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any damages resulting therefrom McGraw-Hill Education has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise To my wife, Kara, and my children, Siddharth, Avani, and Anika—SSS To my wife, Zella, and her three adoring grandsons, Jack, Seneca, and Rainer—SL CONTENTS Contents by Diagnosis Contributors Preface Wheezing Dustin r haferbecker, Evan S Fieldston, Todd A Florin Case 1-1: Eight-Month-Old Girl Case 1-2: Three-Year-Old Boy Case 1-3: Five-Week-Old Boy Case 1-4: Fifteen-Month-Old Girl Case 1-5: Five-Week-Old Boy Case 1-6: Four-Month-Old Boy Decreased Activity Level Matthew Test, Nathan Timm, Phillip Spandorfer, Megan Aylor Case 2-1: Fifteen-Year-Old Girl Case 2-2: Two-Week-Old Boy Case 2-3: Three-Month-Old Girl Case 2-4: Eleven-Month-Old Boy Case 2-5: Nine-Year-Old Boy Case 2-6: Twenty-Month-Old Boy Vomiting Paul L Aronson, Todd A Florin, Amy Feldman, Joanne N Wood, Kamillah N Wood Case 3-1: Seven-Week-Old Boy Case 3-2: Nine-Month-Old Girl Case 3-3: Three-Year-Old Girl Case 3-4: Ten-Year-Old Girl Case 3-5: Four-Year-Old Girl Case 3-6: Ten-Month-Old Girl Case 3-7: Two-Year-Old Boy Case 3-8: Two-Year-Old Girl Cough Debra Boyer, Stephanie Zandieh, Tregony Simoneau, Lianne Kopel, Alicia Casey, Todd A Florin, Phuong VO Case 4-1: Sixteen-Year-Old Girl Case 4-2: Seven-Week-Old Boy Case 4-3: Seven-Month-Old Girl Case 4-4: Three-Year-Old Boy Case 4-5: Two-Year-Old Girl Case 4-6: Four-Month-Old Boy Back, Joint, and Extremity Pain Megan Aylor, Sanjeev K Swami, Maya A Jones, Evan S Fieldston, Pamela A Mazzeo Case 5-1: Two-Year-Old Boy Case 5-2: Two-Year-Old Boy Case 5-3: Fourteen-Year-Old Boy Case 5-4: Sixteen-Year-Old Girl Case 5-5: Thirteen-Year-Old Boy Case 5-6: Nine-Year-Old Boy Poor Weight Gain Stephen Ludwig, Brandon C KU, Sanjeev K Swami, Maya A Jones, Kamillah N Wood Case 6-1: Sixteen-Month-Old Boy Case 6-2: Seven-Month-Old Boy Case 6-3: Twenty-Day-Old Girl Case 6-4: Five-Day-Old Boy Case 6-5: Three-Month-Old Girl Case 6-6: Twenty-One-Month-Old Boy Case 6-7: Eighteen-Month-Old Boy Abdominal Pain Marina Catallozzi, Sanjeev K Swami, Paul L Aronson Case 7-1: Thirteen-Year-Old Boy Case 7-2: Five-Year-Old Girl Case 7-3: Eleven-Year-Old Girl Case 7-4: Nine-Year-Old Girl Case 7-5: Eight-Year-Old Boy Case 7-6: Two-Year-Old Girl Case 7-7: Three-Year-Old Girl Altered Mental Status Nathan Timm, Jennifer L McGuire Case 8-1: Three-Year-Old Boy Case 8-2: Twenty-Month-Old Boy Case 8-3: Nine-Year-Old Boy Case 8-4: Eight-Month-Old Boy Case 8-5: Fourteen-Year-Old Girl Case 8-6: Four-Year-Old Boy Rash Kara N Shah, Kamillah N Wood, Joanne N Wood, Christine T Lauren Case 9-1: Eight-Year-Old Girl Case 9-2: Eleven-Week-Old Girl Case 9-3: Four-Year-Old Girl Case 9-4: Fourteen-Year-Old Boy Case 9-5: Sixteen-Year-Old Girl Case 9-6: Eighteen-Month-Old Girl 10 Pallor Stephen Ludwig, Brandon C Ku, Maya A Jones Case 10-1: Three-Week-Old Boy Case 10-2: Twelve-Month-Old Girl Case 10-3: Five-Month-Old Boy Case 10-4: Six-Year-Old Girl Case 10-5: Five-Year-Old Girl Case 10-6: Two-Year-Old Boy 11 Fever Samir S Shah, rebecca Tenney-Soeiro, Matthew Test Case 11-1: Eighteen-Month-Old Girl Case 11-2: Ten-Year-Old Boy Case 11-3: Fourteen-Year-Old Boy Case 11-4: Seven-Month-Old Girl Case 11-5: Six-Year-Old Boy 12 Constipation Heidi C Werner, Samir S Shah, rebecca Tenney-Soeiro, Pratichi K Goenka Case 12-1: Eleven-Month-Old Girl Case 12-2: Three-Year-Old Boy Case 12-3: Three-Month-Old Boy Case 12-4: Twelve-Month-Old Girl Pharyngitis, group A beta-hemolytic streptococcal, 143, 144, 145 Phenobarbital, vitamin D metabolism and, 422 Photoallergy, bergamot, 236, 237t Phototoxicity, psoralens, 236t, 237t Pica, geophagus, 193 Plaque, 224, 225t Plasmodium, 387, 389, 389f See also Malaria Pleural effusion, 95–96, 96t Pneumocystis jiroveci pneumonia (PCP) clinical presentation of, 29 conditions associated with, 27, 29 diagnosis of, 29–30 differential diagnosis of, 27–29, 28t epidemiology of, 29 incidence of, 29 treatment of, 30–31 Pneumonia bacterial, 28t, 367 case history, 27–29, 27f, 366, 366f community-acquired, 367 diagnosis of, 368, 368f differential diagnosis of, 14, 367 etiology of, 27, 28t, 367, 369t fungal, 28t HIV-associated, 28t incidence of, 367 M pneumoniae, 210–211, 369, 369t P jiroveci See Pneumocystis jiroveci pneumonia (PCP) parasitic, 28t recurrent, 17–18, 92 treatment of, 368–369, 369t viral, 28t, 367 Pneumothorax case history, 363–364, 364f clinical presentation of, 365 diagnosis of, 365 incidence of, 364 pathophysiology of, 364 subpleural bullae formation in, 364–365 traumatic, 365 treatment of, 365 types of, 364 Poisoning/overdose differential diagnosis of, 213, 217 with tricyclic antidepressants See Tricyclic antidepressant toxicity Polycyclic lesions, 231t Polyhydramnios, congenital diaphragmatic hernia and, 11 Polyposis syndromes, 440t Poor weight gain See Failure to thrive Pork tapeworm, 497–498 See also Neurocysticercosis Posterior embryotoxon, 401 Postrenal azotemia, 73 Prednisone, for Henoch-Schönlein purpura, 245 Prerenal azotemia, 73 See also Renal insufficiency/failure Primary sclerosing cholangitis (PSC) case history, 394–395, 395f clinical presentation of, 397 complications of, 397, 397t diagnosis of, 396, 396f, 397 incidence of, 397 treatment of, 397–398 Propranolol, for supraventricular tachycardia, 68 Pseudomonas aeruginosa in epidural abscess, 121t in HIV infection, 28t Psoralens, phototoxic reaction to, 236, 237t Psoriatic arthritis, 410t, 411 Pulmonary disease, differential diagnosis of, 286 Pulmonary sequestration anatomy of, 15 anomalies associated with, 15, 15t case history, 13–14, 14f clinical presentation of, 15 diagnosis of, 15–16 differential diagnosis of, 14–15 incidence of, 15 treatment of, 16 Pupil, misshapen, 467, 467f Purpura with abdominal pain and polyarthritis, 242–243, 242f anaphylactoid See Henoch-Schönlein purpura characteristics of, 224, 228t differential diagnosis of, 243, 243t Pustule, 224, 226t Pustulosis, neonatal staphylococcal, 226f Pyloric stenosis case history, 164, 165f clinical presentation of, 165 diagnosis of, 165–166, 165f differential diagnosis of, 164–165 epidemiology of, 165 incidence of, 165 treatment of, 166 R “Raccoon eyes,” 426 Rash/cutaneous findings See also Bruising; Purpura with ataxia and fever, 219–220, 220f color of, 224 with cough and fever, 102–103, 103f definition of, 223 with diarrhea, 431 differential diagnosis of, 253–254 diffuse papulovesicular, 253–254, 254f in Epstein-Barr virus infection, 455, 455f, 456 in Langerhans cell histiocytosis, 312f, 313 in Lyme disease, 225f, 299f in meningococcal disease, 45, 45f, 46 morphologic patterns of, 225–231t physical examination of, 224 progression of, 223 questions about history of, 223–224 in secondary syphilis, 378f, 379 with seizures, 475 shape and configuration of, 223, 229–231t in systemic lupus erythematosus, 351f, 353, 354t terminology for, 224 