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. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Lateral neck xray in epiglottitis show swollen epiglottis
If aortic root reaches 45 mm
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

2. failure to thrive
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
If aortic root reaches 45 mm
Less than 5th percentile
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

3. thumb sign
Croup tx cool mist; racemic epi - corticosteroid
Atypical lymphocyte
Develops in 21 dasy
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

4. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Penicillin G 4h before delivery
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
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

5. dx for DDH
To make hip flexed and abducted position in DDH
Strep pneumonie; moraxella; h influenze
Penicillin G 4h before delivery
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

6. low grade fever - cough - diffuse bilat ground glass opacities
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
1.5%
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

7. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
14yrs
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Foreign body sensation - photophobia - corneal opacity tx abx
Methylephenidate toxicity; cannot be stopped abruptly; taper

8. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Congenital rubella syndrome
Candidal diapar rash; tx clotrimazol
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

9. What is earliest sign of puberty?
Rapid detection of RSV antigen in nasl
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Thalassemia - congenital hemolytic anemia

10. down syndrome has inreased risk of developing
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
1.5%
No wheezing - no feever in chlamydia
ALL - alzheimers autism adhd depression seizure

11. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Develops in 21 dasy
Black

12. if bone age lower than actual and puberty delayed
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Constitutional pubertal delay
Pho for forward bending; forward defect; common finding has no adverse physical effect
<2yrs - abd pain - diarrhoea - ARF

13. 21 hydroxylase
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
>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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

14. What is thumbprint sign
Oral DMSA or EDTA IV
No reticulocyte vs high reticulocyte
Lateral neck xray in epiglottitis show swollen epiglottis
Brown

15. decreased mobility of tympanic membrane after otitis media
No reticulocyte vs high reticulocyte
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Brown
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

16. dx of lyme
Between pregnenolone and 17oh pregnenolone
No reticulocyte vs high reticulocyte
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Mainly clinical; serology with initial ELISA - with western blot confirmation;

17. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Neurofibromatosis type2
Central isosexual precocious puberty; hypothalmaic hamartoma
Between pregnenolone and 17oh pregnenolone

18. cleft lip but no cleft palate
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Increase of pregnenolone
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

19. adenovirus
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
URI
Dactylitis; 2nd common is splenic seqestration
Candidal diapar rash; tx clotrimazol

20. When to give HRT in turner
Congenital rubella syndrome
14yrs
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

21. When to bevioral and enviromental measure in led intoxication?
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Strep pneumonie; moraxella; h influenze
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

22. major depression
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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; staph - HiB tx: ceftriaxone/cefotaxime

23. How to differentiate croup vs epiglotitis
Imaging study to r/o VUR
Prolactinoma
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

24. defcicieny of 21 hydroxylase
Candidal diapar rash; tx clotrimazol
Croup tx cool mist; racemic epi - corticosteroid
Increase of progesteron/17oh progesterone
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

25. Tx of children constipation

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

26. infant botulism
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
No wheezing - no feever in chlamydia
D for d; down syndrome and polyhydramnios

27. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No reticulocyte vs high reticulocyte
URI

28. What is the most common initial symptom in sickle cell
No wheezing - no feever in chlamydia
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Dactylitis; 2nd common is splenic seqestration

29. sickle cell with symmetrical swelling of hands and feet
Meconeum ileus; think about CF
Prolactinoma
Vaso-occlusive crisis; dx hb electrophoresis
Central isosexual precocious puberty; hypothalmaic hamartoma

30. viruses cause bronhioltitis
110 kcl/kg/day
RSV - rhino and influenza
Candidal diapar rash; tx clotrimazol
Congenital rubella syndrome

31. centor criteria for bact pharyngitis
1.5%
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

32. Neonatal conjugated hyperbilirubinemia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Candidal diapar rash; tx clotrimazol
24-72 hours
Biliary atresia; tx surgery

33. HUS
<2yrs - abd pain - diarrhoea - ARF
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
TB - breastfeeding - asymptomatic hiv
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

34. When to give hpv vaccien
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
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
Oral DMSA or EDTA IV
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

35. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Decr calorie intake; decr calorie absorption;incr calorie demand
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Wait until 6 months

36. Neonatal unconjugated hyperbilirubine
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Biliary atresia; tx surgery
Decreased UGT enzyme
Constitutional pubertal delay

37. Tx of botulism
No intervention; 90% foreign bodies pass without difficulty
Increase of pregnenolone
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

38. microcytic - hypochromic anemia - hepatospelnomegaly
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Thalassemia - congenital hemolytic anemia
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

39. penicillin effective against pseudomonas
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Brown
Pipercillin (zosyn) - ticarcillin

40. What is the definition of delayed puberty?
Croup tx cool mist; racemic epi - corticosteroid
Strep pneumonie; moraxella; h influenze
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

41. physiological jaundice
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Brown
24h to 7d of birth
Rapid detection of RSV antigen in nasl

42. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Central isosexual precocious puberty; hypothalmaic hamartoma
After 24h of abx therapy
No intervention; 90% foreign bodies pass without difficulty

43. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Congenital rubella syndrome
Decr calorie intake; decr calorie absorption;incr calorie demand
Lateral neck xray in epiglottitis show swollen epiglottis

44. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Methylephenidate toxicity; cannot be stopped abruptly; taper

45. impaired gag reflex
Central isosexual precocious puberty; hypothalmaic hamartoma
Injury to b/l glossopharyngeal. present in botulism
ALL - alzheimers autism adhd depression seizure
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)

46. Tx of community acquired pneumonia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
1.5%
No myoclonic activity in JME
Faciform RBC cause vascular occlusion

47. How to difference viral and bact pneumonia
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Croup tx cool mist; racemic epi - corticosteroid

48. 18mo bilat breast enlargment - some pubic hair
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Benign permature thelarche; expectant management
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
No wheezing - no feever in chlamydia

49. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
D for d; down syndrome and polyhydramnios

50. deficinecy of 17 hydroxylase
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Increase of pregnenolone
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)