Pediatrics

SECOND EDITION

Editors

Lloyd J. Brown, MD, FAAP

Professor and Vice Chair of Education and Integrated Care

Palo Alto Medical Foundation

Palo Alto, California

Adjunct Clinical Associate Professor of Pediatrics

Stanford School of Medicine

Stanford, California

Ryan J. Coller, MD, MPH, FAAP

Chief, Division of Pediatric Hospital Medicine Assistant Professor of Pediatrics

University of Wisconsin School of Medicine and Public Health Madison, Wisconsin

Lee Todd Miller, MD, FAAP

Associate Dean for Student Affairs

Professor of Pediatrics

Director, Global Health Education Programs

David Geffen School of Medicine at UCLA

Los Angeles, California

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Contents

Cover image

Title page

Copyright

Dedication

Preface

Acknowledgments

Contributors

Contributors to the Previous Edition

Chapter 1 Pediatric Health Supervision

I. Well-Child Care—General Concepts

II. Growth

III. Immunizations

IV. Well-Child Screening

V. Circumcision

VI. Pediatric Dental Care

VII. Developmental Screening

VIII. Anticipatory Guidance

Review Test

Answers and Explanations

Chapter 2 Behavioral and Developmental Pediatrics

I. Normal Developmental Milestones

II. Disorders of Development

III. Specific Sensory Impairments

IV. Common Behavioral Concerns

Review Test

Answers and Explanations

Chapter 3 Adolescent Medicine

I. Adolescent Growth and Development

II. Adolescent Health Screening

III. Depression and Suicide

IV. Substance Abuse

V. Obesity and Eating Disorders

VI. Female Reproductive Health Issues

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VII. Sexually Transmitted Infections (STIs)

VIII. Menstrual Disorders

IX. Reproductive Health Issues in Males

Review Test

Answers and Explanations

Chapter 4 Neonatology

I. Evaluation of the Newborn

II. Abnormalities of Maturity

III. Growth Abnormalities

IV. Cyanosis

V. Respiratory Distress

VI. Respiratory Distress Syndrome (RDS)

VII. Meconium Aspiration Syndrome (MAS)

VIII. Persistent Pulmonary Hypertension of the Newborn (PPHN) IX. Apnea of Prematurity

X. Neonatal Jaundice

XI. Fetal Exposure to Drugs of Abuse

XII. Surgical Conditions of the Newborn

XIII. Hypoglycemia

XIV. Infants of Diabetic Mothers (IDMs)

XV. Polycythemia

Review Test

Answers and Explanations

Chapter 5 Genetic Disorders and Inborn Errors of Metabolism

I. Inheritance Patterns

II. Types of Genetic Tests

III. Fetal Evaluation and Prenatal Diagnosis

IV. Common Genetic Disorders

V. General Concepts of Inborn Errors of Metabolism (IEM) VI. Defects in Amino Acid Metabolism

VII. Defects of Carbohydrate Metabolism

VIII. Fatty Acid Oxidation Disorders

IX. Lysosomal Storage Diseases

X. Mitochondrial Disorders

XI. Disorders of Metal Metabolism

Review Test

Answers and Explanations

Chapter 6 Endocrinology

I. Short Stature

II. Disorders of Puberty

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III. Disorders of Sexual Differentiation (DSD or Formerly Known as Ambiguous Genitalia) IV. Disorders of the Adrenal Gland

V. Diabetes Mellitus

VI. Type 1 Diabetes Mellitus (Type 1 DM)

VII. Type 2 Diabetes Mellitus (Type 2 DM)

VIII. Diabetic Ketoacidosis (DKA)

IX. Thyroid Disorders

X. Bone Mineral Disorders

XI. Diabetes Insipidus (DI)

XII. Hypoglycemia

Review Test

Answers and Explanations

Chapter 7 Infectious Diseases

I. General Approach to the Child With Possible Infection

II. Evaluation of the Child With Fever

III. Fever of Unknown Origin (FUO)

IV. Meningitis

V. Upper Respiratory Infections

VI. Middle and Lower Respiratory Infections

VII. Cervical Lymphadenitis

VIII. Parotitis

IX. Skin and Soft Tissue Infections

X. Bone and Joint Infections (see Chapter 17, section III.B)

XI. Diarrhea

XII. Urinary Tract Infections (see Chapter 11, section XIV)

XIII. Specific Viral Infections

XIV. Specific Fungal Infections

XV. Specific Parasitic Infections

XVI. Specific Helminth Infections

XVII. Miscellaneous Infections

Review Test

Answers and Explanations

Chapter 8 Cardiology

I. Congestive Heart Failure (CHF)

II. Innocent Cardiac Murmurs

III. Acyanotic Congenital Heart Disease

IV. Cyanotic Congenital Heart Disease

V. Acquired Heart Disease

VI. Dysrhythmias

VII. Chest Pain

Review Test

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Answers and Explanations

Chapter 9 Pulmonology

I. Anatomy and Physiology of the Respiratory System

II. Clinical Assessment of Pulmonary Disease

III. Infectious Disorders of the Respiratory Tract

IV. Noninfectious Disorders of the Respiratory Tract

Review Test

Answers and Explanations

Chapter 10 Gastroenterology

I. Nutrition

II. Malabsorption

III. Gastroesophageal Reflux

IV. Intestinal Anatomic Obstructions That Result in Vomiting V. Acute Abdominal Pain

VI. Chronic Abdominal Pain

VII. Constipation

VIII. Diarrhea

IX. Inflammatory Bowel Disease (IBD)

X. Gastrointestinal Bleeding

XI. Liver Abnormalities and Hepatitis

Review Test

Answers and Explanations

Chapter 11 Nephrology and Urology

I. Fluids, Electrolytes, and Dehydration

II. Hematuria

III. Proteinuria

IV. Hypertension

V. Glomerulonephritis

VI. Nephrotic Syndrome (NS)

VII. Hemolytic Uremic Syndrome (HUS)

VIII. Hereditary Renal Diseases

IX. Renal Tubular Acidosis (RTA)

X. Acute Kidney Injury

XI. Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) XII. Structural and Urologic Abnormalities

XIII. Urolithiasis

XIV. Urinary Tract Infection (UTI)

Review Test

Answers and Explanations

Chapter 12 Neurology

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I. The Hypotonic Infant

II. Hydrocephalus

III. Spina Bifida

IV. Approach to the Comatose Patient

V. Seizure Disorders of Childhood

VI. Headaches in Childhood

VII. Approach to Unsteady Gait

VIII. Movement Disorders

IX. Duchenne and Becker Muscular Dystrophies (DMD, BMD) X. Myasthenia Gravis

Review Test

Answers and Explanations

Chapter 13 Hematology

I. Anemia

II. Pancytopenia and Aplastic Anemia

III. Polycythemias

IV. Disorders of Hemostasis

V. Neutropenia

Review Test

Answers and Explanations

Chapter 14 Oncology

I. General Considerations

II. Leukemias

III. Lymphomas

IV. Brain Tumors

V. Renal and Suprarenal Tumors

VI. Soft Tissue Tumors

VII. Bone Tumors

VIII. Liver Tumors

IX. Retinoblastoma

X. Germ Cell Tumors (Germinomas)

XI. Langerhans Cell Histiocytosis (LCH)

Review Test

Answers and Explanations

Chapter 15 Allergy and Immunology

I. Anaphylaxis

II. Allergic Rhinitis

III. Atopic Dermatitis

IV. Food Allergy

V. Insect Venom Allergy

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VI. Urticaria (Hives)

VII. Drug Allergy

VIII. Asthma

IX. Immunology Overview

X. Disorders of Lymphocytes (Figure 15-2)

XI. Disorders of Granulocytes (Figure 15-3)

XII. Disorders of the Complement System

Review Test

Answers and Explanations

Chapter 16 Rheumatology

I. Henoch–Schönlein Purpura (HSP)

II. Kawasaki Disease (KD)

III. Juvenile Idiopathic Arthritis (JIA)

IV. Systemic Lupus Erythematosus (SLE)

V. Juvenile Dermatomyositis (JDM)

VI. Rheumatic Fever

VII. Lyme Disease

VIII. Other Rheumatologic Conditions of Childhood

Review Test

Answers and Explanations

Chapter 17 Orthopedics

I. Upper Extremity

II. Spine

III. Hip

IV. Lower Extremity

V. Common Fractures

Review Test

Answers and Explanations

Chapter 18 Ophthalmology

I. Ocular Examination and Vision Screening II. Normal Visual Development and Amblyopia III. Conjunctivitis and Red Eye

IV. Abnormal Tearing

V. Ocular Trauma

VI. Congenital Glaucoma

VII. Retinopathy of Prematurity (ROP)

VIII. Leukocoria

IX. Strabismus

Review Test

Answers and Explanations

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Chapter 19 Dermatology

I. General Concepts

II. Newborn Skin Diseases

III. Inflammatory Disorders

IV. Hypersensitivity Disorders

V. Infections of the Skin

VI. Pigmentary Disorders

VII. Disorders of the Hair

VIII. Acne Vulgaris

IX. Vascular Skin Lesions

Review Test

Answers and Explanations

Chapter 20 Emergency Medicine

I. Infant and Child Cardiopulmonary Resuscitation (CPR)

II. Shock

III. Trauma

IV. Burns

V. Drowning

VI. Child Abuse

VII. Sudden Infant Death Syndrome (SIDS)

VIII. Poisonings

IX. Mammalian Bites

X. Biologic Poisonings (Venoms)

Review Test

Answers and Explanations

Index

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Copyright

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Second edition

Copyright © 2019 Wolters Kluwer

Copyright © 2005 Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com or via our website at shop.lww.com (products and services).

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Printed in China

Library of Congress Cataloging-in-Publication Data

Names: Brown, Lloyd J., editor. | Coller, Ryan, editor. | Miller, Lee T. (Lee Todd) editor.

Title: Pediatrics / Lloyd J. Brown, FAAP, Regional Chair of Pediatrics, Palo Alto Division, Palo Alto Medical Foundation, Palo Alto, California, Adjunct Clinical Associate Professor of Pediatrics, Stanford School of Medicine, Stanford, California, Ryan J. Coller, MD, MPH, FAAP, Chief, Division of Pediatric Hospital Medicine, Assistant Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, Lee Todd Miller, MD, FAAP, Associate Dean for Student Affairs, Professor of Pediatrics, Director, Global Health Education Programs, David Geffen School of Medicine at UCLA, Los Angeles, California. Description: Second edition. | Philadelphia : Wolters Kluwer, [2019] | Series: Board review series.

Identifiers: LCCN 2018014018 | ISBN 9781496309754 (paperback)

Subjects: LCSH: Pediatrics—Examinations, questions, etc. | BISAC: MEDICAL / Pediatrics

Classification: LCC RJ48.2 .P385 2019 | DDC 618.9200076—dc23 LC record available at https://lccn.loc.gov/2018014018

This work is provided “as is,” and the publisher disclaims any and all warranties, expressed or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon health care professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data, and other factors unique to the patient. The publisher does not provide medical advice or guidance, and this work is merely a reference tool. Health care professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made, and health care professionals should consult a variety of sources. When prescribing medication, health care professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings, and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, is infrequently used, or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.

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Dedication

To Bobbie, for her love, support, and laughter and for being a truly wonderful mother to our son; to Danny, the sunshine and pure joy of my life; and to my family and friends for their ongoing love and friendship.

Lloyd Brown

To Karen, Olivia, and Penelope, for providing me with life’s true education, day after day. To my parents, siblings, and close friends, for believing more in me than I ever could myself.

Ryan Coller

To Kai, the rest of my family, and my dear friends, for their unwavering support, encouragement, and love, and to my mother, who was excited and very proud of this project and others at her 90th birthday celebration, with much love from Lee.

Lee Miller

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Preface

We created this text to provide medical students and physicians with a comprehensive, yet hopefully very manageable, overview of the basic principles of pediatric medicine.

It is our great hope that medical students on their core pediatric clerkships, senior students on pediatric subinternships and pediatric subspecialty rotations, and students or physicians studying for the USMLE Step 2 examination will gain a strong foundation in pediatrics, on which to build their subsequent learning in both primary care and subspecialty pediatrics.

We have created case-based review questions at the end of each chapter to emphasize key takehome points and to help the reader to assess his or her understanding of each chapter’s contents. The review questions are followed by answers and detailed explanations for both the correct and incorrect choices. Cross-references to the text appear in square brackets.

There is also a comprehensive 150-question examination at the end of the text to provide the reader with a self-assessment tool and additional review of the primary care and subspecialty areas covered in this text. Similar to the chapter review tests, the comprehensive examination includes detailed explanations for both the correct and incorrect choices.

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