INDEX OF SUSPICION

1994 ◽  
Vol 15 (5) ◽  
pp. 201-203
Author(s):  
Mary D. Dvorak ◽  
Britta Mazur ◽  
A. George Pascual
Keyword(s):  
Early Diagnosis ◽  
Physical Examination ◽  
General Pediatrician ◽  
History Of ◽  
Night Awakening ◽  
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 6-day-old girl is brought into the clinic having a 12-hour history of fever to 101°F(38.3°C), irritability, and refusal to breastfeed. The child's mother is a bright, articulate woman who is very concerned about providing the best for this baby, her first, and is dedicated to breastfeeding. She notes that the child previously had been "a very good baby" - quiet, pleasant, and nondisruptive. Since birth, the child has slept for much of the day and night, awakening every 5 to 7 hours to feed. The baby usually wets her diapers after each feeding. However, her mother says that the last wet diaper was noted 6 hours ago, and it was barely wet. Upon physical examination, the child appears quiet but awake.

INDEX OF SUSPICION

1993 ◽  
Vol 14 (9) ◽  
pp. 361-363
Author(s):  
Elizabeth R. Marino ◽  
Robert B. Baker ◽  
Jeffrey M. Devries ◽  
Sanjiv B. Amin
Keyword(s):  
Blood Pressure ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Sleep Disturbance ◽  
Nasal Congestion ◽  
Family Members ◽  
Respiratory Difficulty ◽  
General Pediatrician ◽  
Mucous Membranes ◽  
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 You are seeing a 16-year-old male who has had nasal congestion that began a few months ago. The congestion was intermittent at first but has become constant. He denies sneezing, itchy eyes, or other respiratory difficulty. His mother is concerned because he often is awakened by his congestion. He frequently is irritable in the mornings, and she believes the sleep disturbance is responsible for the decline in his grades, which had been very good. Except for one uncle, no family members have complained of allergies. He is a slim boy whose pulse is 90 beats/min, blood pressure is 136/80 mm Hg, and temperature is 98.8°F (37.1°C). Physical examination otherwise is normal except for mildly reddened, edematous nasal mucous membranes that have a small amount of thin white mucoid discharge.

INDEX OF SUSPICION

1995 ◽  
Vol 16 (9) ◽  
pp. 349-351
Author(s):  
Sanjiv B. Amin ◽  
Jeffrey M. Devries ◽  
Patricia McQuilkin ◽  
Nathalie Quion ◽  
Thomas G. DeWitt
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Chest Pain ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Respiratory Rate ◽  
General Pediatrician ◽  
Difficulty Breathing ◽  
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 15-year-old girl comes to your office complaining that she has experienced intermittent, sudden episodes of chest pain, fatigue, palpitations, and sensations of difficulty breathing and lightheadedness for 2 months. These episodes occur several times daily and are unaccompanied by other symptoms such as syncope, wheezing, swelling of the extremities, or fever. She denies being worried, but reports that her parents are very frightened because a 16-year-old male cousin died recently while playing soccer, and two other relatives, a 27-year-old cousin and a 29-year-old uncle, died suddenly during exercise. The physical examination reveals a somewhat anxious girl complaining of mild precordial chest pain. Her temperature is 36.9°C(98.4°F) orally, respiratory rate is 16 breaths/min, heart rate is 110 beats/min, and blood pressure is 100/60 mm Hg; weight and height are at the 75th percentile.

INDEX OF SUSPICION

1996 ◽  
Vol 17 (5) ◽  
pp. 181-183
Author(s):  
Janice L. Block ◽  
Selina Daisy ◽  
A K Mostaque ◽  
James A. Waler
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Physical Examination ◽  
General Pediatrician ◽  
Amoxicillin Clavulanate ◽  
Drug Regimens ◽  
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 11-month-old boy is brought to the emergency department because of 3 days of fever, "crossed eyes," and a discharge of bloody pus from his left ear. His mother also has noticed that he is less steady on his feet. His left ear has been infected for 6 months despite therapy with amoxicillin/clavulanate, cefpodoxime, clarithromycin, ceftriaxone, cefaclor, and antibiotic drops with hydrocortisone. The mother states that she has been fully compliant with the drug regimens. On physical examination, the child's height and weight are in the 50th percentile. He tugs frequently at both ears but is afebrile and does not look ill. He is unable to move his left eye laterally past midline, giving him a cross-eyed appearance on left lateral gaze.

