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Test your basic knowledge |
USMLE Step3 Pediatrics
Start Test
Study First
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. difference between breast milk and breafeeding jaundice
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
To make hip flexed and abducted position in DDH
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
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
2. cat scratch disease
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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)
Bartonella henselae; complication is suppuration of lymph node
14yrs
3. acute otitis media-pathogen
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Strep pneumonie; moraxella; h influenze
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
4. lead 44-70
Strep pneumonie; moraxella; h influenze
Oral DMSA or EDTA IV
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
5. failure to thrive
Less than 5th percentile
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Mainly clinical; serology with initial ELISA - with western blot confirmation;
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)
6. HUS
<2yrs - abd pain - diarrhoea - ARF
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
After 24h of abx therapy
7. crying during urination. bacteriuria pyruria - rec episodes
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Imaging study to r/o VUR
8. aplasic crisis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Wait until 6 months
9. target cell
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
To make hip flexed and abducted position in DDH
Oral DMSA or EDTA IV
T for t ; thalassemia; inc serum iron and Iron binding
10. Neonatal unconjugated hyperbilirubine
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
Decreased UGT enzyme
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
110 kcl/kg/day
11. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Faciform RBC cause vascular occlusion
Erb paralysis leading to diaphragmatic paralysis
Foreign body sensation - photophobia - corneal opacity tx abx
Injury to b/l glossopharyngeal. present in botulism
12. mech of botulism
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
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
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
13. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Benign permature thelarche; expectant management
Vaso-occlusive crisis; dx hb electrophoresis
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
14. the recommended ca supplementation
Strep pneumonie; moraxella; h influenze
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
15. lens dislocation
Thalassemia - congenital hemolytic anemia
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Marfans - ehlers danlos - homocystinuria
16. splenic infarction in sickle cell
1.5%
Faciform RBC cause vascular occlusion
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
17. dx for DDH
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
18. osler rendu weber syndrom
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
Neurofibromatosis type2
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
Multiple telangiectesia - vasular lesion in CNS
19. red oozing rash on cheek - scaly - dry
Atopic dermatitis; strong allergic/immunologic component; incr IgE
36 hours
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
Croup tx cool mist; racemic epi - corticosteroid
20. tick transmits lyme
Brown
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Decreased UGT enzyme
21. is local anesthetics be used in cellulitis to reduce pain
Injury to lower roots of brachial plexus
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
1.5%
22. pavlik harness
<2yrs - abd pain - diarrhoea - ARF
To make hip flexed and abducted position in DDH
Strep pneumonie; moraxella; h influenze
D for d; down syndrome and polyhydramnios
23. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Neurofibromatosis type2
Methylephenidate toxicity; cannot be stopped abruptly; taper
Tx only symptomatic carrier
24. Parents can _____ vaccine
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Decreased UGT enzyme
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
refuse
25. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
36 hours
26. What is the definition of delayed puberty?
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
27. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Female - breech delivery - family history; tx referral to ortho
Wait until 6 months
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Pipercillin (zosyn) - ticarcillin
28. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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
29. decreased mobility of tympanic membrane after otitis media
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Pho for forward bending; forward defect; common finding has no adverse physical effect
Tx only symptomatic carrier
30. duodenal atresia
Pho for forward bending; forward defect; common finding has no adverse physical effect
D for d; down syndrome and polyhydramnios
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
31. tick transmits RMSF
24-72 hours
Black
Imaging study to r/o VUR
No wheezing - no feever in chlamydia
32. defcicieny of 21 hydroxylase
Thalassemia - congenital hemolytic anemia
Increase of progesteron/17oh progesterone
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
110 kcl/kg/day
33. Tx of bact conjunctivitis
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
34. penicillin effective against pseudomonas
Pipercillin (zosyn) - ticarcillin
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
35. carditis and arthritis after rheumatic fever
Risk of neurological dysfunction
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
Develops in 21 dasy
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
36. what conditions are not contraindicated
Lateral neck xray in epiglottitis show swollen epiglottis
Dx US tx; correct serum electrolyte - pyloromyotom
TB - breastfeeding - asymptomatic hiv
Do HIV testing at first
37. Nocturnal enuresis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
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
Female - breech delivery - family history; tx referral to ortho
38. how smoking contributes otitis media in children
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
39. thumb sign
After 24h of abx therapy
Meconeum ileus; think about CF
Imaging study to r/o VUR
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
40. complete airway obstruction with FB
Injury to lower roots of brachial plexus
After 24h of abx therapy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
>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
41. 12y - obese - hip pain - hip ext rotated
Lateral neck xray in epiglottitis show swollen epiglottis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Do HIV testing at first
No intervention; 90% foreign bodies pass without difficulty
42. side effect of testosteron therapy
Herpes
Decreases height - expensive; reserved for severe cases of delayed puberty
Increase of pregnenolone
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
43. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Bartonella henselae; complication is suppuration of lymph node
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
44. mcCune albright`
Diet modification to provide 110kc/kg/d
HSP - look for symmetric skin lesions
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
45. viruses cause bronhioltitis
>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
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)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
RSV - rhino and influenza
46. difference between rubeola (measles) and rulbella
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
refuse
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Injury to lower roots of brachial plexus
47. horner syndrom
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Injury to lower roots of brachial plexus
Meconeum ileus; think about CF
Diet modification to provide 110kc/kg/d
48. language delay
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Injury to b/l glossopharyngeal. present in botulism
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
49. indications of VUR
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Herpes
50. When to bevioral and enviromental measure in led intoxication?
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
No wheezing - no feever in chlamydia