csv-export2 diseases with strawberry tongue?Strep pharyngitisKawasaki diseaseTime to development of coronary artery aneurysms in Kawasaki disease?4 weeks(follow up with Cardiology within 2 weeks)Risk of long term aspirin treatment for Kawasaki disease?Reye syndrome if you get the flu(make sure they get flu shots!)Risk of coronary artery aneurysm after Kawasaki disease and change in risk with IVIG?20%down to 24%Aspirin vs IVIG treatment in Kawasaki?Aspirin reduces febrile course of illness (DON'T use Ibuprofen)

IVIG reduces risk of coronary artery aneurysmWhat happens to the ESR after the fever in Kawasaki disappears?Stays elevated!

(Platelets are also elevated)Complications of Kawasaki's?CNS (90%)Coronary artery aneurysm (2025%)Liver dysfunction (40%)Arthritis (30%)Hydrops gallbladder (10%)Diseases associated with diffuse adenopathy?EBV, CMV, HIV, Histo, Toxo, Mycobacteria, Measles, Lymphoma, Leukemia, Neuroblastoma, Rhabdomyosarcoma, HistiocytosisPalm/sole rash?Enterovirus (coxsackie)SyphilisRMSFKawasakiRashes that start on trunk?Varicella (mild fever after)

Roseola (fever first) (in kids < 2)Fever in Erythema infectiosum (B19) vs Measles?B19: temp of 100101

Measles: T > 101Rashes that follow fever?B19: rash follows fever 710d later

Roseola: rash 34d after feverTriad of RMSF?FeverHeadacheRashRash of SJS?Blistering, purpuric macules on face/trunk, erythema multiforme, severe mucosal changes (stomatitis)Diagnosis criteria of Kawasaki?High fever > 5 dChanges in oral mucosaExtremity changes (red/swell)RashConjunctivitisCervical adenopathyWho to suspect bacterial cervical adenitis in?15 yo with recurrent URI, strep, or staph

Pt has high fever, toxic appearance, sometimes cellulitis or fluctuanceAppearance of someone with mycobacterial lymphadenitis?Often appear well

Nodes can rupture through skin though > tx with surgical excisionCoughs that are worse at night?AsthmaSinusitisDry coughs?Environmental irritantFungal infectionAsthmaBarking cough?CroupSubglottic diseaseForeign bodyParoxysmal coughs?PertussisChlamydiaMycoplasmaForeign bodyBrassy/honking cough?Habitual coughTracheitisChange in voice implies what?Laryngeal irritation (can be from rhinitis, GERD, etc)Radiology findings in TB?Primary complex (large hilar adenopathy with initial lung focus)Focal hyperinflationAtelectasisSmall local pleural effusionsWho uses inhaled steroids?All pts with persistent asthma

Need to monitor BP, glucose, growth delay, cataractsWho gets methacholine, histamine, or exercise challenge?When asthma is suspected but spirometry is normalAbx to treat sinusitis?CefuroximeAmoxicillinclavulanateTiming of sinus development?Ethmoid and maxillary at birthFrontal start around 68 yrComplications of sinusitis?Orbital sinusitisCavernous sinus thrombosisMeningitisEpidural abscessCause of rhonchi?Mucus/secretions in airways

Continuous, low pitched, polyphonicCause of cobblestoning of posterior pharynx?Lymphoid hyperplasia from chronic post nasal drip and with chronic nasal allergiesStages of asthma exacerbation?Early asthmatic reaction: 1 hr, PGs/LTs, permeability, hypersecretion, bronchoconstriction

Late: 23 hrs later, epithelial destruction, fibrotic remodeling, hyperplasia of bronchial smooth muscle

Airway hyperresponsiveness can persist for days to weeksCerebellar hemispheric vs deep cerebellar nuclei lesions?Hemispheric: limb abnormalities, nystagmus, tremor, dysmetria (spares speech)

Deep nuclei: resting tremor, myoclonus, opsoclonus (neuroblastoma)Most common childhood brain tumors?Medulloblastoma (20%)

Juvenile pilocytic astrocytoma (20%)Classic vs common migraine?Classic has aura

Common: no aura, more commonTriad of ICP signs?HTNBradycardiaIrregular respirationComplication of pseudutumor cerebri?Blindness from elevated pressure around optic nerve sheathCauses of pseudotumor cerebri?ObesityMeds (Vit A, tetracycline, OCPs, steroids)Metabolic disorders (galactosemia, hypoPTH)Infection (sinusitis, OM)Location of germ cell tumors in brain?Pineal gland or suprasellar regionPresentation of supratentorial vs infratentorial tumor?Infratentorial: cerebellar signs, signs of raised ICP

Supratentorial: focal motor and sensory abnl on opposite side of lesionMale predominance of what types of brain tumors?MedulloblastomaEpendymomaTwo peaks of incidence of brain tumors?First decade8th decadeAges where supra or infratentorial tumors are more common?Supra < 2yoInfa in kidsSupra in adolescents/adultsWho does postinfectious cerebellitis appear in?13 yoSeveral wks after viral infection (varicella, coxsackie)CSF w/ pleocytosis, high protInfectious cerebellitis can be caused by what?MumpsEnterovirusEBVBacterial meningitis pathogensExamples of toxins that can cause sudden ataxia?AlcoholAnticonvulsants

Often get dysmetria and nystagmus alsoAge of neuroblastoma/opsoclonusmyoclonus?6mo to 3yoInitial workup for CHF?CXREKG(save echo for later)Murmurs associated with CHF?Aortic stenosisCoarctationPDAVSDWhen is a VSD first heard?Days to weeks of age occurs as pulmonary resistance decreasesEKG changes with VSD?Large: RVH and upright T wave in V1Moderate: LVHSmall: nlWhen are ASD and Coarctation detected?Preschool ageMost common murmur in kids?Innocent murmur37 yoWhat does Still's murmur sound like?Musical/vibratoryBest heard LLSB, supine37 yoDigoxin and Lasix treat what?Symptoms of CHF

Digoxin: not good for VSDMost common hip disorder in adolescents?SCFE

posterior displacement of capital femoral epiphysis from femoral neck through cartilage growth plateComplications of LeggCalvePerthes disease?Femoral head deformityDegenerative arthritis

often in boys 410 yoHow long after and after what types of infections does reactive arthritis occur?24 wks after GI or GU infectionWhat action is impaired with a SCFE?Internal rotationHow is pain from transient synovitis and septic arthritis relieved?By opening the hip capsule (hold hip in flexion and external rotation)Key way to distinguish transient synovitis vs septic arthritis?Elevated ESR, CRP in septic arthritis (can wait for lab values before doing joint tap if low suspicion)What worsens pain with osteomyelitis?Weight bearing

Pain is NOT position dependent (like in septic arthritis or transient synovitis)Time of ESR vs CRP elevation?ESR: remains elevated for weeks after improvement

CRP: elevated 46 hrs after initial insult, peaks at 3650 hrs, and returns to normal after 37 days3 reasons kids are at higher risk of dehydration?1. Higher SA to body mass ratio2. Higher basal metabolic rate3. Higher percentage of body weight that's waterDiagnosis of DKA?1. Random BS > 2002. pH < 7.3 or HCO3 < 153. Modlg ketonuria or ketonemiaDx of diabetes?1. Sx and random glucose > 2002. Fasting > 1263. 2hr GTT > 2004. HbA1c > 6.5Most common cause of diabetesassociated death in children?Cerebral edemaReplacement complications of hyponatremia and hypernatremia?Hyponatremia: replacement can cause central pontine myelinolysis

Hypernatremia: replacement can cause cerebral edemaCause of iso/hypo/hyper tonic/natremic dehydration?Iso: AGE, diarrheaHypo: adrenal insufficiencyHyper: breastfeeding failure, DI, inappropriate rehydration solutionsRisk factors for cerebral edema?High BUNAcidosis with hypocapniaAttenuated rise in Na+ with treatmentAdmin of bicarbOther Abs to check in DM workup?Antipancreatic (Anti insulin, GAD, IA2)Autoimmune thyroiditis and celiac

