A 5yearold presents with complaint of anorexia abdominal pain and diarrhea The patient is noted to have a yellowgreen

Hookworm is a helminthic disease that can cause blood loss, iron deficiency, anemia, and protein malnutrition. Risk Factors Etiology. Ancylostoma duodenale, and Necator americanus cause classic hookworm. Hookworms are found in warm, moist soil, especially in rural areas where human feces is used as fertilizer. There may be penetration through the skin (A. duodenale and N. americanus), or ingestion (A. duodenale). No matter what the mode of entry, these helminths eventually attach to...

Ataxiatelangiectasia Ai2

Ataxia-telangiectasia is transmitted as an autosomal recessive trait. The defect is found on the long arm of chromosome 11. Ataxia begins shortly after children learn to walk. It is progressive, and patients end up in wheelchairs by age 10-12 years. Telangiectasia first appears at 3-6 years of age and can occur anywhere, but is typically on the bulbar conjunctiva. Patients have chronic upper respiratory infections and deficient cellular immunity (low or absent IgA and IgILlymphopenia). They are...

The school nurse refers a student to your clinic because of an annular rash that has scaling and central clearing Other

Tinea corporis is a fungal infection of the skin that excludes the palm, the soles, and the groin. Risk Factors Etiology. Tinea corporis may be caused by most dermatophyte species, but Trichophyton rubrum and Trichophyton mentagrophytes are the most prevalent agents. Presentation. The patient presents with a rash. Physical Examination. An annular lesion that has a raised border, scaling, and central clearing, i.e., ringworm is found on inspection. Diagnostic Tests. The diagnosis is...

Herpes

A 17-year-old sexually active boy presents to the physician because of painful ulcerations on his glans penis and on the shaft of his penis. He has multiple sexual partners and does not use condoms. Fever and inguinal adenopathy are also present. Definition. Herpes simplex virus is a double-stranded, DNA-containing enveloped virus that causes a number of problems involving the skin, eye, oral mucosa, CNS, and genital tract. There are two types of herpes simplex virus, HSV-1 and HSV-2. HSV-1 may...

A 4yearold is brought to the physicians office because she developed red cheeks that appear as if someone has slapped

Erythema infectiosum is a benign, self-limited exanthematous illness. Risk Factors Etiology. The etiology of erythema infectiosum is parvovirus B19, a DNA virus. Humans are the only known host, and they transmit the virus via respiratory secretions and blood. This disease is commonly seen in the spring. The incubation period ranges from 4 to 28 days. Presentation. The patient usually presents with mild systemic symptoms, including low-grade fever, headache, and upper respiratory...

Nonorganic Failure To Thrive

A 4-month-old infant presents to the emergency department because the mother states that the infant has upper respiratory symptoms. The patient is less than the fifth percentile in weight and length. He is 3.5 kg. Birth weight was 4.2 kg. The mother states that the patient takes 16 oz of infant formula per day with cereal added. Definition. Nonorganic failure to thrive usually occurs when an infant or child is fed insufficient calories. Risk Factors Etiology. Factors contributing to nonorganic...

A newborn is noted to have a foot that is stiff and slightly smaller than the other one The affected foot is medially

Talipes equinovarus (clubfoot) is a deformity of the foot and lower leg. Risk Factors Etiology. Although the cause is unknown, clubfoot can be related to in utero displacement and malalignment. Inheritance plays a part, and there is probably a neuromuscular basis. Half of all cases are bilateral. Associated disorders include developmental hip dysplasia, 1 amniotic bands, spina bifida, and arthrogryposis. Clubfoot is more common in boys. Presentation. Isolated congenital clubfoot is...

A patient is brought to the physicians office because the mother found a worm in the diaper

Ascariasis is a helminthic disease. Risk Factors Etiology. Infection is usually seen in young children (preschool or early school age). Ascariasis is caused by Ascaris lumbricoides. It is found in warm climates, and is a soil-transmitted infection. The use of human feces as fertilizer is the cause of this disease. The mode of transmission is hand to mouth. Raw foods contaminated by human fertilizer or flies also cause A. lumbricoides. The life cycle of A. lumbricoides is as follows...

