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ScrofulaA 16-year-old Asian American girl presented for evaluation of a cyst on the anterior neck that had become enlarged and inflamed over the past 9 months. She also had a productive cough for 1 month. There was no history of night sweats, weight loss, or fever.
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Photoclinic: RingwormA 5-year-old boy, who lives on a farm and routinely plays with his pet dogs, presented with these scaly, inflamed macules with a central clearingon the abdomen (A) and forehead.
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ADHD: Answers to Questions Physicians Often AskThere are many exciting new studies of the biologic basis of ADHD that use neuroimaging and genetic testing. However, none of these methods can reliably diagnose this complex disorder. Someday, these technologies will be used to help subtype ADHD and improve treatment matching.
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Perianal Pinworms (Enterobiasis)The mother of a 4-year old girl complained that the child had been "pulling at her bottom" for several weeks, presumably imitating her younger brother. Visual inspection of the area revealed the real problem.
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Chronic Bullous Disease of ChildhoodA 4-year-old, previously healthy girl presented to a tertiary care children’s hospital emergency department (ED) with large, tense bullae involving up to 40% of her body surface area. The patient’s parents described a 12-day history of itchy, papulovesicular lesions that had progressed into large blisters.
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Two Missed Cases of Abuse: Lessons LearnedA 7-month-old male infant was brought to the emergency department (ED) by his biological mother, who reported noticing dried blood on the baby's penis and in his mouth. For several hours prior, he had been in the care of her boyfriend. On physical examination, there were severe ecchymoses and petechiae on the penile glans and shaft (Figure 1), ecchymoses on the right side of the soft palate, a laceration of the lingular frenulum, and a 2-cm bruise with dried blood over the right lip.
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Drug Eruptions: The Benign-and the Life-Threatening“Drug rash” is a common pediatric complaint in both inpatient and outpatient settings. This term, however, denotes a clinical category and is not a precise diagnosis. Proper identification and classification of drug eruptions in children are important for determining the possibility of-and preventing progression to-internal involvement. Accurate identification is also important so that patients and their parents can be counseled to avoid future problematic drug exposures.
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ADHD and the Adolescent Driver:ABSTRACT: Adolescent drivers with attention deficit hyperactivity disorder (ADHD) are more likely to be involved in--and to die of--a driving accident than any other cause. The higher occurrence of driving mishaps is not surprising given that the core symptoms of ADHD are inattention, impulsivity, and hyperactivity. Safe driving habits can diminish the risk, however. The first step is to inform patients of the dangers of driving; the significance of adolescence, ADHD, and medication can be underscored in a written "agreement." Strategies to promote safer driving--especially optimally dosed long-acting stimulant medication taken 7 days a week--may be critical. A number of measures lead to safer driving by reducing potential distractions during driving (eg, setting the car radio before driving, no drinking or eating or cell phone use while driving, no teenage passengers in the car for the first 6 months of driving, and restricted night driving).
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Intussusception With a Pathological Lead PointA 4-month-old girl was admitted to a rural hospital with nonbilious vomiting and bloody stools that began the prior evening. The parents reported that the infant had periods of excessive irritability mixed with periods of calm. She had no fever, exposure to illness, or surgical history.
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What Rx Findings Reveal About Teenage Boy’s Elbow PainA 15-year-old boy presents with pain in the medial aspect of his right elbow that began 4 to 6 weeks earlier and progressively worsened.
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Reversibility of TPN-Induced CholestasisA 6-month-old boy was hospitalized because of fever and suspected central line sepsis. He had been receiving total parenteral nutrition (TPN) since shortly after birth following a small-bowel resection, which was performed to repair a midgut volvulus. Abdominal ultrasonographic findings after the procedure were normal. The infant was born at term after an uneventful pregnancy and delivery. Alkaline phosphatase and γ-glutamyl transpeptidase levels were elevated, without hyperbilirubinemia. An ultrasonogram showed hyperhomogeneous and nonhomogeneous echogenicities of the liver, consistent with fatty changes and fibrosis.
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What Caused This Skin Eruption?A 3-month-old infant presented with a 4-week history of a symmetric skin eruption on her face, axillae, distal extremities, and external genitalia. The infant was otherwise healthy, although colicky since birth. She was exclusively breast-fed and had a good appetite. Voiding and stooling patterns were normal. Her growth was appropriate for age.
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Older Man With Weakness and TremorA 71-year-old man presents with stiffness, clumsiness, and a sense of weakness in his left arm. He is concerned that he has had a stroke. What is the most appropriate management strategy?
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Acute Lymphoblastic Leukemia Presenting as Soft Tissue MassFor 3 months, a 9-year-old boy had swelling of the left upper arm. An MRI scan obtained at another facility 1 week after onset showed extensive edema of the soft tissue at the midhumeral level. Laboratory results, including complete blood cell (CBC) count and Lyme titer, were normal.
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Tuberculosis of the Mandibular Bone and Masseter Muscle AbscessThe patient had no recent fevers, cough, or weight loss. His medical history was notable for chronic thrombocytopenia and reactive arthritis, for which he had been hospitalized. His maternal grandmother had systemic lupus erythematosus; his mother had died of congestive heart failure and emphysema.
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Red-Colored StoolThe parents of a 9-month-old boy were concerned about the bright red color of their son's feces. Over the course of an hour, the infant had 3 bowel movements that appeared to the family to be "more blood than stool." He had no fever or emesis and no history of unusual contacts or travel. There had been no change in his diet; he had not been given any dietary supplements, such as iron.
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Botulism: An Unusual Cause of Lethargy and Constipation in a 3-Month-OldA 3-month-old boy was brought to the pediatrician with a 2-day history of "moaning," lethargy, and difficulty in latching on for breast-feeding. The infant had not had a wet diaper for the past 24 hours, and his last bowel movement was more than 48 hours ago.
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ID Q & A: Answers to Infectious Disease Questions Treating Spider Bites: Is Dapsone an Option?Some studies suggest that orally administered dapsone is effective for infections caused by spider bites (eg, brown recluse spiders) in dosages of 4 mg/kg/d for 3 days. Can dapsone be used in children and, if so, at what dosage?
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White Patches on a Young Boy's TrunkA 3-year-old boy with white patches on the trunk first noticed shortly after birth.
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Acute Poisoning: Keys to Zeroing In on the CausePoisons have been a threat to the health and well-being of humankind for millennia. Given the ubiquitous nature of potential poisons, exposure to a toxin should be included in the differential diagnosis of patients with unexplained illnesses or unusual presentations.
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Carbon Monoxide Poisoning: Clues to Unmasking the Great MasqueraderA 14-year-old boy was brought to theemergency department (ED) by paramedicsafter he complained of dizzinessand an episode of falling down earlythat morning when he awoke to go tothe bathroom.
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Photoclinic: Asymmetric Periflexural ExanthemThis day-old, macular, blanching, nonpruritic rash had developed in the right axilla and on the right arm and right side of the trunk of a 3 1/2-year-old boy. He was otherwise asymptomatic. Other physical examination findings were unremarkable.
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Asthma Therapy Complicated by Peters Plus SyndromeThe authors describe the case of a 2-year-old girl with severe persistent asthma whose disease management was complicated by this rare clinical diagnosis.
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Eczema HerpeticumOne week earlier, a 14-month-old girl with a history of eczema was evaluated because of a diffuse rash of excoriated lesions, some of them purulent. She was afebrile. Worsening eczema with secondary infection was diagnosed. Treatment with oral clindamycin was prescribed. At follow-up, the lesions had worsened. The child had multiple excoriated papules, some of which had coalesced into plaques. She also had two 5-mm vesicles on her right shoulder. Eczema herpeticum was diagnosed clinically. Culture of the vesicles later grew herpes simplex virus (HSV).
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An Active 15-Year-Old Girl With a Rash on Both FeetA15-year old girl presented with a rash on both feet that had appeared a month earlier. Initially the rash looked like bruising at the base of both large toenails.
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Hematemesis Caused by Esophageal DuplicationA17-month-old girl was hospitalized 3 weeks earlier because of gagging and retching emesis that contained blood-streaked mucus. Her symptoms persisted and she was transferred to a tertiary care center for further workup.
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Polycystic Ovary Syndrome: Update on the Pros and Cons of Treatment OptionsABSTRACT: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among females of reproductive age. In adolescents, PCOS often manifests with irregular menses, hirsutism, and acne. Despite general agreement that the metabolic derangements of PCOS arise during puberty, the condition is diagnosed more often in adults than in adolescents. Treatment is focused on weight loss, menstrual cycle regulation, and amelioration of physical symptoms. Acute symptoms can be managed with combination oral contraceptives and antiandrogens and potentially with insulin-sensitizing drugs. Lifestyle modification, especially in overweight patients, can reduce symptoms and help prevent long-term health consequences.
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Hypertransaminasemia: A Diagnostic DilemmaA 4-year-old Hispanic boy was referred to our facility because of elevated levels of alanine trans- aminase (ALT) and aspartate transaminase (AST), which were detected during an evaluation of transient abdominal pain while the boy was in Puerto Rico. He was otherwise in perfect health; a review of systems was negative. His past medical history and birth history were noncontributory. Immunizations, including hepatitis B, were up-to-date. The family history was significant for tuberculosis and rheumatoid arthritis.
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Atopic Dermatitis Superinfection Caused by Staphylococcus sciuri and Enterobacter asburiaeThe rash on this 4-week-old girl had appeared 5 days earlier on her face as thickened scales on an erythematous base and subsequently spread to the scalp, shoulder, chest, abdomen, and extremities. A few bullae were noted on the neck and hands. Initial treatment with cephalexin failed to control the rash, and the infant was admitted to the hospital for further evaluation.
