Step 2 Ck Pediatrics

Front 1

What are the Left-to-right shunts?

Back 1

the 3 D’s:
VSD
ASD
PDA

Front 2

VSD: PE and management

Back 2

pansystolic murmur at the lower left sternal border a loud pulmonic S2
>> do an echo

Front 3

Tx VSD

Back 3

>>Most small VSDs close spontaneously
>> large VSD early surgical
repair
>>Treat existing CHF with diuretics, inotropes, and ACEIs
>>Endocarditis and septic emboli prophylaxis (e.g., amoxicillin) before dental
or pulmonary procedures

Front 4

how to diagnose ASD

Back 4

>>Echocardiogram with color flow Doppler
>>ECG shows right-axis deviation
>>CXR reveals cardiomegaly and ↑ pulmonary vascular markings.

Front 5

treatment of ASD

Back 5

>>Small defects may close spontaneously and do not require treatment
>>Antibiotic prophylaxis before dental procedures
>>Surgical closure in infants with CHF and patients with > 2:1 ratio of pulmonary-
to-systemic blood flow.

Front 6

PDA tx

Back 6

>>Give indomethacin unless the PDA is needed for survival
>>If indomethacin fails or if the child is > 6–8 months of age, surgical closure
is preferred.

Front 7

tx for coarctationof aorta

Back 7

TREATMENT
■ Surgical correction or balloon angioplasty (controversial).
■ Continue endocarditis prophylaxis even after treatment.

Front 8

transposition of great vessels
Hx/PE
x-ray

Back 8

Hx/PE: Critical illness and cyanosis typically occur immediately after birth
>>(“egg-shaped silhouette”).

Front 9

tx: transposition of great vessels

Back 9

■ If present, keep the PDA open with prostaglandin E1 (PGE1).
■ Balloon atrial septostomy if immediate surgery is not feasible.
■ Surgical correction (arterial or atrial switch).

Front 10

what are the Right-to-left shunt?

Back 10

the 5 T’s:
Tetralogy
Transposition
Truncus arteriosus
Tricuspid atresia
Total anomalous
pulmonary venous
return

Front 11

Tetralogy of Fallot: what are the defects?

Back 11

PROVe
Pulmonary stenosis
RVH
Overriding aorta
VSD

Front 12

Tetralogy of Fallot: diagnosis

Back 12

>>Echocardiography and catheterization.
>>CXR shows a “boot-shaped” heart with ↓ pulmonary vascular markings.
>>ECG shows right-axis deviation and RVH.

Front 13

treatment of tetralogy of fallot:

Back 13

TREATMENT
■ Administer PGE1 to keep the PDA open.
>>Treat cyanotic spells with O2, propranolol, knee-chest position, fluids, and
morphine

Front 14

Contraindications of vaccination

Back 14

■ Current moderate to severe illness (with or without fever).
■ Severe allergy to a vaccine component or a prior dose of vaccine.
■ Encephalopathy within seven days of prior pertussis vac.
■ Anaphylactic egg allergy for influenza vaccine (do prior skin testing).
■ Recent administration of antibody-containing blood products (for live injected vac).
■ Avoid live vaccines (oral polio vaccine, varicella, MMR) in immunocompromised
and pregnant patients (exception: HIV patients without immunocompromise may receive MMR and varicella).

Front 15

give 3 example of not a contraindication

Back 15

>>Mild illness and/or low-grade fever.
>>Current antibiotic therapy.
>>Prematurity

Front 16

when is HBV vaccine given?

Back 16

birth, 2 mo and 6 mo

Front 17

when is DTap vaccine given?

Back 17

2, 4, 6, 1-18 mo and 4-6 y/o

Front 18

when is PPV and HiB vaccine given?

Back 18

2,4,6, 12-15mo

Front 19

when is IPV vaccine given?

Back 19

2,4,6, 4-6 y/o

Front 20

when is MMR given?

Back 20

12-15mo, 4-6 y/o

Front 21

when is varicella given?

Back 21

12-15 months

Front 22

when is HAV given?

Back 22

2 years old

Front 23

management of a child with severe neglect and malnourishment

Back 23

Hospitalize if there is evidence of neglect or severe malnourishment.

Front 24

treatment for CF

Back 24

Pulmonary manifestations are managed with chest physical therapy,
bronchodilators, anti-inflammatory agents, antibiotics, and DNase.
■ Administer pancreatic enzymes and fat-soluble vitamins A, D, E, and K
for malabsorption

Front 25

how is CF diagnosed

Back 25

Sweat chloride test > 60 mEq/L for those < 20 years of age and > 80 mEq/L in adults; genetic testing.

