No child will be present; only the parent will relate the story, either in person or by telephone.
Key History
Onset, location, duration, affecting one or both eyes; eye discharge, itching, pain, photophobia, tearing; associated symptoms (constitutional, dermatologic, GI, cardiac, pulmonary, renal, pelvic, rheumatologic); exacerbating and alleviating factors; medications; sick contacts, day care, immunizations; history of similar symptoms.
Key Physical Exam
Vital signs; HEENT exam.
Presentation |
Differential |
Workup |
■ 3 yo F presents with a 3-day history of “pink eye.” It began in the right eye but now involves both eyes. She has mucoid discharge, itching, and difficulty opening her eyes in the morning. Her mother had the flu last week. She has a history of asthma and atopic dermatitis. |
Bacterial conjunctivitis Viral conjunctivitis Keratitis Seasonal allergies Uveitis |
Physical exam Ophthalmoscopic eye exam CBC Electrolytes Discharge cultures Slit lamp exam |
No child will be present; only the parent will relate the story, either in person or by telephone.
Key History
Associated symptoms (constitutional, GI, cardiac, pulmonary, renal, pelvic, endocrine); medications; prenatal and birth history, growth history; past medical history; family history; cognitive abilities, school performance.
CHILD WITH SHORT STATURE (cant'd)
Key Physical Exam
Vital signs; height, weight; HEENT, heart, lung, abdominal, and neurologic exams.
Presentation |
Differential |
Workup |
■ 14 yo M presents with short stature and lack of sexual development. His birth weight and length were normal, but he is the shortest child in his class. His father and uncles had the same problem when they were young, but they are now of normal stature. |
Constitutional short stature Growth hormone (GH) deficiency Hypothyroidism Chronic renal insufficiency Genetic causes Cystic fibrosis |
Physical exam CBC Electrolytes GH stimulation test IGF-1, IGFBP-3 levels TSH, FT4 XR—hand U/S—renal and cardiac Sweat chloride testing BUN/Cr Karyotype |
No child will be present; only the parent will relate the story, either in person or by telephone.
Key History
Onset, severity, duration, triggers; physical violence or use of weapons; substance use, developmental history, changes in environment or school performance; change in personality, anhedonia.
Key Physical Exam
Vital signs; neurologic exam.
Presentation |
Differential |
Workup |
■ 9 yo M presents with a 2-year history of angry outbursts both in school and at home. His mother complains that he runs around “as if driven by a motor.” His teacher reports that he cannot sit still in class, regularly interrupts his classmates, and has trouble making friends. |
Attention-deficit hyperactivity disorder (ADHD) Oppositional defiant disorder Manic episode Conduct disorder Hyperthyroidism |
Physical exam Mental status exam TSH, FT4 EEG |
BEHAVIORAL PROBLEMS IN CHILDHOOD (cant'd) |
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Presentation |
Differential |
Workup |
■ 12 yo F presents with a 2-month history of fighting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems. |
Adjustment disorder Substance intoxication, abuse, or dependence Manic episode Oppositional defiant disorder Conduct disorder |
Physical exam Mental status exam Urine toxicology |
■ 15 yo M presents with a 1-year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out, it is with a new set of friends. |
Substance abuse Conduct disorder Oppositional defiant disorder Adjustment disorder |
Urine toxicology Mental status exam Physical exam |
■ 5 yo M presents with a 6-month history of temper tantrums that last 5-10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite, and does not display these behaviors when he is at day care. |
Age-appropriate behavior ADHD Oppositional defiant disorder |
Physical exam Mental status exam |