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TitlePediatric Board Study Guide.pdf
Tags Clinical Medicine Medical Specialties Diseases And Disorders Health Sciences
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Table of Contents
                            Foreword
Contents
Contributors
General Pediatrics
	Growth
	Macrocephaly
	Microcephaly
	Plagiocephaly
	Developmental Milestones
		Key Points to Developmental Milestones
	Language Development
	Immunizations
	Hepatitis B Vaccine
	Rotavirus Vaccine
		DTaP/Tdap Vaccine
		Haemophilus Influenzae Type b Conjugate Vaccine (Hib)
	Pneumococcal Vaccine
		Inactivated Poliovirus Vaccine (IPV)
	Oral Poliovirus Vaccine
		Measles, Mumps, and Rubella (MMR) Vaccine
	Varicella
		Hepatitis A (HepA) Vaccine
		Meningococcal Conjugate Vaccines
		Human Papillomavirus (HPV) Vaccines
		Anaphylaxis and Vaccinations
		Common Adverse Reaction of Vaccines
		General Conditions Commonly Misperceived as Contraindications (i.e., Vaccination May Be Administered Under These Conditions)
			Special Considerations
	Screening
		Newborn Screening
		Vision Screening
		Hearing Screening (See ENT Chapter for More Details)
		Blood Pressure Screening
		Lead Screening
		Iron Deficiency Screening
		Urinalysis Screening
		Tuberculosis (TB) Screening
		Autism Screening
		Oral Health Screening
	Well Child Visits
		Well Visit Schedule
		Counseling Each Well Visit Is Very Important
		Age Appropriate Anticipatory Guidance, e.g.,
		Environmental Safety Counseling
	Nutrition
	Discipline
	Immigrants and Internationally Adopted Children
	Infantile Colic or Crying Infants
	Limb Pain
	Suggested Readings
Behavioral, Mental Health Issues and Cognitive Disorders
	Anxiety Disorders
	Obsessive Compulsive Disorders (OCD)
		Habit Disorders
			General Management of Habit Disorders
	Mood and Affect Disorders
	Major Depression
	Dysthymic Disorders
	Depressive Disorders Not Otherwise Specified
	Bipolar Disorders
		Suicidal Behaviors
		Attention Deficit Hyperactivity Disorders (ADHD)
	Aggression
	Antisocial Behaviors and Delinquency
	Autistic Disorders
	Sleep Disorders
	Sexual Behaviors
	Enuresis
		Fecal Soiling
	Childhood Schizophrenia
	Specific Learning Disabilities (LD)
		Communication Disorders
		Intellectual Disability
	Suggested Readings
Psychological Issues and Problems
	Critical Life Events
		Death
		Divorce
	Transition of Adolescents to Young Adulthood for Vulnerable Populations
		Discipline
		Adoption
		Media
		Foster Care
		Enuresis
		Encopresis
	Psychosomatic Disorders
		Pain
		Sibling Rivalry
		Separation Anxiety and School Refusal
		Sleep Disorders
		Night Terrors
		Nightmare Disorder
		Vulnerable Child Syndrome
		Rumination
		Gifted Child
	Chronic Illness and Handicapping Conditions
		Transplantation
	Family Violence
		Child Abuse
		Neglect
			Factitious Disorder (Munchausen Syndrome) by Proxy
		Sexual Abuse
	Suggested Readings
The Acutely III Child
	Common Early Symptoms, Signs and Clues to  a Very Ill Child
	Shock
	Hypovolemic Shock
	Cardiogenic Shock
	Distributive or Neurogenic Shock
	Septic Shock
		Management of Shock
	Acute Respiratory Distress Syndrome
	Brain Death
	Suggested Readings
Emergency Care
	Poisoning
	Anticholinergic Ingestion
	Carbamazepine Ingestion
	Clonidine
	Opiates
	Phenothiazine Ingestion
	Foxglove(Digitalis) Ingestion
	Seeds (Cherries, Apricots, Peaches, Apples, Plums) Ingestion
	Mushrooms Ingestion
	Acetaminophen Ingestion
	Ibuprofen Ingestion
	Salicylic acid Ingestion
	Tricyclic Antidepressants Ingestion
	Caustic Ingestion
	Organophosphate and Insecticide Exposure
	Hydrocarbon Ingestion
	Methanol Ingestion
	Ethylene Glycol Ingestion (Antifreeze)
	Carbon Monoxide Poisoning
	Iron Ingestion
	Head Trauma
	Drowning
	Wounds
	Puncture Wounds
	Lacerations
	Animal and Human Bites
		Dog Bites
		Cat Bites
		Other Animals
		Human Bites
	Snake Bites
	Black Widow Spider Bite
	Brown Recluse Spider
	Scorpion Stings
	Status Epilepticus
	Burns
	Resuscitation
		Tachycardias with Pulse
		Tachycardia without Pulse
	Suggested Readings
Genetics and Dysmorphology
	Autosomal Dominant
	Autosomal Recessive
	X-Linked Disorders
	Genomic Imprinting
	Mitochondrial Disorders
	Multifactorial Inheritance
	Down Syndrome (Fig. 4)
	Trisomy 18 (Edwards Syndrome Fig. 5)
	Trisomy 13 (Patau Syndrome Figs. 6 and 7)
	47 ,XXY (Klinefelter Syndrome Fig. 8)
	X (Turner Syndrome Figs. 9 and 10)
	Noonan Syndrome
	Prader–Willi Syndrome (PWS)
	Angleman Syndrome
	Williams Syndrome (7q11.23)
	WAGR Syndrome
	Alagille Syndrome
	DiGeorge Syndrome
	4 P-Wolf–Hirschhorn Syndrome
	5 p-Cri-Du-Chat Syndrome
	De Grouchy Syndrome
	Achondroplasia
	Marfan Syndrome (Figs. 13, 14, and 15)
	Ehlers–Danlos Syndrome (Fig. 16)
	Osteogenesis Imperfecta (Fig. 17)
	Beckwith–Wiedemann Syndrome
	Sotos Syndrome (Fig. 18)
	Poland Sequence
	Treacher Collins Syndrome
	Waardenburg Syndrome
	Pierre–Robin Sequence
	Amniotic Band Sequence or Amniotic Rupture Sequence (Fig. 19)
	Goldenhar Syndrome (Fig. 20)
	Craniosynostosis
	Plagiocephaly
	Suggested Readings
Metabolic Disorder
	Abbreviations
	General Rules in Approaching a Child  with Metabolic Disease (Table 1)
	Section 1: Organic Acidemias (Fig. 2)
		Isovaleric Acidemia (Odor Sweaty Feet)
		Maple Syrup Urine Disease
		Methylmalonic Acidemia
		Propionic Acidemia
		Isolated Beta-methylcrotonyl-CoA Carboxylase deficiency
		Biotinidase Deficiency
		Glutaric Aciduria Type I or Glutaric Acidemia
	Section 2: Disorders of Amino Acid Metabolism
		Phenylketonuria (PKU)
		Type I Hepatorenal Tyrosinemia
		Tyrosinemia Type II (Oculocutaneous Tyrosinemia)
		Homocystinuria
		Alkaptonuria
		Glycine Encephalopathy (Nonketotic Hyperglycinemia)
	Section 3: Urea Cycle Disorders
		Ornithine Transcarbamylase (OTC) Deficiency
	Section 4: Disorders of Fatty Acid Oxidations and Mitochondrial Metabolism
		Medium-Chain Acyl-Coa Dehydrogenase Deficiency (MCAD) (Fatty Acid Oxidation Defect)
		Glutaric Acidemia Type II
	Section 5: Disorders of Carbohydrate Metabolism
		Galactosemia
		Galactokinase Deficiency
		Glycogen Storage Diseases
		Von Gierke Disease (Glucose-6-phosphate deficiency)
		Pompe Disease
		McArdle Disease, Muscle Phosphorylase Deficiency
		Adenylate Deaminase Deficiency
		Deficiency of Fructose 1, 6-Bisphosphate Aldolase
		Fructokinase Deficiency
		Mucopolysaccharidosis (MPS)
	Section 6: Lysosomal Storage Disorders
		Gaucher Disease
		Niemann-Pick Disease (NPD)
		Tay-Sachs Disease
		Fabry Disease
		Wolman Syndrome
		Metachromatic Leukodystrophy
	Section 7: Peroxisomal Disorders
		Zellweger Syndrome
		X-linked Adrenoleukodystrophy (X-ALD)
	Section 8: Disorders of Porphyrin Metabolism(Porphyrias)
		Porphyria Cutanea Tarda
		Erythropoietic Protoporphyria
	Section 9: Disorders of Purine or PyrimidineMetabolism
		Lesch-Nyhan Disease (Hypoxanthine Guanine Phosphoribosyltransferase Deficiency)
	Section 10: Various Metabolic Disorders
		Familial Hypercholesterolemia
		Smith-Lemli-Opitz Syndrome
		Krabbe Disease
		Menkes Disease (Kinky Hair Disease)
		Body Odors
	Suggested Readings
Fetus and Newborn Infants (Neonatology)
	Abbreviations
	Definitions
	Prenatal Care
		General Neonatal Risks
		Known Risk Factors of Prematurity
		Factors Associated with Preterm High Mortality Rate
		Umbilical Cord
		Placenta
		Cesarean Section (C-section)
	Fetal Distress
	Premature Rupture of Membranes (PROM)
	Chorioamnionitis
	Preeclampsia
	Diabetes Mellitus
	Newborn Examination
		Apgar Score
		Newborn crying
		Temperature
		Skin
		Head
		Eyes
		Ears
		NOSE
		Mouth
	Neck
		Obstetrical Brachial Plexus Injuries (OBPI)
		Chest
		Lung
		Heart
		Abdomen
	Genitalia
		Female
		Male
		Anus
		Back and Spinal Column
		Extremities
		Neonatal Prophylaxis
	Intrauterine Growth Retardation (IUGR)
		Assessment of gestational age (Table 3)
	Multiple Births
	Infants of Diabetic Mother (IDM)
	Hyperbilirubinemia
	Physiologic Jaundice
	Early Onset Breast Feeding Jaundice
	Late Onset Human Milk Jaundice
	Jaundice in Premature Infants
		Unconjugated Hyperbilirubinemia
		Conjugated Hyperbilirubinemia
	Kernicterus
		Evaluation of Infant with Hyperbilirubinemia
		Transcutaneous Bilirubin Devices
	Management of Hyperbilirubinemia
	Anemia
		ABO Incompatibility
		Rh Incompatibility
		Hemorrhagic Disease of the Newborn
	Respiratory Distress Syndrome (Hyaline Membrane Disease)
	Transient Tachypnea of Newborn (TTN)
	Persistent Pulmonary Hypertension of Newborn (PPHN)
	Meconium Aspiration Syndrome
	Pneumothorax and Pneumomediastinum
	Neonatal Sepsis
		Background
	Group B Streptococcal Infection in Neonates
	Congenital Rubella Infection
	Congenital Cytomegalovirus (CMV) Infection
	Congenital Toxoplasmosis
	Congenital Syphilis
	Failure to Pass Meconium in the First 48 h of Life
	Meconium Plug
	Meconium Ileus
	Necrotizing Enterocolitis (NEC)
	Congenital Diaphragmatic Hernia (CDH)
	Vomiting
	Hypoxic Ischemic Encephalopathy (HIE)
	Intraventricular Hemorrhage (IVH) and Leukomalacia
	Teratogens (Table 6)
	Fetal Alcohol Syndrome
	Suggested Readings
Adolescent Medicine and Gynecology
	Abbreviations
	Physiological Changes and Development During Adolescence
	Risks and Conditions Associated with Adolescents
	Emancipation and Health Care Decisions
	Adolescent Routine Health Visit
	Substance Abuse (Table 3)
	Eating Disorders
	Anorexia Nervosa
	Bulimia
	Female Breast Masses
	Amenorrhea
	Dysmenorrhea
	Dysfunctional Uterine Bleeding
	Gynecomastia
	Scrotal Masses
	Contraception
	Sexually Transmitted Disease in Adolescents
		Neisseria Gonorrhoeae
		Chlamydia trachomatis
	Pelvic Inflammatory Disease
		Trichomoniasis
	Human Papillomavirus (HPV)
	Human Immunodeficiency Virus (HIV)
	Herpes Simplex
	Pediculosis
	Scabies
	Vaccines Prevent STDs
	Suggested Readings
Allergic and Immunologic Disorders
	Abbreviations
	Introduction
	Skin Testing
	In Vitro Allergy Testing
	Allergic Rhinitis (AR)
	Anaphylaxis
	Food Allergies
	Drug Reaction
	Serum Sickness
	Urticaria
	Chronic Urticaria
	Mastocytosis
	Hereditary Angioedema (HAE)
	Immunology
		Introduction
			T lymphocyte
	B Cells
	Initial Immunologic Testing of a Child with Recurrent Infections
	Primary Defects of Cellular Immunity
		DiGeorge Anomaly (CATCH22)
	Chronic Mucocutaneous Candidiasis (CMC)
	Primary Defects of Antibody Production
		Bruton Agammaglobulinemia
	Common Variable Immunoglobulin Deficiency (CVID)
	Transient Hypogammaglobulinemia of Infancy (THI)
	Selective IgA Deficiency (IgAD)
	XL-HyperIgM Syndrome
	X-linked Lymphproliferative Syndrome (XLP)
	Hyper-IgE Syndrome (HIES)
	Primary Combined Antibody and Cellular Immunodeficiencies
		Severe Combined Immunodeficiency Disease (SCID)
	Wiscott–Aldrich Syndrome
	Cartilage Hair Hypoplasia with Short-Limbed Dwarfism
	Ataxia-Telangiectasia
	Disorders Phagocyte Function
		Leukocyte Adhesion Defect
	Chediak–Higashi Syndrome
	Myeloperoxidase (MPO) Deficiency
	Chronic Granulomatous Disease (CGD)
	Disorders of the Complement System
		Complement Defect
	Suggested Readings
Rheumatologic Disorders
	Juvenile Idiopathic Arthritis (JIA)
	Macrophage-Activation Syndrome (MAS)
	Systemic Lupus Erythematosus (SLE)
	Neonatal Lupus Erythematosus (NLE)
	Drug-Induced Lupus (DIL)
	Management of SLE
	Mixed Connective Tissue Disease (MCTD)
	Sjögren Syndrome
	Ankylosing Spondylitis (AS) and Spondyloarthropathy
		Enthesitis Arthropathy
		Arthritis with Inflammatory Bowel Disease (IBD)
	Reactive Arthritis
		Juvenile Psoriatic Arthritis
	Juvenile Dermatomyositis (JDM)
	Systemic Scleroderma
	Localized Scleroderma
	Behcet's disease
	Vasculitic Disorders
		Henoch-Schönlein Purpura (HSP)
	Kawasaki Disease (KD)
	Polyarteritis Nodosa (PAN)
	Takayasu Arteritis
		Wegener Granulomatosis “Granulomatosis with Polyangiitis” (GPA)
	Pain Syndromes
		Growing Pain
		Hypermobility Syndrome
		Fibromyalgia
		Reflex Sympathetic Dystrophy
	Periodic Fever
		Familial Mediterranean Fever (MEFV)
		Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA)
		TNF Receptor-1-Associated Periodic Syndrome (TRAPS)
		Hyper-immunoglobulin (Ig) D Syndrome
	Suggested Readings
Infectious Diseases
	Prevention of Infectious Diseases
		Child-Care Center
		Prevention of Hospital and Office Infection
		Prevention of Infection Through Breast Feeding
		Medical Evaluation of Internationally Adopted Children
		Prevention of Vector-Borne Disease
		Recreational Water Use
		Infections in Immunocompromised Hosts
	Antibiotics
		Aminoglycosides, e.g., gentamicin, tobramycin, and amikacin
		Beta Lactam Antibiotics
		Penicillins, e.g., crystalline penicillin
		Ampicillin
		Amoxicillin-Clavulanate (Augmentin)
		Penicillinase Resistant Penicillins, e.g., naficillin or oxacillin
		Anti-Pseudomonal Penicillins, e.g., piperacillin and ticarcillin
		Cephalosporins (penicillinase-resistant)
		Carbapenems, e.g., imipenem/cilastatin and meropenem
		Monobactam, e.g., aztreonam
	Other Commonly used antibiotics
		Clindamycin
		Macrolides, e.g., azithromycin and clarithromycin
		Rifampin
		Fluoroquinolones, e.g., ciprofloxacin
		Tetracycline
		Trimethoprim/sulfamethoxazole
		Vancomycin
	Antivirals
		Acyclovir
		Valacyclovir
		Ganciclovir
		Foscarnet
	Other Antiviral Agents, Against DNA Viruses
		Nucleoside Reverse Transcriptase Inhibitors
		Nonnucleoside Reverse Transcriptase Inhibitors (NNRTI)
		Protease Inhibitors
	Antiparasites
		Permethrin
		Metronidazole
		Malathion
		Choloroquine
		Mefloquine and atovaquone/proguanil
	Antifungals
		Amphotericin B
		Fluconazole
		Griseofulvin
	Herpes Family Viruses (DNA Viruses)
		Herpes Simplex Virus (HSV)1 and HSV2
		Epstein–Barr Virus (EBV)
		Cytomegalovirus (CMV)
		Varicella-Zoster Virus (VZV); Chickenpox
		Shingles (Herpes Zoster)
		Human Herpesvirus Type (HHV)-6 or Roseola Infantum (Exanthem Subitum)
		Human Herpes Virus-7 (HHV-7)
		Human Herpes Virus-8 (HHV-8)
	Other DNA Viruses
		Parvovirus B19 (Erythema Infectiosum/Fifth Disease)
		Adenovirus
		Respiratory Viruses
		Influenza Virus
		Avian Influenza H5N1
		Parainfluenza Virus
		Respiratory Syncytial Virus
		Human Metapneumovirus
		Rhinoviruses (RVs)
		Severe Acute Respiratory Syndrome (SARS) Associated Coronavirus Infection
	Gastrointestinal Viral Infection
		Norwalk Virus
		Rotavirus
	RNA Viruses
		Enteroviruses
		Measles
		Mumps
		Rubella
		Rabies Virus
		West Nile Virus
		Dengue Fever
	Hepatitis A Virus (HAV)
	Hepatitis B Virus (HBV)
	Hepatitis C Viral Infection (HCV)
	Human Papilloma Virus (HPV)
	Bacterial Pathogens
		Gram Positive Bacteria
			S. aureus
		Toxic Shock Syndrome (TSS)
			Staphylococcal Scalded Skin Syndrome (SSSS)
			Staphylococcal, Coagulase-Negative
			Methicilin-Sensitive S. aureus (MSSA)
			Methicillin-Resistant Staphylococcus aureus (MRSA)
			Group B Streptococcus (GBS) or Streptococcus agalactiae
			Streptococcus pyogenes
		Group A Beta-Hemolytic Strepotococci (GABHS) Pharyngitis
		Scarlet Fever
		Impetigo
		Perianal Streptococcal Dermatitis
		Erysipelas GAS
		Acute Rheumatic Fever (ARF)
		Poststreptococcal Glomerulonephritis
		Streptococcal Toxic Shock Syndrome
		Pediatric Autoimmune Neuropsychiatric Disorder Associated with Group A Streptococci (PANDAS)
		Necrotizing Fasciitis
		Listeria monocytogenes
		Corynebacterium diphtheriae
		Enterococcus
		Bacillus anthracis
		Bacillus cereus
		Arcanobacterium haemolyticum
	Anaerobes
		Clostridium botulinum
		Clostridium perfringens
		Clostridium tetani
		Clostridium difficile
		Actinomycosis
	Gram Negative Bacteria
		Gram Negative Anaerobes
			Bacteroides and Fusobacterium anaerobes
			Campylobacter species
			Chlamydophila pneumonia
			Chlamydophila psittaci
			Chlamydia trachomatis
			Pneumonia due to C. trachomatis
			Neisseria gonorrhoeae (Gonococcal Infections)
			N. meningitidis (Meningococcal Infections)
			Helicobacter pylori
			Mycoplasma pneumonia
			Pasteurella multocida
			Bordetella pertussis
			Legionella pneumophilia
			Brucellosis
			Bartonella henselae (Cat-scratch disease)
			Citrobacter
			Klebsiella
			Pseudomonas species
			Nontyphoidal Salmonella
			Shigella
			Escherichia coli
			Yersinia enterocolitica
			Yersinia pestis
			Treponema pallidum
			Mycobacterium tuberculosis
			Mycobacterium avium-intracellulare
			Nocardia
			Candida Species
			Aspergillus
			Cryptococcosis
			Malassezia furfur
			Coccidioides (Coccidioidomycosis)
			Blastomyces
			Entamoeba histolytica
			Toxoplasma gondii (Toxoplasmosis)
			Plasmodium (Malaria)
	Helminthic Organisms
		Ascaris lumbricoides (Ascariasis)
		Necactor americanus (Hookworm) or Ancylostoma duodenale
		Trichuriasis (Whipworms)
		Trichinosis (Trichinella spiralis)
		Strongyloides sterocoralis
		Toxocariasis
		Cestodes (Platyhelminthes)
		Trematodes (Platyhelminthes)
		Fever Without Focus
			Febrile Neonate
			Fever in 1–3 Months Infants
			Fever in 3–36 Months of Age
			Fever of Unknown Origin (FUO)
	Central Nervous System (CNS) Infections
		Encephalitis
			Meningitis
		Brain Abscess
	Suggested Readings
Gastrointestinal Disorders
	Nutrition and Nutritional Disorders
		Vitamins
		Minerals
	Failure to Thrive
	Acute Abdominal Pain
		Clues to Acute Abdominal Pain
	Acute Appendicitis
	Volvulus
	Intussusception
	Acute Pancreatitis
	Acute Cholecystitis
	Choledocholithiasis and Cholangitis
	Inguinal Hernia
	Esophagus
		Esophageal Atresia, Tracheoesophageal Fistula (TEF)
	Regurgitation
	Rumination
	Gastroesophageal Reflux (GER)
	Gastroesophageal Reflux Disease (GERD)
	Eosinophilic Esophagitis (EE)
	Esophageal Varices
	Foreign Body in the Esophagus
	Caustic Esophageal Injuries
	Stomach
		Vomiting
			Diagnostic Clues to a Child with Vomiting
	Cyclic Vomiting (Abdominal Migraine)
	Peptic Ulcer Disease
	Zollinger–Ellison Syndrome (ZES)
	Foreign Body in the Stomach
	Bezoars
	Pyloric Stenosis
	Duodenal Obstruction
	Superior Mesenteric Artery Syndrome (Cast Syndrome)
	Constipation
	Anal Fissure
	Hirschsprung Disease
	Rectal Prolapse
	Recurrent Abdominal Pain (RAP)
	Inflammatory Bowel Disease (IBD)
	Ulcerative Colitis (UC)
	Crohn’s Disease (CD)
	Irritable Bowel Syndrome (IBS)
	Gluten-Sensitive Enteropathy (Celiac disease)
	Cystic Fibrosis (CF)
	Shwachman–Diamond Syndrome
	Protein Losing Enteropathy
	Intestinal Lymphangiectasia
	Short Bowel Syndrome
	Small Bowel Bacterial Overgrowth
	Diarrhea
	VIPoma
		Chronic Diarrhea
	Chronic Nonspecific Diarrhea (CNSD)
	Disaccharide Intolerance
	Secondary Lactase Deficiency
	Intractable Diarrhea of Infancy
