Core Clinical Cases in Paediatrics PDF

Index abdominal pain 109–19 arrhythmia 44–8 ABO incompatibility 124 asphyxia at birth 17–18 abroad, return from 52, 57–8 aspiration 80–1 abscesses (brain) 90, 94–5 astatic episodes 78 abuse 157–8, 160–1...

Index abdominal pain 109–19 arrhythmia 44–8 ABO incompatibility 124 asphyxia at birth 17–18 abroad, return from 52, 57–8 aspiration 80–1 abscesses (brain) 90, 94–5 astatic episodes 78 abuse 157–8, 160–1 asthma 65, 67, 70–2, 74 N-acetylcysteine 146, 148, 152 attention deficit hyperactivity disorder activated charcoal 146 (ADHD) 156, 158–9 acute appendicitis 116–17 autism (pervasive development disorder) acute fever 51–61 20–1, 156, 158–61 acute gastroenteritis 103–7 acute post-streptococcal glomerulonephritis bacterial infections 112, 114–17 breathing ceased 44–8 acute severe illness 35–50 gastroenteritis 104–5 acyanotic congenital heart disease 79 lower respiratory tract infections 70–2 adenovirus, croup 66 pneumonia 69–70 ADHD see attention deficit hyperactivity tonsillitis 59–60 disorder barium swallow test 30 adolescent growth spurt 4 basic life support 46 advanced life support 47 BCG vaccine 55 airways bedwetting 116, 162–3 inflammation 38, 66 behavioural problems 153–63 obstruction 38, 44–8 benign congenital hypotonia 17–18 alarms for bedwetting 162 beta-haemolytic streptococcal septicaemia alcohol ingestion, teenage fits 83–5 80–1 alkaline diuresis 146 bile 130 allergens 66–7 bilharzia 114–15 alpha-1-antitrypsin deficiency 124 biliary atresia 124, 126–7 anatomy 38 bilirubin 124, 130 anorexia nervosa 9–10 birth trauma 17–18 antibiotics bleeding disorders, haematuria with accidental ingestion 146 abdominal pain 114–15 acute severe illness 39 blood culture 38 meningococcal disease 141 blood sugar 38 antidotes 146 blue babies 42–3, 80 antihistamines 146 blue breath-holding attacks 78, 86 apnoeas 101 bone age appendicitis 116–17 delayed puberty 10 arms, stiff 14, 18–19 short stature 7 166 Index bone age – contd chronic active hepatitis 128–9 thelarche variant 8 chronic fever 51–61 bottle feeding 33, 100 ciprofloxacin 135 bowels clotting disorders 137–9 intussuception 101–2 CMV see cytomegalovirus lymphoma 113 coeliac disease 104–5, 112–13, 117–18 brain colic 101, 103–4, 108 abscesses 90, 94–5 communication impairment 156 injury 16 concentration 156 tumours 94–5 congenital heart disease breast development 2, 7–9 acute severe illness 42–3 breast feeding acyanotic 79 stool frequency 100 cyanotic 79–81 weight faltering 24–5, 30–3 weight faltering 27–9 breast milk jaundice 124, 126–7, 130 congenital myopathy 17–18 breath-holding attacks 78, 86 conjunctivitis 54–6 breathing consanguinity 41 ceased 36, 43–8 constipation 119 difficult 36, 40–3, 70–2 constitutional delay of growth 6–7 shortness 72–3 constitutional short stature 6–7, 11 bronchiolitis 67, 69–70 contact dermatitis 141 bronchoconstriction 66–7 convulsions 78 bronchospasm 66 Coombs test 126 bruising 137–9 cosmetics ingestion 146 button batteries ingestion 152 coughing acute breathing difficulties 70–2 calcium serum levels 82 acute severe illness 40–2 Camphylobacter 104 asthma 74 candidiasis 134, 136–7, 141 cystic fibrosis 72–3 carbamazepine 146 noisy breathing 69–72 carbohydrate malabsorption 26 cow’s milk protein intolerance 117–18 carbon monoxide poisoning 91–5, Coxsackie virus A16 134 150–1 C-reactive protein (CRP) 38 carboxyhaemoglobin 151 croup 66, 69–70 cardiac anomaly, breathing ceased 44–8 CRP see c-reactive protein (CRP) cardiac failure 69–70 CT scans 96 ‘catch-down’ growth 30–3 cyanosis 79–81 centiles 26 cystic fibrosis (CF) 27–9, 67–8, 72–4 cerebral cortical function disturbance 78 cytomegalovirus (CMV) infection 124, 128–9 cerebral palsy 16, 18–19, 22 cerebrospinal fluid microscopy 39 DAT see direct antibody test chicken pox 134 dehydration 44–9, 100 child/adult differences 38 delayed development 13–22 childhood growth phases 4 delayed puberty 2, 4, 9–10 childhood infectious diseases 54 delayed walking 15, 22 chloroquine 58 dermatitis 141 chromosomal disorders 17–18 desferrioxamine 146, 150 chromosome karyotype 10 developmental delay 13–22  Index 167 developmental language disorders 20–1 fears 156 development milestones 16 febrile convulsions 78, 86 diabetic ketoacidosis 112, 115–17 feeding diarrhoea 97–108 diarrhoea and abdominal pain 117–18 abdominal pain 117–18 disturbance 156 acute severe illness 40–1, 49 drive 27–30 dietary advice 11 inability 26 Dioralyte 49 refusal 24–5, 29–30, 33 diphtheria, tetanus, accelular pertussis, fever 40–2, 51–61, 78 inactivate polio vaccine, Haemophilus fidgeting 156 influenzae (DTP/IPV/Hib) 55 fifth disease 134 diplegia 16 fits 75–86 direct antibody test (DAT) 126 ‘floppy’ (hypotonic) babies 14, 17–18 dishwasher powder ingestion 146 fontanelles 82–3, 100 disordered social background 157–8 full blood count 38 distraction 156 fundoplication 101 Down’s syndrome 15, 17–18, 22 fungal infections 134, 136–7, 141 drug intoxication 83–5 funny turns 75–86 drug withdrawal 82–3 DTP/IPV/Hib vaccine 55 galactosaemia 125–6 ductus arteriosus 42 gas appliances in carbon monoxide duodenal web 106 poisoning 150 dystonic movements 101 gastric peristalsis 102 gastroenteritis eating disturbance 156 acute severe illness 40–2, 49 ecchymoses 135 diarrhoea and vomiting 103–7 eczema 134, 136–7 poisoning differential diagnosis 150–1 electroencephalography (EEG) 78 gastro-oesophageal reflux 101, 106–8 electrolyte disturbance 38, 44–8 breathing ceased 44–8 emotional problems 153–63 weight faltering 26–30 encephalitis 90, 94–5, 134 genetics environmental responses 156 cystic fibrosis 68, 74 epiglottitis 66 emotional and behavioural responses 156 epilepsy 78–9, 83–5 German measles see rubella epiphyseal fusion 4 glandular fever 59–60, 124, 128–9 erythematous rashes 134 gliadin 112 erythrocyte haemolysis 124 glomerular inflammation 112 ethnicity, height 6 glomerulonephritis 112, 114–17 exanthems 134 glucose 100, 112 exercise advice 11 glucose-phosphate dehydrogenase deficiency extrahepatic biliary atresia 124, 126–7 125 glucuronyl transferase 124 failure to thrive see weight faltering gluten 112–13, 118 faints 75–86 group A streptococcal infection 59–60 Falciparum infection 57 growth 1–11 familial delayed puberty 9–10 first year of life 38 familial short stature 6–7, 11 phases of childhood 4 fatty acids 112 spurts 4 168 Index growth hormones idiopathic epilepsy 79, 83–5 deficiency 6–7, 11 idiopathic thrombocytopenia purpura (ITP) Turner syndrome 5 137–40 immune system 54 haematuria 112, 114–15 immunization 55, 61, 66, 135 haemodialysis 146 immunoglobulins 54 haemofiltration 146 impetigo 134 haemolytic jaundice 125–6 impulsivity 156 haemolytic uraemic syndrome 114–15 inattention 156 haemophilia 137–9 inborn errors of metabolism 40–3, 82–3 Haemophilus influenzae vaccine 55, 66 infantile colic 101, 103–4, 108 headaches 87–96 infantile eczema 136–7 head injuries 90, 94–5 infectious childhood diseases 54 hearing impairment 19–21, 157–61 infectious mononucleosis 128–9 heating systems in carbon monoxide inflammation of airways 66 poisoning 150 inflammatory bowel disease 117–18 height influenza 66, 150–1 clinical cases 2, 6–7 inhaled foreign bodies 70–2 counselling cases 3, 11 inherited metabolic disease 125–6 final height estimation 5 insulin 112, 117 velocity measurement 4–5 insulin stress test 7 hemiplegia 16 interactions impairment 156 Henoch–Schönlein purpura (HSP) 114–15, intestinal obstructions 103–4, 106–7 135, 137–40 intracranial haemorrhage 82–3, 90 hepatitis 124, 126–9 intracranial hypertension 91–4 hepatitis B vaccine 55 intracranial infections 90, 94–5 hepatoxicity 148, 152 intracranial lesions 83–5 hernia 103–4 intracranial pressure raise 90–4 hives 134 intracranial sepsis 90, 94–5 hormones intracranial trauma 82–3, 94–5 growth 5–7, 11 intracranial tumours 8 luteinizing hormone-releasing hormone intussuception 101–4 test 8, 10 invagination of bowel 101–2 replacement 5 involuntary soiling 119 household substance ingestion 146, 152 iron tablets 144, 146, 148–50 HSP see Henoch–Schönlein purpura (HSP) irritable bowel syndrome 119 hyperactivity 156–8 isolated growth hormone deficiency 6–7, hyperbaric oxygen therapy 151 11 hyperteleorism 10 isolated thelarche 7–8 hypertension 90–4, 112 ITP see idiopathic thrombocytopenia hypertonia 16 purpura hypochloraemic alkalosis 102 hypoglycaemia 40–2, 83–5 jaundice 121–30 hypothermia 80–1 jitters 78 hypothyroidism 27–9 hypotonia 14, 17–18 Kasai portoenterostomy 124 Kawasaki disease 55–7, 59–60 iatrogenic poisoning 44–8 Kayser Fleischer rings 128  Index 169 ketoacidosis 112, 115–17 measles 54, 56–7, 59–61 ketones 116 croup 66 key concepts exanthems 134 abdominal pain 112–13 measles, mumps and rubella (MMR) vaccine acute severe illness 38–9 55, 61 developmental delay 16 meconium ileus 74 diarrhoea and vomiting 100–2 meningitis 40–2, 49 emotional and behavioural problems fits 82–3 156 headaches 90, 94–5 fever 54–5 lumbar puncture 39 fits, faints and funny turns 78 rashes 135, 141 growth problems 4–5 meningococcal infection headaches 90 lumbar puncture 39 jaundice 124 mild fever 56–7 poisoning 146 rashes 56–7, 134–5, 139–41 rashes 134–5 return from abroad 57–8 respiratory problems 66–8 meningococcus C vaccine 55, 135 weight faltering 36 mental retardation, speech 20–1 mesenteric adenitis 115–17 lactose intolerance 104–5, 117–18 mesenteric tuberculosis 117–18 Ladd’s bands 106 metabolism language 14, 19–21, 156 bilirubin 124 laryngotracheobronchitis 66, 69–70 disorders 17–19, 124–6 laxatives 119 inborn errors 40–3, 82–3 learning disabilities 156–61 migraine 90–4, 96 legs, stiff 14, 18–19 milestones of development 16 leukaemia 135, 137–9 milk LHRH (luteinizing hormone-releasing allergies 117–18 hormone) test 8, 10 aspiration 69–70 life support methods 46–7 MMR vaccine 55, 61 lipase 112 mononucleosis 128–9 liver function tests 127 mood swings 8 lower respiratory tract infections (LRTI) Moro reflex 19 acute breathing difficulties, coughing and mosaicism 10, 22 wheezing 70–2 motor skills 16 acute severe illness 40–3 mumps vaccines 55, 61 bronchiolitis 67, 69–70 murmurs 42 cystic