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. pavlik harness
To make hip flexed and abducted position in DDH
36 hours
<2yrs - abd pain - diarrhoea - ARF
Candidal diapar rash; tx clotrimazol

2. aplasic crisis
After 6m; breast mild provides iron until 6m.
To make hip flexed and abducted position in DDH
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

3. Parents can _____ vaccine
refuse
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Injury to lower roots of brachial plexus
Decreases height - expensive; reserved for severe cases of delayed puberty

4. indications of audiometry in childrens
Atopic dermatitis; strong allergic/immunologic component; incr IgE
To make hip flexed and abducted position in DDH
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Medical emergency; dimercaprol/edta

5. 17 alpha hydroxylase
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Between pregnenolone and 17oh pregnenolone
110 kcl/kg/day
Atopic dermatitis; strong allergic/immunologic component; incr IgE

6. osler rendu weber syndrom
24h to 7d of birth
Injury to lower roots of brachial plexus
To make hip flexed and abducted position in DDH
Multiple telangiectesia - vasular lesion in CNS

7. indications of VUR
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
INH 9m if INH resistant rifampin 6m in children and 4m in adults
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

8. carditis and arthritis after rheumatic fever
Medical emergency; dimercaprol/edta
Develops in 21 dasy
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)
After 6m; breast mild provides iron until 6m.

9. When to do aortic root surgery in marfans to prevent dissection?
ALL - alzheimers autism adhd depression seizure
24-72 hours
If aortic root reaches 45 mm
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

10. language delay
No intervention; 90% foreign bodies pass without difficulty
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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

11. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
Risk of neurological dysfunction
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

12. association with infantile pyloric stenosis
Female - breech delivery - family history; tx referral to ortho
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Atypical lymphocyte
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

13. Tx of FTT
Diet modification to provide 110kc/kg/d
Injury to b/l glossopharyngeal. present in botulism
24h to 7d of birth
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

14. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
36 hours
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

15. cardiac manifestation of turner
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Lateral neck xray in epiglottitis show swollen epiglottis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

16. sickle cell with symmetrical swelling of hands and feet
No intervention; 90% foreign bodies pass without difficulty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Vaso-occlusive crisis; dx hb electrophoresis

17. contraindications of MMR vaccine
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Congenital rubella syndrome
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
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

18. coin in child's stomach
Fifth disease; febrile syndrome
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
No intervention; 90% foreign bodies pass without difficulty
Facial portwine stain

19. 18mo bilat breast enlargment - some pubic hair
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Benign permature thelarche; expectant management
Risk of neurological dysfunction
Central isosexual precocious puberty; hypothalmaic hamartoma

20. can women with abnormal smear or genital get vaccine
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Central isosexual precocious puberty; hypothalmaic hamartoma
Yes; but it will be less effective
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

21. physiological jaundice
24h to 7d of birth
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

22. adrenal tumor
Constitutional pubertal delay
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Methylephenidate toxicity; cannot be stopped abruptly; taper
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

23. How to dx RSV
36 hours
Multiple telangiectesia - vasular lesion in CNS
TB - breastfeeding - asymptomatic hiv
Rapid detection of RSV antigen in nasl

24. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Meconeum ileus; think about CF
Decreased UGT enzyme
Vaso-occlusive crisis; dx hb electrophoresis

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

26. major depression
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
No intervention; 90% foreign bodies pass without difficulty
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

27. Tx of community acquired pneumonia
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

28. thumb sign
Injury to lower roots of brachial plexus
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

29. 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
If aortic root reaches 45 mm
Neurofibromatosis type2
Bartonella henselae; complication is suppuration of lymph node

30. 12y - obese - hip pain - hip ext rotated
Decreases height - expensive; reserved for severe cases of delayed puberty
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Injury to b/l glossopharyngeal. present in botulism

31. flexible kyphosis
Foreign body sensation - photophobia - corneal opacity tx abx
Pho for forward bending; forward defect; common finding has no adverse physical effect
Central isosexual precocious puberty; hypothalmaic hamartoma
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

32. Parvovirus
D for d; down syndrome and polyhydramnios
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Fifth disease; febrile syndrome

33. Tx of botulism
Methylephenidate toxicity; cannot be stopped abruptly; taper
Injury to b/l glossopharyngeal. present in botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Absence seizure; tx ethosuximide

34. cat scratch disease
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Rapid detection of RSV antigen in nasl
Bartonella henselae; complication is suppuration of lymph node

35. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
14yrs
TB - breastfeeding - asymptomatic hiv
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

36. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Pipercillin (zosyn) - ticarcillin
Penicillin G 4h before delivery
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

37. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
refuse
Risk of neurological dysfunction
Biliary atresia; tx surgery

38. down syndrome has inreased risk of developing
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
ALL - alzheimers autism adhd depression seizure
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

39. Nocturnal enuresis
Dactylitis; 2nd common is splenic seqestration
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Thalassemia - congenital hemolytic anemia
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

40. down syndrome with holocystolic mumur
Central isosexual precocious puberty; hypothalmaic hamartoma
Erb paralysis leading to diaphragmatic paralysis
Endocardial cushion defect (no separation between heart chambers)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

41. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Croup
Strep pneumonie; moraxella; h influenze
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

42. complete airway obstruction with FB
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
No intervention; 90% foreign bodies pass without difficulty
>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
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

43. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Prolactinoma
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

44. impaired gag reflex
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Endocardial cushion defect (no separation between heart chambers)
Injury to b/l glossopharyngeal. present in botulism
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

45. How to investigate delayed puberty
Pho for forward bending; forward defect; common finding has no adverse physical effect
Medical emergency; dimercaprol/edta
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
No intervention; 90% foreign bodies pass without difficulty

46. How to evaluate well appearing child just born in GBS pos mother?
Candidal diapar rash; tx clotrimazol
Vaso-occlusive crisis; dx hb electrophoresis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

47. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Black
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
24h to 7d of birth
Multiple telangiectesia - vasular lesion in CNS

48. infantile hypertrophic pyloric stenosis
After 24h of abx therapy
Dx US tx; correct serum electrolyte - pyloromyotom
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
After 6m; breast mild provides iron until 6m.

49. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Female - breech delivery - family history; tx referral to ortho
Wait until 6 months
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

50. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Biliary atresia; tx surgery
Decreased UGT enzyme
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications