BOOK
Nelson Pediatric Symptom-Based Diagnosis E-Book
Robert M. Kliegman | Patricia S Lye | Brett J. Bordini | Heather Toth | Donald Basel
(2017)
Additional Information
Book Details
Abstract
Nelson Pediatric Symptom-Based Diagnosis uses a unique, step-by-step, symptom-based approach to differential diagnosis of diseases and disorders in children and adolescents. Conveniently linked to the world’s best-selling pediatric reference, Nelson Textbook of Pediatrics, 20th Edition, it focuses on the symptoms you’re likely to see in general practice, as well as uncommon disorders. You’ll find clear guidance on exactly what to consider and how to proceed when faced with a host of common symptoms such as cough, fever, headache, chest pain, gait disturbances, and many more.
- Features a practical, symptom-based approach that enables you to form an accurate diagnosis.
- Uses the same consistent, step-by-step presentation in every chapter: History, Physical Examination, Diagnosis (including laboratory tests), Imaging, Diagnosis, and Treatment.
- Covers new approaches to diagnostic imaging and genetic testing, new diagnostic guidelines, BRUE (brief resolved unexplained event), stroke in children, behavior disorders, syncope, recurrent fever syndromes, and much more.
- Includes full-color illustrations, algorithms, tables, and "red flags" to aid differential diagnosis.
- Serves as an ideal companion to Nelson Textbook of Pediatrics, 20th Edition.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Nelson Pediatric Symptom-Based Diagnosis | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | ix | ||
| Table Of Contents | xi | ||
| 1 Respiratory Disorders | 1 | ||
| 1 Sore Throat | 1 | ||
| Viral Pharyngitis | 1 | ||
| Infectious Mononucleosis | 4 | ||
| Pathogenesis | 4 | ||
| Clinical Features | 4 | ||
| Diagnosis | 4 | ||
| Group A Streptococcal Infection | 6 | ||
| Epidemiology | 6 | ||
| Clinical Features | 6 | ||
| Scarlet Fever | 7 | ||
| Diagnosis | 7 | ||
| Treatment | 8 | ||
| Suppurative Complications | 9 | ||
| Nonsuppurative Sequelae | 10 | ||
| Treatment Failure and Chronic Carriage | 11 | ||
| Recurrent Acute Pharyngitis | 12 | ||
| Infection With Streptococci That Are Not Group A (Non-A Streptococci) | 12 | ||
| Fusobacterium Necrophorum | 12 | ||
| Arcanobacterium Infection | 12 | ||
| Epiglottitis and Bacterial Tracheitis | 13 | ||
| Diphtheria | 13 | ||
| Pathogenesis | 14 | ||
| Clinical Features | 14 | ||
| Diagnosis | 14 | ||
| Gonococcal Pharyngitis | 14 | ||
| Chlamydial and Mycoplasmal Infections | 14 | ||
| Summary and Red Flags | 14 | ||
| References | 14 | ||
| References | 14.e1 | ||
| Group A Streptococci | 14.e1 | ||
| Other Causes | 14.e1 | ||
| Complications | 14.e1 | ||
| Treatment | 14.e1 | ||
| 2 Cough | 15 | ||
| Introduction | 15 | ||
| Pathophysiology | 15 | ||
| History | 15 | ||
| Demographics | 15 | ||
| Characteristics of the Cough | 15 | ||
| Associated Symptoms | 15 | ||
| Family and Patient’s Medical History | 15 | ||
| Physical Examination | 16 | ||
| Inspection | 16 | ||
| Fingers. | 16 | ||
| Chest, abdomen, and spine. | 16 | ||
| Palpation | 17 | ||
| Percussion | 18 | ||
| Auscultation | 19 | ||
| Diagnostic Studies | 20 | ||
| Radiography | 20 | ||
| Hematology/Immunology | 20 | ||
| Bacteriology/Virology | 22 | ||
| Other Tests | 22 | ||
| Differential Diagnosis and Treatment | 22 | ||
| Infection | 22 | ||
| Infections in infants. | 22 | ||
| Viral upper respiratory infections (URI). | 22 | ||
| Croup (laryngotracheobronchitis). | 23 | ||
| Bronchiolitis. | 23 | ||
| Viral pneumonia. | 23 | ||
| Pertussis (whooping cough). | 23 | ||
| Chlamydial infection. | 24 | ||
| Ureaplasmal infection. | 24 | ||
| Bacterial pneumonia. | 24 | ||
| Infections in toddlers and children | 24 | ||
| Viral URIs. | 24 | ||
| Sinusitis. | 24 | ||
| Pneumonia. | 26 | ||
| Tuberculosis. | 28 | ||
| Aspiration | 29 | ||
| Foreign Body | 29 | ||
| Gastroesophageal Reflux | 29 | ||
| Asthma | 30 | ||
| Cystic Fibrosis | 30 | ||
| Anatomic Abnormalities | 32 | ||
| Vascular rings and slings. | 32 | ||
| Pulmonary sequestration. | 32 | ||
| Congenital pulmonary airway malformation (CPAM). | 32 | ||
| Congenital lobar emphysema. | 32 | ||
| Tracheoesophageal fistula. | 33 | ||
| Hemangiomas. | 33 | ||
| Enlarged lymph nodes. | 33 | ||
| Bronchial stenosis. | 35 | ||
| Bronchogenic cysts. | 35 | ||
| Habit (Psychogenic) Cough | 35 | ||
| Other Causes of Cough | 36 | ||
| Bronchiectasis. | 36 | ||
| Ciliary dyskinesia. | 36 | ||
| Interstitial lung disease. | 36 | ||
| Pulmonary hemosiderosis. | 36 | ||
| Tumors. | 36 | ||
| Tracheomalacia and bronchomalacia. | 36 | ||
| Spasmodic croup. | 36 | ||
| Obliterative bronchiolitis. | 36 | ||
| Hemoptysis | 36 | ||
| When Cough Itself Is a Problem | 38 | ||
| Summary and Red Flags | 38 | ||
| References | 38 | ||
| References | 38.e1 | ||
| Cough | 38.e1 | ||
| Upper Respiratory Infection | 38.e1 | ||
| Pneumonia | 38.e1 | ||
| Foreign Bodies | 38.e1 | ||
| Cystic Fibrosis | 38.e1 | ||
| Asthma | 38.e1 | ||
| Hemoptysis | 38.e1 | ||
| 3 Respiratory Distress | 39 | ||
| Introduction | 39 | ||
| Diagnostic Approach | 39 | ||
| History | 39 | ||
| Physical Examination | 39 | ||
| Pulmonary Physical Examination | 39 | ||
| Other Parts of the Physical Examination | 41 | ||
| Laboratory Tests | 41 | ||
| Imaging | 41 | ||
| Radiography | 41 | ||
| Computed Tomography | 42 | ||
| Magnetic Resonance Imaging | 43 | ||
| Fluoroscopy | 43 | ||
| Endoscopy | 43 | ||
| Causes of Respiratory Distress | 43 | ||
| Wheezing | 43 | ||
| Asthma | 44 | ||
| Bronchiolitis | 47 | ||
| Mycoplasma pneumoniae Infections | 48 | ||
| Vocal Cord Dysfunction | 48 | ||
| Foreign Body Aspiration | 49 | ||
| Stridor | 50 | ||
| Croup | 50 | ||
| Bacterial Tracheitis | 51 | ||
| Epiglottitis | 53 | ||
| Laryngomalacia | 54 | ||
| Vocal Cord Paralysis | 54 | ||
| Vascular Rings | 54 | ||
| Subglottic Stenosis | 55 | ||
| Cough | 56 | ||
| Viral and Bacterial Pneumonia | 56 | ||
| Hypersensitivity Pneumonitis | 57 | ||
| Allergic Bronchopulmonary Aspergillosis | 57 | ||
| Other Causes of Respiratory Distress | 58 | ||
| Aspiration of Oropharyngeal Contents | 58 | ||
| Gastroesophageal Reflux | 59 | ||
| Pneumothorax | 59 | ||
| Cystic Fibrosis | 59 | ||
| Dyskinetic Cilia Syndrome | 59 | ||
| Nonpulmonary Causes of Respiratory Distress | 59 | ||
| Cardiac | 59 | ||
| Neurologic | 60 | ||
| Other | 60 | ||
| Summary and Red Flags | 60 | ||
| References | 60 | ||
| References | 60.e1 | ||
| General | 60.e1 | ||
| Wheezing | 60.e1 | ||
| Stridor | 60.e1 | ||
| Cough | 60.e1 | ||
| 4 Earache | 61 | ||
| Introduction | 61 | ||
| History | 61 | ||
| Physical Examination | 61 | ||
| Diagnostic Tests | 65 | ||
| Bacterial Cultures | 65 | ||
| Tympanometry | 65 | ||
| Acoustic Reflectometry | 66 | ||
| Diagnostic Imaging | 66 | ||
| Differential Diagnosis | 66 | ||
| Otitis Externa | 67 | ||
| Malignant Otitis Externa | 67 | ||
| Acute Otitis Media | 68 | ||
| Bacteriology/Virology | 68 | ||
| Treatment | 68 | ||
| Patients With Persistent Symptoms | 71 | ||
| Recurrent Acute Otitis Media | 71 | ||
| Otitis Media With Effusion | 71 | ||
| Mastoiditis | 72 | ||
| Cholesteatoma | 72 | ||
| Intracranial Complications | 72 | ||
| Summary and Red Flags | 74 | ||
| References | 74 | ||
| References | 74.e1 | ||
| 5 Apparent Life Threatening Event–Brief Resolved Unexplained Event | 75 | ||
| Definition | 75 | ||
| Epidemiology | 75 | ||
| Etiology | 75 | ||
| Clinical Evaluation | 75 | ||
| History | 75 | ||
| Physical Examination | 76 | ||
| Diagnostic Evaluation | 77 | ||
| Differential Diagnosis by System | 79 | ||
| Gastrointestinal | 79 | ||
| Infectious Disease | 79 | ||
| Neurologic | 80 | ||
| Airway/Pulmonary | 81 | ||
| Child Maltreatment | 81 | ||
| Cardiac | 81 | ||
| Metabolic/Genetic | 82 | ||
| Summary and Red Flags | 82 | ||
| References | 82 | ||
| References | 82.e1 | ||
| Apparent Life-Threatening Event | 82.e1 | ||
| Brief Resolved Unexplained Event | 82.e1 | ||
| Gastrointestinal | 82.e1 | ||
| Infectious | 82.e1 | ||
| Neurologic | 82.e1 | ||
| Airway/Pulmonary | 82.e1 | ||
| Child Maltreatment | 82.e1 | ||
| Cardiac | 82.e1 | ||
| 2 Cardiac Disorders | 83 | ||
| 6 Syncope and Dizziness | 83 | ||
| Syncope | 83 | ||
| Neurocardiogenic Syncope | 84 | ||
| Orthostatic Syncope | 84 | ||
| Postural Orthostatic Tachycardia Syndrome (Pots) | 85 | ||
| Cardiac Syncope/Sudden Cardiac Death | 87 | ||
| Neurologic Causes of Syncope-Like Episodes | 90 | ||
| Metabolic Causes of Syncope | 92 | ||
| Psychiatric Causes of Syncope | 92 | ||
| Evaluation of the Syncopal Child | 92 | ||
| History | 92 | ||
| Physical Examination | 92 | ||
| Diagnostic Tests | 92 | ||
| Summary and Red Flags | 92 | ||
| Vertigo | 92 | ||
| Evaluation of the Patient with Vertigo | 94 | ||
| History | 94 | ||
| Physical Examination | 95 | ||
| Diagnostic Tests | 95 | ||
| Summary and Red Flags | 95 | ||
| Disequilibrium | 95 | ||
| Evaluation of the Patient with Disequilibrium | 98 | ||
| History | 98 | ||
| Physical Examination | 99 | ||
| Diagnostic Tests | 99 | ||
| Summary and Red Flags | 99 | ||
| Lightheadedness | 101 | ||
| Evaluation of the Patient with Lightheadedness | 102 | ||
| History | 102 | ||
| Physical Examination | 102 | ||
| Diagnostic Tests | 103 | ||
| Summary and Red Flags | 103 | ||
| References | 103 | ||
| References | 103.e1 | ||
| General | 103.e1 | ||
| Syncope | 103.e1 | ||
| Vertigo | 103.e1 | ||
| Disequilibrium | 103.e1 | ||
| Lightheadedness | 103.e1 | ||
| 7 Chest Pain | 104 | ||
| Causes of Chest Pain | 104 | ||
| Approach to the Patient With Chest Pain | 104 | ||
| History | 104 | ||
| Musculoskeletal | 106 | ||
| Respiratory | 106 | ||
| Psychogenic/Idiopathic | 107 | ||
| Gastrointestinal | 108 | ||
| Other | 108 | ||
| Cardiac | 111 | ||
| Physical Examination | 112 | ||
| Electrocardiogram | 114 | ||
| Further Diagnostic Testing | 114 | ||
| Treatment | 115 | ||
| References | 115 | ||
| References | 115.e1 | ||
| 8 Murmurs | 116 | ||
| Thorax | 116 | ||
| Origins of the Heart Sounds | 116 | ||
| Cardiac Cycle | 116 | ||
| Changes in the Circulation at Birth | 116 | ||
| Normal Intracardiac Pressures | 117 | ||
| Pediatric Cardiovascular Evaluation | 117 | ||
| History | 117 | ||
| Symptoms and Signs of Heart Disease | 119 | ||
| Physical Examination | 119 | ||
| Overall Appearance | 119 | ||
| Vital Signs | 120 | ||
| Respiratory Assessment | 122 | ||
| Cardiovascular Assessment | 122 | ||
| Arterial Examination | 122 | ||
| Venous Examination | 122 | ||
| Precordial Examination | 122 | ||
| Auscultation | 122 | ||
| Heart Sounds | 123 | ||
| First Heart Sound | 123 | ||
| Second Heart Sound | 123 | ||
| Third Heart Sound | 124 | ||
| Fourth Heart Sound | 124 | ||
| Ejection Click | 124 | ||
| Opening Snap | 124 | ||
| Non-Ejection Click | 124 | ||
| Classification of Cardiac Murmurs | 124 | ||
| Pediatric Murmur Evaluation | 125 | ||
| Systolic Murmurs | 125 | ||
| Diastolic Murmurs | 125 | ||
| Continuous Murmurs | 125 | ||
| Murmurs in Children With Normal Hearts | 127 | ||
| Vibratory Still Murmur | 127 | ||
| Pulmonary Flow Murmur | 127 | ||
| Peripheral Pulmonary Arterial Stenosis Murmur | 127 | ||
| Supraclavicular or Brachiocephalic Systolic Murmur | 127 | ||
| Aortic Systolic Murmur or “Athlete’s Murmur” | 128 | ||
| Normal Continuous Murmurs | 128 | ||
| Venous Hum | 128 | ||
| Mammary Arterial Soufflé | 128 | ||
| Physical Examination of Common Lesions With Left-to-Right Shunt | 128 | ||
| Atrial Septal Defects | 128 | ||
| Patent Ductus Arteriosus | 129 | ||
| Ventricular Septal Defects | 129 | ||
| Size | 129 | ||
| Location | 130 | ||
| Shunt Flow | 130 | ||
| Pulmonary Hypertension | 130 | ||
| Associated Anomalies | 130 | ||
| Complete Atrioventricular Septal Defects | 131 | ||
| Physical Examination of Common Lesions With Right-to-Left Shunt: Cyanosis | 131 | ||
| Tetralogy of Fallot | 131 | ||
| Tricuspid Valve Atresia | 132 | ||
| Pulmonary Atresia With Intact Ventricular Septum | 133 | ||
| Transposition of the Great Arteries | 133 | ||
| Hypoplastic Left Heart Syndrome | 134 | ||
| Physical Examination of Common Lesions With Simple Obstruction | 134 | ||
| Pulmonary Valve Stenosis | 134 | ||
| Aortic Valve Stenosis | 134 | ||
| Coarctation of the Aorta | 136 | ||
| Mitral Valve Stenosis | 136 | ||
| Atrioventricular Valve and Semilunar Valve Insufficiency | 137 | ||
| Tricuspid Valve Regurgitation | 137 | ||
| Mitral Valve Insufficiency | 137 | ||
| Mitral Valve Prolapse | 137 | ||
| Pulmonary Valve Insufficiency | 138 | ||
| Aortic Valve Insufficiency | 138 | ||
| Miscellaneous Cardiac Anomalies | 139 | ||
| Pericardial Disease | 139 | ||
| Pulmonary Hypertension | 139 | ||
| Approach to Congenital Heart Disease | 139 | ||
| Acute Rheumatic Fever and Rheumatic Heart Disease | 140 | ||
| Infective Endocarditis | 140 | ||
| Summary and Red Flags | 143 | ||
| References | 143 | ||
| References | 143.e1 | ||
| Introduction | 143.e1 | ||
| Origins of Heart Sounds | 143.e1 | ||
| Cardiovascular Assessment | 143.e1 | ||
| Murmurs in Children with Normal Hearts | 143.e1 | ||
| Vibratory Still Murmur | 143.e1 | ||
| Peripheral Pulmonary Arterial Stenosis | 143.e1 | ||
| The Supraclavicular Murmur | 143.e1 | ||
| Aortic Systolic Murmur | 143.e1 | ||
| Venous Hum | 143.e1 | ||
| Mammary Arterial Soufflé | 143.e1 | ||
| Congenital Heart Disease | 143.e1 | ||
| Acute Rheumatic Fever and Rheumatic Heart Disease | 143.e1 | ||
| Infective Endocarditis | 143.e2 | ||
| 3 Gastrointestinal Disorders | 144 | ||
| 9 Failure to Thrive | 144 | ||
| Normal Growth | 144 | ||
| Definitions | 144 | ||
| Interpretation of Growth Charts | 145 | ||
| Epidemiology | 146 | ||
| Clinical Presentation | 146 | ||
| Approach to Determining Etiology | 147 | ||
| History | 148 | ||
| History of the Present Illness | 149 | ||
| Medical History | 150 | ||
| Family History | 150 | ||
| Social History | 151 | ||
| Review of Systems | 151 | ||
| Physical Examination | 152 | ||
| Laboratory Evaluation | 152 | ||
| Overall Approach to Management | 154 | ||
| Steps to Improve Calorie Intake | 154 | ||
| Mealtime Behavior | 154 | ||
| Beverages | 154 | ||
| Food Selection | 155 | ||
| Daily Routines and Snacks | 157 | ||
| Calculating Caloric Need | 157 | ||
| Nutritional Supplementation for the Older Infant and Child | 158 | ||
| Referral Resources and Other Options | 158 | ||
| Multidisciplinary Team | 158 | ||
| Recording or Direct Observation | 158 | ||
| Involvement of Social Service Agencies | 158 | ||
| Behavioral Strategies | 159 | ||
| Non-Oral Enteral Feeding | 159 | ||
| Children With Special Health Care Needs | 159 | ||
| Criteria for Hospitalization | 159 | ||
| Monitoring | 159 | ||
| Long-Term Outcomes | 160 | ||
| Summary and Red Flags | 160 | ||
| References | 160 | ||
| References | 160.e1 | ||
| Reviews | 160.e1 | ||
| Treatment and Outcomes | 160.e1 | ||
| 10 Abdominal Pain | 161 | ||
| Pathophysiology of Abdominal Pain | 161 | ||
| Visceral Pain | 161 | ||
| Parietal Pain | 161 | ||
| Acute Abdominal Pain | 161 | ||
| History | 161 | ||
| Essential Components of the History | 161 | ||
| Time of onset of pain. | 161 | ||
| Location of pain. | 162 | ||
| Character of pain. | 162 | ||
| Child’s activity level. | 162 | ||
| Gastrointestinal symptoms. | 163 | ||
| Associated symptoms. | 166 | ||
| Family history and personal medical history. | 166 | ||
| Physical Examination | 166 | ||
| Laboratory Evaluation | 169 | ||
| Complete Blood Cell Count | 169 | ||
| Urinalysis | 169 | ||
| Other Laboratory Tests | 169 | ||
| Imaging Evaluation | 169 | ||
| Plain Radiography | 170 | ||
| Ultrasonography | 170 | ||
| Contrast Studies | 170 | ||
| Computed Tomography | 171 | ||
| Management | 171 | ||
| Specific Causes of Acute Abdominal Pain | 171 | ||
| Appendicitis | 171 | ||
| Diagnosis | 172 | ||
| Laboratory and Radiographic Testing | 172 | ||
| Treatment | 173 | ||
| Pancreatitis | 173 | ||
| Manifestations | 173 | ||
| Complications | 174 | ||
| Management | 174 | ||
| Cholelithiasis | 175 | ||
| Diagnosis | 176 | ||
| Treatment | 176 | ||
| Peptic Ulcer Disease | 176 | ||
| Chronic Abdominal Pain | 176 | ||
| Making a Diagnosis of Functional Abdominal Pain | 178 | ||
| Severity and Location of Pain | 179 | ||
| Approach to Treatment | 179 | ||
| Red Flags | 180 | ||
| References | 181 | ||
| References | 181.e1 | ||
| Acute Abdominal Pain | 181.e1 | ||
| Peptic Ulcer Disease | 181.e1 | ||
| Appendicitis | 181.e1 | ||
| Pancreatitis | 181.e1 | ||
| Hepatobiliary Tract Disease | 181.e1 | ||
| Chronic Abdominal Pain | 181.e2 | ||
| 11 Diarrhea | 182 | ||
| Acute Diarrhea | 182 | ||
| History | 182 | ||
| Physical Examination | 182 | ||
| Viral Diarrhea | 182 | ||
| Rotavirus infection. | 182 | ||
| Norovirus infection. | 182 | ||
| Bacterial Diarrhea | 184 | ||
| Salmonella infection. | 184 | ||
| Shigella infection. | 184 | ||
| Campylobacter infection. | 184 | ||
| Yersinia infection. | 184 | ||
| Escherichia coli infection. | 185 | ||
| Clostridium difficile infection. | 187 | ||
| Aeromonas infection. | 187 | ||
| Plesiomonas infection. | 187 | ||
| Parasitic Diarrhea | 188 | ||
| Giardiasis. | 188 | ||
| Entamoeba histolytica infection. | 188 | ||
| Cryptosporidium infection. | 188 | ||
| Other Causes of Acute Diarrhea | 188 | ||
| Parenteral secondary diarrhea. | 188 | ||
| Medications. | 188 | ||
| Food poisoning (Table 11.9; see Fig. 11.1). | 188 | ||
| Chronic Diarrhea | 188 | ||
| History | 188 | ||
| Physical Examination | 190 | ||
| Diagnostic Evaluation | 190 | ||
| Disorders of Carbohydrate Malabsorption | 190 | ||
| Disaccharidase Deficiency | 191 | ||
| Congenital sucrase-isomaltase deficiency (CSID). | 191 | ||
| Maltase-glucoamylase deficiency. | 193 | ||
| Congenital glucose-galactose malabsorption (CGGM). | 193 | ||
| Congenital lactase deficiency. | 193 | ||
| Primary lactase deficiency (lactose intolerance). | 193 | ||
| Secondary lactase deficiency. | 194 | ||
| Chronic NonSpecific Diarrhea | 194 | ||
| Small Intestinal Bacterial Overgrowth (SIBO) | 194 | ||
| Irritable Bowel Syndrome (IBS) | 197 | ||
| Celiac Disease | 198 | ||
| Inflammatory Bowel Disease (IBD) | 199 | ||
| Clinical presentation. | 199 | ||
| Diagnosis. | 199 | ||
| Summary and Red Flags | 203 | ||
| References | 203 | ||
| References | 203.e1 | ||
| Acute Gastroenteritis | 203.e1 | ||
| Chronic Diarrhea | 203.e1 | ||
| 12 Vomiting and Regurgitation | 204 | ||
| Definitions | 204 | ||
| Neuroanatomy of Vomiting | 204 | ||
| Data to Guide the Diagnosis | 204 | ||
| History | 204 | ||
| Demographics | 204 | ||
| Characteristics of Vomiting | 204 | ||
| Associated symptoms. | 205 | ||
| Medical, family, and social history. | 205 | ||
| Physical Examination | 205 | ||
| Abdominal Examination | 205 | ||
| Rectal Examination | 208 | ||
| Laboratory Data | 208 | ||
| Radiographic and Procedure Data | 208 | ||
| Differential Diagnosis | 208 | ||
| General Approach | 208 | ||
| Gastrointestinal Obstruction | 210 | ||
| Esophageal Obstruction | 210 | ||
| Esophageal atresia. | 210 | ||
| Esophageal stenosis. | 210 | ||
| Esophageal strictures. | 210 | ||
| Pyloric Stenosis | 210 | ||
| Intestinal Obstruction | 210 | ||
| Duodenal atresia, stenosis, and web; annular pancreas. | 215 | ||
| Duodenal hematoma. | 215 | ||
| Jejunal atresia, ileal atresia, and ileal stenosis. | 215 | ||
| Intestinal strictures. | 215 | ||
| Adhesions. | 215 | ||
| Duplications. | 215 | ||
| Meconium ileus and distal intestinal obstruction syndrome (DIOS). | 216 | ||
| Incarcerated hernia. | 216 | ||
| Malrotation and volvulus. | 216 | ||
| Meckel diverticulum. | 217 | ||
| Intussusception. | 217 | ||
| Superior mesenteric artery syndrome. | 217 | ||
| Constipation, meconium plug, and anal stenosis. | 218 | ||
| Gastrointestinal Dysmotility | 218 | ||
| Achalasia | 218 | ||
| Gastroesophageal Reflux | 218 | ||
| Gastric Stasis and Gastroparesis | 218 | ||
| Ileus | 218 | ||
| Pseudoobstruction | 219 | ||
| Gastrointestinal Inflammation | 219 | ||
| Esophagitis | 219 | ||
| Gastroenteritis | 219 | ||
| Peptic Ulcer Disease | 220 | ||
| Meckel Diverticulitis | 220 | ||
| Mesenteric Adenitis | 220 | ||
| Appendicitis | 220 | ||
| Inflammatory Bowel Disease | 220 | ||
| Allergic Enteropathy, Eosinophilic Gastroenteropathy, and Eosinophilic Esophagitis | 220 | ||
| Gastrointestinal Ischemia and Vascular Insufficiency | 221 | ||
| Abdominal Migraine | 221 | ||
| Vasculitis | 221 | ||
| Volvulus and Intussusception | 221 | ||
| Mesenteric Ischemia | 221 | ||
| Gastrointestinal Perforation and Peritonitis | 221 | ||
| Hepatobiliary Disorders | 221 | ||
| Hepatitis | 221 | ||
| Biliary Colic and Cholecystitis | 222 | ||
| Pancreatitis | 222 | ||
| Gynecologic and Urologic Disorders | 222 | ||
| Pyelonephritis | 222 | ||
| Ureteropelvic Junction Obstruction and Hydronephrosis | 222 | ||
| Renal Colic | 222 | ||
| Dysmenorrhea, Endometriosis, and Pelvic Inflammatory Disease | 222 | ||
| Ovarian Torsion | 222 | ||
| Hyperemesis Gravidarum | 222 | ||
| Testicular Torsion | 222 | ||
| Respiratory Disorders | 222 | ||
| Sinusitis, Pharyngitis, and Otitis | 222 | ||
| Pneumonia | 222 | ||
| Central Nervous System Disorders | 222 | ||
| Increased Intracranial Pressure | 222 | ||
| Abdominal Epilepsy | 222 | ||
| Vestibular Disorders, Motion Sickness | 223 | ||
| Ventriculoperitoneal Shunt Complications | 223 | ||
