INDEX OF SUSPICION

1994 ◽  
Vol 15 (12) ◽  
pp. 495-497
Author(s):  
Elliott M. Friedman ◽  
Alexandre T. Rotta ◽  
Vincent J. Menna
Keyword(s):  
Urinary Tract Infection ◽  
Early Diagnosis ◽  
Acute Urinary Retention ◽  
Positive Culture ◽  
Tanner Stage ◽  
Pubic Hair ◽  
The Past ◽  
Hair Development ◽  
Case Presentations ◽  
Similar Episode

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 13-year-old girl comes to you because it is so painful for her to urinate that she has developed acute urinary retention. Over the past 6 months she has had recurrent mild abdominal cramps; exactly 1 month ago she experienced a similar episode of dysuria. At that time she was able to urinate and was diagnosed by positive culture as having a urinary tract infection, for which she was treated. While preparing to catheterize her, you notice that this young woman is Tanner stage 5 in breast and pubic hair development, yet she states that she has never had a menstrual period. Her mother recalls her own menarche at age 11 years. Observations during the procedure allow you to determine the underlying cause of her problems.

INDEX OF SUSPICION

1992 ◽  
Vol 13 (11) ◽  
pp. 435-437
Author(s):  
Summer Smith ◽  
John L. Green ◽  
Susan K Lynch ◽  
Mark J. Polak
Keyword(s):  
Early Diagnosis ◽  
Physical Exertion ◽  
Tanner Stage ◽  
Pubic Hair ◽  
Acting Out ◽  
History Of ◽  
Prolonged Fatigue ◽  
Axillary Hair ◽  
Case Presentations ◽  
Diagnosed Diabetes

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 17-year-old boy is admitted to the hospital for evaluation and management of recently diagnosed diabetes mellitus. His mother expresses concern about his acting-out behavior and about frequent difficulties in drinking from a glass due to tremors. On examination he is found to be 68.5 inches tall, and he has a mild scoliosis. Evaluation of sexual development reveals axillary hair at Tanner stage III, pubic hair at stage V, penile length of 8 cm, left testicular volume of 3.0 x 1.8 cm, and an undescended right testicle. No breast tissue is palpable. Case 2 Presentation A 16-year-old girl is seen at your office with a history of prolonged fatigue and weakness. She has missed school frequently over the past 4 to 5 months, having had many vague complaints of "no energy," headaches, sore throats, aching knees, and the feeling that she will almost "pass out" if she does gymnastics or physical exertion of any kind.

INDEX OF SUSPICION

1994 ◽  
Vol 15 (10) ◽  
pp. 391-393
Author(s):  
David M. Tejeda ◽  
Jessica Kaplan ◽  
John S. Andrews ◽  
Catherine DeAngelis ◽  
Neeru Sehgal
Keyword(s):  
Blood Pressure ◽  
Eye Movements ◽  
Early Diagnosis ◽  
Otitis Media ◽  
The Past ◽  
General Pediatrician ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation The parents of a 22-month-old boy complain that he has been increasingly clumsy and cranky for the past 7 days. He initially developed a stumbling gait and now prefers to crawl; he no longer can sit on his own. The child has been afebrile but has had a cough for several weeks. He has been on antibiotics for otitis media (with a presumed labyrinthitis) for 5 days. There have been no other recent illnesses, and he has not been ill in the past. On examination, the child appears irritable and has occasional jerking movements of his extremities. His temperature is 36.3°C, pulse is 128 beats/min, and blood pressure is 84/40 mm Hg. Chaotic, irregular eye movements are present.

INDEX OF SUSPICION

1994 ◽  
Vol 15 (9) ◽  
pp. 369-371
Author(s):  
Linda S. Nield ◽  
David M. Tejeda ◽  
Lynn C. Garfunkel
Keyword(s):  
Clostridium Difficile ◽  
Early Diagnosis ◽  
Medical History ◽  
Middle Ear ◽  
The Past ◽  
Neurologic Impairment ◽  
Middle Ear Infection ◽  
Clostridium Difficile Toxin ◽  
Her 2 ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A mother is concerned because her 2-year-old son is "not as sure on his feet as he used to be." In the past 2 weeks she has noticed that he seems clumsy and is falling more than usual when playing or walking. His babysitter also has noticed this change in abilities, heightening the mother's concern. No other neurologic impairment is noted, and his play does not seem disrupted. The boy's medical history is unremarkable. Recently, he had a persistent middle ear infection that finally resolved after 1 month of treatment with three different antibiotics. He also has been having 6 to 12 loose stools a day. Clostridium difficile toxin has been isolated from his stool.

