Lessons from the Grand Rounds 2: Options in Rational Management

This unique book is all about the art of clinical analysis. It comprises of 133 actual cases as they presented with their varied symptom complexes, encompassing a wide clinical spectrum in different subspecialties. To begin with, it briefly discusses the basic concepts of symptoms and signs pertaining to a system, before proceeding with representative cases, which are listed according to the presenting symptoms. It describes how a sequential analysis of every point in the history, clinical examination and investigations leads to the correct diagnosis. While reading through the cases, the keywords are highlighted, facilitating a quick revision. Thus, this book is different and one of its kind in the sense that it does not intend to teach pediatrics at all; it purely stimulates the reader to develop a fine sense of rational thinking that facilitates clinical diagnosis in the field of pediatrics, through a self-learning, totally case-based format. Extremely interesting for clinicians, physicians, pediatricians, hematologists, nephrologists, hepatologists, rheumatologists, cardiologists, endocrinologists, neurologists, etc. as well as medical students, teachers and practitioners.

Table of Contents:
Section 1 TIME TESTED HYPOTHESIS Case 1 ‘Patient’ hearing a must !! Case 2 History begins with age. How ‘old’ are you? Case 3 History begins with age Case 4 Respect chief complaints Case 5 Respect chief complaints Case 6 Origin matters Case 7 Origin matters Case 8 Do not ignore clinical setting Case 9 Do not ignore clinical setting Case 10 Duration is important Case 11 Caution against unexpected progress Case 12 Sudden improvement may be ominous Case 13 Beware of partial improvement Case 14 Monitor progress of fever: Biphasic fever Case 15 Past—A lead for the future Case 16 Attention to personal history Case 17 First impression Case 18 General examination is special Case 19 Correlate temperature, pulse and respiration (TPR) Case 20 Observe pattern of breathing Case 21 Listen to the sounds that breathing makes Case 22 Nail down the diagnosis Case 23 Stick out the neck Case 24 Stretch your imagination Case 25 Head start Section 2 MANAGEMENT DILEMMAS IN OFFICE PRACTICE Case 26 Viral fever Case 27 Enteric fever Case 28 Enteric fever Case 29 Enteric fever Case 30 Frequent illnesses diagnosed as primary complex twice Case 31 Short stature due to IUGR with malpositioned kidney Case 32 Breastfed baby with intermittent blood in stools Case 33 Breastfed baby with suspected GI infection who recovered fast Case 34 Empyema Case 35 Empyema who was given steroids Case 36 Rheumatic fever Case 37 UTI—1st episode at 4 years of age Case 38 Constipation Case 39 Nephrotic syndrome Case 40 Immune thrombocytopenic purpura Case 41 Reactive arthritis secondary to mediastinal malignancy Case 42 Mismanaged gastroenteritis Case 43 Inadequate feeding investigated for failure to thrive Case 44 Infant with atypical Kawasaki disease Case 45 Fungal pneumonia Case 46 Palatopharyngeal incompetence Case 47 Hemophagocytic syndrome Case 48 Leukemia presenting as scurvy Case 49 Poststreptococcal reactive arthritis Case 50 Suspected Kawasaki disease presenting in 2nd week Case 51 Galactosemia Case 52 Mismanaged UTI presenting as breathlessness Case 53 Gaucher disease Case 54 Autoimmune disorder Case 55 Idiopathic thrombocytopenic purpura Case 56 Sudden falls in a 12-year-old Case 57 Dengue shock syndrome Case 58 Capillaria hepatica Fever with skin rash Case 59 Systemic inflammatory disorder Case 60 Meningococcemia Case 61 Stevens-Johnson syndrome Case 62 Dengue shock syndrome Case 63 Rickettsial disease Case 64 Severe combined immunodeficiency Case 65 Streptococcal infection Case 66 Hodgkin’s lymphoma Inborn errors of metabolism Case 67 Metabolic disorder presenting as complication of diarrhea Case 68 Metabolic disorder presenting as unexplained encephalopathy Case 69 Urea cycle defect Case 70 Galactosemia Case 71 Phenyl ketonuria Case 72 Mitochondrial encephalopathy with lactic acidosis Case 73 Metabolic disorder with cardiomyopathy Case 74 Ataxia presenting as metabolic disorder Section 3 AN APPROACH TO RECURRENT/ PERSISTENT PNEUMONIA Case 75 Clinical recovery, radiological persistence duplication of esophagus Case 76 Clinical recovery, radiological persistence Case 77 Clinical recovery, radiological persistence Case 78 Clinical and radiological persistence Case 79 Clinical persistence, radiological recovery Case 80 Recurrent pneumonia at the same site Case 81 Subacute pneumonia Case 82 Nonbacterial etiology Case 83 Complication Case 84 Complication Case 85 True recurrence Case 86 True recurrence Recurrent cough with or without wheezing Case 87 Wheeze associated lower respiratory infection Case 88 Gastroesophageal reflux disease (GERD) Case 89 Achalasia cardia Case 90 Coarctation of aorta Case 91 Cystic fibrosis Case 92 Foreign body Case 93 Miliary tuberculosis Recurrent cough, cold and fever in office practice Case 94 Frequent viral infections Case 95 Asthma Case 96 Bacterial infection secondary to adenoid hypertrophy Comparison/comment on the above three cases Case 97 Recurrent cold and fever Recurrent abdominal pain Case 98 Habitual constipation Case 99 Meckel’s diverticulum Case 100 Dyspepsia Case 101 Functional abdominal pain Case 102 Inflammatory bowel disease Case 103 Irritable bowel syndrome Recurrent diarrhea Case 104 Recurrent GI infection Case 105 HIV infection Case 106 Gluten induced enteropathy Case 107 Chronic giardiasis Case 108 Recurrent swelling around angle of mandible Section 4 VAGARIES IN TUBERCULOSIS Host chooses pathology and decides the outcome Case 109 Lobar emphysema as a presentation of large mediastinal lymph node Case 110 Missed mediastinal lymph node enlargement on routine chest X-ray Case 111 Missed mediastinal lymph node enlargement on routine chest X-ray Case 112 Acute onset pleural effusion that was TB Case 113 Localized pleural effusion Case 114 Tuberculous empyema Case 115 Bilateral pleural effusion Case 116 Subacute pneumonia missed as acute bacterial pneumonia Case 117 Mediastinal lymph node, cavity and miliary lesion in same child at a time Case 118 Fever, cough, breathlessness (TB lymph node and miliary) Case 119 Recurrent arthritis as an immune mediated manifestation of TB Case 120 Persistence of fever for months in spite of radiological improvement Case 121 Suspected MDR TB Case 122 MDR TB Case 123 Extensive tuberculosis in infant poorly responsive to treatment Case 124 Worsening mediastinal lymph node enlargement on recovery of primary complex Case 125 Development of cervical lymph node on recovery of TB pneumonia Case 126 Recurrence of meningitis on compliant anti-TB therapy Case 127 Development of tuberculoma on recovery of TBM Case 128 BCG lymphadenitis Case 129 Flaring of BCG scar as a manifestation of immune disorder Case 130 Psoriatic arthritis mistaken for TB Case 131 Suspected abdominal TB Case 132 Multiple recovering bony lesions of Hodgkin’s mistaken as TB Case 133 TB lymphadenitis which was lymphoma Index