Adolescence

Adolescence is the period bridging childhood and adulthood. It begins at approximately 11-12 years and ends at approximately 18-21 years. During this period the adolescent experiences many changes, such as completing puberty and somatic growth developing socially, emotionally, and cognitively moving from concrete to abstract thinking establishing an independent identity and preparing for a career or vocation. Adolescence includes, but does not correspond with, puberty. Risk Factors...

Antihistamines

A 2-year-old took his brother's allergy medication. He is brought to the hospital by ambulance because of tremors and hyperactivity. The medics report that the child had a seizure before arriving at the hospital. On physical examination the patient has fever, flushed skin, tachycardia, and fixed dilated pupils. Definition. Antihistamines are used as sedatives, for allergies, for antinausea, and for motion sickness. They are available over the counter and as prescription. They may be found in...

Autism

A 4-year-old child speaks in unintelligible mumbles, prefers to play by himself, and rocks back and forth constantly. Parents state that as an infant he had a delayed social smile and was never very playful or interactive. Definition. Autism is a developmental disorder characterized by impaired social relatedness, deficits in verbal and nonverbal communication, and unusual responses to the environment. Risk Factors Etiology. Autism develops before 30 months of age. The cause is unknown. It is...

Brain Tumors

Brain tumors are the most common solid tumors in childhood and the second most common malignancy in this group. Two thirds of these tumors arise below the tentorium and one third arises above the tentorium. CNS tumors may be classified as (1) infratentorial tumors or (2) supratentorial tumors. Infratentorial tumors, i.e., cerebellar astrocytomas, medulloblastomas, brain stem gliomas, and ependymomas are more common in children. However, in children younger than 2 years and in adolescents,...

Bronchiolitis

A 6-month-old infant presents to the physician with a 3-day history of upper respiratory tract infection, wheezy cough, and dyspnea. On physical examination, the patient has a temperature of 39 C, respirations of 60 breaths min, alae nasi flare, and accessory muscle usage. The patient appears to be air hungry, and the oxygen saturation is 92 . Definition. Bronchiolitis is a lower respiratory infection in infants caused by inflammatory obstruction of the small airways of the lower respiratory...

Caustics Acids and Alkalis

A 2-year-old presents to the emergency center with his parents who say that they found the patient drinking some Red Devil lye. The patient is crying profusely, and has blisters and burns in his mouth. The patient is drooling. Definition. Caustics include both acids and alkali (bases). Examples of acids include metals, toilet bowel cleaners, and batteries. Examples of bases are Purex, Drano, dishwashing detergent, Red Devil lye, and Liquid Plummer. Risk Factors Etiology. Acids cause tissue...

Cerebral Palsy

Cerebral palsy (CP) is a disorder of impaired motor functioning and posture with onset before or at birth or during the first year of life. It is a nonprogressive disorder and varies widely in its causes, manifestations, and prognosis. The most obvious manifestation is impaired ability of voluntary muscles. Risk Factors Etiology. The incidence of CP is approximately 1.5-5 per 1000 live births. The specific etiology is unknown but the incidence is high among infants who are small for...

Chest

Breast hypertrophy In the neonate, this is a temporary condition secondary to increased circulating hormones. Supernumerary nipples (polythelia) These usually occur along the mammary line. There is an association with renal and cardiovascular anomalies. Poland syndrome amastia, pectoralis muscle aplasia, rib deformities, webbed fingers, radial nerve aplasia. Pectus excavatum (funnel), pectus carinatum (pigeon) These are usually benign, isolated deformities of the chest. Surgical correction is...

Congenital Anomalies

The pediatrician is called to the delivery room because an infant is born with a defect in the lumbosacral area. Definition. Myelomeningocele is a neural tube defect and the most severe form of dysraphism involving the vertebral column. Risk Factors Etiology. The etiology is unknown however, it is thought that agents such as drugs, radiation, malnutrition, and genetics have a role in adversely affecting normal CNS development. Presentation. The majority of patients will present with the defect...

