Rishi

Kumar

Pediatrics Core

Hydroxyurea (tx HbS) increases fetal Hb. Tet spells -> knee to chest -> inc SVR -> inc pulm flow PDA -> distal pulses louder Whole milk -> dec iron (anemia) -> dec reticulocytes RDW, MCHC, and iron studies WNL -> micro anemia -> thalassemia trait Pericardial effusion s/p cardiac surgery in pt with congenital heart dz Vaginal foreign body -> foul-smelling discharge/bleeding -> irrigate out Vascular rings -> tracheal compression -> stridor, wheezing, SOB after birth Night terror -> non-REM screaming and crying -> no memory Neck swelling, resist movement -> torticollis -> XR to r/o racture Dec LOC after crying/upset -> 45 seconds -> alert afterwards -> breath holding spells (reassure) Bilious vomiting, distention -> gasless distal abdomen on XR -> atresia Outstretched arm fall (supracondylar humerus) -> swollen, pale, edematous (compartment syn) Known anaphylaxis -> epi pen upon reexposure Eczema, many bacterial infxs, small platelets -> Wiskott-Aldrich (dec platelet production) ADHD (two settings, 6+ months, <7 y/o) use teacher evals HbS can cause childhood stroke. (CBC/retic to dx HbS) CF is autosomal recessive. RDS a/w gDM and prematurity WPW (type of SVT) -> accessory pathway -> delta wave Kawasaki vasculitis -> fever, conjunctivitis, cervical LAD, rash. Concern for coronary aneurysm Osgood Schlatter -> traction apophysis of tibial tubercle (sports) Dec breast feeding first week -> inc ind bili -> breastfeeding jaundice Diarrhea + dermatitis + dementia -> pellagra (niacin deficiency) Cyanotic at birth, weak cry, 100% O2 small improvement -> PG-E1 infusion Delayed growth spurt, puberty, and bone age -> constitutional growth delay Recurrent sinopulm infxn, anaphylactic transfusion rxn -> IgA def Newborn male w/ oliguria + midline abdom mass (bladder) -> posterior urethral valves VSD -> FTT, fatigue, heart failure (holosystolic murmur at left parasternal) 15 y/o, breast Tanner 2, scant pubic hair, dec. femoral pulses (coarct) -> Turner (karyotype) Colicky abdom pain, vomiting, blood in stool -> air contrast enema (dx + tx intussusception) Large thymic shadow normal on CXR if < 2y/o Newborn polycythemia -> RDS, dec feeding, neuro symptoms 12 months triple birth weight, inc height by 50% OI -> blue sclera, hearing loss, opalescent teeth, joint hypermobility Low CD19+ cells -> Brutons (X-linked) -> give IVIG HbS -> vasoocclusion of bone -> osteonecrosis (joint pain + limitation) HbS -> chronic hemolysis (macro anemia) + reticulocytosis -> need folate Risperidone -> galactorrhea (hyperPRL) + amenorrhea PMHx sore throat -> rash+arthralgia -> truncal rash -> rheumatic fever Sickle crisis -> will see retics and sickle cells on blood smear 9 y/o AAM -> fever, dec appetite, irritable -> no vaccines -> dies (conjugate capsular polysaccharide for pneumococcal sepsis in HbS) Fever + confusion + rash (measles) -> Vitamin A Viral prodrome -> fever, lethargy, cardiac dysfxn -> myocarditis Bat saliva -> rabies ppx Acute, unilateral cervical lymphadenitis -> S. aureus Preseptal cellulitis: eyelid swelling/discoloration (not in orbital cellulitis) Inc head circumference -> sx of inc ICP -> CT head Vaccination schedule from chrono age, not gestational age Vision screening in children 0 5 y/o Food (peanut) major cause of outpt anaphylaxis -> give subQ epi Fingerstick lead unreliable -> do serum lead level (>10, intervention needed) Reluctance to toilet training -> stop for several months 6 y/o dragging leg, arm weakness, delayed growth, fever -> cyanosis when crying -> brain abscess

Rishi Kumar

Pediatrics Core

Fever, sore throat, hoarse, bulging pharyngeal wall -> retropharyngeal abscess Normal exam -> FOBT+ -> maroon stool in diaper -> radionuclide scan (Meckels) MC factor for acute bacterial sinusitis = Viral URI (rhinorrhea, cough, low fever) Neck pain/swelling for days -> dicloxacillin (MSSA) also cephalexin or clinda TORCH (prevent with MMR) -> microcephaly, HSM, deafness, chorioretinitis Vaccines: HiB (4x by 15mo), pneumo conj. (4x by 15 mo), MMR (one year, 4-5 years), HepB (3x by 18 mo), IPV (3x by 18mo, 4th at 4-5 years) Aggression, acne, baldness, gynecomastia -> anabolic steroids Resuscitation IVF LR or NS (0.9%) HSM, anemia, hyperbili, foot ulcerative lesions, rhinorrhea -> congenital syphilis MCC viral meningitis: echo/coxsackie Water intoxication -> dec electrolytes -> seizures, hyponatremia Int carotid dissection -> mouth trauma -> S/sx of stroke Newborn jaundice -> exam WNL -> physiologic jaundice Leucocoria -> refer to ophtho Ankle dorsi/plantar flexion limited, mild calf atrophy -> clubfoot -> stretching, manipulation, serial casting (tx immediately) MCC nephrotic syn < 16 y/o = MCD (light microscopy WNL) Inattentive, does not listen, limited language -> undetected hearing impairment 2 y/o, profuse watery diarrhea, dehydrated (rotavirus MCC acute diarrhea children) Recurrent ear/lung infn, candida, rotavirus -> absent thymic shadow -> SCID Pneumonia, supparative adenitis, S. aureus infxns -> CGD HbS -> chronic hemolysis -> high RBC turnover -> high LDH, low haptoglobin Low platelet, anemic, high WBC, painless LAD -> ALL (>25% lymphoblasts in marrow) Thick nasal discharge, swollen tubinates -> start amoxicillin (clinical dx) ADHD -> impulsive, short attn span, hyperactivity > 6 mo in at least two settings HbS pt (functional asplenia) -> high fever/chills x 2d -> WBC 16 -> pneumococcal sepsis Spondylolisthesis -> L5 slip over S1 -> back pain, palpable step off if severe MCC amblyopia = strabismus (patch good eye) PSGN (ASO high) -> smoky urine + HTN, C3 low, C4 WNL -> complement nl in 8-12 wks IgA nephropathy -> persistent microscopic hematuria (> 6 mo) Down syn -> endocardial cushion defect (leads to pulmonary HTN) Bedwetting normal till 5 y/o Lymphadenitis, hepatic abscesses, osteo multiple sites -> + NBT -> CGD Simple febrile seizure -> one episode = no workup (discharge from EC) Sickle trait have some protection against malaria Coughing episodes 20-30 min each, subQ emphysema + subconjunc hemorrhage -> pertussis (also rectal prolapse from coughing) Turners syndrome -> CXR with rib notching from coarctation Salt wasting + virilization = 21-OH def MCC CAH (inc 17-alpha-hydroxyprogesterone) Fever, flank pain, dysuria -> pyelo x 2 before-> reflux on VCUG -> renal scarring if no tx Tx URI w/ ASA -> irritable, lethargic, agigated -> Reyes Vomiting, dehydration, hypoNa+, hyperK+, metabolic acidosis -> CAH (21-OH def) Scalp discoloration limited to one bone -> cephalohematoma Hx of multiple AOM, dec social interaction, not respond to name -> audiology eval Lobular flank mass, kidneys palpable bilat -> Wilms (tumor from metanephros). Kidneys not palpable in neuroblastoma 12 y/o proteinuria 3+, anasarca -> start prednisone for MCD Inc IgM, dec IgA/IgG and dec total B-lympocytes/neutrophils -> Hyper IgM (poor response to immunizations) Easy bruising/rash + petechiae after URI prodrome -> ITP Bone tenderness + HSM -> Gaucher -> def. acid beta-glucosidase Premature adrenarche (axillary hair) = < 6y/o -> premature androgen from adrenals benign Premature pubarche (public hair) = < 8y/o -> 50% a/w CNS disorder Klumpkes -> hand paralysis + ipsi Horners

Rishi Kumar

Pediatrics Core

Breastfeeding contraindic: Active drug abuse, active TB, HIV Eosinophilic truncal/abdominal pusticular/vesicular rash -> erythema toxicum Precocious puberty w/ S/sx of androgen XS (acne, growth spurt) -> gonadotropin independent -> XS sex steroids -> late onset CAH (21-OH def) Congenital toxoplasmosis triad -> chorioretinitis, hydrocephalus, intracranial Ca2+ Cri-du-chat: 5p deletion Meningitis sequelae: hearing loss, seizures, MR, loss of cognitive fxns Fetal EtOH -> short palpebral fissures, epicanthal folds, long philtrum, thin upper lip 7 y/o boy w/ persistent nocturnal enuresis -> DDAVP or imipramine Choke/emesis from birth -> salivating -> bilateral atelectasis -> esophageal atresia HbS pt -> severe anemia w/ no retics -> aplastic crisis Galactosemia -> FTT, bilateral cataracts, hypoglycemia (also E.coli sepsis) Lyme dz -> circular rash (target lesion), headache, myalgia -> wear light colored clothing + long sleeves gDM baby -> birth injuries 2/2 large size -> greenstick clavicular frx heal quickly Viral infn one week prior -> ascending polyneuropathy -> Guillain-Barre RTA non-AG metab acidosis -> FTT Duodenal atresia -> bilious vomiting + double bubble in Downs RSV inc risk of asthma later. Newborn cyanosis w/ left axis deviation -> tricuspid atresia 6 y/o high fever + face to trunk rash -> measles -> Vitamin A Impetigo -> tx w/ topical mupirocin or oral erythromycin Hydroxyurea -> dec incidence of painful crises in HbS Premature infant -> dec LOC, hypotonia, tense fontanels, ventricular dilation per CT -> IVH Exposure to chicken pox one week prior -> will develop rash (not high risk, so no ppx or vaccine) SGA infants (<10th percentile for weight) -> hypoxia, polycythemia, hypoglycemia MCC acute sinusitis: pneumococcus > H. flu > Moraxella Suspect NEC in distention, bloody diarrhea, leukocytosis -> pneumatosis intestinalis Riboflavin def: sore throat, hyperemic membranes, chelitis, stomatitis, photophobia Wilms from metanephros (renal parenchyma), neuroblastoma from neural crest (inc HVA/VMA, calcifications) Edwards -> micrognathia/cephaly, rocker bottom feet, absent palmar creases, VSD Squatting improves cyanosis in TOF Foreign body aspiration -> direct laryngoscopy + rigid bronchoscopy PKU -> blue eyes, musty odor, eczema, [phenylalanine] > 20mg/dL, normal [tyrosine] Healthy SVD -> initial physical assessment (APGAR) -> suction secretions -> keep infant dry/warm -> give Vit K/ophtho drops 6 mo boy w/ TSC -> sudden jerky movements -> give ACTH IM for infantile spasms Conjunctivitis (24hr chemical, 2-5 days gonococcal, 5-14 days chlamydia): tx chlamydia with oral erythromycin Recurrent sinusitis, bronchiectasis, dextrocardia -> Kartegeners syndrome Low-grade fever, LAD (suboccipital and posterior auricular), maculopapular rash from face-> trunk = rubella Human milk -> whey easily digested (more than casein) -> improved gastric emptying Lesch-Nyhan -> def HPRT -> self- mutilation, MR, dystonia, inc uric acid (boy with gout) Batteries lodged in esophagus removed by endoscopy. MCC subarachnoid hemorrhage in children = AVM -> seizures + migraine Has SVD at home -> bruising easily -> prolonged PT/PTT -> Vit K def

