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. dx for DDH
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
No; they are basic compound will be neutralized in an acidic environment of cellulitis
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

2. How to investigate delayed puberty
Injury to lower roots of brachial plexus
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Between pregnenolone and 17oh pregnenolone
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

3. What are the risk factors of developmental dysplais of hip
After 6m; breast mild provides iron until 6m.
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Female - breech delivery - family history; tx referral to ortho
1.5%

4. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Fifth disease; febrile syndrome

5. doing worse in school - lack of attention - starring speel
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Absence seizure; tx ethosuximide
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

6. major depression
Croup tx cool mist; racemic epi - corticosteroid
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
After 24h of abx therapy
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

7. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Candidal diapar rash; tx clotrimazol
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Vaso-occlusive crisis; dx hb electrophoresis

8. What is thumbprint sign
Female - breech delivery - family history; tx referral to ortho
Lateral neck xray in epiglottitis show swollen epiglottis
24-72 hours
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

9. What is the most common initial symptom in sickle cell
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
No wheezing - no feever in chlamydia
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Dactylitis; 2nd common is splenic seqestration

10. When to do surgery for undescended testes
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
If aortic root reaches 45 mm
Injury to lower roots of brachial plexus
Wait until 6 months

11. most common complication of otitis media
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

12. association with infantile pyloric stenosis
Lateral neck xray in epiglottitis show swollen epiglottis
Endocardial cushion defect (no separation between heart chambers)
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

13. bromocriptine
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
110 kcl/kg/day
Prolactinoma
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

14. How long anti-TB drugs given for TB meningitis?
Benign permature thelarche; expectant management
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
To make hip flexed and abducted position in DDH

15. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Croup tx cool mist; racemic epi - corticosteroid
Benign permature thelarche; expectant management
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

16. acute otitis media-pathogen
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Strep pneumonie; moraxella; h influenze
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

17. difference between breast milk and breafeeding jaundice
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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
Dx US tx; correct serum electrolyte - pyloromyotom
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

18. can women with abnormal smear or genital get vaccine
Penicillin G 4h before delivery
Decreased UGT enzyme
Yes; but it will be less effective
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

19. infant botulism
RSV - rhino and influenza
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
After 6m; breast mild provides iron until 6m.

20. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
Prolactinoma
Biliary atresia; tx surgery
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

21. How to differential bact vs viral conjunctivitis
refuse
Injury to lower roots of brachial plexus
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do 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

22. 17 alpha hydroxylase
Oral DMSA or EDTA IV
<2yrs - abd pain - diarrhoea - ARF
Between pregnenolone and 17oh pregnenolone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

23. 18mo bilat breast enlargment - some pubic hair
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Benign permature thelarche; expectant management
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Erb paralysis leading to diaphragmatic paralysis

24. How to dx post uretheral valve
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
No intervention; 90% foreign bodies pass without difficulty
1.5%
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

25. if bone age lower than actual and puberty delayed
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Constitutional pubertal delay
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Thalassemia - congenital hemolytic anemia

26. What is the definition of delayed puberty?
No reticulocyte vs high reticulocyte
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
Rapid detection of RSV antigen in nasl
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

27. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Wait until 6 months
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Candidal diapar rash; tx clotrimazol

28. language delay
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

29. Parvovirus
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
Fifth disease; febrile syndrome
Atypical lymphocyte
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

30. pumonary TB
Lateral neck xray in epiglottitis show swollen epiglottis
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
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)
ALL - alzheimers autism adhd depression seizure

31. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
1.5%
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

32. low grade fever - cough - diffuse bilat ground glass opacities
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Rapid detection of RSV antigen in nasl
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Less than 5th percentile

33. tuberous sclerosis
Increase of progesteron/17oh progesterone
Black
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

34. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
Central isosexual precocious puberty; hypothalmaic hamartoma
Dactylitis; 2nd common is splenic seqestration
Develops in 21 dasy

35. viruses cause bronhioltitis
RSV - rhino and influenza
Central isosexual precocious puberty; hypothalmaic hamartoma
Strep pneumonie; moraxella; h influenze
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

36. When to give HRT in turner
No myoclonic activity in JME
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
14yrs
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

37. Tx of community acquired pneumonia
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
1.5%
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

38. acute abd pain - hx URI - lower extremity maculo papular rash
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
HSP - look for symmetric skin lesions
36 hours
No; they are basic compound will be neutralized in an acidic environment of cellulitis

39. kallman syndrome
ALL - alzheimers autism adhd depression seizure
Tx only symptomatic carrier
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Candidal diapar rash; tx clotrimazol

40. complication of lumbosacral meningocele
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Bladder dysfunction; UTI and renal dysfunctoin
Absence seizure; tx ethosuximide
Biliary atresia; tx surgery

41. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erb paralysis leading to diaphragmatic paralysis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Prolactinoma

42. crying during urination. bacteriuria pyruria - rec episodes
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
Imaging study to r/o VUR
Thalassemia - congenital hemolytic anemia
Strep pneumonie; moraxella; h influenze

43. physiological jaundice
Atypical lymphocyte
24h to 7d of birth
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
14yrs

44. lens dislocation
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Atypical lymphocyte
Marfans - ehlers danlos - homocystinuria

45. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Faciform RBC cause vascular occlusion
Erb paralysis leading to diaphragmatic paralysis
Between pregnenolone and 17oh pregnenolone
No reticulocyte vs high reticulocyte

46. splenic infarction in sickle cell
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Faciform RBC cause vascular occlusion
No myoclonic activity in JME
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

47. Infant with serum billlirubin >25
refuse
Risk of neurological dysfunction
Croup tx cool mist; racemic epi - corticosteroid
Herpes

48. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
24h to 7d of birth
TB - breastfeeding - asymptomatic hiv
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

49. lead 44-70
Oral DMSA or EDTA IV
Black
Pipercillin (zosyn) - ticarcillin
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

50. osler rendu weber syndrom
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Multiple telangiectesia - vasular lesion in CNS