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. how smoking contributes otitis media in children
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

2. tick transmits RMSF
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
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
Black
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)

3. difference between diaper dermatitis and rash
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
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
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

4. difference between structural disorder and flexible kyphosis
Dx US tx; correct serum electrolyte - pyloromyotom
Decreases height - expensive; reserved for severe cases of delayed puberty
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Develops in 21 dasy

5. kallman syndrome
To make hip flexed and abducted position in DDH
Benign permature thelarche; expectant management
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)

6. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
>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
Vaso-occlusive crisis; dx hb electrophoresis
Facial portwine stain

7. tick transmits lyme
Brown
Female - breech delivery - family history; tx referral to ortho
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
To make hip flexed and abducted position in DDH

8. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Meconeum ileus; think about CF
Central isosexual precocious puberty; hypothalmaic hamartoma
Rapid detection of RSV antigen in nasl

9. tzanck
Herpes
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Penicillin G 4h before delivery
Dactylitis; 2nd common is splenic seqestration

10. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
Female - breech delivery - family history; tx referral to ortho
No; they are basic compound will be neutralized in an acidic environment of cellulitis
No myoclonic activity in JME
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

11. HUS
Atopic dermatitis; strong allergic/immunologic component; incr IgE
<2yrs - abd pain - diarrhoea - ARF
Medical emergency; dimercaprol/edta
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

12. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
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
TB - breastfeeding - asymptomatic hiv
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Prolactinoma

13. What are the risk factors of developmental dysplais of hip
Penicillin G 4h before delivery
Female - breech delivery - family history; tx referral to ortho
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate

14. How long patient needs to be exposed to tick to get infected
36 hours
To make hip flexed and abducted position in DDH
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
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. 3yo - never able to walk
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Increase of pregnenolone
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
refuse

16. lead 44-70
Tx only symptomatic carrier
refuse
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Oral DMSA or EDTA IV

17. bromocriptine
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Develops in 21 dasy
Prolactinoma
Oral DMSA or EDTA IV

18. cardiac manifestation of turner
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
If aortic root reaches 45 mm

19. 21 hydroxylase
No intervention; 90% foreign bodies pass without difficulty
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Dx US tx; correct serum electrolyte - pyloromyotom
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone

20. language expectation from 2yo
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
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)
14yrs
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

21. How to difference RSV and neonatal chlamydia
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No wheezing - no feever in chlamydia
110 kcl/kg/day
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

22. sturge weber syndrome
Facial portwine stain
Thalassemia - congenital hemolytic anemia
Absence seizure; tx ethosuximide
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

23. What is the most common initial symptom in sickle cell
Brown
Dactylitis; 2nd common is splenic seqestration
Facial portwine stain
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

24. the risk of lyme after bitten by a tick
Benign permature thelarche; expectant management
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Oral DMSA or EDTA IV
1.5%

25. viruses cause bronhioltitis
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
24-72 hours
RSV - rhino and influenza
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

26. iron supplement in child
After 6m; breast mild provides iron until 6m.
Meconeum ileus; think about CF
Black
Increase of pregnenolone

27. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Diet modification to provide 110kc/kg/d
>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
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. pneumonia in CF patient
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
24-72 hours
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

29. difference between breast milk and breafeeding jaundice
Foreign body sensation - photophobia - corneal opacity tx abx
Pipercillin (zosyn) - ticarcillin
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
Bartonella henselae; complication is suppuration of lymph node

30. Infant with serum billlirubin >25
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Risk of neurological dysfunction
Female - breech delivery - family history; tx referral to ortho

31. patient with white plaques in mouth and lump in back
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Do HIV testing at first
Faciform RBC cause vascular occlusion
Croup

32. physiological jaundice
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
24h to 7d of birth
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO

33. acute otitis externa

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

34. what conditions are not contraindicated
TB - breastfeeding - asymptomatic hiv
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Strep pneumonie; moraxella; h influenze
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry

35. indications of VUR
Between pregnenolone and 17oh pregnenolone
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
Dactylitis; 2nd common is splenic seqestration
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

36. side effect of testosteron therapy
Decreases height - expensive; reserved for severe cases of delayed puberty
Do HIV testing at first
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime

37. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Herpes
T for t ; thalassemia; inc serum iron and Iron binding
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

38. mcCune albright`
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Fifth disease; febrile syndrome
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

39. Tx of community acquired pneumonia
24-72 hours
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro

40. centor criteria for bact pharyngitis
<2yrs - abd pain - diarrhoea - ARF
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
After 24h of abx therapy
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)

41. cleft lip but no cleft palate
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Faciform RBC cause vascular occlusion
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

42. How to difference viral and bact pneumonia
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Central isosexual precocious puberty; hypothalmaic hamartoma
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

43. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Erb paralysis leading to diaphragmatic paralysis
Candidal diapar rash; tx clotrimazol
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
ALL - alzheimers autism adhd depression seizure

44. can women with abnormal smear or genital get vaccine
Central isosexual precocious puberty; hypothalmaic hamartoma
Yes; but it will be less effective
Diet modification to provide 110kc/kg/d
Congenital rubella syndrome

45. osler rendu weber syndrom
Facial portwine stain
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
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
Multiple telangiectesia - vasular lesion in CNS

46. spitting up - vomiting at night - weight stable
Mainly clinical; serology with initial ELISA - with western blot confirmation;
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

47. 12y - obese - hip pain - hip ext rotated
Lateral neck xray in epiglottitis show swollen epiglottis
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
Decreased UGT enzyme

48. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Candidal diapar rash; tx clotrimazol
Croup

49. down syndrome has inreased risk of developing
Erb paralysis leading to diaphragmatic paralysis
ALL - alzheimers autism adhd depression seizure
Dx US tx; correct serum electrolyte - pyloromyotom
Tx only symptomatic carrier

50. rapid acceleration of height - thelarche - adrenarche - purbarche - menarche - inc estrogen - inc gronadotrophin
T for t ; thalassemia; inc serum iron and Iron binding
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Central isosexual precocious puberty; hypothalmaic hamartoma
Faciform RBC cause vascular occlusion