Pediatrics in Review
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(Pediatrics in Review. 1997;18:32-35.)
© 1997 American Academy of Pediatrics

Index of Suspicion

Jeanette R. White, MD*
* University of Washington School of Medicine, Seattle, WA

This section of Pediatrics in Reviewreminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.

We invite readers to contribute case presentations and discussions.


   Case 1 Presentation
 
A 6-year-old boy is seen in the office because of persistent pain in his left ear. There is no history of rhinorrhea, cough, or elevated temperature. He was exposed to a child who had streptococcal pharyngitis 1 week ago. Results of physical examination are completely normal, including tympanic membranes, external auditory canals, and teeth. No cervical adenopathy is noted. A throat culture is negative for Streptococcus. You treat him with a decongestant for possible eustachian tube dysfunction and acetaminophen for pain.

One week later, the boy returns because of persistent pain. Again, results of his examination are normal. He is referred to an otolaryngologist, who finds no cause for the pain. The tympanogram and audiogram are normal.

Because of persistent pain, he is referred to a pediatric dentist, who makes the diagnosis.


   Case 2 Presentation
 
A 6-year-old boy who is developmentally delayed is brought to your office because he has been experiencing polydipsia, nocturia, and polyuria for several months. He is 3 to 4 years delayed in language, motor, and social skills. Physical examination reveals a healthy-looking child whose height and weight are between the 5th and 10th percentiles. All vital signs are normal, and no abnormalities are found on complete physical examination.

Laboratory evaluation includes a normal complete blood count and differential leukocyte count. His serum sodium is . . . [Full Text of this Article]






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Copyright © 1997 by the American Academy of Pediatrics.