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INTRODUCTION TO PBR
ABOUT THE PBR CORE STUDY GUIDE
Hi. My name is Ashish Goyal and Ive written the PBR core study guide to provide you with all of the
information you need to pass the American Board of Pediatrics initial certification exam. There has been a
very strong effort on my part to use easy to understand language, and to provide you with hundreds of
memory aids. This will significantly cut down on the amount of time you need to spend on each topic. Your
efficiency will allow you to go through the material multiple times and feel confident on the test day that you
are well prepared to take the exam.
Before you begin your studying, though, Id like to share some key pieces of information with you. I took the
ABP initial certification exam the year that I graduated residency. I used multiple study guides to prepare and
felt okay going into it, and felt nauseous coming out of it. I was possible that I had failed a board exam for
the first time in my life. I went home and made notes about how I would do things differently if there was a
next time. The passing score at the time was a 410 and I scored a 380. I failed by 7-9 questions. The
following year I made key strategy changes based on my previous experience. I studied for hundreds of hours
as though it was a fulltime job. I took the test again and felt amazing this time. My score increased by
160 points up to a 540! I passed by 37-39 questionsI was really just happy to pass. Failing the first time
had cost me extra time, money and energy that I would have preferred to spend with my loved ones.
Prior to writing the PBR core study guide, I didnt really like to share the fact that I had to take the exam twice.
The reason Ive decided to share this information with you is to hopefully gain your trust in my ability to help
you pass this exam based on my own experience. IM AN AVERAGE PERSON WHO DID EXTREMELY
WELL ON THE EXAM. I enjoy teaching and Ive been able to incorporate my studying techniques and tools
into the PBR system. Its easy to follow, focused, efficient, has had GREAT success rates, and is guaranteed
to help you pass. All you have to do is FOLLOW THE ROADMAP.
PEG
TREE TRUNK
2
3
4
5
6
LIGHT SWITCH or
LIGHT BULB
STOOL
CAR
GLOVE or HAND
GUN
7
8
DICE or CARDS
ICE SKATE
9
10
CAT
BOWLING BALL or
PINS
AMERICAN
FOOTBALL or GOAL
POST
EGGS
HOCKEY MASK
11
12
13
14
TWENTY PEGS
EXPLANATION
Imagine the number 1 looking like a huge, brown tree trunk with limbs full of green
foliage sitting at the top of a lush, green hilltop.
A light switch/bulb has 2 positions (ON & OFF)
Imagine a dark, cherry wood stool with 3 legs.
Cars have FOUR doors and FOUR wheels
A glove has 5 fingers. Consider making MJs shiny glove your symbol for FIVE
Another name for a gun is a 6-shooter since they used to only hold 6 bullets.
GUNS also kill people and put them 6 feet under the ground.
Lucky number 7! Think Vegas, think craps or gambling with dice or cards
Ice skaters are known for performing a move called the figure 8. Eight also
rhymes with skate.
Ever heard of the phrase, cats have 9 lives.
The goal of bowling is to knock down 10 pins.
In American football, a field goal occurs when a football is kicked through two,
white, vertical uprights (the goal post). A goal post which look like the number 11.
15
ROSE or
CHOCOLATE HEART
PAYCHECK
16
DRIVERS LICENSE
17
18
19
20
MAGAZINE
VOTING BOOTH
KNIGHTING
CIGARETTES
There are TONS of mnemonics throughout PBR. Many will seem brilliant. Others may not work for you at all.
If that happens, please CREATE YOUR OWN. Its initially intimidating, but gets much easier with time.
OKAY, ARE YOU READY TO GET STARTED WITH THE PBR? LETS GO!!!
Table of Contents
COPYRIGHT INFORMATION ...........................................................................................................2
MEMBER REGISTRATION...............................................................................................................3
WHY REGISTER?.................................................................................................................................................................................3
FORM .......................................................................................................................................................................................................3
SUBMISSION .........................................................................................................................................................................................3
TALL STATURE.................................................................................................................................................................................44
(DOUBLE TAKE) KLINEFELTER SYNDROME (aka KLINEFELTERS) .......................................................................44
(DOUBLE TAKE) MARFANS SYNDROME (aka MARFANS SYNDROME)..................................................................45
HIGH CALORIC INTAKE .................................................................................................................................................................45
OBESITY................................................................................................................................................................................................45
GROWTH CHART TRENDS...........................................................................................................................................................45
ENDOCRINE DISORDERS ..............................................................................................................................................................45
CHROMOSOMAL ABNORMALITIES...........................................................................................................................................46
INADEQUATE CALORIC INTAKE or MALABSORPTIVE DISORDERS..........................................................................46
SPARING OF HEAD CIRCUMFERENCE ....................................................................................................................................46
SMALL HEAD DISORDERS ............................................................................................................................................................46
AMENORRHEA..................................................................................................................................................................................46
AMENORRHEA PEARLS .................................................................................................................................................................46
AMENORRHEA WORKUP ..............................................................................................................................................................46
PRIMARY AMENORRHEA..............................................................................................................................................................47
SECONDARY AMENORRHEA .......................................................................................................................................................47
ANOREXIA AS A CAUSE OF AMENORRHEA...........................................................................................................................47
BULIMIA AS A CAUSE OF AMENORRHEA ..............................................................................................................................47
POLYCYSTIC OVARIAN SYNDROME (PCOS) AS A CAUSE OF AMENORRHEA ........................................................47
DYSFUNCTIONAL UTERINE BLEEDING (DUB) AS A CAUSE OF AMENORRHEA..................................................48
MENORRHAGIA AND AMENORRHEA ......................................................................................................................................48
PREMENSTRUAL SYNDROME & DYSMENORRHEA .........................................................................................................48
PREMENSTRUAL SYNDROME (PMS).......................................................................................................................................48
PRIMARY DYSMENORRHEA ........................................................................................................................................................48
SECONDARY DYSMENORRHEA ..................................................................................................................................................48
SOCIAL ISSUES..................................................................................................................................................................................48
AUTONOMY.........................................................................................................................................................................................48
BREAST EXAMS .................................................................................................................................................................................48
RAPE/PTSD .........................................................................................................................................................................................49
DEPRESSION.......................................................................................................................................................................................49
OSTEOPOROSIS .................................................................................................................................................................................49
ALCOHOL AND TOBACCO .............................................................................................................................................................49
MARIJUANA.........................................................................................................................................................................................49
INHALANTS.........................................................................................................................................................................................49
CONDOMS ............................................................................................................................................................................................49
PLAN B ..................................................................................................................................................................................................49
PAP SMEARS .......................................................................................................................................................................................49
ASCUS.....................................................................................................................................................................................................50
HUMAN PAPILLOMA VIRUS (HPV)...........................................................................................................................................50
CHLAMYDIA TRACHOMATIS .......................................................................................................................................................50
MOTOR VEHICLE ACCIDENTS ....................................................................................................................................................50
GUNS ......................................................................................................................................................................................................50
HOMOSEXUALITY.............................................................................................................................................................................50
SELF CONSENT..................................................................................................................................................................................50
DRUG SCREENING............................................................................................................................................................................50
EXOGENOUS ANABOLIC STEROIDS..........................................................................................................................................50
EATING DISORDERS.......................................................................................................................................................................51
ANOREXIA............................................................................................................................................................................................51
BULIMIA ...............................................................................................................................................................................................51
REFEEDING SYNDROME ...............................................................................................................................................................51
OVERWEIGHT VERSUS OBESE ...................................................................................................................................................51
SCROTAL MASS ................................................................................................................................................................................52
TESTICULAR CANCER.....................................................................................................................................................................52
Copyright Pediatrics Board Review, Inc. 2011 Present.
All Right Reserved. Do Not Copy Without Written Permission.
HYDROCELE........................................................................................................................................................................................52
SPERMATOCELE ...............................................................................................................................................................................52
VARICOCELE .......................................................................................................................................................................................52
INGUINAL HERNIA ..........................................................................................................................................................................52
TESTICULAR AND PENILE ISSUES...........................................................................................................................................52
TESTICULAR TORSION...................................................................................................................................................................52
TORSION OF THE APPENDIX TESTES OR EPIDIDYMIS ..................................................................................................52
EPIDIDYMITIS....................................................................................................................................................................................53
ORCHITIS..............................................................................................................................................................................................53
BALANITIS...........................................................................................................................................................................................53
PHIMOSIS.............................................................................................................................................................................................53
PENILE EPIDERMAL INCLUSION CYSTS................................................................................................................................53
ENDOCRINOLOGY .......................................................................................................................54
THYROID DISORDERS KEY TERMINOLOGY......................................................................................................................54
HYPOTHYROIDISM .........................................................................................................................................................................54
THYROXINE-BINDING GLOBULIN DEFICIENCY.................................................................................................................54
HYPOTHYROIDISM & CONGENITAL HYPOTHYROIDISM ...............................................................................................54
THYROGLOSSAL DUCT CYST .......................................................................................................................................................55
THYROID NODULES ........................................................................................................................................................................55
HYPERTHYROIDISM.......................................................................................................................................................................55
GRAVES DISEASE = HYPERthyroidism....................................................................................................................................55
NEONATAL THYROTOXICOSIS (aka NEONATAL GRAVES DISEASE)........................................................................55
CALCIUM AND VITAMIN D RELATED DISORDERS...........................................................................................................56
(DOUBLE TAKE) HYPERCALCEMIA..........................................................................................................................................56
(DOUBLE TAKE) HYPOCALCEMIA ............................................................................................................................................56
VITAMIN D & ITS EVALUATION.................................................................................................................................................58
(DOUBLE TAKE) RICKETS ............................................................................................................................................................58
(DOUBLE TAKE) RICKETS OF PREMATURITY ....................................................................................................................59
(DOUBLE TAKE) LIVER DYSFUNCTION .................................................................................................................................59
ADRENAL DISORDERS ..................................................................................................................................................................60
CUSHINGS SYNDROME (aka CUSHINGS SYNDROME)....................................................................................................60
ADDISONS DISEASE (aka ADDISONS DISEASE)................................................................................................................60
CONGENITAL ADRENAL HYPERPLASIA (CAH)...................................................................................................................61
21-HYDROXYLASE DEFICIENCY ................................................................................................................................................62
11-HYDROXYLASE DEFICIENCY ................................................................................................................................................62
17-HYDROXYLASE DEFICIENCY ................................................................................................................................................63
PANHYPOPITUITARISM ................................................................................................................................................................63
AMBIGUOUS GENITALIA & CHROMOSOMAL ABNORMALITIES ................................................................................63
AMBIGUOUS GENITALIA ...............................................................................................................................................................63
MICROPENIS.......................................................................................................................................................................................63
TESTICULAR FEMINIZATION......................................................................................................................................................64
MULLERIAN INHIBITOR HORMONE DEFICIENCY (aka MIH RECEPTOR DEFECT) ...........................................64
MALE PSEUDOHERMAPHRODISM............................................................................................................................................64
TRUE HERMAPHRODISM..............................................................................................................................................................64
(DOUBLE TAKE) TURNER SYNDROME (aka TURNERS) ................................................................................................64
(DOUBLE TAKE) KLINEFELTER SYNDROME (aka KLINEFELTERS) ........................................................................65
DIABETES MELLITUS ....................................................................................................................................................................65
HONEYMOON PERIOD....................................................................................................................................................................65
HEMOGLOBIN A1C...........................................................................................................................................................................65
SOMOGYI EFFECT & DAWN PHENOMENA ...........................................................................................................................65
HYPOGLYCEMIA................................................................................................................................................................................66
DIABETIC KETOACIDOSIS or HYPEROSMOLAR NON-KETOTIC HYPERGLYCEMIC STATE .............................66
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10
PSEUDOHYPONATREMIA .............................................................................................................................................................66
ACANTHOSIS NIGRICANS .............................................................................................................................................................66
METABOLIC SYNDROME...............................................................................................................................................................66
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CARDIOLOGY ..............................................................................................................................91
EKG FINDINGS ..................................................................................................................................................................................91
RIGHT ATRIAL ENLARGEMENT (RAE) ...................................................................................................................................91
NEGATIVE T WAVE..........................................................................................................................................................................91
PREMATURE ATRIAL CONTRACTIONS (PACs) ...................................................................................................................91
PREMATURE VENTRICULAR CONTRACTIONS (PVCs) ....................................................................................................91
EKG CHANGES DUE TO ELECTROLYTE DISTURBANCES ...............................................................................................91
NORMAL HEART RATES...............................................................................................................................................................92
NORMAL HEART RATES ................................................................................................................................................................92
SINOATRIAL NODE (SA node).....................................................................................................................................................92
ATRIOVENTRICULAR NODE (AV NODE)................................................................................................................................92
VENTRICLE..........................................................................................................................................................................................92
ARRHYTHMIAS.................................................................................................................................................................................92
BRUGADA SYNDROME ...................................................................................................................................................................92
SUPRAVENTRICULAR TACHYCARDIA (SVT)........................................................................................................................92
WOLFF-PARKINSON-WHITE SYNDROME (WPW) ............................................................................................................93
VAGAL MANEUVERS/ADENOSINE ...........................................................................................................................................93
AV NODE REENTRANT TACHYCARDIA (AVNRT) ..............................................................................................................93
AV REENTRANT TACHYCARDIA (AVRT)................................................................................................................................93
ATRIAL TACHYCARDIAS................................................................................................................................................................93
ATRIAL FIBRILLATION & ATRIAL FLUTTER........................................................................................................................94
VENTRICULAR TACHYCARDIA (VT or VTACH)...................................................................................................................94
PROLONGED QT ................................................................................................................................................................................94
HEART BLOCKS (AV Blocks or AVB).......................................................................................................................................94
FIRST DEGREE AV BLOCK ............................................................................................................................................................94
SECOND DEGREE AV BLOCK .......................................................................................................................................................94
THIRD DEGREE AV BLOCK = COMPLETE HEART BLOCK...............................................................................................94
BUNDLE BRANCH BLOCKS...........................................................................................................................................................95
SEPTAL DEFECTS ............................................................................................................................................................................95
CARDIAC SHUNT PEARLS & MNEMONICS ............................................................................................................................95
ATRIAL SEPTAL DEFECTS (ASD)...............................................................................................................................................95
VENTRICULAR SEPTAL DEFECTS (VSDs)..............................................................................................................................96
AV CANAL DEFECT ..........................................................................................................................................................................96
AV CANAL DEFECT & VSD ............................................................................................................................................................96
MURMURS & SPLITS ......................................................................................................................................................................96
PATHOLOGIC MURMURS ..............................................................................................................................................................96
MURMUR TERMINOLOGY.............................................................................................................................................................96
PULMONARY STENOSIS (PS) ......................................................................................................................................................97
MITRAL STENOSIS (MS)................................................................................................................................................................97
TRICUSPID STENOSIS (TS)...........................................................................................................................................................97
AORTIC STENOSIS (AS)..................................................................................................................................................................97
MITRAL REGURGITATION (MR) ................................................................................................................................................97
MITRAL VALVE PROLAPSE (MVP)............................................................................................................................................97
AORTIC REGURGITATION/INSUFFICIENCY (AR or AI)...................................................................................................98
RIGHT UPPER STERNAL BOARDER (RUSB) MURMURS .................................................................................................98
LEFT UPPER STERNAL BOARDER (LUSB) MURMURS ....................................................................................................98
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PULSUS PARADOXUS....................................................................................................................................................................109
PERICARDITIS .................................................................................................................................................................................110
PERICARDIAL EFFUSIONS .........................................................................................................................................................110
MYOCARDITIS .................................................................................................................................................................................110
EARLY CONGESTIVE HEART FAILURE.................................................................................................................................110
HYPERTROPHIC CARDIOMYOPATHY = HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HCM,
HOCM).................................................................................................................................................................................................110
CARDIOMEGALY and HYPERTROPHY ..................................................................................................................................111
CHEST PAIN......................................................................................................................................................................................111
SVC SYNDROME..............................................................................................................................................................................111
MEDIALLY DISPLACED PMI......................................................................................................................................................111
PEDIATRIC BLOOD PRESSURE GUIDELINES ....................................................................................................................112
CHOLESTEROL SCREENING = HYPERLIPIDEMIA SCREENING.................................................................................112
FAMILIAL HYPERCHOLESTEROLEMIA................................................................................................................................112
DERMATOLOGY.........................................................................................................................113
GENERAL DERMATOLOGY .......................................................................................................................................................113
CONTACT DERMATITIS, A DIAPER RASH ...........................................................................................................................113
(DOUBLE TAKE) CUTANEOUS CANDIDIASIS, A DIAPER DERMATITIS .................................................................113
ATOPIC DERMATITIS (ECZEMA) ............................................................................................................................................113
NUMMULAR ECZEMA ..................................................................................................................................................................113
(DOUBLE TAKE) ECZEMA HERPETICUM............................................................................................................................113
SEBORRHEIC DERMATITIS (aka CRADLE CAP)...............................................................................................................114
PSORIASIS .........................................................................................................................................................................................114
GUTTATE PSORIASIS....................................................................................................................................................................114
(DOUBLE TAKE) LANGERHANS CELL HISTIOCYTOSIS (LCH) = HISTIOCYTOSIS X .........................................114
RASHES THAT SPARE THE INGUINAL FOLDS ..................................................................................................................114
PRURITIC RASHES.........................................................................................................................................................................114
KERATOSIS PILARIS .....................................................................................................................................................................114
LICHEN SCLEROSUS .....................................................................................................................................................................115
LICHEN STRIATUS.........................................................................................................................................................................115
ALLERGIC CONTACT DERMATITIS, A TYPE IV HYPERSENSITIVITY SKIN RASH..............................................115
(DOUBLE TAKE) BIOTIN/BIOTINIDASE DEFICIENCY ..................................................................................................115
PAPULAR URTICARIA ..................................................................................................................................................................116
VITILIGO ............................................................................................................................................................................................116
(NAME ALERT) ICHTHYOSIS VULGARIS .............................................................................................................................116
(NAME ALERT) LAMELLAR ICHTHYOSIS ...........................................................................................................................116
(NAME ALERT) HARLEQUIN ICHTHYOSIS.........................................................................................................................116
PYODERMA GANGRENOSUM....................................................................................................................................................116
(DOUBLE TAKE) ECTHYMA GANGRENOSUM ...................................................................................................................117
GRANULOMA ANNULARE ..........................................................................................................................................................117
PITTED KERATOLYSIS.................................................................................................................................................................117
DERMATOMYOSITIS.....................................................................................................................................................................117
STEVENS-JOHNSON SYNDROME (SJS) and TOXIC ENDODERMAL NECROLYSIS (TEN)................................117
ERYTHEMA MULTIFORME ........................................................................................................................................................118
NEONATAL LUPUS ........................................................................................................................................................................118
URTICARIA/HIVES ........................................................................................................................................................................118
SCLERODERMA...............................................................................................................................................................................118
DERMOID CYSTS (aka EPIDERMOID CYSTS) ....................................................................................................................119
COMEDONAL ACNE.......................................................................................................................................................................119
INFLAMMATORY ACNE...............................................................................................................................................................119
ISOTRETINOIN................................................................................................................................................................................119
(DOUBLE TAKE) APHTHOUS ULCERS ..................................................................................................................................119
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MILIA...................................................................................................................................................................................................131
SEBACEOUS HYPERPLASIA .......................................................................................................................................................131
TRANSIENT NEONATAL PUSTULAR MELANOSIS...........................................................................................................131
NEONATAL ACNE (aka NEONATAL CEPHALIC PUSTULOSIS) ..................................................................................132
INFANTILE ACNE...........................................................................................................................................................................132
LIVEDO RETICULARIS (aka CUTIS MARMORATA) .........................................................................................................132
ALOPECIA & HAIR FINDINGS ..................................................................................................................................................132
ALOPECIA AREATA .......................................................................................................................................................................132
ALOPECIA TOTALIS ......................................................................................................................................................................132
ALOPECIA UNIVERSALIS ............................................................................................................................................................132
(DOUBLE TAKE) ZINC DEFICIENCY ......................................................................................................................................133
(DOUBLE TAKE) ACRODERMATITIS ENTEROPATHICA ..............................................................................................133
(DOUBLE TAKE) BIOTIN/BIOTINIDASE DEFICIENCY ..................................................................................................133
TELOGEN EFFLUVIUM ................................................................................................................................................................133
TINEA CAPITIS (aka RINGWORM).........................................................................................................................................133
TRICHOTILLOMANIA ...................................................................................................................................................................134
(DOUBLE TAKE) ESSENTIAL FATTY ACID DEFICIENCIES..........................................................................................134
APLASIA CUTIS CONGENITA.....................................................................................................................................................134
NEONATOLOGY .........................................................................................................................135
WEIGHT, LENGTH & HEAD CIRCUMFERENCE ................................................................................................................135
NEWBORNS WEIGHT...................................................................................................................................................................135
NEWBORNS LENGTH...................................................................................................................................................................135
INTRAUTERINE GROWTH RESTRICTION = INTRAUTERINE GROWTH RETARDATION = IUGR ...............135
HEAD CIRCUMFERENCE Macrocephaly, Hydrocephaly & Microcephaly..........................................................135
NUTRITION, BREAST MILK & FORMULA ...........................................................................................................................136
NEONATAL POTASSIUM REQUIREMENTS.........................................................................................................................136
NEONATAL SODIUM REQUIREMENTS.................................................................................................................................136
PROTEIN INTAKE ..........................................................................................................................................................................136
NEONATAL CALORIC REQUIREMENT ..................................................................................................................................136
EXCLUSIVELY BREAST FED BABIES .....................................................................................................................................137
BREAST MILK ..................................................................................................................................................................................137
FORMULA ..........................................................................................................................................................................................138
IRON SUPPLEMENTATION........................................................................................................................................................138
WHOLE MILK...................................................................................................................................................................................138
PREMATURE INFANTS...............................................................................................................................................................138
ESTIMATING GESTATIONAL AGE BY PHYSICAL EXAM................................................................................................138
CALCULATING GESTATIONAL AGE........................................................................................................................................139
PREMATURE INFANT NUTRITION ........................................................................................................................................139
TOTAL PARENTERAL NUTRITION (TPN)...........................................................................................................................139
RETINOPATHY OF PREMATURITY (ROP)...........................................................................................................................139
NEONATAL JAUNDICE, HYPERBILIRUBINEMIA & HEMOLYTIC DISEASE OF THE NEWBORN................139
NEONATAL JAUNDICE.................................................................................................................................................................139
HYPERBILIRUBINEMIA...............................................................................................................................................................140
RISK FACTORS FOR DEVELOPING HYPERBILIRUBINEMIA .......................................................................................140
(DOUBLE TAKE) RHESUS DISEASE (aka RH DISEASE)................................................................................................140
(DOUBLE TAKE) ABO INCOMPATIBILITY ..........................................................................................................................141
(DOUBLE TAKE) GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY (G6PD DEFICIENCY) ........141
MISCELLANEOUS..........................................................................................................................................................................141
FULL TERM.......................................................................................................................................................................................141
NEONATE ..........................................................................................................................................................................................141
INFANT...............................................................................................................................................................................................141
APNEA.................................................................................................................................................................................................141
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CHARCOAL ........................................................................................................................................................................................164
GASTRIC LAVAGE...........................................................................................................................................................................164
AMPHETAMINES............................................................................................................................................................................164
COCAINE ............................................................................................................................................................................................165
PHENYLCYCLIDINE (PCP) .........................................................................................................................................................165
BARBITURATES (like phenoBARBITal) ...............................................................................................................................165
OPIOIDS..............................................................................................................................................................................................165
ALCOHOL (ETHANOL) .................................................................................................................................................................165
ETHYLENE GLYCOL INGESTION .............................................................................................................................................165
METHANOL INGESTION .............................................................................................................................................................166
ISOPROPYL ALCOHOL..................................................................................................................................................................166
MARIJUANA (MJ)............................................................................................................................................................................166
NICOTINE/TOBACCO/SMOKING ............................................................................................................................................167
ACETAMINOPHEN INGESTION................................................................................................................................................167
CHOLINERGICS ...............................................................................................................................................................................167
ANTICHOLINERGICS.....................................................................................................................................................................167
TRICYCLIC ACID (TCA) TOXICITY...........................................................................................................................................168
SALICYLATES...................................................................................................................................................................................168
IBUPROFEN OVERDOSE..............................................................................................................................................................168
IRON OVERDOSE ............................................................................................................................................................................168
(DOUBLE TAKE) LEAD TOXICITY...........................................................................................................................................169
CLONIDINE & PHENOTHIAZINES OVERDOSE ..................................................................................................................169
CALCIUM CHANNEL BLOCKER) OVERDOSE......................................................................................................................170
DIGOXIN TOXICITY........................................................................................................................................................................170
THEOPHYLLINE .............................................................................................................................................................................170
CARBON MONOXIDE (CO)..........................................................................................................................................................170
METHEMOGLOBINEMIA.............................................................................................................................................................170
HYDROCARBON INGESTION.....................................................................................................................................................171
HYDROCARBONS INHALATION...............................................................................................................................................171
ACID OR BASE INGESTION ........................................................................................................................................................171
FOREIGN BODY INGESTION......................................................................................................................................................171
(DOUBLE TAKE) RABIES VIRUS ..............................................................................................................................................171
BROWN RECLUSE SPIDER.........................................................................................................................................................172
BLACK WIDOW ...............................................................................................................................................................................172
COMMON BITES .............................................................................................................................................................................172
BURN TREATMENT ......................................................................................................................................................................172
NEAR DROWNING .........................................................................................................................................................................173
POOL SAFETY ..................................................................................................................................................................................173
HYPOTHERMIA ...............................................................................................................................................................................173
HEAD INJURY...................................................................................................................................................................................174
POST CONCUSSION TREATMENT...........................................................................................................................................174
ENDOTRACHEAL TUBES & VENTILATION.........................................................................................................................174
IMPAIRED PERFUSION/HYPOVOLEMIA .............................................................................................................................175
CARDIOPULMONARY RESUSCITATION (CPR) ..................................................................................................................175
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GASTROENTEROLOGY ...............................................................................................................183
LIVER DISEASE ..............................................................................................................................................................................183
CONGENITAL HEPATIC FIBROSIS ..........................................................................................................................................183
HEPATOMEGALY............................................................................................................................................................................183
GALLBLADDER HYDROPS..........................................................................................................................................................183
HEPATOBLASTOMA......................................................................................................................................................................183
PRIMARY SCLEROSING CHOLANGITIS (PSC) ....................................................................................................................183
HEPATOBILIARY IMINODIACETIC ACID SCAN (aka HIDA SCAN or CHOLESCINTIGRAPHY) .....................184
TRANSAMINITIS.............................................................................................................................................................................184
ALKALINE PHOSPHATASE.........................................................................................................................................................184
BILIARY OBSTRUCTION..............................................................................................................................................................184
JAUNDICE .........................................................................................................................................................................................184
JAUNDICE ..........................................................................................................................................................................................184
CHOLESTASIS ..................................................................................................................................................................................184
BILIARY ATRESIA ..........................................................................................................................................................................185
CHOLEDOCHAL CYSTS.................................................................................................................................................................185
PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS (PFIC).............................................................................185
ALAGILLE SYNDROME (aka ARTERIOHEPATIC DYSPLASIA)....................................................................................185
IDIOPATHIC NEONATAL HEPATITIS ....................................................................................................................................186
VIRAL HEPATITIS ..........................................................................................................................................................................186
HEPATITIS A ....................................................................................................................................................................................186
HEPATITIS B ....................................................................................................................................................................................186
HEPATITIS C ....................................................................................................................................................................................186
GILBERTS SYNDROME (aka GILBERTS SYNDROME)...................................................................................................186
CRIGLER-NAJJAR SYNDROME ..................................................................................................................................................187
DUBIN JOHNSON SYNDROME ..................................................................................................................................................187
REYES SYNDROME (aka REYES SYNDROME)..................................................................................................................187
(DOUBLE TAKE) WILSONS DISEASE ....................................................................................................................................187
CHOLECYSTITIS..............................................................................................................................................................................188
CHOLELITHIASIS ...........................................................................................................................................................................188
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ICTERUS .............................................................................................................................................................................................188
CLASSIC FUNCTIONAL ABDOMINAL PAIN OF CHILDHOOD ......................................................................................189
CONSTIPATION...............................................................................................................................................................................189
FECAL OVERFLOW ENCOPRESIS............................................................................................................................................189
HELICOBACTER PYLORI .............................................................................................................................................................189
NSAID-INDUCED DYSPEPSIA, ULCERS AND EROSIVE GASTRITIS ..........................................................................189