Rishi Kumar

Pediatrics Core

FTT -> erythematous symmetric vesicles over extensor elbows/knees -> Celiac dz Abrupt fever, dysphagia, drooling, resp distress -> unimmunized HiB -> epiglottitis 2-5 y/o -> localized abdom mass + hematuria -> Wilms (if < 1 y/o, think neuroblastoma) Jaundice after 3 days old, poor feeding, lethargic -> sepsis workup (blood cx, LP) Delayed cord separation, necrotic periodontal/cutaneous/sinus infns, leukocytosis -> impaired adhesion NBNB vomiting in 4-8 wk infant -> abdominal U/S to confirm pyloric stenosis MC presentation for HbS -> painless gross hematuria Iron poisoning -> N/V/D/abdom pain -> GI bleed -> metab acid Painless melena in 2-3y/o -> Meckel 2-3y/o -> impaired vision in darkness, photophobia, dry scaly skin -> Vit A def Pubertal gynecomastia (14 y/o, asymmetric, tender) -> reassurance Absence sz -> brief lapses of consciousness, no postictal, daydreaming Newborn fails meconium passage in 24 hrs -> SBO at ileum -> CF 2/2 gene deletion OI type 2 (fatal in utero) -> limb deformities, multiple fractures, blue sclerae NEC -> pnematosis intestinalis, low birth weight, fever, vomiting, distention Pinworm -> nocturnal pruritic vulva in prepubescence -> Scotch tape test Inflamed TM with no movement on insufflation -> specific for AOM Gastroschisis -> immediately wrap exposed bowel to prevent heat/fluid loss Cyanosis with feeding but relieved with crying -> choanal atresia A minor who is a parent can consent to treatment/procedures for their child Toilet trained at 4 y/o -> bedwetting at 7 y/o -> UA to r/o treatable causes of enuresis Guthrie urine test -> PKU dx -> fair skin, blue eyes, eczema, dehydration, mousy odor Suspect congenital diaphragmatic hernia -> drop suction OG tube (dec lung compression) Cystic calcified parasellar lesion -> central DI -> craniopharyngioma (Rathke derivative) 4wk/o NBNB projectile vomiting, macrocytosis -> abdominal U/S for pyloric stenosis Severe hip pain, fever, turbid synovial fluid (WBC > 90) -> septic joint -> drainage HSP -> palpable purpura, scrotal edema, hematuria, abdom pain -> risk to intussuscept Treat pertussis with macrolide (erythro) regardless of immunization/age/dz stage Noisy inspiratory breathing supine -> improves prone -> epiglottis rolled side-to-side -> laryngomalacia -> always feed upright Beckwidth-Wiedemann: macrosomia, macroglossia, visceromegaly, omphalocele, hypoglycemia/hyperinsulinemia (gDM does not have dysmorphic features) Alkali ingestion -> EGD Internal tibial torsion and metatarsus adductus -> reassurance Umbilical cord stump infn, spasms, poor suckling, -> tetanus Absent thymus, prolonged QT -> 22q11 deletion -> monitor [calcium] 8 mo/o -> vomiting, oliguria, fever -> dec arousability -> bulging TMs -> start cefotaxime for CNS infn first, then CTH to r/o inc ICP 7y/o oliguria, lethargy -> UA performed on all with suspected renal dz (noninvasive, helpful, fast) Clavicular frx (shoulder dystocia, LGA) -> crepitus, dec movement -> no tx required 9 m/o AAM swelling hands/feet and pale -> VSS -> dec ROM -> vaso-occlusive phenomena (dactylitis) Turners syndrome -> coarctation of aorta Medulloblastoma from vermis -> truncal dystaxia, papilledema, horizontal nystagmus, unbalanced 7 y/o recurrent URI, bilateral nasal polyps -> must r/o CF 3-7 y/o, acute resp dist, toxic, drooling, high fever -> epiglottitis -> tracheal intubation < 3m/o develop vaginal spotting/bleeding (maternal estrogens) w/ no odor -> reassurance 6 m/o w/ postprandial emesis, FTT, arched back during emesis (Sandifers syn, protects airway) -> GERD -> 24 hr esophageal pH monitoring 15 d/o -> bilious vomit, distention, blood in stool -> completely healthy (passed meconium) -> volvulus MCC neonatal sepsis = GBS > E.coli > Listeria. 2 wk/o (late onset) -> meningitis (hypotonia, poor reflex) 2 y/o abrupt N/V/bloody stools -> intussusception PWS sporadic -> imprinting -> almond-shaped eyes, fish mouth, obesity, hypotonia, hypogonadism Edema in Turners from lymphatic dysgenesis Migraine w/ no fever and normal neuro exam -> Tylenol/NSAIDs (LP if meningeal signs) 1 y/o on XS cow milk -> iron def anemia -> oral iron therapy

