Step 2 Pediatrics 1 (10-14-15)

ruhland1's version from 2015-10-23 10:58

Section 1

Question Answer
ASDfixed split s2
ToFdilated aorta* up aortic valve structural change* diastolic prolapse causes early systolic click
Venous HumJugular valve flapping when sitting, supine goes a way to do increased blood vol
VSDholosystolic murmur at left sternal border
palpable thrillfinding in VSD due to LCH (strong systolic contraction=compensation)
Patent Ductus Arteriosuscontinuous machine like murmur due to flow across in both systole and diastole heard at 2nd ICS
transfer object from one hand to next6 mo
stranger anx6 mo
separation anx12 mo
look self in mirror6 mo
mama-dada non specific9 mo
wave bye-bye9 mo
4-6 word vocab15 mo
using cup15 mo
temper tantrum15 mo

Section 2

Question Answer
wheezemusical >250 msec, >400hz
wheeze vs rhonchirhonci is lower freq <400 hz
wheezeasthma exacerbation (MC sound)
egophanyEEEE->AAA lobar consolidated pneumonia
pleural friction rubvisceral and parietal pleura inflamed*roughened* up splinting
leather on leather soundpleural friction rub (heard at same point in inspirtory and expirtory cycles
splintingpleural friction rub * up pain * stop breathing
whispered pectoriloquyhear whispered word on ausc. normal not heard. fluid = heard (lobar consolidation)
tracheal membranes swellforeign object causing stridor
reverseible FEV1asthma
asthma findeosinophilia
asthma lunghyperinflation
foreign objectRIGID bronchoscopy tx
interstitial pneumoniarales, whisper petrio, egophany
pleuritisleather on leather friction rub (same point on insp and exp cycles)
asthma FEV1dn
asthma FEV1/FVCdn

Section 3

Question Answer
stridorforeign object
2nd metatarsophalangeal joint painfreiberg's infarction (osteochondrosis)
freiberg infarction txorthotic/NSAID-> surgery
keinbocklunate(bluemoon), repititive compressive loading (pushing kegs all day)
Kohlers diseaseKohls and Old navy (navicular osteonec)
Panner'sPitcher's disease(capitellum=capture the ball)
Severs diseaseosteochon of Achilles at calcaneal tuberosity (severed achilles) periods of rapid growth
child petitmalethosuximide
petit mal findingEEG is 3 hertz spike and wave patten
petit mal 2ndvalporate
child generalized szlevertiracetam
petite mal erdtopiramate
infant generalized epilepsyphenobabr

Section 4

Question Answer
LTB mildcool mist and fluid
LTB moderateO2, corticosteroid, racemic epineph
LTB severehospitalization and racemic epi
bronchiolitis<2yo, RSV, low grade F,tachypnea,wheeze
epiglottiis bugstrep>HiB(#1 if unvax)
sniffing dogepiglottis
tracheitisstridor, 3mo-2yo, uncommon
croupLow F, hoarse,
foreign bodylung hyperinflation(easier to get air in lungs than push it out)
subglottic narrowingcroup
supraglottic narrowingepiglottis
Apgar1 and 5 min
Appearance 1pale extrem
Pulse 1<100
Grimmace 1grimace
grimace 2sneeze cry cough
activity 1flex arm and legs
resp 1slow and irregular
intubation 4cm above carina
medialstinal shifttowards side of collpase

Section 5

Question Answer
needle thoracostomytension pneumothorax
needle thoracostomy=needle decompression
ortalani manuverrelocates dislocated hip from barlow
ortalaniflexhip to 90degree, anterior and abducting, hear click=DDH
DDHdevelopmental dysplasia of hip (posterior dislocation with barlow, click and relocation with ortalani)
barlowadduct hip and flex knee 90degree, push posterior on knee, hip dislocates then ortalani is used to confirm with click
nephrogenic DI lithium decreases ADH effect
neophrogenic DI labhypernatremia, low sodium urine
ddx central vs nephrogenic DIADH has no effect on nephrogenic, central is due to lack of ADH
SIADH txdemeclocycline
-vaptansvasopressin receptor antag
DM T2 dxfasting>125, single read >200, or A1C>6.5%

Section 6

Question Answer
renal tubular acidosis Idistal RTA= potassium replaces hydrogen in urine, also distal cannot make bicarb now because of H+ present
RTA IIproximal RTA= PCT cannot resorb HCO3-, so dn pH, and hypokalemia
RTA IVdiabetic, Urine is pH<5.5 and hyperkalemia
RTA IV MOAdn aldosterone effect + dn Na+ and up K+ and H+
Auto dom kidneyPCKDz
PCysticKDzbil flank pain, diastolic htn, hematuria, cysts in liver(nodular hepmeg)
AD PCKDz aortathoracic dissection
AD PCKDz brainintracerebral berry aneurysm
intracerbral berry aneurysmup SAH
Acute Interstitial Nephritis(Autoimmune) rash, F, eosinophilia
bladder cxcigarettes, anilline/azo dye, cyclophosphamide
bladder cx urinerbc painless
nephrolithiasis other findingsedema,eczema(atopicdermatitis),pallor, bilateral heaviness
UTI workupurinalysis
PCKDz gold dxU/S
AD PCKDz outcomehemodialysis due to ESRF at age 60, nephrectomy is last resort
VHL diseasehemangioblastomas
tuberous sclerosisangiomyolipoma kidney
VHL kidneyup RCCx
renal replacement therapy=hemodialysis

Section 7

Question Answer
physical signs of child abusebruising hx, injury to back/back of leg, belt/hand/burn mark
Herpanginamultiple vesicles with central ulceration on posterior pharyngeal wall
herpangina bug Coxsackie A
Herpangina txibuprofen and fluid
aphtous stomatitis etiounknown/AI/trx
aphtous stomatitis findpainful ulcers anywhere on mucous mem 7-10 days
aphtous stomatitis txtopical anti-inflamm, immune modulators
hand foot and mouth bug Coxsackie A
hand foot mouthvesicles all over mouth, red rash on plam sole and butt
hand foot mouth txfluid
trigeminal neuralgiaherpes etio
herpes gold dxPCR>Tzanck(better for initial dx)
HSV2 latent in ____ gangliasacral
mumps (big bumps)swollen face and testes, HA and F
hear soil thinktetanus
lack of standard prenventative medicine (e.g. unvax)implies poor health care delivery

Section 8

Question Answer
VSDholosystolic murmur at left lower sternal border
bicuspid aortic valveharsh ejection murmur at right sternal border
central cyanosiseisenmenger
eisenmengerup central cyan due to L->R shunt going to R-> L
eisenmenger pathophyswhen pulm vasc resistance (PVR) > than SVR from chronic L to R shunting. PVR gets bad enough shunting flips to R->L resulting in cyanosis
PDAcontinuous machine, LVH and more blood in systemic(less in lung) so widened pulse pressure so loud S2 and bounding periphreal pulse (palpable thrill)
rotatory nystygmusPCP
reyes syndromeliver failure and encephalopathy(+babinski bilateral) due to ASA uses
intruterine growth restrictionnicotine
hypospadiasventral surface
epispadiasdorsal surface
epispadias findingbladder exstrophy
hypospadias txcircumcision contra
chordeeventral curveature of penis
chordee assochypospadias
hypospadis findingcrytorchidism, inguinal hernia
remnant of tunica vaginalishydrocele