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 to differentiate caput succedanueum and cephalohematoma
Rash distribution same; measles-3C - cough - conjunctivitis - coryza; koplik spot; rubell; LG fever. lymphadenopahty - tx; self limiting
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
No intervention; 90% foreign bodies pass without difficulty

2. association with infantile pyloric stenosis
RSV - rhino and influenza
Nocturnal increase of LH; then daytime increase of gonadotrophin/testosteron; physical exam enlargement of testes
refuse
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child

3. 4d old infant with dilated loop of bowel;; constipaion; ground glass mass abdomen
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
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
24-72 hours
Meconeum ileus; think about CF

4. How to dx endopthalmitis
Smoking alters mucosa - cilia - adenoid structure - make children susceptible to infection
Atypical lymphocyte
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

5. How long patient needs to be exposed to tick to get infected
36 hours
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Dactylitis; 2nd common is splenic seqestration
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -

6. thumb sign
Epiglotitis; staph - HiB tx: ceftriaxone/cefotaxime
Neurofibromatosis type2
1.5%
Medical emergency; dimercaprol/edta

7. splenic infarction in sickle cell
Diet modification to provide 110kc/kg/d
Absence seizure; tx ethosuximide
Faciform RBC cause vascular occlusion
Fifth disease; febrile syndrome

8. sublottic narrowing
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI
No; they are basic compound will be neutralized in an acidic environment of cellulitis
Croup tx cool mist; racemic epi - corticosteroid
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness

9. target cell
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Strep pneumonie; moraxella; h influenze
T for t ; thalassemia; inc serum iron and Iron binding
Increase of pregnenolone

10. difference between structural disorder and flexible kyphosis
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
refuse
TB - breastfeeding - asymptomatic hiv
No intervention; 90% foreign bodies pass without difficulty

11. What is the definition of delayed puberty?
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Benign permature thelarche; expectant management
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Absence of puberty sign by 14yrs; testicle <2.5cm dm;

12. doing worse in school - lack of attention - starring speel
Less than 5th percentile
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy
Absence seizure; tx ethosuximide
Infection in aqueus and vitreous humors; posttraumatic - postcataract surgery;

13. How to differentiate croup vs epiglotitis
Medical emergency; dimercaprol/edta
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Candidal diapar rash; tx clotrimazol

14. Tx of FTT
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Croup tx cool mist; racemic epi - corticosteroid
Diet modification to provide 110kc/kg/d
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis

15. complication of lumbosacral meningocele
Bladder dysfunction; UTI and renal dysfunctoin
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

16. how thalassemia die
Iron overload from excessive transfusion and ineffective hematopoisis; many raw material but no products
Decresed visio - sudden onset - seeing halos around light - headache - eye pain
Bladder dysfunction; UTI and renal dysfunctoin
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

17. How to evaluate well appearing child just born in GBS pos mother?
Injury to lower roots of brachial plexus
Observe for 48h; look for bacerimia - sepsis - meningitis - ventrculitis
Faciform RBC cause vascular occlusion
Fluoroqunoloes to kill pseudmonas which is a common pathogen in these patients

18. differentiate between central and peripheral precocious puberty
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Anosmia and hypogonadotropic hypogonadism; genetic defect; defective migration of GnRH secreting and olfactory neurons to their final destination
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance

19. sturge weber syndrome
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Anaphylaxis or encephalopathy within 7d of administration; temporary contraindications moderate to severe illness
Diet modification to provide 110kc/kg/d
Facial portwine stain

20. microcytic - hypochromic anemia - hepatospelnomegaly
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts
Erb paralysis leading to diaphragmatic paralysis
Thalassemia - congenital hemolytic anemia

21. major depression
Intussuseption; dx Us: tx enema comlication; perforation <1% if patient <6m and symptoms presented 3d; have SBO
At least 5 of 9 symptoms: DIGFAST depressed mood - insomnia - guilt - f - anhedonia - suicidal ideation -
Strep pneumonie; moraxella; h influenze
1.5%

