Free Dermatology Study Guide

PEDIATRICS BOARD REVIEW:
MNEMONICS, FREE BOARD

REVIEW QUESTIONS & A FIRSTTIME PASS GUARANTEE!
Efficiency In Studying So That

You Can Start Living!
Written By Ashish Goyal, MD
www.PediatricsBoardReview.com
Copyright Pediatrics Board Review, Inc. 2011 Present.

All Right Reserved. Do Not Copy Without Written Permission.
***COPYRIGHT PAGE
COPYRIGHT INFORMATION
2011, 2012 Pediatrics Board Review, Inc.
All rights reserved. No part of this document may be reproduced or transmitted in
any form or by any means, electronic, mechanical, photocopying, recording, digital
storage or otherwise, without prior written permission of Pediatrics Board Review,
Inc.
ISBN 978-1-300-45528-8

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guarantee. It must be submitted within 90 days of your purchase and before you take the exam. This helps
PBR release a certain amount of funds for use. As mentioned on the PBR site, this guarantee applies to
anyone taking an ABP initial or recertification exam for the first-time. The original PBR purchase must have
been made at least 45 days prior to the exam. Money Back requests may be made within 180 days of the
score release date. For complete details, please visit: http://www.pediatricsboardreview.com/guarantee
* FREE UPDATES: I often create last minute e-book bonuses (previous examples include the lab norms
section, intrauterine drug exposures, a corrections and errata guide, etc.). These are given to existing
members of the PBR community for FREE. If similar tools are created, theyll be sent to you for FREE as well.
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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.

YOUR PBR ROADMAP TO SUCCESS

If youre one of the many new pediatricians out there wondering if youre going to be in the passing 75%, or
the failing 25%, I urge you to follow just a few simple, yet HIGH-YIELD recommendations:
* PLEASE stick to one primary study guide this one! The BIGGEST MISTAKE you can make is
spreading yourself too thin. Thats an extremely common trend Ive noticed in my discussions with numerous
pediatricians looking for advice on how to avoid failing again. Do not spend your time going through other
books, DVDs, or live courses. Go through the PBR core study guide at least 4-5 times.
Start with a very fast run through in which you get familiar with the content and with the writing style.
Do not spend time cross-referencing with Nelsons, the Red Book or Harriet Lane. If you have
questions, write them in the margins and work on the answer next time.
The second time, answer the questions written in the margins. Do NOT let your curiosity of non-PBR
topics distract you (its a guaranteed waste of precious time).
The third, fourth and fifth times through the PBR, you should be adding more and more information
into your long-term memory through repetition and the use of mnemonics. Again, you must resist
that urge to look up extraneous information.
Your primary goal should be to pass the exam. If you know everything in the core study guide and are a
descent standardized test taker, you will easily pass. If you try to learn everything in pediatrics, you will get
overwhelmed and possibly fail the exam. Also, I spent over well over 300 hours studying for the boards. Try to
map out at least 200 hours of studying.
* Use PBRs Q&A product(s) to get familiar with very high-yield topics and questions. The format is
short and to the point so that you learn the information you need to without wasting too much time digging
through extra information. The questions will help you understand what types of key findings you need to be
on the lookout for during your test prep and during the test.
* Go through about 3 years of PREP questions. Please dont go through them all at once. Go through
about 25-50 questions every 2-3 days and aim to finish them by the end of September. As you go through the
questions, work on your timing. If you can average about 1 minute and 15-25 seconds per question, you
should be fine for the boards. Do not try to understand why every single incorrect answer is wrong. Just focus
on the correct answer, and also on the answer that you chose. Remember, the AAP writes PREP, the
ABP writes the boards. PREP is great, but its for CME. It is not designed to be a study guide for the ABP.
So its a good practice tool, but your highest-yield information will come from this study guide and system.
* EXTREMELY Important Test Day Tips: http://www.pediatricsboardreview.com/category/test-day-tips
GETTING THE MOST OUT OF THE PBR FORMAT

* GRAY HIGHLIGHTING OR RED FONT: For the PBR hardcopy, gray highlighting is used over a word,
phrase or heading that you should KNOW! Those are very high yield topics or have at least been on board
exams in the past. In the online PBR, such text will appear in red.
* PEARLS: These are pieces of information that help tie key concepts together for you.
PEARL: There are only a finite number of ways the ABP can test you on a disease process. In some
PEARLS, I try to show you ways how you could be presented with information on the exam.
* MNEMONICS: These are memory aids designed to increase your efficiency as you go through the study
guide. Some of them will work for you, others will not. My mnemonics will give you a feel for how to create
memory aids so that you can then create and personalize your own. When creating a mnemonic, use as
much action and color as possible. Also, the crazier it is, the more likely it is to stick in your mind.
* (DOUBLE TAKE): This means a topic is presented in multiple areas of the book. This is done to limit the
number of times you have to bounce around the guide. Most of these topics tend to be very high-yield.
* NAME ALERTS: Some disease names are extremely similar, and thus confusing (e.g. Condyloma Lata
versus Acuminata, or Shwachman-Diamond Syndrome versus Diamond-Blackfan Anemia). NAME ALERTS
serve as reminders to look for these subtle differences.
* ABBREVIATIONS: Some of the disorders are discussed using their abbreviations, other are discussed with
their proper name. Please keep that in mind if you are using the online study guide. This is especially
important when doing a search on the PBR site.

PBR & AVSAR THE NONPROFIT CONNECTION

WHAT IS AVSAR? AVSAR is a nonprofit organization I started at the age of 27 to help support other
nonprofit organizations that are already doing phenomenal work in the slums of India.
AVSAR stands for the Alliance of Volunteers for Service, Action and Reform. After graduating medical school
I spent 1 year volunteering in the slums of Mumbai. The need for help was astounding and conditions were
shocking. Six-year-old children worked as child laborers. Their small, agile fingers apparently allow for
detailed handwork, such as the creation of stunningly beautiful tapestries. Others spent their days digging
through garbage dumps and landfills looking for metal or plastic recyclables that would be sold for about $1 $2 per day.
During my year of volunteering, I bonded with these children and was compelled to create AVSAR, a 501-c-3
nonprofit organization under the U.S. IRS. AVSAR quickly recruited over 100 volunteers from around the
world to do the same thing I did, volunteer in India to work on some amazing projects. We recruited
volunteers from all walks of life (college students, dentists, doctors, medical students and even MBA
students). My personal success stories included the creation of an efficient Western-style clinic for child
laborers in partnership with the Niramaya Foundation, the establishment of an adolescent sex education
curriculum and the creation of AVSAR, a nonprofit organization that I believe has the power to effect
tremendous change throughout India.
AVSAR has helped thousands of people, and its likely that the systems created through the organization
continue to help thousands more every year. The core volunteer and assistance program was shut down in
my last year of residency because of a lack of funding and my competing responsibilities. The creation of
PBR has been integral in helping re-launch the organization. Through PBR I have been able to generate
over $50,000, all of which went to the nonprofit organization. To date, I have contributed over $70,000
to AVSAR and hope to officially re-launch the organization in late 2013 or early 2014. My goal is to
make the new AVSAR bigger and better than ever before. While PBR has been transitioned to a regular
personal business and is no longer a nonprofit project or company, its great to know that if AVSAR needs
help, PBR and I will be there.
If youd like to learn more about AVSAR, please contact me by email or through the PBR website. You can
learn more about AVSAR at www.avsarindia.org.
If you would like to make a donation, your generosity would be greatly appreciated.
DONATION OPTIONS
* CHECK/MONEY ORDER: Please mail a check payable to AVSAR, Inc. to the address below.
AVSAR Donation
P.O. Box 870835
Stone Mountain, GA 30087
* ONLINE DONATIONS: http://www.avsarindia.org/new/Donate%20now.htm

MEMORY AIDS PEGS AND MNEMONICS

MNEMONICS: Mnemonics are memory aids that assist in helping you recall something. They are used
throughout the study guide in an effort to help you study in a more focused and efficient manner.
PEGS: Memory pegs are typically used to help you remember a list of items. By having 20 pre-memorized
pegs that represent the numbers 1-20, you can easily peg items to those numbers. For example, if you are
memorizing a grocery list of 10 items and the 9th item is a gallon of milk, you could imagine a BLACK CAT
drinking from a bowl of milk. In the system below, CAT symbolizes the number 9 since cats are said to have
nine lives. Some of the pegs below will be used in high-yield mnemonics. Go through them a few times to
see if you can get the hang of it.
NOTE: Some of the peg associations below may not work for you. If you have ideas on how to make them
better, please do so for yourself, and consider sharing them with the PBR community.
#
1
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
Eggs usually come in a carton that contains a dozen eggs.

Unlucky number 13 and the unlucky day/movie Friday the 13th. The main
character in the movie, Friday the 13th is Jason. A hockey mask wearing killer.
February 14th is Valentines Day! So think of a long-stem, red ROSE or perhaps a
big CHOCOLATE HEART
Every year, your TAXES are due on APRIL 15th and the IRS takes a huge chunk
out of your PAYCHECK. Welcome to healthcare.
Age at which you get a drivers license. Other considerations: CANDLES, CANDY
or a BIRTHDAY CAKE for Sweet SIXTEEN
There is a teen magazine called SEVENTEEN
Age when you become legal in the U.S. and are allowed to vote.
Imagine a KNIGHTING ceremony
A pack of cigarettes has 20 cigarettes in it.
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
INTRODUCTION TO PBR ................................................................................................................4

ABOUT THE PBR CORE STUDY GUIDE......................................................................................................................................4
YOUR PBR ROADMAP TO SUCCESS............................................................................................................................................5
GETTING THE MOST OUT OF THE PBR FORMAT................................................................................................................5
PBR & AVSAR THE NONPROFIT CONNECTION.................................................................................................................6
ADOLESCENT MEDICINE ..............................................................................................................37

PUBERTY.............................................................................................................................................................................................37
NORMAL PUBERTY TIMELINE...................................................................................................................................................37
NORMAL PUBERTY PEARLS ........................................................................................................................................................38
HEIGHT .................................................................................................................................................................................................38
GROWTH SPURTS.............................................................................................................................................................................38
THELARCHE, ADRENARCHE THEN MENARCHE................................................................................................................38
(DOUBLE TAKE) AGE RANGE OF NORMAL PUBERTY .....................................................................................................38
ESTROGEN...........................................................................................................................................................................................39
ANDROGENS .......................................................................................................................................................................................39
BREAST MASSES FIBROADENOMAS AND FIBROCYSTIC DISEASE.........................................................................39
PUBERTY GONE HAYWIRE .........................................................................................................................................................39
(DOUBLE TAKE) AGE RANGE OF NORMAL PUBERTY .....................................................................................................39
PRECOCIOUS PUBERTY .................................................................................................................................................................40
PSEUDOPRECOCIOUS PUBERTY................................................................................................................................................40
ADRENAL ANDROGENS .................................................................................................................................................................40
PREMATURE ADRENARCHE........................................................................................................................................................40
CONGENITAL ADRENAL HYPERPLASIA (CAH)...................................................................................................................40
TROPIC ..................................................................................................................................................................................................41
PREMATURE THELARCHE ...........................................................................................................................................................41
PREMATURE ADRENARCHE IN GIRLS....................................................................................................................................41
PRECOCIOUS PUBERTY IN GIRLS..............................................................................................................................................41
PRECOCIOUS PUBERTY IN BOYS...............................................................................................................................................42
DELAYED PUBERTY .......................................................................................................................................................................42
DELAYED PUBERTY DEFINITION AND PEARLS ................................................................................................................42
PROLACTINOMA ...............................................................................................................................................................................42
CONSTITUTIONAL DELAY OF PUBERTY................................................................................................................................42
HYPOGONADOTROPIC OVARIAN FAILURE...........................................................................................................................43
KALLMANN SYNDROME................................................................................................................................................................43
HYPERGONADOTROPIC OVARIAN FAILURE........................................................................................................................43
SHORT STATURE .............................................................................................................................................................................43
GENETIC OR FAMILIAL SHORT STATURE.............................................................................................................................43
CONSTITUTIONAL GROWTH DELAY (& PUBERTAL DELAY) .......................................................................................43
GROWTH HORMONE DEFICIENCY ...........................................................................................................................................43
CONGENITAL GROWTH HORMONE DEFICIENCY..............................................................................................................44
ACQUIRED GROWTH HORMONE DEFICIENCY ...................................................................................................................44
OTHER CONSIDERATIONS FOR SHORT STATURE ............................................................................................................44
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
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
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
10
PSEUDOHYPONATREMIA .............................................................................................................................................................66
ACANTHOSIS NIGRICANS .............................................................................................................................................................66
METABOLIC SYNDROME...............................................................................................................................................................66
OB/GYN & SOME STDs ................................................................................................................67

OBSTETRICS ......................................................................................................................................................................................67
ORAL CONTRACEPTIVE PILLS (OCPs) ....................................................................................................................................67
CONCEPTION......................................................................................................................................................................................67
PRENATAL CARE (PNC).................................................................................................................................................................67
GROUP B BETA HEMOLYTIC STREPTOCOCCUS (GBS) ....................................................................................................67
GESTATIONAL DIABETES MELLITUS......................................................................................................................................67
SERUM ALPHA-FETOPROTEIN (AFP) SCREEN...................................................................................................................67
CHORIONIC VILLUS SAMPLING .................................................................................................................................................67
AMNIOCENTESIS ..............................................................................................................................................................................68
MATERNAL SERUM TRIPLE SCREEN OR QUADRUPLE SCREEN.................................................................................68
FIRST TRIMESTER SCREENING OPTIONS FOR DOWNS SYNDROME .......................................................................68
NON STRESS TEST ...........................................................................................................................................................................68
BIOPHYSICAL PROFILE (BPP) ....................................................................................................................................................68
STRESS TEST (aka CONTRACTION STRESS TEST)............................................................................................................69
FOLIC ACID..........................................................................................................................................................................................69
LUNG MATURITY..............................................................................................................................................................................69
MONOZYGOTIC TWINS ..................................................................................................................................................................69
DIZYGOTIC TWINS...........................................................................................................................................................................69
GYNECOLOGY & SOME STDs ......................................................................................................................................................69
PARENTAL CONSENT .....................................................................................................................................................................69
(DOUBLE TAKE) CHLAMYDIA TRACHOMATIS....................................................................................................................70
NEISSERIA GONORRHEA ..............................................................................................................................................................70
NONGONOCOCCAL URETHRITIS ...............................................................................................................................................70
PELVIC INFLAMMATORY DISEASE (PID)..............................................................................................................................71
FITZ-HUGH CURTIS SYNDROME (aka PERI-HEPATITIS)...........................................................................................71
(DOUBLE TAKE) SYPHILIS ...........................................................................................................................................................71
BACTERIAL VAGINOSIS (aka GARDNERELLA) ...................................................................................................................72
(DOUBLE TAKE) TRICHOMONAS VAGINALIS......................................................................................................................72
(DOUBLE TAKE) HERPES SIMPLEX VIRUS (HSV)..............................................................................................................72
VAGINAL FOREIGN BODY .............................................................................................................................................................72
ULCERS versus DISCHARGE .........................................................................................................................................................72
VAGINAL DISCHARGE AT BIRTH...............................................................................................................................................73
VAGINAL ADHESIONS (PENILE ADHESIONS for boys)............................................................................................73
BARTHOLIN GLAND CYSTS..........................................................................................................................................................73
SEXUAL ABUSE IN GIRLS ..............................................................................................................................................................73
ALLERGY & IMMUNOLOGY..........................................................................................................74

HAY FEVER, FOOD ALLERGIES AND ALLERGIC RASHES ..............................................................................................74
CHRONIC RHINITIS..........................................................................................................................................................................74
VASOMOTOR RHINITIS..................................................................................................................................................................74
SKIN TESTING....................................................................................................................................................................................74
IMMUNOTHERAPY...........................................................................................................................................................................74
RADIOALLERGOSORBENT TESTING (aka RAST)...............................................................................................................74
FOOD ALLERGIES .............................................................................................................................................................................74
PEANUT ALLERGY ...........................................................................................................................................................................75
FOOD SENSITIVITIES..................................................................................................................................................................75
ECZEMA (aka ATOPIC DERMATITIS) ......................................................................................................................................75
URTICARIA ..........................................................................................................................................................................................75
11
CHRONIC URTICARIA (> 6 wks) .................................................................................................................................................75

ARTIFICIAL FOOD COLORING.....................................................................................................................................................75
(DOUBLE TAKE) ANAPHYLAXIS ................................................................................................................................................75
FIXED DRUG REACTION ................................................................................................................................................................76
TRUE MILK PROTEIN ALLERGY.................................................................................................................................................76
(DOUBLE TAKE) PROTEIN INDUCED ENTEROCOLITIS..................................................................................................76
(DOUBLE TAKE) LACTOSE INTOLERANCE (aka LACTASE DEFICIENCY) ..............................................................77
IMMUNOLOGY...................................................................................................................................................................................77
EPINEPHRINE PEN..........................................................................................................................................................................77
TYPES OF HYPERSENSITIVITY REACTIONS.........................................................................................................................77
(DOUBLE TAKE) ANAPHYLAXIS ................................................................................................................................................78
DRUG HYPERSENSITIVITY SYNDROME .................................................................................................................................78
ANTICONVULSANT HYPERSENSITIVITY SYNDROME .....................................................................................................78
IGE MEDIATED MEDICATION HYPERSENSITIVITY..........................................................................................................78
PENICILLIN (PCN) ALLERGY.......................................................................................................................................................78
SERUM SICKNESS.............................................................................................................................................................................78
BEE STINGS.........................................................................................................................................................................................78
POISON IVY, POISON OAK & POISON SUMAC ......................................................................................................................79
TYPES OF IMMUNITY .....................................................................................................................................................................79
CD4 CELL..............................................................................................................................................................................................79
CD8 CELL..............................................................................................................................................................................................79
NEUTROPENIA ..................................................................................................................................................................................79
PEARLS/MNEMONICS FOR BRUTONS, SCID AND HYPER-IGM ..................................................................................80
PNEUMOCYSTIS CARINII PNEUMONIA (PCP).....................................................................................................................80
PEDIATRIC LYMPHOcyte COUNTS............................................................................................................................................80
T-CELL DEFICIENCIES AND COMBINED T-CELL/B-CELL DEFICIENCIES..............................................................80
SEVERE COMBINED IMMUNODEFICIENCY (SCID)...........................................................................................................81
MNEMONICS & PEARL for SCID and WISKOTT-ALDRICH .............................................................................................81
(DOUBLE TAKE) WISKOTT-ALDRICH SYNDROME ...........................................................................................................82
CHROMOSOME 22 LOCUS Q11 = DIGEORGE SYNDROME or DIGEORGE LOCUS..................................................82
(DOUBLE TAKE) ATAXIA TELANGIECTASIA........................................................................................................................83
COMMON VARIABLE IMMUNE DEFICIENCY (CVID) ........................................................................................................83
B-CELL DEFICIENCIES...................................................................................................................................................................83
PEARLS: .............................................................................................................................................................................................83
HYPER-IGM SYNDROME (aka HyperIgM Syndrome) .......................................................................................................84
AGAMMAGLOBULINEMIA (aka X-LINKED AGAMMAGLOBULINEMIA, aka BRUTONS
AGAMMAGLOBULINEMIA)...........................................................................................................................................................85
TRANSIENT HYPOGAMMAGLOBULINEMIA OF INFANCY..............................................................................................85
IGA DEFICIENCY ...............................................................................................................................................................................85
HYPER-IGE SYNDROME.................................................................................................................................................................85
COMPLIMENT DEFICIENCIES ....................................................................................................................................................85
C1-4 COMPLIMENT DEFICIENCY ..............................................................................................................................................86
C5-9 COMPLIMENT DEFICIENCY ..............................................................................................................................................86
C1 ESTERASE DEFICIENCY (HEREDITARY ANGIOEDEMA)..........................................................................................86
NEUTROPHIL DISORDERS/PHAGOCYTIC ISSUES ............................................................................................................87
NEUTROPENIA DEFINITIONS.....................................................................................................................................................87
CHRONIC BENIGN NEUTROPENIA ...........................................................................................................................................87
TRANSIENT NEUTROPENIA........................................................................................................................................................87
CYCLIC NEUTROPENIA ..................................................................................................................................................................87
SEVERE CONGENITAL NEUTROPENIA (aka KOSTMANN SYNDROME) ..................................................................87
(DOUBLE TAKE) CHRONIC GRANULOMATOUS DISEASE (CGD) = SERRATIA ......................................................87
LEUKOCYTE ADHESION DEFICIENCY (aka LEUKOCYTE ADHESION DEFECT)...................................................88
CHEDIAK-HIGASHI SYNDROME.................................................................................................................................................88
12
(DOUBLE TAKE) SHWACHMAN-DIAMOND SYNDROME ................................................................................................88

IMMUNOLOGY TESTS, A RECAP ...............................................................................................................................................89
SKIN TESTING....................................................................................................................................................................................89
TITERS...................................................................................................................................................................................................90
CH50.......................................................................................................................................................................................................90
NITROblue TETRAZOLIUM (NBT).............................................................................................................................................90
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
13
LEFT LOWER STERNAL BORDER (LLSB) MURMURS ......................................................................................................98

APICAL MURMURS...........................................................................................................................................................................98
HOLOSYSTOLIC MURMURS..........................................................................................................................................................98
CONTINUOUS MURMURS..............................................................................................................................................................99
BOUNDING PULSE ...........................................................................................................................................................................99
WIDE PULSE PRESSURE................................................................................................................................................................99
CRANIAL BRUITS..............................................................................................................................................................................99
CAROTID BRUITS..............................................................................................................................................................................99
FIXED SPLIT S2..................................................................................................................................................................................99
WIDELY SPLIT S2 .............................................................................................................................................................................99
PARADOXICAL SPLIT OF S2 .........................................................................................................................................................99
FETAL CIRCULATION..................................................................................................................................................................100
NORMAL CIRCULATION..............................................................................................................................................................100
FETAL CIRCULATION...................................................................................................................................................................100
RIGHT VENTRICLE (RV) .............................................................................................................................................................100
CYANOTIC CONGENITAL HEART DISEASES (CCHD)....................................................................................................100
PEARL (re: SHUNTS) ....................................................................................................................................................................100
CYANOTIC CONGENITAL HEART DISEASES MNEMONIC............................................................................................100
CYANOSIS ALGORITHM AND PEARL.....................................................................................................................................101
PROSTAGLANDIN (PGE) = PROSTACYCLIN .......................................................................................................................101
PATENT DUCTUS ARTERIOSUS (PDA).................................................................................................................................101
COARCTATION OF THE AORTA ...............................................................................................................................................101
PREDUCTAL & POSTDUCTAL SATURATION......................................................................................................................102
TRUNCUS ARTERIOSUS (TA)....................................................................................................................................................102
TRANSPOSITION OF THE GREAT ARTERIES (TGA/TOGA).........................................................................................102
TRICUSPID ATRESIA ....................................................................................................................................................................102
TETRALOGY OF FALLOT (TOF) ...............................................................................................................................................103
TOTAL ANOMALOUS PULMONARY VENOUS RETURN (TAPVR)..............................................................................103
HYPOPLASTIC LEFT HEART .....................................................................................................................................................104
PULMONARY ATRESIA ................................................................................................................................................................104
PERSISTENT PULMONARY HYPERTENSION = PERSISTENCE OF FETAL CIRCULATION .............................104
RHEUMATIC FEVER & RHEUMATIC HEART DISEASE .................................................................................................105
RHEUMATIC FEVER......................................................................................................................................................................105
JONES CRITERIA for RHEUMATIC FEVER...........................................................................................................................105
MAJOR JONES CRITERIA FOR ACUTE RHEUMATIC FEVER.........................................................................................105
MINOR JONES CRITERIA FOR ACUTE RHEUMATIC FEVER ........................................................................................106
RHEUMATIC FEVER TREATMENT .........................................................................................................................................106
RHEUMATIC FEVER ASSOCIATIONS .....................................................................................................................................106
KAWASAKI DISEASE, aka MUCOCUTANEOUS LYMPH NODE SYNDROME .........................................................107
DIAGNOSTIC CRITERIA FOR KAWASAKI DISEASE .........................................................................................................107
SUPPORTIVE DATA .......................................................................................................................................................................107
COMPLICATIONS OF KAWASAKI DISEASE.................................................................................................................107
TREATMENT OF KAWASAKI DISEASE .........................................................................................................................107
ENDOCARDITIS..............................................................................................................................................................................108
ENDOCARDITIS DEFINITION ...................................................................................................................................................108
ACUTE BACTERIAL ENDOCARDITIS .....................................................................................................................................108
SUBACUTE BACTERIAL ENDOCARDITIS.............................................................................................................................108
DIAGNOSING ENDOCARDITIS ..................................................................................................................................................108
TREATMENT OF ENDOCARDITIS ...........................................................................................................................................108
NATIVE VALVE ENDOCARDITIS..............................................................................................................................................108
PROSTHETIC VALVE ENDOCARDITIS...................................................................................................................................109
PROPHYLAXIS FOR SUBACUTE BACTERIAL ENDOCARDITIS (SBE).......................................................................109
MISCELLANEOUS CARDIOLOGY ............................................................................................................................................109
14
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
15
TEETH ISSUES ................................................................................................................................................................................120

TOOTH TIMELINE .........................................................................................................................................................................120
PEG TEETH .......................................................................................................................................................................................120
HUTCHINSON TEETH ..................................................................................................................................................................120
TETRACYCLINE TEETH STAINING ........................................................................................................................................120
FLUOROSIS........................................................................................................................................................................................120
VASCULAR & PIGMENTED LESIONS ....................................................................................................................................120
HEMANGIOMAS ..............................................................................................................................................................................120
PHACES SYNDROME.....................................................................................................................................................................121
(DOUBLE TAKE) KASABACH MERRITT SYNDROME......................................................................................................121
NEVUS SIMPLEX.............................................................................................................................................................................121
PORT WINE STAINS (PWS) (aka NEVUS FLAMMEUS) .................................................................................................122
STURGE WEBER SYNDROME (SWS) .....................................................................................................................................122
CAPILLARY MALFORMATION ASSOCIATIONS ................................................................................................................122
(DOUBLE TAKE) KLIPPEL-TRENAUNAY SYNDROME ...................................................................................................122
(NAME ALERT) KLIPPEL-FEIL SYNDROME.......................................................................................................................123
CONGENITAL MELANOCYTIC NEVUS...................................................................................................................................123
MCCUNE ALBRIGHT SYNDROME (aka POLYOSTOTIC FIBROUS DYSPLASIA) ...................................................123
TUBEROUS SCLEROSIS................................................................................................................................................................123
NEUROFIBROMATOSIS I (NF1) ...............................................................................................................................................124
NEUROFIBROMATOSIS 2 (NF2) ..............................................................................................................................................124
INCONTINENTIA PIGMENTI.....................................................................................................................................................124
HYPOHIDROTIC ECTODERMAL DYSPLASIA ......................................................................................................................125
INFECTIOUS SKIN CONDITIONS ............................................................................................................................................125
(DOUBLE TAKE) ECTHYMA GANGRENOSUM ...................................................................................................................125
STREPTOCOCCAL INFECTIONS OF THE GROIN ...............................................................................................................125
(DOUBLE TAKE) CUTANEOUS CANDIDIASIS, A DIAPER DERMATITIS .................................................................125
BULLOUS IMPETIGO/STAPH SCALDED SKIN SYNDROME (SSSS)...........................................................................126
STAPHYLOCOCCUS EPIDERMIDIS..........................................................................................................................................126
CELLULITIS ......................................................................................................................................................................................126
TINEA CORPORIS ...........................................................................................................................................................................126
TINEA VERSICOLOR......................................................................................................................................................................126
PITYRIASIS ROSEA ........................................................................................................................................................................126
MOLLUSCUM CONTAGIOSUM ..................................................................................................................................................127
HUMAN PAPILLOMA VIRUS (HPV) ........................................................................................................................................127
CONDYLOMA LATA .......................................................................................................................................................................127
HERPES SIMPLEX VIRUS II (HSV II)......................................................................................................................................128
HERPES SIMPLEX VIRUS ENCEPHALITIS (HSV ENCEPHALITIS) ............................................................................128
HERPES SIMPLEX VIRUS GINGIVOSTOMATITIS..............................................................................................................128
(DOUBLE TAKE) ECZEMA HERPETICUM............................................................................................................................128
(DOUBLE TAKE) BLUEBERRY MUFFIN SYNDROME .....................................................................................................128
SCABIES..............................................................................................................................................................................................128
PEDICULOSIS CAPITIS (aka HEAD LICE)............................................................................................................................129
PEDICULOSIS PUBIS (aka PUBIC LICE or CRABS) ..........................................................................................................129
THE ERYTHEMA RASHES ......................................................................................................................................................129
ERYTHEMA NODOSUM................................................................................................................................................................129
(DOUBLE TAKE) ERYTHEMA CHRONICUM MIGRANS..................................................................................................129
ERYTHEMA MARGINATUM .......................................................................................................................................................130
(DOUBLE TAKE) ERYTHEMA INFECTIOUSUM.................................................................................................................130
ERYTHEMA TOXICUM NEONATORUM.................................................................................................................................130
ERYTHEMA MULTIFORME ........................................................................................................................................................131
THE NEWBORN RASHES ...........................................................................................................................................................131
MILIARIA RUBRA ...........................................................................................................................................................................131
16
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
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
17
SUDDEN INFANT DEATH SYNDROME (SIDS)...................................................................................................................142

ANURIA...............................................................................................................................................................................................142
ANEMIA..............................................................................................................................................................................................142
APT TEST...........................................................................................................................................................................................142
NEONATAL HYPOGLYCEMIA ....................................................................................................................................................142
SHOCK-LIKE SYMPTOMS............................................................................................................................................................142
SEPTIC WORKUP............................................................................................................................................................................142
CRYING ...............................................................................................................................................................................................142
COLIC...................................................................................................................................................................................................143
SLEEP ..................................................................................................................................................................................................143
SUN SAFETY .....................................................................................................................................................................................143
AUTOMOBILE AND CAR SEAT SAFETY ................................................................................................................................143
VERY LOW BIRTH WEIGHT (VLBW).....................................................................................................................................143
PREGNANCY INDUCED HYPERTENSION (PIH)................................................................................................................144
NALOXONE .......................................................................................................................................................................................144
FAILURE TO THRIVE (FTT).......................................................................................................................................................144
ARTHROGRYPOSIS MULTIPLEX ..............................................................................................................................................144
CEPHALOHEMATOMA .................................................................................................................................................................144
CAPUT SUCCEDANEUM...............................................................................................................................................................144
UMBILICAL CORD ..........................................................................................................................................................................144
CORD CATHETERS.........................................................................................................................................................................144
SINGLE UMBILICAL ARTERY ....................................................................................................................................................145
NECROTIZING ENTEROCOLITIS..............................................................................................................................................145
HYPOSPADIAS .................................................................................................................................................................................145
UNDESCENDED TESTICLE ........................................................................................................................................................145
DEVELOPMENTAL MILESTONES .................................................................................................146

DEVELOPMENTAL MILESTONES THROUGH ADOLESCENCE...................................................................................146
DEVELOPMENTAL MILESTONES SCREENING TOOLS..................................................................................................146
DRAWING SHAPES ........................................................................................................................................................................147
DEVELOPMENTAL MILESTONES CHART, BIRTH TO 2 MONTHS AGE...................................................................148
DEVELOPMENTAL MILESTONES CHART, 4 MONTHS AGE.........................................................................................149
DEVELOPMENTAL MILESTONES CHART, 12 MONTHS AGE......................................................................................152
DEVELOPMENTAL MILESTONES CHART, 2-YEAR OLD ...............................................................................................156
DEVELOPMENTAL MILESTONES CHART, 3-YEAR OLD ...............................................................................................157
DEVELOPMENTAL MILESTONES CHART, 4 YEAR OLD................................................................................................158
COGNITION......................................................................................................................................................................................162
COGNITIVE AND CONCRETE THINKING .............................................................................................................................162
EMERGENCY MEDICINE & TOXICOLOGY ....................................................................................163

MENTAL STATUS CHANGES .....................................................................................................................................................163
PUPILS ................................................................................................................................................................................................163
MIOSIS ................................................................................................................................................................................................163
MYDRIASIS........................................................................................................................................................................................163
DIAPHORESIS ..................................................................................................................................................................................163
NYSTAGMUS.....................................................................................................................................................................................164
SYRUP OF IPECAC..........................................................................................................................................................................164
18
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
VITAMIN & NUTRITIONAL DISORDERS.......................................................................................176

FAT-SOLUBLE VITAMINS..........................................................................................................................................................176
FAT-SOLUBLE VITAMINS...........................................................................................................................................................176
VITAMIN A (aka RETINOL) .......................................................................................................................................................176
VITAMIN K DEFICIENCY (aka PHYTONADIONE DEFICIENCY) ................................................................................176
EARLY VITAMIN K DEFICIENCY..............................................................................................................................................177
LATE VITAMIN K DEFICIENCY ................................................................................................................................................177
VITAMIN E DEFICIENCY (aka TOCOPHEROL DEFICIENCY) ......................................................................................177
19
VITAMIN D (ERGOCALCIFEROL, CHOLECALCIFEROL) EXCESS................................................................................177

VITAMIN D DEFICIENCY (Related terms: ERGOCALCIFEROL, CHOLECALCIFEROL) ......................................177
(DOUBLE TAKE) RICKETS .........................................................................................................................................................178
(DOUBLE TAKE) RICKETS OF PREMATURITY..................................................................................................................178
(DOUBLE TAKE) LIVER DYSFUNCTION...............................................................................................................................179
WATER-SOLUBLE NUTRIENTS ..............................................................................................................................................179
THIAMINE (B1) DEFICIENCY ...................................................................................................................................................179
RIBOFLAVIN (B2) DEFICIENCY...............................................................................................................................................179
NIACIN (B3) DEFICIENCY ..........................................................................................................................................................179
PYRIDOXINE (B6) DEFICIENCY...............................................................................................................................................180
(DOUBLE TAKE) FOLATE (B9) DEFICIENCY.....................................................................................................................180
(DOUBLE TAKE) B12 DEFICIENCY (aka CYANOCOBALAMIN DEFICIENCY)......................................................180
VITAMIN C DEFICIENCY & EXCESS........................................................................................................................................180
(DOUBLE TAKE) ZINC DEFICIENCY ......................................................................................................................................181
(DOUBLE TAKE) ACRODERMATITIS ENTEROPATHICA ..............................................................................................181
COPPER DEFICIENCY...................................................................................................................................................................181
(DOUBLE TAKE) STRICT VEGETARIANS & VEGANS......................................................................................................181
NUTRITIONAL DEFICIENCIES.................................................................................................................................................182
KWASHIORKOR...............................................................................................................................................................................182
MARASMUS.......................................................................................................................................................................................182
(DOUBLE TAKE) ESSENTIAL FATTY ACID DEFICIENCIES..........................................................................................182
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
20
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
21
IMPERFORATE ANUS (aka ANAL ATRESIA)......................................................................................................................198

PERSISTENT CLOACA ..................................................................................................................................................................199
RECTAL PROLAPSE .......................................................................................................................................................................199
TYPHLITIS.........................................................................................................................................................................................199
OMPHALOCELE...............................................................................................................................................................................199
GASTROSCHISIS..............................................................................................................................................................................199
PHARMACOLOGY & DRUG PEARLS ............................................................................................200

MISCELLANEOUS DRUGS ..........................................................................................................................................................200
MISOPROSTOL.................................................................................................................................................................................200
SUCRALFATE (ALUMINUM HYDROXIDE COMPLEX).....................................................................................................200
MAGNESIUM SULFATE................................................................................................................................................................200
TERBUTALINE ................................................................................................................................................................................200
ACE INHIBITORS ............................................................................................................................................................................200
DIAZEPAM.........................................................................................................................................................................................200
METOCLOPRAMIDE & PROMETHAZINE .............................................................................................................................200
BLEOMYCIN......................................................................................................................................................................................200
VINCRISTINE & VINBLASTINE ................................................................................................................................................201
DOXORUBICIN & DAUNOMYCIN .............................................................................................................................................201
CYCLOPHOSPHAMIDE .................................................................................................................................................................201
ASPARAGINASE ..............................................................................................................................................................................201
METHOTREXATE (aka MTX) ....................................................................................................................................................201
MALIGNANT HYPERTHERMIA.................................................................................................................................................201
HEPATIC INDUCERS .....................................................................................................................................................................201
HEPATIC INHIBITORS .................................................................................................................................................................202
ALTERNATIVE MEDICATIONS.................................................................................................................................................202
INTRAUTERINE DRUG EXPOSURES .....................................................................................................................................202
COCAINE EXPOSURE ....................................................................................................................................................................202
HEROIN EXPOSURE ......................................................................................................................................................................202
METHADONE EXPOSURE ...........................................................................................................................................................203
(DOUBLE TAKE) MAGNESIUM SULFATE INFUSION......................................................................................................203
WARFARIN EXPOSURE................................................................................................................................................................203
ANTISEIZURE MEDICATIONS (aka ANTI-SEIZURE MEDICATIONS) ......................................................................203
PHENYTOIN EXPOSURE..............................................................................................................................................................203
VALPROIC ACID EXPOSURE ......................................................................................................................................................203
CARBAMAZEPINE EXPOSURE ..................................................................................................................................................203
LITHIUM EXPOSURE ....................................................................................................................................................................204
ETHANOL EXPOSURE ..................................................................................................................................................................204
VITAMIN A (aka RETINOL) EXPOSUE ..................................................................................................................................204
ISOTRETINOIN EXPOSUE...........................................................................................................................................................204
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
22
STRABISMUS....................................................................................................................................................................................206
PSEUDOSTRABISMUS ..................................................................................................................................................................206
AMBLYOPIA......................................................................................................................................................................................207
ESOTROPIA.......................................................................................................................................................................................207
EXOTROPIA.......................................................................................................................................................................................207
NYSTAGMUS.....................................................................................................................................................................................207
COLOR VISION.................................................................................................................................................................................207
CORNEAL LIGHT REFLEX TEST...............................................................................................................................................207
GENETICS & INHERITED DISEASES..............................................................................................208