DON'T check TFTs (can be elevated due to nonthyroidal illness)Sodium concentration in oral rehydration solution?4550 mEq/LWhere's the blood in malrotation (+/ volvulus)?Blood in stool but not in vomitCurrent jelly stools?Intussusception

also bilious emesis, crampy abd pain, and sausage mass on examElectrolyte changes in vomiting from pyloric stenosis?Hypochloremic, hypokalemic metabolic alkalosisTime of presentation of pyloric stenosis?312 weeksOrder of exam in child?1. General obs2. Eyes3. CV/Lungs/Abd4. Ears/oral cavityMost important characteristics of ear exam?Mobility and Position

Also color, translucency, and otherAppearance of TM in AOM?Bulging, yellow, poorly mobileBacterial causes of AOM?1/2. S. pneumo/Nontypeable H. inf3. M. catarrhalis4. S. pyogenesWho do we treat AOM with amoxicillinclavulanate with (as opposed to just amoxicillin)?Kid with fever > 39C or moderate to severe otalgiaAlternative treatments for AOM?AzithromycinErythromycinClindamycinUse of conventional vs visual reinforcement audiometry (VRA)?VRA: good 6 mo to 2.5 yo, not ear specific

Conventional: > 4yo, frequencyspecificWhich hearing test is used in newborn assessments?Otoacoustic emissions (OAE)

measure cochlear fxn in response to presentation of stimulusFindings associated with otitis external?Bullous myringitisRadial vascular dilation (bicyclespoke distribution)Marked erythema with cobblestone" appearance of TM"Who to use abx vs no abx for AOM?Abx: < 6mo, 6mo to 2 yr: if certain dx or severe disease, >2 yo with severe illness

No abx: 6mo to 2yr with uncertain dx, > 2yo without severe illnessWho should get a hearing test?Effusion > 3moIf nl, follow q36moIf not, consider bilateral myringotomy with tube placementTest for 06yo that reports percent of children who successfully perform each task?Denver IIComplications of untreated chronic OME?Permanent sensory neural hearing loss (SNHL)TympanosclerosisAdhesive otitis mediaCholesteatomaTM perforationMastoiditis, Labyrinthitis, MeningitisEpidural/brain abscessCause of RUQ pain in PID?FitzHughCurtisWhat should you ask the child to do during a rectal exam?Bear down as you enter the rectum to relax the external sphincterPresentation of hernia? 5 nights/week

Age: > 2 wks, peaks at 6 wks, lessens by 34 moTime of SIDS vs ALTE (apparent life threatening event)?SIDS: most are midnight to 6am

ALTE: most are 8am8pmOther names for Mongolian spots?Congenital dermal melanocytoses

Slate gray patchesFracture that can be confused for abuse?Toddler's fracture: fracture of tibia in walking childrenPosterior rib fractures can result from what?Squeezing baby's thorax (shaken baby syndrome)What's the fattest baby" age?"4mo: 25% of weight is fatWhen is the physiologic nadir for Hgb?Around 79 weeksHgb 11Then starts to rise afterWhat can cause false positive sweat test results?Adrenal insufficiencyHypothyroidismScreening vs confirmatory test for CF?Screening (newborn): detects immunoreactive trypsinogen in blood

Confirmatory = genotyping for specific mutationsWhat percent of CF pts present with pancreatic insufficiency?8590%aka 1015% don't have it (they have normal weight gain, normal stools)Pain scales by age?FLACC (face, legs, activity, cry, consolability) for nonverbal kids

FACES: for 38 yo

010 scale: > 8 yoMost common cause of abd pain in kids?Functional abdominal painFirst signs of chronic GI illness?Slowing of weight gain (or especially weight loss)

Change in height velocity suggests more long standing illnessWhat percent of pts with HSP have guiac positive stool?50% are guiac positive2 problems with barium enema?1. Contrast delays potential colonoscopy

