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Test your basic knowledge |
USMLE Step3 Pediatrics
Start Test
Study First
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;