AUTOSOMAL DOMINANT DISORDERS................................................................................................................................208
AUTOSOMAL DOMINANT DISORDERS.................................................................................................................................208
AUTOSOMAL DOMINANT MNEMONIC.................................................................................................................................208
WAARDENBURG SYNDROME...................................................................................................................................................209
APERT SYNDROME (aka APERTS SYNDROME) ...............................................................................................................210
NAIL PATELLA SYNDROME ......................................................................................................................................................210
NOONAN SYNDROME (aka NOONANS SYNDROME) .....................................................................................................210
ACHONDROPLASIA (aka DWARFISM) .................................................................................................................................211
PEUTZ-JEGHERS SYNDROME (aka HEREDITARY INTESTINAL POLYPOSIS).....................................................211
GARDNER SYNDROME (aka GARDNERS SYNDROME) .................................................................................................212
(DOUBLE TAKE) RETINOBLASTOMA ...................................................................................................................................212
OTHER AUTOSOMAL DOMINANT DISORDERS.................................................................................................................212
AUTOSOMAL RECESSIVE ..........................................................................................................................................................212
AUTOSOMAL RECESSIVE (AR) DISORDERS PEARLS .....................................................................................................213
AUTOSOMAL RECESSIVE MNEMONIC..................................................................................................................................213
JOHANSON-BLIZZARD SYNDROME .......................................................................................................................................213
X-LINKED DISORDERS................................................................................................................................................................214
X-LINKED DOMINANT DISORDERS ......................................................................................................................................214
FAMILIAL HYPOPHOSPHATEMIC RICKETS .......................................................................................................................214
AICARDI SYNDROME....................................................................................................................................................................214
(DOUBLE TAKE) ALPORT SYNDROME (aka ALPORTS SYNDROME)......................................................................214
X-LINKED RECESSIVE DISORDERS .......................................................................................................................................215
PEARLS............................................................................................................................................................................................215
(DOUBLE TAKE) CHRONIC GRANULOMATOUS DISEASE (CGD) = SERRATIA....................................................215
(DOUBLE TAKE) DUCHENNE MUSCULAR DYSTROPHY...............................................................................................215
(DOUBLE TAKE) HEMOPHILIA A and HEMOPHILIA B (aka FACTOR VIII and FACTOR IX DEFICIENCY)
................................................................................................................................................................................................................216
HUNTER SYNDROME ...................................................................................................................................................................216
NEPHROGENIC DIABETES INSIPIDUS .................................................................................................................................216
ORNITHINE TRANSCARBAMYLASE.......................................................................................................................................217
RETINITIS PIGMENTOSA ...........................................................................................................................................................217
TESTICULAR FEMINIZATION (aka ANDROGEN INSENSITIVITY) ...........................................................................217
(DOUBLE TAKE) WISKOTT-ALDRICH SYNDROME.........................................................................................................217
TRISOMY DISORDERS.................................................................................................................................................................217
DOWN SYNDROME (aka DOWNS SYNDROME) ...............................................................................................................218
TRISOMY 18 (aka EDWARDS SYNDROME)........................................................................................................................219
TRISOMY 13 (aka PATAU SYNDROME) ...............................................................................................................................219
MISCELLANEOUS GENETIC FINDINGS & DISORDERS .................................................................................................220
TERMINOLOGY ...............................................................................................................................................................................220
CLEFT DISORDERS........................................................................................................................................................................220
WILLIAMS SYNDROME (aka WILLIAMS SYNDROME).................................................................................................221
HOLT ORAM SYNDROME............................................................................................................................................................221
23
CRI-DU-CHAT SYNDROME (aka 5p- or 5p SHORT ARM DELETION........................................................................221

CROUZON SYNDROME (aka CRANIOFACIAL DYSOSTOSIS) .......................................................................................222
FRAGILE X SYNDROME ...............................................................................................................................................................222
ANGELMAN SYNDROME (aka ANGELMANS SYNDROME)..........................................................................................222
PRADER-WILLI SYNDROME (aka PRADER WILLI SYNDROME) ..............................................................................223
LAURENCE MOON BIEDL SYNDROME .................................................................................................................................223
BECKWITH-WIEDEMANN SYNDROME................................................................................................................................224
(DOUBLE TAKE) KLIPPEL-TRENAUNAY SYNDROME ...................................................................................................224
PROTEUS SYNDROME..................................................................................................................................................................225
PIERRE-ROBIN SYNDROME (aka PIERRE-ROBIN SEQUENCE) ................................................................................225
CHARGE SYNDROME ....................................................................................................................................................................225
COCKAYNE SYNDROME ..............................................................................................................................................................225
AUTISM...............................................................................................................................................................................................226
ASPERGER SYNDROME (aka ASPERGERS SYNDROME) ..............................................................................................226
RETT SYNDROME (RETTS SYNDROME)..............................................................................................................................226
(DOUBLE TAKE) KLINEFELTER SYNDROME (aka KLINEFELTERS) .....................................................................226
(DOUBLE TAKE) MARFANS SYNDROME (aka MARFANS SYNDROME) ...............................................................226
EHLERS DANLOS SYNDROME..................................................................................................................................................227
(DOUBLE TAKE) HOMOCYSTEINURIA .................................................................................................................................227
(DOUBLE TAKE) TURNER SYNDROME (aka TURNERS)..............................................................................................228
RUSSELL-SILVER SYNDROME (aka SILVER RUSSELL SYNDROME).......................................................................228
POTTERS SYNDROME..................................................................................................................................................................228
(DOUBLE TAKE) VACTER-L (aka VACTERL or VATER) SYNDROME......................................................................229
(DOUBLE TAKE) PRUNE BELLY SYNDROME ....................................................................................................................229
GENETIC TESTING ........................................................................................................................................................................229
MISCELLANEOUS ABNORMALITIES OF FINGERS AND TOES....................................................................................229
HEMATOLOGY & ONCOLOGY ....................................................................................................230

PEDIATRIC LEUKEMIAS ............................................................................................................................................................230
LEUKEMIA PEARL .........................................................................................................................................................................230
ACUTE LYMPHOCYTIC LEUKEMIA (ALL) ...........................................................................................................................230
ACUTE MYELOID LEUKEMIA (AML) .....................................................................................................................................230
CHRONIC MYELOGENOUS LEUKEMIA (CML) & CHRONIC LYMPHOCYTIC LEUKEMIA CLL ........................231
PEDIATRIC LYMPHOMAS..........................................................................................................................................................231
HODGKINS LYMPHOMA..............................................................................................................................................................231
NON-HODGKIN LYMPHOMA (NHL).......................................................................................................................................231
BONE TUMORS...............................................................................................................................................................................232
LONG BONE TUMORS PEARL ...................................................................................................................................................232
OSTEOGENIC SARCOMA & EWINGS SARCOMA (aka EWING SARCOMA).............................................................232
OSTEOCHONROMA........................................................................................................................................................................232
OSTEOID OSTEOMA......................................................................................................................................................................233
OTHER MALIGNANCIES, TUMORS & SYNDROMES .......................................................................................................233
WILMS TUMOR ...............................................................................................................................................................................233
(DOUBLE TAKE) RETINOBLASTOMA ...................................................................................................................................233
NEUROBLASTOMA ........................................................................................................................................................................234
BRAIN TUMORS ..............................................................................................................................................................................234
(DOUBLE TAKE) LANGERHANS CELL HISTIOCYTOSIS (LCH) = HISTIOCYTOSIS X .........................................234
RHABDOMYOSARCOMA ..............................................................................................................................................................234
TUMOR LYSIS SYNDROME.........................................................................................................................................................234
CORD COMPRESSION ...................................................................................................................................................................235
ANTERIOR MEDIASTINAL MASS ............................................................................................................................................235
RBC BASICS & SOME HEMOGLOBIN FACTS......................................................................................................................235
(DOUBLE TAKE) CELL LIFE SPANS .......................................................................................................................................235
24
FETAL & ADULT HEMOGLOBIN STRUCTURE ...................................................................................................................235

NEWBORN ANEMIA......................................................................................................................................................................235
RBC MCV ............................................................................................................................................................................................236
POLYCYTHEMIA .............................................................................................................................................................................236
PRBC TRANSFUSIONS..................................................................................................................................................................236
NORMOCYTIC ANEMIA ..............................................................................................................................................................236
PHYSIOLOGIC ANEMIA................................................................................................................................................................236
HEMOLYTIC ANEMIAS.................................................................................................................................................................237
COOMBS TEST PEARLS ...............................................................................................................................................................237
(DOUBLE TAKE) RHESUS DISEASE (aka RH DISEASE)................................................................................................237
(DOUBLE TAKE) ABO INCOMPATIBILITY ..........................................................................................................................237
PYRUVATE KINASE DEFICIENCY............................................................................................................................................238
HEREDITARY SPHEROCYTOSIS...............................................................................................................................................238
(DOUBLE TAKE) ERYTHEMA INFECTIOUSUM.................................................................................................................238
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) ..............................................................................................239
SICKLE CELL ANEMIA..................................................................................................................................................................239
TRANSIENT ERYTHROBLASTOPENIA OF CHILDHOOD ...............................................................................................240
ACUTE BLOOD LOSS ANEMIA ..................................................................................................................................................240
(DOUBLE TAKE) ANEMIA OF CHRONIC DISEASE...........................................................................................................241
END STAGE RENAL DISEASE (aka ESRD or RENAL FAILURE) .................................................................................241
PEARLY REMINDERS: ..................................................................................................................................................................241
MICROCYTIC ANEMIA.................................................................................................................................................................241
MICROCYTIC ANEMIA DEFINITION ......................................................................................................................................241
IRON DEFICIENCY ANEMIA ......................................................................................................................................................241
(DOUBLE TAKE) ANEMIA OF CHRONIC DISEASE...........................................................................................................242
THALASSEMIAS ..............................................................................................................................................................................242
ALPHA THALASSEMIA.................................................................................................................................................................242
BETA THALASSEMIA....................................................................................................................................................................242
(DOUBLE TAKE) LEAD TOXICITY...........................................................................................................................................243
LAB REVIEWS - FERRITIN, TIBC, RDW, & TRANSFERRIN SATURATION .............................................................243
MACROCYTIC ANEMIA ...............................................................................................................................................................244
MACROCYTIC ANEMIAS (aka MEGALOBLASTIC ANEMIA).........................................................................................244
(DOUBLE TAKE) FOLATE (B9) DEFICIENCY.....................................................................................................................244
(DOUBLE TAKE) B12 DEFICIENCY (aka CYANOCOBALAMIN DEFICIENCY)......................................................244
(DOUBLE TAKE) FANCONI ANEMIA .....................................................................................................................................244
(DOUBLE TAKE) DIAMOND-BLACKFAN ANEMIA...........................................................................................................245
APLASTIC ANEMIA.......................................................................................................................................................................246
PLATELET DISORDERS ..............................................................................................................................................................246
(DOUBLE TAKE) CELL LIFE SPANS .......................................................................................................................................246
THROMBOCYTOPENIA ................................................................................................................................................................247
MATERNAL IDIOPATHIC THROMBOCYTOPENIA PURPURA (ITP)..........................................................................247
NEONATAL SEPSIS-INDUCED THROMBOCYTOPENIA..................................................................................................247
THROMBOCYTOPENIA AND ABSENT RADIUS (aka TAR SYNDROME) .................................................................247
IDIOPATHIC THROMBOCYTOPENIA (ITP) .........................................................................................................................247
(DOUBLE TAKE) WISKOTT-ALDRICH SYNDROME.........................................................................................................247
(DOUBLE TAKE) KASABACH MERRITT SYNDROME......................................................................................................248
GLANZMANN THROMBASTHENIA.........................................................................................................................................248
BERNARD-SOULIER SYNDROME ............................................................................................................................................248
COAGULOPATHY...........................................................................................................................................................................248
VITAMIN K DEPENDENT FACTORS.......................................................................................................................................248
COAGULATION CASCADE ...........................................................................................................................................................249
VITAMIN K DEFICIENCY.............................................................................................................................................................249
25
(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
INFECTIOUS DISEASES ...............................................................................................................250

ANTIBIOTICS A BRIEF REVIEW..........................................................................................................................................250
ANTIBIOTIC AGE PEARLS ..........................................................................................................................................................250
PENICILLIN ......................................................................................................................................................................................250
CLINDAMYCIN.................................................................................................................................................................................250
VANCOMYCIN, LINEZOLID & AMPICILLIN .........................................................................................................................250
CEPHALOSPORINS.........................................................................................................................................................................251
MACROLIDES ...................................................................................................................................................................................251
CARBAPENEMS...............................................................................................................................................................................251
MEBENDIZOLE, ALBENDAZOLE & PYRANTEL PAMOATE..........................................................................................251
METRONIDAZOLE .........................................................................................................................................................................252
GRAM POSITIVE ORGANISMS .................................................................................................................................................252
ENTEROCOCCUS FAECALIS.......................................................................................................................................................252
LISTERIA MONOCYTOGENES ...................................................................................................................................................252
CLOSTRIDIUM TETANI (aka TETANUS) .............................................................................................................................252
(DOUBLE TAKE) CLOSTRIDIUM BOTULISM......................................................................................................................252
(DOUBLE TAKE) CORYNEBACTERIUM DIPHTHERIAE.................................................................................................253
STREPTOCOCCAL INFECTIONS ..............................................................................................................................................253
STREPTOCOCCUS (aka STREP) ...............................................................................................................................................253
ALPHA HEMOLYTIC STREPTOCOCCUS (VIRIDANS & PNEUMONIAE)...................................................................253
BETA HEMOLYTIC STREPTOCOCCUS (AGALACTIAE & PYOGENES) ......................................................................253
STREPTOCOCCAL PHARYNGITIS (aka STREP PHARYNGITIS or STREP THROAT)..........................................254
(DOUBLE TAKE) POST STREPTOCOCCAL GLOMERULONEPHRITIS (PSGN, aka POST INFECTIOUS
GLOMERULONEPHRITIS)...........................................................................................................................................................254
PERITONSILLAR ABSCESS .........................................................................................................................................................255
RETROPHARYNGEAL ABSCESS ...............................................................................................................................................255
SCARLET FEVER.............................................................................................................................................................................255
OCCULT BACTEREMIA.................................................................................................................................................................255
PNEUMONIA ....................................................................................................................................................................................255
GROUP B STREPTOCOCCAL SEPSIS (GBS SEPSIS) ..........................................................................................................255
GBS SCREENING & PROPHYLAXIS MADE EASY!..............................................................................................................256
STAPHYLOCOCCUS AUREUS & EPIDERMIDIS...................................................................................................................256
STAPHYLOCOCCUS AND STREPTOCOCCUS COMPARISON CHART .........................................................................257
GRAM NEGATIVE ORGANISMS ...............................................................................................................................................258
RICKETTSIA RICKETTSII and ROCKY MOUNTAIN SPOTTED FEVER (RMSF)......................................258
ENTEROBACTER ............................................................................................................................................................................258
(DOUBLE TAKE) BARTONELLA HENSELAE ......................................................................................................................258
CITROBACTER FREUNDII ..........................................................................................................................................................258
(DOUBLE TAKE) CHLAMYDIA TRACHOMATIS.................................................................................................................258
CHLAMYDIA PNEUMONIAE ......................................................................................................................................................259
CHLAMYDIA PSITTACI ................................................................................................................................................................259
MYCOPLASMA PNEUMONIA .....................................................................................................................................................259
HEMOPHILUS INFLUENZAE (aka H. FLU)..........................................................................................................................260
BORDETELLA PERTUSSIS (aka WHOOPING COUGH) ...................................................................................................260
PSEUDOMONAS ..............................................................................................................................................................................260
FUNGAL & ATYPICAL BACTERIA...........................................................................................................................................260
CRYPTOCOCCUS..............................................................................................................................................................................260
26
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
27
OTITIS EXTERNA (aka SWIMMERS EAR) ..........................................................................................................................275

