Screening tests, diagnostic tools, most accurate treatments & memorable mnemonics (Nelson Textbook of Pediatrics 22nd Ed). Designed for quick recall & clinical application.
🌐 paeds.online — Pediatric Learning PlatformNewborn hip exam (Barlow/Ortolani), routine observation of gait, torsional profile for in-toeing.
Clinical exam; radiographs for suspected dysplasia, bone age for growth assessment.
Reassurance for physiologic bowing/intoing. Pavlik harness for DDH <6mo.
“CUTE” — Cartilage, Ultrasound for DDH, Tibial torsion observation, Epiphysis remodeling.
pGALS (gait, arms, legs, spine) for school-age children, limb symmetry, gait observation.
Beighton score (hypermobility); neurology exam; radiographs; MRI for soft tissue/occult pathology.
Depends on underlying disorder; early physical therapy for motor delay.
“SPINE” — S ymmetry, P algation, I nspection, N eurologic, E xam (ROM).
Newborn foot exam; heel bisector line; clubfoot screening.
Radiographs for tarsal coalition (CT gold standard); Ponseti method for clubfoot.
Clubfoot: Ponseti casting + tenotomy + abduction bracing. Flexible flatfoot: observation.
“CAVE” — Cavus, Adductus, Varus, Equinus (clubfoot components).
Foot progression angle, femoral anteversion (prone internal rotation), thigh-foot angle.
Physical exam; scanogram for leg length; standing alignment radiographs for Blount.
Observation for physiologic bowing (resolves by 3-4y). Blount: bracing or osteotomy.
“FIT” — F emoral anteversion (intoing), I nternal tibial torsion, T arget observation.
Galeazzi sign, standing block test, pelvic level.
Scanogram, EOS (low-dose), CT for precise measurement, bone age (Greulich-Pyle).
Epiphysiodesis for 2-5 cm predicted discrepancy; lengthening for >5 cm (magnetic nail).
“BLT” — B lock test, L engthening, T iming (epiphysiodesis by multiplier method).
Lachman, anterior drawer, McMurray, patellar apprehension.
MRI for ACL/meniscus/OCD; radiographs for OCD (tunnel view).
ACL reconstruction (physeal-sparing if open physes). OCD: stable → rest; unstable → drilling/fixation.
“SNAP” — S napping (discoid meniscus), N on-op ACL?, A pophysitis (Osgood), P atellar instability.
Barlow/Ortolani (newborn), limited abduction (infant), Trendelenburg gait.
Ultrasound (<6mo); radiographs after 4-6mo; MRI for LCPD/AVN.
DDH: Pavlik harness (<6mo); LCPD: containment (bracing/osteotomy); SCFE: in situ pinning.
“HIP” — H arness (DDH), I n-situ screw (SCFE), P erthes containment.
Adams forward bend test, scoliometer, neurologic exam.
Cobb angle (standing radiograph); MRI for intraspinal anomalies; SPECT for spondylolysis.
AIS: bracing 25-45°, surgery >50°. Spondylolysis: rest, PT, TLSO.
“BRACE” — B race for curves, R adiographs Cobb, A SSI (spinal fusion), C ongenital MRI, E xtension pain (spondylolysis).
Head tilt/rotation, SCM mass, cervical ROM.
Ultrasound (CMT), dynamic CT (atlantoaxial rotary displacement), MRI spine.
CMT: stretching (first 3mo); Klippel-Feil: avoid contact sports; Grisel: traction + collar.
“TORT” — T rauma/infection, O rtho (CMT), R otatory displacement, T oughey (Klippel-Feil).
Nursemaid elbow (arm held pronated), polydactyly, thumb hypoplasia.
Radiographs; Fanconi workup for radial deficiency; echocardiogram for Holt-Oram.
Nursemaid elbow: supination+flexion reduction. Polydactyly: excision 9-12mo. Trigger thumb: A1 pulley release.
“RULE” — R adial deficiency screen, U lnar polydactyly, L ittle league elbow rest, E xcision of extra digit.
Multiple joint contractures at birth, midface hemangioma (amyoplasia).
EMG/nerve biopsy, muscle MRI, genetic testing (MYH3, etc).
Ponseti for clubfoot, serial casting, surgical releases, physical therapy.
“STIFF” — S erial casting, T endon transfers, I ntact intellect, F eet/knees sequential, F unctional goals.
Ottawa ankle/knee rules, neurovascular exam.
Radiographs (AP/lateral/oblique), CT for triplane/Tillaux, MRI for occult fractures.
Supracondylar humerus type III: closed reduction + pinning. Femur: age-based (spica, flexible nails).
“SHARP” — S alter-Harris, H umerus supracondylar, A cceptable angulation, R emodeling potential, P hysis respect.
Fever + focal bone pain + refusal to bear weight (esp. child).
MRI with STIR (gold standard), CRP, blood culture, bone aspirate.
IV antibiotics (cefazolin/vancomycin) 4-6 wks; surgical drainage if abscess.
“MRI C” — M RI early, R esolution CRP, I V then oral switch, C over S. aureus/Kingella.
Kocher criteria (fever, non‑WB, ESR>40, WBC>12k).
Joint aspiration (WBC>50k), Gram stain, PCR (Kingella). Ultrasound for effusion.
Surgical drainage (arthrotomy/arthroscopy) + IV antibiotics (10-14 days).
“DR IP” — D rainage, R emember Kocher, I V antibiotics, P CR for Kingella.
Preparticipation exam (cardiac history, prior injury, heat illness).
ECG for syncope/family history; functional screening for ACL risk.
Neuromuscular training (ACL prevention), acclimatization, rule enforcement.
“SAFE” — S creening (PPE), A cclimatization, F air play, E quipment (helmets).
PRICE (protection, rest, ice, compression, elevation).
X-ray, MRI for stress fracture/OCD; compartment pressure.
4-phase rehab (relative rest → sport‑specific). Compartment syndrome → fasciotomy.
“PRICE” — P rotection, R est, I ce, C ompression, E levation (acute).
SCAT6/Child-SCAT6, symptom checklist, balance mBESS.
Clinical diagnosis; CT if red flags; computerized neurocognitive testing.
Return‑to‑learn → graduated return‑to‑play (6 stages).
“RETURN” — R emove, E valuation, T argeted rest, U pdated plan, R ehabilitation steps, N o same‑day return.
Neck pain, neuro deficit, Canadian C‑spine rule.
Flexion/extension radiographs, CT for fracture, MRI for cord.
Stinger → return if normal. Transient quadriparesis with stenosis → absolute contraindication to contact.
“STABLE” — S tener, T ransient quadri, A tlantoaxial, B race?, L oss of lordosis, E mergency MRI.
Heat index, hydration status, acclimatization.
Rectal temperature (core), electrolytes, renal function.
Heat stroke: cold water immersion (emergency).
“COLD” — C ramp → oral electrolyte, O verheating → ice water, L oss of consciousness → 911, D ehydration prevention.
Menstrual history, stress fractures, eating attitudes.
DXA (Z-score), LH/FSH/estradiol, testosterone, ferritin.
Increase energy availability (diet + reduce exercise).
“RED-S” — R elative energy deficiency, E ating, D elayed menarche, S tress fractures.
Query at PPE, acne, striae, gynecomastia, testicular atrophy.
Urine drug screen (anabolic steroids), LFTs, lipids.
Cessation + counselling; no specific antidote.
“STEROIDS” — S triae, T esticular atrophy, E motional lability, R educed HDL, O ra l/inj, I nfertility, D angerous.
Pitch counts (baseball), heading rules (soccer), weight classification (wrestling).
Sport‑specific radiographs, MRI for overuse.
Little league elbow: rest 4-6 weeks; gymnast wrist: rest 6 weeks.
“PITCH” — P rotect growth plate, I njury prevention, T hrowing limits, C ore stability, H eat acclimatization.
Disproportionate short stature, arm span/height ratio.
Skeletal survey, FGFR3/COL2A1 genetic testing.
Vosoritide (achondroplasia ≥5y); supportive care; growth hormone controversial.
“RHIZO” — R hizomelic, H ydrocephalus (monitor), I nterpediculate narrowing, Z inc finger (trident), O besity prevention.
Myopia, cleft palate, hearing loss (Stickler), short trunk (SED).
COL2A1, COMP sequencing; ophthalmology exam.
Retinal detachment prevention (laser), hearing aids, joint replacement.
“STICK” — S tickler (Pierre‑Robin), T runk shortening (SED), I rregular epiphysis, C ollagen gene, K niest (dumbbell).
Rhizomelic shortening, macrocephaly, trident hand, hypercalcemia (Jansen).
FGFR3 (achondroplasia), PTHR1 sequencing, calcium level.
Vosoritide (achondroplasia); manage hypercalcemia in Jansen.
“FGF” — F oramen magnum stenosis, G ains (gain‑of‑function), F ibroblast growth factor receptor 3.
Hitchhiker thumb, cauliflower ear, clubfoot, cleft palate (diastrophic).
SLC26A2 sequencing, radiographs.
Clubfoot surgery (resistant to Ponseti), cleft palate repair.
“DTS” — D iastrophic dysplasia, T humb (hitchhiker), S ulfate transporter.
Bowed tibias (campomelic), absent clavicles (cleidocranial), iliac horns (nail‑patella).
SOX9, RUNX2, LMX1B sequencing; renal ultrasound (nail‑patella).
Supernumerary teeth extraction (cleidocranial), growth hormone (SHOX).
“CLAP” — C leidocranial (clavicles), L MX1B (nail‑patella), A utosomal dominant, P ierre‑Robin (campomelic).
Macrocephaly, hepatosplenomegaly, pancytopenia (infantile).
Radiograph (bone‑within‑bone), genetic (TCIRG1, CLCN7), acid phosphatase.
HSCT (for malignant ARO), calcitriol, interferon‑gamma.
“MARBLE” — M arrow failure, A nemia, R adiodense, B lindness, L iver spleen, E ndobones.
Polydactyly + heart defect (Ellis‑van Creveld), narrow thorax (Jeune), sparse hair (cartilage‑hair).
EVC/EVC2, DYNC2H1, RMRP sequencing; echocardiogram.
VEPTR for thoracic insufficiency; HSCT for cartilage‑hair hypoplasia (SCID).
“JEC” — J eune (asphyxiating), E llis‑van Creveld (CHD), C artilage‑hair (immunodeficiency).
Blue sclerae, recurrent fractures, dentinogenesis imperfecta.
COL1A1/COL1A2 sequencing, bone biopsy, DXA.
IV pamidronate (bisphosphonate), rodding surgery, physical therapy.
“BOW” — B lue sclera, O steopenia, W ormian bones.
Arm span/height ratio, wrist/thumb sign, ectopia lentis (upward).
Echocardiogram (aortic root), FBN1 sequencing, slit lamp.
Beta‑blocker/ARB (losartan), prophylactic aortic root replacement (≥50mm).
“MARFAN” — M itral prolapse, A ortic dilation, R etinal detachment, F BN1, A rachnodactyly, N o contact sports.
Beighton score, skin hyperextensibility, atrophic scars.
COL5A1/COL3A1 sequencing; urine deoxypyridinoline (kyphoscoliotic).
Physical therapy (hEDS); vascular EDS: celiprolol, avoid arteriography.
“CLASS” — C lassical (scars), L axity, A rterial (vascular), S kin stretch, S cort (Beighton).
Loose, sagging skin (inelastic), aged facies, occipital horns (X‑linked).
ELN, FBLN5, ATP7A sequencing; copper/ceruloplasmin.
Supportive; copper histidine for X‑linked.
“CLX” — C uper deficiency, L axa (skin), X‑linked horns.
Growth curve, calcium/phosphate/ALP, vitamin D level.
PTH, 25(OH)D, 1,25(OH)2D, FGF23, renal function.
Vitamin D and calcium repletion; phosphate/calcitriol for hypophosphatemic rickets.
“VIP” — V itamin D, I ntestine (Ca absorption), P TH (bone‑kidney).
Low serum ALP, premature tooth loss (root intact), rickets.
Elevated PLP (vit B6), urinary PEA, ALPL sequencing.
Asfotase alfa (enzyme replacement).
“ALP” — A LP low, L ost teeth, P LP high.
Incidental high ALP, post-viral (benign), bone deformity (juvenile Paget).
ALP isoenzymes, GGT normal (BTH), TNFRSF11B sequencing.
BTH: observation. Juvenile Paget: bisphosphonates.
“BTH” — B enign, T ransient, H igh ALP (post‑viral).
Low‑impact fractures, back pain (vertebral), risk factors (steroids, malnutrition).
DXA (Z‑score ≤ -2.0), vertebral fracture assessment, calcium/vitamin D labs.
Calcium, vitamin D, weight‑bearing exercise; bisphosphonates (pamidronate) for severe cases.
“FRACTURE” — F ragility, R isk factors (glucocorticoid), A ctivity (weight‑bearing), C alcium, T reat (bisphosphonates), U sual labs, R epeat DXA, E xercise.