Schwartz's Clinical Handbook of Pediatrics by Dr. Joseph J. Zorc MD MSCE, Dr. Elizabeth R. Alpern MD

By Dr. Joseph J. Zorc MD MSCE, Dr. Elizabeth R. Alpern MD MSCE, Dr. Lawrence W. Brown M.D., Kathleen M. Loomes MD, Bradley S. Marino MD MPP MSCE, Dr. Cynthia J. Mollen MD PhD, Dr. Leslie J. Raffini MD MSCE

Prepared through leader grievance, this finished, pocket-sized guide for clinical scholars and citizens covers the prognosis and administration of greater than eighty universal difficulties present in kids, concentrating on indicators, differential prognosis, laboratory overview, and numerous cures for every challenge. scholars and citizens word that the key strengths of this publication are its clarity and straightforwardness of use. It comprises the ideal volume of aspect and emphasizes high-yield issues that seem on end-of-rotation and in-service checks and very is helping direct one's pondering procedure.

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Figure 3-3 Gesell figures used to assess visual-motor skills. Children are capable of drawing progressively more complex shapes. LABORATORY EVALUATION Genetic Testing In the etiologic workup of children with developmental delay or mental retardation, a comparative genomic hybridization (CGH) array analysis and Fragile X testing should be performed. If CGH testing is normal, then routine karyotyping to detect balanced translocations should be considered. Additional genetic testing includes testing for the MECP2 mutation in girls with severe delays (see Chapter 4, "Developmental Disabilities").

Determining Hearing Acuity Determining hearing acuity clinically is difficult in babies and young children. 20 paper behind each ear. Check to see if the child is startled by the sound (usually by age 1 month) or looks toward the source of the sound (by about age 5 months). HINT: One helpful approach to determining hearing acuity in infants and young children is simply to ask the parents. NOSE Check the nasal mucosae. Pale, boggy mucosae with a watery discharge suggest allergy, whereas hyperemic mucosae with a mucopurulent discharge suggest infection.

Decreased breath sounds suggest decreased air exchange. It is important to evaluate air movement because a patient with severe asthma can have such overwhelming obstruction that no wheezing is heard. The patient with severe asthma but no wheezing may be in impending respiratory failure! HINT: Breath sounds tend to be harsher sounding (more bronchial) in children (as compared with adults) because the thinner chest wall of the child does not muffle the breath sounds as much. Chest Sounds Identify adventitious chest sounds: Rales are fine crackles, usually heard best at the end of inspiration, that generally reflect the presence of fluid or exudate in the alveoli.

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