2. Increased risk of toxic megacolon with UCAre crypt abscesses are more common with UC or CD?UC2 studies to distinguish UC vs CD?Upper GI studyColonoscopy2 characteristics of Crohn's on barium enema?1. Cobblestoning2. Separation from nearby loops (bowel wall thickening)Does UC or CD have a stronger inheritable component?CDTreatments for IBD?1st line: aminosalicylates (mesalamine)> Corticosteroids, abx (cipro, metro), immunomodulators (6MP, MTX), antiTNFWhen do you stop using prematurity corrected charts?age 2

premature infants should catch up by thenMost variable component of development?LanguageWhen does the AAP recommend developmental screening?9, 18, and 30 monthsWhat causes pigeontoeing?Internal tibial torsion common in childhood, resolves with growthHow long does it take the pedal arch to develop?8 yrs can have flat feet until thenWhen does child gait look like an adult?3 yo heel strike presentWhen do you screen for autism?18 and 24 months3 realms of changes in autism?1. Social interaction2. Communication3. Restricted repetitive and stereotyped patternsWhich types of diseases will cause regression of milestones?Neurodegenerative diseasePsychosocialDescription of cerebral palsy?Heterogeneous group of nonprogressive disorders motor and postural dysfunctionRisk factors for cerebral palsy?Perinatal asphyxia (10%)Intrauterine infection (28%)Prematurity (78%)IUGR (34%)Sequence of events in retinopathy of prematurity?Extraretinal fibrovascular proliferationDetachmentBlindness/visual impairment

risk: BW < 1500gComplication associated with IVH?Periventricular Leukomalacia (PVL) damage from hypoxia, ischemia, inflammationComplications of kernicterus?Abnl motor development (choreoathetoid cerebral palsy)Sensorineural hearing loss2 surgeries common in sickle cell patients?TonsillectomyCholecystectomyCause of gallstones in sickle cell?Hemolytic anemia > bilirubin gallstones > cholelithiasis > cholecystitisWhich sickle cell pts get abx prophylaxis?Age 2 mo to 56 yrs oral penicillin BIDPCV23 is given to who and when?Pts with sickle cell get PCV23

2yo and then repeat 35 yr later same schedule for meningococcal2 things that can worsen anemia with sickle cell pts?1. Myelosuppression by viruses (parvovirus)2. Hypersplenism (spleen enlarges and traps RBCs)Who gets transcranial doppler (TCD) and why?Sickle cell pts between 215 yo determine risk of stroke (10% risk by 15 yo)Causes of impaired height and weight in sickle cell?Chronic anemiaPoor nutritionPainful crisesEndocrine dysfunctionPoor pulmonary functionWhat happens to the spleen of sickle cell pts?Becomes progressively fibrotic and no longer palpable by age 46

Hgb SC or Sbetathal can have splenic enlargement into adolescenceBaseline Hgb in sickle cell?69Treatment of painful crises in sickle cell?IVF and IV narcoticsPeak time of lymphoid tissue growth?Age 46 yo tonsils can be mildly enlarged during this timeMost common infection with steroid use for nephrotic syndrome?Spontaneous peritonitis often S. pneumo or GNRsManagement of nephrotic syndrome?1. Albumin infusion2. IV furosemide3. Corticosteroids (taper over wks)4. Sodium restriction (15002000 mg/d)What are pts with nephrotic syndrome predisposed to?Venous thrombosis urinary loss of anticoagulants, lipids destabilize platelets, inc fibrinogen, inc blood viscosity (high Hct)4 categories of MCD?Steroid responsiveRelapsingSteroiddependentResistant (> bx)PID and TOA are best detected with which type of imaging?UltrasoundChronic abd pain is best assessed with which type of imaging?Barium studyWho needs to be seen immediately for a fever?Kids younger than 68 wksWhat is the worst measure of circulatory status?Cold extremities(pt can be cold with adequate circulation)What do the D and E stand for in the ABCDEs of assessment?D: disability (quick neuro assessment ICP, toxidromes, etc) and dextrose (check for hypoglycemia)

