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. 12y - obese - hip pain - hip ext rotated
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

2. causes of acute anemia
No wheezing - no feever in chlamydia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Vaso-occlusive crisis; dx hb electrophoresis
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

3. target cell
Foreign body sensation - photophobia - corneal opacity tx abx
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
T for t ; thalassemia; inc serum iron and Iron binding

4. What is the calorie requirement of newborn?
110 kcl/kg/day
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)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Dx US tx; correct serum electrolyte - pyloromyotom

5. Neonatal conjugated hyperbilirubinemia
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
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Biliary atresia; tx surgery
Endocardial cushion defect (no separation between heart chambers)

6. 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
Multiple telangiectesia - vasular lesion in CNS
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Fifth disease; febrile syndrome

7. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Herpes
Vaso-occlusive crisis; dx hb electrophoresis
Methylephenidate toxicity; cannot be stopped abruptly; taper
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

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

9. non immune pregnant women exposed to rubella in first trimester
Congenital rubella syndrome
Croup
14yrs
110 kcl/kg/day

10. down syndrome with holocystolic mumur
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
HSP - look for symmetric skin lesions
Endocardial cushion defect (no separation between heart chambers)
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery

11. IM
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Congenital rubella syndrome
Atypical lymphocyte
Croup tx cool mist; racemic epi - corticosteroid

12. 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
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
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

13. pneumonia in CF patient
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

14. 3yo - febrile - left hip externally rotated
Penicillin G 4h before delivery
Yes; but it will be less effective
No reticulocyte vs high reticulocyte
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

15. horner syndrom
Imaging study to r/o VUR
Injury to lower roots of brachial plexus
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Do HIV testing at first

16. language delay
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

17. lens dislocation
Marfans - ehlers danlos - homocystinuria
Black
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
14yrs

18. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Marfans - ehlers danlos - homocystinuria
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

19. acute otitis externa

20. How to prevent GBS in neonate
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Tx only symptomatic carrier
Penicillin G 4h before delivery
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

21. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
1.5%
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

22. osler rendu weber syndrom
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Multiple telangiectesia - vasular lesion in CNS
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

23. decreased mobility of tympanic membrane after otitis media
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
110 kcl/kg/day
No wheezing - no feever in chlamydia
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

24. What is earliest sign of puberty?
Prolactinoma
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Constitutional pubertal delay
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

25. Febrile seizure
Absence seizure; tx ethosuximide
Bartonella henselae; complication is suppuration of lymph node
After 6m; breast mild provides iron until 6m.
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

26. congenital adrenal hyperplasi
Endocardial cushion defect (no separation between heart chambers)
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Lateral neck xray in epiglottitis show swollen epiglottis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

27. Tx of community acquired pneumonia
Female - breech delivery - family history; tx referral to ortho
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Prolactinoma

28. the risk of lyme after bitten by a tick
Vaso-occlusive crisis; dx hb electrophoresis
Black
1.5%
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -

29. pumonary TB
Constitutional pubertal delay
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)
Prolactinoma
URI

30. down syndrome has inreased risk of developing
ALL - alzheimers autism adhd depression seizure
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
Multiple telangiectesia - vasular lesion in CNS
Medical emergency; dimercaprol/edta

31. How to investigate delayed puberty
After 24h of abx therapy
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Brown

32. centor criteria for bact pharyngitis
Vaso-occlusive crisis; dx hb electrophoresis
Methylephenidate toxicity; cannot be stopped abruptly; taper
No intervention; 90% foreign bodies pass without difficulty
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

33. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
No myoclonic activity in JME
Endocardial cushion defect (no separation between heart chambers)

34. low grade fever - cough - diffuse bilat ground glass opacities
Benign permature thelarche; expectant management
Absence seizure; tx ethosuximide
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

35. HUS
Vaso-occlusive crisis; dx hb electrophoresis
<2yrs - abd pain - diarrhoea - ARF
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH

36. tuberous sclerosis
Dactylitis; 2nd common is splenic seqestration
<2yrs - abd pain - diarrhoea - ARF
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

37. physiological jaundice
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Congenital rubella syndrome
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
24h to 7d of birth

38. How to dx RSV
14yrs
Rapid detection of RSV antigen in nasl
Injury to lower roots of brachial plexus
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

39. How to difference RSV and neonatal chlamydia
No wheezing - no feever in chlamydia
Central isosexual precocious puberty; hypothalmaic hamartoma
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Pipercillin (zosyn) - ticarcillin

40. microcytic - hypochromic anemia - hepatospelnomegaly
No wheezing - no feever in chlamydia
Thalassemia - congenital hemolytic anemia
Injury to lower roots of brachial plexus
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

41. causes of FTT
Methylephenidate toxicity; cannot be stopped abruptly; taper
Dactylitis; 2nd common is splenic seqestration
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

42. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Diet modification to provide 110kc/kg/d
Neurofibromatosis type2
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

43. difference between breast milk and breafeeding jaundice
Multiple telangiectesia - vasular lesion in CNS
If aortic root reaches 45 mm
Biliary atresia; tx surgery
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

44. the recommended ca supplementation
D for d; down syndrome and polyhydramnios
Central isosexual precocious puberty; hypothalmaic hamartoma
Fifth disease; febrile syndrome
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

45. sickle cell with symmetrical swelling of hands and feet
Lateral neck xray in epiglottitis show swollen epiglottis
Vaso-occlusive crisis; dx hb electrophoresis
Multiple telangiectesia - vasular lesion in CNS
24h to 7d of birth

46. When to do aortic root surgery in marfans to prevent dissection?
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
If aortic root reaches 45 mm
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Vaso-occlusive crisis; dx hb electrophoresis

47. How to dx endopthalmitis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Fifth disease; febrile syndrome
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

48. cat scratch disease
Neurofibromatosis type2
Bartonella henselae; complication is suppuration of lymph node
Atypical lymphocyte
Develops in 21 dasy

49. giardiasis
Tx only symptomatic carrier
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
After 24h of abx therapy
Neurofibromatosis type2

50. iron supplement in child
After 6m; breast mild provides iron until 6m.
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
No myoclonic activity in JME
Foreign body sensation - photophobia - corneal opacity tx abx