What Causes Irritability?
Discussion Child abuse or non-accidental trauma is a clinical diagnosis. It is the constellation of history, physical examination, radiographic evaluation, laboratory testing and investigation that determines if child abuse has occurred. Irritability caused by fractures or other trauma can be a presenting symptom of abuse. Fractures can be a presentation but they are also common problems not associated with abuse. Femoral shaft fractures are estimated to account for only 1.6% of all fractures in children, therefore they are potentially more suspicious for child abuse. A review of femur fractures can be found here. A review...
Source: PediatricEducation.org - October 18, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Is In That Ear?
Discussion The external auditory canal mainly derives from the ectoderm however it abuts other structures which arise from mesodermal or endodermal tissues. The lateral 1/3 is primarily cartilaginous with the inner 2/3rd being bony with the tympanic, temporal and mastoid bone forming various parts. The canal is lined with squamous epithelium and has various structures such as sebaceous glands, hair follicles and of course ceruminous glands. It is not surprising that this structure is subject to obstruction given its small size. Cerumen, hair and other cellular debris may become impacted if they are not regularly expelled f...
Source: PediatricEducation.org - October 11, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Causes Facial Pain?
Discussion Dental caries are one of the most common infections. It is usually caused by Streptococcus viridans. Dental caries are also quite preventable with brushing the teeth at least twice a day with a fluoridated dentifrice, use of dental floss, and preventative dental appointments with application of fluoride varnish and sealants as appropriate. Fluoridated water supplies also help. A review can be found here. Facial pain is often acute, self-limited and etiologies that may be obvious such as trauma or infection. Facial pain can also overlap with cranial pain (mainly headache), neck pain (often lymphadenopathy or musc...
Source: PediatricEducation.org - October 4, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Looks Like Acrocyanosis?
Discussion Acrocyanosis is a peripheral vascular disease where the skin and mucous membranes have a persistent, painless, deep-bluish color due to decreased oxygenated blood which usually is benign. The deoxygenated blood can be due to a central cause such as cyanotic congenital heart disease or localized problems often due to vasospasm. Hands and feet are the most common areas affected. It is thought that there is “…vasospasm of the cutaneous arteries, and arterioles along with compensatory dilatation in the capillary and post capillary venules caus[ing] cyanosis and sweating.” Palms and soles may or ma...
Source: PediatricEducation.org - September 27, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Can You Do to Improve Compliance with Eyeglasses or Spectacle Use?
Discussion Uncorrected refractive errors (URE) are a major cause of visual impairment and blindness globally. It is estimated that more than 12.8 million children ages 5-15 years have URE. URE can cause astigmatism, anisometropia, amblyogenic hyperopia and myopia. It can also be a factor in injuries, behavioral problems and academic and social impairments. Spectacles (or eyeglasses or eye wear) are a low-cost, non-invasive, simple to use treatment for URE. Spectacle use has many benefits but depend on end-user use. Learning Point Non-compliance with spectacle use is estimated to be 40.1% overall with a range of 9.8-78.6% i...
Source: PediatricEducation.org - September 20, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are the Advantages and Disadvantages of Different Renal Replacement Therapies?
Discussion Kidneys are amazing in that they filter the blood, eliminate toxins, balance fluids and electrolytes plus have a lot of reserve to do the job they need to do even when injured. Therefore, depending on the problem, chronic renal disease (CRD) often allows time before renal replacement therapy (RRT) is needed. RRT currently is dialysis (peritoneal or hemodialysis) or renal transplant. In general, the patient’s own kidneys do the best job for them but there is always a balance between the problems of CRD and its management, versus the potentially improved renal function with RRT. RRT itself though has a diffe...
Source: PediatricEducation.org - September 13, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How does Lichen Sclerosus et Atrophicus Present?
Discussion Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory disease with a strong autoimmune association. It can occur with other autoimmune diseases. Its specific cause is unknown. It affects females and males of all ages, but especially females 40-60 years. In the pediatric population it affects prepubertal females most often. Treatment includes steroid medications or anti-inflammatory medications. Other treatments may be offered including phototherapy, and much less commonly systemic steroids or immunosuppressive therapy. Circumcision may also be an option for some males. Childhood LSA generally improves b...
Source: PediatricEducation.org - September 6, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What are Some of the Complications of Short Bowel Syndrome?
Discussion Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in neonates. Mortality rates are from 0-45% depending on infant weight and gestation with more premature and smaller infants having greater mortality. NEC usually occurs in premature infants but it also occurs in term infants. The etiology is unknown but is probably multifactorial with ischemia and/or reperfusion playing some role. There are ‘outbreaks’ of NEC but no causative organism has been identified. Regardless of the originating cause, inflammation of the intestine and release of inflammatory mediators cause...
Source: PediatricEducation.org - August 30, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Causes Anisocoria?
Discussion Anisocoria is a common physical finding caused by the mechanical imbalance of the iris dilator (sympathetic innervation causing dilation) and sphincter muscles (parasympathetic innervation causes miosis). Which pupil is abnormal is important to determine. “Anisocoria greater in the light signifies an abnormal large pupil, whereas anisocoria in the dark indicates an abnormal small pupil.” The pupillary size should be noted along with any changes with accommodation, extra ocular movements and lighting. The time it takes to revert to the baseline pupillary size can also be helpful. Any ptosis, lacrimati...
Source: PediatricEducation.org - August 23, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Summertime Break
Summertime! PediatricEducation.org is taking a summer break. The next case will be published on August 23. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - August 9, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Can Rusty Nails Cause Tetanus?
Discussion Clostridium tetani is a gram-positive bacillus that is anaerobic and spore forming. Tetanus spores are found universally worldwide in the soil and the stool of animals and people. The spores are hardy and can persist in a variety of environments. Contamination through the skin in wounds (especially deep puncture wounds) and the umbilicus are the primary entry points. It is not unusual for the organism not to grow in cultures. The bacteria grow in low oxygen environments and produces a potential neurotoxin which blocks the myoneural junction. Incubation period is 3-21 days, averaging 10 days. Neonatal tetanus gen...
Source: PediatricEducation.org - August 2, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Do You Treat Immersion Foot Injury?
Discussion All occupations have some type of potential health consequences. Some are obvious because of the environment such as kitchen workers, first responders, helicopter pilots, etc. Others are may be less obvious or not considered such as slip and falls, cleaning supply chemical exposure, animal bites for postal and utility workers, etc. Noise and lifting objects are often overlooked problems in some settings but obvious in others such as construction. Protective measures, especially appropriate education and training and protective clothing and safety gear are obviously important for performing the work as safely as ...
Source: PediatricEducation.org - July 26, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

When is Post-Operative Bleeding Most Likely to Occur after a Tonsillectomy?
Discussion Tonsillectomy is one of the most commonly performed surgical procedures in the US with pressure equalizing tubes and circumcisions also being among the top procedures. About 500,000 are performed yearly in the US in children under 15 years. Primary indications are recurrent throat infections (e.g. “
Source: PediatricEducation.org - July 19, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Considerations About Deciding to Send a Child to School
Discussion For parents there can be a lot of pressure to “get it right” when deciding to send their child to school. Positive adult life outcomes such as employment, physical and mental health, and prosocial relationships are associated with higher educational attainment. Higher educational attainment such as finishing high school and potentially an advanced degree is associated with positive school experiences and domain specific skill attainment (e.g. reading, writing, math skills) and is also associated with readiness to begin school. Therefore if a child is “not ready” to start school, then the ...
Source: PediatricEducation.org - July 12, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Problems are Ciliopathies Associated With?