E: exposure/environment (expose all parts of pt, keep pt warm)What's a practical problem with vasoconstriction in shock?Vasoconstriction can make it difficult to get a good pulse ox measurementNext line of management if you can't get a peripheral IV in for a pt in shock?Intraosseus line if peripheral IV can't be placed in 90 seconds central line also acceptable in older kid or adultProphylaxis for meningococcus?Rifampin, cipro, or ceftriaxoneComplications of meningococcal meningitis?1119% get complications: hearing loss neuro disability digit/limb amputations skin scarProblem with penicillin treatment of meningococcus?Doesn't eliminate carrier state. Need rifampin (kids, young adults) or cipro (adults) or 57 d ceftriaxone to eliminate carrier stateContraindications to IO line?Osteogenesis imperfectaFractureRecently used siteInfectionComplications of IO line?FractureFluid into subQ (> compartment syndrome)OsteomyelitisMicroscopic fat, BM emboliActions of TCAs?Inhibit reuptake of NEAntagonize ACh (> hypotension), Na+ channels (> dysrhythmias), and GABA (> seizure)Sympathomimetic toxidrome?MydriasisFeverDiaphoresisTachycardiaAgitationSZOpioid toxidrome?MiosisResp depressionHypotensionBradycardiaHypothermiaAMSSedativehypnotic toxidrome?Miosis OR mydriasisHypotensionBradycardiaHypothermiaSedationAnticholinergic toxidrome?MydriasisDry skinFlushingTachycardiaIleusUrinary retentionFeverDelirium, SZCholinergic toxidrome?Miosisn/v/dTearsSweatingUrinatingBronchorrheaBronchospasmMuscle twitchBradycardiaSZ, comaWhat is given with activated charcoal in poisoning cases?Cathartics charcoal helps absorb the toxins and cathartics accelerate defecationSeries of events in anorexia?AmenorrheaBradycardiaPostural hypotensionElectrolyte abnormalitiesContinued deficiency of Ca, MgNeuro changes, increased reflex tone, compromised cardiac functionBest tests for dx of von Willebrand's disease?Platelet function testsFactor VIII activityvWf antigen and activity (Ristocetin)aPTT (but can be normal, other tests are better)Genetics of vWD?Autosomal dominant with variable penetrance: Type 1 and 2

Autosomal recessive: Type 3Meds to treat vWD?Intranasal or IV desmopressinvWFOCPs/levonorgestrel IUD (for menorrhagia)Most common hereditary bleeding disorder?von Willebrand's disease 1% of populationWhen does fever after a vaccine usually present?Usually 2472 hours after

MMR and Varicella: can be 710d after3 clinical tests/findings in meningitis?1. Kernig's: resist knee extension2. Brudzinski's: flex hip/knee in response to neck flexion3. Opisthotonos: hyperextension of neck and spine

often NOT positive in infants > ability of chest wall muscles to expandSounds with narrowing of airways above vs below thoracic inlet?Above: stridor

Below: wheezingSounds from secretions causing airway narrowing?RhonchiCause of fine vs coarse crackles?Coarse: purulent secretions in alveoli

Fine: pulmonary edema, interstitial diseaseWhat should you get before getting a bronchoscopy?Obtain imaging (xray or fluoroscopy) firstDynamic eval over several breaths to see foreign body?Chest fluoroscopyTwo manifestations of foreign body and findings on imaging?Partial obstruction: get air trapping/hyperinflation

Complete obstruction: get atelectasis, signs of volume loss of xray (mediastinal shift)Most consistent finding with Down syndrome?#1 finding = Hypotonia small ears are also commonFindings on US with Down syndrome?Nuchal skin thicknessNasal bone ossificationGrowth parametersStandard karyotype test?Lymphocyte karyotype easier than skin fibroblastsPurpose of annual CBC in pts with Down syndrome?Infancy: leukemoid rxn, transient myeloproliferative disorders (TMD)

