Robert Laverty

Peds UWorld QBank Notes

1. Osgood Schlatter: common adolescent source of knee pain
a. Quadriceps tendon puts traction on apophysis of tibial tubercle where patellar tendon
inserts
b. XR: irregularity or fragmentation of tubercle
2. Henoch-Schonlein Purpura
a. P: IgA mediated leukocytoclastic vasculitis
b. C: palpable purpura, arthritis/arthralgia, abdominal pain, intussusceptions, Renal disease
similar to IgA nephropathy
c. Lab: elevate creatinine, hematuria +/1 RBC casts +/- proteinuria
d. Tx: Supportive
e. H: IgA deposition in mesangium
3. Acquired torticollis
a. E: URIs, minor trauma, cervical lymphadenitis, retropharyngeal abscess
b. G: Neck twisting due to asymmetric muscle activity
4. Delayed passage of meconium
a. Meconium ileus
i. Inspissated meconium
ii. Associated with cystic fibrosis
1. Mutation in CP transmembrane conductance regulator gener resulting in
abnormal chloride and sodium transport
b. Hirschsprung disease: congenital aganglionic megacolon
5. Gynecomastia
a. G: Enlarged glandular tissue of male breast, occurs in up to 2.3 of pubertal boys
b. C: Unilateral or bilateral firm subareolar nodules
c. P: Testicular production of estrogen over testosterone and peripheral conversion of
prohormones to estrogen
i. Pathological: Testicular, adrenal or human chorionic gonadotropic–secreting
tumors; cirrhosis, thyrotoxicosis, excessive aromatase activity, androgen use, drugs
(spironolactone, cimetidine)
ii. Androgen deficiency: primary or secondary male hypogonadism (Klinefelter),
hyperprolactinemia, renal failure
6. Holosystolic murmur @ LLSB
a. Characteristic of VSD
7. Constipation
a. C: straining with stools, cramping abdominal pain
b. Comp: anal fissures, hemorrhoids, encopresis, enuresis, UTIs, vomiting
c. Tx: increase dietary fiber, laxative, suppositories/enema
8. Cerebral palsy
a. G: Nonprogressive motor dysfunction
i. Spastic, dyskinetic, and ataxic
b. Spastic diplegia: hypertonia and hyperreflexia that predominantly involves lower
extremities with both feet pointing downwards
c. Risk factor: prematurity, IGR, intrauterine infection, antepartum hemorrhage, placental
pathology, multiple gestation, maternal alcohol and tobacco use
d. Management: PT, OT, speech therapy
i. Baclofen and botulinum toxin for spasticity
e. Comorbidities: intellectual disability, epilepsy, strabismus, scoliosis
9. Selective mutism (DSM-5)
 Robert Laverty
Peds UWorld QBank Notes
a. Consistent failure to speak in some situations but not in others in which one is expected to
speak
b. Duration of at least one month
c. Interference with educational or other expected achievement or with social communication
d. Not attributable to lack of knowledge or comfort with spoken language
10. Cryptorchidism
a. Risk: prematurity, small for gestational age, low birth weight, in utero exposure to
diethylstilbestrol and pesticides, genetic disorders, NTDs
b. C: empty, hypoplastic, poorly rugated scrotum or hemiscrotum
c. Tx: orchioplexy
d. Comp: inguinal hernia, testicular torsion, subfertility, testicular cancer
11. Sickle cell trait
a. Dx: normal hemoglobin, reticulocyte count, RBC indices and morphology
i. Hemoglobin electrophoresis shows both HbA and HbS
b. Comp: hematuria, UTI, renal medullary carcinoma
i. Splenic infarction, venous thromboembolism, priapism
12. Fragile X Syndrome
a. G: Characterized by low to normal IQ with learning disabilities, generalized language
disability, short attention span, autism, large head, prominent jaw, large low set ears and
macroorchidism
b. P: full mutation in FMR1 gene caused by increased number of CGG trinucleotide repeats
13. Orbital cellulitis
a. Red flags: decreased visual acuity, diplopia, ophthalmoplegia, and proptosis
14. Cyanosis in newborns
a. Transposition of the great vessels
i. HS: single S2, +/-VSD murmur
ii. XR: Egg-on-a-string heart (narrow mediastinum)
iii. Tx: prostaglandins initially to keep ductus arteriosus open, surgery eventually
b. Tetralogy of Fallot
i. Harsh pulmonic stenosis murmur, VSD murmur
ii. XR: boot-shaped heart (right ventricular hypertrophy)
c. Tricuspid atresia
i. Single S2, VSD murmur
ii. XR: minimal pulmonary blood flow
d. Truncus arteriosus
i. Single S2, systolic ejection murmur
ii. XR: increased pulmonary blood flow, edema
15. Measles
a. C: Prodrome—fever, malaise, anorexia, conjunctivitis, coryza, cough and Koplik spots
i. Exanthem: Blanching, reddish-brown maculopapular rash, cephalocaudal and
centrifugal spread, usually spares palms and soles
b. Dx: PCR
c. Prevention: live attenuated measles vaccine
d. Tx: supportive, vitamin A
e. Comp: Otitis media, pneumonia, encephalitisacute disseminated
encephalomyelitissubacute sclerosing panencephalitis, gastroeneteritis
16. Precocious puberty
a. C: Development of secondary sex characteristics before the age of 8 in girls and 9 in boys
b. E: central and peripheral
 Robert Laverty
Peds UWorld QBank Notes
i. C: early activation of hypothalamic-pituitary-ovarian axis
1. Elevation of FSH and LH
17. Sickle cell anemia
a. G: AR inheritance of sickle beta globin mutation
b. C: hemolytic anemia, dactylitis
c. Lab: decreased hematocrit, elevated retic, elevated LDL, elevated unconjugated bilirubin
i. Peripheral smear: sickled red cells, howell-jolly bodies
d. Maintenance: vaccination, penicillin, folic acid supplementation, hydroxyurea
e. Functional asplenia
i. Risk for s pneumo, h influenza, n meningitides and salmonella
18. Cystic Fibrosis
a. Clinically
i. Respiratory: obstructive lung diseasebronchiectasis
1. Recurrent pneumonia, chronic rhinosinusitis
ii. GI: obstruction: meconium ileus
1. Pancreatic disease: exocrine pancreatic insufficiency, diabetes
iii. Reproductive: infertility
iv. MSK: osteopenia, kyphoscoliosis, digital clubbing
19. Neonatal Rashes
a. Erythema toxicum neonaturum
i. C: Asymtpomatic scattered erythematous macules, papules and pustules throughout
body
ii. Tx: None
b. Neonatal HSV
i. C: Vesicular clusters on skin, eyes and mucous membranes, CNS infection, fulminant
multi-organ disease
ii. Tx: acyclovir
c. Neonatal varicella
i. C: Fever, ranges from clusters on skin to fulminant, disseminated disease
ii. Tx: Acyclovir
d. Staphylococcal scalded skin syndrome
i. C: fever, irritability and diffuse erythema followed by blistering and exfoliation,
positive Nikolsky’s sign
ii. Tx: oxacillin, nafcillin or vancomycin
20. Developmental dysplasia of hip
a. G: dislocation of femoral head from acetabulum
b. Comp: Trendelenburg gait, scoliosis, arthritis, and avascular necrosis
c. PE: Ortolani and Barlow maneuvers, leg-length discrepancy, asymmetric inguinal skin folds
21. Neonatal displaced clavicular fracture
a. Risk: fetal macrosomia, instrumental delivery, shoulder dystocia
b. C: crepitus over clavicle, asymmetric moro
c. Tx; reassurance, gentle handling, place arm in sleeve
22. Reye syndrome
a. G: encephalopathy and acute liver failure after a viral infection
b. P: microvesicular fatty infiltration and hepatic mitochondrial dysfunction
c. E: Pediatric aspirin use in setting of influenza or varicella
d. Lab: elevated transaminases, PT, INR and PTT, elevated ammonia
23. Mild metatarsus adductus
a. G: Congenital foot deformity, corrects spontaneously
 Robert Laverty
Peds UWorld QBank Notes
24. Kallman syndrome
a. G: X-linked recessive disorder of fetal gonadotropin-releasing hormone (GnRH) and
olfactory neurons resulting in hypogonadotrophic hypogonadism and rhinencephalon
hypoplasia—46XX
b. C: Short stature and delayed puberty, anosmia/hyposmia
c. Lab: low LH and FSH
d. Turner Syndrome: 45XO
i. Primary amenorrhea but FHS is elevated due to ovarian failure
e. Klinefelter: 47 XXY
i. Male phenotype with small testes
25. Tinea capitis
a. C: scaly erythematous patch on scalp, possible painful lymphadenopathy, can cause
alopecia
b. Tx: Oral griseofulvin, terbinafine, itraconazole or fluconazole
26. Respiratory distress syndrome
a. G: Pulmonary condition caused by immature lungs and surfactant
b. Risk: prematurity, maternal diabetes (delays surfactant maturity), c-section
c. P: Fetal hyperglycemiafetal insulinemiaantagonizes cortisol and blocks maturation of
sphingomyelin
d. C: tachypnea, retractions, grunting, nasal flaring, and cyanosis
e. CXR: diffuse reticulogranular pattern (ground-glass opacities)
f. Tx: corticosteroids and exogenous surfactant and respiratory support
27. Flaccid paralysis
a. Infant botulism
i. P: ingestion of clostridium botulinum spores from environment dust
ii. C: descending flaccid paralysis
iii. Tx: human-derived botulism immune globulin
b. Foodborne botulism
i. P: ingestion of preformed C botulinum toxin
ii. C: Descending flaccid paralysis
iii. Tx: equine-derived botulism antitoxin
c. Guillain-Barre syndrome
i. P: autoimmune peripheral nerve demyelination
ii. C: ascending flaccid paralysis
iii. Tx: pooled human immune globulin
28. Seizures
a. Generalized: can have LOC, involves both hemispheres of brain, bilateral motor findings,
can be convulsive or nonconvulsive
b. Partial: only involves one hemisphere
i. Simple partial: no LOC, feeling a familiarity, can have aura
ii. Partial seizures with generalization: LOC, tonic-clonic activity
iii. Complex partial seizures: LOC, can have aura, motor automatisms (chewing,
swallowing, sucking)
29. Brain Abscesses
a. Risk: recurrent sinusitis and cyanotic congenital heart disease
i. RL shunt bypasses pulmonary circulation where bacteria in the bloodstream are
typically filtered and removed by phagocytosis
b. C: fever, severe headache and focal neurologic changes, seizures
30. Epidural hematoma
 Robert Laverty
Peds UWorld QBank Notes
a. P: caused by injury to meningeal blood vessels, do not cross suture lines because of better
dural attachment at the sutures
b. C: Head injury followed by lucid interval then rapid neurologic deterioration with HA,
vomiting, seizures, confusion and lethargy
c. Tx: craniotomy if GCS <8, signs of increased ICP, pupillary abnormalities, hemiparesis, or
cerebellar signs
31. Benign astrocytoma
a. G: CNS tumor, most common solid tumors typically arise infratentorial, or are
supratentorial
32. Muscular dystrophy
a. Duchenne
i. G: X-linked recessive deletion of dystrophin gene on chromosome Xp21
ii. C: progressive weakness, calf pseudohypertrophy, gower maneuver
1. Comp: scoliosis, cardiomyopathy
iii. Prog: death by age 20-30 from respiratory or heart failure
b. Becker
i. G: X-linked recessive deletion of dystrophin gene on chromosome Xp21
ii. C: Milder weakness compared to Duchene
1. Comp: cardiomyopathy
iii. Prog: death by 40-50 from heart failure
c. Myotonic
i. G: AD expansion of CTG trinucleotide repeat in DMPK gene on chromosome 19q
13.3
ii. C: facial weakness, hand grip myotonia, dysphagia
1. Comp: arrhythmias, cataracts, balding, testicular atrophy
33. Waterhouse-Friderichsen syndrome
a. G: vasomotor collapse and skin rash (large purpuric lesions on flanks) in meningococcemia
i. Adrenal hemorrhage
34. Sexually active screening
a. Chlamydia trachomatis and Neisseria gonorrhoeae
i. Patients can be asymptomatic, can lead to PID
b. Test: nucleic acid amplification test
35. Causes of Stridor
a. Croup (laryngotracheobronchitis): barky cough, fever, rhinorrhea and congestion
b. Laryngomalacia: persistent stridor that worsens in supine position and improves prone
c. Vascular ring: stridor that improves with neck extension, ass with cardiac abnormalities
36. Necrotizing enterocolitis
a. P: gut immaturity and exposure to bacteria from enteral feeds leading to cascade of
inflammation and damage to the bowel wall
i. Premature intestinal mucosa thought to have increased permeability and bacterial
penetration
b. XR: air visible in bowel wall (double-line or train-track appearance) leading to pnematosis
intestinalis; linear, branching areas of lucency over the liverportal venous air
37. Anemia of prematurity
a. G: affects most preterm infants
b. P: EPO usually decreases at delivery due to increased oxygen concentration in tissue
i. Causes decreased reticulocyte counts
38. Deletion of 5p
a. Cri-du-chat (cry of the cat) syndrome
 Robert Laverty
Peds UWorld QBank Notes
b. C: hypotonia, short stature, microcephaly with protruding metopic suture, moonlike face,
hypertelorism, bilateral epicanthal folds, high arched palate, wide and flat nasal bridge, MR
39. Dysmenorrhea
a. Primary: release of prostaglandins from endometrium causes uterine contractions
b. Secondary
i. Endometriosis
1. PE: uterosacral nodularity, adnexal tenderness
ii. Adenomyosis: uterine tenderness and enlargement
iii. Pelvic infection: CMT, purulent cervical discharge
iv. Uterine leiomyomata
40. Jaundice of the newborn
a. Unconjugated hyperbilirubinemia secondary to hepatic uridine diphosphogluconurate
glucuronsyltransferase does not reach adult levels until two weeks
b. Tx: phototherapy to prevent kernicterus
41. Enuresis
a. Tx: enuresis alarm
i. Desmopressin, TCAs
42. Milestones
a. 24 months: vocab of 150-300 words, speech 50% comprehensible, combine 2 words into
sentence
43. Prevent SIDSsleep supine
44. Acute rheumatic fever
a. C: Major—joints (migratory arthritis), carditis, subcutaneous nodules, erythema
marginatum, Sydenham chorea
i. Minor—fever, arthralgia, elevated ESR, CRP, prolonged PR interval
ii. Late sequelae: mitral regurgitation/stenosis
b. Tx: Penicillin for GAS pharyngitis
45. Cat bites
a. E: Pasteurella multocida, bartonella henslae
b. Tx: Amoxicillin/clavulanate
46. Vesicoureteral reflux
a. G: retrograde flow of urine from bladder into ureter and renal pelvis
b. Risk: recurrent UTIs, renal scarring, renal insufficiency and ESRD
c. Dx: voiding cystourethrogram
47. Methylphenidate
a. G: CNS stimulant used to treat ADHD (hyperactivity, short attention span, and easy
distractibility)
b. SE: nervousness, loss of appetite, nausea, abdominal pain, insomnia, tachycardia
48. Cystic Fibrosis
a. C: recurrent sinopulmonary infections, chronic cough, nasal polyps and digital clubbing
b. Dx: quantitative pilocarpine iontophoresis and sweat chloride
49. Laryngomalacia
a. P: increased laxity of supraglottic structures
b. C: inspiratory stridor, worsens when supine, crying or feeding
c. Dx: flexible laryngoscopy showing collapse of supraglottic structures with inspiration and
omega-shaped epiglottis
d. Tx: reassurance, supraglottoplasty
50. Leukocyte adhesion deficiency type I
 Robert Laverty
Peds UWorld QBank Notes
a. C: Absence of pus formation, delayed umbilical cord separation, poor wound healing,
periodontitis, often necrotizing
b. Lab: leukocytosis with neutrophil predominance, cultures with S aureus and Gram-negative
bacteria
c. P: deficient expression of CD18, essential component of certain integrins present on surface
of leukocytesleukocytes unable to exit vasculature and migrate to areas of infection or
inflammation
51. Acquired aplastic anemia
a. P: injury to bone marrow by radiation, drugs (chemo, abx—chloramphenicol), insecticides,
toxins (benzene, carbon tetrachloride) or infections
b. C: pallor, fatigue, weakness, loss of appetite, easy bruising, petechiae, mucosal hemorrhage
and fever
c. Lab: normocytic or macrocytic anemia, leukopenia, reticulocytopenia, thrombocytopenia
52. Other anemias
a. Fanconi’s: pancytopenia and congenital anomalies like hyperpigmentation on trunk, neck
and intertriginous areas and/or café-au-lait spots, short stature, upper limb anomalies,
hypogonadism, skeletal anomalies, eye changes, renal malformations
b. Diamond-Blackfan anemia: congenital pure red cell aplasia with pallor and poor feeding.
Normocytic anemia with reticulocytopenia
c. Acute myeloid leukemia: bone marrow infiltration resulting in pancytopenia by crowding
out the normal bone marrow elements
i. C: bruising and bleeding (thrombocytopenia) and unexplained fever
53. Growing pains
a. G: occur primarily at night, affect lower extremities bilaterally (thighs, calves)
b. Tx: massaging, stretching, heat and analgesics
54. Rheumatic fever
a. Persistent valvular disease (mitral stenosis)
b. Tx: continuous prophylaxis of penicillin
55. Abnormal uterine bleeding
a. Tx options: High-dose estrogen, combined OCPs, progestin, tranexamic acid
b. E: ovulation dysfunction
56. Autism spectrum disorder
a. DSM-5
i. Multiple, persistent deficits in social communication and interactions by:
1. Social-emotional reciprocity, nonverbal communicative behaviors,
developing, maintaining and understanding relationships
ii. Restricted, repetitive patterns of behavior
1. Repetitive motor movements, insistence on sameness, inflexibility, fixated
interests, adverse responses to sensory inputs
b. Evaluation: assessment of social, language and intellectual development in addition to
hearing, vision and genetic testing
57. Biliary atresia
a. P: progressive obliteration of the extrahepatic biliary ducts connecting liver to small bowel
b. C: jaundice, pale stools, hepatomegaly, conjugated hyperbilirubinemia, elevated
transaminases
c. Dx: US, hepatobiliary scintigraphy, liver biopsy (expanded portal tracts with bile duct
obstruction and proliferation, intraoperative cholangiogram
d. Tx: hepatoportoenterostomy (Kasai procedure), liver transplant
58. Congenital diaphragmatic hernia
 Robert Laverty
Peds UWorld QBank Notes
a. P: abdominal viscera herniate into chest resulting in pulmonary hypoplasia and pulmonary
hypertension
b. C: polyhydramnios can result, concave abdomen, barrel-shaped chest, deviation of heart to
right
c. Tx: emergency intubation, nasal or orogastric tube should be placed to decompress
stomach and bowel
59. Cyclical vomiting syndrome
a. G: recurrent, predictable pattern of acute and frequent vomiting that resolves
spontaneously with no symptoms in between episodes
b. Tx: hydration, antiemetics (odansetron)
60. Other vomiting disorders
a. Bulimia nervosa: self-induced purging
b. Intestinal malrotation: can lead to volvulus, causes severe bilious emesis and hypovolemic
shock
c. Mesenteric adenitis: AP (RLQ), abdominal guarding and tenderness
d. Munchausen syndrome: factitious disorder to draw attention to self
61. Maternal estrogen effect in newborns
a. Mammary gland enlargement, non-purulent vaginal discharge (leucorrhea) and mild uterin
withdrawal bleeding
62. Guillain-Barre syndrome
a. G: acute ascending polyneuropathy after recent URI or GI (campylobacter jejuni) infection
b. P: demyelination of peripheral motor nerves (sensory and autonomic may also be affected)
c. C: ascending weakness, feet tingling and neuropathic painflaccid paralysis with absent
DTRs
d. CSF: increased protein
e. Tx: IVIG, plasmapheresis
63. Differential diagnosis of neuromuscular weakness
a. Upper motor neurons
i. Leukodystrophies, vasculitis, brain mass, vitamin B12 deficiency
b. Peripheral nerves
i. Heriditary primary motor sensory neuropathy, guillain-barre syndrome, diabetic
neuropathy, amyloid neuropathy, lead poisoning
c. Neuromuscular junction
i. Myasthenia gravis, lambert-eaton syndrome, organophosphate poisoning, botulism
d. Anterior horn cells
i. Spinal muscular atrophy, amyotrophic lateral sclerosis, paraneoplastic syndrome,
poliomyelitis
e. Muscle fibers
i. Muscular dystrophies, polymyositis and dermatomyosisits, hypothyroidism,
corticosteroids, HIV myopathy
64. Rubella
a. Congenital: sensorineural hearing loss, intellectual disability, cardiac anomalies, cataracts,
glaucoma
b. C: low-grade fever, conjunctivitis, coryza, cervical LAD, Forschheimer spots, cephalocaudal
spread of blanching, erythematous maculopapular rash
65. Syndromes
a. Edwards’: Trisomy 18
 Robert Laverty
Peds UWorld QBank Notes
i. Low birth weight, closed fists with index overlapping third finger and 5th digit
overlapping the 4th, microcephaly, prominent occiput, micrognathia, rocker-bottom
feet
b. Down: trisomy 21
i. Hypotonia, flat face, upward and slanted palpebral fissures, epicanthal folds,
brushfield spots, dysplasia of the pelvis, cardiac malformations, simian crease, short
and broad hands, hypoplasia of the middle phalanx of 5th finger, intestinal atresia
c. Patau’s: trisomy 13
i. Cleft lip, flexed fingers with polydactyly, ocular hypotelorism, bulbous nose, low-set
malformed ears, small abnormal skill, cerebral malformation, microphthalmia,
cardiac malformation, scalp defects,
d. Cri-du-chat: protruding metopic suture, cat-like cry; 5- deletion
66. Renal tubular acidosis
a. Type I (Distal)
i. G: poor hydrogen secretion into urine
ii. L: Urine pH >5.5, low potassium
iii. E: genetic disorders, medication toxicity, autoimmune disorders (RA, SS)
b. Type II (proximal)
i. G: poor bicarbonate resorption
ii. L: urine pH <5.5, low-normal potassium
iii. E: Fanconi syndrome (glucosuria, phosphaturia, aminaciduria)
c. Type IV
i. G: aldosterone resistence
ii. L: urine pH <5.5, high serum potassium
iii. E: Obstructive uropathy, CAH
d. C: normal anion gap acidosis, failure to thrive
e. L: low serum bicarbonate, hyperchloremia (normal anion gap metabolic acidosis)
67. Anorexia nervosa
a. C: BMI <18.5, fear of weight gain, distorted views of body weight and shape
b. Tx: cognitive-behavioral therapy, nutritional rehabilitation, olanzapine
68. Bulimia nervosa
a. C: recurrent episodes of binge eating, binge eating followed by compensatory behavior,
normal BMI
b. Tx: cognitive-behavioral therapy, nutritional rehabilitation, SSRI
69. Osteogenesis imperfect
a. G: inherited CT disorder
b. E: mutation in genes coding for type I collagen
c. P: important structural protein present in skin, sclera, bone, tendon, and ligament
d. C: multiple recurrent fractures, blue sclera, hearing loss, joint laxity, short stature, and
scoliosis
70. Legg-Calve-Perthes disease
a. G: Syndrome of osteonecrosis (avascular necrosis) of femoral head
b. E: unclear, thrombophilia may be underlying cause
c. C: mild chronic hip or knee pain of insidious onset as well as antalgic gait
i. Internal rotation and abduction limited
d. Slipped capital femoral epiphysis
i. C: also presents with limp and insidious hip pain, however, classically occurs in
obese adolescents
71. Wilms tumor (nephroblastoma)
 Robert Laverty
Peds UWorld QBank Notes
a. G: most common renal malignancy in childhood
b. Associated syndromes
i. WAGR (Wilms tumor, aniridia, genitourinary anomalies, MR)
ii. Beckwith-Wiedemann syndrome
iii. Denys-Drash syndrome
c. C: asymptomatic, firm, smooth, abdominal mass that does not cross midline, abdominal
pain, hypertension, hematuria and fever
d. Tx: tumor excision or nephrectomy, chemotherapy, +/- radiation
72. Potter sequence
a. G: urinary tract anomalyanuria/oliguria in uterooligohydramniospulmonary
hypoplasia, flat facies and limb deformities
b. E: posterior urethral valves most common cause of urinary tract obstruction
c. P: abnormal folds in distal prostatic urethra obstruct urinary flow, resulting in progressive
dilation of the bladder, ureters and kidneys
d. Prenatal US: bladder distension, bilateral hydroureters and bilateral hydronephrosis, also
oligohydramnios seen
73. Fanconia anemia
a. G: AR or X-linked disorder, with genes implicated in DNA repair
b. Clinical
i. Bone marrow: aplastic anemia and progressive bone marrow failure
ii. Appearance: short stature, microcephaly, abnormal thumbs and hypogonadism
iii. Skin: hypopigmented/hyperpigmented areas, café-au-lait, large freckles
iv. Eyes/ears: strabismus, low-set ears, and middle ear anomalies
c. Tx: hematopoietic stem cell transplantation
74. Seborrheic dermatitis
a. G: common, chronic, inflammatory papulosquamous disease
b. C: transparent to yellow papules and occasional plaques are characteristic
i. Involve eyebrows, nasolabial folds, bases of eyelashes, and paranasal skin
c. Tx: moisturizers, topical antifungals, topical steroids
75. Nephrotic syndrome
a. Disease types
i. Minimal change
1. H: normal
2. EM: diffuse effacement of foot processes of podocytes (renal epithelial cells)
3. Epi: most common cause in pre-adolescent children
ii. Focal glomerulosclerosis
1. H: crescent formation
2. Epi: most common cause in adults
iii. Membranous glomerulonephritis
1. H: thickened basement membrane, subepithelial spikes
2. Epi: second most common cause in adults
b. C: edema, fatigue, AP (from rapid fluid accumulation), proteinuria
76. Irregular menstrual cycles
a. E: immaturity of developing hypothalamic-pituitary-gonadal axis that does not produce
enough proportions of LH and FSH to induce ovulation
77. Niemann-Pick Disease
a. E: Sphingomyelinase deficiency
b. Epi; AR, Ashkenazi jewish heritage
c. Onset: 2-6 months
 Robert Laverty
Peds UWorld QBank Notes
d. C: loss of motor milestones, hypotonia, feeding difficulties, cherry-red macula,
hepatosplenomegaly, areflexia
78. Tay-Sachs disease
a. E: Beta-hexosaminidase A deficiency
b. Epi: AR, Ashkenazi
c. O: 2-6 months
d. C: loss of motor milestones, hypotonia, feeding difficulties, cherry-red macula,
hyperreflexia
79. Prader-Willi
a. C: Hypotonia, weak suck/feeding problems in infancy, hyperphagia/obesity, short stature,
hypogonadism, MR, dysmorphic facies (narrow forehead, almond-shaped eyes, down-
turned mouth)
b. Dx: deletions on paternal 15q11-q13
c. Risk: sleep apnea, NIDDM, gastric rupture
80. Kawasaki disease
a. G: acute vasculitis of small and medium arteries
b. P: Persistent release of proinflammatory cytokines causes prolonged fever, irritability, and
systemic inflammation
c. C: Fever for >five consecutive days with
i. Conjunctivitis: bilateral, non-exudative, spares limbus
ii. Oral mucosal changes: erythema, fissured lips, strawberry tongue
iii. Rash
iv. Extremity changes: erythema, edema, desquamation of hands and feet
v. Cervical LAD: unilateral
d. L: elevated CRP and ESR, lukocytosis with neutrophilia, reactive thrombocytosis, sterile
pyuria
e. Comp: coronary artery aneurysms, MI
81. Avascular necrosis
a. Common complication of sickle cell disease—occlusion of end arteries supplying femoral
headbone necrosis and eventual collapse of periarticular bone and cartilage
82. Legg-Calve-Perthes disease
a. G: idiopathic avascular necrosis of femoral capital epiphysis
b. C: hip, groin or knee pain plus an antalgic gait
83. Hereditary spherocytosis
a. C: hemolytic anemia, jaundice, splenomegaly
b. L: Elevated MCHC, spherocytes on peripheral smear, negative coombs test, elevated
osmotic fragility on acidified glycerol lysis test, abnormal eosin-5-maleimide binding test
c. Tx: folic acid supplementation, blood transfusios, splenectomy
d. E: AD mutation of ankyrin gene causes decreased ankyrin in RBC membrane resulting in
spectrin deficiencyBC becomes round and unstable
84. Alport syndrome
a. G: familial syndrome that presents with gross hematuria, proteinuria and sensineural
deafness
b. EM: alternating areas of thinned and thickened capillary loops with splitting of the
glomerular basement membrane
85. DTaP vaccine
a. Acellular pertussis antigens with diphtheria and tetanus toxoid
b. Contraindications: immediate anaphylaxis, unstable neurological disorders and
encephalopathy within a week of administration
 Robert Laverty
Peds UWorld QBank Notes
86. Cystic fibrosis
a. E: mutation in deltaF508
b. Comp: meconium ileus dx via contrast enema
c. P: viscous meconium accumulation and obstruction in terminal ileus
d. Tx: hyperosmolar enema can break up inspissated meconium and dissolve obstruction
87. Neonatal sepsis
a. C: temperature instability (hyper or hypothermia), poor feeding, irritability or lethargy
i. Respiratory distress, vomiting, seizures, jaundice, apnea, cyanosis, bulging
fontanelle
88. Croup
a. G: laryngotracheitis—characterized by laryngeal inflammation that results in hoarseness, a
barking cough and varying degrees of respiratory distress
b. E: parainfluenza virus
c. XR: steeple sign—subglottic narrowing
89. Elbow fractures
a. G: supracondylar humerus fracture typically from FOOSH
b. XR: large or triangular fat pad (lucency) and the presence of posterior fat pad (lucency)
sign
c. Comp: neurovascular injury or compartment syndrome
90. Nocturnal vulvar itching
a. E: pinworms dx with scotch tape test
b. Tx: mebendazole
91. Kartagener’s syndrome
a. C: situs inversus, recurrent sinusitis and bronchiectasis
b. CXR: dextrocardia (apex of heart in right chest)
c. E: AR—dysmotile cilia, aberrant production or attachment of dynein arms
d. P: poor clearance of secretions
92. Pyloric stenosis
a. C: projectile nonbilious emesis, poor weight gain, dehydration, olive-shaped abdominal
mass
b. L: Hypochloremix metabolic alkalosis
c. Dx: Abdominal ultrasound
d. Tx: intravenous rehydration, pyloromyotomy
93. Niacin deficiency
a. Pellagra: diarrhea, dermatitis, dementia
b. C: AP, nausea, glossitis and watery diarrhea
94. Acute lymphoblastic leukemia
a. G: most predominant type of leukemia in children from ages 2-10
b. C: infections, LAD and splenomegaly
c. L: anemia, neutropenia and thrombocytopenia
d. Dx: More than 25% lymphoblasts in bone marrow
i. Lack peroxidase positive granules but often contain cytoplasmic aggregates of
periodic acid Schiff. Immunostaining for terminal deoxynucleotidyltransferase—
only expressed in pre B and T lymphoblasts
95. Complete androgen insensitivity syndrome
a. G: 46, XY but phenotypically female due to defective androgen receptors
b. P: Peripheral tissues unresponsive to normal male levels of androgennormal external
female genitalia
i. Breast development occurs because it is estrogen-driven
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ii. Functionally normal gonads are cryptorchid—risk of developing dysgerminoma or
gonadoblastoma after puberty
96. Erythema chronicum migrans
a. G: classic targetoid rash that is present in patients with early Lyme disease
b. C: HA, malaise, fatigue and fever
c. E: Borrelia burgdorferi via Ixodes tick
d. Tx: doxycycline, amoxicillin (patients younger than 8 and pregnant women)
97. Duchenne muscular dystrophy
a. C: bilateral calf pseudohypertrophy and Gower sign
b. E: X-linked recessive transmission, deletion of dystrophin gene on Xp21
98. Cephalohematoma
a. G: subperiosteal hemorrhage, limited to surface of one cranial bone
99. Strabismus
a. G: intermittent or constant ocular misalignment usually due to nasal deviation (esotropia)
or less commonly temporal deviation (exotropia)
b. C: eye deviation, asymmetric corneal light reflexes, torticollis
c. Tx: occlusion or penalization (cycloplegic drops to blur eye) therapy, prescription
eyeglasses, surgery
100. Hepatitis B Virus
a. Labs
i. HBsAg: surface antigen that is first evidence of infection
ii. HBeAg: soluble protein that is marker of viral replication and infectivity
iii. IgM anti-HBcAg: antibody to hepatitis B core antigen
b. Tx: vertical transmission to newborn
i. Passively immunized with hepatitis B immune globulin followed by active
immunization with recombinant HBV vaccine
101. Refeeding Syndrome
a. G: pathological derangements from surge in insulin activity as the body resumes anabolism
b. P: Carbohydrate ingestion causes insulin secretioncellular uptake of phosphorus,
potassium and magnesium
i. Phosphorus needed for ATP creation
ii. Deficiencies in K and Mg result in arrhythmias
102. Bacterial meningitis
a. C: Fever, vomiting, seizures, AMS, nuchal rigidity, Kernig and Brudzinski signs, bulging
anterior fontanelle
b. E: Streptococcus pneumoniae and Neisseria meningitidis
c. Tx: IV vancomycin and ceftriaxone or cefotaxime; dexamethasone for Haemophilus
influenza type b
103.Thymus
a. G: normally visible on CXR in children aged <3yo
b. P: located in anterior mediastinum, functions in utero and childhood for lymphocyte
production and maturation
c. CXR: sail sign, behind sternum and in front of heart, aortic arch and trachea
d. E: absence could be suggestive of thymic hypoplasia or aplasia (DiGeorge syndrome)
104. Causes of edema
a. Increased capillary pressure
i. Heart failure, glomerulonephritis, renal failure, venous obstruction (cirrhosis,
venous insufficiency)
b. Decreased oncotic pressure (hypoalbuminemia)
 Robert Laverty
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i. Protein loss (nephrotic or protein-losing enteropathy), decreased albumin synthesis
(cirrhosis, malnutrition)
c. Increased capillary permeability
i. Burns, trauma, sepsis, allergic reactions
d. Lymphatic obstruction
i. Malignancy, hypothyroidism, congenital lymphedema
1. Turner syndrome: webbed neck, carpal and pedal edema, nail dysplasia,
horseshoe kidney, congenital lymphedema
e. Iron deficiency anemia
i. E: introduction of cow, goat or soy milk
ii. L: anisocytosis (RBC of unequal size), increased RDW, MCV and MCH drop,
microcytosis and hypochromic
105. Attention-deficit hyperactivity disorder
a. DSM-5 criteria
i. >=inattentive and/or hyperactive/impulsive symptoms for >6 months
ii. Present before age 12
iii. Occur in at least 2 settings (home, school, peer relations)
iv. Functional impairment
b. Inattention symptoms
i. No attention to details, difficulty focusing, cannot follow instructions, difficulty
organizing tasks, easily distracted, forgetful
c. Hyperactivity
i. Fidgets, difficulty staying seated, physically active, talks constantly
106.Conduct disorder
a. G: behavior that violates major societal norms (aggression, property destruction, theft,
deceitfulness, rule violations)
107.Disruptive mood dysregulation disorder
a. G: severe, pervasive irritability and poor frustration tolerance, resulting in frequent temper
outbursts
108.Autism Spectrum Disorder
a. Multiple, persistent deficits in social communication and interactions involving:
i. Social-emotional reciprocity, nonverbal communicative behaviors; developing,
maintaining and understanding relationships
ii. Restrictive motor movements, insistence on sameness, adverse response to sensory
input
b. C: social isolation, poor eye contact, limited play and speech delay, odd repetitive behaviors
109.Mullerian agenesis
a. E: hypoplastic or absent mullerian ductal system
b. P: absent or rudimentary uterus and upper vagina, normal ovaries
110.Turner Syndrome
a. G: 45, X
b. P: normal uterus and vagina, streak ovaries
111. 5 alpha-reductase deficiency
a. G: cannot convert testosterone to more potent DHT, 46, XY
b. P: male internal genitalia, and female or undermasculinized external genitalia
112. Howell-Jolly bodies
a. G: nuclear remnants within RBCs that are typically removed by the spleen
b. H: evident on peripheral blood smear as single, round, blue inclusions on Wright stain
 Robert Laverty
Peds UWorld QBank Notes
c. P: indicates physical absence of spleen or function hyposplenism due to splenic
autoinfarction
113. Heinz bodies
a. G: Hgb precipitation seen in G6PD deficiency
114. Schistocytes
a. Mechanical RBC damage—RBCs shear on a foreign object
b. E: artificial heart valve
115. Henoch-Schonlein Purpura
a. G: Immune-mediated vasculitis of childhood that often occurs after mild illnesses such as
upper respiratory tract infections
b. C: AP, palpable purpura on LE, arthralgias, and renal disease, scrotal swelling and swelling
c. Comp: intussusception
i. P: bowel wall edema and localized hemorrhage which act as lead points for
intussusception
116. Vitamin D deficiency rickets
a. C: craniotabes (ping-pong ball skull), delayed fontanel closure, enlarged skull,
costochondral joints (rachitic rosary), long bone joints, genu varum
b. L: calcium down, phos normal to down, alkaline phosphatase elevated, parathyroid
elevated, 25-OH vitamin D down
117. Developmental milestones
a. 2 months
i. Gross motor: lifts head/chest in prone position
ii. Fine motor: hand unfisted >50% of time, tracks past midline
iii. Language: alerts to voice/sound, coos
iv. Social/cognitive: social smile, recognizes parents
b. 4 months
i. Gross motor: sits with trunk support, begins rolling
ii. Fine motor: hand mostly open, reaches midline
iii. Language: laughs, turns to voice
iv. Social/cognitive: enjoys looking around
c. 6 months
i. Gross motor: sits momentarily propped on hands (unsupported at 7)
ii. Fine motor: transfers objects hand to hand, raking grasp
iii. Language: responds to name, babbles
iv. Social/cognitive: strange anxiety
d. 9 months
i. Gross motor: pulls to stand, cruises
ii. Fine motor: 3-finger pincer grasp, holds bottle or cup
iii. Language: says dada or mama
iv. Social/cognitive: waves bye, plays pat-a-cake
e. 12 months
i. Gross motor: stands well, walks first steps independently, throws ball
ii. Fine motor: 2-finger pincer grasp
iii. Language: says first words
iv. Social anxiety: separation anxiety, comes when called
118. Hypertrophic cardiomyopathy
a. P: cardiac myocyte hypertrophy and fibrosis peak during puberty, exertion can precipitate
left ventricular outflow tract obstruction
i. Predisposes to fatal arrhythmias (VFib)
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b. Prematurity