	Allergic Enteropathy
	Allergic Colitis
	Immunodeficiency States Associated with Chronic Diarrhea
	Congenital Secretory Diarrhea
	Tufting Enteropathy
	Microvillus Inclusion Disease
	Johanson–Blizzard Syndrome
	Pearson Syndrome
	Gastrointestinal Bleeding (Fig. 6)
	Upper GI Bleeding
		Hematemesis
	Mallory–Weiss Tear Syndrome
	Reactive Gastritis
	Esophageal Varices
	Lower GI Bleeding (Hematochezia)
	Meckel Diverticulum (MD)
	Bright Red Rectal Bleeding
	Occult Blood Loss
	Hamartomatous Polyposis
	Juvenile Polyposis
	Peutz–Jegher Syndrome
	Wilson’s Disease
	Jaundice
	Cholestasis
	Biliary Atresia (BA)
	Alagille Syndrome
	Hepatomegaly
	Hepatitis B Virus Infection
	Hepatitis C Virus Infection
	Autoimmune Hepatitis
	Fulminant Hepatitis
	Portal Hypertension
	Suggested Readings
Respiratory Disorders
	Diagnostic Testing for Respiratory Conditions
	Pulmonary Function Testing (PFT)
	Stridor
	Cough
	Clubbing of Digits or Hypertrophic Pulmonary Osteodystrophy
	Hemoptysis
	Croup
	Bacterial Tracheitis
	Common Cold
	Acute Bronchiolitis
	Asthma
		Management of Asthma
	Asthma Medications
		β2-Agonists
	Inhaled Corticosteroids
	Leukotriene Antagonists
		Prognosis of Asthma
	Pneumonia
		Pneumonia with Associated Exanthems
		Pneumonia via Animal Vectors
		Pneumonia Pathogens by Geographic Tropism
		Five Years Through Adolescence
		Three Months to Four Years
		Three Weeks to Three Months
		Pleural Effusion
	Pneumothorax
	Aspiration Syndrome
	Foreign Body Aspiration
	Pulmonary Abscess
		Congenital Pulmonary Malformations
	Primary Ciliary Dyskinesia (PCD)
	Bronchiectasis
	Bronchopulmonary Dysplasia
	Pulmonary Hemosiderosis
	Sarcoidosis
	Cystic Fibrosis
	Obstructive Sleep Apnea (OSA)
	ALTE/Sudden Infant Death Syndrome
	Chest Deformities
	Suggested Readings
Cardiovascular Disorders
	Chest Pain
	Syncope
	Murmur
	Congestive Heart Failure
	ECG Interpretation and Cardiac Arrhythmias
	Sinus Rhythm and Sinus Arrhythmia
	Premature Atrial Contractions
	Atrial Flutter
	Atrial Fibrillation (AF)
	Supraventricular Tachycardia (SVT)
	Wolff–Parkinson–White (WPW) Syndrome
	Sick Sinus Syndrome (SSS)
	Premature Ventricular Contractions (PVC)
	Prolonged Q–T Interval
	Long QT Syndrome (LQTS)
	Ventricular Tachycardia
	Ventricular Fibrillation
	Atrioventricular Block
	Congenital Heart Defects
		Atrial Septal Defect (ASD)
		Ventricular Septal Defect (VSD)
	Patent Ductus Arteriosus (PDA)
	Pulmonary Valve Stenosis (PS)
	Peripheral Pulmonary Stenosis (PPS)
	Aortic Stenosis (AS)
	Coarctation of Aorta
	Tetralogy of Fallot
	Ebstein Anomaly
	Transposition of Great Arteries
	Total Anomalous Pulmonary Venous Return (TAPVR)
	Truncus Arteriosus
	Hypoplastic Left Heart Syndrome
	Infective Endocarditis (IE)
	Acute Pericarditis
	Constrictive Pericarditis
	Cardiac Tamponade
	Acute Rheumatic Fever (ARF)
	Kawasaki Disease (KD)
	Myocarditis
	Cardiomyopathies
		Dilated Cardiomyopathy
		Hypertrophic Cardiomyopathy
		Restrictive Cardiomyopathy
	Dyslipidemia
	Suggested Readings
Blood and Neoplastic Disorders
	Abbreviations
	Blood Disorders
	Red Cell Disorders
		Anemia
	Anemia in the Newborn
		Hemolysis
	Approach to Diagnosis of Anemia in Older Child
	Iron Deficiency Anemia (IDA)
	Anemia of Chronic Disease
	Lead Poisoning
	Thalassemias
		Alpha Thalassemia
			Alpha Thalassemia Syndromes
		Beta Thalassemia
			Beta Thalassemia Syndromes
		Other Hemoglobinopathies
		Rare Disorders
	Macrocytic Anemia (MCV > 100 in Child Older than 2)
		Folic Acid Deficiency
		Vitamin B12 Deficiency
	Pearson Marrow–Pancreas Syndrome
	Diamond–Blackfan Anemia (Congenital Hypoplastic Anemia)
	Normocytic Anemia (MCV > 70 + Age and < 100 in Child Older Than 2; Fig. 7)
	Transient Erythroblastopenia Childhood
	Hereditary Spherocytosis
	Hereditary Elliptocytisis
	Paroxysmal Nocturnal Hemoglobinurinia
		Sickle Cell Disease (SCD)
			Methemoglobinemia
		Pyruvate Kinase Deficiency
		Glucose-6-Phosphate Dehydrogenase
			Other Enzyme Deficiencies
	Autoimmune Hemolytic Anemia
	Hemolytic Anemia Secondary to Extracellular Factors
		Erythrocytosis
		Fanconi Anemia
		Shwachman–Diamond Syndrome
	White Cell Disorders
		Neutropenia
	Platelet Disorders (Fig. 10)
		Thrombocytopenia
		Decreased Production
			Amegakaryocytic Thrombocytopenia
		Thrombocytopenia Absent Radius Syndrome (TARS)
		Increased Destruction
			Idiopathic Thrombocytopenic Purpura (ITP)
			Hemolytic uremic syndrome
			Thrombotic Thrombocytopenia Purpura (TTP)
	Abnormal Platelets
		Wiskott–Aldrich Syndrome
		Bernard–Soulier Syndrome
		Glanzmann Thrboathenia
	Coagulation Disorders
		Hemophilia
		Von Willebrand Disease
		Disseminated Intravenous Coagulopathy
	Neoplastic Disorders
		Acute Leukemia
	Lymphadenopathy
	Hodgkin Lymphoma
	Non-Hodgkin Lymphoma
	Brain Tumors
	Neuroblastoma
	Wilms Tumor
	Rhabdomyosarcoma
	Osteosarcoma
	Ewing Sarcoma
	Osteoid Osteoma
	Retinoblastoma
	Hepatoblastoma
	Suggested Readings
Renal Disorders
	Normal Renal Function
	Proteinuria
	Nephrotic Syndrome
	Hematuria
	Hypertension [5]
	Glomerular Abnormalities Presenting with Predominantly Nephritic Syndrome
		Acute Postinfectious Glomerulonephritis
		IgA Nephropathy (Berger’s Disease)
		Alport Syndrome
		Nail–Patella Syndrome
		Membranoproliferative Glomerulonephritis (MPGN)
		Dense Deposit Disease (MPGN Type II)
		Lupus Nephritis (LN)
		Henoch–Schonlein Purpura (HSP)
		Anti-Glomerular Basement Disease and Good Pasture Syndrome
		Familial Thin Basement Membrane Nephropathy
	Glomerular Abnormalities Presenting with Predominantly Nephrotic Syndrome
		Congenital Nephrotic Syndrome
		Infantile Nephrotic Syndrome
		Frasier Syndrome
		Denys–Drash Syndrome
		Membranous Nephropathy (MN)
	Tubular Abnormalities
		Idiopathic Hypercalciuria [3]
		Renal Tubular Acidosis (RTA)
		Nephrogenic Diabetes Insipidus (NDI)
		Bartter Syndrome
		Acute Interstitial Nephritis (AIN)
		Cystinosis
		Sickle Cell Nephropathy
	Cystic Kidney Diseases
		Autosomal Recessive Polycystic Kidney Disease (ARPKD)
		Autosomal Dominant Polycystic Kidney Disease (ADPKD)
		Nephronophthisis (NPH)
		Laurence–Moon–Bardet–Biedl Syndrome
		Multicystic Dysplastic Kidney Disease
