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Test your basic knowledge |
USMLE Step3 Pediatrics
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Study First
Subjects
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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. When to do aortic root surgery in marfans to prevent dissection?
Brown
Atypical lymphocyte
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
If aortic root reaches 45 mm
2. dx for turner
Vaso-occlusive crisis; dx hb electrophoresis
Oral DMSA or EDTA IV
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
3. How to dx post uretheral valve
Decr calorie intake; decr calorie absorption;incr calorie demand
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
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)
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
4. How to differentiate caput succedanueum and cephalohematoma
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Female - breech delivery - family history; tx referral to ortho
Atypical lymphocyte
5. 3yo - febrile - left hip externally rotated
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Marfans - ehlers danlos - homocystinuria
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Fifth disease; febrile syndrome
6. How long patient needs to be exposed to tick to get infected
Medical emergency; dimercaprol/edta
36 hours
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
110 kcl/kg/day
7. sturge weber syndrome
Facial portwine stain
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Fifth disease; febrile syndrome
8. 21 hydroxylase
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
RSV - rhino and influenza
Biliary atresia; tx surgery
9. dx for DDH
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
RSV - rhino and influenza
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
10. non immune pregnant women exposed to rubella in first trimester
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Penicillin G 4h before delivery
Congenital rubella syndrome
Do HIV testing at first
11. Tx of children constipation
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12. How to dx keratitis?
Methylephenidate toxicity; cannot be stopped abruptly; taper
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)
Foreign body sensation - photophobia - corneal opacity tx abx
Lateral neck xray in epiglottitis show swollen epiglottis
13. lens dislocation
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Marfans - ehlers danlos - homocystinuria
Decreased UGT enzyme
14. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
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
Biliary atresia; tx surgery
15. lead 44-70
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Develops in 21 dasy
Oral DMSA or EDTA IV
Congenital rubella syndrome
16. doing worse in school - lack of attention - starring speel
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Absence seizure; tx ethosuximide
17. Febrile seizure
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
D for d; down syndrome and polyhydramnios
18. Nocturnal enuresis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
RSV - rhino and influenza
Biliary atresia; tx surgery
19. What is the calorie requirement of newborn?
HSP - look for symmetric skin lesions
110 kcl/kg/day
24-72 hours
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
20. failure to thrive
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
T for t ; thalassemia; inc serum iron and Iron binding
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Less than 5th percentile
21. echymoses with low platelet <30k
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
22. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erb paralysis leading to diaphragmatic paralysis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
23. complication of lumbosacral meningocele
14yrs
Bladder dysfunction; UTI and renal dysfunctoin
Decreases height - expensive; reserved for severe cases of delayed puberty
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
24. thumb sign
<2yrs - abd pain - diarrhoea - ARF
>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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
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
25. How to differential bact vs viral conjunctivitis
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
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
To make hip flexed and abducted position in DDH
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
26. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Meconeum ileus; think about CF
27. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
<2yrs - abd pain - diarrhoea - ARF
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
28. cardiac manifestation of turner
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Less than 5th percentile
Lateral neck xray in epiglottitis show swollen epiglottis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
29. How to dx RSV
Rapid detection of RSV antigen in nasl
If aortic root reaches 45 mm
Penicillin G 4h before delivery
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
30. association with infantile pyloric stenosis
After 24h of abx therapy
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Dactylitis; 2nd common is splenic seqestration
31. impaired gag reflex
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Absence seizure; tx ethosuximide
Injury to b/l glossopharyngeal. present in botulism
After 24h of abx therapy
32. What is thumbprint sign
Decreased UGT enzyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Lateral neck xray in epiglottitis show swollen epiglottis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
33. centor criteria for bact pharyngitis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
ALL - alzheimers autism adhd depression seizure
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
To make hip flexed and abducted position in DDH
34. benefits of antibiotic therapy in acute pharyngitis?
Absence seizure; tx ethosuximide
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
36 hours
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
35. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
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
Dx US tx; correct serum electrolyte - pyloromyotom
Oral DMSA or EDTA IV
36. Tx of FTT
Diet modification to provide 110kc/kg/d
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
Decr calorie intake; decr calorie absorption;incr calorie demand
37. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth
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38. is local anesthetics be used in cellulitis to reduce pain
Dactylitis; 2nd common is splenic seqestration
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Imaging study to r/o VUR
39. viruses cause bronhioltitis
Dactylitis; 2nd common is splenic seqestration
TB - breastfeeding - asymptomatic hiv
RSV - rhino and influenza
Marfans - ehlers danlos - homocystinuria
40. language delay
Congenital rubella syndrome
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Erb paralysis leading to diaphragmatic paralysis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
41. bromocriptine
Prolactinoma
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
42. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Decreases height - expensive; reserved for severe cases of delayed puberty
Do HIV testing at first
No myoclonic activity in JME
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
43. HUS
<2yrs - abd pain - diarrhoea - ARF
Lateral neck xray in epiglottitis show swollen epiglottis
No reticulocyte vs high reticulocyte
Pipercillin (zosyn) - ticarcillin
44. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
45. indications of VUR
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
14yrs
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
46. causes of FTT
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Decr calorie intake; decr calorie absorption;incr calorie demand
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
47. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Female - breech delivery - family history; tx referral to ortho
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
Thalassemia - congenital hemolytic anemia
48. What are the risk factors of developmental dysplais of hip
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Female - breech delivery - family history; tx referral to ortho
Between pregnenolone and 17oh pregnenolone
49. how smoking contributes otitis media in children
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
After 24h of abx therapy
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
50. cat scratch disease
Tx only symptomatic carrier
Bartonella henselae; complication is suppuration of lymph node
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Brown