EROSIVE GASTRITIS aka EROSIVE GASTROPATHY .......................................................................................................190
NON-ULCER DYSPEPSIA.............................................................................................................................................................190
NON-EROSIVE GASTRITIS..........................................................................................................................................................190
ZOLLINGER-ELLISON SYNDROME .........................................................................................................................................190
INFANTILE GASTROESOPHAGEAL REFLUX (GERD)......................................................................................................190
IRRITABLE BOWEL SYNDROME (IBS) .................................................................................................................................190
INFLAMMATORY BOWEL DISEASE (IBD) CROHNS AND ULCERATIVE COLITIS ..........................................190
APPENDICITIS.................................................................................................................................................................................191
PANCREATITIS................................................................................................................................................................................191
INTUSSUSCEPTION.......................................................................................................................................................................191
(DOUBLE TAKE) GIARDIA..........................................................................................................................................................192
ABDOMINAL PAIN PEARL..........................................................................................................................................................192
DIARRHEA........................................................................................................................................................................................192
CHRONIC NONSPECIFIC DIARRHEA .....................................................................................................................................192
(DOUBLE TAKE) LACTOSE INTOLERANCE (aka LACTASE DEFICIENCY) ...........................................................192
BACTERIAL OVERGROWTH ......................................................................................................................................................193
CELIAC DISEASE (aka CELIAC SPRUE) ................................................................................................................................193
INFECTIOUS DIARRHEAL ILLNESSES ..................................................................................................................................193
CONSTIPATION..............................................................................................................................................................................193
FUNCTIONAL CONSTIPATION .................................................................................................................................................193
IRRITABLE BOWEL SYNDROME (IBS) .................................................................................................................................193
CONGENITAL HYPOTHYROIDISM ..........................................................................................................................................193
CYSTIC FIBROSIS (CF) .................................................................................................................................................................193
HIRSCHSPRUNG DISEASE ..........................................................................................................................................................194
MECONIUM ILEUS .........................................................................................................................................................................194
VOMITING ........................................................................................................................................................................................194
GASTROESOPHAGEAL REFLUX DISEASE (GERD) ...........................................................................................................194
PYLORIC STENOSIS.......................................................................................................................................................................194
ANTRAL WEB ..................................................................................................................................................................................195
ESOPHAGEAL WEB .......................................................................................................................................................................195
ACHALASIA .......................................................................................................................................................................................195
VOLVULUS.........................................................................................................................................................................................195
ANNULAR PANCREAS ..................................................................................................................................................................196
CYCLIC VOMITING .........................................................................................................................................................................196
RUMINATION...................................................................................................................................................................................196
BILIOUS EMESIS IN A NEWBORN ..........................................................................................................................................196
DOUBLE BUBBLE...........................................................................................................................................................................196
VOMITING PEARLS........................................................................................................................................................................196
GI BLEEDING...................................................................................................................................................................................197
GI BLEEDING PEARL ....................................................................................................................................................................197
LOWER GI BLEEDING (LGIB) ...................................................................................................................................................197
PAINLESS RECTAL BLEEDING.................................................................................................................................................197
MECKELS DIVERTICULUM (aka MECKELS) .....................................................................................................................197
FAMILIAL ADENOMATOUS POLYPOSIS (FAP)..................................................................................................................198
MISCELLANEOUS GI CONDITIONS & TERMINOLOGY..................................................................................................198
NASOGASTRIC TUBE FEEDINGS (NG TUBE FEEDINGS) ..............................................................................................198
ESOPHAGEAL PERFORATION ..................................................................................................................................................198
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21
OPHTHALMOLOGY ....................................................................................................................205
HORDEOLUM (aka STYE)...........................................................................................................................................................205
CHELAZION ......................................................................................................................................................................................205
CORNEAL ABRASIONS .................................................................................................................................................................205
HYPHEMA..........................................................................................................................................................................................205
PAPILLEDEMA ................................................................................................................................................................................205
PAPILLITIS........................................................................................................................................................................................206
CATARACTS ......................................................................................................................................................................................206
MYOPIA ..............................................................................................................................................................................................206
PRESBYOPIA ....................................................................................................................................................................................206
VISUAL ACUITY BY AGE ..............................................................................................................................................................206
VISION SYMMETRY.......................................................................................................................................................................206
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STRABISMUS....................................................................................................................................................................................206
PSEUDOSTRABISMUS ..................................................................................................................................................................206
AMBLYOPIA......................................................................................................................................................................................207
ESOTROPIA.......................................................................................................................................................................................207
EXOTROPIA.......................................................................................................................................................................................207
NYSTAGMUS.....................................................................................................................................................................................207
COLOR VISION.................................................................................................................................................................................207
CORNEAL LIGHT REFLEX TEST...............................................................................................................................................207
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(DOUBLE TAKE) HEMOPHILIA A and HEMOPHILIA B (aka FACTOR VIII and FACTOR IX DEFICIENCY)
................................................................................................................................................................................................................249
BLEEDING CIRCUMCISION ........................................................................................................................................................249
VON WILLEBRAND DISEASE (aka VON WILLEBRAND FACTOR DEFICIENCY) ................................................249
DISSEMINATED INTRAVASCULAR COAGULATION (DIC)............................................................................................249
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BLASTOMYCOSIS............................................................................................................................................................................261
COCCIDIOIDOMYCOSIS................................................................................................................................................................261
HISTOPLASMOSIS..........................................................................................................................................................................261
(DOUBLE TAKE) ASPERGILLUS...............................................................................................................................................261
MYCOBACTERIUM TUBERCULOSIS (aka MTB or TB)...................................................................................................262
VIRUSES ............................................................................................................................................................................................263
COXSACKIE VIRUS & ENTEROVIRUS.....................................................................................................................................263
ADENOVIRUS ...................................................................................................................................................................................263
ARBOVIRUS ENCEPHALITIS .....................................................................................................................................................263
RESPIRATORY SYNCYTIAL VIRUS (RSV).............................................................................................................................264
EPSTEIN-BARR VIRUS (EBV)....................................................................................................................................................264
HUMAN HERPES VIRUS 6 (aka HHV-6)...............................................................................................................................264
(DOUBLE TAKE) HERPES SIMPLEX VIRUS (HSV)...........................................................................................................264
(DOUBLE TAKE) VARICELLA ZOSTER VIRUS (CHICKEN POX) .................................................................................265
HUMAN IMMUNODEFICIENCY VIRUS (HIV) .....................................................................................................................265
(DOUBLE TAKE) RABIES VIRUS ..............................................................................................................................................266
MEASLES (aka RUBEOLA) .........................................................................................................................................................266
(DOUBLE TAKE) RUBELLA VIRUS (aka GERMAN MEASLES)....................................................................................267
MUMPS VIRUS .................................................................................................................................................................................267
PARASITES/PROTOZOA ............................................................................................................................................................268
(DOUBLE TAKE) ERYTHEMA CHRONICUM MIGRANS..................................................................................................268
LEPTOSPIROSIS ..............................................................................................................................................................................268
ENTAMOEBA HISTOLYTICA (aka AMEBIASIS) ................................................................................................................269
(DOUBLE TAKE) TRICHOMONAS VAGINALIS ...................................................................................................................269
BABESIOSIS ......................................................................................................................................................................................269
CRYPTOSPORIDIUM......................................................................................................................................................................270
MALARIA............................................................................................................................................................................................270
TRYPANOSOMA CRUZI ................................................................................................................................................................270
TRYPANOSOMA BRUCEI.............................................................................................................................................................270
WORMS..............................................................................................................................................................................................270
ENTEROBIUS (aka PINWORMS).............................................................................................................................................271
(DOUBLE TAKE) ASCARIS LUMBRICOIDES........................................................................................................................271
SCHISTOSOMIASIS (SCHISTOSOMA).....................................................................................................................................271
TAENIA SOLIUM .............................................................................................................................................................................271
TAENIA SAGINATA........................................................................................................................................................................271
(DOUBLE TAKE) TOXOCARA CANIS ......................................................................................................................................272
HOOKWORM ....................................................................................................................................................................................272
TRICHURIS........................................................................................................................................................................................272
FILARIASIS........................................................................................................................................................................................272
STRONGYLOIDES ...........................................................................................................................................................................272
DIPHYLLOBOTHRIUM LATUM.................................................................................................................................................273
SYNDROMES ...................................................................................................................................................................................273
GROUND GLASS PNEUMONIA ..................................................................................................................................................273
ADOLESCENT + PNEUMONIA + LOW GRADE FEVER ....................................................................................................273
SPONTANEOUS BACTERIAL PERITONITIS (SBP) ...........................................................................................................273
SECONDARY PERITONITIS ........................................................................................................................................................273
TOXIC SHOCK SYNDROME (TSS) ............................................................................................................................................273
DENTAL ABSCESS..........................................................................................................................................................................274
NEONATAL FEVER ........................................................................................................................................................................274
NEONATAL BACTEREMIA..........................................................................................................................................................274
SINUSITIS ..........................................................................................................................................................................................274
PAROTIDITIS (aka PAROTITIS)...............................................................................................................................................274
MASTOIDITIS...................................................................................................................................................................................275
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VACCINE CONTRAINDICATIONS.................................................................................................294
ILLNESS..............................................................................................................................................................................................294
CHICKEN or EGG ALLERGY........................................................................................................................................................294
DTaP CONTRAINDICATIONS ....................................................................................................................................................294
GELATIN ALLERGY........................................................................................................................................................................294
NEOMYCIN & POLYMIXIN ALLERGIES.................................................................................................................................295
STREPTOMYCIN ALLERGY ........................................................................................................................................................295
ANAPHYLAXIS MANAGEMENT................................................................................................................................................295
THIMEROSAL...................................................................................................................................................................................295
COMPLETE CDC GUIDE ...............................................................................................................................................................295
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GLUTARIC ACIDEMIA...................................................................................................................................................................299
METHYLMALONIC ACIDEMIA & PROPIONIC ACIDEMIA .............................................................................................300
UREA CYCLE DEFECTS ...............................................................................................................................................................300
