,USMLE Step 2 – Pediatrics | 325+ Exam-Focused
Clinical Q&A for Rapid Mastery (2025 Edition).
In what two circumstances should child abuse be suspected?
When the history and the physical findings do not match up (e.g. "2 month old rolled of couch" - 2
month olds can't roll)
If there is a delay in seeking treatment
What are the three main risk factors for child abuse?
Alcoholism/Drug use
Mentally retarded/handicapped child
Repeated hospitalisations
Also mental illness w/in family + Hx of DV
What are some of the medical symptoms that can arise from child abuse?
Apnea
Seizures
Feeding intolerance
Excessive irritability
Somnolence
Failure to thrive
What are the biggest two findings on history consistent with neglect in older children?
Poor hygiene
Behavioural abnormalities
What is the most common physical finding of child abuse, and what are some of its common features
in a child abuse case?
Bruises
Can have geometric patterns (e.g. belt mark)
Atypical locations (face, thighs)
What kind of burns would make you suspect child abuse?
Cigarette or iron-shaped
Stocking-glove shaped
Well demarcated lines (e.g. on buttocks) may suggest forced immersion into boiling water
,What three main fracture types are consistent with child abuse?
Spiral fractures of radius/femur
Epiphyseal-metaphyseal "bucket fractures"
Posterior rib facet fractures
Which fracture type is common in under 3 year olds experiencing child abuse?
Spiral fractures of radius/femur
What usually causes the epiphyseal-metaphyseal bucket fractures?
Shaking or jerking of the child's limbs (highly diagnostic in infants)
What kind of fracture is squeezing a child's chest associated with?
Posterior rib (facet) fractures
What must you first do to assess whether child abuse is occurring?
Rule out conditions which can mimic child abuse
What organic conditions must you consider in suspected child abuse?
Bleeding disorders
Mongolian spots
Osteogenesis imperfecta
Bullous impetigo (can look like cigarette burns)
Alternative medicine (e.g. coining)
What tests might you consider in a 3 year old suspected of being abused?
X-Ray or Bone Scan
Sexual abuse testing
Non-contrast CT (subdural haematomas) or MRI (shaken baby syndrome changes in white matter)
Fundoscopy
What five things must be tested for in suspected sexual abuse?
Gonorrhoea
Syphilis
Chlamydia
HIV
Sperm
Why is isolated gonorrhoea on vaginal culture in a child definitive of sexual abuse, but chlamydia is
not?
, Chlamydia can be acquired during child birth; gonorrhoea cannot
Child abuse should be suspected in all cases of genital trauma, bleeding or discharge. What other
diagnosis should be considered in females, especially in the setting of foul smelling discharge,
bleeding and pain?
Foreign body
Vulvovaginitis (infx or non-infx)
What would be the appropriate protocol in the case of confirmed gonorrhoea on vaginal swab and
bruising in a 7 year old child?
Document injuries (size, shape, colour, location and nature)
Treat gonorrhoea
Consider notifying Child Protective Services
Hospitalise if necessary
What is the main classification of congenital heart diseases, and in what direction are the shunts?
Acyanotic (pink) - Left-to-right shunts
Cyanotic (blue) - Right-to-left shunts
What are the five Ts of Cyanotic Heart Defects?
Truncus Arteriosus (One vessel overriding the ventricles)
Transposition of the great vessels (two arteries switched)
Tricuspid atresia (three)
Tetralogy of fallot (four - overriding aorta, pulmonary stenosis, VSD, right ventricular hypertrophy)
Total anomalous pulmonary venous return (five words)
What are the three main acyanotic heart defects?
Three Ds:
VSD
ASD
PDA
What is the most common congenital heart defect?
VSD
With what conditions is VSD associated with?
Fetal Alcohol Syndrome
TORCH Infections
Clinical Q&A for Rapid Mastery (2025 Edition).
In what two circumstances should child abuse be suspected?
When the history and the physical findings do not match up (e.g. "2 month old rolled of couch" - 2
month olds can't roll)
If there is a delay in seeking treatment
What are the three main risk factors for child abuse?
Alcoholism/Drug use
Mentally retarded/handicapped child
Repeated hospitalisations
Also mental illness w/in family + Hx of DV
What are some of the medical symptoms that can arise from child abuse?
Apnea
Seizures
Feeding intolerance
Excessive irritability
Somnolence
Failure to thrive
What are the biggest two findings on history consistent with neglect in older children?
Poor hygiene
Behavioural abnormalities
What is the most common physical finding of child abuse, and what are some of its common features
in a child abuse case?
Bruises
Can have geometric patterns (e.g. belt mark)
Atypical locations (face, thighs)
What kind of burns would make you suspect child abuse?
Cigarette or iron-shaped
Stocking-glove shaped
Well demarcated lines (e.g. on buttocks) may suggest forced immersion into boiling water
,What three main fracture types are consistent with child abuse?
Spiral fractures of radius/femur
Epiphyseal-metaphyseal "bucket fractures"
Posterior rib facet fractures
Which fracture type is common in under 3 year olds experiencing child abuse?
Spiral fractures of radius/femur
What usually causes the epiphyseal-metaphyseal bucket fractures?
Shaking or jerking of the child's limbs (highly diagnostic in infants)
What kind of fracture is squeezing a child's chest associated with?
Posterior rib (facet) fractures
What must you first do to assess whether child abuse is occurring?
Rule out conditions which can mimic child abuse
What organic conditions must you consider in suspected child abuse?
Bleeding disorders
Mongolian spots
Osteogenesis imperfecta
Bullous impetigo (can look like cigarette burns)
Alternative medicine (e.g. coining)
What tests might you consider in a 3 year old suspected of being abused?
X-Ray or Bone Scan
Sexual abuse testing
Non-contrast CT (subdural haematomas) or MRI (shaken baby syndrome changes in white matter)
Fundoscopy
What five things must be tested for in suspected sexual abuse?
Gonorrhoea
Syphilis
Chlamydia
HIV
Sperm
Why is isolated gonorrhoea on vaginal culture in a child definitive of sexual abuse, but chlamydia is
not?
, Chlamydia can be acquired during child birth; gonorrhoea cannot
Child abuse should be suspected in all cases of genital trauma, bleeding or discharge. What other
diagnosis should be considered in females, especially in the setting of foul smelling discharge,
bleeding and pain?
Foreign body
Vulvovaginitis (infx or non-infx)
What would be the appropriate protocol in the case of confirmed gonorrhoea on vaginal swab and
bruising in a 7 year old child?
Document injuries (size, shape, colour, location and nature)
Treat gonorrhoea
Consider notifying Child Protective Services
Hospitalise if necessary
What is the main classification of congenital heart diseases, and in what direction are the shunts?
Acyanotic (pink) - Left-to-right shunts
Cyanotic (blue) - Right-to-left shunts
What are the five Ts of Cyanotic Heart Defects?
Truncus Arteriosus (One vessel overriding the ventricles)
Transposition of the great vessels (two arteries switched)
Tricuspid atresia (three)
Tetralogy of fallot (four - overriding aorta, pulmonary stenosis, VSD, right ventricular hypertrophy)
Total anomalous pulmonary venous return (five words)
What are the three main acyanotic heart defects?
Three Ds:
VSD
ASD
PDA
What is the most common congenital heart defect?
VSD
With what conditions is VSD associated with?
Fetal Alcohol Syndrome
TORCH Infections