INDEX OF SUSPICION

1996 ◽  
Vol 17 (6) ◽  
pp. 221-223
Author(s):  
Linda S. Nield ◽  
Jonette E. Keri ◽  
Randall G. Fisher ◽  
Nasha't M. Khanfar
Keyword(s):  
Early Diagnosis ◽  
Late Spring ◽  
The Sun ◽  
Erythematous Rash ◽  
The Past ◽  
General Pediatrician ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 10-year-old boy is brought to your office in late spring because of an erythematous rash on his arms and legs that has been present for 4 days and because he is having joint pains. The rash first appeared after the boy had been playing outdoors for several hours in the sun. He did have a new commercial sunblock lotion applied to his skin before going outdoors. His father is concerned because even though the rash is less pronounced, his son has been experiencing stiff and painful knees and ankles upon awakening for the past 2 days. The joint discomfort improves with movement during the day. The boy has had no other symptoms and has been free of fever.

INDEX OF SUSPICION

1992 ◽  
Vol 13 (1) ◽  
pp. 33-34
Author(s):  
Catherine DeAngelis ◽  
William O. Robertson ◽  
Daniel D. Chapman
Keyword(s):  
Abdominal Pain ◽  
Sickle Cell Disease ◽  
Early Diagnosis ◽  
Sickle Cell ◽  
Cell Disease ◽  
The Past ◽  
Initial Impression ◽  
General Pediatrician ◽  
Prolonged Delay ◽  
Case Presentations

Clinicians often form a diagnostic impression at the time of a patient's first presentation. Usually the initial impression is correct because commonly encountered illnesses come to mind and are, of course, most likely to be responsible. Sometimes, however, a less familiar disorder is responsible and will not be detected or will be diagnosed after a prolonged delay unless the physician maintains a suspicion of the unusual. This section reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to put in writing possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations with discussions. Case 1 Presentation A 4-year-old black boy known to have sickle cell disease is brought to your office by his mother, who is concerned because he has become listless and weak during the past 12 hours. He has been complaining of abdominal pain and is breathing "harder and faster" than usual. On examination, a greatly enlarged, tender spleen is palpated.

scholarly journals Precocious Puberty – A Case Report

2016 ◽  
Vol 30 (2) ◽  
pp. 109-112
Author(s):  
Poly Begum ◽  
Dipti Rani Saha ◽  
Md Kamrul Hassan
Keyword(s):  
Precocious Puberty ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Central Precocious Puberty ◽  
Female Child ◽  
Pubic Hair ◽  
Breast Development ◽  
Average Height ◽  
Hypothalamic Pituitary Axis ◽  
Hair Development

The parents of a 04-year-old girl bring her to a Gynaecologist because of breast development, appearance of pubic hair and periodic per vaginal bleeding. Her medical history is unremarkable. The parents are of average height, and the mother reports first menstruating when she was 11 years old. At physical examination, the girl is 100 cm tall , weighs 17 kg, and has a bodymass index of 17. Her pubertal development is classified as Tanner stage 3 breast development and Tanner stage 2 pubic hair development. She was diagnosed as a case of precocious puberity. Appearance of secondary sexual development before the age of 9 in a male child and before the age of 8 in a female child is called precocious puberty. When the cause of precocious puberty is premature activation of the hypothalamic-pituitary axis, it is called central or complete precocious puberty and she was a case of central precocious puberty. After proper consult she was treated by GnRHa suppressor of pituitary till 11 years of age.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(2) : 109-112

scholarly journals Delayed pubertal onset and development in German children and adolescents with type 1 diabetes: cross-sectional analysis of recent data from the DPV diabetes documentation and quality management system

2007 ◽  
Vol 157 (5) ◽  
pp. 647-653 ◽  
Author(s):  
Tilman Rohrer ◽  
Eva Stierkorb ◽  
Sabine Heger ◽  
Beate Karges ◽  
Klemens Raile ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Sexual Maturity ◽  
Insulin Dose ◽  
Tanner Stage ◽  
Pubic Hair ◽  
Diabetes Duration ◽  
Diabetic Patients ◽  
Pubertal Onset ◽  
Hair Development

