Полезные материалы за все 6 курсов / Учебники, методички, pdf / Kaplan Pediatrics USMLE 2CK 2021
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USMLE®
Step 2 CK
Lecture Notes
2021
Pediatrics
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USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), which neither sponsor nor endorse this product.
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Editors
William G. Cvetnic, MD, MBA
Fellow of the American Academy of Pediatrics
Board Certified in Pediatrics and Neonatal-Perinatal Medicine
Jacksonville, Florida
Eduardo Pino, MD
Associate Professor, Department of Pediatrics
Marshall University School of Medicine
Medical Director, Hoops Family Children’s Hospital
Cabell Huntington Hospital
Huntington, West Virginia
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Table of Contents |
00 |
Chapter Title |
Chapter 1: The Newborn . . . . . . . . . . . . . . . . . . . . . . . |
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. . 1 |
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Chapter 2: Genetics/Dysmorphology . . . . . . . . . . . . . |
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. 21 |
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Chapter 3: Growth and Nutrition . . . . . . . . . . . . . . . . |
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. 31 |
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Chapter 4: Development . . . . . . . . . . . . . . . . . . . . . . . |
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. 43 |
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Chapter 5: Behavioral/Psychological Disorders . . . . . |
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. 49 |
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Chapter 6: Immunizations . . . . . . . . . . . . . . . . . . . . . . |
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. 53 |
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Chapter 7: Child Abuse and Neglect . . . . . . . . . . |
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.61. . . . . . . |
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Chapter 8: Respiratory |
Disease . . . . . . . . . . . |
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67. . . . . . . . . . . . . |
Chapter 9: Allergy and |
Asthma . . . . . . . . . . . |
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81. . . . . . . . . . . . . |
Chapter 10: Immune-Mediated Disease . . . . . . . . . . . |
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. 91 |
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Chapter 11: Disorders of the Eye .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. |
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99 |
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Chapter 12: Disorders of the Ear, Nose, and Throat . |
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105 |
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Chapter 13: Cardiology |
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113 |
Chapter 14: Gastrointestinal Disease . . . . . . . . . . . . . |
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139 |
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Chapter 15: Renal and Urologic Disorders . . . . . . |
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. 155. . . . . . . . |
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Chapter 16: Endocrine Disorders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. |
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167 |
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Chapter 17: Orthopedic Disorders . . . . . . . . . . . . . . |
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179. . . |
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v
USMLE Step 2 CK λ Pediatrics
Chapter 18: Rheumatic and Vasculitic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Chapter 19: Hematology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Chapter 20: Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Chapter 21: Neurology . . . . . . . . . . . |
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. 219. . . . . . . . . |
Chapter 22: Infectious Disease . . . . . . . . |
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237 |
Chapter 23: Adolescence . . . . . . . . |
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261. . . . . . . . . . . . |
Index . . . . . . . . . . . . . . . . . . . . . . |
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267. . . . . . . . . . . |
Additional resources available at kaptest.com/usmlebookresources
vi
The Newborn |
1 |
Chapter Title |
Learning Objectives
Calculate an Apgar score
Use knowledge of birth injuries to predict symptomology
Demonstrate understanding of newborn screening, fetal growth/maturity, and neonatal infections
APGAR SCORE
A newborn infant at birth is noted to have acrocyanosis, heart rate 140/min, and grimaces to stimulation. She is active and has a lusty cry. What is her Apgar score?
Table 1-1. Apgar Scoring System
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Evaluation |
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0 Points |
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1 Point |
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2 Points |
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Heart rate |
0 |
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<100/min |
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>100/min |
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Respiration |
None |
Irregular, shallow, gasps |
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Crying |
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Color |
Blue |
Pale, blue extremities |
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Pink |
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Tone |
None |
Weak, passive |
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Active |
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Reflex irritability |
None |
Facial grimace |
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Active withdrawal |
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Apgar scores are routinely assessed at 1 and 5 minutes, and every 5 minutes thereafter as long as resuscitation is continuing.
•The 1-minute score gives an idea of what was going on during labor and delivery.
•The 5-minute score gives an idea of response to therapy (resuscitation).
In general, the Apgar score is not predictive of outcome; however, infants with score 0−3 at ≥5 minutes compared to infants with score 7−10 have a worse neurologic outcome.
