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I Thieme Pediatrics A Case-Based Review Michaela Kreckmann, MD Ill Private Practice Saarbriicken,Gerrnany 141 illustrations Thieme Stuttgart · New York · Delhi · Rio de Janeiro em.- Unry of cm1ng1~1n-Pablladan nm is Impartmt Date: Medicine is an ~Di science avallab~ from the publisher. umiergoing motinual dewlopmeot. ~ and dioial ~ are c:ontinually expanding our lcoowledge. in This book is an authorized trmslatioo of the 2nd German particular our knawledge of proper tremnent and drug editioo published and copyrighted 2008 by Georg Thieme tberapy. Insolilr as this book mentions any dosage or appli Verlag. Stuttgart. Title of the Gerrrulo edition: Pallbuch Pae cation. readers may rest assured that the authors. editors, di.atrle and pubJlshers have made every effort to ensure that such referen<:eS are in accordance with the m2 of JmowleQe Transktor: Gertrude Champe. Surry, MB, USA iU the time ofp rodac:doD oldie book. Nevertheless, this does not lovolve, lmply, or express any guarantee or responsibility on the part of the publishers In Names: Kreckmann. Michaela, author. respect to any dosaac irutructiom and fonm ofa pplications Title: Pedlatrlcs : a case-based review/ Mlchula stalOO io tbe book. Ewery U9el' II requesled to euadae ca Kreckmann ; trauslator, Gertrude Clwnpc. nfull,ythe manufacturers' !Rfletsa ccumpanying each drug Other titles: Fallbuch Phadiatrie. Eoglisb and to cbeck. if necessary in consultation with a physici Desaiption: Stut!iart; New Yort: Thieme, (2019) I 'This an or specialist, whether the dosage schedules mentiooed book is an authorized translation oft he 2nd GemYn therein or the contnirutialions mted by tbe manufartu· edition published and copyrjgbted 2008 by Georg rers differ from the stall!lneoa made in the present book. Thieme Ved~ Stuttg;lrt. Titfe oft he Gennan edition: Such exmtioatioo is particularly important with drugs that F.JUbuchPaediatrie"-Galley. I lnd.udes llmx. I are either rarely used or have been newly rel~ on the Identifiers: I.a:N 2019020002 (print) I LCCN 2019021658 market. Every dosage schedule or every rorm of applicati IV (ebook) I ISBN 9783132053717 () I ISBN 9783132053618 on used is entirely at the user's own risk and responslblllty. (alk. paper) I ISBN 9783132053717 (e-ISBN) The authors and publishers request every user m report to Subjects: I MESH: Pediatrics I Diagnosis, Dltrerentlal I the publishen any discrepancies or inaccuracies noticed. If DiaJMstlc Techniques and Procedures I case Reports errors In this work are round ~publication, errata will OUs.iflcadon: LCC RJSO (ebook) I I.CC RJ50 (print) I NIM be posted at www.thleme.com on the product description ws 100 I DOC 618.92f007S-dc23 ~- LC rea>rd available at hn:ps:/Jlccn.loc.gxw/2019020002 Some of tbe im>duct names, patents, and registered de- 5igns ~ to in this book are in fact Rgisteml trade maiks or pwprictary names even though specifac n:ference to this fact is not always made in the text. Therefott, the appearance of a rwne without designation as proprietary C 2019 Georg Thieme Verlag KG is not to be coostrued as a representation by the publisher that it is in the public donWn. Thieme Publishers Stuttgart ROdigerstrasse 14, 70469 Stuttgart, Germany +49 [0(711 8931 421, customl!nervi.ceOthieme.de Thieme Publishers New York 333 Seventh Avenue, New York, NY 10001, USA +1 -800-782-3488. cusmlMl"SeNi~ieme.mm Thieme Publishers Delhi A-12, Semrut Floor. Sectm-2, Nolda-201301 Uttar Pradesll. lndla +9112045 566 00. cu..stomerservldthieme.in Thieme Publishers Rio. Thieme Publi~e.s Ltl:l.a. Edillclo Rodolpbo de Paoli, 25! andar Av. Nilo ~.SO-Sala 2508 Rio de Janeiro 20020.S06 BRsil +SS 21311222r;n J +ss 213112 1896 CDYer design: Thieme Publishing Group Typesetting byT homson Digial, lrutia This book. induding all parts tbereo( is legally protat2d by copyright. Any use. exploitation, or rommerdalizatlon out- Printed in Germany by CPI Books 5 4 3 2 1 side the J:WTIJW limits set by copyright legislation, without ISBN 978-3-13-205361-8 tbe publisher's consent, is illegal and liable to prosecution. This applil!S in particular to phomstat reproduction, copy Also avallabJe as an e-book: ing. mimeographing. preparation of miaor.J.ms, and elec e!SBN 978-3-13-205371-7 tronic data processing and st:Drage. Preface This casebook presents 85 disease patterns observed are often frightened and uncooperative, and their in daily pediatric practice. The intention is to make parents. The student is trained to think and act like a the preparation for examinations easier for the stu doctor through case-and problem-oriented practice. dents. The descriptions of the medical histories and Last but not the least, this book would also like to situations are as close as possible to clinical events show students the joy that work in pediatrics can as they have been encountered in the emergency bring, especially in light of the current public dis department or reported by patients, parents, and cussion of health policy. I myself have experienced nurses. Laboratory results, X-rays, and other diag most of these cases, or similar ones, as a resident in nostic results are presented for analysis. This book a hospital for children and adolescents in the Saar explains the importance of why medical histories land, Germany. Every interested student and future v should be taken, diagnoses established, and treat colleague is warmly invited to take a look inside this ment planned. In addition to everyday, easily diag book and enliven all the study of theory with a taste nosed general pediatric and neonatal diseases, this of clinical daily life. book also presents misleading and easily misinter This book would not have been possible without preted symptoms that are intended to illustrate the the help of many people. I owe a heartfelt thanks, first special problems of pediatric diagnosis. Naturally, ofa ll, to the children and parents who were willing to this book includes cases exemplifying classic emer be photo models, and to Dr. Thomas Llebner, the head gency situations, which can be expected in every physician of the Oinic for Children and Adolescents day pediatric practice. Special problematic cases in in the Reinhard-Nieter Hospital, Wilhelmshaven, social pediatrics and related fields are examined and Germany, for his support and valuable advice. My discussed, such as pediatric surgery and child and thanks also to my colleagues for their encourage adolescent psychiatry. The diagnosis and treatment ment and to the staff at Thieme Publishers, in par described for such cases are based on the current ticular Angelika-Marie Findgott, Joanne Stead, and guidelines of pediatrics associations and recommen Apoorva Gaurav Prabhuzantye, without whose active dations in the current specialized literature. participation, constructive criticism, and persistent However, this book cannot and does not intend to inquiries, this book would not have become what it replace a textbook. Rather, it is intended to encourage is today. A lot of thanks to Gertrude Champe for her a critical approach to the, often dry, subject matter great translation. I also thank my family and all my and to clarify and simplify problems by presenting friends for their patience, and especially my husband them in a clinical context. It is also meant to help and children. who supported my work with thought young colleagues in their first steps in clinical prac ful critiques and lovingly tolerated everything that tice. For this purpose, it suggests simple and struc they had to go through. tured workflows for diagnosis and treatment and practical tips for interacting with little children, who Michaela Kreckmann, MD Case Page Description I. . 2 Six-year-old boy with high fever, vomiting, and headache I. . 3 Child with barking cough and dyspnea I. . 4 Child with high fever and seizure I. . 5 Apathetic infant with persistent skin folds I. . 