in varicella infection, 220, 220f, 221 Reactive airway disease, 114 Rectal bleeding See Hematochezia Refusal to walk causes of, 403, 404t differential diagnosis of, 409–410, 413–414, 416, 424–425 with fever and back pain, 424 with fever and irritability, 415–416, 416f with fever, weight loss, and rash, 408–409, 409f questions about history of, 403–405 sudden vs gradual onset of, 404 with swelling and limp, 413, 414f Renal insufficiency/failure differential diagnosis of, 73 in hemolytic uremic syndrome See Hemolytic uremic syndrome in Henoch-Schönlein purpura, 244 in systemic lupus erythematosus, 353 vomiting in, 68–69 Respiratory distress See also Wheezing with cyanosis, 21–22, 22f differential diagnosis of, 14, 22, 27 with fever, 13–14, 26–27 with lobar consolidation, 13–14, 14f progressive, in infancy, 26–27 Retinal hemorrhage, in child abuse, 52, 53 Retinal pigment epithelium, congenital hypertrophy of, 440, 441 Rheumatic fever, acute See Acute rheumatic fever (ARF) Rickets case history, 420, 421f clinical presentation of, 422 diagnosis of, 422–423, 423t differential diagnosis of, 420–421 pathophysiology of, 421–422 prevention of, 423 treatment of, 423 Rickettsial disease, 387t Rifabutin, side effects of, 108 Rifampin, side effects of, 108 Right aortic arch with anomalous left subclavian artery and left ductus arteriosus/ligamentum arteriosum, 6f, Right subclavian artery, aberrant, 6f, Rosai-Dorfman disease case history, 337, 338f clinical presentation of, 338–339 diagnosis of, 338, 339 differential diagnosis of, 337 epidemiology of, 338 treatment of, 339 Rovsing sign, 175 Rubella, neonatal clinical manifestations of, 379 Russell-Silver syndrome, 283t S Salmonella, in epidural abscess, 121t Salt wasting, 39 Sandifer syndrome, 56, 471 Sarcoidosis clinical presentation of, 286, 467f, 468–469 diagnosis of, 467, 469–460 differential diagnosis of, 286, 467 epidemiology of, 468 incidence of, 468 treatment of, 470 Scabies, 228f Scale, 224, 228t Scar, 224 Scar sarcoidosis, 469 Scarlet fever, 145 SCFE See Slipped capital femoral epiphysis (SCFE) Schistosomiasis, 387t Sclerosing cholangitis, 133, 396 See also Primary sclerosing cholangitis (PSC) Screening, 255 Scrotal mass, painful, 432–433 Seizures causes of, 471–472 by age, 472t by etiology, 473–474t classification of, 471 complex partial, 496–497 definition of, 471 differential diagnosis of, 471, 476–477, 480–481, 483–484, 497 with fever, 281–282, 474, 491–492, 491f after head injury, 474–475 with hypoglycemia, 483–484 with lethargy and poor appetite, 487–488 in neonate, 475–477, 476f, 477f, 479–481 in neurofibromatosis type 1, 284 questions about history of, 474–475 with skin abnormalities, 475 Sepsis case history, 391–392 differential diagnosis of, 392 with jaundice, 391–392 meningococcal, 45, 45f See also Meningococcal disease Septal reduction therapy, 463 Septic arthritis, 409 Serpiginous, 230t Shigella infection, 436 Shwachman-Diamond syndrome case history, 154–155 clinical presentation of, 156 diagnosis of, 155–156 incidence of, 156 treatment of, 156–157 SIADH (syndrome of inappropriate secretion of antidiuretic hormone), in infant botulism, 317 Sickle cell disease aplastic crisis in, 273t case history, 135–136, 272 clinical presentation of, 138–139, 138t diagnosis of, 139, 272f, 273 differential diagnosis of, 136–137, 273 epidemiology of, 138 forms of, 273 genotypes of, 137–138, 137t hemolytic crisis in, 273t incidence of, 137, 273 splenic