ACUTE & RECURRENT OTITIS MEDIA .................................................................................................................................275
CHOLESTEATOMA.........................................................................................................................................................................275
CHRONIC OTORRHEA & RECURRING OTORRHEA ..........................................................................................................275
MENINGITIS, BACTERIAL & VIRAL........................................................................................................................................276
TORCH INFECTIONS....................................................................................................................................................................276
TOXOPLASMA GONDII .................................................................................................................................................................276
(DOUBLE TAKE) VARICELLA ZOSTER VIRUS (CHICKEN POX) .................................................................................277
(DOUBLE TAKE) SYPHILIS ........................................................................................................................................................277
(DOUBLE TAKE) RUBELLA VIRUS (aka GERMAN MEASLES)....................................................................................278
CYTOMEGALOVIRUS (CMV) ......................................................................................................................................................278
(DOUBLE TAKE) BLUEBERRY MUFFIN SYNDROME .....................................................................................................278
ACUTE WATERY DIARRHEA....................................................................................................................................................279
ROTAVIRUS.......................................................................................................................................................................................279
ADENOVIRUS ...................................................................................................................................................................................279
NORWALK VIRUS...........................................................................................................................................................................279
ESCHERICHIA COLI (E. coli)......................................................................................................................................................279
SHIGELLA DYSENTERIAE ..........................................................................................................................................................280
SALMONELLA ..................................................................................................................................................................................280
CAMPYLOBACTER JEJUNI ..........................................................................................................................................................280
STAPHYLOCOCCUS AUREUS & BACILLUS CEREUS.........................................................................................................281
YERSINIA ENTEROCOLITICA....................................................................................................................................................281
CLOSTRIDIUM PERFRINGENS .................................................................................................................................................281
CLOSTRIDIUM DIFFICILE (C. DIFFICILE or C. DIFF)......................................................................................................281
PEARLY DIARRHEA REVIEW....................................................................................................................................................281
CHRONIC DIARRHEA...................................................................................................................................................................282
(DOUBLE TAKE) GIARDIA..........................................................................................................................................................282
CHRONIC NONSPECIFIC DIARRHEA (aka TODDLERS DIARRHEA) ........................................................................282
(DOUBLE TAKE) PROTEIN INDUCED ENTEROCOLITIS...............................................................................................282
(DOUBLE TAKE) LACTOSE INTOLERANCE (aka LACTASE DEFICIENCY) ...........................................................283
INTESTINAL LYMPHANGIECTASIA .......................................................................................................................................283
FAT & CARBOHYDRATE MALABSORPTION .......................................................................................................................283
ACUTE LYMPHADENOPATHY (< 3 WEEKS) IN THE HEAD AND NECK AREA...................................................283
STAPHYLOCOCCUS AUREUS & STREPTOCOCCUS PYOGENES (aka GAS or STREP PYOGENES)................283
PREAURICULAR LYMPHADENOPATHY ...............................................................................................................................284
EMPIRIC TREATMENT ................................................................................................................................................................284
CHRONIC CERVICAL LYMPHADENOPATHY (> 3 WEEKS) .........................................................................................284
(DOUBLE TAKE) BARTONELLA HENSELAE ......................................................................................................................284
FRANCISELLA TULARENSIS......................................................................................................................................................284
MYCOBACTERIUM TUBERCULOSIS (MTB or TB)............................................................................................................284
ATYPICAL MYCOBACTERIA.......................................................................................................................................................284
BRUCELLOSIS ..................................................................................................................................................................................285
LYMPHADENOPATHY IN OTHER AREAS ...........................................................................................................................285
(DOUBLE TAKE) LYMPHOGRANULOMA VENEREUM SEROVAR..............................................................................285
YERSINIA PESTIS ...........................................................................................................................................................................285
NONTENDER LYMPHADENOPATHY....................................................................................................................................285
SPOROTRICHOSIS (aka ROSE PICKERS DISEASE) ..........................................................................................................285
MYCOBACTERIUM TUBERCULOSIS.......................................................................................................................................285
ATYPICAL MYCOBACTERIA.......................................................................................................................................................286
(DOUBLE TAKE) HODGKINS LYMPHOMA ..........................................................................................................................286
NONTENDER SUPRACLAVICULAR LYMPHADENOPATHY ..........................................................................................286
MISCELLANEOUS ID RELATED TOPICS..............................................................................................................................286
SPLENECTOMY PATIENTS ........................................................................................................................................................286
28
DFA & ELISA TESTING.................................................................................................................................................................286

GROWTH MEDIA & STAINING .................................................................................................................................................287
LATEX AGGLUTINATION ............................................................................................................................................................287
DROPLET PRECAUTIONS ...........................................................................................................................................................287
STACCATO, BARKY & PAROXYSMAL COUGHS...................................................................................................................287
(DOUBLE TAKE) APHTHOUS ULCERS ..................................................................................................................................287
VACCINES & IMMUNIZATIONS...............................................................................................................................................288
SOME PERTINENT CDC LINKS.................................................................................................................................................288
STEROIDS AND IMMUNIZATIONS..........................................................................................................................................288
PREMATURITY AND VACCINATIONS ...................................................................................................................................288
LIVE VACCINES ...............................................................................................................................................................................288
MEASLES, MUMPS, RUBELLA (MMR) & VARICELLA (VZV) PEARLS ......................................................................289
ROTAVIRUS VACCINE ..................................................................................................................................................................289
INFLUENZA VACCINATION .......................................................................................................................................................289
HEPATITIS A VACCINE ................................................................................................................................................................290
HEPATITIS B VACCINE................................................................................................................................................................290
HUMAN PAPILLOMA VIRUS VACCINE (HPV) ....................................................................................................................290
MENINGOCOCCAL VACCINE (aka MENINGOCOCCUS VACCINE) .............................................................................290
POSTEXPOSURE PROPHYLAXIS ..............................................................................................................................................290
TETANUS BOOSTER......................................................................................................................................................................291
VACCINE SCHEDULE REMINDERS.........................................................................................................................................291
CATCH-UP IMMUNIZATION SCHEDULE PEARLS ............................................................................................................292
CROUP, TRACHEITIS & EPIGLOTTITIS.................................................................................................................................292
CROUP, TRACHEITIS & EPIGLOTTITIS SUMMARY TABLE.........................................................................................293
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
INBORN ERRORS OF METABOLISM (IEM) & MISCELLANEOUS METABOLIC DISORDERS ..............296

INBORN ERRORS OF METABOLISM (IEM) PEARLS ......................................................................................................297
INBORN ERRORS OF METABOLISM (PEARLS) .................................................................................................................297
ORGANIC ACIDEMIAS (PEARLS) .............................................................................................................................................297
UREA CYCLE DEFECTS (PEARLS)...........................................................................................................................................297
FATTY ACID METABOLISM DISORDERS (PEARLS).......................................................................................................297
STORAGE DISEASES (PEARLS) ................................................................................................................................................297
MITOCHONDRIAL DISORDERS (PEARLS)...........................................................................................................................297
AMINO ACIDOPATHIES (PEARLS)..........................................................................................................................................298
GALACTOSEMIA (PEARLS) ........................................................................................................................................................298
HYPERGLYCINEMIA (PEARLS) ................................................................................................................................................298
NEWBORN SCREEN (NBS).........................................................................................................................................................298
AMMONIA LEVEL...........................................................................................................................................................................298
INHERITANCE PATTERN ...........................................................................................................................................................298
ORGANIC ACIDEMIAS .................................................................................................................................................................298
ORGANIC ACIDEMIAS OVERVIEW..........................................................................................................................................298
ISOVALERIC ACIDEMIA...............................................................................................................................................................299
29
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
ACID-BASE DISORDERS ..............................................................................................................312

A GUIDE TO CALCULATIONS & SHORTCUTS FOR ACID BASE DISORDERS........................................................312
THE ULTIMATE ABG CALCULATOR BIBLE!......................................................................................................................312
ACID-BASE DISORDERS & PEARLS .......................................................................................................................................313
ACIDOSIS............................................................................................................................................................................................313
ANION GAP .......................................................................................................................................................................................313
ANION GAP METABOLIC ACIDOSIS .......................................................................................................................................313
NON-ANION GAP METABOLIC ACIDOSIS............................................................................................................................314
RENAL TUBULAR ACIDOSIS (RTA) ........................................................................................................................................314
RENAL TUBULAR ACIDOSIS TYPE I (RTA I, aka CLASSIC DISTAL RTA) ...............................................................315
RENAL TUBULAR ACIDOSIS TYPE II (RTA II, aka PROXIMAL RTA)........................................................................315
30
RENAL TUBULAR ACIDOSIS TYPE IV (RTA IV).................................................................................................................315

METABOLIC ALKALOSIS .............................................................................................................................................................317
RESPIRATORY ACIDOSIS ............................................................................................................................................................318
RESPIRATORY ALKALOSIS.........................................................................................................................................................318
FLUIDS & ELECTROLYTES ...........................................................................................................319

MAINTENANCE IV FLUIDS (MIVF) & DEHYDRATION..................................................................................................319
MAINTENANCE IV FLUIDS (MIVF) ........................................................................................................................................319
DEHYDRATION ...............................................................................................................................................................................319
GASTROENTERITIS.......................................................................................................................................................................320
HEAT STROKE .................................................................................................................................................................................320
ELECTROLYTES .............................................................................................................................................................................320
(DOUBLE TAKE) HYPERCALCEMIA.......................................................................................................................................320
(DOUBLE TAKE) HYPOCALCEMIA..........................................................................................................................................320
HYPOKALEMIA................................................................................................................................................................................322
HYPERKALEMIA.............................................................................................................................................................................322
HYPONATREMIA ............................................................................................................................................................................323
HYPERNATREMIA .........................................................................................................................................................................324
DIABETES INSIPIDUS (DI).........................................................................................................................................................325
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
HEMOLYTIC UREMIC SYNDROME (HUS)............................................................................................................................330
INTRINSIC RENAL DISEASE.....................................................................................................................................................330
RENAL FAILURE.............................................................................................................................................................................330
OLIGURIA...........................................................................................................................................................................................331
RENOVASCULAR DISEASE .........................................................................................................................................................331
GLOMERULONEPHRITIS ............................................................................................................................................................331
IGA NEPHROPATHY......................................................................................................................................................................331
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS (MPGN) ............................................................................332
RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS (RPGN).........................................................................................332
NEPHROTIC SYNDROME ............................................................................................................................................................332
MEDULLARY SPONGE DISEASE ..............................................................................................................................................333
MEDULLARY CYSTIC DISEASE.................................................................................................................................................333
31
(DOUBLE TAKE) FANCONI SYNDROME ..............................................................................................................................333

(DOUBLE TAKE) ALPORT SYNDROME (aka ALPORTS SYNDROME)......................................................................334
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
32
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
ORTHOPEDICS & SPORTS MEDICINE ..........................................................................................353

EPIPHYSIS, PHYSIS & METAPHYSIS ......................................................................................................................................353
SALTER HARRIS FRACTURES...................................................................................................................................................353
TORUS FRACTURE (aka BUCKLE FRACTURE) .................................................................................................................354
DISTAL HUMERAL FRACTURES ..............................................................................................................................................354
DISLOCATED SHOULDER ...........................................................................................................................................................354
OSTEOGENESIS IMPERFECTA .................................................................................................................................................354
VALGUS DEFORMITY ...................................................................................................................................................................354
33
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
34
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
35
PSYCHIATRY & SOME SOCIAL ISSUES .........................................................................................377

ATTENTION DEFICIT DISORDER (aka ADD, ADHD, and ATTENTION DEFICIT HYPERACTIVE
DISORDER) .......................................................................................................................................................................................377
LEARNING DISABILITIES ...........................................................................................................................................................377
SCHOOL PHOBIA ............................................................................................................................................................................377
DEPRESSION ....................................................................................................................................................................................377
DEATH RESPONSE IN CHILDREN...........................................................................................................................................377
DIVORCE ............................................................................................................................................................................................378
PARENTAL ADJUSTMENT TO A CHILD WITH MALFORMATIONS...........................................................................378
CHRONICALLY ILL FAMILY MEMBER ..................................................................................................................................378
CONVERSION DISORDER............................................................................................................................................................378
SOMATIZATION ..............................................................................................................................................................................378
PSYCHOSOMATIC...........................................................................................................................................................................378
BREATH HOLDING SPELLS .......................................................................................................................................................379
NIGHT TERRORS ............................................................................................................................................................................379
NIGHTMARES ..................................................................................................................................................................................379
CHILD DISCIPLINE ........................................................................................................................................................................379
THUMB SUCKING...........................................................................................................................................................................379
CHILD ABUSE...................................................................................................................................................................................380
IMPACT OF MEDIA ON CHILDREN.........................................................................................................................................380
MISCELLANEOUS TID BITS & PEARLS ................................................................................................................................380
PREVENTATIVE MEDICINE TERMINOLOGY .....................................................................................................................380
MOUTH GUARDS ............................................................................................................................................................................380
CONTACT SPORTS PARTICIPATION ......................................................................................................................................381
BICYCLE SAFETY............................................................................................................................................................................381
FIRST DENTAL EXAM ..................................................................................................................................................................381
HOT WATER HEATER ..................................................................................................................................................................381
BOAT SAFETY ..................................................................................................................................................................................381
TONGUE TIED (aka TONGUE TIE) .........................................................................................................................................381
ENURESIS AND ENCOPRESIS ...................................................................................................................................................381
PEDIATRIC LAB VALUES .............................................................................................................383

COMPLETE BLOOD COUNT (CBC) ..........................................................................................................................................383
COAGULATION STUDIES ............................................................................................................................................................383
NORMAL PEDIATRIC ELECTROLYTE VALUES..................................................................................................................383
ALKALINE PHOSPHATASE.........................................................................................................................................................384
GAMMA-GLUTAMYL TRANSPEPTIDASE (GGT)................................................................................................................384
DIRECT BILIRUBIN .......................................................................................................................................................................384
PEDIATRIC VITAL SIGNS .............................................................................................................385

PEDIATRIC RESPIRATORY RATES .........................................................................................................................................385
PEDIATRIC HEART RATE OR PULSE .....................................................................................................................................385
PEDIATRIC BLOOD PRESSURE ................................................................................................................................................385

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.
(DOUBLE TAKE) CUTANEOUS CANDIDIASIS, A DIAPER DERMATITIS

Cutaneous candidiasis, a diaper dermatitis, can occur secondary to a contact dermatitis or recent antibiotic
use. Beefy red rash with papular satellite lesions. This rash goes into the inguinal folds. Use a KOH prep to
confirm diagnosis and treat with a topical antifungal, such as nystatin or clotrimazole.
IMAGE (includes satellite lesions): http://www.pediatrics.wisc.edu/education/derm/tutc/80.html
ATOPIC DERMATITIS (ECZEMA)

In babies, atopic dermatitis (eczema), SPARES the diaper folds/flexural surfaces (but not in older kids). It is
PRURITIC and LICHENIFIED. Food allergies CAN exacerbate eczema and avoidance of certain foods MAY
the delay onset (but not prevent). Breastfeeding also DELAYS the onset. Watch for superinfection if not
improving.
IMAGE: http://skininfo.org/wp-content/uploads/2010/06/atopic_dermatitis.jpg
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).
(DOUBLE TAKE) ECZEMA HERPETICUM

Eczema herpeticum is a potentially life threatening disseminated herpes (HSV) infection occurring at sites of
skin damage, including sites of eczema. Look for HSV Vesicles + Crusted Lesions. Even if a description is not
given of a vesicular rash, have a high index of suspicion for a rash not improving with steroids and/or
antibiotics. Diagnose with viral culture for HSV, but do not delay treatment. A Tzanck smear can support the
diagnosis. Treat by STOPPING topical steroids and/or immunosuppressants and starting Acyclovir.
IMAGE: http://bit.ly/nkSGQU

113
SEBORRHEIC DERMATITIS (aka CRADLE CAP)

Seborrheic dermatitis (aka cradle cap), is a NONpruritic, inflammatory, flaky rash with white to yellow scales
that usually forms in oily areas (e.g., scalp). Often seen in first two months of life. After that, not very common
until adolescence. May treat with topical antifungal agents or mild steroids. Skin may be left with
hypopigmented areas, especially in the folds. If asked to name the hypopigmented areas, choose
PITYRIASIS ALBA.
IMAGE: http://hardinmd.lib.uiowa.edu/dermnet/seborrheicdermatitis18.html
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
(DOUBLE TAKE) LANGERHANS CELL HISTIOCYTOSIS (LCH) = HISTIOCYTOSIS X

Langerhans Cell Histiocytosis (LCH), aka Histiocytosis X, is a PAPULAR rash that is sometimes associated
with petechiae. The rash is located in the folds (inguinal folds, supra-pubic folds, perianal area). It can
resemble eczema, but the petechiae or PAPULES should guide you towards this diagnosis. LCH is a type of
cancer. You may be shown lytic bone lesion (possibly of the skull). Diagnose by skin biopsy. Can also be
associated with DIABETES INSIPIDUS. Treat by removing the lesion and giving steroids, +/- chemotherapy.
PEARLS: Do not confuse this with Wiskott-Aldrich (WiXotT-Aldrich, X-linked, low IgM, high IgA, TIE =
Thrombocytopenia, small platelets, Infections and Eczema). Also, if they describe an eczema or seborrheic
dermatitis type of rash in a patient with high urine output, LCH is your diagnosis.
IMAGE: http://bit.ly/pJIQSN
IMAGE: http://bit.ly/pc5dEG
RASHES THAT SPARE THE INGUINAL FOLDS

Eczema and Contact Dermatitis should be high on your differential for rashes that spare the inguinal folds.
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.
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
ALLERGIC CONTACT DERMATITIS, A TYPE IV HYPERSENSITIVITY SKIN RASH

Allergic contact dermatitis is a Type IV hypersensitivity skin rash requires a prior exposure, and tends to be
pruritic. See if the location of the rash is in an area where a nickel-containing belt buckle, earring, necklace or
other jewelry could have been. Rash may present even after years of wearing the irritant. The rash from a
nickel exposure is more erythematous and can become lichenified. The classic example of Type IV reactions
is the rash of poison ivy, or other leaves of 3 (including poison oak or poison sumac). Regarding a contact
dermatitis from these plants, it will not spread once the affected area is washed with soap and water. The fluid
from within the vesicles cannot spread the rash. This reaction is a Type IV Cell Mediated Hypersensitivity
Reaction, and is called a Rhus reaction. The rash is vesicular and may be in a linear configuration (where the
leaves rubbed across the skin).
* PEARL: First exposure may take 1 week to develop the rash as helper T cells proliferate and remember
the agent. After that, the rash may develop within hours of exposure. No wonder I had to go through the 2step PPD before starting as an attending!
* PEARL: REMINDERS: A PPD and the skin testing of Candida, Mumps and Tetanus are all Type IV
reactions.
* MNEMONICS:
LEAVES OF THREE, LET THEM BE!
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
(DOUBLE TAKE) BIOTIN/BIOTINIDASE DEFICIENCY

Biotin, or Biotinidase, deficiency may present with a RASH + ALOPECIA + NEUROLOGIC SIGNS (ataxia,
coma, etc.). Patients may also have lactic acidosis. Treat with Biotin.
MNEMONIC: Imagine the TIN MAN from the Wiz of Oz walking with an ATAXIC gait as he SCRATCHES his
arm. Notice that he has NO HAIR!
115
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
(NAME ALERT) ICHTHYOSIS VULGARIS

Ichthyosis vulgaris is a rash that resembles FISH SCALES. Often seen in atopic dermatitis patients. May
attempt treatment with ammonium lactate or alpha hydroxyacid containing agents. The name alert is for
lamellar ichthyosis and harlequin ichthyosis.
IMAGES: http://www.skinsight.com/adult/ichthyosisVulgaris.htm
(NAME ALERT) LAMELLAR ICHTHYOSIS

Lamellar ichthyosis is noted at the time of birth in newborns. A thin, transparent film is noted on the body.
Eyelashes are missing. Eyelids seem inverted. The name alert is for harlequin ichthyosis and ichthyosis
vulgaris.
IMAGE: http://bit.ly/okfaoh
IMAGE: http://bit.ly/q3unlU
(NAME ALERT) HARLEQUIN ICHTHYOSIS

Harlequin ichthyosis presents with a newborn that looks much more abnormal than lamellar icthyosis. The
covering is hard (armor-like) and horny. Movement is restricted. Prognosis is poor comparatively. The name
alert is for lamellar ichthyosis and ichthyosis vulgaris.
IMAGE: http://bit.ly/nhplsa
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

116
(DOUBLE TAKE) ECTHYMA GANGRENOSUM

Ecthyma gangrenosum is usually a sign of a PSEUDOMONAS infection and possibly sepsis in an
immunocompromised patient, especially LEUKEMIA! Look for a neutropenic patient with black, necrotic,
ulcerative lesions with surrounding erythema and edema. Often located in the groin/diaper area.
IMAGE: http://www.nlm.nih.gov/medlineplus/ency/imagepages/2647.htm
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
STEVENS-JOHNSON SYNDROME (SJS) and TOXIC ENDODERMAL NECROLYSIS (TEN)

The terminology for Stevens-Johnson Syndrome (SJS) and Toxic Endodermal Necrolysis (TEN) varies. Many
now view these disorders on a spectrum. SJS and TEN are the same, but TEN is the diagnosis if > 30% of
body surface area involved. Look for bullae or erosions followed by hemorrhagic crusting. There may be
severe blistering with the Nikolsky sign when pressure is applied. It is a full thickness rash similar to a burn.
Skin lesions may look like a BULLSEYE or TARGET lesion, with the center described as DARK, DUSKY or
VIOLACEOUS. The target CAN be a blister or vesicle. At least 2 mucous membranes must be involved (most
commonly the lips and eyes). If the eyes are involved, this is an ocular emergency!
MEDICATION ASSOCIATIONS: Aromatic seizure medications, penicillins, NSADS and sulfa drugs. The rash
usually occurs within 2 months of starting the medication.

117
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).
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
118
DERMOID CYSTS (aka EPIDERMOID CYSTS)

Dermoid cysts (aka epidermoid cysts) are saclike growths present at birth. They are like teratomas in that
they can contain hair and teeth. They are often associated with tufts or sinuses. They grow slowly and can get
infected, so most of them should be REMOVED. Especially those in sensitive areas, including the face or
nasal area.
IMAGE: http://bit.ly/V4FCbp
IMAGE: http://bit.ly/QJMShp
IMAGE: http://www.dermaamin.com/site/atlas-of-dermatology/4-d/351-dermoid-cyst-.html
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.
(DOUBLE TAKE) APHTHOUS ULCERS

Aphthous ulcers are painful lesions found within the oral mucosa (buccal mucosa, lips and tongue) with a
grayish-white base and a rim of erythema. Can occur in isolation or in association with Behcets or
Schwachman Diamond syndrome.
IMAGE: http://upload.wikimedia.org/wikipedia/commons/4/45/Aphthous_ulcer.jpg
IMAGE: http://upload.wikimedia.org/wikipedia/commons/2/2d/Aphtha2.jpg

119
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/
TETRACYCLINE TEETH STAINING

If tetracycline is used at a young age, teeth can end up having yellow, brown or blue band-like stains. Avoid
tetracycline until patients are at least 8 years of age.
IMAGE: http://img.medscape.com/pi/emed/ckb/dermatology/1048885-1076389-2302tn.jpg
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
VASCULAR & PIGMENTED LESIONS

PEARL/MNEMONIC: HEMANGIOMAS
are different than VASCULAR MALFORMATIONS (e.g., Port Wine
Stains/capillary malformations). VASCULAR MALFORMATIONS tend to have much more associated

morbidity. You might say that VMs are Very Morbid in comparison.
IMAGES: (slideshow on birthmarks) http://www.webmd.com/skin-problems-and-treatments/slideshowbirthmarks
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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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
(DOUBLE TAKE) KASABACH MERRITT SYNDROME

In Kasabach Merritt syndrome, there are large, congenital vascular tumors. They are not true hemangiomas
but can cause a severe CONSUMPTIVE COAGULOPATHY (in the form of thrombocytopenia and the
consumption of coagulation factors) and death.
IMAGE: http://img.medscape.com/pi/emed/ckb/hematology/197800-202455-5213tn.jpg
IMAGE: http://img.medscape.com/pi/emed/ckb/hematology/197800-202455-5214tn.jpg
PEARL: Look at the above images closely. Make sure you look closely at images so that you do not get this
vascular tumor confused with hemihypertrophy.
MNEMONIC:
>---< is used by many of us when recording CBC results.
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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PEARL: These BLANCH with pressure.
PORT WINE STAINS (PWS) (aka NEVUS FLAMMEUS)

Port Wine Stains (PWS), aka nevus flammeus, are CAPILLARY malformations. They start as pink/flat lesions
that become dark red-purple. They then progress to being thick/raised in adulthood. These PWSs are Present
at birth and are PERMANENT. They are benign if noted in isolation. If noted on the face, they can be
associated with glaucoma (increased intraocular pressure that can present as a red eye).
IMAGE: http://www.fungur.com/uploads/2010/05/Mikhail-Gorbachev-1.jpg
IMAGES: http://bit.ly/U1lWnE
PEARL: They grow in proportion to child.
MNEMONIC: Glaucoma is a concern if a PWS is noted in the facial area. Is that why Mikhail Gorbachev
wears Glasses? Because he has that big FLAME on his head?
STURGE WEBER SYNDROME (SWS)

The Sturge Weber Syndrome (SWS) includes the following findings: Port Wine Stain (PWS or NEVUS
FLAMMEUS)
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
CAPILLARY MALFORMATION ASSOCIATIONS

(DOUBLE TAKE) KLIPPEL-TRENAUNAY SYNDROME
Klippel-Trenaunay syndrome is associated with AV fistulae causing skeletal or limb OVERGROWTH
(hemihypertrophy). Patients with Klippel-Trenaunay have Port Wine Stains and overgrowth of tissue, bones
and soft tissue. Look for unilateral limb overgrowth and CHF.
* IMAGES: http://geneticpeople.com/wp-content/uploads/2011/03/bobbyreport001xb.jpg
* PEARL: Hemihypertrophy images on the pediatric exam should very quickly clue you in to a few disorders.
Highest on your differential should be Beckwith-Wiedemann Syndrome, then Klippel-Trenaunay, then RussellSilver Syndrome and then possibly Proteus Syndrome.
* MNEMONIC: From now on, say CRIPPLE-T. Think of these patients as having a CRIPPLING disorder in
which they have one HUGE leg that prevents them from getting around.
* NAME ALERT: KLIPPEL-FEIL SYNDROME. Completely different disorder. Look for a Torticollis-like
photograph (due to fused cervical vertebrae).

