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PEDIATRICS BOARD REVIEW

Your Certification SYSTEM for


Passing the Pediatric Boards

100% Money Back Pass Guarantee


MASSIVE Online Community
Board-Focused, Manageable Content
Powerful Mnemonics

EFFICIENT LEARNING So You Can


Enjoy Life & Have More Fun!

Written By Ashish Goyal, MD

Edited By Dr. Michael Blyth (A PBR Alum)

www.PediatricsBoardReview.com ***COPYRIGHT

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COPYRIGHT INFORMATION
2011, 2012, 2013, 2014, 2015, 2016 Pediatrics Board Review, Inc.

All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, digital storage or otherwise, without prior written permission
of Pediatrics Board Review, Inc.

Any reproduction, presentation, distribution, transmission, or commercial use of the concepts, strategies,
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Board Review, Inc. in any media, now known or hereafter invented, is prohibited without the express written
permission of Pediatrics Board Review, Inc. It is prohibited to use any device, now existing or hereafter
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video materials of Pediatrics Board Review, Inc.

The legal entity Pediatrics Board Review, Inc. may be referred to as Pediatrics Board Review or PBR.

Reproduction of Pediatrics Board Review, Inc. material without written permission is punishable by
law.

ISBN 978-1-300-45528-8

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INTRODUCTION TO THE PBR EXPERIENCE! (Please Read This!!!)
HI! My name is Ashish Goyal. Ive been fortunate enough help thousands of pediatricians with
their board review experience through the PBR. Im a double-boarded physician living on the
most isolated landmass in the world, yet some of my greatest success stories come for
pediatricians across the United States.

My favorite stories are those from pediatricians who had previously failed 46 times before they found the
PBR, but then passed by using the PBR Certification System. Those wonderful success stories clearly show
that the PBR system is perfect for first-time AND repeat test takers. While there are PBR digital, audio and
video resources available to streamline and cement the core material, the Core Study Guide and the Q&A
book are at the center of the PBR system and they are essential towards helping you pass your exam.

PBR is great for residents looking to boost their In-Training Exams (ITE), new pediatricians taking their
American Board of Pediatrics (ABP) initial certification exam for the first time, pediatricians who have failed
the initial certification exam, and for busy pediatricians studying for their ABP Maintenance of
Certification (MOC) exam.

PBR is much more than a collection of study resources. Its a group experience and a system that
provides you with ALL of the CONTENT, test-taking TECHNIQUE, GUIDANCE, and COMMUNITY
SUPPORT that you need to pass your exam. You truly do NOT need any other board review book to pass
your exam.

The national first-time pass rate is usually in the 75%85% range for the (ABP) initial certification exam. By
analyzing surveys, Money Back Pass Guarantee requests, and emails, we estimate that PBRs first-time
pass rate for all ABP exam is > 95%!

For the ABP MOC recertification exam, the pass rate with PBR has been 100% (2011 2014) for practicing
general pediatricians, and very similar for pediatric subspecialists. In 2015, only ONE pediatrician failed on his
first attempt at the MOC, and he admitted that he barely looked at the PBR resources.

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WHY DOES THE PBR WORK?
EFFICIENCY THROUGH SYSTEMS AND INNOVATION

Most board review books and courses simply hand you a book and say, good luck. Thats how I
studied for the USMLE exams, the pediatric board exam (twice) and the Internal Medicine board exam. I was
completely isolated! After purchasing thousands of dollars of board materials, I was left to go through the
books and video courses with no real guidance, no feedback from my peers, and absolutely no advice from
the authors (besides a one-page preface).

Because of how excruciatingly painful that was, Ive create a community of pediatricians for you to study
with and a blueprint of what to study, how to study it and how to do so EFFICIENTLY!

In fact, ALL of the PBR resources are created with your time in mind.

Will the resource be easy to use?


Will it provide more value than existing resources AND provide that value in a more streamlined fashion?
Can we make the resource digital for easy access via smart phones and tablets?
Will the resource reinforce the core concepts laid out in the PBR and in the Q&A book instead of
overwhelming with new concepts?
Can we make the resource portable (e.g., audio or video?) so that it can be used at times when a
physician, or a mom, or a dad, or a gym-enthusiast, would not normally be able to study?

PBR is a system unlike anything you have ever experience before in your medical career. The Core
Study Guide is written in easy-to-understand language and provides you with hundreds of time-saving
memory aids. The online systems allow for one-click access to hundreds of high-yield images across the web.
The Q&A book has some of the highest yield and most board-relevant questions available.

You also have a ready-made study group of hundreds of pediatricians. Its called the PBR Facebook
CREW, and it will help you EFFICIENTLY blow past trouble spots in your studying. Plus, if you see an
error in the book, or if you would like to submit an official request for content clarification, you can simply
submit the info to me through PBRs error submission portal (http://www.pediatricsboardreview.com/error).
Your submissions will likely be used to create a PDF response that is made available to ALL PBR
members in order to enhance the PBR experience for the entire PBR community.

All of these efficiency-focused systems SAVE YOU OVER 100 HOURS OF TIME and give you flexibility in
your life to enjoy your family, your friends, or to reinvest that time into repetition of the PBR material.

A critical component of ANY individualized board review plan is to go through the study material MULTIPLE
times. PBR is concise, makes the learning manageable, and will allow you to feel confident on your test
day because of well prepared you are for your exam.

4 Copyright Pediatrics Board Review, Inc. 2011 Present.


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WHAT ARE THE 7+ RESOURCES THAT YOU HAVE ACCESS TO?
The PBR Ultimate Bundle Pack and the ALL ACCESS PASS packages have become our two most popular
memberships. If you have one of these memberships, please make sure you take advantage of all of
these resources!

1. PBRS MEMBERS-ONLY FACEBOOK CREW: JOIN THE CREW! Do not study in isolation! You
have a community of pediatricians to support you. MANY members say this is one of the most
valuable components of the PBR system. Studying for a board exam can be GRUELING, but
having others to lean on for clarification, advice or just some moral support can make all the
difference in your studying experience.

==========================================

==========================================

==========================================

Visit the following link to read more: http://www.pediatricsboardreview.com/facebook

2. HARDCOPY PBR CORE STUDY GUIDE: YOU WILL LEARN TO LOVE YOUR PBR! It is at the
center of your success blueprint. Carry it everywhere, highlight it, draw pictures, create mnemonics
and add notes to help you cement the 2000 MUST-KNOW topics in this book. After your exam, I
promise you that you will MISS IT!

Copyright Pediatrics Board Review, Inc. 5


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3. HARDCOPY PBR Q&A BOOK: KNOW this book! It is NOT a random collection of questions. The
material should be considered CORE material for you to study over and over again. Carry it around
and mark it up! Make sure you review this book as many times as you review the Core Study Guide.

4. ONLINE VERSIONS OF THE PBR CORE STUDY GUIDE: All 2000 topics are available in a scrolling
PDF style format and in a topic-by-topic, searchable format. Keep this open and use the one-click
image links while you study or after each two-hour block of studying. Its iPhone/smart phone
compatible, iPad/tablet compatible and desktop compatible.

5. ONLINE VERSION OF THE PBR Q&A BOOK: Have a few minutes while at work? Open the scrolling
PDF version of the Q&A book and go through one or two questions.

6. PBR WEBSITE: The website has a TREMENDOUS amount of valuable content. Each article was
written to help address a need expressed by pediatricians. Read as many of the articles as you can!
There is also a TOOLS section where you can find links to discounted pediatric board review
question banks.

7. PBRs TEST-TAKING STRATEGIES & COACHING COURSE: Physicians are NOT taught HOW to
take tests. GOOD pediatricians with sound clinical reasoning WRONGLY believe that a board
exam is a measure of ones knowledge base, and thus a measure of ones abilities as a clinician.
That is completely false.

Exams require mastery of the English language, mastery of pacing, mastery of your emotional state
during an exam, and an understanding of the deceptive tactics employed by question-writers to
create seemingly possible yet blatantly WRONG answer choices.

The PBR TEST-TAKING STRATEGIES & COACHING COURSE (a paid resource for PBR members
only through http://www.pediatricsboardreview.com/strategies) offers insights into this board
game so that you stop viewing question as miniature patients, and start viewing them as miniature
riddles. Riddles with concrete rules and strategies to help you reach the correct answer quickly (even
if you do not have the clinical knowledge to answer it!). Understanding the rules of the game will
completely change your outlook on how to prepare for the exam and how to use board review
questions for PRACTICE instead of content.

I HIGHLY recommend the PBR Test-Taking Strategies & Coaching Course for anyone who did
not get an above average score on the USMLE Step 1 (much easier than the ABP initial
certification exam!) and for anyone with limited time to study consistently.

The course helps you understand the techniques and skills associated with answering board-style
questions correctly. Weve helped pediatricians finally pass the boards after failing SIX times, so
helping you should be easy.

To get just a taste of how you can increase your board scores immediately, and to learn a few of the
rules to the board game, click here to read a PBR article I wrote titled, 3 Strategies To Skyrocket
Your Score! - http://www.pediatricsboardreview.com/techniques

Also, visit http://www.pediatricsboardreview.com/strategies and watch a FREE test-taking strategies


session right now.

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I love to collect feedback after my webinars. Here are just a few of the messages that weve received during
and after our Test-Taking Strategies course (most are submitted anonymously).

I found myself stuck many times, failing to pick the best answer even though the correct answer was always
between my best 2 options. Everything was more clear when Ashish recommended to always pick the
answer that addresses the "most important clinical issue" of the question. I started to use this technique
this past week, and my test scores have improved remarkably. Thanks so much!! I am ready for the next
webinar!!
- Dr. HL, Now A Board Certified Pediatrician

Appreciated that Ashish was able to break down the thought process and convey it to me... I was beginning to
feel like I was "all over the place" when approaching questions. The techniques were articulated in a
way which "clicked" with me.

Definitely helped to get a better understanding of the "board game" that Ashish mentions. I'm sure I've fallen
prey to those traps in the past.
Also, knowing the types of questions and the algorithm to figuring out how to spend my time answering the
questions-- never would have thought about the Hybrid approach to just reading the last line of the vignette
for "this/these" questions.

Really didn't know that I shouldn't be spending time reading through the whole vignette... or doing the
"top to bottom" approach!
Overall it was great and I really appreciate you taking the time and effort putting this together and making sure
that we can succeed our first time around.
Helped immensely with reading/understanding the "English" of the questions - I actually would've gotten
one example question wrong in the past had I not used the AaCNI mnemonic

I had very little time to prepare for the boards... The core study guide helped me focus on topics that were
high yield on the exam. In addition, the strategies taught by Ashish were very helpful and is what I
believe helped me PASS. I would highly recommend the PBR for anyone needed to review in a short period
of time. It is worth every penny!

- Dr. Darlene Melk, Board Certified Pediatrician

If you think you might need some help with test-taking strategies, you already do.

Signup For Your FREE Strategy Session Now

http://www.pediatricsboardreview.com/strategies

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DID YOU KNOW THAT I FAILED THE BOARDS?
I took the ABP initial certification exam the year that I graduated from residency. I
used multiple study guides to prepare. Because there was so much
information in front of me (print and video), I only got through everything once.

I felt okay going into the exam. I thought, Ive been through the MCAT, three
USMLE exams and an Internal Medicine board exam. I did fine in residency and I
studied really hard for two months. Im sure Ill be fine.

Coming out of that exam room on test-day, I felt nauseous. I realized that I might have just failed my first
medical board exam, ever! I was upset with myself for getting so scattered with all of those different
study materials, but I was also annoyed because I still couldnt think of a single resource that I could
use as a primary study guide the next time around.

I went home and made notes about how I would study differently if I had failed. What topics would I
concentrate on? What topics just dont seem to be testable? What information is a waste of time to study?

When the results came, I saw that I had failed by seven to nine questions. I made key strategy changes
based on my previous experience. I studied for hundreds of hours while still working a full-time job. I focused
on efficiency, solid mnemonics for memorization and I stopped trying to learn all of pediatrics.

You never feel great coming out of a board exam, but the following year I felt like I
had a fighting chance. My score increased by 160 points, and I had passed by
about 3739 questions! Pretty soon, I even received a letter from the ABP. The
American Board of Pediatrics asked ME to write questions for the boards!!!

I was really just happy to pass. Failing the first time had cost me extra time,
money and energy that I would have preferred to spend with my loved ones.

Prior to creating the Pediatrics Board Review experience, I was ashamed that I had
failed. Now, Ive taken a horrible experience and Ive created something that is helping residents and
pediatrician across the country. Ive also realized that failing the boards did not mean that I was a bad
pediatrician. Nor did passing by such a wide margin mean that I am a great pediatrician.

IM JUST AN AVERAGE PERSON WHO DID EXTREMELY WELL ON THE EXAM AND THEN TOOK MY
NOTES AND SYSTEMS AND TURNED THEM INTO THE PBR. No matter who you are, I know that you can
pass your exam, too. Thats why the PBR materials come with a 100% money-back first-time pass
guarantee.

Its the most EFFICIENT and well-integrated Certification SYSTEM to help you PASS the pediatric boards. So
rest assured that by joining the PBR family, youre already on the right track to success.

JUST FOLLOW THE EFFICIENCY BLUEPRINT!

8 Copyright Pediatrics Board Review, Inc. 2011 Present.


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THE PBR EFFICIENCY BLUEPRINT
The pediatric initial certification exam has one of the highest failure rates of any medical board exam. I
URGE you to follow just a few of my simple but CRITICAL recommendations as you go through your board
review experience. ESPECIALLY #1!

1. PLEASE STICK TO ONE PRIMARY STUDY GUIDE - the PBR! Spreading yourself too thin by
reviewing multiple resources is the BIGGEST MISTAKE you can make. Ive gone through
thousands of emails, interviews, emails and surveys. Its clear that this one, single
recommendation that will increase your chances of board success more than anything else I can say.

This is a key similarity amongst pediatricians who failed the boards, but then went on to pass
using the PBR system. So please do not spend your time going through other books, DVDs or
live courses. Go through the PBR books (Core Study Guide + Q&A Book) and the PBR
companion products (videos, MP3s, digital picture atlas, webinars) exclusively.

2. Approach your PBR material by first simply SEEING all of the PBR content in the Core Study Guide
and Q&A Book. Spend about 6090 seconds per page to simply SEE everything that you will need to
learn so that you have an idea about the type of knowledge youll need to acquire in order to pass this
exam. This should take you a full day. DO NOT spend time writing notes of any kind during
this process. Do NOT treat the Q&A Book like other questions. This is CORE content.

During your first official read through, leave no stone unturned. Crosscheck anything that confuses
you. Create mnemonics, notes and drawings in the margins so that you understand EVERYTHING.
Make sure that you will NEVER have to go outside of the PBR for additional knowledge or
clarifications again. If you get stuck on a concept, reach out to your peers on the PBR Facebook
CREW (http://www.pediatricsboardreview.com/facebook)! If you think youve found an error, notify us
through our special error submission link (http://www.pediatricsboardreview.com/error). This will
help you maintain your PACE and promote EFFICIENCY! When crosschecking, ONLY go outside
of PBR for possible errors or confusion. Thats it! Do NOT go down the black hole of GOOGLE!

Your second time should be MUCH faster. Do NOT let your curiosity of non-PBR topics distract
you. As you break up your studying time with questions, you WILL want to look up new topics and
crosscheck facts between the PBR and PREP. DO NOT DO IT! Its a guaranteed waste of precious
time that could be spent on PBR, the HIGHEST YIELD resource that you will have at your disposal to
pass the board exam.

Your third, fourth and fifth times through the PBR content should strictly focus on adding more
information into your long-term memory through repetition, through the use of mnemonics, and
through the use of MULTI-MODALITY studying. Use audio, video, webinars, study buddy sessions,
flash cards, etc. Just use something to mix things up because its been proven to increase learning!

Again, you must resist that urge to look up extraneous information and you must focus on QUALITY
study time. Ensure that your reading is focused on LEARNING and REMEMBERING the concepts.
Do not simply read for the sake of reading, and do not study when youre exhausted or irritable.

Your primary goal is to pass the exam. Even if you are an average test taker, as long as you
KNOW everything from the Core Study Guide + Q&A Book, you will easily pass. However, if you
try to learn all of pediatrics you will get overwhelmed and probably fail the exam. Map out at
least 300 hours of studying for the initial certification exam (I studied 400+ hours.)
Copyright Pediatrics Board Review, Inc. 9
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3. Use PBRs Q&A book as more CORE material. Also use it to get familiar with very high-yield
topics and questions. The format is short and to the point without too much extra information. The
questions will help you understand what types of key findings you need to identify on your practice
questions and on your exam. Please remember that the Q&A book is considered CORE
CONTENT. You need to KNOW IT COLD! Do NOT treat the PBR questions like PREP questions.

4. Go through about 1000 practice questions. Dont go through them all at once (much more on this
in the schedule outlines below). As you go through the questions, work on your timing. If you can
average about 1 minute and 15 seconds per question, you will be fine for the boards. Do not try to
understand why every single incorrect answer is wrong. Just focus on the correct answer, and if
your answer is wrong, figure out WHY its wrong. Skip explanations about all of the other answer
choices.

When evaluating WHY you got a question wrong, figure out if it was because of a CONTENT
problem or if it was due to a TECHNIQUE problem. If youre not sure, then its a TECHNIQUE
problem and you must get help http://www.pediatricsboardreview.com/strategies.

Did you answer a question incorrectly because of a CONTENT issue? Meaning, you had a
knowledge deficiency? If so, was the content in the PBR? If the answer is yes then you MUST know
that information. If the answer is no then do NOT worry about it! Do NOT start looking at Nelsons,
Harriet Lane, Google, etc. Its a black hole that you must avoid because it will only overwhelm you,
and it will keep you from the two main goals of knowing the PBR CONTENT COLD and
PRACTICING tons of questions to master your test-taking technique!

Remember, the AAP writes PREP, the ABP writes the boards. Going through three to four
years of PREP is great, but keep in mind that the resource is great for CME. Any single year of
PREP questions is not designed to be a stand-alone study guide for the ABP. The questions are
EXCELLENT for practicing and mastering your test-taking technique, but your highest-yield
information will come from the PBR study guides and systems. If you need MORE questions, you can
get discounted practice questions by visiting http://www.pediatricsboardreview.com/tools.

Did you answer a question incorrectly because of a TECHNIQUE issue? Did you add extra
information and assumptions to the question or the answers that led you to the wrong answer? Did
you spend too much time on a question even though it was clear that you didnt have the knowledge
to answer it? Did the question-writer trick you with a distractor? Did the question writer trick you with
an English question instead of a clinical question? Did you get anxious or nervous under a timed
mock exam? Are you still confused about why the answer you chose is wrong?

Make notes about the kinds of issues youre having and try to figure out solution and strategies to
avoid similar pitfalls in the future. If you notice that TECHNIQUES-BASED PROBLEMS creeping in
over and over again, you need to seek out help through the PBR Test-Taking Strategies &
Coaching course http://www.pediatricsboardreview.com/strategies.

5. EXTREMELY Important Test Day Tips: PLAN to be successful. You will find two links below. The
first breaks down the number of questions, time per block, etc. The second is a list of excellent PBR
articles.
http://www.pediatricsboardreview.com/examday
http://www.pediatricsboardreview.com/category/test-day-tips

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STUDY SCHEDULE: Resident? First-Time? Failed? MOC? I GOT
YOU!
I have a TON of guidance on how you can schedule your study time. Since PBR is of benefit to pediatricians
at all different levels, Ive tailored my recommendations accordingly below.

For everyone, you MUST recognize the difference between clinical practice and what the ABP would
want you to do on the exam. The exam is filled with answer choices that sound like they would be great
options in practice, but unless you know what the book says, you will have to simply roll the dice.

For anyone taking the Initial Certification exam, recognize that the pass rates are DRAMATICALLY LOWER
than the USMLE Step Exams. In the 20082009 timeframe the pass rate for the USMLE exams was in the
90s while the pass rate for the ABP initial certification exam was in the 70s! The PBR pass rate for
first-time test takers of the ABP exams is estimated to be around 95% (or higher)! So stay focused on
your PBR!

For anyone taking the pediatric Maintenance of Certification (MOC) exam, youre in luck! The national
pass rate is in the mid-90s for first-time test takers, but the PBR has had multiple years of pass rates that
have been 100% for practicing general pediatricians!

* ARE YOU A RESIDENT? Simply familiarizing yourself with everything in the PBR content before you
graduate will dramatically increase your chances of passing the boards.

While on subspecialty rotations, READ and KNOW the associated PBR chapter. While on general inpatient or
outpatient rotations, focus on the rest of the book. Pace yourself so that you can get through the material at
least once per year. Thats it! If you do that, your in-training scores will skyrocket and you will DESTROY the
boards.

* ARE YOU TAKING THE INITIAL EXAM FOR THE FIRST TIME? If you have never taken the pediatric
boards before and you have never come close to failing a medical board exam (average or above average
board scores), visit the following PBR article for a detailed study schedule:

http://www.pediatricsboardreview.com/schedule

* HAVE YOU EVER FAILED A MEDICAL BOARD EXAM (OR COME CLOSE)? If you have ever failed ANY
medical board exam, or if you scored below the national average on your USMLE exams, visit the
following PBR article for detailed instructions on how you can avoid failing your next attempt at the pediatric
boards:

http://www.pediatricsboardreview.com/schedule-failed

* ARE YOU STUDYING FOR THE MOC? If you are taking the pediatric recertification exam then your goal
should be to get through the PBR materials at least twice and to do at least 550 practice questions. For a
video on how to get 200 FREE ABP questions scroll to the bottom of this article (for board-certified
pediatricians only after logging into the ABP website):

http://www.pediatricsboardreview.com/abp

Copyright Pediatrics Board Review, Inc. 11


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PBR MEMORY AIDS - USING MNEMONICS AND PEGS
MNEMONICS: Mnemonics are memory aids that assist in helping you recall something. They are used
throughout this study guide to help you study in a more focused and EFFICIENT manner. Not all of them will
work for you, but many will. At the time of the exam you WILL use many of the mnemonics in this book to help
you answer questions. If youre lucky, you might even get a smile on your face as you think about me acting
like a bit of a fool in some of the videos from the PBR Online Video Course (http://
www.pediatricsboardreview.com/videos).

PEGS: Memory pegs are typically used to help you remember a list of items. By having 20 pre-memorized
pegs that represent the numbers 120, you can easily peg items to those numbers. For example, in the
PEG system outlined in this guide, a CAT symbolizes the number 9 (since cats are said to have nine lives).

So, if you are trying to memorize a grocery list of 10 items and one of those items is a gallon of milk, then the
th
9 item could be tied to an image, or a story, about a cat. It could be as simple as visualizing a funky looking
BLACK CAT that has white legs drinking from an orange bowl of MILK. The white legs and orange bowl are
simply thrown in to add color and imagination. Other strategies would include the use of disproportional size,
the use of action, or the use of sound. The crazier the image, or story, the better!

Please note that some of the pegs in this guide will be used in the high-yield mnemonics in this book. Please
look through them a few times to see if you can get the hang of it. If you can, then you might even be able to
start creating some of your OWN fun and interesting mnemonics. If you cannot, its okay. Move on since there
are only a handful of mnemonics that use one of the pegs listed here. Plus, if I do use a peg, I usually try to
remind you of the peg association in the book.

Do you have ideas on how to make the pegs or mnemonics in this book more useful?

Please consider sharing your thoughts in the private, members only community called the PBR Facebook
CREW! You can also submit them directly to us for consideration through our errors and clarifications portal:

http://www.pediatricsboardreview.com/ERROR

12 Copyright Pediatrics Board Review, Inc. 2011 Present.


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TWENTY PEGS

# USE THIS PEG DESCRIPTIONS AND EXPLANATIONS OF PEGS


1 TREE TRUNK Imagine the number 1 looking like a huge, brown tree trunk with limbs full of
green foliage sitting at the top of a lush, green hilltop.
2 LIGHT SWITCH A light switch has 2 positions (ON & OFF). Use a switch OR a bulb for 2.
3 STOOL Imagine a dark, cherry wood stool with 3 legs.
4 CAR Cars have FOUR doors and FOUR wheels.
5 GLOVE or HAND A glove has 5 fingers. Consider making Michael Jacksons shiny glove your
peg for the number FIVE.
6 GUN Another name for a gun is a 6-shooter (since guns used to only hold 6
bullets). GUNS also kill people and put them 6 feet under the ground.
7 DICE or CARDS Lucky number 7! Think Vegas, think craps, think gambling with dice or
cards!
8 ICE SKATE Ice skaters are known for performing a move called the figure 8. Eight also
rhymes with skate.
9 CAT Ever heard of the phrase, Cats have nine lives?
10 BOWLING BALL or The goal of bowling is to knock down 10 pins.
BOWLING PINS
11 AMERICAN In American football, a field goal occurs when a football is kicked through
FOOTBALL or GOAL two, white, vertical uprights (the goal post). A goal post looks like the
POST number 11.
12 EGGS Eggs usually come in a carton that contains a dozen (12) eggs.
th
13 HOCKEY MASK Unlucky number 13 and the unlucky day/movie Friday the 13 . The main
th
character in the movie Friday the 13 is Jason, a hockey-mask-wearing
killer.
th
14 ROSE or February 14 is Valentines Day! So think of a long-stemmed, red ROSE or
CHOCOLATE HEART perhaps a big CHOCOLATE HEART.
15 PAYCHECK You get to give the IRS a huge chunk of your PAYCHECK every single year
th
on TAX-DAY! APRIL 15 . Welcome to healthcare.
16 DRIVERS LICENSE Age at which you get a drivers license. Other pegs to consider include
CANDLES, CANDY, or a BIRTHDAY CAKE for Sweet SIXTEEN.
17 MAGAZINE There is a teen magazine called SEVENTEEN.
18 VOTING BOOTH Age when you become a legal adult in the U.S. and are allowed to VOTE.
19 KNIGHTING Imagine a KNIGHTING ceremony (sounds like 19) or a KNIGHT.
20 CIGARETTES A pack of CIGARETTES has 20 cigarettes in it.
There are TONS of mnemonics throughout PBR. Many will seem brilliant. Others may not work for you at all.
If that happens, please CREATE YOUR OWN. Its initially intimidating but gets much easier with time.

Click here to read PBRs article on mnemonics: http://pbrlinks.com/MNEMONICS

Copyright Pediatrics Board Review, Inc. 13


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GETTING THE MOST OUT OF THE PBR FORMAT
* GRAY HIGHLIGHTING OR YELLOW HIGHLIGHTING: In the PBR hardcopy resources, gray highlighting is
used over a word, phrase or chapter title to feature content that you MUST KNOW! These are very high-yield
topics and are likely to be seen on the exam as an answer choice. PBRs online books may have this content
in red.

* DOUBLE TAKE: You will LOVE THESE! DOUBLE TAKE means the topic is in the book multiple times.
Medicine ties together. Ordinarily, that results in flipping back and forth between chapters. Double Take is a
PBR-specific system used to increase efficiency by reducing the flipping back and forth between related (or
similar) topics. Most of these topics tend to be very high-yield.

* NAME ALERTS: Many disease names sound very similar (e.g., Condyloma Lata versus Condyloma
Acuminata, or Shwachman-Diamond Syndrome versus Diamond-Blackfan Anemia). NAME ALERTS serve as
reminders to look for these subtle differences.

* ABBREVIATIONS: Some disorders are discussed using their abbreviations while others are discussed with
their proper names. When searching for a topic online you should do a search for both. If you encounter an
unfamiliar acronym, try this tool: http://www.AcronymFinder.com

* MNEMONICS: If youre much smarter than me, you dont need these. If you have an average memory, like
me, you MUST learn to take advantage of memory aids. They can dramatically increase your efficiency as
you journey to retain thousands of bits of information. The PBR mnemonics may or may not work for you, but
many of them should serve as excellent examples of the various types of memory aids you can begin to
create. As a tip, always use as much action, color, exaggeration and crazy as possible.

* PEARLS: These are bits of information that help tie key concepts together for you. Members LOVE THEM!
Heres a PEARL for you. There are only a finite number of ways that the ABP can test you on a disease
process. Some PEARLS will show you how information could be presented on the exam.

PBR ERRORS
Are there errors in the PBR? Of course there are! But I also update the PBR every year with new
recommendations and guidelines. Im able to do this because of YOUR support. If you notice ANY error in the
PBR materials (e.g., incorrect spelling, grammar, incomplete sentence, contradictory information, etc.),
PLEASE visit the following link to submit the error:

http://www.pediatricsboardreview.com/ERROR

Please DO NOT email individual errors or clarification requests to me. Its WAY too overwhelming. If you
have MULTIPLE possible errors, send us a Word document. I LOVE the members who do that!!

Also, because its impossible for me to respond to every submission individually, I frequently release PBR
CONTENT & CLARIFICATION GUIDES to active PBR members (FREE). Please note that THIS IS NOT A
GUARANTEED SERVICE, but it is something I have done every single year. Your submissions drive this
process and allow me to providing you with updated pediatric knowledge year after year.

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PBR CLARIFICATIONS OR CONFUSION
If you are struggling with a concept, get help from the members only PBR Facebook CREW! Its
EXTREMELY active (especially starting around June or July of every year). If you find a concept explained
poorly and think the PBR needs a revision, feel free to use the error portal to bring it to my attention:

http://www.pediatricsboardreview.com/ERROR

PBR IMAGE LINKS


The image links in the PBR lead to PHENOMENAL images throughout the World Wide Web! BUT, these
images are located on NON-PBR websites. Some websites go out of business. When this happens, we
simply need to replace the image. Typically no more than 5% of the links within PBR are bad. We have an
awesome system that allows us to change the link on our end but we need your help when a link dies.
Simply submit any bad link through the portal below and well take care of it!

http://www.pediatricsboardreview.com/BADLINK

PBR & AVSAR THE NON-PROFIT CONNECTION


WHAT IS AVSAR? I started a non-profit organization, named AVSAR Inc., at the age of 27 to help support
existing non-profit organizations that were already doing great work in slum areas.

After medical school I spent one year volunteering in the slums of Mumbai. The need for help was profound
and conditions were shocking. Six-year-old children worked as child laborers, using their small, agile fingers
to make beautifully detailed handiwork. Others spent their days looking for recyclables in garbage dumps.

I bonded with these children. At the age of 27 I created a non-profit organization under the U.S. IRS, called
AVSAR. We recruited volunteers from around the world (college students, dentists, doctors, MBA students) to
help where the help was needed. My personal success stories included the creation of an efficient Western-
style clinic for child laborers and the establishment of an adolescent sex-education curriculum.

AVSAR helped thousands of people, but the core volunteer program was shut down in my last year of
residency due to lack of funding and my 80-hour workweeks. Even so, the projects and systems created by
volunteers live on and continue to help thousands more every year.

In order to re-launch AVSAR, we needed funding. Through Pediatrics Board Review (a private company) I
donated over $50,000 to AVSAR before ever paying myself a penny.

Its because of my passion for helping people that I created AVSAR, and then the PBR EXPERIENCE.

I hope that youre able to use the many resources within the PBR Certification System and the PBR
community to EFFICIENTLY study and pass your exam.

I very much look forward to being a part of your success. Now lets get started!

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PRODUCT REGISTRATION
As mentioned on the PBR site, this guarantee applies to anyone taking an ABP initial or recertification exam
for the first time. Money Back requests may be made within 90 days of the score release date. The original
PBR purchase must have been made at least 45 days prior to the exam. Submission of the product
registration form is required for the money back pass guarantee and the form must be submitted within 90
days of your purchase and before you take the exam. For complete details, please visit:

http://www.pediatricsboardreview.com/guarantee

Visit the following link to register your product(s):

http://www.pediatricsboardreview.com/register

For hardcopy purchases from PBR, but through Lulu.com, Amazon.com, etc., also fax your receipt to (775)
854-4637.

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CHAPTER LIST
ADOLESCENT MEDICINE - 52
ENDOCRINOLOGY - 69
OB/GYN & SOME STDs - 82
ALLERGY & IMMUNOLOGY - 89
CARDIOLOGY - 107
DERMATOLOGY - 131
NEONATOLOGY - 153
DEVELOPMENTAL MILESTONES - 164
EMERGENCY MEDICINE & TOXICOLOGY - 178
VITAMIN AND NUTRITIONAL DISORDERS - 188
GASTROENTEROLOGY - 198
PHARMACOLOGY & DRUG PEARLS - 214
OPHTHALMOLOGY - 219
GENETICS & INHERITED DISEASES - 222
HEMATOLOGY & ONCOLOGY - 244
INFECTIOUS DISEASES - 264
VACCINES, IMMUNIZATIONS AND CONTRAINDICATIONS - 303
INBORN ERRORS OF METABOLISM (IEM) & MISCELLANEOUS METABOLIC DISORDERS - 310
ACID-BASE DISORDERS - 325
FLUIDS & ELECTROLYTES - 333
NEPHROLOGY - 340
STATISTICS - 349
NEUROLOGY - 356
ORTHOPEDICS AND SPORTS MEDICINE - 371
RHEUMATOLOGY - 380
PULMONOLOGY - 384
PSYCHIATRY AND SOME SOCIAL ISSUES - 394
ETHICS IN PEDIATRICS - 399
PATIENT SAFETY AND QUALITY IMPROVEMENT - 405
PEDIATRIC LAB VALUES - 409
PEDIATRIC VITAL SIGNS - 411
INDEX - 414

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DETAILED TABLE OF CONTENTS

INTRODUCTION TO THE PBR EXPERIENCE! (Please Read This!!!) .................................................. 3


WHY DOES THE PBR WORK? ..................................................................................................................................................................... 4
WHAT ARE THE 7+ RESOURCES THAT YOU HAVE ACCESS TO? .............................................................................................. 5
DID YOU KNOW THAT I FAILED THE BOARDS? ............................................................................................................................... 8
THE PBR EFFICIENCY BLUEPRINT ......................................................................................................................................................... 9
STUDY SCHEDULE: Resident? First-Time? Failed? MOC? I GOT YOU! ...............................................................................11
PBR MEMORY AIDS - USING MNEMONICS AND PEGS .................................................................................................................12
GETTING THE MOST OUT OF THE PBR FORMAT ...........................................................................................................................14
PBR ERRORS ....................................................................................................................................................................................................14
PBR CLARIFICATIONS OR CONFUSION ...........................................................................................................................................15
PBR IMAGE LINKS .........................................................................................................................................................................................15
PBR & AVSAR THE NON-PROFIT CONNECTION ..........................................................................................................................15
PRODUCT REGISTRATION ........................................................................................................................................................................16
CHAPTER LIST............................................................................................................................ 17
ADOLESCENT MEDICINE ............................................................................................................ 51
PUBERTY ...........................................................................................................................................................................................................51
NORMAL PUBERTY TIMELINE......................................................................................................................................................... 51
NORMAL PUBERTY PEARLS.............................................................................................................................................................. 52
HEIGHT ...................................................................................................................................................................................................... 52
GROWTH SPURTS .................................................................................................................................................................................. 52
THELARCHE, ADRENARCHE THEN MENARCHE ...................................................................................................................... 52
(DOUBLE TAKE) AGE RANGE OF NORMAL PUBERTY ............................................................................................................ 52
ESTROGEN................................................................................................................................................................................................ 53
ANDROGENS ............................................................................................................................................................................................ 53
BREAST MASSES FIBROADENOMAS AND FIBROCYSTIC DISEASE ................................................................................ 53
PUBERTY GONE HAYWIRE .......................................................................................................................................................................53
(DOUBLE TAKE) AGE RANGE OF NORMAL PUBERTY ............................................................................................................ 53
PRECOCIOUS PUBERTY....................................................................................................................................................................... 54
GONADOTROPIN-INDEPENDENT PRECOCIOUS PUBERTY .................................................................................................. 54
PRECOCIOUS PUBERTY IN GIRLS ................................................................................................................................................... 54
PRECOCIOUS PUBERTY IN BOYS..................................................................................................................................................... 54
ADRENAL ANDROGENS ...................................................................................................................................................................... 54
PREMATURE ADRENARCHE ............................................................................................................................................................. 55
CONGENITAL ADRENAL HYPERPLASIA (CAH) INTRO .......................................................................................................... 55
TROPIC ....................................................................................................................................................................................................... 55
PREMATURE THELARCHE ................................................................................................................................................................. 55
PREMATURE ADRENARCHE IN GIRLS .......................................................................................................................................... 56
DELAYED PUBERTY .....................................................................................................................................................................................56
DELAYED PUBERTY DEFINITION AND PEARLS ....................................................................................................................... 56
PROLACTINOMA .................................................................................................................................................................................... 56
CONSTITUTIONAL DELAY OF PUBERTY ...................................................................................................................................... 56

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HYPOGONADOTROPIC OVARIAN FAILURE .................................................................................................................................56
KALLMANN SYNDROME .....................................................................................................................................................................56
HYPERGONADOTROPIC OVARIAN FAILURE .............................................................................................................................. 57
SHORT STATURE .......................................................................................................................................................................................... 57
GENETIC OR FAMILIAL SHORT STATURE ...................................................................................................................................57
CONSTITUTIONAL GROWTH DELAY (& PUBERTAL DELAY) .............................................................................................. 57
GROWTH HORMONE DEFICIENCY ................................................................................................................................................. 57
CONGENITAL GROWTH HORMONE DEFICIENCY .................................................................................................................... 57
ACQUIRED GROWTH HORMONE DEFICIENCY .......................................................................................................................... 58
OTHER CONSIDERATIONS FOR SHORT STATURE ................................................................................................................... 58
TALL STATURE .............................................................................................................................................................................................. 58
(DOUBLE TAKE) KLINEFELTER SYNDROME (AKA KLINEFELTERS) ............................................................................. 58
(DOUBLE TAKE) MARFANS SYNDROME (AKA MARFANS SYNDROME) ........................................................................ 58
HIGH CALORIC INTAKE .......................................................................................................................................................................59
OBESITY ....................................................................................................................................................................................................59
GROWTH CHART TRENDS ....................................................................................................................................................................... 59
ENDOCRINE DISORDERS ....................................................................................................................................................................59
CHROMOSOMAL ABNORMALITIES ................................................................................................................................................ 59
INADEQUATE CALORIC INTAKE or MALABSORPTIVE DISORDERS ................................................................................. 59
SPARING OF HEAD CIRCUMFERENCE........................................................................................................................................... 59
SMALL HEAD DISORDERS ..................................................................................................................................................................60
AMENORRHEA ............................................................................................................................................................................................... 60
AMENORRHEA PEARLS .......................................................................................................................................................................60
AMENORRHEA WORKUP ....................................................................................................................................................................60
PRIMARY AMENORRHEA ...................................................................................................................................................................60
SECONDARY AMENORRHEA ............................................................................................................................................................. 61
ANOREXIA AS A CAUSE OF AMENORRHEA .................................................................................................................................61
BULIMIA AS A CAUSE OF AMENORRHEA.....................................................................................................................................61
POLYCYSTIC OVARIAN SYNDROME (PCOS) AS A CAUSE OF AMENORRHEA ................................................................ 61
DYSFUNCTIONAL UTERINE BLEEDING (DUB) AS A CAUSE OF AMENORRHEA .......................................................... 61
MENORRHAGIA AND AMENORRHEA ............................................................................................................................................ 61
PREMENSTRUAL SYNDROME & DYSMENORRHEA ...................................................................................................................... 61
PREMENSTRUAL SYNDROME (PMS) ............................................................................................................................................. 61
PRIMARY DYSMENORRHEA .............................................................................................................................................................. 62
SECONDARY DYSMENORRHEA ........................................................................................................................................................ 62
SOCIAL ISSUES ............................................................................................................................................................................................... 62
AUTONOMY .............................................................................................................................................................................................. 62
BREAST EXAMS ...................................................................................................................................................................................... 62
RAPE/PTSD .............................................................................................................................................................................................. 62
DEPRESSION ............................................................................................................................................................................................ 62
OSTEOPOROSIS....................................................................................................................................................................................... 62
ALCOHOL AND TOBACCO ...................................................................................................................................................................62
MARIJUANA .............................................................................................................................................................................................. 62
INHALANTS .............................................................................................................................................................................................. 62
CONDOMS .................................................................................................................................................................................................63
PLAN B .......................................................................................................................................................................................................63
PAP SMEARS ............................................................................................................................................................................................ 63
ASCUS (ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE) .............................................................. 63
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(DOUBLE TAKE) HUMAN PAPILLOMA VIRUS (HPV) .............................................................................................................. 63
CHLAMYDIA TRACHOMATIS ............................................................................................................................................................. 64
MOTOR VEHICLE ACCIDENTS .......................................................................................................................................................... 64
GUNS ........................................................................................................................................................................................................... 64
HOMOSEXUALITY .................................................................................................................................................................................. 64
SELF CONSENT ....................................................................................................................................................................................... 64
DRUG SCREENING ................................................................................................................................................................................. 64
EXOGENOUS ANABOLIC STEROIDS ............................................................................................................................................... 64
EATING DISORDERS ....................................................................................................................................................................................64
ANOREXIA ................................................................................................................................................................................................ 65
BULIMIA .................................................................................................................................................................................................... 65
REFEEDING SYNDROME .................................................................................................................................................................... 65
OVERWEIGHT VERSUS OBESE ......................................................................................................................................................... 65
SCROTAL MASS ..............................................................................................................................................................................................65
TESTICULAR CANCER .......................................................................................................................................................................... 65
HYDROCELE............................................................................................................................................................................................. 66
SPERMATOCELE .................................................................................................................................................................................... 66
VARICOCELE ............................................................................................................................................................................................ 66
INGUINAL HERNIA ............................................................................................................................................................................... 66
TESTICULAR AND PENILE ISSUES ........................................................................................................................................................66
TESTICULAR PAIN ................................................................................................................................................................................ 66
TESTICULAR TORSION ........................................................................................................................................................................ 66
TORSION OF THE APPENDIX TESTES OR EPIDIDYMIS ......................................................................................................... 66
EPIDIDYMITIS......................................................................................................................................................................................... 66
ORCHITIS .................................................................................................................................................................................................. 66
BALANITIS................................................................................................................................................................................................ 66
PHIMOSIS.................................................................................................................................................................................................. 68
PENILE EPIDERMAL INCLUSION CYSTS ...................................................................................................................................... 68
ENDOCRINOLOGY ..................................................................................................................... 69
THYROID DISORDERSKEY TERMINOLOGY ............................................................................................................................ 69
HYPOTHYROIDISM .......................................................................................................................................................................................69
THYROXINE-BINDING GLOBULIN DEFICIENCY ....................................................................................................................... 69
HYPOTHYROIDISM & CONGENITAL HYPOTHYROIDISM ...................................................................................................... 69
THYROGLOSSAL DUCT CYST ............................................................................................................................................................. 70
THYROID NODULES.............................................................................................................................................................................. 70
HYPERTHYROIDISM ....................................................................................................................................................................................70
GRAVES DISEASE = HYPERthyroidism .......................................................................................................................................... 70
NEONATAL THYROTOXICOSIS (AKA NEONATAL GRAVES DISEASE) .............................................................................. 71
CALCIUM AND VITAMIN D RELATED DISORDERS ........................................................................................................................71
(DOUBLE TAKE) HYPERCALCEMIA ............................................................................................................................................... 71
(DOUBLE TAKE) HYPOCALCEMIA .................................................................................................................................................. 71
VITAMIN D & ITS EVALUATION ...................................................................................................................................................... 73
(DOUBLE TAKE) RICKETS.................................................................................................................................................................. 73
(DOUBLE TAKE) RICKETS OF PREMATURITY (AKA OSTEOPENIA OF PREMATURITY) .......................................... 74
(DOUBLE TAKE) LIVER DYSFUNCTION ....................................................................................................................................... 74
ADRENAL DISORDERS ................................................................................................................................................................................75
NORMAL ADRENAL STEROID SYNTHESIS PATHWAY ........................................................................................................... 75

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CUSHINGS SYNDROME (AKA CUSHINGS SYNDROME) .......................................................................................................... 75
ADDISON DISEASE (AKA ADDISONS DISEASE) ........................................................................................................................ 75
CONGENITAL ADRENAL HYPERPLASIA (CAH) ......................................................................................................................... 76
21-HYDROXYLASE DEFICIENCY ...................................................................................................................................................... 77
11-HYDROXYLASE DEFICIENCY ...................................................................................................................................................... 77
17-HYDROXYLASE DEFICIENCY ...................................................................................................................................................... 77
PANHYPOPITUITARISM ......................................................................................................................................................................78
AMBIGUOUS GENITALIA & CHROMOSOMAL ABNORMALITIES ............................................................................................. 78
AMBIGUOUS GENITALIA.....................................................................................................................................................................78
MICROPENIS ............................................................................................................................................................................................ 78
ANDROGEN INSENSITIVITY SYNDROME (AKA TESTICULAR FEMINIZATION) ........................................................... 78
MULLERIAN INHIBITOR HORMONE DEFICIENCY (AKA MIH RECEPTOR DEFECT) .................................................. 79
MALE PSEUDOHERMAPHRODISM.................................................................................................................................................. 79
TRUE HERMAPHRODISM ...................................................................................................................................................................79
(DOUBLE TAKE) TURNER SYNDROME (AKA TURNERS) ......................................................................................................79
(DOUBLE TAKE) KLINEFELTER SYNDROME (AKA KLINEFELTERS) ............................................................................. 80
DIABETES MELLITUS ................................................................................................................................................................................. 80
HONEYMOON PERIOD ......................................................................................................................................................................... 80
HEMOGLOBIN A1C ................................................................................................................................................................................ 80
SOMOGYI EFFECT & DAWN PHENOMENA ..................................................................................................................................80
HYPOGLYCEMIA ..................................................................................................................................................................................... 81
DIABETIC KETOACIDOSIS or HYPEROSMOLAR NON-KETOTIC HYPERGLYCEMIC STATE .....................................81
(DOUBLE TAKE) PSEUDOHYPONATREMIA ................................................................................................................................ 81
ACANTHOSIS NIGRICANS ...................................................................................................................................................................81
METABOLIC SYNDROME ....................................................................................................................................................................81
OB/GYN & SOME STDs............................................................................................................... 82
OBSTETRICS ................................................................................................................................................................................................... 82
ORAL CONTRACEPTIVE PILLS (OCPs)........................................................................................................................................... 82
CONCEPTION ........................................................................................................................................................................................... 82
PRENATAL CARE (PNC) ......................................................................................................................................................................82
GROUP B BETA HEMOLYTIC STREPTOCOCCUS (GBS) ........................................................................................................... 82
GESTATIONAL DIABETES MELLITUS ............................................................................................................................................ 82
SERUM ALPHA-FETOPROTEIN (AFP) SCREEN ......................................................................................................................... 82
CHORIONIC VILLUS SAMPLING ....................................................................................................................................................... 82
AMNIOCENTESIS ................................................................................................................................................................................... 83
MATERNAL SERUM TRIPLE SCREEN AND QUADRUPLE SCREEN ..................................................................................... 83
FIRST TRIMESTER SCREENING OPTIONS FOR DOWNS SYNDROME ............................................................................... 83
NON STRESS TEST ................................................................................................................................................................................ 83
BIOPHYSICAL PROFILE (BPP) .......................................................................................................................................................... 83
STRESS TEST (AKA CONTRACTION STRESS TEST) ................................................................................................................. 83
FOLIC ACID ............................................................................................................................................................................................... 84
LUNG MATURITY ................................................................................................................................................................................... 84
MONOZYGOTIC TWINS ........................................................................................................................................................................ 84
DIZYGOTIC TWINS ................................................................................................................................................................................ 85
GYNECOLOGY & SOME STDs ................................................................................................................................................................... 85
PARENTAL CONSENT .......................................................................................................................................................................... 85
(DOUBLE TAKE) CHLAMYDIA TRACHOMATIS .......................................................................................................................... 85
NEISSERIA GONORRHEA ....................................................................................................................................................................85
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NONGONOCOCCAL URETHRITIS ..................................................................................................................................................... 86
PELVIC INFLAMMATORY DISEASE (PID) .................................................................................................................................... 86
FITZ-HUGH CURTIS SYNDROME (AKA PERI-HEPATITIS) .................................................................................................... 86
(DOUBLE TAKE) SYPHILIS ................................................................................................................................................................ 86
BACTERIAL VAGINOSIS (AKA GARDNERELLA)......................................................................................................................... 87
(DOUBLE TAKE) TRICHOMONAS VAGINALIS ............................................................................................................................ 87
(DOUBLE TAKE) HERPES SIMPLEX VIRUS (HSV) .................................................................................................................... 87
VAGINAL FOREIGN BODY................................................................................................................................................................... 87
ULCERS VERSUS DISCHARGE ........................................................................................................................................................... 88
VAGINAL DISCHARGE AT BIRTH ..................................................................................................................................................... 88
LABIAL ADHESIONS (PENILE ADHESIONS for boys) .............................................................................................................. 88
BARTHOLIN GLAND CYSTS ............................................................................................................................................................... 88
SEXUAL ABUSE IN GIRLS .................................................................................................................................................................... 88
ALLERGY & IMMUNOLOGY ........................................................................................................ 89
HAY FEVER, FOOD ALLERGIES, AND ALLERGIC RASHES ...........................................................................................................89
HAY FEVER/ALLERGIC RHINITIS ................................................................................................................................................... 89
CHRONIC RHINITIS............................................................................................................................................................................... 89
VASOMOTOR RHINITIS ....................................................................................................................................................................... 89
SKIN TESTING ......................................................................................................................................................................................... 89
IMMUNOTHERAPY................................................................................................................................................................................ 89
RADIOALLERGOSORBENT TESTING (AKA RAST) .................................................................................................................... 89
FOOD ALLERGIES .................................................................................................................................................................................. 89
PEANUT ALLERGY ................................................................................................................................................................................ 90
FOOD SENSITIVITIES ....................................................................................................................................................................... 90
(DOUBLE TAKE) ATOPIC DERMATITIS (ECZEMA) .................................................................................................................. 90
URTICARIA (HIVES) .............................................................................................................................................................................. 90
CHRONIC URTICARIA (> 6 weeks) .................................................................................................................................................. 90
ARTIFICIAL FOOD COLORING........................................................................................................................................................... 91
(DOUBLE TAKE) ANAPHYLAXIS ...................................................................................................................................................... 91
FIXED DRUG REACTION...................................................................................................................................................................... 91
TRUE MILK PROTEIN ALLERGY ...................................................................................................................................................... 91
(DOUBLE TAKE) FOOD PROTEIN INDUCED ENTEROPATHY ............................................................................................. 91
(DOUBLE TAKE) FOOD PROTEIN INDUCED PROCTITIS/COLITIS ................................................................................... 92
(DOUBLE TAKE) FOOD PROTEIN INDUCED ENTEROCOLITIS SYNDROME (FPIES) ................................................ 92
(DOUBLE TAKE) LACTOSE INTOLERANCE (AKA LACTASE DEFICIENCY)..................................................................... 92
IMMUNOLOGY ................................................................................................................................................................................................93
EPINEPHRINE PEN ............................................................................................................................................................................... 93
TYPES OF HYPERSENSITIVITY REACTIONS ............................................................................................................................... 93
(DOUBLE TAKE) ANAPHYLAXIS ...................................................................................................................................................... 93
DRUG HYPERSENSITIVITY SYNDROME ....................................................................................................................................... 94
ANTICONVULSANT HYPERSENSITIVITY SYNDROME ............................................................................................................ 94
IGE MEDIATED MEDICATION HYPERSENSITIVITY ................................................................................................................ 94
PENICILLIN (PCN) ALLERGY ............................................................................................................................................................ 94
SERUM SICKNESS .................................................................................................................................................................................. 94
BEE STINGS.............................................................................................................................................................................................. 94
POISON IVY, POISON OAK, & POISON SUMAC ............................................................................................................................ 94
TYPES OF IMMUNITY .......................................................................................................................................................................... 94
CD4 CELL .................................................................................................................................................................................................. 95

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CD8 CELL...................................................................................................................................................................................................95
NEUTROPENIA ....................................................................................................................................................................................... 95
PEARLS/MNEMONICS FOR BRUTONS, SCID, AND HYPER-IGM......................................................................................... 95
PNEUMOCYSTIS CARINII PNEUMONIA (PCP) ........................................................................................................................... 96
PEDIATRIC LYMPHOcyte COUNTS .................................................................................................................................................. 96
T-CELL DEFICIENCIES AND COMBINED T-CELL/B-CELL DEFICIENCIES .......................................................................... 96
SEVERE COMBINED IMMUNODEFICIENCY (SCID) .................................................................................................................. 97
MNEMONICS & PEARL FOR SCID AND WISKOTT-ALDRICH ................................................................................................ 97
(DOUBLE TAKE) WISKOTT-ALDRICH SYNDROME .................................................................................................................. 97
22Q11.2 DELETION SYNDROME = DIGEORGE SYNDROME OR DIGEORGE LOCUS .................................................... 98
(DOUBLE TAKE) ATAXIA TELANGIECTASIA .............................................................................................................................. 99
COMMON VARIABLE IMMUNE DEFICIENCY (CVID) ............................................................................................................... 99
B-CELL DEFICIENCIES ............................................................................................................................................................................... 99
PEARLS: .....................................................................................................................................................................................................99
HYPER IGM SYNDROME ................................................................................................................................................................... 100
AGAMMAGLOBULINEMIA (AKA X-LINKED AGAMMAGLOBULINEMIA, AKA BRUTONS
AGAMMAGLOBULINEMIA) ............................................................................................................................................................. 100
TRANSIENT HYPOGAMMAGLOBULINEMIA OF INFANCY .................................................................................................. 101
IGA DEFICIENCY ................................................................................................................................................................................. 101
HYPER-IGE SYNDROME ................................................................................................................................................................... 101
COMPLEMENT DEFICIENCIES .............................................................................................................................................................. 101
GENERAL PEARLS .............................................................................................................................................................................. 101
C14 COMPLEMENT DEFICIENCY ............................................................................................................................................... 101
C59 COMPLEMENT DEFICIENCY ............................................................................................................................................... 102
C1 ESTERASE DEFICIENCY (HEREDITARY ANGIOEDEMA) .............................................................................................. 102
CONDITIONS WITH LOW COMPLEMENT LEVEL .................................................................................................................. 102
NEUTROPHIL DISORDERS/PHAGOCYTIC ISSUES ....................................................................................................................... 103
NEUTROPENIA DEFINITIONS ....................................................................................................................................................... 103
CHRONIC BENIGN NEUTROPENIA .............................................................................................................................................. 103
TRANSIENT NEUTROPENIA ........................................................................................................................................................... 103
CYCLIC NEUTROPENIA..................................................................................................................................................................... 103
SEVERE CONGENITAL NEUTROPENIA (AKA KOSTMANN SYNDROME) ...................................................................... 103
(DOUBLE TAKE) CHRONIC GRANULOMATOUS DISEASE (CGD) = SERRATIA ........................................................... 103
LEUKOCYTE ADHESION DEFICIENCY (AKA LEUKOCYTE ADHESION DEFECT) ....................................................... 104
CHEDIAK-HIGASHI SYNDROME .................................................................................................................................................... 104
(DOUBLE TAKE) SHWACHMAN-DIAMOND SYNDROME .................................................................................................... 104
(DOUBLE TAKE) DIAMOND-BLACKFAN ANEMIA ................................................................................................................. 105
IMMUNOLOGY TESTS, A RECAP .......................................................................................................................................................... 105
SKIN TESTING ...................................................................................................................................................................................... 105
TITERS .................................................................................................................................................................................................... 106
CH50 ........................................................................................................................................................................................................ 106
NITROblue TETRAZOLIUM (NBT)................................................................................................................................................ 106
CARDIOLOGY ........................................................................................................................... 107
EKG FINDINGS ............................................................................................................................................................................................. 107
RIGHT ATRIAL ENLARGEMENT (RAE) ...................................................................................................................................... 107
LEFT ATRIAL ENLARGEMENT (LAE) ......................................................................................................................................... 107
NEGATIVE T WAVE ............................................................................................................................................................................ 107
PREMATURE ATRIAL COMPLEXES (PACs) ............................................................................................................................... 107
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PREMATURE VENTRICULAR COMPLEXES (PVCs) ................................................................................................................ 107
EKG CHANGES DUE TO ELECTROLYTE DISTURBANCES ................................................................................................... 107
NORMAL HEART RATES .................................................................................................................................................................. 108
SINOATRIAL NODE (SA NODE), ATRIOVENTRICULAR NODE (AV NODE) and VENTRICULAR INTRINSIC
RATES ...................................................................................................................................................................................................... 108
ARRHYTHMIAS............................................................................................................................................................................................ 108
BRUGADA SYNDROME ..................................................................................................................................................................... 108
SUPRAVENTRICULAR TACHYCARDIA (SVT) ........................................................................................................................... 109
WOLFF-PARKINSON-WHITE SYNDROME (WPW) AND AV REENTRANT TACHYCARDIA (AVRT) .................. 109
AV NODE REENTRANT TACHYCARDIA (AVNRT) ................................................................................................................. 110
ADENOSINE AND VAGAL MANEUVERS ..................................................................................................................................... 110
ATRIAL TACHYCARDIAS .................................................................................................................................................................. 110
ATRIAL FIBRILLATION & ATRIAL FLUTTER ........................................................................................................................... 110
VENTRICULAR TACHYCARDIA (VT OR VTACH) ..................................................................................................................... 110
PROLONGED QT .................................................................................................................................................................................. 111
HEART BLOCKS (AV BLOCKS OR AVB) ............................................................................................................................................ 111
FIRST DEGREE AV BLOCK ............................................................................................................................................................... 111
SECOND DEGREE AV BLOCK .......................................................................................................................................................... 111
THIRD DEGREE AV BLOCK = COMPLETE HEART BLOCK .................................................................................................. 111
BUNDLE BRANCH BLOCKS ............................................................................................................................................................. 112
SEPTAL DEFECTS ....................................................................................................................................................................................... 112
CARDIAC SHUNT PEARLS & MNEMONICS ............................................................................................................................... 112
ATRIAL SEPTAL DEFECTS (ASD) ................................................................................................................................................. 112
VENTRICULAR SEPTAL DEFECTS (VSDS) ................................................................................................................................ 112
AV CANAL DEFECT ............................................................................................................................................................................ 113
AV CANAL DEFECT & VSD ............................................................................................................................................................... 113
MURMURS & SPLITS ................................................................................................................................................................................. 113
PATHOLOGIC MURMURS ................................................................................................................................................................. 113
MURMUR TERMINOLOGY ............................................................................................................................................................... 113
PULMONARY STENOSIS (PS) ......................................................................................................................................................... 114
MITRAL STENOSIS (MS) .................................................................................................................................................................. 114
TRICUSPID STENOSIS (TS) ............................................................................................................................................................. 114
AORTIC STENOSIS (AS) .................................................................................................................................................................... 114
MITRAL REGURGITATION (MR) ................................................................................................................................................... 114
MITRAL VALVE PROLAPSE (MVP) ............................................................................................................................................... 114
AORTIC REGURGITATION/INSUFFICIENCY (AR OR AI) ..................................................................................................... 115
RIGHT UPPER STERNAL BORDER (RUSB) MURMURS ........................................................................................................ 115
LEFT UPPER STERNAL BORDER (LUSB) MURMURS ........................................................................................................... 115
LEFT LOWER STERNAL BORDER (LLSB) MURMURS .......................................................................................................... 115
LEFT SUBCLAVICULAR MURMURS ............................................................................................................................................. 115
APICAL MURMURS ............................................................................................................................................................................. 115
HOLOSYSTOLIC MURMURS ............................................................................................................................................................ 115
CONTINUOUS MURMURS ................................................................................................................................................................ 115
BOUNDING PULSE.............................................................................................................................................................................. 116
WIDE PULSE PRESSURE .................................................................................................................................................................. 116
CRANIAL BRUITS ................................................................................................................................................................................ 116
CAROTID BRUITS ................................................................................................................................................................................ 116
FIXED SPLIT S2 ................................................................................................................................................................................... 116

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WIDELY SPLIT S2 ............................................................................................................................................................................... 116
PARADOXICAL SPLIT OF S2 ............................................................................................................................................................ 116
FETAL CIRCULATION ............................................................................................................................................................................... 117
NORMAL CIRCULATION ................................................................................................................................................................... 117
FETAL CIRCULATION ........................................................................................................................................................................ 117
RIGHT VENTRICLE (RV) .................................................................................................................................................................. 118
CYANOTIC CONGENITAL HEART DISEASES (CCHD) ................................................................................................................. 118
PEARL (RE: SHUNTS) ........................................................................................................................................................................ 118
CYANOTIC CONGENITAL HEART DISEASES MNEMONIC ................................................................................................... 118
CYANOSIS ALGORITHM AND PEARL........................................................................................................................................... 118
PROSTAGLANDIN (PGE1)................................................................................................................................................................ 118
PATENT DUCTUS ARTERIOSUS (PDA) ....................................................................................................................................... 118
COARCTATION OF THE AORTA ..................................................................................................................................................... 119
PREDUCTAL & POSTDUCTAL SATURATION ............................................................................................................................ 119
TRUNCUS ARTERIOSUS (TA) ......................................................................................................................................................... 119
TRANSPOSITION OF THE GREAT ARTERIES (TGA/TOGA) ................................................................................................ 119
TETRALOGY OF FALLOT (TOF) ..................................................................................................................................................... 120
TOTAL ANOMALOUS PULMONARY VENOUS RETURN (TAPVR) ..................................................................................... 121
HYPOPLASTIC LEFT HEART ........................................................................................................................................................... 121
TRICUSPID ATRESIA ......................................................................................................................................................................... 121
PULMONARY ATRESIA (AKA PULMONARY VALVE ATRESIA) ......................................................................................... 121
PERSISTENT PULMONARY HYPERTENSION = PERSISTENCE OF FETAL CIRCULATION ..................................... 121
RHEUMATIC FEVER & RHEUMATIC HEART DISEASE .............................................................................................................. 123
RHEUMATIC FEVER ........................................................................................................................................................................... 123
JONES CRITERIA FOR RHEUMATIC FEVER .............................................................................................................................. 123
MAJOR JONES CRITERIA FOR ACUTE RHEUMATIC FEVER ............................................................................................... 123
MINOR JONES CRITERIA FOR ACUTE RHEUMATIC FEVER ............................................................................................... 123
RHEUMATIC FEVER TREATMENT ............................................................................................................................................... 124
RHEUMATIC FEVER ASSOCIATIONS ........................................................................................................................................... 124
KAWASAKI DISEASE, AKA MUCOCUTANEOUS LYMPH NODE SYNDROME .................................................................... 125
DIAGNOSTIC CRITERIA FOR KAWASAKI DISEASE ................................................................................................................ 125
SUPPORTIVE DATA ............................................................................................................................................................................ 125
COMPLICATIONS OF KAWASAKI DISEASE ............................................................................................................................... 125
TREATMENT OF KAWASAKI DISEASE ....................................................................................................................................... 125
ENDOCARDITIS ........................................................................................................................................................................................... 125
ENDOCARDITIS DEFINITION ......................................................................................................................................................... 125
ACUTE BACTERIAL ENDOCARDITIS ........................................................................................................................................... 126
SUBACUTE BACTERIAL ENDOCARDITIS................................................................................................................................... 126
DIAGNOSING ENDOCARDITIS ....................................................................................................................................................... 126
TREATMENT OF ENDOCARDITIS ................................................................................................................................................. 126
NATIVE VALVE ENDOCARDITIS ................................................................................................................................................... 126
PROSTHETIC VALVE ENDOCARDITIS ........................................................................................................................................ 126
PROPHYLAXIS FOR SUBACUTE BACTERIAL ENDOCARDITIS (SBE) .............................................................................. 127
MISCELLANEOUS CARDIOLOGY .......................................................................................................................................................... 127
PULSUS PARADOXUS ......................................................................................................................................................................... 127
PERICARDITIS ...................................................................................................................................................................................... 127
PERICARDIAL EFFUSIONS .............................................................................................................................................................. 128
MYOCARDITIS ...................................................................................................................................................................................... 128
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EARLY CONGESTIVE HEART FAILURE ...................................................................................................................................... 128
HYPERTROPHIC CARDIOMYOPATHY = HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HCM, HOCM)
................................................................................................................................................................................................................... 128
CARDIOMEGALY AND HYPERTROPHY ...................................................................................................................................... 129
CHEST PAIN .......................................................................................................................................................................................... 129
SVC SYNDROME .................................................................................................................................................................................. 129
MEDIALLY DISPLACED PMI ........................................................................................................................................................... 129
PEDIATRIC BLOOD PRESSURE GUIDELINES .......................................................................................................................... 129
CHOLESTEROL SCREENING = HYPERLIPIDEMIA SCREENING ........................................................................................ 130
FAMILIAL HYPERCHOLESTEROLEMIA...................................................................................................................................... 130
DERMATOLOGY ...................................................................................................................... 131
GENERAL DERMATOLOGY..................................................................................................................................................................... 131
CONTACT DERMATITIS, A DIAPER RASH ................................................................................................................................. 131
(DOUBLE TAKE) CUTANEOUS CANDIDIASIS, A DIAPER DERMATITIS ........................................................................ 131
(DOUBLE TAKE) ATOPIC DERMATITIS (ECZEMA) ............................................................................................................... 131
NUMMULAR ECZEMA ....................................................................................................................................................................... 131
(DOUBLE TAKE) ECZEMA HERPETICUM.................................................................................................................................. 131
SEBORRHEIC DERMATITIS (AKA CRADLE CAP) .................................................................................................................... 132
PSORIASIS.............................................................................................................................................................................................. 132
GUTTATE PSORIASIS ........................................................................................................................................................................ 132
(DOUBLE TAKE) LANGERHANS CELL HISTIOCYTOSIS (LCH) = HISTIOCYTOSIS X ................................................. 132
RASHES THAT SPARE THE INGUINAL FOLDS ........................................................................................................................ 132
PRURITIC RASHES.............................................................................................................................................................................. 132
KERATOSIS PILARIS .......................................................................................................................................................................... 132
LICHEN SCLEROSUS .......................................................................................................................................................................... 133
LICHEN STRIATUS ............................................................................................................................................................................. 133
ALLERGIC CONTACT DERMATITIS, A TYPE IV HYPERSENSITIVITY SKIN RASH ..................................................... 133
(DOUBLE TAKE) BIOTIN/BIOTINIDASE DEFICIENCY ........................................................................................................ 133
PAPULAR URTICARIA ....................................................................................................................................................................... 134
VITILIGO................................................................................................................................................................................................. 134
(NAME ALERT) ICHTHYOSIS VULGARIS .................................................................................................................................. 134
(NAME ALERT) LAMELLAR ICHTHYOSIS (AKA COLLODION BABY) ............................................................................ 134
(NAME ALERT) HARLEQUIN ICHTHYOSIS .............................................................................................................................. 134
PYODERMA GANGRENOSUM ......................................................................................................................................................... 134
(DOUBLE TAKE) ECTHYMA GANGRENOSUM ......................................................................................................................... 135
GRANULOMA ANNULARE ............................................................................................................................................................... 135
PITTED KERATOLYSIS...................................................................................................................................................................... 135
(DOUBLE TAKE) DERMATOMYOSITIS ....................................................................................................................................... 135
STEVENS-JOHNSON SYNDROME (SJS) and TOXIC EPIDERMAL NECROLYSIS (TEN) ............................................. 135
ERYTHEMA MULTIFORME ............................................................................................................................................................. 135
(DOUBLE TAKE) NEONATAL LUPUS .......................................................................................................................................... 136
RASHES WITH CENTRAL CLEARING (PEARL) ........................................................................................................................ 136
RASHES WITH CENTRAL DARKENING/TARGET LESIONS (PEARL) ............................................................................. 136
URTICARIA/HIVES ............................................................................................................................................................................. 136
SCLERODERMA ................................................................................................................................................................................... 136
DERMOID CYSTS (AKA EPIDERMOID CYSTS) ......................................................................................................................... 137
COMEDONAL ACNE ........................................................................................................................................................................... 137
INFLAMMATORY ACNE .................................................................................................................................................................... 137
ISOTRETINOIN .................................................................................................................................................................................... 137
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(DOUBLE TAKE) APHTHOUS ULCERS ........................................................................................................................................ 137
TEETH ISSUES .............................................................................................................................................................................................. 138
TOOTH TIMELINE .............................................................................................................................................................................. 138
PEG TEETH ............................................................................................................................................................................................ 138
HUTCHINSON TEETH ....................................................................................................................................................................... 138
TETRACYCLINE TEETH STAINING .............................................................................................................................................. 138
FLUOROSIS ............................................................................................................................................................................................ 138
VASCULAR & PIGMENTED LESIONS .................................................................................................................................................. 138
HEMANGIOMAS ................................................................................................................................................................................... 138
PHACES SYNDROME .......................................................................................................................................................................... 139
(DOUBLE TAKE) KASABACH-MERRITT SYNDROME............................................................................................................ 139
NEVUS SIMPLEX.................................................................................................................................................................................. 139
PORT WINE STAINS (PWS) (AKA NEVUS FLAMMEUS) ...................................................................................................... 139
STURGE-WEBER SYNDROME (SWS) .......................................................................................................................................... 140
CAPILLARY MALFORMATION ASSOCIATIONS ............................................................................................................................. 140
(DOUBLE TAKE) KLIPPEL-TRENAUNAY SYNDROME ........................................................................................................ 140
(NAME ALERT) KLIPPEL-FEIL SYNDROME ............................................................................................................................. 140
CONGENITAL MELANOCYTIC NEVUS......................................................................................................................................... 141
MCCUNE-ALBRIGHT SYNDROME (AKA POLYOSTOTIC FIBROUS DYSPLASIA) ......................................................... 141
TUBEROUS SCLEROSIS ..................................................................................................................................................................... 141
NEUROFIBROMATOSIS I (NF1) ..................................................................................................................................................... 141
NEUROFIBROMATOSIS 2 (NF2) .................................................................................................................................................... 142
INCONTINENTIA PIGMENTI .......................................................................................................................................................... 142
HYPOHIDROTIC ECTODERMAL DYSPLASIA ............................................................................................................................ 143
INFECTIOUS SKIN CONDITIONS .......................................................................................................................................................... 143
(DOUBLE TAKE) ECTHYMA GANGRENOSUM ......................................................................................................................... 143
STREPTOCOCCAL INFECTIONS OF THE GROIN ..................................................................................................................... 143
(DOUBLE TAKE) CUTANEOUS CANDIDIASIS, A DIAPER DERMATITIS ........................................................................ 143
BULLOUS IMPETIGO/STAPH SCALDED SKIN SYNDROME (SSSS) .................................................................................. 143
STAPHYLOCOCCUS EPIDERMIDIS ............................................................................................................................................... 144
CELLULITIS ........................................................................................................................................................................................... 144
TINEA CORPORIS ................................................................................................................................................................................ 144
TINEA VERSICOLOR........................................................................................................................................................................... 144
PITYRIASIS ROSEA ............................................................................................................................................................................. 144
MOLLUSCUM CONTAGIOSUM ........................................................................................................................................................ 144
(DOUBLE TAKE) HUMAN PAPILLOMA VIRUS (HPV) ........................................................................................................... 144
CONDYLOMA LATA ........................................................................................................................................................................... 145
HERPES SIMPLEX VIRUSES 1 & 2 (HSV 1 & 2) ........................................................................................................................ 145
HERPES SIMPLEX VIRUS ENCEPHALITIS (HSV ENCEPHALITIS) ................................................................................... 146
HERPES SIMPLEX VIRUS GINGIVOSTOMATITIS .................................................................................................................... 146
(DOUBLE TAKE) ECZEMA HERPETICUM .................................................................................................................................. 146
(DOUBLE TAKE) BLUEBERRY MUFFIN SYNDROME ............................................................................................................ 146
SCABIES .................................................................................................................................................................................................. 146
PEDICULOSIS CAPITIS (AKA HEAD LICE) ................................................................................................................................. 146
PEDICULOSIS PUBIS (AKA PUBIC LICE or CRABS) ............................................................................................................... 147
THE ERYTHEMA RASHES.................................................................................................................................................................... 147
ERYTHEMA NODOSUM ..................................................................................................................................................................... 147
(DOUBLE TAKE) ERYTHEMA CHRONICUM MIGRANS ........................................................................................................ 147

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(DOUBLE TAKE) ERYTHEMA MARGINATUM ......................................................................................................................... 148
(DOUBLE TAKE) ERYTHEMA INFECTIOUSUM ....................................................................................................................... 148
ERYTHEMA TOXICUM NEONATORUM ...................................................................................................................................... 148
ERYTHEMA MULTIFORME ............................................................................................................................................................. 148
THE NEWBORN RASHES ......................................................................................................................................................................... 148
MILIARIA RUBRA ................................................................................................................................................................................ 148
MILIA ....................................................................................................................................................................................................... 148
SEBACEOUS HYPERPLASIA ............................................................................................................................................................ 149
ERYTHEMA TOXICUM NEONATORUM ...................................................................................................................................... 149
TRANSIENT NEONATAL PUSTULAR MELANOSIS ................................................................................................................. 149
NEONATAL ACNE (AKA NEONATAL CEPHALIC PUSTULOSIS) ........................................................................................ 149
INFANTILE ACNE ............................................................................................................................................................................... 149
LIVEDO RETICULARIS (AKA CUTIS MARMORATA) .............................................................................................................. 149
ALOPECIA & HAIR FINDINGS................................................................................................................................................................ 150
ALOPECIA AREATA ............................................................................................................................................................................ 150
ALOPECIA TOTALIS ........................................................................................................................................................................... 150
ALOPECIA UNIVERSALIS ................................................................................................................................................................. 150
(DOUBLE TAKE) ZINC DEFICIENCY ............................................................................................................................................ 150
(DOUBLE TAKE) ACRODERMATITIS ENTEROPATHICA ..................................................................................................... 151
(DOUBLE TAKE) BIOTIN/BIOTINIDASE DEFICIENCY ........................................................................................................ 151
TELOGEN EFFLUVIUM ..................................................................................................................................................................... 151
TINEA CAPITIS (AKA RINGWORM) ............................................................................................................................................. 151
TRICHOTILLOMANIA ........................................................................................................................................................................ 151
(DOUBLE TAKE) ESSENTIAL FATTY ACID DEFICIENCIES ................................................................................................ 151
APLASIA CUTIS CONGENITA .......................................................................................................................................................... 152
NEONATOLOGY ....................................................................................................................... 153
WEIGHT, LENGTH, & HEAD CIRCUMFERENCE ............................................................................................................................ 153
NEWBORN WEIGHT .......................................................................................................................................................................... 153
PREDICTED GROWTH RULES OF THUMB ................................................................................................................................ 153
INTRAUTERINE GROWTH RESTRICTION = INTRAUTERINE GROWTH RETARDATION = IUGR ....................... 153
HEAD CIRCUMFERENCE MACROCEPHALY, HYDROCEPHALY, AND MICROCEPHALY ....................................... 154
NUTRITION, BREAST MILK, & FORMULA ....................................................................................................................................... 154
NEONATAL POTASSIUM REQUIREMENTS ............................................................................................................................... 154
NEONATAL SODIUM REQUIREMENTS ...................................................................................................................................... 154
PROTEIN INTAKE ............................................................................................................................................................................... 154
NEONATAL CALORIC REQUIREMENT ........................................................................................................................................ 155
EXCLUSIVELY BREASTFED BABIES ............................................................................................................................................ 155
BREAST MILK ....................................................................................................................................................................................... 155
FORMULA .............................................................................................................................................................................................. 156
IRON SUPPLEMENTATION ............................................................................................................................................................. 156
WHOLE MILK ....................................................................................................................................................................................... 156
PREMATURE INFANTS ............................................................................................................................................................................ 156
ESTIMATING GESTATIONAL AGE BY PHYSICAL EXAM ...................................................................................................... 156
CALCULATING GESTATIONAL AGE ............................................................................................................................................. 157
PREMATURE INFANT NUTRITION .............................................................................................................................................. 157
TOTAL PARENTERAL NUTRITION (TPN) ................................................................................................................................. 157
RETINOPATHY OF PREMATURITY (ROP) ................................................................................................................................ 157

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NEONATAL JAUNDICE, HYPERBILIRUBINEMIA, AND HEMOLYTIC DISEASE OF THE NEWBORN ...................... 157
NEONATAL JAUNDICE ...................................................................................................................................................................... 157
HYPERBILIRUBINEMIA .................................................................................................................................................................... 158
RISK FACTORS FOR DEVELOPING HYPERBILIRUBINEMIA .............................................................................................. 158
(DOUBLE TAKE) RHESUS DISEASE (AKA RH DISEASE) ..................................................................................................... 159
(DOUBLE TAKE) ABO INCOMPATIBILITY ................................................................................................................................ 159
(DOUBLE TAKE) GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY (G6PD DEFICIENCY) ................ 159
MISCELLANEOUS........................................................................................................................................................................................ 159
FULL TERM ........................................................................................................................................................................................... 159
NEONATE ............................................................................................................................................................................................... 159
INFANT ................................................................................................................................................................................................... 159
APNEA ..................................................................................................................................................................................................... 160
SUDDEN INFANT DEATH SYNDROME (SIDS) ......................................................................................................................... 160
ANURIA ................................................................................................................................................................................................... 160
ANEMIA .................................................................................................................................................................................................. 160
APT TEST ............................................................................................................................................................................................... 160
NEONATAL HYPOGLYCEMIA ......................................................................................................................................................... 160
SHOCK-LIKE SYMPTOMS ................................................................................................................................................................. 160
SEPTIC WORKUP ................................................................................................................................................................................ 160
CRYING .................................................................................................................................................................................................... 160
COLIC ....................................................................................................................................................................................................... 161
SLEEP ...................................................................................................................................................................................................... 161
SUN SAFETY .......................................................................................................................................................................................... 161
AUTOMOBILE AND CAR SEAT SAFETY ...................................................................................................................................... 161
VERY LOW BIRTH WEIGHT (VLBW)........................................................................................................................................... 161
PREGNANCY INDUCED HYPERTENSION (PIH) ...................................................................................................................... 162
NALOXONE ............................................................................................................................................................................................ 162
FAILURE TO THRIVE (FTT) ............................................................................................................................................................ 162
ARTHROGRYPOSIS MULTIPLEX.................................................................................................................................................... 162
CEPHALOHEMATOMA ...................................................................................................................................................................... 162
CAPUT SUCCEDANEUM .................................................................................................................................................................... 162
UMBILICAL CORD ............................................................................................................................................................................... 162
CORD CATHETERS ............................................................................................................................................................................. 162
SINGLE UMBILICAL ARTERY ......................................................................................................................................................... 163
(DOUBLE TAKE) NECROTIZING ENTEROCOLITIS ................................................................................................................ 163
HYPOSPADIAS ...................................................................................................................................................................................... 163
UNDESCENDED TESTICLE .............................................................................................................................................................. 163
DEVELOPMENTAL MILESTONES ............................................................................................... 164
DEVELOPMENTAL MILESTONES THROUGH ADOLESCENCE ................................................................................................ 164
DEVELOPMENTAL MILESTONES SCREENING TOOLS ........................................................................................................ 164
DRAWING SHAPES ............................................................................................................................................................................. 165
DEVELOPMENTAL MILESTONES CHART, BIRTH TO 2 MONTHS OF AGE ................................................................... 165
DEVELOPMENTAL MILESTONES CHART, 4 MONTHS OF AGE ......................................................................................... 166
DEVELOPMENTAL MILESTONES CHART, 6 MONTHS OF AGE ......................................................................................... 167
DEVELOPMENTAL MILESTONES CHART, 9 MONTHS OF AGE ......................................................................................... 168
DEVELOPMENTAL MILESTONES CHART, 12 MONTHS OF AGE ...................................................................................... 169
DEVELOPMENTAL MILESTONES CHART, 15 MONTHS OF AGE ...................................................................................... 170
DEVELOPMENTAL MILESTONES CHART, 18 MONTHS OF AGE ...................................................................................... 171

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DEVELOPMENTAL MILESTONES CHART, 2-YEAR-OLD ..................................................................................................... 172
DEVELOPMENTAL MILESTONES CHART, 3-YEAR-OLD ..................................................................................................... 173
DEVELOPMENTAL MILESTONES CHART, 4-YEAR-OLD ..................................................................................................... 174
DEVELOPMENTAL MILESTONES CHART, 5-YEAR-OLD ..................................................................................................... 175
DEVELOPMENTAL MILESTONES CHART, 6-YEAR-OLD ..................................................................................................... 176
COGNITION ................................................................................................................................................................................................... 177
COGNITIVE REASONING VERSUS CONCRETE THINKING .................................................................................................. 177
EMERGENCY MEDICINE & TOXICOLOGY................................................................................... 178
MENTAL STATUS CHANGES ........................................................................................................................................................... 178
PUPILS .................................................................................................................................................................................................... 178
MIOSIS..................................................................................................................................................................................................... 178
MYDRIASIS ............................................................................................................................................................................................ 178
DIAPHORESIS ....................................................................................................................................................................................... 178
TOXIDROMES ....................................................................................................................................................................................... 179
NYSTAGMUS ......................................................................................................................................................................................... 179
SYRUP OF IPECAC ............................................................................................................................................................................... 179
CHARCOAL............................................................................................................................................................................................. 179
GASTRIC LAVAGE ............................................................................................................................................................................... 179
AMPHETAMINES ................................................................................................................................................................................ 179
COCAINE................................................................................................................................................................................................. 179
PHENCYCLIDINE (PCP) .................................................................................................................................................................... 180
BARBITURATES (like phenoBARBITal) ..................................................................................................................................... 180
OPIOIDS .................................................................................................................................................................................................. 180
ALCOHOL (ETHANOL) ...................................................................................................................................................................... 180
ETHYLENE GLYCOL INGESTION .................................................................................................................................................. 180
METHANOL INGESTION .................................................................................................................................................................. 181
ISOPROPYL ALCOHOL ....................................................................................................................................................................... 181
MARIJUANA (MJ) ................................................................................................................................................................................ 181
NICOTINE/TOBACCO/SMOKING .................................................................................................................................................. 181
ACETAMINOPHEN INGESTION ..................................................................................................................................................... 181
CHOLINERGICS .................................................................................................................................................................................... 182
ANTICHOLINERGICS ......................................................................................................................................................................... 182
TRICYCLIC ANTIDEPRESSANT (TCA) TOXICITY .................................................................................................................... 182
SALICYLATES ....................................................................................................................................................................................... 183
IBUPROFEN OVERDOSE................................................................................................................................................................... 183
IRON OVERDOSE................................................................................................................................................................................. 183
(DOUBLE TAKE) LEAD TOXICITY ................................................................................................................................................ 183
CLONIDINE & PHENOTHIAZINES OVERDOSE ........................................................................................................................ 184
CALCIUM CHANNEL BLOCKER OVERDOSE ............................................................................................................................. 184
DIGOXIN TOXICITY ............................................................................................................................................................................ 184
THEOPHYLLINE .................................................................................................................................................................................. 184
CARBON MONOXIDE (CO) ............................................................................................................................................................... 184
METHEMOGLOBINEMIA.................................................................................................................................................................. 185
HYDROCARBON INGESTION .......................................................................................................................................................... 185
HYDROCARBON INHALATION ...................................................................................................................................................... 185
ACID OR BASE INGESTION ............................................................................................................................................................. 185
FOREIGN BODY INGESTION ........................................................................................................................................................... 185
(DOUBLE TAKE) RABIES VIRUS ................................................................................................................................................... 186

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BROWN RECLUSE SPIDER .............................................................................................................................................................. 186
BLACK WIDOW .................................................................................................................................................................................... 186
COMMON BITES .................................................................................................................................................................................. 186
BURN TREATMENT ........................................................................................................................................................................... 187
NEAR DROWNING .............................................................................................................................................................................. 187
POOL SAFETY ....................................................................................................................................................................................... 188
HYPOTHERMIA .................................................................................................................................................................................... 188
HEAD INJURY ....................................................................................................................................................................................... 188
POST-CONCUSSION TREATMENT (2013 AAN GUIDELINES) ........................................................................................... 188
ENDOTRACHEAL TUBES AND VENTILATION......................................................................................................................... 189
IMPAIRED PERFUSION/HYPOVOLEMIA ................................................................................................................................... 189
CARDIOPULMONARY RESUSCITATION (CPR) ........................................................................................................................ 189
VITAMIN AND NUTRITIONAL DISORDERS ................................................................................. 190
FAT-SOLUBLE VITAMINS ................................................................................................................................................................ 190
VITAMIN A (AKA RETINOL) ........................................................................................................................................................... 190
VITAMIN K DEFICIENCY (AKA PHYTONADIONE DEFICIENCY) ...................................................................................... 191
VITAMIN E DEFICIENCY (AKA TOCOPHEROL DEFICIENCY) ............................................................................................ 191
VITAMIN D (ERGOCALCIFEROL, CHOLECALCIFEROL) EXCESS ....................................................................................... 191
VITAMIN D DEFICIENCY .................................................................................................................................................................. 192
(DOUBLE TAKE) RICKETS ............................................................................................................................................................... 192
(DOUBLE TAKE) RICKETS OF PREMATURITY (AKA OSTEOPENIA OF PREMATURITY) ....................................... 193
(DOUBLE TAKE) LIVER DYSFUNCTION .................................................................................................................................... 193
WATER-SOLUBLE NUTRIENTS ............................................................................................................................................................ 193
THIAMINE (B1) DEFICIENCY ........................................................................................................................................................ 193
RIBOFLAVIN (B2) DEFICIENCY .................................................................................................................................................... 193
NIACIN (B3) DEFICIENCY ............................................................................................................................................................... 194
PYRIDOXINE (B6) DEFICIENCY .................................................................................................................................................... 194
(DOUBLE TAKE) FOLATE (B9) DEFICIENCY ........................................................................................................................... 194
(DOUBLE TAKE) B12 DEFICIENCY (AKA CYANOCOBALAMIN DEFICIENCY) ............................................................ 195
VITAMIN C DEFICIENCY AND EXCESS ....................................................................................................................................... 195
(DOUBLE TAKE) ZINC DEFICIENCY ............................................................................................................................................ 195
(DOUBLE TAKE) ACRODERMATITIS ENTEROPATHICA ..................................................................................................... 196
(DOUBLE TAKE) BIOTIN/BIOTINIDASE DEFICIENCY ........................................................................................................ 196
COPPER DEFICIENCY ........................................................................................................................................................................ 196
(DOUBLE TAKE) STRICT VEGETARIANS AND VEGANS ...................................................................................................... 196
NUTRITIONAL DEFICIENCIES .............................................................................................................................................................. 196
ENERGY REQUIREMENTS IN CHILDREN .................................................................................................................................. 196
KWASHIORKOR ................................................................................................................................................................................... 196
MARASMUS ........................................................................................................................................................................................... 197
(DOUBLE TAKE) ESSENTIAL FATTY ACID DEFICIENCIES ................................................................................................ 197
GASTROENTEROLOGY .............................................................................................................. 198
LIVER DISEASE ............................................................................................................................................................................................ 198
CONGENITAL HEPATIC FIBROSIS ................................................................................................................................................ 198
HEPATOMEGALY ................................................................................................................................................................................ 198
GALLBLADDER HYDROPS ............................................................................................................................................................... 198
HEPATOBLASTOMA ........................................................................................................................................................................... 198
PRIMARY SCLEROSING CHOLANGITIS (PSC) .......................................................................................................................... 198
HEPATOBILIARY IMINODIACETIC ACID SCAN (AKA HIDA SCAN or CHOLESCINTIGRAPHY)............................. 198
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TRANSAMINITIS ................................................................................................................................................................................. 199
ALKALINE PHOSPHATASE .............................................................................................................................................................. 199
BILIARY OBSTRUCTION ................................................................................................................................................................... 199
CAUSES OF JAUNDICE .............................................................................................................................................................................. 199
CHOLESTASIS ....................................................................................................................................................................................... 199
BILIARY ATRESIA ............................................................................................................................................................................... 199
CHOLEDOCHAL CYSTS...................................................................................................................................................................... 199
PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS (PFIC).................................................................................... 199
ALAGILLE SYNDROME (AKA ARTERIOHEPATIC DYSPLASIA) ......................................................................................... 200
IDIOPATHIC NEONATAL HEPATITIS .......................................................................................................................................... 200
VIRAL HEPATITIS ............................................................................................................................................................................... 200
GILBERTS SYNDROME (AKA GILBERTS SYNDROME) ........................................................................................................ 201
CRIGLER-NAJJAR SYNDROME........................................................................................................................................................ 201
DUBIN JOHNSON SYNDROME ....................................................................................................................................................... 202
REYES SYNDROME (AKA REYES SYNDROME) ...................................................................................................................... 202
(DOUBLE TAKE) WILSONS DISEASE ......................................................................................................................................... 202
CHOLECYSTITIS ................................................................................................................................................................................. 203
CHOLELITHIASIS ................................................................................................................................................................................ 203
ICTERUS ................................................................................................................................................................................................. 203
CAUSES OF ABDOMINAL DISCOMFORT & PAIN .......................................................................................................................... 203
CLASSIC FUNCTIONAL ABDOMINAL PAIN OF CHILDHOOD ............................................................................................. 203
CONSTIPATION ................................................................................................................................................................................... 203
FECAL OVERFLOW ENCOPRESIS ................................................................................................................................................. 203
HELICOBACTER PYLORI .................................................................................................................................................................. 203
NSAID-INDUCED DYSPEPSIA, ULCERS, AND EROSIVE GASTRITIS ................................................................................ 204
EROSIVE GASTRITIS AKA EROSIVE GASTROPATHY ............................................................................................................ 204
NON-EROSIVE GASTRITIS ............................................................................................................................................................... 204
NON-ULCER DYSPEPSIA .................................................................................................................................................................. 204
ZOLLINGER-ELLISON SYNDROME .............................................................................................................................................. 204
INFANTILE GASTROESOPHAGEAL REFLUX (GERD) ............................................................................................................ 204
(DOUBLE TAKE) IRRITABLE BOWEL SYNDROME (IBS) .................................................................................................... 204
INFLAMMATORY BOWEL DISEASE (IBD) CROHNS AND ULCERATIVE COLITIS ................................................. 205
APPENDICITIS ..................................................................................................................................................................................... 205
PANCREATITIS .................................................................................................................................................................................... 205
INTUSSUSCEPTION............................................................................................................................................................................ 206
(DOUBLE TAKE) GIARDIA ............................................................................................................................................................... 206
ABDOMINAL PAIN PEARL ............................................................................................................................................................... 206
CAUSES OF DIARRHEA ............................................................................................................................................................................ 206
CHRONIC NONSPECIFIC DIARRHEA ........................................................................................................................................... 206
(DOUBLE TAKE) LACTOSE INTOLERANCE (AKA LACTASE DEFICIENCY) .................................................................. 206
BACTERIAL OVERGROWTH............................................................................................................................................................ 207
CELIAC DISEASE (AKA CELIAC SPRUE) ..................................................................................................................................... 207
INFECTIOUS DIARRHEAL ILLNESSES ........................................................................................................................................ 207
CAUSES OF CONSTIPATION .................................................................................................................................................................. 207
FUNCTIONAL CONSTIPATION ...................................................................................................................................................... 207
(DOUBLE TAKE) IRRITABLE BOWEL SYNDROME (IBS) .................................................................................................... 207
CONGENITAL HYPOTHYROIDISM ................................................................................................................................................ 208
CYSTIC FIBROSIS (CF) ...................................................................................................................................................................... 208

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HIRSCHSPRUNG DISEASE ............................................................................................................................................................... 208
MECONIUM ILEUS .............................................................................................................................................................................. 208
CAUSES OF VOMITING ............................................................................................................................................................................. 208
GASTROESOPHAGEAL REFLUX DISEASE (GERD) ................................................................................................................. 208
PYLORIC STENOSIS ............................................................................................................................................................................ 208
ANTRAL WEB ....................................................................................................................................................................................... 209
ESOPHAGEAL WEB ............................................................................................................................................................................ 209
ACHALASIA............................................................................................................................................................................................ 209
VOLVULUS ............................................................................................................................................................................................. 209
ANNULAR PANCREAS ....................................................................................................................................................................... 210
CYCLIC VOMITING .............................................................................................................................................................................. 210
RUMINATION ....................................................................................................................................................................................... 210
BILIOUS EMESIS IN A NEWBORN ................................................................................................................................................ 210
DOUBLE BUBBLE ................................................................................................................................................................................ 210
VOMITING PEARLS ............................................................................................................................................................................ 211
GI BLEEDING ................................................................................................................................................................................................ 211
GI BLEEDING PEARL ......................................................................................................................................................................... 211
LOWER GI BLEEDING (LGIB) ......................................................................................................................................................... 211
PAINLESS RECTAL BLEEDING ...................................................................................................................................................... 211
MECKELS DIVERTICULUM (AKA MECKELS) .......................................................................................................................... 212
FAMILIAL ADENOMATOUS POLYPOSIS (FAP) ........................................................................................................................ 212
MISCELLANEOUS GI CONDITIONS & TERMINOLOGY ............................................................................................................... 212
OMPHALOCELE ................................................................................................................................................................................... 212
GASTROSCHISIS................................................................................................................................................................................... 212
NASOGASTRIC TUBE FEEDINGS (NG TUBE FEEDINGS) ..................................................................................................... 212
ESOPHAGEAL PERFORATION ........................................................................................................................................................ 212
IMPERFORATE ANUS (AKA ANAL ATRESIA) ........................................................................................................................... 213
PERSISTENT CLOACA ....................................................................................................................................................................... 213
RECTAL PROLAPSE ............................................................................................................................................................................ 213
TYPHLITIS ............................................................................................................................................................................................. 213
PHARMACOLOGY & DRUG PEARLS ........................................................................................... 214
MEDICATION PEAK............................................................................................................................................................................ 214
MEDICATION TROUGH ..................................................................................................................................................................... 214
MISCELLANEOUS DRUGS........................................................................................................................................................................ 214
MISOPROSTOL ..................................................................................................................................................................................... 214
SUCRALFATE (ALUMINUM HYDROXIDE COMPLEX) ........................................................................................................... 214
MAGNESIUM SULFATE ..................................................................................................................................................................... 214
TERBUTALINE ..................................................................................................................................................................................... 214
ACE INHIBITORS ................................................................................................................................................................................. 214
DIAZEPAM ............................................................................................................................................................................................. 214
METOCLOPRAMIDE & PROMETHAZINE ................................................................................................................................... 215
BLEOMYCIN .......................................................................................................................................................................................... 215
VINCRISTINE AND VINBLASTINE ................................................................................................................................................ 215
DOXORUBICIN AND DAUNOMYCIN ............................................................................................................................................. 215
CYCLOPHOSPHAMIDE ...................................................................................................................................................................... 215
ASPARAGINASE ................................................................................................................................................................................... 215
METHOTREXATE (AKA MTX) ........................................................................................................................................................ 215
MALIGNANT HYPERTHERMIA ...................................................................................................................................................... 215
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HEPATIC INDUCERS .......................................................................................................................................................................... 216
HEPATIC INHIBITORS ...................................................................................................................................................................... 216
ALTERNATIVE MEDICATIONS ...................................................................................................................................................... 216
INTRAUTERINE DRUG EXPOSURES................................................................................................................................................... 216
COCAINE EXPOSURE ......................................................................................................................................................................... 216
HEROIN EXPOSURE ........................................................................................................................................................................... 217
METHADONE EXPOSURE ................................................................................................................................................................ 217
LITHIUM EXPOSURE ......................................................................................................................................................................... 217
(DOUBLE TAKE) MAGNESIUM SULFATE INFUSION ............................................................................................................ 217
WARFARIN EXPOSURE ..................................................................................................................................................................... 217
ANTI-SEIZURE MEDICATION EXPOSURE ................................................................................................................................. 217
PHENYTOIN EXPOSURE .................................................................................................................................................................. 217
VALPROIC ACID EXPOSURE ........................................................................................................................................................... 218
CARBAMAZEPINE EXPOSURE ....................................................................................................................................................... 218
ETHANOL EXPOSURE ....................................................................................................................................................................... 218
VITAMIN A (AKA RETINOL) EXPOSURE .................................................................................................................................... 218
ISOTRETINOIN EXPOSURE ............................................................................................................................................................. 218
OPHTHALMOLOGY .................................................................................................................. 219
HORDEOLUM (AKA STYE) .............................................................................................................................................................. 219
CHALAZION ........................................................................................................................................................................................... 219
CORNEAL ABRASIONS ...................................................................................................................................................................... 219
HYPHEMA .............................................................................................................................................................................................. 219
PAPILLEDEMA ..................................................................................................................................................................................... 219
PAPILLITIS ............................................................................................................................................................................................ 219
CATARACTS........................................................................................................................................................................................... 220
MYOPIA................................................................................................................................................................................................... 220
HYPEROPIA ........................................................................................................................................................................................... 220
VISION SCREENING ........................................................................................................................................................................... 220
VISUAL ACUITY BY AGE ................................................................................................................................................................... 220
VISION SYMMETRY ............................................................................................................................................................................ 220
STRABISMUS ........................................................................................................................................................................................ 220
PSEUDOSTRABISMUS ....................................................................................................................................................................... 220
AMBLYOPIA .......................................................................................................................................................................................... 220
ESOTROPIA ........................................................................................................................................................................................... 221
EXOTROPIA ........................................................................................................................................................................................... 221
NYSTAGMUS ......................................................................................................................................................................................... 221
COLOR VISION ..................................................................................................................................................................................... 221
CORNEAL LIGHT REFLEX TEST .................................................................................................................................................... 221
GENETICS & INHERITED DISEASES ............................................................................................ 222
AUTOSOMAL DOMINANT DISORDERS ............................................................................................................................................. 222
AUTOSOMAL DOMINANT DISORDERS ...................................................................................................................................... 222
AUTOSOMAL DOMINANT MNEMONIC ...................................................................................................................................... 222
WAARDENBURG SYNDROME ........................................................................................................................................................ 224
APERT SYNDROME (AKA APERTS OR APERTS SYNDROME) ......................................................................................... 224
NAIL PATELLA SYNDROME ............................................................................................................................................................ 225
NOONAN SYNDROME (AKA NOONANS SYNDROME) ......................................................................................................... 225
ACHONDROPLASIA (AKA DWARFISM) ...................................................................................................................................... 225
PEUTZ-JEGHERS SYNDROME (AKA HEREDITARY INTESTINAL POLYPOSIS) ........................................................... 226
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GARDNER SYNDROME (AKA GARDNERS SYNDROME) ...................................................................................................... 226
(DOUBLE TAKE) RETINOBLASTOMA ......................................................................................................................................... 226
OTHER AUTOSOMAL DOMINANT DISORDERS ....................................................................................................................... 226
AUTOSOMAL RECESSIVE DISORDERS .............................................................................................................................................. 227
AUTOSOMAL RECESSIVE (AR) DISORDERS PEARLS ............................................................................................................ 227
AUTOSOMAL RECESSIVE MNEMONIC ....................................................................................................................................... 227
JOHANSON-BLIZZARD SYNDROME ............................................................................................................................................. 228
X-LINKED DISORDERS ............................................................................................................................................................................. 228
X-LINKED DOMINANT DISORDERS ................................................................................................................................................... 228
FAMILIAL HYPOPHOSPHATEMIC RICKETS ............................................................................................................................. 228
AICARDI SYNDROME ......................................................................................................................................................................... 228
(DOUBLE TAKE) ALPORT SYNDROME (AKA ALPORTS SYNDROME)........................................................................... 228
X-LINKED RECESSIVE DISORDERS .................................................................................................................................................... 229
PEARLS ................................................................................................................................................................................................... 229
(DOUBLE TAKE) CHRONIC GRANULOMATOUS DISEASE (CGD) = SERRATIA ........................................................... 229
(DOUBLE TAKE) DUCHENNE MUSCULAR DYSTROPHY ..................................................................................................... 230
(DOUBLE TAKE) GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY (G6PD DEFICIENCY) ................ 230
(DOUBLE TAKE) HEMOPHILIA A AND HEMOPHILIA B (AKA FACTOR VIII AND FACTOR IX DEFICIENCY) .. 230
HUNTER SYNDROME ........................................................................................................................................................................ 231
NEPHROGENIC DIABETES INSIPIDUS ....................................................................................................................................... 231
ORNITHINE TRANSCARBAMYLASE ............................................................................................................................................ 231
ANDROGEN INSENSITIVITY SYNDROME (AKA TESTICULAR FEMINIZATION) ........................................................ 231
(DOUBLE TAKE) WISKOTT-ALDRICH SYNDROME ............................................................................................................... 231
TRISOMY DISORDERS .............................................................................................................................................................................. 232
DOWN SYNDROME (AKA DOWNS SYNDROME) ................................................................................................................... 232
TRISOMY 18 (AKA EDWARDS SYNDROME) ............................................................................................................................. 233
TRISOMY 13 (AKA PATAU SYNDROME) .................................................................................................................................... 234
MISCELLANEOUS GENETIC FINDINGS & DISORDERS .............................................................................................................. 234
TERMINOLOGY .................................................................................................................................................................................... 234
CLEFT DISORDERS ............................................................................................................................................................................. 234
WILLIAMS SYNDROME (AKA incorrectly as WILLIAMS SYNDROME) ......................................................................... 235
HOLT ORAM SYNDROME ................................................................................................................................................................. 235
CRI-DU-CHAT SYNDROME (AKA 5p-, 5p minus or 5p DELETION SYNDROME) ........................................................ 235
CROUZON SYNDROME (AKA CRANIOFACIAL DYSOSTOSIS) ............................................................................................. 236
FRAGILE X SYNDROME .................................................................................................................................................................... 236
ANGELMAN SYNDROME (AKA ANGELMANS SYNDROME) .............................................................................................. 236
PRADER-WILLI SYNDROME (AKA PRADER WILLI SYNDROME) .................................................................................... 237
LAURENCE MOON BIEDL SYNDROME ....................................................................................................................................... 238
BECKWITH-WIEDEMANN SYNDROME ..................................................................................................................................... 238
(DOUBLE TAKE) KLIPPEL-TRENAUNAY SYNDROME ........................................................................................................ 238
PROTEUS SYNDROME ....................................................................................................................................................................... 239
PIERRE-ROBIN SYNDROME (AKA PIERRE-ROBIN SEQUENCE) ...................................................................................... 239
CHARGE SYNDROME ......................................................................................................................................................................... 239
COCKAYNE SYNDROME ................................................................................................................................................................... 239
AUTISM ................................................................................................................................................................................................... 240
ASPERGER SYNDROME (AKA ASPERGERS SYNDROME) ................................................................................................... 240
RETT SYNDROME (AKA RETTS SYNDROME) ......................................................................................................................... 240
(DOUBLE TAKE) KLINEFELTER SYNDROME (AKA KLINEFELTERS) .......................................................................... 240
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(DOUBLE TAKE) MARFANS SYNDROME (AKA MARFANS SYNDROME) ..................................................................... 240
EHLERS-DANLOS SYNDROME ....................................................................................................................................................... 241
(DOUBLE TAKE) HOMOCYSTEINURIA ....................................................................................................................................... 241
(DOUBLE TAKE) TURNER SYNDROME (AKA TURNERS) ................................................................................................... 241
RUSSELL-SILVER SYNDROME (AKA SILVER RUSSELL SYNDROME) ............................................................................. 242
POTTERS SYNDROME ...................................................................................................................................................................... 242
(DOUBLE TAKE) PRUNE BELLY SYNDROME .......................................................................................................................... 243
GENETIC TESTING ............................................................................................................................................................................. 243
MISCELLANEOUS ABNORMALITIES OF FINGERS AND TOES .......................................................................................... 243
HEMATOLOGY & ONCOLOGY .................................................................................................. 244
PEDIATRIC LEUKEMIAS .......................................................................................................................................................................... 244
ACUTE LYMPHOCYTIC LEUKEMIA (ALL) ................................................................................................................................. 244
ACUTE MYELOID LEUKEMIA (AML) ........................................................................................................................................... 244
CHRONIC MYELOGENOUS LEUKEMIA (CML) & CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) ............................. 244
PEDIATRIC LYMPHOMAS ....................................................................................................................................................................... 245
(DOUBLE TAKE) HODGKINS LYMPHOMA ............................................................................................................................... 245
NON-HODGKIN LYMPHOMA (NHL) ............................................................................................................................................ 245
BONE TUMORS ............................................................................................................................................................................................ 246
LONG BONE TUMORS ....................................................................................................................................................................... 246
OSTEOGENIC SARCOMA & EWINGS SARCOMA (AKA EWING SARCOMA) .................................................................. 246
OSTEOCHONDROMA ......................................................................................................................................................................... 246
OSTEOID OSTEOMA ........................................................................................................................................................................... 246
OTHER MALIGNANCIES, TUMORS, & SYNDROMES.................................................................................................................... 247
WILMS TUMOR .................................................................................................................................................................................... 247
(DOUBLE TAKE) RETINOBLASTOMA ......................................................................................................................................... 247
NEUROBLASTOMA ............................................................................................................................................................................. 247
BRAIN TUMORS ................................................................................................................................................................................... 248
(DOUBLE TAKE) LANGERHANS CELL HISTIOCYTOSIS (LCH) = HISTIOCYTOSIS X ................................................. 248
RHABDOMYOSARCOMA ................................................................................................................................................................... 248
TUMOR LYSIS SYNDROME .............................................................................................................................................................. 248
CORD COMPRESSION ........................................................................................................................................................................ 248
ANTERIOR MEDIASTINAL MASS .................................................................................................................................................. 248
RBC BASICS & SOME HEMOGLOBIN FACTS ................................................................................................................................... 249
(DOUBLE TAKE) CELL LIFE SPANS ............................................................................................................................................. 249
FETAL & ADULT HEMOGLOBIN STRUCTURE ......................................................................................................................... 249
NEWBORN ANEMIA .......................................................................................................................................................................... 249
RBC MCV................................................................................................................................................................................................. 249
POLYCYTHEMIA .................................................................................................................................................................................. 250
PRBC TRANSFUSIONS ....................................................................................................................................................................... 250
NORMOCYTIC ANEMIA ............................................................................................................................................................................ 250
PHYSIOLOGIC ANEMIA ..................................................................................................................................................................... 250
HEMOLYTIC ANEMIAS ..................................................................................................................................................................... 250
COOMBS TEST PEARLS .................................................................................................................................................................... 250
(DOUBLE TAKE) RHESUS DISEASE (AKA RH DISEASE) ..................................................................................................... 251
(DOUBLE TAKE) ABO INCOMPATIBILITY ................................................................................................................................ 251
(DOUBLE TAKE) GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY (AKA G6PD DEFICIENCY) ....... 251
PYRUVATE KINASE DEFICIENCY ................................................................................................................................................. 251

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HEREDITARY SPHEROCYTOSIS .................................................................................................................................................... 252
(DOUBLE TAKE) ERYTHEMA INFECTIOUSUM ....................................................................................................................... 252
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) ..................................................................................................... 252
SICKLE CELL ANEMIA ....................................................................................................................................................................... 252
TRANSIENT ERYTHROBLASTOPENIA OF CHILDHOOD ...................................................................................................... 254
ACUTE BLOOD LOSS ANEMIA ........................................................................................................................................................ 254
(DOUBLE TAKE) ANEMIA OF CHRONIC DISEASE ................................................................................................................. 254
END STAGE RENAL DISEASE (AKA ESRD or RENAL FAILURE) ....................................................................................... 254
PEARLY REMINDERS ........................................................................................................................................................................ 254
MICROCYTIC ANEMIA .............................................................................................................................................................................. 255
MICROCYTIC ANEMIA DEFINITION ............................................................................................................................................ 255
IRON DEFICIENCY ANEMIA ............................................................................................................................................................ 255
(DOUBLE TAKE) ANEMIA OF CHRONIC DISEASE ................................................................................................................. 255
THALASSEMIAS ................................................................................................................................................................................... 255
ALPHA THALASSEMIA ...................................................................................................................................................................... 255
BETA THALASSEMIA ......................................................................................................................................................................... 256
(DOUBLE TAKE) LEAD TOXICITY ................................................................................................................................................ 256
LAB REVIEWS FERRITIN, TIBC, RDW, & TRANSFERRIN SATURATION .................................................................... 257
MACROCYTIC ANEMIA ............................................................................................................................................................................. 257
MACROCYTIC ANEMIAS (AKA MEGALOBLASTIC ANEMIA) .............................................................................................. 257
(DOUBLE TAKE) FOLATE (B9) DEFICIENCY ........................................................................................................................... 257
(DOUBLE TAKE) B12 DEFICIENCY (AKA CYANOCOBALAMIN DEFICIENCY) ............................................................ 257
(DOUBLE TAKE) FANCONI ANEMIA .......................................................................................................................................... 258
(DOUBLE TAKE) FANCONI SYNDROME ................................................................................................................................... 258
(DOUBLE TAKE) DIAMOND-BLACKFAN ANEMIA ................................................................................................................. 259
(DOUBLE TAKE) SHWACHMAN-DIAMOND SYNDROME .................................................................................................... 259
APLASTIC ANEMIA PEARLS .................................................................................................................................................................. 260
PLATELET DISORDERS ............................................................................................................................................................................ 260
(DOUBLE TAKE) CELL LIFE SPANS ............................................................................................................................................. 260
THROMBOCYTOPENIA ..................................................................................................................................................................... 260
MATERNAL IMMUNE (OR IDIOPATHIC) THROMBOCYTOPENIC PURPURA (ITP) ................................................... 260
NEONATAL SEPSIS-INDUCED THROMBOCYTOPENIA ........................................................................................................ 260
THROMBOCYTOPENIA AND ABSENT RADIUS (AKA TAR SYNDROME) ....................................................................... 260
IMMUNE THROMBOCYTOPENIA PURPURA (AKA ITP, AKA IDIOPATHIC THROMBOCYTOPENIA PURPURA
.................................................................................................................................................................................................................... 261
(DOUBLE TAKE) WISKOTT-ALDRICH SYNDROME ............................................................................................................... 261
(DOUBLE TAKE) KASABACH-MERRITT SYNDROME............................................................................................................ 261
GLANZMANN THROMBASTHENIA .............................................................................................................................................. 262
BERNARD-SOULIER SYNDROME .................................................................................................................................................. 262
COAGULOPATHY ........................................................................................................................................................................................ 262
VITAMIN K DEPENDENT FACTORS............................................................................................................................................. 262
COAGULATION CASCADE ................................................................................................................................................................ 262
VITAMIN K DEFICIENCY .................................................................................................................................................................. 262
(DOUBLE TAKE) HEMOPHILIA A AND HEMOPHILIA B (AKA FACTOR VIII AND FACTOR IX DEFICIENCY) .. 262
BLEEDING CIRCUMCISION ............................................................................................................................................................. 262
VON WILLEBRAND DISEASE (AKA VON WILLEBRAND FACTOR DEFICIENCY) ....................................................... 263
DISSEMINATED INTRAVASCULAR COAGULATION (DIC) .................................................................................................. 263

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INFECTIOUS DISEASES ............................................................................................................. 264
ANTIBIOTICS A BRIEF REVIEW ....................................................................................................................................................... 264
ANTIBIOTIC AGE PEARLS ............................................................................................................................................................... 264
PENICILLIN ........................................................................................................................................................................................... 264
CLINDAMYCIN ..................................................................................................................................................................................... 264
VANCOMYCIN, LINEZOLID, AND AMPICILLIN ........................................................................................................................ 264
CEPHALOSPORINS ............................................................................................................................................................................. 265
MACROLIDES........................................................................................................................................................................................ 265
CARBAPENEMS ................................................................................................................................................................................... 265
ALBENDAZOLE & PYRANTEL PAMOATE .................................................................................................................................. 265
METRONIDAZOLE .............................................................................................................................................................................. 265
GRAM-POSITIVE ORGANISMS .............................................................................................................................................................. 266
ENTEROCOCCUS FAECALIS ............................................................................................................................................................ 266
LISTERIA MONOCYTOGENES ........................................................................................................................................................ 266
CLOSTRIDIUM TETANI (AKA TETANUS) .................................................................................................................................. 266
(DOUBLE TAKE) CLOSTRIDIUM BOTULINUM ........................................................................................................................ 266
(DOUBLE TAKE) CORYNEBACTERIUM DIPHTHERIAE ....................................................................................................... 266
STREPTOCOCCAL INFECTIONS ........................................................................................................................................................... 267
STREPTOCOCCUS (AKA STREP) ................................................................................................................................................... 267
ALPHA HEMOLYTIC STREPTOCOCCUS (VIRIDANS AND PNEUMONIAE) .................................................................... 267
BETA HEMOLYTIC STREPTOCOCCUS (AGALACTIAE AND PYOGENES) ....................................................................... 267
STREPTOCOCCAL PHARYNGITIS (AKA STREP PHARYNGITIS or STREP THROAT) ................................................ 267
(DOUBLE TAKE) POST STREPTOCOCCAL GLOMERULONEPHRITIS (PSGN, AKA POST INFECTIOUS
GLOMERULONEPHRITIS)................................................................................................................................................................ 268
PERITONSILLAR ABSCESS .............................................................................................................................................................. 268
RETROPHARYNGEAL ABSCESS ..................................................................................................................................................... 268
SCARLET FEVER.................................................................................................................................................................................. 269
OCCULT BACTEREMIA ..................................................................................................................................................................... 269
PNEUMONIA ......................................................................................................................................................................................... 269
GROUP B STREPTOCOCCAL SEPSIS (GBS SEPSIS)................................................................................................................. 269
GBS SCREENING AND PROPHYLAXIS MADE EASY! .............................................................................................................. 269
STAPHYLOCOCCUS AUREUS & EPIDERMIDIS......................................................................................................................... 270
STAPHYLOCOCCUS AND STREPTOCOCCUS COMPARISON CHART ................................................................................ 271
GRAM-NEGATIVE ORGANISMS ............................................................................................................................................................ 272
RICKETTSIA RICKETTSII and ROCKY MOUNTAIN SPOTTED FEVER (RMSF) ............................................................ 272
ENTEROBACTER ................................................................................................................................................................................. 272
(DOUBLE TAKE) BARTONELLA HENSELAE ............................................................................................................................ 272
CITROBACTER FREUNDII ............................................................................................................................................................... 272
(DOUBLE TAKE) CHLAMYDIA TRACHOMATIS ....................................................................................................................... 273
CHLAMYDIA PNEUMONIAE ........................................................................................................................................................... 273
CHLAMYDIA PSITTACI ..................................................................................................................................................................... 273
MYCOPLASMA PNEUMONIAE ....................................................................................................................................................... 273
HEMOPHILUS INFLUENZAE (AKA H. FLU) .............................................................................................................................. 273
BORDETELLA PERTUSSIS (AKA WHOOPING COUGH) ........................................................................................................ 274
PSEUDOMONAS ................................................................................................................................................................................... 274
FUNGAL & ATYPICAL BACTERIA ........................................................................................................................................................ 274
CRYPTOCOCCUS .................................................................................................................................................................................. 274
BLASTOMYCOSIS ................................................................................................................................................................................ 275
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COCCIDIOIDOMYCOSIS ..................................................................................................................................................................... 275
HISTOPLASMOSIS ............................................................................................................................................................................... 275
(DOUBLE TAKE) ASPERGILLUS .................................................................................................................................................... 275
MYCOBACTERIUM TUBERCULOSIS (AKA MTB or TB) ........................................................................................................ 276
VIRUSES .......................................................................................................................................................................................................... 277
COXSACKIE VIRUS & ENTEROVIRUS .......................................................................................................................................... 277
ADENOVIRUS ........................................................................................................................................................................................ 277
ARBOVIRUS ENCEPHALITIS ........................................................................................................................................................... 278
RESPIRATORY SYNCYTIAL VIRUS (RSV) ................................................................................................................................... 278
EPSTEIN-BARR VIRUS (EBV) ......................................................................................................................................................... 278
HUMAN HERPES VIRUS 6 (AKA HHV-6) .................................................................................................................................... 278
(DOUBLE TAKE) HERPES SIMPLEX VIRUS (HSV) ................................................................................................................. 279
(DOUBLE TAKE) VARICELLA ZOSTER VIRUS (CHICKEN POX) ........................................................................................ 279
HUMAN IMMUNODEFICIENCY VIRUS (HIV) ........................................................................................................................... 279
(DOUBLE TAKE) RABIES VIRUS.................................................................................................................................................... 280
MEASLES (AKA RUBEOLA) ............................................................................................................................................................. 280
(DOUBLE TAKE) RUBELLA VIRUS (AKA GERMAN MEASLES) ......................................................................................... 281
MUMPS VIRUS ...................................................................................................................................................................................... 281
PARASITES/PROTOZOA .......................................................................................................................................................................... 282
(DOUBLE TAKE) ERYTHEMA CHRONICUM MIGRANS ........................................................................................................ 282
LEPTOSPIROSIS ................................................................................................................................................................................... 282
ENTAMOEBA HISTOLYTICA (AKA AMEBIASIS) ..................................................................................................................... 283
(DOUBLE TAKE) TRICHOMONAS VAGINALIS ......................................................................................................................... 283
BABESIOSIS ........................................................................................................................................................................................... 283
CRYPTOSPORIDIUM .......................................................................................................................................................................... 283
MALARIA ................................................................................................................................................................................................ 284
TRYPANOSOMA CRUZI ..................................................................................................................................................................... 284
TRYPANOSOMA BRUCEI .................................................................................................................................................................. 284
WORMS ........................................................................................................................................................................................................... 284
ENTEROBIUS (AKA PINWORMS) ................................................................................................................................................. 284
(DOUBLE TAKE) ASCARIS LUMBRICOIDES.............................................................................................................................. 285
SCHISTOSOMIASIS (SCHISTOSOMA)........................................................................................................................................... 285
TAENIA SOLIUM .................................................................................................................................................................................. 285
TAENIA SAGINATA ............................................................................................................................................................................. 285
(DOUBLE TAKE) TOXOCARA CANIS ............................................................................................................................................ 285
HOOKWORM ......................................................................................................................................................................................... 286
CUTANEOUS LARVA MIGRANS...................................................................................................................................................... 286
TRICHURIS ............................................................................................................................................................................................ 286
FILARIASIS ............................................................................................................................................................................................ 286
STRONGYLOIDES ................................................................................................................................................................................ 286
DIPHYLLOBOTHRIUM LATUM ...................................................................................................................................................... 286
INFECTIOUS SYNDROMES .................................................................................................................................................................. 287
GROUND GLASS PNEUMONIA ....................................................................................................................................................... 287
ADOLESCENT + PNEUMONIA + LOW GRADE FEVER........................................................................................................... 287
SPONTANEOUS BACTERIAL PERITONITIS (SBP) .................................................................................................................. 287
SECONDARY PERITONITIS ............................................................................................................................................................. 287
TOXIC SHOCK SYNDROME (TSS) .................................................................................................................................................. 287
DENTAL ABSCESS ............................................................................................................................................................................... 287

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NEONATAL FEVER ............................................................................................................................................................................. 287
NEONATAL BACTEREMIA ............................................................................................................................................................... 288
SINUSITIS .............................................................................................................................................................................................. 288
PAROTIDITIS (AKA PAROTITIS) ................................................................................................................................................... 288
MASTOIDITIS ....................................................................................................................................................................................... 288
OTITIS EXTERNA (AKA SWIMMERS EAR) ............................................................................................................................... 289
ACUTE AND RECURRENT OTITIS MEDIA ................................................................................................................................. 289
CHOLESTEATOMA .............................................................................................................................................................................. 289
CHRONIC OTORRHEA AND RECURRING OTORRHEA .......................................................................................................... 289
MENINGITIS, BACTERIAL AND VIRAL ....................................................................................................................................... 289
TORCH INFECTIONS ................................................................................................................................................................................. 290
TOXOPLASMA GONDII ...................................................................................................................................................................... 290
(DOUBLE TAKE) VARICELLA ZOSTER VIRUS (CHICKEN POX) ........................................................................................ 290
(DOUBLE TAKE) SYPHILIS ............................................................................................................................................................. 291
(DOUBLE TAKE) RUBELLA VIRUS (AKA GERMAN MEASLES) ......................................................................................... 291
CYTOMEGALOVIRUS (CMV) ........................................................................................................................................................... 292
(DOUBLE TAKE) BLUEBERRY MUFFIN SYNDROME ............................................................................................................ 292
ACUTE WATERY DIARRHEA ................................................................................................................................................................. 292
ROTAVIRUS ........................................................................................................................................................................................... 293
ADENOVIRUS ....................................................................................................................................................................................... 293
NORWALK VIRUS................................................................................................................................................................................ 293
ESCHERICHIA COLI (E. coli) ........................................................................................................................................................... 293
SHIGELLA INFECTIONS.................................................................................................................................................................... 293
SALMONELLA ....................................................................................................................................................................................... 294
CAMPYLOBACTER JEJUNI ............................................................................................................................................................... 294
STAPHYLOCOCCUS AUREUS AND BACILLUS CEREUS ......................................................................................................... 294
YERSINIA ENTEROCOLITICA ......................................................................................................................................................... 295
CLOSTRIDIUM PERFRINGENS ....................................................................................................................................................... 295
CLOSTRIDIUM DIFFICILE (C. DIFFICILE or C. DIFF) ............................................................................................................ 295
PEARLY DIARRHEA REVIEW ......................................................................................................................................................... 295
CHRONIC DIARRHEA ................................................................................................................................................................................ 295
(DOUBLE TAKE) GIARDIA ............................................................................................................................................................... 295
CHRONIC NONSPECIFIC DIARRHEA (AKA TODDLERS DIARRHEA) ............................................................................. 296
(DOUBLE TAKE) FOOD PROTEIN INDUCED ENTEROPATHY .......................................................................................... 296
(DOUBLE TAKE) FOOD PROTEIN INDUCED PROCTITIS/COLITIS ................................................................................ 296
(DOUBLE TAKE) FOOD PROTEIN INDUCED ENTEROCOLITIS SYNDROME (FPIES) ............................................. 296
(DOUBLE TAKE) LACTOSE INTOLERANCE (AKA LACTASE DEFICIENCY) .................................................................. 297
INTESTINAL LYMPHANGIECTASIA ............................................................................................................................................. 297
FAT AND CARBOHYDRATE MALABSORPTION ....................................................................................................................... 297
ACUTE LYMPHADENOPATHY (< 3 WEEKS) IN THE HEAD AND NECK AREA ................................................................ 297
STAPHYLOCOCCUS AUREUS AND STREPTOCOCCUS PYOGENES (AKA GAS or STREP PYOGENES) ................. 297
PREAURICULAR LYMPHADENOPATHY ..................................................................................................................................... 297
EMPIRIC TREATMENT ..................................................................................................................................................................... 298
CHRONIC CERVICAL LYMPHADENOPATHY (> 3 WEEKS) ...................................................................................................... 298
(DOUBLE TAKE) BARTONELLA HENSELAE ............................................................................................................................ 298
FRANCISELLA TULARENSIS ........................................................................................................................................................... 298
MYCOBACTERIUM TUBERCULOSIS (MTB or TB) .................................................................................................................. 298
ATYPICAL MYCOBACTERIA ............................................................................................................................................................ 298

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BRUCELLOSIS ....................................................................................................................................................................................... 298
LYMPHADENOPATHY IN OTHER AREAS ........................................................................................................................................ 299
* (DOUBLE TAKE) LYMPHOGRANULOMA VENEREUM SEROVAR .................................................................................. 299
YERSINIA PESTIS ................................................................................................................................................................................ 299
NONTENDER LYMPHADENOPATHY ................................................................................................................................................. 299
SPOROTRICHOSIS (AKA ROSE PICKERS DISEASE) .............................................................................................................. 299
MYCOBACTERIUM TUBERCULOSIS............................................................................................................................................. 299
ATYPICAL MYCOBACTERIA ............................................................................................................................................................ 299
(DOUBLE TAKE) HODGKINS LYMPHOMA ............................................................................................................................... 299
MISCELLANEOUS ID RELATED TOPICS ........................................................................................................................................... 300
SPLENECTOMY PATIENTS .............................................................................................................................................................. 300
DFA AND ELISA TESTING ................................................................................................................................................................ 300
GROWTH MEDIA AND STAINING ................................................................................................................................................. 300
LATEX AGGLUTINATION ................................................................................................................................................................. 300
DROPLET PRECAUTIONS ................................................................................................................................................................ 300
(DOUBLE TAKE) APHTHOUS ULCERS ........................................................................................................................................ 300
STACCATO, BARKY, AND PAROXYSMAL COUGH PEARLS ................................................................................................... 301
CROUP, TRACHEITIS, AND EPIGLOTTITIS SUMMARY TABLE .......................................................................................... 302
VACCINES, IMMUNIZATIONS AND CONTRAINDICATIONS ......................................................... 303
PERTINENT CDC LINKS ................................................................................................................................................................... 303
STEROIDS AND IMMUNIZATIONS ............................................................................................................................................... 303
PREMATURITY AND VACCINATIONS ......................................................................................................................................... 303
LIVE VACCINES .................................................................................................................................................................................... 303
MEASLES, MUMPS, RUBELLA (MMR) AND VARICELLA (VZV) PEARLS........................................................................ 304
ROTAVIRUS VACCINE ....................................................................................................................................................................... 304
INFLUENZA VACCINATION ............................................................................................................................................................ 304
HEPATITIS A VACCINE ..................................................................................................................................................................... 305
HEPATITIS B VACCINE ..................................................................................................................................................................... 305
HUMAN PAPILLOMA VIRUS VACCINE (HPV) .......................................................................................................................... 305
MENINGOCOCCAL VACCINE (AKA MENINGOCOCCUS VACCINE) ................................................................................... 305
PREGNANCY AND IMMUNIZATION ............................................................................................................................................. 306
POSTEXPOSURE PROPHYLAXIS .................................................................................................................................................... 306
TETANUS BOOSTER ........................................................................................................................................................................... 307
VACCINE SCHEDULE REMINDERS .............................................................................................................................................. 307
CATCH-UP IMMUNIZATION SCHEDULE PEARLS .................................................................................................................. 307
VACCINE CONTRAINDICATIONS .................................................................................................................................................. 308
CHICKEN OR EGG ALLERGY ........................................................................................................................................................... 308
DTaP CONTRAINDICATIONS ......................................................................................................................................................... 308
GELATIN ALLERGY ............................................................................................................................................................................ 309
NEOMYCIN, POLYMIXIN, AND STREPTOMYCIN ALLERGIES ............................................................................................ 309
ANAPHYLAXIS MANAGEMENT ..................................................................................................................................................... 309
THIMEROSAL ALLERGY ................................................................................................................................................................... 309
COMPLETE CDC GUIDE .................................................................................................................................................................... 309
INBORN ERRORS OF METABOLISM (IEM) & MISCELLANEOUS METABOLIC DISORDERS ............. 310
INBORN ERRORS OF METABOLISM (IEM) PEARLS.................................................................................................................... 311
INBORN ERRORS OF METABOLISM (PEARLS) ....................................................................................................................... 311
ORGANIC ACIDEMIAS (PEARLS) ................................................................................................................................................... 311

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UREA CYCLE DEFECTS (PEARLS) ................................................................................................................................................ 311
FATTY ACID METABOLISM DISORDERS (PEARLS) .............................................................................................................. 311
STORAGE DISEASES (PEARLS) ..................................................................................................................................................... 311
MITOCHONDRIAL DISORDERS (PEARLS) ................................................................................................................................ 311
AMINO ACIDOPATHIES (PEARLS) ............................................................................................................................................... 311
GALACTOSEMIA (PEARLS) ............................................................................................................................................................. 312
HYPERGLYCINEMIA (PEARLS) ..................................................................................................................................................... 312
NEWBORN SCREEN (NBS) .............................................................................................................................................................. 312
AMMONIA LEVEL ............................................................................................................................................................................... 312
INHERITANCE PATTERN ................................................................................................................................................................ 312
ORGANIC ACIDEMIAS ............................................................................................................................................................................... 312
ORGANIC ACIDEMIAS OVERVIEW ............................................................................................................................................... 312
ISOVALERIC ACIDEMIA .................................................................................................................................................................... 313
GLUTARIC ACIDEMIA ........................................................................................................................................................................ 313
METHYLMALONIC ACIDEMIA & PROPIONIC ACIDEMIA .................................................................................................... 313
UREA CYCLE DEFECTS ............................................................................................................................................................................. 314
UREA CYCLE SUMMARY................................................................................................................................................................... 314
UREA CYCLE DEFECTS INCLUDE ............................................................................................................................................. 314
ORNITHINE TRANSCARBAMYLASE DEFICIENCY ................................................................................................................. 315
CITRULLINEMIA ................................................................................................................................................................................. 315
ARGININOSUCCINIC ACIDURIA .................................................................................................................................................... 315
UREA CYCLE LAB SUMMARY (TABLE) ...................................................................................................................................... 315
MITOCHONDRIAL DISORDERS ............................................................................................................................................................ 315
FATTY ACID OXIDATION DISORDERS .............................................................................................................................................. 315
GLYCOGEN STORAGE DISEASES ......................................................................................................................................................... 316
GSD I (AKA VON GIERKES DISEASE) ......................................................................................................................................... 316
GSD II (AKA POMPE or POMPES DISEASE) ............................................................................................................................. 316
AMINOACIDOPATHIES ............................................................................................................................................................................ 317
PHENYLKETONURIA (PKU) ........................................................................................................................................................... 317
ALKAPTONURIA (AKA ALCAPTONURIA) .................................................................................................................................. 317
MAPLE SYRUP URINE DISEASE (MSUD AKA BRANCHED-CHAIN KETOACIDURIA) ............................................... 317
(DOUBLE TAKE) HOMOCYSTEINURIA ....................................................................................................................................... 318
CARBOHYDRATE METABOLISM DISORDERS ............................................................................................................................... 318
DISORDERS OF CARBOHYDRATE METABOLISM ................................................................................................................... 318
GALACTOSEMIA (AKA GALACTOSE-1-PHOSPHATE URIDYLTRANSFERASE DEFICIENCY or GALT
DEFICIENCY) ........................................................................................................................................................................................ 318
HEREDITARY FRUCTOSE INTOLERANCE ................................................................................................................................. 319
LYSOSOMAL STORAGE DISEASES ...................................................................................................................................................... 319
MUCOPOLYSACCHARIDOSES (MPS) ........................................................................................................................................... 319
SPHINGOLIPIDOSES .................................................................................................................................................................................. 320
TAY-SACHS DISEASE ......................................................................................................................................................................... 320
GAUCHER DISEASE (AKA GAUCHERS DISEASE) ................................................................................................................... 320
FABRY DISEASE (AKA FABRYS DISEASE)................................................................................................................................ 320
NIEMANN-PICK DISEASE ................................................................................................................................................................ 320
MISCELLANEOUS DISORDERS AND PEARLS ................................................................................................................................. 321
HYPOGLYCEMIA DIFFERENTIAL ................................................................................................................................................. 321
INFANT OF A DIABETIC MOTHER (IDM) .................................................................................................................................. 321

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PURINE AND PYRIMIDINE DISORDERS .................................................................................................................................... 321
(DOUBLE TAKE) WILSONS DISEASE ......................................................................................................................................... 322
MENKES KINKY HAIR SYNDROME (AKA MENKES SYNDROME) .................................................................................... 322
SMITH-LEMLI-OPITZ SYNDROME ............................................................................................................................................... 322
CHERRY RED SPOT DIFFERENTIAL ............................................................................................................................................ 323
GENERAL IEM PEARLS & RECAPS ............................................................................................................................................... 323
ACID-BASE DISORDERS ............................................................................................................ 325
A GUIDE TO CALCULATIONS AND SHORTCUTS FOR ACID BASE DISORDERS .............................................................. 325
THE ULTIMATE ABG CALCULATOR BIBLE! ................................................................................................................................... 325
ABG FUNDAMENTALS AND TERMINOLOGY ........................................................................................................................... 325
ABG & CHEMISTRY NUMBERS THE BASICS ......................................................................................................................... 325
ABG RULES FOR A RESPIRATORY ACIDOSIS OR RESPIRATORY ALKALOSIS ............................................................. 326
ABG RULES FOR A METABOLIC ACIDOSIS ................................................................................................................................ 327
ABG & CHEMISTRY PEARLS ........................................................................................................................................................... 328
ABG & CHEMISTRY SHORTCUTS .................................................................................................................................................. 328
ACID-BASE DISORDERS & PEARLS .................................................................................................................................................... 328
ACIDOSIS ................................................................................................................................................................................................ 328
ANION GAP ............................................................................................................................................................................................ 328
ANION GAP METABOLIC ACIDOSIS ............................................................................................................................................. 328
NON-ANION GAP METABOLIC ACIDOSIS .................................................................................................................................. 329
RENAL TUBULAR ACIDOSIS (RTA) .............................................................................................................................................. 329
RENAL TUBULAR ACIDOSIS TYPE I (RTA I, AKA CLASSIC DISTAL RTA) ..................................................................... 329
RENAL TUBULAR ACIDOSIS TYPE II (RTA II, AKA PROXIMAL RTA).............................................................................. 330
RENAL TUBULAR ACIDOSIS TYPE IV (RTA IV) ....................................................................................................................... 330
METABOLIC ALKALOSIS .................................................................................................................................................................. 331
RESPIRATORY ACIDOSIS ................................................................................................................................................................. 332
RESPIRATORY ALKALOSIS .............................................................................................................................................................. 332
FLUIDS & ELECTROLYTES .......................................................................................................... 333
MAINTENANCE IV FLUIDS (MIVF) AND DEHYDRATION ......................................................................................................... 333
MAINTENANCE IV FLUIDS (MIVF) .............................................................................................................................................. 333
DEHYDRATION .................................................................................................................................................................................... 333
GASTROENTERITIS ............................................................................................................................................................................ 334
HEAT STROKE ...................................................................................................................................................................................... 334
HEAT EXHAUSTION ........................................................................................................................................................................... 334
ELECTROLYTES ........................................................................................................................................................................................... 334
(DOUBLE TAKE) HYPERCALCEMIA............................................................................................................................................. 334
(DOUBLE TAKE) HYPOCALCEMIA ............................................................................................................................................... 335
HYPOKALEMIA .................................................................................................................................................................................... 336
HYPERKALEMIA .................................................................................................................................................................................. 336
HYPONATREMIA ................................................................................................................................................................................. 337
HYPERNATREMIA .............................................................................................................................................................................. 339
DIABETES INSIPIDUS (DI) .............................................................................................................................................................. 339
NEPHROLOGY .......................................................................................................................... 340
THE URINALYSIS ........................................................................................................................................................................................ 340
MICROSCOPIC HEMATURIA ........................................................................................................................................................... 340
PROTEINURIA ...................................................................................................................................................................................... 340
WBC CASTS ........................................................................................................................................................................................... 341
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RBC CASTS ............................................................................................................................................................................................. 341
URINARY CRYSTAL IDENTIFICATION........................................................................................................................................ 341
UROLOGY, OBSTRUCTIONS, AND MASSES ..................................................................................................................................... 341
URETEROPELVIC JUNCTION OBSTRUCTION (UPJ OBSTRUCTION)............................................................................... 341
VESICOURETERAL REFLUX (VUR) .............................................................................................................................................. 342
POSTERIOR URETHRAL VALVES (PUV) .................................................................................................................................... 342
NARROW FEMALE URETHRA ........................................................................................................................................................ 342
ABDOMINAL MASS AT BIRTH ....................................................................................................................................................... 342
MULTICYSTIC DYSPLASTIC KIDNEY (MCDK) ........................................................................................................................ 343
URETEROCELE .................................................................................................................................................................................... 343
INFECTIONS.................................................................................................................................................................................................. 343
URINARY TRACT INFECTION (UTI or PYELONEPHRITIS) ................................................................................................ 343
(DOUBLE TAKE) POST STREPTOCOCCAL GLOMERULONEPHRITIS (PSGN, AKA POST INFECTIOUS
GLOMERULONEPHRITIS)................................................................................................................................................................ 343
HEMOLYTIC UREMIC SYNDROME (HUS).................................................................................................................................. 344
INTRINSIC RENAL DISEASE .................................................................................................................................................................. 344
RENAL FAILURE.................................................................................................................................................................................. 344
OLIGURIA ............................................................................................................................................................................................... 344
RENOVASCULAR DISEASE .............................................................................................................................................................. 345
GLOMERULONEPHRITIS ................................................................................................................................................................. 345
IGA NEPHROPATHY........................................................................................................................................................................... 345
(DOUBLE TAKE) POST STREPTOCOCCAL GLOMERULONEPHRITIS (PSGN, AKA POST INFECTIOUS
GLOMERULONEPHRITIS)................................................................................................................................................................ 345
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS (MPGN) ................................................................................... 345
RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS (RPGN) ............................................................................................... 346
NEPHROTIC SYNDROME ................................................................................................................................................................. 346
MEDULLARY SPONGE DISEASE .................................................................................................................................................... 346
AUTOSOMAL DOMINANT TUBULOINTERSTITIAL KIDNEY DISEASE (ADTKD) ....................................................... 347
(DOUBLE TAKE) FANCONI SYNDROME ................................................................................................................................... 347
(DOUBLE TAKE) ALPORT SYNDROME (AKA ALPORTS SYNDROME) .......................................................................... 347
STATISTICS .............................................................................................................................. 349
STATISTICS OVERVIEW .......................................................................................................................................................................... 349
CALCULATIONS OVERVIEW .................................................................................................................................................................. 349
STATISTICS TERMINOLOGY RELATED TO DIAGNOSTIC TESTS .......................................................................................... 349
SENSITIVITY = TP/(TP+FN)........................................................................................................................................................... 350
SPECIFICITY = TN/(TN+FP) ........................................................................................................................................................... 350
LIKELIHOOD RATIO = SENSITIVITY/(1SPECIFICITY) ...................................................................................................... 350
POSITIVE PREDICTIVE VALUE = TP/(TP+FP) ........................................................................................................................ 351
NEGATIVE PREDICTIVE VALUE = TN/(TN+FN) .................................................................................................................... 351
NULL HYPOTHESIS ............................................................................................................................................................................ 351
P VALUE ................................................................................................................................................................................................. 351
SIGNIFICANT RESULTS .................................................................................................................................................................... 351
TYPE I ERROR ...................................................................................................................................................................................... 351
TYPE II ERROR..................................................................................................................................................................................... 351
PREVALENCE ....................................................................................................................................................................................... 351
INCIDENCE............................................................................................................................................................................................ 352
SAMPLE SIZE ........................................................................................................................................................................................ 352
NUMBER NEEDED TO TREAT (NNT) ......................................................................................................................................... 352
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RELATIVE RISK.................................................................................................................................................................................... 352
ODDS RATIO.......................................................................................................................................................................................... 352
VALIDITY HIERARCHY ............................................................................................................................................................................. 352
SYSTEMATIC REVIEW AND META-ANALYSIS ........................................................................................................................ 352
RANDOMIZED CONTROLLED TRIALS ........................................................................................................................................ 352
COHORT STUDIES............................................................................................................................................................................... 352
CASE-CONTROL STUDIES ................................................................................................................................................................ 354
CROSS-SECTIONAL STUDIES.......................................................................................................................................................... 355
CASE STUDIES ...................................................................................................................................................................................... 355
NEUROLOGY ............................................................................................................................ 356
NEUROLOGIC TESTS, PARALYSES & PALSIES ............................................................................................................................... 356
SOMATOSENSORY EVOKED POTENTIALS (SEP) ................................................................................................................... 356
NERVE CONDUCTION VELOCITIES ............................................................................................................................................. 356
ELECTROMYOGRAM (EMG) ............................................................................................................................................................ 356
MAGNETIC RESONANCE IMAGING (MRI)................................................................................................................................. 356
COMPUTER TOMOGRAPHY SCAN (CT SCAN) .......................................................................................................................... 356
SPINAL ULTRASOUND ...................................................................................................................................................................... 356
ERBS PALSY AND KLUMPKE PALSY........................................................................................................................................... 356
HORNER SYNDROME (AKA HORNERS) .................................................................................................................................... 357
SPASTIC CEREBRAL PALSY (CP) .................................................................................................................................................. 357
ATHETOID CEREBRAL PALSY ....................................................................................................................................................... 357
WEAKNESS AND PARALYSIS PEARL .......................................................................................................................................... 357
GUILLAIN-BARRE SYNDROME (GBS, AKA ACUTE INFLAMMATORY DEMYELINATING POLYNEUROPATHY or
AIDP) ....................................................................................................................................................................................................... 357
(DOUBLE TAKE) TICK PARALYSIS ............................................................................................................................................... 358
(DOUBLE TAKE) TODD PARALYSIS (AKA TODDS PARALYSIS) ...................................................................................... 358
TRANSVERSE MYELITIS .................................................................................................................................................................. 358
EPIDURAL ABSCESS OF THE SPINE ............................................................................................................................................ 358
MYASTHENIA GRAVIS (MG) ........................................................................................................................................................... 359
(DOUBLE TAKE) CLOSTRIDIUM BOTULINUM ........................................................................................................................ 359
(DOUBLE TAKE) CORYNEBACTERIUM DIPHTHERIAE ....................................................................................................... 359
INCREASED INTRACRANIAL PRESSURE AND HEADACHES................................................................................................... 359
INCREASED INTRACRANIAL PRESSURE (ICP) ....................................................................................................................... 359
LUMBAR PUNCTURE ......................................................................................................................................................................... 360
DANDY WALKER MALFORMATION ............................................................................................................................................ 360
(DOUBLE TAKE) PSEUDOTUMOR CEREBRI (AKA IDIOPATHIC INTRACRANIAL HYPERTENSION or BENIGN
INTRACRANIAL HYPERTENSION) ............................................................................................................................................... 361
TENSION HEADACHES ..................................................................................................................................................................... 361
MIGRAINE HEADACHES ................................................................................................................................................................... 361
OMINOUS HEADACHES .................................................................................................................................................................... 361
MOVEMENT DISORDERS ........................................................................................................................................................................ 362
(DOUBLE TAKE) DYSTONIC REACTIONS .................................................................................................................................. 362
TICS .......................................................................................................................................................................................................... 362
TOURETTE SYNDROME (AKA TOURETTES SYNDROME) ................................................................................................. 362
STEREOTYPY ........................................................................................................................................................................................ 362
CHOREA .................................................................................................................................................................................................. 362
SYDENHAM CHOREA (AKA SYDENHAMS CHOREA) ............................................................................................................ 362
HUNTINGTON DISEASE (AKA HUNTINGTONS DISEASE) ................................................................................................. 363

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DYSTROPHIES .............................................................................................................................................................................................. 363
SPINAL MUSCULAR ATROPHY TYPE I (AKA WERDNIG-HOFFMANN DISEASE) ...................................................... 363
(DOUBLE TAKE) DUCHENNE MUSCULAR DYSTROPHY ..................................................................................................... 363
MYOTONIC DYSTROPHY .................................................................................................................................................................. 363
SENSORY NEUROPATHIES ..................................................................................................................................................................... 363
SEIZURES ....................................................................................................................................................................................................... 364
FIRST-TIME SEIZURE ....................................................................................................................................................................... 364
EPILEPSY AND SEIZURE PRECAUTIONS AND EDUCATION .............................................................................................. 364
EMERGENCY ROOM PEDIATRIC SEIZURE MANAGEMENT ............................................................................................... 364
SEIZURE TERMINOLOGY ................................................................................................................................................................. 364
SIMPLE PARTIAL SEIZURES ........................................................................................................................................................... 365
COMPLEX PARTIAL SEIZURES ...................................................................................................................................................... 365
BENIGN EPILEPSY OF CHILDHOOD (AKA BENIGN ROLANDIC EPILEPSY) ................................................................ 365
ABSENCE SEIZURES .......................................................................................................................................................................... 365
TONIC-CLONIC SEIZURE .................................................................................................................................................................. 365
NEONATAL SEIZURES ...................................................................................................................................................................... 365
INFANTILE SPASMS .......................................................................................................................................................................... 366
FEBRILE SEIZURE .............................................................................................................................................................................. 366
BREAKTHROUGH SEIZURE ............................................................................................................................................................. 366
STATUS EPILEPTICUS ...................................................................................................................................................................... 366
(DOUBLE TAKE) TODD PARALYSIS (AKA TODDS PARALYSIS) ...................................................................................... 366
ATAXIA AND RELATED CONDITIONS ............................................................................................................................................... 367
ACUTE CEREBELLAR ATAXIA ........................................................................................................................................................ 367
(DOUBLE TAKE) ATAXIA TELANGIECTASIA ........................................................................................................................... 367
FRIEDREICH ATAXIA (AKA FRIEDREICHS ATAXIA) ............................................................................................................ 367
BENIGN POSITIONAL VERTIGO (BPV) ....................................................................................................................................... 367
PERILYMPHATIC FISTULA ............................................................................................................................................................. 367
MISCELLANEOUS NEUROLOGIC CONDITIONS AND FINDINGS ............................................................................................ 367
JAW CLONUS AND BILATERAL ANKLE CLONUS.................................................................................................................... 367
UPPER MOTOR NEURON DISEASE .............................................................................................................................................. 368
LOWER MOTOR NEURON DISEASE ............................................................................................................................................ 368
HEAD TRAUMA .................................................................................................................................................................................... 368
NEUROCARDIOGENIC SYNCOPE .................................................................................................................................................. 368
CEREBROVASCULAR ACCIDENT (AKA CVA or STROKE) .................................................................................................... 368
MENTAL RETARDATION ................................................................................................................................................................. 368
EPIDURAL HEMATOMA ................................................................................................................................................................... 368
SUBDURAL HEMATOMA (SDH) .................................................................................................................................................... 369
SUBARACHNOID HEMORRHAGE .................................................................................................................................................. 369
MENINGITIS PEARLS ........................................................................................................................................................................ 369
SPINA BIFIDA ....................................................................................................................................................................................... 369
CHIARI MALFORMATION (ARNOLD-CHIARI MALFORMATION) ..................................................................................... 370
ORTHOPEDICS AND SPORTS MEDICINE .................................................................................... 371
EPIPHYSIS, PHYSIS, AND METAPHYSIS..................................................................................................................................... 371
SALTER HARRIS FRACTURES ........................................................................................................................................................ 371
TORUS FRACTURE (AKA BUCKLE FRACTURE) ...................................................................................................................... 372
GREENSTICK FRACTURE ................................................................................................................................................................. 372
DISTAL HUMERAL FRACTURES.................................................................................................................................................... 372
DISLOCATED SHOULDER ................................................................................................................................................................ 372
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OSTEOGENESIS IMPERFECTA ....................................................................................................................................................... 372
VALGUS DEFORMITY ........................................................................................................................................................................ 372
VARUS...................................................................................................................................................................................................... 372
GENU VARUM (AKA BOWED LEGS) ............................................................................................................................................ 372
RICKETS.................................................................................................................................................................................................. 373
BLOUNT DISEASE ............................................................................................................................................................................... 373
INTOEING .............................................................................................................................................................................................. 373
CLUB FOOT (AKA TALIPES EQUINOVARUS or EQUINOVARUS DEFORMITY) ............................................................ 373
PES CAVUS ............................................................................................................................................................................................. 374
PES PLANUS .......................................................................................................................................................................................... 374
SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)................................................................................................................... 374
LEGG-CALVE-PERTHES DISEASE ................................................................................................................................................. 374
OSGOOD SCHLATTER DISEASE ..................................................................................................................................................... 375
OSTEOCHONDRITIS DISSECANS .................................................................................................................................................. 375
SCOLIOSIS .............................................................................................................................................................................................. 375
SPONDYLOLYSIS ................................................................................................................................................................................. 375
SPONDYLOLISTHESIS ....................................................................................................................................................................... 375
SUBLUXED RADIAL HEAD (AKA NURSEMAIDS ELBOW) .................................................................................................. 376
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH).............................................................................................................. 376
TOXIC SYNOVITIS (AKA TRANSIENT SYNOVITIS OF THE HIP) ....................................................................................... 376
SEPTIC ARTHRITIS............................................................................................................................................................................. 377
OSTEOMYELITIS ................................................................................................................................................................................. 377
STRAINS ................................................................................................................................................................................................. 377
SPRAINS.................................................................................................................................................................................................. 377
ROTATOR CUFF TEARS .................................................................................................................................................................... 377
ANTERIOR CRUCIATE LIGAMENT TEAR (ACL TEAR) ......................................................................................................... 378
JOINT HYPERMOBILITY ................................................................................................................................................................... 378
COMPARTMENT SYNDROME ......................................................................................................................................................... 378
ACROMIOCLAVICULAR JOINT SEPARATION (AC JOINT SEPARATION) ........................................................................ 378
SPORTS INJURY PEARL .................................................................................................................................................................... 378
CONGENITAL TORTICOLLIS ........................................................................................................................................................... 378
POLYDACTYLY ..................................................................................................................................................................................... 378
RHEUMATOLOGY .................................................................................................................... 380
ARTHRITIC CONDITIONS ....................................................................................................................................................................... 380
ARTHROCENTESIS (JOINT ASPIRATION) PEARLS ................................................................................................................ 380
JUVENILE IDIOPATHIC ARTHRITIS (JRA, JIA) ......................................................................................................................... 380
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) ............................................................................................................................ 381
(DOUBLE TAKE) NEONATAL LUPUS .......................................................................................................................................... 381
DRUG INDUCED LUPUS .................................................................................................................................................................... 381
JUVENILE ANKYLOSING SPONDYLITIS ..................................................................................................................................... 382
JUVENILE REITER SYNDROME (AKA JUVENILE REITERS SYNDROME) ..................................................................... 382
BEHCET SYNDROME (AKA BEHCETS DISEASE, BEHET SYNDROME, ETC.) ........................................................... 382
NON-ARTHRITIC CONDITIONS ............................................................................................................................................................ 382
(DOUBLE TAKE) DERMATOMYOSITIS ....................................................................................................................................... 382
HENOCH SCHONLEIN PURPURA (HSP) ..................................................................................................................................... 382
SARCOIDOSIS ........................................................................................................................................................................................ 383
SJOGREN SYNDROME (AKA SJOGRENS SYNDROME) .......................................................................................................... 383
RAYNAUDS PHENOMENON (AKA RAYNAUDS) ..................................................................................................................... 383

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WEGENERS GRANULOMATOSIS.................................................................................................................................................. 383
PULMONOLOGY ...................................................................................................................... 384
CYSTIC FIBROSIS AND NASAL POLYPS ............................................................................................................................................ 384
CYSTIC FIBROSIS (CF) ...................................................................................................................................................................... 384
STRIDOR ......................................................................................................................................................................................................... 385
INSPIRATORY STRIDOR ................................................................................................................................................................... 385
EXPIRATORY STRIDOR ..................................................................................................................................................................... 385
BIPHASIC STRIDOR ............................................................................................................................................................................ 386
CONGENITAL PULMONARY DISEASE ............................................................................................................................................... 386
CONGENITAL DIAPHRAGMATIC HERNIA ................................................................................................................................. 386
CONGENITAL PULMONARY MALFORMATIONS ..................................................................................................................... 386
PERSISTENT PULMONARY HYPERTENSION .......................................................................................................................... 387
CHOANAL ATRESIA............................................................................................................................................................................ 387
ASTHMA ......................................................................................................................................................................................................... 387
EXERCISE-INDUCED ASTHMA ...................................................................................................................................................... 387
PEDIATRIC ASTHMA CLASSIFICATION ..................................................................................................................................... 387
RHINOVIRUS......................................................................................................................................................................................... 388
RESPIRATORY SYNCYTIAL VIRUS (RSV) ................................................................................................................................... 388
DUST MITES ......................................................................................................................................................................................... 388
BETA BLOCKERS AND ASPIRIN .................................................................................................................................................... 388
ADULT ASTHMA .................................................................................................................................................................................. 388
ASTHMA DIFFERENTIAL ................................................................................................................................................................. 389
PNEUMONIA ................................................................................................................................................................................................. 389
RECURRENT PNEUMONIA ..................................................................................................................................................................... 389
ATAXIA TELANGIECTASIA .............................................................................................................................................................. 389
BRUTONS X-LINKED AGAMMAGLOBULINEMIA ................................................................................................................... 389
SEVERE COMBINED IMMUNODEFICIENCY (SCID)............................................................................................................... 389
HYPER-IGM SYNDROME (AKA HYPER IGM SYNDROME) .................................................................................................. 389
HYPER-IGE SYNDROME (AKA HYPER IGE SYNDROME) ..................................................................................................... 389
COMMON VARIABLE IMMUNE DEFICIENCY (CVID) ............................................................................................................ 390
(DOUBLE TAKE) ASPERGILLUS .................................................................................................................................................... 390
BRONCHIOLITIS OBLITERANS WITH ORGANIZING PNEUMONIA (BOOP)................................................................. 390
INTRAPULMONARY SEQUESTRATION ...................................................................................................................................... 390
MIGRATING PNEUMONIAS .................................................................................................................................................................... 390
VISCERAL LARVA MIGRANS ........................................................................................................................................................... 390
(DOUBLE TAKE) ASCARIS LUMBRICOIDES ............................................................................................................................. 390
MISCELLANEOUS PULMONARY DEFINITIONS AND CONDITIONS ..................................................................................... 391
VOCAL FREMITUS .............................................................................................................................................................................. 391
COR PULMONALE ............................................................................................................................................................................... 391
TACHYPNEA ......................................................................................................................................................................................... 391
HYPERCAPNIA (AKA HYPERCAPNEA) ....................................................................................................................................... 391
ACUTE LIFE THREATENING EVENT (ALTE) ........................................................................................................................... 392
ALPHA-1-ANTITRYPSIN DEFICIENCY ........................................................................................................................................ 392
RESPIRATORY DISTRESS SYNDROME (RDS) .......................................................................................................................... 392
NASAL FOREIGN BODY .................................................................................................................................................................... 392
FOREIGN BODY ASPIRATION ........................................................................................................................................................ 392
VOCAL CORD NODULES ................................................................................................................................................................... 392
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CHRONIC COUGH ................................................................................................................................................................................ 392
PNEUMOTHORAX ............................................................................................................................................................................... 393
FLAIL CHEST ........................................................................................................................................................................................ 393
BRONCHIECTASIS............................................................................................................................................................................... 393
HIGH-YIELD CHEST X-RAY FINDINGS AND PEARLS .................................................................................................................. 393
PULMONARY VASCULAR CONGESTION..................................................................................................................................... 393
PATCHY AREAS OF DIFFUSE ATELECTASIS ............................................................................................................................ 393
FLUID IN HORIZONTAL FISSURE ................................................................................................................................................. 393
UNDERINFLATED CHEST X-RAY .................................................................................................................................................. 393
DIFFUSE OPACITIES WITH CYSTIC AREAS .............................................................................................................................. 393
PSYCHIATRY AND SOME SOCIAL ISSUES ................................................................................... 394
ATTENTION DEFICIT DISORDER (AKA ADD, ADHD, and ATTENTION DEFICIT HYPERACTIVE DISORDER)
.................................................................................................................................................................................................................... 394
LEARNING DISABILITIES ................................................................................................................................................................ 394
SCHOOL PHOBIA ................................................................................................................................................................................. 394
DEATH RESPONSE IN CHILDREN ................................................................................................................................................ 394
DEPRESSION ......................................................................................................................................................................................... 395
DIVORCE................................................................................................................................................................................................. 395
PARENTAL ADJUSTMENT TO A CHILD WITH MALFORMATIONS .................................................................................. 395
CHRONICALLY ILL FAMILY MEMBER ........................................................................................................................................ 395
CONVERSION DISORDER ................................................................................................................................................................. 395
SOMATIZATION ................................................................................................................................................................................... 395
PSYCHOSOMATIC ................................................................................................................................................................................ 395
BREATH-HOLDING SPELLS ............................................................................................................................................................ 395
NIGHT TERRORS ................................................................................................................................................................................. 396
NIGHTMARES ....................................................................................................................................................................................... 396
CHILD DISCIPLINE ............................................................................................................................................................................. 396
THUMB SUCKING ................................................................................................................................................................................ 396
CHILD ABUSE ....................................................................................................................................................................................... 396
IMPACT OF MEDIA ON CHILDREN .............................................................................................................................................. 397
MISCELLANEOUS TID BITS AND PEARLS ....................................................................................................................................... 397
PREVENTATIVE MEDICINE TERMINOLOGY ........................................................................................................................... 397
MOUTH GUARDS ................................................................................................................................................................................. 397
CONTACT SPORTS PARTICIPATION ............................................................................................................................................ 397
BICYCLE SAFETY................................................................................................................................................................................. 397
FIRST DENTAL EXAM ....................................................................................................................................................................... 397
FLUORIDE SUPPLEMENTATION .................................................................................................................................................. 397
HOT WATER HEATER ....................................................................................................................................................................... 398
BOAT SAFETY ....................................................................................................................................................................................... 398
TONGUE TIED (AKA TONGUE TIE).............................................................................................................................................. 398
ENURESIS AND ENCOPRESIS ........................................................................................................................................................ 398
ETHICS IN PEDIATRICS.............................................................................................................. 399
MAIN PRINCIPLES AND TERMS........................................................................................................................................................... 399
AUTONOMY ........................................................................................................................................................................................... 399
BENEFICENCE ..................................................................................................................................................................................... 399
CONSENT ............................................................................................................................................................................................... 399
PERMISSION ......................................................................................................................................................................................... 400
RELIGIOUS, CULTURAL, AND PERSONAL OBJECTIONS ...................................................................................................... 400
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ASSENT ................................................................................................................................................................................................... 400
TRUTHFULNESS ................................................................................................................................................................................. 401
CONFIDENTIALITY ............................................................................................................................................................................ 401
PHYSIOLOGIC FUTILITY .................................................................................................................................................................. 401
QUALITATIVE FUTILITY .................................................................................................................................................................. 402
SPECIFIC ISSUES ......................................................................................................................................................................................... 402
IMPAIRED NEUROLOGIC STATES ................................................................................................................................................ 402
DO NOT RESUSCITATE (DNR; DNAR) ORDERS ...................................................................................................................... 403
EUTHANASIA AND PHYSICIAN ASSISTED SUICIDE ............................................................................................................. 403
OTHER ISSUES ..................................................................................................................................................................................... 403
PATIENT SAFETY AND QUALITY IMPROVEMENT ...................................................................... 405
SYSTEMS APPROACH ........................................................................................................................................................................ 405
TEAM APPROACH ............................................................................................................................................................................... 405
CULTURE OF TRANSPARENCY...................................................................................................................................................... 405
NON-PUNITIVE APPROACH ........................................................................................................................................................... 406
LEARNING FROM ERRORS .............................................................................................................................................................. 406
QUALITY IMPROVEMENT ...................................................................................................................................................................... 406
DATA DRIVEN APPROACH .............................................................................................................................................................. 406
PSYCHOLOGY OF CHANGE .............................................................................................................................................................. 407
CYCLE OF CONTINUOUS IMPROVEMENT ................................................................................................................................ 407
PEDIATRIC LAB VALUES ........................................................................................................... 409
COMPLETE BLOOD COUNT (CBC) ............................................................................................................................................... 409
COAGULATION STUDIES ................................................................................................................................................................. 409
NORMAL PEDIATRIC ELECTROLYTE VALUES ........................................................................................................................ 409
ALKALINE PHOSPHATASE .............................................................................................................................................................. 410
GAMMA-GLUTAMYL TRANSPEPTIDASE (GGT) ...................................................................................................................... 410
DIRECT BILIRUBIN ............................................................................................................................................................................ 410
PEDIATRIC VITAL SIGNS ........................................................................................................... 411
PEDIATRIC RESPIRATORY RATES ............................................................................................................................................... 411
PEDIATRIC HEART RATE OR PULSE........................................................................................................................................... 411
PEDIATRIC BLOOD PRESSURE...................................................................................................................................................... 411
Index ...................................................................................................................................... 415

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ADOLESCENT MEDICINE
PUBERTY
NOTES: Please note that there is a great deal of overlap and repetition between the puberty section and the
Endocrinology section.
* Know conversion from inches to centimeters. 1 inch is about 2.5 cm!
* Sexual Maturity Ratings (SMR) and Tanner Staging begins with ONE. Theres NO ZERO. Tanner/SMR 1 =
Prepubertal
* Experts disagree regarding some SMR descriptions. They definitely cant agree on the age at which
Delayed Puberty is diagnosed. Dont stress! Questions on the exam should be fairly clear.

NORMAL PUBERTY TIMELINE


SMR Girls Boys
Limits Delayed Puberty: 13 14 yo Delayed Puberty: 14 15 yo
Precocious Puberty: 2 signs before 8 yo Precocious Puberty: 2 signs before 9 yo
1 Basal growth at 56 cm/yr, boyish chest <4 ml volume or <2.5 cm diameter of testicle,
(papilla elevation only), no hair no hair, baby penis, basal rate of 56 cm/yr,
no hair
2 Accelerated growth at 78 cm/yr, a breast >4 ml or >2.5 cm (this is the 1st sign of
bud is the 1st sign of puberty (palpable, areola puberty), hair at base of penis. Penis may
enlarges), Hair only along the labia (coarse) start to enlarge (usually at SMR 3)
3 PEAK ht velocity of 810 cm/yr, elevation of Accelerated vertical (and penile) growth
breast contour, areola enlarges, curly hair at >12 ml/3.5 cm, Gynecomastia in 50% of boys
pubis, axillary hair begins, acne. This stage is 1016 yo, resolve in 3 yrs), CURLY hair at
similar to a boys SMR 3 + 4 combined. pubis. Think about the 3 Stooges. They all
Imagine a girl sitting on a 3-LEGGED STOOL had funny pubertal voices, and the fat one
crying because she has hair in her armpit and had BOOBS/GYNECOMASTIA and was
now has acne! named CURLY.
4 Mound on mound, enlarged areola. Dense PEAK height velocity at 10 cm/yr, no thigh
hair, none at the thigh. Menses usually occurs hair, develops AXillary hair, acne, and body
around SMR 3 or 4. odor. Teenage boy with raging hormones is
pissed about acne & hair so takes an AX to
his 4 DOOR CAR (SMR 4) which explodes
and burns his hair!
5 Stop growing at about 16 yo, areola recesses >4.5 cm penis, thigh hair, stop growing at
to general contour of breast and the breasts ~17 or 18, +facial hair at sides, no more
again look like Tanner 3 gynecomastia

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NORMAL PUBERTY PEARLS
Here are some great pearls and shortcuts about normal puberty.
* Girls have adult-looking breasts in SMR 3 and 5.
* SMR 4 = mound on mound breasts
* SMR 2 to 5 usually lasts about 3 to 5 years in total duration for both sexes.
* MENARCHE usually occurs in SMR 3 or SMR 4 (more likely 4) OR within 23 YEARS of the onset of
puberty. Amenorrhea does not require workup until 2 years after puberty has ended. Since puberty may
take 5 years to complete, its possible a patient may not need a workup for amenorrhea until 7 years after
their breast buds form.
* MENSES/HEIGHT: At the onset of menses, girls are probably within 12 inches (2.55 cm) of their adult
height. Why do I say that? Because theyre probably in SMR 4 (which occurs after the peak height
velocity).
* VAGINAL BLEEDING: Bloody vaginal discharge while in SMR 2 shouldnt happen. Consider a foreign body
(e.g., toilet paper) in your differential.

HEIGHT
For the test, pre-pubertal basal rate for height in both boys and girls is 56 cm/year. The peak is 10 cm/yr.
Early puberty results in shorter adult height.

GROWTH SPURTS
Elevated alkaline phosphatase can be normal during growth spurts. Hematocrit increases alongside growth
spurts.

THELARCHE, ADRENARCHE THEN MENARCHE


(THELARCHE) Breast development (ADRENARCHE) Hair development (MENARCHE) Menses
PEARLS AND MNEMONICS: Girls are TAMer than boys. Boys like to TAP Her!

Girls are TAMer = Thelarche, then Adrenarche, then Menarche = Breast development Hair
development Menses. Thelarche = first sign of puberty stage 2. Adrenarche is the same thing as
Pubarche. Breasts: Look most natural at SMR 1, 3, and 5. TAM = Breasts are higher than Pubic hair
which is higher than a Vagina.
Boys = TAP Her = Testicular enlargement, then Adrenarche, then Phallus/Penile enlargement,
THEN Height velocity peaks.

(DOUBLE TAKE) AGE RANGE OF NORMAL PUBERTY


Age ranges for puberty = 8 to 13 for girls, and 9 to 14 for boys. If puberty begins at those age ranges, that is
okay, but before that is precocious puberty and after that is delayed puberty.
MNEMONIC: Imagine Reese Witherspoon being pissed because she hasnt hit puberty yet! She puts on a
HOCKEY MASK and ICE SKATES and then knocks a huge CHOCOLATE HEART out of the hands of Tom
Cruise with her hockey stick. He falls backwards and lands on a white CAT! Now theyre both upset and
crying like little children! Those are the shortest celebs I could think of to represent pre-pubertal kids. Hockey
Mask and Ice Skates = 13 (Jason from Friday the 13th) and 8 (figure 8). Those are for the normal age range
for puberty in girls. Chocolate heart and Cat = 14 (Valentines Day) & 9 (nine lives) for the normal age range
for puberty in boys.

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ESTROGEN
Estrogen causes the development of Breasts + Change in vaginal color + Labial Prominence.

ANDROGENS
Androgens cause pubic hair development. So when you think of pubic hair, think of an androgen-related
issue.
PEARL: If youre presented with an adolescent girl with breasts but NO pubic hair, guess what? Shes NOT
A GIRL! Think ANDROGEN INSENSITIVITY (aka TESTICULAR FEMINIZATION) in someone carrying XY
chromosomes.
PEARL: If presented with an adolescent female with a history of pubic hair development, but no history of
preceding breast development, the patient likely has ANDROGEN EXCESS or LOW ESTROGEN.
PEARL: If an adolescent presents with isolated PREMATURE ADRENARCHE (pubic hair with no breasts or
no increase in testicular size), get bone age films! If the bone age films are within 12 years of the chronologic
age, its OKAY TO OBSERVE. If not, the patient will need an Endocrinologist to intervene.
PEARL: Girl with no breasts (or just buds), no hair or only scant pubic hair, no menses TURNERS
SYNDROME Get a karyotype.
PEARL: Always question whether or not the girl in your question is truly a normal XX girl without any
hormonal issues/deficiencies.

BREAST MASSES FIBROADENOMAS AND FIBROCYSTIC DISEASE


Breast masses in children are usually benign and due to fibrocystic disease or fibroadenomas. Check the
masses at the end of menstrual periods. Mammography is NOT needed until patients are much older since
their breast tissue is dense. To evaluate, use ULTRASOUND. Excisional biopsy is almost never indicated
(only if aspirate is bloody).
* FIBROCYSTIC DISEASE is the most common breast disease and is usually bilateral and tender. OCPs
may help.
* FIBROADENOMAS are unilateral and ESTROGEN-dependent (bigger with OCPs/pregnancy). Refer to
gynecology if there is bloody aspirate or if it persists beyond 3 cycles.

PUBERTY GONE HAYWIRE

(DOUBLE TAKE) AGE RANGE OF NORMAL PUBERTY


Age ranges for puberty = 8 to 13 for girls, and 9 to 14 for boys. If puberty begins at those age ranges, that is
okay, but before that is precocious puberty and after that is delayed puberty.
MNEMONIC: Imagine Reese Witherspoon being pissed because she hasnt hit puberty yet! She puts on a
HOCKEY MASK and ICE SKATES and then knocks a huge CHOCOLATE HEART out of the hands of Tom
Cruise with her hockey stick. He falls backwards and lands on a white CAT! Now theyre both upset and
crying like little children! Those are the shortest celebs I could think of to represent pre-pubertal kids. Hockey
Mask and Ice Skates = 13 (Jason from Friday the 13th) and 8 (figure 8). Those are for the normal age range
for puberty in girls. Chocolate heart and Cat = 14 (Valentines Day) & 9 (nine lives) for the normal age range
for puberty in boys.

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PRECOCIOUS PUBERTY
Precocious puberty can be due to a brain hormone problem OR a problem with hormone production from
somewhere else. If you suspect precocious puberty on the exam start to rule out TESTICULAR or
OVARIAN TUMORS by your EXAM! LOOK at, and FEEL, the size/consistency of your patients gonads. Then
move on to getting LH and FSH levels (look for elevations) to look for a central disorder, doing a pelvic
ultrasound in girls. For boys, pubarche (adrenarchy/hair growth) + an enlarged phallus without testicular
enlargement means there is the presence of excess androgens from outside the normal gonads. Remember,
testicular enlargement is the FIRST sign of puberty in boys, so if other signs of puberty exist without testicular
enlargement, something is wrong!
* ULTRASOUND is useful to look for adrenal or ovarian masses.
* CENTRAL VS. PERIPHERAL: Get LH, FSH, and Adrenal Steroid levels to help differentiate

GONADOTROPIN-INDEPENDENT PRECOCIOUS PUBERTY


In gonadotropin-independent precocious puberty (AKA precocious pseudopuberty or pseudoprecocious
puberty), there is some sex-steroid production going on in the body but not because of pituitary hormone
production. The hormones usually come from the adrenals, ovaries or testes. If gonadotropes (LH and FSH)
levels are normal and everything in the history sounds like its on a proper timeline except for one
abnormality, such as breast development followed by the onset of menstruation but without pubic hair, then
consider this category of precocious puberty. Specific causes of Non-pituitary related precocious puberty
include tumors, congenital adrenal hyperplasia, McCune-Albright syndrome and Leydig cell hyperplasia
(boys).

PRECOCIOUS PUBERTY IN GIRLS


In girls, precocious puberty is defined as having breasts + vaginal bleeding OR accelerated growth. Get LH,
FSH, estrogen, and progesterone. This condition is often idiopathic when brain hormones have started early
(elevated LH and FSH). If there are elevated gonadal hormones but low brain hormones (meaning a
gonadotropin-independent precocious puberty), this could be BAD (tumor). Look for ovarian tumors with a
pelvic ultrasound. You may consider getting an MRI to look for a pituitary tumor if neurologic signs are present
and/or central hormones are elevated. Treat CENTRAL PRECOCIOUS PUBERTY with a GnRH Analogue
(gonadoTROPIN releasing hormone analogue) called Leuprolide or Lupron. Its counterintuitive, but it
eventually results in the suppression of LH and FSH release and therefore results in suppression of ovarian
(or testicular) steroidogenesis.

PRECOCIOUS PUBERTY IN BOYS


In boys, precocious puberty can be caused by elevated LH alone causing elevated gonadal androgens. HCG
can act on the same LH receptors; therefore an HCG-SECRETING TUMOR can also cause it. Look for
increased testicular size/volume.
PEARL/SHORTCUT: In order to choose an answer that has PUBERTY in it (CENTRAL PRECOCIOUS
PUBERTY or TRUE PUBERTY), there must be evidence of testicular enlargement (>4 ml/2.5 cm). So if the
testes are small (<4 ml/2.5 cm), but there is evidence of extra hair, penile enlargement, and/or a growth spurt,
there is a non-central and non-gonadal problem think late onset Congenital Adrenal Hyperplasia or a
VIRILIZING TUMOR or EXOGENOUS STEROIDS!

ADRENAL ANDROGENS
Adrenal androgens cause body odor, acne, and hair development. Etiology of ACNE androgens. The term
adrenarche = hair.

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PREMATURE ADRENARCHE
Premature adrenarche is common in girls. Parents bring them to the office quickly because they are
concerned about their hairy/mannish princess. Its usually not a big deal. In boys its VERY concerning, but
boys are unfortunately NOT brought to the office often enough because parents think boys are supposed to
be hairy! Its serious in boys because it can be due to CONGENITAL ADRENAL HYPERPLASIA (CAH).
PEARL: If workup suggests an adrenal source, choose CAH over adrenal tumor as your answer.

CONGENITAL ADRENAL HYPERPLASIA (CAH) INTRO


In congenital adrenal hyperplasia (CAH), there is a cortisol and aldosterone manufacturing problem in the
adrenal glands. Negative feedback results in high levels of ACTH being released from the pituitary glands
Results in an increase in cortisol precursors Resulting in more ANDROGENS. It is diagnosed by
measuring 17-hydroxyprogesterone (expect levels to he be HIGH). (More details in ENDOCRINOLOGY under
Congenital Adrenal Hyperplasia)

NORMAL ADRENAL STEROID SYNTHESIS

PROGESTERONE 17-HYDROXYPROGESTERONE ADRENAL ANDROGENS

(21-hydroxylase) (21-hydroxylase)

DEOXYCORTICOSTERONE 11-DEOXYCORTISOL


CORTICOSTERONE CORTISOL

18-HYDROXYPROGESTERONE


ALDOSTERONE

TROPIC
In endocrinology, TROPIC refers to central hormones. Break down big words. So HYPERGONADOTROPIC
refers to an excess of central hormones

PREMATURE THELARCHE
Premature thelarche is defined as thelarche prior to the age of 8, though most cases occur around 2 years of
age. Breast development can be unilateral or bilateral, and its not associated with other secondary sex
characteristics. Theres normal linear and bone growth. This is usually benign. Treat with reassurance and
frequent office visits to ensure there are no additional signs of early puberty.
PEARL: You might hear a parent say, My baby had boobies since the day she was born! This is NOT a big
deal unless shes also having menses. Again, this condition is usually benign.
PEARL: If there are additional pubertal signs, look for evidence of excess estrogens from an exogenous
source, an estrogen-secreting tumor, or early activation of the hypothalamic-pituitary axis. Endocrinology
referral is also warranted.

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I really hope that you've enjoyed this free chapter. The links are active to show you how
valuable an online learning experience can be. My sincere recommendation is that you
purchase a PBR bundled product that includes both the online AND the hardcopy versions
of the PBR materials so that you can mark things up, make notes, but also be EFFICIENT!

Now how about a handful of free questions?


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QUESTIONS

1. A premature baby needs:


a. More sodium than a full term neonate. Sodium supplementation should be started
immediately.
b. More sodium than a full term neonate. Sodium supplementation can be started after 24
hours.
c. Less sodium than a full term baby.
d. The same amount of sodium as a full-term baby.
2. A premie is born at 33 weeks in a taxi. In the ER, the baby is noted to have a temperature of 35
degrees Celsius. The child should be placed:
a. In a bassinette.
b. In an incubator at 40 degrees Celsius.
c. Under a radiant warmer at max temperature.
d. Under a radiant warmer at preferred skin temperature.
3. An LGA baby is noted to have a firm, freely mobile, erythematous and nodular mass with distinct
borders at the upper cheek on DOL 13. This is likely:
a. Fat necrosis of the newborn.
b. A lipoma
c. A sarcoma
d. Related to child abuse.
4. Which abnormality is common in the recipient of a PRBC transfusion and also in the recipient twin of
a twin-to-twin transfusion?
a. Hyponatremia
b. Hypokalemia
c. Hypocalcemia
d. Hypophosphatemia
5. A child is born by a normal vaginal delivery. About an hour later he is noted to be tachypneic and
pale. Labs show that he is anemic. Reticulocyte count is 15%. The RBCs are noted to be normal
under microscopy. What is the likely etiology of these finding?
a. Chronic intrauterine blood loss.
b. Acute blood loss at birth.
c. Congenital heart disease.
d. Congenital syphilis

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ANSWERS?

WHERE ARE THE ANSWERS?


Sorry, these are real questions from the PBR Q&A Book. Youll need to get the PBR Ultimate Bundle Pack
or the PBR 12-Month ALL ACCESS PASS package by visiting:
http://www.pediatricsboardreview.com/catalog

FREE QUESTIONS AND ANSWERS


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If youve ever failed ANY medical board exam before, OR if you are usually just above the passing grade,
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boards. Its one of the hardest medical board exams around, and Id strongly recommend that you read the
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IF YOU ENJOYED IT, GET IT!

Still not sure where to get started? Buy the PBR FOR LIFE! and youll have everything you
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Best,
- Ashish

Pediatrics Board of Review


Copyright Pediatrics Board Review, Inc. 2011 Present.
All Right Reserved. Do Not Copy Without Written Permission
Hope Youve Enjoyed It!
A Few [CRITICAL] Reminders

* TAKING THE INITIAL CERTIFICATION EXAM? READ MORE!

This exam is MUCH HARDER than the USMLE exam. Go through the PBR Core Study Guide and Q&A
Book 35 times. Go through the material three times if youre recently out of residency, studying for
the initial certification boards, and typically score above the national average on board exams. Go
through the material FIVE times if you typically score below the national average on medical board
exams, or if you have ever failed a medical board exam.

* TAKING THE MOC? READ MORE!

Going through the PBR Core Study Guide and Q&A Book 23 times should be enough. The pass rate
for the PBR has been100% (2011 2014) for practicing general pediatricians, and in the super high
90s for subspecialists.

* LOW-ISH USMLE SCORES? FAILED A PEDS BOARD EXAM? WORK ON TECHNIQUE!

Seriously, seriously, SERIOUSLY! This exam can wreek havoc and chaos in you life. The techniques that
are taught in PBRS Test-Taking Strategies & Coaching course have helped pediatricians finally pass
the boards after they had failed MULTIPLE times. Learn the board game by understanding question-
answering STRATEGIES. You can see an increase in your practice exam scores IMMEDIATELY. PBR has
helped pediatricians pass after SIX failed attempts! So helping you should be easy. Dont have
regrets. Learn more now by visiting:

http://www.pediatricsboardreview.com/technique

* LOVE YOUR PBR? KEEP ONLINE ACCESS FOR LIFE!


I love it too! PBR FOR LIFE! is an awesome way to keep online access to the PBR books for LIFE!
Upgrade information is available in the members area or by contacting us.

Copyright Pediatrics Board Review, Inc. 2011 Present.


All Right Reserved. Do Not Copy Without Written Permission.
* DONT FORGET TO DO TONS OF BOARD REVIEW QUESTIONS FOR PRACTICE!
Do at least 700 1000 practice questions if youre studying for the ABP initial certification boards,
and at least 300 if youre taking the ABP MOC recertification exam. The first choice is the AAP
PREP series of questions, but PBR also has trusted affiliate relationships with other great
companies that give you MASSIVE discounts on questions to use for PRACTICE! Just visit
http://www.pediatricsboardreview.com/tools

* MAXIMIZE YOUR LEARNING OPPORTUNITIES & MODALITIES!


PBR helps you study EFFICIENTLY. Its an entire system that BUILDS on itself to give you the
highest chance of passing your board exam. REPETITION and MULTI-MODALITY studying
have both been proven to increase learning. Do you only have the hardcopy books? Do you
need to maximize your time? Visit http://www.pediatricsboardreview.com/products to find the
right PBR companion products to help you learn efficiently and maximally (MP3s, Video Course,
Webinars, Pediatric Atlas).

Cant Decide What To Use Next? You Dont Have To!


PBR is now offering ALL BOARD REVIEW products for over 50% off the value. This should
remove the mental obstacles of money and finances that sometimes causes pediatricians to
fail. The package is called the PBR ALL ACCESS PASS, and it includes MP3s, online videos,
live/recorded webinars, an online digital atlas and more!

Visit the Link Below and Learn More About the PBR All Access Pass Enrollment & Upgrade
Opportunities

www.pediatricsboardreview.com/AAP

Again, CONGRATS on getting through the book! Now lets do it again!!!


- Ashish & Team PBR

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All Rights Reserved. Do Not Copy Without Written Permission.