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Crash Course Paediatrics PDF

328 Pages·2013·7.27 MB·English
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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

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