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A 2-year-old girl was transferred to the pediatric ICU from a nearby community hospital because of nonremitting, generalized abdominal pain associated with fever and vomiting. Her symptoms had begun 3 days earlier and had progressively worsened despite treatment with antibiotics, pain medication, and fluids.

“Texting,” “tweeting,” “friending,” “IMing.” Many physicians have heard their teenaged patients use these terms to describe how they communicate with their peers.

A 20-month-old boy brought to the emergency department with swelling on the right side of the neck and fever (temperature, 39.3°C [102.7°F]) of 1 day’s duration. The parents reported that the child had had intermittent fevers and poor weight gain for the past 3 months but no vomiting, diarrhea, rash, drooling, or difficulty in swallowing.

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Complete duplication of the left thumb in a baby boy was noted at birth; a radiograph of the thumb showed 2 proximal and distal phalanges with 1 first metacarpal bone. He also had fusion and incomplete bony duplication of the right thumb; a radiograph of this digit showed normal proximal and distal phalanges plus a small tiny bony remnant of the proximal and distal phalanges of an accessory thumb.

Imagine that you are working in an outpatient pediatric practice one morning when a mother arrives with her 3-month-old infant who is in respiratory florid distress.