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Test your basic knowledge |
USMLE Step3 Pediatrics
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Study First
Subjects
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health-sciences
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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. cleft lip but no cleft palate
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Multiple telangiectesia - vasular lesion in CNS
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
2. complication of lumbosacral meningocele
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Bladder dysfunction; UTI and renal dysfunctoin
Lateral neck xray in epiglottitis show swollen epiglottis
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
3. How to dx post uretheral valve
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
HSP - look for symmetric skin lesions
If aortic root reaches 45 mm
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
4. major depression
After 6m; breast mild provides iron until 6m.
Prolactinoma
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Dactylitis; 2nd common is splenic seqestration
5. giardiasis
ALL - alzheimers autism adhd depression seizure
Diet modification to provide 110kc/kg/d
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
6. can women with abnormal smear or genital get vaccine
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
Yes; but it will be less effective
36 hours
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
7. indications of audiometry in childrens
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
ALL - alzheimers autism adhd depression seizure
Wait until 6 months
8. causes of acute anemia
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Yes; but it will be less effective
9. 3yo - febrile - left hip externally rotated
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
RSV - rhino and influenza
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
10. difference between rubeola (measles) and rulbella
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Pho for forward bending; forward defect; common finding has no adverse physical effect
Herpes
Meconeum ileus; think about CF
11. complete airway obstruction with FB
Multiple telangiectesia - vasular lesion in CNS
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
>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
12. When to do surgery for undescended testes
Wait until 6 months
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Candidal diapar rash; tx clotrimazol
Dx US tx; correct serum electrolyte - pyloromyotom
13. hypopigmented spots - family hx bilat deafness
Neurofibromatosis type2
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Tx only symptomatic carrier
14. How to difference RSV and neonatal chlamydia
Female - breech delivery - family history; tx referral to ortho
Develops in 21 dasy
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
No wheezing - no feever in chlamydia
15. How to evaluate well appearing child just born in GBS pos mother?
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
<2yrs - abd pain - diarrhoea - ARF
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Tx only symptomatic carrier
16. acute abd pain - hx URI - lower extremity maculo papular rash
Pho for forward bending; forward defect; common finding has no adverse physical effect
Decreases height - expensive; reserved for severe cases of delayed puberty
Constitutional pubertal delay
HSP - look for symmetric skin lesions
17. congenital adrenal hyperplasi
No intervention; 90% foreign bodies pass without difficulty
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Strep pneumonie; moraxella; h influenze
Endocardial cushion defect (no separation between heart chambers)
18. irritable - aggressive - nervous - unable to sleep - dilaed pupil - mouth dry - on methylephenidate
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
Methylephenidate toxicity; cannot be stopped abruptly; taper
TB - breastfeeding - asymptomatic hiv
HSP - look for symmetric skin lesions
19. starring spells 10-20sec
After 24h of abx therapy
No myoclonic activity in JME
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Medical emergency; dimercaprol/edta
20. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Pipercillin (zosyn) - ticarcillin
Yes; but it will be less effective
Croup
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
21. carditis and arthritis after rheumatic fever
Wait until 6 months
No reticulocyte vs high reticulocyte
Develops in 21 dasy
Bladder dysfunction; UTI and renal dysfunctoin
22. crying during urination. bacteriuria pyruria - rec episodes
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)
110 kcl/kg/day
Imaging study to r/o VUR
Do HIV testing at first
23. non immune pregnant women exposed to rubella in first trimester
Yes; but it will be less effective
Female - breech delivery - family history; tx referral to ortho
Increase of progesteron/17oh progesterone
Congenital rubella syndrome
24. kallman syndrome
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
TB - breastfeeding - asymptomatic hiv
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
25. language delay
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Bladder dysfunction; UTI and renal dysfunctoin
26. HUS
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Imaging study to r/o VUR
Croup tx cool mist; racemic epi - corticosteroid
<2yrs - abd pain - diarrhoea - ARF
27. lead 44-70
Penicillin G 4h before delivery
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Oral DMSA or EDTA IV
24h to 7d of birth
28. horner syndrom
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Foreign body sensation - photophobia - corneal opacity tx abx
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Injury to lower roots of brachial plexus
29. language expectation from 2yo
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Erb's palsy; upper roots of brachial plexus injury (c5 -c6 - c7; complication diaphragmatic paralysis; 80% recovery
Mainly clinical; serology with initial ELISA - with western blot confirmation;
30. benefits of antibiotic therapy in acute pharyngitis?
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
Croup tx cool mist; racemic epi - corticosteroid
Decreases height - expensive; reserved for severe cases of delayed puberty
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
31. sickle cell with symmetrical swelling of hands and feet
Black
Foreign body sensation - photophobia - corneal opacity tx abx
Vaso-occlusive crisis; dx hb electrophoresis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
32. How to dx keratitis?
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Multiple telangiectesia - vasular lesion in CNS
110 kcl/kg/day
Foreign body sensation - photophobia - corneal opacity tx abx
33. Infant with serum billlirubin >25
Increase of progesteron/17oh progesterone
Risk of neurological dysfunction
Erb paralysis leading to diaphragmatic paralysis
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
34. difference between absence seizure and juvenyle myoclonic epilepsy (JME)
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
Herpes
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
No myoclonic activity in JME
35. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Pipercillin (zosyn) - ticarcillin
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Meconeum ileus; think about CF
36. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Cholesterol--pregnenolore---->17 Oh pregnenolone--->dehydroepiandosterone - pregnenolone--->progesterone--->dexoycorticosterone->corticosterone--->aldosterone -17 oh pregnenolone--->17 0Hprotesteronee--->cortisol - dehydroepiandosterone--->androstene
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Central isosexual precocious puberty; hypothalmaic hamartoma
37. aplasic crisis
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Less than 5th percentile
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
38. infant botulism
Central isosexual precocious puberty; hypothalmaic hamartoma
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
39. Tx of FTT
After 24h of abx therapy
Imaging study to r/o VUR
36 hours
Diet modification to provide 110kc/kg/d
40. dx for DDH
36 hours
No wheezing - no feever in chlamydia
Female - breech delivery - family history; tx referral to ortho
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;
41. red oozing rash on cheek - scaly - dry
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
Tx only symptomatic carrier
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
42. low grade fever - cough - diffuse bilat ground glass opacities
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Bladder dysfunction; UTI and renal dysfunctoin
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
43. patient with white plaques in mouth and lump in back
Bartonella henselae; complication is suppuration of lymph node
Do HIV testing at first
Increase of progesteron/17oh progesterone
Faciform RBC cause vascular occlusion
44. When to do aortic root surgery in marfans to prevent dissection?
If aortic root reaches 45 mm
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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
45. adrenal tumor
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Lateral neck xray in epiglottitis show swollen epiglottis
No wheezing - no feever in chlamydia
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
46. How to prevent GBS in neonate
Injury to lower roots of brachial plexus
Penicillin G 4h before delivery
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
47. lead >70
Medical emergency; dimercaprol/edta
Pho for forward bending; forward defect; common finding has no adverse physical effect
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
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
48. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
Central isosexual precocious puberty; hypothalmaic hamartoma
49. What is the definition of delayed puberty?
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
URI
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
50. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
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
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
Benign permature thelarche; expectant management