sequestration crisis in, 273–274, 273t treatment of, 139–140 Sinus histiocytosis with massive lymphadenopathy See Rosai-Dorfman disease Skinfold freckling, 283 Slipped capital femoral epiphysis (SCFE) case history, 217–218 clinical presentation of, 129 diagnosis of, 128, 128f, 129 etiology of, 128–129 incidence of, 128–129 risk factors for, 128–129 treatment of, 128, 128f, 129–130 SMA syndrome See Superior mesenteric artery (SMA) syndrome Spherocytosis, hereditary See Hereditary spherocytosis Spinal cord tumors case history, 322–323 clinical presentation of, 323–324 diagnosis of, 324 differential diagnosis of, 323 pathophysiology of, 323 treatment of, 324 Spinal epidural abscess case history, 119–120, 120f clinical presentation of, 121 diagnosis of, 121–122 etiology of, 120–121, 121t incidence of, 120 mortality from, 122 treatment of, 122 Splenectomy for hereditary spherocytosis, 271 for sickle cell disease, 274 Splenic rupture, in Epstein-Barr virus infection, 457 Splenic sequestration crisis, in sickle cell disease, 273–274, 273t Staphylococcal pustulosis, neonatal, 226f Staphylococcus aureus in epidural abscess, 121, 121t, 122 in HIV infection, 28t in osteomyelitis, 417, 419t Steppage gait, 403 Stertor, Streptococcal intertrigo, 227f Streptococcus group A, 120 group B, 476, 477f Streptococcus pneumoniae in hemolytic uremic syndrome, 437 in HIV infection, 28t in pneumonia, 369, 369t Stridor Stroke, in sickle cell disease, 139 Subacute sclerosing panencephalitis (SSPE), 104 Succimer, for lead poisoning, 490 Sulfasalazine, for Crohn disease, 134 Superior mesenteric artery (SMA) syndrome case history, 183–184, 185f clinical presentation of, 186 diagnosis of, 185, 185f, 186 pathophysiology of, 185 risk factors for, 185–186 treatment of, 186 Supraventricular tachycardia (SVT) case history, 63–64, 64f clinical presentation of, 67 diagnosis of, 64–65, 65f, 67 differential diagnosis of, 459, 459f etiology of, 65–67 incidence of, 460 treatment of, 67–68 in Wolff-Parkinson-White syndrome See Wolff-Parkinson-White syndrome Sweat chloride test, 12, 110, 159t Swenson procedure, 310 Sydenham chorea, 144, 409t Syncope cardiac causes of, 459, 461–462 causes of, 453 by age, 454t by etiology, 454t definition of, 453 differential diagnosis of, 455–456, 459–460, 461–462, 462f, 467 with fatigue and dyspnea, 466–467 incidence of, 453 with mental status changes, 464–465 with no other symptoms, 458, 461 questions about history of, 453–454 with rash and intermittent fever, 455 vs seizures, 453 with tachycardia, 458–459 Syndrome of inappropriate secretion of antidiuretic hormone (SIADH), in infant botulism, 317 Synechiae, 467, 467f Syphilis diagnosis of, 380–381 maternal-fetal transmission of, 379–380 See also Congenital syphilis secondary, 378f, 379 Systemic lupus erythematosus case history, 351–352, 351f, 352f clinical presentation of, 352–353 diagnosis of, 352, 353, 354t epidemiology of, 352 incidence of, 352 joint involvement in, 143 treatment of, 353–354 T Tachycardia, differential diagnosis of, 459, 459f Taenia solium, 497–498 See also Neurocysticercosis Tapeworm, 497–498 See also Neurocysticercosis Telangiectasia, 224 Testicular torsion, 433 Thalassemia trait, 264t Thrombocytopenia differential diagnosis of, 455–456 drug-induced, 456 Thyroglossal duct cyst, infected case history, 328–329, 328f clinical presentation of, 32 diagnosis of, 329–330 pathophysiology of, 329 treatment of, 330 Thyroid gland, ectopic, 320 See