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. contraindications of MMR vaccine
No myoclonic activity in JME
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Yes; but it will be less effective
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

2. Tx of botulism
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Decr calorie intake; decr calorie absorption;incr calorie demand
No wheezing - no feever in chlamydia

3. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Croup tx cool mist; racemic epi - corticosteroid

4. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

5. contraindications of DTap
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
24-72 hours
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications

6. What is the definition of delayed puberty?
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Central isosexual precocious puberty; hypothalmaic hamartoma
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

7. How to dx acute angle closure glaucoma
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
No myoclonic activity in JME
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

8. hypopigmented spots - family hx bilat deafness
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Benign permature thelarche; expectant management
Neurofibromatosis type2

9. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

10. red oozing rash on cheek - scaly - dry
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Atopic dermatitis; strong allergic/immunologic component; incr IgE

11. giardiasis
Between pregnenolone and 17oh pregnenolone
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Tx only symptomatic carrier
Oral DMSA or EDTA IV

12. How to evaluate well appearing child just born in GBS pos mother?
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
ALL - alzheimers autism adhd depression seizure
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

13. is local anesthetics be used in cellulitis to reduce pain
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
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
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No; they are basic compound will be neutralized in an acidic environment of cellulitis

14. spitting up - vomiting at night - weight stable
Multiple telangiectesia - vasular lesion in CNS
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

15. dx for turner
Fifth disease; febrile syndrome
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Herpes
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

16. How to prevent GBS in neonate
Penicillin G 4h before delivery
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

17. Tx of FTT
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Diet modification to provide 110kc/kg/d
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

18. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
If aortic root reaches 45 mm
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Erb paralysis leading to diaphragmatic paralysis

19. 17 alpha hydroxylase
Increase of pregnenolone
36 hours
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Between pregnenolone and 17oh pregnenolone

20. mcCune albright`
Endocardial cushion defect (no separation between heart chambers)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
D for d; down syndrome and polyhydramnios

21. TB prophylaxis
INH 9m if INH resistant rifampin 6m in children and 4m in adults
24h to 7d of birth
<2yrs - abd pain - diarrhoea - ARF
Injury to lower roots of brachial plexus

22. cat scratch disease
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Atypical lymphocyte
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bartonella henselae; complication is suppuration of lymph node

23. When to do surgery for undescended testes
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Constitutional pubertal delay
Wait until 6 months
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

24. complete airway obstruction with FB
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
>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
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

25. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Increase of progesteron/17oh progesterone
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

26. aplasic crisis
After 6m; breast mild provides iron until 6m.
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
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

27. What is earliest sign of puberty?
Facial portwine stain
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

28. How to investigate delayed puberty
Absence seizure; tx ethosuximide
refuse
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Increase of pregnenolone

29. when bact conjunctivitis patient can go back to school
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
After 24h of abx therapy

30. duodenal atresia
Female - breech delivery - family history; tx referral to ortho
Absence seizure; tx ethosuximide
Prolactinoma
D for d; down syndrome and polyhydramnios

31. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
No reticulocyte vs high reticulocyte
Bladder dysfunction; UTI and renal dysfunctoin

32. 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
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality

33. difference between breast milk and breafeeding jaundice
Faciform RBC cause vascular occlusion
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
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

34. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Bladder dysfunction; UTI and renal dysfunctoin
No myoclonic activity in JME
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
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

35. sublottic narrowing
Constitutional pubertal delay
Croup tx cool mist; racemic epi - corticosteroid
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
HSP - look for symmetric skin lesions

36. pavlik harness
Pipercillin (zosyn) - ticarcillin
To make hip flexed and abducted position in DDH
36 hours
D for d; down syndrome and polyhydramnios

37. What is the calorie requirement of newborn?
Multiple telangiectesia - vasular lesion in CNS
Vaso-occlusive crisis; dx hb electrophoresis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
110 kcl/kg/day

38. cleft lip but no cleft palate
To make hip flexed and abducted position in DDH
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Candidal diapar rash; tx clotrimazol
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

39. centor criteria for bact pharyngitis
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Develops in 21 dasy

40. low grade fever - cough - diffuse bilat ground glass opacities
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Risk of neurological dysfunction
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
No myoclonic activity in JME

41. down syndrome with holocystolic mumur
Endocardial cushion defect (no separation between heart chambers)
Congenital rubella syndrome
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

42. association with infantile pyloric stenosis
Strep pneumonie; moraxella; h influenze
No reticulocyte vs high reticulocyte
Croup tx cool mist; racemic epi - corticosteroid
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

43. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Pipercillin (zosyn) - ticarcillin
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Meconeum ileus; think about CF

44. major depression
Neurofibromatosis type2
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

45. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
14yrs
To make hip flexed and abducted position in DDH

46. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Pho for forward bending; forward defect; common finding has no adverse physical effect
Constitutional pubertal delay

47. pneumonia in CF patient
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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
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)

48. differentiate between central and peripheral precocious puberty
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
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
TB - breastfeeding - asymptomatic hiv
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

49. sudden onset of fever - difficulty in breathing
Do HIV testing at first
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

50. target cell
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
T for t ; thalassemia; inc serum iron and Iron binding
1.5%
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients