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Archive for the ‘Pediatrics’ Category

Kawasaki’s Disease for the Boards & Wards

Posted by medliorator on April 29, 2010

Pathophysiology:

  • necrotizing vasculitis of early childhood
  • possible infectious etiology (parvovirus B19)

Workup:

  • CBC –> normocytic anemia followed by thrombocytosis
  • ESR –> elevated
  • CRP –> elevated
  • LFTs –> low albumin

Diagnosis: clinical (“CRASH & Burn”)

  • 4 of 5 signs:
    • Conjunctivitis – bilateral nonsuppurative
    • Rash – primarily truncal
    • Adenopathy – cervical, at least 1.5cm
    • Strawberry Tongue – URI mucous membrane changes
    • Hands & feet – erythema, edema, desquamation
  • Fever x 5 days

Treatment:

  • High dose IVIG
  • High dose ASA
  • After discharge, low dose of ASA x 8 weeks

Differential:

  • Mercury poisoning (acrodynia)
  • Scarlet fever
  • Toxic shock syndrome
  • juvenile idiopathic arthritis

See also,

Kawasaki’s Disease [Inside Surgery]

Posted in Pediatrics, Rheumatology | Comments Off on Kawasaki’s Disease for the Boards & Wards

How to Approach Adolescent Athletes – Sports Preparticipation Examination

Posted by medliorator on November 30, 2009

The adolescent athlete frequently appears in clinic for sports preparticipation examination.  3rd & 4th year medical students should be prepared.  Important aspects of this assessment include:

  • cardiovascular health (hypertrophic cardiomyopathy)
  • non-cardiac issues (loss of consciousness or concussion, recovery from musculoskeletal injuries)
  • general health assessment
  • counseling
  • assessing fitness level for specific sports

Medliorate readers will benefit from the Georgia Chapter of the American Academy of Pediatrics’ Preparticipation Physical Evaluation form.  Print off a few copies for your clinic rotations in pediatrics and family medicine.  The form includes a history portion that the guardian may complete.

AAP [Georgia Chapter]

Posted in Diagnostic Examination, Family Practice, Pediatrics | Comments Off on How to Approach Adolescent Athletes – Sports Preparticipation Examination

Assessing Jaundice in Newborns – BiliTool

Posted by medliorator on July 5, 2009

BitiTool assesses the risk of hyperbilirubinemia in newborns and provides American Academy of Pediatrics’ phototherapy recommendation.  Available online and for iPhone.

BiliTool is designed to help clinicians assess the risks toward the development of hyperbilirubinemia or “jaundice” in newborns.

Required values include the age of the child in hours (between 18-168 hours) and the total bilirubin in either US (mg/dl) or SI (µmol/L) units.

Posted in OB GYN, Pediatrics, Tools | 1 Comment »

2009 Childhood Immunization Schedules

Posted by medliorator on February 10, 2009

Bookmark this on your mobile device:

http://www.immunizationed.org/ShotsOnline.aspx

2009 Childhood Immunization Schedules [Society of Teachers of Family Medicine]

Posted in Clinical Rotations, Pediatrics | Comments Off on 2009 Childhood Immunization Schedules

On Teen Pregnancy

Posted by medliorator on June 28, 2008

Kenneth F. Trofatter, Jr., MD, PhD…

We live in times when there has never in the history of humans been a greater disparity between the age of puberty and the social and economic demands that allow us to survive productively in this world. That also means that children are now reaching the age of ‘reproductive maturity’ when they are least likely to be in a position to control impulses, to understand the consequences of, and to make sensible decisions (or to resist sexual overtures of older and more experienced males) related to, sexual activity. The consequences are not only pregnancies and sexually transmitted disease but, in most cases, as has been shown repeatedly in the past, a loss of lifetime opportunities for success, a life spent in poverty, poor health, a long history of dependency on social welfare, limited access to an adequate health care system, and the high likelihood that their inheritance to their children will be a life similar to theirs.

Abstinence-alone efforts have also failed as a widespread approach and are practically meaningless anyway to children at the age at which they are now reaching puberty. There is growing data to support that teaching about contraception is “not associated with increased risk of adolescent sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education (Kohler, et al., J Adolesc Health 2008;42:344-51).” But, all this needs to be presented in a program of ongoing education and practical incentivization. “The most expedient way to strengthen the impact of pregnancy prevention programs on adolescent childbearing is to shift the focus of intervention …to helping young women develop goals that make adolescent childbearing a threat to what they want in life. This means intervening actively enough to ensure that goal setting translates into an internal desire to postpone childbearing beyond adolescence (Sheeder, et al., Matern Child Health J 2008: epub May 16).”

Teen Pregnancy: We ARE Failing our Children [Healthline]

Posted in Pediatrics | Comments Off on On Teen Pregnancy

Munchausen Syndrome by Proxy (MSBP)

Posted by medliorator on April 30, 2008

Mary E. Muscari, PhD, CPNP, APRN-BC at Medscape

…usually describes the deliberate production, or feigning, of physical or psychological symptoms in another person who is under the individual’s care. …usually involves a mother and young child; however, there have been cases of MSBP involving illness produced or feigned in other adults and even in pets

Research criteria include:

  • Intentional production of or feigning of physical or psychological symptoms in a person under one’s care;
  • Perpetrator motivated by assuming the sick role by proxy;
  • External incentives (such as monetary gain) are absent; and
  • Behavior is not better accounted for by another disorder.[3]

Subtypes
Chronic Munchausen by proxy is characterized by the constant pursuit of attention by inducing symptoms in another person. Individuals displaying chronic MSBP are compulsive, and the behavior consumes most of their lives.

Episodic Munchausen by proxy occurs in spurts. There are intervals when the person experiences symptoms of MSBP and intervals where the person lives a normal life.

In mild Munchausen by proxy, affected individuals fabricate medical histories for their children and lie about their children being sick rather than actively causing sickness. Their motivation is the emotional gratification they receive from medical attention.

In intense Munchausen syndrome by proxy, the person resorts to measures such as inducing vomiting, poisoning, removing blood from the child, and suffocation. The individual is able to induce severe illness in his or her own child, yet remain cooperative, concerned, and compassionate in the presence of healthcare providers

Presentation
Victims are equally divided between male and female, and children most at risk are those aged 15 months to 72 months. Victims frequently have baffling symptoms and see multiple healthcare providers before a diagnosis of MSBP is made. In 98% of cases, the perpetrator is the biological mother.[6] Characteristics of perpetrators include female, white, experiencing marital discord, having healthcare knowledge or training, friendly and cooperative with staff, very attentive to the child, and may have a history of abuse and/or psychiatric disorders.[7]

Ways that MSBP can present include[6,7]:

  • Complex pattern of illness and recurrent infection without physiologic explanation;
  • Seizure activity that does not respond to medication and that is only witnessed by the caretaker;
  • Bleeding from anticoagulants and poisons; use of caretaker’s own blood or red-colored substances to simulate bleeding;
  • Vomiting precipitated by ipecac administration;
  • Diarrhea induced by laxatives or salt administration;
  • Hypoglycemia from administration of insulin or hypoglycemic agents;
  • Rashes from caustic substances applied to the skin;
  • Hematuria or rectal bleeding from trauma;
  • Recurrent apparent life-threatening events (ALTE) from purposeful suffocation; and
  • Central nervous system depression (usually from drug administration).

Mason and Poirier[6] recommend looking for these warning signs:

  • Illness that is multisystemic, prolonged, unusual, or rare;
  • Symptoms that are inappropriate or incongruent;
  • Multiple allergies;
  • Symptoms that disappear when caretaker is absent;
  • One parent, usually the father, absent during the child’s hospitalization;
  • History of sudden infant death syndrome (SIDS) in siblings;
  • Parent who is overly attached to the patient;
  • Parent who has medical knowledge/background;
  • Child who has poor tolerance of treatment;
  • Parent who encourages medical staff to perform numerous tests and studies; and
  • Parent who shows inordinate concern for feelings of the medical staff.

When should I suspect Munchausen syndrome by proxy in a patient? [Medscape Med Students]

Posted in Pediatrics, Psychiatry | Comments Off on Munchausen Syndrome by Proxy (MSBP)

How to Control Unruly Patients

Posted by medliorator on January 18, 2008

The kid then raised a royal tantrum and started throwing things. I managed to calm him down for a bit so I could go through the physical exam. I gave him my reflex hammer and told him he was supposed to hit a spot on the bed when I told him to, and then stand absolutely straight after hitting that spot. I found that for many children, letting them play with my reflex hammer and turning it into a game is the best way to calm them down. I’ve also discovered that for children who have a phobia of stethoscopes, if I let them listen to my heart first, they’ll usually let me listen to theirs next.

Oh Pediatrics [Half MD]

Posted in Clinical Rotations, How-To, Pediatrics | Comments Off on How to Control Unruly Patients