The Washington Manual of Pediatrics (Spiral Manual Series) (Lippincott Manual Series (Formerly Known as the Spiral Manual Series))

Description:

Concise, portable, and user-friendly, The Washington Manual® of Pediatrics, 2nd Edition, focuses on the essential information you need to know when caring for children in the hospital, ICU, emergency department, and subspecialty outpatient clinics.  This practical reference presents brief, logical approaches to the diagnosis and treatment of common inpatient pediatric problems, as well as evidence-based references where they are available.  Thoroughly updated throughout, the 2nd Edition provides a clear view of the challenges faced by residents, interns, and medical students, plus offers practical solutions, and expert guidance – all in one convenient and easily accessible source.

Key Features:

•Thoroughly revised chapters with up-to-date, clinically applicable content that is easy for providers at all levels.•New chapters on Development Milestones, Child Maltreatment, and Patient Safety and Quality Improvement•Coverage includes growth and nutrition, emergencies, poisonings, newborn medicine, critical care, surgery, adolescent medicine, child maltreatment, allergy and immunology, radiology, sedation, genetic diseases, and much more.•Numerous tables, algorithms, and evidence-based references keep you up to date.•Written by interns, residents, chief residents, subspecialty fellows, and faculty at St. Louis Children's Hospital and Washington University in St. Louis. Now with the print edition, enjoy the bundled interactive eBook edition, which can be downloaded to your tablet and smartphone or accessed online and includes features like:•Complete content with enhanced navigation•Powerful search tools and smart navigation cross-links that pull results from content in the book, your notes, and even the web•Cross-linked pages, references, and more for easy navigation•Highlighting tool for easier reference of key content throughout the text•Ability to take and share notes with friends and colleagues•Quick reference tabbing to save your favorite content for future useThe Washington Manual® is a registered mark belonging to Washington University in St. Louis to which international legal protection applies. The mark is used in this publication by Wolters Kluwer under license from Washington University.

 

Table fo Contents:

 

Chapter 1: Common Topics

Chapter 1 Introduction

Health Supervision Visits

Development

Table 1-1: Developmental Milestones by Age

Sleeping

General Principles

Common Concerns

Behavioral Insomnia of Childhood

Night Terrors

Nightmares

Sleepwalking

Colic

General Principles

Diagnosis

Treatment

Stooling

General Principles

Constipation

Diarrhea

Intractable Diarrhea of Infancy

Toddler’s Diarrhea

Urinating

General Principles

Enuresis

Discipline

Vaccinations

Oral Health

Dental Development

Dental Hygiene

Dental Caries

Early Childhood Caries

Lead Screening and Toxicity

Definitions

Epidemiology

Screening for Lead Exposure

History

Physical Examination

Laboratory Studies and Imaging

Treatment

Table 1-2: Assessment and Management of Confirmed Elevated BLL

Chapter 1 Suggested Readings

Suggested Readings

Chapter 2: Growth and Nutrition

Normal Growth

Typical Growth Patterns

Weight

Height

Head Circumference

Preterm Infants and Other Variants from Typical Growth Patterns

Normal Diet

Infants

Breastfeeding

Formula Feeding

Complementary Foods

Toddlers, Children, and Adolescents

Table 2-1: Common Infant Enteral Nutrition

Common Childhood Concerns

Failure to Thrive (FTT)

Physiologic Reflux

Picky Eating

Obesity

Vitamin Deficiency

Iron Deficiency

Table 2-2: Clinical Signs of Vitamin and Mineral Deficiency

Chapter 2 Suggested Readings

Suggested Readings

Chapter 3: Fluid and Electrolyte Management

Chapter 3 Introduction

Fluid Maintenance

Dehydration and Hypovolemia

Table 3-1: Symptoms Associated with Dehydration

Table 3-2: Composition of ORS Compared with Common Oral Fluids

Electrolyte Abnormalities

Hypernatremia

Definition

Etiology

Clinical Presentation

Treatment

Hyponatremia

Definition

Etiology

Clinical Presentation

Treatment

Hyperkalemia

Definition

Etiology

Clinical Presentation

Treatment

Hypokalemia

Definition

Etiology

Clinical Presentation

Treatment

Hypercalcemia

Definition

Etiology

Clinical Presentation

Diagnostic Evaluation

Treatment

Hypocalcemia

Definition

Etiology

Clinical Presentation

Diagnostic Evaluation

Treatment

Hyperphosphatemia

Definition

Etiology

Clinical Presentation

Treatment

Hypophosphatemia

Definition

Etiology

Clinical Presentation

Treatment

Chapter 3 Suggested Readings

Suggested Readings

Chapter 4: Emergencies

Chapter 4 Introduction

Cardiopulmonary Resuscitation

Etiology

Treatment (Basic Life Support; Table 4-1)

Table 4-1: Basic Techniques of Pediatric Life Support

Coma

Table 4-2: Glasgow Coma Scale

Trauma

Primary Survey and Management of the Trauma Patient (ABCs)

Secondary Survey

Laboratory Studies and Imaging

Prevention

Traumatic Brain Injury

Diagnosis and Treatment

Types of Injury

Neck Injury

Diagnosis and Treatment

Table 4-3: Evaluation and Management of Concussion

Burns

Diagnosis and Treatment

Figure 4-1: Rule of nines for child (left) and adult (right).

Lacerations (Table 4-4)

Table 4-4: Suture Characteristics for Lacerations in Various Locations

Bites

Human

Mammal

Hymenoptera (Bees, Wasps, and Ants)

Spiders

Table 4-5: Tetanus Prophylaxis

Procedural Sedation in Children

Chapter 4 Suggested Readings

Suggested Readings

Chapter 5: Poisonings

Chapter 5 Introduction

Classification by Age

Infants (

Toddlers (1–3 Years of Age)

School-Aged Children

Adolescents

Diagnosis

History

Clinical Presentation

Laboratory Studies

Blood Glucose and Serum Electrolytes

Blood Gas

Drug Screen

Specific Laboratory Studies

Intentionally Induced Hypoglycemia

Carboxyhemoglobin

Specific Drug Levels

Other Useful Diagnostic Studies

Electrocardiography

Radiography

Table 5-1: Backyard Plants of Interest

Table 5-2: Common Findings and Management Approach in Prescription Drug Ingestions

Table 5-3: Common Findings and Management Approach in Nonprescription Substance Ingestions or Exposures

Figure 5-1

Figure 5-2

Treatment

Elimination of Ingested Poisons

Antidotes/Therapy for Prescription Medication Ingestion (See Table 5-2)

Antidotes/Therapy for Nonprescription Substance Ingestion/Exposure (See Table 5-3)

Child Abuse by Poisoning

Diagnosis

Chapter 5 Suggested Readings

Suggested Readings

Chapter 6: Basic Orthopedics

Musculoskeletal Trauma

Fractures

Evaluation

General Management

Concerns Related to Nonaccidental Trauma

Multiple Fractures

Complex Skull Fractures

Rib Fractures

Classic Metaphyseal Lesions (“Corner Fractures” or “Bucket-Handle Fractures”)

Humerus Fractures

Femur Fractures

Table 6-1: Types of Salter-Harris Fractures

Figure 6-1: Casts appropriate for various fractures.

Upper Extremity Musculoskeletal Injuries

Clavicular Fracture

Shoulder Dislocation

Proximal Humerus Fracture

Elbow Injuries

Supracondylar Humerus Fracture

Radial Head Subluxation (“Nursemaid’s Elbow”)

Forearm Fractures

Hand Fractures

Scaphoid Fracture

Boxer Fracture

Lower Extremity Musculoskeletal Injuries and Abnormalities

Slipped Capital Femoral Epiphysis

Legg-Calve-Perthes Disease

Knee

Fractures

Ligamentous Injuries

Osgood-Schlatter Disease

Lower Leg

Tibial Shaft Fractures

Toddler Fracture

Foot/Ankle

Ankle Sprains

Sever Disease

Table 6-2: Injuries to Ligaments of the Knee

Evaluation of a Child with a Limp

History

Physical Exam

Differential Diagnosis

Laboratory and Radiographic Evaluation

Table 6-3: Differential Diagnosis of Limp by Age

Infectious Etiologies

Septic Joint

Background

Clinical Presentation

Evaluation

Diagnosis

Management

Osteomyelitis

Background

Clinical Presentation

Evaluation

Management

Transient Synovitis

Presentation

Evaluation

Management

Developmental Musculoskeletal Disorders

Developmental Dysplasia of the Hip (DDH)

Definition and Etiology

Epidemiology

Evaluation

Management

Scoliosis

In-toeing

Out-toeing

Bowlegs (Genu Varum)

Knock Knees (Genu Valgum)

Figure 6-2

Figure 6-3: Scoliosis.