Rishi Kumar

Pediatrics Core

10 y/o paralysis vertical gaze, lid retraction, HA -> pinealoma Knows two words, throws objects, walks alone -> 12 month milestone Childhood bruising, bleeding after dental procedure -> hemophilia -> hemosiderin deposits + fibrosis Hypothyroidism -> large tongue, hypotonia, umbilical hernia, bloating (all states screen for hypothyroidism, PKU, and galactosemia) Neonatal abstinence syndrome withdrawal to opiates (heroin) -> high pitched cry, tremors, seizures, sneezing, N/V/diarrhea HUS -> abrupt bloody diarrhea, pain, anemia, thrombocytopenia, renal insufficiency (from E.coli) < 3 y/o w/ stereotyped behaviors, impaired social/communication skills, delayed language -> autism IVH > prematurity and LBW -> seizures, hypoTN, bulging fontanel -> U/S head Turner (45,XO) -> bilateral abdominal gonadectomy (gonadoblastoma) Calculate APGAR Infant born at 32 wks, 1200 grams with Hb 7 -> anemia of prematurity TCA intox -> seizure, hypoTN, wide QRS on EKG -> give bicarb for acidosis + QRS 1 m/o harsh holosystolic murmur on left lower sternum -> VSD -> reassurance + abx ppx Rocker-bottom feet, overlapping digits, small jaw -> Edwards Turners -> gonadal dysgenesis -> low estrogen -> osteoporosis Blue/gray sacral lesion since birth -> Mongolian spot Mammary gland enlargement + nonpurulent vaginal discharge = normal newborn findings Marfan features + thromboembolic event = classic homocystinuria (cystathione synthase def, tx B6) MCC acute UTI 5y/o (children) -> VUR (reflux) Fall outstretched hand -> anterior displaced fat pad -> supracondylar frx -> Volkmanns ischemic contracture -> swelling due to ischemia of forearm tissues Premature, 8 wk/o, pallor -> breast milk -> give iron supplementation (prevent anemia of prematurity) 2-12 y/o w/ leg pains only at night -> growing pains -> reassurance 8 y/o -> coughing paroxysms -> subQ emphysema -> do CXR to r/o pneumothorax Disruptive, violate social norms for one year: conduct d/o (<18 y/o), antisocial PD (>18 y/o) 9 y/o w/ grand mal seizures -> HA in morning -> astrocytoma (MCC supra and infratentorial lesion) Lyme dz (stage 1); if < 9 y/o, amoxicillin, if > 9 y/o, doxy 150-300 words, understandable, me instead of I, combine words into sentences = 24 months SCFE limp after falling, overweight adolescent 4-6 w/o w/ projectile vomiting, olive-mass in abdomen, [K+]=3mEq/mL -> IVF + lytes first, then surg 3 y/o AAM w/ spontaneous hemarthrosis + soft tissue hematomas -> hemophilia A -> get factor 8 level 10 y/o recurrent UTI 2/2 reflux -> IVP -> parenchymal scarring/blunted calyces -> chronic pyelo Umbilical hernia -> if < 1 y/o: spon resolution; if 3-4 y/o, symptomatic, or > 2cm: surgery 6 y/o URI -> ITP -> if platelets < 30K, then steroids; otherwise observe Marfans (AD mut FBN1)-> tall, long, emaciated, hypermobility, upward lens dislocation, aortic root dilation + Coombs = autoimmune hemolysis, + osmotic fragility = HS Kawasaki tx high dose ASA and IVIG 2 y/o barking cough -> laryngotracheiobronchitis -> croup -> 2L O2 (sats drop) -> racemic epi trial before intubation 5 y/o asyx 2/6 murmur, VSS, change with position -> observe (benign) 2 y/o not walking -> hypotonia, learning disabilities, inc DTRs -> CP 2/2 cerebral anoxia (MCC) 2 y/o whistling sound, barky cough -> lateral XR subglottic narrowing -> MCC Paraflu -> croup Niemann-Pick: HSM, LAD, regression of milestones, cherry red macula (def sphingomyelinase) 10 y/o obese whose dad has HLD -> if > 240mg/dL or risk factors for CAD, get screening cholesterol Functional asplenia in HbS -> Howell Jolly bodies on smear (nuclear remnant) 7 y/o recurrent self-limited N/V -> normal exam -> cyclical vomiting Vit D def rickets -> craniotabes, rachitic rosary, large anterior fontanelle -> inadequate sun Kawasaki is (-) for Strep and has inflamed lips compared to scarlet fever Von Gierckes -> hyperuricemia, lactic acidosis, hypoglycemia, large liver, fat cheeks (G6-phosphatase def) HA + focal neuro findings after AOM -> brain abscess -> ring enhancing lesions on CT/MRI 6 y/o joint/abdom pain, maculopap rash of LE, 4+ RBC on urine -> HSP (mesangial IgA deposition) 1 d/o Downs -> duodenal gas distention w/ no air distal -> no stools passed -> Hirschsprungs dz Fragile X -> language/learning disability, large head, prominent jaw, macroorchidism (inc CGG repeats)

