100 Cases in Paediatrics by Ronny Cheung, Aubrey Cunnington, Simon Drysdale, Joseph

By Ronny Cheung, Aubrey Cunnington, Simon Drysdale, Joseph Raine, Joanna Walker

The recent version of this best-selling identify from the preferred a hundred instances sequence explores universal paediatric situations that might be encountered via the clinical pupil and junior health care provider in the course of sensible education at the ward, within the emergency division, in outpatient clinics and locally, and that are more likely to function in qualifying examinations. The publication covers a accomplished variety of displays from cough to constipation, equipped through sub-specialty sector for ease of reference. accomplished solutions spotlight key take domestic issues from each one case and supply useful recommendation on the way to take care of the demanding situations that ensue while training paediatric drugs in any respect degrees.

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If still abnormal, consider an inhaled foreign body Respiratory KEY POINTS • A lower lobe pneumonia should always be considered in the differential diagnosis of an acute abdomen in children. • ‘Vaccine failures’ should be investigated for an underlying immune problem. 25 This page intentionally left blank CASE 8: A TEENAGER WITH CHEST PAIN History Fabio is a 13-year-old boy who presents to outpatients with a 6-month history of chest pain. The pain can occur at rest or on exercise and is central with no radiation.

The apex beat is in the fifth intercostal space in the mid-clavicular line. Both heart sounds are present but the pulmonary component of the second sound is quiet. There is a click immediately after the first heart sound and an ejection systolic murmur which is heard loudest in the pulmonary area. This radiates into both lung fields and is heard in the back between the scapulae. Examination of the respiratory and abdominal systems is normal with no hepatomegaly. 1. 1 Lola’s electrocardiogram. Questions • Why did the GP bring her back to listen again?

15 100 Cases in Paediatrics ANSWER 5 The chest radiograph shows consolidation with some collapse of the left lower lobe and further consolidation in the right middle lobe. There are small bilateral pleural effusions. These features are consistent with the clinical diagnosis of pneumonia. The combination of clubbing and recurrent chest infections is strongly suggestive of cystic fibrosis (CF). This is the commonest cause of clubbing in children in the UK. Normal immunoglobulins exclude antibody deficiencies such as X-linked hypogammaglobulinaemia.

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