13 ⼀PEDIATRICS Flashcards
(223 cards)
1
Q
What is the treatment for Developmental Dysplasia of Hip?
A
Pavlik Harness that holds hip in flexion and ABduction
2
Q
What demographic is affected by Hypertrophic Pyloric Stenosis ?
A
[3-6 week old boys]
3
Q
describe Puberty timeline for females (3)
A
[8-12 yof: breast + pubic hair]
[–(within 2.5y)–> growth spurt] ->
[MENARCHEby 13y or [by 15y if ⊕F∆]]
1º amenorrhea = NO MENSES by 13y or ([15y if ⊕F∆])*
4
Q
What does Constitutional Short Stature refer to
A
“late bloomer” but will attain normal adult height later
pts have normal birth wt and ht but ht velocity slows between 6 mo-3 yo, picks back up after and slows again at adolescence. bone radiographs will show delayed bone age
5
Q
[Genu Varum] is normal during age ⬜ and presents as (⬜3) . When should this correct by?
A
0-2 yo ; [BL symmetric bow leg, normal stature, no lateral thrust]
_________________
should correct by 2 yo
[varum is nml 0-2 yo] [ValGus = nml in 4-7 yo]
obtain XR if > 2 yo, short stature or uL
6
Q
Newborn failure to pass meconium within 48 hours of birth likely indicates ⬜
MOD -5
A
Hirschsprung Disease
________________
[RET gene mutation vs Trisomy 21] →
failure of neural crest cell migration → absence of ganglion cells from [Auerbach/Meissner enteric nervous plexus] in rectosigmoid (confirmed by rectal suction biopsy)]
= transition zone cutoff between
[narrow aganglionic rectosigmoid] and [markedly dilated innervated descending colon]
EARLY AFTER BIRTH
7
Q
Craniopharyngioma etx
A
[Calcified low grade malignancy] dervied from epithelial remnants of Rathke pouch within the pituitary stalk of the SUPRAsellar region
8
Q
Marfan Syndrome and Ehlers Danlos can present similarly
How do you discern the two?-2 ; What is the etx for Ehlers Danlos?
A
“Marfan BAATHES a lot! “
BUT Ehlers Danlos does NOT have
- Ectopia Lentis
- Arm-to-Height Ratio that’s INC
Ehlers Danlos etx = defective collagen production
9
Q
diagnostic criteria for suspected septic joint
_________________
empiric abx for septic joint
A
[WBC >50Kneutrophil predominance] in [joint aspirated_synovial fluid]
_________________
Vanc IV
10
Q
cp for [Measles rubeOla] -6
A
[fever + conjunctivitis + coryza + Koplik spots + cough] prodrome –(2-4days)–> [maculopapular rash sspreading head to body]
tx = supportive +/- [Vitamin A if hospitalized]
11
Q
After successfully treating Acute Otitis Media, how should you manage a patient who p/w persistent middle ear fluid build up?
_________________
Explain why
A
WATCHFUL WAIT X 3 MO after treatment
_________________
serous fluid may persist in middle ear self-limited to 3 mo after AOM treatment (= [SOME - serous otitis media with effusion] )
further w/u if: infection / BL effusion / sx > 3 mo
12
Q
Risk factors for Developmental Dysplasia of Hip - 3
________________
when should you stop screening for this?
A
- Breech Delivery - GET HIP IMAGING IF FEMALE AND BREECHED
- Female - GET HIP IMAGING IF FEMALE AND BREECHED
- Fam hx
12 months old
13
Q
Dx Criteria for Kawasaki Disease
A
{[4/5 CRASH] + [Burning HIGH Fever ≥ 5 days]}
- Conjunctivitis
- Rash
- Adenopathy uL in cervical region (least likely)
- Strawberry tongue/oral mucosa changes
-
Hand/Feet redness or swelling
THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION
14
Q
Meckel’s Diverticulum etx -4
tx = surgery
A
👶failure of [pre-gastropancreatic_vitelline duct] to obliterate during first 8 WG
👶 ➜leaves behind RLQ [gastropancreatic ectopic tissue] in blind pouch
👶this blind pouch ectopically produces gastric acid that irritates mucosal lining → mucosal bleeding
👶 ultimately = [NONPAINFUL HEMATOCHEZIA +/- IDA IN 2 YOM]
also could be: asx / [Intussusception] / Diverticulitis / Bowel obstruction
15
Q
Malrotation and Volvulus are both diagnosed with ⬜
Describe how both would look on this diagnostic?
A
[UGSBS- Upper GI Series barium swallow]
________________
Malrotation = Ligament of Treitz on the R side of the abd in a gasless abd
________________
Volvulus = corkscrew image
16
Q
management of
pediatric functional constipation (3)
A
1st: dietary ∆
2nd: Osmotic Laxatives
ACUTE DISIMPACTION: STIMULANT LAXATIVE
_________________
dietary ∆ = [⇪ fiber/water] | [cow’s milk< 24oz]
17
Q
How do you manage infants born to Mothers with Active Hepatitis B (4)
_________________
How do you determine if the infant was vertically infected?
A
infant receives @:
- [BIRTH⼀within 12h of delivery: {obtain[HBV 🅂Ag]🧪1 → administer[HBVIG with HBV💉1]}
_________________ _________________
- [2 mo: HBV💉2]
_________________ _________________
- [6 mo: HBV💉3]
_________________ _________________
- {–(3 months later)–> [9 mo: obtain🧪[HBV 🅂Ag]🧪2 }
_________________
[HBV 🅂Ag] = [HBV “🅂”urface antigen]
[HBV 🅂Ag]
⚠️if [HBV 🅂Ag] positive = HBV VERTICALLY INFECTED!
___________________________x____________________________________
🧪 = labs || 💉=vaccine
18
Q
Annual Influenza vaccine is recommended for kids age ⬜ for what purpose?
A
≥6 month old ; prevent [infection and spread of infection] to at-risk populations (asthma/chronic illness/<2 yo)
19
Q
Hypetrophic Pyloric Stenosis cp (6)
A
- age 3-6 weeks old
- [POSTPRANDIAL PROJECTILE NONBILIOUS EMESIS]
- [“Hungry Vomiter” (hunger immediately after vomiting)]
- [Epigastric Palpable Olive mass]
- Visible peristalsis
- [hypOchloremic hypOkalemic metabolic alkalosis]
_________________
[dx = US] | [tx = IVF ➜ Pyloromyotomy]
20
Q
FPIAP is a ⬜ reaction to ⬜ that presents in normal infants as ⬜ . The treatment in formula-fed infants is ⬜
FPIAP = Food Protein Induced Allergic Proctocolitis
A
[non-IgE allergy] ; [milk protein (cow’s milk or soy protein)] ; blood-streaked stools ; Extensively Hydrolyzed Formula
FPIAP = non-IgE rxn to milk protein (casein/whey) = no skin/pulm rxn
21
Q
Slipped Capital Femoral Epiphysis is a complication of childhood obesity
When does this present?
________________
How does this present?
________________
dx?
A
puberty (most common hip disorder in fat teens!)
________________
[M: [CHRONIC vague hip/knee pain]
________________
pelvis XRay
“Fat teen Slipped on [ASS, broke Neck] [PIS off Heads]”
[Fat teenchild obesity] during [Slipped Capital Femoral Epiphysis]
–(gradually)– > [ANT SUP Slip femNeck]
which → [POST INF Slip femHead]
➜ [CHRONIC vague hip/knee pain]</sub>
22
Q
Oligohydramnios –> ⬜ sequence.
Name the 3 most common causes of Oligohydramnios
A
Oligohydramnios –> POTTER Sequence
POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> Oligohydramnios during utero)
23
Q
What is [Impetigo Diaper Dermatitis]? (3)
________________
Tx? -3
A
-secondary bacterial diaper infection (by staphA > GASP)
-[PAINFUL honey-crusted papules and pustules]
-in neonates can be c/b sepsis
________________
[: + sepsis s/s]: [Admit for IV Abx and sepsis w/u]
________________
sepsis s/s = [neonatal fever/irritability/lethargy]
24
Q
Both [Croup Laryngotracheitis] and Epiglottitis cause inspiratory stridor
How do you discern the two?
A
Epiglottitis causes Drooling!
25
Language delay in any child warrants ⬜
Audiology
26
# For ⬜ name the ⬜ developmental milestone(s)
*1 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Gross motor -3
27
# For ⬜ name the ⬜ developmental milestone(s)
*1 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
fine motor
28
# For ⬜ name the ⬜ developmental milestone(s)
*1 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Language
29
# For ⬜ name the ⬜ developmental milestone(s)
*1 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SOCIAL -2
## Footnote
-1 step command
-separation anxiety
30
[Clubfoot Equinovarus] is a deformity of the ⬜ bone which results in what clinical presentation?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx for this?
Talus; *PIA* BL feet [**P**lantar flexed + **I**nverted + **A**DDudcted]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
serial Foot Cast
31
In a neonate, when should chest compressions be started?
HR \<60
32
There are 5 major complications of Kawasaki Disease
In order of GREATEST to least, list them
{[4/5 **CRASH**] + [**B**urning HIGH Fever ≥ 5 days]}
* * *
[CNS ∆(irritability/aseptic meningitis)] \> [**CORONARY ARTERY ANEURYSM** **(within 1-4 wks!)**] \> Liver dysfxn \> Arthritis \> GallBladder Hydrops
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION*
33
In Infants, what is "Periodic Breathing" ?
***BENIGN*** physiologic breathing pattern in young infants in which they demonstrate
([**breath pause x 5-10 seconds**] ➜ [rapid shallow breaths x 10-15 seconds] ➜)
x several cycles before returning to normal breathing
34
Which diseases in kids have [rash **involving palms and soles**] - 4
*"**K**iller **R**ashes **E**ntrap **S**oles"*
1. **K**awasaki
2. **E**nteroviruses
3. **S**yphilis
4. **R**ocky Mountain Spotted Fever
35
⬜ is a [pediatric renal tumor that crosses the midline] and presents in the ⬜ year of life
Neuroblastoma
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
first
36
Explain why [unconjugated Bilirubin] in newborns is physiologically elevated -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How does phototherapy treat this?
- liver immaturity
- lack of intestinal bacteria to catabolize bilirubin
- high hgb turnover (will ⇪ if cephalohematoma present)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
phototherapy converts bilirubin ➜ [water soluble lumirubin] ➜ excrete in urine and stool
37
The 2 major causes of [bloody stool \< 6 month old are **FPIAP**] and **⬜**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What is the long term prognosis of an infant with FPIAP?
*FPIAP = Food Protein Induced Allergic Proctocolitis*
Anal fissure
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[self limited to 2 weeks] & they will be able to tolerate milk protein **BY 1 YEAR OLD**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*FPIAP = allergic but (non-IgE rxn ( = NO skin/ NO pulm involvement) to milk protein (casein/whey) → ⊕Hematochezia. but ⊝skin/pulm rxn*
38
A child comes in with neonatal conjunctivitis
DDx?-3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you differentiate each?
39
Based on PECARN rule, name the [high risk Pediatric TBI features] for [2 -18 yo] (6)
*high risk Ped TBI = [noncontrast head CT (or 5h obs if med risk)]*
40
List the Vaccines that are *Live Attenuated* - (12)
*"**[MY MVP RiB RATS]** are live!"*
**M**easles rubeOla
**Y**ellow fever
**M**umps
**V**aricella
**P**olioSabin
**R**ubella
**i**nfluenzaintraNasal
**B**CG
**R**otavirus
**A**denovirus
**T**yphoidPO
**S**mallpox
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Pregnant Women should NOT get Live attenuated vaccines but their household contacts SHOULD as this is less severe than wild-type*
41
explain why early environmental exposure for newborns is important
Normal newborn immunity is polarized toward [Th2 response ( which will ➜ ATOPY = IgE, mast cell, eosinophil production) = Asthma/Eczema/Allergic Rhinitis]
BUT this is balanced by the [Th1 cytokine profile] you can only develop from **exposure to nonpathogenic microorganisms**
42
*APGAR is used to assess newborn status immediately postpartum*
Describe the grading system for **A**ctivity & tone?
APG**A**R
## Footnote
0 = no motion
1 = arms & legs **flexed** but not active
2 = Active Motion of extremities
43
*infant presents with refractory candidiasis*
suspected diagnosis?
infant HIV
44
PSGN-PiG is a complication of ⬜ that typically presents with (⬜4)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's the treatment for PSGN-PiG? (4)
[s/p GASP 1-4 wks prior];
1. [AGN AKI_nephritic w/low complement]**💊HD**
2. [prOteinuria + gross hematuriiia*"tea urine"*]**💊supportive**
3. [Edema]**💊Furosemide**
4. [HTN]**💊antiHTN**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx = HD, Supportive, Furosemide, antiHTN,
| 💊 = tx
## Footnote
💡MOD: [IgG-C3-**PSGN-PiGantigen**] lodges into [glomerular capillary subepithelial basement membrane] and recruits C5a complement ➜ damage ➜ [prOteinuria + gross hematuriiia*"tea urine"* + inappropriate RAA activation*➜ Na+ retention ➜ fluid retention ➜Edema, HTN*]
45
Malrotation and Volvulus are both diagnosed with ⬜
What would Volvulus look like on this diagnostic?
**XR**[Upper GI series barium swallow]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
corkscrew image
| *Try not to use CT scans in kids*
46
What is the treatment for BreastMilk Jaundice?
**OBSERVATION**
| (*BMJ is self limited to 3 mo :-)*)
47
Which 3 microbes cause pediatric sepsis in
[age group: ≤28 days old]?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Based on that, name the empiric abxs given for pediatric sepsis [age group ≤ 28 day old] -4
*"pediatric sepsis from ***LEG-NS*** "
1-**L**isteria = Ampicillin
2A- **E** Coli = [Gentamicin
2B-*but → {substitute with CefoTAX vs CefTAZ if meningitis suspected}]*
3-**G**BS = Ampicillin
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Ampicillin + [Gentamicin *(or CefoTAX | CefTAZ if meningitis)*]
48
Precocious puberty is (premature) development of 2º sex characteristics in girls age ⬜ and boys age ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's the treatment of *central* Precocious puberty?
g\< 8 | b\< 9
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[GnRH🟢]
## Footnote
(* GnRH🟢 binds to [hypothalamus GnRH Receptors] ➜ positive feedback ➜ ⬇︎GnRH secretion ➜ ⬇︎LH/FSH*)
49
clinically associated conditions with Down Syndrome (8)
**SHEEPPS** & [**SHALA** **H**as **D**own **S**yndrome]
## Footnote
[**SHALA** **H**as **D**own **S**yndrome]
1. **[SEPTAL ENDOCARDIAL CUSION DEFECT]**
2. **H**irschsprung's disease
3. **A**tlanta-axial instability
4. [**L**eukemia (LATER IN LIFE!)]
5. [***A***ltered Psyche (Autism/ADHD/Alzheimer-like dementia)]
6. **h**ypOthyroid
7. **D**uodenal atresia
8. [tri**S**omy 21]
50
diagnostic criteria for SIDS
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Sudden Infant Death Syndrome*
[Sudden *unexplained* (Infant\<12 mo) Death with inconslusive autopsy]
51
What are the recommendations regarding Patient Confidentiality and Adolescents?
MD should honor [Adolescent Patient Confidentiality] for care regarding [**SEX**, **DRUGS** and **PSYCH**]
**BUT MUST BREAK AND ALERT PARENTS IF AT RISK FOR HARM TO SELF OR OTHERS**
*(pregnancy/contraception, STI, substance abuse/mental health)*
52
# Kawasaki dx = [4/5 CRASH] + [Burning HIGH fever ≥5d]
Recite the very important caveat regarding incomplete diagnostic criteria for Kawasaki Disease (4)
KD dx normally requires: {[4/5 *CRASH*] + [*Burn*ing HIGH fever ≥5d]}
## Footnote
* * *
▶but Because Kawasaki Disease sx do NOT manifest simultaneously → _[dx caveat]_ =
▶if {[\<4 *CRASH*] is present **BUT** pt does have [*Burning* HIGH fever ≥5d]}
▶= ["*febrile vasculitis of uncertain etiology"*]→
⭐[obtain CRP, ESR and f/u daily to reassess for onset (or not) of final criterion]
53
Congenital Toxoplasmosis is given to baby via ⬜ but acquired by Mom via ⬜-3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Sx-4
Transplacental
- Raw undercooked meat
- unwashed produce (contaminated soil)
- cat feces
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Tox- **HICH***
**H**ydrocephalus
**I**ntracranial Calcifications
**C**horioretinitis
(also **H**earing impairment)
54
*child presents with 2º enuresis*
DDx? -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*2º enuresis = bed wetting ≥5 yo after established period of nighttime dryess*
DM (*order CBC/CMP*)
vs
psychological stressor (*I.e. parents' divorce*)
55
What is the most common cause of hip pain in kids?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dx?
