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Stress Fractures: Their Causes and Principles of Treatment

Introduction Historical Perspective Stress fractures were first described in 1855 by Briethaupt, a Prussian military physician who observed foot pain and swelling in young military recruits unaccustomed to the rigors of training. He considered it to be an inflammatory reaction in the tendon sheaths resulting from trauma and called the condition Fussgeschwulst . It was not until the advent of radiographs that the signs and symptoms…

Impingement Syndromes of the Ankle

Introduction Impingement is derived from the Latin verb impingere, meaning “to force against,” where an anatomic structure becomes entrapped causing pain, bony and soft tissue injury, decreased range of motion, and dysfunction. When impingement occurs, one bone repetitively strikes another, which over time can stimulate the deep layer of the periosteum to form osteophytes that further exacerbate the impingement and alter the normal mechanics of the…

Fundamentals of Pediatric Radiology

Introduction Children have special needs and unique disease processes, and thus the diagnostic imaging approaches are also different. Pediatric imaging should be problem oriented. Communication between the referring physician and the pediatric radiologist is encouraged. The essential components of a pediatric imaging facility are listed in Box 25.1 . Box 25.1 Essential Components of Pediatric Imaging From Osborn LM, DeWitt TG, First LR, et al, eds. Pediatrics…

Otolaryngology

Acknowledgments The authors acknowledge and thank Children’s Hospital of Pittsburgh, Department of Radiology, and University of Pittsburgh School of Medicine, Department of Neuroradiology, for providing many of the radiographs and CT scans in this chapter. Supplemental videos are available at expertconsult.com . The importance of pediatricians and family physicians having understanding of and experience with otolaryngologic problems and being skilled in techniques of examination of the…

Pediatric Plastic Surgery

The word “plastic” is derived from the Greek word for “moldable.” Therefore, plastic surgery refers to surgery that focuses on form and function. Form is often related to appearance, which is why aesthetics usually plays an important role in plastic surgery. Although all surgeons repair function to some degree, plastic surgery emphasizes functions that improve quality of life, such as eating, speaking, self-confidence, and social interactions.…

Orthopedics

Children with musculoskeletal injuries and afflictions are brought for care because of pain, deformity, or loss of function. Because of their rapid physical growth and the special properties of their developing bones, children often pose special problems for the clinician. Musculoskeletal problems in children fall into several general categories. Trauma (discussed here and in Chapter 6 ) Congenital problems—problems resulting from genetic factors and from exposure…

Oral Disorders

Assessment Techniques Because oral and oropharyngeal problems and disorders are common and cause a wide variety of symptoms, routine and thorough oral examinations are an essential component of a complete physical examination; this enables the practitioner to make an appropriate diagnosis without undue delay. The American Academy of Pediatric Dentistry (AAPD) recommends that children are seen for a dental exam by no later than 1 year…

Ophthalmology

The pediatrician may be faced with a child who is systemically well or systemically unwell and has a common eye or visual problem, OR a child who is systemically well or unwell with an uncommon eye or visual problem. In the systemically unwell child, the eye findings may well help towards a unifying diagnosis. Assessing the child from an anatomical or structural attitude as well as…

Pediatric and Adolescent Gynecology

Acknowledgment The authors gratefully acknowledge Pamela Murray and Gina Succato for all of their work on previous versions of this chapter, as well as for contributing all the photographs not otherwise attributed. Supplemental videos are available at expertconsult.com . Normal Female Genitalia Newborn and Prepubertal In the newborn, the physical appearance of the genitalia reflects stimulation by maternal sex hormones ( Fig. 19.1 ). Separation of…

Surgery

Introduction General pediatric surgery encompasses a wide spectrum of disorders and malformations that overlap with other medical and surgical specialties. All pediatricians will undoubtedly be faced with conditions that warrant the involvement of a surgeon. The emphasis of this chapter is on the common conditions that may be seen in general pediatric primary care practices, including some unusual cases. Head and Neck Head and neck lesions…

Pulmonary Disorders

Introduction Respiratory diseases are among the most common reasons for pediatric patients to seek medical attention. Signs and symptoms can be subtle, and a careful history and physical examination are useful in assessing pediatric patients with respiratory complaints. Diseases of the chest can be divided into two major categories: acquired and congenital. Congenital chest diseases are often symptomatic rather than episodical. The spectrum of diseases involving…

Neurology

Acknowledgment The authors wish to thank Rajiv Varma and Shelley D. Williams for their work on this chapter in the previous edition. Neurologic Examination The primary objective of the neurologic examination is to assess the functional integrity of the central nervous system (CNS) and the peripheral nervous system (PNS) and to detect and localize any sites of neurologic dysfunction. Techniques and interpretation of the pediatric neurologic…

Urologic Disorders

Many congenital urologic malformations and acquired disorders, as well as the results of common urologic surgical procedures, produce visible or palpable findings on physical examination. Some clinical presentations are unique. In other cases, disorders of varying etiology may present similar signs, symptoms, and physical findings. Differential diagnosis is essential to an appreciation of pediatric urologic disorders. Physical Examination Prior to any physical exam, a thorough history…

Nephrology

The manifestations of kidney and genitourinary disorders range from readily apparent gross structural abnormalities to subtle abnormalities of the urinary sediment. This chapter will review key history and physical findings, characteristic urinary findings, and updated diagnostic and radiographical studies of renal disorders encountered in both ambulatory and hospital settings. Essentials Of Medical History and Physical Examination The medical history and physical examination often provide clues implicating…

Infectious Diseases

Infectious Exanthems Exanthematous disorders are numerous, and commonly encountered, because they have many similarities, often a source of clinical confusion. In establishing a diagnosis, the clinician should not only attend to the basic character of the exanthem but also to its mode of spread, its distribution, the evolution of lesions, and the constellation of associated symptoms. In some illnesses, the presence of a characteristic oral enanthem…

Hematology and Oncology

Hematology Red Blood Cells The red blood cell (RBC) is classically described as a biconcave disk. Red cells evolve from immature forms, beginning with pronormoblasts, which are large cells with dark blue cytoplasm and a large centrally located nucleus. As the cell matures, the nucleus becomes pyknotic and is eventually extruded from the cell completely. As the cell begins to make hemoglobin, the cytoplasm undergoes a…

Nutrition and Gastroenterology

Nutritional and gastrointestinal (GI) symptoms are two of the most common themes encountered in general pediatric medicine. Globally, undernutrition and diarrheal disease cause substantial morbidity and mortality. In the developed world, nutritional assessment is paramount in well-childcare and chronic illness management. GI symptoms are common in acute and chronic illnesses. Since one of the main functions of the GI system is to provide fluid, vitamins/minerals, and…

Vascular Anomalies

Introduction Vascular anomalies represent a broad spectrum of disorders from the simple birthmark to the multisystem life-threatening disorder. Classically they have had a variable nomenclature that has promoted misdiagnosis and mistreatment. The modern movement in the field of vascular anomalies has been to create a uniform classification system based on the pathophysiology of these disorders, which also lends to understanding the individualized treatment regimen of each…

Pediatric Endocrinology

Introduction Clinical presentations of endocrine disease can vary widely. Alterations in hormone balance can result in distinct phenotypes affecting linear growth, timing of puberty, and body composition as well as metabolic functions. The steady stream of discoveries of new genes, novel mutations, and alterations in gene expression has provided insight and will continue to elucidate the functional genomics of the clinical presentations associated with insufficient or…