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. duodenal atresia
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Facial portwine stain
D for d; down syndrome and polyhydramnios
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

2. contraindications of DTap
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
If aortic root reaches 45 mm
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

3. Nocturnal enuresis
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Risk of neurological dysfunction

4. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
After 6m; breast mild provides iron until 6m.
Methylephenidate toxicity; cannot be stopped abruptly; taper
36 hours
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

5. sudden onset of fever - difficulty in breathing
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
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
Meconeum ileus; think about CF
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

6. splenic infarction in sickle cell
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Do HIV testing at first
Faciform RBC cause vascular occlusion
Absence seizure; tx ethosuximide

7. defcicieny of 21 hydroxylase
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Increase of progesteron/17oh progesterone
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

8. patient with white plaques in mouth and lump in back
Do HIV testing at first
Increase of pregnenolone
No intervention; 90% foreign bodies pass without difficulty
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

9. contraindications of MMR vaccine
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

10. When to do surgery for undescended testes
24-72 hours
Wait until 6 months
Congenital rubella syndrome
Tx only symptomatic carrier

11. failure to thrive
Less than 5th percentile
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Dx US tx; correct serum electrolyte - pyloromyotom
Bartonella henselae; complication is suppuration of lymph node

12. the risk of lyme after bitten by a tick
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
1.5%
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

13. microcytic - hypochromic anemia - hepatospelnomegaly
No reticulocyte vs high reticulocyte
Methylephenidate toxicity; cannot be stopped abruptly; taper
Thalassemia - congenital hemolytic anemia
110 kcl/kg/day

14. How to dx RSV
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Rapid detection of RSV antigen in nasl
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

15. dx for DDH
Dx US tx; correct serum electrolyte - pyloromyotom
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
Meconeum ileus; think about CF
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment

16. 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
Bladder dysfunction; UTI and renal dysfunctoin
To make hip flexed and abducted position in DDH
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

17. tzanck
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Marfans - ehlers danlos - homocystinuria
Herpes
After 24h of abx therapy

18. bromocriptine
Prolactinoma
Increase of progesteron/17oh progesterone
Neurofibromatosis type2
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

19. low grade fever - cough - diffuse bilat ground glass opacities
Diet modification to provide 110kc/kg/d
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone

20. indications of VUR
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
No myoclonic activity in JME
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

21. cardiac manifestation of turner
Develops in 21 dasy
Endocardial cushion defect (no separation between heart chambers)
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

22. What is the calorie requirement of newborn?
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
Pho for forward bending; forward defect; common finding has no adverse physical effect
Atopic dermatitis; strong allergic/immunologic component; incr IgE
110 kcl/kg/day

23. sublottic narrowing
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Pipercillin (zosyn) - ticarcillin
Croup tx cool mist; racemic epi - corticosteroid

24. crying during urination. bacteriuria pyruria - rec episodes
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
1.5%
Imaging study to r/o VUR
Female - breech delivery - family history; tx referral to ortho

25. infant botulism
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
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Atopic dermatitis; strong allergic/immunologic component; incr IgE

26. when bact conjunctivitis patient can go back to school
Prolactinoma
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
After 24h of abx therapy

27. TB prophylaxis
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
INH 9m if INH resistant rifampin 6m in children and 4m in adults

28. infantile hypertrophic pyloric stenosis
Central isosexual precocious puberty; hypothalmaic hamartoma
Dx US tx; correct serum electrolyte - pyloromyotom
Thalassemia - congenital hemolytic anemia
Black

29. language expectation from 2yo
Bartonella henselae; complication is suppuration of lymph node
Faciform RBC cause vascular occlusion
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
No reticulocyte vs high reticulocyte

30. starring spells 10-20sec
Injury to lower roots of brachial plexus
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

31. adrenal tumor
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Tx only symptomatic carrier
Medical emergency; dimercaprol/edta
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

32. Tx of botulism
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Facial portwine stain

33. How to prevent GBS in neonate
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
Central isosexual precocious puberty; hypothalmaic hamartoma
Penicillin G 4h before delivery
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

34. Infant with serum billlirubin >25
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
RSV - rhino and influenza
Wait until 6 months
Risk of neurological dysfunction

35. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Black
24h to 7d of birth
Pipercillin (zosyn) - ticarcillin
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

36. giardiasis
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
refuse
Tx only symptomatic carrier
Decreases height - expensive; reserved for severe cases of delayed puberty

37. Tx of community acquired pneumonia
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy

38. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)

39. HUS
To make hip flexed and abducted position in DDH
<2yrs - abd pain - diarrhoea - ARF
Marfans - ehlers danlos - homocystinuria
Multiple telangiectesia - vasular lesion in CNS

40. When erythema chronicum migrans develops after tick bite
24-72 hours
Female - breech delivery - family history; tx referral to ortho
14yrs
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

41. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Bladder dysfunction; UTI and renal dysfunctoin
Erb paralysis leading to diaphragmatic paralysis
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

42. complete airway obstruction with FB
Facial portwine stain
Candidal diapar rash; tx clotrimazol
>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
Diet modification to provide 110kc/kg/d

43. difference between structural disorder and flexible kyphosis
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
No intervention; 90% foreign bodies pass without difficulty

44. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
T for t ; thalassemia; inc serum iron and Iron binding
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

45. IM
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Lateral neck xray in epiglottitis show swollen epiglottis
Atypical lymphocyte

46. the recommended ca supplementation
No myoclonic activity in JME
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

47. 17 alpha hydroxylase
Decreased UGT enzyme
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
After 6m; breast mild provides iron until 6m.
Between pregnenolone and 17oh pregnenolone

48. pneumonia in CF patient
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Marfans - ehlers danlos - homocystinuria

49. osler rendu weber syndrom
Foreign body sensation - photophobia - corneal opacity tx abx
Multiple telangiectesia - vasular lesion in CNS
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food

50. how smoking contributes otitis media in children
Injury to b/l glossopharyngeal. present in botulism
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Yes; but it will be less effective