i. Comp: RDS, PDA, bronchopulmonary dysplasia, IVH, NEC, retinopathy
ii. IVH: accumulation of blood in subarachnoid space can impair the ability of
arachnoid villi to absorb cerebrospinal fluid resulting in communicating
hydrocephalus
119. Granulosa cell tumor
a. Prepubertal: precocious puberty often presenting symptom
i. Secondary sexual characteristics, hypertrophy of breasts and external genitalia,
pubic hair growth, hyperplasia of uterus
b. P: produces large amounts of estrogen
120. Hydroxyurea
a. G: Chemotherapy agent used in sickle cell disease to decrease vaso-occlusive pain crises
b. P: increases amount of fetal hemoglobin in the circulationdilutes number of sickled cells
in the circulation and reduces vaso-occlusive episodes
c. SE: leukopenia, anemia and thrombocytopenia may occur
121. Infant nutrition
a. Iron and vitamin D supplementation in exclusively breastfed infants
b. 6 months: pureed foods
c. 12 months: cow’s milk intro
122. Patent ductus arteriosus
a. Murmur: continuous flow murmur (continuous flow from aorta to pulmonary artery)
b. C: mildly accentuated peripheral pulses
123. Intussusception
a. G: telescoping of one bowel segment into the lumen of another
b. C: episodic, crampy abdominal pain, currant jelly stools, sausage-shaped abdominal mass
c. US: target sign
d. Risk: recent viral illness, pathological lead points: Meckel’s diverticulum, HSP, Celiac
disease, intestinal tumor, polyps
e. Tx: enema, surgical removal of lead point
124. Congenital hypothyroidism
a. E: thyroid dysgenesis (aplasia, hypoplasia, ectopic gland), inborn errors of thyroxin
synthesis, transplacental thyrotropin-receptor blocking antibodies
b. C: normal at birthapathy, weakness, hypotonia, large tongue, sluggish movement,
abdominal bloating and umbilical hernia
c. PE: pathologic jaundice, difficult breathing, noisy respiration, hypothermia and refractory
macrocytic anemia
d. Screening: measuring serum T4 and TSH levels
e. Tx: levothyroxine
125. Slipped capital femoral epiphysis
a. G: displacement of the femoral head on the femoral neck due to disruption of the proximal
femoral growth plate
b. Epi: obese adolescent males
c. P: physis (physical junction between the head and neck) weakens during early adolescence
because it is rapidly expanding and primarily composed of cartilage
d. PE: loss of abduction and internal rotation of hip as well as external rotation of hip while it
is being flexed
e. Tx: surgical pinning of slipped epiphysis to lessen risk of avascular necrosis of femoral
head and chondrolysis
126. Pediatric immunizations
 Robert Laverty
Peds UWorld QBank Notes
a. Types
i. Inactivated (killed): polio and hepatitis A
ii. Toxoid (inactivated toxin): diphtheria and tetanus
iii. Subunit/conjugate: hepatitis B, pertussis, Hib, pneumococcal, meningococcal,
human papillomavirus, influenza (injection)
iv. Live attenuated: rotavirus, measles, mumps, rubella, varicella, influenza (intranasal)
b. Administration
i. According to chronologic age
ii. Hepatitis B at birth
iii. 2 months: Hep B second dose, tetanus, diphtheria, acellular pertussis, Hib,
pneumococcal, and inactivated polio
127. Pineal gland mass
a. C: Parinaud syndrome (dorsal midbrain syndrome): limited upward gaze, ptosis, upper
eyelid retraction, pupillary abnormalities
i. Obstructive hydrocephalus: papilledema, HA, vomiting, ataxia
ii. Central precocious puberty
b. Work-up: brain MRI, serum and CSF alpha-fetoprotein and beta-hCG
c. Other tumors
i. Craniopharyngioma: suprasellar masses that can compress the optic chiasm
resulting in visual field defects
ii. Medulloblastomas: usually arise from the cerebellar vermis and present with ataxia
and truncal instability from hydrocephalus and mass effect
iii. Neuroblastomas: usually located in the adrenal glands and intracranial tumors are
rare. Associated with opsoclonus-myoclonus syndrome
iv. Retinoblastoma: intraocular tumor that
128. Craniopharyngioma
a. C: Increased ICP (HA, vomiting), bitemporal hemianopsia, and calcified lesion above the
sella
b. P: derived from epithelial remnants of Rathke’s pouch, located suprasellar and inferior to
optic chiasm—resulting in bi-temporal hemianopsia
c. H: characterized by nests of squamous cells in a loose stroma
d. Dx: presence of calcified parasellar lesion on MRI
129. Lyme disease
a. Clinically
i. Early localized: erythema migrans, fatigue, malaise, lethargy, mild HA and neck
stiffness, myalgias and arthralgias
ii. Early disseminated: carditis, neurologic (unilateral or bilateral CN defects,
meningitis, encephalitis), muscular, conjunctivitis , skin, regional or generalized LAD
iii. Late or chronic: muscular (arthritis), neurologic (encephalomyelitis, peripheral
neuropathy)
b. E: Borrelia, burgdorferia carried by Ixodes scapularis
c. Dx: Western blot or ELISA
d. Tx: amoxicillin or doxycycline
130. Milk- or soy-protein-induce colitis
a. G: presents at 2-8 weeks, family hx of allergies, eczema or asthma
b. P: non-IgE-mediated immunologic response to dairy and/or soy proteins
c. C: regurgitation or vomiting, painless bloody stools, eczema
d. Tx: elimination of milk and/or soy, initiation of hydrolyzed formula
131. Iron poisoning
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a. P: free radical production and lipid peroxidation that impairs various cell processes leading
to systemic manifestations
b. C: AP, hematemesis, hypovolemic shock and metabolic acidosis
c. Tx: deferoxamine
132. Congenital syphilis
a. E: Treponema pallidum
b. C: cutaneous lesions on palms and soles, heaptosplenomegaly, jaundice, anemia and
rhinorrhea
c. XR: metaphyseal dystrophy and periostitis
d. Late manifestations: frontal bossing, high arched palate, Hutchinson teeth, interstitial
keratitis, saddle nose and perioral fissues
e. Dx: Screening with: VDRL, rapid plasma regain (RPR) test or enzyme immunoassay test
(EIA)
i. Confirm: fluorescent treponemal antibody absorption test or the treponena
pallidum particle agglutination assay (TPPA)
f. Tx: parenteral penicillin G
133. Sickle cell anemia
a. G: chronic hemolysis is a trademark
b. P: intrinsic hemoglobin defects lead to high RBC turnover and anemia
i. Occurs primarily outside vessels (spleen and bone marrow), but also intravascularly
c. L: heme catabolismelevated LDH, inconjugated hyperbilirubinemia and compensatory
reticulocytosis
i. Excess hemoglobin (from hemolysis) binds to haptoglobin decreasing levels
134. HIV infection
a. C: FTT, diarrhea, diffuse LAD, and thrush
b. Parents at risk should undergo HIV antibody (anti-envelope) testing in 1st and 3rd trimester
135. DDx for crying infant
a. Colic: crying >3 hours a day, >3 days a week and for longer than 3 weeks
b. GERD, corneal abrasion, hair tourniquet, milk-protein allergy (blood-streaked, mucousy,
loose stools or severe constipation), normal infant crying
136. Osteomyelitis
a. E: Staphylococcus aureus
137. Nephrotic v nephritic
a. Nephrotic
i. C: edema, fatigue, proteinuria, absence of hematuria, hypoalbuminemia
ii. Peds E: minimal change disease
iii. Adult E: FSGS, membranous nephropathy, Membranoproliferative
glomerulonephritis
b. Nephritic
i. C: HTN, oliguria, hematuria, proteinuria, casts
ii. Ped E: postreptococcal glomerulonephritis, HUS
iii. Adult E: IgA nephropathy, Membranoproliferative glomerulonephritis, crescentic
glomerulonephritis
138. Neonatal polycythemia
a. E: Increased erythropoiesis from intrauterine hypoxia (maternal diabetes, maternal HTN,
smoking, IUGR); erythrocyte transfusion (delayed cord clamping, twin-twin transfusion)
b. C: ruddy skin, hypoglycemia, respiratory distress, cyanosis, apnea, irritability, jitteriness,
abdominal distension
c. Tx: partial exchange transfusion
 Robert Laverty
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d. L: Hct >65%
139. Hirschsprung disease
a. Associated: down syndrome (trisomy 21)
b. Obstruction: rectosigmoid
i. Constrast enema delineates level of obstruction—transition zone between
narrowed aganglionic segment and normally innervated, dilated colon
ii. Gold standard: rectal suction biopsy
c. Squirt sign: positive
d. P: aganglionic megacolon
140. Ewing sarcoma
a. G: highly malignant tumor that is found in the LE, commonly in metaphysis and diaphysis of
femur followed by the tibia and humerus
b. XR: lytic central lesion with endosteal scalloping
i. Onion-skin appearance often followed with a moth-eater or mottled appearance and
extension into soft tissue
141. Marfan syndrome & Homocystinuria
a. Overlapping: pectus deformity, tall stature, arachnodactyly, joint hyperlaxity, skin
hyperelasticity, scoliosis
b. Marfan: AD, normal intellect, aortic root dilation, upward lens dislocation
c. Homocystinuria: AR, MR, thrombosis, downward lens dislocation, megaloblastic anemia,
fair complexion
i. E: errors in methionine metabolism secondary to cystathionine synthase deficiency
ii. Dx: elevated homocysteine and methionine levels
d. Ehlers-Danlos
i. G: collagen disorder characterized by scoliosis, joint laxity, and skin hyperelasticity
142. Choanal atresia
a. G: newborn with cyanosis that is aggravated by feeding and relieved by crying
b. P: congenital nasal malformation—failure of posterior nasal passage to canalize
143. Friedreich Ataxia
a. G: AR condition characterized by an excessive number of trinucleotide repeat sequences
resulting in abnormal tocopherol transfer protein
b. P: necrosis and degeneration of cardiac muscle fibersmyocarditis, myocardial fibrosis
and cardiomyopathy
144. NAT
a. Injuries: abusive head trauma
b. P: repetitive acceleration-deceleration forces cause shearing of dural veins and coup-
countrecoup injury with brain impact on the skull
i. Subdural bleeding can manifest as seizures, increasing head circumference, bulging
fontanelle, AMS
ii. Shaking causes vitreoretinal traction and retinal hemorrhages
145. Fetal alcohol syndrome
a. Facial dysmorphisms: small palpebral fissures, smooth philtrum, thin vermillion border
i. Down: flat facial profile, low-set ears, slanted palpebral fissures
1. Excess skin at nape of neck, single transverse palmar crease, clinodactyly
ii. Fragile X: long narrow face, prominent forehead and chin, large ears, macrocephaly,
macroorchidism
146. Allergic contact dermatitis
a. C: erythema, edema, pruritis, tiny vesciles and weepy or crusted lesions
b. E: cell-mediated (type IV) HSR
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147. CSF analysis
a. Normal: WBC 3-5, glucose 40-70, protein <40
b. Bacterial meningitis: WBC >1000, glucose <40, protein >250
c. TB meningitis: WBC 5-1000, glucose <10, protein >250
d. Viral meningitis: WBC 100-1000, glucose 40-70, protein <100
e. Guillain Barre: WBC 0-5, glucose 40-70, protein 45-1000
148. Viral meningitis
a. E: non-polio enteroviruses such as echovirus and coxsackievirus
b. C: prodrome of URI, low-grade feverhigh fever, HA, nuchal rigidity, irritability
c. CSF: pleocytosis with lymphocytic dominance, protein slightly elevated, glucose normal
149. Infants SGA
a. At risk for: hypoxia, perinatal asphyxia, meconium aspiration, hypothermia, hypoglycemia,
hypocalcemia and polycythemia
150. Meningococcal meningitis
a. C: fever, HA, neck stiffness, AMS, petechial or purpuric rash
151. Congenital hypothyroidism
a. E: thyroid dysgenesis
b. C: lethargy, hoarse cry, poor feeding, constipation, jaundice, dry skin, large fontanelles
c. Dx: Elevated TSH and low free T4 levels
d. Tx: levothyroxine
152. Intussusception
a. G: telescoping of one bowel segment into another
b. P: ileum telescopes into cecumpain, obstruction, edemacompression of blood
vesselsbowel ischemiarectal bleeding (currant jelly stools)
i. Ileocolic junction most frequently involved
c. E: Preceding viral infections are thought to play a role in inflaming intestinal lymphatic
tissue (Peyer patches) which subsequently serve as lead point
i. Meckel’s diverticulum, polyps and hematomas (HSP) also triggers
d. C: periodic pain, emesis (nonbilious), currant jelly stools, sausage-shaped mass, RLQ and
RUQ pain
e. Dx: US—target sign
f. Tx: air enemas reduce obstructions
153. Neonatal evals
a. Dehydration: decreased wet diapers, absence of tears, sunken fontanelle, dry MM,
decreased skin turgor, delayed CR
b. Weight loss: up to 7% in first 5 days, should be regained in 10-14 days