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Test your basic knowledge |
USMLE Step3 Pediatrics
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Study First
Subjects
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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. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Vaso-occlusive crisis; dx hb electrophoresis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Oral DMSA or EDTA IV
2. sturge weber syndrome
Facial portwine stain
TB - breastfeeding - asymptomatic hiv
Yes; but it will be less effective
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
3. is local anesthetics be used in cellulitis to reduce pain
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Less than 5th percentile
Lateral neck xray in epiglottitis show swollen epiglottis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
4. duodenal atresia
D for d; down syndrome and polyhydramnios
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)
>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
Develops in 21 dasy
5. language expectation from 2yo
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Strep pneumonie; moraxella; h influenze
6. can women with abnormal smear or genital get vaccine
Diet modification to provide 110kc/kg/d
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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
Yes; but it will be less effective
7. aplasic crisis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
RSV - rhino and influenza
8. How to differentiate caput succedanueum and cephalohematoma
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Pipercillin (zosyn) - ticarcillin
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Decr calorie intake; decr calorie absorption;incr calorie demand
9. When to bevioral and enviromental measure in led intoxication?
Between pregnenolone and 17oh pregnenolone
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No; they are basic compound will be neutralized in an acidic environment of cellulitis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
10. Infant with serum billlirubin >25
No myoclonic activity in JME
Risk of neurological dysfunction
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Do HIV testing at first
11. TTP pentad
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Injury to lower roots of brachial plexus
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
12. What is earliest sign of puberty?
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
13. 3yo - febrile - left hip externally rotated
No; they are basic compound will be neutralized in an acidic environment of cellulitis
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)
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
14. How to dx acute angle closure glaucoma
Pipercillin (zosyn) - ticarcillin
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Brown
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
15. acute otitis media-pathogen
Brown
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Strep pneumonie; moraxella; h influenze
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
16. difference between rubeola (measles) and rulbella
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No intervention; 90% foreign bodies pass without difficulty
17. bromocriptine
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No reticulocyte vs high reticulocyte
Prolactinoma
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
18. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Croup
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Less than 5th percentile
19. what conditions are not contraindicated
110 kcl/kg/day
After 24h of abx therapy
TB - breastfeeding - asymptomatic hiv
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
20. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
21. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Injury to b/l glossopharyngeal. present in botulism
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Methylephenidate toxicity; cannot be stopped abruptly; taper
Brown
22. How to dx keratitis?
Female - breech delivery - family history; tx referral to ortho
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to b/l glossopharyngeal. present in botulism
Black
23. tuberous sclerosis
1.5%
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
D for d; down syndrome and polyhydramnios
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
24. What is the calorie requirement of newborn?
Erb paralysis leading to diaphragmatic paralysis
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
110 kcl/kg/day
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
25. causes of FTT
Decr calorie intake; decr calorie absorption;incr calorie demand
Injury to b/l glossopharyngeal. present in botulism
Pho for forward bending; forward defect; common finding has no adverse physical effect
Bladder dysfunction; UTI and renal dysfunctoin
26. cat scratch disease
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Bartonella henselae; complication is suppuration of lymph node
27. IM
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
refuse
Atypical lymphocyte
28. dx for turner
ALL - alzheimers autism adhd depression seizure
T for t ; thalassemia; inc serum iron and Iron binding
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Decreased UGT enzyme
29. Parvovirus
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
36 hours
Fifth disease; febrile syndrome
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
30. lens dislocation
Marfans - ehlers danlos - homocystinuria
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Benign permature thelarche; expectant management
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
31. contraindications of DTap
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
110 kcl/kg/day
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
32. difference between structural disorder and flexible kyphosis
Atypical lymphocyte
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
RSV - rhino and influenza
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
33. When to give HRT in turner
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
14yrs
Black
34. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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
Lateral neck xray in epiglottitis show swollen epiglottis
Endocardial cushion defect (no separation between heart chambers)
35. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
After 6m; breast mild provides iron until 6m.
Prolactinoma
36. physiological jaundice
24h to 7d of birth
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
37. carditis and arthritis after rheumatic fever
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
110 kcl/kg/day
Develops in 21 dasy
Atypical lymphocyte
38. spitting up - vomiting at night - weight stable
Marfans - ehlers danlos - homocystinuria
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
If aortic root reaches 45 mm
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
39. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
D for d; down syndrome and polyhydramnios
URI
Meconeum ileus; think about CF
36 hours
40. adrenal tumor
24-72 hours
Methylephenidate toxicity; cannot be stopped abruptly; taper
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
41. 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
Tx only symptomatic carrier
Marfans - ehlers danlos - homocystinuria
Atopic dermatitis; strong allergic/immunologic component; incr IgE
42. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth
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43. adenovirus
No intervention; 90% foreign bodies pass without difficulty
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
URI
Endocardial cushion defect (no separation between heart chambers)
44. target cell
RSV - rhino and influenza
Develops in 21 dasy
T for t ; thalassemia; inc serum iron and Iron binding
TB - breastfeeding - asymptomatic hiv
45. penicillin effective against pseudomonas
ALL - alzheimers autism adhd depression seizure
>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
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Pipercillin (zosyn) - ticarcillin
46. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Medical emergency; dimercaprol/edta
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
47. Tx of FTT
Bartonella henselae; complication is suppuration of lymph node
110 kcl/kg/day
Diet modification to provide 110kc/kg/d
Rapid detection of RSV antigen in nasl
48. low grade fever - cough - diffuse bilat ground glass opacities
Dx US tx; correct serum electrolyte - pyloromyotom
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No intervention; 90% foreign bodies pass without difficulty
Medical emergency; dimercaprol/edta
49. viruses cause bronhioltitis
RSV - rhino and influenza
If aortic root reaches 45 mm
Multiple telangiectesia - vasular lesion in CNS
Female - breech delivery - family history; tx referral to ortho
50. acute otitis externa
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