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Test your basic knowledge |
USMLE Step3 Pediatrics
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Study First
Subjects
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health-sciences
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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 thalassemia die
Constitutional pubertal delay
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
Erb paralysis leading to diaphragmatic paralysis
2. TTP pentad
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Strep pneumonie; moraxella; h influenze
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
3. language delay
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
4. dx for turner
Foreign body sensation - photophobia - corneal opacity tx abx
URI
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
ALL - alzheimers autism adhd depression seizure
5. lead 44-70
Croup tx cool mist; racemic epi - corticosteroid
Oral DMSA or EDTA IV
Bartonella henselae; complication is suppuration of lymph node
HSP - look for symmetric skin lesions
6. How to dx keratitis?
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)
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to b/l glossopharyngeal. present in botulism
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
7. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Central isosexual precocious puberty; hypothalmaic hamartoma
Do HIV testing at first
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
8. sudden onset of fever - difficulty in breathing
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
Facial portwine stain
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
9. What is the definition of delayed puberty?
Foreign body sensation - photophobia - corneal opacity tx abx
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
10. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Decreases height - expensive; reserved for severe cases of delayed puberty
36 hours
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
11. Neonatal conjugated hyperbilirubinemia
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Biliary atresia; tx surgery
Black
Wait until 6 months
12. How to dx post uretheral valve
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Less than 5th percentile
13. How to dx endopthalmitis
Wait until 6 months
Benign permature thelarche; expectant management
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
14. Infant with serum billlirubin >25
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Risk of neurological dysfunction
15. Tx of bact conjunctivitis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Thalassemia - congenital hemolytic anemia
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
16. bromocriptine
Decr calorie intake; decr calorie absorption;incr calorie demand
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Atypical lymphocyte
Prolactinoma
17. the risk of lyme after bitten by a tick
1.5%
Tx only symptomatic carrier
Brown
Bladder dysfunction; UTI and renal dysfunctoin
18. horner syndrom
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Injury to lower roots of brachial plexus
19. Tx of FTT
Decreased UGT enzyme
Develops in 21 dasy
Diet modification to provide 110kc/kg/d
Croup tx cool mist; racemic epi - corticosteroid
20. contraindications of DTap
Dx US tx; correct serum electrolyte - pyloromyotom
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
21. Parvovirus
Fifth disease; febrile syndrome
Pipercillin (zosyn) - ticarcillin
No intervention; 90% foreign bodies pass without difficulty
Black
22. 12y - obese - hip pain - hip ext rotated
Central isosexual precocious puberty; hypothalmaic hamartoma
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
36 hours
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
23. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth
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24. flexible kyphosis
Neurofibromatosis type2
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Pho for forward bending; forward defect; common finding has no adverse physical effect
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
25. adrenal tumor
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Constitutional pubertal delay
26. giardiasis
No reticulocyte vs high reticulocyte
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Tx only symptomatic carrier
27. Febrile seizure
To make hip flexed and abducted position in DDH
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
28. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Bladder dysfunction; UTI and renal dysfunctoin
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Biliary atresia; tx surgery
29. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Meconeum ileus; think about CF
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
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
30. Tx of botulism
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Constitutional pubertal delay
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
31. How to differentiate croup vs epiglotitis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Diet modification to provide 110kc/kg/d
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
32. 21 hydroxylase
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
refuse
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
33. Tx of community acquired pneumonia
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
24h to 7d of birth
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
refuse
34. physiological jaundice
Tx only symptomatic carrier
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
24h to 7d of birth
35. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
<2yrs - abd pain - diarrhoea - ARF
Erb paralysis leading to diaphragmatic paralysis
36. coin in child's stomach
110 kcl/kg/day
No intervention; 90% foreign bodies pass without difficulty
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Faciform RBC cause vascular occlusion
37. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
HSP - look for symmetric skin lesions
Injury to lower roots of brachial plexus
Meconeum ileus; think about CF
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
38. aplasic crisis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Yes; but it will be less effective
Marfans - ehlers danlos - homocystinuria
39. indications of audiometry in childrens
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
<2yrs - abd pain - diarrhoea - ARF
Dactylitis; 2nd common is splenic seqestration
40. 3yo - never able to walk
No myoclonic activity in JME
1.5%
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
Benign permature thelarche; expectant management
41. How to difference RSV and neonatal chlamydia
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Absence seizure; tx ethosuximide
No wheezing - no feever in chlamydia
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
42. spitting up - vomiting at night - weight stable
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Pho for forward bending; forward defect; common finding has no adverse physical effect
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Do HIV testing at first
43. difference between diaper dermatitis and rash
If aortic root reaches 45 mm
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
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
44. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
45. difference between breast milk and breafeeding jaundice
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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
Congenital rubella syndrome
46. causes of acute anemia
Black
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
47. How long anti-TB drugs given for TB meningitis?
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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Oral DMSA or EDTA IV
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
48. What are the risk factors of developmental dysplais of hip
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Female - breech delivery - family history; tx referral to ortho
Decr calorie intake; decr calorie absorption;incr calorie demand
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
49. How to prevent GBS in neonate
Marfans - ehlers danlos - homocystinuria
Penicillin G 4h before delivery
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
50. hypopigmented spots - family hx bilat deafness
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Neurofibromatosis type2
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery