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. lead 44-70
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Thalassemia - congenital hemolytic anemia
Oral DMSA or EDTA IV
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

2. How to difference viral and bact pneumonia
Diet modification to provide 110kc/kg/d
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
ALL - alzheimers autism adhd depression seizure
Erb paralysis leading to diaphragmatic paralysis

3. centor criteria for bact pharyngitis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Injury to lower roots of brachial plexus
Pho for forward bending; forward defect; common finding has no adverse physical effect
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

4. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
No myoclonic activity in JME
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

5. target cell
T for t ; thalassemia; inc serum iron and Iron binding
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Lateral neck xray in epiglottitis show swollen epiglottis

6. language delay
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Rapid detection of RSV antigen in nasl
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Diet modification to provide 110kc/kg/d

7. complication of lumbosacral meningocele
Benign permature thelarche; expectant management
Bladder dysfunction; UTI and renal dysfunctoin
Congenital rubella syndrome
Decreased UGT enzyme

8. tzanck
After 6m; breast mild provides iron until 6m.
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
Herpes
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

9. What is the definition of delayed puberty?
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
<2yrs - abd pain - diarrhoea - ARF
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

10. association with infantile pyloric stenosis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Penicillin G 4h before delivery
D for d; down syndrome and polyhydramnios

11. splenic infarction in sickle cell
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
14yrs
<2yrs - abd pain - diarrhoea - ARF
Faciform RBC cause vascular occlusion

12. acute abd pain - hx URI - lower extremity maculo papular rash
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
HSP - look for symmetric skin lesions
Diet modification to provide 110kc/kg/d
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

13. non immune pregnant women exposed to rubella in first trimester
TB - breastfeeding - asymptomatic hiv
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Decreased UGT enzyme
Congenital rubella syndrome

14. how thalassemia die
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Herpes
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

15. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Erb paralysis leading to diaphragmatic paralysis
Atypical lymphocyte
Dx US tx; correct serum electrolyte - pyloromyotom

16. contraindications of DTap
If aortic root reaches 45 mm
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Do HIV testing at first
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

17. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Meconeum ileus; think about CF
Benign permature thelarche; expectant management
Pho for forward bending; forward defect; common finding has no adverse physical effect
Black

18. red oozing rash on cheek - scaly - dry
36 hours
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Atopic dermatitis; strong allergic/immunologic component; incr IgE
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)

19. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Candidal diapar rash; tx clotrimazol
Marfans - ehlers danlos - homocystinuria
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis

20. flexible kyphosis
Pho for forward bending; forward defect; common finding has no adverse physical effect
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

21. lead >70
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
HSP - look for symmetric skin lesions
Do HIV testing at first
Medical emergency; dimercaprol/edta

22. When to do surgery for undescended testes
Bartonella henselae; complication is suppuration of lymph node
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Wait until 6 months

23. carditis and arthritis after rheumatic fever
D for d; down syndrome and polyhydramnios
24-72 hours
Develops in 21 dasy
Yes; but it will be less effective

24. TB prophylaxis
24h to 7d of birth
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
INH 9m if INH resistant rifampin 6m in children and 4m in adults

25. crying during urination. bacteriuria pyruria - rec episodes
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Facial portwine stain
Methylephenidate toxicity; cannot be stopped abruptly; taper
Imaging study to r/o VUR

26. dx for turner
After 24h of abx therapy
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Brown
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

27. microcytic - hypochromic anemia - hepatospelnomegaly
Thalassemia - congenital hemolytic anemia
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
Female - breech delivery - family history; tx referral to ortho
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

28. failure to thrive
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Less than 5th percentile
No reticulocyte vs high reticulocyte

29. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

30. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
After 6m; breast mild provides iron until 6m.
Constitutional pubertal delay
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

31. How long patient needs to be exposed to tick to get infected
Dx US tx; correct serum electrolyte - pyloromyotom
Decreases height - expensive; reserved for severe cases of delayed puberty
36 hours
URI

32. impaired gag reflex
Injury to b/l glossopharyngeal. present in botulism
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
36 hours
D for d; down syndrome and polyhydramnios

33. most common complication of otitis media
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Do HIV testing at first
Atopic dermatitis; strong allergic/immunologic component; incr IgE
24h to 7d of birth

34. How to dx endopthalmitis
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
24h to 7d of birth
Injury to b/l glossopharyngeal. present in botulism

35. dx for DDH
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Imaging study to r/o VUR
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
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

36. sudden onset of fever - difficulty in breathing
Bladder dysfunction; UTI and renal dysfunctoin
T for t ; thalassemia; inc serum iron and Iron binding
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate

37. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Decreased UGT enzyme
Dactylitis; 2nd common is splenic seqestration
14yrs
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

38. 21 hydroxylase
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

39. difference between structural disorder and flexible kyphosis
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)
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
RSV - rhino and influenza

40. What is thumbprint sign
Pho for forward bending; forward defect; common finding has no adverse physical effect
Faciform RBC cause vascular occlusion
refuse
Lateral neck xray in epiglottitis show swollen epiglottis

41. difference between diaper dermatitis and rash
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
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
ALL - alzheimers autism adhd depression seizure
Absence seizure; tx ethosuximide

42. sturge weber syndrome
1.5%
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Facial portwine stain

43. How to investigate delayed puberty
After 6m; breast mild provides iron until 6m.
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Increase of pregnenolone

44. How to difference RSV and neonatal chlamydia
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Bartonella henselae; complication is suppuration of lymph node
No wheezing - no feever in chlamydia
INH 9m if INH resistant rifampin 6m in children and 4m in adults

45. Infant with serum billlirubin >25
Bartonella henselae; complication is suppuration of lymph node
Risk of neurological dysfunction
Biliary atresia; tx surgery
Decr calorie intake; decr calorie absorption;incr calorie demand

46. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
110 kcl/kg/day
No reticulocyte vs high reticulocyte
Croup

47. 12y - obese - hip pain - hip ext rotated
110 kcl/kg/day
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
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

48. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Pho for forward bending; forward defect; common finding has no adverse physical effect
Benign permature thelarche; expectant management
URI

49. Neonatal unconjugated hyperbilirubine
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Decreased UGT enzyme
After 24h of abx therapy

50. How to prevent GBS in neonate
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Penicillin G 4h before delivery
Candidal diapar rash; tx clotrimazol
Brown