BC USMLE Step 2 Pediatrics (Kaplan)

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Normal Vital Signs Newborn

RR
HR
SBP
DBP

RR-40-60
HR-120-160
SBP-65
DBP-50

Conjunctivitis Cause:
Day 1Day2-7>7 Days>3 weeks-

Day 1- chemical
irritation
Day 2-7- Neisseria
gonorrhea
>7 DaysChlamydia
trachomatis
>3 weeks- herpes

What Dx of Newborn:
X-linked, hemolytic crises.
Tx?

G-6-PD
Tx: reduce
oxidative stress
and special diet

What Dx of Newborn:
AR, mental retardation, deficiency
in enzyme phenylalanine
hydroxylase

PKU
Tx: special diet low
in phenylalanine
for first 16 years

What Dx of Newborn:
mental and developmental
retardation, inability to breast feed,
inability to metabolize galactose

Galactosemia
Tx: cut out all
lactose

What Dx of Newborn:
Cretinism

Congenital
hypothyroidism
Tx: replace
hormone

What Dx of Newborn:
multiple AR disease resulting in
errors of steroidogenesis

Congenital adrenal
hyperplasia
Tx: replace
mineralocorticoids
and
glucocorticoids

Palmar Grasp
Presents:
Disappears:

Presents: birth
Disappears:2-3
months

Rooting
Presents:
Disappears:

Presents:birth
Disappears: <1
month

Moro
Presents:
Disappears:

Presents:birth
Disappears:4-6
months

Tonic neck
Presents:
Disappears:

Presents:birth
Disappears: 6-7
months

Babinksi
Presents:
Disappears:

Presents:birth
Disappears:18
months

Parachute
Presents:
Disappears:

Presents:6-8 months
Disappears: never

What is Dx?
cyanosis of lips and extremities,
holosystolic murmur, squatting

Tetralogy of Fallot

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Tetralogy of Fallot 4 aspects

1) VSC
2) pulmonary stenosis
3) RVH
4) Overriding aorta
a/w chromosome 22
deletion

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3 holosystolic murmurs

1) VSD
2) mitral regurg
3) tricuspid regurg

What is Dx?
Early, severe cyanosis. Single S2.
CXR "egg on string"

Transposition of Great
Vessels
Tx: PGE1, until surgery

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Pulsus paradoxus

cardiac tamponade and

tensions
pneumothorax

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Pulsus alternans

left ventricular systolic

dysfunction

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Irregularly irregular

atrial fibrillation

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Pulsus tardus et parvus

aortic stenosis

What is Dx?
-absent pulses with single S2
-increased right ventricular
impulse
-gray rather than bluish
cyanosis,

hypoplastic left heart

syndrome
-LV hypoplasia
-mitral valve atresia
-aortic valve lesions
Tx: PGE1 until surgery
pulmonary edema
globular shaped heart

What is Dx?
Sxs in first few days of life
severe dyspnea
early and frequent respiratory
infxns
single S2, systolic ejection
murmur

Truncus Arteriosus
-single truck emerges
from R and L ventricles

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Cyanotic Heart Lesions

Tetralogy of Fallot
Transposition Great
Vessels
Hypoplastic LH
syndrome
Truncus Arteriosus
TAPVR

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Acyanotic Heart Lesions

VSD
ASD
PDA

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What is Dx?
dyspnea with respiratory
distress
holosystolic mumur
loud pulmonic S2

VSD
CXR-vascular markings
Echo-diagnostic, cardiac
cath definitive

What is Dx?
asymptomatic except fixed
wide splitting S2

ASD
-cardiac cath is definitive
-echo less invasive just as
effective

What is Dx?
machine like murmur
wide pulse pressure
bounding pulses

PDA
echo best initial
cardiac cath is most
accurate
LVH on EKG

What is Dx?
Severe CHF with resp
distress first few months
different BP in upper and
lower extremities

Coarctation of the Aorta

-rib notching and "3" sign
-cardiac cath most
accurate test

What is Dx?
vomiting with first feeding

esophageal atresia
-90% have TEF

gastric and esophageal air

bubble

Esophageal atresia

What is Dx?
Projectile vomiting
1-6 months
"olive pit" epigastrium

Pyloric Stenosis
-metabolic alkalosishypocholoremic,
hypokalemia
Initial Test- abdominal
U/S
Best Test- upper GI series

What is Dx?
child turns blue when feeding
and pink when crying

Choanal atresia
Dx with CT scan

What is Dx?
late meconium >48 hrs
extreme constipation
rectal exam shows extremely
tight sphincter, can't pass
flatus

Hirschprung Disease
AXR-distended bowel
loops
Manometry high pressure
anal sphincter
Dx-full thickness biopsy
showing lack of
ganglionic cells

VACTERL

V-vertebral anomalies
A-anal atresia
C-cardio anomalies
T-TEF
E-esopageal atresia
R-renal anomalies
L-limb anomalies

What is Dx?
bilious vomiting within 12
hours birth
CXR-double-bubble

Duodenal atresia
a/w annular pancreas and
Down Syndrome
1st step - IVF

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Painless rectal bleeding

Meckel's diverticulum
Best test-technetium 99 scan aka
Meckel scan

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Findings in IDM-5

1) Macrosomia- enlarged organs

except brain, polycythemia
2) Small Left Colon Syndromedescending colon
3) Cardiac abnormalitiesasymmetric septal hypertrophy
4) Renal Vein Thrombosis
5) Metabolic changes
-hypoglycemia-szrs
-hypocalcemia-tetany, lethargy
-hypomagnesemia-hypocalcemia
and PTH disease
-hyperbilirubinemia-icterus and
kernicterus

Findings in 17-alpha
hydroxylase deficiency
Aldosterone:
Cortisol:
Sex hormone:
BP:
Sxs:
Electrolytes:

Aldosterone:increase
Cortisol:decrease
Sex hormone: decrease
HTN
Sxs: female-normal @ birth,
delayed puberty
male-pseudohermaphrodite
Electrolyes-hypokalemia

Findings in 21hydroxylase deficiency

Aldosterone:
Cortisol:
Sex hormone:
BP:
Sxs:
Electrolytes:

Aldosterone:decrease
Cortisol:decrease
Sex hormone:increase
BP: hypotension
Sxs: female-look male, internal
female
male-normal @ birth
Electrolytes-hyponatremia,
hypochloremia, hyperkalemia

11-beta hydroxylase
deficiency
Aldosterone:
Cortisol:
Sex hormone:
BP:
Sxs:
Electrolytes:

Aldosterone:decrease
Cortisol:decrease
Sex hormone:increase
11-DOC-increase (weaker
aldosterone)
BP: HTN
Sxs: female-virilized
male- normal @ birth
Electrolytes:no change

Vit D. deficiency
CalciumPhosphate1-25 Vit. D25 Vit. D-

Calcium- Normal or decreased

Phosphate-decreased
1-25 Vit. D-decreased
25 Vit. D-decreased

Vit. D dependency
CalciumPhosphate1-25 Vit. D25 Vit. D-

Calcium-decreased
Phosphate-normal
1-25 Vit. D-decreaed
25 Vit. D-normal

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X-linked hypophosphatemia

Calciumnormal
Phosphatedecreased
1-25 Vit. Dnormal
25 Vit. Dnormal

What is Dx?
chorioretinitis, hydrocephalus, ringenhancing lesions on CT

Toxoplasmosis

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Dx test Toxo

Initial-IgM
Best- PCR

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Tx Toxo

Pyrimethamine
and
Sulfadiazine

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What is Dx?
rash on palms, soles, snuffles, frontal
bossing, Hutchinson 8th nerve palsy,
saber shins/teeth

Syphillis

Dx test Syphilis

Initial-VDRL
or RPR
Best- FTA ABs
or dark field
micro
Penicillin

What is Dx?
PDA, cataracts, deafness, IUGR,
blueberry muffin rash, hyperbili,
hepatosplenomegaly

Rubella

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Dx test Rubella

Maternal IgM

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Tx Rubella

Supportive

What is Dx?
periventricular calcifications with
microcephaly, chorioretiinitis, hearing
loss, petechiae

CMV

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Dx test CMV

initial-urine or
saliva titers
best- urine or
saliva PCR for
viral DNA

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Tx CMV

Ganciclovir

What is Dx?
week 1-shock and DIC
week 2- vesicular lesions
week 3-encephalitis

Herpes

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Dx test Herpes

Initial- Tzanck
Best-PCR

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Tx Herpes

Acyclovir and
supportive

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Tx Syphilis

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What is Dx?
pruritic vesicular rash
beginning on face, fever, malaise

Varicella

What is Dx?
cough, coryzam conjunctivitis
with Koplik spots on buccal
mucosa

Measels/Rubeola
(paramyxovirus)

What is Dx?
fever and URI progressing to
rash "slapped cheek"
appearance

Fifth disease/Erythema
infectiosum (Parvovirus
B19)

What is Dx?
Fever and URI progressing to
diffuse rash

Roseola (Herpes 6 and

7)

What is Dx?
fever precedes parotid gland
swelling with possible orchitis

Mumps
(paramyxovirus)

What is Dx?
Barking cough
Coryza
Inspiratory Stridor
Hypoxia

Croup
-parainfluenza virus 1
and 2, RSV

What is Dx?
Fever
Drooling in tripod position
"hot potato" voice
refusal to lie flat

Epiglottitis
H. influenza type B.
(Stept and staph too)
3-7 year olds

Tx Epigottitis

Ceftriazone 7-10 days

Intubate if severe
Rifampin to close
contacts

What is Dx?
severe coughing episodes with
extreme gasps for air followed
by vomiting

Whooping Cough
Bordetella pertussis

Tx Whooping Cough

Erythromycin or
Azithromycin (only in
catarrhal stage)
isolate child
Macrolides to close
contacts
DTaP vaccine-herd
immunity important

What is Dx?
gray pseudomembrane plaques
on pharyngeal wall.

Diptheria
Corynebacterium
diptheriae
DO NOT SCRAP
Tx-antitoxin, ABX
don't work

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What is Dx?
Painful limp, 2-8 year old
XR?
Tx?

Legg-Calve-Perthes Dx
avascular necrosis of femoral head
XR-widening and effusions of joint
Rest and NSAIDs, then surgery on both hips

What is Dx?
Painful lump and externally rotated leg
XR?
Tx?

Slipped capital femoral epiphysis, displacement/shift of growth plate

common in obese adolescent
XR-widening of joint space
Tx-internal fixation with pinning