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. lens dislocation
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Marfans - ehlers danlos - homocystinuria
Increase of progesteron/17oh progesterone

2. indications of audiometry in childrens
Methylephenidate toxicity; cannot be stopped abruptly; taper
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds
Oral DMSA or EDTA IV
Vaso-occlusive crisis; dx hb electrophoresis

3. How to prevent GBS in neonate
D for d; down syndrome and polyhydramnios
Penicillin G 4h before delivery
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Croup tx cool mist; racemic epi - corticosteroid

4. Tx of children constipation

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

5. horner syndrom
Injury to lower roots of brachial plexus
If aortic root reaches 45 mm
Atypical lymphocyte
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

6. duodenal atresia
No myoclonic activity in JME
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
D for d; down syndrome and polyhydramnios
No; they are basic compound will be neutralized in an acidic environment of cellulitis

7. 3yo - febrile - left hip externally rotated
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;

8. indications of VUR
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Between pregnenolone and 17oh pregnenolone
INH 9m if INH resistant rifampin 6m in children and 4m in adults
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

9. complete airway obstruction with FB
Dx US tx; correct serum electrolyte - pyloromyotom
Yes; but it will be less effective
>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
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

10. doing worse in school - lack of attention - starring speel
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Absence seizure; tx ethosuximide
Hx hearing loss - meningitis - recurrent or persisten OM >3m - IU infection - ototoxic meds

11. causes of FTT
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
No wheezing - no feever in chlamydia
Marfans - ehlers danlos - homocystinuria
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops

12. tick transmits RMSF
Congenital rubella syndrome
Black
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis

13. pavlik harness
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
To make hip flexed and abducted position in DDH
Thrombocytopeni - micorangiopathic hemolytic anemia - neurolotgical signs - RF - fever ; p/w PPPP pallor - petechia - pever - pailure tx plasmpheresis
Spores of c boutlium; colonizes in GI tract; release neurotoxin which blocks presynaptic cholinergic transmission; dysfunction of skeletal and smooth muscles

14. sickle cell with symmetrical swelling of hands and feet
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Vaso-occlusive crisis; dx hb electrophoresis
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Medical emergency; dimercaprol/edta

15. When erythema chronicum migrans develops after tick bite
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
24-72 hours
14yrs
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

16. tuberous sclerosis
>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
Increase of pregnenolone
Multiple telangiectesia - vasular lesion in CNS
Hypopigmented macule - glial proliferation - organ haramtomas/cysts

17. What is earliest sign of puberty?
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes

18. What is thumbprint sign
T for t ; thalassemia; inc serum iron and Iron binding
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
After 24h of abx therapy
Lateral neck xray in epiglottitis show swollen epiglottis

19. when bact conjunctivitis patient can go back to school
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
After 24h of abx therapy
Benign permature thelarche; expectant management
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

20. What is the most common initial symptom in sickle cell
Bartonella henselae; complication is suppuration of lymph node
RSV - rhino and influenza
Pipercillin (zosyn) - ticarcillin
Dactylitis; 2nd common is splenic seqestration

21. kallman syndrome
Multiple telangiectesia - vasular lesion in CNS
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Vaso-occlusive crisis; dx hb electrophoresis
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination

22. osler rendu weber syndrom
24h to 7d of birth
Multiple telangiectesia - vasular lesion in CNS
Diet modification to provide 110kc/kg/d
HSP - look for symmetric skin lesions

23. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Croup tx cool mist; racemic epi - corticosteroid

24. if bone age lower than actual and puberty delayed
Constitutional pubertal delay
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
2wk to 6 months p/w poor feeding - hypotonia - weakness - loss of DTR; soucee raw honey and soil - canned food
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products

25. 3yo - never able to walk
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Female - breech delivery - family history; tx referral to ortho
Multiple telangiectesia - vasular lesion in CNS
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

26. spitting up - vomiting at night - weight stable
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
INH 9m if INH resistant rifampin 6m in children and 4m in adults
Foreign body sensation - photophobia - corneal opacity tx abx
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery

27. How long patient needs to be exposed to tick to get infected
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
36 hours
Increase of progesteron/17oh progesterone

28. Tx of botulism
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
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)
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

29. thumb sign
Evaluate other developmental delay (microcephaly - lead poisoing) screen for eye prob and audiometry
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
1.5%

30. viruses cause bronhioltitis
Herpes
No wheezing - no feever in chlamydia
RSV - rhino and influenza
No myoclonic activity in JME

31. When to do surgery for undescended testes
Methylephenidate toxicity; cannot be stopped abruptly; taper
Biliary atresia; tx surgery
Wait until 6 months
Develops in 21 dasy

32. giardiasis
Benign permature thelarche; expectant management
Injury to b/l glossopharyngeal. present in botulism
Tx only symptomatic carrier
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes

33. Parents can _____ vaccine
refuse
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
R/o serious disorder; Hirschprug's disease; CF - hypothyroidism; then tx MgOH
Multiple telangiectesia - vasular lesion in CNS

34. How to differentiate croup vs epiglotitis
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Yes; but it will be less effective
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y

35. Infant with serum billlirubin >25
Risk of neurological dysfunction
Marfans - ehlers danlos - homocystinuria
Central isosexual precocious puberty; hypothalmaic hamartoma
12 month; inh - rifampin - pyrizinamide for 2m and inh and rifampin for 12m; may be continued to 18-24m based on response

36. Tx of FTT
Diet modification to provide 110kc/kg/d
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Female - breech delivery - family history; tx referral to ortho
Risk of neurological dysfunction

37. pneumonia in CF patient
Risk of neurological dysfunction
After 6m; breast mild provides iron until 6m.
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

38. coin in child's stomach
<2yrs - abd pain - diarrhoea - ARF
Swimmer's ear; due to decrease canal acidity and bacterial overgrowth; pseudmonas
No intervention; 90% foreign bodies pass without difficulty
Central isosexual precocious puberty; hypothalmaic hamartoma

39. what conditions are not contraindicated
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
Dx US tx; correct serum electrolyte - pyloromyotom
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

40. most common complication of otitis media
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
URI
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

41. How to dx endopthalmitis
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry

42. side effect of testosteron therapy
Atopic dermatitis; strong allergic/immunologic component; incr IgE
Between pregnenolone and 17oh pregnenolone
36 hours
Decreases height - expensive; reserved for severe cases of delayed puberty

43. How to difference aplastic vs hyperhemolytic/spleenic sequetratoin crisi
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
No reticulocyte vs high reticulocyte
GERD - try thickened formula if no improvement - H2 antagonists - last resort surgery
Herpes

44. association with infantile pyloric stenosis
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

45. anorexia nervosa got feeding now dyspnoes - nocturia - leg edema; jvd distended
Refeeding syndrome; edema and heart failure; severe hypophosphatemia tx iv phosophate
Oral DMSA or EDTA IV
Less than 5th percentile
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

46. difference between diaper dermatitis and rash
Increase of progesteron/17oh progesterone
Brown
Hypopigmented macule - glial proliferation - organ haramtomas/cysts
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

47. Tx of bact conjunctivitis
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
RSV - rhino and influenza
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
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng

48. How to dx acute angle closure glaucoma
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
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Use of teratogenic agents like alcohol during pregnancy; reconstruction at 3m; rule of 10; 10ib - 10w and 10g hb

49. echymoses with low platelet <30k
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation
Do HIV testing at first

50. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Do HIV testing at first
Candidal diapar rash; tx clotrimazol
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
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis