Usmle Step 3: Pediatrics

Front 1

Pediatrics

Screening/Prevention: Metabolic/Congenital

Back 1

-hypothyrodism
-phenylketonuria (birth)
-glactosemia
-sickle cell dz

Front 2

Pediatrics

Screening/Prevention:
Anticipatory Guidance

Back 2

-water heater < 110-120
-car restraints
-baby to sleep on back (prevent SIDS)
-small objects that baby may aspirate
-no cow's milk before 1 year
-introduce solid foods at 6 months
-keep chemicals out of reach
-supervise in pool/bathtub

Front 3

Pediatrics

Screening/Prevention:
Growth Monitoring

Back 3

-Head circumference until 2 years (hydrocephalu, tumor, microcephaly {TORCH- toxoplasmosis, other [syphilis/virus], rubella, CMV, herpes}
-Hight/Weight until adulthood, monitor pattern of growth, if child goes from normal to abnormal curve then is worrisome

Front 4

Pediatrics

Screening/Prevention:
Vision/Hearing

Back 4

-Hearing measured at birth and until 4 years (every 2 years)
-Vision measured every few years at 3 until late adolescence
-check red reflex at birth to r/o congenital cataracts (TORCH/reinoblastoma)

Front 5

Pediatrics

Screening/Prevention:
Anmia

Back 5

-only recommended for pt w/ RF for Fe deficiency during infancy (premature, low birth wt, cows milk in first year, poor diet intake)

Front 6

Pediatrics

Screening/Prevention:
Lead

Back 6

-exposure can cause neurologic damage (mild LD or ADHD, MR)
-screen high risk children (old building, paint chips, battery recycling plant)
->10ug/dl needs close f/u
-stop exposure, chelation w/succimer or dimercaptosuccinic acid (DMSA)

Front 7

Pediatrics

Screening/Prevention:
Fluoride

Back 7

-most don't need supplementation b/c is in tap water (unless in rural areas)
-too much causes mottled bones & teeth
-first dental appt at 3 years

Front 8

Pediatrics

Screening/Prevention:
Vitamin D

Back 8

-supplement only if high risk (poor maternal intake, little sunlight, dark skin, exclusive breast milk > 6 months)

Front 9

Pediatrics

Screening/Prevention:
Tuberculosis

Back 9

-screen if risk factors or sx
-HIV, incarceration- yearly
-high risk immigrant population- 4-6 years & 11-16 years

Front 10

Pediatrics

Screening/Prevention:
Urinalysis

Back 10

-check at age 5

Front 11

Pediatrics

Screening/Prevention:
Immunizations- Hepatitis B

Back 11

0-1 m
1-4 m
6-18 m

-give first dose at birth w/ HBV immune globulin if mother with active HBV infection

Front 12

Pediatrics

Screening/Prevention:
Immunizations- Diptheria, Tetanus, Pertussis (DTP)

Back 12

2 m
4 m
6 m
15-18 m
4-6 y
Td booster every 10 y

Front 13

Pediatrics

Screening/Prevention:
Immunizations- Haemophilus influenzae, type b

Back 13

2 m
4 m
6 m
12-15 m

Front 14

Pediatrics

Screening/Prevention:
Immunizations- Polio (inactive, IPV)

Back 14

2 m
4 m
6 m
4-6 u

-avoid in children with anaphylaxis to neomycin or streptomycin

Front 15

Pediatrics

Screening/Prevention:
Immunizations- Measles, Mumps, Rubella (MMR)

Back 15

12-15 m
4-6 y

-avoid in anaphylaxis to eggs/neomycin and immunodeficiency

Front 16

Pediatrics

Screening/Prevention:
Immunizations- Pneumococcus (heptavalent)

Back 16

3 m
4 m
6 m
12-15 m

-give to children > 2 who have immunodeficieny, aspenia, poor splenic function (sickle cell)

Front 17

Pediatrics

Screening/Prevention:
Immunizations- Varicella

Back 17

12-18 m

-avoid in immunodeficiency or anaphylaxis to neomycin

Front 18

Pediatrics

Screening/Prevention:
Immunizations- Influenza

Back 18

-children > 6m with immunodeficiency, severe heart/lung dz, or on chronic ASA (prevent Reye syndrome)

Front 19

Pediatrics

Infants:
APGAR

Back 19

-performed at minutes 1 & 5
-resuscitation/monitoring if > 7
-Heart Rate: absent (0), <100 (1), >100 (2)
-Repiratory effort: none (0), slow, weak cry (1), good, strong cry (2)
-Muscle tone: limp (0), some flexion (1), active motion (2)
-Color: pale/blue (0), pink body/blue extremities (1), pink (2)
-Reflex inrritability: none (0), grimace (1), grimace/strong cry/cough/sneeze (2)

Front 20

Pediatrics

Infants:
Umbilical Cord

Back 20

-check at birth for 2 arteries, one vein, & abscence of urachus
-if only 1 artery- congenital renal malformation

Front 21

Pediatrics

Infants:
Caput succedaneum

Back 21

-diffuse swelling/edema of scalp that crosses midline
-birth trauma
-benign

Front 22

Pediatrics

Infants:
Cephalhematomas

Back 22

-subperiosteal hemorrhages that are sharply limited by sutures and don't cross midline
-birth trauma
-usually benign/self resolving, but rarely may be secondary to scull fracture (may consider Head CT)

Front 23

Pediatrics

Infants:
Cavernous hemangiomas

Back 23

-appear in first days of life
-increases in size
-gradually resolves in first few years
-no treatment

Front 24

Pediatrics

Infants:
Anterior Fontanell

Back 24

-usually closes by 18 months
-large or delayed closure may indicated hypothyrodism, hydrocephalus, rickets, or intrauterine grwoth retardation (IUCG)

Front 25

Pediatrics

Infants:
Moro/Palmar Grasp reflex

Back 25

-usually disappears at 6 m