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. adrenal tumor
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Biliary atresia; tx surgery
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

2. if bone age lower than actual and puberty delayed
24-72 hours
Constitutional pubertal delay
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

3. deficinecy of 17 hydroxylase
Increase of progesteron/17oh progesterone
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Wait until 6 months
Increase of pregnenolone

4. failure to thrive
Less than 5th percentile
Imaging study to r/o VUR
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
HSP - look for symmetric skin lesions

5. language delay
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Lateral neck xray in epiglottitis show swollen epiglottis
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

6. acute otitis externa

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

7. Nocturnal enuresis
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
refuse
Croup
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

8. tick transmits lyme
If aortic root reaches 45 mm
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
Brown
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

9. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Develops in 21 dasy
URI

10. aplasic crisis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
After 24h of abx therapy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Strep pneumonie; moraxella; h influenze

11. non immune pregnant women exposed to rubella in first trimester
Fifth disease; febrile syndrome
Congenital rubella syndrome
Lateral neck xray in epiglottitis show swollen epiglottis
36 hours

12. pumonary TB
Brown
Atypical lymphocyte
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)
Develops in 21 dasy

13. Tx of FTT
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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Diet modification to provide 110kc/kg/d

14. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Benign permature thelarche; expectant management
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

15. down syndrome has inreased risk of developing
Do HIV testing at first
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
ALL - alzheimers autism adhd depression seizure
Endocardial cushion defect (no separation between heart chambers)

16. When to do aortic root surgery in marfans to prevent dissection?
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Faciform RBC cause vascular occlusion
110 kcl/kg/day
If aortic root reaches 45 mm

17. can women with abnormal smear or genital get vaccine
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Dx US tx; correct serum electrolyte - pyloromyotom
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Yes; but it will be less effective

18. flexible kyphosis
Facial portwine stain
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Between pregnenolone and 17oh pregnenolone
Pho for forward bending; forward defect; common finding has no adverse physical effect

19. HUS
<2yrs - abd pain - diarrhoea - ARF
Multiple telangiectesia - vasular lesion in CNS
Between pregnenolone and 17oh pregnenolone
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

20. differentiate between central and peripheral precocious puberty
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Endocardial cushion defect (no separation between heart chambers)
Fifth disease; febrile syndrome

21. How to difference viral and bact pneumonia
Neurofibromatosis type2
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Bladder dysfunction; UTI and renal dysfunctoin

22. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Pipercillin (zosyn) - ticarcillin
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
No myoclonic activity in JME
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

23. How to difference RSV and neonatal chlamydia
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No wheezing - no feever in chlamydia
To make hip flexed and abducted position in DDH

24. Neonatal conjugated hyperbilirubinemia
Black
Absence seizure; tx ethosuximide
Biliary atresia; tx surgery
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection

25. What is thumbprint sign
Facial portwine stain
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Lateral neck xray in epiglottitis show swollen epiglottis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

26. side effect of testosteron therapy
14yrs
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Decreases height - expensive; reserved for severe cases of delayed puberty
Biliary atresia; tx surgery

27. duodenal atresia
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
D for d; down syndrome and polyhydramnios
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Atypical lymphocyte

28. What are the risk factors of developmental dysplais of hip
14yrs
Brown
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Female - breech delivery - family history; tx referral to ortho

29. doing worse in school - lack of attention - starring speel
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Absence seizure; tx ethosuximide

30. acute otitis media-pathogen
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Injury to lower roots of brachial plexus
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Strep pneumonie; moraxella; h influenze

31. crying during urination. bacteriuria pyruria - rec episodes
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
HSP - look for symmetric skin lesions
Vaso-occlusive crisis; dx hb electrophoresis
Imaging study to r/o VUR

32. dx for DDH
Imaging study to r/o VUR
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
INH 9m if INH resistant rifampin 6m in children and 4m in adults

33. What is the most common initial symptom in sickle cell
Imaging study to r/o VUR
No reticulocyte vs high reticulocyte
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Dactylitis; 2nd common is splenic seqestration

34. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Increase of pregnenolone
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

35. difference between structural disorder and flexible kyphosis
Between pregnenolone and 17oh pregnenolone
After 6m; breast mild provides iron until 6m.
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

36. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Constitutional pubertal delay
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

37. complete airway obstruction with FB
>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
If aortic root reaches 45 mm
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
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

38. 12y - obese - hip pain - hip ext rotated
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

39. How to investigate delayed puberty
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Endocardial cushion defect (no separation between heart chambers)
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

40. lens dislocation
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Vaso-occlusive crisis; dx hb electrophoresis
Marfans - ehlers danlos - homocystinuria

41. 18mo bilat breast enlargment - some pubic hair
Decr calorie intake; decr calorie absorption;incr calorie demand
Bartonella henselae; complication is suppuration of lymph node
Benign permature thelarche; expectant management
Lateral neck xray in epiglottitis show swollen epiglottis

42. When erythema chronicum migrans develops after tick bite
Bladder dysfunction; UTI and renal dysfunctoin
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Between pregnenolone and 17oh pregnenolone
24-72 hours

43. patient with white plaques in mouth and lump in back
Do HIV testing at first
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Biliary atresia; tx surgery
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

44. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

45. coin in child's stomach
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No intervention; 90% foreign bodies pass without difficulty
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

46. TTP pentad
Herpes
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

47. tzanck
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
Herpes
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Yes; but it will be less effective

48. centor criteria for bact pharyngitis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
URI

49. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

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

50. iron supplement in child
After 6m; breast mild provides iron until 6m.
Faciform RBC cause vascular occlusion
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Wait until 6 months