Pediatrics in Review
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INDEX OF SUSPICION

Dennis J. McCarthy MD1
Robert J. Tuite MD2
Gregory P. Conners MD3
 1 Butte, MT
2 Rochester, NY
3 University of Rochester School of Medicine and Dentistry, Rochester, NY

This section of Pediatrics in Review reminds 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 5-year-old girl is brought to your office because she has been unable to walk since awakening this morning. Last night her family returned from a 4-day summer camping trip during which she was active and healthy. Her past medical history is unremarkable and she is fully immunized. There is no evidence of infectious, drug, or toxic exposures.

On examination, the child is alert and cooperative but unable to stand or walk, although she denies pain. Deep tendon reflexes cannot be elicited in her lower extremities. Hercranial nerve function is normal, as are her vital signs and the rest of her physical examination.

Case 2 Presentation

A 4-year-old girl is brought to the office because of a swollen, tender 3.0-cm mass under her left mandible that has been present for 2 weeks.






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Copyright © 1995 by the American Academy of Pediatrics.