100 Cases in Paediatrics is a medical book that covers all the important topics related to a patient’s medical history and the key findings of a clinical examination as well as together with initial investigation processed data for evaluation. Paediatrics is a fascinating and multifaceted specialty. In addition to treating standard medical conditions that arise in children, it covers neonatology and the premature infant (often seen as ‘other world’ by newcomers to a neonatal intensive care unit), genetics, ethics, child development, protection child and child and adolescent psychiatry. You can download this free medical paediatrics book in pdf with an easy google drive link.
During the brief pediatric ties of medical students, and in the era of dwindling working hours for beginning physicians, exposure to the diverse range of pediatric conditions is limited. In the 100 cases that follow, we have tried to cover most of the key areas in paediatrics. We have addressed problems that arise in different settings, such as primary care, emergency services, pediatric outpatient clinics, pediatric ward, and maternity and neonatal intensive care units. We hope we did it in an interesting way that brings the cases to life.
After reading the case and the questions, the reader should carefully consider their answer and ideally write their thoughts on paper, before looking at the answers on the page. We have also tried to demonstrate how an experienced paediatrician would approach and solve the clinical problem and explain some underlying principles in a way that helps build understanding and knowledge.
Table of Contents
Overview:
| Book Name | 100 Cases in Paediatrics |
| Author | Joseph Raine |
| Edition | 1st |
| Language | English |
| Format | |
| Category | 100 Cases Series |
Topics of this Edition:
100 Cases in Paediatrics by Joseph Raine free pdf has the following topics:
Respiratory
An infant with noisy breathing
A child with noisy breathing
A chesty infant
A chronic cough
Recurrent chest infections
A wheezy teenager
Fever and breathlessness
A teenager with chest pain
Cardiology
A cyanosed newborn
A shocked neonate
A pale, breathless baby
An incidental murmur
A funny turn
Endocrinology and diabetes
A thirsty boy
A tall boy
A short girl
An overweight boy
A girl with early puberty
A boy with delayed puberty
Is it a boy or a girl?
A boy with breasts
A boy with bow legs
Gastroenterology
A vomiting Infant
A child with bloody diarrhea
A teenager with chronic diarrhoea
Acute diarrhea and vomiting
Acute abdominal pain
Recurrent abdominal pain
A constipated toddler
An infant with poor weight gain
An infant with persistent jaundice
Abdominal pain and jaundice
A lump in the groin
Nephrology
Abdominal pain and dysuria
Red urine
A puffy face
A bed wetter
High blood pressure
Infections
Fever and a rash
Fever in a returning traveler
Sticky eyes
A persistent fever
Recurrent infections
Unexplained weight loss
Dermatology
An itchy rash
Deteriorating eczema
An infant with blisters
Hematology
A pale child
Easy bruising
A child with chest pain
Oncology
An abdominal mass
An unsteady child
Lymphadenopathy
A swollen shoulder
Fever in a patient on chemotherapy
Aches and pains
Bones and joints
A girl with a limp
Pain and fever
Swollen joints
A spinal deformity
Neurology
A fitting child
A febrile, drowsy child
A big head
A child in a coma
A late walker
A child with learning difficulties
Sudden weakness
Chronic headaches
A funny smile
Weak legs
Developmental regression
A deaf boy
A child with a squint
Child and adolescent psychiatry
A boy with no friends
A hyperactive child
A teenager who won’t eat
Neonatology
Born too early
A breathless newborn
Recurrent apnoeas
A sudden collapse in a ventilated preterm neonate
Bilious vomiting in a neonate
A jaundiced neonate
A floppy infant
A difficult delivery
A newborn with congenital abnormalities
Sudden deterioration in a term baby
A case of possible trisomy
Abnormal movements in an an-day-old baby
Miscellaneous
A fracture in an infant
A vaginal discharge
An odd-shaped head
A drowsy toddler
A confused teenager
A drunken adolescent
An unusual appetite
A sudden collapse
A pregnant-year-old
A sudden, unexpected death
A tired teenager
Poor weight gain
About Author:
Joseph Raine MD FRCPCH DCH, Consultant Paediatrician, The Whittington Hospital, London; Honorary Senior Lecturer, University College London, UK
Aubrey Cunnington BMBCh MA MRCPCH DTM&H, Specialist Registrar, St Mary’s Hospital, London, UK
Demo Content:
Here is the demo content of 100 Cases in Paediatrics you can read a piece of content from this free medical book.
Case 1: An infant with Noisy Breathing (Respiratory)
History: Mr Ali is a 3-month-old boy, brought to a paediatric rapid referral clinic because of persistent noisy breathing. He was born in the UK at term after an uneventful pregnancy and is the fifth child of non-consanguineous Somalian parents. His birth weight was 3.7 kg (75th centile). Since he was a few weeks old, he has had noisy breathing, which hasn’t affected his feeding, and his parents were repeatedly reassured that it would get better. He has continued to have intermittent noisy breathing, especially when agitated, and sometimes during sleep. Over the last few days, his breathing has been noisier than usual. Otherwise, he has been well without any fevers. All of his siblings have recently had coughs and colds.
Examination:
He is active and smiles responsively. Oxygen saturations are 95 percent in air and his temperature is 36.9ºC. He is coryzal and has intermittent stridor. There is a small ‘strawberry’ haemangioma on his forehead. The respiratory rate is 45/min, there is subcostal recession and mild tracheal tug. Air entry is symmetrical in the chest, with no crackles or wheeze. Cardiovascular examination is unremarkable. His weight is 6.7 kg (75th centile).
Questions:
- What is the most likely cause of his stridor
- What other important diagnoses need to be considered?
- How can the diagnosis be confirmed?
Answer:
Stridor is an inspiratory sound due to the narrowing of the upper airway. Mohammed is most likely to have stridor due to laryngomalacia. This means that the laryngeal cartilage is soft and floppy, with an abnormal epiglottis and/or arytenoid cartilages. The larynx collapses and narrows during inspiration (when there is a negative intrathoracic pressure), resulting in inspiratory stridor. It is usually a benign condition with noisy breathing but no major problems with feeding or significant respiratory distress. Most cases resolve spontaneously within a year as the larynx grows and the cartilaginous rings stiffen. The reason Mohammed now has respiratory distress is that he has an intercurrent viral upper respiratory tract infection. A very important diagnosis to consider in this boy is a haemangioma in the upper airway. The majority of haemangiomas are single cutaneous lesions, but they can also occur at other sites and the upper airway is one position where they can enlarge with potentially life-threatening consequences. The presence of one haemangioma increases the likelihood of a second one. This boy should be referred for assessment by an ENT surgeon.
There are many other possible congenital causes of stridor that affect the structure or function of the upper airway. Infectious causes of stridor, such as croup and epiglottitis, are very rare in this age group.
Differential diagnosis of stridor in an infant:
• Laryngomalacia
• Laryngeal cyst, haemangioma or web
• Laryngeal stenosis
• Vocal cord paralysis
• Vascular ring
• Gastro-oesophageal reflux
• Hypocalcaemia (laryngeal tetany)
• Respiratory papillomatosis
• Subglottic stenosis
Case 2: A Vomiting Infant (Gastroenterology)
History:
John is a 7-week-old infant who presents to the A&E department with a 1-week history of non-bilious vomiting. His mother describes the vomit as ‘shooting out’. He has a good appetite but has lost 300 g since he was last weighed a week earlier. He has mild constipation. The family have recently returned from Spain. There is no vomiting in any other members of the family. His sister suffers from vesicoureteric reflux and urinary tract infections.
Examination:
John is apyrexial and mildly dehydrated. His pulse is 170 beats/min, blood pressure 82/43 mmHg, and peripheral capillary refill 2 s. There is no organomegaly, masses or tenderness on abdominal examination. There are no signs in the other systems.
Investigation:
Questions:
- What is the likely diagnosis?
- What is the differential diagnosis?
- How would you confirm the diagnosis?
- What is the treatment?
Answer:
In an infant this age with non-bilious projectile vomiting, pyloric stenosis is the most likely diagnosis. This condition presents between 2 weeks and 5 months of age (median 6 weeks) and projectile vomiting is typical. The vomitus is never bile-stained as the obstruction is proximal to the duodenum.
As in this case, infants may also be constipated. The hypochloraemic alkalosis is characteristic and is due to vomiting HCl. The low potassium is due to the kidneys retaining hydrogen ions in favor of potassium ions. The raised urea and creatinine suggest that there is also mild dehydration. The male-to-female ratio is 4:1 and occasionally there is a family history (multifactorial inheritance).
Differential diagnosis:
Gastro-oesophageal reflux
• Gastritis
• Urinary tract infection
• Overfeeding
Gastro-oesophageal reflux usually presents from or shortly after birth. Gastritis usually occurs with enteritis and diarrhoea. A urinary infection at this age may present in a very non-specific way and therefore it is mandatory to test the urine. The absence of nitrites and leucocytes in the urine dipstick makes a urinary infection very unlikely. Overfeeding should be elucidated from a careful history. The diagnosis could be clinically confirmed by carrying out a test feed.
A feed leads to peristalsis which occurs from left to right. The abdominal wall is usually relaxed during a feed, making palpation easier. A pyloric mass, which is the size of a 2-cm olive, may be felt in the right hypochondrium by careful palpation. An ultrasound is also usually done for further confirmation. Tom is slightly tachycardic (pulse rate 1 year, 110–160 beats/min) with normal blood pressure and capillary refill time. His urea is slightly elevated.
Initial treatment consists of treating the dehydration, acid-base, and electrolyte abnormalities with intravenous fluids (0.9 percent saline with 5 percent dextrose and added KCl would be the appropriate starting fluid in this infant with low sodium and potassium). Feeds should be stopped, a nasogastric tube inserted and the stomach emptied. The definitive operation is Ramstedt’s pyloromyotomy
KEY POINTS:
- The peak age of presentation of pyloric stenosis is 6 weeks.
- The typical biochemical picture is a hypochloraemic alkalosis.
- The definitive treatment is Ramstedt’s pyloromyotomy.