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 low...
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 < or = to 3 mm, benign, white, superficial keratinous cysts. They can arise spontaneously (are defined as primary) or because of other conditions (are defined as secondary). Milia can occur at any age but are common in adult patients. However, primary care providers for neonates see it commonly as well as congenital milia occurs in 40-50% of newborns.
Milia occurs more often on the face (especially the nose), but also scalp, neck/upper parts of the trunk and upper extremities. They usually resolve spontaneously in a few weeks, but patient and parent preference may dictate treatment. T...
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
How are Personality Disorders Clustered?
Discussion
Personality traits (PT) represent patterns of thinking, perceiving, reacting, and relating that are relatively stable over time. There are 5 major PT:
Extraversion (e.g. tendency to be sociable)
Neuroticism (e.g. susceptibility to negative thoughts and distress)
Conscientiousness (e.g. self-regulation and being able to look at long term goals)
Agreeableness (e.g. self-regulations and relationship maintenance)
Openness to experience (e.g. imaginative, creative, curiosity).
Personality disorders (PD) occur when these personality traits become so conspicuous, rigid and maladaptive that they cause impairment in ...
Source: PediatricEducation.org - October 19, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What are Potential Complications of Ichthyosis?
Discussion
Ichthyosis is a large group of dermatological disorders which are caused by abnormal epidermal differentiation. The term ichthys means fish and refers to the scale-like dermatological pattern seen in these disorders.
Acquired ichthyosis is rare but more common in adults than children and has a rough, dry skin with prominent scaling, distributed symmetrically on the trunk and limbs (especially extensor surfaces), and is associated with autoimmune, infectious diseases, metabolic and malignant causes. Congenital or inherited ichthyosis is divided into non-syndromic (more common) and syndromic forms (generally ver...
Source: PediatricEducation.org - October 12, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Are the Symptoms of Herpes Simplex Keratitis?
Discussion
Herpes simplex virus (HSV) infections are common with an estimated 50% of the US population being infected by age 30, and with latent infection harboring in the trigeminal nerve in 100% of people by age 60 years. HSV infections can cause a vesicular or pustular skin rash that is painful, burning or pruritic and also flu-like symptoms with fever, chills, headache, and fatigue. HSV can also be asymptomatic.
To laymen, herpes simplex viruses cause “cold sores,” but to health care personnel, herpes causes many systemic infections including eczema herpeticum, folliculitis, herpes gladiatorum, whitlow, e...
Source: PediatricEducation.org - October 5, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Are the Clinical Signs and Symptoms of Congenital Syphilis?
Discussion
Syphilis is caused by the spirochete Treponema pallidum. It is a very old disease that despite understanding the organism and readily available treatment, still causes disease. Syphilis is transmitted sexually. According to the Centers for Disease Control, “[i]n 2018, a total of 35,063 cases of [Primary and Secondary] syphilis were reported in the United States, yielding a rate of 10.8 cases per 100,000 population …. This rate represents a 14.9% increase compared with 2017 (9.4 cases per 100,000 population), and a 71.4% increase compared with 2014 (6.3 cases per 100,000 population).” The increa...
Source: PediatricEducation.org - September 28, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Are Systemic Disease Causes of Oral Ulcers?
Discussion
Oral ulcers are common problems seen by dentists but pediatricians also see them. Usually families have are concerned because they are painful and acute. Ulcers are sometime noticed by the physician and not the family as in the case of herpangina or hand-foot and mouth disease. Chronic or recurrent ulcerations present less commonly and therefore it may be more difficult to determine their etiology. Many of the systemic disease causes of oral ulcers are overall infrequent and/or not common in the pediatric age range.
Ulcers can be classified in several ways but acute ulcers are usually painful and last less tha...
Source: PediatricEducation.org - September 21, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What is the Allergen Cross-Reactivity Rate of Legumes?
Discussion
There are 8 common foods which compromise 90% of food allergens with those being peanuts, soybeans, cow’s milk, eggs, fish, crustacean/shellfish, wheat and tree nuts. Some people believe that lupin (a legume) is 9th.
Legumes belong to the Fabaceae family. They provide protein, fat, vitamins other essential nutrients and therefore are used in the human diet throughout the world.
“[A]llergenicity due to consumption of legumes in decreasing order may be peanut, soybean, lentil, chickpea, pea, mung bean and red gram.” Other common legumes include alfalfa, clovers, beans, lupins, mesquite, carob...
Source: PediatricEducation.org - September 14, 2020 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
