Stead Family Department of Pediatrics

  • Common Clinical Problems

    Rationale

    A patient's illness comes to the physician's attention as a clinical problem. The problem that prompts the visit to the physician may be a complaint (e.g. headache) or a complex of symptoms and signs (e.g. fever, rash and sore throat); or the problem may be identified as a finding on physical examination or from the results of diagnostic tests. The physician must solve the problems posed by the patient using information obtained from the history, the physical examination and, when appropriate, diagnostic tests. In the problem-solving process the physician typically develops a problem list that includes differential diagnoses for each of the problems identified. The diagnostic process demands knowledge of disease etiology, pathophysiology and epidemiology and of the patient's gender, ethnicity, environment and prior health status. When the patient is an infant, child or adolescent, the physician must also consider the effects of age, physical growth, developmental stage and family environment. Commonly occurring illnesses will be the first considered, but other, less common disorders may need to be included in the evaluation of various clinical problems.

    Objectives

    • Develop a diagnostic approach to any of the clinical problems listed below.
    • Explain how the physical manifestations of many pediatric illnesses, as well as their evaluation and management, vary with the age of the patient. Give specific examples.
    • Discuss the characteristics of the patient and of the illness that must be considered when making the decision to either manage the patient in the outpatient setting or to admit to hospital.
    • Develop a differential diagnosis for each of the clinical problems physical findings or diagnostic test results listed below.
    • For each of the conditions identified in the differential diagnosis of the clinical problems be able to discuss the following:
      • Etiology and / or pathophysiology
      • Natural history of the disease
      • Presenting signs and symptoms
      • Initial laboratory test and/or imaging studies indicated for diagnosis
      • Plan for initial management
       

    Common Clinical Problems

    • Fever
    • Cough / wheeze
    • Sore throat
    • Ear pain
    • Upper respiratory tract infection (viral and bacterial)
    • Abdominal pain
    • Vomiting
    • Diarrhea (with or without vomiting)
    • Dysuria and / or frequency
    • Headache
    • Seizure
    • Poor vision
    • Hearing loss
    • Trauma
      • Bites, animal and human
      • Burns
      • Head trauma
      • Sprain / strain / fracture
      • Unexplained injuries / child abuse
       
    • Joint or limb pain / limp

    Diagnostic Test Results

    • Complete blood count
      • Anemia
      • Leukocytosis
      • Thrombocytopenia
       
    • Serum chemistry analysis
    • Urinalysis
      • Hematuria
      • Proteinuria
      • White blood cells
      • "Dip stick" abnormalities
       
    • Hemoccult positive stool
    • Abnormality on chest radiograph (e.g. infiltrate, hyperaeration, atelectasis)

    Common Physical Findings

    • Heart murmur
    • Lymphadenopathy
    • Pharyngeal inflammation
    • Joint swelling / tenderness
    • Abdominal mass / tenderness
    • Hepatomegaly
    • Splenomegaly
    • Abnormal eye examination
      • White pupillary reflex
      • Strabismus
    • Bruising / petechiae
    • Rashes:
      • Diaper rash
      • Rash associated with fever
      • Rash associated with medication
      • Itchy / excoriated rash
      • Infection / cellulitis