Rishi Kumar

Pediatrics Core

15 y/o AAF malar rash, anemia, leukopenia -> RPR/ANA + -> anti-Sm/anti-dsDNA to confirm SLE Supracondylar frx -> brachial artery compromised (must assess radial pulse) GAS -> erythryogenic toxin -> sandpaper rash, gray-white pharyngeal exudate -> scarlet fever (penicillin V) Congenital rubella triad -> sensorineural deafness, PDA/ASD, and cataracts (leukocoria) Regardless of age, immunization, or symptoms, erythro x 14d for pertussis ppx for close contacts. 2 y/o abrupt epistaxis, foul-smelling stools -> FTT 2/2 CF (dec pancreatic enzymes) 2 y/o asthma exacerbation -> no air entry, continues to desat on steroids -> mechanical ventilation 15 mo/o cough, facial maculopapular rash, bluish-white lesions oral mucosa -> rubeola (measles) -> report Bruton (XLR) -> male with recurrent pneumonia and AOM -> all Igs are low Clitoromegaly, facial hair, obese -> inc 17-OH-progesterone -> CAH (LH > FSH in both CAH and PCOS) Bili inc rate more than 5 mg/dL/day, bili > 12 (term) or > 10-14 (preterm), jaundice after two weeks, or jaundice initially in first 24-36 hrs of life -> further eval; conjugated hyperbili -> biliary atresia TOA -> MCC cyanotic heart dz p/w cyanosis in first 24 hrs (seen in DM mothers) -> single loud S2 Macro anemia, low retics, congenital anomalies (short, webbed neck, cleft lip) -> Diamond-Blackfan Precocious puberty, caf au lait spots, bone defects (polyostatic fibrous dysplasia) -> McCune-Albright (defect in G-protein cAMP-kinase) 14 y/o HbS s/p crisis 3 months ago -> afebrile now -> no local tenderness, but limited ROM hip -> AVN Pull on arm -> radial head subluxation -> Nursemaids elbow -> tx by flex + supinate Fever, pericarditis, erythema marginatum, subQ nodules, chorea -> rheumatic fever -> GAS MCC pneumonia in CF -> Haemophilis, Pseudomonas, and Staph Lytic bone lesion + hyperCa -> Langerhans cell histiocytosis Friedreich ataxia -> combo neuro (ataxia, dysarthria), skeletal (scoliosis), and cardio (HOCM MCC death) Hip pain post viral infn -> transient synovitis -> rest + NSAIDs (septic joint = WBC > 12, T = 102, ESR > 40) Meningococcus -> suddenly hypoTN -> WF syndrome (adrenal hemorrhage) -> vasomotor collapse Sits unsupported, looks around, babbles, raking grasp -> 6 month milestone 3 m/o -> ptosis, mydriasis, dec