22. Parvovirus
Develops in 21 dasy
Fifth disease; febrile syndrome
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

23. deficinecy of 17 hydroxylase
Erythromycin ointment - sulfa drops - polymyxin /trimethoprim drops
Increase of pregnenolone
Croup
Fifth disease; febrile syndrome

24. How to dx RSV
Between pregnenolone and 17oh pregnenolone
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Rapid detection of RSV antigen in nasl

25. decreased mobility of tympanic membrane after otitis media
Croup; hx coughx2-3d - gradual onset; high fever; barking cough; <3y; epiglotitis; sudden onset; stridor; >3y
Feeding prob; milk protein intolerance; errors in metabolism; infection; CF GERD; RTA
Biliary atresia; tx surgery
Middle ear effusion persists 3 m after OM; if no symptoms - just watch - if symptoms add another abx. if no improvement tympanocenesis/myringotomy

26. adrenal tumor
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
9-18yrs; 1300 mg; 19-50;l 1000mg; >50 1200mng
Heterosexual precocious puberty in females; inc androgen and cortisol - virilization in females - cushing (incr cortisol)
Cafe au lait spot - fibrous dysplasia of bone; excessive production of estrogen from ovarian cysts

27. poor feeding - rhinorrhoea - no fever - hyperinflation - eosinophilia - 2m
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
Between progesteron/170h progestreon adn dexoxycorticosteron/17OH corticosterone
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
Coarcation - bicuspic aortic valve - mitral prolapse - hypoplastic heart

28. contraindications of MMR vaccine
1.5%
Female - breech delivery - family history; tx referral to ortho
Current moderate of severe fever; anaphylaxis to gelatin/neomycin; immunodeficiency(hiv - chemo); thrombocytopenia; recent administration of immunoglobulin (can diminish efficacy); preganancy
Increase of progesteron/17oh progesterone

29. difference between breast milk and breafeeding jaundice
RSV - rhino and influenza
Endocardial cushion defect (no separation between heart chambers)
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
14yrs

30. 3yo - never able to walk
Injury to lower roots of brachial plexus
Tonsilar exudate - tender cervical nodes - fever - no cough/nasal dischr (suggest viral inf)
Bacterial: sudden onset - high fever - cxr consolidation. viral; gradual onset - diffuse bilat infhiltrate tx; bact-amoxi;
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

31. failure to thrive
Less than 5th percentile
Multiple telangiectesia - vasular lesion in CNS
Splenic sequestraion crisis - aplastic crisis - hyperhemolytic crisis
To make hip flexed and abducted position in DDH

32. 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
Dx US tx; correct serum electrolyte - pyloromyotom
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Risk of neurological dysfunction

33. When to give hpv vaccien
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
Multiple telangiectesia - vasular lesion in CNS
Injury to lower roots of brachial plexus
Benign permature thelarche; expectant management

34. 18mo bilat breast enlargment - some pubic hair
Benign permature thelarche; expectant management
Erythromycin (used for pertusis prophylaxis) or macrolides in breastfeeding child
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Tx with antipseudomnal abx; ticar/piper plus tobra or fourth gen cephalosporin ceftazidime - cefepime or carbapenem (imi/ mero)

35. hx shoulder dystocia - pw tahypnoea - cyanosis - weak cry; dec movement rib cage
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -
Biliary atresia; tx surgery
Erb paralysis leading to diaphragmatic paralysis
Absence seizure/epilepsy: normal EEG - no myoclonic activity; prognosis good if no generalized seiure

36. 4m severe papulovesicular rash in genitalia - buttocks - perineum - crural folds
Less than 5th percentile
Candidal diapar rash; tx clotrimazol
Males - weak stream - bladder distension - bladder wall thickening - vesicoureteral reflex; most common caUse of obstructive uropathy in children dx cystourethrogram
<5 febrile UTI. males after first UTI - females <3yrs after first UTI - UTI unreponsive to abx - recurrent UTI

