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. viruses cause bronhioltitis
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
RSV - rhino and influenza
Meconeum ileus; think about CF
refuse

2. pumonary TB
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
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)

3. How to dx RSV
Candidal diapar rash; tx clotrimazol
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Rapid detection of RSV antigen in nasl

4. How long patient needs to be exposed to tick to get infected
36 hours
After 24h of abx therapy
Rapid detection of RSV antigen in nasl
1.5%

5. complete airway obstruction with FB
ALL - alzheimers autism adhd depression seizure
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
>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
Injury to lower roots of brachial plexus

6. what conditions are not contraindicated
Decreased UGT enzyme
TB - breastfeeding - asymptomatic hiv
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Wait until 6 months

7. down syndrome with holocystolic mumur
Imaging study to r/o VUR
Endocardial cushion defect (no separation between heart chambers)
Meconeum ileus; think about CF
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

8. 21 hydroxylase
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

9. pneumonia in CF patient
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Injury to b/l glossopharyngeal. present in botulism
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Croup

10. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Erb paralysis leading to diaphragmatic paralysis
Candidal diapar rash; tx clotrimazol
T for t ; thalassemia; inc serum iron and Iron binding

11. infant botulism
Biliary atresia; tx surgery
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
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

12. When erythema chronicum migrans develops after tick bite
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Constitutional pubertal delay
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
24-72 hours

13. Neonatal unconjugated hyperbilirubine
Rapid detection of RSV antigen in nasl
Marfans - ehlers danlos - homocystinuria
Decreased UGT enzyme
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

14. How to dx post uretheral valve
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
<2yrs - abd pain - diarrhoea - ARF
Faciform RBC cause vascular occlusion
Herpes

15. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Between pregnenolone and 17oh pregnenolone

16. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Risk of neurological dysfunction
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas

17. thumb sign
Rapid detection of RSV antigen in nasl
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Atopic dermatitis; strong allergic/immunologic component; incr IgE
<2yrs - abd pain - diarrhoea - ARF

18. How to dx endopthalmitis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
No wheezing - no feever in chlamydia
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

19. contact lens keratitis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Risk of neurological dysfunction
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
D for d; down syndrome and polyhydramnios

20. Infant with serum billlirubin >25
RSV - rhino and influenza
36 hours
No intervention; 90% foreign bodies pass without difficulty
Risk of neurological dysfunction

21. pavlik harness
Atypical lymphocyte
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 -
To make hip flexed and abducted position in DDH

22. causes of acute anemia
No intervention; 90% foreign bodies pass without difficulty
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

23. language expectation from 2yo
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Diet modification to provide 110kc/kg/d

24. What is thumbprint sign
>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
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Lateral neck xray in epiglottitis show swollen epiglottis

25. lead >70
Develops in 21 dasy
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Medical emergency; dimercaprol/edta
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

26. penicillin effective against pseudomonas
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Pipercillin (zosyn) - ticarcillin
Dx US tx; correct serum electrolyte - pyloromyotom
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

27. indications of audiometry in childrens
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Methylephenidate toxicity; cannot be stopped abruptly; taper
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Absence seizure; tx ethosuximide

28. impaired gag reflex
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
After 24h of abx therapy
Injury to b/l glossopharyngeal. present in botulism
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

29. association with infantile pyloric stenosis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

30. most common complication of otitis media
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Atypical lymphocyte

31. How to prevent GBS in neonate
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
HSP - look for symmetric skin lesions
Penicillin G 4h before delivery

32. doing worse in school - lack of attention - starring speel
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Absence seizure; tx ethosuximide
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

33. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace

34. cardiac manifestation of turner
To make hip flexed and abducted position in DDH
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
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

35. IM
Candidal diapar rash; tx clotrimazol
Atypical lymphocyte
Croup
ALL - alzheimers autism adhd depression seizure

36. What are the risk factors of developmental dysplais of hip
Faciform RBC cause vascular occlusion
Rapid detection of RSV antigen in nasl
Female - breech delivery - family history; tx referral to ortho
Herpes

37. 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

38. mech of botulism
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Erb paralysis leading to diaphragmatic paralysis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Wait until 6 months

39. TTP pentad
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
36 hours
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

40. physiological jaundice
Black
24h to 7d of birth
Yes; but it will be less effective
Atopic dermatitis; strong allergic/immunologic component; incr IgE

41. How to dx keratitis?
Foreign body sensation - photophobia - corneal opacity tx abx
Atypical lymphocyte
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
36 hours

42. giardiasis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Tx only symptomatic carrier
Black
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

43. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Risk of neurological dysfunction
Absence seizure; tx ethosuximide

44. cleft lip but no cleft palate
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
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Strep pneumonie; moraxella; h influenze
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

45. carditis and arthritis after rheumatic fever
Develops in 21 dasy
36 hours
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
110 kcl/kg/day

46. sturge weber syndrome
Facial portwine stain
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Diet modification to provide 110kc/kg/d
After 24h of abx therapy

47. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
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
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
14yrs

48. When to give HRT in turner
14yrs
INH 9m if INH resistant rifampin 6m in children and 4m in adults
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
ALL - alzheimers autism adhd depression seizure

49. Parents can _____ vaccine
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
refuse
Do HIV testing at first
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

50. decreased mobility of tympanic membrane after otitis media
TB - breastfeeding - asymptomatic hiv
No intervention; 90% foreign bodies pass without difficulty
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy