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. failure to thrive
Risk of neurological dysfunction
Less than 5th percentile
Multiple telangiectesia - vasular lesion in CNS
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)

2. sublottic narrowing
Dx US tx; correct serum electrolyte - pyloromyotom
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Croup tx cool mist; racemic epi - corticosteroid
T for t ; thalassemia; inc serum iron and Iron binding

3. viruses cause bronhioltitis
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Less than 5th percentile
RSV - rhino and influenza
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

4. How to prevent GBS in neonate
Rapid detection of RSV antigen in nasl
Erb paralysis leading to diaphragmatic paralysis
Penicillin G 4h before delivery
Lateral neck xray in epiglottitis show swollen epiglottis

5. sturge weber syndrome
Facial portwine stain
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
No; they are basic compound will be neutralized in an acidic environment of cellulitis

6. difference between breast milk and breafeeding jaundice
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
TB - breastfeeding - asymptomatic hiv
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
Dx US tx; correct serum electrolyte - pyloromyotom

7. crying during urination. bacteriuria pyruria - rec episodes
Croup tx cool mist; racemic epi - corticosteroid
Imaging study to r/o VUR
Tx only symptomatic carrier
Strep pneumonie; moraxella; h influenze

8. tzanck
Herpes
Risk of neurological dysfunction
Increase of progesteron/17oh progesterone
Pipercillin (zosyn) - ticarcillin

9. When to give HRT in turner
Yes; but it will be less effective
Constitutional pubertal delay
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
14yrs

10. How to difference RSV and neonatal chlamydia
Biliary atresia; tx surgery
No wheezing - no feever in chlamydia
Lateral neck xray in epiglottitis show swollen epiglottis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

11. low grade fever - cough - diffuse bilat ground glass opacities
Multiple telangiectesia - vasular lesion in CNS
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

12. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
No reticulocyte vs high reticulocyte
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
URI

13. pavlik harness
To make hip flexed and abducted position in DDH
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Brown
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

14. How to dx acute angle closure glaucoma
No myoclonic activity in JME
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

15. causes of FTT
<2yrs - abd pain - diarrhoea - ARF
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Decr calorie intake; decr calorie absorption;incr calorie demand
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

16. sickle cell with symmetrical swelling of hands and feet
refuse
Vaso-occlusive crisis; dx hb electrophoresis
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
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)

17. How to dx post uretheral valve
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Penicillin G 4h before delivery

18. When to bevioral and enviromental measure in led intoxication?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

19. lens dislocation
Increase of progesteron/17oh progesterone
Marfans - ehlers danlos - homocystinuria
36 hours
Lateral neck xray in epiglottitis show swollen epiglottis

20. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Meconeum ileus; think about CF

21. Nocturnal enuresis
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
Multiple telangiectesia - vasular lesion in CNS
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

22. lead >70
Medical emergency; dimercaprol/edta
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Tx only symptomatic carrier
No intervention; 90% foreign bodies pass without difficulty

23. How to differentiate croup vs epiglotitis
After 24h of abx therapy
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Do HIV testing at first

24. mech of botulism
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
24-72 hours
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

25. benefits of antibiotic therapy in acute pharyngitis?
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
24h to 7d of birth
Develops in 21 dasy

26. How to evaluate well appearing child just born in GBS pos mother?
Tx only symptomatic carrier
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis

27. bromocriptine
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Prolactinoma

28. How to difference viral and bact pneumonia
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

29. starring spells 10-20sec
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
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
Oral DMSA or EDTA IV
Erb paralysis leading to diaphragmatic paralysis

30. 3yo - never able to walk
Black
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
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
To make hip flexed and abducted position in DDH

31. What is thumbprint sign
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Lateral neck xray in epiglottitis show swollen epiglottis
Vaso-occlusive crisis; dx hb electrophoresis
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene

32. How to dx RSV
Injury to b/l glossopharyngeal. present in botulism
Bladder dysfunction; UTI and renal dysfunctoin
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
Rapid detection of RSV antigen in nasl

33. contact lens keratitis
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Decresed visio - sudden onset - seeing halos around light - headache - eye pain

34. target cell
T for t ; thalassemia; inc serum iron and Iron binding
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Strep pneumonie; moraxella; h influenze

35. tick transmits RMSF
Lateral neck xray in epiglottitis show swollen epiglottis
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Herpes
Black

36. down syndrome with holocystolic mumur
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Endocardial cushion defect (no separation between heart chambers)
Vaso-occlusive crisis; dx hb electrophoresis
Imaging study to r/o VUR

37. contraindications of DTap
Erb paralysis leading to diaphragmatic paralysis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Between pregnenolone and 17oh pregnenolone

38. difference between structural disorder and flexible kyphosis
Constitutional pubertal delay
After 24h of abx therapy
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Biliary atresia; tx surgery

39. echymoses with low platelet <30k
24h to 7d of birth
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
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
If aortic root reaches 45 mm

40. how thalassemia die
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Dactylitis; 2nd common is splenic seqestration

41. defcicieny of 21 hydroxylase
Herpes
Increase of progesteron/17oh progesterone
Meconeum ileus; think about CF
ALL - alzheimers autism adhd depression seizure

42. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Bladder dysfunction; UTI and renal dysfunctoin
Croup
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Increase of pregnenolone

43. 21 hydroxylase
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Injury to lower roots of brachial plexus
Absence seizure; tx ethosuximide

44. microcytic - hypochromic anemia - hepatospelnomegaly
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
After 6m; breast mild provides iron until 6m.
Thalassemia - congenital hemolytic anemia
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

45. language expectation from 2yo
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Imaging study to r/o VUR
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

46. duodenal atresia
Risk of neurological dysfunction
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
D for d; down syndrome and polyhydramnios
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

47. acute otitis media-pathogen
After 6m; breast mild provides iron until 6m.
Strep pneumonie; moraxella; h influenze
To make hip flexed and abducted position in DDH
Methylephenidate toxicity; cannot be stopped abruptly; taper

48. How to differential bact vs viral conjunctivitis
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
URI
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
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

49. tuberous sclerosis
Between pregnenolone and 17oh pregnenolone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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

50. pneumonia in CF patient
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
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Penicillin G 4h before delivery
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;