Table 6-4: Types of In-toeing

Chapter 6 Suggested Readings

Suggested Readings

Chapter 7: Neonatology

Approach to the Neonate in Respiratory Distress

History

Physical Examination

Etiology

Laboratory Studies and Imaging

Treatment

Special Considerations: Pulmonary Hypertension

Figure 7-1: Approach to respiratory distress in a neonate.

Figure 7-2: Algorithm to use when cardiac disorder should be suspected in a neonate.

Table 7-1: Endotracheal Tube Size in Neonates

Table 7-2: Endotracheal Tubes and Depth of Insertion in Neonates*

Approach to the Neonate with a Heart Murmur

Differential Diagnosis

Etiology

Clinical Diagnoses

Figure 7-3: Differential diagnosis of cyanosis in a neonate.

Figure 7-4: Diagnostic use of pulse oximetry.

Approach to the Neonate with Apnea and Bradycardia

Differential Diagnosis

Approach to the Neonate with an Unacceptable Blood Gas Analysis Result

Imaging

Etiology and Treatment

Approach to the Neonate with Pregavage Aspirate

Diagnosis and Treatment

Necrotizing Enterocolitis

Intestinal Obstruction

Incorrectly Placed Feeding Tube

Intestinal Dysmotility

Approach to the Neonate with Poor Feeding

Clinical Presentation and Physical Examination

Diagnosis and Treatment

Approach to a Neonate with Hypoglycemia

Figure 7-5

Figure 7-6: Approach to a neonate with hypoglycemia.

Approach to the Neonate Who Has Not Passed Urine

Definition: Oliguria Urine Output

Etiology

Diagnosis and Treatment

Approach to the Newborn with Jaundice (Fig. 7-7)

Epidemiology

History and Physical Examination

Treatment

Follow-Up

Figure 7-7: Approach to a term neonate with jaundice.

Approach to the Neonate with “High” Serum Potassium

Treatment

Emergency Treatment

Nonemergency Treatment

Approach to the Neonate with “High” Blood Pressure

Etiology

History

Physical Examination

Laboratory Studies and Imaging

Treatment

Nutritional Requirements of Neonates

Calories

Proteins

Fats

Carbohydrates

Strategies for Providing Nutrition

Nutrition Monitoring

Expected Weight Gain

Expected Increase in Head Circumference

Retinopathy of Prematurity

Classification (Table 7-3)

Screening

Treatment

Figure 7-8

Table 7-3: International Classification of Retinopathy of Prematurity

Chapter 7 Suggested Readings

Suggested Readings

Chapter 8: Critical Care

Respiratory Failure

Causes of Hypoxemia and/or Hypercapnia

Additional Causes of Hypoxemia

Respiratory Support

Noninvasive Support

Invasive Support

Intubation

Preparation

Signs of a Difficult Airway

Table 8-1: Selection of Medications for Intubation

Airway Management

Rapid Sequence Induction and Emergent Intubation

Bag-Mask Ventilation

Ventilating Bags

Selection of Laryngoscopy Blade and Endotracheal Tubes

During and after Intubation

Mechanical Ventilation

Modes of Conventional Mechanical Ventilation

High-Frequency Oscillatory Ventilation

Assessment of Mechanical Ventilation

Respiratory Failure Refractory to Mechanical Ventilation

Table 8-2: Comparison of Common Conventional Ventilator Strategies

Shock

Classification

Monitoring

Treatment

Table 8-3: Classification of Shock

Table 8-4: Vasoactive Medications Used in Shock

Increased Intracranial Pressure

Cerebral Perfusion Pressure and Cerebral Autoregulation

ICP Monitoring

Airway Management

Treatment

Death on the Basis of Neurologic Criteria (Brain Death)

