteroid

40. thumb sign
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

41. major depression
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Between pregnenolone and 17oh pregnenolone
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

42. difference between structural disorder and flexible kyphosis
Absence seizure; tx ethosuximide
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Penicillin G 4h before delivery
Oral DMSA or EDTA IV

43. dx for DDH
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
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Increase of progesteron/17oh progesterone

44. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
URI

45. language expectation from 2yo
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
No myoclonic activity in JME
Congenital rubella syndrome
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

46. differentiate between central and peripheral precocious puberty
Decr calorie intake; decr calorie absorption;incr calorie demand
Imaging study to r/o VUR
Marfans - ehlers danlos - homocystinuria
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

47. Tx of FTT
Diet modification to provide 110kc/kg/d
RSV - rhino and influenza
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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

48. What is earliest sign of puberty?
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Injury to b/l glossopharyngeal. present in botulism

49. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Wait until 6 months
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

50. mcCune albright`
T for t ; thalassemia; inc serum iron and Iron binding
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
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