New PDF release: 100 Cases in Paediatrics

By Ronny Cheung, Aubrey Cunnington, Simon Drysdale, Joseph Raine, Joanna Walker

The recent version of this best-selling name from the preferred a hundred instances sequence explores universal paediatric situations that might be encountered via the scientific scholar and junior general practitioner 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 function in qualifying examinations. The booklet covers a accomplished diversity of shows from cough to constipation, equipped by means of sub-specialty sector for ease of reference. accomplished solutions spotlight key take domestic issues from each one case and supply sensible recommendation on tips on how to take care of the demanding situations that take place while training paediatric drugs in any respect degrees.

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Sian had a febrile convulsion at 18 months of age and she has fainted on about five occasions, mostly in emotional situations or when it has been hot. She describes herself as an anxious girl, and has a sensation of her heart racing every few weeks. She has never been in hospital, but has seen her GP for heavy periods. There is no family history of epilepsy, but her aunt collapsed and died at the age of 28 in Canada. She is top of her year at school and hopes to be a doctor or lawyer. Examination Her height is 170 cm (91st centile) and her weight is 53kg (50 th).

She is otherwise entirely healthy with no significant past medical or family history. Examination Lola looks generally healthy and her height and weight are on the 75th centiles. She is not clinically anaemic, jaundiced or cyanosed. Her pulse is 88/min and her blood pressure 90/50 mmHg. She has normal femoral pulses. Examination of the praecordium shows no thrills but there is a heave at the lower left sternal border. The apex beat is in the fifth intercostal space in the mid-clavicular line. Both heart sounds are present but the pulmonary component of the second sound is quiet.

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. Nevertheless parents are understandably anxious and must be reassured that an innocent murmur is simply a ‘noise’.

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