USMLE Step 3 Pediatric Notes

  • Caput succedaneum crosses suture lines; cephalohematoma does not. Caput can be ecchymotic; it presents soon after birth + self-­‐resolves in weeks.
  • Cephalohematoma is associated with an underlying skull fracture in 10-­‐25%, there is no discoloration of the scalp, and it is not visible for several hours because of slow bleeding; it self-­‐resolves in two weeks to three months. Neither requires treatment.
  • A child has a 3% chance of acquiring T1DM if only his or her mom has T1DM, and 6% chance if the father has T1DM (difference not fully elucidated). A monozygotic twin has a 50% chance of developing T1DM if his or her twin has it.
  • Fluoxetine is the anti-­‐depressant of choice in children/adolescents
  • Typical onset of narcolepsy is late-­‐teens-­‐early-­‐ Dx with polysomnography.
  • For ITP in children: skin manifestations only -> observe; bleeding -> IVIG or glucocorticoids
  • Oral erythromycin (14 days) is Tx for both neonatal conjunctivitis and pneumonia. Topical is not Although erythromycin increases risk of pyloric stenosis, it is the only macrolide well-­‐studied to be effective. Prophylactic eye drops are not effective.
  • Risk factors for development dysplasia of the hip are female gender, breech delivery and family history. Pavlik harness for 1-­‐2 months is treatment, and referral to an orthopedic surgeon is necessary.
  • HPV vaccine should be administered starting at age 11-­‐12 and given as three doses in a 6-­‐month period. It should be administered to all individuals 11-­‐26 years of age. The only contraindication to the HPV vaccine is pregnancy because of limited safety data.
  • Risk factors for paediatric constipation are introducing solid food and cows milk, toilet draining, and school entry. Complications are anal fissures, haemorrhoids, encopresis, UTIs/pyelo, vomiting. Tx is increasing fiber, limiting cows milk consumption to <24oz/day, laxatives, suppositories/enema.
  • For choking children who are conscious, if age <1: turn face/head down and administer 5 back blows; then turn face up and give 5 chest thrusts. If age >1, lean the child forward and give 5 abdominal thrusts (Heimlich maneuver); alternatively, with the child leaning forward, 5 back blows followed by 5 abdominal thrusts may be administered. If unconscious, perform CPR.
  • All children <2 years with first-­‐time febrile UTI should be given 7-­‐10 days of antibiotics (trimethoprim 4mg/kg, 150mg max, BD; TMP-­‐SMX 0.5mL/kg; 20mL max BD; or cephalexin 15mg/kg, 500mg max, TDS) and have a renal AND bladder ultrasound to look for structural anomalies. Indications for voiding cystourethrogram: complex or atypical presentation, recurrent febrile UTI, or renal/bladder ultrasound showing HHOR  hydronephrosis, or high-­‐grade vesicoureteral reflux, or obstructive nephropathy, or renal scarring.
  • Constipation in children is treated initially with diet modification. If this is unsuccessful, mild laxatives should be used (e.g., magnesium hydroxide, aka milk of magnesia). Enemas and suppositories are reserved for severe constipation or as short-­‐term rescue.
  • Nursemaid’s elbow is radial head subluxation. In the process, the annular ligament becomes displaced between the radiohumeral joint. Supination and flexion of the forearm at the elbow, OR hyperpronation of the forearm are the two maneuvres to Tx.

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