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(NAME ALERT) KLIPPEL-FEIL SYNDROME

Klippel-Feil Syndrome results in a torticollis-like appearance. Results from fused cervical vertebrae. Patients
will likely have a short, webbed neck, limited range of motion at the neck and possibly other anomalies.
Etiology is unknown. The Name Alert is because this is a completely different disorder than KlippelTrenaunay Syndrome (limb overgrowth due to AV fistulae).
CONGENITAL MELANOCYTIC NEVUS

Congenital melanocytic nevi are commonly referred to as moles. Present at birth or within the first few months
of life. Generally benign, but carry an increased risk of MELANOMA if there are multiple moles (more than
three) or if they are > 20 cm. Associated with spinal dysraphisms and Dandy Walker Syndrome (fossa
abnormality)
MCCUNE ALBRIGHT SYNDROME (aka POLYOSTOTIC FIBROUS DYSPLASIA)

McCune Albright syndrome (aka Polyostotic Fibrous Dysplasia) findings include IRREGULAR caf-au-lait
MACULES (either > 3 cm or multiple), PRECOCIOUS PUBERTY, BONE PROBLEMS (fractures, cranial
deformities) and possibly other endocrine issues (hyperthyroidism). Can cause fractures of long bones and
bowing of arms.
IMAGE: http://en.wikipedia.org/wiki/File:Mccune-albrightsyndrome1.jpg
MNEMONIC: Call it MACULE Albright Syndrome from now on.
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
* SHAGREEN PATCH (hypERpigmented plaque that can be rough/thick and papular)
IMAGE: http://bit.ly/n02Q8f
IMAGE: http://bit.ly/ojT5CF
* SEBACEOUS GLAND HYPERPLASIA
PEARL: Often misdiagnosed as acne. LOOK FOR SPARING OF THE FOREHEAD
IMAGE: http://en.wikipedia.org/wiki/File:TuberSclerosisCase-143.jpg
* PERIVENTRICULAR OR CORTICAL TUBERS: Usually associated with INFANTILE SPASMS or seizures

* CARDIAC RHABDOMYOMAS: Look for a kid with arrhythmias!
* RENAL ANGIOMYOLIPOMA
MANAGEMENT OF TUBEROUS SCLEROSIS: Most of the management has to do with seizures/infantile
spasms and cardiac arrhythmias.
* MNEMONICS:

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Imagine a TUBULAR bazooka shooting out WHITE LEAVES. The leaves have DANCING (seizing)
tics on them!
ASH is typically GRAY/WHITE/HYPOPIGMENTED, whereas a PATCH of GREEN is typically

DARKER/HYPERPIGMENTED.
* 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
* Optic nerve gliomas. This is the neurologic component

* 6 REGULAR caf-au-lait macules. As they get older, SIZE DOES MATTER. If prepubertal, > 5 mm, if
postpubertal, > 15 mm. 10 years of age is a good cutoff. These macules can be present at birth. Children can
have an increase in the size and number as they age. Therefore, it is very important that they have regular
followup, especially if there is a family history of the disorder. As a side note, children can also get
pheochromocytomas or renal artery stenosis, so BP should be monitored regularly.
Scoliosis or bony abnormalities
* Axillary or inguinal freckling
* MNEMONIC: (FOR NF-1) SKIN + ORTHO + NEURO issues = S.O.N. This is NF ONE, SON (or
daughter!)!!!
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
HYPOHIDROTIC ECTODERMAL DYSPLASIA

Hypohidrotic ectodermal dysplasia is a condition related to INCONTINENTIA PIGMENTI, but this can occur in
boys. HYPOHIDROSIS (decreased sweating, which can lead to hyperthermia), HYPOTRICHOSIS (sparse
hair, so no eyebrows/lashes), DELAYED TOOTH ERUPTION, DEFORMED/PEGGED TEETH
IMAGES: http://bit.ly/oAyEsN
IMAGE: http://en.wikipedia.org/wiki/File:Michael_Berryman_2007.png
INFECTIOUS SKIN CONDITIONS

(DOUBLE TAKE) ECTHYMA GANGRENOSUM
Ecthyma gangrenosum is usually a sign of a PSEUDOMONAS infection and possibly sepsis in an
immunocompromised patient, especially LEUKEMIA! Look for a neutropenic patient with black, necrotic,
ulcerative lesions with surrounding erythema and edema. Often located in the groin/diaper area.
STREPTOCOCCAL INFECTIONS OF THE GROIN

Streptococcal infections of the groin or perineum are associated with pain with stooling, pruritus, redness and
possible a fissure. Unlike zinc deficiency, there is no desquamation. If vaginal or vulvovaginitis, look for a
history of vaginal discharge. Diagnose by culturing the area. Treat with amoxicillin, penicillin (PCN) or a first
generation cephalosporin. Risk factors include abuse and previous instrumentation. Look for a history of
recent antibiotics in case the discharge is due to Candida.
(DOUBLE TAKE) CUTANEOUS CANDIDIASIS, A DIAPER DERMATITIS

Cutaneous candidiasis, a diaper dermatitis, can occur secondary to a contact dermatitis or recent antibiotic
use. Beefy red rash with papular satellite lesions. This rash goes into the inguinal folds. Use a KOH prep to
confirm diagnosis and treat with a topical antifungal, such as nystatin or clotrimazole.
IMAGE (includes satellite lesions): http://www.pediatrics.wisc.edu/education/derm/tutc/80.html

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BULLOUS IMPETIGO/STAPH SCALDED SKIN SYNDROME (SSSS)

Bullous impetigo, or Staph Scalded Skin Syndrome (SSSS), is a spectrum of the same disease.
* IMPETIGO: Look for honey colored, crusting lesions and bullae. Non-bullous impetigo and look similar but
without vesicle/bullae (more oozing/crusting)
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.
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.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.
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.
MNEMONIC:
HUMAN PAPILLOMA VIRUS (HPV)

Human papilloma virus (HPV) causes VERRUCA VULGARIS (warts). They can be on the hands, knees, feet
and in the anogenital region. If genital, the condition is referred to as CONDYLOMA ACUMINATA (> 90% are
from HPV 6 or HPV 11, which are NOT likely to induce cervical cancer). Lesions are NOT tender but easily
bleed with minimal trauma. The risk of cervical cancer is increased depending on the subtype (16, 18 are
most commonly associated with cervical cancer). Anogenital warts can be due to maternal-fetal
transmission and may not present unitl 3 years after birth! BUT, if you note anogenital warts AFTER 3 years
of age, think SEXUAL ABUSE. Treat with self-applied topical podofilox or imiquimod. Treatment with
cryotherapy or podophyllin is done by a physician.
IMAGE: http://dermatlas.med.jhmi.edu/data/images/verruca_vulgaris_1_090828.jpg
IMAGE: http://img.medscape.com/pi/emed/ckb/urology/435575-455021-4185tn.jpg (Acuminata)
MNEMONIC: Dont get confused with molluscum. hpV = VVarts/Warts = Verruca Vulgaris = Venereal
VVarts/Warts. VVarts on your hands or knees? Its probably from those darn Vs!
MNEMONIC: The HPV 16 & HPV 18 strains are the two you should remember (associated with the highest
risk of cervical cancer): Imagine an adolescent couple. Their birthdays are on the same day, 7/1 (Zodiac of
CANCER). The boy is turning 18 and hes excited to finally VOTE. His girlfriend is turning 16 and shes
excited because shell finally get her DRIVERS LICENSE now that shes celebrating her SWEET
SIXTEENTH. As they go to blow out the BIRTHDAY CAKE candles, you notice that she has VVarts on her
lips! It turns out he also has VVarts, but his are Venereal (anogenital).
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.
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.
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HERPES SIMPLEX VIRUS II (HSV II)

Herpes simplex virus II is an STD. The initial flare is often very painful. Pain may precede the presentation of
lesions. Look for multiple, painful ulcers or vesicles on the labia or penis. Can have lymphadenopathy. The
vesicles are CLUSTERED on an ERYTHEMATOUS BASE. Lesions can also be ULCERATIVE. Diagnose by
obtaining a viral culture or HSV PCR. The Tzanck smear is not specific for HSV. Treat with ORAL Acyclovir x
7 days (not topical). Treat babies with IV Acyclovir.
IMAGE: http://www.coldsoreblisters.com/images/herpes1.jpg
PEARL: HSV can be associated with a very painful infection called a HERPETIC WHITLOW (typically of a
thumb or finger) .
IMAGE: http://img.medscape.com/pi/emed/ckb/pediatrics_general/960757-964866-1733tn.jpg
HERPES SIMPLEX VIRUS ENCEPHALITIS (HSV ENCEPHALITIS)

A question about herpes simplex virus encephalitis (HSV encephalitis) would likely mention fever, seizures
and possibly the a CT finding in the temporal lobe. Treatment is STAT IV acyclovir, followed by a lumbar
puncture to obtain fluid for PCR testing. EEG might show PLEDs (periodic lateralizing epileptiform
discharges).
HERPES SIMPLEX VIRUS GINGIVOSTOMATITIS

Herpes simplex virus gingivostomatitis presents with oral and perioral/vermillion border lesions/vesicles.
Gingiva is friable and malodorous. There is associated lymphadenopathy.
IMAGE: http://img.medscape.com/pi/emed/ckb/pediatrics_general/960757-964866-1734tn.jpg
(DOUBLE TAKE) ECZEMA HERPETICUM

Eczema herpeticum is a potentially life threatening disseminated herpes (HSV) infection occurring at sites of
skin damage, including sites of eczema. Look for HSV Vesicles + Crusted Lesions. Even if a description is not
given of a vesicular rash, have a high index of suspicion for a rash not improving with steroids and/or
antibiotics. Diagnose with viral culture for HSV, but do not delay treatment. A Tzanck smear can support the
diagnosis. Treat by STOPPING topical steroids and/or immunosuppressants and starting Acyclovir.
IMAGE: http://bit.ly/nkSGQU
(DOUBLE TAKE) BLUEBERRY MUFFIN SYNDROME

Blueberry muffin syndrome represents extramedullary hematopoiesis. Can be seen in congenital viral
infections like Rubella, Coxsackie, Cytomegalovirus (CMV), Herpes Simplex Virus (HSV) and Parvovirus.
Can also be associated with congenital Toxoplasmosis (a protozoa).
IMAGES: http://alturl.com/pfdqj
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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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
PEDICULOSIS CAPITIS (aka HEAD LICE)

Pediculosis capitis (aka head lice) results in nits/ova of the lice at the hair shafts, especially in the occipital
area. Treat with permethrin. More symptoms at night when lice tend to be more active. Itching is from the
bites. Unlike scabies, repeat permethrin again in 7-10 days because eggs can hatch up to 10 days later.
PEARL: If an African American child is pictured, it is NOT lice
IMAGES: http://www.dermaamin.com/site/atlas-of-dermatology/15-p/1246-pediculosis-capitis-.html
PEDICULOSIS PUBIS (aka PUBIC LICE or CRABS)

Pediculosis pubis (aka pubic lice or crabs) is an infection in the groin that results in red, crusted suprapubic
macules and possibly bluish-gray dots. There is a STRONG ASSOCIATION with sexual abuse in children.
IMAGES: http://www.dermaamin.com/site/atlas-of-dermatology/15-p/1248-pediculosis-pubis-.html
THE ERYTHEMA RASHES

ERYTHEMA NODOSUM
For erythema nodosum, look for PAINFUL, shiny, red to bluish shin lesions in a patient with a history of a
chronic disease or on certain medications. Associations include Crohns Disease, Ulcerative Colitis, Drugs
(oral contraceptives and sulfa drugs), Infections (yersinia, EBV, Tuberculosis, fungal infections) and
Sarcoidosis.
MNEMONIC: For this shiny skin finding, use CUDIS (kind of like CUTIS, which means skin) to help you
remember the following associations: Crohns, UC, Drugs, Infections and Sarcoidosos.
IMAGE: http://www.health-writings.com/erythema-nodosum-children/
IMAGE: http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-731469363
(DOUBLE TAKE) ERYTHEMA CHRONICUM MIGRANS

