1.

Kawaski
a. 5 symptoms
i. non-purulent conjunctivitis
ii. strawberry tongue/cracked lips (oral mucosa involvement)
iii. fever >5 days
iv. rash palms/ soles = desquamating
v. unilateral (mc) or bilateral (>1.5 cm) cervical AD * Big
b. treatment/MGT
i. echo-r/o coronary artery aneurysm (immediately)
ii. IVIG
iii. Aspirin
iv. @2 months (6-8 weeks later) repeat echo
v. + vaccinate against flu and varicella (d/t aspirin want to
prevent viral infection)
vi. reyes syndrome
c. labs
i. anemia with high platelets ** (thrombocytosis)
ii. elevated ESR/CRP
iii. elevated hepatic enzymes
2. Epiglotitis
a. Used to H. Flu no with step pneumo, non type influenza
b. Symptoms
i. Stridor
ii. Red epiglottitis
iii. DIB
iv. High fever-abrupt
v. Drooling
vi. Sniffing position
c. Dont look until OR - get in OR and have specialist look and
intubate at same time
d. Secure airway
3. Meningitis
a. Buizzinski flex hip = forced flex neck
b. Kurnigs flex hip/ ext knees = pain
c. Signs
i. Nuchal rigidity
ii. Fever
iii. Headache
d. Babies
i. Poor feeding, irritability
ii. Fever
iii. Bulging fontanel
4. Chronic otitis media
a. Check hearing @ 3 months
i. Bad = tubes
 ii. Fine = antibiotics check @ 6 months but effusion; still
effusion = tubes
5. Bronchiolitis/RSV
a. Symptoms
i. Wheezing, inspiratory stridor, excess muscle use, low grade
fever
ii. Increased respiratory rate = bad progress factor
iii. **4th/5th day is the worst
b. diagnosis/history (clinical)
c. treatment
i. 1st line hydration/O2
ii. 2nd line hospitalization +intubation
iii. paluvisumab prophylaxis syngeristic only up to 2 years
iv. bronchopulmonary dysplasia
v. congenital heart disease
vi. prematurity (<29 weeks)
6. Croup parainfluenza
a. Symptoms: inspiratory stridor, seal barking cough, worse at night,
better with cold air, low grade fever, ** trachitis superimposed
bacterial infection occurs over few days
b. Diagnosis: clinical
i. Chest x-ray- septal sign
c. Treatment first line supportive
i. Second line severe hospitalize
1. + racemic epi
2. consider intubation
ii. mycobacterium TB
1. normal bacteria labs, but increased lymphocytes
7. Peritonsilar Abscess:
a. Distortion of uvula
b. Diagnosis - clinical
c. One sided push uvula to other side
d. Treatment incision/ drain abscess
e. Complication strep throat
8. Retropharngyeal abscess
a. Acute high onset fever, drooling, hot potatoe voice (same
symptoms of epiglottitis) sniffing position, DIB
b. Diagnosis: lateral abscess neck, retropharyngeal spaces <50% or
vertebral body
i. If >50% = diagnostic
c. Treatment: incision/drainage; abscess specialist
d. Can see trismus cannot open mouth fully
9. Strep throat center criteria
a. <15 year old = 1 pt
b. fever = 1 pt
c. NO cough = 1 pt
 d. Exudates = 1 pt
e. Anterior cervical adenopathy = 1 pt
f. 0-1 pt = send home
g. 2-3 pt = swab
h. 4-5 pt = antibiotics (even if rapid negative)
i. ***kids swab for rapid strep and culture; negative = culture
positive = antibiotics no culture
10. Tonsillar exudates:
a. Mono - + post cervical LAD, splenomegaly
b. Strep - + No cough, fever, anterior cervical LAD
c. Adeno - + Red eyes
11. Conjunctivitis in the Newborn
a. Within 1st 24 hours chemical conjunctivitis
b. 1st week Gonorrhea 3rd generation cephalosporin
(cephtriaxone)
c. 1-2 weeks Chlamydia erythro drops and oral
d. Herpes anywhere within 2 weeks associated with vesicles
seomwhere on body; acyclovir or topical vidarabine
12. Whooping Cough (pertussis)
a. azithromycin and contacts with azithromycin
13. Measles
a. maculopapular rash starts behind neck and goes down the trunk
b. Koplick spots, cough, coriza, conjunctivitis
c. Give vitamin A
14. Rubella
a. LAD, and rash (similar to measles)
b. Congenital PDA, blindness, deafness
15. Roseola
a. high fever and then get rash, + febrile seizures
16. Toxoplasmosis
a. Chorioretinitis, intracranial calcification (in cortex), hydrocephalus
(triad)
17. CMV
a. Congenital: periventricular calcification, sensory hearing loss,
blueberry muffin rash, seizures
18. Syphilis
a. congenital: severe runny nose right at birth
19. Breast milk jaundice:
a. prevent 2 wk ** read Kaplan
20. RDS:
a. Ground glass appearance on chest x-ray or air bronchograms
21. Low birth weight with prematurity:
a. Greatest risk factor for CP
b. * no cure, diagnosis by not meeting motor milestones over time,
affects legs more
c. * hand predominately over feet
22. All boys 2-5 years old:
a. White males
b. Recurring infection
c. Petechia
d. Anemia
e. Weight loss
f. Fever
g. Definitive diagnosis bone marrow
h. ** present with severe bone pain
i. biopsy >25% blasts
i. comp-chemo tumor lysis syndrome
23. Tumor lysis syndrome
a. All high electrolytes except calcium is decreases (binds to
phosphate)
b. All 15% relapse from remission into
i. CNS
ii. Testicles
c. after round chemo-interthecal methotrexate to get residue in
brain, chemo does not cross BBB
d. hyperuricemia tx allopurinol
24. Neuroblastoma:
a. N-MYC
b. Along sympathetic chain in abdomen
c. Crosses midline
d. Abdomen mass, opsoclonus, myoclonus, ptosis, subcutaneous
noducles on feet/hands, +/- HTN,
e. Diagnosis:
i. 1st line urine test for catecholamines
ii. definitive biopsy, rosettes small round blue homer-wright
25. Wilms: Abdominal mass, HTN, DOES NOT CROSS MIDLINE,
hematuria (micro or gross)
a. WAGR & Beckwith-weirderman
i. B-cell hypoplasia, hypoglycemia
b. Need to check AFP, increase IGF, (hepatoblastoma) and for wilms,
hemihypertrophy, macroglossia, macrosomnia, in baby with mom
without DM
c. Diagnosis: 1st line = ultrasound; confirm biopsy
26. Osteoma
a. Pain relieved with NSAID
b. Unilateral
c. ** order x-ray of leg
i. dot with small (sclerotic) central lucency/ clearing
27. growing pains
a. relieved with NSAIDs
b. bilateral migrating
c. ** reassure parents
28. Ewing sarcoma
a. + systemic symptoms fever, weight loss
b. x-ray onion skin
29. Osteosarcoma
a. No systemic symptoms
b. X-ray sunburst appearance and codmans triangle
30. Osgood schlatter High yield
a. Over use in active people/runners
b. Tender over tibial tuberosity
c. Treatment decreased activity 2-3 months until asymptomatic
31. Supracondylar fracture
a. Medical nerve and brachial artery
b. Decrease motion of thumb and 1st 2 fingers and sensation
32. Salter-harris fracture
a. Fracture of epiphyseal plate
33. Duchennes muscular dystrophy
a. Dystrophin deficiency in males 2-3 years old
b. Proximal muscle weakness, gower maneuver, calf
pseudohypertrophy
c. Diagnosis: increased CK 1st line
i. Definitive muscle biopsy
ii. MCC death- dilated cardiomyopathy
34. Developmental hip dysplasia high yeidl
a. oligohydramnios/ multiple gestation
b. family history
c. female
d. breech position
e. PE leg length discrepancy
i. Asymmetrical skin folds
ii. Barlow dislocation = chunk
iii. Ortolani put back in place
f. Next step
i. <6mos US of hip
ii. >6mos xray of hip
g. treatment
i. <6mos pelvic harnis
ii. >6mos spike cast or surgery
35. SCFE
a. > 10 year old boys *** classic obese patient with knee pain!