Discussion Nephronophthisis (NPHP) one cause of end-stage renal disease (ESRD) usually occurring before age 30 years. NPHP is a non-motile ciliopathy affecting cellular sensing in the renal tubular epithelium. See To Learn More below. The incidence varies according to location with 1:1 million in the US but 1:50,000 in Finland. There are 3 subtypes: Infantile Occurs usually within 1 year of life Enlarged kidneys and severe hypertension In utero can have oligohydramnios problems such as pulmonary hypoplasia, facial dysmorphisms, limb contractures Extra-renal problems include congenital heart disease, liver fibrosis, recur...
Source: PediatricEducation.org - July 5, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Types of New Therapies are Available for Cystic Fibrosis?
Discussion Cystic fibrosis (CF) was identified in 1938 by Dr. Dorothy Andersen who described 49 patients with pancreatic insufficiency. Since that time significant achievements in the knowledge about the disease and treatments for patients have changed the mortality from a few months to patients living into middle adulthood or even later. Quality of life for patients and their families and friends has also markedly improved. CF is the classic Mendelian autosomal recessive genetic disorder which is a worldwide disorder but affects people of north European ancestry more often where the main mutation is more common. There are...
Source: PediatricEducation.org - June 28, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Summertime Break
PediatricEducation.org is taking a summer break. The next case will be published in on June 28th. In the meantime, please take a look at the different Differential Diagnoses, Symptom and Disease listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - June 21, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Dacrocystitis in a Teenager?
Discussion Tears are produced in the lacrimal gland which resides in the upper outer quadrant of the eye. The tears flow across the eye medially and are collected in the superior and inferior puncta which drain into their respective canaliculi, and these drain into a common canaliculus. Tears then pass through the valve of Rosenmuler into the lacrimal sac where they are collected. Tears then pass through the nasolacrimal duct, through the distal valve of Hasner and into the nasal cavity. Vascular connections are extensive in this anatomic area and veins do not have valves. Therefore infections can spread easily through dir...
Source: PediatricEducation.org - June 14, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Some Indications for Using Dexamethasone?
Discussion Corticosteroids are a group of drugs which can be naturally or synthetically produced. Naturally occurring substances are produced in the adrenal gland, and are protein-bound (primarily corticosteroid-binding globulin and albumin). In the target tissues, they may need to be converted to an active substance. They are then reduced, oxidized, hydroxylated or conjugated as measures to inactivate them. Synthetic steroids have less protein binding and depending on their structure are more or less resistant to inactivation. Prednisone is the glucocorticoid most often used for treatment, especially as it has a short hal...
Source: PediatricEducation.org - June 7, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Which Premature Infants Need Eye Exams?
Discussion Retinopathy of prematurity (ROP) is a developmental problem. Term infants have full vascularization of the retina and therefore cannot have ROP. Premature infants however do not have full vascularization (which proceeds from the periphery to the central retinal area) and therefore may have abnormal and excessive vascularization. It affects premature infants primarily
Source: PediatricEducation.org - May 31, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Common are Co-infections with Trichomonas and Bacterial Vaginosis?
Discussion Vulvovaginitis is a common gynecological complaint for females of all ages. It is specifically the inflammation of the vulva and vagina but is used as a general term often to mean vulvar irritation, itching, and burning that can occur with or without vaginal discharge. In prepubertal females there is lack of estrogenization, and less lactobacillus species which creates a more neutral pH (normal vaginal pH is 20%. BV is caused by a change in the normal vaginal flora with a decrease in lactobacillus and an overgrowth of facultative anaerobic organisms. These organisms include Garnerella vaginalis, Atopobium vagina...
Source: PediatricEducation.org - May 24, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What are Common Causes of Anaphylaxis?
Discussion Anaphylaxis is a potentially life-threatening hypersensitivity reaction of the body. Usually anaphylaxis is IgE mediated but complement-mediated immune complex reactions or IgG mediated reactions can cause anaphylaxis. Usually mucous membranes or skin are involved, but it is a systemic disease process with at least 2 systems involved (respiratory is second most common followed by gastrointestinal system). The epidemiology is difficult to discern but the estimated incidence is about 50-112 episodes per 100,000 person-years and estimated prevalence is 0.3-5.1%. There is data supporting an increased incidence. Over...
