By Ronny Cheung, Aubrey Cunnington, Simon Drysdale, Joseph Raine, Joanna Walker
The recent version of this best-selling name from the preferred a hundred situations sequence explores universal paediatric eventualities that would be encountered by means of the scientific pupil and junior healthcare professional in the course of functional education at the ward, within the emergency division, in outpatient clinics and in the neighborhood, and that are prone to characteristic in qualifying examinations. The e-book covers a finished variety of shows from cough to constipation, geared up by way of sub-specialty quarter for ease of reference. accomplished solutions spotlight key take domestic issues from each one case and supply sensible recommendation on find out how to care for the demanding situations that ensue while practicing paediatric drugs in any respect degrees.
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Additional resources for 100 Cases in Paediatrics
Bubble blowing. Encourage mobility Monitor for development of a pleural effusion. If the chest X-ray is suspicious, an ultrasound will be diagnostic. If present, a longer course of antibiotics is recommended to prevent empyema (a purulent pleural effusion). A chest drain may be necessary if there is worsening respiratory distress, mediastinal shift on the chest X-ray, a large effusion or failure to respond to adequate antibiotics Ensure adequate nutrition – children have often been anorectic for several days.
15 100 Cases in Paediatrics ANSWER 5 The chest radiograph shows consolidation with some collapse of the left lower lobe and further consolidation in the right middle lobe. There are small bilateral pleural effusions. These features are consistent with the clinical diagnosis of pneumonia. The combination of clubbing and recurrent chest infections is strongly suggestive of cystic fibrosis (CF). This is the commonest cause of clubbing in children in the UK. Normal immunoglobulins exclude antibody deficiencies such as X-linked hypogammaglobulinaemia.
If the murmur persists, they should be referred. That it was not heard at the 6-week check is irrelevant – murmurs in children are often difficult to hear. A murmur can be diagnosed as innocent on the basis of the certain clinical findings (see box). Clinical findings in innocent murmurs • • • • • • • • Asymptomatic No thrills or heaves Normal heart sounds, normally split with no added clicks Quiet and soft Systolic (isolated diastolic murmurs are never innocent) Short, ejection (pansystolic murmurs are pathological) Single site with no radiation to neck, lung fields or back Varies with posture (decreases or disappears when patient sits up, loudest when they’re lying) Further investigations are rarely indicated.