Front 26

DiGeorge syndrome: describe

Back 26

CATCH-22
Congenital heart disease
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia
22q deletion

Front 27

how will you know if a child has an B cell immunodeficiency?

Back 27

present after six
months of age with recurrent sinopulmonary, GI, and urinary tract infections with encapsulated organisms (

Front 28

Tx for x-linked agammaglobulenemia

Back 28

Quantitative immunoglobulin
levels; treat with prophylactic
antibiotics and IVIG.

Front 29

tx. for common variable immunodeficiency

Back 29

Quantitative immunoglobulin
levels; and treat with IVIG

Front 30

tx. IgA deficiency

Back 30

treat infection. quantitative IgA levels

Front 31

treatment for di-george syndrome

Back 31

Absolute lymphocyte count;
and mitogen stimulation
response; delayed
hypersensitivity skin testing.
Treat with bone marrow
transplantation and IVIG for
antibody deficiency; PCP
prophylaxis.
Alternative—thymus transplant

Front 32

Ataxia-telangiectasia

Back 32

no treatment

Front 33

SCID tx

Back 33

bone marrow transplant, stem cell transplant and IVIG for antibody deficiency

Front 34

tx for wiskott aldrich syndrome

Back 34

IVIG and antibiotic. patients rarely survive adulthood

Front 35

which of the immunodefieciencies need prophylaxis

Back 35

SCID needs PCP prophylaxis

Front 36

Dx: CGD

Back 36

>>Nitroblue tetrazolium test is diagnostic for chronic
granulomatous disease.
>>Treat with daily TMP-SMX

Front 37

Chédiak-Higashi

Back 37

Bone marrow transplant is the
treatment of choice

Front 38

complement C1 esterase deficiency test.

Back 38

>>total hemolytic complement (CH50)
>>treat with prophylactic danazol
>>Purified C1 esterase
and FFP can be used prior to
and provoked by surgery.

Front 39

terminal complement deficiency (C5-C9)

Back 39

meningococal vaccine and appropriate antibiotics

Front 40

t-cell deficiencies: how does it manifest

Back 40

Tend to present earlier (1–3 months) with opportunistic
and low-grade fungal, viral, and intracellular bacterial infections
(e.g., mycobacteria). 2° B-cell dysfunction may also be seen.

Front 41

Phagocyte deficiencies presentation

Back 41

Characterized by mucous membrane infections,
abscesses, and poor wound healing. Catalase-
(e.g., S. aureus) and gram- enteric organisms are common. Delayed umbilical cord separation may be an early sign.

Front 42

Complement deficiencies presentation

Back 42

Characterized by recurrent bacterial infections with encapsulated organisms

Front 43

what are the 2 phases of kawasaki disease?

Back 43

Subacute-phase manifestations
Acute-phase manifestations

Front 44

Acute-phase manifestations kawasaki disease

Back 44

are as follows (fever plus ≥ 4 of the criteria are required for diagnosis): mneumonic CRASH

Front 45

Subacute-phase kawasaki disease

Back 45

manifestations are thrombocytosis and ↑ ESR.

Front 46

treatment for kawasaki

Back 46

High-dose aspirin (for inflammation and fever) and IVIG (to prevent
aneurysms).
■ Corticosteroids may ↑ aneurysm formation and are currently contraindicated.

Front 47

complication of kawasaki

Back 47

coronary aneurysm

Front 48

what is bronchiolitis?

Back 48

acute inflammatory illness of the small airways that primarily affects infants and children < 2 years of age. RSV is the most common cause

Front 49

bronchiolitis history and PE

Back 49

Low-grade fever, rhinorrhea, cough, apnea (in young infants).
■ Examination reveals tachypnea, wheezing, crackles, prolonged expiration,
and hyperresonance to percussion

Front 50

bronchiolitis mild tx

Back 50

Treat mild disease with outpatient management using fluids, nebulizers,and O2 if needed

Front 51

when should a patient be hospitalized for bronchiolitis?

Back 51

respiratory distress, O2 saturation of < 92%, toxic appearance, dehydration/poor oral feeding, a history of prematurity(< 34 weeks), age < 3 months, underlying cardiopulmonary disease,
or unreliable parents.
>>Treat inpatients with contact isolation, hydration, and O2

Front 52

when is RSV prophylaxis given?

