Distended proximal duodenum and distended stomach is the description of double

bubble sign.

Tetanus with wound…

Ask how many lifetime doses

>3 then look for clean (<10 home) or dirty (<5 home)
<3 look at clean (TDAP) and dirty (TDAP and TIG)

GAS pharyngitis is more common in children than adults. The modified centor
criteria can often overpredict infections in young children so rapid testing (with
culture confirmation if negative) is the first choice in children older than 3 years but
not in adolescence

Absolute contridications for vaccinations is encephalopathy and anaphylaxis.

Relative contridications are Inconsolable crying for 3 hours and fever of 105.

Bone cancer + child + proximal long bone = osteosarcoma. Osteosarcoma is the

most common bone cancer of childhood. Retinoblastoma. ALK phosph. LDH.
Sunburst pattern.

Ewing is bone cancer + shaft + child with onion skinning with a lytic appearance
plus periosteal elevation on imaging. These tumors are located in the shaft
(diaphyseal location).
Leukocytosis, Anemia, And ESR.

Oligohydramnios, Suprapubic mass, absence of urinary output, it is possible for

posterior urethral valves therefore straight cath would relieve the obstruction.

Screening tests on newborns does not include lead becaue they are
asymptomatic.
Ciprofloxacin is used in otitis externa.

Qualities of a possible physiologic murmur are no palpable thrill, <3/6 in intesity,

systolic occurence, and decreases with valsalva or decrease venous return

After diagosis of intussusception whether ultrasound or CT, it requires interventiion via

treatment. This is either air enema which must be done before bowel is dead or
Laparoscopy if the bowel is dead (blood in the stool).

Always do the diagnostic thing first in a child suspected of Abuse. then contact Child
protective services

VSD is the most common especially in down syndrome. ASD’s generally do not occur
alone but with VSDs CAVSD. OR also known as endocardial cushion defect

Tuberous sclerosis, seizures, Ash-leaf spots, Tubers (small benighn tumors that can
occur in multiple organ systems. Sebaceous adenoma. Angiofibromas of the face and
mental retardation.