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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. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
2. How to dx keratitis?
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Foreign body sensation - photophobia - corneal opacity tx abx
3. what conditions are not contraindicated
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Pho for forward bending; forward defect; common finding has no adverse physical effect
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
TB - breastfeeding - asymptomatic hiv
4. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
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
T for t ; thalassemia; inc serum iron and Iron binding
5. When to give HRT in turner
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
14yrs
Imaging study to r/o VUR
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
6. carditis and arthritis after rheumatic fever
Develops in 21 dasy
No wheezing - no feever in chlamydia
URI
Injury to b/l glossopharyngeal. present in botulism
7. When to give hpv vaccien
36 hours
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
Female - breech delivery - family history; tx referral to ortho
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
8. is local anesthetics be used in cellulitis to reduce pain
110 kcl/kg/day
Rapid detection of RSV antigen in nasl
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
No; they are basic compound will be neutralized in an acidic environment of cellulitis
9. Febrile seizure
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
URI
10. microcytic - hypochromic anemia - hepatospelnomegaly
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Thalassemia - congenital hemolytic anemia
Decreases height - expensive; reserved for severe cases of delayed puberty
Strep pneumonie; moraxella; h influenze
11. how smoking contributes otitis media in children
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
<2yrs - abd pain - diarrhoea - ARF
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
12. HUS
<2yrs - abd pain - diarrhoea - ARF
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
24h to 7d of birth
Atopic dermatitis; strong allergic/immunologic component; incr IgE
13. doing worse in school - lack of attention - starring speel
Vaso-occlusive crisis; dx hb electrophoresis
Absence seizure; tx ethosuximide
Brown
Decreases height - expensive; reserved for severe cases of delayed puberty
14. giardiasis
Faciform RBC cause vascular occlusion
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Tx only symptomatic carrier
15. patient with white plaques in mouth and lump in back
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Do HIV testing at first
Dx US tx; correct serum electrolyte - pyloromyotom
Atopic dermatitis; strong allergic/immunologic component; incr IgE
16. adducted internally rotated arm; forearm pronation - wrist flexion of baby after birth
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17. aplasic crisis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
RSV - rhino and influenza
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
18. can women with abnormal smear or genital get vaccine
No reticulocyte vs high reticulocyte
Croup tx cool mist; racemic epi - corticosteroid
Yes; but it will be less effective
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
19. cat scratch disease
Fifth disease; febrile syndrome
T for t ; thalassemia; inc serum iron and Iron binding
Absence seizure; tx ethosuximide
Bartonella henselae; complication is suppuration of lymph node
20. lead 44-70
Oral DMSA or EDTA IV
<2yrs - abd pain - diarrhoea - ARF
Dx US tx; correct serum electrolyte - pyloromyotom
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
21. Infant with serum billlirubin >25
Bartonella henselae; complication is suppuration of lymph node
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
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Risk of neurological dysfunction
22. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
23. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
To make hip flexed and abducted position in DDH
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
24. difference between rubeola (measles) and rulbella
No reticulocyte vs high reticulocyte
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Central isosexual precocious puberty; hypothalmaic hamartoma
25. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb paralysis leading to diaphragmatic paralysis
>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
refuse
Black
26. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
110 kcl/kg/day
Pho for forward bending; forward defect; common finding has no adverse physical effect
27. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Constitutional pubertal delay
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
28. sickle cell with symmetrical swelling of hands and feet
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Vaso-occlusive crisis; dx hb electrophoresis
Candidal diapar rash; tx clotrimazol
29. contact lens keratitis
Herpes
Injury to b/l glossopharyngeal. present in botulism
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
TB - breastfeeding - asymptomatic hiv
30. the risk of lyme after bitten by a tick
1.5%
Decreases height - expensive; reserved for severe cases of delayed puberty
Bartonella henselae; complication is suppuration of lymph node
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
31. How to dx post uretheral valve
1.5%
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
32. thumb sign
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Methylephenidate toxicity; cannot be stopped abruptly; taper
33. Tx of FTT
Marfans - ehlers danlos - homocystinuria
Diet modification to provide 110kc/kg/d
Congenital rubella syndrome
<2yrs - abd pain - diarrhoea - ARF
34. down syndrome has inreased risk of developing
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
ALL - alzheimers autism adhd depression seizure
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
35. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
36. hypopigmented spots - family hx bilat deafness
Strep pneumonie; moraxella; h influenze
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Neurofibromatosis type2
37. 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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
38. contraindications of MMR vaccine
After 6m; breast mild provides iron until 6m.
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
39. IM
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Croup
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Atypical lymphocyte
40. mech of botulism
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
41. tzanck
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Herpes
If aortic root reaches 45 mm
>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
42. tick transmits lyme
Candidal diapar rash; tx clotrimazol
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Brown
43. cardiac manifestation of turner
>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
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
110 kcl/kg/day
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
44. difference between structural disorder and flexible kyphosis
Dactylitis; 2nd common is splenic seqestration
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Pho for forward bending; forward defect; common finding has no adverse physical effect
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
45. dx for DDH
Between pregnenolone and 17oh pregnenolone
Dx US tx; correct serum electrolyte - pyloromyotom
24h to 7d of birth
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
46. What is the most common initial symptom in sickle cell
Yes; but it will be less effective
Dactylitis; 2nd common is splenic seqestration
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Prolactinoma
47. flexible kyphosis
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Pho for forward bending; forward defect; common finding has no adverse physical effect
24-72 hours
48. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Lateral neck xray in epiglottitis show swollen epiglottis
Between pregnenolone and 17oh pregnenolone
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
49. acute abd pain - hx URI - lower extremity maculo papular rash
TB - breastfeeding - asymptomatic hiv
Lateral neck xray in epiglottitis show swollen epiglottis
HSP - look for symmetric skin lesions
No reticulocyte vs high reticulocyte
50. sublottic narrowing
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
14yrs
Croup tx cool mist; racemic epi - corticosteroid
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)