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. 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)
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Do HIV testing at first

2. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Endocardial cushion defect (no separation between heart chambers)

3. hypopigmented spots - family hx bilat deafness
Faciform RBC cause vascular occlusion
No wheezing - no feever in chlamydia
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Neurofibromatosis type2

4. infant botulism
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Pipercillin (zosyn) - ticarcillin

5. How to differential bact vs viral conjunctivitis
No myoclonic activity in JME
Candidal diapar rash; tx clotrimazol
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
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

6. pneumonia in CF patient
Congenital rubella syndrome
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Injury to b/l glossopharyngeal. present in botulism
Candidal diapar rash; tx clotrimazol

7. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
No reticulocyte vs high reticulocyte
Endocardial cushion defect (no separation between heart chambers)
Decreases height - expensive; reserved for severe cases of delayed puberty

8. tzanck
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Herpes
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

9. side effect of testosteron therapy
Multiple telangiectesia - vasular lesion in CNS
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Decreases height - expensive; reserved for severe cases of delayed puberty
Strep pneumonie; moraxella; h influenze

10. how smoking contributes otitis media in children
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
D for d; down syndrome and polyhydramnios
Pipercillin (zosyn) - ticarcillin

11. How to difference viral and bact pneumonia
Female - breech delivery - family history; tx referral to ortho
Diet modification to provide 110kc/kg/d
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

12. down syndrome with holocystolic mumur
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Endocardial cushion defect (no separation between heart chambers)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

13. How long anti-TB drugs given for TB meningitis?
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

14. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Central isosexual precocious puberty; hypothalmaic hamartoma
Fifth disease; febrile syndrome

15. failure to thrive
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Less than 5th percentile

16. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

17. Tx of bact conjunctivitis
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Faciform RBC cause vascular occlusion

18. When erythema chronicum migrans develops after tick bite
24-72 hours
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

19. differentiate between central and peripheral precocious puberty
RSV - rhino and influenza
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Prolactinoma
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

20. dx for DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
36 hours
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Dactylitis; 2nd common is splenic seqestration

21. TTP pentad
refuse
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
To make hip flexed and abducted position in DDH
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

22. cat scratch disease
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Bartonella henselae; complication is suppuration of lymph node
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
No myoclonic activity in JME

23. When to do surgery for undescended testes
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
Wait until 6 months
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

24. How to differentiate caput succedanueum and cephalohematoma
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
No wheezing - no feever in chlamydia

25. sickle cell with symmetrical swelling of hands and feet
Vaso-occlusive crisis; dx hb electrophoresis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
No intervention; 90% foreign bodies pass without difficulty
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

26. congenital adrenal hyperplasi
Between pregnenolone and 17oh pregnenolone
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Central isosexual precocious puberty; hypothalmaic hamartoma

27. most common complication of otitis media
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Increase of pregnenolone
Wait until 6 months

28. indications of audiometry in childrens
T for t ; thalassemia; inc serum iron and Iron binding
Injury to lower roots of brachial plexus
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

29. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Injury to lower roots of brachial plexus
Do HIV testing at first
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

30. What is earliest sign of puberty?
Dx US tx; correct serum electrolyte - pyloromyotom
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Lateral neck xray in epiglottitis show swollen epiglottis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

31. Tx of children constipation

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

32. starring spells 10-20sec
Medical emergency; dimercaprol/edta
24-72 hours
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
refuse

33. spitting up - vomiting at night - weight stable
No myoclonic activity in JME
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Prolactinoma
Biliary atresia; tx surgery

34. lead >70
Medical emergency; dimercaprol/edta
Prolactinoma
Meconeum ileus; think about CF
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

35. What are the risk factors of developmental dysplais of hip
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Female - breech delivery - family history; tx referral to ortho
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
No reticulocyte vs high reticulocyte

36. language expectation from 2yo
Yes; but it will be less effective
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
36 hours

37. benefits of antibiotic therapy in acute pharyngitis?
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Female - breech delivery - family history; tx referral to ortho
Absence seizure; tx ethosuximide
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

38. low grade fever - cough - diffuse bilat ground glass opacities
Female - breech delivery - family history; tx referral to ortho
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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
Decreased UGT enzyme

39. 3yo - febrile - left hip externally rotated
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

40. splenic infarction in sickle cell
Medical emergency; dimercaprol/edta
Faciform RBC cause vascular occlusion
Wait until 6 months
URI

41. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Endocardial cushion defect (no separation between heart chambers)

42. dx of lyme
After 6m; breast mild provides iron until 6m.
Dx US tx; correct serum electrolyte - pyloromyotom
1.5%
Mainly clinical; serology with initial ELISA - with western blot confirmation;

43. Tx of FTT
Bartonella henselae; complication is suppuration of lymph node
Diet modification to provide 110kc/kg/d
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Develops in 21 dasy

44. TB prophylaxis
After 6m; breast mild provides iron until 6m.
Atypical lymphocyte
Mainly clinical; serology with initial ELISA - with western blot confirmation;
INH 9m if INH resistant rifampin 6m in children and 4m in adults

45. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Oral DMSA or EDTA IV
No myoclonic activity in JME
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

46. complication of lumbosacral meningocele
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Bladder dysfunction; UTI and renal dysfunctoin
Atopic dermatitis; strong allergic/immunologic component; incr IgE

47. Neonatal conjugated hyperbilirubinemia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Biliary atresia; tx surgery
Black
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

48. echymoses with low platelet <30k
>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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

49. dx for turner
Pho for forward bending; forward defect; common finding has no adverse physical effect
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
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

50. defcicieny of 21 hydroxylase
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Increase of progesteron/17oh progesterone
110 kcl/kg/day
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart