CLIPP Notes

Who to susp

Appearance

Coughs that

Dry coughs

15 yo with recurrent URI, strep, or staph_x000D__x000D_Pt has high fever, toxic appearance, sometimes cellulitis or fluctuance

Often appear well_x000D__x000D_Nodes can rupture through skin though > tx with surgical excisionAsthma_x000D_Sinusitisental irritant_x000D_Fungal infection_x000D_Asthma

Barking co

Paroxysmal

Brassy/honChange in vLaryngeal irritation (can be from rhinitis, GERD, etc)

Radiology f

00D_Subglottic disease_x000D_Foreign bodyPertussis_x000D_Chlamydia_x000D_Mycoplasma_x000D_Foreign bodyHabitual cough_x000D_Tracheitis

Primary complex (large hilar adenopathy with initial lung focus)_x000D_Focal hyperinflation_x000D_Atelectasis_x000D_Small local pleural effusions

Who uses inWho gets meWhen asthma is suspected but spirometry is normal

Abx to treat

Timing of

Complicatio

All pts with persistent asthma_x000D__x000D_Need to monitor BP, glucose, growth delay, cataracts

Cefuroxime_x000D_AmoxicillinclavulanateEthmoid and maxillary at birth_x000D_Frontal start around 68 yrOrbital sinusitis_x000D_Cavernous sinus thrombosis_x000D_Meningitis_x000D_Epidural abscess

Cause of rh

Cause of co

Mucus/secretions in airways_x000D__x000D_Continuous, low pitched, polyphonic

Lymphoid hyperplasia_x000D_ from chronic post nasal drip and with chronic nasal allergies

Stages of

reaction: 1 hr, PGs/LTs, permeability, hypersecretion, bronchoconstriction_x000D__x000D_Late: 23 hrs later, epithelial destruction, fibrotic remodeling, hyperplasia of bronchial smooth muscle_x000D__x000D_Airway hyperresponsiveness can persist for days to weeks

Cerebellar

Most commo

Classic vs

Triad of ICPComplicatiBlindness from elevated pressure around optic nerve sheath

Hemispheric: limb abnormalities, nystagmus, tremor, dysmetria (spares speech)_x000D__x000D_Deep nuclei: resting tremor, myoclonus, opsoclonus (neuroblastoma)Medulloblastoma (20%)_x000D__x000D_Juvenile pilocytic astrocytoma (20%)Classic has aura_x000D__x000D_Common: no aura, more commonHTN_x000D_Bradycardia_x000D_Irregular respiration

Causes of Location ofPineal gland or suprasellar region

Presentatio

Male predo

Two peaks o

Obesity_x000D_Meds (Vit A, tetracycline, OCPs, steroids)_x000D_Metabolic disorders (galactosemia, hypoPTH)_x000D_Infection (sinusitis, OM)

Infratentorial: cerebellar signs, signs of raised ICP_x000D__x000D_Supratentorial: focal motor and sensory abnl on opposite side of lesionMedulloblastoma_x000D_EpendymomaFirst decade_x000D_8th decade

Ages where

Who does po

Infectious

Examples ofAge of neu6mo to 3yo

Supra < 2yo_x000D_Infa in kids_x000D_Supra in adolescents/adults

13 yo_x000D_Several wks after viral infection (varicella, coxsackie)_x000D_CSF w/ pleocytosis, high protMumps_x000D_Enterovirus_x000D_EBV_x000D_Bacterial meningitis pathogensAlcohol_x000D_Anticonvulsants_x000D__x000D_Often get dysmetria and nystagmus also

Initial wor

Murmurs as

When is a V

EKG changeWhen are APreschool age

Most commo

What does S

D_EKG_x000D_(save echo for later)stenosis_x000D_Coarctation_x000D_PDA_x000D_VSD

Days to weeks of age_x000D_ occurs as pulmonary resistance decreasesLarge: RVH and upright T wave in V1_x000D_Moderate: LVH_x000D_Small: nlInnocent murmur_x000D_37 yoMusical/vibratory_x000D_Best heard LLSB, supine_x000D_37 yo

Digoxin and

Most commo

ComplicatiHow long af24 wks after GI or GU infectionWhat actionInternal rotationHow is painBy opening the hip capsule (hold hip in flexion and external rotation)Key way to Elevated ESR, CRP in septic arthritis (can wait for lab values before doing joint tap if low suspicion)

Symptoms of CHF_x000D__x000D_ Digoxin: not good for VSD

SCFE_x000D__x000D_ posterior displacement of capital femoral epiphysis from femoral neck through cartilage growth plate

Femoral head deformity_x000D_Degenerative arthritis_x000D__x000D_often in boys 410 yo

What worse

Time of ESR

Weight bearing_x000D__x000D_Pain is NOT position dependent (like in septic arthritis or transient synovitis)

ESR: remains elevated for weeks after improvement_x000D__x000D_CRP: elevated 46 hrs after initial insult, peaks at 3650 hrs, and returns to normal after 37 days

3 reasons k

Diagnosis

Dx of diabeMost commoCerebral edema

1. Higher SA to body mass ratio_x000D_2. Higher basal metabolic rate_x000D_3. Higher percentage of body weight that's water1. Random BS > 200_x000D_2. pH < 7.3 or HCO3 < 15_x000D_3. Modlg ketonuria or ketonemiaglucose > 200_x000D_2. Fasting > 126_x000D_3. 2hr GTT > 200_x000D_4. HbA1c > 6.5

Replacemen

Cause of is

Hyponatremia: replacement can cause central pontine myelinolysis_x000D__x000D_Hypernatremia: replacement can cause cerebral edema

Iso: AGE, diarrhea_x000D_Hypo: adrenal insufficiency_x000D_Hyper: breastfeeding failure, DI, inappropriate rehydration solutions

Risk factor

Other Abs Sodium conc4550 mEq/LWhere's theBlood in stool but not in vomit

High BUN_x000D_Acidosis with hypocapnia_x000D_Attenuated rise in Na+ with treatment_x000D_Admin of bicarb

Antipancreatic (Anti insulin, GAD, IA2)_x000D_Autoimmune thyroiditis and celiac_x000D__x000D_DON'T check TFTs (can be elevated due to nonthyroidal illness)

Current jellElectrolyteHypochloremic, hypokalemic metabolic alkalosisTime of pre312 weeks

Order of ex

Most importAppearanceBulging, yellow, poorly mobile

Bacterial c

Intussusception_x000D__x000D_ also bilious emesis, crampy abd pain, and sausage mass on exam

obs_x000D_2. Eyes_x000D_3. CV/Lungs/Abd_x000D_4. Ears/oral cavityMobility and Position_x000D__x000D_ Also color, translucency, and other

1/2. S. pneumo/Nontypeable H. inf_x000D_3. M. catarrhalis_x000D_4. S. pyogenes

Who do we tKid with fever > 39C or moderate to severe otalgia

Alternative

Use of conv

Which hear

cin_x000D_Erythromycin_x000D_Clindamycin

VRA: good 6 mo to 2.5 yo, not ear specific_x000D__x000D_Conventional: > 4yo, frequencyspecific

Otoacoustic emissions (OAE)_x000D__x000D_ measure cochlear fxn in response to presentation of stimulus

Findings as

Who to use

Bullous myringitis_x000D_Radial vascular dilation (bicyclespoke distribution)_x000D_Marked erythema with cobblestone" appearance of TM"

Abx: < 6mo, 6mo to 2 yr: if certain dx or severe disease, >2 yo with severe illness_x000D__x000D_No abx: 6mo to 2yr with uncertain dx, > 2yo without severe illness

Who should Test for 0 Denver II

ComplicatiCause of RUFitzHughCurtisWhat shouldBear down as you enter the rectum to relax the external sphincter

Effusion > 3mo_x000D_If nl, follow q36mo_x000D_If not, consider bilateral myringotomy with tube placement

Permanent sensory neural hearing loss (SNHL)_x000D_Tympanosclerosis_x000D_Adhesive otitis media_x000D_Cholesteatoma_x000D_TM perforation_x000D_Mastoiditis, Labyrinthitis, Meningitis_x000D_Epidural/brain abscess

PresentatioUse of CT fAbscesses and AppendicitisUse of US iPID, tuboovarian abscess (TOA)

Use of bari

Use of KUB What causeBacteria spills from uterus, tracks along paracolic gutter, and causes inflammation of the hepatic capsule and diaphragm

Immediate What can beOctreotide

EKG findin

2 causes o

2 types of

Wide complex tachycardia_x000D_ inc PR interval_x000D_ QRS widening_x000D_ QT interval prolongation

Myocardial depression of Na+ channels_x000D__x000D_Alpha1 blockPallid (acyanotic): associated with fall_x000D__x000D_Cyanotic: associated with anger_x000D__x000D_ occurs 6mo to 6yr

Time period

Time of SID

Other nameFracture thToddler's fracture: fracture of tibia in walking childrenPosterior r Squeezing baby's thorax (shaken baby syndrome)What's the 4mo: 25% of weight is fat

When is the

What can ca

Several hours > 5 nights/week_x000D__x000D_Age: > 2 wks, peaks at 6 wks, lessens by 34 moSIDS: most are midnight to 6am_x000D__x000D_ALTE: most are 8am8pm

Congenital dermal melanocytoses_x000D__x000D_Slate gray patches

9 weeks_x000D_Hgb 11_x000D_Then starts to rise afterAdrenal insufficiency_x000D_Hypothyroidism

Screening v

What percen

Screening (newborn): detects immunoreactive trypsinogen in blood_x000D__x000D_Confirmatory = genotyping for specific mutations

8590%_x000D_aka 1015% don't have it (they have normal weight gain, normal stools)

Pain scalesMost commoFunctional abdominal pain

First signs What percen50% are guiac positive

FLACC (face, legs, activity, cry, consolability) for nonverbal kids_x000D__x000D_FACES: for 38 yo_x000D__x000D_010 scale: > 8 yo

Slowing of weight gain (or especially weight loss)_x000D__x000D_Change in height velocity suggests more long standing illness

2 problemsAre crypt UC

2 studies t

2 characterDoes UC orCD

1. Contrast delays potential colonoscopy_x000D__x000D_2. Increased risk of toxic megacolon with UC

Upper GI study_x000D_Colonoscopy

1. Cobblestoning_x000D_2. Separation from nearby loops (bowel wall thickening)

Treatments

When do youMost varia LanguageWhen does 9, 18, and 30 months

What cause

How long do

1st line: aminosalicylates (mesalamine)_x000D_> Corticosteroids, abx (cipro, metro), immunomodulators (6MP, MTX), antiTNF

age 2_x000D__x000D_premature infants should catch up by then

Internal tibial torsion_x000D_ common in childhood, resolves with growth8 yrs_x000D_ can have flat feet until then

When does cWhen do yo18 and 24 months

3 realms of

Which types

Description

yo_x000D_ heel strike present

1. Social interaction_x000D_2. Communication_x000D_3. Restricted repetitive and stereotyped patterns

Neurodegenerative disease_x000D_Psychosocial

Heterogeneous group of nonprogressive disorders_x000D_ motor and postural dysfunction

Risk factor

Sequence of

Complicatio

asphyxia (10%)_x000D_Intrauterine infection (28%)_x000D_Prematurity (78%)_x000D_IUGR (34%)Extraretinal fibrovascular proliferation_x000D_Detachment_x000D_Blindness/visual impairment_x000D__x000D_ risk: BW < 1500g

Periventricular Leukomalacia (PVL)_x000D_ damage from hypoxia, ischemia, inflammation

Complicatio

2 surgeriesCause of galHemolytic anemia > bilirubin gallstones > cholelithiasis > cholecystitis

Which sickl

PCV23 is g

Abnl motor development (choreoathetoid cerebral palsy)_x000D_Sensorineural hearing lossTonsillectomy_x000D_Cholecystectomy

Age 2 mo to 56 yrs_x000D_ oral penicillin BIDPts with sickle cell get PCV23_x000D__x000D_ 2yo and then repeat 35 yr later_x000D_ same schedule for meningococcal

2 things th

Who gets t

Causes of i

1. Myelosuppression by viruses (parvovirus)_x000D_2. Hypersplenism (spleen enlarges and traps RBCs)Sickle cell pts between 215 yo_x000D_ determine risk of stroke (10% risk by 15 yo)

Chronic anemia_x000D_Poor nutrition_x000D_Painful crises_x000D_Endocrine dysfunction_x000D_Poor pulmonary function

What happenBaseline Hg69Treatment ofIVF and IV narcotics

Peak time o

Most common

Becomes progressively fibrotic and no longer palpable by age 46_x000D__x000D_Hgb SC or Sbetathal can have splenic enlargement into adolescence

Age 46 yo_x000D_ tonsils can be mildly enlarged during this time

Spontaneous peritonitis_x000D_ often S. pneumo or GNRs

Management

What are p

1. Albumin infusion_x000D_2. IV furosemide_x000D_3. Corticosteroids (taper over wks)_x000D_4. Sodium restriction (15002000 mg/d)

Venous thrombosis_x000D_ urinary loss of anticoagulants, lipids destabilize platelets, inc fibrinogen, inc blood viscosity (high Hct)

4 categoriPID and TOAUltrasoundChronic abdBarium studyWho needs Kids younger than 68 wks

What is the

Steroid responsive_x000D_Relapsing_x000D_Steroiddependent_x000D_Resistant (> bx)

Cold extremities_x000D_(pt can be cold with adequate circulation)

What do thWhat's a prVasoconstriction can make it difficult to get a good pulse ox measurement

Next line oProphylaxi Rifampin, cipro, or ceftriaxone

D: disability (quick neuro assessment ICP, toxidromes, etc) and dextrose (check for hypoglycemia)_x000D__x000D_E: exposure/environment (expose all parts of pt, keep pt warm)

Intraosseus line_x000D_ if peripheral IV can't be placed in 90 seconds_x000D_ central line also acceptable in older kid or adult

Complicati

Problem wit

Contraindic

1119% get complications:_x000D_ hearing loss_x000D_ neuro disability_x000D_ digit/limb amputations_x000D_ skin scar

Doesn't eliminate carrier state._x000D_ Need rifampin (kids, young adults) or cipro (adults) or 57 d ceftriaxone to eliminate carrier stateesis imperfecta_x000D_Fracture_x000D_Recently used site_x000D_Infection

Complicatio

Actions of

Sympathomi

Fracture_x000D_Fluid into subQ (> compartment syndrome)_x000D_Osteomyelitis_x000D_Microscopic fat, BM emboli

Inhibit reuptake of NE_x000D_Antagonize ACh (> hypotension), Na+ channels (> dysrhythmias), and GABA (> seizure)Mydriasis_x000D_Fever_x000D_Diaphoresis_x000D_Tachycardia_x000D_Agitation_x000D_SZ

Opioid tox

Sedativeh

Anticholine

00D_Resp depression_x000D_Hypotension_x000D_Bradycardia_x000D_Hypothermia_x000D_AMS

Miosis OR mydriasis_x000D_Hypotension_x000D_Bradycardia_x000D_Hypothermia_x000D_SedationDry skin_x000D_Flushing_x000D_Tachycardia_x000D_Ileus_x000D_Urinary retention_x000D_Fever_x000D_Delirium, SZ

Cholinergic

What is giv

0D_Sweating_x000D_Urinating_x000D_Bronchorrhea_x000D_Bronchospasm_x000D_Muscle twitch_x000D_Bradycardia_x000D_SZ, coma

Cathartics_x000D_ charcoal helps absorb the toxins and cathartics accelerate defecation

Series of e

Best tests

Amenorrhea_x000D_Bradycardia_x000D_Postural hypotension_x000D_Electrolyte abnormalities_x000D_Continued deficiency of Ca, Mg_x000D_Neuro changes, increased reflex tone, compromised cardiac function

Platelet function tests_x000D_Factor VIII activity_x000D_vWf antigen and activity (Ristocetin)_x000D_aPTT (but can be normal, other tests are better)

Genetics o

Meds to tr

Most commo

When does f

Autosomal dominant with variable penetrance: Type 1 and 2_x000D__x000D_Autosomal recessive: Type 3

Intranasal or IV desmopressin_x000D_vWF_x000D_OCPs/levonorgestrel IUD (for menorrhagia)von Willebrand's disease_x000D_ 1% of population

Usually 2472 hours after_x000D__x000D_MMR and Varicella: can be 710d after

3 clinical tMost commoS. pneumoHow common present in 35% of 336mo with fever

Indications

1. Kernig's: resist knee extension_x000D_2. Brudzinski's: flex hip/knee in response to neck flexion_x000D_3. Opisthotonos: hyperextension of neck and spine_x000D__x000D_ often NOT positive in infants

Who doesn't

Treatment oWho shouldAfter second febrile UTI or with concerning findings on renal/bladder ultrasoundWho shouldPts who don't respond to txHow prevalPresent in 2550% of infants following first UTI

Kids 1 yo)_x000D_TMPSMX: good

Management

Benefit of

Most common type_x000D_ most often resolves spontaneously in 25 yrs_x000D_ PCP can follow (whereas grade 35 needs to be referred to urology)

Exposes pt to smaller doses of radiation than VCUG_x000D_ preferred imaging study to follow pts with VUR

What percen

Sequelae o

What is gru

Signs and c

Only 1030%_x000D_ some just have fever and irritability_x000D_ most common in 10 mo 3 yrIncreased caloric requirement_x000D_Illness_x000D_Neuro disease

Respiratory distress_x000D_ closure of glottis with expiration

Chest drawn in with inspiration, abd rises_x000D_ Force of contraction from diaphragm >> ability of chest wall muscles to expand

Sounds withSounds froRhonchi

Cause of fiWhat shoulObtain imaging (xray or fluoroscopy) firstDynamic evaChest fluoroscopy

Two manifes

Above: stridor_x000D__x000D_Below: wheezing

Coarse: purulent secretions in alveoli_x000D__x000D_Fine: pulmonary edema, interstitial disease

Partial obstruction: get air trapping/hyperinflation_x000D__x000D_Complete obstruction: get atelectasis, signs of volume loss of xray (mediastinal shift)

Most consi

Findings o

Standard ka

Purpose of

Which vacci

#1 finding = Hypotonia_x000D_ small ears are also common

Nuchal skin thickness_x000D_Nasal bone ossification_x000D_Growth parameters

Lymphocyte karyotype_x000D_ easier than skin fibroblasts

Infancy: leukemoid rxn, transient myeloproliferative disorders (TMD)_x000D__x000D_> 1 yo: iron deficiency anemiaTdap_x000D_Meningococcal

Methods of

CharacterizTanner stagStage 4Tanner stagStage 2Tanner stagStage 3Differentia Costochondritis: lasts hrs to days (compared to seconds to minutes)

