Paediatric Symptom Sorter

384 Pages·2017·100.74 MB·English

by  A. Sahib El-Radhi

Paediatric Symptom Sorter
Based on an original idea by Dr Keith Hopcroft
and Dr Vincent Forte
(Symptom Sorter, now in its Fourth Edition (20 I 0)
and published by Radcliffe Publishing Ltd)

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© 2011 A Sahib El-Radhi
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CONTENTS
Foreword vi
About the author vii
List of abbreviations viii
Introduction 1
Abdomen 5
Bones and joints 37
Cerebral 55
Chest 79
Ear 111
Eye 127
Face 151
General physical 167
Genital 191
Hair and nails 215
Neck 229
Nose 249
Oral 257
Skin 269
Unexplained fever 311
Urinary 329
Index 353
FOREWORD
In evaluating a child in the acute situation, it is always great to have a textbook available and to turn
to the correct section of the book in a timely manner. Most textbooks, however, are treatises on
diseases, mechanisms of disease, and treatment along with the theory of treatment of the disease.
And so it is often not quick or easy, and time that should be spent with the child and family is
consumed trying to piece together a logical approach.
Paediatric Symptom Sorter is designed to bridge the gap between the patient and the
undiagnosed symptom, and to do so in a manner that is fast and felicitous to patient care. Dr EI-
Radhi achieves this aim by a rapid overview of the problem, a brieflisting of the common and less
common diagnoses, a practical differential diagnosis chart, a list of the investigations that might
be necessary, and some practical advice (Top tips and Redf lags). All of this is brought together in
a few brief pages for each symptom.
A word about differential diagnosis: often differential diagnosis is offered merely as a listing
of the possible diagnoses. Such a list does not serve to discriminate among the possibilities. Dr
EI-Radhi achieves this aim with a tabulation of the diagnostic possibilities versus the appropriate
clinical signs and symptoms to be considered for the symptom. For example, the common causes
of tremor are assessed by a consideration of family history, progressivity, and features of the
examination.
The practical advice offered (Top tips and Redf lags), for example the symptom of headache, is
quite useful, noting here the usual lack of need for neuroimaging but the importance of looking
for papilloedema.
A new book should @I a vacuum. Paediatric Symptom Sorter achieves the goal by a few concise,
experience-based pages for almost all paediatric symptoms.
I envision that Paediatric Symptom Sorter will become a fixture in paediatric emergency rooms
and hospital on-call rooms. I advise that the book be affixed to the furniture in a secure manner.
Otherwise, it will soon disappear.
James Carroll, MD
Professor of Neurology and Pediatrics
Chief, Child Neurology
Medical College of Georgia
Augusta,GA
USA
May20n
vi
ABOUTTHEAUTHOR
A Sahib El-Radhi, PhD, MRCPCH, DCH, completed his primary medical study at the Free
University of West Berlin, Germany, where he also obtained his PhD. After working in various
hospitals in Berlin, he moved to England where he worked as a paediatric Senior House Officer
and Registrar. His MRCP and DCH were achieved in the 1970s. He then went to Iraq, his
country of birth, to work for 5 years at a hospital on the outskirts of Baghdad. He then moved to
Finland and later Kuwait as head of a paediatric department for nearly 10 years. Due to the Gulf
War in 1990, he returned to Finland for rwo and a halfy ears, working as a specialist paediatrician.
His paediatric experience widened when he came to England in 1993 to work as a consultant
paediatrician, undergraduate tutor and honorary senior lecturer, ending a long career in practising
paediatrics. For over 10 years he had a leading role in managing children with enuresis in a
specialist hospital clinic and outreach clinics in Bexley, Kent. He is currently serving as Honorary
Consultant Paediatrician at ~een Mary's Hospital, Sidcup, Kent, and Honorary Senior Lecturer
at the Medical School, London. As a guest speaker and visiting fellow, Dr El-Radhi has lectured in
numerous countries worldwide at international conferences, workshops, symposia and seminars.
His work as a general paediatrician in many different countries, including Germany, Finland,
Iraq, Kuwait and the United Kingdom, has provided him with a wide experience of infectious
and allergic diseases.
As an author over three decades, Dr El-Radhi has sat on several academic task forces and has
lectured both nationally and internationally on hisspecial interest in fever-related subjects. He has
also served as an advisor and peer reviewer for several medical journals, including the Archives of
Disease in Childhood. He has published over 30 papers in indexed journals and editorials, as well as
having contributed to several paediatric books. Dr El-Radhi has spent most of his medical career
in research performing numerous controlled and multi-centre studies. He has been privileged to
be an undergraduate and postgraduate examiner for the Royal College of Paediatrics and Child
Health, and in particular the MRCPCH and DCH exams, for over 10 years.
vii
LIST OF
ABBREVIATIONS
A&E accident and emergency CRF chronic renal failure
ACS acute confusional state CRP c-reactive protein
AD atopic dermatitis CSF cerebrospinal fluid
ADH antidiuretic hormone CT computed tomography
AED antiepileptic drug CTD connective tissue disease
AHG acute herpetic CULLP congenital unilateral lower lip
gingivostomatitis palsy
ANA anti-nuclear antibodies CVS congenital varicella syndrome
AOS arterial oxygen saturation DHEAS dehydroepiandrosterone
AR allergic rhinitis sulfate
ARF acute renal failure DI diabetes insipidus
ASO antistreptolysin DIC disseminated intravascular
BC blood culture coagulation
BG blood glucose DKA diabetic ketoacidosis
BPV benign paroxysmal vertigo DM diabetes mellitus
CAH congenital adrenal hyperplasia DP delayed puberty
CANOMAD chronic ataxic neuropathy EBV Epstein -Barr virus
with ophthalmoplegia, ECG electrocardiogram
M-protein, agglutination, and EEG electroencephalogram
disialosyl antibodies EKC epidemic keratoconjunctivitis
CCF congestive cardiac failure EM erythema multiforme
CCMT congenital cutis marmorata EM LA eutectic mixture oflocal
telangiectatica anaesthetics
CD Crohn's disease ENT ear, nose and throat
CF cystic fibrosis EOAE evoked otoacoustic emissions
CFS chronic fatigue syndrome ESR erythrocyte sedimentation
CHARGE coloboma, heart defect, atresia rate
of the choanae, retarded FB foreign body
growth, genital hypoplasia and FBC full blood count
ear anomaly MFBC maximal functional bladder
CHD congenital heart disease capacity
CMV cytomegalovirus FCUS familial cold urticaria
CNS central nervous system syndrome
CPK creatine phosphokinase FMF familial Mediterranean fever
CREST calcinosis, Raynaud's FS febrile seizures
phenomenon, oesophageal FSH follicle-stimulating hormone
dysmotility, sclerodactyly and FTT failure to thrive
telangiectasia FWF fever without focus
viii
LIST OF ABBREVIATIONS ix
GAHS group A ~-haemolytic mucocutaneous myxoma and
streptococci blue nevi
GE gastroenteritis LEOPARD A syndrome oflentigines,
GF glandular fever ECG abnormalities, ocular
GH growth hormone hypertelorism, pulmonary
GI gastrointestinal stenosis, abnormal genitalia,
GN glomerulonephritis retarded growth, deafness
GnRH gonadotropins-releasing LFT liver function tests
hormone LH luteinising hormone
GO gastro-oesophageal LMN lower motor neurone
HAV hepatitis A virus LP lumbar puncture
Hb haemoglobin LRTI lower respiratory tract
HbA2 haemoglobin alpha 2 infection
HbF haemoglobin F MCV mean cell volume
HbS haemoglobin S MELAS mitochondrial
HD Hirschsprung's disease encephalopathy, lactic acidosis
HL Hodgkin's lymphoma and stroke-like episodes
HHT hereditary haemorrhagic MRI magnetic resonance imaging
telangiectasia MSPS musculoskeletal pain
HHV-6 human herpesvirus 6 syndrome
HIDS hyperimmunoglobuliaemia D MWS Muckle-Wells syndrome
syndrome NAI non-accidental injury
HIE hypoxic-ischaemic NCSE non-convulsive status
encephalopathy epilepticus
HIV human immunodeficiency virus NE nocturnal enuresis
HSP Henoch-Schonlein purpura NF-l neurofibromatosis type 1
HUS haemolytic-uraemic syndrome NFLE nocturnal frontal lobe
HVA homovanillic acid epilepsy
IBD inflammatory bowel disease NIDDM non-insulin-dependent
IBS irritable bowel syndrome diabetes mellitus
ICP intracranial pressure NMD neuromuscular disorders
ID intellectual disability NS nephrotic syndrome
IDA iron-deficiency anaemia NSAID non-steroidal anti-
IgM-RF immunoglobulin M inflammatory drug
rheumatoid factor NUG necrotising ulcerative
IH inguinal hernia gingivostomatitis
IQ intelligence quotient NV neonatal varicella
ISO idiopathic scrotal oedema OCD obsessive-compulsive disorder
ITP idiopathic thrombocytopenic OE otitis externa
purpura OM otitis media
IV intravenous OME otitis media with effusion
JHR Jarisch-Herxheimer reaction OSAS obstructive sleep apnoea
JRA juvenile rheumatoid arthritis syndrome
KLS Kleine-Levin syndrome POS polycystic ovary syndrome
LAMB A syndrome of PCR polymerase chain reaction
lentigines, atrial myxoma, PF periodic fever