> 1 yo: iron deficiency anemiaWhich vaccines are first given at adolescence?TdapMeningococcalMethods of calculating BMI?Total body waterTotal body potassiumBioelectrical impedanceDualenergy xray absorptiometryCharacterization of chest pain in precordial catch syndrome?Sudden, sporadic onset, sharpLocation: LSBExacerbated by deep inspirationLasts sec to minResolves spontaneouslyTanner stage with increased penis length AND circumference?Stage 4Tanner stage with small amount of pubic hair but still childlike phallus?Stage 2Tanner stage with moderate curly pubic hair and phallus of increased length?Stage 3Differentiation of costochondritis pain with precordial catch syndrome?Costochondritis: lasts hrs to days (compared to seconds to minutes)Symptoms of hypoglycemic syncope?DiaphoresisAnxietyTremulousnessHungerErythema multiforme progression?Dusky red macules > wheals > target lesions > fixed for 13 wks

Most common with HSV, medsCommon time of onset and treatment of candidal rash?Diaper dermatitis, 710 mo (can also have satellite lesions)

Tx: nystatin or imidazole antifungalsSelenium sulfide is used to treat what?Tinea versicolorTreatment of tinea capitis?PO griseofulvin, 68 wksZinc oxide is used to treat what? What can help distinguish it from other rashes?Irritant dermatitis

spares intertriginous creasesStrength of steroids?Clobetasol > Betamethasone > triamcinolone > hydrocortisoneLocation of staph folliculitis vs nodular/cystic acne?Folliculitis often below waste/groinPseudofolliculitis appearance?Papules NOT pustules distinguish from acne by presence of inflammationRadiographic appearance of intussusception?Mass with central ring of hypoattenuation (mesenteric fat in intussusceptum)Most common manifestations of HSP?75% arthritis65% colicky abd pain25% renal involvement510% intussusceptionWhat is small for gestational age (SGA) most often due to?Constitutional factors maternal ethnicity, parity, weight, height3 risks for babies with SGA?HypoglycemiaHypothermiaPolycythemiaPresentation of polycythemia in infants?Ruddy"/red color to skinRespiratory distressPoor feedingHypoglycemiaSluggish blood flow"Symmetric vs asymmetric IUGR?Symmetric: both head and abd circumference decreased proportionately

Asymmetric: greater decrease in abd than head (head sparing phenomenon")"5 basics of newborn resuscitation?DryWarm (large SA/V)PositionSuctionStimulate (vigorous cry)What percent of newborn and 12mo olds have palpable spleens?30% of newborns10% of 12 mo

Often palpable 12cm below L costal marginMost common presentation of congenital CMV?> 90% have no clinical evidence of disease as newborns

But 40% are SGA, 30% preterm, 25% of males have inguinal hernias5 types of treatments for eczema?LubricationAntiinflammatoriesTopical hydrocortisoneAntihistamines (sedating and non)Calcineurin inhibitors2 things to prevent dental caries?Stop bottle feeding by 1215 mo

Fluoride (promotes remineralization of Ca into enamel)2 metabolic causes of hyperbili?Galactosemia

HypothyroidismSevere manifestations of kernicterus?Lose suck reflexLethargyIrritabilitySeizuresDeathSigns of kernicterus in those who survive?Opisthotonus, rigidity, oculomotor paralysis, tremor, hearing loss, ataxiaWhen and how does biliary atresia usually present?> 2 wksDirect hyperbili (progressive)Acholic stoolsHow does jaundice progress?Cephalocaudal direction 45 at face, 1015 below knees dermal zones often underestimate true level thoughOptimal time for newborn exam?>/= 24 hrs after birth earlier: might miss PKU and other metabolic disorders that require accumulationTime of breast feeding vs breast milk jaundice?Breast feeding: early 1st week

Breast milk: first 47d, peaks 1014d, can last up to 12 wksIs PE common in neonates?NO. Often only occurs with underlying clotting disorder or placement of central venous catheterIs prematurity a risk factor for TTN?NO

TTN: more common in term babies risks: mother with DM, C/S deliveryAre APGAR scores predictive of neurologic outcome?NO