Deficit

There are three different types of deficits that can develop. Isonatremic (isotonic) Na is 130-150 mEq L with proportional losses of fluid and electrolytes from the extracellular space. Hyponatremia (hypotonic) Na < 130 mEq L lose more Na than water, or have excess water. Hypernatremic (hypertonic) Na > 150 mEq L lose more water, or provide excess Na. A clinical assessment should be made to assess the deficit. This can be done using the history, physical examination, and laboratory test...

Ehlersdanlos

Ehlers-Danlos is an autosomal dominant disease, with a wide variance in expression. It has been classified into 10 different types of disease. Type VI is autosomal recessive. The problem is a qualitative collagen deficiency. Findings include a narrow maxilla, hypermobile ears, and velvety skin, which is hyperextensible. The skin is fragile and demonstrates poor wound healing. Joints are also hyperextensible and easily dislocated. Patients exhibit easy bruising and flat feet, and may have mitral...

Endocarditis

A 6-year-old boy has had high intermittent fevers for 3 weeks, accompanied by chills. He has a past history of bicuspid aortic valvesand recently had dental work. Risk Factors Etiology. Streptococcus viridans is the most common cause of endocarditis, although in some series Staphylococcus aureus is more common, certainly if there is no underlying heart disease. S. viridans is more common after dental procedures. Pseudomonasaeruginosa and Serratia marcescens are seen more commonly in intravenous...

Epiglottitis

A 2-year-old child presents to the emergency center with her parents because of high fever and difficulty swallowing. The parents state that the child had been in her usual state of health but awoke with fever of 104 F, a hoarse voice, and difficulty swallowing. On physical examination, the patient is sitting in a tripod position. The child is drooling, has expiratory stridor, nasal flaring, and retractions of the suprasternal notch and supraclavicular and intercostal spaces. Definition....

Generalized Seizures

A 6-month-old infant is noted to have brief, symmetric contractions (more than 100 times) of the head, neck, and extremities onto the trunk. Definition. Infantile spasms are characterized by brief, symmetric contractions of neck, trunk, and extremities. They usually begin around 4-8 months of age. Risk Factors Etiology. It is hypothesized that corticotropin-releasing hormone is overproduced in patients with infantile spasms causing neuronal hyperexcitability and seizures. Presentation. The...

Foreign Body Aspiration

A toddler presents to the emergency center after choking on some coins. The child's mother believes that the child swallowed a quarter. On physical examination the patient is noted to be drooling and in moderate respiratory distress. There are decreased breath sounds on the right with intercostal retractions. Definition. Foreign bodies include items such as hot dogs, peanuts, beans, coins, buttons, nuts, uninflated balloons, etc. These items when aspirated may go to the esophagus or to the...

Genitourinary

Epispadias occurs when the urethral opening is located on the dorsum of the shaft of the penis. It is usually repaired by 6-12 months of age. Hypospadias is a urethral opening located on the ventral side of the shaft of the penis. A ventral hood is seen, and chord.ee is sometimes associated. Circumcision should be avoided because the foreskin is needed in the repair. Undescended testes are usually in the inguinal canal and must be differentiated from retractile testes. Testes that have not...

Gl Bleeding

GI bleeding can be described as one of the following Hematemesis this is bloodstained vomitus and usually indicates bleeding proximal to the ligament of Treitz. Melena these are soft, black, tarry stools and can represent bleeding anywhere from the oropharynx to the colon. Hematochezia these are bright red stools and are usually from the colon but can reflect upper GI bleeding if the transit time is fast enough. Causes of GI bleeding are divided by site of bleeding and age group. Table 18.4...

Hemophilia A Factor VIII Deficiency

A newborn infant has. prolonged bleeding after circumcision. There is no family history of bleeding disorders. Definition. Hemophilia A is an X-linked recessive deficiency of factor VIII activity. Etiology Risk Factors. Hemophilia A accounts for 80 of all hemophilias. Approximately, 1 in 5,000 to 10,000 males are affected. Family history is usually positive for hemophilia A. Presentation. Bleeding can be seen in neonatal period hematomas after injection or circumcision. Ninety percent of...

Introduction

As always, a history is extremely important in arriving at any diagnosis. Children, however, do not present with the typical features of congestive heart failure that are seen in adults. Consequently, the age is very important when assessing a child in possible heart failure. Infants present with feeding difficulties, easy fatigability, sweating while feeding, and rapid respirations. An older child may have shortness of breath and dyspnea on exertion. Orthopnea, edema, and nocturnal...

Iron

The most common cause of death from poisoning in childhood is iron poisoning. The severity of the poisoning depends on the amount of elemental iron ingested. Adult preparations are responsible for serious poisonings. Presentation Physical Examination. Iron poisoning occurs in four stages Stage 1 occurs 30 min-6 h after ingestion, with symptoms of nausea, vomiting, and diarrhea and abdominal pain. Hemorrhagic gastroenteritis may be present in more serious iron ingestion....

Juvenile Rheumatoid Arthritis

A 7-year-old girl has been complaining of pain and swelling of the left wrist and right knee off and on for the past 3 months. She has been previously healthy. The pain is worse in the morning and improves throughout the day. Physical examination is remarkable for swelling and effusion of the right knee, with decreased range of motion. Definition. JRA is a chronic nonsuppurative inflammation of the synovium of the joints. It is characterized by joint effusions, destruction of joint cartilage,...

Klinefelter Syndrome

This is the most common single cause of hypogonadism and infertility, occurring in 1 500-1 1000 newborn boys. 47,XXY is the most common pattern. Patients tend to have low IQ. Behavior problems and immaturity are early manifestations, arising in childhood well before adolescence and hypogonadism. Fire-setting behavior has been reported. Patients tend to be tall and slim with long limbs. They may be obese as adults. Hypogonadism and a small penis are observed cryptorchidism or hypospadias may...

Laryngotracheobronchitiscroup pw

A 12-month-old child is brought to your office because of a barky cough. The mother states that over the past 3 days the child has developed a runny nose, fever, and a cough. The symptoms are getting worse, and the child seems to have difficulty breathing. He sounds like a seal when he coughs. Definition. Laryngotracheobronchitis caused by viruses is the most common syndrome of infectious upper airway obstruction. Risk Factors Etiology. Parainfluenza virus is the predominant cause of croup....

Legg CalvePerthes

A 5-year-old boy has developed progressive limping. At first painless, it now hurts to run and walk. The pain is in the anterior thigh. The pain is relieved by rest. Definition. Legg-Calve-Perthes disease is an avascular necrosis of the femoral head. It should be considered in any limping child 4-12 years of age. q iJf ff (x Risk Factors Etiology. The cause of Legg-Calve-Perthes is unknown. The femoral head has a tenuous vascular supply, which, when interrupted, can lead to necrosis. Trauma,...

Marfan Syndrome P

Findings of Marfan include tall stature, long limbs, little subcutaneous fat, muscle hypotonia, and arachnodactyly. Sixty percent have kyphosis or scoliosis. Pectus excavatum or carinatum is very common. Ocular findings include lens subluxation, myopia, and retinal detachment. Cardiac anomalies are dilatation with or without dissecting aneurysm of the ascending aorta, and mitral valve prolapse. Occasionally, patients have large ears, hemivertebra, learning disorders, and attention deficit...

Medical

Neuroblastoma represents 8 of all childhood tumors and occurs at a rate of 10 1,000,000 per year. This is the most common solid malignancy in children outside of the CNS. It occurs predominantly in preschool children, and 90 of diagnoses will be made before 5 years of age. It is slightly more common in boys and in whites. There appears to be an association with Beckwith-Wiedemann syndrome. It arises anywhere there are neural crest cells. Presentation. The clinical...