also Hypothyroidism Tinea faciei, 228f Tobramycin, for cystic fibrosis, 112 Toddler’s fracture case history, 413, 414f clinical presentation of, 415 diagnosis of, 415 differential diagnosis of, 413–414 incidence of, 414–415 treatment of, 415 TORCH infections, 379t See also specific infections Torticollis, neonatal, 335 Total anomalous pulmonary venous connection (TAPVC) case history, 21–22, 22f clinical presentation of, 24–25 diagnosis of, 23, 23f, 25 differential diagnosis of, 22 etiology of, 23 incidence of, 23–24 variants of, 23, 24f Toxic epidermal necrolysis, 228f Toxocara, 193, 194f See also Visceral larva migrans Toxoplasma gondii, 28t, 151, 152f Toxoplasmosis case history, 148–150 clinical presentation of, 151, 153f congenital, 151, 153t, 379t, 477, 477f diagnosis of, 152–154, 153f epidemiology of, 151 pathophysiology of, 151, 152f treatment of, 154 Tracheoesophageal fistula case history, 17, 18f clinical presentation of, 19–20 diagnosis of, 20 etiology of, 18–19 incidence of, 18 treatment of, 20 types of, 18, 19f Transient erythroblastopenia of childhood case history, 275 clinical presentation of, 276 diagnosis of, 276–277, 276f, 276t incidence of, 276 treatment of, 277 TRAPS (tumor necrosis factor-associated periodic fever syndrome), 198t Traumatic brain injury, in child abuse, 239 Travelers, returned diarrhea in, 431 fever in, 280, 386, 387t Trendelenburg gait, 403 Treponema pallidum, 379 See also Syphilis Tricyclic antidepressant toxicity case history, 216–217 clinical presentation of, 217–218 diagnosis of, 218, 218f differential diagnosis of, 217 incidence of, 217 treatment of, 218–219 Trientine hydrochloride, for Wilson disease, 179–180 Trimethoprim-sulfamethoxazole (TMP-SMX), for PCP, 29, 30 Tuberculosis HIV-associated, 28t incidence of, 356 pericarditis in See Tuberculous pericarditis Tuberculous pericarditis case history, 355–356, 356f clinical presentation of, 357 diagnosis of, 356, 357–358 treatment of, 357–358 Tuberous sclerosis, 283t, 471 Tumor, 224 Tumor lysis syndrome, in ALL, 125t, 126 Turcot syndrome, 440t 21-hydroxylase deficiency, 39 See also Congenital adrenal hyperplasia (CAH) 22q11 deletion syndromes, 482 Typhoid fever, 387t U Ulcer, cutaneous, 224, 227t Ulcerative colitis, primary sclerosing cholangitis and, 397 Urinary ketones, 484–485 Urticaria, 227f, 230f, 231f Uteropelvic junction obstruction case history, 80 clinical presentation of, 83 diagnosis of, 80–81 epidemiology of, 83 incidence of, 83 treatment of, 85 Uveitis clinical presentation of, 468 diagnosis of, 469 differential diagnosis of, 467, 468t in sarcoidosis, 468 treatment of, 470 V Vaccines measles, 105 meningococcal, 47 pertussis, 116 varicella, 220–221 Vagal maneuvers, 68 Varicella infection case history, 219–220, 220f clinical presentation of, 220f, 221, 254 diagnosis of, 221 incidence of, 220–221 treatment of, 221–222 Vascular rings and slings anatomy of, 6–7, 6f clinical presentation of, 7–8 diagnosis of, incidence of, 6–7 treatment of, Vasculitis cutaneous, 228f leukocytoclastic, 225f Vasoactive intestinal peptide (VIP), 450 VATER association, 19 Ventricular septal defect case history, 97–99, 98f classification of, 99, 99f clinical presentation of, 99–100, 100t diagnosis of, 100–101, 101f etiology of, 99 incidence of, 99 treatment of, 101–102 Verner-Morrison syndrome, 444 Verruca vulgaris, 225f Vertebrae, butterfly, 399f, 401 Vertebral depressions, biconcave, 136f, 137 Vertebral osteomyelitis, 312 Vesicle, 224, 226t Video capsule endoscopy, 134 Visceral larva migrans clinical presentation of, 193 diagnosis of, 193 differential diagnosis of, 193 pathophysiology of, 193, 194f treatment of, 193 Vitamin B12 deficiency case history, 34–36, 36f clinical presentation of, 37 diagnosis of, 36, 37 differential diagnosis of, 36 etiology of, 36–37 treatment of, 37 Vitamin D, 421 deficiency, 421–422 See also Rickets Vitamin K deficiency bleeding, 236, 237t Volvulus, 191 Vomiting with abdominal pain, 58, 80, 175, 189–190 in adrenal insufficiency, 72 bilious, 56, 430 with bloody emesis, 56–57 causes of by age, 56t by etiology, 57t with constipation, 78–79 cyclic See Cyclic vomiting definition of, 55 with diarrhea, 58, 430 with diarrhea and inguinal mass, 432, 433f differential diagnosis of, 59–60, 64, 77 duration of, 55 in early infancy, 58–60, 59f with edema, 86 with fever, 58 with hematochezia, 75–76 pathophysiology of, 55 pattern of, 56 in pyloric stenosis, 165 questions about history of, 55–58 in renal failure, 68–69 Von Willebrand disease cutaneous symptoms of, 236, 237t differential diagnosis of, 247 W Waddling gait, 403 Walk, refusal to See Refusal to walk Waterhouse-Friderichsen syndrome, 46 Weakness, differential diagnosis of, 406 Weight gain, poor See Failure to thrive Weight loss, differential diagnosis of, 167, 184–185 Wheal, 224, 227t Wheezing See also Respiratory distress age at onset of, causes of by age group, 2t by mechanism, 2t definition of, differential diagnosis of, 4, 9–10, 17–18 first episode of, 1, questions about history of, 1–3 recurrent or persistent, 1, 4, 17–18 Whooping cough case history, 113–114, 114f clinical presentation of, 115 complications of, 115 diagnosis of, 115 differential diagnosis of, 98 epidemiology of, 114 incidence of, 114 treatment of, 115–116 Wilms tumor, 182 Wilson disease case history, 175–176 clinical presentation of, 178 diagnosis of, 176–177, 177f genetic factors in, 178 incidence of, 178 pathophysiology of, 178 treatment of, 177–178 Wolff-Parkinson-White syndrome case history, 458–459 clinical presentation of, 460 diagnosis of, 459f, 460 differential diagnosis of, 459 pathophysiology of, 460 treatment of, 460–461 Z Zoonoses, 193 [...]... of Cincinnati College of Medicine CINCINNATI, OHIO Chapter 9 Samir S Shah, MD, MSCE Director, Division of Hospital Medicine Cincinnati Children’s Research Foundation Endowed Chair Attending Physician in Hospital Medicine & Infectious Diseases Cincinnati Children’s Hospital Medical Center Professor, Department of Pediatrics University of Cincinnati College of Medicine CINCINNATI, OHIO Chapters 11, 12,... breathing, wheezing is the most common of clinical significance COMPLAINT BY CAUSE AND FREQUENCY The causes of wheezing in childhood vary by age (Table 1-1) and may also be grouped in categories based on the following criteria: (1) Anatomic (extrinsic or intrinsic to the airway), (2) Inflammatory/Infectious, (3) Genetic/Metabolic, or (4) Miscellaneous causes (Table 1-2) TABLE 1-1 Causes of wheezing in. .. Professor of Clinical Pediatrics Children’s Hospital of Philadelphia Perelman School of Medicine PHILADELPHIA, PENNSYLVANIA Chapters 11, 12, and 19 Matthew Test, MD Division of Hospital Medicine University of Cincinnati College of Medicine CINCINNATI, OHIO Chapters 2 and 19 Nathan Timm, MD Emergency Medicine Cincinnati Children’s Hospital Medical Center and Department of Pediatrics University of Cincinnati... The cases presented in this text have common complaints, but, despite the protean presenting signs and symptoms, evolve into challenging diagnostic dilemmas Each chapter in this book begins with a definition of a complaint, exploration of associated signs and symptoms that bring the patient to the physician, and discussion of questions associated with the complaint The chapters then include a series of... a case and lead a discussion while using the text to facilitate dialogue Samir S Shah Stephen Ludwig CHAPTER 1 WHEEZING DUSTIN R HAFERBECKER DEFINITION OF THE COMPLAINT Noisy breathing in infants is a common presenting complaint The first step toward formulating a differential diagnosis is to characterize the type of sound heard Stertor, a low-pitched rattling inspiratory noise, is caused by obstruction... even more relevant, in the changing environment of physician training and education and advancing medical technology which combine to make it less likely that an individual physician will witness the evolution of a complex case from start to finish By understanding what happens in individual cases, one is able to generalize to similar situations and incorporate basic principles into practice We are... MSHP Assistant Professor of Pediatrics Perelman School of Medicine University of Pennsylvania Children’s Hospital of Philadelphia PHILADELPHIA, PENNSYLVANIA Chapters 1 and 5 Todd A Florin, MD, MSCE Assistant Professor of Pediatrics University of Cincinnati College of Medicine Attending Physician Division of Emergency Medicine Cincinnati Children’s Hospital Medical Center CINCINNATI, OHIO Chapters 1, 3,... infection caused by atypical bacteria, such as Mycoplasma pneumoniae • Is the wheezing a new onset or recurrent? —The initial episode of wheezing in a previously healthy infant in conjunction with symptoms of upper respiratory tract infection usually indicates bronchiolitis A sudden onset of wheezing is also characteristic of anaphylaxis; particularly in the presence of urticaria, stridor, or pertinent... common presenting complaints may have unusual or uncommon conditions The cases are accompanied by clinical or radiologic images to enhance learning and retention Following each case presentation, there is discussion of a broad differential diagnosis, commentary about which particular elements of that case led to the final diagnosis, and detailed discussion about the diagnosis in question, including epidemiology,... oral intake and urine output and was febrile to 39.7°C at home MEDICAL HISTORY The girl’s history was remarkable for frequent episodes of wheezing since 5 months of age She had received nebulized albuterol intermittently, including every 4 hours for the past month, without significant improvement in her wheezing Her cough was worse at night but did not seem to be worse with feeding or supine positioning ... Cincinnati College of Medicine CINCINNATI, OHIO Chapters and 19 Nathan Timm, MD Emergency Medicine Cincinnati Children’s Hospital Medical Center and Department of Pediatrics University of Cincinnati... using the text to facilitate dialogue Samir S Shah Stephen Ludwig CHAPTER WHEEZING DUSTIN R HAFERBECKER DEFINITION OF THE COMPLAINT Noisy breathing in infants is a common presenting complaint... complete cartilaginous rings causing tracheal stenosis CLINICAL PRESENTATION OF VASCULAR RINGS AND SLINGS Most infants present with symptoms in early infancy Superimposed viral infection with edema