AbstractObjectiveTo investigate the effect of type 1 diabetes on pubertal onset and development, and to identify factors potentially affecting puberty, including glycemic control, relative diabetes duration, body mass index standard delta score (BMI SDS), insulin dose, and intensity of insulin therapy.Research design and methodsInitiated in 1990, the Diabetes-Patienten-Verlaufsdaten (DPV) is an ongoing, prospective longitudinal follow-up program to benchmark the quality of diabetes care provided to, predominantly, pediatric patients. Data collection for this non-interventional audit was carried out at 202 German diabetes treatment centers. Patient recruitment was done by referral, clinic/hospital ascertainment, or self-report. Data were analyzed for subcohorts of 1218–2409 boys and 579–2640 girls from a cohort of 24 385 pediatric type 1 diabetic patients. Selection was based on ethnicity and availability of data on Tanner stage 2, or higher, of genital and pubic hair development (boys) or breast and pubic hair development, and menarche (girls).ResultsBoys showed significant (P<0.05) delay (years) in mean ages at onset of genital development (12.0 (±0.9) years) and pubarche (12.2 (±0.4) years). In girls, mean ages at thelarche (11.4 (±0.5) years), pubarche (11.5 (±0.1) years), and menarche (13.2 (±0.5) years) were significantly delayed compared with the general population. Sexual maturity (Tanner stage 5) was not delayed in either sex. Elevated glycohemoglobin and decreased BMI SDS were associated with significantly delayed pubertal onset, whereas relative diabetes duration and insulin dose were not.ConclusionsPubertal onset, but not sexual maturity, is delayed in children with type 1 diabetes. Delay increases with higher glycohemoglobin and lower BMI SDS.

INDEX OF SUSPICION

1993 ◽  
Vol 14 (3) ◽  
pp. 117-119
Author(s):  
Vincent J. Menna ◽  
Summer Smith ◽  
Gregory S. Liptak
Keyword(s):  
Early Diagnosis ◽  
Blood Count ◽  
Complete Blood Count ◽  
Hip Pain ◽  
Physical Finding ◽  
The Past ◽  
History Of ◽  
Gag Reflex ◽  
Case Presentations ◽  
Breast Fed

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A 2-month-old breast-fed boy is brought to the office with a 2-day history of constipation, poor feeding, lethargy, wheezing, and a temperature of 101°F (38.3°C). In the office his temperature is recorded at 98.8°F (37.1°C) rectally. The infant does not appear lethargic, and the only significant physical finding is tearing of the left eye. Because of the history of fever, a complete blood count is obtained, which is normal. The infant is discharged home with a diagnosis of conjunctivitis and possible viremia. He returns within 48 hours and is found to be hypotonic with a poor gag reflex, weak suck, and weak cry. Despite his normal temperature a septic evaluation is initiated. Case 2 Presentation A 17-year-old boy complains of bilateral hip pain that has bothered him for the past year.

INDEX OF SUSPICION

1992 ◽  
Vol 13 (4) ◽  
pp. 157-159
Author(s):  
Daniel D. Chapman ◽  
Marie C. McCormick
Keyword(s):  
Early Diagnosis ◽  
Left Knee ◽  
Perianal Area ◽  
The Past ◽  
Supervised Exercise ◽  
Reduction Program ◽  
Calorie Diet ◽  
History Of ◽  
Ear Infections ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation A prepubertal 12-year-old boy who is obese (192 lbs, 68 in) is seen in the office for pain in the anterior and medial aspect of the left knee. The knee is not tender to palpation and has a range of motion equal to the normal right knee. He is in a weight-reduction program consisting of an 1800-calorie diet and supervised exercise four times per week. No history of trauma is elicited. Case 2 Presentation During the past 2 months, you have seen an 8-month-old boy twice for ear infections. At the last visit, 3 weeks ago, he also had a rash over his buttocks and in the perianal area that you treated with zinc oxide cream.

INDEX OF SUSPICION

1996 ◽  
Vol 17 (11) ◽  
pp. 405-407
Author(s):  
Gregory P. Conners ◽  
Angela E. Lin ◽  
Juan A. Rivera
Keyword(s):  
Nursing Home ◽  
Early Diagnosis ◽  
Respiratory Infections ◽  
Vital Signs ◽  
Volunteer Work ◽  
Medial Margin ◽  
Upper Respiratory Infections ◽  
The Past ◽  
Upper Respiratory ◽  
Case Presentations

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page. We invite readers to contribute case presentations and discussions. Case 1 Presentation An 18-year-old girl comes to your office complaining of a sore nose. She reports that the tip of her nose has been red and tender for the past few days and seems to be worsening. Because of the erythema, she was not allowed to do her usual volunteer work at a local nursing home. Her health has been good and she denies having any recent upper respiratory infections. She has not had fever and is taking no medication. She recalls having a similar nasal condition at least once before; it was not as uncomfortable and cleared up without treatment. On physical examination, she is afebrile, and all other vital signs are normal. The tip of her nose is slightly but noticeably swollen, and the medial margin of her right nostril is moderately erythematous.

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