Flank PainA 10-year-old boy presents to your office with sharp right-sided flank pain.
Systemic Lupus ErythematosusFor 2 weeks, this 13-year-old girl felt tired and achy.
Spider biteThe family of a 3-year-old girl was concerned about a painful lump in her right palm that they suspected was the result of a spider bite.
X-Linked Ichthyosis<p><img src="/sites/default/files/rash.png" style="border: 1px solid black; margin-left: 8px; margin-right: 8px; float: left;" height="113" width="150">A 4-year-old boy was referred for evaluation of refractory eczema that first appeared at 1 month of age. His mother thought that his skin always seemed “dirty” and she was unable to remove the scales completely. He was born via cesarean section because of failure of labor to progress; the delivery was otherwise uncomplicated. Development was normal. He had no history of asthma or allergies or family history of rashes.</p>
hydrocephalus<p><img src="/sites/default/files/transfer/Hydrocephalus_Secondary_to_GBS_Meningitis3.jpg" style="border: 1px solid black; display: block; float: left; margin-left: 8px; margin-right: 8px;" width="150" height="155">A female infant born at 29 weeks’ gestation after premature membrane rupture was admitted to the neonatal ICU in respiratory distress. Delivery was complicated by maternal fever and meconium stained amniotic fluid. The mother had not been screened for group B streptococci (GBS) infection and had received 1 dose of penicillin less than 4 hours before delivery. Results of a complete blood cell (CBC) count, cerebrospinal fluid (CSF) analysis, and urinalysis were unremarkable; cultures showed no bacterial growth. The infant received a 10-day course of antibiotics.</p>
pityriasis rosea<p><img src="/sites/default/files/transfer/pityriasis_rosea_teaser_pic.jpg" width="150" height="110" style="float: left; border: 1px solid black; margin-left: 8px; margin-right: 8px;">In the course of studying azithromycin as a treatment for pityriasis rosea (PR)<sup>1</sup> which we found does not work, we collected much data on the distribution, morphology, and course of the lesions.<sup>2</sup> We also amassed many photos, some of which appear in this Photo Essay. These photos highlight the various presentations of PR in African American children, which we discovered are often different from the standard “textbook” descriptions.</p><p> </p>
Assigning Blame in Medicine<p style="text-align: left;"><strong>Warning:</strong> this is a column about political correctness. If you find it impossible to be judgmental in any situation, or are incapable of offering decisive opinions about anything, you are advised to go no further—your feelings will be hurt. The way in which some people currently assess blame is a path containing at least 3 steps. These steps range from the useful to the ridiculous—from an approach to improving care that takes human tendencies and weaknesses into consideration (Step 1) to the dangerous denial of reality that leads to persistent pernicious pollyannaism (Step 3). Following this path will ultimately lead to our brains falling out.</p>
Chest Radiograph<p><img src="/sites/default/files/transfer/chest_xray.png" style="float: left; margin-left: 8px; margin-right: 8px; border: black 1px solid;" height="169" width="150">A 3-year-old boy with chest pain and trouble breathing that had developed over the past 24 hours was brought to the emergency department. The parents reported that his most prominent symptom was a cough. The chest pain appeared to worsen with coughing. He had undergone open atrial septal defect repair about 3 weeks before presentation. He had been otherwise healthy. Several family members recently had a GI illness. However, the child had no vomiting, diarrhea, or fevers.</p>