Usmle Step 2 Pediatrics

Front 1

polycythemia of the Newborn

Back 1

Hypoxia during labor -> Epo
(first breath will inc. pO2 to stop Epo)

Front 2

Transient Tachypnea of the Newborn:

Back 2

C/S babies, precipitous delivery

SOB in first 3-4 hrs

due to excess fluid in lungs

Front 3

Neonate is SOB >4 hrs

what should be considered?

Back 3

Septic, until proven otherwise

Front 4

what does physiologic jaundice lead to?

how does the body compensate?

Back 4

Leads to physiologic anemia at 2mo: Hb=6mg/ dL

=> Epo turns back on at 6mo: HbF=>HbA

Front 5

if a baby has a yellow sclera. approx the bilirubin?

Back 5

>2mg/dl

Front 6

treatment for hyperbilirubinemia?

20 mg/dl?
>25 mg/dl?

Back 6

• Phototherapy (20mg/dl): 270nm; toxic to retina

• Exchange transfusion

Front 7

NEC

presentation
management
tx

Back 7

air in bowel wall

=> stop feedings, NG tube, TPN

tx for anaerobes

Front 8

What do I do? The Baby's here!

Back 8

>>Suction nose/mouth BEFORE deliver 2nd shoulder
>>Place under a warmer
>>Vitamin K
>>silver nitrate and erythromycin in eyes
>> encourage breast feeding right away

Front 9

why do we have to suction the mouth and nose BEFORE delivery of the 2nd shoulder?

Back 9

To avoid meconium aspiration

Front 10

what is the significance of putting the baby in the warmer right away after being delivered?

Back 10

cold => shivering => burns sugar => hypoglycemia

Front 11

what are silver nitrate and erythromycin eye drops for?

when do we use oral erythromycin?

Back 11

>>Silver nitrate to prevent Gonococcal conjunctivitis (opthalmia neonatorum)

>>Erythromycin to prevent Trachoma (staccato cough, eosinophilia)

>>use PO erythromycin when >3 weeks, to protect against disseminated cases

Front 12

if the baby was born with gonnorrhea due to the mother, what is the tx?

Back 12

systemic ceftriaxone

Front 13

Sepsis Workup: (5)
treatment

Back 13

• Blood cx
• UA/ urine cx
• CXR
• LP
• Tx: Cefotaxime

Front 14

Eye Infections: Day 1:
most common dx?
tx?

Back 14

Eye Infections:
Day 1: Silver nitrate => clear discharge

Front 15

Eye Infections: Day 1-7:
most common dx?
tx?

Back 15

Gonorrhea=> purulent discharge
(tx: Ceftriaxone)

Front 16

eye infections > Day 7
most common dx?
tx?

Back 16

> Day 7: Chlamydia
(tx: Erythromycin)

Front 17

in what situations should mom AVOID breastfeeding?

diseases (4)
congenital diseases?
drugs (7)

Back 17

o HIV, TB, Varicella

o Baby has Galactosemia

o Chemo-/Cancer/Street Rx/Li/Sedative/Stimulant
Metronidazole: stop breastfeeding x 24hr

Front 18

how much should a baby gain weight, and when:

Back 18

2 wk: back to birth weight
6 mo: double birth weight
1 yr: triple birth weight

Front 19

how much formula or calories per day does a baby need?

Back 19

need 100-120cal/ kg/ day= 36oz/ day formula at birth

Front 20

what a baby can eat at..
4mo:

Back 20

rice cereal

Front 21

what can a baby eat at 6 months?

Back 21

fruits, yellow veggies

Front 22

what can a baby eat at 9 months?

Back 22

2% milk, soft table foods

Front 23

what can a baby eat at 1 year old?

Back 23

whole milk, table foods

Front 24

what can a baby develop if they are fed with protein too early?

Back 24

can get allergies/eczema

Front 25

Hemangioma: define, management and tx.

Back 25

>>flat blood vessels
>>Tx: observe first, if growing rapidly, steroid injection or laser surgery if on face

Front 26

Milia

Back 26

neonatal acne due to progesterone in utero

Front 27

Acrochordom

Back 27

skin tag

Front 28

Vaginal bleeding

Back 28

due to estrogen withdrawal from Mom

Front 29

Sacral hair

Back 29

spina bifida occulta

Front 30

Subgaleal hemorrhage:

sx/labs?

what are its 2 types?

Back 30

prolonged jaundice in newborns (trauma to scalp during birth)

>>Caput succedaneum
>> Cephalohematoma

Front 31

Caput succedaneum

Back 31

under scalp (edema crosses suture lines)

Front 32

Cephalohematoma

Back 32

under bone (blood not cross suture lines)

Front 33

Epstein's pearl

Back 33

white pearls on hard palate (will go away)

Front 34

Persistent eye drainage since birth
Dx
Tx

Back 34

blocked duct
(Tx: gentle-massage)

Front 35

Wide cranial sutures

DDx?

