What are the Main Differences Between MIS-C and Kawasaki Disease?
Discussion
SARS-CoV-2 or COVID-19 was first observed in Wuhan China in late 2019. By March 2020 it had spread to become a world-wide pandemic and continues today despite vaccination and other public health measures. Early on people were worried that children would be the major age group affected, but the major groups were older individuals and those with underlying health problems. That is not to say that children are not affected as they were and could have severe disease. However as an overall group, they tend to get the virus and have less severe symptoms than adults. Severe disease is about 1% of pediatric cases compar...
Source: PediatricEducation.org - November 22, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Are Some Indications for a Vesicostomy?
Discussion
A cutaneous vesicostomy is an incontinent diversion of the bladder to the external abdominal wall usually below the umbilicus that maintains a low-pressure urinary system. The urine drains into a collecting bag or hygiene product such as a diaper. It is usually used as a temporary diversion until bladder function resolves or another treatment can be carried out. However, it can also be used as a permanent diversion in some cases. A vesico-cutaneous fistula is similar but performed slightly differently. It is often intended to be a longer-term diversion procedure and is a continent diversion of the bladder.
Some ...
Source: PediatricEducation.org - November 15, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
Is It or Isn ’ t It Abnormal in This Classification System?
Discussion
Chiari I malformations have caudal displacement of cerebellar tonsils with elongation of the 4th ventricle. It is associated with syringomyelia in up to 80% of patients. Syringomyelia is a cyst-like formation within the spinal cord that contains altered glial elements. This may be asymptomatic or have symptoms occurring from infancy to adulthood. Most patients present in the 3rd decade. Hydrocephalus may be present. A review can be found here.
Classifying information and diseases is important in clinical care as it can help determine treatment and prognosis, and improves communication among clinicians and facili...
Source: PediatricEducation.org - November 8, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Are the Clinical Characteristics of the Most Common Skeletal Dysplasia?
Discussion
With more than 200 skeletal dysplasias and multiple variations even for one dysplasia, it can be difficult for the general practitioner to know a lot of specific information about all the skeletal dysplasias. Achondroplasia (ACP) is the most common skeletal dysplasia and specifically short-limbed dwarfism. The incidence is about 1 in 15-40,000 live births. ACP is autosomal dominant with about 80% arising from new mutations with a single nucleotide substitution in the fibroblast growth factor receptor 3 (FGFR3) gene on chromosome 4. This gene regulates the conversion of cartilage to bone, with the problem showing...
Source: PediatricEducation.org - November 1, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What is Refeeding Syndrome?
Discussion
Anorexia nervosa is an eating disorder with an intense fear of being overweight (i.e. distorted body image), and self-starvation and excessive weight loss. It is more common in women (1.2%) than men (0.2%) but can be seen in both genders. Risk factors include high-intelligence, perfectionism/inflexibility, anxiety, activities where thinner body types are expected (e.g. dancer, diver, gymnast, long-distance runner, volleyball player, etc.)
Other eating disorders include bulimia nervosa (i.e. cycles of binge eating and then purging), binge eating disorder (i.e. purging), orthorexia (i.e. obsessions with healthful ...
Source: PediatricEducation.org - October 25, 2021 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
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 may...
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 causes variou...
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.
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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