Transient Synovitis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Clinical **but obtain Xray to r/o Legg Calve Perthes**
*may have ⬆︎inflammatory markers but xrays will be normal*
56
Because of serious possible sequelae associated with Kawasaki disease (*Coronary artery aneurysms*), ⬜ must be performed at ⬜ , ⬜ and ⬜.
TTE; [baseline, 2w after tx, 6w after tx]
* * *
[4/5 **CRASH**] & [**B**urning HIGH Fever ≥ 5 days] sl;l
57
What is the mngmt for an ingested coin? - 3
1. Obs for LOE24h post ingestion UNLESS:
2. Pt is symptomatic = flexible endoscopy
3. Pt has no recollection of ingestion time = flexible endoscopy
58
Risk factors for Developmental Dysplasia of Hip - 3 ; when should you stop screening for this?
1. **Breech Delivery** - GET HIP IMAGING IF FEMALE AND BREECHED
2. Female - GET HIP IMAGING IF FEMALE AND BREECHED
3. Fam hx
12 months old
59
Why can't Ceftriaxone be used during the 1st month of life?
[*albumin-bound*_Ceftriaxone_] can displace [*albumin-bound* _bilirubin_] ➜ allows free [*indirect unconjugated* bilirubin] to cross blood brain barrier ➜ (in pts LOE1 mo) [Kernicterus bilirubin encephalopathy]
60
*Cerebral Palsy is a group of clinical syndromes generally characterized as ⬜*
How does it present? - 3
Nonprogressive motor dysfunction (Prematurity\>EtOH = RF) ;
## Footnote
"Cerebral Palsy presents **SAD** on 3 **SAD** types"
1. [**S**pastic UMN ∆ LE>UE]
2. [**A**MS Retardation]
3. [**D**eformed BL equinovarus club feet (image)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*types:*
***S**pastic
**A**taxic
**D**yskinetic*
*Greatest RF = prematurity ( \< 32WG)*
61
In Infants, what is [Apnea of Prematurity]?
[**TRUE** apnea episodes ≥20 seconds] in premature infants, that resolves by [corrected gestational age 37 WG]
62
What is Osgood Schlatter Disease
**Traction apophysitis of the tibial tubercle** from Self-limited irritation of the growth plate at the tibial tuberosity (front of tibia) possibly --\> hard nodule, relieved with rest/growth spurt
## Footnote
*xray: lifting of tubercle from the shaft*
63
Dx for Intussuception -2
[Ultrasound guided **AIR** enema] or [Ultrasound guided **BARIUM CONTRAST** enema]
## Footnote
Intussuception age = 3-36 mo
Look for the Target Sign on US!
64
DDx for neonatal rectal bleeding - 5
1. FPIAP -[Food (Milk/Soy) Protein-Induced ALLERGIC Proctocolitis] ⭐
2. Anal Fissure ⭐
3. Meckel Diverticulum *= nonpainful Hematochezia*
4. Volvulus *= bloody stool from intestinal ischemia*
5. Intussuception *= (dx:AIR|water contrast enemaUS guided)*
65
*AP**G**AR is used to assess newborn status immediately postpartum*
Describe the grading system for **G**rimace & reflex irritability?
AP**G**AR
## Footnote
*In response to stimulation (i.e. pinch) baby rxn = ...*
0 = none
1 = grimace
2 = [grimace **AND** (cry|coryza*sneeze*|cough)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*grimace = ugly twisted facial expression*
66
A: [**POTTER** Sequence] etx
B: Clinical Presentation - 6
A: [**R**enalFETAL agenesis/dysfunction BL] --\> [Oligohydr*AMNIO*s*(low *AMNIO*tic fluid)*] ➜
B. **POTTER**
**P**ulm hypOplasia
**O**ligohydrAMNIOs
**T**wisted Face
**T**wisted shortened Limbs
**E**ars set low
[**R**enalFETAL agenesis/dysfunction BL] = cause
67
by age ⬜ , full term infants should be able to sleep thru the night without overnight feeds
If they can't, how do you change this?
6 months old
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
AVOID OVERNIGHT FEEDS
(do NOT offer feeding during nocturnal awakenings. Just check on baby)
68
In terms of etiology, what is a difference between Breastfeeding Failure jaundice and Breast Milk jaundice?
**B****F****F** = "(*lowkey*)[**B**ilirubin *Uncj* ⇪] 2/2 **F**ailed [**F**ecal_Stooling] ⼀[*F*irst week of life]."
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
🍼within **F**irst week of life *D0-D7*
🍼{[**F**ailed *F*eeding] --\> [**F**ailed **F**ecal_Stooling]} --\>
🍼⬇︎[Unconjugated bilirubin] elimination --\>
🍼{⬆︎[Unconjugated bilirubin] recycling = Jaundice}
| ⭐**B**reast**F**eeding **F**ailure⭐
69
Clinical *characteristics* of Down Syndrome pts - 7
**SHEEPPS** & [**SHALA** **H**as **D**own **S**yndrome]
the **SHEEPPS** of genetics
1. **S**kin excessive at the nape of the neck = nuchal skin
2. **H**ypOtonia w/ ⬇︎ Startle Moro reflex
3. **E**picanthal folds
4. **E**ars that are small
5. **P**rotruding tongue w/flat face
6. **P**alpebral fissures are upslanted
7. **S**ingle palmar crease
*these pts also have ⬆︎risk for hypOthyroidism*
70
What are the 2 major complications of Mumps
1. Orchitis
2. Aseptic Meningitis
71
in newborns, bilirubin greater than ⬜ ➜ ⬜. Describe this condition
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
management?
[🆃wenty] ➜ [kernic🆃erus bilirubin encephalopathy] *(mvmnt DO and hearing loss)*
*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
Exchange Transfusion
*{exchanges newborn's blood containing [SEVERE HYPERBILIRUBINEMIA > 🆃wenty]
and/or
[DAT+ maternal Ab]}
and transfuse newborn with new replacement RBC*
72
cp for neonatal Lactose Intolerance - 3
"LI **D**efinitely **P**roduces **F**latulence"
1. Diarrhea **NONBLOODY**
2. Flatulence
3. Periumbilical crampy abdP
## Footnote
*Lactose Intolerance = no Lactase ➜ Sx same as adult
73
What is the tell tale sign of child abuse
**SUDDEN CHANGE IN BEHAVIOR**
## Footnote
(RISQUE SEXUAL BEHAVIOR/IRRITABILITY/CONCENTRATION ⬇︎)
74
[Strabismus ocular misalignment] after the age of ⬜ is abnormal and requires intervention to prevent ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Which intervention is employed for this? - 3
4 mo ; Amblyopia(vision loss from disuse of the deviated eye)
1. CTL eye patch to strengthen deviated eye OR
2. CTL cycloplegic eye drops (blurs normal eye to strengthen deviated eye)
3. Corrective lens
Dx = asymmetric corneal light reflex
75
At what age should you be concerned for an infant not walking yet?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What age do infants usually learn to walk?
*"walk by 16mo, drive by 16Y"*
\> 16 mo
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
9-16 mo
76
Pts who've recovered from RSV Bronchiolitis are at ⇪ risk for [⬜ +/- recurring]. Ergo, ⬜ should be avoided
WHEEZING; cigarette smoke (and other airway reactivity triggers)
| Bronchiolitis:*[Wet&Hot👃]/[Wheezing recurrent]/[WOB] - in Winter*
77
Osgood Schlatter Disease tx -3
1. NSAIDs
2. Ice
3. self-limited (stops with end of growth spurt)
## Footnote
*xray: lifting of the tibial tubercle from the shaft*
78
Peds with untreated iron deficiency anemia are at INC risk for what 2 comorbidites?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How is this mitigated? -3
psychomotor delay
neurocognitive impairment
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[universal screening starts age 1 yo]
--(if hgb \<11)--\> [PO ferrous sulfate]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*IDA is the most common nutritional deficiency in kids*
79
*Slipped Capital Femoral Epiphysis is a complication of childhood obesity*
MOD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
management?
"*_Fat teen_ _Slipped_ [on _ASS_,broke _Neck_] [to _PIS_ off _Heads_]*"
[Fat teenchild obesity] during [Slipped Capital Femoral Epiphysis]
--(acutely)-- > [ANT SUP Slip femNeck]
which → [POST INF Slip femHead]
➜ [Months of vague hip/knee pain]
\_\_\_\_\_\_\_\_=\_\_\_\_\_\_\_\_\_
[surgical pinning **within 24 HOURS**]
## Footnote
fat teen --*acutely*-- > [ANT SUP Slippage of femoral Neck] ➜ [POST INFERIOR displacement of Femoral head] ➜ [Months of vague hip/knee pain]
80
Reconstruction of cleft lip is generally performed at (⬜age)
10 weeks old
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(in accordance with rule of 10s = 10 lbs|10 weeks old|10 g hgb)
81
*APGAR is used to assess newborn status immediately postpartum*
Describe the grading system for **A**ppearance?
