Crash Course Paediatrics

328 Pages·2013·7.27 MB·English

by  Rajat Kapoor, Katy Barnes

PAEDIATRICS

����������������

First and second edition authors:

Christine Budd
Mark Gardiner
David Pang
Tim Newson
Third edition author:

Shyam Bhakthavalsala

4 th Edition
CRASH COURSE
SERIES EDITOR:
Dan Horton-Szar
BSc(Hons) MBBS(Hons) MRCGP
Northgate Medical Practice,
Canterbury,
Kent, UK

FACULTY ADVISOR:
Victoria Jones
BSc(Hons), MBBS, MRCPCH
Consultant Paediatrician,
North Middlesex University Hospital,
London UK

Paediatrics

Rajat Kapoor
BMedSci (Hons), BMBS, DCH, MRCPCH
Specialty Registrar,
Imperial College Healthcare NHS Trust,
London, UK
Katy Barnes
MA, MBBS Specialty Registrar,
Barts Health NHS Trust,
London UK

Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2013

Content Strategist: Jeremy Bowes
Content Development Specialist: Fiona Conn
Project Manager: Andrew Riley
Designer: Christian Bilbow
Icon Illustrations: Geo Parkin
Illustration Manager: Jennifer Rose

© 2013 Elsevier Ltd. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing
from the publisher. Details on how to seek permission, further information about the Publisher’s permissions
policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Li-
censing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein).

First edition 1999

Second edition 2004

Third edition 2008

Fourth edition 2013

ISBN: 978-0-7234-3635-5

British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library

Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any
information, methods, compounds, or experiments described herein. In using such information or methods they
should be mindful of their own safety and the safety of others, including parties for whom they have a professional
responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to
verify the recommended dose or formula, the method and duration of administration, and contraindications. It is
the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate
safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability
for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or
from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

The
Publisher's
policy is to use
paper manufactured
from sustainable forests

Printed in China

Series editor foreword

The Crash Course series first published in 1997 and now, 16 years on, we are still
going strong. Medicine never stands still, and the work of keeping this series
relevant for today’s students is an ongoing process. These fourth editions build on
the success of the previous titles and incorporate new and revised material, to keep
the series up to date with current guidelines for best practice, and recent
developments in medical research and pharmacology.

We always listen to feedback from our readers, through focus groups and student
reviews of the Crash Course titles. For the fourth editions we have completely re-
written our self-assessment material to keep up with today’s ‘single-best answer’
and ‘extended matching question’ formats. The artwork and layout of the titles has
also been largely re-worked to make it easier on the eye during long sessions of
revision.

Despite fully revising the books with each edition, we hold fast to the principles on
which we first developed the series. Crash Course will always bring you all the
information you need to revise in compact, manageable volumes that integrate
basic medical science and clinical practice. The books still maintain the balance
between clarity and conciseness, and provide sufficient depth for those aiming at
distinction. The authors are medical students and junior doctors who have recent
experience of the exams you are now facing, and the accuracy of the material is
checked by a team of faculty advisors from across the UK.

I wish you all the best for your future careers!

Dr Dan Horton-Szar

Series Editor

v

Intentionally left as blank

Preface

The new edition of Crash Course: Paediatrics has been reformatted compared
to previous editions to provide a structure for history and examination at the
beginning of the book. The self assessment section has been updated to include
‘single best answer’ and ‘extended matching’ questions to reflect the current
form of assessment.

This edition continues to provide a practical approach to paediatrics and the hints
and tips boxes have been revised to reflect this. The booked is aimed at the
undergraduate but would be a great resource for foundation trainees or specialty
doctors embarking on a career in paediatrics.

Rajat Kapoor
Katy Barnes
Victoria Jones

vii

Intentionally left as blank

Acknowledgements

We would like to thank our families for their continuous support.

Rajat Kapoor
Katy Barnes
Victoria Jones

ix

Intentionally left as blank

Contents

Series editor foreword
. . . . . . . . . . . . . . .
v

Preface . . . . . . . . . . . . . . . . . . . . . . .
vii

Acknowledgements . . . . . . . . . . . . . . . . .
ix

1. History and examination . . . . . . . . . . 1

Paediatric history taking . . . . . . . . . . 1
Neonatal history . . . . . . . . . . . . . . 2
Examination . . . . . . . . . . . . . . . . 2
The neonatal examination . . . . . . . . . 5
Medical sample clerking . . . . . . . . . . 6

2. Developmental assessment. . . . . . . . . 9

History . . . . . . . . . . . . . . . . . . 9
Examination . . . . . . . . . . . . . . . . 9
Signs of abnormal development:
‘limit ages’ . . . . . . . . . . . . . . . 12

3. Investigations . . . . . . . . . . . . . . 13

Blood tests
. . . . . . . . . . . . . . . 13
Urine tests. . . . . . . . . . . . . . . . 21
Cerebrospinal fluid . . . . . . . . . . . . 21
Imaging . . . . . . . . . . . . . . . . . 22

