1.Evaluating neonatal jaundice, categorized by time of first appearance:
-First 24 hrs: hemolysis until proven otherwise. ABO, G6PD, spherocytosis, etc. Workup: CBC with diff and smear and retics, coombs, G6PD, fractionated bilirubin.
-Approx day 1-2: likely physiologic. Workup: transcutaneous bili, followed by serum if levels are high
-Approx day 3-5: likely "breastfeeding jaundice" aka dehydration jaundice. Increase feedings, supplement with formula. Do not give IV fluids unless there are signs of dehydration... hooking a kid up to an IV will only encumber further breastfeeding efforts by mom and worsen then problem.
-Approx weeks 1-3: likely breastmilk jaundice. Can switch to formula for a day or two and go back to breast milk, jaundice shouldn't return; alternatively, can breastfeed through it.
-If the kid has been jaundiced at a low-grade level for 4-5 weeks after birth continually/without resolution, consider a chronic process like biliary atresia (conjugated) or hypothyroid (unconjugated). Work this up, because if it is a biliary atresia, the Kasai needs to be done by 2 mos for good outcomes.
2. Hypothyroidism facts:
-Newborn screen checks for T4 levels, to be followed by TSH if T4 was low.
-Only 60% of kids with positive newborn screen for hypothyroid are actually hypothyroid; maternal antibody transfer can result in a false positive.
-In kids who are unscreened, symptoms will first appear around 8-12 weeks: hypotonia/decreased suck leading to FTT, constipation, jaundice, macroglossia, hoarse cry/lethargy, big fontanelles. The facial features usually do not appear until very late.
-Most common type of hypothyroid in this country is acquired: hashimoto's. Symptoms that kids usually present with: constipation, lethargy/decreased school performance, weight gain, decreased growth velocity, delayed puberty.
3. Hyperthyroidism facts: 
-Most common is Graves, which archetypally presents in a teen girl (F:M = 5:1), with a family history of autoimmune disease.
-Symptoms of presentation are not the same as in adults. Kids do not usually get the proptosis. Instead, they may present with an ADHD type story, of decreased school performance, inattention, insomnia, emotional lability, plus diarrhea, sweating, palpitations, amenorrhea. There will be weight loss, but that is not a symptom patients (esp teen girls) will usually complain of to their physicians.
-Be suspicious of any teenager who presents with "ADHD", for that is nearly always diagnosed at a younger age. In such a case, always run: thyroid, lead, and hearing/vision tests.
-In kids, we manage hyperthyroid medically rather than with surgery/radiation. PTU causes agranulocytosis and lupus-like picture, methimazole can also cause agranulocytosis but is preferred because it has qd dosing and is easier to titrate.
4. The Erythemas...
-Marginatum: serpiginous, expanding borders, largeish (rheumatic fever)
-Migrans: smaller, rounder/nonserpiginous borders, annular (lyme)
-Nodosum: painful, red, nodular, pretibial (IBD, sarcoid, infections- strep)
-Multiforme: targetoid, urticaria-like, multiple. Large differential: viral (herpes, HIV), bacterial (strep, staph), fungal/parasitic (toxo), drug reactions (penicillins, sulfa drugs, AEDs, aspirin, allopurinol, anti-TB), autoimmune or neoplastic.
-Toxicum: vesicles on erythematous base, common in neonates.
5. Facts about rheumatic fever: 
-Chorea can occur up to a year after a strep infection, and is the only symptom that can diagnose RF in the absence of any other signs. Penicillin, for an unknown reason, treats chorea.
-Minor criteria: arthralgia (without swelling), increased PR interval, fever.
-The migratory polyarthritis-- joints are swollen and painful, and the pain migrates by the day, which is a relatively unique identifier. Other causes of migratory polyarthralgia: rat bite fever, disseminated gonoccocus
-the N&E criteria of JONES criteria (subcutaneous nodules and erythema marginatum) are always accompanied by carditis. If these symptoms are present, search for the carditis.
6. Pauciarticular/Oligoarticular juvenille RA
-most common subset of JRA (~50%), affects 1-4 joints.
-F>M, peak age 2-3 years, rare >10 years
-Usually affects large joints, rarely hip
-Uveitis is really common in this group-- 20% overall, up to 50% in kids who are ANA+. Get a slit lamp if you suspect.
-Lab findings: not too many; may have a low ESR or low ANA titer.
-Rarely progresses to destructive arthritis.
7. Polyarticular JRA: 
-Second most common subset of JRA (30-40%), affects 5+ joints
-F>M, bimodal peak age: 2-5 years, and then again in preteen years (10-14)
-Can affect any joints, but usually doesn't start in the hips
-Uveitis less common
-Labs: 10-20% will have +RF, many will show a mild elevated ESR, the younger kids will often have +ANA titer (low)
-Destructive arthritis is common (>50%), DMARD use common
8. Systemic JRA:
-Least common subset of JRA (10-15%), affects any age, all joints
-Diurnal fevers, evanescent salmon-pink rash, HSM, LAD
-Uveitis is rare.
-Labs: elevated WBC with left shift, anemia, elevated ESR. ANA/RF are usually negative!
-Destructive arthritis/DMARD use are common.
9. SCFE vs LCP: 
-SCFE: overweight preteens
-LCP: underweight 5-7 year olds
Frog-leg AP pelvic x-ray to differentiate
10. Osteomyelitis vs Septic joint: MRI for definitive determination.