Symptoms o

Total body water_x000D_Total body potassium_x000D_Bioelectrical impedance_x000D_Dualenergy xray absorptiometrysporadic onset, sharp_x000D_Location: LSB_x000D_Exacerbated by deep inspiration_x000D_Lasts sec to min_x000D_Resolves spontaneously

is_x000D_Anxiety_x000D_Tremulousness_x000D_Hunger

Erythema m

Common timSelenium suTinea versicolorTreatment oPO griseofulvin, 68 wks

Zinc oxide Strength ofClobetasol > Betamethasone > triamcinolone > hydrocortisoneLocation of Folliculitis often below waste/groin

Dusky red macules > wheals > target lesions > fixed for 13 wks_x000D__x000D_Most common with HSV, meds

Diaper dermatitis, 710 mo (can also have satellite lesions)_x000D__x000D_Tx: nystatin or imidazole antifungals

Irritant dermatitis_x000D__x000D_ spares intertriginous creases

PseudofolliRadiographMass with central ring of hypoattenuation (mesenteric fat in intussusceptum)

Most commoWhat is smaConstitutional factors maternal ethnicity, parity, weight, height

3 risks forPresentatioRuddy"/red color to skinRespiratory distressPoor feedingHypoglycemiaSluggish blood flow"

Papules NOT pustules_x000D_ distinguish from acne by presence of inflammation

000D_65% colicky abd pain_x000D_25% renal involvement_x000D_510% intussusception

mia_x000D_Hypothermia_x000D_Polycythemia

Symmetric

5 basics of

What perce

Symmetric: both head and abd circumference decreased proportionately_x000D__x000D_Asymmetric: greater decrease in abd than head (head sparing phenomenon")"D_Warm (large SA/V)_x000D_Position_x000D_Suction_x000D_Stimulate (vigorous cry)

30% of newborns_x000D_10% of 12 mo_x000D__x000D_Often palpable 12cm below L costal margin

Most commo

5 types of

> 90% have no clinical evidence of disease as newborns_x000D__x000D_But 40% are SGA, 30% preterm, 25% of males have inguinal hernias

Lubrication_x000D_Antiinflammatories_x000D_Topical hydrocortisone_x000D_Antihistamines (sedating and non)_x000D_Calcineurin inhibitors

2 things to

2 metabolic

Severe maniSigns of keOpisthotonus, rigidity, oculomotor paralysis, tremor, hearing loss, ataxia

When and ho

Stop bottle feeding by 1215 mo_x000D__x000D_Fluoride (promotes remineralization of Ca into enamel)Galactosemia_x000D__x000D_HypothyroidismLose suck reflex_x000D_Lethargy_x000D_Irritability_x000D_Seizures_x000D_Deathwks_x000D_Direct hyperbili (progressive)_x000D_Acholic stools

How does j

Optimal ti

Time of bre

Cephalocaudal direction_x000D_ 45 at face, 1015 below knees_x000D_ dermal zones often underestimate true level though

>/= 24 hrs after birth_x000D_ earlier: might miss PKU and other metabolic disorders that require accumulation

Breast feeding: early 1st week_x000D__x000D_Breast milk: first 47d, peaks 1014d, can last up to 12 wks

Is PE commNO. Often only occurs with underlying clotting disorder or placement of central venous catheter

Is prematur

Are APGAR s

Small, appr

NO_x000D__x000D_TTN: more common in term babies_x000D_ risks: mother with DM, C/S delivery

NO_x000D__x000D_ Documented asphyxia is correlated with neuro outcome. Check cord arterial blood gas for acidosis.SGA: < 10th %_x000D_AGA: 1090th %_x000D_LGA: > 90th %

Complicati

What is Tra

Causes of Which cardiTransposition of the great arteries (TGA)

clavicle_x000D_Brachial plexus injury_x000D_Facial nerve palsy_x000D_Complications of C/S, forceps, and vacuum_x000D_Hypoglycemia

Delayed absorption of pulmonary fluid_x000D_ aka persistent postnatal pulmonary edema.