INDEX OF SUSPICION

1994 ◽  
Vol 15 (7) ◽  
pp. 289-291
Author(s):  
John C. Leopold ◽  
Andrew P. Sirotnak ◽  
Joseph Ryan ◽  
Vincent J. Menna
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Good Health ◽  
Burning Sensation ◽  
Periorbital Edema ◽  
Pediatric Clinic ◽  
General Pediatrician ◽  
The Family ◽  
History Of ◽  
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 13-year-old boy who has been in good health previously comes to the pediatric clinic with a history of a pruritic red rash that comes and goes for several hours after he has been swimming. This rash has been a problem for the last 5 days. Two days ago, after swimming, he developed a diffuse rash together with periorbital edema and a burning sensation on his back. He suddenly became lightheaded and collapsed into his mother's arms, losing consciousness briefly. By the time he arrived at the emergency department, the rash was gone and his examination was normal. No treatment was prescribed. Yesterday, while washing the family car with cold soapy water, his right arm and hand swelled and turned solidly red in a "glove" distribution.

INDEX OF SUSPICION

1992 ◽  
Vol 13 (8) ◽  
pp. 295-297
Author(s):  
John L. Green ◽  
Michael Shannon ◽  
Frederick H. Lovejoy ◽  
Catherine DeAngelis
Keyword(s):  
Pain Relief ◽  
Early Diagnosis ◽  
Left Testis ◽  
General Pediatrician ◽  
History Of ◽  
Case Presentations ◽  
Great Pain

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 12-y-old boy is seen several hours after the onset of rather severe scrotal discomfort. The pain began shortly after the gym class in which an errant basketball pass struck him squarely in the scrotal area. He is in obvious pain, complains of nausea, and vomited on the car ride to your office. On examination, there is swelling and erythema of the left hemiscrotum and any movement or palpation of the left testis causes great pain; gentle elevation of the testis brings no pain relief. The testis is of firm consistency and quite tense. A cremasteric reflex cannot be elicited on the left side. Case 2 Presentation A 12-y-old boy is brought to the office with a 3- to 4-d history of intermittent headache and lethargy.

INDEX OF SUSPICION

1996 ◽  
Vol 17 (2) ◽  
pp. 65-68
Author(s):  
Martha Toledo-Valido ◽  
M. Joyce Neal ◽  
John T. Duelge ◽  
Meena Kalyanaraman ◽  
Maria Patterson
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Respiratory Distress ◽  
Shortness Of Breath ◽  
Breath Sounds ◽  
History Of ◽  
Case Presentations ◽  
The Right

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 3-year-old girl is brought to the emergency department because of 24 hours of fever, nonproductive cough, and shortness of breath that has worsened progressively. She has no history of significant illness. She has been taking amoxicillin for 1 week to treat otitis media and pharyngitis. On physical examination, the child appears in obvious respiratory distress. She has a temperature of 101°F (38.3°C), pulse of 150 beats/min, respiratory rate of 46 breaths/min, and blood pressure of 137/72 mm Hg. She is breathing with subcostal and intercostal retractions and nasal flaring. Her breath sounds are diminished in the area of the right upper lobe, and generalized inspiratory and expiratory wheezing is heard. Both tympanic membranes are red and distorted.

INDEX OF SUSPICION

1994 ◽  
Vol 15 (3) ◽  
pp. 117-119
Author(s):  
Najla N. Falaki ◽  
Michael Shannon ◽  
Anthony M. Policastro
Keyword(s):  
Early Diagnosis ◽  
Maculopapular Rash ◽  
General Pediatrician ◽  
Tympanostomy Tubes ◽  
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 with discussions. Case 1 Presentation A 7-month-old boy is brought to your office because of swelling in his neck. He has a history of recurrent ear infections and had tympanostomy tubes inserted 2 weeks ago. Some ear drainage has been noted in the last few days. The child has had a recurrent rash on his face and scalp as well as a stubborn diaper rash that has not responded to nystatin ointment. He has had no fever and has been active and feeding well. On examination, the child appears healthy, and his temperature is 36.5°C (97.8°F) rectally. There is a seborrhealike maculopapular rash on his forehead and scalp, with some interspersed petechiae; inflamed skin is noted in the perineal area.

INDEX OF SUSPICION

1995 ◽  
Vol 16 (3) ◽  
pp. 117-119
Author(s):  
Randy Cron ◽  
Laurette Ho ◽  
Bradley Bradford
Keyword(s):  
Early Diagnosis ◽  
External Genitalia ◽  
Low Grade ◽  
Palpable Mass ◽  
Pelvic Ultrasonography ◽  
Distended Bladder ◽  
Focus Of Infection ◽  
History Of ◽  
Case Presentations ◽  
Free Area

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 previously healthy 6-month-old girl is seen at the office for evaluation of fussiness and infrequent urination. The child has not voided in the past 9 hours despite her usual fluid intake. She is afebrile, with no focus of infection found on careful physical examination. A palpable mass is felt in the suprapubic area. Her external genitalia are normal. Renal and pelvic ultrasonography reveal an echo-free area superior to a normal lower renal ureteral segment on the left side, with a circular echo free area at the lower end of the ureter extending into and taking up about one quarter of the space within a distended bladder. Case 2 Presentation A 4-year-old boy is seen in your office with a 4-day history of sore throat and low-grade fever.

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.

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