Definition

Brain Death Examination

Postoperative Care of Patients after Cardiac Surgery

Preoperative Details

Operative Details

ICU Management: The First Several Hours

ICU Management: Overnight

ICU Management: The Next Several Days

Management of Children with Single Ventricle Lesions

Balanced Circulation

Excessive Pulmonary Flow

Insufficient Pulmonary Blood Flow

Surgery

Norwood

Hybrid

Glenn Shunt

Fontan Shunt

Chapter 8 Suggested Readings

Suggested Readings

Chapter 9: Surgery

Chapter 9 Introduction

Congenital Disorders: Abdominal Wall Defects

Definition and Anatomy

Epidemiology

Etiology

History and Physical Examination

Imaging

Treatment

Postnatal

Surgery

Results and Complications

Congenital Diaphragmatic Hernia

Definition and Anatomy

Epidemiology

Etiology

History

Physical Examination

Laboratory Studies and Imaging

Differential Diagnosis

Treatment

Extracorporeal Membrane Oxygenation

Surgery

Results and Complications

Esophageal Atresia and Tracheoesophageal Fistula

Definition and Anatomy

Epidemiology and Etiology

History

Physical Examination

Laboratory Studies and Imaging

Treatment: Surgery

Complications

Malrotation

Definition and Anatomy

Epidemiology and Etiology

History

Physical Examination

Laboratory Studies and Imaging

Surgery

Complications

Inguinal Hernia

Definition

Epidemiology and Etiology

History

Physical Examination

Imaging

Differential Diagnosis

Treatment

Surgery

Complications

Acquired Disorders: Necrotizing Enterocolitis

Definition and Anatomy

Epidemiology and Etiology

History

Physical Examination

Laboratory Studies and Imaging

Monitoring

Treatment

Nonoperative

Surgery

Complications

Differential Diagnosis

Infantile Hypertrophic Pyloric Stenosis

Definition

Epidemiology and Etiology

History and Physical Examination

Laboratory Studies and Imaging

Treatment

Results and Complications

Intussusception

Definition and Classification

Epidemiology and Etiology

History

Physical Examination

Laboratory Studies and Imaging

Treatment

Nonoperative

Surgery

Recurrence

Appendicitis

Definition

Epidemiology and Etiology

History

Physical Examination

Laboratory Studies

Imaging and Surgical Diagnostic Procedures

Differential Diagnosis

Treatment

Surgery

Complications

Abdominal Trauma

Definition and Anatomy

Epidemiology and Etiology

History

Physical Examination

Laboratory Studies and Imaging

Treatment

Nonoperative

Surgery

Soft Tissue Abscess

Definition

Epidemiology and Etiology

History

Physical Examination, Laboratory Studies, and Imaging

Surgical Diagnostic Procedures

Treatment

Medications

Surgery

Referrals

Patient Education

Chapter 9 Suggested Readings

Suggested Readings

Chapter 10: Adolescent Medicine

Chapter 10 Introduction

Sexually Transmitted Diseases

Definition and Etiology

Screening and Prevention

Diagnosis and Treatment

Complications

Table 10.1: Characteristics and Therapy for Sexually Transmitted Diseases

Pelvic Inflammatory Disease

Definition and Etiology

Diagnosis

Treatment

Follow-Up

Dysmenorrhea

Definition and Etiology

Treatment

Abnormal Uterine Bleeding

Definition and Etiology

History and Physical Examination

Laboratory Studies

Diagnosis

Treatment

Contraception

Table 10.2: Contraceptive Methods

Eating Disorders

Definitions and Diagnostic Criteria

Epidemiology

Clinical Presentation

Physical Examination

Laboratory/EKG Findings

Treatment

Therapeutic Guidelines

Admission Criteria

Complications

Depression

Definitions

Epidemiology

Treatment