**A**PGAR
## Footnote
0 = entirely blue
1 = pink with blue extremities
2 = entriely pink
82
What is the most common congenital cyanotic heart defect in the neonatal period?
Transposition of Great Vessels
## Footnote
*Look for the **single Loud second heart sound!***
83
What is Erythema Toxicum Neonatorum ; tx?
benign neonatal rash with blanching erythematous papules and/or pustules ; self limited to 2 weeks after birth
84
# Reye Syndrome
MOD -4
-pediatrics
-with **viral** illness
-who takes **ASA**
-develops **VELLDS***sx*
| *Reye's = [peds+virus+ASA→**VELLDS**]*
## Footnote
***V**omiting, {**E**ncephalopathy from ⇪ICP}, _**L**IVER❌_, **L**ethargy, **D**EATH, **S**eizures*
85
# Reye's Syndrome
clinical presentation -9
**VELLDS**
| *Reye's = [peds+virus+ASA→**VELLDS**]*
## Footnote
***V**omiting, {**E**ncephalopathy from ⇪ICP}, _**L**IVER❌_, **L**ethargy, **D**EATH, **S**eizures*
86
Bronchiolitis is a ⬜ respiratory infection that occurs in the ⬜ by the ⬜ virus
What are the sx ? (3)
lower; **W**inter ; RSV
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**W**ET & HOT nose*(RHINORRHEA with FEVER)*] | [**W**HEEZING*(+/- recurring)*] | [**W**OB⇪]
| *dx = clinical \> nasal/pulmonary antigen test*
87
[T or F]
UNILATERAL cervical LAD in kids (typically from ⬜ bacteria ) is not common and needs further workup
FALSE!
| *Impetigo and [ped uL cerv LAD] = **Sg***
## Footnote
✏️[ped uL cervical LAD (typically from **Sg**)] is common!
*🔎**Sg** = **S**taph >**g**ASP*
88
*APGAR is used to assess newborn status immediately postpartum*
Describe the grading system for **R**espiration?
APGA**R**
## Footnote
0 = not breathing
1 = [breathing slow|irregular]
2 = crying
89
Oligohydramnios --\> ⬜ sequence.
Describe this clinical presentation for this Sequence
Oligohydraminos --\> **POTTER** Sequence
**P**ulmonary hypOplasia
**O**ligohydraminos from renal agenesis/damage (cause)
[**T**wisted Face & Extremities]
**T**wisted Skin
**E**ars set low
**R**enal agenesis/damage
90
Based on PECARN rule, name the [high risk Pediatric TBI features] for [ < 2 y/o ] -5
"TBI is the **LASH'S** fault!"
1. LOC
2. AMS
3. [Skull Fx_palpable]
4. *{Hematoma_nonfrontal scalp}*
5. SEVERE MECHANISM
91
At what point, should you consider Antibiotic prophylaxis (*continuous vs postcoital*) for young female patients with recurrent UTI? (2)
[≥ 2 UTI in 6 mo]
OR
[≥3 UTI in 12mo]
*obtain further diagnostics if c/f nephrolithiasis or obstruction*
92
Necrotizing Enterocolitis cp - 3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
X ray finding?
1. Bloody stools
2. feeding intolerance
3. abd distension
X-ray = Pneumotosis Intestinalis
Risk factors= prematurity, congenital heart disease, hypotension
93
Neonatal Respiratory Distress Syndrome is caused by ⬜
What are the major risk factors?-2
Surfactant Deficiency
1. Prematurity
2. Maternal DM
94
What is Legg Calve Perthes Disease?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Demographic?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
mngmt-2?
Avascular necrosis of the Capital Femoral Epiphysis ; [Boys 4-10 yo) ;
1. Self limited but can --\>deformity/degeneration
2. contain femoral head within acetabulum during encounter
95
How do you manage a choking child? (2)
96
Name the markers of onset Puberty for
Girls
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Boys
*"Her 2 by 12 | His 4 by 14"*
[girls: 2 **Breast** by 12 yo]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[boys: 4 cc*(or more)***size Testicle** by 14 yo]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*delayed secondary sexual characteristics + delayed XR bone age = [Constitutional Delay of Puberty]*
97
What's used to keep the PDA Patent?
Prostaglandin E1
| *"E1 kEEPs the duct open and the dick up!"*
98
Describe the best approach to [Vaccine Refusal/Hesitancy] (4)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**AC/DC**
1. [**A**LLOW Parents to voice concerns]
2. [**C**ORRECT misinformation (*i.e. Autism/Overload/Natural immunity*)]
3. [**DISCUSS** risk/benefits of immunization]
4. [**CONTINUE** ONGOING DIALOGUE AT SUBSEQUENT VISITS DESPITE INITIAL REFUSAL]
99
McCune-Albright Syndrome
clinical features (3)
**M**cCune **A**lbright **S**yndrome
1. [**M**acules (Coast of Maine irregular cafe au lait spots)]
2. [**A**xillary hair, Pubic hair and Breast develop precociously]
3. [**S**pongy trabeculae bone undergoes *fibrous* *dysplasia*]
100
cp for Congenital Rubella Syndrome (6)
***[BL cataracts]***
***[sensorineural hearing loss]***
***[patent ductus arteriosus]***
[Bluberry muffin rash (purpuric lesions)]
low birth weight
microcephaly
101
At what age does Bedwetting start to become pathological for kids?
5 yo
102
A Contrast enema demonstrating microcolon is indicative of what condition? ; etx?
Meconium iLeus 2/2 Cystic Fibrosis
viscous meconium accumulation obstructs terminal iLeum --\> underused colon --\> contracted microcolon
103
*Typically, for minors, informed consent must be obtained by the [minor's **ADULT legal guardian**]
... unless* ⬜3
| (list the _3 exceptions_ in which peds pt do NOT need Adult consent)
*"peds don't need Parents for **EEE**verything*
## Footnote
1. **E**mergency*(delaying tx could → life/limb❌)*
2. **E**mancipated*(ped pt is a [Parent|$ independent|HS grad|court📄|etc])*
3. "**E**dgybut noncidal" eval *[Sex, Drugs, noncidalPsych]*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*noncidal = NOT threat to self/suicidal or others/homocidal.
(⚠️PARENTS MUST BE INFORMED OF CIDAL MINORS ⚠️)*
104
cp for Febrile Seizure -4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⬜ is the primary management.
but When do you give [Abortive Antiepileptics]?
1. [child [6 month - 5 year old] with [\< 15m GTC nonfocal seizure]]
2. **NO** *afebrile* seizure within prior 24h
3. **NO** CNS infection (meningismus, bulging fontanelles)
4. **NO** metabolic❌ (hypOglycemia)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
[AntiPyretics with Reassurance]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
➜ [Abortive AntiEpileptics if seizure ≥5 min]
105
cp for Bronchiolitis in neonates - 3
_________________
px for this?