Nephrotic Syndromef

A 3-year-old child presents to the physician with a chief complaint of puffy eyes. On physical examination there is no erythema or evidence of trauma, insect bite, cellulitis conjunctival injection, or discharge. Definition. Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Nephrotic syndrome may be classified as (i) idiopathic (minimal change disease, 85 focal sclerosis, 10 and mesangial proliferation, 5 ) and (2) glomerulonephritis (membranous and...

O medical

Increased glomerular capillary wall permeability Edema secondary to decreased oncotic pressure - Decreased protein stimulates protein synthesis, including lipoproteins Presentation. Nephrotic syndrome usually follows a viral upper respiratory infection. There may be generalized or pitting edema. The patient may have complaints of fatigue, anorexia, abdominal pain, or diarrhea. Hypertension is not common. The patient may have weight gain. Physical Examination. On physical examination the...

Other Neural Tube Defects

Other examples of neural tube defects (dysraphism) include spina bifida occulta and meningocele. Spina bifida occulta is the most benign form of dysraphism. There is a defect of the closure of the posterior vertebral arches and laminae usually at L5 and SI. Most children will be asymptomatic. However, a dermal sinus or patch of hair may be present over the defect. Patients may have recurrent meningitis because of the sinus opening. A spinal roentgenogram shows a defect in closure of the...

Peutzjeghers Syndrome

Fifty percent of patients have no family history, implying a high rate of spontaneous mutation. This syndrome is known for pigmentation and polyps. Vertical bands of epidermal pigment appear as blue-gray or brownish spots on the lips, oral mucous membranes, and periorally. Polyps can be found in the jejunum, nasopharynx, and bladder. The spots appear in infancy to early childhood, and fade in adults. Seventy percent of patients have GI problems by age 20....

Phenylketonuria

Phenylketonuria (PKU) results from a defect in hydroxylation of phenylalanine to tyrosine. Risk Factors Etiology. PKU is transmitted as an autosomal recessive trait and occurs with a frequency of 1 10,000. Presentation. Affected infants are normal at birth until there is sufficient buildup of toxic metabolites. Mental retardation is the most common manifestation and is very severe. Vomiting can be projectile in nature and can be confused with pyloric stenosis. Infants tend to be...

Pneumonia

A 3-year-old child presents to the physician with a temperature of 104 F, tachypnea, and a wet cough. The patient's sibling has similar symptoms. The child attends daycare but has no history of travel or pet exposure. The child has a decreased appetite but is able to take fluids and has good urine output. Immunizations are up to date. Definition. Pneumonia is an inflammation of pulmonary tissue, associated with consolidation of the alveolar spaces. It may be classified by location Pneumonitis...

Rhabdomyosarcoma

A mother brings her 3-year-old daughter to the physician for evaluation because the young girl has grapes growing out of her vagina. Definition. Rhabdomyosarcoma, a tumor of striated muscle, is the most common soft tissue sarcoma in children and accounts for 5-8 of childhood cancers. Risk Factors Etiology. Rhabdomyosarcoma is a round cell tumor, and it is thought to arise from the same mesenchyme as striated muscle. There are varying histologic subtypes (1) embryonal type, responsible for 60 of...

Sexual Abuse

A 3-year-old girl presents with green vaginal discharge. Microscopic examination of the discharge revealed Gram-negative intracellular diplococci. Definition. Sexual abuse includes any activity with a child, before the age of legal consent, which is for sexual satisfaction of an adult or someone who is significandy older than the child. Sexual abuse may include molestation, sexual intercourse, incest, and rape. Risk Factors Etiology. The perpetrator for sexual abuse of children is usually a...

Small For Gestational Age

A term infant weighs 4 pounds at birth. Physical exam reveals a small infant with a disproportionately larger head. Mother has a history of smoking during the pregnancy. Definition. Small for gestational age (SGA) babies, also known as intrauterine growth retardation (IUGR), are those infants whose birth weights fall below the third percentile for their calculated gestational age. They are divided into symmetric, in which all the growth variables (weight, length, head circumference) are equally...

