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. most common complication of otitis media
Rapid detection of RSV antigen in nasl
<2yrs - abd pain - diarrhoea - ARF
Strep pneumonie; moraxella; h influenze
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

2. giardiasis
Oral DMSA or EDTA IV
Wait until 6 months
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Tx only symptomatic carrier

3. When to do surgery for undescended testes
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Wait until 6 months
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

4. Infant with serum billlirubin >25
Meconeum ileus; think about CF
Risk of neurological dysfunction
Biliary atresia; tx surgery
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

5. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Faciform RBC cause vascular occlusion

6. When erythema chronicum migrans develops after tick bite
Mainly clinical; serology with initial ELISA - with western blot confirmation;
24-72 hours
Develops in 21 dasy
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

7. sublottic narrowing
Do HIV testing at first
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Croup tx cool mist; racemic epi - corticosteroid

8. starring spells 10-20sec
Faciform RBC cause vascular occlusion
Brown
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

9. Tx of community acquired pneumonia
Black
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Congenital rubella syndrome
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

10. What are the risk factors of developmental dysplais of hip
Between pregnenolone and 17oh pregnenolone
Female - breech delivery - family history; tx referral to ortho
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

11. association with infantile pyloric stenosis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Central isosexual precocious puberty; hypothalmaic hamartoma
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

12. What is the calorie requirement of newborn?
110 kcl/kg/day
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
T for t ; thalassemia; inc serum iron and Iron binding

13. congenital adrenal hyperplasi
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
Bartonella henselae; complication is suppuration of lymph node
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Tx only symptomatic carrier

14. kallman syndrome
After 6m; breast mild provides iron until 6m.
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

15. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Congenital rubella syndrome
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
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Lateral neck xray in epiglottitis show swollen epiglottis

16. When to give HRT in turner
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
14yrs
24-72 hours
No reticulocyte vs high reticulocyte

17. contraindications of MMR vaccine
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

18. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

19. red oozing rash on cheek - scaly - dry
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
1.5%
ALL - alzheimers autism adhd depression seizure
Atopic dermatitis; strong allergic/immunologic component; incr IgE

20. tuberous sclerosis
Absence seizure; tx ethosuximide
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

21. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Foreign body sensation - photophobia - corneal opacity tx abx
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

22. complete airway obstruction with FB
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Dx US tx; correct serum electrolyte - pyloromyotom
>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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

23. How long anti-TB drugs given for TB meningitis?
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
110 kcl/kg/day
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

24. thumb sign
To make hip flexed and abducted position in DDH
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Increase of pregnenolone

25. difference between diaper dermatitis and rash
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
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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
If aortic root reaches 45 mm

26. 3yo - never able to walk
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
Thalassemia - congenital hemolytic anemia
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

27. How to dx acute angle closure glaucoma
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Less than 5th percentile
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

28. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
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
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Faciform RBC cause vascular occlusion
After 24h of abx therapy

29. viruses cause bronhioltitis
After 24h of abx therapy
Facial portwine stain
RSV - rhino and influenza
Do HIV testing at first

30. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
Endocardial cushion defect (no separation between heart chambers)
To make hip flexed and abducted position in DDH
URI

31. contraindications of DTap
Benign permature thelarche; expectant management
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Female - breech delivery - family history; tx referral to ortho

32. deficinecy of 17 hydroxylase
Increase of pregnenolone
Strep pneumonie; moraxella; h influenze
Imaging study to r/o VUR
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

33. hypopigmented spots - family hx bilat deafness
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
refuse
After 6m; breast mild provides iron until 6m.
Neurofibromatosis type2

34. mech of botulism
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

35. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Decr calorie intake; decr calorie absorption;incr calorie demand

36. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Neurofibromatosis type2
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Risk of neurological dysfunction

37. How long patient needs to be exposed to tick to get infected
14yrs
36 hours
After 24h of abx therapy
Increase of progesteron/17oh progesterone

38. failure to thrive
Medical emergency; dimercaprol/edta
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Less than 5th percentile
Mainly clinical; serology with initial ELISA - with western blot confirmation;

39. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

40. When to give hpv vaccien
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
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
T for t ; thalassemia; inc serum iron and Iron binding
No myoclonic activity in JME

41. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Do HIV testing at first
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

42. iron supplement in child
After 6m; breast mild provides iron until 6m.
Do HIV testing at first
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Lateral neck xray in epiglottitis show swollen epiglottis

43. when bact conjunctivitis patient can go back to school
Develops in 21 dasy
Constitutional pubertal delay
After 24h of abx therapy
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

44. 17 alpha hydroxylase
Between pregnenolone and 17oh pregnenolone
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Wait until 6 months

45. IM
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Biliary atresia; tx surgery
Atypical lymphocyte

46. lens dislocation
Do HIV testing at first
Develops in 21 dasy
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Marfans - ehlers danlos - homocystinuria

47. patient with white plaques in mouth and lump in back
Brown
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Tx only symptomatic carrier
Do HIV testing at first

48. Tx of botulism
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Prolactinoma

49. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Croup tx cool mist; racemic epi - corticosteroid

50. How to investigate delayed puberty
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
14yrs
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops