Consultant for Pediatricians Vol 5 No 12

ABSTRACT: Because the clinical diagnosis of influenza can be difficult, pediatricians often turn to rapid antigen tests to confirm a clinical suspicion of influenza. However, keep in mind that the predictive values of such tests vary with disease prevalence; despite the favorable sensitivity and specificity of most such tests, their positive predictive value is relatively low early and late in the influenza season. In addition, to gauge the predictive accuracy of a test in a particular setting, consider the degree of clinical suspicion as well as the frequency of influenza in the community at that time. Rapid influenza tests are most often helpful when the likelihood of influenza is intermediate (ie, in the early phase of influenza season when there is very strong clinical suspicion or during the peak of the season when there is moderate clinical suspicion).

An almost 7-year-old girl was referred to Child Protective Services for evaluation of suspected sexual abuse after a school nurse noticed marks on her neck (Figure). The nurse was concerned that the marks were "hickeys," or suction marks, made by another person's mouth.

We, as physicians, complain about patients not following our advice and not listening to us. We should not forget that they are listening, that our words are not ignored, and that therefore, they should be well chosen.

A 16-year-old boy complains of an itchy scalp and areas of hair loss. Physical examination reveals a 2- to 3-cm patch of alopecia studded with black dots, as well as posterior cervical and occipital lymphadenopathy.

The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2Z\x weeks earlier, when he was hit in the face by a baseball. The sharply defined, slightly elevated, pink macule had fine papules with an annular flat area at its inferior central aspect. A potassium hydroxide preparation of scrapings from the lesion was negative for hyphae. However, fungus culture grew Cladosporium species.

Photoclinic: Langerhans Cell Histiocytosis

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.

A 16-year-old girl presented to the emergency department (ED) with a 24-hour history of feeling tired and weak. The patient reported that she awoke that morning with the "worst headache of her life" and "passed out" while sitting on the edge of her bed. She did not tell her friends or family.

What should primary care pediatricians do--and what should we not do--when we encounter a patient with newly diagnosed diabetes?

A 12-year-old girl presents with a 1-year history of itchy lesions on her right leg. The lesions are worse during the winter. She has a history of atopic dermatitis and asthma.

Lately, the media has been riddled with news about a recent study pertaining to brainstem abnormalities in sudden infant death syndrome (SIDS). How pertinent are the findings to your everyday practice? Should this study change the anticipatory guidance that you provide to new parents?

Patient delivered vaginally at term to a G2P1 24-year-old mother following an uncomplicated pregnancy. Apgar scores, 7 and 9 at 1 and 5 minutes, respectively. No history of maternal exposure to teratogens. Parents non-consanguineous. No family history of congenital or chromosomal abnormality.

An 8-year-old boy whose family had recently immigrated from Southeast Asia was brought to the emergency department (ED) with a well-demarcated, pruritic rash that had appeared on his face 6 weeks earlier. At that time, the patient's primary care physician had diagnosed Fifth disease. As the rash spread to the child's arms and back, atopic dermatitis was considered. The week before presentation in the ED, the rash had become more inflamed and pruritic and was accompanied by fevers.