Meconium aspiration syndrome_x000D_Diaphragmatic hernia_x000D_Hypoplastic lungs_x000D_In utero asphyxia

Best indicaRelationshiBabies with RR > 80 often can't tolerate oral or NG feeds and need IV nutrition

HypoglycemiWhat can haRebound hypoglycemia 12 hrs after

When are el

Major malformations are directly related to the FirstTrimester HbA1C level_x000D_ HbA1C levels >12: 12x risk

< 35 if asymptomatic_x000D__x000D_< 45 if symptomatic

After 1224 hours_x000D__x000D_ sooner: indicative of mother's status and any medications administered

What are th

What is anDistinguishJitteriness: stimulussensitive movements, generalized symmetric

Breech position: 3050% of DDH cases occur in infants born in the breech position._x000D_ Gender: 9:1 female predominance._x000D_ Family history.

Myelopathic signs/sx for atlantoaxial instability_x000D_ importance of cervical spine positioning during procedures

Risks of hoDefinition > 65%

When does

Causes of l

Neonatal tetanus_x000D_Omphalitis_x000D_Hemorrhagic disease of the newborn (with no Vitamin K)

12 days_x000D_ sx due to protein in breast milk or formula > poor feeding, lethargy, and vomiting

Skeletal disorders (rickets, osteogenesis imperfecta)_x000D_Chromosomal abnl (Down)_x000D_Hypothyroid_x000D_Malnutrition_x000D_ICP

Causes of p

Later symp

Most commo

Risk of aduPsychiatricODD/CD

When to sta

Microcephaly_x000D_Craniosynostosis_x000D_Hyperthyroidism_x000D_Nl variantLarge tongue_x000D_Hoarse cry_x000D_Puffy myxedematous faciesmo_x000D_poor suck and weak cry20% of obese 4 yo_x000D_80% of obese adolescents

Vision: start 3 yr_x000D__x000D_Hearing: newborns, then resume at 4 mo

Sequelae of

When to su

Who and ho

Sleep apnea (7% of overweight)_x000D_Dyslipidemia_x000D_HTN (33% of obese)_x000D_Nonalcoholic fatty liverIn young kids_x000D__x000D_> 6 yo: most is primary

> 10 yo or puberty onset_x000D_q2 yr with fasting serum glucose_x000D__x000D_ overweight, FH, race/ethnicity, insulin resistance (AN, PCOS, HTN, dyslipid)

Car seat ru

Causes of a

Times of ad

Times of adTimes of ad12 mo, second dose 6 months after and before 2nd birthday

Times of ad

Times of a

< 2 yo: rear facing car seat_x000D_24 yo: forward facing car seat_x000D_48 yo: belt booster seatCataracts_x000D_Glaucoma_x000D_Retinoblastoma_x000D_Chorioretinitis0, 1, 6 mo_x000D__x000D_3 times2, 4, 6 mo_x000D__x000D_3 times

yr_x000D__x000D_2 times_x000D_ same as MMR1 yr and 46 yr_x000D__x000D_2 times_x000D_ same as Varicella

Times of ad

Times of ad

Times of ad

Times of ad

2, 4, 6 mo, 46 yr_x000D__x000D_4 timesD__x000D_4 times_x000D_ same as HibD__x000D_4 times_x000D_ same as PCV2, 4, 6, 15mo, 46 yr_x000D__x000D_5 times_x000D_ start getting Tdap 1112 yo

Elevated ESR, CRP in septic arthritis (can wait for lab values before doing joint tap if low suspicion)

Bacteria spills from uterus, tracks along paracolic gutter, and causes inflammation of the hepatic capsule and diaphragm

Hemolytic anemia > bilirubin gallstones > cholelithiasis > cholecystitis

After second febrile UTI or with concerning findings on renal/bladder ultrasound

Mass with central ring of hypoattenuation (mesenteric fat in intussusceptum)

NO. Often only occurs with underlying clotting disorder or placement of central venous catheter

Babies with RR > 80 often can't tolerate oral or NG feeds and need IV nutrition

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