6 Two-year-old girl with colic-like stomach pains and vomiting I. . 7 Twelve-month-old boy comes for a health screening I. . 8 Ten-year-old boy with painfully swollen knee I. . 9 Girl with petechial dermatorrhagie I. . 10 Infant with projectile vomiting llm 11 Young girl with recurrent shortness of breath llm 12 Fourteen-month-old toddler with "runny ear· llEll 13 Three-year-old boy who has had contact with chicken pox 11!11 14 Five-year-old girl with a swollen jaw angle IBll 15 Severely ill infant with cough and shortness of breath llm 16 Young girl with difficulty swallowing and fatigue I =D ifficult Case llm 17 Two-year-old boy with coughing fit and cyanosis llm 18 Twelve-month-old boy with screaming fit and swollen testicles llill 19 Eight-year-old boy with macrohematuria llm 20 Boy almost 1-year-old with failure to thrive lml 21 Macrosomal newborn after obstructed labor with shoulder dystocia IEm 22 Ten-year-old girl with fever and headache 1&11 23 Eight-year-old boy with high fever and rash IEll 24 Five-year-old girl after fall from jungle gym lml 25 Infant with high fever, sucking weakness, and vomiting IEm 26 Toddler burned by boiling water VII IEm 27 Five-year-old girl with abdominal pain and anal itching IE.m 28 Fourteen-year-old girl with weight loss and social withdrawal IEill 29 Newborn whose mother has poorly controlled diabetes mellitus llill 30 Five-year-old girl with hematuria IE!ll 31 Three-year-old boy with numerous pigment spots llm 32 Feverish 2-year-old girl with pustulent crusty rash IEll 33 Hypotrophic newborn with abnormal phenotype IEll 34 Five-year-old boy with knee pain and protective limping lml 35 Ten-year-old boy with sderal icterus llm 36 Fifteen-month-old child with an abrasion and no tetanus vaccination llm 37 Fifteen-year-old girl found unconscious with hypothermia llill 38 Two-year-old child who has ingested an unknown fluid llill 39 Five-day-old newborn with icterus and sucking weakness IE.m 40 Three-year-old girl refusing to eat lml 41 Newborn with morphological abnonnalities llm 42 Two siblings with itching and eczematous changes on the skin of the neck and head 11!11 43 Consultation regarding •sudden infant death syndrome" (SIDS) I =D ifficult case IEll 44 Five-year-old boy with high fever and abdominal pain lml 45 Four-year-old boy with recurrent urinary tract infections ll'm 46 Seven-year-old boy with pneumonia and bone pain llm 47 Four-year-old boy with fever and exanthema IEll 48 Four-year-old girl with facial swelling ll'Ill 49 Five-year-old girl with pale skin and splenomegaly llm 50 Seven-year-old girl with headaches and abnormal behavior lml 51 Four-year-old boy with pain in right lower abdomen llm 52 Three-year-old girl with protective posture of right arm !IEll 53 Ten-year-old boy with tingling paresthesia, speech disorder, and headache VIII llm 54 Sixteen-month-old boy with undescended testis llDI 55 Eight-year-old boy with abdominal pain and weight loss llm 56 Premature birth in the 28th week of pregnancy with shortness of breath and abdominal pain on pressure lml 57 Five-year-old boy with intense abdominal pain IEll 58 Two-year-old boy with a high fever, rash, and swollen joints IEll 59 Four-month-old screaming infant with inguinal swelling IEll 60 Nineteen-month-old girl with bloody diarrhea, hematomas, and anuria !lctlll 61 Newborn with persistent cyanosis ll'm 62 Four-year-old boy with rattling breath and hypersalivation llDI 63 Six-year-old boy with failure to thrive and recurrent pulmonary infections llDI 64 Fourteen-year-old girl who collapsed on a school trip 11'!11 65 Three-year-old boy with deteriorating general condition and gastroenteritis 11.m 66 Healthy newborn delivered by cesarean section llm 67 Eleven-year-old boy with high fever and joint pain ll'm 68 Newborn boy with conspicuous genitals II.Ill 69 Six-year-old girl with abnormal appearance llm 70 Premature baby with acute deterioration of general condition I =D ifficult Case