UjSN0SS_SS_SS_SS_SS _S S _S S _SS_SS_SS_SS_SS_SS_SS_SS_SS_S S!_0S"S#_S$S%_S&S'_S(S)_S*S+_S,S-_S.S/_S0S1_S2S3_S4S5_S6S7_S8S9_S:S;_SS?_S@SA_SBSC_E0SDSE_SFSG_SHSI_SJSK_SLSM_SNSO_SPSQ_SRSS_STSU_SVSW_SXSY_SZS[_S\S]_S^S__S`Sa_SbSc_SdSe_ESfSgShSi.Ergj)kaBronchiolitis is the most common lower respiratory tract infection in infants, usually caused by respiratory syncytial virus, and follows 1-3 days of coryza with cough, tachypnea, wheeze and crackles that peak on day 3-5. The diagnosis is clinical, and care is supportive with suctioning, hydration and oxygen, since bronchodilators, corticosteroids and antibiotics are not routinely indicated.a^Acute otitis media is a middle-ear effusion with acute signs of inflammation, diagnosed by a bulging tympanic membrane or new otorrhea together with acute onset of symptoms. Every child needs analgesia, while antibiotics are reserved for young infants, severe symptoms or bilateral disease in the very young, with observation and follow-up otherwise.aKawasaki disease is an acute, self-limited vasculitis of young children presenting with at least five days of fever plus bilateral non-exudative conjunctivitis, oral mucosal changes, polymorphous rash, extremity changes or cervical lymphadenopathy. Inflammatory markers are raised and echocardiography assesses the coronary arteries, since early intravenous immunoglobulin with aspirin reduces the risk of aneurysms.aType 1 diabetes results from autoimmune destruction of pancreatic beta cells and presents over days to weeks with polyuria, polydipsia and weight loss, with new nocturnal enuresis in a previously dry child a useful clue. [[241|Diabetic ketoacidosis]] adds Kussmaul breathing, vomiting and abdominal pain, and is treated by restoring circulation and correcting deficits gradually before starting insulin. aChildhood asthma presents with recurrent, variable wheeze, cough and breathlessness that respond to bronchodilators, confirmed by spirometry showing reversible airflow obstruction where the child can perform it, usually from about age 5. Acute attacks need inhaled short-acting beta agonists, systemic corticosteroids and oxygen, while chronic control uses step therapy with inhaler technique reviewed at every visit. aDevelopmental surveillance at every health visit, with standardized screening at set ages, underpins early identification, and gross motor, fine motor, language and social development are tracked separately because delay in one domain need not mean global delay. Loss of previously acquired skills is a red flag, warranting prompt evaluation, hearing and vision checks and referral to early intervention.aCongenital hearing loss affects about 1-3 per 1,000 births and is roughly half genetic and half acquired, with 80% of genetic cases autosomal recessive. Universal newborn screening by otoacoustic emissions or auditory brainstem response replaced risk-based screening because only about half of affected infants have a risk factor, and the critical window for speech is birth to 3 years.iakOtitis media with effusion is middle-ear fluid without signs of acute infection, which distinguishes it from [[4|acute otitis media]], and it causes mild hearing loss or aural fullness rather than pain or fever. It usually resolves within 3 months, antibiotics have no role, and trials found no advantage to early tympanostomy tubes in otherwise healthy children.iawPatent ductus arteriosus is failure of the ductus to close after birth, and its incidence rises as gestational age falls, affecting about 45% of infants under 1,750 g and 80% of those under 1,000 g. Clinical signs are unreliable so echocardiography confirms it, and indomethacin closes about two-thirds of significant shunts before catheter or surgical closure is considered.i aTetanus follows wound contamination by Clostridium tetani, whose toxin blocks inhibitory spinal synapses to cause uncontrolled spasms, typically 4-14 days after injury and almost exclusively in unvaccinated children. Trismus is the presenting sign in about half, and treatment is tetanus immune globulin plus metronidazole, with prophylaxis guided by immunization history and wound type.i utBurns are classified by depth into first-degree, partial-thickness and full-thickness injury, and resuscitation uses the Parkland formula of 4 mL/kg per percent