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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. how thalassemia die
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
1.5%
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

2. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Pipercillin (zosyn) - ticarcillin
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
TB - breastfeeding - asymptomatic hiv

3. sudden onset of fever - difficulty in breathing
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Bladder dysfunction; UTI and renal dysfunctoin

4. TTP pentad
Pipercillin (zosyn) - ticarcillin
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

5. hypopigmented spots - family hx bilat deafness
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Neurofibromatosis type2
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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

6. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Erb paralysis leading to diaphragmatic paralysis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

7. decreased mobility of tympanic membrane after otitis media
Injury to b/l glossopharyngeal. present in botulism
Oral DMSA or EDTA IV
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

8. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Endocardial cushion defect (no separation between heart chambers)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

9. Tx of botulism
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Absence seizure; tx ethosuximide
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
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

10. most common complication of otitis media
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Brown

11. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
110 kcl/kg/day
Marfans - ehlers danlos - homocystinuria

12. How to dx acute angle closure glaucoma
To make hip flexed and abducted position in DDH
24h to 7d of birth
Congenital rubella syndrome
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

13. nuchal rigidity - fever - sore throat - headache - dioriented
After 6m; breast mild provides iron until 6m.
110 kcl/kg/day
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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

14. Tx of bact conjunctivitis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Neurofibromatosis type2

15. difference between structural disorder and flexible kyphosis
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Facial portwine stain
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

16. pavlik harness
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Facial portwine stain
To make hip flexed and abducted position in DDH
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

17. iron supplement in child
Croup tx cool mist; racemic epi - corticosteroid
After 6m; breast mild provides iron until 6m.
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
Faciform RBC cause vascular occlusion

18. differentiate between central and peripheral precocious puberty
Biliary atresia; tx surgery
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Candidal diapar rash; tx clotrimazol

19. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
HSP - look for symmetric skin lesions
No myoclonic activity in JME
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Marfans - ehlers danlos - homocystinuria

20. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

21. Tx of children constipation

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22. pneumonia in CF patient
No myoclonic activity in JME
Wait until 6 months
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

23. Parvovirus
After 24h of abx therapy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Fifth disease; febrile syndrome
Lateral neck xray in epiglottitis show swollen epiglottis

24. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Strep pneumonie; moraxella; h influenze
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

25. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
D for d; down syndrome and polyhydramnios
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

26. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Meconeum ileus; think about CF
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

27. acute abd pain - hx URI - lower extremity maculo papular rash
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
HSP - look for symmetric skin lesions
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

28. association with infantile pyloric stenosis
14yrs
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
D for d; down syndrome and polyhydramnios

29. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Dx US tx; correct serum electrolyte - pyloromyotom
110 kcl/kg/day
Between pregnenolone and 17oh pregnenolone
Erb paralysis leading to diaphragmatic paralysis

30. What is the definition of delayed puberty?
Increase of pregnenolone
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
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Decr calorie intake; decr calorie absorption;incr calorie demand

31. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Thalassemia - congenital hemolytic anemia
14yrs
Penicillin G 4h before delivery
Croup

32. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Biliary atresia; tx surgery
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

33. thumb sign
Do HIV testing at first
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
D for d; down syndrome and polyhydramnios

34. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Vaso-occlusive crisis; dx hb electrophoresis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

35. What are the risk factors of developmental dysplais of hip
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Pipercillin (zosyn) - ticarcillin
Female - breech delivery - family history; tx referral to ortho
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

36. congenital adrenal hyperplasi
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
URI
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

37. if bone age lower than actual and puberty delayed
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Constitutional pubertal delay
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

38. cat scratch disease
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)
Foreign body sensation - photophobia - corneal opacity tx abx
Bartonella henselae; complication is suppuration of lymph node

39. bromocriptine
Prolactinoma
Neurofibromatosis type2
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

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

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41. adrenal tumor
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Foreign body sensation - photophobia - corneal opacity tx abx

42. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

43. adenovirus
URI
Lateral neck xray in epiglottitis show swollen epiglottis
Erb paralysis leading to diaphragmatic paralysis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

44. target cell
TB - breastfeeding - asymptomatic hiv
Atypical lymphocyte
T for t ; thalassemia; inc serum iron and Iron binding
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

45. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Diet modification to provide 110kc/kg/d
Erb paralysis leading to diaphragmatic paralysis

46. major depression
After 6m; breast mild provides iron until 6m.
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Black
Increase of pregnenolone

47. echymoses with low platelet <30k
TB - breastfeeding - asymptomatic hiv
Between pregnenolone and 17oh pregnenolone
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Pho for forward bending; forward defect; common finding has no adverse physical effect

48. Nocturnal enuresis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Less than 5th percentile
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

49. When to give hpv vaccien
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Methylephenidate toxicity; cannot be stopped abruptly; taper
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
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

50. what conditions are not contraindicated
No intervention; 90% foreign bodies pass without difficulty
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Female - breech delivery - family history; tx referral to ortho
TB - breastfeeding - asymptomatic hiv