fibrosis 72–3 muscular dystrophy 22 lumbar puncture (LP) 39 myaesthenia gravis 17–18 lungs, cystic fibrosis 74 myotonic dystrophy 17–18 luteinizing hormone-releasing hormone (LHRH) test 8, 10 NAI see non-accidental injury naloxone 146 magnesium serum levels 82 nappy rash 141 malabsorption 26, 29–30, 117–18 nasal breathers 38 malaria 57–8, 95 Neisseria meningitidis 135, 141 malignancy, weight faltering 27–9 neonatal hepatitis 124, 126–7 maturational language delay 19–21 neonatal seizures 78 170 Index neonatal septicaemia 42–3 pervasive development disorder (autism) nephritis 112, 114–15 20–1, 156, 158–61 neuroblastoma 117–18 petechiae 135 neuromuscular disorders 18–19 Peyer’s patches 102 night terrors 163 phobias 156 nitrogen washout test 81 phototherapy 126, 130 nocturnal screaming 163 physical abuse 157–8, 160–1 noisy breathing 66 physiological changes with age 38 non-accidental injury (NAI) physiological jaundice 124–6, 130 breathing ceased 44–8 Pneumococcus 39 pain and drawing up of legs 103–4 pneumonia 69–70, 80–1 rashes and bruising 135, 137–9 pneumothorax 70–3 non-blanching rashes 135 poisoning 44–8, 90, 143–52 normal infant development 16 polio vaccine 55 post-streptococcal glomerulonephritis 112, obesity 11 114–17 obligate nasal breathers 38 precocious puberty 4, 7–9 obstructive jaundice 124 pregnancy, rubella 54, 61 ocular headaches 90 preschool behaviour problems 157–8 oesophageal sphincter 101 protein malabsorption 26 oesophagitis 101 proteinuria 112 oliguria 112 psychology, children 38 opiates 146 psychosocial issues oral contraceptive ingestion 146 short stature 6–7 oral rehydration therapy 100 speech 20–1 orchidometers 4 puberty oromotor dysfunction 30–2 delayed 2, 4, 9–10 oven cleaners ingestion 152 precocious 4, 7–9 overdoses 152 pubic hair 8 overweight 3, 11 purpura 135 pyelonephritis 115–17 paediatric advanced life support 47 pyloric stenosis 102, 106–7 paediatric basic life support 46 pyloromyotomy 102, 107 paints ingestion146 paracetamol ingestion 146–8, 152 quadriplegia 16 parainfluenza virus 66 paralytic conditions 17–18 rashes 52, 56–7, 131–41 paramyxovirus virus 134 reciprocal interactions/communication 156 parasites 58, 117–18 recurrent headaches 90, 92–4 parental anxiety 38 ‘redcurrant jelly’ stools 101 parvovirus B19 134 reflex anoxic seizures 78 pathological jaundice 124 reflex anoxic syncope 78 peeling skin 52, 59–60 reflexes, primitive 19 perianal tears 119 rehydration 100, 117 peri-orbital oedema 112 renal calculi 114–15 peristalsis, gastric 102 renal disease, weight faltering 27–9 persistent fetal circulation 80–1 respiratory problems 63–74 pertussis (whooping cough) 69–70 respiratory syncytial virus (RSV) 66–7  Index 171 respiratory tract infections see lower sinusitis 90–4 respiratory tract infections; upper sitting up, developmental delay 14, 18–19 respiratory tract infections sleep resuscitation 46–7 bedwetting 162 Rhesus isoimmunization 124 disturbance 156 rifampicin 135 night terrors 163 ringworm 134, 136–7 walking 163 rituals 156 slurred speech 88 roseola 56–7, 59–60 smoky coloured urine 114–15 rotavirus 49 social issues routines (marked) 156 disordered background 157–8 rubella 54, 56–60 impaired interactions 156 exanthems 134 weight faltering 27–9 pregnancy 54, 61 sodium serum levels 82 vaccine 55, 61 soiling, involuntary 119 Rubella syndrome 54 space-occupying lesions 