4. Fever or rash
. . . . . . . . . . . . . . 27

The feverish child . . . . . . . . . . . . 27
The child with a rash . . . . . . . . . . . 29
The child with fever and petechial rash . . 31

5. Heart, lung or ENT problems . . . . . . . 33

Heart . . . . . . . . . . . . . . . . . . 33
Lung . . . . . . . . . . . . . . . . . . 35
Ear, nose and throat . . . . . . . . . . . 38

6. Gut or liver problems
. . . . . . . . . . 41

Gut . . . . . . . . . . . . . . . . . . . 41
Liver . . . . . . . . . . . . . . . . . . 46

7. Haematuria or proteinuria . . . . . . . . 49

Haematuria . . . . . . . . . . . . . . . 49
Proteinuria. . . . . . . . . . . . . . . . 50

8. Neurological problems . . . . . . . . . . 51

Fits, faints and funny turns . . . . . . . . 51

Headache . . . . . . . . . . . . . . . . 53
The unconscious child . . . . . . . . . . 54

9. Musculoskeletal problems . . . . . . . . 57

Limp . . . . . . . . . . . . . . . . . . 57
The painful limb . . . . . . . . . . . . . 57
The painful joint . . . . . . . . . . . . . 58
Normal postural variants . . . . . . . . . 58

10. Pallor, bleeding, splenomegaly or
lymphadenopathy . . . . . . . . . . . . 61

Pallor . . . . . . . . . . . . . . . . . . 61
Bleeding disorders . . . . . . . . . . . . 62
Splenomegaly . . . . . . . . . . . . . . 64
Lymphadenopathy . . . . . . . . . . . . 66

11. Short stature or developmental delay . . . 69

Growth . . . . . . . . . . . . . . . . . 69
Developmental delay . . . . . . . . . . . 71

12. Neonatal problems. . . . . . . . . . . . 73

Feeding difficulties . . . . . . . . . . . . 73
Vomiting . . . . . . . . . . . . . . . . 73
Jaundice. . . . . . . . . . . . . . . . . 74
Breathing difficulties . . . . . . . . . . . 76
Neonatal seizures
. . . . . . . . . . . . 77
Congenital malformations
. . . . . . . . 78
Complex genital anomaly. . . . . . . . . 80

13. Infectious diseases and immunodeficiency . .81

Viral infections. . . . . . . . . . . . . . 81
Bacterial infections . . . . . . . . . . . . 87
Parasitic infections . . . . . . . . . . . . 91
Kawasaki disease. . . . . . . . . . . . . 93
Immunodeficiency . . . . . . . . . . . . 93

14. Allergy and anaphylaxis . . . . . . . . . 97

Epidemiology . . . . . . . . . . . . . . 97
Cross-reaction to allergens . . . . . . . . 98
Clinical aspects of allergy . . . . . . . . . 98
Management of allergy. . . . . . . . . . 99
Anaphylaxis . . . . . . . . . . . . . . . 99

xi

15. Skin disorders . . . . . . . . . . . . . . 103

Eczema (dermatitis)
. . . . . . . . . . . 103
Infections . . . . . . . . . . . . . . . . 105
Viral
. . . . . . . . . . . . . . . . . . 105
Infestations . . . . . . . . . . . . . . . 106
Other childhood skin diseases. . . . . . . 107

16. Cardiovascular disorders . . . . . . . . . 109

Congenital heart disease . . . . . . . . . 109
Rheumatic fever . . . . . . . . . . . . . 114
Cardiac infections . . . . . . . . . . . . 115
Cardiac arrhythmias . . . . . . . . . . . 116

17. Disorders of the respiratory system . . . . 117

Upper respiratory tract infections . . . . . 117
Lower respiratory tract infections . . . . . 119
Asthma . . . . . . . . . . . . . . . . . 122
Cystic fibrosis . . . . . . . . . . . . . . 127

18. Disorders of the gastrointestinal
system . . . . . . . . . . . . . . . . . 129

Infantile colic . . . . . . . . . . . . . . 129
Gastro-oesophageal reflux . . . . . . . . 129
Gastroenteritis . . . . . . . . . . . . . . 130
Pyloric stenosis. . . . . . . . . . . . . . 131
Intussusception
. . . . . . . . . . . . . 132
Meckel’s diverticulum . . . . . . . . . . 132
Acute appendicitis . . . . . . . . . . . . 132
Mesenteric adenitis. . . . . . . . . . . . 133
Coeliac disease. . . . . . . . . . . . . . 133
Food intolerance . . . . . . . . . . . . . 134
Inflammatory bowel disease
. . . . . . . 134
Hirschsprung’s disease (congenital
aganglionic megacolon) . . . . . . . . . 134
Bile duct obstruction . . . . . . . . . . . 135
Constipation. . . . . . . . . . . . . . . 135

19. Renal and genitourinary disorders
. . . . 137

Urinary tract anomalies . . . . . . . . . . 137
Genitalia
. . . . . . . . . . . . . . . . 139
Urinary tract infection . . . . . . . . . . 141
Acute nephritis. . . . . . . . . . . . . . 143
Nephrotic syndrome . . . . . . . . . . . 143
Haemolytic uraemic syndrome . . . . . . 144