b. pain anterior thigh and knee
c. diagnosis
i. x-ray anterior/frog
d. treatment: immediately = crutches and stop weight bearing =
surgery to stabilize ( screw)
e. Obese + SCFE look for hypothyroid
36. Legg-calve-perthes
 a. <10 year old boys
b. painless limb
c. diagnosis same as SCFE
d. treatment from none to decreased range of motion/symptoms
bracing avascular necrosis

37. scoliosis
a. need to tanner stage to see if still going to go through growth
spurt
b. can get worse
c. 20-49 degrees = brace
d. >50 degrees = surgery
38. No bottles in crib: erode teeth from sugar

brown on top upper tooth decay

39. encephalopathy within 1 week of Tdap
a. cannot give pertussis anymore, have to give TD;
b. only way to not give any = anaphylaxis to Tdap
40. Lead poisoning
a. Test at 1 and 2 years old
b. 45-70 oral succimer
c. >70 admit EDTA and BAL (dimercaperol)
d. <45 retest (increase number, sooner retest)
41. iron poisoning
a. N/VID bloody
b. X-ray white dots = iron
42. Posterior urethral valves
a. Found in the newborn istended bladder and weak stream
b. Treat catheter and drain bladder
i. Surgery remove
c. Can get bilateral hydronephrosis
43. Ureterovesical Reflex
a. Recurrent UTIs
b. Grade 1-2 reflux prophylactic antibiotics prevent UTIs > 3
surgery
c. Test 1st US (dilatory ureters/hydronephrosis +); 2nd - VCUG
(voiding cystourethrogram); renal scarring
d. See if reflex is present and grade
e. Complication = renal scarring
44. Testicles should be distended by 6 months
a. If not, surgery to bring them down/ remove by 1 year old
i. Retractile testes:
1. Manipulated into testicle okay
 a. Will come down on own (short spermatic cord)
45. ADHD
a. Need symptoms in at least 2 settings
b. <13 years old
46. skin
a. tinea capitus griseofulvin
b. tinea corporus terbinafine
47. Eczema
a. Topical corticosteroids
48. Puberty
a. precocious - > 8 years old
b. delayed - < 16 years old in boys; < 14 years old in secondary CH
49. eczema herpeticum
a. emergency admit immediately
50. herpes in kids can cause pneumonia and encephalitis
51. most serious complication of otitis media and sinusitis =
cerebral abscessed
a. visualize via head CT or MRI
b. symptoms persistent fever, variable neuro defects, HA, seizures,
increased intracranial pressure d/t edema, surgically remove
52. differential diagnosis for acute appendicitis
a. Yersinia enterocolitis
b. Mesenteric adenitis
c. Constipation
d. Crohns
e. Meckels diverticulum
f. Ectopic pregnancy
g. Ovarian torsion
h. UTI
53. Most common cardiac abnormality in infants of DM **
improves with time
a. Asymptomatic septal hypertrophy (LV outflow tract)
b. Also increase incidence of retained lung fluid (tachypnea with
perihilar edema and fluid in tissues)
c. Surfactant deficiency at or near term = RDS
54. Renovascular disease is most common cause of secondary
HTN in young children
55. Apnea or prematurity apnea associated with bradycardia and
hypoxemia. d/t immaturity of infant neurological and respiratory
symptoms
a. Primary treatment methylxanthines( caffeine/theophylline) to
stimulate respiratory neurons
i. Typically resolves by time infant is 34-36 weeks gestational
age
56. Pyloric stenosis: hypochloremic, hypokalemic, metabolic
alkalosis
 a. Barium enema = string sign
b. Definitive diagnosis = Ultrasound
57. Infantile hemangiomas
a. Most common benign tumor of children (arise from vasculature)
can arise cutaneously or be present with in any organ
i. Self-limiting, involuting ~ 18 months
ii. Lung tumors = high output cardiac failure d/t increased
blood flow to the lesions
iii. Can cause platelet sequestration and destruction, leading
to coagulopathy
iv. May rupture and cause bleeding
58. 21-alpha-hydroxylase deficiency
a. decreased cortisol/aldosterone
b. increased testosterone
c. increase 17-hydroxyprogesterone
d. ambiguous genitalia in girls, salt wasting, vomiting, hypotension,
decreased sodium, increase potassium
59. 11-beta-hydroxylase deficiency
a. decreased cortisol/aldosterone
b. increased testosterone
c. increased 11-deoxycorticosterone (weak mineral corticoid) and 11
deoxycortisol
d. ambiguous genitalia in girls, fluid and salt retention
60. 17 alpha hydroxylase deficiency
a. decreased cortisol/testosterone
b. increased mineral corticoids
c. increased corticosterone (weak glucocorticoids)
d. all pts phenotypically female, fluid, salt retension
61. tetralogy of fallot
a. tet spells treat with knee-chest position (squatting) to increase
systemic vascular resistance, decrease shunting of Deoxygenated
blood into aorta (through VSD), instead into pulm artery
62. leading factor for CP
a. prematurity
63. bacterial sinusitis
a. persistent nasal drainage, congestion, and cough ~10-30 days
without improvement; can have high fever
i. MC predisposing factor is viral URI
ii. TX augmentin amoxicillin/clauvanic acid
64. Pathologic lead point should be suspected in older
children with recurrent intussusception. Meckles most
common congenital anomaly
65. McCune-Albright
a. Precocious puberty, pigmentation (caf au lait spots), and
polyostotic fibrous dysplasia (bone replaced by fibrous tissue