Study Notes
– PediatricsJames
Lamberg 28Jul2010D
O NOT DISTRIBUT
E - 2 -treatment). For
presentation of well-
child visits, cover all
the bases, but focus
on the patients’
concerns and
yourfindings. There
are specific issues to
discuss depending
on the age of
the child. Past history
and development
isimportant, but so is
anticipatory
guidance–prevention
and expectations for
what is to come.
The goal is to
be bothefficient and
thorough.
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Top 100 Secrets –
Pediatric Secrets
(4th, Polin & Ditmar)
1) Methods to
increase compliance
by adolescents with
medical regimens
include the following:
simplifying
theregimen, making
the
patient responsible,
discussing potential
side effects, using
praise liberally, and
educating
the patient.2) A pelvic
examination is
not required before
prescribing oral
contraceptives for
teenagers without risk
factors.Appropriate
screening for sexually
transmitted diseases
and possible cervical
dysplasia can be
scheduled,
butdelaying oral
contraception
unnecessarily
increases the risk of
pregnancy.3)
Emergency
contraception should
be discussed with all
sexually active
adolescents; 90%
of teenage
pregnanciesare
unintended.4)
Teenagers with
attention deficit
hyperactivity disorder
(ADHD) and conduct
disorders are at high
risk forsubstance
abuse disorders.
Substance abuse is
often associated
with comorbid
psychiatric
disorders.5) Calluses
over the
metacarpophalangeal
joints of the index
and/or middle fingers
(Russell sign)
may indicaterepetitiv
e trauma from self-
induced attempts at
vomiting in patients
with
eating disorders.6)
Appreciating that
ADHD is a chronic
condition (like
asthma or diabetes) is
useful for
management
strategies,follow up,
and ongoing
patient/parental
education and
involvement.7)
Although colic is
common and resolves
spontaneously by 3
months, do
not underestimate the
physical
and psychological
impact of
the condition on a
family.8) Bilingual
children develop
speech milestones
normally; two-
language households
should not be
presumed as acause
of speech delay.9)
Most amblyopia is
unilateral; vision
testing solely with
both eyes open is
inadequate.10)
Congenitally missing
or misshapen teeth
can be markers
for hereditary
syndromes.11)
Syncope in a deaf
child should lead
one to suspect
prolongation of the
QT wave on the
electrocardiogram.12)
Bounding pulses in
an infant with
congestive heart
failure should cause
one to consider a
large patient
ductusarteriosus.13)
If a bruit is heard
over the anterior
fontanel in a newborn
with congestive heart
failure, suspect a
systemicarteriovenou
s fistula.14) The chief
complaint in a child
with congestive heart
failure may be
nonspecific
abdominal pain.15)
Diastolic murmurs
are never innocent
and deserve further
cardiac
evaluation.16)
Patients with atypical
Kawasaki disease
(documented by
coronary artery
abnormalities despite
not fulfillingclassic
criteria) are usually
younger (<1 year old)
and most commonly
lack cervical
adenopathy and
extremitychanges.17)
Neonates with
midline lumbosacral
lesions (e.g., sacral
pits, hypertrichosis,
lipomas) should
have screeningimagin
g of the spine
performed to search
for occult spinal
dysraphism.18)
Hemangiomas in
the "beard
distribution" may be
associated
with internal airway
hemangiomas.19)
Infantile acne
necessitates an
endocrine workup to
rule out precocious
puberty.20) If a
child develops
psoriasis for the first
time or has a flare of
existing disease, look
for streptococcal phar
yngitis.21) Look for
associated
autoimmune
thyroiditis in children
who present with
a family history of
thyroid disease
andextensive alopecia
areata or vitiligo.22)
Most cardiac arrests
in children are
secondary
to respiratory arrest.
Therefore, early
recognition of
respiratorydistress
and failure in
children is crucial.23)
Because children are
much more elastic
than adults, beware
of internal injuries
after trauma; these
can occurwithout
obvious
skeletal injuries.24)
Because children get
colder faster than
adults as the result of
a higher ratio of body
surface area to body
mass, besure that
hypothermia is not
compounding
hemodynamic
instability in
a pediatric trauma
patient in shock.25)
Hypotension and
excessive fluid
restriction should be
avoided at all costs in
the child in shock
with severe
headinjury because
such a patient
is highly sensitive to
secondary brain
injury from
hypotension.26) The
most common