83–5, 90 rubivirus 134 spasms 78 Russell Silver syndrome 7 spasticity 16 speech 14, 19–21, 156 salicylate ingestion 146 spherocytosis 124 Salmonella 104 spinal muscular atrophy 17–18 Sandifer syndrome 101 stenosis 102, 106–7 scabies 134, 136–7 stercobilinogen 124 scarlet fever 59–60, 134 stiff arms and legs 14, 18–19 schoolchildren stools headaches 88, 90–2 see also diarrhoea tummy aches 119 constipation 119 screaming (nocturnal) 163 frequency 100 seizures 44–8, 78, 90 jaundice 124, 130 self-harm 152, 156 weight faltering 30 sensory responses abnormality 156 strangulated inguinial hernia 103–4 sepsis 17–18, 124–6 streptococcal infections septicaemia 40–2 acute post-streptococcal blue babies 80–1 glomerulonephritis 112, 114–17 headaches 94–5 blue babies 80–1 rashes 135, 141 group A 59–60 serial height measurements 4–5 mild fever and rash 56–7 serum bilirubin 124 septicaemia 80–1 sexual abuse 157–8, 160–1 streptococcus A 134 Shigella dysentery 104 stridor 66 shock sudden infant death syndrome (SIDS) 43–8 blue babies 80–1 surfactant deficiency 80–1 intussuception 102 sweat test 30 thirst and abdominal pain 117 syncope attacks 78 short stature 2, 6–7, 11 syncope-related reflex epileptic seizures sickle cell disease 114–15 83–5 SIDS see sudden infant death syndrome silica gel 146 tachypnoea 80–1 172 Index Tanner staging 4 thirst and abdominal pain 115–17 tantrums 156 vomiting 106–7 teenage fits 83–5 urine temper tantrums 156 bedwetting 162 tension headaches 90–4 jaundice 124, 130 testes smoky coloured 114–15 size 4 urobilinogen 124 torsion 103–4 URTI see upper respiratory tract infections tetanus vaccine 55 urticaria 134 thelarche 4, 7–9 UTI see urinary tract infections thelarche variant 7–9 theophylline 146 vaccinations 55, 61, 66, 135 thrombocytopenia purpura 135, 137–40 varicella zoster virus 134 toilet cistern blocks ingestion 146 vaso-vagal attacks 78 tonsillitis 59–60 viral infections TORCH screen 127 bronchiolitis 67 toxic substance ingestion 146, 152 croup 66 toxoplasmosis 124 gastroenteritis 104–5 transient tachypnoea 80–1 hepatitis 128–9 trauma lower respiratory tract infections 67, birth 17–18 69–72 haematuria with abdominal pain 114–15 Peyer’s patches 102 headaches 94–5 poisoning differential diagnosis 150–1 intracranial 82–3, 94–5 return from abroad 57–8 non-blanching rashes 135 tonsillitis 59–60 teenage fits 83–5 upper respiratory tract infections 57–8, travel return 52, 57–8 69–70 tricarboxylic acid cycle 112 wheezing 66 tuberculosis 54, 117–18 vision problems 157–61 Turner syndrome 5, 9–10 vitamin tablets 146 vomiting 97–108 UK immunization schedule 55 acute severe illness 40–1, 49 undernutrition 27–32 recurrent headaches 88, 92–4 unsteady gait 88, 94–5 weight faltering 26 upper respiratory tract infections (URTI) cough and noisy breathing 69–70 walking developmental delay 15, 22 respiratory embarrassment and feeding washing powder ingestion 146, 152 difficulties 38 weight meningitis fear 49 faltering 23–33, 112–13 return from abroad 57–8 overweight 11 urea and electrolyte investigations 38 prediction 38 urinalysis 38 wheat 112 urinary tract infections (UTI) wheezing 64, 66, 70–2, 74 acute severe illness 40–3 whole-bowel irrigation 146, 150 haematuria with abdominal pain 114–15 whooping cough 69–70 jaundice 126–7 Wilms’ tumour 114–15, 117–18 pain and drawing up of legs 103–4 Wilson’s disease 128–9