Source: PediatricEducation.org - May 17, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Risk Factors for Bronchopulmonary Dysplasia?
Discussion Bronchopulmonary dysplasia (BPD) was first described in 1967 by Northway et.al. At that time it was described as “relatively mature preterm infants with severe respiratory failure to survive their initial respiratory distress syndrome after receiving aggressive respiratory support with high oxygen and positive pressure ventilation. Their clinical course was characterized by severe chronic respiratory failure with a radiographic picture showing areas of hyperinflation alternating with adjacent increased densities.” This is often referred to as “Old BPD.” Over time more has been learned and...
Source: PediatricEducation.org - May 10, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Some Etiologies for Intellectual Disability?
Discussion “Intellectual disability (ID) is a neurodevelopmental disorder that is characterized by deficits in both intellectual functioning and adaptive function whose onset is in the development period.” Global developmental delay (GDD) is used to describe children from 0-5 years old with significant delays in 2 or more developmental areas. These delays may be transient but up to 2/3 of children with GDD will have ID. Overall 1-3% of the general population has ID which makes it very common. Most children with GDD/ID are identified because of delays in meeting milestones or general academic achievement. ID pat...
Source: PediatricEducation.org - May 3, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Are There Developmental Changes in Platelet Function for Children?
Discussion While most people realize that each stage of a child’s life is different, there are some areas that people do not realize are different. For example, there are many laboratory values which are different based on the age because there are developmental changes. Within the hematopoietic system there are many developmental changes that are common such as hemoglobin and hematocrit. Others are less well known such as children have quantitatively less fibrinogen, but the activity is the same as adult fibrinogen. Platelets are an important part of both the primary and secondary hemostasis processes. They develop ...
Source: PediatricEducation.org - April 26, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Are Iliac Fractures Treated?
Discussion Avulsion fractures of the pelvis are more commonly seen in adults and teenage athletes. Currently they are more common in male athletes but with the increased number of females in sports, more are also being seen in females. Soccer and track and field are common sports where these injuries occur. The injuries are felt to be caused by a repetitive traction on the apophysis or more commonly due to a ‘sudden, forceful, or unbalanced contraction of an attached musculotendinous unit while engaged in a sporting event…. Skeletal maturity has a direct effect on the incidence of the injury.” They can o...
Source: PediatricEducation.org - April 19, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Toxin-Mediated Diseases?
Discussion A poison is a generic term for “a substance with an inherent property that tends to destroy life or impair health.” A toxin is more specific and is “any poison produced by an organism, characterized by antigenicity in certain animals and high molecular weight, and including the bacterial toxins that are the causative agents of tetanus, diphtheria, etc., and such plant and animal toxins as ricin and snake venom.” A toxin does not include those substances that are made synthetically produced. Venom is also a toxin that is used by animals and insects for predation or defense which can cause ...
Source: PediatricEducation.org - April 12, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Recommendations for Using Portable Listening Devices?
In this study listening to audiobooks, movies, or playing videogames was less likely to exceed the threshold. However the use of PLDs has increased overtime, particularly with the need for online educational activities due the COVID-19 pandemic. Use of PLDs particularly in the setting of other ambient noise and the duration of the activities may have changed since this and other studies were published. Problems associated with increased noise aren’t just hearing loss but other aural problems including tinnitus, sound distortion, difficulty understanding speech, dizziness, and earache. Other “extra-auditive da...
Source: PediatricEducation.org - April 5, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Indications for a Ileostomy?
Discussion There are three types of inflammatory bowel disease (IBD): Crohn’s disease (CD) – can affect entire gastrointestinal tract but often is discontinuous (i.e., has skipped areas), has transmural inflammation and disease, has granulomas Ulcerative colitis (UC) – affects the colon, is continuous (i.e., has no skipped areas) and has superficial mucosal ulcerations Unclassified IBD – has chronic colitis but not specific features of CD or UC The specific pathogenesis appears to be multifactorial with having a genetic predisposition (1.6 – 30% risk of developing UC if patient has first deg...