Suicide in Adolescents

Epidemiology

Treatment

Alcohol and Drug Abuse

Definition and Epidemiology

Treatment

Consent and Confidentiality

Definitions

Chapter 10 Suggested Readings

Suggested Readings

Chapter 11: Developmental and Behavioral Pediatrics

Chapter 11 Introduction

Key Principles Underlying Developmental–Behavioral Diagnosis

Learning Disabilities

Identifying Children at Risk

Learning Disability Subtypes/Comorbidities

Interventions and Advocacy

Federal Laws

Speech and Language Development and Disorders

Table 11-1: Components of Speech and Language

Table 11-2: Developmental Milestones for Language

Variations in Development

Speech Disorders

Language Disorders

Receptive Language Disorders

Expressive Language Disorder

Mixed Receptive, Expressive Language Disorder, Four Subtypes

Disorders of Pragmatic Language

Dyslexia

Attention Deficit Hyperactivity Disorder

Diagnosis

Treatment

Medications

Side Effects

Anxiety Disorders

Treatment Guidelines for Antidepressant Agents

Table 11-3: Normal Anxiety Triggers by Developmental Level

Table 11-4: Dosing Guidelines for Antidepressant Agents

Autism Spectrum Disorders

Definition

Diagnostic Criteria (Adapted from DSM 5)

Parent Completed Screening Instruments for Use in Primary Care

Genetic Testing

Complementary and Alternative Medicine

Figure 11-1

Table 11-5: Psychotropic Medication Options for Common Target Symptoms

Table 11-6: Results of Trials of Complementary and Alternative Therapies

Disruptive Behavior Disorders

Definition

Oppositional Defiant Disorder

Intermittent Explosive Disorder

Conduct Disorder

Psychoeducational Testing

Intelligence Testing

Chapter 11 Suggested Readings

Suggested Readings

Chapter 12: Child Maltreatment

Chapter 12 Introduction

Mandatory Reporting of Child Maltreatment

Recognizing and Responding to Neglect Concerns

Recognizing and Responding to Physical Abuse Concerns

Bruises

Fractures

Burns

Abusive head trauma (AHT)

Abdominal trauma

Medical Workup for Physical Abuse

Table 12-1: Common Characteristics of Abusive versus Accidental Bruises

Figure 12-1

Figure 12-2

Figure 12-3

Recognizing and Responding to Sexual Abuse Concern

Medical Evaluation of Sexual Abuse

Figure 12-4: Diagram of the genital anatomy of a prepubertal girl.

Recognizing and Responding to Caregiver-Fabricated Illness Concern

Chapter 12 Suggested Readings

Suggested Readings

Chapter 13: Allergic Diseases and Asthma

Allergic Rhinitis

Pathophysiology

History

Physical Examination

Evaluation

Treatment

Table 13-1: Medications Used in the Treatment of Allergic Rhinitis

Allergic Conjunctivitis

History and Physical Examination

Evaluation

Treatment

Table 13-2: Medications Used in the Treatment of Allergic Conjunctivitis

Atopic Dermatitis (Eczema)

History

Physical Examination

Evaluation

Treatment

Special Considerations

Asthma

Definition

History

Physical Examination

Laboratory Studies

Treatment during Acute Episode

Daily Management of Pediatric Asthma

Control of Asthma

Controlling Precipitating Factors (Triggers)

Patient Education

Table 13-3: Differential Diagnosis for Wheezing Not Responsive to Asthma Therapy

Table 13-4: Classifying Asthma Severity and Initiating Therapy in Children

Table 13-5: Assessing Asthma Control and Adjusting Therapy in Children

Table 13-6: Respiratory Rate for Children by Age

Table 13-7: Predicted Peak Flow by Height

Table 13-8: Emergency Dosing of Albuterol

Figure 13-1

Figure 13-2: Stepwise approach to management of asthma in children.