body surface area burned, half in the first 8 hours. Because a child withdraws from water above 120°F within seconds, a full-thickness immersion burn is rarely accidental and should prompt evaluation for abuse.iawChildren average 5-10 upper respiratory infections a year, especially under age 2, with clear nasal discharge, cough and early fever that usually settle within 10-14 days, though about 10% still have symptoms at day 14. New fever and worsening cough around day 9 suggest secondary bacterial sinusitis, and an active infection raises the risk of laryngospasm under anesthesia.iaeAcute pharyngitis peaks between ages 4 and 7 and is rare under 1, and over 90% of febrile sore throat in children is viral, with group A Streptococcus causing only 15-30%. Clinical criteria are too nonspecific to diagnose it, so culture or a rapid antigen test is required, and confirming GAS matters because untreated infection can lead to rheumatic fever.ia{Serious bacterial infection occurs in 7-13% of febrile neonates and young infants, of which urinary tract infection accounts for 5-13%, bacteremia 1-2% and meningitis 0.2-0.5%, with risk highest in the youngest and the clinically unwell. Escherichia coli is the most common organism overall, and separating invasive infection from UTI matters because UTI is often treated orally.iaCannabis is the most commonly used illicit drug among US adolescents, with about half having tried it by 12th grade, and earlier onset predicts later substance use and psychiatric comorbidity. DSM-5 grades use disorder on 11 criteria rather than separating abuse from dependence, and chronic heavy use can produce a withdrawal syndrome and cannabinoid hyperemesis relieved by hot showers.iajCephalohematoma is a subperiosteal hemorrhage confined to a single cranial bone that never crosses suture lines, distinguishing it from caput succedaneum, and complicates about 1-2.5% of births, far more often after vacuum or forceps delivery. Swelling appears hours to days later and resolves over 2-6 weeks, needing only monitoring of hematocrit and bilirubin.iaCongestive heart failure is the heart's inability to meet metabolic demand, most often from congenital heart disease or cardiomyopathy, and presents in infants with tachypnea, sweating with feeds and poor weight gain but in older children with exertional breathlessness and edema. Treatment escalates from diuretics and ACE inhibitors to mechanical support, though structural causes are usually reversible with surgery.i#a|Drowning is respiratory impairment from submersion or immersion, classified only as fatal or nonfatal, and is the leading cause of injury-related death in children under 5, who most often drown in swimming pools during brief lapses in supervision. Immediate on-scene resuscitation is the single most important step, and pool fencing, life jackets and touch supervision prevent it.i%aGeneralized [[206|epilepsy]] is the most common childhood epilepsy, accounting for about half of pediatric cases, and involves diffuse bilateral discharges from seizure onset with abrupt loss of awareness and no preceding aura. Absence seizures peak at 3-8 years in otherwise normal children and are usually outgrown, though 40-60% eventually have a generalized tonic-clonic seizure.i-aInfantile spasms are brief, stereotyped clusters of neck, trunk and limb contractions beginning between 3 and 12 months, peaking at 4-6 months, and are often mistaken for colic or reflux because they cluster around falling asleep and waking. With hypsarrhythmia and developmental regression they form West syndrome, and urgent MRI and EEG matter because prompt treatment improves developmental outcome.i/abJuvenile idiopathic arthritis is arthritis of unknown cause lasting at least 6 weeks with onset before age 16, affecting about 1 in 1,000 children and more girls than boys. ILAR divides it into seven categories by joint pattern in the first 6 months, and because chronic anterior uveitis is usually silent, scheduled ophthalmologic screening is required.i5aMuscle contusion is a crush injury to soft tissue with hematoma formation, the familiar charley horse, and together with sprains and strains accounts for most pediatric musculoskeletal injury. Immediate swelling, deformity, a painful pop or joint locking points instead to fracture or internal derangement, while treatment is ice, compression and rest with pain-free movement started the same day.i7ahObstructive sleep apnea syndrome is recurrent upper airway obstruction during sleep, affecting 1-5% of children and peaking at 2-8 years when tonsils and adenoids are largest relative to the airway. Over 95% of cases are structural, polysomnography confirms the diagnosis and severity, and adenotonsillectomy is first-line with CPAP for those it does not help.i=anPeptic ulcer disease is a mucosal break through the muscularis mucosa of the stomach or duodenum, uncommon in children at 0.5-4.4 per 100,000, and its presentation shifts with age from neonatal stress ulcers bleeding or perforating to adult-type epigastric pain in adolescents. Two-thirds of confirmed cases carry H. pylori, treated with 7-14 days of triple therapy.i>aPhenylketonuria is autosomal recessive deficiency of phenylalanine hydroxylase affecting about 1 in 10,000-15,000 births, and infants appear normal before developing vomiting, irritability and a musty odor. Brain damage becomes irreversible by around 8 weeks, so newborn screening detects nearly all cases and a lifelong phenylalanine-restricted diet started within weeks preserves neuropsychological outcome.i?aMost pediatric puncture wounds occur when a child steps on a nail, and the majority heal after thorough irrigation and a tetanus booster if indicated. Punctures through a sneaker risk Pseudomonas alongside Staphylococcus, wounds over the metatarsophalangeal joints risk osteomyelitis, and radiographs are needed for a retained foreign body, though wood is radiolucent and needs ultrasound or MRI.i@a?School refusal is missing school 2-3 days a week for at least 2 weeks out of fear of leaving home or of school, with the parent aware and somatic morning symptoms that resolve by midday. It peaks at ages 4-6 and 11-12, and prompt return to school matters because untreated refusal leaves 45% not completing high school.iEaRickets is defective mineralization of growing bone, most often from [[326|vitamin D deficiency]] but also from calcium or phosphorus deficiency and distal renal tubular acidosis. It produces craniotabes, frontal bossing, rachitic rosary, widened wrists and bowed legs with metaphyseal cupping and fraying on radiographs, which is why the AAP advises 400 IU of vitamin D daily for breastfed infants.iFaVitamin D deficiency is a serum 25-hydroxyvitamin D below 15 ng/mL, and the main at-risk groups are exclusively breastfed infants without supplementation, dark-skinned and premature children, and those with fat malabsorption. It causes hypocalcemia, hypophosphatemia and rickets, presenting in young infants as hypocalcemic seizures, and resolves within months of treatment, though prolonged deficiency can leave permanent deformity.iHaCompartment syndrome develops when pressure inside a closed fascial compartment exceeds capillary perfusion pressure, obstructing flow and causing muscle and neurovascular ischemia, and lower leg fractures cause about 60% of pediatric cases. Children are recognized by the 3 As of anxiety, agitation and rising analgesia need rather than the adult 5 Ps, and treatment is urgent fasciotomy.iIa_Child abuse covers physical and sexual abuse, emotional and physical neglect and medical child abuse, and the caregiver is responsible in about 90% of cases. Neglect is the most common form, while physical abuse is the leading cause of serious [[139|head trauma]] in the first year of life, and an implausible or evolving history should raise concern.iJaHerpes zoster is reactivation of varicella-zoster virus latent in a sensory ganglion since primary infection, and is uncommon in healthy children under 10 except those infected in utero or during the first year of life. It causes grouped vesicles across one to three dermatomes, is milder than in adults with postherpetic neuralgia rare, and V1 involvement needs ophthalmologic examination.iLaSpinal cord injury is rare in children, who account for about a quarter of all traumatic cases, and motor vehicle collisions remain the leading cause. Children under 5 injure the upper cervical spine while adolescents resemble adults, and because spinal cord injury without radiologic abnormality is common, a normal radiograph never excludes it; neurologic status at presentation best predicts outcome.iOaSunburn is the most common photosensitive reaction in children, a UVB-induced thermal injury whose redness, edema and blistering appear 6-12 hours after exposure and peak at about 24 hours. Treatment is cool compresses, analgesia and a bland emollient, and because most people receive over half their lifetime UV dose by age 20, blistering childhood sunburn raises later melanoma risk.iPaTicks transmit Lyme disease, spotted fever rickettsioses, ehrlichiosis, babesiosis, anaplasmosis, tularemia and relapsing fever to children exposed through pets or grass and brush. Attachment of 6 hours or more allows transmission, so frequent checks and prompt removal are the mainstay of prevention, while tick paralysis causes an ascending flaccid weakness that resolves rapidly once the tick is removed.iTaVaricella-zoster virus causes chickenpox, a pruritic exanthem appearing in crops that spreads centrifugally from trunk and scalp, with papules, vesicles, pustules and crusts present simultaneously after a 10-21 day incubation. Children stay infectious until every lesion crusts, and acyclovir is reserved for adolescents and those with chronic skin or lung disease or immunocompromise.iXaAcrocyanosis is bluish discoloration confined to the hands, feet and perioral area with trunk and mucous membranes staying pink, reflecting benign peripheral vasoconstriction rather than hypoxia. It is normal in the first 24 to 48 hours of life and resolves with warming, so cyanosis beyond that distribution, or central cyanosis persisting after the first minutes, needs prompt evaluation.iYaAcne vulgaris is chronic inflammation of the pilosebaceous unit affecting about 85% of people aged 12-24, typically starting at 12-14 years and earlier in girls, and driven by sebum production, abnormal keratinization, Cutibacterium acnes and inflammation. First-line treatment is topical retinoids, benzoyl peroxide and antibiotics, with isotretinoin reserved for the most severe disease.i^uBacteremia complicates 3-5% of children with fever without a source, particularly under 2 years and with temperatures above 39°C, and Streptococcus pneumoniae, Staphylococcus and Haemophilus influenzae predominate at that age. Occult bacteremia often resolves spontaneously but 3-5% of pneumococcal cases progress to meningitis, and asplenic, neutropenic or catheterized children are at highest risk.i_aIsolated proteinuria is found in 5-15% of children, and about 80% of it is transient while orthostatic proteinuria, which is benign and peaks in adolescence, accounts for roughly 60% of asymptomatic cases. A positive dipstick is confirmed with a first-morning protein-to-creatinine ratio, and a value of 1.0 or higher on repeat testing warrants full evaluation and nephrology referral.i`aCervicitis is inflammation of the cervix in the postpubertal adolescent, most often from Neisseria gonorrhoeae or Chlamydia trachomatis, and is frequently asymptomatic or causes only purulent discharge, postcoital bleeding or dyspareunia. Sexually active patients are treated empirically for both organisms, because untreated infection ascends to cause [[106|pelvic inflammatory disease]], infertility and ectopic pregnancy.idavCryptorchidism is failure of a testis to descend into the scrotum, affecting 2-4.6% of full-term and up to a third of premature boys, with a third to a half descending spontaneously by about 3 months. Bilateral nonpalpable testes must prompt exclusion of congenital adrenal hyperplasia, and orchiopexy between 6 and 18 months best preserves fertility and lowers cancer risk.ikaGastroesophageal reflux is physiologic and near-universal in infants, becoming gastroesophageal reflux disease only when it causes troublesome symptoms or complications, which affects 10-20% of infants and 5-8% of older children. Regurgitation peaks at 3-4 months and resolves in over 80% by 18 months, so treatment starts with smaller thickened feeds and positioning before acid suppression.imazGroup B Streptococcus colonizes the genital tract of 15-35% of pregnant women and is the source of most infant infection, causing early-onset disease within the first 24 hours with respiratory distress and shock, or late-onset disease at 3-4 weeks with bacteremia and meningitis. Intrapartum prophylaxis has cut early-onset disease by 85% but has not reduced late-onset disease.iouHeat exhaustion is the moderate stage of the heat illness continuum, with a core temperature of 37.7-40°C and weakness, headache, nausea and orthostasis but little CNS dysfunction, arising from water depletion, salt depletion or both. Children are more vulnerable than adults, and treatment is rest in a cool place with cooling and electrolyte rehydration before it progresses to [[295|heat stroke]].iuaInsulin resistance is reduced tissue responsiveness to insulin, most often from obesity in children, with acanthosis nigricans present in over 60% of those whose BMI exceeds the 98th percentile and about half of severely obese children affected. Rare INSR mutations cause severe syndromes such as Donohue and Rabson-Mendenhall, while treatment remains lifestyle change since metformin is not yet recommended.ivaIrritable bowel syndrome is a disorder of gut-brain interaction affecting up to 3% of school-aged children, causing recurrent crampy abdominal pain with altered bowel habits but no structural damage. Rome IV requires pain at least 4 days a month for 2 months without alarm features, and affected children stay well, which distinguishes it from inflammatory bowel disease and celiac disease.i~azMyelomeningocele is the most severe form of spina bifida, an open neural tube defect from failed caudal closure in the third gestational week, most often lumbar, and recurrence risk is 3-4% after one affected child. Nearly all cases have a Chiari II malformation causing hydrocephalus in 80-85%, and deficits follow the neurologic level, needing lifelong multidisciplinary care.iaZNocturnal enuresis is involuntary bedwetting at least twice a week for 3 months in girls over 5 and boys over 6, affecting about 15% of 5-year-olds and resolving spontaneously at roughly 15% a year. Fewer than 5% have an organic cause, family history predicts strongly, and behavioral measures with alarm therapy are first-line before medication.iaPhenylketonuria is the classic gene-environment disease: phenylalanine hydroxylase deficiency causes irreversible brain damage by 8 weeks only when dietary phenylalanine is present, so a child identified early and kept on a restricted diet develops normally. Newborn screening detects nearly all of the roughly 1 in 10,000-20,000 affected infants, and untreated disease causes microcephaly, seizures and severe intellectual disability.iaNeurofibromatosis type 1 is the most common neurocutaneous disorder, affecting about 1 in 3,000, caused by loss-of-function NF1 mutations, half inherited and half sporadic. Diagnosis needs two of seven criteria led by six or more cafe-au-lait macules, most children qualify by 8-10 years, and complications include optic pathway glioma in 15-20% and [[114|learning disability]] in 30-60%.aPolycystic ovary syndrome is the most common endocrine disorder of reproductive-age women, affecting about 10% of adolescent females and often first presenting in adolescence with menstrual irregularity and hyperandrogenism. Ovarian ultrasound criteria do not apply to teenagers because normal adolescent ovaries look polycystic, and management centers on lifestyle change, since 5-10% weight loss meaningfully improves symptoms.aPersistent postconcussion symptoms affect the minority of concussed children whose somatic, cognitive, emotional and sleep symptoms last beyond 28 days, when most sport-related concussions resolve within 7-10 days. Initial symptom burden is the strongest predictor, and management is graduated return to school and sport, since a second impact before full recovery risks permanent disability or death.aySubstance intoxication is accidental in about 97% of pediatric cases, peaking in the second year of life with 85% occurring under age 5, while ingestions in adolescents are largely intentional. Alcohol is the substance most often abused by young people, and management is airway, breathing and circulation first, then identifying the agent and giving an antidote if one exists.)iiiN)NEW`/tmp/claude-0/-home-danvics-docker-quiz/c1e0577a-e42c-4a3d-b1ea-3edd61103a4e/scratchpad/new54.pyr sy7P7d7f7Y 7 g 7 [ 7J7s77K7|77m7C7L7 r!7"k#7$D%7&G'7(Z)7*j+7,U-7.p/70v172a374T576G778W97:y;7<M=7>g?7@NA7B[C7DIE7F_G7HII7JNK7LMM7NYO7PIQ7RpS7T~U7VPW7XBY7ZY[7\`]7^N_7`Ba7bbc7d{e7fLg7huYAm7r