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Infectious diseases

Acknowledgment The editors gratefully acknowledge contributions by Drs. Jennifer Duchon, Alexis M. Elward, David A. Hunstad, Lisa Saiman, and Joseph W. St. Geme III that were retained from previous editions of Pediatric Secrets. Anti-infective therapy Key Points: Anti-Infective Therapy 1. Formal allergy testing is frequently negative in patients who report a penicillin allergy. 2. Rashes seen with viral or bacterial illnesses may confound a history of…

Hematology

Acknowledgment The editors gratefully acknowledge contributions by Dr. Anne F. Reilly, Dr. Greg A. Holländer, and Dr. Anders Fasth that were retained from previous editions of Pediatric Secrets . Bone marrow failure 1 What are the types of bone marrow failure? Bone marrow failure is manifested by pancytopenia or, at times, by cytopenia of a single cell type. It can be acquired (acquired aplastic anemia) or…

Genetics

Acknowledgment The editors gratefully acknowledge contributions by Drs. Elaine H. Zackai, JoAnn Bergoffen, Alan E. Donnenfeld, and Jeffrey E. Ming that were retained from previous editions of Pediatric Secrets . Clinical Issues 1 Which disorders with ethnic and racial predilections most commonly warrant maternal screening for carrier status? See Table 8.1 . Table 8.1 Maternal Screening According to Ethnic and Racial Predilections Disorder Ethnic or Racial…

Gastroenterology

Acknowledgment The editors gratefully acknowledge contributions by Drs. Douglas Jacobstein, Candi Jump, Chris A. Liacouras, Peter Mamula, Jonathan E. Markowitz, Amanda Muir, David A. Piccoli, Orith Waisbourd-Zinman, and Danielle Wendel that were retained from previous editions of Pediatric Secrets . Clinical issues 1 What is the definition of failure to thrive? Failure to thrive (FTT) is a sign, not a diagnosis, and not a syndrome. It…

Endocrinology

Acknowledgment We would like to thank Dr. Daniel E. Hale for his significant contributions to this text as one of the original authors of the chapter, as well as Dr. Mary Patricia Gallagher and Dr. Marisa Censani for their work in the most recent prior versions. Adrenal disorders 1 What are the symptoms of adrenal insufficiency? Newborns: Nonspecific findings of vomiting, irritability, and poor weight gain;…

Emergency medicine

Acknowledgment The editors gratefully acknowledge contributions by Dr. Jane Lavelle and Dr. Fred Henretig that were retained from previous editions of Pediatric Secrets . Bioterrorism 1 Why are children more vulnerable to biologic agents than adults? Anatomic and physiologic differences: Thinner dermis, increased surface area–to–volume ratio, smaller relative blood volume, higher minute ventilation Developmental considerations: Inability to flee dangerous situations, possible increased risk for posttraumatic stress…

Dermatology

Acknowledgment The editors gratefully acknowledge contributions by Dr. Robert Hayman, Dr. Leonard Kristal, and Dr. Vivian Lombillo that were retained from previous editions of Pediatric Secrets. Acne 1 When is acne most likely to develop? The development of microcomedones is typically the earliest sign of acne. Studies have shown that comedones occur in three-fourths of premenarchal girls at an average age of 10 years and in…

Pediatric cardiology

Acknowledgment The editors gratefully acknowledge the contributions by Dr. Bernard J. Clark III that were retained from previous editions of Pediatric Secrets . Clinical issues 1 Is cardiac disease the most common cause of chest pain in children? A cardiac cause of chest pain is very uncommon and represents less than 1% of cases in a published series. The most common identifiable causes involve musculoskeletal pain…

Behavior and development

Acknowledgment The editors gratefully acknowledge contributions by Drs. Nathan J. Blum, Mark Clayton, and James Coplan that were retained from previous editions of Pediatric Secrets . Attention-deficit/hyperactivity disorder 1 What are the characteristics of attention-deficit/hyperactivity disorder (ADHD)? ADHD is a chronic neurodevelopmental and behavioral disorder, considered to have neurobiologic origins, that is diagnosed on the basis of the number, severity, and duration of three clusters of…

Adolescent medicine

Clinical issues 1 How does the “HEEADSSSS” mnemonic assist in adolescent interviewing? This mnemonic allows for a systematic approach to the evaluation of multiple health issues and risk factors that affect teenagers: H–Home (living arrangement, family relationships, support) E–Education (school issues, study habits, achievement, expectations) E–Eating (healthy eating lifestyle, binge, purge, restricting, food security) A–Activities (recreation, friends, exercise, employment) D–Drugs (alcohol, tobacco, marijuana, cocaine, pills, etc.)…

How to set up a headache clinic

Introduction Although ☆ Editor’s note: In this chapter the authors share how to set up a headache clinic that is multidisciplinary and comprehensive. They show the data that these clinics work to improve outcome for patients and families. They give advice on how to convince skeptics that such an approach is helpful. I would add that in addition to sharing data, bringing a patient and family…

Growing up: Transitioning to adult care

Health-care transition from a child-centered to an adult-oriented health system is a planned process aimed at ensuring continuity of care and patients’ adherence to medical care, with an emphasis on promoting active involvement of the patients, whenever possible. The lack of a structured transition plan can lead to disruption of health care, higher emergency room and hospital visits, higher health-care costs, and poor medical compliance. Similar…

Advocacy for children with migraine

Headache expert perspective Migraine is the most common neurological disease and, in adults, it has the largest overall impact after stroke, and the largest effect on disability. Relative to its huge impact, society allocates to migraine only a small fraction of the resources it should be getting from the research community and the treatment infrastructure. This is in part due to the stigmatization of the headache…

Smell and Taste

Epidemiology Loss of smell is increasingly being recognized by the fifth decade of life, and an inability to smell or a diminished sense of smell is present in 3 to 20% of the population. Nevertheless, these disorders are often neglected because they are not fatal and, unlike abnormalities of vision and hearing, are not considered serious handicaps. Recently, however, loss of taste and smell has been…

Approach to the Patient with Nose, Sinus, and Ear Disorders

Patients with nose, sinus, and ear disorders may have a variety of chief complaints. Nasal symptoms, including rhinorrhea and congestion, may be due to allergic, infectious, inflammatory, neoplastic, or structural causes. Sinus disorders generally result in concomitant nasal inflammation, so the term rhinosinusitis is preferred. Patients who have rhinosinusitis are more likely to present with purulent rhinorrhea, facial pressure, loss of smell, and pain or headache…

Diseases of the Mouth and Salivary Glands

More than 200 primary lesions or diseases occur in the oral mucosa, gingiva, teeth, jaws, and minor or major salivary glands. In addition, secondary abnormalities of the oral mucosa or salivary glands can be caused by systemic diseases or drugs. The most common or important of these diseases may be observed during physical examination. Oral Mucosal Diseases Acute Ulcerations Painful, short-lasting ulcerations can be caused by…

Neuro-Ophthalmology

A mechanistic understanding of vision impairment along with disturbances in pupillary and oculomotor control is often critical for diagnosing neurologic disorders. Although all physicians should be able to recognize neuro-ophthalmologic abnormalities, precise diagnosis and treatment commonly requires specialty consultation. Vision One of the most difficult diagnostic problems is vision loss that cannot be explained by obvious abnormalities of the eye. To evaluate such a patient properly,…

Diseases of the Visual System

The eye is a compact, complicated structure ( Fig. 391-1 ) that is remarkably stable throughout life. Once the growth of the eye is complete, at approximately age 7 to 8 years, the structure of the eye changes very little throughout one’s life. Open full size image FIGURE 391-1 Anatomy of the eye. The eyelids physically protect the eye. The pathway of light through the eye,…

Disorders of Neuromuscular Transmission

Definition The clinical recognition of neuromuscular transmission disorders ( Table 390-1 ) is critically important because all are treatable. Afflicted patients have the potential to improve substantially or even return to normal function, whereas undiagnosed or untreated disease leads to severe morbidity and death. Each of these disorders compromise the postsynaptic potential, thereby reducing the force generated by muscles. Myasthenia gravis and Lambert-Eaton syndrome are autoimmune…