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. How to dx endopthalmitis
TB - breastfeeding - asymptomatic hiv
Meconeum ileus; think about CF
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erb paralysis leading to diaphragmatic paralysis

2. tzanck
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Herpes
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Dx US tx; correct serum electrolyte - pyloromyotom

3. 3yo - never able to walk
Absence seizure; tx ethosuximide
Penicillin G 4h before delivery
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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

4. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Decreases height - expensive; reserved for severe cases of delayed puberty
Tx only symptomatic carrier

5. osler rendu weber syndrom
refuse
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Multiple telangiectesia - vasular lesion in CNS
Endocardial cushion defect (no separation between heart chambers)

6. causes of FTT
110 kcl/kg/day
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
If aortic root reaches 45 mm

7. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Injury to lower roots of brachial plexus
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Candidal diapar rash; tx clotrimazol
Imaging study to r/o VUR

8. the risk of lyme after bitten by a tick
Herpes
1.5%
refuse
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

9. Tx of bact conjunctivitis
Dactylitis; 2nd common is splenic seqestration
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Atypical lymphocyte

10. 3yo - febrile - left hip externally rotated
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

11. sudden onset of fever - difficulty in breathing
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
24-72 hours

12. Infant with serum billlirubin >25
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Risk of neurological dysfunction
TB - breastfeeding - asymptomatic hiv
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

13. tuberous sclerosis
HSP - look for symmetric skin lesions
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

14. duodenal atresia
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Between pregnenolone and 17oh pregnenolone
Central isosexual precocious puberty; hypothalmaic hamartoma
D for d; down syndrome and polyhydramnios

15. physiological jaundice
Tx only symptomatic carrier
24h to 7d of birth
Marfans - ehlers danlos - homocystinuria
Decreased UGT enzyme

16. cat scratch disease
Pipercillin (zosyn) - ticarcillin
Bartonella henselae; complication is suppuration of lymph node
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Brown

17. Tx of FTT
D for d; down syndrome and polyhydramnios
Lateral neck xray in epiglottitis show swollen epiglottis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Diet modification to provide 110kc/kg/d

18. aplasic crisis
Decreased UGT enzyme
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
14yrs

19. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

20. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Croup
Bladder dysfunction; UTI and renal dysfunctoin

21. low grade fever - cough - diffuse bilat ground glass opacities
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Bartonella henselae; complication is suppuration of lymph node

22. most common complication of otitis media
Bartonella henselae; complication is suppuration of lymph node
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

23. How to investigate delayed puberty
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Risk of neurological dysfunction
HSP - look for symmetric skin lesions

24. How to dx RSV
refuse
>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
After 6m; breast mild provides iron until 6m.
Rapid detection of RSV antigen in nasl

25. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Penicillin G 4h before delivery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Meconeum ileus; think about CF

26. how smoking contributes otitis media in children
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Black

27. lens dislocation
Increase of pregnenolone
24-72 hours
Marfans - ehlers danlos - homocystinuria
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

28. starring spells 10-20sec
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Dactylitis; 2nd common is splenic seqestration
1.5%
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

29. When to bevioral and enviromental measure in led intoxication?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Prolactinoma
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Medical emergency; dimercaprol/edta

30. What is earliest sign of puberty?
Injury to lower roots of brachial plexus
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

31. What are the risk factors of developmental dysplais of hip
Wait until 6 months
Female - breech delivery - family history; tx referral to ortho
Meconeum ileus; think about CF
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

32. How to difference RSV and neonatal chlamydia
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
No wheezing - no feever in chlamydia
Less than 5th percentile

33. sturge weber syndrome
Pho for forward bending; forward defect; common finding has no adverse physical effect
Herpes
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Facial portwine stain

34. coin in child's stomach
No intervention; 90% foreign bodies pass without difficulty
ALL - alzheimers autism adhd depression seizure
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

35. sickle cell with symmetrical swelling of hands and feet
After 24h of abx therapy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Vaso-occlusive crisis; dx hb electrophoresis
24h to 7d of birth

36. What is the definition of delayed puberty?
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

37. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
URI
INH 9m if INH resistant rifampin 6m in children and 4m in adults

38. HUS
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
<2yrs - abd pain - diarrhoea - ARF
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

39. infant botulism
Candidal diapar rash; tx clotrimazol
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
refuse
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

40. How long patient needs to be exposed to tick to get infected
36 hours
Wait until 6 months
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

41. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Atypical lymphocyte

42. association with infantile pyloric stenosis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

43. lead >70
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Multiple telangiectesia - vasular lesion in CNS
Medical emergency; dimercaprol/edta

44. How to prevent GBS in neonate
Strep pneumonie; moraxella; h influenze
Bladder dysfunction; UTI and renal dysfunctoin
Penicillin G 4h before delivery
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

45. What is the calorie requirement of newborn?
Foreign body sensation - photophobia - corneal opacity tx abx
No reticulocyte vs high reticulocyte
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
110 kcl/kg/day

46. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Brown
Meconeum ileus; think about CF

47. language expectation from 2yo
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Black

48. When to give hpv vaccien
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Methylephenidate toxicity; cannot be stopped abruptly; taper
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

49. acute otitis media-pathogen
URI
Marfans - ehlers danlos - homocystinuria
Strep pneumonie; moraxella; h influenze
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

50. down syndrome has inreased risk of developing
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
ALL - alzheimers autism adhd depression seizure
Do HIV testing at first
Hypopigmented macule - glial proliferation - organ haramtomas/cysts