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Test your basic knowledge |
USMLE Step3 Pediatrics
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health-sciences
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usmle-step-3
Instructions:
Answer 50 questions in 15 minutes.
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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. 12y - obese - hip pain - hip ext rotated
Penicillin G 4h before delivery
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Atypical lymphocyte
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
2. infant botulism
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
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
Yes; but it will be less effective
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
3. How to dx endopthalmitis
Candidal diapar rash; tx clotrimazol
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
24-72 hours
Bladder dysfunction; UTI and renal dysfunctoin
4. cat scratch disease
Bartonella henselae; complication is suppuration of lymph node
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Pipercillin (zosyn) - ticarcillin
5. kallman syndrome
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
6. sturge weber syndrome
Facial portwine stain
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Constitutional pubertal delay
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
7. down syndrome with holocystolic mumur
Marfans - ehlers danlos - homocystinuria
Pho for forward bending; forward defect; common finding has no adverse physical effect
Endocardial cushion defect (no separation between heart chambers)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
8. can women with abnormal smear or genital get vaccine
Yes; but it will be less effective
Injury to b/l glossopharyngeal. present in botulism
Medical emergency; dimercaprol/edta
Benign permature thelarche; expectant management
9. When erythema chronicum migrans develops after tick bite
Black
24-72 hours
Increase of progesteron/17oh progesterone
Foreign body sensation - photophobia - corneal opacity tx abx
10. centor criteria for bact pharyngitis
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
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
Croup
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
11. the recommended ca supplementation
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Vaso-occlusive crisis; dx hb electrophoresis
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
12. Parvovirus
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Fifth disease; febrile syndrome
Endocardial cushion defect (no separation between heart chambers)
Bartonella henselae; complication is suppuration of lymph node
13. thumb sign
Dx US tx; correct serum electrolyte - pyloromyotom
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Foreign body sensation - photophobia - corneal opacity tx abx
Brown
14. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
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)
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Fifth disease; febrile syndrome
15. Tx of FTT
Female - breech delivery - family history; tx referral to ortho
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Diet modification to provide 110kc/kg/d
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
16. Infant with serum billlirubin >25
Risk of neurological dysfunction
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
17. causes of FTT
24-72 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
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Injury to lower roots of brachial plexus
18. tuberous sclerosis
No reticulocyte vs high reticulocyte
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
19. pavlik harness
To make hip flexed and abducted position in DDH
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Rapid detection of RSV antigen in nasl
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
20. when bact conjunctivitis patient can go back to school
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
Decreases height - expensive; reserved for severe cases of delayed puberty
After 24h of abx therapy
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
21. mcCune albright`
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Brown
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Decreased UGT enzyme
22. infantile hypertrophic pyloric stenosis
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Oral DMSA or EDTA IV
Dx US tx; correct serum electrolyte - pyloromyotom
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
23. what conditions are not contraindicated
Black
Fifth disease; febrile syndrome
Vaso-occlusive crisis; dx hb electrophoresis
TB - breastfeeding - asymptomatic hiv
24. Tx of bact conjunctivitis
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
No; they are basic compound will be neutralized in an acidic environment of cellulitis
25. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
26. Tx of children constipation
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27. sickle cell with symmetrical swelling of hands and feet
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Injury to lower roots of brachial plexus
Vaso-occlusive crisis; dx hb electrophoresis
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
28. dx of lyme
Injury to lower roots of brachial plexus
Mainly clinical; serology with initial ELISA - with western blot confirmation;
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Between pregnenolone and 17oh pregnenolone
29. causes of acute anemia
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Vaso-occlusive crisis; dx hb electrophoresis
Biliary atresia; tx surgery
Diet modification to provide 110kc/kg/d
30. decreased mobility of tympanic membrane after otitis media
Herpes
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
31. How long anti-TB drugs given for TB meningitis?
Female - breech delivery - family history; tx referral to ortho
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Develops in 21 dasy
32. how smoking contributes otitis media in children
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
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)
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
33. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
No reticulocyte vs high reticulocyte
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
34. cyring/laughing for no reason - restless - distracted - distal hand and foot movemnets -facial grimacing
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
URI
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
35. When to give HRT in turner
14yrs
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
36. differentiate between central and peripheral precocious puberty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
36 hours
37. echymoses with low platelet <30k
Faciform RBC cause vascular occlusion
Neurofibromatosis type2
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
38. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
D for d; down syndrome and polyhydramnios
No; they are basic compound will be neutralized in an acidic environment of cellulitis
No myoclonic activity in JME
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
39. difference between rubeola (measles) and rulbella
24-72 hours
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Risk of neurological dysfunction
refuse
40. coin in child's stomach
Less than 5th percentile
refuse
Atopic dermatitis; strong allergic/immunologic component; incr IgE
No intervention; 90% foreign bodies pass without difficulty
41. failure to thrive
Less than 5th percentile
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Atypical lymphocyte
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
42. low grade fever - cough - diffuse bilat ground glass opacities
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
43. How to prevent GBS in neonate
To make hip flexed and abducted position in DDH
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Female - breech delivery - family history; tx referral to ortho
Penicillin G 4h before delivery
44. 17 alpha hydroxylase
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Black
Do HIV testing at first
Between pregnenolone and 17oh pregnenolone
45. nuchal rigidity - fever - sore throat - headache - dioriented
Increase of progesteron/17oh progesterone
Pho for forward bending; forward defect; common finding has no adverse physical effect
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
46. 21 hydroxylase
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Faciform RBC cause vascular occlusion
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
47. lens dislocation
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Marfans - ehlers danlos - homocystinuria
24-72 hours
Pho for forward bending; forward defect; common finding has no adverse physical effect
48. Neonatal unconjugated hyperbilirubine
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
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Decreased UGT enzyme
To make hip flexed and abducted position in DDH
49. hypopigmented spots - family hx bilat deafness
Yes; but it will be less effective
Neurofibromatosis type2
1.5%
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
50. impaired gag reflex
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Injury to b/l glossopharyngeal. present in botulism
Decr calorie intake; decr calorie absorption;incr calorie demand
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Sorry!:) No result found.
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