Strabismus

Strabismus is misalignment of the eyes. Deviations can be convergent (esotropia) or divergent (exotropia). This results from abnormal innervation of muscles from the supranuclear nerve. Transient strabismus is common up to 4 months of age. Pseudostrabismus is caused by the unique facial characteristics of the infant and is not a pathologic condition. Diagnosis. The Hirschberg test, looking for the corneal reflex, and the cover test are useful in diagnosing strabismus. Extraocular...

Sturge Weber

A newborn is examined in the nursery by the pediatrician. The patient is a product of a term spontaneous vaginal delivery without complications. On physical examination the patient is noted to have a facial nevus. Definition. Sturge-Weber syndrome is a neurocutaneous syndrome that has a facial nevus (port-wine stain) in the trigeminal area of the face. It is associated with intracranial calcifications, hemiparesis contralateral to the facial lesion, and in half the cases, mental retardation or...

Table of Contents

Chapter 1 Chapter 2 Resuscitation Chapter 3 Nutrition Chapter 4 Growth Chapter 5 Fluids and Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Infectious Chapter 12 Chapter 13 Chapter 14 Mouth and Teeth Chapter 15 Ears, Nose, and Chapter 16 Chapter 17 Chapter 18 Gastroenterology Chapter 19 Renal Chapter 20 Rheumatology Chapter 21 Endocrine Chapter 22 Hematology Chapter 23 Oncology Chapter 24 Neurology Chapter 25 Child Abuse Chapter 26 Adolescence Chapter 27 Syndromes

The school nurse refers a firstgrade student to you because of nits in the childs hair

Lice are obligate parasites of the human host. There are three types (J) body or clothing lice, (2) head lice, and (3) pubic lice. Risk Factors Etiology. A risk factor for Pediculus corporis and Pediculus capitis is poor hygiene. Phthirus pubis is usually transmitted via sexual contact with an infested individual. P. corporis and P. pubis are rarely seen in children, although sexually active adolescents are at risk for P. pubis. Presentation. Pruritus accompanies all types of lice...

Tuberous Sclerosis

A 1-month-old infant presents with infantile spasms and has a hypsarrhythmic EEG pattern. Definition. Tuberous sclerosis is a neurocutaneous syndrome characterized by the triad of mental retardation, facial fibroangiomas, and hypopigmented spots of the skin, and epilepsy. It is an autosomal dominant disease. The gene is located on chromosomes 9 and 16 however, 50 of the cases are the result of new mutations. Risk Factors Etiology. Mental retardation is more prevalent in patients who present...

Urinary Tract Infection

A 12-day-old infant presents with fever of 39 C, vomiting, and diarrhea. On physical examination the infant appears to be ill and mildly dehydrated. Definition. There are three basic forms of urinary tract infection (UTI) (i) pyelonephritis (involvement of the upper urinary tract), (2) cystitis (infection involving the bladder), and (3) asymptomatic bacteriuria (positive urine culture with no associated clinical findings and no renal injury, except in pregnant women). Risk Factors Etiology....

Vesicoureteral Reflux

A 2-year-old girl presents with urinary tract infection. She has had multiple urinary tract infections since birth but has never had any follow-up studies to evaluate these infections. Physical examination is remarkable for an ill-appearing child who has a temperature of 40 C and is vomiting. Definition. Vesicoureteral reflux is abnormal back flow of the urine from the bladder to the kidney. Risk Factors Etiology. Vesicoureteral reflux is caused by congenital incompetence of the vesicoureteral...

Failure to Thrive

A baby weighs 16 pounds at 1 year of age. Birth weight was 8 pounds. Parents state that the baby feeds well. Physical exam reveals a baby with little subcutaneous fat, long dirty fingernails, impetigo, and a flat occiput. Definition. Failure to thrive is failure to gain weight or deceleration of wreight growth. Risk Factors Etiology. Failure to thrive can result from malnutrition (starvation, deprivation, abuse), malabsorption (from infection, celiac disease, cystic fibrosis, disaccharidase...

Pertussis

A 10-month-old child who is delayed in immunizations presents with a paroxysmal cough. The patient appears ill and continuously coughs throughout the examination. The patient has facial petechiae, and conjunctival hemorrhages. In addition the patient has posttussive emesis. Definition. Pertussis is an acute respiratory infection caused by the agent Bordetella pertussis. This is sometimes referred to as whooping cough because patients with this illness may have a forceful inspiratory gasp...

Acute Poststreptococcal Glomerulonephritis

A 10-year-old boy presents with Coca-Cola-colored urine and edema of his lower extremities. On physical examination the patient has a blood pressure of 185 100. He does not appear to be in any distress. His lungs are clear to auscultation, and his heart has a regular rate and rhythm without any murmurs, gallops, or rubs. His past medical history is remarkable for a sore throat that was presumed viral by his physician 2 weeks before. Definition. Acute poststreptococcal glomerulonephritis follows...

Thalassemia Major Cooley Homozygous B

A 9-year-old has a greenish-brown complexion, maxillary hyperplasia, splenomegaly, and gallstones. Her Hb level is 5.0 g dl, and she has an MCV of 65 ml. Definition. Thalassemia major is a severe blood disorder resulting from an imbalance of a- and (3-globin chains. There is a surplus of a-globin chains, causing ineffective erythropoiesis and hemolysis. Risk Factors Etiology. Reduced oxygen carrying ability, ineffective increase in iron absorption, and red marrow expansion are present....

Intussusception

A 15-month-old child is seen for cramping, colicky abdominal pain of 12 h duration. He has had two episodes of vomiting and a fever. Physical examination is remarkable for a lethargic child abdomen is tender to palpation. Leukocytosis is present. During examination, the patient passes a bloody stool with mucus. Definition. Intussusception occurs when a portion of the GI tract slips or telescopes into the portion just distal to it. Most intussusceptions are ileocolic. Risk Factors Etiology. The...

Hypothyroidism see Endocrine Chapter Infants Of Diabetic Mothers

You are called to see a 9.5-pound newborn infant who is jittery. Physical exam reveals a large plethoric infant who is tremulous. A murmur is heard. Blood sugar is low. Definition. Infants of diabetic mothers (IDM) are those infants whose mothers have or develop diabetes during their pregnancy. Risk Factors Etiology. Maternal hyperglycemia leads to fetal hyperglycemia, which in turn leads to fetal hyperinsulinemia. Insulin is a growth hormone, which, in combination with the hyperglycemia,...

Asthma

A 6-year-old boy presents to his physician with end-expiratory wheezing scattered throughout the lung fields. He is noted to have nasal flaring, tachypnea, and intercostal retractions. These symptoms are triggered by changes in the weather. He has a family history of asthma and atopic dermatitis. He has never been intubated or admitted to the pediatric ICU. His last hospitalization for asthma was 6 months ago. He takes medication for asthma only when he starts to wheeze. Definition. Asthma is a...

Hemolyticuremic Syndrome Hu5

A 3-year-old child presents to the emergency center with history of bloody diarrhea and decreased urination. The mother states that the child's symptoms began 5 days ago after the family ate at a fast-food restaurant. At that time the patient developed fever, vomiting, abdominal pain, and diarrhea,On physical examination the patient appears ill. He isj)ale and lethargic. Definition. Hemolytic uremic syndrome is a systemic disease that causes acute renal failure in young children, as well as...

Immune Deficiencies

In immunodeficiency, infections are characterized by increased frequency, unusual severity, a prolonged course or persistence of infection, and at times unusual organisms. Some common clinical manifestations that may be seen in immunodeficiency are recurrent sinopulmonary infections, failure to thrive, persistent thrush, diarrhea, and malabsorption. Associated conditions may include skin lesions such as eczema and pyoderma. Patients may have autoimmune disease and hematologic abnormalities such...