1.[**W**ET &HOT👃]
2.[**W**HEEZING recurrently]
3.[**W**OB]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
-[***paliVizumab** px in infant < 2 mo*]
| Bronchiolitis:*[Wet&Hot👃]/[Wheezing recurrent]/[WOB] - in Winter*
106
Why can Moms breastfeed on methadone treatment, but can NOT breastfeed if actively using recreational substances/opioids?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What is the requirement to be candidate for [breastfeeding on methadone tx] -2
[methadone treatment concentration in breastmilk] is low and unrelated to maternal dose
but
recreational substances have unpredictable pharmacology (mixed with other drugs/inconsistent dosing)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
compliant with methadone treatment throughout pregnancy and after pregnancy/postpartum/breastfeeding
+
NO active recreational drug use relapse
107
What is **premature adrenarche**? (3)
| *AKA [Idiopathic premature adrenarche-pubarche]*
*AKA: "premature **adrenarche**"*
-precocious 2/2 pubic hair
-bone age NORMAL
-[precocious qualifier = ONLY PUBIC HAIR]
[precociouswith isolated PUBIC HAIR + boneNORMAL age
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
in (male \<9 / female\<8][precocious⊕2º sex qualifier *(pubic hair_adrenarche vs breast_thelarche)*
+
[normal bone age*(no excess LH driving precociousness)*]
but only pubic hair present
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⚠️If [pubic hair] is the **only** precocious qualifier present *(io\normal bone age)* = [isolated **pubic hair**] = premature **adrenarche**
| ***with NO other endocrine*** ∆
108
# *newborn patient presents with (image)*
Diagnosis? ; Name the major risk factor for this
HIRSCHSPRUNG DISEASE ; [Mom ≥ 35 yo]
## Footnote
*markedly dilated descending colon*
109
cp for [Radial head subluxation Nursemaid's elbow]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx? (3)
[sudden **refusal to move arm** s/p forcibly pulled pronated forearm]
affected arm with forearm pronated
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*extend*arm ➜ *pressure*radial head ➜ **HYPERPRONATE**FOREARM (*create "waiter's tip")*
## Footnote
*"pt suddenly refuses to move arm after arm was forcibly pulled while forearm was pronated"*
110
SIDS
risk factors for the infant? -4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
risk factors for Mom *during pregnancy*? -4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Sudden Infant Death Syndrome = [Sudden unexplained (Infant\<12 mo) Death with inconclusive postmortem exam]*
**SLEEPING PRONE** \> \> \> [prematurity | low birth wt | smoke exposure]
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[pregnant teenager *(<20 yo)*] | [pregnant smoker*(smoking)*] | [pregnant druger*(substance use)* | pregnant slacker*(spotty prenatal care)*
111
Diagnostic Criteria for Colic - 4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
tx -2
Colic = the 4 - 3's
**_C_rying**
▶first 3 weeks of life that's
▶≥3hrs/day (usually evenings) for
▶≥3days / week for
▶≥3weeks / month in a healthy infant
Tx =
▶Soothing techniques
▶feeding techniques
112
Describe Metatarsus Adductus
Most common congenital foot deformity in which there is BL medial deviation of the forefoot **usually in 1st born infants**
## Footnote
*Tx = this corrects spontaneously*
113
clinical features of
Neonatal Clavicular fracture (3)
1. self limited with NO LONG TERM SEQUELAE (tx = spportive only)
2. localized clavicular creptius
3. irritability with passive IPL UE movement
* dx confirmed by XR*
114
Tx for Kawasaki disease
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
when should this be given?
★*"① plus ② ⼀within 10"*★
\_\_ \_\_ \_\_
[① plus ② ⼀*within 10d of 💥*]
[4/5 **CRASH**] & [**B**urn💥 ≥ 5 days]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
①. **ASA***(🅷🄻❤️)* :
{[🅷KD]*until ❄*} ---->
{[🄻KD]*6 weeks*} -->
{[❤️⊕ ➜ ⊕🄻KD*♾️*] *or* [❤️⊝ ➲ ⊝LKD]}
\_\_\_\_\_\_\_plus_\_\_\_\_\_\_\_\_\_
②. [**IVIG2 g/kg** over 12 hours]⼀*DEC Coronary Aneurysm risk*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
🔎{*🅷KD = HIGH Kawasaki Dose = [80-100 mg/kg divided over 4 *]*daily*}
🔎{*🄻KD = Low Kawasaki Dose = [3-5 mg/kg as one dose*]*daily*}
🔎❄ = defevervescence
🔎❤️ = coronary involvement
🔎♾️ = indefinitely
115
[Atlantoaxial joint] Instability MOD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Which demographic are at most risk for this?
excessive laxity in the Posterior transverse ligament ➜ ⬆︎mobility between [C2 aXis: dens] and the [C1 atlas] --\> spinal cord compression ➜ UMN signs
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**Down Syndrome** (remember pts with down syndrome are *usually* hypOtonic but not with Atlantoaxial instability!)
## Footnote
{[**SHEEPPS**]*traits* & [**SHALA** **H**as **D**own **S**yndrome]*conditions*}
116
What is Primary nocturnal enuresis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1st step in evaluation?
lack of nighttime dryness in kids age ≥5 y/o *that usually spontaneously resolves over time*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UA (r/o DM, DI, infection)
117
For a patient receiving ⬜ to diagnose and treat intussuception, what is a potential complication ?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how is this potential complication diagnosed?
[air|water|barium_contrastENEMA] ; intestinal perforation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[abd xr series] (*to assess for free air*)
118
Name the 7 most common manifestations of **Marfan Syndrome**
etx = mutation of fibrillin 1 gene
"Marfan **BAATHES** a lot! "
1. **E**ctopia Lentis
2. **A**rm-to-Height Ratio ⬆︎
3. **H**eart issues (*MVP or [idiopathic _Aortic_ cystic medial degeneration]--\> _Aortic Dissection and Aneurysm_*)
4. **S**coliosis vs. Kyphosis
5. **B**reastbone structural abnormalities
6. **A**rachnodactyly (Steinberg thumb & wrist)
7. **T**all / slender / flat feet
etx = mutation of fibrillin 1 gene
119
Name the 3 major points of misinformation regarding Vaccines
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you mitigate each one?
1. **AUTISM**: following retraction of the *fraudulent Wakefield study*, many large-scale systematic reviews have consistently shown no association between Vaccines and Autism
2. **"VCCs OVERLOAD IMMUNE SYSTEM?"**: exposure to multiple antigens at once is NOT harmful and will NOT "overload" immune system
3. **"NATURAL IMMUNITY IS BETTER":** Natural immunity/infxn = ⇪ risk for severe complications (i.e. hospitalization)
120
When should ingested batteries be emergently [*flex* endoscopically] removed? (2)
▶*911 FLEX ENDOSCOPY*ONLY when the battery is still **IN** the esophagus and not distal to it.
▶If distal --\> obs
## Footnote
*this also includes sharp objects, or multiple magnets*
121
Which 2 microbes cause pediatric sepsis in [age group: > 28 days old]?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Based on that, name the empiric abxs given for pediatric sepsis [age group > 28 day old] -3
"pediatric sepsis from ***LEG-NS*** "
2. [**N**eisseria meningitidis ⼀Ceftriaxone (+ Vancomycin *if M or M suspected*)]
3. [**S**trep Pneumo ⼀Ceftriaxone (+ Vancomycin *if M or M suspected*)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Ceftriaxone (+ Vancomycin *if **M**RSA or **m**eningitis suspected*)
## Footnote
[*if **M**RSA suspected⼀ add Vancomycin*]
[*if **M**eningitis suspected* ⼀add Vancomycin]
122
the timing of neonatal jaundice differentiates [G6PD deficiency] from [Hemolytic Disease of Newborn] explain
_neonatal jaudice presenting within first_
24 hours of life = HDN
(*⊕direct Coombs | A or B infant born to O mother*)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
2-3 DAYS of life = G6PD deficiency
123
What is the treatment for Bronchiolitis? -6
## Footnote
*typically from RSV*
-IVF
-nasal bulb suctioning
-humidified O2
-contact precautions
-droplet precautions
-[*paliVizumab px in infant < 2 mo*]
| Bronchiolitis:*[Wet&Hot👃]/[Wheezing recurrent]/[WOB] - in Winter*
124
Pediatric dyslipidemia is a risk factor for adulthood progression of ⬜ and ⬜.
Because of this, what is the recommended lipid screening for peds?
atherosclerosis / CVD
## Footnote
*note: universal [fasting lipid panel] screening should still be obtained ages 9-11 and 17-21 regardless of CV risk factors*
125
3 classic **Clinical** Manifestations of [Tetralogy of Fallot]
A:
1. [**S**ystolic Ejection HARSH Murmur @ L Sternal 2/3 ICS] from [**RVOO** -R Vt Outflow Obstruction]
2. **S**quatting relieves sx (INC afterload--\> [DEC amount of R to L shunt]
3. [**C**yanotic lethal Tet Spells] (tx: Knee chest positioning and inhaled O2)
"**VOIR** is to have **S**ee + **S**ight & **C**ry"
126
Name the specific signs of congenital syphilis - 3
1. Rhinorrhea
2. [***P&S***Maculopapular rash] that dequamates or becomes bullous
3. Abnormal long bone xrays (i.e. metaphyseal lucency)
| P&S = Palms & Soles
127
Name the red flags that indicate pathologic (CA/infection/autoimmune) etx for a child p/w leg pain (5)
1. **uni**lateral
2. progressive (osteoid osteoma/osteosarcoma)
3. joint involvement (JIA)
4. systemic sx
5. abnl PEx (focal TTP/petechiae/hepatosplenomegaly)
128
Pink Stains or Brick Dust in neonatal diapers indicates the presence of ⬜
Uric Acid Crystals
129
define Primary amenorrhea (2)
*NO MENSES*
*by*
*([15y with F*∆] or *[13y with **no** F*∆])
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*F* ∆ = *Female changes-sex characteristics (breast/pubic hair)*
130
Violent Infant Shaking ---\> ⬜ . This is characterized by what 3 things?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How is this differentiated from similar conditions?
