Other Common Pediatric Conditions

Wheezing infant DDx, common rashes, congenital heart disease patterns, FTT.

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◆Congenital heart disease patterns

•Cyanotic (5 T's): Truncus arteriosus, Transposition, Tricuspid atresia, Tetralogy of Fallot, TAPVR
•TOF: VAR-PHS — VSD, Overriding aorta, RV hypertrophy, Pulmonary stenosis; 'tet spells' (squat to ↑SVR); boot-shaped heart
•Transposition: cyanosis at birth; egg-on-a-string CXR; need PGE1 + balloon atrial septostomy then arterial switch
•PDA: continuous machine-like murmur, wide pulse pressure; close with INDOMETHACIN (term infant) or wait if cyanotic CHD (then keep open with PGE1)
•VSD: most common CHD; holosystolic at LLSB
•ASD: fixed split S2
•Coarctation: arm > leg BP; HTN in upper, ↓ in lower; rib notching; Turner syndrome association
•Ebstein anomaly: lithium teratogen; apical displacement of tricuspid valve

•Weight <5th %ile or crossing 2 major %iles down
•Non-organic (most common): poor feeding/social
•Organic: CF, celiac, cow milk protein allergy, congenital heart disease, hypothyroid, immunodeficiency
•Workup: feeding history, growth chart, CBC, BMP, UA, sweat chloride if recurrent infections

•Roseola: fever then rash (HHV-6)
•Erythema toxicum: normal newborn rash (eosinophilic, harmless)
•Mongolian spot: dermal melanocytes, blue-gray lower back; not bruising
•Caput succedaneum: crosses suture lines (vs cephalohematoma which doesn't)
•Pyloric stenosis: 3–6 weeks, projectile non-bilious vomiting (covered in S3 GI)
•Strabismus: requires evaluation if persists >4 months
•Leukocoria: think retinoblastoma

•ALL: most common childhood cancer; bone pain, fever, bleeding, blasts on smear; Philadelphia chromosome worse; treat with multi-agent chemo
•Wilms tumor (nephroblastoma): abdominal mass (don't palpate excessively → rupture risk); WAGR/Denys-Drash syndromes
•Neuroblastoma: <2 yr; abdominal mass crossing midline + opsoclonus-myoclonus (dancing eyes); ↑urine VMA/HVA; N-MYC amplification poor prognosis
•Retinoblastoma: leukocoria + absent red reflex; RB1 mutation; ↑osteosarcoma risk
•Medulloblastoma: cerebellar; most common malignant brain tumor in kids
•Osteosarcoma: distal femur/proximal tibia in adolescent; Codman triangle, sunburst
•Ewing sarcoma: diaphysis of long bones; 'onion skin'; t(11;22)

•Legg-Calve-Perthes: AVN of femoral head in 4–10 yr; painless limp + ↓ROM
•SCFE: obese adolescent; gradual hip/knee pain + ↓internal rotation; surgical pinning
•Septic arthritis vs transient synovitis: Kocher criteria (fever >38.5, WNB, ESR>40, WBC>12K)
•Nursemaid's elbow (radial head subluxation): toddler arm pulled; refuses to use arm; reduce by supinate + flex
•DDH: Ortolani/Barlow exam; US <6 months, X-ray after

◆FTT mnemonic for organic causes: GI (CF, celiac), endocrine, cardiac, renal, immune, mental
◆Caput succedaneum CROSSES sutures (soft tissue swelling); cephalohematoma does NOT cross (subperiosteal blood)
◆Wilms vs neuroblastoma: Wilms = doesn't cross midline; neuroblastoma = crosses midline + opsoclonus-myoclonus
◆Don't push fluids in a child with tet spell — squat them and give O₂ + morphine + beta-blocker

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