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USMLE Step 2 CK λ Pediatrics
Newborn Care
•Vitamin K IM
•Prophylactic eye erythromycin
•Umbilical cord care
•Hearing test
•Newborn screening tests
BIRTH INJURIES
On physical exam, a 12-hour-old newborn is noted to have nontender swelling of the head that does not cross the suture line. What is the most likely diagnosis?
Table 1-2. Common Injuries During Deliveries
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Injury |
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Specifics |
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Outcome |
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Skull fractures |
In utero from pressure against bones or |
• Linear: no symptoms and no treatment needed |
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forceps; linear: most common |
• Depressed: elevate to prevent cortical injury |
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Brachial palsy |
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Erb-Duchenne: C5–C6; cannot abduct |
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Most with full recovery (months); depends on |
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shoulder; externally rotate and supinate |
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whether nerve was injured or lacerated; Rx: proper |
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forearm; Klumpke: C7–C8 ± T1; paralyzed |
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positioning and partial immobilization; massage |
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hand ± Horner syndrome |
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and range of motion exercises; if no recovery in |
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3–6 mo, then neuroplasty |
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Clavicular fracture |
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Especially with shoulder dystocia in vertex |
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Palpable callus within a week; Rx: with |
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position and arm extension in breech |
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immobilization of arm and shoulder |
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Facial nerve palsy |
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Entire side of face with forehead; forceps |
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Improvement over weeks (as long as fibers were |
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delivery or in utero pressure over facial nerve |
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not torn); need eye care; neuroplasty if no |
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improvement (torn fibers) |
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Caput succedaneum |
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Diffuse edematous swelling of soft tissues of |
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Disappears in first few days; may lead to molding |
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scalp; crosses suture lines |
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for weeks |
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Cephalohematoma |
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Subperiosteal hemorrhage: does not cross |
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May have underlying linear fracture; resolve in 2 wk |
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suture lines |
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to 3 mo; may calcify; jaundice |
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2
Chapter 1 λ The Newborn
PHYSICAL EXAMINATION
A newborn infant has a blue-gray pigmented lesion on the sacral area. It is clearly demarcated and does not fade into the surrounding skin. What is the most likely diagnosis?
A newborn has a flat, salmon-colored lesion on the glabella, which becomes darker red when he cries. What is the best course of management?
Table 1-3. Physical Examination—Common Findings
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Finding/Diagnosis |
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Description/Comments |
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Skin |
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Cutis marmorata |
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Lacy, reticulated vascular pattern over most of body when baby is cooled; improves over first |
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month; abnormal if persists |
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Salmon patch |
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Pale, pink vascular macules; found in nuchal area, glabella, eyelids; usually disappears |
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(nevus simplex) |
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Mongolian spots |
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Blue to slate-gray macules; seen on presacral, back, posterior thighs; > in nonwhite infants; |
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arrested melanocytes; usually fade over first few years; differential: child abuse |
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Erythema toxicum, |
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Firm, yellow-white papules/pustules with erythematous base; peaks on second day of life; contain |
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neonatorum |
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eosinophils; benign |
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Hemangioma |
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Superficial: bright red, protuberant, sharply demarcated; most often appear in first 2 months; |
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most on face, scalp, back, anterior chest; rapid expansion, then stationary, then involution (most |
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by 5–9 years of age); Rx: beta blockers, embolization; deeper: bluish hue, firm, cystic, less likely |
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to regress; Rx: (steroids, pulsed laser) only if large and interfering with function |
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Head |
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Preauricular |
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Look for hearing loss and genitourinary anomalies. |
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tags/pits |
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Coloboma of iris |
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Cleft of lid, iris, lens, retina, or choroid. In iris, manifests as keyhole appearance at the 6 o’clock |
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position. May be autosomal-dominant or part of CHARGE syndrome. |
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Leukocoria—white |
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Retinoblastoma; cataract; retinopathy of prematurity; retinal detachment; larval granulomatosis |
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reflex |
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Aniridia |
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Hypoplasia of iris; defect may go through to retina; association with Wilms tumor |
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Extremities |
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Polydactyly |
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Extra digit, partial digit, or cleft digit after the 4th finger (ulnar side); world’s most common minor |
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malformation; usually surgically removed at 1–2 years of age |
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