Erythema chronicum migrans is caused by BORRELIA BURGDORFERI, the spirochete that causes LYME
DISEASE. Look for a large, flat lesion (> 5 cm) that is annular and has a red border. It is located at the
tick bite site in about 75% of patients. Classis description is a bullseye lesion. The rash shows up 1-2
wks after the bite. Titers may still be negative during this period. Borrelia is transmitted via the Ixodes deer
tick. IF the patient has an acute arthritis, disseminated erythema migrans, a palsy (BELLS PALSY) or
neuropathy, then treat with ORAL medication (Doxycycline if >8 years old, or Penicillin or Amoxicillin if <
8 years old). If the patient has CARDITIS, neuritis (encephalitis/meningitis) or RECURRENT arthritis, then
treat with INTRAVENOUS medication (PCN or Ceftriaxone). Arthritis is usually located at the large joints
(especially the knees). Diagnosing using labs is often difficult. Obtain Lyme antibody titers. If positive,
confirm with a Western blot. This is often a clinical diagnosis.
* IMAGE: (BULLSEYE LESION) http://web.princeton.edu/sites/ehs/bullseye.jpg
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* IMAGE: (BELLS PALSY) http://en.wikipedia.org/wiki/File:Bellspalsy.JPG

* SIDE NOTES
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.
Imagine squeezing LYME into a CAN = Carditis, Arthritis, and Neuritis.
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.
(DOUBLE TAKE) ERYTHEMA INFECTIOUSUM

Erythema infectiousum IS an INFECTIOUS rash!!! Caused by Parvovirus B19. It is also called Fifth Disease
Look for erythematous facial flushing of the cheeks (sometimes described as slapped cheeks appearance).
The extremities will have diffuse macular (or morbilliform) erythema (especially on the extensor surfaces)
referred to as lacy or reticular. Diagnose with IgM titers (there is no culture or rapid antigen available).
PEARLS: The rash occurs AFTER the slapped cheeks rash (often a week later). Patients may also have
knee or ankle pain. Parvovirus B19 infection can result in APLASTIC CRISIS. Intrauterine exposure can
result in hydrops fetalis.
MNEMONIC: infectio5uM = FIFTH disease = Fiver fingers. Imagine a cheek being SLAPPED with FIVE
fingers covered by a white LACY/LACEY glove with a red M on the back of it (extensor surface). M = igM
titers
MNEMONIC: ParVoVirus B19: From now on, say/think parVoVirus V19. V = Roman numeral 5!
ERYTHEMA TOXICUM NEONATORUM

Erythema toxicum neonatorum is seen in up to 50% of newborns and consists of erythematous macules
with raised central lesions (papules or vesicles). Usually seen at birth or by DOL 2. It is a benign rash with an
unknown etiology. It usually disappears by DOL 7. Diagnose by noting eosinophils on microscopy.
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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.
THE NEWBORN RASHES

MILIARIA RUBRA
Look for very superficial vesicles that are easily ruptured in a case of miliaria rubra. Occurs due to obstruction
of sweat glands. Also called prickly heat rash.
IMAGES: http://www.skinsight.com/infant/miliariaRubra.htm
MNEMONIC: Miliaria sounds like malaria, which is usually found in hot countries where you sweat!
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
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
TRANSIENT NEONATAL PUSTULAR MELANOSIS

Transient neonatal pustular melanosis is more common in African-American kids. This is a benign rash with
NO associated erythema. Starts in utero and PRESENT AT BIRTH. Resolves within a few days. Can leave
hyperpigmented macules for a while. Diagnose by examining contents and looking for PMNs on Tzanck
smear.
IMAGE: http://bit.ly/Y1GaX1
IMAGE: http://www.aafp.org/afp/2008/0101/afp20080101p47-f3.jpg
MNEMONICS: transient neonatal PUStular melanosis should remind you of the PMNs on Tzanck smear in
the PUS-like contents of these PUStules. MELANosis should make you think about dark skinned individuals
(AA kids) and the dark macules that can be left behind.

131
NEONATAL ACNE (aka NEONATAL CEPHALIC PUSTULOSIS)

Neonatal acne (aka Neonatal Cephalic Pustulosis) occurs within the first month of life. Resolves by 4 months
of age. Look for inflammatory pustules on the cheeks and forehead without comedones. This is a benign rash
that requires no treatment.
IMAGE: http://www.skinsight.com/infant/neonatalAcneBenignCephalicPustulosis.htm
MNEMONIC: NEONATal = FIRST MONTH OF LIFE!
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
LIVEDO RETICULARIS (aka CUTIS MARMORATA)

Livedo reticularis (aka cutis marmorata) presents as a mottled, reticulate patterned rash. Benign. May be
described as a lacy rash. Resolves by 1 month.
IMAGE: http://www.dermatlas.com/data/images/cutis_marmorata_1_060523.jpg
PEARL: If the baby is healthy and without any concerning symptoms, choose this. If not, consider sepsis in
your differential.
ALOPECIA & HAIR FINDINGS

ALOPECIA AREATA
In alopecia areata, there are round/well-circumscribed area(s) of alopecia. Alopecia can be on the scalp or in
other areas. Hairs at the periphery of the areas are short, pluckable and may resemble an exclamation
point!
IMAGE: http://bit.ly/RgZPzd
IMAGE: http://bit.ly/SoAmlH
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
(DOUBLE TAKE) ZINC DEFICIENCY

Breastfeeding helps with zinc absorption. If a child is begins having medical problems once weaned from
breast milk, consider zinc deficiency in your differential. Zinc deficiency causes a SCALY and EXTREMELY
ERYTHEMATOUS dermatitis in the perioral and perianal area (around the natural orifices) that can
DESQUAMATE. The rash is sometimes described as erosive and eczematous. Can also be associated with
ALOPECIA and poor taste.
* MNEMONIC: Poor taste, huh? Have you ever had Zinc lozenges? They are disgusting! Its probably a good
thing that you have hypogusia when you are eating Zinc lozenges!
* IMAGES: http://www.dermaamin.com/site/atlas-of-dermatology/25-z/505-zinc-deficiency-.html
* IMAGE: http://bit.ly/Y1IxJf
* PEARLS:
CROHNS DISEASE: If a Crohns patient is suffering from diarrhea, they may have zinc deficiency
since Zn is lost in the stool.
STRICT VEGETARIANS & VEGANS: Susceptible to multiple nutritional deficiencies, including

deficiencies in IRON, ZINC, CALCIUM and VITAMIN B12. Vegans avoid all animal derived products
(including milk and eggs). B12 deficiency can result in megaloblastic anemia, vitiligo, peripheral
neuropathy and even regression of milestones
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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!
(DOUBLE TAKE) ACRODERMATITIS ENTEROPATHICA

Acrodermatitis Enteropathica is an inherited condition (autosomal recessive) in which there is a Zinc transport
defect. Can result in alopecia, diarrhea, failure to thrive (FTT) and the rash of zinc deficiency.
(DOUBLE TAKE) BIOTIN/BIOTINIDASE DEFICIENCY

Biotin, or Biotinidase, deficiency may present with a RASH + ALOPECIA + NEUROLOGIC SIGNS (ataxia,
coma, etc.). Patients may also have lactic acidosis. Treat with Biotin.
MNEMONIC: Imagine the TIN MAN from the Wiz of Oz walking with an ATAXIC gait as he SCRATCHES his
arm. Notice that he has NO HAIR!
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.
TINEA CAPITIS (aka RINGWORM)

Tinea capitis (ringworm) results in broken hair that looks like black dot alopecia. There is often
inflammation and this condition can be associated with a kerion (the raised spongy lesion associated with this
infection). Treat with GRISEOFULVIN. You do not need any baseline labs.
133
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
(DOUBLE TAKE) ESSENTIAL FATTY ACID DEFICIENCIES

Essential fatty acids include LINOLEIC ACID and alpha-linolenic acid. Deficiency results in alopecia, a scaly
dermatitis and thrombocytopenia. Treat with IV lipids.
MNEMONIC: Imagine a fish whose red SCALES are shaped like HAIRY PLATELETS. As the fish struggles to
find food, it becomes SKINNIER and skinnier (malnourished) and the hairy platelets begin to fall off. Whats
left is a SKINNY (fat free), BALD and THROMBOCYTOPENIC fish!
APLASIA CUTIS CONGENITA

In aplasia cutis congenita, there is a congenital absence of the skin in an area. Usually in a single location
(most often the scalp), but can be in multiple areas. After the lesion heals and scars, a BALD SPOT is left
behind. Aplasia cutis can be associated with underlying spinal dysraphisms and underlying skull defects.
IMAGE: http://en.wikipedia.org/wiki/File:Aplasia_cutis_congenita.jpg
PEARLS: Look for the HAIR COLLAR SIGN. This is a hairless area with a collar of dense hair at the edges.
If given a picture of a scalp with the hair collar sign, get an MRI
IMAGE: http://bit.ly/nu3VmS

134

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PEDIATRICS BOARD REVIEW:

MNEMONICS, FREE BOARD

Efficiency In Studying So That

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Submission of this form is required for the money back pass

Copyright Pediatrics Board Review, Inc. 2011 Present.

Copyright Pediatrics Board Review, Inc. 2011 Present.

YOUR PBR ROADMAP TO SUCCESS

GETTING THE MOST OUT OF THE PBR FORMAT

Copyright Pediatrics Board Review, Inc. 2011 Present.

PBR & AVSAR THE NONPROFIT CONNECTION

Copyright Pediatrics Board Review, Inc. 2011 Present.

MEMORY AIDS PEGS AND MNEMONICS

Eggs usually come in a carton that contains a dozen eggs.

Copyright Pediatrics Board Review, Inc. 2011 Present.

INTRODUCTION TO PBR ................................................................................................................4

ADOLESCENT MEDICINE ..............................................................................................................37

OB/GYN & SOME STDs ................................................................................................................67

ALLERGY & IMMUNOLOGY..........................................................................................................74

CHRONIC URTICARIA (> 6 wks) .................................................................................................................................................75

(DOUBLE TAKE) SHWACHMAN-DIAMOND SYNDROME ................................................................................................88

LEFT LOWER STERNAL BORDER (LLSB) MURMURS ......................................................................................................98

TEETH ISSUES ................................................................................................................................................................................120

SUDDEN INFANT DEATH SYNDROME (SIDS)...................................................................................................................142

DEVELOPMENTAL MILESTONES .................................................................................................146

EMERGENCY MEDICINE & TOXICOLOGY ....................................................................................163

VITAMIN & NUTRITIONAL DISORDERS.......................................................................................176

VITAMIN D (ERGOCALCIFEROL, CHOLECALCIFEROL) EXCESS................................................................................177

IMPERFORATE ANUS (aka ANAL ATRESIA)......................................................................................................................198

PHARMACOLOGY & DRUG PEARLS ............................................................................................200

GENETICS & INHERITED DISEASES..............................................................................................208

CRI-DU-CHAT SYNDROME (aka 5p- or 5p SHORT ARM DELETION........................................................................221

HEMATOLOGY & ONCOLOGY ....................................................................................................230

FETAL & ADULT HEMOGLOBIN STRUCTURE ...................................................................................................................235

INFECTIOUS DISEASES ...............................................................................................................250

OTITIS EXTERNA (aka SWIMMERS EAR) ..........................................................................................................................275

DFA & ELISA TESTING.................................................................................................................................................................286

INBORN ERRORS OF METABOLISM (IEM) & MISCELLANEOUS METABOLIC DISORDERS ..............296

ACID-BASE DISORDERS ..............................................................................................................312

RENAL TUBULAR ACIDOSIS TYPE IV (RTA IV).................................................................................................................315

FLUIDS & ELECTROLYTES ...........................................................................................................319

(DOUBLE TAKE) FANCONI SYNDROME ..............................................................................................................................333

ORTHOPEDICS & SPORTS MEDICINE ..........................................................................................353

PSYCHIATRY & SOME SOCIAL ISSUES .........................................................................................377

PEDIATRIC LAB VALUES .............................................................................................................383

PEDIATRIC VITAL SIGNS .............................................................................................................385

Copyright Pediatrics Board Review, Inc. 2011 Present.

(DOUBLE TAKE) CUTANEOUS CANDIDIASIS, A DIAPER DERMATITIS

ATOPIC DERMATITIS (ECZEMA)

(DOUBLE TAKE) ECZEMA HERPETICUM

Copyright Pediatrics Board Review, Inc. 2011 Present.

SEBORRHEIC DERMATITIS (aka CRADLE CAP)

(DOUBLE TAKE) LANGERHANS CELL HISTIOCYTOSIS (LCH) = HISTIOCYTOSIS X

RASHES THAT SPARE THE INGUINAL FOLDS

ALLERGIC CONTACT DERMATITIS, A TYPE IV HYPERSENSITIVITY SKIN RASH

LEAVES OF THREE, LET THEM BE!

(DOUBLE TAKE) BIOTIN/BIOTINIDASE DEFICIENCY

(NAME ALERT) ICHTHYOSIS VULGARIS

(NAME ALERT) LAMELLAR ICHTHYOSIS

(NAME ALERT) HARLEQUIN ICHTHYOSIS

Copyright Pediatrics Board Review, Inc. 2011 Present.

(DOUBLE TAKE) ECTHYMA GANGRENOSUM

STEVENS-JOHNSON SYNDROME (SJS) and TOXIC ENDODERMAL NECROLYSIS (TEN)