UREA CYCLE SUMMARY..............................................................................................................................................................300
UREA CYCLE DEFECTS INCLUDE........................................................................................................................................300
ORNITHINE TRANSCARBAMYLASE DEFICIENCY ...........................................................................................................301
CITRULLINEMIA.............................................................................................................................................................................301
ARGININOSUCCINIC ACIDURIA ...............................................................................................................................................301
UREA CYCLE LAB SUMMARY (TABLE).................................................................................................................................301
MITOCHONDRIAL DISORDERS...............................................................................................................................................301
MITOCHONDRIAL DISORDERS OVERVIEW .......................................................................................................................301
FATTY ACID METABOLISM DISORDERS .............................................................................................................................302
GLYCOGEN STORAGE DISEASES OVERVIEW ....................................................................................................................302
GSD I (aka VON GIERKES DISEASE).....................................................................................................................................302
GSD II (aka POMPES DISEASE)................................................................................................................................................302
AMINOACIDOPATHIES...............................................................................................................................................................303
PHENYLKETONURIA (PKU) ......................................................................................................................................................303
ALKAPTONURIA (aka ALCAPTONURIA) .............................................................................................................................304
MAPLE SYRUP URINE DISEASE (MSUd, aka BRANCHED-CHAIN KETOACIDURIA) ........................................304
(DOUBLE TAKE) HOMOCYSTEINURIA .................................................................................................................................304
CARBOHYDRATE METABOLISM DISORDERS ..................................................................................................................305
DISORDERS OF CARBOHYDRATE METABOLISM.............................................................................................................305
GALACTOSEMIA (aka GALACTOSE-1-PHOSPHATE URIDYLTRANSFERASE DEFICIENCY or GALT
DEFICIENCY) ...................................................................................................................................................................................305
HEREDITARY FRUCTOSE INTOLERANCE...........................................................................................................................305
LYSOSOMAL STORAGE DISEASES .........................................................................................................................................305
MUCOPOLYSACCHARIDOSES (MPS)......................................................................................................................................305
SPHINGOLIPIDOSES ....................................................................................................................................................................306
TAY-SACHS DISEASE (aka TAY-SACH DISEASE) .............................................................................................................306
GAUCHER DISEASE (aka GAUCHERS DISEASE)...............................................................................................................307
FABRY DISEASE (aka FABRYS DISEASE)............................................................................................................................307
NIEMANN-PICK DISEASE...........................................................................................................................................................307
MISCELLANEOUS DISORDERS & PEARLS..........................................................................................................................307
HYPOGLYCEMIA DIFFERENTIAL............................................................................................................................................307
(DOUBLE TAKE) INFANT OF A DIABETIC MOTHER (IDM) ........................................................................................308
PURINE & PYRIMIDINE DISORDERS.....................................................................................................................................308
(DOUBLE TAKE) WILSONS DISEASE ....................................................................................................................................309
MENKES KINKY HAIR SYNDROME ........................................................................................................................................309
SMITH-LEMLI-OPITZ SYNDROME..........................................................................................................................................310
CHERRY RED SPOT DIFFERENTIAL ......................................................................................................................................310
GENERAL IEM PEARLS & RECAPS..........................................................................................................................................310
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NEPHROLOGY............................................................................................................................326
THE URINALYSIS...........................................................................................................................................................................326
MICROSCOPIC HEMATURIA ......................................................................................................................................................326
PROTEINURIA .................................................................................................................................................................................326
WBC CASTS.......................................................................................................................................................................................327
RBC CASTS ........................................................................................................................................................................................327
URINARY CRYSTAL IDENTIFICATION..................................................................................................................................327
UROLOGY, OBSTRUCTIONS & MASSES ...............................................................................................................................328
URETEROPELVIC JUNCTION OBSTRUCTION (UPJ OBSTRUCTION)........................................................................328
VESICOURETERAL REFLUX (VUR).........................................................................................................................................328
POSTERIOR URETHRAL VALVES (PUV)...............................................................................................................................328
NARROW FEMALE URETHRA ..................................................................................................................................................329
ABDOMINAL MASS AT BIRTH ..................................................................................................................................................329
MEDULLARY CYSTIC KIDNEY DISEASE (MCKD) .............................................................................................................329
URETEROCELE................................................................................................................................................................................329
INFECTIONS ....................................................................................................................................................................................329
URINARY TRACT INFECTION (UTI or PYELONEPHRITIS)..........................................................................................329
(DOUBLE TAKE) POST STREPTOCOCCAL GLOMERULONEPHRITIS (PSGN, aka POST INFECTIOUS
GLOMERULONEPHRITIS)...........................................................................................................................................................330
HEMOLYTIC UREMIC SYNDROME (HUS)............................................................................................................................330
INTRINSIC RENAL DISEASE.....................................................................................................................................................330
RENAL FAILURE.............................................................................................................................................................................330
OLIGURIA...........................................................................................................................................................................................331
RENOVASCULAR DISEASE .........................................................................................................................................................331
GLOMERULONEPHRITIS ............................................................................................................................................................331
IGA NEPHROPATHY......................................................................................................................................................................331
(DOUBLE TAKE) POST STREPTOCOCCAL GLOMERULONEPHRITIS (PSGN, aka POST INFECTIOUS
GLOMERULONEPHRITIS)...........................................................................................................................................................331
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS (MPGN) ............................................................................332
RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS (RPGN).........................................................................................332
NEPHROTIC SYNDROME ............................................................................................................................................................332
MEDULLARY SPONGE DISEASE ..............................................................................................................................................333
MEDULLARY CYSTIC DISEASE.................................................................................................................................................333
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STATISTICS ................................................................................................................................335
STATISTICS OVERVIEW.............................................................................................................................................................335
STATISTICS TERMINOLOGY ....................................................................................................................................................335
SENSITIVITY = TP/(TP+FN) .....................................................................................................................................................335
SPECIFICITY = TN/(TN+FP)......................................................................................................................................................335
POSITIVE PREDICTIVE VALUE = TP/(TP+FP) ..................................................................................................................335
NEGATIVE PREDICTIVE VALUE = TN/(TN+FN) ..............................................................................................................336
NULL HYPOTHESIS .......................................................................................................................................................................336
P VALUE .............................................................................................................................................................................................336
SIGNIFICANT RESULTS ...............................................................................................................................................................336
TYPE I ERROR..................................................................................................................................................................................336
TYPE II ERROR ................................................................................................................................................................................336
COHORT STUDY..............................................................................................................................................................................336
NEUROLOGY .............................................................................................................................337
NEUROLOGIC TESTS, PARALYSES & PALSIES .................................................................................................................337
SOMATOSENSORY EVOKED POTENTIALS (SEP).............................................................................................................337
NERVE CONDUCTION VELOCITIES........................................................................................................................................337
ELECTROMYOGRAM (EMG) ......................................................................................................................................................337
MAGNETIC RESONANCE IMAGING (MRI)...........................................................................................................................337
COMPUTER TOMOGRAPHY SCAN (CT SCAN)....................................................................................................................337
SPINAL ULTRASOUND.................................................................................................................................................................337
ERBS PALSY AND KLUMPKE PALSY......................................................................................................................................337
HORNERS SYNDROME (aka HORNERS).............................................................................................................................338
SPASTIC CEREBRAL PALSY (CP).............................................................................................................................................338
ATHETOID CEREBRAL PALSY ..................................................................................................................................................338
WEAKNESS & PARALYSIS PEARL...........................................................................................................................................338
GUILLAIN-BARRE SYNDROME (GBS, aka ACUTE INFLAMMATORY DEMYELINATING
POLYNEUROPATHY or AIDP)...................................................................................................................................................339
(DOUBLE TAKE) TICK PARALYSIS .........................................................................................................................................339
(DOUBLE TAKE) TODDS PARALYSIS (aka TODDS PARALYSIS) ..............................................................................339
TRANSVERSE MYELITIS .............................................................................................................................................................340
EPIDURAL ABSCESS OF THE SPINE ......................................................................................................................................340
MYASTHENIA GRAVIS (MG)......................................................................................................................................................340
(DOUBLE TAKE) CLOSTRIDIUM BOTULISM......................................................................................................................340
(DOUBLE TAKE) CORYNEBACTERIUM DIPHTHERIAE.................................................................................................341
INCREASED INTRACRANIAL PRESSURE & HEADACHES............................................................................................341
INCREASED INTRACRANIAL PRESSURE (ICP) .................................................................................................................341
LUMBAR PUNCTURE....................................................................................................................................................................341
DANDY WALKER MALFORMATION.......................................................................................................................................341
(DOUBLE TAKE) PSEUDOTUMOR CEREBRI (aka IDIOPATHIC INTRACRANIAL HYPERTENSION or
BENIGN INTRACRANIAL HYPERTENSION) .......................................................................................................................342
TENSION HEADACHES ................................................................................................................................................................342
MIGRAINE HEADACHES..............................................................................................................................................................343
OMINOUS HEADACHES ...............................................................................................................................................................343
MOVEMENT DISORDERS...........................................................................................................................................................343
(DOUBLE TAKE) DYSTONIC REACTIONS............................................................................................................................343
TICS ......................................................................................................................................................................................................343
TOURETTE SYNDROME (aka TOURETTES SYNDROME)............................................................................................343
STEREOTYPY ...................................................................................................................................................................................343
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CHOREA..............................................................................................................................................................................................344
SYDENHAMS CHOREA (aka SYDENHAMS CHOREA) ....................................................................................................344
HUNTINGTONS DISEASE (aka HUNTINGTONS DISEASE).........................................................................................344
DYSTROPHIES ................................................................................................................................................................................344
SPINAL MUSCULAR DYSTROPHY TYPE I (aka WERDNIG HOFFMANN DISEASE) ...........................................344
(DOUBLE TAKE) DUCHENNE MUSCULAR DYSTROPHY...............................................................................................344
MYOTONIC DYSTROPHY.............................................................................................................................................................345
CONGENITAL LIPODYSTROPHY..............................................................................................................................................345
SEIZURES..........................................................................................................................................................................................345
FIRST-TIME SEIZURE...................................................................................................................................................................345
EPILEPSY & SEIZURE PRECAUTIONS & EDUCATION....................................................................................................345
EMERGENCY ROOM PEDIATRIC SEIZURE MANAGEMENT.........................................................................................346
SEIZURE TERMINOLOGY............................................................................................................................................................346
SIMPLE PARTIAL SEIZURES......................................................................................................................................................346
COMPLEX PARTIAL SEIZURES.................................................................................................................................................346
BENIGN ROLANDIC SEIZURES (aka BENIGN EPILEPSY OF CHILDHOOD)..........................................................346
ABSENCE SEIZURES......................................................................................................................................................................347
TONIC-CLONIC SEIZURE.............................................................................................................................................................347
NEONATAL SEIZURES..................................................................................................................................................................347
INFANTILE SPASMS......................................................................................................................................................................347
FEBRILE SEIZURE..........................................................................................................................................................................347
BREAKTHROUGH SEIZURE .......................................................................................................................................................348
STATUS EPILEPTICUS .................................................................................................................................................................348
(DOUBLE TAKE) TODDS PARALYSIS (aka TODDS PARALYSIS) ..............................................................................348
ATAXIA & RELATED CONDITIONS........................................................................................................................................348
ACUTE CEREBELLAR ATAXIA ..................................................................................................................................................348
(DOUBLE TAKE) ATAXIA TELANGIECTASIA .....................................................................................................................348