Back 35

Poor nutrition, hypothyroid, Down's

Front 36

Cleft lip: what did not fuse? and Tx

Back 36

Medial nasal prominence did not fuse (reconstruct at 10wk old)

Front 37

Cleft palate:
describe what happed
what kind of infection do they usually get?
how should they be fed?

Back 37

Maxillary shelves not fuse=>
recurrent otitis media
(feed w/ long curved nipple)

Front 38

Neonatal Herpes:
what would be seen?
management?

Back 38

Purulent crusted scalp blisters
(do Tzanck smear)

Front 39

Umbilical Hernia, <1 y/o asymptomatic

Indications for surgery?

Back 39

Observe

surgery if::
>3-4 y/o, >2 cm, causes Sx, strangulated, enlarges after 1-2 years.

Front 40

Hydrocele

tx?

Back 40

Observe

Front 41

Clavicle fracture (middle 1/ 3 L clavicle):

Sx?

Back 41

asymmetric Moro reflex

Front 42

Erb's palsy:
describe
prognosis
dx test:

Back 42

C5-6 torn => Waiter's tip,
80% recovery
(Dx: MRI)

Front 43

Klumpke's

Back 43

C8-T1 torn=> claw hand

Front 44

Umbilical stump bleeding

Back 44

Factor XIII deficiency

Front 45

Delayed umbilical cord separation (6 wk)

Back 45

LAD

Front 46

Omphalocele

Back 46

WITH peritoneal covering

Front 47

Gastroschisis

Back 47

abdominal wall defect, intestines protrude off-center WITHOUT peritoneal covering

Front 48

Wilm's tumor:
define
Tx

Back 48

• Kidney tumor
• WAGR
Hemihypertrophy: atrophy of leg on side of tumor
(blood supply sucked away from leg)
• Tx: Dactinomycin

Front 49

Neuroblastoma

Back 49

#1 Abd Tumor in NEONATES

adrenal medulla tumor

hypsarrhythmia, myoclonus, ⇧VMA

Front 50

Tonic-Labyrinthine Reflex

Back 50

used to support self on a surface, "fencing" reflex

Front 51

Stepping reflex

Back 51

"walking" when toes touch surface

Front 52

Parachute Reflex

Back 52

when held at stomach, hands will go out

Front 53

Diving reflex

Back 53

when face is wet, flail arms/legs and close glottis

Front 54

6 month: gross motor abilities?

Back 54

Rolls back to belly, Sits, scoots,Sleeps all night

Front 55

Puberty

Back 55

pulsatile GnRH secretion increases

Front 56

Females Sexual Development, in order:

Back 56

Boobs, Pubes, Spurts, Squirts

Front 57

Males Sexual Development:

Back 57

Gonadarche~> Penis grows~> Growth~> Pubarche

Front 58

Female:
Tanner Stage: I -V

Back 58

I: nipple
II: bud, growth spurt
III: areola, menses
IV: secondary mound
V: separates from the chest

Front 59

Male:
tanner stages I-V

Back 59

I: proportional
II: red scrotal skin
III: growth spurt
IV: long penis
V: longest penis

Front 60

Tanner Stage: I-V
Pubic Hair:

Back 60

I: none
II: sparse, downy
III:corse and curly
IV: covers the pubic symphysis
V: covers the thighs

Front 61

Tanner Stage: IV
Female
Pubic Hair:
Male:

Back 61

Female: secondary mound
Pubic Hair: covers pubic symphysis
Male: longer penis

Front 62

Tanner Stage: V
Female:
Pubic Hair:
Male:

Back 62

Female: separates from chest
Pubic Hair: spreads onto thighs
Male: longest penis wall

Front 63

Fifth Disease (Parvo B-19)
name
presentation
avoid
school attendance

Back 63

erythema infectiosum "slapped cheeks" red lacy body rash

Mom: arthritis, aplastic anemia

keep them away from pregnant mothers for a few days

can go to school

Front 64

Hand-Foot-Mouth Disease

describe and tx

Back 64

mouth ulcers => won't eat or drink, palm/sole rash
(Tx: observation)

Front 65

Kawasaki's disease: type of disease and criteria for diaganosis

Back 65

"CRASH and BURN"
• Conjunctivitis
• Rash (palm/sole)
• Aneurysm (coronary artery)
• Strawberry tongue (like scarlet fever)
• Hot (fever> 102°F for at least 3 days +cervical lymphadenopathy)

Front 66

kawasaki's

treatment?
CI?

Back 66

o ASA (decrease high platelets)
o IVIG (coats receptors so they don't see the body's autoimmune attack)
o Flu vaccine (to avoid Reye's syndrome)
o No live vaccines until 12mo after IVIG

Front 67

what is measels?

virus and what would be seen in pathology?

Back 67

Measles = Rubeola (paramyxovirus)

multinucleated giant cells (lymphocytes)

Front 68

Measles - describe rash?

Back 68

1) Cough, Coryza (thick rhinorrhea), Conjunctivitis
2) Koplik spot (white spot on buccal mucosa) - 24 hrs BEFORE rash
3) Morbilliform blotchy rash - spreads from head down "like a shower"

Front 69

Mumps:
virus
presentation:

Back 69

(paramyxovirus):
parotiditis
red Stenson's duct (behind 3rd molar)
lemons hurt

Front 70

mumps complications:

Back 70

pancreatitis
oophoritis/orchitis
meningoencephalomyelitis (what you are afraid of)

Front 71

mumps treatment

Back 71

Tx: Acetaminophen

Front 72

Pityriasis Rosea:
type of herpes
describe
tx

Back 72

(HHV-7) herald patch => "C-mass tree" appearance on back,
Tx: UV-B-light

Front 73

DX:>>uncouple ETC (⇧temp => burns kid's livers)
>>Sx: fatty liver, brain edema, coma

Back 73

Reye's syndrome

Front 74

causes of reye's syndrome

Back 74

Pregnancy, acetaminophen, ASA w/ influenza or varicellla.

Front 75

treatment for reye's syndrome

Back 75

Tx= Supportive, Glucose, Albumin if fluid needed, FFP prn

Front 76

Rosacea
describe
what makes it worse?

Back 76

malar rash, worse with alchohol

Front 77

Rubella
another name
presentation on adults
pathogen

Back 77

German 3-day measles
(togavirus):
trunk rash, lymphadenopathy behind ear

Front 78

5 Complications of rubella on an infant

Back 78

blueberry muffin rash, cataracts; deafness, PDA (prematurity), extramedullary erythropoiesis.

Front 79

CI to rubella vaccination

Back 79

Don't give Rubella vaccine to pregnant women!

Front 80

Roseola

cause?
presentation

Back 80

(HHV -6), roseola, exanthema subitum

DEFERVESCENCE BEFORE rash

Front 81

Complications of varicella

Back 81

skin infections
varicella pneumonia =>lethal

Front 82

varicella appearance
which one is not infectious?

Back 82

1) Red macule
2) Clear vesicle on red dot
3) Pustules
4) Scab = > not infectious (most infectious: -2 rash+ 3)

Front 83

When is it OK to Stay in Daycare /School for Fifth Disease?

Back 83

when "slapped.cheeks" appear

Front 84

When is it OK to Stay in Daycare /School Chickenpox?

Back 84

when all lesions are scabs

Front 85

Most Common Causes of Death: first trimester:

Back 85

miscarriages (chromosomal abnormalities)
TORCH infections

Front 86

Most Common Causes of Death: 1 month

Back 86

prematurity

Front 87

Most Common Causes of Death: 6 mo-1 year old

Back 87

Child abuse

Front 88

DDx for child abuse

Back 88

osteogenesis imperfecta
bleeding disorders
Mongolian spots

Front 89

Most Common Causes of Death in 1-2 yrs:

Back 89

• Drowning (due to big head )
• Accidental ingestions

Front 90

Most Common Causes of Death 2-5 yrs:

Back 90

• #1: Car accidents
• #2: Accidental head injury (down stairs)

Front 91

Most Common Causes of Death 5-10 yrs:

Back 91

• #1: Pedestrian injuries
• #2: Baseball=> epidural hematomas (MMA)

Front 92

Most Common Causes of Death 10-19 yrs:

Back 92

• Car accidents
• Homicide (Blacks/ Hispanics)
• Suicide (white/Asian males/rich)

Front 93

Most Common Causes of Death: 19-44 yrs:

Back 93

• AIDS (got it as a teenager)
• Car accidents
• Homicide

Front 94

at what age are the DTap shots done

Back 94

4 years old

Front 95

history of tetanus toxid is <3 doses:
management for clean wounds

Back 95

DTap vaccination only

Front 96

history of tetanus toxid is >3 doses:
management for clean wounds

Back 96

no DTap (vac) or TIG (immu)

if the vaccination was > 10 years ago, give DTap

Front 97

history of tetanus toxid is >3 doses:
management for dirty wounds

Back 97

no DTap or TIG

if the vaccination was given >5 years ago, give DTap

Front 98

history of tetanus toxid is <3 doses:
management for dirty wounds

Back 98

give both DTap and TIG

Front 99

what are the 2 reflexes that stay throughout life?

Back 99

parachute and right reflex

Front 100

tanner III in females

Back 100

menses