DTRs, hypotonia -> C. botulinum in GI tract Malaise, sore throat, fever -> given amoxicillin for apparent URI -> polymorphous body rash -> EBV Immediate anaphylaxis, encephalopathy, or CNS syx within 7 days from DTaP are CIs (pertussis component); substitute DT CF -> meconium ileus -> bilious vomiting, failure to pass meconium, ground glass abdominal XR Stranger anxiety -> exposed to unfamiliar individuals -> peaks at 12-15 months Prevent SIDS by placing in supine position. Home monitors do not decrease risk MCC M&M after HUS is of renal etiology 13 y/o -> prog muscle weakness, temporal wasting, atrophy thenar/hypothenar, delayed relaxation -> myotonic muscular dystrophy (AD) Downs -> bilious vomit, no abdom distention, double-bubble -> duodenal atresia Oral thrush, LAD, HSM -> presenting signs of AIDS in infants (dx by viral cx, PCR, and P24 not serology) Emergent fluid access -> if not IV, then interosseous DMD -> screen with CK, confirm with muscle bx CF acute exacerbation of lung dz abx to cover for pseudomonas (ceftaz + gent) Increased gastric residues in preterm neonate -> NEC 5 d/o maroon stools x 3d + vomiting -> stool + for RBC and eos -> milk protein intolerance (FHx of atopy) Childhood obesity inc risk of SCFE, HTN, DM2, and uterine cancer later in life. 30 minute old born at 28wks -> RR 70, RDS, nasal O2 no improvement -> HMD (tx mech vent + surfactant) 9 y/o unsteady gait, dec vibration in LE, wide based gait, T-wave inversions on EKG -> FA -> counseling Low birth weight or post-mature infant -> MAS -> RDS, hyperinflation, patchy opacities on CXR Infantile colic -> XS crying in healthy infant (3+ hrs/day more than 3 days/wk more than 3wks/mo) -> resolves by 4 months of age 18 mo/o boy -> recurrent sinopulm + Giardia infn (IgA) -> abnl B-cell maturation -> infns after 6 mo/o Unilat cavernous hemangioma, intracranial calcifications, seizures -> Sturge-Weber MCC congenital hypothyroid (jaundice, large tongue, hoarse cry, lethargy) = thyroid dysgenesis 5 y/o AAM rt knee pain, fever, chills x 2 day -> inc WBC/ESR -> septic joint -> arthrocentesis + IV nafcillin 6 y/o acute hemiplegia w/ LOC -> paralysis once conscious -> CTH WNL -> seizure (Todds paralysis) Downs with UMN findings (ataxia, +Babinski, incontinence) -> atlantoaxial instability