oN a 60 Cases to excel on the boards and wards USMILE - style review questions Award-winning learning system Proven to increase shelf-exam scores LANGEeee eS Eugene C. Toy,MD " Rebecca G . Giradet, MO * Mark D. Hormann, MID See ete ey Ce iL eek aa) Mes euec sou MeMN (Si TO) SSSING Sar aN iS meee sie Ol iia WAS SI Re a ee noo eee Rec Tuto SCS Ce ee Oe ee een Rec Rect in pediatrics. Perfect for the clerkship and the USMLE Step 2, each case includes an extended discussion, definitions of key terms, clinical pearls, and USMLE-style review questions. This interactive learning system helps you to eS oct eae CO geen ck ect CUS nm Se ee une Me ae ane UR ee ey en tn Cu ees ese sy " Superior to other case file books." - Chang-Kun Choi, Medical Student, Midwestern Universty School of Medicine "Using clinical scenarios not only makes the reading fun and interesting, but it is far more engaging than sitting down with a bulleted text and reviewing detail after detail. This is a much better way to learn clinical information. | have not read a book like this before, and | certainly ce nae Sm ue er a a rd “ILOVED this book! | would recommended This book to all third-year students...The book uses a clinical approach and does not lose sight of the pathophysilogy behind the disease-GREAT preparation for being on the wards! The subject matter is also deceptively detailed, with much more information than one normally finds in a text of case files. The reader can use this book as either a rigorous self-test or a read-through introduction to the subject. One again - a GREAT text!" eS ees UCL TTR LL CLR ALAR LaeCase Files: PediatricsNOTICE Medicine is an ever-changing science. As new research and clinical experi- ence broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the editors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged tu confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product infor- mation sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindica- tions for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.Case Files: Pediatrics > EUGENE C. TOY, MD The John S. Dunn, Senior Academic Chief Obstetrics/Gynecology Residency Program Christus-St. Joseph Hospital’ Ob/Gyn Residency Program Clerkship Director, Assistant Clinical Professor Department of Obstetrics and Gynecology University of Texas—Houston Medical School Houston, Texas MARK D. HORMANN. MD Assistant Professor of Pediatrics Director. Medical Student Clerkship Division of Community: and General Pediatrics Department of Pediatrics Universiny of Texas— Houston Medical School Houston, Texas MARGARET © McNEESE, MD Professor of Peduatries associate Dean of Snudent Affairs Division of Community and General Pediatrics Department of Pediatrics University of Texas-—Houston Medical School Houston, Texas REBECCA G. GIRARDET, MD Assistant Professor of Pediatrics Division of Community and General Pediatrics Department of Pediatrics University of Texas—Houston Medical School Houston, Texas SHEELA L. LAHOTI, MD Assistant Professor of Pediatrics Division of Community and General Pediatrics Department of Pediatrics University of Texas—Houston Medical School Houston, Texas DEBORAH K. PARKS, DSN, RN, PNP Associate Professor of Pediatrics Director, Division of Nurse Practitioners Department of Pediatrics University of Texas—Houston Medical School Houston, Texas ROBERT J. YETMAN, MD Professor of Pediatrics Director, Division of Community and General Pediatrics Department of Pediatrics University of Texas—Houston Medical School Houston, Texas ° McGraw-Hill PROFESSIONAL New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Dethi San Juan Seoul Singapore Sydney ToronteCase Files: Pediatrics Copyright € 2004 by the McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means. or stored in a data base or retrieval system. without the prior written permission of the publisher. 1234567890 DOCMDOC 09876543 ISBN 0-07-141016-3 This book was set in Times New Roman by ATLIS Graphics and Design. ‘The editors were Catherine A. Johnson and Karen G. Edmonson, ‘The production supervisor was Rick Ruzycka. The cover designer was Mary McKeon. ‘The index was prepared by Pamela Edwards. RR Donnelley was printer and binder. This book is printed on acid-free paper. Library of Congress Cataloging-in-Publication Data Clinical cases. pediatrics / Eugene C. Toy, ..fet al} pom. Includes bibliographical references and index, ISBN 0-07-141016-3 (alk. paper) 1, Pediatrics—Problems. exercises, etc. 2. Pediatrics—Case studies. I. Title. Pediatrics. IL. Toy, Eugene C {DNLM: 1. Pediatrics—-Case Report. 2. Pediatrics—Problems and Exercises. WS 18.2 C641 2003} JAK 2.0537 2003 G18 92°009—de21 2003048777To my father-in-law J. Yen (Tommy) Ligh, whose: inventive genius and sense of humor is infectious, and in loving memory of Lillie Woo Ligh, my mother-in-law whose grace and beauty continue to shine. —ECT@ CONTENTS INTRODUCTION xi-xiii SECTION I How to Approach Clinical Problems il Approaching the Patient 3 Approaching Clinical Problem Solving 11 Approaching Reading 14 SECTION II Clinical Cases 21 Sixty Case Scenarios 23 SECTION III Listing of Cases 603 Listing by Case Number 605 Listing by Disorder (Alphabetical) 606<& CONTRIBUTORS Eugene C. Toy, MD The John S. Dunn, Senior Academic Chair Christus St. Joseph Hospital Ob/Gyn Residency Program Clerkship Director, Assistant Clinical Professor Department of Obstetrics and Gynecology University of Texas-Houston Medical School Houston, Texas Rebecca G. Girardet, MD Assistant Professor of Pediatrics Division of Community and General Pediatrics Department of Pediatrics : University of Texas-Houston Medical Schoo! Houston, Texas Mark D. Hormann, MD Assistant Professor of Pediatrics Director, Medical Student Clerkship Division of Community and General Pediatrics Department of Pediatrics University of Texas-Houston Medical School Houston, Texas Sheela L. Lahoti, MD Assistant Professor of Pediatrics Division of Community and General Pediatrics Department of Pediatrics ersity of Texas-Houston Medical School Houston, Texas Margaret C. McNeese, MD + Professor of Pediatrics Associate Dean of Student Affairs Division of Community and General Pediatrics Department of Pediatrics University of Texas-Houston Medical Schoo! Houston, TexasCONTRIBUTORS, Deborah K. Parks, DSN, RN, PNP Associate Professor of Pediatrics Director, Division of Nurse Practitioners Department of Pediatrics University of Texas-Houston Medical School Houston, Texas Robert J. Yetman, MD Professor of Pediatrics Director, Division of Community and General Pediatrics Department of Pediatrics University of Texas-Houston Medical School Houston, Texasra INTRODUCTION Mastering the cognitive knowledge within a field such as pediatrics is a formidable task. It is even more difficult to draw on that knowledge, procure and filter through the clinical and laboratory data, develop a differential diagnosis, and finally form a rational treatment plan. To gain these skills, the student often learns best at the bedside, guided and instructed by experienced teachers, and inspired toward self- directed, diligent reading. Clearly, there’ is no replacement for educa- tion at the bedside. Unfortunately, clinical situations usually do not encompass the breadth of the specialty. Perhaps the best alternative is a carefully crafted patient case designed to simulate the clinical approach and decision-making.-In an attempt to achieve that goal, we have constructed a collection of clinical vignettes to teach diagnostic or therapeutic approaches relevant to pediatrics. Most impor- tantly, the explanations for the cases emphasize the mechanisms and underlying principles, rather than merely rote questions and answers. This book is organized for versatility: it allows the student “in a rush” to go quickly through the scenarios and check the corresponding answers, while allowing the student who wants thought-provoking explanations to go at a more measured pace. The answers are arranged from simple to complex: a summary of the pertinent points, the bare answers, an analysis of the case, an approach to the topic, a compre- hension test at the end for reinforcement and emphasis, and a list of resources for further reading. The clinical vignettes are purposely placed in random order to simulate the way that real patients present to the practitioner. Section IIT includes a listing of cases to aid the stu- dent who desires to test his or her knowledge of a certain area, or who wants to review a topic, including basic definitions. Finally, we inten- tionally did not primarily use a multiple choice question format because clues (or distractions) are not available in the real world. Nevertheless, several multiple choice questions are included at the end of each scenario to reinforce concepts or to introduce related topics. HOW TO GET THE MOST OUT OF THIS BOOK Each case is designed to simulate a patient encounter with open-ended questions. At times, the patient’s complaint is different from the most