		Acute Kidney Injury (AKI) [1, 2]
		Hemolytic Uremic Syndrome (HUS)
		Acute Tubular Necrosis (ATN)
		Nocturnal Enuresis [4]
		Renal Vein Thrombosis (RVT)
	Dehydration and Maintenance Fluid Calculations
		Maintenance Fluid Requirements
		Classification of Dehydration by Severity
		Calculating Replacement in Various Types of Dehydration
	Suggested Readings
Urologic Disorders
	Urinary Tract Infection (UTI)
	Vesicoureteral Reflux (VUR)
	Ureteropelvic Junction Obstruction
	Ureterocele
	Posterior Urethral Valve
	Female Urethral Prolapse
	Prune-Belly Syndrome (Eagle–Barrett Syndrome)
	Urinary Incontinence
	Bladder Exstrophy
	Hypospadias
	Phimosis
	Paraphimosis
	Posthitis
	Circumcision
	Micropenis
	Testicular Torsion
	Neonatal Testicular Torsion
	Testicular Appendage Torsion
	Cryptorchidism
	Varicoceles
	Hydroceles
	Kidney Stones
	Urethral Injuries
	Suggested Readings
Endocrine Disorders
	Growth
		Approach the Child with Worrisome Growth
	Constitutional Delay of Growth and Puberty (CDGP)
	Familial/Genetic Short Stature
	Psychosocial Dwarfism
		Other Causes of Short Stature
	Pituitary Gland
	Congenital Hypopituitarism
	Neonatal Hypoglycemia
	Craniopharyngioma
	Diabetes Insipidus (DI)
	Syndrome of Inappropriate ADH Secretion (SIADH)
	Cerebral Salt Wasting
	Hyperpituitarism
	Prolactinoma
	SMRs
	Precocious Puberty
	McCune–Albright Syndrome (MAS)
	Premature Adrenarche
	Premature Thelarche
	Premature Menarche
	Thyroid Gland
		Introduction
	Congenital Hypothyroidism
	Hashimoto, Lymphocytic Thyroiditis (Autoimmune Thyroiditis)
	Subacute (de Quervain) Thyroiditis
	Graves Disease
	Neonatal Thyrotoxicosis
	Solitary Thyroid Nodules
	Thyroid Cancer
	Thyroid Storm
	Hypocalcemia
	Hypoparathyroidism
	Pseudohypoparathyroidism (PHP; Albright Hereditary Osteodystrophy (AHO))
	Familial Hypocalciuric Hypercalcemia (Familial Benign Hypercalcemia)
	Hyperparathyroidism
	Rickets
		Vitamin D Deficiency Rickets
	Hypophosphatemic Rickets (X-linked Hypophosphatemic Rickets)
	Cushing Syndrome
	Hyperaldosteronism
	Addison Disease
	Pheochromocytoma
	Primary Hypogonadism
	Klinefelter Syndrome (See Genetics Chapter for More Details)
	Gynecomastia
	Turner Syndrome (See Genetic Chapter for More Details)
	Denys-Drash Syndrome
	Swyer Syndrome (XY Pure Gonadal Dysgenesis)
	5 -Alpha-Reductase Deficiency
	Androgen Insensitivity Syndrome (AIS)
	Diabetes Mellitus
		Type 1 Diabetes Mellitus
	Type 2 Diabetes Mellitus
	Diabetes Ketoacidosis
	Outpatient Management of Sick Days in Patient With DM
	Maturity-Onset Diabetes of Youth (MODY)
	Obesity
	Suggested Readings
Pediatric Neurology
	Abbreviations
	Seizures and Epilepsy
		Classification of Seizure Types
		Febrile Seizures
		Neonatal Seizures
		Infantile Spasms
		Childhood Absence Epilepsy
		Benign Epilepsy with Centrotemporal Spikes (BECTS)
		Juvenile Myoclonic Epilepsy
		Lennox–Gastaut Syndrome
		Landau–Kleffner Syndrome
		Rasmussen’s Encephalitis
		Status Epilepticus
	Epilepsy Mimics
		Breath Holding Spells
		Sandifer’s Syndrome
		Syncope
		Night Terrors
		Movement Disorders
	Idiopathic Intracranial Hypertension
	Treatment of Primary Headache Syndromes
	Diagnosis of Primary Headache Syndromes
	Headache “Red Flags”
	Chronic Progressive Headache
	Chronic Nonprogressive Headache
	Tension Headache
	Migraine Headache
	Headache
	Malformations of the Brain
		Arnold–Chiari Malformation Type I
		Arnold–Chiari Malformation Type II
		Lissencephaly
		Polymicrogyria
		Agenesis of Corpus Callosum
		Dandy–Walker Malformation
		Disorders of Head Growth
			Microcephaly
		Macrocephaly
		Hydrocephalus
		Craniosynostosis
		Vascular Anomalies
			Stroke
		Arteriovenous Malformations (AVMs)
		Vein of Galen Malformation
		Cerebral Venous Thrombosis
		Epidural Hemorrhage
		Subdural Hemorrhage
		Subarachnoid Hemorrhage
	Spinal Cord Disease
		Tethered Cord
		Spina Bifida Occulta
		Meningocele
		Myelomeningocele
		Transverse Myelitis
	Disorders of the Neuromuscular Junction
		Myasthenia Gravis
		Botulism
	Primary Muscle Disease (Myopahties)
		Duchenne Muscular Dystrophy
		Becker’s Muscular Dystrophy
		Congenital Myotonic Dystrophy
	Neuropathies
		Acute Inflammatory Demyelinating Polyneuropathy (Guillain–Barre Syndrome, GBS)
		Hereditary Motor Sensory Neuropathy (Charcot–Marie–Tooth Disease)
		Spinal Muscular Atrophy (SMA)
		Familial Dysautomomia (Riley–Day Syndrome)
		Bell’s Palsy
	Disorders of Movement
		Ataxia
		Acute Cerebellar Ataxia
		Ataxia Telangiectasia
		Friedreich Ataxia
		Tics
		Tourette Syndrome
		Sydenham’s Chorea
	Developmental Disorders
		Cerebral Palsy
		Spastic Hemiplegia
		Spastic Diplegia
		Spastic Quadriplegia
		Dyskinetic Cerebral Palsy
		Rett Syndrome
	Suggested Readings
Eye Disorders
	Ophthalmia Neonatorum
	Ophthalmia Neonatorum due to N. Gonorrhoeae
	Ophthalmia Neonatorum due to Chlamydia
	Acute Bacterial Conjunctivitis
	Parinaud Oculoglandular Syndrome
	Acute Hemorrhagic Conjunctivitis
	Pharyngoconjunctival Fever
	Herpes Simplex Virus Conjunctivitis
	Parasitic Conjunctivitis
	Atopic (Seasonal) Allergic Conjunctivitis
	Anterior Uveitis
	Preseptal Cellulitis
	Orbital Cellulitis
	Hordeolum (Stye) and Chalazion
	Nasolacrimal Duct Obstruction (Congenital Dacryostenosis)
	Congenital Ptosis
	Acquired Ptosis
	Congenital Glaucoma
	Congenital Cataract
	Retinoblastoma (RB)
	Papilledema
	Optic Neuritis
	Retinopathy of Prematurity (ROP)
	Orbital Fracture
	Corneal Abrasion
	Eye Foreign Body
	Hyphema
	Amblyopia
	Nystagmus
	Suggested Readings
Ear, Nose, and Throat Disorders
	Ears
		Preauricular Pits/Sinus (PPS)
		Otitis Externa
		Foreign Body in the External Ear
		Hematoma of the Ear Pinna
		Acute Otitis Media (AOM)
		Otitis Media with Effusion (OME)
		Chronic Suppurative Otitis Media (CSOM)
		Acute Mastoiditis (AM)
		Cholesteatoma
		Labrynthitis
		Vertigo
		Benign Paroxysmal Positional Vertigo (BPPV)
		Meniere Disease
		Congenital Hearing Loss
		Genetic Syndromic Hearing Loss
		Genetic Nonsyndromic Hearing Loss
		Universal Newborn Hearing Screening
		Pediatric Audiometric Testing
			Evoked Otoacoustic Emission (OAE)
			Auditory Brainstem Response (ABR)