Documented asphyxia is correlated with neuro outcome. Check cord arterial blood gas for acidosis.Small, appropriate, and large for gestational age percentiles?SGA: < 10th %AGA: 1090th %LGA: > 90th %Complications of LGA?Fractured clavicleBrachial plexus injuryFacial nerve palsyComplications of C/S, forceps, and vacuumHypoglycemiaWhat is Transient Tachypnea of the Newborn (TTN) due to and what is it also known as?Delayed absorption of pulmonary fluid aka persistent postnatal pulmonary edema.Causes of persistent pulmonary HTN of the newborn (PPHN)?Meconium aspiration syndromeDiaphragmatic herniaHypoplastic lungsIn utero asphyxiaWhich cardiac anomaly is associated with maternal diabetes?Transposition of the great arteries (TGA)Best indicator of fetal malformations in moms with diabetes?Major malformations are directly related to the FirstTrimester HbA1C level HbA1C levels >12: 12x riskRelationship of respiratory rate and feedings?Babies with RR > 80 often can't tolerate oral or NG feeds and need IV nutritionHypoglycemic glucose values that require intervention?< 35 if asymptomatic

< 45 if symptomaticWhat can happen after giving a hyperinsulinemic infant glucose water?Rebound hypoglycemia 12 hrs afterWhen are electrolyte values indicative of the infant's status?After 1224 hours

sooner: indicative of mother's status and any medications administeredWhat are the risk factors for DDH? Breech position: 3050% of DDH cases occur in infants born in the breech position. Gender: 9:1 female predominance. Family history.What is an MSK concern for pts with Down syndrome?Myelopathic signs/sx for atlantoaxial instability importance of cervical spine positioning during proceduresDistinguish neonatal seizures from jitteriness?Jitteriness: stimulussensitive movements, generalized symmetricRisks of home deliveries?Neonatal tetanusOmphalitisHemorrhagic disease of the newborn (with no Vitamin K)Definition of polycythemia in term newborn?> 65%When does OTC deficiency present?12 days sx due to protein in breast milk or formula > poor feeding, lethargy, and vomitingCauses of large anterior fontanelle?Skeletal disorders (rickets, osteogenesis imperfecta)Chromosomal abnl (Down)HypothyroidMalnutritionICPCauses of premature closure of anterior fontanelle?MicrocephalyCraniosynostosisHyperthyroidismNl variantLater symptoms of congenital hypothyroidism?Large tongueHoarse cryPuffy myxedematous faciesMost common time and presentation of botulism?34 mopoor suck and weak cryRisk of adulthood obesity with childhood obesity?20% of obese 4 yo80% of obese adolescentsPsychiatric condition with the highest comorbidity with ADHD?ODD/CDWhen to start vision and hearing screening?Vision: start 3 yr

Hearing: newborns, then resume at 4 moSequelae of obesity?Sleep apnea (7% of overweight)DyslipidemiaHTN (33% of obese)Nonalcoholic fatty liverWhen to suspect secondary causes of HTN?In young kids

> 6 yo: most is primaryWho and how to screen for type 2 DM?> 10 yo or puberty onsetq2 yr with fasting serum glucose

overweight, FH, race/ethnicity, insulin resistance (AN, PCOS, HTN, dyslipid)Car seat rules?< 2 yo: rear facing car seat24 yo: forward facing car seat48 yo: belt booster seatCauses of absent red reflex?CataractsGlaucomaRetinoblastomaChorioretinitisTimes of administration of Hep B?0, 1, 6 mo

3 timesTimes of administration of Rotavirus?2, 4, 6 mo

3 timesTimes of administration of Hep A?12 mo, second dose 6 months after and before 2nd birthdayTimes of administration of Varicella?1 yr and 46 yr

2 times same as MMRTimes of administration of MMR?1 yr and 46 yr

2 times same as VaricellaTimes of administration of IPV?2, 4, 6 mo, 46 yr

4 timesTimes of administration of PCV?2, 4, 6, 12 mo

4 times same as HibTimes of administration of Hib?2, 4, 6, 12 mo

4 times same as PCVTimes of administration of DTaP?2, 4, 6, 15mo, 46 yr

5 times start getting Tdap 1112 yo