Urticaria and Angioedema

Acute Urticaria (with or without Angioedema)

Etiology

Evaluation

Treatment

Chronic Urticaria (with or without Angioedema)

Etiology

Evaluation

Treatment

Angioedema (without Urticaria)

Treatment

Food Allergy

Definition

Epidemiology

Clinical Presentation

IgE-Mediated Food Allergy

Non–IgE-Mediated Food Hypersensitivity

Diagnosis: History

Diagnosis: Laboratory Studies (IgE-Mediated Food Allergy)

Oral Food Challenges

Treatment

Table 13-9: Common Food Allergens

Table 13-10: Characteristics of Adverse Food Reactions Based on Mechanism

Table 13-11: Positive and Negative Predictive Values for Food-Specific IgE Levels

Anaphylaxis

Etiology

Pathophysiology

Diagnosis

Treatment

Acute Therapy

Observation

Discharge and Follow-Up

Chapter 13 Suggested Readings

Suggested Readings

Chapter 14: Cardiology

Electrocardiogram Interpretation

Rate

Rhythm

PR Interval

QRS Axis and Duration

ECG Abnormalities

Ventricular Hypertrophy

Bundle Branch Blocks

QT Prolongation

Table 14-1: Normal Heart Rates in Children*

Table 14-2: Normal PR Intervals

Table 14-3: Normal QRS Axis Ranges by Age

Table 14-4: Normal QRS Duration

Figure 14-1: Electrocardiogram showing a sinus rhythm and corrected QTc of 700 ms.

Arrhythmia

General Principles

Diagnosis

Clinical Presentation and History

Physical Examination

Differential Diagnosis: ECG Findings

Treatment (Acute)

Initial Therapy

Therapy to Terminate the Arrhythmia

Figure 14-2: Electrocardiogram showing a narrow complex regular tachycardia from a supraventricular tachycardia pathway.

Figure 14-3: Electrocardiogram showing a sinus rhythm with preexcitation from a pathway that causes depolarization of some of the ventricular mass before depolarization through the usual delay via the atrioventricular node (Wolff-Parkinson-White syndrome).

Figure 14-4: Electrocardiogram showing an irregular wide complex tachycardia from atrial fibrillation that is conducted rapidly down the aberrant pathway.

Channelopathies

Figure 14-5: Electrocardiogram showing a Brugada pattern with right ventricular conduction delay and a coved, elevated ST segment in V1 and V2.

Newborn with Heart Disease

General Principles

Diagnosis

Clinical Presentation and History

Physical Examination

Diagnostic Studies

Imaging

Treatment (See “Management of Children with Single Ventricles” in Chapter 8, Critical Care)

Medications

Nonoperative: Mechanical Ventilation

Table 14-5: Clinical Presentations of Congenital Heart Disease in Newborns

Chest Pain

Diagnosis

Clinical Presentation and History

Physical Examination

Diagnostic Studies

Treatment

Medications

Referrals

Syncope

Definition and Epidemiology

Etiology

Diagnosis

Clinical Presentation and History

Physical Examination

Diagnostic Testing

Treatment

Behavioral

Medications

Referrals

Table 14-6: Pallid versus Cyanotic Breath-Holding Spell

Table 14-7: Common Situations for Neurally Mediated Syncope

Table 14-8: Historical Red Flags in Syncope That Suggest a Seizure

Table 14-9: Historical Red Flags That Suggest a Cardiac Cause of Syncope

Table 14-10: Family History That Suggests a Cardiac Cause of Syncope

Heart Murmurs

General Principles

Diagnosis

Clinical Presentation and History

Physical Examination

Treatment

Table 14-11: Features That May Suggest a Pathologic Murmur

Table 14-12: Characteristics of Systolic Murmurs along Right Upper Sternal Border

Table 14-13: Characteristics of Systolic Murmurs along Left Upper Sternal Border

Table 14-14: Characteristics of Systolic Murmurs along Left Lower Sternal Border

Table 14-15: Characteristics of Systolic Murmurs at Apex

Table 14-16: Characteristics of Diastolic Murmurs

Table 14-17: Characteristics of Continuous Murmurs

Congestive Heart Failure

General Principles

Diagnosis

Clinical Presentation and History

Physical Examination

Diagnostic Studies

Treatment (See “Management of Children with Single Ventricles” in Chapter 8, Critical Care)

Table 14-18: Common Causes of Congestive Heart Failure by Age

Implanted Cardiac Devices

Implantable Loop Recorder (ILR)

Pacemaker (PM)

Intracardiac Defibrillator

Cardiac Resynchronization Therapy (CRT)

Chapter 14 Suggested Readings

Suggested Readings

Chapter 15: Dermatologic Diseases

Chapter 15 Introduction

Neonatal Dermatoses

Cutis Marmorata

Erythema Toxicum Neonatorum

Transient Neonatal Pustular Melanosis

Acne Neonatorum

Milia

Miliaria

Harlequin Color Change

Subcutaneous Fat Necrosis

Figure 15-1: Erythema toxicum neonatorum.

