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Supracondylar ProcessA 10-year-old boy injured his left elbow during football practice. He subsequently had pain with normal range of motion of the elbow.
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Flat Warts and SyringomasThis girl was brought for evaluation of these "bumps" around her eyes. Her parents are concerned that the lesions will interfere with her vision.
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Update on Pediatric RheumatologyABSTRACT: Dramatic progress has been made in our understanding of pediatric rheumatic disease. Various classification systems help identify juvenile idiopathic arthritis (JIA), which involves unique considerations that distinguish it from rheumatoid arthritis in adults. Vaccination issues are important for children with JIA. Renal involvement with systemic lupus erythematosus (SLE) is more common and more severe in children than in adults, but treatment of children who have SLE is similar to that of adults. Neonatal lupus erythematosus may occur in infants whose mothers have SLE. Juvenile dermatomyositis is associated with significant morbidity and mortality. Kawasaki disease is a common vasculitis of childhood, especially in infants and toddlers. Each of at least 8 major familial periodic fever clinical syndromes has specific distinguishing characteristics.
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Child With Unusual Appearance, Inguinal Hernia, Accelerated Growth, and Developmental DelayA 10-month old white child was admitted for evaluation of an enlarged abdomen, splenomegaly, and developmental delay. The child had a normal gestation and birth weight. He had a right hydrocele at birth and rapid scrotal enlargement at age 3 months that led to repair of a right inguinal hernia.
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Cystic Hygroma in an 11-Year-Old GirlAn 11-year-old girl presented with a swelling on the left side of the chin of 1 month's duration; in the past 24 hours, following a bite by an unidentified insect, the swelling had rapidly enlarged and become painful (A). She was otherwise healthy and had no significant medical or family history.
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Eczema Herpeticum With MRSA SuperinfectionA 7-month-old boy with a history of severe atopic dermatitis and asthma was brought for evaluation of a generalized rash, fever, and irritability of 2 days’ duration. He had no respiratory symptoms. His medical history was significant for anorexia, without vomiting or diarrhea. He had a strong family history of allergy.
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Conjoined TwinsThe enterocele was partially resected in an attempt to maximize bowel length, but the intestinal tracts could not be completely separated. Postoperatively, both infants remained hypoxemic and became increasingly septic despite antibiotic therapy and critical life support. Support was ultimately withdrawn on the 65th day of life on parental request.
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A New Zip in Playground InjuriesWhile playing on the school playground, a 10-year-old boy decided to try a zip line. He grabbed the pulley and slid down the cable. When the pulley came to a stop, he fell off and sustained a right ankle injury.
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Podcast: Flu Vaccination Again This Year?: What To Say When Patients AskHow will you address this question when your patients ask? Find out in this podcast.
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A Young Girl With Unexplained Cervical Lymphadenopathy: Infection? Lymphoma--or Something Else?An 11-year-old African American girl was hospitalized with new fever in the context of unexplained cervical chain lymphadenopathy. WBC and ANC were low, ESR and LDH levels were elevated. Does the image here offer a clue to the ultimate diagnosis?
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Neuroblastoma in a Child With Persistent Hip PainA 4-year-old boy presented for further evaluation of persistent right hip painof 2 months’ duration. Before the onset of the pain, he had been limping,favoring his right side. For several days before he was brought in forevaluation, he had had fevers and sweating in addition to the right hippain.
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Case in Point: Child With Dysphagia, Fever, and Weight LossA 5-year-old African girl, whose family lived in France, was brought to the emergency department of our hospital during a family visit to the United States. The child had a 1-week history of difficulty in swallowing, a temperature of up to 38.3°C (101°F), and rhinorrhea. She had lost 4 lb during the week. According to her mother, the patient had no history of cough, nausea, vomiting, diarrhea, abdominal pain, or sick contacts.
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Positional Plagiocephaly, Part 2: Prevention and TreatmentPrimary care pediatric providers are instrumental in educating new parents about how to prevent the development or progression of plagiocephaly.
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Case In Point: An Unusual Case of Ileal-Ileo IntussusceptionAn 8-year-old Hispanic child with no significant medical history presented to our pediatric clinic after 2 episodes of vomiting, diarrhea, and abdominal pain. Symptoms had begun earlier the same morning; the child and his parents described the vomitus as "yellowish" and diarrhea "watery." There was no associated fever.
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Top 10 Common Medication Errors-Drug #9: ClonidineAfter several 5 mg doses of clonidine, this 5 kg boy became extremely lethargic and hypotensive. What went wrong?
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Positional Plagiocephaly, Part 2: Prevention and TreatmentPrimary care pediatric providers are instrumental in educating new parents about how to prevent the development or progression of plagiocephaly.
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Itchy, Acne-Like Rash on a Boy’s Face and Upper ArmsAn 11-year-old boy with 4-month history of acnelike rash on his face and both upper arms. Rash is associated with redness and itching. Application of adapalene gel resulted in no change.
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Cystic Hygroma in an 11-Year-Old GirlAn 11-year-old girl presented with a swelling on the left side of the chin of 1 month's duration; in the past 24 hours, following a bite by an unidentified insect, the swelling had rapidly enlarged and become painful (A). She was otherwise healthy and had no significant medical or family history.
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Chronic Recurrent Multifocal Osteomyelitis: REFERENCES:ABSTRACT: Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory bone disease that occurs primarily in childhood. The clinical picture often is confused with bacterial osteomyelitis. Awareness of CRMO as a clinical entity helps avoid diagnosis and treatment delays. Our patient, an 8-year-old girl, presented with acute left hip pain. One month after presentation, a lytic lesion was seen on plain radiographs; biopsy revealed nonspecific inflammation. It was not until more than 2 years later, when multifocal bone lesions and psoriasis developed, that the diagnosis became clear. Our patient's case demonstrates several key points: not all children with CRMO present with multifocal disease, patients frequently have comorbid inflammatory conditions, and there are no diagnostic laboratory studies. The optimal treatments remain unknown.
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Case In Point: Infant With Aldosterone DeficiencyA 45-day-old boy was referred for evaluation of persistent hyponatremia and hyperkalemia. On the 9th day of the boy's life, his serum potassium level was elevated (8 mEq/L) and on the 12th day, his serum sodium level was low (131 mEq/L). Supplementation with sodium chloride was initiated.
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Herpes Zoster (Shingles) in a TeenagerSixteen-year-old with a recurrent, painful, pruritic rash on right cheek and right eyelid. Current outbreak started 2 days earlier. The rash always appears in the same fashion and in the same location; it typically lasts a few days and resolves spontaneously.
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Case In Point: Subconjunctival Hemorrhages in a Teenage BoyA 13-year-old Hispanic boy presented to emergency department with a 1-day history of red eyes. The eye changes were not associated with vision changes, increased tearing, discharge, pain, fever, or trauma.
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Itchy, Acne-Like Rash on a Boy’s Face and Upper ArmsAn 11-year-old boy with 4-month history of acnelike rash on his face and both upper arms. Rash is associated with redness and itching. Application of adapalene gel resulted in no change.
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Osteomyelitis Associated With Cat-Scratch DiseaseA 3-year-old girl was hospitalized because of purulent drainage from a right middle finger wound (Figure 1) and a tender right axillary mass (Figure 2) of 2 days’ duration.
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Pediatric Musculoskeletal Infections: Managing the Significant OrganismsMusculoskeletal infections in children include osteomyelitis, septic arthritis, and pyomyositis. Most of these infections are bacterial.
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Case In Point: Subconjunctival Hemorrhages in a Teenage BoyA 13-year-old Hispanic boy presented to emergency department with a 1-day history of red eyes. The eye changes were not associated with vision changes, increased tearing, discharge, pain, fever, or trauma.
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ADHD and the Adolescent Driver:ABSTRACT: Adolescent drivers with attention deficit hyperactivity disorder (ADHD) are more likely to be involved in--and to die of--a driving accident than any other cause. The higher occurrence of driving mishaps is not surprising given that the core symptoms of ADHD are inattention, impulsivity, and hyperactivity. Safe driving habits can diminish the risk, however. The first step is to inform patients of the dangers of driving; the significance of adolescence, ADHD, and medication can be underscored in a written "agreement." Strategies to promote safer driving--especially optimally dosed long-acting stimulant medication taken 7 days a week--may be critical. A number of measures lead to safer driving by reducing potential distractions during driving (eg, setting the car radio before driving, no drinking or eating or cell phone use while driving, no teenage passengers in the car for the first 6 months of driving, and restricted night driving).
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Nickel DermatitisFor the past few weeks, a 10-year-old boy had a pruritic abdominal rash that had not responded to over-the-counter topical medications. The rash had appeared around the time he started wearing a new belt (shown). The child was otherwise healthy. There was a family history of asthma.
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Blaschko Lines:Following "Lines of Evidence" to a Rash DiagnosisMany factors can be considered in attempting to establish the cause of a skin disorder. These include the color, morphology, and location of the lesions; associated symptoms, such as itching and fever; and exposure to drugs or to other children who have a rash. Linearity of the lesions may also suggest the diagnosis.
