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. When to do aortic root surgery in marfans to prevent dissection?
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Decreased UGT enzyme
If aortic root reaches 45 mm

2. acute otitis media-pathogen
Strep pneumonie; moraxella; h influenze
14yrs
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)
Constitutional pubertal delay

3. language delay
Increase of progesteron/17oh progesterone
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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

4. down syndrome has inreased risk of developing
Between pregnenolone and 17oh pregnenolone
Faciform RBC cause vascular occlusion
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
ALL - alzheimers autism adhd depression seizure

5. What is the most common initial symptom in sickle cell
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
Less than 5th percentile
Dactylitis; 2nd common is splenic seqestration
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

6. centor criteria for bact pharyngitis
36 hours
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

7. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
No reticulocyte vs high reticulocyte
Meconeum ileus; think about CF
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Black

8. lead 44-70
Neurofibromatosis type2
Dx US tx; correct serum electrolyte - pyloromyotom
Oral DMSA or EDTA IV
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

9. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
TB - breastfeeding - asymptomatic hiv
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
36 hours

10. How to dx endopthalmitis
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Pho for forward bending; forward defect; common finding has no adverse physical effect
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

11. Infant with serum billlirubin >25
Risk of neurological dysfunction
Dactylitis; 2nd common is splenic seqestration
24-72 hours
Thalassemia - congenital hemolytic anemia

12. Parents can _____ vaccine
refuse
Wait until 6 months
Injury to b/l glossopharyngeal. present in botulism
Endocardial cushion defect (no separation between heart chambers)

13. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
HSP - look for symmetric skin lesions
Croup
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Central isosexual precocious puberty; hypothalmaic hamartoma

14. What is the calorie requirement of newborn?
Lateral neck xray in epiglottitis show swollen epiglottis
110 kcl/kg/day
Decreases height - expensive; reserved for severe cases of delayed puberty
No; they are basic compound will be neutralized in an acidic environment of cellulitis

15. What is the definition of delayed puberty?
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Oral DMSA or EDTA IV
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

16. Tx of bact conjunctivitis
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Increase of progesteron/17oh progesterone
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

17. side effect of testosteron therapy
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Do HIV testing at first
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Decreases height - expensive; reserved for severe cases of delayed puberty

18. sturge weber syndrome
Atypical lymphocyte
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Facial portwine stain

19. language expectation from 2yo
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
No reticulocyte vs high reticulocyte

20. failure to thrive
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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
Less than 5th percentile
Injury to lower roots of brachial plexus

21. 3yo - never able to walk
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Decreases height - expensive; reserved for severe cases of delayed puberty
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
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

22. iron supplement in child
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Neurofibromatosis type2
After 6m; breast mild provides iron until 6m.
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

23. Febrile seizure
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Penicillin G 4h before delivery

24. red oozing rash on cheek - scaly - dry
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Multiple telangiectesia - vasular lesion in CNS
Atopic dermatitis; strong allergic/immunologic component; incr IgE
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

25. When to give HRT in turner
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) -
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
14yrs

26. differentiate between central and peripheral precocious puberty
Penicillin G 4h before delivery
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Prolactinoma

27. How to dx acute angle closure glaucoma
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Absence seizure; tx ethosuximide

28. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Thalassemia - congenital hemolytic anemia
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
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

29. 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
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Strep pneumonie; moraxella; h influenze
Penicillin G 4h before delivery

30. horner syndrom
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
Penicillin G 4h before delivery
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Injury to lower roots of brachial plexus

31. 21 hydroxylase
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Croup tx cool mist; racemic epi - corticosteroid
Endocardial cushion defect (no separation between heart chambers)

32. viruses cause bronhioltitis
RSV - rhino and influenza
Pipercillin (zosyn) - ticarcillin
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
Herpes

33. When to give hpv vaccien
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
24-72 hours
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
Constitutional pubertal delay

34. the recommended ca supplementation
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

35. dx for turner
Penicillin G 4h before delivery
Increase of pregnenolone
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
No reticulocyte vs high reticulocyte

36. How to differentiate croup vs epiglotitis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

37. tick transmits lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
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
Brown
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

38. carditis and arthritis after rheumatic fever
Develops in 21 dasy
Female - breech delivery - family history; tx referral to ortho
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Between pregnenolone and 17oh pregnenolone

39. how thalassemia die
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Faciform RBC cause vascular occlusion
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

40. TTP pentad
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram

41. coin in child's stomach
Penicillin G 4h before delivery
No intervention; 90% foreign bodies pass without difficulty
Decreases height - expensive; reserved for severe cases of delayed puberty
1.5%

42. echymoses with low platelet <30k
refuse
After 6m; breast mild provides iron until 6m.
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

43. Tx of children constipation

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

44. What are the risk factors of developmental dysplais of hip
Female - breech delivery - family history; tx referral to ortho
Fifth disease; febrile syndrome
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Injury to b/l glossopharyngeal. present in botulism

45. When erythema chronicum migrans develops after tick bite
Imaging study to r/o VUR
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
24-72 hours

46. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Pho for forward bending; forward defect; common finding has no adverse physical effect
Methylephenidate toxicity; cannot be stopped abruptly; taper

47. splenic infarction in sickle cell
Brown
Faciform RBC cause vascular occlusion
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA

48. difference between diaper dermatitis and rash
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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
Penicillin G 4h before delivery
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

49. benefits of antibiotic therapy in acute pharyngitis?
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery

50. target cell
Increase of progesteron/17oh progesterone
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
T for t ; thalassemia; inc serum iron and Iron binding