37. barking cough - inspiratory stridor - hoarsenes - p/w few days after URI
Fifth disease; febrile syndrome
Another episode of otitis media; children more than 2 episodes have inc risk; other compli acute mastoiditis
Croup
INH 9m if INH resistant rifampin 6m in children and 4m in adults

38. language expectation from 2yo
Bartonella henselae; complication is suppuration of lymph node
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
50+ vocabulary; 2-3 word phrases; follow 2 step command; if delayed do audiometry
If <7 reassure parents; use alarms - desmopressin and tricyclics less effective than alarms

39. when bact conjunctivitis patient can go back to school
Benign permature thelarche; expectant management
After 24h of abx therapy
Angulation in forward bending think about structural problem; will not be corrected on its own; tx milwakee brace
SCFE - stable-if patient can bear weight; unstable-if cannot ambulate; complications avascular necrosis; dx xray tx immediate int fixaton

40. hypopigmented spots - family hx bilat deafness
To make hip flexed and abducted position in DDH
Hospital admission - NG feeding - purgative botulinum antitoxin - no abx (they cause lysis of spores--release more toxin) -
Dactylitis; 2nd common is splenic seqestration
Neurofibromatosis type2

41. the risk of lyme after bitten by a tick
1.5%
Congenital rubella syndrome
HSP - look for symmetric skin lesions
Biliary atresia; tx surgery

42. acute otitis media-pathogen
Bartonella henselae; complication is suppuration of lymph node
Risk of neurological dysfunction
1.5%
Strep pneumonie; moraxella; h influenze

43. dx for turner
36 hours
Caput crosses suture line; caput has color (echymotic); caput clears early (within weeks versus several months in cephalo)
Definitive karyotype; echo for cardiac - tsh for hypothyroid; and renal US to eval horshoe kidney; visual and hearing assessment
Prednisone/methyleprednison; IVIG - chronic ITP-spelenctomy

44. side effect of testosteron therapy
Parvovirus B19 infection---failure of erythropoisis---no reticulocytes
Age<6 - no past h/o afebrile seizure - temp>38 - no cns infection - no metabolic disturbance
Decreases height - expensive; reserved for severe cases of delayed puberty
Viral meningitis/encephalitis caused by arbovirus children; HSV in adults

45. When to bevioral and enviromental measure in led intoxication?
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
Foreign body sensation - photophobia - corneal opacity tx abx
<44 - CBC - Electrolyte - and urinanlysis; if >44 oral chelation; >70 hospitalization and parenteral chelation

46. non immune pregnant women exposed to rubella in first trimester
ALL - alzheimers autism adhd depression seizure
Congenital rubella syndrome
Tx only symptomatic carrier
US and barlow test: attempt to dislocated unstable hip; sometimes make clunking sound;

47. infantile hypertrophic pyloric stenosis
Dx US tx; correct serum electrolyte - pyloromyotom
At first imaging test to dx bone age; if normal do testing to r/o chromosomal or endocrine abnormality
1.5%
Fifth disease; febrile syndrome

48. 3yo - febrile - left hip externally rotated
INH 9m if INH resistant rifampin 6m in children and 4m in adults
RSV - rhino and influenza
Absence of puberty sign by 14yrs; testicle <2.5cm dm;
Transient synovitis or toxic synovitis; bilateral effusion; preceded by URI -

49. What are the risk factors of developmental dysplais of hip
Absence seizure; tx ethosuximide
Female - breech delivery - family history; tx referral to ortho
No intervention; 90% foreign bodies pass without difficulty
Central-increased androgen - inc GnRH; peripheral-increased androgenq(acne - growth acceleration) dec GnRH (due to feedback)

50. How to dx keratitis?
Diet modification to provide 110kc/kg/d
Penicillin G 4h before delivery
Methylephenidate toxicity; cannot be stopped abruptly; taper
Foreign body sensation - photophobia - corneal opacity tx abx