100 Cases in Paediatrics Second edition 100 Cases in Paediatrics Second edition Ronny Cheung BMBCh MA MRCPCH PgDipMedEd Consultant Paediatrician, Evelina Children’s Hospital, London, UK Aubrey Cunnington PhD FRCPCH DTM&H Clinical Senior Lecturer and Honorary Consultant in Paediatric Infectious Diseases, Imperial College, London, UK Simon Drysdale BSc (Hons), MBBS, MRCPCH, PhD, PgDip PID NIHR Academic Clinical Lecturer and Honorary Specialty Registrar in Paediatric Infectious Diseases, Oxford University, and The Children’s Hospital, Oxford, UK Joseph Raine MD FRCPCH DCH Consultant Paediatrician, Whittington Hospital NHS Trust, London, UK Joanna Walker BA FRCP FRCPCH Consultant Paediatrician, Portsmouth Hospitals NHS Trust, Portsmouth, UK 100 Cases Series Editor: Janice Rymer MBBS FRACP Professor of Obstetrics & Gynaecology and Dean of Student Affairs, King’s College London School of Medicine, London, UK Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2017 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper Version Date: 20161208 International Standard Book Number-13: 978-1-4987-4723-3 (Paperback) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com To Elaine, Katie and Ben; Marianne, Amelie and Elise; Carolyn, Daniel and Conor; Eva, Isabella and Thomas CONTENTS Preface xi Acknowledgements xiii Abbreviations xv Normal values xvii Respiratory Case 1: An infant with noisy breathing 1 Case 2: A child with noisy breathing 3 Case 3: A chesty infant 7 Case 4: A chronic cough 11 Case 5: Recurrent chest infections 13 Case 6: A wheezy teenager 17 Case 7: A wheezy child 21 Case 8: Fever and breathlessness 23 Case 9: A teenager with chest pain 27 Cardiology Case 10: A cyanosed newborn 29 Case 11: A shocked neonate 31 Case 12: A pale, breathless baby 33 Case 13: An incidental murmur 37 Case 14: A funny turn 41 Endocrinology and diabetes Case 15: A thirsty boy 45 Case 16: A tall boy 49 Case 17: A short girl 51 Case 18: An overweight boy 55 Case 19: A girl with early puberty 58 Case 20: A boy with delayed puberty 61 Case 21: Is it a boy or a girl? 63 Case 22: A boy with breasts 65 Case 23: A boy with bow legs 67 Case 24: A girl with neck swelling 71 vii Contents Gastroenterology Case 25: A vomiting infant 75 Case 26: A child with bloody diarrhoea 77 Case 27: A teenager with chronic diarrhoea 81 Case 28: Acute diarrhoea and vomiting 85 Case 29: Acute abdominal pain 89 Case 30: Recurrent abdominal pain 91 Case 31: A constipated toddler 95 Case 32: An infant with poor weight gain 98 Case 33: Abdominal pain and jaundice 103 Case 34: A lump in the groin 105 Nephrology Case 35: Abdominal pain and dysuria 109 Case 36: Red urine 111 Case 37: A puffy face 115 Case 38: A bed wetter 119 Case 39: High blood pressure 121 Infectious diseases Case 40: Fever in a returning traveller 125 Case 41: A persistent fever 127 Case 42: Recurrent infections 129 Case 43: Unexplained weight loss 131 Case 44: Hot but cold 135 Dermatology Case 45: An itchy rash 139 Case 46: Deteriorating eczema 142 Case 47: An infant with blisters 145 Case 48: A purpuric rash 148 Haematology Case 49: A pale child 153 Case 50: Easy bruising 157 Case 51: A child with chest pain 161 Oncology Case 52: An abdominal mass 165 Case 53: An unsteady child 167 viii Contents Case 54: Lymphadenopathy 171 Case 55: A swollen shoulder 175 Case 56: Fever in a patient on chemotherapy 179 Case 57: Aches and pains 183 Bones and joints Case 58: A girl with a limp 187 Case 59: Pain and fever 191 Case 60: Swollen joints 195 Case 61: A spinal deformity 199 Neurology Case 62: A fitting child 202 Case 63: A febrile, drowsy child 207 Case 64: A child in a coma 210 Case 65: A late walker 215 Case 66: A child with learning difficulties 217 Case 67: Chronic headaches 219 Case 68: A funny smile 223 Case 69: Weak legs 225 Case 70: Developmental regression 229 Case 71: A deaf boy 233 Case 72: A child with a squint 237 Child and adolescent psychiatry Case 73: A boy with no friends 241 Case 74: A hyperactive child 243 Case 75: A teenager who will not eat 245 Neonatology Case 76: Born too early 247 Case 77: A breathless newborn 251 Case 78: Recurrent apnoeas 253 Case 79: A sudden collapse in a ventilated preterm neonate 256 Case 80: Bilious vomiting in a neonate 259 Case 81: A jaundiced neonate 261 Case 82: A floppy infant 265 Case 83: A difficult delivery 267 Case 84: A newborn with congenital abnormalities 271 ix