| Psychobehavioral Disorders | 223 | ||
| Psychogenic Vomiting | 223 | ||
| Rumination | 223 | ||
| Eating Disorders | 223 | ||
| Management | 223 | ||
| Metabolic Disorders | 223 | ||
| Poisonings and Drugs | 223 | ||
| Hematemesis | 223 | ||
| Other Causes of Vomiting | 224 | ||
| Chemotherapy | 224 | ||
| Radiation Therapy | 224 | ||
| Cyclic Vomiting | 224 | ||
| Porphyria | 225 | ||
| Familial Mediterranean Fever (Benign Paroxysmal Peritonitis, Periodic Peritonitis, Polyserositis) | 225 | ||
| Familial Dysautonomia | 225 | ||
| Complications of Vomiting | 225 | ||
| Metabolic Complications | 225 | ||
| Nutritional Complications | 225 | ||
| Mallory-Weiss Tear | 225 | ||
| Peptic Esophagitis | 225 | ||
| Therapy | 232 | ||
| Treatment of Behavioral Aspects | 232 | ||
| Antiemetic Drugs | 232 | ||
| Summary and Red Flags | 234 | ||
| References | 234 | ||
| References | 234.e1 | ||
| General | 234.e1 | ||
| Gastrointestinal Obstruction | 234.e1 | ||
| Gastroesophageal Reflux | 234.e1 | ||
| Other Etiologies | 234.e1 | ||
| Therapy | 234.e1 | ||
| 13 Gastrointestinal Bleeding | 235 | ||
| Definitions | 235 | ||
| Hematemesis | 235 | ||
| Hematochezia and melena | 235 | ||
| Approach to Gastrointestinal Bleeding | 235 | ||
| Hematemesis and Melena: Upper Gastrointestinal Bleed | 235 | ||
| History | 235 | ||
| Physical Examination | 236 | ||
| Differential Diagnosis | 237 | ||
| Hematochezia: Lower Gastrointestinal Bleed | 238 | ||
| History | 238 | ||
| Physical Examination | 238 | ||
| Differential Diagnosis | 238 | ||
| Occult Blood Loss | 239 | ||
| Laboratory Evaluation | 239 | ||
| Imaging | 239 | ||
| Radiographs | 239 | ||
| Abdominal Ultrasound | 240 | ||
| Computed Tomography | 240 | ||
| Magnetic Resonance Enterography | 240 | ||
| Angiography | 240 | ||
| Nuclear Imaging | 240 | ||
| Imaging | 241 | ||
| Capsule Endoscopy | 241 | ||
| Treatment | 241 | ||
| Resuscitation | 241 | ||
| Vasoactive Agents | 242 | ||
| Endoscopic Modalities | 243 | ||
| Interventional Radiology | 243 | ||
| Summary and Red Flags | 243 | ||
| References | 243 | ||
| References | 243.e1 | ||
| 14 Hepatomegaly | 244 | ||
| Assessment of the Liver | 244 | ||
| History and Physical Examination | 244 | ||
| Pathophysiology | 246 | ||
| Evaluation of the Child With Hepatomegaly | 246 | ||
| Laboratory Studies | 246 | ||
| Hepatocellular Injury | 247 | ||
| Biliary Injury | 247 | ||
| Exocrine Function | 247 | ||
| Synthetic Function | 247 | ||
| Metabolic Function | 247 | ||
| Extrahepatic Involvement | 248 | ||
| Imaging Studies | 249 | ||
| Liver Biopsy | 249 | ||
| Specific Issues in the Diagnosis and Treatment of Hepatomegaly | 249 | ||
| Hepatomegaly in the Infant | 249 | ||
| Hepatomegaly in the Child and Adolescent | 251 | ||
| Steatohepatitis | 251 | ||
| Viral Hepatitis | 251 | ||
| Toxins | 252 | ||
| Alpha-1-Antitrypsin Deficiency | 252 | ||
| Wilson Disease | 252 | ||
| Autoimmune Liver Disease | 252 | ||
| Primary Sclerosing Cholangitis | 252 | ||
| Acquired Immunodeficiency Syndrome | 253 | ||
| Other Infections | 253 | ||
| Fitz-Hugh–Curtis Syndrome | 253 | ||
| Hepatic Abscess | 253 | ||
| Endocrine Disorders | 253 | ||
| Liver Tumors | 253 | ||
| Hepatic Cysts | 254 | ||
| Hepatic Venous Outflow Obstruction | 254 | ||
| Summary and Red Flags | 254 | ||
| References | 254 | ||
| References | 254.e1 | ||
| General Review | 254.e1 | ||
| Clinical Assessment of Liver Size | 254.e1 | ||
| Biochemical Studies of Liver Function and Injury | 254.e1 | ||
| Neonatal Cholestasis | 254.e1 | ||
| Viral Hepatitis | 254.e1 | ||
| Metabolic Liver Disease | 254.e1 | ||
| Autoimmune Liver Disease | 254.e1 | ||
| Liver Tumors | 254.e1 | ||
| Miscellaneous Disorders Causing Hepatomegaly | 254.e1 | ||
| 15 Jaundice | 255 | ||
| Diagnostic Strategies | 255 | ||
| Bilirubin | 255 | ||
| Aminotransferases | 255 | ||
| Alkaline Phosphatase | 255 | ||
| γ-Glutamyltransferase | 259 | ||
| Bile Acids | 259 | ||
| Albumin | 259 | ||
| Prothrombin Time | 259 | ||
| Ultrasonography | 259 | ||
| Scintigraphy | 259 | ||
| Computed Tomography | 259 | ||
| Magnetic Resonance | 259 | ||
| Endoscopic Retrograde Cholangiopancreatography | 259 | ||
| Percutaneous Transhepatic Cholangiography | 259 | ||
| Liver Biopsy | 259 | ||
| Jaundice in the Neonate and Infant | 260 | ||
| History | 260 | ||
| Physical Examination | 261 | ||
| Differential Diagnosis | 261 | ||
| Physiologic and Breast Milk Jaundice | 261 | ||
| Unconjugated Hyperbilirubinemia | 263 | ||
| Polycythemia. | 263 | ||
| Hemolytic disorders. | 264 | ||
| Isoimmune hemolytic disease. | 264 | ||
| Erythrocyte membrane defects. | 264 | ||
| Other considerations. | 264 | ||
| Familial disorders of bilirubin metabolism | 264 | ||
| Gilbert syndrome. | 264 | ||
| Crigler-Najjar syndrome. | 264 | ||
| Lucey-Driscoll syndrome. | 264 | ||
| Therapy. | 265 | ||
| Neonatal Conjugated Hyperbilirubinemia | 265 | ||
| Obstructive/anatomic abnormalities, idiopathic cholestasis, and idiopathic neonatal hepatitis | 265 | ||
| Biliary atresia. | 265 | ||
| Alagille syndrome. | 266 | ||
| Choledochal cysts. | 266 | ||
| Treatable infections | 267 | ||
| Bacterial infection. | 267 | ||
| Herpes simplex. | 267 | ||
| Enteroviruses. | 267 | ||
| Cytomegalovirus infection. | 267 | ||
| Hepatitis B. | 267 | ||
| Syphilis. | 267 | ||
| Toxoplasmosis. | 267 | ||
| Treatable metabolic disorders. | 267 | ||
| Galactosemia. | 267 | ||
| Other identifiable infectious and metabolic causes of cholestasis | 268 | ||
| α1-Antitrypsin deficiency. | 268 | ||
| Cystic fibrosis. | 268 | ||
| Hypothyroidism and hypopituitarism. | 268 | ||
| Progressive Familial Intrahepatic Cholestasis | 268 | ||
| Idiopathic neonatal hepatitis. | 269 | ||
| Treatment of cholestasis. | 269 | ||
| Jaundice in the Child and Adolescent | 269 | ||
| History | 269 | ||
| Physical Examination | 269 | ||
| Differential Diagnosis | 269 | ||
| Unconjugated Hyperbilirubinemia | 269 | ||
| Conjugated Hyperbilirubinemia | 270 | ||
| Obstruction. | 270 | ||
| Gallstones. | 270 | ||
| Primary sclerosing cholangitis. | 270 | ||
| Infection. | 271 | ||
| Hepatitis A. | 272 | ||
| Hepatitis B. | 272 | ||
| Hepatitis C. | 272 | ||
| Hepatitis D. | 273 | ||
| Hepatitis E. | 273 | ||
| Epstein-Barr virus. | 273 | ||
| Other viruses. | 273 | ||
| Wilson disease. | 273 | ||
| Drugs and toxins. | 273 | ||
| Autoimmune hepatitis. | 273 | ||
| Summary and Red Flags | 274 | ||
| References | 274 | ||
| References | 274.e1 | ||
| General | 274.e1 | ||
| Diagnostic Strategies | 274.e1 | ||
| Neonatal Jaundice | 274.e1 | ||
| Alagille Syndrome, Primary Intrahepatic Cholestasis | 274.e1 | ||
| α1-Antitrypsin Deficiency | 274.e1 | ||
| Biliary Atresia | 274.e1 | ||
| Crigler-Najjar Syndromes | 274.e1 | ||
| Cystic Fibrosis | 274.e1 | ||
| Erythrocyte Enzyme Defects | 274.e1 | ||
| Gilbert Syndrome | 274.e1 | ||
| Lucey-Driscoll Syndrome | 274.e1 | ||
| Physiologic and Breast Milk Jaundice | 274.e1 | ||
| Jaundice in Older Children and Adolescents | 274.e1 | ||
| Autoimmune Hemolytic Anemia | 274.e1 | ||
| Autoimmune Hepatitis | 274.e1 | ||
| Drugs | 274.e1 | ||
| Gallstones | 274.e1 | ||
| Hepatitis | 274.e1 | ||
| Primary Sclerosing Cholangitis | 274.e1 | ||
| Wilson Disease | 274.e1 | ||
| 16 Constipation | 275 | ||
| Physiology of Normal Defecation and Constipation | 275 | ||
| Data Collection and Assessment | 275 | ||
| History | 275 | ||
| Physical Examination | 277 | ||
| Diagnostic Evaluation | 278 | ||
| Differential Diagnosis | 278 | ||
| Hirschsprung Disease | 278 | ||
| Chronic Intestinal Pseudoobstruction | 281 | ||
| Anterior Anal Displacement | 281 | ||
| Anal Stenosis | 281 | ||
| Imperforate Anus | 281 | ||
| Spina Bifida and Spina Bifida Occulta | 281 | ||
| Metabolic Diseases | 281 | ||
| Neurologic Disease | 282 | ||
| Medication-Related Constipation | 282 | ||
| Encopresis | 282 | ||
| Summary and Red Flags | 282 | ||
| References | 282 | ||
| References | 282.e1 | ||
| 17 Abdominal Masses | 283 | ||
| Diagnostic Strategies | 283 | ||
| Clinical History | 283 | ||
| Physical Examination | 283 | ||
| Laboratory and Imaging Studies | 285 | ||
| Splenomegaly | 286 | ||
| History | 287 | ||
| Physical Examination | 289 | ||
| Approach to the Child with Splenomegaly | 289 | ||
| Laboratory Investigation | 289 | ||
| Complete Blood Cell Count | 289 | ||
| Leukocyte Count and Differential. | 289 | ||
| Hemoglobin, Erythrocyte Morphology, and Reticulocyte Count. | 289 | ||
| Platelet Count. | 289 | ||
| Pancytopenia. | 289 | ||
| Erythrocyte Sedimentation Rate | 289 | ||
| Liver Function Tests | 291 | ||
| Immunologic Evaluation | 291 | ||
| Viral Antibody Titers | 291 | ||
| Cultures | 291 | ||
| Bone Marrow Examination | 291 | ||
| Imaging | 292 | ||
| Splenectomy | 292 | ||
| Neuroblastoma | 292 | ||
| Renal Masses | 294 | ||
| Congenital Hydronephrosis | 294 | ||
| Cystic Abnormalities of the Kidney | 294 | ||
| Wilms Tumor (Nephroblastoma) | 295 | ||
| Liver Tumors | 295 | ||
| Hepatoblastoma | 295 | ||
| Hepatocellular Carcinoma | 296 | ||
| Congenital Dilatation of the Bile Ducts | 296 | ||
| Intestinal and Pancreatic Masses | 296 | ||
| Appendiceal Phlegmon and Abscess | 296 | ||
| Bezoar | 298 | ||
| Duplications | 298 | ||
| Neoplasms of the Gastrointestinal Tract | 298 | ||
| Mesenteric, Omental, and Retroperitoneal Cysts | 299 | ||
| Pancreatic Pseudocyst and Neoplasms | 299 | ||
| Ovarian Tumors | 300 | ||
| Summary and Red Flags | 301 | ||
| References | 301 | ||
| References | 301.e1 | ||
| Diagnostic Strategies | 301.e1 | ||
| Splenomegaly | 301.e1 | ||
| Neuroblastoma | 301.e1 | ||
| Renal Masses | 301.e1 | ||
| Wilms Tumor | 301.e1 | ||
| Liver Tumors | 301.e1 | ||
| Congenital Dilatation of the Bile Ducts | 301.e1 | ||
| Intestinal and Pancreatic Masses | 301.e1 | ||
| Duplications | 301.e1 | ||
| Ovarian Tumors | 301.e2 | ||
| 4 Genitourinary Disorders | 302 | ||
| 18 Dysuria | 302 | ||
| Neonates | 302 | ||
| Children 2-24 Months of Age | 302 | ||
| Preschool Children | 304 | ||
| School-Aged/Prepubertal Children | 304 | ||
| Adolescents | 305 | ||
| Summary and Red Flags | 310 | ||
| References | 311 | ||
| References | 311.e1 | ||
| 19 Proteinuria | 312 | ||
| Nephrotic Syndrome in Young Children | 312 | ||
| Differential Diagnosis | 312 | ||
| Minimal Change Disease | 314 | ||
| Diagnosis | 314 | ||
| Treatment | 315 | ||
| Complications of Nephrotic Syndrome | 316 | ||
| Infection. | 316 | ||
| Thrombosis. | 317 | ||
| Hyperlipidemia. | 317 | ||
| Other Forms of Nephrotic Syndrome | 317 | ||
| Focal Segmental Sclerosis | 317 | ||
| Diagnosis | 317 | ||
| Treatment | 317 | ||
| Membranous Nephropathy | 317 | ||
| Treatment | 318 | ||
| Nephrotic Syndrome in Infants Younger Than 1 Year | 318 | ||
| Congenital Nephrotic Syndrome | 318 | ||
| Diffuse Mesangial Sclerosis | 318 | ||
| Asymptomatic Proteinuria Disorders | 318 | ||
| Summary and Red Flags | 320 | ||
| References | 320 | ||
| References | 320.e1 | ||
| 20 Hematuria | 321 | ||
| Gross Hematuria | 321 | ||
| History | 321 | ||
| Physical Examination | 323 | ||
| Evaluation | 323 | ||
| Laboratory Tests | 323 | ||
| Imaging and Cystoscopy | 325 | ||
| Microscopic Hematuria | 325 | ||
| More Common Causes of Hematuria | 326 | ||
| Postinfectious Glomerulonephritis | 326 | ||
| Immunoglobulin A (IgA) Nephropathy | 326 | ||
| Hereditary Nephritis | 327 | ||
| Polycystic Kidney Disease | 327 | ||
| Uncommon Causes of Hematuria in Childhood | 327 | ||
| Red Flags | 328 | ||
| References | 329 | ||
| References | 329.e1 | ||
| 21 Acute and Chronic Scrotal Swelling | 330 | ||
| Scrotal and Inguinal Anatomy | 330 | ||
| Inguinal Region | 330 | ||
| Testis Descent | 330 | ||
| Scrotum | 330 | ||
| Testis | 330 | ||
| Diagnostic Strategies | 330 | ||
| History | 330 | ||
| Physical Examination | 331 | ||
| Pubertal development. | 331 | ||
| Scars in the inguinal region. | 331 | ||
| Scrotal skin changes and fixation. | 331 | ||
| Testis position within the scrotum. | 332 | ||
| Cremasteric reflex. | 332 | ||
| Laboratory Data | 332 | ||
| Imaging Studies | 332 | ||
| Differential Diagnosis | 333 | ||
| Testicular Torsion | 333 | ||
| Torsion of the Appendix Testis | 334 | ||
| Epididymitis, Epididymoorchitis, and Orchitis | 335 | ||
| Trauma and Hematocele | 335 | ||
| Varicocele | 336 | ||
| Inguinal Hernia | 336 | ||
| Hydrocele | 336 | ||
| Testicular Tumors | 337 | ||
| Meconium Peritonitis | 338 | ||
| Scrotal Wall Swelling | 338 | ||
| Henoch-Schönlein Purpura | 338 | ||
| Acute Idiopathic Scrotal Wall Edema | 338 | ||
| Idiopathic Fat Necrosis | 338 | ||
| Fournier Gangrene | 338 | ||
| Referred Pain | 338 | ||
| Red Flags | 338 | ||
| References | 338 | ||
| References | 338.e1 | ||
| Testicular Torsion | 338.e1 | ||
| Torsion of the Appendix Testis | 338.e1 | ||
| Epididymoorchitis | 338.e1 | ||
| Trauma | 338.e1 | ||
| Varicocele | 338.e1 | ||
| Testicular Tumors | 338.e1 | ||
| Other Diagnoses | 338.e1 | ||
| Diagnostic Strategies | 338.e2 | ||
| Imaging | 338.e2 | ||
| 22 Menstrual Problems and Vaginal Bleeding | 339 | ||
| Prepubertal Vaginal Bleeding | 339 | ||
| Abnormal Bleeding in Adolescence | 341 | ||
| Review of the Menstrual Cycle | 341 | ||
| Pregnancy | 342 | ||
| Coagulopathy | 342 | ||
| Ovulatory Dysfunction | 342 | ||
| Endometrial Causes | 344 | ||
| Iatrogenic Causes | 344 | ||
| Not Yet Classified | 344 | ||
| Structural Causes: PALM | 344 | ||
| Congenital Anomalies | 345 | ||
| Treatment | 345 | ||
| Menstrual Pain in Adolescents | 346 | ||
| Summary and Red Flags | 347 | ||
| References | 347 | ||
| References | 347.e1 | ||
| 23 Disorders of Sex Development | 348 | ||
| Overview of Sex Differentiation | 348 | ||
| Overview of Gonadal Function | 348 | ||
| Testes | 348 | ||
| Ovaries | 351 | ||
| Diagnostic Approach to the Patient With Atypical or Ambiguous Genitalia | 356 | ||
| Basic Approaches to the Diagnosis and Management of Disorders of Sex Development | 358 | ||
| Specific Types of Disorders of Sex Development | 359 | ||
| 46,XX Disorders of Sex Development | 359 | ||
| Androgen Exposure/Fetoplacental Source | 359 | ||
| Congenital adrenal hyperplasia. | 359 | ||
| Aromatase deficiency. | 360 | ||
| Cortisol resistance due to glucocorticoid receptor gene mutation. | 360 | ||
| Androgen Exposure: Maternal Source | 360 | ||
| Virilizing maternal tumors. | 360 | ||
| Administration of androgenic drugs to women during pregnancy. | 360 | ||
| Disorders of Ovarian Development | 360 | ||
| 46,XX testicular DSD. | 360 | ||
| 46,XX gonadal dysgenesis. | 360 | ||
| Undetermined/unknown. | 361 | ||
| 46,XY Disorders of Sex Development | 361 | ||
| Defects in Testicular Development | 361 | ||
| Wilms tumor suppressor gene (WT1) mutations: Denys-Drash, Fraser and WAGR syndromes. | 361 | ||
| Campomelic syndrome. | 361 | ||
| Steroidogenic Factor 1 (SF1) Gene Mutations | 361 | ||
| Other Known Genetic Causes of 46,XY DSD | 361 | ||
| XY pure gonadal dysgenesis (Swyer syndrome). | 361 | ||
| XY gonadal agenesis syndrome (embryonic testicular regression syndrome). | 361 | ||
| Deficiency of Testicular Hormone Production | 362 | ||
| Leydig cell aplasia. | 362 | ||
| Congenital adrenal hyperplasia (CAH). | 362 | ||
| Deficiency of 17-ketosteroid reductase. | 362 | ||
| Persistent müllerian duct syndrome. | 363 | ||
| Smith-Lemli-Opitz syndrome. | 363 | ||
| Defects in Androgen Action | 363 | ||
| Dihydrotestosterone deficiency. | 363 | ||
| Androgen receptor defects: androgen insensitivity syndromes (AISs). | 364 | ||
| Undetermined Causes of 46,XY Disorders of Sex Development | 365 | ||
| Ovotesticular Disorders of Sex Development | 365 | ||
| Sex Chromosome Disorders of Sex Development | 366 | ||
| Red Flags | 366 | ||
| References | 366 | ||
| References | 366.e1 | ||
| 5 Developmental and Psychiatric Disorders | 367 | ||
| 24 Intellectual and Developmental Disability | 367 | ||
| Definitions | 367 | ||
| Epidemiology | 367 | ||
| Intellectual Disability | 367 | ||
| Developmental Disability | 367 | ||
| Diagnosis | 368 | ||
| Identification | 368 | ||
| Developmental Risk Factors | 369 | ||
| Developmental Protective Factors | 369 | ||
| Screening for Specific Abnormalities | 370 | ||
| Visual Deficits | 370 | ||
| Loss of Hearing | 370 | ||
| Speech and Language Disorders | 370 | ||
| Other Conditions | 371 | ||
| Prenatal and Newborn Screening Programs | 371 | ||
| Prenatal Screening | 371 | ||
| Newborn Screening | 371 | ||
| Identification of Children With Developmental Disabilities in Primary Health Care Settings | 371 | ||
| Developmental Screening | 372 | ||
| Developmental Surveillance | 372 | ||
| Comprehensive Developmental Assessment | 372 | ||
| Neurodevelopmental Pediatric Assessment | 372 | ||
| History | 372 | ||
| Physical Examination | 375 | ||
| Neurodevelopmental Examination | 378 | ||
| Formal Neurodevelopmental Assessments | 378 | ||
| Psychologic Evaluation | 378 | ||
| Speech-Language and Oral Motor Evaluation | 378 | ||
| Diagnostic Strategy | 378 | ||
| Laboratory Testing | 379 | ||
| Genetic Tests | 382 | ||
| Metabolic Tests | 382 | ||
| Neuroimaging | 384 | ||
| Ultrasonography | 384 | ||
| Computed Tomography Scans | 385 | ||
| Magnetic Resonance Imaging | 385 | ||
| Indications for Various Imaging Modalities | 385 | ||
| Other Tests | 386 | ||
| Discussing a Developmental Diagnosis with Parents | 386 | ||
| Specific Conditions | 386 | ||
| Cerebral Palsy | 386 | ||
| Autism Spectrum Disorder | 387 | ||
| Fragile X Syndrome | 387 | ||
| Inborn Errors of Metabolism and Storage Diseases | 388 | ||
| Congenital Infections | 388 | ||
| Postnatal Infections | 388 | ||
| Treatment | 388 | ||
| Complementary and Alternative Therapies | 391 | ||
| Pitfalls and Hazards in Developmental Diagnosis | 391 | ||
| Summary and Red Flags | 392 | ||
| References | 392 | ||
| References | 392.e1 | ||
| 25 Dysmorphology | 393 | ||
| Diagnostic Approaches | 393 | ||
| Human Variation | 393 | ||
| Teratology | 394 | ||
| Embryogenesis | 396 | ||
| Birth Defects | 396 | ||
| Clinical Classification | 396 | ||
| Single-System Defects | 396 | ||
| Association | 396 | ||
| Sequence | 396 | ||
| Syndrome | 396 | ||
| Complex | 396 | ||
| Dysmorphic Evaluation | 397 | ||
| Components of Dysmorphic Evaluation | 397 | ||
| Detailed History | 397 | ||
| Family health history. | 398 | ||
| Pregnancy and birth history. | 398 | ||
| Developmental history. | 401 | ||
| Examination | 401 | ||
| Initial Inspection | 403 | ||
| Anthropometrics | 403 | ||
| Head and Neck | 404 | ||
| Face | 405 | ||
| General “Rules” | 405 | ||
| Assembling the Data | 405 | ||
| Minimal Diagnostic Criteria | 405 | ||
| Tools to Assist the Diagnostic Odyssey | 405 | ||
| Genetic Testing | 408 | ||
| References | 410 | ||
| References | 410.e1 | ||
| Bone Age and Physical Measurements | 410.e1 | ||
| Syndrome References | 410.e1 | ||
| 26 Irritable Infant | 411 | ||
| Diagnostic Approach | 411 | ||
| Addressing Caregivers’ Response to Crying | 416 | ||
| Specific Diagnoses | 418 | ||
| Child Maltreatment | 418 | ||
| Infantile Colic | 419 | ||
| Feeding and Gastrointestinal Dysfunction | 419 | ||
| Teething | 419 | ||
| Drug Reactions | 420 | ||
| Summary and Red Flags | 420 | ||
| References | 420 | ||
| References | 420.e1 | ||
| Child Maltreatment | 420.e1 | ||
| Infantile Crying and Colic | 420.e1 | ||
| Gastrointestinal Causes of Irritability | 420.e1 | ||
| Teething | 420.e1 | ||
| Medication or Drug Reactions | 420.e1 | ||
| 27 Unusual Behaviors | 421 | ||
| Conditions Characterized by Disruptive Behaviors | 421 | ||
| Conditions That Do Not Violate the Rights of Others | 421 | ||
| Attention-deficit/hyperactivity disorder. | 421 | ||
| Inattention | 421 | ||
| Hyperactivity/Impulsivity | 422 | ||
| Tic disorders. | 424 | ||
| Disruptive mood dysregulation disorder. | 425 | ||
| Substance Use Disorder. | 425 | ||
| Conditions That Violate the Rights of Others | 425 | ||
| Oppositional defiant disorder. | 425 | ||
| Conduct disorder. | 425 | ||
| Conditions Characterized by Disruption in Mood | 426 | ||
| Conditions Characterized by Depressed Mood | 426 | ||
| Major depressive disorder. | 426 | ||
| Premenstrual dysphoric disorder. | 427 | ||
| Substance-induced mood disorders. | 427 | ||
| Adjustment disorder. | 427 | ||
| Conditions Characterized by Extremes of Mood Lability | 428 | ||
| Addressing Suicidal Thoughts and Attempts | 428 | ||
| Conditions Characterized by Worry, Fear, and Panic | 428 | ||
| Conditions Characterized by Worry | 428 | ||
| Worry Without Unusual Behaviors | 429 | ||
| Adjustment disorder with anxiety. | 429 | ||
| Worry With Unusual Behaviors | 429 | ||
| Pediatric autoimmune neuropsychiatric disorders associated with Streptococcus pyogenes (PANDAS). | 430 | ||
| Conditions Characterized by Fear | 430 | ||
| Fears Arising Spontaneously | 430 | ||
| Specific phobias. | 430 | ||
| Social anxiety disorder (social phobia). | 430 | ||
| Separation anxiety disorder. | 430 | ||
| Selective mutism. | 430 | ||
| Fears Arising from Traumatic Events | 430 | ||
| Conditions Characterized by Panic | 431 | ||
| Panic disorder. | 431 | ||
| Agoraphobia. | 431 | ||
| Conditions Characterized by Mental Status Abnormalities | 431 | ||
| Conditions Characterized by Hallucinations | 431 | ||
| Fantasy-based hallucinations. | 432 | ||
| Grief-induced hallucinations. | 432 | ||
| Hallucinations associated with sleep. | 432 | ||
| Phobic hallucinations. | 432 | ||
| Febrile hallucinations. | 432 | ||
| Schizophrenia. | 433 | ||
| Conditions Characterized by Fluctuating Mental Status | 434 | ||
| Delirium. | 434 | ||
| Substance intoxication. | 434 | ||
| Serotonin syndrome. | 435 | ||
| Neuroleptic malignant syndrome. | 435 | ||
| Conditions Characterized by Persistent Delay in Development | 435 | ||
| Autism spectrum disorder. | 435 | ||
| Conditions Characterized by Physical Findings or Complaints | 435 | ||
| Conditions Characterized by Parental Concerns | 435 | ||
| Parental worry. | 435 | ||
| Factitious disorder imposed on another (formerly Munchausen syndrome by proxy) (see also Chapter 26). | 436 | ||
| Conditions Characterized by the Patient’s Physical Complaints | 436 | ||
| Illness anxiety disorder (hypochondriasis). | 436 | ||
| Somatic symptom disorder. | 436 | ||
| Factitious disorder. | 436 | ||
| Conversion disorder (functional neurologic symptom disorder). | 436 | ||
| Conditions Characterized by Changes in Eating or Weight | 436 | ||
| Anorexia nervosa. | 436 | ||
| Bulimia nervosa. | 437 | ||
| Binge eating disorder. | 437 | ||
| Avoidant/restrictive food intake disorder (ARFID). | 437 | ||
| Summary and Red Flags | 438 | ||
| References | 438 | ||
| References | 438.e1 | ||
| General References | 438.e1 | ||
| History Taking | 438.e1 | ||
| Disruptive Behaviors | 438.e1 | ||
| Mood Disorders | 438.e1 | ||
| Anxiety | 438.e1 | ||
| Altered Mental Status | 438.e1 | ||
| Physical Symptoms | 438.e1 | ||
| 6 Neurosensory Disorders | 439 | ||
| 28 Headaches | 439 | ||
| Introduction | 439 | ||
| History | 439 | ||
| Physical Examination | 442 | ||
| Neuroimaging | 443 | ||
| Laboratory Investigations | 444 | ||
| Classification of Headaches | 444 | ||
| Primary Headaches | 444 | ||
| Tension-Type Headaches | 444 | ||
| Migraine Headaches | 447 | ||
| Migraine without aura. | 447 | ||
| Migraine with aura. | 447 | ||
| Complications of migraine. | 448 | ||
| Trigeminal Autonomic Cephalgias | 448 | ||
| Cluster headache. | 448 | ||
| Paroxysmal Hemicrania | 449 | ||
| Secondary Headaches | 449 | ||
| Headache Associated with Trauma | 449 | ||
| Acute headache. | 449 | ||
| Persistent headache. | 449 | ||
| Headaches Associated with Vascular Disorders | 449 | ||
| Acute ischemic stroke. | 449 | ||
| Aneurysms and Arteriovenous Malformations | 449 | ||
| Arteritis, Cerebral Venous Thrombosis, and Vascular Dissection | 449 | ||
| Vasculitis | 449 | ||
| Genetic Vasculopathies | 449 | ||
| Headaches Associated With Nonvascular Intracranial Disorders | 449 | ||
| Disorders Associated with Increased CSF Pressure | 450 | ||
| Disorders Associated with Decreased CSF Pressure | 451 | ||
| Intracranial Masses | 451 | ||
| Headaches Associated with Epileptic Seizures | 451 | ||
| Chiari I Malformations | 451 | ||
| Headaches Related to a Substance | 451 | ||
| Medication-Overuse Headaches | 452 | ||
| Caffeine Withdrawal Headaches | 452 | ||
| Intracranial and Systemic Infections | 452 | ||
| Disorders Affecting Homeostasis | 452 | ||
| Headaches and/or Facial Pain Related to Dysfunction of Head and Neck Structures (Table 28.17) | 452 | ||
| Psychologic Factors | 453 | ||
| Summary and Red Flags | 454 | ||
| References | 454 | ||
| References | 454.e1 | ||
| 29 Hypotonia, Weakness, and Stroke | 455 | ||
| Muscle Weakness and Hypotonia | 455 | ||
| Hypotonic Infant | 455 | ||
| Clinical Evaluation | 455 | ||
| Muscle Strength | 455 | ||
| Passive Tone | 455 | ||
| Joint Extensibility | 457 | ||
| Postural Reflexes | 457 | ||
| Traction response (pull-to-sit). | 457 | ||
| Axillary suspension. | 463 | ||
| Ventral suspension. | 463 | ||
| Diagnostic Approach | 464 | ||
| Common Disorders | 464 | ||
| Hypoxic-ischemic encephalopathy. | 464 | ||
| Brain malformations. | 467 | ||
| Uncommon Disorders | 467 | ||
| Progressive encephalopathies of infancy. | 467 | ||
| Mitochondrial diseases. | 468 | ||
| Brain malformation syndromes. | 468 | ||
| Hypotonic Older Child | 468 | ||
| Clinical Evaluation | 468 | ||
| Posture and Strength | 468 | ||
| Passive Tone | 468 | ||
| Joint Extensibility | 468 | ||
| Diagnostic Approach | 468 | ||
| Anatomic Localization | 468 | ||
| Is the Problem a Systemic Disorder? | 472 | ||
| Diagnostic Considerations | 472 | ||
| Common Disorders | 473 | ||
| Down syndrome. | 473 | ||
| Prader–Willi syndrome. | 473 | ||
| Uncommon Disorders | 473 | ||
| Metabolic disorders. | 473 | ||
| Neurologic disorders. | 473 | ||
| Congenital malformation syndromes. | 474 | ||
| Connective tissue disorders. | 474 | ||
| Is the Problem in the Cerebrum or Cerebellum? | 475 | ||
| Is the Problem in the Spinal Cord? | 475 | ||
| Common Disorders | 475 | ||
| Meningomyelocele. | 475 | ||
| Transverse myelitis. | 476 | ||
| Uncommon Disorders | 476 | ||
| Is the Problem in the Motor Unit? | 476 | ||
| Diagnostic Considerations | 476 | ||
| Common Disorders | 476 | ||
| Anterior horn cell disease. | 476 | ||
| Neuropathies. | 477 | ||
| Muscle and neuromuscular junction disorders. | 478 | ||
| Myopathies. | 478 | ||
| Neuromuscular junction disorders. | 483 | ||
| Stroke in Childhood | 484 | ||
| Neonates | 488 | ||
| Perinatal Ischemic Stroke | 488 | ||
| Polycythemia | 493 | ||
| Neonatal Cerebral Sinovenous Thrombosis (CSVT) | 496 | ||
| Intracranial Hemorrhage in the Neonate | 497 | ||
| Subdural Hemorrhage | 497 | ||
| Subarachnoid Hemorrhage | 498 | ||
| Intraparenchymal and Intraventricular Hemorrhage | 498 | ||
| Evaluation of Stroke in Infants | 498 | ||
| Children Aged 1-13 Years | 499 | ||
| Ischemic Stroke in Children | 500 | ||
| Congenital Heart Disease | 500 | ||
| Procoagulopathies | 501 | ||
| Autoimmune Disorders | 501 | ||
| Metabolic Disorders Causing Stroke | 502 | ||
| Moyamoya Disease | 503 | ||
| Sickle Cell Disease | 503 | ||
| Intracranial Hemorrhage | 504 | ||
| Coagulopathies | 504 | ||
| Thrombocytopenia | 504 | ||
| Vascular Malformations | 504 | ||
| Evaluation of Stroke in Children | 505 | ||
| Adolescents | 506 | ||
| Fibromuscular Dysplasia | 506 | ||
| Sexual Activity, Oral Contraception, and the Puerperium | 506 | ||
| Cocaine Use | 506 | ||
| Causes of Stroke Unrelated to Age | 507 | ||
| Pharyngeal Infection | 507 | ||
| Head and Neck Trauma | 507 | ||
| Migraine Headache | 507 | ||
| Summary and Red Flags | 507 | ||
| References | 507 | ||
| References | 507.e1 | ||
| Hypotonic Infant | 507.e1 | ||
| Arthrogryposis | 507.e1 | ||
| Hypoxic-Ischemic Encephalopathy | 507.e1 | ||
| Central Nervous System | 507.e1 | ||
| Systemic Disorders | 507.e1 | ||
| Spinal Muscular Atrophy | 507.e1 | ||
| Peripheral Neuropathy | 507.e1 | ||
| Neuromuscular Junction | 507.e1 | ||
| Myopathies | 507.e2 | ||
| Stroke: General | 507.e2 | ||
| Stroke: Neonate | 507.e2 | ||
| Polycythemia | 507.e3 | ||
| Neonatal Cerebral Venous Thrombosis | 507.e3 | ||
| Intracranial Hemorrhage in the Neonate | 507.e3 | ||
| Children Aged 1-13 Years: Congenital Heart Disease | 507.e3 | ||
| Children Aged 1-13 Years: Procoagulopathies | 507.e3 | ||
| Children Aged 1-13 Years: Autoimmune Disorders | 507.e3 | ||
| Children Aged 1-13 Years: Metabolic Disorders Causing Stroke | 507.e3 | ||
| Moyamoya Disease | 507.e3 | ||
| Sickle Cell Disease | 507.e3 | ||
| Children Aged 1-13 Years: Thrombocytopenia | 507.e3 | ||
| Children Aged 1-13 Years: Vascular Malformations | 507.e3 | ||
| Adolescents | 507.e3 | ||
| Causes of Stroke Unrelated to Age: Pharyngeal Infection | 507.e3 | ||
| Causes of Stroke Unrelated to Age: Head and Neck Trauma | 507.e4 | ||
| Causes of Stroke Unrelated to Age: Migraine Headache | 507.e4 | ||
| Causes of Stroke Unrelated to Age: Conditions Resembling Stroke | 507.e4 | ||
| 30 Paroxysmal Disorders | 508 | ||
| Introduction | 508 | ||
| History | 508 | ||
| Physical Examination | 508 | ||
| Red Flags | 509 | ||
| Increased Intracranial Pressure or Large Intracranial Mass | 509 | ||
| Ongoing Status Epilepticus | 509 | ||
| Stroke or Complicated Migraine | 510 | ||
| Meningitis | 510 | ||
| Paroxysmal Spells of Altered Behavior or Movement | 510 | ||
| Epileptic Seizures | 510 | ||
| Epidemiology and Causes of Seizures and Epilepsy | 510 | ||
| Genetics | 510 | ||
| Seizure Classification and Terminology | 511 | ||
| Focal Seizures | 512 | ||
| Localization-Related Seizures, Partial Seizures | 512 | ||
| Generalized Seizures | 515 | ||
| Diagnostic Evaluation of a Seizure Disorder | 515 | ||
| Electroencephalographic Studies | 515 | ||
| Neuroimaging Studies | 516 | ||
| Evaluation of the First Seizure | 516 | ||
| Status Epilepticus | 518 | ||
| Classification of Epilepsies and Epileptic Syndromes | 518 | ||
| Neonatal Period | 518 | ||
| Paroxysmal Nonepileptic Disorders | 518 | ||
| Jitteriness. | 518 | ||
| Benign neonatal sleep myoclonus. | 520 | ||
| Acute Symptomatic Seizures and Occasional Seizures | 520 | ||
| Diagnostic investigations. | 520 | ||
| Prognosis. | 520 | ||
| Treatment. | 521 | ||
| Epileptic Syndromes | 521 | ||
| Benign idiopathic neonatal convulsions, familial and nonfamilial. | 521 | ||
| Vitamin-dependent seizures. | 521 | ||
| Structural focal epilepsy. | 524 | ||
| Early-onset generalized epileptic syndromes with encephalopathy. | 524 | ||
| Infancy | 524 | ||
| Paroxysmal Nonepileptic Disorders | 524 | ||
| Infantile syncope | 524 | ||
| Cyanotic infant syncope (breath-holding spells). | 524 | ||
| Pallid infant syncope. | 525 | ||
| Hyperekplexia. | 525 | ||
| Sleep disorders. | 525 | ||
| Shivering attacks. | 525 | ||
| Paroxysmal torticollis. | 526 | ||
| Infantile masturbation. | 526 | ||
| Spasmus nutans. | 526 | ||
| Benign paroxysmal vertigo. | 527 | ||
| Benign myoclonus of early infancy. | 527 | ||
| Alternating hemiplegia of childhood. | 527 | ||
| Acute Symptomatic Seizures and Occasional Seizures | 527 | ||
| Febrile convulsions. | 527 | ||
| Epileptic Syndromes | 528 | ||
| West syndrome | 528 | ||
| Evaluation: EEG, MRI. | 529 | ||
| Severe myoclonic epilepsy in infancy (Dravet syndrome) | 529 | ||
| Childhood | 529 | ||
| Paroxysmal Nonepileptic Disorders | 529 | ||
| Migraine and migraine equivalents. | 529 | ||
| Tic disorders | 530 | ||
| Sleep disorders | 531 | ||
| Night terrors and confusional arousals. | 531 | ||
| Somnambulism. | 531 | ||
| Self-stimulatory behavior/stereotypies. | 531 | ||
| Acute Symptomatic Seizures and Occasional Seizures | 531 | ||
| Epileptic Syndromes | 531 | ||
| Benign partial epilepsies of childhood. | 531 | ||
| Acquired epileptic aphasia and continuous spike-and-wave patterns in slow-wave sleep. | 533 | ||
| Symptomatic focal (localization-related) epilepsy. | 534 | ||
| Childhood absence epilepsy. | 534 | ||
| Epilepsia partialis continua and Rasmussen encephalitis. | 534 | ||
| Lennox-Gastaut syndrome. | 535 | ||
| Adolescence | 535 | ||
| Paroxysmal Nonepileptiform Disorders | 535 | ||
| Syncope. | 535 | ||
| Paroxysmal psychiatric events. | 535 | ||
| Acute Symptomatic Seizures and Occasional Seizures | 536 | ||
| Epileptic Syndromes | 537 | ||
| Juvenile myoclonic epilepsy. | 537 | ||
| Juvenile absence epilepsy. | 537 | ||
| Epilepsy with generalized tonic-clonic seizures on awakening. | 537 | ||
| Principles of Antiepileptic Drug Use | 538 | ||
| Choice of Antiepileptic Drugs | 538 | ||
| Focal Epilepsies | 538 | ||
| Focal seizures and secondary generalized tonic-clonic seizures. | 538 | ||
| Idiopathic Generalized Epilepsy | 538 | ||
| Primary generalized tonic-clonic seizures. | 538 | ||
| Absence seizures. | 538 | ||
| Myoclonic seizures. | 538 | ||
| Symptomatic Generalized Epilepsies | 540 | ||
| Tonic, atonic, and atypical absence seizures. | 540 | ||
| Stopping Antiepileptic Drugs | 542 | ||
| Lifestyle | 542 | ||
| References | 542 | ||
| References | 542.e1 | ||
| General | 542.e1 | ||
| Neonatal Period | 542.e1 | ||
| 7 Musculoskeletal Disorders | 594 | ||
| 33 Arthritis | 594 | ||
| Introduction | 594 | ||
| History | 594 | ||
| Pain Location | 594 | ||
| Pain Character | 594 | ||
| Pain Timing | 596 | ||
| Pain Acuity | 596 | ||
| Signs of Inflammation | 596 | ||
| Disability | 596 | ||
| Medical History | 597 | ||
| Medications | 597 | ||
| Family History | 597 | ||
| Social History | 597 | ||
| Review of Systems | 597 | ||
| Constitutional Symptoms | 597 | ||
| Skin Changes | 598 | ||
| Additional Symptoms | 598 | ||
| Physical Examination | 600 | ||
| Laboratory Studies | 602 | ||
| Antinuclear Antibody | 602 | ||
| Rheumatoid Factor | 602 | ||
| Additional Antibody Testing | 602 | ||
| Complement | 603 | ||
| Diagnostic Imaging | 603 | ||
| Radiographs | 603 | ||
| Magnetic Resonance Imaging (MRI) | 603 | ||
| Bone Scan | 604 | ||
| Additional Imaging Studies | 604 | ||
| Joint Fluid Aspiration | 604 | ||
| Invasive Testing | 605 | ||
| Juvenile Idiopathic Arthritis | 606 | ||
| Oligoarticular Juvenile Idiopathic Arthritis | 606 | ||
| Polyarticular Juvenile Idiopathic Arthritis | 606 | ||
| Enthesitis-Related Arthritis | 606 | ||
| Psoriatic Arthritis | 607 | ||
| Systemic Juvenile Idiopathic Arthritis | 607 | ||
| 8 Hematologic Disorders | 647 | ||
| 36 Lymphadenopathy and Neck Masses | 647 | ||
| Mechanism of Lymphadenopathy | 647 | ||
| History | 647 | ||
| Physical Examination | 650 | ||
| Size | 650 | ||
| Quality | 650 | ||
| Distribution | 650 | ||
| Differential Diagnosis | 650 | ||
| Differential Diagnosis of Head and Neck Lymphadenopathy: Head and Neck Masses | 651 | ||
| Evaluation and Management Strategies | 651 | ||
| Regional Lymphadenopathy | 651 | ||
| Generalized Lymphadenopathy | 651 | ||
| Lymphadenopathy Patterns | 653 | ||
| Infections of the oropharynx. | 653 | ||
| Infections of the extremities. | 655 | ||
| Epstein–barr virus infection. | 655 | ||
| Cytomegalovirus infection. | 657 | ||
| Cat-scratch disease. | 657 | ||
| Chronic granulomatous disease. | 657 | ||
| Human immunodeficiency virus. | 657 | ||
| Mycobacterial infections. | 657 | ||
| Toxoplasmosis. | 658 | ||
| Syphilis. | 659 | ||
| Acute leukemia, lymphoma, and other malignancies. | 659 | ||
| Ulceroglandular disorders. | 660 | ||
| Kimura disease. | 660 | ||
| Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis). | 660 | ||
| Sinus histiocytosis with massive lymphadenopathy (Rosai–Dorfman disease). | 660 | ||
| Castleman disease. | 660 | ||
| Summary and Red Flags | 660 | ||
| References | 660 | ||
| References | 660.e1 | ||
| General References | 660.e1 | ||
| Medication-Related Causes of Lymphadenopathy | 660.e1 | ||
| Cervical Adenopathy | 660.e1 | ||
| Epstein–Barr Viral Infections | 660.e1 | ||
| Cat-Scratch Disease | 660.e1 | ||
| Human Immunodeficiency Virus | 660.e1 | ||
| Mycobacterial Infections | 660.e1 | ||
| Toxoplasmosis | 660.e1 | ||
| Sexually Transmitted Diseases | 660.e1 | ||
| Other Disorders | 660.e1 | ||
| 37 Pallor and Anemia | 661 | ||
| Introduction | 661 | ||
| History | 661 | ||
| Physical Examination | 661 | ||
| Laboratory Evaluation | 662 | ||
| Classification of Anemia | 663 | ||
| Reticulocyte Count | 663 | ||
| Red Blood Cell Size | 663 | ||
| Red Blood Cell Morphology | 664 | ||
| Other Laboratory Abnormalities Associated with Anemia | 665 | ||
| Diagnostic Work-up | 665 | ||
| Differential Diagnosis of Anemia | 667 | ||
| Anemia Secondary to Acute Blood Loss | 667 | ||
| Anemia Secondary to Underproduction | 668 | ||
| Microcytic Anemias | 669 | ||
| Iron deficiency anemia. | 669 | ||
| Thalassemia syndromes. | 670 | ||
| Lead poisoning. | 671 | ||
| Anemia of inflammation. | 671 | ||
| Rare causes of microcytic anemia. | 671 | ||
| Normocytic Anemia Secondary to Underproduction | 671 | ||
| Macrocytic Anemia (Figs. 37.1 and 37.4) | 673 | ||
| Megaloblastic anemia (vitamin B12 deficiency or folate deficiency). | 673 | ||
| Anemia caused by increased red blood cell destruction. | 674 | ||
| Membrane defects. | 674 | ||
| Enzyme defects. | 675 | ||
| Hemoglobinopathies. | 675 | ||
| Acquired autoimmune hemolytic anemia. | 676 | ||
| Anemia in the Neonate | 677 | ||
| Neonatal Anemia Caused by Blood Loss | 677 | ||
| Neonatal Anemia Caused by Decreased Red Blood Cell Production | 678 | ||
| Neonatal Anemia Caused by Increased Red Blood Cell Destruction | 678 | ||
| Summary and Red Flags | 681 | ||
| References | 681 | ||
| References | 681.e1 | ||
| Work-up of Anemia | 681.e1 | ||
| Anemia with Acute and Chronic Disease | 681.e1 | ||
| Hemolytic Anemia | 681.e1 | ||
| Hypoplastic Anemia | 681.e1 | ||
| Iron Deficiency | 681.e1 | ||
| Macrocytic Anemia | 681.e1 | ||
| 38 Bleeding and Thrombosis | 682 | ||
| Coagulation Cascade | 682 | ||
| Coagulation Inhibitors | 682 | ||
| Antithrombin | 682 | ||
| Protein C/Protein S System | 682 | ||
| Fibrinolytic System | 682 | ||
| Platelet-Endothelial Cells Axis | 683 | ||
| Developmental Hemostasis | 685 | ||
| Clues From History and Physical Examination | 685 | ||
| History | 685 | ||
| Physical Examination | 685 | ||
| Coagulation Screening Tests | 687 | ||
| Prothrombin Time and Partial Thromboplastin Time | 687 | ||
| Bleeding Time | 688 | ||
| Platelet Function Analysis | 688 | ||
| Thrombin Time and Reptilase Time | 688 | ||
| Mucocutaneous Bleeding | 688 | ||
| Neonatal Thrombocytopenia | 691 | ||
| Child Abuse | 692 | ||
| Chronic/Insidious Onset of Mucocutaneous Bleeding | 692 | ||
| Platelet Function Defects | 693 | ||
| Chronic Thrombocytopenic Syndromes | 693 | ||
| Deep Bleeding | 694 | ||
| Surgical Bleeding | 695 | ||
| Generalized Bleeding | 695 | ||
| Disseminated Intravascular Coagulation | 695 | ||
| Neonatal Purpura Fulminans | 697 | ||
| Other Causes of Generalized Bleeding | 697 | ||
| Thrombosis | 698 | ||
| Venous Thromboembolic Disease | 698 | ||
| Diagnostic Approach | 698 | ||
| Specific Diagnostic Studies | 698 | ||
| Thrombophilia Testing | 698 | ||
| Arterial Thrombosis | 699 | ||
| Anticoagulant Therapy | 699 | ||
| Heparin | 699 | ||
| Fibrinolytic Therapy | 699 | ||
| Warfarin | 700 | ||
| Summary and Red Flags | 700 | ||
| References | 700 | ||
| References | 700.e1 | ||
| General | 700.e1 | ||
| Coagulopathy | 700.e1 | ||
| Platelets | 700.e1 | ||
| Thrombosis | 700.e1 | ||
| Therapy | 700.e1 | ||
| 9 Infectious Diseases | 701 | ||
| 39 Fever | 701 | ||
| Pathophysiology of Fever | 701 | ||
| Fever Without Source | 701 | ||
| History | 702 | ||
| Fever: Temperature Measurement | 702 | ||
| Physical Examination | 702 | ||
| Observational Scales | 702 | ||
| Differential Diagnosis | 702 | ||
| Urinary Tract Infections (UTIs) | 703 | ||
| Bacteremia | 703 | ||
| Role of Diagnostic Testing in Patients with Fever Without Source | 704 | ||
| Complete Blood Count and Other Markers of Inflammation | 704 | ||
| Polymerase Chain Reaction (PCR) | 704 | ||
| Blood Cultures | 705 | ||
| Urinalysis and Urine Culture | 705 | ||
| Lumbar Puncture | 705 | ||
| Chest Radiographs | 705 | ||
| Stool Cultures | 705 | ||
| Evaluation and Management | 705 | ||
| Children Younger Than 3 Months | 705 | ||
| Children Aged 3 to 36 Months | 706 | ||
| Children Older Than 36 Months | 707 | ||
| Central Nervous System Infections | 707 | ||
| Bacterial Meningitis | 707 | ||
| Diagnostic Studies | 708 | ||
| Lumbar Puncture and Cerebrospinal Fluid Analysis | 708 | ||
| Computed Tomography | 712 | ||
| Other Laboratory Tests | 712 | ||
| Aseptic Meningitis | 712 | ||
| Viral Meningitis | 712 | ||
| Tuberculous Meningitis | 712 | ||
| Encephalitis | 714 | ||
| Fever of Unknown Origin | 714 | ||
| Evaluation | 716 | ||
| History | 716 | ||
| Physical Examination | 719 | ||
| Eyes | 719 | ||
| Ears, Nose, and Throat | 719 | ||
| Neck | 719 | ||
| Heart, Lungs, and Abdomen | 720 | ||
| Musculoskeletal Evaluation | 720 | ||
| Skin | 721 | ||
| Diagnostic Studies | 721 | ||
| Cause | 721 | ||
| Infections | 721 | ||
| Bacterial endocarditis. | 721 | ||
| Urinary tract infection. | 721 | ||
| Sinusitis. | 721 | ||
| Abscesses. | 722 | ||
| Osteomyelitis. | 722 | ||
| Rheumatic fever. | 722 | ||
| Bacterial Syndromes | 722 | ||
| Lyme disease. | 722 | ||
| Cat-scratch disease. | 722 | ||
| Q fever. | 722 | ||
| Rat bite fever. | 722 | ||
| Tularemia. | 722 | ||
| Brucellosis. | 722 | ||
| Leptospirosis. | 722 | ||
| Fungal Infections | 722 | ||
| Chlamydial Infection | 723 | ||
| Rickettsial Infections | 723 | ||
| Rocky mountain spotted fever. | 723 | ||
| Ehrlichiosis and Anaplasmosis. | 723 | ||
| Viral Infections | 723 | ||
| Cytomegalovirus infection. | 723 | ||
| Infectious mononucleosis. | 723 | ||
| Human immunodeficiency virus infection. | 723 | ||
| Parasites | 723 | ||
| Infections in Children Who Live in or Have Traveled to Developing Countries | 723 | ||
| Malaria | 723 | ||
| Hepatitis | 723 | ||
| Typhoid Fever (Enteric Fever) | 723 | ||
| Tuberculosis | 723 | ||
| Amebiasis | 724 | ||
| Rheumatic Causes of Fever of Unknown Origin | 724 | ||
| Juvenile Idiopathic Arthritis | 724 | ||
| Polyarteritis | 724 | ||
| Systemic Lupus Erythematosus | 724 | ||
| Behçet Syndrome | 724 | ||
| Neoplasms | 724 | ||
| Hodgkin Disease | 724 | ||
| Lymphoma | 724 | ||
| Neuroblastoma | 724 | ||
| Leukemia | 724 | ||
| Pheochromocytoma | 724 | ||
| Miscellaneous Causes of Fever of Unknown Origin | 724 | ||
| Genetic Diseases (See Chapter 41) | 724 | ||
| Drug Fever | 724 | ||
| Kawasaki Disease | 724 | ||
| Inflammatory Bowel Disease | 724 | ||
| Thyrotoxicosis | 725 | ||
| Factitious Disorders | 725 | ||
| Patients in Whom No Diagnosis Is Made | 725 | ||
| Summary and Red Flags | 725 | ||
| References | 725 | ||
| References | 725.e1 | ||
| General | 725.e1 | ||
| Fever Without Source | 725.e1 | ||
| Central Nervous System Infection | 725.e1 | ||
| Fever of Unknown Origin | 725.e2 | ||
| 40 Fever and Rash | 726 | ||
| Fever and Rash | 726 | ||
| History | 726 | ||
| Examination | 726 | ||
| Specific Skin Lesions | 727 | ||
| Maculopapular Eruptions | 727 | ||
| Petechiae and Purpura | 735 | ||
| Vesiculobullous Eruptions | 735 | ||
| Nodules | 736 | ||
| Ulcers | 736 | ||
| Erythema | 736 | ||
| Other Physical Examination Findings | 736 | ||
| Joint Manifestations | 736 | ||
| Cardiac Manifestations | 737 | ||
| Ocular Manifestations | 737 | ||
| Neurologic Manifestations | 737 | ||
| Pulmonary Manifestations | 737 | ||
| Clusters of Findings | 737 | ||
| Diagnostic Studies | 737 | ||
| Laboratory Tests | 738 | ||
| Histopathology | 738 | ||
| Other Diagnostic Studies | 738 | ||
| Diagnosis and Decision Making | 738 | ||
| Clinical Syndromes | 739 | ||
| Kawasaki Disease | 739 | ||
| Toxic Shock Syndrome | 739 | ||
| Staphylococcal Toxic Shock Syndrome | 739 | ||
| Streptococcal Toxic Shock Syndrome | 740 | ||
| Erythema Multiforme | 742 | ||
| Stevens–Johnson Syndrome, Toxic Epidermal Necrolysis, and Staphylococcal Scalded Skin Syndrome | 742 | ||
| Serum Sickness and Serum Sickness-Like Reaction | 743 | ||
| Henoch-Schonlein Purpura | 744 | ||
| Other Disorders | 744 | ||
| Management | 744 | ||
| Summary and Red Flags | 745 | ||
| References | 745 | ||
| References | 745.e1 | ||
| 41 Recurrent Fever, Infections, Immune Disorders, and Autoinflammatory Diseases | 746 | ||
| History and Physical Examination | 746 | ||
| History | 746 | ||
| Perinatal History | 746 | ||
| Medical History | 746 | ||
| Anatomic Abnormalities | 747 | ||
| Family History | 750 | ||
| Environmental History | 750 | ||
| Physical Examination | 750 | ||
| Diagnostic Categories | 751 | ||
| Patient Who Is Probably Healthy | 751 | ||
| Patient with Hereditary Inflammatory Disorders | 751 | ||
| Immunodeficient Patient | 751 | ||
| Diagnostic Approach to the Patient with Recurrent Infections | 751 | ||
| Humoral Immune Disorders | 756 | ||
| X-Linked Agammaglobulinemia (XLA) | 756 | ||
| Common Variable Immunodeficiency | 756 | ||
| Transient Hypogammaglobulinemia of Infancy | 758 | ||
| Immunoglobulin A Deficiency | 758 | ||
| Specific Antibody Deficiency | 758 | ||
| Hyperimmunoglobulin M Syndrome | 758 | ||
| Combined Immunodeficiency Disorders | 759 | ||
| Severe Combined Immunodeficiency | 759 | ||
| Combined Immune Deficiencies | 759 | ||
| Purine Nucleoside Phosphorylase Deficiency | 762 | ||
| Hyperimmunoglobulin E Syndrome | 762 | ||
| Immunodeficiencies With Syndromic Features | 762 | ||
| Wiskott-Aldrich Syndrome | 762 | ||
| Ataxia-Telangiectasia | 762 | ||
| DiGeorge Syndrome (22q Deletion Syndrome) and Other Thymic Defects | 764 | ||
| Cartilage-Hair Hypoplasia | 764 | ||
| Complement System Deficiencies | 764 | ||
| Diagnosis of Complement Deficiencies | 766 | ||
| Phagocyte Disorders | 766 | ||
| Disorders of Neutrophil Numbers | 766 | ||
| Inherited Forms of Neutropenia | 766 | ||
| Acquired Neutropenia | 767 | ||
| Disorders of Neutrophil Adhesion and Chemotaxis | 767 | ||
| Disorders of Neutrophil Function | 767 | ||
| Disorders of Macrophage Function | 769 | ||
| Asplenia | 769 | ||
| Autoinflammatory Disorders | 770 | ||
| Familial Mediterranean Fever | 770 | ||
| Pyogenic Arthritis, Pyoderma Gangrenosum, and Acne Syndrome | 770 | ||
| Cryopyrin-Associated Periodic Syndromes | 770 | ||
| Hyperimmunoglobulin D Syndrome | 771 | ||
| Deficiency of the Interleukin-1 Receptor Antagonist | 771 | ||
| TNF Receptor–Associated Periodic Syndrome (TRAPS) | 771 | ||
| Deficiency of Adenosine Deaminase 2 | 771 | ||
| Blau Syndrome | 771 | ||
| Majeed Syndrome | 771 | ||
| Immune Dysregulation Syndromes | 771 | ||
| Hemophagocytic Lymphohistiocytosis | 772 | ||
| X-Linked Lymphoproliferative Disease Type 1 and Type 2 | 772 | ||
| Immune Dysregulation, Polyendocrinopathy, Enteropathy, X-Linked and Related Disorders | 772 | ||
| CD25 Deficiency | 772 | ||
| Signal Transducer and Activator of Transcription Protein 5B Deficiency | 772 | ||
| Cytotoxic T Lymphocyte Antigen 4 Deficiency | 772 | ||
| Autoimmune Polyendocrinopathy-Candidiasis–Ectodermal Dystrophy | 772 | ||
| Autoimmune Lymphoproliferation Syndrome | 773 | ||
| Summary and Red Flags | 773 | ||
| References | 773 | ||
| References | 773.e1 | ||
| Overview, History, Exam, and Diagnostic Approach | 773.e1 | ||
| Complement System Deficiency | 773.e1 | ||
| Phagocyte Disorders | 773.e1 | ||
| Asplenia | 773.e1 | ||
| Humoral Immune Defects | 773.e1 | ||
| Combined Immune Deficiencies | 773.e1 | ||
| Autoinflammatory and Immune Dysregulation Disorders | 773.e1 | ||
| 10 Endocrine and Metabolic Disorders | 774 | ||
| 42 Disorders of Puberty | 774 | ||
| Normal Pubertal Development | 774 | ||
| Terminology | 774 | ||
| Anatomy | 774 | ||
| Physiology | 774 | ||
| Perinatal Period and Infancy | 774 | ||
| Childhood | 774 | ||
| Adolescence | 774 | ||
| Sex Steroid Effects | 775 | ||
| Chronology of Puberty | 775 | ||
| Females | 775 | ||
| Males | 775 | ||
| Clinical Staging of Puberty | 776 | ||
| Females | 776 | ||
| Males | 776 | ||
| Females and Males | 776 | ||
| Family Patterns | 776 | ||
| Precocious Puberty | 776 | ||
| Definition | 776 | ||
| Normal Variants | 776 | ||
| Idiopathic Isolated Premature Thelarche | 776 | ||
| Idiopathic Isolated Precocious Adrenarche | 777 | ||
| Isosexual Central Precocious Puberty | 777 | ||
| Incomplete Isosexual Precocity (Precocious Pseudopuberty) | 778 | ||
| Androgen Exposure or Overproduction | 780 | ||
| Females. | 780 | ||
| Males. | 780 | ||
| Estrogen Overproduction | 780 | ||
| McCune–Albright syndrome. | 781 | ||
| Vaginal Bleeding | 781 | ||
| Gynecomastia | 781 | ||
| Diagnostic Approach to Precocious Puberty | 781 | ||
| Treatment of Precocious Puberty | 783 | ||
| General Issues | 783 | ||
| Central Precocious Puberty | 784 | ||
| Precocious Pseudopuberty (Incomplete Isosexual Precocity) | 784 | ||
| Delayed or Absent Puberty | 784 | ||
| Differential Diagnosis | 784 | ||
| Constitutional Delay of Growth and Puberty | 785 | ||
| Hypogonadotropic Hypogonadism | 786 | ||
| Kallmann syndrome. | 786 | ||
| Hypergonadotropic Hypogonadism: Males | 787 | ||
| Klinefelter syndrome. | 787 | ||
| Hypergonadotropic Hypogonadism: Females | 787 | ||
| Turner syndrome. | 787 | ||
| Females with Delayed or Absent Adrenarche | 787 | ||
| Diagnostic Approach to Delayed Puberty | 787 | ||
| Treatment of Delayed Puberty | 788 | ||
| Summary and Red Flags | 790 | ||
| References | 790 | ||
| References | 790.e1 | ||
| Normal Pubertal Development | 790.e1 | ||
| Precocious Puberty | 790.e1 | ||
| Delayed or Absent Pubertal Development | 790.e1 | ||
| 43 Short Stature | 791 | ||
| Definition | 791 | ||
| Normal Growth | 791 | ||
| Fetal Growth and Birth Size | 791 | ||
| Postnatal Growth Patterns | 791 | ||
| Measuring a Child | 793 | ||
| Body Proportions | 793 | ||
| Familial and Genetic Factors | 795 | ||
| Ethnic Factors and Secular Trend | 795 | ||
| General Well-Being | 795 | ||
| Psychologic Factors | 795 | ||
| Endocrine Regulation of Growth | 795 | ||
| Bone Age | 796 | ||
| Causes of Short Stature | 796 | ||
| Normal Variants | 796 | ||
| Familial Short Stature | 796 | ||
| Constitutional Delay of Growth and Puberty | 798 | ||
| Idiopathic Short Stature | 799 | ||
| Small for Gestational Age | 799 | ||
| Endocrine Disorders | 799 | ||
| Growth Hormone Deficiency | 799 | ||
| Growth Hormone Deficiency Presenting in the Neonatal Period | 799 | ||
| Growth Hormone Deficiency in Childhood | 800 | ||
| Acquired Growth Hormone Deficiency | 800 | ||
| Growth Hormone Insensitivity | 801 | ||
| Hypothyroidism | 801 | ||
| Glucocorticoid Excess (Cushing Syndrome) | 803 | ||
| Other Endocrine Disorders | 803 | ||
| Genetic Causes of Short Stature | 803 | ||
| Turner syndrome. | 803 | ||
| Down syndrome. | 804 | ||
| Prader–Willi syndrome (PWS). | 804 | ||
| Russell–Silver syndrome. | 804 | ||
| Short stature HomeoboX gene mutations. | 804 | ||
| Noonan syndrome. | 805 | ||
| Malnutrition | 805 | ||
| Chronic Illness | 805 | ||
| Emotional Deprivation | 806 | ||
| Iatrogenic Causes | 806 | ||
| Bone Dysplasias | 806 | ||
| Achondroplasia | 806 | ||
| Hypochondroplasia | 807 | ||
| Osteogenesis Imperfecta | 807 | ||
| Evaluating the Child With Short Stature | 807 | ||
| Important Considerations in the History | 808 | ||
| Pregnancy and Birth History | 808 | ||
| Infancy and Childhood | 808 | ||
| Review of Systems | 808 | ||
| Family History | 808 | ||
| Physical Examination | 808 | ||
| Therapeutic Options | 808 | ||
| Specific Treatment of the Primary Disorder | 808 | ||
| Sex Steroids | 809 | ||
| Counseling | 809 | ||
| Growth Hormone Therapy | 809 | ||
| Other Treatments | 809 | ||
| Summary and Red Flags | 809 | ||
| References | 810 | ||
| References | 810.e1 | ||
| 44 Hypoglycemia | 811 | ||
| Definition of Hypoglycemia | 811 | ||
| Regulation of Blood Glucose Concentration | 811 | ||
| Clinical Manifestations | 813 | ||
| Causes of Transient Neonatal Hypoglycemia | 813 | ||
| Normal Newborns | 813 | ||
| Newborns Small for Gestational Age and Premature Infants | 814 | ||
| Infants of Diabetic Mothers | 814 | ||
| Perinatal Stress-Induced Hyperinsulinism | 814 | ||
| Erythroblastosis Fetalis | 814 | ||
| Intrapartum Maternal Glucose Administration | 814 | ||
| Maternal Drug Therapy | 816 | ||
| Beckwith-Wiedemann Syndrome | 816 | ||
| Causes of Persistent Hypoglycemia in Infants and Children | 816 | ||
| Hyperinsulinism | 816 | ||
| Recessive KATP Channel Hyperinsulinism | 816 | ||
| Focal KATP Channel Hyperinsulinism | 816 | ||
| Dominant KATP Channel Hyperinsulinism | 816 | ||
| Dominant Glutamate Dehydrogenase Hyperinsulinism | 816 | ||
| Dominant Glucokinase Hyperinsulinism | 817 | ||
| Insulinoma | 817 | ||
| Insulin Reaction, Oral Hypoglycemic Agents, and Surreptitious Insulin Administration | 817 | ||
| Counter-Regulatory Hormone Deficiencies | 817 | ||
| Hypopituitarism | 817 | ||
| Isolated Cortisol Deficiency | 819 | ||
| Epinephrine Deficiency | 819 | ||
| Metabolic Enzyme Defects | 819 | ||
| Hepatic Gluconeogenesis | 819 | ||
| Glucose-6-phosphatase deficiency (Glycogen storage disease type 1a and type 1b). | 819 | ||
| Glucose transporter 2 deficiency (Fanconi-Bickel syndrome). | 820 | ||
| Fructose-1,6-diphosphatase deficiency. | 820 | ||
| Pyruvate carboxylase deficiency. | 820 | ||
| Hepatic Glycogenolysis | 820 | ||
| Debrancher enzyme deficiency (type 3 glycogen storage disease). | 820 | ||
| Phosphorylase/phosphorylase kinase deficiency. | 820 | ||
| Glycogen synthase deficiency. | 820 | ||
| Fatty Acid Oxidation Disorders | 820 | ||
| Other Metabolic Causes of Hypoglycemia | 820 | ||
| Glucose transporter 1 deficiency. | 820 | ||
| Hereditary fructose intolerance. | 820 | ||
| Galactosemia (galactose-1-phosphate uridyl transferase deficiency). | 821 | ||
| Reactive Hypoglycemia | 821 | ||
| Glutamate dehydrogenase-hyperinsulinism, hyperinsulinism/hyperammonemia syndrome. | 821 | ||
| Post–Nissen fundoplication hypoglycemia (late dumping syndrome). | 821 | ||
| Hereditary fructose intolerance. | 821 | ||
| Diagnosis of Hypoglycemia | 821 | ||
| Critical Samples | 821 | ||
| Fasting Study | 821 | ||
| Useful “Casual Specimen” Tests | 823 | ||
| Glucagon Stimulation | 823 | ||
| Acute Insulin Response Tests for Hyperinsulinism | 823 | ||
| Plasma Acyl-Carnitine Profile | 823 | ||
| Urinary Organic Acid Quantitation | 823 | ||
| Cultured Cells | 823 | ||
| Mutation Analysis | 823 | ||
| Treatment of Hypoglycemia | 823 | ||
| Summary and Red Flags | 823 | ||
| References | 823 | ||
| References | 823.e1 | ||
| General | 823.e1 | ||
| Hyperinsulinism | 823.e1 | ||
| Fatty Acid Oxidation Disorders | 823.e1 | ||
| 45 Urinary Incontinence and Polyuria | 824 | ||
| Voiding Physiology | 824 | ||
| Toilet Training | 824 | ||
| Urine Volume and Solute Diuresis | 824 | ||
| History | 825 | ||
| Polyuria | 825 | ||
| Voiding History | 825 | ||
| Primary Nocturnal Enuresis | 826 | ||
| Behavioral Issues | 826 | ||
| Physical Examination | 826 | ||
| Diagnosis | 826 | ||
| Laboratory Assessment | 827 | ||
| Imaging and Cystometry | 827 | ||
| Differential Diagnosis | 827 | ||
| Primary Nocturnal Enuresis | 827 | ||
| Dysfunctional Voiding | 827 | ||
| Mild voiding dysfunction. | 828 | ||
| Moderate voiding dysfunction. | 828 | ||
| Severe dysfunctional voiding. | 828 | ||
| Neuropathic Bladder | 828 | ||
| Anatomic Defects | 828 | ||
| Posterior urethral valves and urethral obstruction. | 828 | ||
| Renal duplication. | 828 | ||
| Vesicoureteral reflux. | 828 | ||
| Metabolic Disorders | 828 | ||
| Hypercalcemia. | 828 | ||
| Hypokalemia. | 828 | ||
| Diabetes mellitus. | 829 | ||
| Central Diabetes Insipidus | 829 | ||
| Renal Concentrating Defects | 829 | ||
| Renal tubular acidosis. | 829 | ||
| Sickle cell disease. | 829 | ||
| Nephronophthisis. | 829 | ||
| Nephrogenic diabetes insipidus. | 829 | ||
| Treatment | 829 | ||
| Primary Nocturnal Enuresis | 829 | ||
| Dysfunctional Voiding | 830 | ||
| Polyuria | 830 | ||
| Neuropathic Bladder and Anatomic Disorders | 830 | ||
| Summary and Red Flags | 830 | ||
| References | 830 | ||
| References | 830.e1 | ||
| Voiding Physiology | 830.e1 | ||
| Signs and Symptoms | 830.e1 | ||
| Diagnostics | 830.e1 | ||
| Specific Disorders | 830.e1 | ||
| Treatment | 830.e1 | ||
| 46 Acid–Base and Electrolyte Disturbances | 831 | ||
| Acid–Base Balance | 831 | ||
| Acid–Base Disorders | 831 | ||
| Symptoms of Acid–Base Disorders | 831 | ||
| Renal Regulation of Acid–Base Balance | 831 | ||
| Metabolic Acidosis | 833 | ||
| Normal Anion Gap (Hyperchloremic) Metabolic Acidosis | 833 | ||
| Renal Tubular Acidosis | 833 | ||
| Additional Causes of Renal Loss of Bicarbonate | 834 | ||
| Gastrointestinal Loss of Bicarbonate | 834 | ||
| Miscellaneous Causes of Hyperchloremic Acidosis | 834 | ||
| Recovery from ketoacidosis. | 834 | ||
| Dilutional acidosis. | 834 | ||
| Parenteral alimentation. | 834 | ||
| Increased Anion Gap Acidosis | 834 | ||
| Increased Acid Production | 834 | ||
| Diabetic ketoacidosis. | 834 | ||
| Lactic acidosis. | 836 | ||
| Inborn errors of metabolism. | 836 | ||
| Poisonings. | 836 | ||
| Failure of Acid Excretion | 836 | ||
| Treatment of Metabolic Acidosis | 836 | ||
| Metabolic Alkalosis | 836 | ||
| Factors Initiating Metabolic Alkalosis | 836 | ||
| Factors Responsible for Sustaining Alkalosis | 836 | ||
| Differential Diagnosis of Metabolic Alkalosis | 837 | ||
| Urinary Chloride Level Lower Than 15 mEq/L | 837 | ||
| Chloride-deficient diet. | 837 | ||
| Upper gastrointestinal losses. | 837 | ||
| Chloride secreting diarrhea. | 837 | ||
| Diuretic therapy. | 837 | ||
| Hypercapnia. | 837 | ||
| Urinary Chloride Level Higher Than 20 mEq/L with Hypertension | 837 | ||
| Urinary Chloride Level Higher Than 20 mEq/L with Normal Blood Pressure | 837 | ||
| Bartter syndrome and Gitelman syndrome. | 837 | ||
| Treatment of Metabolic Alkalosis | 838 | ||
| Respiratory Acidosis | 838 | ||
| Respiratory Alkalosis | 838 | ||
| Mixed Acid–Base Disorders | 839 | ||
| Potassium Disorders | 839 | ||
| Hypokalemia | 839 | ||
| Increased Renal Losses with Hypertension | 839 | ||
| Mineralocorticoid Excess | 839 | ||
| Liddle Syndrome | 839 | ||
| Increased Renal Losses with Normal Blood Pressure | 839 | ||
| Increased Extrarenal Losses | 840 | ||
| Redistribution | 840 | ||
| Consequences of Hypokalemia | 840 | ||
| Treatment of Hypokalemia | 840 | ||
| Hyperkalemia | 841 | ||
| Reduced Urinary Potassium Excretion | 841 | ||
| Renal Failure | 841 | ||
| Hypoaldosteronism | 841 | ||
| Drugs | 841 | ||
| Primary Tubular Defects | 841 | ||
| Increased Potassium Intake/Tissue Release | 841 | ||
| Redistribution | 842 | ||
| Consequences of Hyperkalemia | 842 | ||
| Treatment of Hyperkalemia | 842 | ||
| Sodium Disorders | 842 | ||
| Hyponatremia | 843 | ||
| Hypovolemic Hyponatremia | 843 | ||
| Euvolemic Hyponatremia | 843 | ||
| Hypervolemic Hyponatremia | 843 | ||
| Clinical Signs and Symptoms of Hyponatremia | 844 | ||
| Treatment of Hyponatremia | 844 | ||
| Hypernatremia | 844 | ||
| Hypovolemic Hypernatremia | 844 | ||
| Euvolemic Hypernatremia | 844 | ||
| Hypervolemic Hypernatremia | 846 | ||
| Clinical Signs and Symptoms of Hypernatremia | 846 | ||
| Treatment of Hypernatremia | 846 | ||
| Calcium Disorders | 846 | ||
| Hypocalcemia | 846 | ||
| Hypercalcemia | 846 | ||
| Rickets | 846 | ||
| Clinical Manifestations | 846 | ||
| Summary and Red Flags | 848 | ||
| References | 850 | ||
| References | 850.e1 | ||
| Acid–Base Disorders | 850.e1 | ||
| Potassium Disorders | 850.e1 | ||
| Sodium Disorders | 850.e1 | ||
| Calcium Disorders | 850.e1 | ||
| Rickets | 850.e1 | ||
| 11 Dermatology | 851 | ||
| 47 Congenital Cutaneous Lesions and Infantile Rashes | 851 | ||
| Rashes | 851 | ||
| Papules and Pustules—Diffuse or Scattered | 851 | ||
| Patches and Plaques | 854 | ||
| Fixed Lesions | 855 | ||
| Macules, Papules, and Pustules | 855 | ||
| Plaques and Patches | 857 | ||
| Pink (Vascular or Other) | 857 | ||
| Hyperpigmented or Darker Pigmented Lesions | 861 | ||
| Hypopigmented and Depigmented Lesions | 862 | ||
| Other | 863 | ||
| Transient and Physiologic Changes to the Skin | 865 | ||
| Cutis Marmorata | 865 | ||
| Harlequin Color Change | 865 | ||
| Acrocyanosis | 865 | ||
| Summary and Red Flags | 865 | ||
| References | 865 | ||
| References | 865.e1 | ||
| Rashes: Papules and Pustules | 865.e1 | ||
| Rashes: Patches and Plaques | 865.e1 | ||
| Fixed Lesions: Macules, Papules, and Pustules | 865.e1 | ||
| Fixed Lesions: Plaques and Patches | 865.e1 | ||
| Fixed Lesions: Hyperpigmented or Darker Pigment | 865.e1 | ||
| Fixed Lesions: Other | 865.e2 | ||
| Transient and Physiologic Changes of the Skin | 865.e2 | ||
| 48 Acquired Rashes in the Older Child | 866 | ||
| History, Physical Examination, and Diagnostic Procedures | 866 | ||
| History | 866 | ||
| Physical Examination | 866 | ||
| Primary Lesions | 866 | ||
| Secondary Lesions | 866 | ||
| Diagnostic Techniques | 866 | ||
| Potassium Hydroxide Test | 866 | ||
| Tzanck Smear | 867 | ||
| Scabies Test | 868 | ||
| Gram Stain | 868 | ||
| Wood Lamp Examination | 868 | ||
| Skin Biopsy | 868 | ||
| Dermatologic Disorders in Older Infants and Children | 868 | ||
| Scaling Disorders | 868 | ||
| Pityriasis Rosea | 868 | ||
| Psoriasis | 870 | ||
| Pityriasis Lichenoides | 871 | ||
| Lichen Planus | 871 | ||
| Seborrheic Dermatitis | 872 | ||
| Atopic Dermatitis | 872 | ||
| Lumps and Bumps | 873 | ||
| Granuloma Annulare | 874 | ||
| Juvenile Xanthogranuloma | 875 | ||
| Vascular Lesions | 876 | ||
| Spider Angioma (Nevus Araneus) | 876 | ||
| Pyogenic Granuloma | 878 | ||
| Disorders of Pigmentation | 878 | ||
| Acquired Disorders of Hypopigmentation or Depigmentation | 878 | ||
| Postinflammatory Hypopigmentation | 878 | ||
| Pityriasis Alba | 878 | ||
| Vitiligo | 878 | ||
| Disorders of Hyperpigmentation | 879 | ||
| Lentigines | 879 | ||
| Café-Au-Lait Macules | 879 | ||
| Postinflammatory Hyperpigmentation | 880 | ||
| Acquired Melanocytic Nevi | 880 | ||
| Melanoma | 880 | ||
| Reactive Erythemas | 880 | ||
| Morbilliform Drug Eruption | 880 | ||
| Fixed Drug Eruption | 880 | ||
| Hypersensitivity Reactions | 881 | ||
| Urticaria | 881 | ||
| Erythema Multiforme | 881 | ||
| Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis Complex | 882 | ||
| Allergic Contact Dermatitis | 884 | ||
| Bullous Lesions | 884 | ||
| Staphylococcal Scalded Skin Syndrome | 884 | ||
| Epidermolysis Bullosa | 886 | ||
| Purpura and Petechiae | 887 | ||
| Henoch–Schönlein Purpura | 887 | ||
| Hair Loss | 888 | ||
| Alopecia Areata | 888 | ||
| Tinea Capitis | 889 | ||
| Traction Alopecia | 890 | ||
| Trichotillomania | 890 | ||
| Telogen Effluvium | 890 | ||
| Infections and Infestations | 890 | ||
| Impetigo | 890 | ||
| Nonbullous Impetigo | 890 | ||
| Bullous Impetigo | 890 | ||
| Molluscum Contagiosum | 891 | ||
| Warts | 891 | ||
| Common Warts | 891 | ||
| Flat Warts | 892 | ||
| Plantar Warts | 892 | ||
| Genital Warts | 892 | ||
| Treatment of Warts | 892 | ||
| Herpes Simplex Virus | 892 | ||
| Varicella | 892 | ||
| Herpes Zoster | 893 | ||
| Scabies | 893 | ||
| Pediculosis | 894 | ||
| Candidiasis | 894 | ||
| Dermatophytoses | 895 | ||
| Tinea Capitis | 895 | ||
| Tinea Corporis | 895 | ||
| Tinea Pedis | 895 | ||
| Tinea Faciei | 895 | ||
| Tinea Cruris | 895 | ||
| Tinea Versicolor | 895 | ||
| Acne Vulgaris | 896 | ||
| Summary and Red Flags | 896 | ||
| References | 896 | ||
| References | 896.e1 | ||
| General Overview | 896.e1 | ||
| Scaling Disorders | 896.e1 | ||
| Lumps and Bumps | 896.e1 | ||
| Disorders of Pigmentation | 896.e1 | ||
| Reactive Erythemas and Hypersensitivity Reactions | 896.e1 | ||
| Bullous Lesions | 896.e1 | ||
| Purpura | 896.e1 | ||
| Hair Loss | 896.e1 | ||
| Infections and Infestations | 896.e1 | ||
| Index | 897 | ||
| A | 897 | ||
| B | 900 | ||
| C | 901 | ||
| D | 904 | ||
| E | 906 | ||
| F | 907 | ||
| G | 909 | ||
| H | 910 | ||
| I | 912 | ||
| J | 914 | ||
| K | 914 | ||
| L | 914 | ||
| M | 915 | ||
| N | 917 | ||
| O | 918 | ||
| P | 919 | ||
| Q | 921 | ||
| R | 921 | ||
| S | 923 | ||
| T | 925 | ||
| U | 927 | ||
| V | 927 | ||
| W | 928 | ||
| X | 929 | ||
| Y | 929 | ||
| Z | 929 | ||
| Inside Back Cover | ibc1 |