Violent Infant Shaking --\> [AHT- Abusive Head Trauma]! =
1. Subdural Hemorrhage (from tearing bridging veins between Dura and Arachnoid) ( = GET CT ➜ SKELETAL SURVEY)
2. **BL Retinal Hemorrhages** (from congested retinal vein ruptures)
3. POSTERIOR rib fractures
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⚠️*Usually* Accidental Fall is not sufficient for Subdural Hemorrhage OR [BL Retinal Hemorrhage]
▶*AHT is formely known as Shaken Baby Syndrome*
131
*APGAR is used to assess newborn status immediately postpartum*
Describe the grading system for **P**ulse?
A**P**GAR
## Footnote
0 = No HR
1 = \< 100 bpm
2 = \> 100 bpm
132
list clinical features of
Intussusception (4)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how it it diagnosed? treated?
1. [6 mo - 3 yo]
2. [SEVERE colicky abd pain + emesis]
3. **CURRANT JELLY STOOL**
4. [Target sign on US]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dx & Tx = [Air or Water contrast enema]
133
Hemolytic Uremic Syndrome in kids p/w ⬜ secondary to which 2 microbes?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Name the 3 clinical features of Hemolytic Uremic Syndrome
**BidD***(Bloody-inflammatory diarrhea-Dysentery)* ; [EColi O157:H7] or [Shigella dysenteriae]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[HUS HAT]
[**H**emolytic Anemia (schistocytes)] / **A**KI / **T**hrombocytopenia
134
What is the normal age parameters for physiologic genu varum?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
genu valGum?
[0-(**varum**)-2-(✅)-4-(**valGum**)-7-->(✅)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
varum "bow legged" = [onset birth - resolve by 2 year old]
\_\_\_\_\_\_*(should have ✅straight knees 2-4 yo and ≥7 yo)*\_\_\_\_\_\_\_\_\_\_\_
valGum "Knock Kneed" = [onset 4y - resolve by 7y]
*obtain imaging only if persist beyond upper age limit*
135
Why is cessation of breast feeding in a jaundiced 20 day old pt who is lethargic not necessary?
Galactosemia (**Conjugated** Hyperbilirubenemia) is unlikely considering pt is 20 days old.
Sepsis should be r/o first with blood cx and px abx
136
In Children presenting with uL hip pain, how do you differentiate [septic arthritis] from [*(viral)*transient synovitis of hip]? (4)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's treatment for septic arthritis? (3)
+Kocher criteria = [≥3 **ELFS**] = +septic arthritis
[**E**SR\>40 (or CRP\>2)]
**L**eukocytosis
[**F**ever\>38.5C]
[**S**tanding HURTS (non-weight bearing)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
dx & tx = [IMMEDIATE JOINT ASPIRATION] ➜ [IV Vanc] ➜ [Surgical debridement]
137
Tx for [Neonatal Conjunctivitis⼀**Chlamydia**]?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx for [Neonatal Conjunctivitis⼀**Gonococcal**]? (2)
ncC = [POMacrolide]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
ncG = [IMcefoTaxime|IMcefoTetan]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*nc = neonatal conjunctivitis*
*Topical erythromycin is only for nc**G** Px*
138
Demographic for Hypertrophic pyloric stenosis -2
{[***m***ale first Born] [3-5 wks old]}
## Footnote
*image showing "oilive mass"*
139
What are the only 2 *absolute* contraindications to giving the DTaP vaccine?
Anaphylaxis prior
Encephalopathy prior
140
Hypertrophic Pyloric Stenosis cp -3
1. **OLIVE SHAPED EPIGASTRIC MASS**
2. Visually prominent abd peristaltic waves (from exaggerated gastric contractions)
3. Projectile nonbilious Vomiting
## Footnote
*demographic: [first born boys 3-5 wks old]*
141
What is the treatment for Developmental Dysplasia of Hip?
Pavlik Harness that holds hip in flexion and ABduction
142
Identify possible causes of this rash - 3
**THE STRAWBERRY TONGUE!**
1. [GASP +/- mononucleosis]
2. Kawasaki disease
3. Toxic Shock Syndrome
143
*Transient Synovitis is the most common cause of hip pain in kids*
Mgmt for Transient Synovitis - 3
[**obtain Xray to r/o Legg Calve Perthes**]
Tx = NSAID and rest
144
Young child p/w chronic cough and focal wheezing that are not responsive to albuterol is suspicious for ⬜. Next Step = ⬜
Foreign Body Aspiration ; Bronchoscopy
145
Main features of Becker Muscular Dystrophy - 4
1. [Xp21 deletion] *(X-link recessive deletion on Chromo Xp21)*
2. Scoliosis
3. [peds onset **at 5 yo**]
4. [cardiomyopathy ➜ **4****0-50 yo DEATH**]
146
What is the most common cause of Chronic renal failure (and urinary tract obstruction) in pediatrics?
[Posterior Urethral membranous valves]
| *AFFECTS BOYS ONLY - including newborns*
147
tx for [irritant contact diaper dermatitis] -4
*"treat baby diaper rash you **LZPC**!"*
[**L**ifestyle ∆ (frequent diaper change, avoid tight diapers)]
+
2. **Z**inc Oxide (topical barrier)
3. **P**etrolatum (topical barrier)
4. **C**TS cream
148
Maternal Macrolide use during pregnancy is a risk factor for ⬜ , which typically presents in ⬜ demographic with (⬜3)
[hypertrophic pyloric stenosis] ; [first born boys 3-5w old] ;
[PROJECTILE **NONBILIOUS** VOMITING] + [PALPABLE OLIVE SHAPED ABD MASS] (🎯XR)
| *🎯target sign radio could indicate Pyloric stenosis or intussusception*
149
main characteristics of [Candida Diaper Dermatitis] -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*2nd most common diaper dermatitis*
1. **SKIN FOLD INVOLVEMENT**
2. beefy red plaques
3. satellite lesions
150
diagnosis?
hypertrophic pyloric stenosis
151
Congenital hypOthyroidism is a common and preventable cause of ⬜ in kids; but may be difficult to detect. Why is that?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how do you manage congenital hypOthyroidism?
*sx: hypOtonia/poor feeding/lethargy/constipation*
intellectual disability ; because maternal T4 crosses placenta most newborns lack clinical signs of congenital hypOthyroidism (hypOtonia, poor feeding, lethargy, constipation) at birth
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
give infant levothyroxine [**by 2 WEEKS OF AGE**]
## Footnote
*T4 is important for neurodevelopment and myelination*
152
The 2 major causes of [bloody stool \< 6 month old are **FPIAP**] and **⬜**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how do you manage FPIAP once it's diagnosed?
*FPIAP = Food Protein Induced Allergic Proctocolitis*
Anal fissure
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
*FPIAP = non-IgE rxn to milk protein (casein/whey) = no skin/pulm rxn*
153
Diagnosis?
What other syndrome is this disease a/w?
Hirschsprung disease
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DOWN SYNDROME trisomy 21
## Footnote
{[**SHEEPPS**]*traits* & [**SHALA** **H**as **D**own **S**yndrome]*conditions*}
154
What is the major (and contraindicating) side effect of the Rotareovirus vaccine?
Intussusception
## Footnote
*Live attenuated vaccine*
155
describe clinical course for this infant
[superficicial infantile **hemangioma**] proliferate and grow the 1st year of life
BUT REGRESS EARLY CHILDHOOD
= observation only unless cosmetic/bleeding/functional impairment
156
What is Primary nocturnal enuresis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
After ⬜ months of Behavioral changes, Enuresis Alarm is recommended. How does the Enuresis Alarm work?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What medication can be added if this still doesn't work?
lack of nighttime dryness in kids age ≥5 y/o *that usually spontaneously resolves over time*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
1st: [Behavior ∆ x 3-6 mo] (⬇︎evening fluids/reward system)
2nd: **ENURESIS ALARM** (when sensor in pt's underwear starts detecting moisture ➜ audiovibratory alarm ➜ wakes child right at initiation of their involuntary micturition = before any further bladder emptying occurs. Eventually, alarm conditions the child to wake up just before voiding
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Desmopressin ADH]
157
How do you manage UTI in peds less than 2 yo
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
what about peds \> 2 yo?
after 1st febrile UTI,
in [peds \< 2 yo]= abx +[renal/bladder US (to evaluate for anatomic abnl) --(if abnl)--\>VCUG]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[peds \> 2 yo] =
abx
➜ {R/B US --+→
{VCUG <-N- [ UTI resolve? ] -Y-> Nothing more}
| *VCUG = Voiding CystoUrethroGram*
158
Neonatal brachial plexus injuries (like Erb Duchenne palsy) are most commonly a/w shoulder dystocia in infants that have ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
management?
