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. penicillin effective against pseudomonas
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Wait until 6 months
Pipercillin (zosyn) - ticarcillin
24-72 hours

2. failure to thrive
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Faciform RBC cause vascular occlusion
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Less than 5th percentile

3. difference between diaper dermatitis and rash
Fifth disease; febrile syndrome
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Diet modification to provide 110kc/kg/d
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

4. Parvovirus
refuse
Fifth disease; febrile syndrome
110 kcl/kg/day
Central isosexual precocious puberty; hypothalmaic hamartoma

5. 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
Do HIV testing at first
Decreased UGT enzyme
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

6. microcytic - hypochromic anemia - hepatospelnomegaly
Injury to b/l glossopharyngeal. present in botulism
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Thalassemia - congenital hemolytic anemia
Facial portwine stain

7. sudden onset of fever - difficulty in breathing
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Foreign body sensation - photophobia - corneal opacity tx abx
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

8. when bact conjunctivitis patient can go back to school
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Decreases height - expensive; reserved for severe cases of delayed puberty
After 24h of abx therapy

9. TTP pentad
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
Multiple telangiectesia - vasular lesion in CNS
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
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

10. red oozing rash on cheek - scaly - dry
Tx only symptomatic carrier
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

11. causes of FTT
36 hours
Decr calorie intake; decr calorie absorption;incr calorie demand
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

12. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Wait until 6 months
<2yrs - abd pain - diarrhoea - ARF
Methylephenidate toxicity; cannot be stopped abruptly; taper

13. deficinecy of 17 hydroxylase
No intervention; 90% foreign bodies pass without difficulty
No reticulocyte vs high reticulocyte
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Increase of pregnenolone

14. the recommended ca supplementation
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
110 kcl/kg/day
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

15. How to investigate delayed puberty
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

16. duodenal atresia
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
D for d; down syndrome and polyhydramnios
Dactylitis; 2nd common is splenic seqestration
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

17. horner syndrom
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Herpes
Injury to lower roots of brachial plexus

18. pneumonia in CF patient
TB - breastfeeding - asymptomatic hiv
Diet modification to provide 110kc/kg/d
Marfans - ehlers danlos - homocystinuria
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

19. adenovirus
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Diet modification to provide 110kc/kg/d
URI
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

20. difference between structural disorder and flexible kyphosis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
1.5%
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

21. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Strep pneumonie; moraxella; h influenze
Facial portwine stain
Methylephenidate toxicity; cannot be stopped abruptly; taper
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

22. When to do aortic root surgery in marfans to prevent dissection?
Erb paralysis leading to diaphragmatic paralysis
If aortic root reaches 45 mm
Do HIV testing at first
Penicillin G 4h before delivery

23. language expectation from 2yo
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
1.5%
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

24. contact lens keratitis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Penicillin G 4h before delivery
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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

25. infantile hypertrophic pyloric stenosis
Oral DMSA or EDTA IV
Do HIV testing at first
Dx US tx; correct serum electrolyte - pyloromyotom
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

26. pumonary TB
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)
Yes; but it will be less effective
Croup
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

27. difference between breast milk and breafeeding jaundice
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
Prolactinoma
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

28. coin in child's stomach
URI
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
No intervention; 90% foreign bodies pass without difficulty
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

29. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
If aortic root reaches 45 mm
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

30. can women with abnormal smear or genital get vaccine
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Benign permature thelarche; expectant management
Yes; but it will be less effective
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting

31. acute abd pain - hx URI - lower extremity maculo papular rash
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
HSP - look for symmetric skin lesions
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

32. sturge weber syndrome
Increase of progesteron/17oh progesterone
No myoclonic activity in JME
Facial portwine stain
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

33. tick transmits lyme
>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
Brown
D for d; down syndrome and polyhydramnios
Develops in 21 dasy

34. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Vaso-occlusive crisis; dx hb electrophoresis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

35. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
14yrs
Wait until 6 months
Injury to lower roots of brachial plexus

36. How long patient needs to be exposed to tick to get infected
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
>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
36 hours
Between pregnenolone and 17oh pregnenolone

37. Infant with serum billlirubin >25
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
<2yrs - abd pain - diarrhoea - ARF
Risk of neurological dysfunction
Facial portwine stain

38. 3 wo pharngeal erythema -dry mucus memb - conjuntivitis - hyperinflated thorax
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
URI
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

39. down syndrome with holocystolic mumur
After 6m; breast mild provides iron until 6m.
Endocardial cushion defect (no separation between heart chambers)
Atypical lymphocyte
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

40. centor criteria for bact pharyngitis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

41. dx for DDH
Pho for forward bending; forward defect; common finding has no adverse physical effect
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
T for t ; thalassemia; inc serum iron and Iron binding
Atopic dermatitis; strong allergic/immunologic component; incr IgE

42. IM
Atypical lymphocyte
Croup tx cool mist; racemic epi - corticosteroid
Tx only symptomatic carrier
Neurofibromatosis type2

43. 3yo - febrile - left hip externally rotated
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Yes; but it will be less effective
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

44. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Thalassemia - congenital hemolytic anemia
Croup
TB - breastfeeding - asymptomatic hiv

45. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
24-72 hours
Croup
Penicillin G 4h before delivery
Pipercillin (zosyn) - ticarcillin

46. patient with white plaques in mouth and lump in back
Do HIV testing at first
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

47. Nocturnal enuresis
Brown
36 hours
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

48. Neonatal unconjugated hyperbilirubine
Absence seizure; tx ethosuximide
36 hours
Decreased UGT enzyme
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

49. flexible kyphosis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
URI
Pho for forward bending; forward defect; common finding has no adverse physical effect
Atopic dermatitis; strong allergic/immunologic component; incr IgE

50. target cell
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
T for t ; thalassemia; inc serum iron and Iron binding
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)
Methylephenidate toxicity; cannot be stopped abruptly; taper