		Testing Methods
			Behavioral Observation Audiometry (BOA)
			Visual Response Audiometry (VRA)
			Play Audiometry
			Conventional Audiometry
		Hearing Loss Classification
		Tympanometry
		Patterns of Hearing Loss
			Three Main Types of Hearing Loss
		Common Clinical Scenarios
			Clues to Hearing Loss in a Child Visit
		Sound Amplification Devices
			Hearing Aids
			Bone-Anchored Hearing Aid (Osteointegrated Auditory Implant)
			Cochlear Implants
	Nose and Nasopharynx
		Choanal Atresia
		Epistaxis
		Allergic Rhinitis
			Common Cold
		Nasal Trauma
	Sinuses
		Acute Rhinosinusitis
		Chronic Sinusitis
			Frontal Sinus Trauma
	Throat
		Pharyngitis
		Peritonsillar Abscess
		Retropharyngeal Abscess
	Mouth and Oropharynx
		Aphthous Ulcers
		Herpangina
		Hand-Foot-Mouth Disease (HFMD)
		Gingivostomatitis
		Ankyloglossia
		Mucocele
		Parotitis
		Cleft Lip and Palate
		Robin Sequence (RS)
		Delayed Dental Eruption
		Odontogenic Infection
		Early Childhood Caries
		Dental Trauma and Avulsions
	Neck
		Cervical Lymphadenitis
		Infectious Mononucleosis
		Cat-Scratch Disease
		Atypical Mycobacteria
		Other Causes Lymphadenitis
		Lymphoma
		Thyroglossal Cyst
		Branchial Cleft Cyst
		Lymphatic Malformation
		Acute Laryngitis
		Chronic Laryngitis/Hoarseness
		Vocal Fold Paralysis
	Surgical Interventions
		Indication for Tonsillectomy (+/− Adenoidectomy) [2, 9]
		Indication for Adenoidectomy Alone
		Postsurgical Complications of Adenotonsillectomy
		Indication for Myringotomy and Tympanostomy Tubes for Acute Otitis Media (AOM) and Otitis Media with
		Complications of Tympanostomy Tubes
	Suggested Readings
Skin Disorders
	Skin Disorders in Neonates
		Erythema Toxicum
	Transient Neonatal Pustular Melanosis
	Intertrigo
	Miliaria
	Nevus Sebaceous (of Jadassohn)
	Dermatitis
		Atopic Dermatitis
	Nummular Eczema
	Allergic Contact Dermatitis
	Seborrheic Dermatitis
	Acne
		Acne Vulgaris
	Fungal and Yeast Infections
		Thrush
		Tinea Capitis
		Tinea Corporis
		Tinea Cruris
		Tinea Pedis
		Tinea Versicolor
		Onychomycosis
	Infestations
		Scabies
		Head Lice
	Papulosquamous Diseases
		Psoriasis
		Pityriasis Rosea
	Vascular Lesions
		Infantile Hemangioma
	Vascular Malformation
		Capillary Malformation
		Arteriovenous Malformation
	Vascular Reaction
		Papular Urticaria
		Erythema Multiforme (EM)
		Papular Urticaria
		Urticaria Pigmentosa
	Localized Bacterial Skin Infections
		Impetigo (Pyoderma)
		Streptococcal Cellulitis
		Necrotizing Fasciitis
	Localized Viral Infections
		Molluscum contagiosum
		Condyloma Acuminatum (Ano-Genital Warts)
	Hair Disorders
		Alopecia Areata
		Trichotillomania
		Telogen Effluvium
		Anagen Effluvium
	Disorders of Hyperpigmentation
		Acanthosis Nigricans
		Malignant Melanoma
	Miscellaneous
		Granuloma Annulare
		Acrodermatitis Enteropathica
		Incontinentia Pigmenti
	Suggested Readings
Orthopedics Disorders and Sport Injuries
	Developmental Dysplasia of the Hip (DDH)
	Legg–Calve–Perthes Disease
	Slipped Capital Femoral Epiphysis (SCFE)
	Transient Synovitis
	How to differentiate between transient synovitis and septic arthritis of the hip joint? (Table 1
	Septic Arthritis
	Acute Hematogenous Osteomyelitis
	Genu Varum
	Genu Valgum
	Osgood–Schlatter Disease
	Osteochondritis Dissecans
	Recurrent Patellar Dislocation/Subluxation
	Popliteal Cyst (Baker Cyst)
	Patellofemoral Pain Syndrome
	Intoeing
	Femoral Anteversion
	Internal Tibial Torsion
	Metatarsus Adductus
	Clubfoot (Talipes Equinovarus)
	Calcaneovalgus Foot
	Cavus Foot
	Flat Foot (Pes Planus)
	Tarsal Coalition
	Tip Toe Walking
	Adolescent Hallux Valgus
	Ingrowing Toenail
	Sever’s Disease
	Madelung Deformity
	Meniscal Injury of the Knee
	Medial Collateral Ligament Injury (MCL)
	Anterior Cruciate Ligament (ACL) Injury
	Ankle Sprain
	Hip Dislocation
	Nursemaid Elbow (Pulled Elbow)
	Anterior Shoulder (Glenohumeral) Dislocation
	Acromioclavicular Dislocation
	Compartment Syndrome
	Salter–Harris Injuries
	Clavicular Fracture
	Proximal Humeral Fracture
	Humerus Fracture
	Lateral Condyle Fracture
	Medial Epicondyle Fracture
	Scaphoid Fracture
	Tibial Shaft Fracture
	Toddler Fracture
	Ankle Fracture
	Fracture of the Base of the Fifth Metatarsal Bone
	Unicameral Cyst
	Aneurysmal Bone Cyst (ABC)
	Ewing’s Sarcoma
	Osteoid Osteoma
	Osteochondroma
	Torticollis
	Atlantoaxial Subluxation
	Scoliosis
	Adolescent Idiopathic Scoliosis
	Diskitis and Vertebral Body Osteomyelitis
	Spondylolysis
	Polydactyly of the Hand
	Suggested Readings
Research and Statistics
	Randomized Controlled Trials
	Cohort Studies
	Case-Control Studies
	Cross-Sectional Studies
	Case Studies
	Systematic Reviews
	Meta-analyses
	Case Reports
	Anecdotal Evidence
	Descriptive Epidemiologic Studies
	Validity
	Reliability
	Sensitivity: Screening
	Specificity: Confirmation
	Positive Predictive Value (PPV)
	Negative Predictive Value (NPV)
	p Value
	False Positive
	False Negative
	Odds Ratio (OR)
	Relative Risk (RR)
	Suggested Readings
Radiology Review
	Case 1
	Case 2
	Case 3
	Case 4
	Case 5
	Case 6
	Case 7
	Case 8
	Case 9
	Case 10
	Case 11
	Case 12
	Case 13
	Case 14
	Case 15
	Case 16
	Case 17
	Case 18
	Case 19
	Case 20
	Case 21
	Case 22
	Case 23
	Case 24
	Case 25
	Case 26
	Case 27
	Case 28
	Case 29
	Case 30
	Case 31
	Case 32
	Case 33
	Case 34
	Case 35
	Case 36
	Case 37
	Case 38
	Case 39
	Case 40
	Case 41
	Case 42
	Case 43
	Case 44
	Case 45
	Case 46
	Case 47
	Case 48
	Case 49
	Case 50
	Case 51
	Case 52
	Case 53
	Case 54
	Case 55
	Case 56
	Case 57
	Case 58
	Case 59
	Case 60
	Case 61
	Case 62
	Case 63
	Case 64
	Case 65
	Case 66
	Case 67
	Case 68
	Case 69
	Case 70
	Case 71
	Case 72
The Last Minute Review
	Allergic and Immunologic Disorders
	Adolescent Medicine
	Cardiovascular Disorders
	Skin Disorders
	Endocrine Disorders
	Emergency Care
	General Pediatrics
	Gastrointestinal Disorders
	GENETICS AND DYSMORPHOLOGY
	Blood and Neoplastic Disorders
	Infectious Diseases
	Metabolic Disorders
	Neonatology
	Neurology
	Renal Disorders
	Orthopedic Disorders and Sport Injuries
	Respiratory Disorders
	Rheumatic Diseases of Childhood
	Psychosocial Disorders
Index
                        
