PEDIATRICS - COMMON ACUTE + CHRONIC DISEASE
YEAR 3 | PAGE 30B - SYNDROME RECOGNITION + AGE-SPECIFIC DIFFERENTIALS
C. BUILD ILLNESS SCRIPTS AROUND THE PRESENTING SYNDROME
| Syndrome | High-yield discriminators | Management logic to practice |
|---|---|---|
| Respiratory distress / cough | Age, upper vs lower airway sound, wheeze/stridor/crackles, work of breathing, oxygenation, feeding, viral context, focal exam. | Decide supportive care vs bronchodilator/steroid/antibiotic pathway vs escalation; recognize impending respiratory failure. |
| Fever / infection | Age, appearance, source, immunization status, duration, focal findings, meningismus, perfusion and host risk. | The younger or more toxic the child, the lower the threshold for serious bacterial infection evaluation and supervised escalation. |
| Vomiting / abdominal pain | Bilious vs nonbilious, blood, stooling, episodic vs persistent pain, distention, hydration, age-specific surgical diagnoses. | Separate self-limited illness from obstruction, intussusception, appendicitis, torsion, DKA, intracranial or metabolic causes. |
| Dehydration / diarrhea | Intake/output, tears/mucosa, capillary refill, mental status, weight change, urine output and electrolyte risk. | Estimate severity clinically; use oral/enteral rehydration when appropriate and IV resuscitation when perfusion or tolerance requires it. |
| Seizure / altered mental status | Age, fever, duration/focality, recovery, trauma/toxin exposure, glucose and neurologic exam. | Stabilize first; distinguish simple febrile seizure patterns from CNS infection, epilepsy, metabolic/toxic and structural disease. |
| Murmur / cyanosis / poor feeding | Timing, oxygenation, pulses, perfusion, growth, respiratory symptoms and whether physiology is ductal-dependent or shunt/obstruction related. | Connect congenital physiology to the child's age and instability instead of memorizing lesion names alone. |
| Growth / endocrine / chronic disease | Growth velocity, pubertal stage, BMI, family pattern, systemic symptoms, medications and psychosocial context. | Differentiate normal variants from endocrine, GI, renal, genetic, inflammatory or nutritional disease; manage longitudinally. |
D. ADULT REFLEXES THAT FAIL IN PEDIATRICS
- Normal is age-dependent: heart rate, respiratory rate, blood pressure, communication and examination technique change across childhood.
- Weight is a clinical variable: medication and fluid decisions often require kg-based calculation; recheck units and maximum doses.
- Appearance matters: feeding, interaction, consolability, work of breathing and perfusion can be more informative than one laboratory value.
- Congenital disease can present late: poor feeding, failure to thrive, cyanosis, recurrent infection or exertional symptoms may be the clue.
- Family history is not enough: pediatrics also requires school, nutrition, environment, safety, development and caregiver observations. Direct video repair OPENPediatrics - Bronchiolitis Ninja Nerd - Febrile Seizures Ninja Nerd - Cyanotic Congenital Heart Defects 2026/27 clerkship-expanded edition - verify school and official exam updates before testing