Clinical Problem Solving 1 Module

Common Acute Pediatric Illnesses - Symptoms

Patients often come to medical attention because of a specific problem or complaint. The physician must solve the problems posed by the patient using information obtained from the history, the physical examination, and, when appropriate, laboratory tests and/or imaging studies. In the problem-solving process, the physician typically develops a problem definition (“What is going on here?”) and develops a differential diagnosis 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 are first considered, but other less common disorders may need to be included in the evaluation of various clinical problems.

Competencies:

  1. List the age-appropriate differential diagnosis for pediatric patients presenting with each of the following symptoms (see chart):

Abdominal PainCough and/or Wheeze and/or Stridor

DiarrheaFever with Rash

Fever without a sourceHeadache

Lethargy or IrritabilityLimp or extremity pain

OtalgiaRash without Fever

RhinorrheaSeizure

Sore throatVomiting

Chest painApnea

Constipation

  1. For each of the conditions listed in the chart, know the following:

Etiology and/or pathophysiology

History and physical examination findings

Laboratory and radiographic findings, if appropriate

Management

  1. For each of the conditions listed in the chart, discuss the characteristics of the patient and the illness that must be considered when making the decision to manage the patient in the hospital or in the outpatient setting.

Common Presenting Symptoms and Illnesses

Presenting Symptom / Diagnoses
Abdominal Pain / Appendicitis
Constipation
Gastroenteritis
Henoch Schonlein Purpura
Intussusception
Pelvic inflammatory disease
UTI/pyelonephritis
Pancreatitis
Pregnancy / Cholecystitis
Dysmenorrhea
Hepatitis
Gastritis/Peptic ulcer disease
Malignancy
Malrotation and volvulus
Ovarian or testicular torsion
Functional abdominal pain
Inflammatory bowel disease
Cough and/or Wheeze and/or Stridor / Asthma
Bronchiolitis
Community acquired pneumonia
Croup
Viral URI
Foreign body aspiration
Pertussis
Anaphylaxis / Bronchopulmonary dysplasia
Allergic rhinitis
Chlamydia pneumonia
Cystic fibrosis
Gastroesophageal reflux
Laryngomalacia/tracheomalacia
Tuberculosis
Diarrhea / Gastroenteritis (bacterial, viral)
Inflammatory bowel disease
Clostridium difficile infection
Parenteral diarrhea
Urinary tract infection / Celiac disease
Malabsorption
Encopresis
Toddler’s diarrhea
Antibiotic-associated diarrhea
Fever and Rash / Group A Streptococcal infection
Kawasaki disease
Meningococcemia
Viral exanthem
Juvenile rheumatoid arthritis / Drug reaction
Lyme disease
Rickettsial disease
Toxic shock syndrome
Staphylococcal infection
Fever Without a Source / Bacteremia/sepsis
Urinary tract infection
Meningitis
Occult bacteremia
Viral illnesses / Juvenile rheumatoid arthritis
Malignancy
Osteomyelitis
Headache / Meningitis
Migraine
Tension headache
Brain tumor
Concussion / Hydrocephalus
Increased intracranial pressure
Pseudotumor cerebri
Metabolic disorders
Lethargy or Irritability / Meningitis
Drug ingestion
Head trauma
Increased intracranial pressure / Electrolyte disturbances
Intussusception
Limp or Extremity Pain / Fracture
Legg-Calve-Perthes
Nursemaid elbow
Osgood Schlatter disease
Osteomyelitis
Septic arthritis
Slipped capital femoral epiphysis
Transient synovitis / Rheumatic fever
Henoch Schonlein purpura
Juvenile rheumatoid arthritis
Lyme disease
Malignancy (bone tumor, leukemia)
Reactive arthritis
Sickle cell crisis
Growing pains
Otalgia / Acute otitis media
Otitis media with effusion
Otitis externa
Dental caries / Mastoiditis
TMJ syndrome
Ear canal foreign body
Rash (with or without fever) / Atopic dermatitis
Contact dermatitis
Cellulitis
Impetigo
Lice
Monilial infections
Scabies
Molluscum contagiosum
Acne / Seborrhea
Urticaria
Viral exanthem
Viral enanthem
Drug reaction
Erythema multiforme
Erythema toxicum
Warts
Rhinorrhea / Allergic rhinitis
Viral URI
Rhinitis medicamentosa / Sinusitis
Nasal foreign body
Seizure / Febrile seizure
Meningitis/Encephalitis
Idiopathic (epilepsy) / Post-traumatic
Toxic ingestion
Brain tumor
Sore throat / Streptococcal pharyngitis
Infectious mononucleosis
Viral URI
Postnasal drip / Peritonsillar abscess
Retropharyngeal abscess
Gonococcal infection (adolescents)
Vomiting / Gastroenteritis
Gastroesophageal reflux
Pyloric stenosis
UTI/pyelonephritis
Bowel obstruction
Congenital adrenal hyperplasia
Diabetic ketoacidosis
Renal failure / Eating disorder
Hepatitis
Inborn error of metabolism
Increased intracranial pressure
Meningitis
Poisoning
Pregnancy
Chest Pain / Costochondritis
Asthma
Pneumonia / Pneumothorax
Cardiac (less common)
Esophagitis / Gastroesophageal reflux
Apnea / Sepsis
Gastroesophageal reflux
Choking episode
Seizure / Inborn error of metabolism
Head trauma
RSV infection
Pertussis
Constipation / Functional constipation
Hirschsprung disease
Hypothyroidism / Botulism

OTHER DIAGNOSES TO KNOW:

Acute lymphoblastic leukemiaCongestive heart failure

MyocarditisDiabetic ketoacidosis

HepatitisHydronephrosis

HypothyroidismSIADH

Meckel’s diverticulumAcidosis

VasculitisGuillain-Barre syndrome

Juvenile dermatomyositisSystemic lupus erythematosus

Cerebral vascular accidentMuscular dystrophy

Stevens Johnson syndrome