20. Neurological disorders . . . . . . . . . . 145

Malformations of the central nervous
system . . . . . . . . . . . . . . . . . 145

Infections of the central nervous system . . 146
Cerebral palsy . . . . . . . . . . . . . . 148
Epilepsy . . . . . . . . . . . . . . . . . 149
Febrile convulsions . . . . . . . . . . . . 152
Headache . . . . . . . . . . . . . . . . 152
Neurocutaneous syndromes. . . . . . . . 152
Neurodegenerative disorders of
childhood
. . . . . . . . . . . . . . . 153
Neuromuscular disorders . . . . . . . . . 153

21. Musculoskeletal disorders . . . . . . . . 157

Disorders of the hip and knee. . . . . . . 157
Disorders of the spine . . . . . . . . . . 159
Bone and joint infections . . . . . . . . . 160
Rheumatic disorders . . . . . . . . . . . 161
Genetic skeletal dysplasias . . . . . . . . 162

22. Haematological disorders
. . . . . . . . 163

Haematopoiesis . . . . . . . . . . . . . 163
Anaemia
. . . . . . . . . . . . . . . . 163
Haemolytic anaemia . . . . . . . . . . . 166
Bleeding disorders . . . . . . . . . . . . 168
Coagulation disorders
. . . . . . . . . . 169
Thrombotic disorders in childhood. . . . . 170

23. Malignant disease . . . . . . . . . . . . 173

Childhood cancer
. . . . . . . . . . . . 173
The leukaemias . . . . . . . . . . . . . 175
Lymphomas . . . . . . . . . . . . . . . 176
Brain tumours . . . . . . . . . . . . . . 177
Neuroblastoma
. . . . . . . . . . . . . 178
Wilms’ tumour (nephroblastoma) . . . . . 178
Soft tissue sarcomas . . . . . . . . . . . 179
Bone tumours . . . . . . . . . . . . . . 179
Langerhans cell histiocytosis
. . . . . . . 180

24. Endocrine and metabolic disorders . . . . 181

Disorders of carbohydrate metabolism . . . 181
Thyroid disorders. . . . . . . . . . . . . 185
Adrenal disorders
. . . . . . . . . . . . 186
Disorders of the pituitary gland . . . . . . 187
Disorders of the gonads . . . . . . . . . 188
Inborn errors of metabolism
. . . . . . . 189

25. Disorders of emotion and behaviour . . . 193

Problems of early childhood
. . . . . . . 193
Problems of middle childhood. . . . . . . 195
Problems of adolescence . . . . . . . . . 198

xii

Contents

26. Social and preventive paediatrics . . . . . 201

Prevention in child health. . . . . . . . . 201
Child abuse . . . . . . . . . . . . . . . 204
Sudden infant death syndrome . . . . . . 205
Children and the law . . . . . . . . . . . 205
The child with a disability . . . . . . . . . 206

27. Genetic disorders . . . . . . . . . . . . 209

Basic genetics . . . . . . . . . . . . . . 209
Single gene disorders. . . . . . . . . . . 209
Autosomal dominant disorders . . . . . . 209
Autosomal recessive disorders. . . . . . . 210
X-linked disorders . . . . . . . . . . . . 211
Multifactorial disorders . . . . . . . . . . 212
Chromosomal disorders. . . . . . . . . . 213
Mitochondrial inheritance. . . . . . . . . 215
Polymerase chain reaction . . . . . . . . 216
Genetic counselling
. . . . . . . . . . . 216

28. The newborn . . . . . . . . . . . . . . 217

Maternal and fetal health. . . . . . . . . 217
Fetal assessment and antenatal diagnosis
. 217
Maternal conditions affecting the fetus . . 217

Normal neonatal anatomy and physiology . 220
Birth
. . . . . . . . . . . . . . . . . . 222
Birth injury
. . . . . . . . . . . . . . . 224
Diseases of the newborn . . . . . . . . . 224
Disorders of the preterm infant . . . . . . 226
Disorders of the term infant. . . . . . . . 229

29. Accidents and emergencies. . . . . . . . 233

Accidents . . . . . . . . . . . . . . . . 233
Emergencies . . . . . . . . . . . . . . . 238

30. Nutrition, fluids and prescribing . . . . . 249

Nutrition
. . . . . . . . . . . . . . . . 249
Fluids and electrolytes . . . . . . . . . . 254
Paediatric pharmacology and prescribing. . 255

Self-assessment . . . . . . . . . . . . . . . 257
Best of fives questions (BOFs) . . . . . . . . 259
Extended-matching questions (EMQs). . . . . 277
BOF answers
. . . . . . . . . . . . . . . . 283
EMQ answers . . . . . . . . . . . . . . . . 295
Glossary . . . . . . . . . . . . . . . . . . . 301
Index . . . . . . . . . . . . . . . . . . . . 303

Contents

xiii

Intentionally left as blank