Test your basic knowledge |

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. splenic infarction in sickle cell
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Faciform RBC cause vascular occlusion
No reticulocyte vs high reticulocyte
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

2. sublottic narrowing
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
No reticulocyte vs high reticulocyte
Croup tx cool mist; racemic epi - corticosteroid

3. Neonatal unconjugated hyperbilirubine
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Injury to b/l glossopharyngeal. present in botulism
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Decreased UGT enzyme

4. How long anti-TB drugs given for TB meningitis?
Absence seizure; tx ethosuximide
1.5%
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

5. Tx of bact conjunctivitis
Between pregnenolone and 17oh pregnenolone
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Strep pneumonie; moraxella; h influenze
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

6. kallman syndrome
If aortic root reaches 45 mm
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Pipercillin (zosyn) - ticarcillin

7. major depression
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 -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Penicillin G 4h before delivery

8. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
After 24h of abx therapy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
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

9. IM
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Penicillin G 4h before delivery
Atypical lymphocyte
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

10. Tx of children constipation

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

11. physiological jaundice
To make hip flexed and abducted position in DDH
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
24h to 7d of birth

12. sickle cell with symmetrical swelling of hands and feet
Dactylitis; 2nd common is splenic seqestration
Vaso-occlusive crisis; dx hb electrophoresis
Herpes
24h to 7d of birth

13. dx for DDH
Constitutional pubertal delay
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Lateral neck xray in epiglottitis show swollen epiglottis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

14. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Endocardial cushion defect (no separation between heart chambers)
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

15. How to differential bact vs viral conjunctivitis
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
Dx US tx; correct serum electrolyte - pyloromyotom
Injury to b/l glossopharyngeal. present in botulism
Meconeum ileus; think about CF

16. complete airway obstruction with FB
>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
refuse
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Wait until 6 months

17. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Central isosexual precocious puberty; hypothalmaic hamartoma
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
110 kcl/kg/day

18. When to bevioral and enviromental measure in led intoxication?
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Croup tx cool mist; racemic epi - corticosteroid

19. difference between diaper dermatitis and rash
Rapid detection of RSV antigen in nasl
No wheezing - no feever in chlamydia
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

20. How to differentiate croup vs epiglotitis
Develops in 21 dasy
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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
Medical emergency; dimercaprol/edta

21. When erythema chronicum migrans develops after tick bite
Yes; but it will be less effective
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
24-72 hours
Multiple telangiectesia - vasular lesion in CNS

22. What is the most common initial symptom in sickle cell
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Dactylitis; 2nd common is splenic seqestration
Multiple telangiectesia - vasular lesion in CNS
Methylephenidate toxicity; cannot be stopped abruptly; taper

23. infant botulism
Candidal diapar rash; tx clotrimazol
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Rapid detection of RSV antigen in nasl
Injury to lower roots of brachial plexus

24. lead >70
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)
Medical emergency; dimercaprol/edta
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

25. Infant with serum billlirubin >25
Risk of neurological dysfunction
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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)
1.5%

26. causes of acute anemia
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
HSP - look for symmetric skin lesions
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

27. contact lens keratitis
Penicillin G 4h before delivery
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

28. acute abd pain - hx URI - lower extremity maculo papular rash
Increase of pregnenolone
HSP - look for symmetric skin lesions
Oral DMSA or EDTA IV
Croup tx cool mist; racemic epi - corticosteroid

29. iron supplement in child
Injury to lower roots of brachial plexus
Decreases height - expensive; reserved for severe cases of delayed puberty
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
After 6m; breast mild provides iron until 6m.

30. the risk of lyme after bitten by a tick
Dx US tx; correct serum electrolyte - pyloromyotom
Bartonella henselae; complication is suppuration of lymph node
1.5%
After 24h of abx therapy

31. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Brown
Croup
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

32. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Risk of neurological dysfunction
Congenital rubella syndrome
HSP - look for symmetric skin lesions
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

33. failure to thrive
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Risk of neurological dysfunction
Less than 5th percentile

34. dx for turner
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Constitutional pubertal delay
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

35. echymoses with low platelet <30k
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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
Herpes

36. pneumonia in CF patient
Risk of neurological dysfunction
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

37. duodenal atresia
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
D for d; down syndrome and polyhydramnios
After 6m; breast mild provides iron until 6m.
No wheezing - no feever in chlamydia

38. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Herpes
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Constitutional pubertal delay

39. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
ALL - alzheimers autism adhd depression seizure
Methylephenidate toxicity; cannot be stopped abruptly; taper
HSP - look for symmetric skin lesions
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

40. When to do aortic root surgery in marfans to prevent dissection?
Methylephenidate toxicity; cannot be stopped abruptly; taper
If aortic root reaches 45 mm
Neurofibromatosis type2
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

41. carditis and arthritis after rheumatic fever
Vaso-occlusive crisis; dx hb electrophoresis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Develops in 21 dasy

42. contraindications of MMR vaccine
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Benign permature thelarche; expectant management
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

43. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Strep pneumonie; moraxella; h influenze
110 kcl/kg/day
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

44. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Dactylitis; 2nd common is splenic seqestration
If aortic root reaches 45 mm

45. acute otitis externa

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

46. low grade fever - cough - diffuse bilat ground glass opacities
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
<2yrs - abd pain - diarrhoea - ARF
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

47. infantile hypertrophic pyloric stenosis
24-72 hours
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)
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Dx US tx; correct serum electrolyte - pyloromyotom

48. Nocturnal enuresis
>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
Medical emergency; dimercaprol/edta
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

49. down syndrome with holocystolic mumur
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)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Endocardial cushion defect (no separation between heart chambers)
Tx only symptomatic carrier

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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183