FRIEDREICH ATAXIA (aka FRIEDREICHS ATAXIA) ......................................................................................................349
BENIGN POSITIONAL VERTIGO (BPV) .................................................................................................................................349
PERILYMPHATIC FISTULA ........................................................................................................................................................349
MISCELLANEOUS NEUROLOGIC CONDITIONS & FINDINGS .....................................................................................349
JAW CLONUS & BILATERAL ANKLE CLONUS....................................................................................................................349
UPPER MOTOR NEURON DISEASE ........................................................................................................................................349
LOWER MOTOR NEURON DISEASE.......................................................................................................................................349
HEAD TRAUMA ...............................................................................................................................................................................350
NEUROCARDIOGENIC SYNCOPE .............................................................................................................................................350
CEREBROVASCULAR ACCIDENT (aka CVA or STROKE)...............................................................................................350
MENTAL RETARDATION ............................................................................................................................................................350
EPIDURAL HEMATOMA ..............................................................................................................................................................350
SUBDURAL HEMATOMA (SDH) ...............................................................................................................................................350
SUBARACHNOID HEMORRHAGE ............................................................................................................................................351
MENINGITIS PEARLS ...................................................................................................................................................................351
SPINA BIFIDA ..................................................................................................................................................................................351
CHIARI MALFORMATION ...........................................................................................................................................................352
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VARUS .................................................................................................................................................................................................354
GENU VARUM (aka BOWED LEGS)........................................................................................................................................354
RICKETS .............................................................................................................................................................................................355
BLOUNT DISEASE ..........................................................................................................................................................................355
INTOEING..........................................................................................................................................................................................355
CLUB FOOT (aka TALIPES EQUINOVARUS or EQUINOVARUS DEFORMITY) .....................................................355
PES CAVUS ........................................................................................................................................................................................355
PES PLANUS .....................................................................................................................................................................................356
SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE) ............................................................................................................356
LEGG-CALVE-PERTHES DISEASE ...........................................................................................................................................356
OSGOOD SCHLATTER DISEASE ...............................................................................................................................................356
OSTEOCHONDRITIS DISSECANS.............................................................................................................................................357
SCOLIOSIS..........................................................................................................................................................................................357
SPONDYLOLYSIS ............................................................................................................................................................................357
SPONDYLOLISTHESIS ..................................................................................................................................................................357
SUBLUXED RADIAL HEAD (aka NURSEMAIDS ELBOW)..............................................................................................357
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) .......................................................................................................358
TOXIC SYNOVITIS (aka TRANSIENT SYNOVITIS OF THE HIP) .................................................................................358
SEPTIC ARTHRITIS........................................................................................................................................................................358
OSTEOMYELITIS.............................................................................................................................................................................359
STRAINS .............................................................................................................................................................................................359
SPRAINS .............................................................................................................................................................................................359
ROTATOR CUFF TEARS ...............................................................................................................................................................359
ANTERIOR CRUCIATE LIGAMENT TEAR (ACL TEAR) ...................................................................................................359
JOINT HYPERMOBILITY..............................................................................................................................................................360
COMPARTMENT SYNDROME ...................................................................................................................................................360
ACROMIOCLAVICULAR JOINT SEPARATION (AC JOINT SEPARATION) ................................................................360
SPORTS INJURY PEARL ...............................................................................................................................................................360
CONGENITAL TORTICOLLIS......................................................................................................................................................360
POLYDACTYLY ................................................................................................................................................................................360
RHEUMATOLOGY ......................................................................................................................362
ARTHRITIC CONDITIONS ..........................................................................................................................................................362
ARTHROCENTESIS (JOINT ASPIRATION) PEARLS .........................................................................................................362
JUVENILE RHEUMATOID ARTHRITIS (JRA).......................................................................................................................362
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) ......................................................................................................................363
NEONATAL LUPUS ........................................................................................................................................................................363
DRUG INDUCED LUPUS...............................................................................................................................................................363
JUVENILE ANKYLOSING SPONDYLITIS................................................................................................................................364
JUVENILE REITER SYNDROME (aka JUVENILE REITERS SYNDROME)...............................................................364
BEHCETS SYNDROME (aka BEHCETS DISEASE).............................................................................................................364
NON-ARTHRITIC CONDITIONS...............................................................................................................................................364
DERMATOMYOSITIS.....................................................................................................................................................................364
HENOCH SCHONLEIN PURPURA (HSP) ...............................................................................................................................364
SARCOIDOSIS ...................................................................................................................................................................................365
SJOGRENS SYNDROME (aka SJOGRENS SYNDROME) ..................................................................................................365
RAYNAUDS PHENOMENON (aka RAYNAUDS)................................................................................................................365
WEGENERS GRANULOMATOSIS ............................................................................................................................................365
PULMONOLOGY ........................................................................................................................366
CYSTIC FIBROSIS & NASAL POLYPS .....................................................................................................................................366
CYSTIC FIBROSIS (CF) .................................................................................................................................................................366
STRIDOR ...........................................................................................................................................................................................367
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INSPIRATORY STRIDOR..............................................................................................................................................................367
EXPIRATORY STRIDOR................................................................................................................................................................368
BIPHASIC STRIDOR.......................................................................................................................................................................368
CONGENITAL PULMONARY DISEASE..................................................................................................................................368
CONGENITAL DIAPHRAGMATIC HERNIA ...........................................................................................................................368
CONGENITAL PULMONARY MALFORMATIONS...............................................................................................................368
PERSISTENT PULMONARY HYPERTENSION ....................................................................................................................369
CHOANAL ATRESIA.......................................................................................................................................................................369
ASTHMA............................................................................................................................................................................................369
EXERCISE INDUCED ASTHMA..................................................................................................................................................369
PEDIATRIC ASTHMA CLASSIFICATION................................................................................................................................369
RHINOVIRUS ....................................................................................................................................................................................370
RESPIRATORY SYNCYTIAL VIRUS (RSV).............................................................................................................................371
DUST MITES .....................................................................................................................................................................................371
BETA BLOCKERS & ASPIRIN.....................................................................................................................................................371
ADULT ASTHMA .............................................................................................................................................................................371
ASTHMA DIFFERENTIAL............................................................................................................................................................371
PNEUMONIA ...................................................................................................................................................................................371
RECURRENT PNEUMONIA........................................................................................................................................................371
ATAXIA TELANGIECTASIA.........................................................................................................................................................371
BRUTONS X-LINKED AGAMMAGLOBULINEMIA..............................................................................................................372
SEVERE COMBINED IMMUNODEFICIENCY (SCID) ........................................................................................................372
HYPER-IGM SYNDROME (aka HYPER IGM SYNDROME) .............................................................................................372
HYPER-IGE SYNDROME (aka HYPER IGE SYNDROME) ...............................................................................................372
COMMON VARIABLE IMMUNE DEFICIENCY (CVID)......................................................................................................372
(DOUBLE TAKE) ASPERGILLUS...............................................................................................................................................372
BRONCHIOLITIS OBLITERANS WITH ORGANIZING PNEUMONIA (BOOP) .........................................................372
INTRAPULMONARY SEQUESTRATION ................................................................................................................................373
MIGRATING PNEUMONIAS.......................................................................................................................................................373
(DOUBLE TAKE) TOXOCARA CANIS ......................................................................................................................................373
(DOUBLE TAKE) ASCARIS LUMBRICOIDES........................................................................................................................373
MISCELLANEOUS PULMONARY DEFINITIONS & CONDITIONS ..............................................................................373
VOCAL FREMITUS..........................................................................................................................................................................373
COR PULMONALE ..........................................................................................................................................................................374
TACHYPNEA .....................................................................................................................................................................................374
HYPERCAPNIA (aka HYPERCAPNEA) ..................................................................................................................................374
ACUTE LIFE THREATENING EVENT (ALTE) .....................................................................................................................374
ALPHA-1-ANTITRYPSIN DEFICIENCY ..................................................................................................................................374
RESPIRATORY DISTRESS SYNDROME (RDS) ....................................................................................................................374
NASAL FOREIGN BODY ...............................................................................................................................................................375
FOREIGN BODY ASPIRATION ...................................................................................................................................................375
VOCAL CORD NODULES ..............................................................................................................................................................375
CHRONIC COUGH ...........................................................................................................................................................................375
PNEUMOTHORAX ..........................................................................................................................................................................375
FLAIL CHEST....................................................................................................................................................................................375
BRONCHIECTASIS..........................................................................................................................................................................376
HIGH YIELD CHEST X-RAY FINDINGS & PEARLS ...........................................................................................................376
PULMONARY VASCULAR CONGESTION...............................................................................................................................376
PATCHY AREAS OF DIFFUSE ATELECTASIS ......................................................................................................................376
FLUID IN HORIZONTAL FISSURE ...........................................................................................................................................376
UNDERINFLATED CHEST X-RAY ............................................................................................................................................376
DIFFUSE OPACITIES WITH CYSTIC AREAS ........................................................................................................................376
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35
36
DERMATOLOGY
GENERAL DERMATOLOGY
CONTACT DERMATITIS, A DIAPER RASH
Contact dermatitis, a diaper rash that spares the inguinal folds. Treat with more frequent diaper changes and
a topical barrier, like zinc oxide.
NUMMULAR ECZEMA
Nummular eczema is a coin shaped eczematous lesions usually on the extensor surfaces of extremities.
Lesions are uniform, without any central clearing. Lesions may ooze, crust or have a scaling pattern. Treat
with steroids.
IMAGE: http://suite101.com/article/nummular-eczema-a98681
MNEMONIC: Imagine that you are standing with your arms in abduction and you are balancing silver COINS
that are UNIFORM in color (without central clearing) balancing on the BACK of both of your arms (extensor
surface).
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PSORIASIS
Psoriasis is a very well defined, red, flaky rash covered with silver-white patches. Can also be described as
thick and scaly (like seborrheic dermatitis). Sometimes results in punctate bleeding when scales are removed
(called the Auspitz sign). Can occasionally be limited to the diaper area, in which case it goes into the
inguinal folds.
GUTTATE PSORIASIS
The gttate in guttate psoriasis means drop like, and describes the shape of these discrete psoriatic
lesions. Can be preceded by a Group A Strep (Pyogenes) infection.
IMAGES: http://www.healthy-skin-guide.com/psoriasis-photos.html
PRURITIC RASHES
Consider atopic dermatitis/eczema, HSV, scabies, tinea or Varicella (VZV) in your differential of any pruritic
rashes.
KERATOSIS PILARIS
Keratosis pilaris forms due to overgrowth of the horny skin. Can look similar to eczema. May have a mild
erythematous background. No treatment is needed.
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114
IMAGE: http://bit.ly/rcjX3X
LICHEN SCLEROSUS
Lichen sclerosus is a chronic, inflammatory, dry, white and somewhat scaly rash that is usually found in the
genital area. There is no thickening or sclerosis. There are usually now symptoms, although a small
percentage of patients have pruritus. Look for a picture of labia with a rash.
IMAGE: http://www.medscape.com/viewarticle/712767_5
LICHEN STRIATUS
Lichen striatus is a rash that looks like eczema, but is linear or papular and can follow the Lines of Blaschko
IMAGE: http://emedicine.medscape.com/article/1111723-overview
IMAGE: http://bit.ly/n7GU4p
Type IV reaction: I + V = the Roman numeral IV = 4, and the 4th letter in the alphabet is D =
DELAYED. I + V also should you remind you of poison Ivy.
* IMAGE: http://bit.ly/nWLxen
* IMAGE: http://www.lib.uiowa.edu:8080/hardin/md/cdc/4484.html
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PAPULAR URTICARIA
Papular urticaria is a rash due to hypersensitivities to the insect bites of bedbugs, fleas and mosquitoes that
results in edema, erythema and pruritus. It presents in RECURRENT CROPS. Tends to come and go, wax
and wane every few weeks or months. Some lesions may be umbilicated. Treat by removing the offending
agent (fleas, lice, bedbugs or outside insects).
PEARL: You may not be given the history of a specific insect or exposure
MNEMONIC. CROPular Urticaria. Where do you find insects? In CROPS of course!
IMAGE: http://www.skincareguide.com/gl/p/papular_urticaria.html
VITILIGO
Vitiligo results in hypopigmented macules. Look for a salt and pepper type of pattern of re-pigmentation.
Often associated with HALO NEVI.
IMAGE: http://en.wikipedia.org/wiki/File:Vitiligo2.JPG
PYODERMA GANGRENOSUM
The etiology of pyoderma gangrenosum is unknown, but it is known to e associated with other systemic
diseases such as Crohns. Lesions are described as deep, bluish, necrotic and boggy-looking ulcers.
IMAGE: http://bit.ly/TrDrCf
IMAGE: http://bit.ly/116Vxes
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GRANULOMA ANNULARE
Granuloma annulare is a chronic skin condition with an annular lesion (circular). It may be slightly pruritic.
There are no scales.