Back 52

RSV prophylaxis with injectable poly- or monoclonal antibodies (RespiGam or Synagis) is recommended in winter for high-risk patients

Front 53

treatment for croup: mild, moderate and severe cases

Back 53

■ Mild cases: Outpatient management with cool mist therapy and fluids.
■ Moderate cases: May require oral corticosteroids.
■ Severe cases (e.g., respiratory distress at rest, inspiratory stridor): Hospitalize
and give nebulized racemic epinephrine

Front 54

treatment for epiglotitis

Back 54

■ This disease is a true emergency. Keep the patient (and parents) calm, call
anesthesia, and transfer the patient to the OR.
■ Treat with endotracheal intubation or tracheostomy and IV antibiotics
(ceftriaxone or cefuroxime

Front 55

APGAR what is the management for each?
Scores of 8–10
Scores of 4–7
Scores of 0–3

Back 55

Scores of 8–10 typically reflect good cardiopulmonary adaptation.
■ Scores of 4–7 indicate the possible need for resuscitation. Infants should
be observed, stimulated, and possibly given ventilatory support.
■ Scores of 0–3 indicate the need for immediate resuscitation.

Front 56

Treatment for omphalocele

Back 56

C-section can prevent sac rupture; if sac is intact, postpone surgical correction until the
patient is fully resuscitated. Keep the sac covered/stable with petroleum and gauze. Intermittent NG
suction to prevent abdominal distention

Front 57

treatment for gastroschisis

Back 57

Treatment: A surgical emergency! Single-stage closure is possible in only 10% of cases.

Front 58

treatment for congenital diaphragmatic hernia

Back 58

Treatment: High-frequency ventilation or extracorporeal membrane oxygenation to manage pulmonary
hypertension; surgical repair

Front 59

RDS presentation

Back 59

first 48–72 hours of life with a respiratory rate > 60/min, progressive
hypoxemia, cyanosis, nasal flaring, intercostal retractions, and expiratory
grunting.

Front 60

what are some of the causes of RDS

Back 60

>>RDS:
>>Transient tachypnea of the newborn:
>>Meconium aspiration:
>>Congenital pneumonia:

Front 61

>>RDS: presentation

Back 61

Bilateral diffuse atelectasis → a “ground-glass” appearance and air bronchograms.

Front 62

>>Transient tachypnea of the newborn: presentation

Back 62

Retained amniotic fluid → prominent perihilar streaking in interlobular fissures.

Front 63

>>Meconium aspiration: presentation

Back 63

Coarse, irregular infiltrates; hyperexpansion and pneumothoraces.

Front 64

>>Congenital pneumonia: presentation

Back 64

Nonspecific patchy infiltrates; neutropenia, tracheal
aspirate, and Gram stain suggest the diagnosis

Front 65

treatment for RDS

Back 65

>>Continuous positive airway pressure (CPAP) or intubation and mechanical ventilation.
>>Artificial surfactant administration ↓ mortality.
>>Pretreat mothers at risk for preterm delivery with corticosteroids; monitor
fetal lung maturity via lecithin-sphingomyelin ratio and phosphatidylglycerol.

Front 66

complications of RDS

Back 66

Persistent PDA and bronchopulmonary dysplasia

Front 67

what are the types of cerebral palsy and subtypes

Back 67

Pyramidal (spastic):
Extrapyramidal (nonspastic):
>>>ataxic
>>>dystonic

Front 68

cerebral palsy presentation

Back 68

>>seizure disorder,learning disabilities, and speech deficits.
>>Affected limbs may show hyperreflexia, ↑ tone/contractures,

Front 69

when do we do an LP for febrile seizures

Back 69

LP is indicated if there are clinical
signs of CNS infection

Front 70

treatment for febrile seizures

Back 70

Use antipyretic therapy

Front 71

which of the febrile seizure has increase risk of epilepsy?

Back 71

simple seizures, there is no
↑ risk of epilepsy or developmental, intellectual, or growth abnormalities. Patients
with complex seizures have a 10% risk of developing epilepsy

Front 72

what is a Simple febrile seizure:

Back 72

A short-duration (< 15 minutes), generalized seizure with one seizure in a 24-hour period. High fever (> 39°C) and fever onset within
hours of the seizure are typical.

Front 73

what is a Complex febrile seizure?

Back 73

A long-duration (> 15 minutes), focal seizure with > 1 seizure in a 24-hour period. Low-grade fever for several days before
seizure onset may be present.

Front 74

what are the Top childhood
cancers:

Back 74

1. Leukemia (ALL)
2. CNS tumors
3. Lymphoma
4. Neuroblastoma

Front 75

diagnosis of wilm's tumor

Back 75

Abdominal CT or ultrasound shows a solid intrarenal mass

Front 76

wilm's tumor tx

Back 76

Transabdominal nephrectomy and postsurgical chemotherapy