Document Text Contents
Page 2

Pediatric Board Study Guide

Page 305

300 K. Hardy and O. Naga

Asthma Medications

β2-Agonists

• Relieve the constriction by binding to specific receptors
on airway smooth muscles cells.

• SABAs such as albuterol have rapid onset of action:
within 15 min and relatively short duration of action
approximately 3–4 h.

• LABAs effect can last up to 12 h.
• Use of LABAs alone is not recommended and put the

patient at risk for sudden and life threatening asthma
exacerbation.

• Frequent use of β2-agonists indicates poor asthma control.
• Potential adverse effects
− Agitation, irritability, tremors.
− Insomnia, tachycardia, arrhythmia, and agitation.
− Hypokalemia.
− Patients with diabetes mellitus are at risk of hypogly-

cemia.

Inhaled Corticosteroids

• Inhaled corticosteroids are the most commonly prescribed
maintenance therapy for asthma.

• They effectively decrease airway inflammation, decrease
bronchial hypersensitiveness, relieve asthma symptoms,
and improve lung function.

• Slowing growth and adrenal suppression is a risk in the
patients who require high-dose ICSs.

• To minimize the risk of adverse effects, eliminate triggers
that contribute to airway inflammation.

• Adverse effects
− Oral thrush
− Oral deposition and absorption of drug

◦ Rinse the mouth after taking the medication.
◦ Use metered dose inhaler.

Leukotriene Antagonists

• They block inflammatory pathways that are active in the
disease.

• Most commonly used in children younger than 12 years is
montelukast.

• It is usually well tolerated.
• Montelukast frequently used as add-on therapy in addi-

tion to ICSs.
• Can be beneficial in patients with comorbid allergic rhi-

nitis, recurrent viral-induced asthma exacerbation, and
children with exercise-induced asthma.

Prognosis of Asthma

• Children at significant risk of having asthma symptoms
later in life
− Children with early onset asthma < 3 years of age:
◦ Who had three or more episode of wheezing per

year and at least one major criterion (Eczema or
parental eczema).

◦ Or at least two minor criteria (allergic rhinitis,
wheezing unrelated to colds, or blood eosinophil
count > 4 %).

Pneumonia

Definition
• Infection of lung parenchyma

Table 4 Severity and initiating treatment: children 12 years of age and older
Severity category Days and night with symptoms Pulmonary function Preferred treatment
Intermittent ≤ 2 days/week (days)

≤ 2 night/month (nights)
FEV1: > 80 %
FEV1/FVC: Normal

Step1: SABA PRN

Mild persistent 3–6 days/week (days)
3–4 nights/month (nights)

FEV1: > 80 %
FEV1/FVC: Normal

Step 2: Low-dose ICS

Moderate persistent Daily (days)
2–6 nights/week (nights)

FEV1: 60–80 %
FEV1/FVC: Reduced 5 %

Step 3: Medium-dose
ICS + LABA or Medium-dose ICS
and consider short-course OCS

Severe persistent Throughout (days)
Often, 7 times/week (nights)

FEV1: < 60 %
FEV1/FVC: Reduced > 5 %

Step 5: High-dose ICS + LABA
and consider short-course OCS
Step 4: Medium-dose
ICS + LABA and consider short-
course OCS

OCS oral corticosteroids, LABA long-acting beta2 agonist, SABA short-acting beta2 agonist, FEV1 forced expiratory volume in 1 s, FVC forced
vital capacity, ICS inhaled corticosteroid. Tables 2–4 are adapted from the National Asthma Education and Prevention Program. Expert Panel
Report 3: Guidelines for the Diagnosis and Management of Asthma, 2007.

Page 306

Respiratory Disorders 301

Causes of Pneumonia in Typical Age Groupings:

Three Weeks to Three Months
• Chlamydia trachomatis
− Interstitial infiltrate on chest radiograph

• Respiratory syncytial virus
− Bronchiolitis or pneumonia

• Parainfluenza
− Bronchiolitis or pneumonia

• Streptococcus pneumoniae
− Major cause of pneumonia throughout childhood

• Bordetella pertussis
− Tracheobronchitis with severe paroxysm, usually no

fever
− Pneumonia may occur secondary to aspiration

Three Months to Four Years
• RSV, parainfluenza, human metapneumovirus, influenza,

and rhinovirus
− Most toddler pneumonia is viral

• Streptococcus pneumonia
− Major treatable pathogen in this age group

• Mycoplasma pneumonia
− Increased incidence in children approaching school

age

Five Years Through Adolescence
• M. pneumonia
• Chlamydophila pneumoniae
− Similar clinical presentation to mycoplasma

• S. pneumoniae
• Mycobacterium tuberculosis

Pneumonia Pathogens by Geographic Tropism
• Histoplasmosis

− Ohio and Mississippi River Valleys and Caribbean
• Coccidioidomycosis
− California, Arizona, and New Mexico

• Blastomycosis
− Ohio, Mississippi River Valleys; Great salt lakes states

• Legionella
− Infected water worldwide

• Severe acute respiratory syndrome
− Asia

• Avian influenza
− Southeast Asia

Pneumonia via Animal Vectors
• Tularemia

− Rabbits and ticks
• Psittacosis
− Birds specially parakeets

• Q fever
− Sheep, cow, and goats

Pneumonia with Associated Exanthems
• Varicella

− Human-to-human spread via airborne droplets nuclei
• Measles
− Human-to-human spread via droplet

Clinical presentation
• The hallmark symptoms of pneumonia are fever and

cough.
• Most of the children with fever and cough do not have

pneumonia.
• Tachypnea, retractions (intercostal, subcostal, supraster-

nal), wheezing, nasal flaring, and grunting, apnea and
abdominal pain should be noted.

• Grunting, in particular, may be a sign of pneumonia
as well as of impending respiratory failure in younger
patients/infants.

• Tachypnea is the most sensitive and specific sign of pneu-
monia. Know the World Health Organization (WHO)
Criteria as follows.
– > 50 breaths/min at 2–12 months of age.
– > 40 breaths/min at 1–5 years
– > 20 breaths/min for those older than 5 years
– Subtracting 10 if the child is febrile

• Dullness to percussion, crackles, decreased breath
sounds, and bronchial breath.

