General Pediatrics Catalina Kersten, MD

336 Pages·2009·2 MB·English

SEVENTH EDITION
L A N G E Q & A™
P E D I AT R I C S
Mary Anne Jackson, MD
Chief, Section of Pediatric Infectious Diseases
Children’s Mercy Hospital & Clinics
Professor of Pediatrics
University of Missouri, Kansas City School of Medicine
Kansas City, Missouri
Sara S. Viessman, MD
Former Director, Pediatric Residency Program and Associate Professor
Former Director, Med-Peds Residency Program
University of Missouri-Columbia School of Medicine
Columbia, Missouri
Former Associate Dean for Medical Education at Lehigh Valley Hospital
Penn State College of Medicine
Allentown, Pennsylvania
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Contents
Contributors ........................................................................................................................................................... v
Student Reviewers.............................................................................................................................................. vii
Preface .................................................................................................................................................................... ix
Acknowledgements .............................................................................................................................................. x
1. Warm-Up Questions and Exam-Taking Skills ......................................................................................... 1
MARYANNEJACKSON, MD
Questions .......................................................................................................................................................... 2
Answers and Explanations ............................................................................................................................ 7
2. General Pediatrics ........................................................................................................................................ 15
CATALINAKERSTEN, MD
Questions......................................................................................................................................................... 16
Answers and Explanations........................................................................................................................... 29
3. The Neonate .................................................................................................................................................. 49
EUGENIAK. PALLOTTO, MD
Questions......................................................................................................................................................... 48
Answers and Explanations........................................................................................................................... 64
4. Growth and Development .......................................................................................................................... 81
SARAHE. HAMPL, MD
Questions......................................................................................................................................................... 82
Answers and Explanations........................................................................................................................... 96
5. Feeding and Nutrition .............................................................................................................................. 109
SARAVIESSMAN, MD, MARYSTAHLLEVICK, MD, ANDWILLIAMJ KLISH, MD
Questions........................................................................................................................................................ 110
Answers and Explanations.......................................................................................................................... 117
6. Fluids, Electrolytes, and Metabolic Disorders...................................................................................... 125
JOSEPHT. CERNICH, MD ANDANGELAL. TURPIN, MD
Questions....................................................................................................................................................... 126
Answers and Explanations......................................................................................................................... 135
iii
iv Contents
7. Infectious Diseases .................................................................................................................................... 147
EMILYA. THORELL, MD ANDANGELAMYERS, MD, MPH
Questions....................................................................................................................................................... 148
Answers and Explanations......................................................................................................................... 164
8. Injuries, Poisoning, and Substance Abuse............................................................................................ 181
GARYS. WASSERMAN, DO, JENNIFERA. LOWRY, MD, ANDRICHARDJ. MAZZACCARO, PHD, MD
Questions....................................................................................................................................................... 182
Answers and Explanations......................................................................................................................... 189
9. Pediatric Therapeutics .............................................................................................................................. 197
JASONW. CUSTER, MD, KRISTINEA. RAPAN, PHARMD,ANDR. BLAINEEASLEY, MD
Questions....................................................................................................................................................... 198
Answers and Explanations......................................................................................................................... 213
10. Case Diagnosis and Management .......................................................................................................... 231
MARKA. WARD, MD ANDJOSEPHY. ALLEN, MD
Questions....................................................................................................................................................... 232
Answers and Explanations......................................................................................................................... 252
11. Practice Test ................................................................................................................................................. 275
MARYANNEJACKSON, MD ANDSARAS. VIESSMAN, MD
Questions....................................................................................................................................................... 276
Answers and Explanations......................................................................................................................... 296
Bibliography ...................................................................................................................................................... 315
Index..................................................................................................................................................................... 319
Contributors
Joseph Y. Allen, MD, FAAP William J. Klish, MD
Assistant Professor of Pediatrics Professor of Pediatrics
Baylor College of Medicine Baylor College of Medicine
Texas Children’s Hospital Texas Children’s Hospital
Houston, Texas Houston, Texas
Joseph T. Cernich, MD Mary Stahl-Levick, MD, FAAP
Assistant Professor of Pediatrics Practicing General Pediatrician
Section of Pediatric Endocrinology and Diabetes ABC Family Pediatricians
Children’s Mercy Hospitals & Clinics Lehigh Valley Hospital and Health Network
University of Missouri––Kansas City School Allentown, Pennsylvania
of Medicine
Kansas City, Missouri Jennifer A. Lowry, MD
Assistant Professor
Jason W. Custer, MD Division of Clinical Pharmacology and Medical
Fellow Toxicology
Department of Pediatric Critical Care University of Missouri––Kansas City School
Johns Hopkins University of Medicine
Baltimore, Maryland Children’s Mercy Hospitals & Clinics
Kansas City, Missouri
R. Blaine Easley, MD
Assistant Professor Richard J. Mazzacarro, PhD, MD
Department of Pediatrics, Anesthesiology Pediatric Hospitalist
and Critical Care Department of Pediatrics
Johns Hopkins Medical Institutes Lehigh Valley Hospital
Baltimore, Maryland Allentown, Pennsylvania
Sarah E. Hampl, MD Angela L. Myers, MD, MPH
Assistant Professor of Pediatrics Associate Director, Infectious Diseases
Children’s Mercy Hospitals & Clinics Fellowship Program
University of Missouri––Kansas City School Assistant Professor of Pediatrics
of Medicine University of Missouri––Kansas City School
Kansas City, Missouri of Medicine
Children’s Mercy Hospitals & Clinics
Catalina M. Kersten, MD Kansas City, Missouri
Assistant Clinical Professor
Department of Child Health
University of Missouri School of Medicine
Columbia, Missouri
v
vi Contributors
Eugenia K. Pallotto, MD Angela L. Turpin, MD
Associate Medical Director Associate Medical Director of Diabetes Program
Neonatal Intensive Care Unit Assistant Professor of Pediatrics
Children's Mercy Hospital & Clinics University of Missouri––Kansas City School
Assistant Professor of Pediatrics of Medicine
University of Missouri––Kansas City School Children’s Mercy Hospitals & Clinics
of Medicine Kansas City, Missouri
Kansas City, Missouri
Gary S. Wasserman, DO
Kristine A. Parbuoni, PharmD, BCPS Chief, Section of Medical Toxicology
Pediatric Clinical Pharmacy Specialist Professor of Pediatrics
University of Maryland Medical Center University of Missouri––Kansas City
Clinical Assistant Professor Children’s Mercy Hospitals & Clinics
University of Maryland School of Pharmacy Kansas City, Missouri
Baltimore, Maryland
Emily Thorell, MD
Visiting Instructor
Department of Pediatric Infectious Disease
University of Utah School of Medicine
Salt Lake City, Utah
Student Reviewers
Joseph A. Bart Joshua Lynch, DO
Lake Erie College of Osteopathic Medicine Resident, Emergency Medicine
Class of 2009 University at Buffalo
Steven Cohen Lisa A. Nowell, MD
University of Missouri, Kansas City School of Medicine Resident, Morgan Stanley Children’s Hospital
Class of 2009 New York Presbyterian, Columbia University
Rose Ann Cyriac Crick Watkins
University of Missouri, Kansas City School of Medicine Kansas City University of Medicine and Biosciences
Class of 2009 Class of 2009
vii
Preface
If you are reading this book, you are likely engaged in one of the most important responsibilities of your
career—caring for a child. Pediatric practitioners fulfill a unique role in medicine in that they see the patient
across a continuum of time, often seeing the patient and their family for the first time in the first few minutes of
life. As you look into the eyes of a parent and child, you recognize that the responsibility is beyond measure and
the balance between providing comprehensive preventative health care and recognizing the need for more
in-depth system-specific investigation or treatment can turn on a dime. It requires practitioners to have a solid
knowledge base, be thorough in their assessments, be insightful regarding preventative care approaches, and,
most importantly, be able to recognize when an urgent treatment plan is needed.
This book should serve as an assessment tool for students, residents, and practitioners who wish to evalu-
ate their pediatric knowledge base and clinical deductive skills. The question focus and organization of chap-
ters were chosen to cover topics, by and large, consistent with the American Board of Pediatric general pediatric
core competencies. Chapters cover a range of topics spanning ages from newborn, including the premature
infant through adolescence. Comprehensive dedication to issues related to growth and development, feeding
and nutrition, fluids, electrolytes, and metabolic disorders are included. The infectious disease chapter covers
both common outpatient infection as well as life-threatening infections which occur in the healthy and
immunocompromised host. The chapter on injuries, poisoning, and substance abuse provides review of clinical
problems which may be seen on both outpatient and emergency care encounters. Critical care and pediatric
therapeutic questions target distinctive clinical scenarios and require the clinician to make prompt, evidence-
based medical decisions. The answers and discussion which follow each question include reference to key
pediatric textbooks and American Academy of Pediatrics guidelines.
To those who use this book, I hope you find it useful and that you are fueled throughout your career by the
excitement of discovery stirred by your clinical experiences.
Mary Anne Jackson, MD
ix
Acknowledgements
Many thanks to Sara Viessman for trusting me to complete this labor of love, and to Dr. Martin Loren who
first envisioned the text and brought the first five editions to fruition. It has been a pleasure to work with all of
the authors that gave of their time and who represent expertise from pediatric centers across the United States.
It has been my pleasure to work with Catherine Johnson, Cindy Yoo, and Kirsten Funk from McGraw-Hill.
Their patience, advice, guidance, and encouragement have been invaluable.
I would be remiss if I did not recognize my partners at work who daily remind me how lucky we are to do
what we do. To Lindsay and Nick, seeing you challenge yourself throughout life, be it at work or play, has
inspired me to broaden my own horizons. And to Jay, your unwavering love has energized me every day for
37 years.
x