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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. doing worse in school - lack of attention - starring speel
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No myoclonic activity in JME
After 6m; breast mild provides iron until 6m.
Absence seizure; tx ethosuximide
2. 17 alpha hydroxylase
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
After 24h of abx therapy
Between pregnenolone and 17oh pregnenolone
3. When erythema chronicum migrans develops after tick bite
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
24-72 hours
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
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
4. Neonatal conjugated hyperbilirubinemia
Biliary atresia; tx surgery
Develops in 21 dasy
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Injury to lower roots of brachial plexus
5. lens dislocation
Wait until 6 months
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
36 hours
Marfans - ehlers danlos - homocystinuria
6. cleft lip but no cleft palate
Absence seizure; tx ethosuximide
Pipercillin (zosyn) - ticarcillin
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb
<2yrs - abd pain - diarrhoea - ARF
7. side effect of testosteron therapy
Do HIV testing at first
Croup tx cool mist; racemic epi - corticosteroid
Decreases height - expensive; reserved for severe cases of delayed puberty
Rapid detection of RSV antigen in nasl
8. differentiate between central and peripheral precocious puberty
No intervention; 90% foreign bodies pass without difficulty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Constitutional pubertal delay
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
9. acute abd pain - hx URI - lower extremity maculo papular rash
HSP - look for symmetric skin lesions
Decreased UGT enzyme
To make hip flexed and abducted position in DDH
Methylephenidate toxicity; cannot be stopped abruptly; taper
10. What is thumbprint sign
Lateral neck xray in epiglottitis show swollen epiglottis
ALL - alzheimers autism adhd depression seizure
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Between pregnenolone and 17oh pregnenolone
11. lead 44-70
Oral DMSA or EDTA IV
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
12. cat scratch disease
Pneurmocystis; TMP-SMZ IV doc. if intolerant pentamidine or atovaquone
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Bartonella henselae; complication is suppuration of lymph node
13. child with triad of abd pain - mucoid curant jelly stools - and palpable mass in abd
If aortic root reaches 45 mm
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
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
14. non immune pregnant women exposed to rubella in first trimester
Benign permature thelarche; expectant management
Epiglotitis by H influenze; inflammartory edema of the epiglottis that impinges airway--resp arrest; dx clinical; tx relieve obstruction - intubate
Risk of neurological dysfunction
Congenital rubella syndrome
15. How long anti-TB drugs given for TB meningitis?
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response
Diet modification to provide 110kc/kg/d
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
16. carditis and arthritis after rheumatic fever
Oral DMSA or EDTA IV
36 hours
Develops in 21 dasy
Increase of progesteron/17oh progesterone
17. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Bladder dysfunction; UTI and renal dysfunctoin
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)
If aortic root reaches 45 mm
18. pneumonia in CF patient
<2yrs - abd pain - diarrhoea - ARF
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
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
19. osler rendu weber syndrom
Multiple telangiectesia - vasular lesion in CNS
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
110 kcl/kg/day
Bartonella henselae; complication is suppuration of lymph node
20. sublottic narrowing
Imaging study to r/o VUR
Croup tx cool mist; racemic epi - corticosteroid
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton
21. IM
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Bladder dysfunction; UTI and renal dysfunctoin
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
Atypical lymphocyte
22. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
URI
Benign permature thelarche; expectant management
No reticulocyte vs high reticulocyte
Biliary atresia; tx surgery
23. When to give hpv vaccien
Constitutional pubertal delay
Penicillin G 4h before delivery
Rapid detection of RSV antigen in nasl
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
24. Febrile seizure
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
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
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
25. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Neurofibromatosis type2
Vaso-occlusive crisis; dx hb electrophoresis
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
26. What is the calorie requirement of newborn?
110 kcl/kg/day
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Risk of neurological dysfunction
RSV - rhino and influenza
27. dx of lyme
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Pho for forward bending; forward defect; common finding has no adverse physical effect
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
28. Infant with serum billlirubin >25
Mainly clinical; serology with initial ELISA - with western blot confirmation;
Decreases height - expensive; reserved for severe cases of delayed puberty
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
Risk of neurological dysfunction
29. spitting up - vomiting at night - weight stable
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
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
Meconeum ileus; think about CF
Injury to b/l glossopharyngeal. present in botulism
30. How to difference viral and bact pneumonia
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
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Neonatal chlamydia; time after birth important. develops 3-10 week after delivery
31. failure to thrive
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Rapid detection of RSV antigen in nasl
Less than 5th percentile
Pho for forward bending; forward defect; common finding has no adverse physical effect
32. When to do aortic root surgery in marfans to prevent dissection?
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
If aortic root reaches 45 mm
33. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Croup
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles
Croup tx cool mist; racemic epi - corticosteroid
34. infant botulism
Risk of neurological dysfunction
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Erb paralysis leading to diaphragmatic paralysis
HSP - look for symmetric skin lesions
35. physiological jaundice
24h to 7d of birth
24-72 hours
Dactylitis; 2nd common is splenic seqestration
No myoclonic activity in JME
36. Tx of FTT
Yes; but it will be less effective
36 hours
Diet modification to provide 110kc/kg/d
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
37. sturge weber syndrome
Female - breech delivery - family history; tx referral to ortho
Facial portwine stain
refuse
Risk of neurological dysfunction
38. Nocturnal enuresis
Increase of pregnenolone
Prolactinoma
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
URI
39. Neonatal unconjugated hyperbilirubine
ALL - alzheimers autism adhd depression seizure
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Decreased UGT enzyme
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
40. aplasic crisis
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
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
41. lead >70
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Foreign body sensation - photophobia - corneal opacity tx abx
ALL - alzheimers autism adhd depression seizure
Medical emergency; dimercaprol/edta
42. How to differentiate caput succedanueum and cephalohematoma
Reduction of the severity of symptoms; prevention of rheumatic fever and suppurative complications
D for d; down syndrome and polyhydramnios
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
43. down syndrome has inreased risk of developing
24h to 7d of birth
ALL - alzheimers autism adhd depression seizure
Strep pneumonie; moraxella; h influenze
Black
44. most common complication of otitis media
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Wait until 6 months
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
45. What is earliest sign of puberty?
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
46. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Constitutional pubertal delay
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
47. language delay
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
48. How to dx acute angle closure glaucoma
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Biliary atresia; tx surgery
36 hours
Bugs; strep pneumonia - mycoplasma; give ceftriaxone and azithro
49. How to prevent GBS in neonate
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Penicillin G 4h before delivery
Brown
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
50. microcytic - hypochromic anemia - hepatospelnomegaly
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
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Thalassemia - congenital hemolytic anemia
URI