Source: PediatricEducation.org - March 29, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Enjoying the Spring
PediatricEducation.org is taking a short Spring break. The next case will be published in on March 29. In the meantime, please take a look at the different Differential Diagnoses, Symptom and Disease listed at the top of the page. Maybe enjoy some cool spring air outside as well. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - March 22, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Generalized Anxiety Disorder Treatment Components?
Discussion Generalized anxiety disorder (GAD) is “…excessive anxiety and worry about a number of events and activities coupled with at least one physical symptom, which may include fatigue, poor concentration, restlessness, irritability, muscle tension, and sleep difficulties.” Other ways it presents to the primary care office may be abdominal pain, headache or heart palpitations, dizziness, syncope, numbness, trembling, paresthesia, memory loss, or urinary frequency. It has an estimated prevalence of 15% and is the second most common anxiety disorder in children after social anxiety disorder. GAD can co...
Source: PediatricEducation.org - March 15, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are the Causes of Secondary Amenorrhea?
Discussion The first sign of puberty in females is breast budding (Tanner stage II) which normally occurs from 8-13 years. Menarche usually occurs within 2 years of breast budding occurring usually at Tanner stage III-IV breast development. Menarche occurs for most girls from 10-15 years. Most cycles range between 21-45 days. Age> 13 years without acquisition of secondary sexual characteristics,> 15 years before menarche or 5 years after acquisition of secondary sexual characteristics or cycles longer than 45 days are indications for evaluation. After menarche is it not uncommon to have anovulatory cycles that are ir...
Source: PediatricEducation.org - March 8, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Who Gets Pott ’ s Puffy Tumor?
Discussion Pott’s puffy tumor (PPT) was first described by Sir Percivall Pott in 1775 and who also described other orthopaedic and oncological diseases subsequently named for him. “It is a subperiosteal abscess of the anterior wall of the frontal sinus associated with underlying frontal osteomyelitis.” The tender edema and swelling of the forehead is the sign of PPT. Associated fever, headache, and rhinorrhea along with similar problems such as postnasal drip or nasal congestion are common. Associated ophthalmological problems include peri-orbital or eyelid edema and/or preseptal cellulitis. Ptosis and di...
Source: PediatricEducation.org - March 1, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Common are Aortic Aneurysms?
Discussion Aortic root dilatation or thoracic aortic aneurysm occurs in 6:100,000 individuals> 50 years of age. It is due to aging, hypertension, hypercholesterolemia, and smoking. Tertiary syphilis was a cause in the preantibiotic era. Pediatric aneurysms are very uncommon but the exact prevalence is different due to the various causes. Aneurysms are due to genetic disorders, congenital anomalies or post-surgical repair. In pediatric patients with sudden cardiac deaths, 5.4% are due to ruptured thoracic aortic aneurysms. Learning Point Some causes of pediatric aneurysms include: Familial thoracic aneurysm and dissecti...
Source: PediatricEducation.org - February 22, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

When Should Cutis Aplasia be Worked Up?
Discussion Aplasia cutis congenita (aka cutis aplasia, CA) is an uncommon dermal defect that is usually noted at birth or soon after birth. A variable amount of dermal tissue is absent. It is usually an isolated defect. The actual causes are unknown but genetics, developmental and destructive forces are logically the cause. Developmental forces do not allow the appropriate formation and closure of the skin (example would be a syndrome) and destructive forces (such as amniotic bands) harm the tissue so that it is disrupted. On physical examination CA may look like a small hypertrophic or atrophic scar. It can also be covere...
Source: PediatricEducation.org - February 15, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is a Lipschultz Ulcer?
Discussion Acute genital ulcers (AGU) are much less common in sexually-naive women than sexually experienced or active women. The differential diagnosis of AGU is large. For sexually active women Herpes simplex virus is the most common cause. Sexually transmitted infections are also included in this differential. In addition to the pain, AGUs can cause distress for the patient and family as possible sexual abuse must be considered. The differential diagnosis of AGU in non-sexually active women includes: Aphthosis Lipschutz ulcer Idiopathic Autoimmune or inflammatory diseases Behcet disease Bullous pemphigoid Inflammato...
Source: PediatricEducation.org - February 8, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Potential Complications of Hearing Aids?
Discussion Hearing loss can range from profound deafness to fairly minor loss. The causes vary based on age, type of loss (sensorineuronal or conductive, about half of hearing loss in children has a genetic cause), degree and audiometric configuration. Sensorineuronal hearing loss involves the cochlea and neural connections to the brain and auditory cortex. Conductive hearing loss involves structures from the external ear to the oval window. Deafness is defined as a hearing loss> 90 dB. Hearing loss can affect the living and learning of children more than many people realize. “A child with a mild hearing loss can ...
Source: PediatricEducation.org - February 1, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Causes Lethargy?
Discussion Lethargy is a common word used to describe a person who is drowsy, sluggish, listless and apathetic. Concentration may be difficult and they may have problems doing simple tasks. Many people actual mean fatigue or lassitude or being more tired when they use the word. In medical terms, lethargy is usually used to describe patients who have some type of excessive tiredness and usually have mental status changes with decreased alertness or arousal. Patients and health care providers both usually qualify the term and give more description to better communicate what is implied when using the term. This is true of man...
Source: PediatricEducation.org - January 25, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Potential Problems of Congenital Lung Malformations?
Discussion Congenital lung malformations (CLM) are commonly identified with prenatal ultrasound and occur in ~1:2400 live births. The natural history shows that lesions may remain the same, enlarge or appear to disappear. There is a wide-range of clinical manifestations. Patients may be asymptomatic or symptomatic at birth and often develop symptoms later. The overall natural history is difficult to ascertain as there are fewer studies done in older children and adults. Those that are done often lack a good denominator by which to judge the incidence or prevalence. Resection is carried out usually if a patient is symptomat...
Source: PediatricEducation.org - January 18, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Long Do You Monitor Neonates for Neonatal Abstinence Syndrome (NAS)?
Discussion Neonatal abstinence syndrome (NAS) occurs in the first few days of life and is a complex withdrawal syndrome. The newborn is abruptly cut-off from their exposure to licit or illicit drugs that the mother is chronically consuming and which were being transmitted through the placenta to the fetus. “NAS is a highly variable and severe condition; it may be associated with central and autonomic nervous system dysfunction … and gastrointestinal disorders.” It can cause significant morbidity but is rarely fatal. Fetal exposure has been increasing in the United States. In 2011-12, almost 5.9% of pregn...
Source: PediatricEducation.org - January 11, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Good is Photoscreening For Young Children ’ s Vision Problems?
This study showed that not only was smartphone photoscreening feasible, but was quite good at screening for potential vision problems. Smartphone photoscreening has the advantages of being more ubiquitously available and thus children in almost any location can be screened. A study of photoscreening using a handheld digital photoscreener in primary care offices validated the technology showing an overall referral rate of 10% to an ophthalmologist with suspected astigmatism, anisometropia and strabismus being the most common reasons. The overall positive predictive rate was 0.60. “…[O]ver 60% of children referr...
Source: PediatricEducation.org - January 4, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Holiday Break
PediatricEducation.org is taking an end of the year holiday break. The next case will be published on January 4, 2021. 2020 has been a challenging year for everyone. We wish you and your family and friends a safe holiday season and 2021. In the meantime, please take a look at the different Archives or explore one of the Curriculum Maps listed at the top of the page. Try your hand at the Random Cases too. We continue appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - December 21, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Potential Complications of Breast Surgery?
Discussion Common reasons for seeing a breast surgeon would include management of benign or malignant masses with or without breast reconstruction, breast augmentation, and other reasons can be infection or trauma that need surgical treatment. The breast is formed starting around the 6th week of gestation by breast buds along the mammary line. Breasts then develop from the downgrowth of epithelia into the mesenchymal tissue, which continues to grow. Around 8-9 months a pit forms as entry into the lactiferous ducts. “Nipple inversion is caused either by failure of the lactiferous ducts to develop and grow during matur...
Source: PediatricEducation.org - December 14, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Areas of the Physical Examination are Important in the Pre-participation Physical Examination?
Discussion Participation in organized or non-organized, recreational to elite sports activities can provide excellent recreational and leisure time activities and improve physical and mental health for participants. The Aspen Institute in 2018 reported that more kids are being physically active, more are trying different sports, and multisports play is increasing rather than strict specialization. Unfortunately they note that there is an economic inequality with children from lower-socioeconomic circumstances playing less organized sports. About 70% of children and youth participate in an individual or team sport, but unfo...
Source: PediatricEducation.org - December 7, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Common Are Bone Spurs in Young Athletes?
Discussion The terminology of abnormal calcification of soft tissues and uses of the terms is often muddied. Especially as the causes may be similar and multiple adjacent tissues may be involved. An exostosis is an abnormal proliferation of bone from the joint. They can appear in various forms and in many locations. An osteophyte is also known as a bone spur and is type of exostosis. Osteophytes are thought to be periosteal or synovial mesenchymal stems cells that become calcified. They usually have a more narrow or pointed projection from the joint. Osteophytes are a very common feature of osteoarthritis. Enthesophytes a...
Source: PediatricEducation.org - November 30, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What are Potential Problems Associated with Helicobacter pylori?
Discussion Helicobacter pylori (H. pylori) is a microaerophilis, spiral bacterium that is a prevalent human pathogen. How this infection affects individuals is different in adults and children. Overall seroprevalence rate in children world-wide was estimated to be ~33%, but this seroprevalence rate is decreasing in the developed world for both adults and children. It is acquired in childhood and can persist through colonization throughout life if untreated. Fortunately, it often is asymptomatic and generally does not cause serious disease in children. Some serotyping data shows that within families children acquire it more...
Source: PediatricEducation.org - November 23, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Distinguishes Childhood Masturbation from Other Potential Diagnostic Entities?
Discussion “Childhood masturbation (CM) is defined as self-stimulation of the genitalia in a prepubescent child.” CM is normal sexual behavior and can be noted at all ages including infancy. It becomes very common after puberty. It is one of the most common sexual behaviors. CM can resemble the same adult masturbatory activity including flushing, sweating, muscular contracting and breath holding or tachypnea. However in younger children these changes are not recognized, are interpreted differently or infants and young children may also have different activities. “…(1)stereotyped posturing of the lo...
Source: PediatricEducation.org - November 16, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are the Oral Equivalents of Milia of the Face?
Discussion Milia are small, usually
Source: PediatricEducation.org - November 9, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Common Presentations for Factitious Disorder?
Discussion Factitious disorder (FD) is when patients fabricate illness in themselves or another person without obvious gain. FD has had other terminology and in the past has been called Munchausen Syndrome (if FD in themselves) or Munchausen Syndrome by proxy or FD by proxy (if FD being perpetuated in another person). The current DSM-V terminology is FD imposed on self or FD imposed on another. Malingering (sometimes referred to as simulation) is similar but those that fabricate illness or medical need have an obvious external reward such as gaining access to public social service benefits, free hospital room and board, or...
Source: PediatricEducation.org - November 2, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Causes Joint Pain?
DiscussionMusculoskeletal problems are common problems in pediatric practice with up to 15% of acute care visits being for this problem. Joint pain is a common concern for families but the differential diagnosis is extensive and needs thoughtful consideration. History is a key to discerning the potential diagnosis but also in guiding the physical examination and laboratory examination. Family history especially for systemic diseases should be considered. On physical examination all joints should be examined include sacroiliac and temporomandibular joints. Is this arthritis or arthralgia? Distinction between inflammatory...
Source: PediatricEducation.org - October 26, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news