Ear Pain
ALERTS Mastoiditis Perforated TM Persistent or recurrent OM AGE CONSIDERATIONS Otitis Media: infant, toddler >school age, adolescent DIFFERENTIAL DIAGNOSIS Ear foreign body Otitis Externa Otitis Media Parotitis Referred pain from oropharynx or teeth Temporomandibular joint pain EVALUATION HISTORY Onset and quality of pain, associated fever, URI, ear drainage, ear trauma, recent activities (i.e. swimming) PHYSICAL […]
Toddlers Fracture
EPIDEMIOLOGY OF TIBIAL SHAFT FRACTURES 15 percent of all pediatric fractures are in the tibial shaft 39% tibial fractures are in diaphysis 30% associated with fibula fracture TODDLERS FRACTURES Non displaced spiral or oblique fracture of tibial shaft only (fibula remains intact) Also known as CAST fracture (childhood accidental spiral tibial fracture) Usually low energy […]
Croup
ALERTS Epiglotitis Bacterial tracheitis Peritonsilar/Retropharyngeal abscess Foreign body Anaphylaxis/allergic reaction Upper airway injury Congenital anomalies AGE OR PREGNANCY CONSIDERATIONS ≤ 4years = Typical presentation Chronic croup can remain in older children DIFFERENTIAL DIAGNOSIS Epiglotitis Peritonsilar/Retropharyngeal abscess Laryngomalacia Foreign body Anaphylaxis/allergic reaction Upper airway injury EVALUATION HISTORY Onset and timing of cough, presence of stridor and […]
Sore Throat
ALERTS Peritonsillar abscess Retropharyngeal abscess – <4yrs Epiglottitis Foreign body Trauma AGE CONSIDERATIONS Strep pharyngitis risk – >2yrs Gonococcal & Chlamydial pharyngitis – Adolescents DIFFERENTIAL DIAGNOSIS Viral pharyngitis Herpangina Coxsackie GABHS pharyngitis EBV Post-nasal drip Gonococcal pharyngitis Chlamydia pharyngitis Peritonsillar abscess/cellulitis Retropharyngeal abscess GERD Epiglottitis PFAPA syndrome (Periodic fever, Aphthous ulcers, Pharyngitis, & cervical adenitis) […]
Headache
ALERTS Cerebral anuerysm Meningitis Encephalitis Abscess Brain Tumor Sinus Venous Thrombosis AGE CONSIDERATIONS Toddlers: may manifest as irritability Unusual complaint in younger children DIFFERENTIAL DIAGNOSIS Tension Migraine Cluster ENT infection (otitis, sinusitis pharyngitis, viral infection,etc) Meningitis Psychogenic Seasonal allergies Vision change- need for glasses Brain tumor Pseudotumor Hypertension Toxins (Carbon monoxide, medications, drugs) Head trauma […]
Foreign Body Ear
ALERTS Button Batteries need immediate removal Sharp object such as glass can lacerate canal Live insects can cause extreme discomfort Food items absorb moisture which can lead to inflammation/infection AGE Typical age between 3 and 8 years DIFFERENTIAL DIAGNOSIS Cerumen impaction Abrasion to ear canal Otitis Externa Tumor EVALUATION History Patient may admit to placing […]
Limp
BASICS DESCRIPTION Limp- either painful (antalgic gait) or nonpainful (Trendelenburg gait) Differential diagnosis can be organized by location, age and duration of symptoms or type of gait abnormality RISK FACTORS Trauma, infection, neoplasia and rheumatologic disorders produce antalgic gait Congenital, developmental or muscular disorders produce Trendelenburg gaits PATHOPHYSIOLOGY Antalgic gait has a shortened stance phase […]
Runny Nose
DIFFERENTIAL DIAGNOSIS Allergic Rhinitis URI Foreign Body- Nose Sinusitis CSF Rhinnorhea Medication withdrawal or side effect Systemic Illness (Hypothryroidism,Wegener’s, CF, Sarcoidosis) AGE/GENDER CONSIDERATIONS Allergic Rhinitis can begin at any age. Nasal fractures are uncommon under age five. DIAGNOSIS HISTORY General health-fever Seasonality to symptoms (Allergic Rhinitis) Nasal Itching (Allergic Rhinitis) History of asthma or eczema/ […]