PEARL: Looks kind of like ringworm, but there is NO SCALING! Keep this in mind any time you see Tinea as
an answer choice.
IMAGES: http://anagen.ucdavis.edu/1412/case_presentations/ga/wollina.html
PITTED KERATOLYSIS
Pitted keratolysis is a condition in which there is pitted skin in areas of pressure. There will probably be a
history of strong foot odor.
IMAGES: http://emedicine.medscape.com/article/1053078-media
DERMATOMYOSITIS
Dermatomyositis results in a a heliotropic, violaceous rash in malar area. Gottrons Papules (erythematous,
shiny, pruritic papules over the matacarpals) may be present. Patients will have proximal weakness and
possible telangiectasias near the nail folds. Diagnose with a BIOPSY. CK LEVEL WILL BE HIGH. These
patients can also get calcinosis cutis/calciphylaxis.
PEARL/REMINDER: Duchenne Muscular Dystrophy also has elevated CK levels
IMAGE: http://emedicine.medscape.com/article/332783-media
IMAGE: http://bit.ly/rrzrsY
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ERYTHEMA MULTIFORME
Erythema multiforme is also a confusing topic. It may now also be considered on in the SJS/TEN spectrum,
especially if mucous membranes are involved. Distinguishing erythema multiforme minor from erythema
multiforme major is also confusing, so the terminology is not likely to be tested.
Both minor and major have tiny target lesions (probably dusky in the middle). Sometimes you have to use
your imagination to envision the target. It may just look a little darker on the inside of the lesion than the
outside. Lesions usually start on the hand and/or feet and THEN progress to the trunk. 0-1 mucous
membranes involved (if more, it will likely be called SJS or TEN). IF you are tested on the terminology, pick
minor if the patient is not toxic. Possible etiologies include HSV, Mycoplasma and Syphilis.
IMAGE: http://bit.ly/pwOmhQ
IMAGE: http://bit.ly/r2nHWl
IMAGE: http://bit.ly/V0lmqZ
IMAGE: http://bit.ly/VbOIZx
MNEMONIC: Imagine Stevens and Johnson as two very arrogant hunters. They went TARGET shooting one
day in an area that said, beware of BULLS. They learned their lesson the hard way when a BULL came out
of nowhere and did some target practice of his own.
NEONATAL LUPUS
The baby does NOT have lupus. Neonatal lupus occurs in children of mothers with SLE due to fetal exposure
to maternal antibodies. It is rare. Findings may include increased LFTs, petechiae, rash, scaling,
thrombocytopenia, 3rd degree AVB/bradycardia or hydrops (death) due to AVB. Diagnose by sending AntiRo or anti-La antibodies (aka anti-SS-A or SS-B).
IMAGES: http://emedicine.medscape.com/article/1006582-media
PEARL: RASHES WITH CENTRAL CLEARING: Hives/urticaria, Rheumatic Fever (jonEs = E. Marginatum =
MARGINs progress to give central clearing), Tinea (raised border/ringworm).
PEARL: RASHES WITH CENTRAL DARKENING/TARGET LESIONS: SJS/TEN (target shooting, bull),
Brown recluse spider bite (see Emergency Medicine), Lyme Disease/Borrelia/Erythema Migrans
URTICARIA/HIVES
Urticaria (hives) is a pruritic rash due to an allergic exposure. Pink center with a more erythematous border.
Giving histamine blockers (both H1 & H2) may be helpful. Foods are the most likely cause of chronic urticaria.
IMAGE: http://www.webmd.com/skin-problems-and-treatments/picture-of-urticaria-wheals
IMAGE: http://www.webmd.com/skin-problems-and-treatments/picture-of-hives-urticaria
SCLERODERMA
Scleroderma patients have thickened skin with an ivory or waxy, appearance. Affects girls more frequently.
The limited form is more common than the systemic form in children (located at 1 site only). Lesions may
initially be painful and tender. Skin is often hard and may have a linear appearance. Treat with topical
lubricants for limited cases. May have to use steroids or other immunosuppressives in more severe cases.
IMAGES: (bottom) http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=433473685
Copyright Pediatrics Board Review, Inc. 2011 Present.
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118
COMEDONAL ACNE
Think of comedonal acne as an OBSTRUCTIVE process that creates white heads and black heads. Treat
with a RETINOID keratinolytic agent. May also prescribe benzoyl peroxide.
PEARL: Any answer with topical retinoic acid plus benzoyl peroxide twice daily is WRONG. Benzoyl peroxide
inactivates retinoids, so one should be used at night, and the other in the morning.
INFLAMMATORY ACNE
Inflammatory acne is differentiated from comedonal acne by its red base.
* Minor cases: If the acne is localized with small lesions, use a TOPICAL agent, such as Benzoyl peroxide,
Clindamycin or Erythromycin.
* Severe cases: If large, nodular or in multiple areas, use ORAL antibiotics. First line is Tetracycline or
Erythromycin. Second line agents include Doxycycline and Minocycline. These antibiotics provide a
bacteriocidal and an anti-inflammatory effec. May also try oral contraceptive pills (OCPs) in females for their
anti-androgen effects. If all else fails, use ISOTRETINOIN.
ISOTRETINOIN
Isotretinoin is a miracle drug that fights sebum production and bacteria, while also decreasing inflammation
and comedonal acne. But, it is TERATOGENIC, so obtain TWO negative pregnancy tests before starting the
medications. Also, patients must use TWO forms of birth control starting 1 month before starting the
medication and until 1 month after. In addition, they should have monthly pregnancy tests.
PEARL: Acne can begin as early as 8 years of age. If the boards present a 7-year-old child with what looks
like acne, CONSIDER ANOTHER DIAGNOSIS! Consider exogenous steroid use, precocious puberty and
TUBEROUS SCLEROSIS.
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TEETH ISSUES
TOOTH TIMELINE
Tooth appearance follows a timeline. All anterior teeth are present (nine of them) by about 12 months.
Primary teeth are present by about age 2. Some children do not have teeth by 1 year of age, so reassurance
is ok. For ABP questions, they will be more focused on abnormal looking teeth.
PEG TEETH
Peg teeth refers to teeth that are smaller than usual. Sometimes they are tapered and look like fangs. Usually
affects
the
lateral
incisors.
Associated
with
INCONTINENTIA
PIGMENTI
and
HYPOHIDROTIC
ECTODERMAL DYSPLASIA.
IMAGE: http://www.peglateralincisors.com/pli-e.jpg
IMAGES: http://www.peglateralincisors.com/
HUTCHINSON TEETH
Hutchinson teeth are found in CONGENITAL SYPHILIS. These children have teeth that are smaller and more
widely spaced. They also have notches on the biting surfaces.
IMAGE: http://en.wikipedia.org/wiki/File:Hutchinson_teeth_congenital_syphilis_PHIL_2385.rsh.jpg
IMAGE: http://www.lhup.edu/smarvel/Seminar/FALL_2004/McGovern/
FLUOROSIS
Fluorosis is the mottled discoloration of teeth noted due to excess fluorine use during tooth development (up
to age 4).
IMAGE: http://img.medscape.com/pi/emed/ckb/dermatology/1048885-1076389-2303tn.jpg
HEMANGIOMAS
Hemangiomas are an abnormal build up of blood vessels. They eventually self-involute but are dangerous
during PROLIFERATION PHASE. They are otherwise benign. They usually look red, but can appear blue if
deep (CAVERNOUS HEMANGIOMAS). Proliferation is greatest during the first 6 months and lesions are
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120
largest around 1 year of age. Lesions start to involute around 2 years of age and disappear by 5-10 years of
age. If in a benign area, they can be left alone. If in a more sensitive area (near the eyes, ears, nose, throat or
spine), they may require treatment with systemic steroids. Second line therapies include pulsed dye laser
therapy and surgery.
COMPLICATIONS: If located in the beard area, look for airway issues. If near the eye, its okay as long as
there is no problem with VISION. Those near the ears, nose and lips can be troublesome if they ulcerate. If in
the lumbosacral area, there is concern for spinal dysraphism (incomplete fusion of a raphe, especially the
neural folds/tube). High output congestive heart failure (CHF) can occur due to large, or multiple
hemangiomas.
IMAGE: http://en.wikipedia.org/wiki/File:Capillary_haemangioma.jpg
IMAGE: http://bit.ly/Tkz347
PHACES SYNDROME
A diagnosis of PHACES syndrome requires a large hemangioma in the face/neck area PLUS one of the
following defects:
* Post fossa malformation (DANDY WALKER)
* Hemangioma. Often in the distribution of the Facial Nerve. Look for a large segmental hemangioma in on
the FACE. Segmental refers to what looks like a nerve distribution (segmented by normal skin in between).
Can be associated with STROKES.
* Arterial cerebrovascular anomaly
* Cardiac anomalies: Especially COARCTATION OF THE AORTA
* Eye anomalies: MICROPHTHALMIA, STRABISMUS
* Sternal defect
* IMAGES: http://www.baylorcme.org/hemangioma/presentations/metry/presentation_text.cfm
NEVUS SIMPLEX
A nevus simplex is a Salmon colored lesion often called a Stork bite or Salmon patch. These fade with time
and are benign. Do not get this term confused with Nevus FLAMMEUS (aka PORT WINE STAIN).
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121
EYE/TRIGEMINAL
NERVE
DISTRIBUTION
INTRACRANIAL
VASCULAR
MALFORMATION (look for with MRI) +/- glaucoma +/- Seizures +/- cognitive deficits
MNEMONICS: pWS = sWS Ever heard of a basketball player named Chris WEBBER? Think WEBBER =
Sports = ESPN (I know its a stretch).
* EYE - glaucoma
* SWS
* PWS
* NEUROLOGIC issues: Developmental delay, Seizures
IMAGES: http://emedicine.medscape.com/article/1264848-media
122
TUBEROUS SCLEROSIS
Tuberous sclerosis is AUTOSOMAL DOMINANT. Look for at least 2 of the following features:
* ASH LEAF SPOTS: These are hypOpigmented lesions, which can be seen with a Woods Lamp. Need at
least 3 on the body to help make the diagnosis.
IMAGE: http://bit.ly/nwloFE
IMAGE: http://www.nlm.nih.gov/medlineplus/ency/imagepages/2538.htm
IMAGE: http://bit.ly/n02Q8f
IMAGE: http://bit.ly/ojT5CF
IMAGE: http://en.wikipedia.org/wiki/File:TuberSclerosisCase-143.jpg
123
Imagine a TUBULAR bazooka shooting out WHITE LEAVES. The leaves have DANCING (seizing)
tics on them!
* MNEMONIC: ASHES come from burned WOOD. Woods Lamp needed to see them.