Scarlet Fever

A 7-year-old complains of a headache and a sore throat. On physical examination he has a temperature of 103 F, 3+ tonsils with exudate, and a strawberry tongue. In addition he has circumoral pallor, and a sandpaper rash on his face, trunk, and upper extremities. Pastia lines are also noted. Definition. Scarlet fever is caused by a streptococci infection. Risk Factors Etiology. Group A (3-hemolytic streptococci are the agent. It usually is associated with pharyngitis. However, it may follow...

Enuresis

A 7-year-old boy has problems with bedwetting. The mother says that during the day he has no problems but is usually wet 6 of 7 mornings. He does not report dysuria or frequency, and has not had increased thirst. The mother also says that he is a deep sleeper. Definition. Enuresis is the involuntary passage of urine in a child who is reasonably expected to be toilet trained. Day and night bladder control is usually attained by age 5 years. Risk Factors Etiology. Incidence of enuresis declines...

Congenital Adrenal Hyperplasia

A 1-month-old infant is seen with vomiting and severe dehydration. Physical examination reveals ambiguous genitalia laboratory tests show hyponatremia. Definition. CAH results from Cortisol deficiency, which causes increased corticotropin secretion and subsequent hyperplasia. Risk Factors Etiology. CAH is a series of autosomal recessive disorders 21-hydroxylase deficiency is the most common cause of CAH, followed by 1 l 3-hydroxylase deficiency and 3(3-hydroxysteroid dehydrogenase....

Chlamydia

A 16-year-old boy presents to the emergency center with a persistent penile discharge. The patient states that 1 week ago he saw his family physician for this same problem. At that time the physician gave him an IM shot of penicillin. However, the patient states that the discharge did not resolve with the penicillin therapy. He would like a second opinion. Definition. Chlamydia are intracellular obligate parasites with a cell wall, and they are responsible for a variety of diseases in sexually...

An 18monthold has failure to thrive and developmental delay The patient also has a history of recurrent ear infections

The acquired immunodeficiency syndrome (AIDS) has HIV types 1 and 2 as its agent. Infection with HIV-2 is rarely found in children. Risk Factors Etiology. Most HIV-infected children are born in developing countries. The majority of HIV cases are acquired via vertical transmission from mother to child. Cesarean section combined with prenatal, intrapartum, and neonatal zidovudine (ZDV) therapy significantly reduces transmission of HIV. In developing countries breast-feeding is an...

A mother brings her 5yearold daughter to the physicians office because the child has developed a rash in the

Atopic dermatitis is an inflammatory skin disorder characterized by erythema, edema, pruritus, exudation, crusting, and scaling. Risk Factors Etiology. Patients with atopic dermatitis may have a family history of asthma, hay fever, and atopic dermatitis. Presentation. In infancy the patient may present with an erythematous, pruritic rash with weepy patches on the cheeks, neck, wrist, hands, and extensor aspects of the extremities. Atopic dermatitis in infancy frequently coincides...

A newborn is noted to have white plaques on his buccal mucosa that are difficult to remove

Oral thrush is an infection of the oropharynx caused by Candida albicans. Risk Factors Etiology. Candida infection of the mouth occurs in infants, the immunosup-pressed, patients with poor oral hygiene, and patients taking inhaled steroids. Oral thrush is commonly seen in neonates because of contact with the organism in the birth canal. Presentation. Thrush causes painful inflammation of the tongue, palates, and buccal mucosa. Physical Examination. The lesions of oral thrush look...

Sudden Infant Death Syndrome

A 2-month-old term infant born without any complications via spontaneous vaginal delivery is brought to the emergency center via ambulance with CPR in progress. According to the mother, the patient was in his usual state of good health until 4 am when she found the patient cyanotic and not breathing. The mother states that at midnight the infant was fed 4 ounces of formula without any difficulty. After the feeding, the child was placed to sleep in a crib. At 4 am the mother returned to check on...