Fig. 3 Nine-year-old female presents with cough and fever. Chest
X-ray shows right upper lobe infiltrate

Page 610

613Index

viral infection, 287
virus, 213

Hepatitis C
viral infection, 213, 214, 288

Hepatomegaly, 58, 60, 106, 111, 143, 240, 286, 287, 288, 289, 317
asymptomatic, 286

Hereditary angioedema (HAE), 167
Hip joint disorders, 507
Hirschsprung disease, 48, 86, 144, 272
Hydroceles, 400
Hyperbilirubinemia, 123, 130, 131, 132, 133, 263

conjugated, 286
management of, 134
unconjugated, 132, 135

Hyperparathyroidism, 269, 376, 417, 419, 420
Hypertension, 23, 42, 57, 66, 76, 376, 378

causes of, 376
chronic, 128
intracranial, 251
maternal, 137, 139
portal, 284, 290
pulmonary, 110, 181, 313

Hyphema, 370, 466
Hypoglycemia, 25, 80, 101, 289, 288, 102, 408
Hypoparathyroidism, 308, 349

primary, 419
Hypospadius, 127, 397
Hypoxic ischemic encephalopathy (HIE), 146, 147, 445

I
Immunization, 25, 47, 150, 194, 208, 231
Immunology, 167
Impact of mass media, 47
Impetigo, 220

bullous, 216
staphylococcal, 54, 201

Infantile colic, 27
Infant of diabetic mother, 144, 408
Inflammatory bowel disease (IBD), 52, 166, 227, 250, 259, 273, 276,

350
Iron ingestion, 70

J
Jaundice, 92, 109, 110, 123, 124, 135, 142, 203, 212, 217, 235, 263,

264, 270, 286, 348, 352, 356, 393, 417
neonatal, 356
obstructive, 248
physiologic, 131
premature infants, 132
progressive, 289

Juvenile psoriatic arthritis, 184, 185
Juvenile rheumatoid arthritis (JRA), 177, 239, 313

K
Kidney stones, 115, 400, 401

calcium oxalate, 275
Klinefelter syndrome, 1, 88, 154, 426, 427
Knee disorders, 508, 522, 523

L
Lacerations, 27, 72, 73

of vagina, 154
Language development, 8, 51
Learning disabilities (LD), 34, 51, 453

specific, 42, 43

Limb pain, 27
Lysosomal storage disorders, 112

M
Macrocephaly, 105, 445
Malignant melanoma, 504
Marfan syndrome, 94, 95, 96, 313, 314, 462, 524
mastocytosis, 502
Maturity onset diabetes of youth (MODY), 431
Meckel diverticulum (MD), 262, 282, 284, 285
Meconium ileus, 144, 308
Meningitis, 140, 188, 195, 196, 198, 208, 218, 238, 252, 464, 505

acute bacterial, 236
aseptic, 209, 252
aspetic, 201
bacterial, 230
HSV, 202
mollaret, 202
pneumococcal, 218

Meta-analyses, 543
Microcephaly, 2, 87, 88, 93, 116, 142, 148, 358, 444, 445, 446
Microphilus, 398
Miscellaneous, 400, 505
Mitochondrial disorders, 84, 85
Mood and affect disorders, 31
Movement, 22, 38, 72

bowel, 271, 273
clonic, 112
disorders, 440, 451, 452
involuntary, 455
stereotypic, 39
voluntary, 119

Multifactorial inheritance, 85
characteristics, 85

N
Necrotizing enterocolitis (NEC), 130, 144, 145, 223
Necrotizing fasciitis, 223, 226, 503, 505
Neonatal brachial plexus palsy (BPP), 125
Neonatal hypoglycemia, 408
Neuromuscular, 27, 75, 304, 310, 311, 356, 537
Newborn screening, 21, 87, 308
Normal renal function, 373, 379
Nutrition and nutrional disorders, 257
Nutrition and nutritional disorders, 257
Nystagmus, 468

O
Obesity, 47, 84, 116, 149, 429, 431
Odds ratio (OR), 545
Oppositional defiant disorder, 37, 51
Optic nerve neuritis or papillitis, 464
Orbital cellulitis, 460, 461
Orbital fracture, 465
Organic acidemias, 101, 102
Osteogenesis imperfecta, 54, 97

P
Pain, 49, 69, 155, 262

abdominal, 55, 57, 113, 127, 154, 156, 181, 187, 188, 191, 213,
238, 268, 269

epigastric, 266, 270
growing, 189
muscular, 190
neck, 229
throat, 152

Page 611

614 Index

Papilledema, 464
Pediatric pulmonology, 295, 306
Peptic ulcer disease, 268, 269, 273
Peutz–Jegher syndrome, 286
Pituitary gland, 154, 406, 407, 408
Pityriasis rosea, 499
Plagiocephaly, 2, 3, 100

anterior, 99
Pneumonia, 57, 61, 62, 86, 126, 140, 141, 204, 205, 211, 217, 223,

231, 234, 236, 249, 261, 292, 298, 300, 359, 410
chlamydophila, 227
cryptococcal, 244
due to C trachomatis, 227, 228
mycoplasma, 231
outpatient, 218

Poisoning, 25, 33, 65
carbon monoxide, 70
lead, 347

Polycythemia, 87, 130, 138
Polyscystic ovary disease, 427, 428
Prader-willi syndrome (PWS), 2, 43, 84, 91, 92, 405, 431
Presenting with predominantly nephritic syndrome, 378
Presenting with predominantly nephrotic syndrome, 381
Prevention of infectious diseases, 193
Primary ciliary dyskinesia (PCD), 305
Prolactinoma, 411, 427
Proteinuria, 122, 164, 181, 191, 373, 375, 378, 379, 380, 381, 386

orthostatic, 373
persistent, 374
transient, 373

Protozoal infection, 245
Psychosomatic disorders, 48, 49
Puncture wounds, 27, 72, 73, 225
Pyloric stenosis, 268, 270

R
Randomized controlled trials, 543
Reflex, 112

while papillary, 124
white, 463

Respiratory distress syndrome, 137, 138
Resuscitation, 58, 60, 61, 68, 78, 121, 477
Retinoblastoma (RB), 22, 369, 370, 463, 464
Retinopathy of prematurity (ROP), 464, 465
Rickets, 26, 258, 276, 418, 420

causes of, 420, 421, 422
hypophosphatemic, 423

Rumination, 51, 265

S
Seborrheic dermatitis, 495, 496
Sensitivity, 46, 105, 160, 173, 260, 304, 485
Serum sickness, 164, 165
Sexual abuse, 31, 33, 41, 49, 54, 55, 56, 459
Sexual behaviors, 40, 41
Sexually transmitted disease (STDs), 40, 150, 154, 157

vaccines prevent, 158
Shock, 57, 58, 78, 141

cardiogenic, 58, 61
hypovolemic, 58
neurogenic/disrtibutive, 58
septic, 59, 61

Short bowel syndrome, 277
Skin disorders in neonates, 491
Skin infestation, 498

Skin test, 159, 168
Sleep disorders, 34, 39, 49, 50, 452, 453
Sleep medicine, 431
Specificity, 241, 260, 304
Sport injuries, 539
Status epilepticus (SE), 76, 77, 439
Strabismus, 22, 91, 92, 148, 462, 463
Strabismus 0, 467
Stroke, 130, 181, 326, 445, 446

ischemic, 436
primary prevention of, 354

Substance abuse, 150, 151
Syndrome of inappropriate antidiuretic hormone secretion

(SIADH), 410
Systemic lupus erythematosus (SLE), 128, 180, 183, 295, 313, 389
Systemic sclerosis, 182

T
Teratogens, 444, 463, 483
Testicular appendage torsion, 399
Testicular torsion, 57, 260, 399

neonatal, 399
Thumb sucking, 30, 31
Thyroid cancer, 416

types of
follicular cell origin, 417
medullary, 417

Tracheoesophageal fistula (TEF), 265, 294, 488
Tubular abnormalities, 383
Turner syndrome, 1, 90, 91, 125, 273, 325, 326, 405, 427

U
Urea cycle defects, 101
Uretero-pelvic junction obstruction, 395
Urethral injuries, 401
Urinary incontinence, 396, 397
Urinary tract infection (UTI), 48, 140, 166, 198, 217, 236, 237, 249,

393, 394, 396, 400
Urticaria, 162, 165

papular, 501
pigmentosa, 54

Urticaria pigmentosa (UP), 54, 165, 166, 502

V
Validity, 544
Vesicoureteral reflux (VUR), 394
VIPoma, 278
Viral infections, 166, 250, 378

localized, 503
Vomiting, 268
Vomting, 102
Vulnerable child syndrome, 50, 51

W
Well child visit, 24
Williams syndrome, 92, 324, 325, 377
Wilson syndrome, 286
Wounds, 72

cleaning, 72
facial, 74

Z
Zollinger–ellison syndrome (ZES), 269

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