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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. starring spells 10-20sec
Dx US tx; correct serum electrolyte - pyloromyotom
Yes; but it will be less effective
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Do HIV testing at first

2. contraindications of DTap
No wheezing - no feever in chlamydia
Injury to lower roots of brachial plexus
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

3. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
1.5%
Brown
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Central isosexual precocious puberty; hypothalmaic hamartoma

4. What is the most common initial symptom in sickle cell
Pipercillin (zosyn) - ticarcillin
Dactylitis; 2nd common is splenic seqestration
Neurofibromatosis type2
Strep pneumonie; moraxella; h influenze

5. osler rendu weber syndrom
24h to 7d of birth
RSV - rhino and influenza
Multiple telangiectesia - vasular lesion in CNS
Pho for forward bending; forward defect; common finding has no adverse physical effect

6. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Brown
<2yrs - abd pain - diarrhoea - ARF
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

7. doing worse in school - lack of attention - starring speel
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)
Absence seizure; tx ethosuximide
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Injury to lower roots of brachial plexus

8. splenic infarction in sickle cell
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Faciform RBC cause vascular occlusion
TB - breastfeeding - asymptomatic hiv
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

9. how thalassemia die
Increase of progesteron/17oh progesterone
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
RSV - rhino and influenza

10. tzanck
Herpes
110 kcl/kg/day
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Decreased UGT enzyme

11. impaired gag reflex
No wheezing - no feever in chlamydia
URI
Injury to b/l glossopharyngeal. present in botulism
Rapid detection of RSV antigen in nasl

12. lens dislocation
Biliary atresia; tx surgery
Marfans - ehlers danlos - homocystinuria
Croup tx cool mist; racemic epi - corticosteroid
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

13. When to give hpv vaccien
Thalassemia - congenital hemolytic anemia
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
110 kcl/kg/day
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

14. viruses cause bronhioltitis
RSV - rhino and influenza
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Herpes
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)

15. down syndrome with holocystolic mumur
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Endocardial cushion defect (no separation between heart chambers)
ALL - alzheimers autism adhd depression seizure
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

16. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Atypical lymphocyte
Between pregnenolone and 17oh pregnenolone

17. acute otitis media-pathogen
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Strep pneumonie; moraxella; h influenze

18. contraindications of MMR vaccine
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Pho for forward bending; forward defect; common finding has no adverse physical effect
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

19. lead 44-70
Oral DMSA or EDTA IV
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

20. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Vaso-occlusive crisis; dx hb electrophoresis
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

21. How to dx keratitis?
Risk of neurological dysfunction
1.5%
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Foreign body sensation - photophobia - corneal opacity tx abx

22. How long anti-TB drugs given for TB meningitis?
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Absence seizure; tx ethosuximide
Wait until 6 months
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

23. Tx of children constipation

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24. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
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
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

25. acute abd pain - hx URI - lower extremity maculo papular rash
Decreases height - expensive; reserved for severe cases of delayed puberty
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Rapid detection of RSV antigen in nasl
HSP - look for symmetric skin lesions

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

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27. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
URI

28. carditis and arthritis after rheumatic fever
Tx only symptomatic carrier
Develops in 21 dasy
Wait until 6 months
14yrs

29. thumb sign
Yes; but it will be less effective
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
HSP - look for symmetric skin lesions

30. association with infantile pyloric stenosis
D for d; down syndrome and polyhydramnios
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Dx US tx; correct serum electrolyte - pyloromyotom
Less than 5th percentile

31. How to prevent GBS in neonate
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Penicillin G 4h before delivery
Candidal diapar rash; tx clotrimazol
Dx US tx; correct serum electrolyte - pyloromyotom

32. differentiate between central and peripheral precocious puberty
ALL - alzheimers autism adhd depression seizure
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No wheezing - no feever in chlamydia
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

33. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
No intervention; 90% foreign bodies pass without difficulty
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
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

34. most common complication of otitis media
Vaso-occlusive crisis; dx hb electrophoresis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

35. Tx of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Atopic dermatitis; strong allergic/immunologic component; incr IgE
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Diet modification to provide 110kc/kg/d

36. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Develops in 21 dasy
Medical emergency; dimercaprol/edta
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

37. centor criteria for bact pharyngitis
Herpes
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Decreased UGT enzyme
Imaging study to r/o VUR

38. how smoking contributes otitis media in children
Between pregnenolone and 17oh pregnenolone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Facial portwine stain

39. difference between rubeola (measles) and rulbella
Faciform RBC cause vascular occlusion
Between pregnenolone and 17oh pregnenolone
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

40. Tx of botulism
Pho for forward bending; forward defect; common finding has no adverse physical effect
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Tx only symptomatic carrier
ALL - alzheimers autism adhd depression seizure

41. TB prophylaxis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
URI
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Meconeum ileus; think about CF

42. sublottic narrowing
Croup tx cool mist; racemic epi - corticosteroid
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

43. Nocturnal enuresis
Injury to b/l glossopharyngeal. present in botulism
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
>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

44. 18mo bilat breast enlargment - some pubic hair
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Female - breech delivery - family history; tx referral to ortho
Benign permature thelarche; expectant management
Biliary atresia; tx surgery

45. the risk of lyme after bitten by a tick
Foreign body sensation - photophobia - corneal opacity tx abx
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
1.5%
Brown

46. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Candidal diapar rash; tx clotrimazol
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)
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

47. difference between breast milk and breafeeding jaundice
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
36 hours
Erb paralysis leading to diaphragmatic paralysis

48. dx for DDH
HSP - look for symmetric skin lesions
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

49. difference between structural disorder and flexible kyphosis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Neurofibromatosis type2

50. Parvovirus
Fifth disease; febrile syndrome
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
refuse
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness