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Test your basic knowledge |
USMLE Step3 Pediatrics
Start Test
Study First
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. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
2. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth
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3. pumonary TB
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)
Croup tx cool mist; racemic epi - corticosteroid
Medical emergency; dimercaprol/edta
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
4. target cell
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
T for t ; thalassemia; inc serum iron and Iron binding
Foreign body sensation - photophobia - corneal opacity tx abx
Herpes
5. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
After 6m; breast mild provides iron until 6m.
Erb paralysis leading to diaphragmatic paralysis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
6. tick transmits RMSF
Black
RSV - rhino and influenza
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
7. most common complication of otitis media
Biliary atresia; tx surgery
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
8. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Black
Meconeum ileus; think about CF
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
9. pavlik harness
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
110 kcl/kg/day
To make hip flexed and abducted position in DDH
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
10. non immune pregnant women exposed to rubella in first trimester
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Congenital rubella syndrome
11. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
TB - breastfeeding - asymptomatic hiv
Imaging study to r/o VUR
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
12. doing worse in school - lack of attention - starring speel
T for t ; thalassemia; inc serum iron and Iron binding
Absence seizure; tx ethosuximide
Yes; but it will be less effective
URI
13. How to dx keratitis?
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Foreign body sensation - photophobia - corneal opacity tx abx
ALL - alzheimers autism adhd depression seizure
14. coin in child's stomach
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
No intervention; 90% foreign bodies pass without difficulty
14yrs
Rapid detection of RSV antigen in nasl
15. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Croup
URI
If aortic root reaches 45 mm
16. complete airway obstruction with FB
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
>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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Facial portwine stain
17. deficinecy of 17 hydroxylase
Prolactinoma
TB - breastfeeding - asymptomatic hiv
Increase of pregnenolone
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
18. lead >70
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Diet modification to provide 110kc/kg/d
Medical emergency; dimercaprol/edta
19. How to dx post uretheral valve
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Congenital rubella syndrome
<2yrs - abd pain - diarrhoea - ARF
20. side effect of testosteron therapy
Medical emergency; dimercaprol/edta
T for t ; thalassemia; inc serum iron and Iron binding
Decreases height - expensive; reserved for severe cases of delayed puberty
Multiple telangiectesia - vasular lesion in CNS
21. Nocturnal enuresis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
RSV - rhino and influenza
URI
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
22. IM
Atypical lymphocyte
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
To make hip flexed and abducted position in DDH
23. decreased mobility of tympanic membrane after otitis media
URI
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
If aortic root reaches 45 mm
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
24. dx for turner
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Bartonella henselae; complication is suppuration of lymph node
Facial portwine stain
Diet modification to provide 110kc/kg/d
25. TTP pentad
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Foreign body sensation - photophobia - corneal opacity tx abx
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
26. cardiac manifestation of turner
To make hip flexed and abducted position in DDH
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decr calorie intake; decr calorie absorption;incr calorie demand
27. acute abd pain - hx URI - lower extremity maculo papular rash
Bladder dysfunction; UTI and renal dysfunctoin
HSP - look for symmetric skin lesions
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Decr calorie intake; decr calorie absorption;incr calorie demand
28. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
refuse
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Biliary atresia; tx surgery
29. How to dx endopthalmitis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
30. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
No myoclonic activity in JME
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
Vaso-occlusive crisis; dx hb electrophoresis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
31. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Pipercillin (zosyn) - ticarcillin
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
32. viruses cause bronhioltitis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Lateral neck xray in epiglottitis show swollen epiglottis
Less than 5th percentile
RSV - rhino and influenza
33. 21 hydroxylase
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Endocardial cushion defect (no separation between heart chambers)
34. duodenal atresia
Absence seizure; tx ethosuximide
Decreased UGT enzyme
D for d; down syndrome and polyhydramnios
24h to 7d of birth
35. Tx of bact conjunctivitis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Wait until 6 months
TB - breastfeeding - asymptomatic hiv
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
36. difference between diaper dermatitis and rash
Brown
Increase of pregnenolone
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
Vaso-occlusive crisis; dx hb electrophoresis
37. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
If aortic root reaches 45 mm
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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
38. How to dx acute angle closure glaucoma
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
39. lead 44-70
Foreign body sensation - photophobia - corneal opacity tx abx
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
D for d; down syndrome and polyhydramnios
Oral DMSA or EDTA IV
40. adenovirus
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Fifth disease; febrile syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
URI
41. Tx of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Tx only symptomatic carrier
URI
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
42. splenic infarction in sickle cell
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)
Dactylitis; 2nd common is splenic seqestration
Faciform RBC cause vascular occlusion
Black
43. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
44. When to give HRT in turner
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
14yrs
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Injury to b/l glossopharyngeal. present in botulism
45. HUS
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No myoclonic activity in JME
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<2yrs - abd pain - diarrhoea - ARF
46. dx of lyme
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Mainly clinical; serology with initial ELISA - with western blot confirmation;
36 hours
47. When erythema chronicum migrans develops after tick bite
T for t ; thalassemia; inc serum iron and Iron binding
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Meconeum ileus; think about CF
24-72 hours
48. iron supplement in child
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.
<2yrs - abd pain - diarrhoea - ARF
Decr calorie intake; decr calorie absorption;incr calorie demand
49. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Benign permature thelarche; expectant management
<2yrs - abd pain - diarrhoea - ARF
50. mcCune albright`
Injury to lower roots of brachial plexus
No myoclonic activity in JME
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts