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. 21 hydroxylase
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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

2. low grade fever - cough - diffuse bilat ground glass opacities
1.5%
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Increase of pregnenolone

3. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Strep pneumonie; moraxella; h influenze
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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)

4. sublottic narrowing
Black
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
Croup tx cool mist; racemic epi - corticosteroid
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

5. lead >70
Injury to lower roots of brachial plexus
Medical emergency; dimercaprol/edta
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
36 hours

6. How to dx keratitis?
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
No wheezing - no feever in chlamydia
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Foreign body sensation - photophobia - corneal opacity tx abx

7. is local anesthetics be used in cellulitis to reduce pain
Biliary atresia; tx surgery
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

8. pneumonia in CF patient
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Dactylitis; 2nd common is splenic seqestration

9. penicillin effective against pseudomonas
Absence seizure; tx ethosuximide
Pipercillin (zosyn) - ticarcillin
Constitutional pubertal delay
Black

10. lens dislocation
Increase of pregnenolone
Biliary atresia; tx surgery
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Marfans - ehlers danlos - homocystinuria

11. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Herpes

12. How to dx RSV
Rapid detection of RSV antigen in nasl
Herpes
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

13. IM
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Atypical lymphocyte
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
T for t ; thalassemia; inc serum iron and Iron binding

14. 18mo bilat breast enlargment - some pubic hair
Erb paralysis leading to diaphragmatic paralysis
Neurofibromatosis type2
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Benign permature thelarche; expectant management

15. sudden onset of fever - difficulty in breathing
Tx only symptomatic carrier
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Pipercillin (zosyn) - ticarcillin
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

16. lead 44-70
RSV - rhino and influenza
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
TB - breastfeeding - asymptomatic hiv
Oral DMSA or EDTA IV

17. language expectation from 2yo
Imaging study to r/o VUR
Facial portwine stain
After 24h of abx therapy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

18. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Injury to lower roots of brachial plexus
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

19. thumb sign
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

20. how smoking contributes otitis media in children
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Brown

21. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
24-72 hours
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Foreign body sensation - photophobia - corneal opacity tx abx

22. spitting up - vomiting at night - weight stable
No wheezing - no feever in chlamydia
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

23. When erythema chronicum migrans develops after tick bite
24-72 hours
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

24. infant botulism
refuse
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)
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

25. horner syndrom
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)
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Injury to lower roots of brachial plexus
Pho for forward bending; forward defect; common finding has no adverse physical effect

26. When to give HRT in turner
24-72 hours
14yrs
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

27. dx for DDH
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
110 kcl/kg/day
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Marfans - ehlers danlos - homocystinuria

28. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Multiple telangiectesia - vasular lesion in CNS
No myoclonic activity in JME
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

29. Febrile seizure
D for d; down syndrome and polyhydramnios
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
No intervention; 90% foreign bodies pass without difficulty

30. Tx of FTT
Constitutional pubertal delay
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Diet modification to provide 110kc/kg/d

31. What is the definition of delayed puberty?
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
No myoclonic activity in JME
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

32. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
No myoclonic activity in JME
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
36 hours

33. 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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Congenital rubella syndrome
Croup

34. osler rendu weber syndrom
Absence seizure; tx ethosuximide
Multiple telangiectesia - vasular lesion in CNS
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Do HIV testing at first

35. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Yes; but it will be less effective
ALL - alzheimers autism adhd depression seizure

36. what conditions are not contraindicated
Central isosexual precocious puberty; hypothalmaic hamartoma
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Candidal diapar rash; tx clotrimazol
TB - breastfeeding - asymptomatic hiv

37. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Fifth disease; febrile syndrome
Multiple telangiectesia - vasular lesion in CNS
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
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

38. physiological jaundice
Constitutional pubertal delay
24h to 7d of birth
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Croup

39. tick transmits lyme
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Brown
Marfans - ehlers danlos - homocystinuria
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

40. failure to thrive
Croup tx cool mist; racemic epi - corticosteroid
Yes; but it will be less effective
Less than 5th percentile
Thalassemia - congenital hemolytic anemia

41. carditis and arthritis after rheumatic fever
Penicillin G 4h before delivery
Develops in 21 dasy
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Tx only symptomatic carrier

42. major depression
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

43. echymoses with low platelet <30k
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

44. coin in child's stomach
ALL - alzheimers autism adhd depression seizure
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
No intervention; 90% foreign bodies pass without difficulty
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

45. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Dactylitis; 2nd common is splenic seqestration
Meconeum ileus; think about CF
Congenital rubella syndrome

46. sickle cell with symmetrical swelling of hands and feet
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Benign permature thelarche; expectant management
Vaso-occlusive crisis; dx hb electrophoresis
Herpes

47. Parvovirus
Fifth disease; febrile syndrome
Between pregnenolone and 17oh pregnenolone
Diet modification to provide 110kc/kg/d
Multiple telangiectesia - vasular lesion in CNS

48. sturge weber syndrome
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Facial portwine stain
Brown
Decreases height - expensive; reserved for severe cases of delayed puberty

49. centor criteria for bact pharyngitis
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Thalassemia - congenital hemolytic anemia
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Benign permature thelarche; expectant management

50. mech of botulism
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Decr calorie intake; decr calorie absorption;incr calorie demand
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;