Examination Paediatrics, 4e

675 Pages·2011·6.43 MB·English

by  Wayne Harris MBBS MRCP(UK) FRACP

Examination
Paediatrics
4th edition
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Examination
Paediatrics
4th edition
Wayne Harris
MBBS, MRCP (UK), FRACP
Senior Staff Specialist in Paediatrics,
West Moreton South Burnett Health Service District
Senior Lecturer, Department of Paediatrics and Child Health,
University of Queensland, Brisbane
Sydney Edinburgh London New York Philadelphia St Louis Toronto
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National Library of Australia Cataloguing-in-Publication Data
___________________________________________________________________ 
Author: Harris, Wayne
Title: Examination paediatrics / Wayne Harris.
Edition: 4th ed.
ISBN: 9780729539401 (pbk.)
Notes: Includes index.
Subjects: Pediatrics.  Pediatrics--Examinations, questions, etc.
Dewey Number: 618.92
___________________________________________________________________
Publisher: Sophie Kaliniecki
Developmental Editor: Neli Bryant
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Project Coordinators: Geraldine Minto & Mohanambal Natarajan
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Dedication
To the late Steve Irwin, the ‘Crocodile
Hunter’
(22.2.1962–4.9.2006),
The original Wildlife Warrior,
a remarkable larger-than-life father,
husband and superhero
Steve Irwin was world famous for his remarkably enthusiastic efforts to educate our 
planet about the importance of wildlife and conservation. His honours included: 
1997, discovery of new species of turtle, Elseya irwini; 2000, Honorary Senior 
Fellowship (University of the Sunshine Coast); 2001, Centenary Medal (for global 
conservation); 2002, Queensland Museum Medal; 2003, Queenslander of the Year; 
and—posthumously—2007, baby gorilla named after Steve (Rwandan government); 
2007, Adjunct Professorship (University of Queensland School of Integrative Biology); 
2009, Australian Land Snail named Crikey steveirwini. I will always remember Steve 
as my friend. I was privileged to get to know him, initially as a fellow parent, where 
our daughters attended the same preschool and became best friends. I was always 
impressed with Steve: his unparalleled devotion to his family; giving freely of his 
time to launch a fund-raising charity month supporting the local children’s ward, 
appearing on local radio and giving free entry to over 150 chronic paediatric patients 
from my hospital to his Australia Zoo; and opening the magnificent wildlife hospital. 
I respected his intelligence, his passion for his cause and his genuine compassion for 
sick children, but most of all I was touched by what a fantastic father and husband he 
was. His enthusiasm touched the lives of, and inspired, everyone he met. He is greatly 
missed. 
v
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Contents
Dedication  v Obesity  157
Foreword  ix Normal puberty  163
Preface  xi Precocious puberty  164
Preface to the first edition  xiii Delayed puberty  169
Acknowledgements  xv Disorders of Sexual Develop-
Abbreviation  xvii ment (virilisation in the post- 
Introduction  xxxiii neonatal period)  177
Thyroid disorders  182
1  Approach to the examination  1 Thyroid disorders in infants  186
2  The long case  7
3  The short case  14 8  Gastroenterology  190
4  Achievement psychology  17 Long Cases
5   Behavioural and developmental  Inflammatory bowel disease  190
paediatrics  25 Chronic liver disease (CLD)  200
Long Cases Malabsorption/maldigestion  212
Anorexia nervosa  25 Short Cases
Attention deficit hyperactivity  Gastrointestinal system  217
disorder (ADHD)  35 The abdomen  222
Autistic disorder (autism)  49 Jaundice  229
Short Cases Nutritional assessment  236
Child suspected of having  Failure to thrive  244
ADHD  61 Poor feeding  246
Child with possible autism/autistic  Weight loss—older child/ 
spectrum disorder (ASD)  64 adolescent  246
6  Cardiology  67 9  Genetics and dysmorphology  253
Long Case Long Cases
Cardiac disease  67 Down syndrome  253
Short Case Turner syndrome  265
The cardiovascular system  91 Short Case
The dysmorphic child  277
7  Endocrinology  107
Long Cases 10 Haematology  287
Congenital adrenal  Long Cases
 hyperplasia  107 Haemophilia  287
Diabetes mellitus  116 Sickle cell disease (SCD)  297
Short Cases Thalassaemia: β-thalassaemia 
Disorders of Sexual Development  major  311
(ambiguous genitalia)  132 Short Cases
Diabetes  135 The haematological system  321
Short stature  136 Thalassaemia  329
Tall stature  150
vii
viii Contents
11 Neonatology  332 Neuromuscular assessment  479
Short Cases Scoliosis  480
The neonatal examination  332 Spina bifida  482
The 6-week check  337
14 Oncology  487
12 Nephrology  338 Long Case
Long Cases Oncology  487
Chronic kidney disease  Short Case
(CKD)  338 Late effects of oncology 
Nephrotic syndrome  356  treatment  498
Short Cases
Renal examination  365 15 The respiratory system  503
Hypertension  369 Long Cases
Oedema  374 Asthma  503
Neonatal intensive care unit 
13 Neurology  377 graduate: chronic lung disease/
Long Cases bronchopulmonary dysplasia 
Cerebral palsy  377 (CLD/BPD)  513
Dystrophinopathies:  Duchenne  Cystic fibrosis (CF)  521
muscular dystrophy  Obstructive sleep apnoea 
(DMD)  391 (OSA)  546
Seizures and epileptic  Short Cases
 syndromes  403 The respiratory system  552
Spina bifida  420 The chest  556
Short Cases Stridor  556
Developmental assessment  430 Chest X-rays  558
Eye examination  432
Motor cranial nerves  438 16 Rheumatology  561
Neurological assessment of the  Long Cases
 upper limbs  439 Juvenile idiopathic arthritis 
Gait: a short-case approach  443 (JIA)  561
Neurological assessment of the  Juvenile idiopathic inflammatory 
lower limbs  444 myopathies (JIIMs): juvenile 
Cerebellar function  447 dermatomyositis (JDM)  577
Large head  447 Systemic lupus erythematosus 
Small head  450 (SLE)  587
Seizures  459 Short Case
Facial weakness  462 Joints  598
Floppy infant  464
Hemiplegia  469 Suggested reading  604
Intellectual impairment  472 Quick Reference Mnemonics  607
Involuntary movements  475 Picture Credits  623
Neurofibromatosis, type 1  Index  625
 (NF-1)  477
Foreword
The fourth edition of Examination Paediatrics by Dr Wayne Harris updates this widely 
used text to assist paediatric trainees undertaking the current clinical examinations 
as part of their vocational training and qualifications. Examination candidates in 
Australia, New Zealand, South-East Asia, the United Kingdom and North America 
have benefited from the previous editions over the last 18 years. Next to extensive 
experience and practice in assessing children in clinical situations, this book equips 
candidates with a systematic approach to both the long- and short-case elements used 
in examinations.
The first four chapters outline the general approach to examination procedures, 
including interaction with examiners and practical preparation for the differing 
objectives of short- and long-case examinations. The chapter on achievement psy-
chology is of particular relevance to those who find examination settings and experi-
ence extremely difficult.
Subsequent chapters highlight each of the different areas of paediatrics by sub-
speciality organ system. As in previous editions, there is extensive use of mnemonics 
to assist candidates with recalling the significant issues in examining patients or 
discussing conditions.
Although the book is primarily intended for paediatric trainees, it will also be 
of use for others undertaking clinical examination of children, including medical 
students or general practice trainees. The comprehensive coverage of conditions given 
in the text assists examination candidates to review the scope of their experience and 
knowledge, and identify areas where more experience or practice is needed.
Dr Harris (and his two co-authors of the previous first and second editions of 
Examination Paediatrics) has an extensive involvement in general paediatrics and 
examination experience, on which this book is based. In this new edition, he has 
provided updates in important areas where understanding of causation of disease 
and/or treatment have changed in the last 4 years.
This latest edition will prove to be an invaluable asset to those preparing for and 
undertaking paediatric clinic examinations, especially those in paediatric generalist 
or specialist vocational training.
Professor Allan Carmichael, OAM, MBBS (Monash), M.D. (Melb), FRACP
Professor of Paediatrics and Child Health
Dean, Faculty of Health Science
University of Tasmania
ix