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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. flexible kyphosis
<2yrs - abd pain - diarrhoea - ARF
URI
After 24h of abx therapy
Pho for forward bending; forward defect; common finding has no adverse physical effect

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

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3. association with infantile pyloric stenosis
Endocardial cushion defect (no separation between heart chambers)
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

4. low grade fever - cough - diffuse bilat ground glass opacities
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Marfans - ehlers danlos - homocystinuria
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

5. IM
Endocardial cushion defect (no separation between heart chambers)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Atypical lymphocyte

6. complication of lumbosacral meningocele
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Bladder dysfunction; UTI and renal dysfunctoin
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

7. 18mo bilat breast enlargment - some pubic hair
Strep pneumonie; moraxella; h influenze
Brown
No wheezing - no feever in chlamydia
Benign permature thelarche; expectant management

8. What is the most common initial symptom in sickle cell
Do HIV testing at first
Imaging study to r/o VUR
Dactylitis; 2nd common is splenic seqestration
Increase of pregnenolone

9. when bact conjunctivitis patient can go back to school
After 24h of abx therapy
Foreign body sensation - photophobia - corneal opacity tx abx
Yes; but it will be less effective
Mainly clinical; serology with initial ELISA - with western blot confirmation;

10. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
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
refuse

11. adenovirus
URI
Multiple telangiectesia - vasular lesion in CNS
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

12. spitting up - vomiting at night - weight stable
Benign permature thelarche; expectant management
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Risk of neurological dysfunction
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

13. viruses cause bronhioltitis
Decreases height - expensive; reserved for severe cases of delayed puberty
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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
RSV - rhino and influenza

14. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Brown

15. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
1.5%
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

16. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Candidal diapar rash; tx clotrimazol
24-72 hours

17. hypopigmented spots - family hx bilat deafness
Vaso-occlusive crisis; dx hb electrophoresis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Multiple telangiectesia - vasular lesion in CNS
Neurofibromatosis type2

18. how thalassemia die
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
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
Constitutional pubertal delay

19. defcicieny of 21 hydroxylase
Increase of progesteron/17oh progesterone
refuse
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Congenital rubella syndrome

20. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Prolactinoma
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Decr calorie intake; decr calorie absorption;incr calorie demand

21. language expectation from 2yo
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+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Dx US tx; correct serum electrolyte - pyloromyotom
Tx only symptomatic carrier

22. physiological jaundice
24h to 7d of birth
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Neurofibromatosis type2

23. bromocriptine
Medical emergency; dimercaprol/edta
Atypical lymphocyte
Prolactinoma
After 6m; breast mild provides iron until 6m.

24. TTP pentad
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
HSP - look for symmetric skin lesions
Injury to b/l glossopharyngeal. present in botulism

25. acute otitis externa

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26. deficinecy of 17 hydroxylase
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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)
Increase of pregnenolone

27. tick transmits RMSF
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Methylephenidate toxicity; cannot be stopped abruptly; taper
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Black

28. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
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)
Meconeum ileus; think about CF
No reticulocyte vs high reticulocyte
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

29. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
RSV - rhino and influenza
Foreign body sensation - photophobia - corneal opacity tx abx

30. pneumonia in CF patient
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Strep pneumonie; moraxella; h influenze

31. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
After 6m; breast mild provides iron until 6m.
Medical emergency; dimercaprol/edta
Candidal diapar rash; tx clotrimazol

32. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Less than 5th percentile
Injury to lower roots of brachial plexus
Between pregnenolone and 17oh pregnenolone

33. congenital adrenal hyperplasi
Decreases height - expensive; reserved for severe cases of delayed puberty
Croup tx cool mist; racemic epi - corticosteroid
Meconeum ileus; think about CF
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

34. How to investigate delayed puberty
Prolactinoma
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
INH 9m if INH resistant rifampin 6m in children and 4m in adults

35. pavlik harness
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Oral DMSA or EDTA IV
Facial portwine stain
To make hip flexed and abducted position in DDH

36. What is the definition of delayed puberty?
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Do HIV testing at first
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

37. Tx of bact conjunctivitis
Croup
Thalassemia - congenital hemolytic anemia
Constitutional pubertal delay
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

38. Tx of FTT
After 24h of abx therapy
Diet modification to provide 110kc/kg/d
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
24h to 7d of birth

39. What are the risk factors of developmental dysplais of hip
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Decreases height - expensive; reserved for severe cases of delayed puberty
Female - breech delivery - family history; tx referral to ortho

40. splenic infarction in sickle cell
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
110 kcl/kg/day
Faciform RBC cause vascular occlusion

41. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Multiple telangiectesia - vasular lesion in CNS
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

42. infantile hypertrophic pyloric stenosis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
No intervention; 90% foreign bodies pass without difficulty
<2yrs - abd pain - diarrhoea - ARF
Dx US tx; correct serum electrolyte - pyloromyotom

43. indications of VUR
Prolactinoma
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

44. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Imaging study to r/o VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

45. Tx of children constipation

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46. horner syndrom
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
RSV - rhino and influenza
Injury to lower roots of brachial plexus
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

47. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Dactylitis; 2nd common is splenic seqestration

48. lens dislocation
Marfans - ehlers danlos - homocystinuria
>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
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Risk of neurological dysfunction

49. How to dx endopthalmitis
Between pregnenolone and 17oh pregnenolone
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Meconeum ileus; think about CF
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

50. Febrile seizure
ALL - alzheimers autism adhd depression seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Wait until 6 months
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -