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Test your basic knowledge |
USMLE Step3 Pediatrics
Start Test
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. 18mo bilat breast enlargment - some pubic hair
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Benign permature thelarche; expectant management
Imaging study to r/o VUR
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
2. difference between rubeola (measles) and rulbella
Female - breech delivery - family history; tx referral to ortho
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
<2yrs - abd pain - diarrhoea - ARF
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
3. How to difference viral and bact pneumonia
1.5%
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
110 kcl/kg/day
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
4. cardiac manifestation of turner
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No reticulocyte vs high reticulocyte
5. down syndrome with holocystolic mumur
Increase of pregnenolone
Imaging study to r/o VUR
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Endocardial cushion defect (no separation between heart chambers)
6. acute abd pain - hx URI - lower extremity maculo papular rash
Faciform RBC cause vascular occlusion
Develops in 21 dasy
HSP - look for symmetric skin lesions
36 hours
7. How to differentiate caput succedanueum and cephalohematoma
<2yrs - abd pain - diarrhoea - ARF
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
24h to 7d of birth
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
8. What is thumbprint sign
Erb paralysis leading to diaphragmatic paralysis
Lateral neck xray in epiglottitis show swollen epiglottis
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
9. Tx of community acquired pneumonia
Penicillin G 4h before delivery
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
110 kcl/kg/day
10. side effect of testosteron therapy
To make hip flexed and abducted position in DDH
T for t ; thalassemia; inc serum iron and Iron binding
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Decreases height - expensive; reserved for severe cases of delayed puberty
11. lead 44-70
Between pregnenolone and 17oh pregnenolone
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Oral DMSA or EDTA IV
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
12. starring spells 10-20sec
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Pipercillin (zosyn) - ticarcillin
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
13. causes of FTT
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Decr calorie intake; decr calorie absorption;incr calorie demand
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)
14. How to differentiate croup vs epiglotitis
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Increase of pregnenolone
Medical emergency; dimercaprol/edta
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
15. How long patient needs to be exposed to tick to get infected
Bartonella henselae; complication is suppuration of lymph node
No myoclonic activity in JME
Croup tx cool mist; racemic epi - corticosteroid
36 hours
16. What are the risk factors of developmental dysplais of hip
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Female - breech delivery - family history; tx referral to ortho
Imaging study to r/o VUR
Fifth disease; febrile syndrome
17. infant botulism
Herpes
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
18. nuchal rigidity - fever - sore throat - headache - dioriented
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Erb paralysis leading to diaphragmatic paralysis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Lateral neck xray in epiglottitis show swollen epiglottis
19. Nocturnal enuresis
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
110 kcl/kg/day
Candidal diapar rash; tx clotrimazol
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
20. What is the calorie requirement of newborn?
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
110 kcl/kg/day
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
21. horner syndrom
Vaso-occlusive crisis; dx hb electrophoresis
Injury to lower roots of brachial plexus
Neurofibromatosis type2
Risk of neurological dysfunction
22. What is earliest sign of puberty?
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Injury to b/l glossopharyngeal. present in botulism
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
To make hip flexed and abducted position in DDH
23. contact lens keratitis
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Brown
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
24. tuberous sclerosis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
25. hypopigmented spots - family hx bilat deafness
Faciform RBC cause vascular occlusion
After 24h of abx therapy
Neurofibromatosis type2
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
26. 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
24-72 hours
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Meconeum ileus; think about CF
27. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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
Candidal diapar rash; tx clotrimazol
Diet modification to provide 110kc/kg/d
28. major depression
Pho for forward bending; forward defect; common finding has no adverse physical effect
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
29. physiological jaundice
24h to 7d of birth
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Candidal diapar rash; tx clotrimazol
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
30. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
refuse
Tx only symptomatic carrier
Herpes
31. sturge weber syndrome
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Facial portwine stain
24-72 hours
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
32. What is the definition of delayed puberty?
Risk of neurological dysfunction
After 24h of abx therapy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
33. How to dx keratitis?
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Foreign body sensation - photophobia - corneal opacity tx abx
34. contraindications of DTap
Croup tx cool mist; racemic epi - corticosteroid
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Mainly clinical; serology with initial ELISA - with western blot confirmation;
35. pumonary TB
Penicillin G 4h before delivery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
RSV - rhino and influenza
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)
36. Tx of botulism
If aortic root reaches 45 mm
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
37. flexible kyphosis
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Pho for forward bending; forward defect; common finding has no adverse physical effect
Bladder dysfunction; UTI and renal dysfunctoin
38. acute otitis media-pathogen
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Black
T for t ; thalassemia; inc serum iron and Iron binding
Strep pneumonie; moraxella; h influenze
39. HUS
Black
<2yrs - abd pain - diarrhoea - ARF
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Biliary atresia; tx surgery
40. deficinecy of 17 hydroxylase
Increase of pregnenolone
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
41. 3yo - febrile - left hip externally rotated
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Increase of pregnenolone
42. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Methylephenidate toxicity; cannot be stopped abruptly; taper
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
43. lead >70
Do HIV testing at first
If aortic root reaches 45 mm
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)
Medical emergency; dimercaprol/edta
44. What is the most common initial symptom in sickle cell
Dactylitis; 2nd common is splenic seqestration
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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 first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
45. When to do surgery for undescended testes
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Wait until 6 months
Endocardial cushion defect (no separation between heart chambers)
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
46. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Pho for forward bending; forward defect; common finding has no adverse physical effect
Oral DMSA or EDTA IV
47. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Decreased UGT enzyme
48. complication of lumbosacral meningocele
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Bladder dysfunction; UTI and renal dysfunctoin
1.5%
Dx US tx; correct serum electrolyte - pyloromyotom
49. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
refuse
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
50. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Meconeum ileus; think about CF
Vaso-occlusive crisis; dx hb electrophoresis
Wait until 6 months