[macrosomia \> 4 kg]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
supportive care (*recovers spontaneous*)
159
Why do pts with this condition often have polyhydramnios?
Hernia of Diaphragm compresses esophagus --\> polyhydramnios
## Footnote
Congenital Diaphragmatic Hernia
*Image = Scaphoid concave abdomen with Barrel Chest*
160
[Croup Laryngotracheitis] treatment (4)
1. [mild (no Stridor at rest)] = h +/- C
2. [MODERATE/SEVERE (STRIDOR AT REST)] = C + E
| h:humidified air / C:CTS / E:Epinephrine-Nebulized-Racemic
## Footnote
*[Croup Laryngotracheitis] = paraflu that --> subglottic edema and narrowing = barky brassy cough f/b inspiratory stridor*
161
*5 month old female* pt presents with apparent leg length discrepancy and is diagnosed with \_\_\_\_\_\_
What is the work up for this condition?-2
Developmental Dysplasia of Hip
hip ultrasound \< 4 mo \< hip xray
162
Name the 4 major risk factors for Hypertrophic Pyloric Stenosis
*"Hypetrophic Pyloric Stenosis _M_mmmakes a tight first in his stomach"*
- *m*ale firstborn
- [*m*acrolide exposure*[anytime from (pregnancy - 2 wks old)]*]
- *m*aternal smoking
- *m*ega fam hx
163
What are 2 major signs of tooth decay?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Name 3 risk factors for a baby developing tooth decay?
white spots / discoloration
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. frequent sugar
2. nighttime bottle/feedings
3. Inadequate fluoride
*Primary Dentist must be established by 1 y/o*
164
cp Thyroglossal duct cyst
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How should it be managed (2)? why?
[s/p URI, superior to thyroid, fluctuant midline neck mass, in kids that moves superiorly when swallowing]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1st: [Thyroid imaging *(to ensure native thyroid is functional and/or ensure (prior to planned surgical removal)TDC isn't the sole site of functioning [ectopic] thyroid tissue)*
2nd: ➜ **TDC planned surgical removal**]
## Footnote
(TDC may be the only site of functioning [ectopic] thyroid tissue so obtain thyroid imaging prior to definitive **surgical** removal)
165
Name the 3 classic sx of [Croup LaryngoTracheitis]
{[Barky *Brassy* cough]
+hoarseness}
➜ [inspiratory stridor]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
{[mild*h +/- C*] ←N**(istridor at rest?)**Y➜MOD/SEVERE*C+E*]}
166
[Advanced Maternal Age ≥35] is a risk factor for ⬜, which is a/w with which 8 comorbid conditions?
Down Syndrome Trisomy 21
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
{**SHALA** **H**as **D**own **S**yndrome]*conditions*}
1. [**S**EPTAL ENDOCARDIAL CUSION DEFECT]
2. [🍼**H**irschsprung disease (dilated Colon)]
3. [**A**tlanto-axial instability]
4. [**L**eukemia (Later in life)]
5. [**A**ltered Psyche (ADHD/Autism/Alzheimer-like dementia)]
6. **H**ypOthyroid
7. [🍼**D**uodenal atresia (double bubble)]
8. [*tri***S**omy 21]
| 🍼 = neonatal onset
## Footnote
{[**SHEEPPS**]*traits*
167
Which 2 deformations is Breech positioning associated with?
Torticollis
[DDH (Developmental Dysplasia of Hip)]
168
cp for Laryngomalacia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
dx?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
tx?
[P2: inspiratory stridor that improves when prone]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Direct laryngoscopy
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
self limited to 18 mo
169
infant pt presenting with undescended testis = ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
At what age should this infant be **referred** for Orchiopexy?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
When should Orchiopexy occur?
Cryptorchidism
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
≥ 6 months old
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Orchiopexy before 1 yo
170
In peds **\> 1 yo**, ⬜ and/or ⬜ are primary contributors to the development of iron deficiency anemia
How does this present? -2
[excessive milk intake \> 24 oz/day] ; [low intake of iron-rich food]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
microcytic anemia + elevated RDW
171
What do you do if a family comes to clinic and you suspect the infant patient (their child) is being abused? (2)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What are telltale signs of intentional *burn* injury? (4)
[arrange STAT ambulance transport to ED] + [notify child protective services]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
- [uniform burn with linear demarcation] ... that has
- NO splash marks
- NO flexural crease involvement
- NO central buttock involvement
172
A: Clinical Manifestations of **DiGeorge Syndrome** (5)
B: Genetic Cause
"**CATCH 22** & **P**a**3**"
## Footnote
**C**ardiac (*Aortic Arch abnormalitites, Tetralogy of Fallot*)
**A**bnormal face (Bifid Uvula/low set ears)
**T**hymus Aplasia
**C**left Palate
[**H**ypOcalcemia from PTH deficiency] *may*--\> *Carpopedal Spasms*
**22**q.11.2 deletion
**P**haryngeal arch - **3**rd/4th both fail to develop
173
Main features of Duchenne Muscular Dystrophy - 5
1. [**CALF PSEUDOHYPERTROPHY** requiring gower manuever + teenage wheelchair] = [⇪ Creatine Kinase]
------------
2. [Xp21 deletion] *(X-link recessive deletion on Chromo Xp21)*
3. Scoliosis
4. [peds onset **at 2 yo**]
5. [cardiomyopathy ➜ **20-30 yo DEATH**]
174
etx for Choanal atresia in kids
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cp
Congenital **failure of posterior nasal passage to canalize** --\> bony obstruction instead
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*baseline cyanotic infant* whose:
cyanosis [⇪ with feeding] but [⬇︎ with crying]
*Dx = inability to pass catheter thorugh nares*
175
cp for "Growing Pains"
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?
[childhood 3-12 yo] with [**nocturnal** BILATERAL LE pain] and NO OTHER FINDINGS
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[supportive (massage/heat/stretching/analgesic)]
176
Precocious puberty is (premature) development of 2º sex characteristics in girls age ⬜ and boys age ⬜
How do you work this up?
g< 8 | b< 9
177
Tx for Congenital Toxoplasmosis -3
[Pyrimethamine with Folinic acid FH4 *B9*]
*PLUS*
## Footnote
{[SulfaDiazine] or [Clindamycin]}
178
Exchange Transfusion in neonates involves ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
When is this indicated? (3)
exchanging [blood with SEVERE HYPERBILIRUBINEMIA and/or DAT+ maternal Ab] from baby and transfusing baby with replacement RBC
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
1. total bilirubin \> 20-25
2. worsening hyperbilirubinemia on phototherapy
3. kernicterus bilirubin encephalopathy
179
*Your infant patient is due for the [Varicella Zoster Virus] Vaccine, but the patient lives with its immunocompromised grandmother*
How do you manage this? (2)
* [VZV (live) vaccine] CAN be administered to [immuno**competent**(baby)] patients with household contacts who are [immuno**C❌MPROMISED**(grandmother)] as long as the [immuno**competent**(baby)] develops NO RASH after given Live Vaccine
* After given [VZV (live) vaccine] monitor [immuno**competent**(baby)] for rash --(if rash develops)--\> isolate [immuno**competent**(baby)] from [immuno**C❌MPROMISED**(grandmother)] in the household
180
Meckel's Diverticulum symptoms-5
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you diagnose Meckel's Diverticulum
⭐[NONPAINFUL HEMATOCHEZIA +/- IDA in 2y/o] ⭐
*(also possible):*
-asx
-Intussusception
-diverticulitis-
-Bowel obstruction
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[ MT9P scan]
| MT9P = [Meckel's Technetium-99m Pertechnetate]
181
For teens, what's the difference/define [Constitutional Delay of Puberty]-4
and [Familial Short Stature]-2 ?