NEUROFIBROMATOSIS I (NF1)
Neurofibromatosis I (NF1) is an AUTOSOMAL DOMINANT disorder involving the SKIN, BONES and
NERVOUS SYSTEM. Diagnose with at least 2 of the following:
* First degree relative has the disease
* Neurofibromas
* Lisch Nodules in the iris (they look like mini neurofibromas
IMAGE: http://www.milesresearch.com/eerf/images/lisch1-300.jpg
NEUROFIBROMATOSIS 2 (NF2)
(Low yield topic). Neurofibromatosis 2 (NF2) findings include nonmalignant tumors of the nervous system,
especially acoustic nerve tumors (aka neuromas or schwannomas). These can cause tinnitus or even hearing
loss. Can also have eye tumors, cataracts, retinal problems, spinal cord tumors and meningiomas. Look for a
family history.
PEARL: Tuberous Sclerosis and Neurofibromatosis are both AUTOSOMAL DOMINANT. BUT, they both
have a HIGH RATE OF NEW MUTATIONS. Do not exclude these from your differential if they mention that
the patients parents do not have the disorder.
INCONTINENTIA PIGMENTI
Incontinentia pigmenti is a severe X-linked DOMINANT disease which results in DEATH for all MALES. If
presented with this as an answer choice, make sure the ABP vignette refers to a FEMALE patient. There are
four stages of this disorder: Inflammatory vesicular phase, followed by a verrucous phase, followed by the
hyperpigmentation phase noted along the lines of Blaschko, and finally a phase in which the
hyperpigmentation disappears. Can leave atrophy or hypopigmentation behind.
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SYSTEMIC ASSOCIATIONS: DELAYED DENTITION, Mental retardation, Paralysis, PEGGED teeth and
Seizures.
IMAGE: http://www.med-ars.it/various/blaschko_def.jpg
IMAGE: http://bit.ly/n5LAMT
IMAGES: http://bit.ly/nK0Nx7
IMAGES: http://bit.ly/oH27dE (bottom of page)
IMAGE: http://bit.ly/o6VQEu
MNEMONIC: As WOMEN age, they tend to have more INCONTINENTs. Incontinentia = Female patient.
Imagine a WOMAN on the ground having a SEIZURE. She becomes INCONTINENT of urine which streams
down her PEGG legs and creates black and white LINEAR SKIN LESIONS. PEGG refers to PEGGED
TEETH
125
IMAGE: http://bit.ly/rmVh8u
* SSSS: A very painful and red rash in which large, thin blisters are the result of an exotoxin. There is sheetlike skin loss/separation. Looks very superficial compared to impetigo. Obtain a BIOPSY to prove that it is
SSSS and Stevens Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN), both of which have
deeper/dermal involvement.
IMAGES: http://emedicine.medscape.com/article/788199-media
PEARL: Lesions are NOT in eye or mouth, but may be around the eyes and mouth (as opposed to
SJS/TEN, which may be IN the eyes and mouth).
STAPHYLOCOCCUS EPIDERMIDIS
Staphylococcus epidermis is the most likely answer if you are presented with a premature baby that has a
skin infection.
CELLULITIS
Cellulitis is defined as a well-demarcated area of erythema, edema and induration secondary to an infection.
May be associated with bullae. For treatment, start with Cefazolin as your first line agent.
TINEA CORPORIS
In tinea corporis, a thin, circular lesion with THIN SCALES, a RAISED border and central clearing is noted.
The ring of the ringworm looks like a worm.
IMAGES: http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=447741726
TINEA VERSICOLOR
Tinea versicolor results in hypopigmentd OR hyperpigmented macules. Its caused by MALASSEZIA
FURFUR. Treat with fluconazole, ketoconazole or selenium sulfide, but NOT griseofulvin (use that for T.
capitis).
IMAGE: http://www.nlm.nih.gov/medlineplus/ency/imagepages/1890.htm
IMAGE: http://www.herbalgranny.com/wp-content/uploads/2009/09/Tinea-Versicolor.jpg
PITYRIASIS ROSEA
Pityriasis rosea presents as oval, parallel lesions with THICK scales. Look for a herald patch (first lesion).
Associated with winter and spring. Lesions are often in a Christmas tree pattern. Treat with light exposure.
IMAGES: http://emedicine.medscape.com/article/762725-media
PEARL: Unlike secondary syphilis, there are no lesions on the palms/soles
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MOLLUSCUM CONTAGIOSUM
Molluscum contagiosum results in flesh-colored, pearly papules that are dome-shaped and umbilicated.
Caused by the POX virus. NO treatment is needed, but sometimes cryotherapy or topical Cantharidin,
Podophyllotoxin, Imiquimod or Potassium hydroxide.
IMAGE: http://www.nlm.nih.gov/medlineplus/ency/imagepages/1380.htm
MNEMONIC:
CONDYLOMA LATA
Condyloma lata is found in secondary syphiLis = White-gray, coalescing papules. These are much more
FLAT appearing than Condyloma Acuminata
IMAGE: http://en.wikipedia.org/wiki/File:Vaginal_syphilis_(disturbing_image).jpg
NAME ALERT: An A in Acuminata looks like a flipped V, which may help you remember that a diagnosis
of Condyloma Acuminata represents an hpV infection. The L in Condyloma Lata, should remind you that
you are dealing with syphiLis.
Copyright Pediatrics Board Review, Inc. 2011 Present.
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127
SCABIES
Scabies presents as linear, papular, erythematous, pruritic, vesicular and crusting lesions most often seen in
areas with CREASES (wrist, groin, webbing of fingers). May see burrows. Treat with permethrin overnight
from head to toe for the entire family. Retreat if the patient is still having No need to retreat unless the patient
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128
is still having symptoms after 14 days and LIVE MITES are found because the persisting pruritus can be from
residual inflammation. Try topical steroids or antihistamines for that interim.
PEARL: Unlike papular urticaria, lesions are not in crops
IMAGES: http://hardinmd.lib.uiowa.edu/dermnet/scabies.html
129
BELLS PALSY: Unilateral facial nerve paralysis (CN VII). Often idiopathic.
The Jarisch-Herxheimer reaction results in fever, chills, hypotension, headache, myalgia, and
exacerbation of skin lesions during antibiotic treatment of a bacterial disease (typically spirochetes).
Due to large quantities of toxins released into the body. Classically associated with syphilis, but can
also occur with Lyme disease. May only last a few hours
* MNEMONICS:
From now on, think/say borreLIYME. Dont ever throw a borLIYME to MY GRANy! Or, Dont ever
borre-LIE to MY GRANy. Borrrelia = borreLIYME. MY GRANy = Migrans.
Imagine that BULLS EYES are made of 2 bright neon-green LIMES! This should remind of you of the
classic description.
ERYTHEMA MARGINATUM
Erythema marginatum is a transient, erythematous, macular and light colored described as serpentiginous,
in which the MARGINs progress as the center clears. It is part of the Jones criteria for Rheumatic Fever.
IMAGE: http://www.dermaamin.com/site/atlas-of-dermatology/5-e/470-erythema-marginatum-of-rheumaticfever-.html
MNEMONICS: Erythema MARGINatum. The E in Erythema is part of the E in jonEs, and the name
MARGINatum should remind you to look for an interesting description of the rashs MARGINs.
130
MNEMONIC: Although the name TOXICum suggests otherwise, this is a NON-toxix rash resulting in
nontoxic looking babies.
MNEMONIC: This is an Early, Erythematous, Eosinophilled rash called Erythema toxEEEcum.
ERYTHEMA MULTIFORME
See the Stevens-Johnson syndrome section for more information on erythema multiforme. Look for target
lesions.
MILIA
Milia are small, pearly inclusion cysts which look like little white heads. Theres NO associated erythema. If on
the nose, can be very easy to confuse with SEBACEOUS HYPERPLASIA.
IMAGE: http://newborns.stanford.edu/PhotoGallery/Milia1.html
IMAGE: http://www.nlm.nih.gov/medlineplus/ency/imagepages/2677.htm
SEBACEOUS HYPERPLASIA
In sebaceous hyperplasia, pinpoint white-yellow papules appear on the nose and central face. NO associated
erythema. Results due to maternal androgen exposure. Benign.
IMAGE: http://www.dermatlas.com/data/images/milia_1_040329.jpg
IMAGE: http://newborns.stanford.edu/images/sebac-hyp2.jpg
131
INFANTILE ACNE
Infantile acne looks like typical pubertal acne, but it is found in babies. Onset is usually around 2-3 months of
age and it is due to androgenic stimulation. There can be COMEDONES (whiteheads and blackheads). The
rash can resolve in a few weeks or it can take up to a year.
MNEMONIC: INFANTile = Infants. Dont choose this if the baby is 4 weeks old.
IMAGE: http://www.dermnetnz.org/common/image.php?path=/acne/img/s/acne-infant.jpg
ALOPECIA TOTALIS
Alopecia totalis is the loss of all hair on the HEAD.
IMAGE: http://www.dermaamin.com/site/atlas-of-dermatology/1-a/88-alopecia-totalis-.html
ALOPECIA UNIVERSALIS
Alopecia universalis is the loss of all hair on the entire BODY. Usually a SYSTEMIC etiology such as
hypothyroidism, a nutritional deficiency or even lupus (SLE).
IMAGE: http://www.pediatrics.wisc.edu/education/derm/tutc/86m.jpg
132
CROHNS DISEASE: If a Crohns patient is suffering from diarrhea, they may have zinc deficiency
since Zn is lost in the stool.
MNEMONIC: Did you know giraffes are vegetarian? Imagine a giraffe standing in Time
Square reaching its long neck into the sunroof of a FUZZY CAB that has green, grass-like
seats and fuzzy floor mats. FUZZY CAB = FeZi CaB12!
TELOGEN EFFLUVIUM
Telogen effluvium is a form of acute hair shedding that occurs diffusely. Often related to a psychologic or
medical stressor. Treat with REASSURANCE because the will grow back.
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IMAGES: http://emedicine.medscape.com/article/787217-media
IMAGES: http://www.healthhype.com/itchy-scalp-causes-and-treatment.html
TRICHOTILLOMANIA
Trichotillomania is a body-focused repetitive behavior in which patients pull out their own hair (may be on a
location other than the scalp). Look for loss of hair in an irregular pattern (not a nice circle). Also, the
irregularly shaped patches will contain incomplete hair loss in which you will see hair of differing lengths.
IMAGE: http://bit.ly/nySzrr
IMAGE: http://en.wikipedia.org/wiki/File:Trichotillomania_1.jpg
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