[Constitutional **DELAY** of Puberty] = [**DELAYED** secondary sexcharacteristics] + [**DELAYED** XR wrist bone age] + [**DELAYED**"short" height] + [**DELAYED** sx also in fam hx]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Familial Short Stature] = Short Stature + [Normal XR wrist bone age]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*BOTH MUST HAVE NORMAL GROWTH VELOCITY*
182
**In medicine, children vaccine are almost never postponed**
Describe why [IVIG tx (i.e. Kawasaki tx)] can delay the pediatric vaccine schedule? (2)
▶IVIG is composed of pooled antibodies → can alter patient's normal immune response to *live* vaccines =
⭐patient must wait 11 months after completing Kawasaki disease treatment before they can receive any *live* vaccines
183
*Newborn failure to pass meconium **within 48 hours of birth** likely indicates ⬜*
how is this diagnosed? -2
Hirschsprung Disease
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Abd XR = contrast enema demonstrating transition zone] ➜ [**RECTAL SUCTION BIOPSY** (***gold standard*****)]**
184
***Physiological** Gastroesophageal reflux is common in infants*
What is the mngmt for this?-3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
When should you be concerned for GER Disease in infants?-2
**\*REASSURANCE**
\*[hold infant upright after feeds]
\*[(**if GERD**) = thicken feeds with oatmeal + PPI]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
GERD =
- failure to thrive
- opisthotonic posturing after feeds
185
Infants that are Small for Gestational Age (SGA) are at risk for developing what complications? - 4
"I'm small, **GOT C**alcium?"
1. low **G**lucose
2. [low **O**xygen --\> (high RBC polycythemia)]
3. low **T**emperature
4. low **C**alcium
186
⬜ is the preferred imaging for Pyloric Stenosis
How does this present?
Abdominal ultrasound
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[First born males 3-5 weeks old] ➜ Non-bilious emesis **withOUT abdominal distension** + epigastric olive mass
187
Dx
X-ray = Pneumotosis Intestinalis
Necrotizing Enterocolitis
188
What is [Physiologic anemia of infancy] -4?
🔴ASYMPTOMATIC and Expected DEC in newborn hgb 2nd month of living
🔴2/2 INC oxygen to [newborn ex utero (compared to in utero)] ➜ transient downregulation of erythropoietin ➜ DEC RBC
🔴DEC RBC resultantly = [Hgb \> 14 at birth/1ST month living] to [**Hgb 9-11 at 2ND month living**] to [Hgb nml 12-13 GOE 3RD month living]
🔴At GOE 3 months old, erythropoietin drive should return to normal
## Footnote
*red flags: anemia 1st month |hgb < 9 |hemolysis (constant jaundice|reticulocytosis) / hypOchromic|microcytic RBC (iron deficiency/thalassemia)*
189
# Physiologic anemia of infancy should resolve ___ months of age
Name the RED FLAGS of [Physiologic anemia of infancy] -5
GOE3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*anemia 1st month*
*hgb < 9*
*hemolysis (constant jaundice|reticulocytosis)*
*[hypOchromic RBC (iron deficiency/thalassemia)]*
*[microcytic RBC (iron deficiency/thalassemia)]*
## Footnote
🔴physiologic DEC EPO/RBC resultantly = [Hgb \> 14 at birth/1ST month living] to [**Hgb 9-11 at 2ND month living**] to [Hgb nml 12-13 GOE 3RD month living]
190
What's the main difference between [irritant contact diaper dermatitis] and [candida diaper dermatitis]?
[Candida Diaper Dermatitis] **INVOLVES [GENITOCRURAL SKIN FOLDS]**
191
Childhood Absence Epilepsy
cp
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dx?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?
multiple brief (\< 20 seconds) lapses in consciousness every day
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[EEG 3 Hz Spike] ; Ethosuximide
192
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*Birth*
HBV
## Footnote
"**Hewa** / D P His Hairy Pretty Rectum / "/ "/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) "
193
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*2 months old*
1. **D**TaP
2. **P**olio
3. **H**BV
4. **H**ib
5. **P**CV
6. **R**V
## Footnote
"Hewa /**D P His Hairy Pretty Rectum** / "/ "/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) "
194
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*4 months old*
1. **D**TaP
2. **P**olio
3. **H**BV
4. **H**ib
5. **P**CV
6. **R**SV
## Footnote
"Hewa / D P His Hairy Pretty Rectum /**"**/ "/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) "
195
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*6 months old*
1. **D**TaP
2. **P**olio
3. **H**BV
4. **H**ib
5. **P**CV
6. **R**SV
## Footnote
"Hewa / D P His Hairy Pretty Rectum / "/ **"**/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) "
196
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*12 months old*
1. **H**AV
2. **M**MR
3. **V** ZV
4. **H**ib
5. **P**CV
## Footnote
"Hewa / D P His Hairy Pretty Rectum / "/ "/ **He Made Victor Have Pussy** / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) "
197
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*15 months old*
**D**TaP
## Footnote
"Hewa / D P His Hairy Pretty Rectum / "/ "/ He Made Victor Have Pussy / **Dick** / Head // Victor D P Me /Handed Me T/ Making Me / (fall) "
198
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*18 months old*
**H**AV
## Footnote
"Hewa / D P His Hairy Pretty Rectum / "/ "/ He Made Victor Have Pussy / Dick / **Head** // Victor D P Me /Handed Me T/ Making Me / (fall) "
199
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*4-6 year old*
1. **V**aricella
2. **D**TaP
3. **P**olio
4. **M**MR
## Footnote
"Hewa / D P His Hairy Pretty Rectum / "/ "/ He Made Victor Have Pussy / Dick / Head // **Victor D P Me** /Handed Me T/ Making Me / (fall) "
200
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*11-12 year old*
1. **H**PV
2. **M**enACWYD
3. **T**DaP
| Men: Meningococcal
## Footnote
"Hewa / D P His Hairy Pretty Rectum / "/ "/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /**Handed Me T** / Making Me / (fall) "
201
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*16 year old*
1. **M**enACWYD
2. **M**enB
| Men: Meningococcal
## Footnote
"Hewa / D P His Hairy Pretty Rectum / "/ "/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T / **Making Me** / (fall) "
202
# Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
*annual*
for all ≥6 month old:
1. [every**(fall)** → Flu x 1]
2. [COVID x 3] x 1
## Footnote
"Hewa / D P His Hairy Pretty Rectum / "/ "/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T / Making Me / **(fall)**"
203
# For ⬜ name the ⬜ developmental milestone(s)
*18 month old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Gross motor
204
# For ⬜ name the ⬜ developmental milestone(s)
*18 month old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
fine motor -2
205
# For ⬜ name the ⬜ developmental milestone(s)
*18 month old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Language -2
206
# For ⬜ name the ⬜ developmental milestone(s)
*18 month old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SOCIAL -2
207
# For ⬜ name the ⬜ developmental milestone(s)
*2 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Gross motor -2
208
# For ⬜ name the ⬜ developmental milestone(s)
*2 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
fine motor -2
209
# For ⬜ name the ⬜ developmental milestone(s)
*2 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Language -2
210
# For ⬜ name the ⬜ developmental milestone(s)
*2 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SOCIAL -3
211
# For ⬜ name the ⬜ developmental milestone(s)
*3 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Gross motor -2
212
# For ⬜ name the ⬜ developmental milestone(s)
*3 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
fine motor -2
213
# For ⬜ name the ⬜ developmental milestone(s)
*3 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Language -2
214
# For ⬜ name the ⬜ developmental milestone(s)
*3 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SOCIAL -3
215
# For ⬜ name the ⬜ developmental milestone(s)
*4 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Gross motor -2
216
# For ⬜ name the ⬜ developmental milestone(s)
*4 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
fine motor
217
# For ⬜ name the ⬜ developmental milestone(s)
*4 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Language -2
218
# For ⬜ name the ⬜ developmental milestone(s)
*4 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SOCIAL
*4S:* Cooperative Play
219
# For ⬜ name the ⬜ developmental milestone(s)
*5 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Gross motor -2
220
# For ⬜ name the ⬜ developmental milestone(s)
*5 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
fine motor -5
221
# For ⬜ name the ⬜ developmental milestone(s)
*5 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Language -2
222
# For ⬜ name the ⬜ developmental milestone(s)
*5 year old*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SOCIAL -2
223
APAP
MOA
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
During APAP OD, how does it cause damage? ; How is Alcohol related?
*reversibly* inhibits *CNS*_COX = antipyretic | analgesic ONLY (NOT ANTIINFLAMMATORY)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
| COX = Cyclooxygenase
## Footnote
▶APAP OD forms [TOXIC_NAPQI] → which eventually depletes [protective_Glutathione] = [TOXIC_NAPQI] accumulates to cause hepatic necrosis.
▶EtOH stimulates ([CYP450-2E1] - which catalyzes APAP → [TOXIC_NAPQI].
⭐APAP before ALcohol is ✅