Figure 15-2: Transient neonatal pustular melanosis.

Figure 15-3: Acne neonatorum.

Figure 15-4: Milia.

Birth Marks

Mongolian Spots (Dermal Melanosis)

Café-au-Lait Macules

Congenital Melanocytic Nevi

Nevus Sebaceous

Aplasia Cutis Congenita

Port Wine Stain

Salmon Patch/Nevus Simplex (“Stork Bite”)

Hemangiomas

Appearance

Course

Complications and Associations

Treatment

Figure 15-5: Mongolian spots (dermal melanosis).

Figure 15-6: Café-au-lait macules.

Figure 15-7: Congenital melanocytic nevi.

Figure 15-8: Nevus sebaceous.

Figure 15-9: Aplasia cutis congenita.

Figure 15-10: Port wine stain.

Figure 15-11: Nevus simplex (angel’s kiss).

Figure 15-12: Hemangioma.

Acne Vulgaris

Classification

Treatment

Figure 15-13: Acne vulgaris.

Atopic Dermatitis

Definition

Epidemiology

Subtypes

Treatment

Figure 15-14: Atopic dermatitis.

Diaper Dermatitis

Seborrheic Dermatitis

Figure 15-15: Seborrheic dermatitis.

Contact Dermatitis

Figure 15-16: Contact dermatitis.

Tinea

Clinical Presentation

Treatment

Figure 15-17: A,B.

Figure 15-18: Tinea corporis.

Warts

Classification

Treatment

Figure 15-19: Warts.

Molluscum Contagiosum

Figure 15-20: Molluscum contagiosum.

Erythema Multiforme

Erythema Multiforme Minor

Treatment

Erythema Multiforme Major (Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis)

Treatment

Figure 15-21: Erythema multiforme with typical target lesions.

Chapter 15 Suggested Readings

Suggested Readings

Chapter 16: Genetic Diseases

Dysmorphic Features and Malformations

Definitions and Epidemiology

Etiology

Diagnosis and Evaluation

Table 16-1: Frequently Encountered Genetic Disorders

Newborn Screening

Disorders of Fatty Acid Oxidation

Amino Acid and Urea Cycle Disorders

Organic Acidemias

Metabolic Decompensation as a Presentation of Inborn Errors of Metabolism

Clinical Presentation

Laboratory Studies

Treatment

Genetic Disorders Presenting with Hypoglycemia

Genetic Disorders Presenting with Hyperammonemia

Clinical Presentation

Laboratory Studies

Treatment

Table 16-2: Clinical Features of Selected Genetic Disorders Causing Elevated Ammonium Levels

Genetic Disorders Presenting with Infantile Hypotonia

Etiology

Clinical Presentation

Laboratory Studies

Treatment

Genetic Disorders Presenting with Intellectual Disability or Global Developmental Delay

Definitions

Initial Evaluation

Treatment

Genetic Disorders Associated with Congenital Heart Lesions or Cardiomyopathy

Diagnosis and Evaluation

Genetic Disorders Presenting with Hepatic Symptomatology

Diagnosis and Evaluation

Treatment

Table 16.3: Clinical Features and Recommended Tests for Genetic Disorders Presenting with Hepatomegaly, Hepatic Dysfunction,* and/or Hyperbilirubinemia

Online Genetic Resources

GeneReviews

GTR: Genetic Testing Registry

Online Mendelian Inheritance in Man

American Academy of Pediatrics Committee on Genetics

American College of Medical Genetics (ACMG) Newborn Screening ACTion (ACT) Sheets

Chapter 16 Suggested Readings

Suggested Readings

Chapter 17: Gastroenterology

Chapter 17 Introduction

Abdominal Pain

History

Physical Exam

Vomiting

Diarrhea

Constipation

Gastrointestinal Bleeding

Jaundice (Hyperbilirubinemia)

Acute Liver Failure

Chapter 17 Suggested Readings

References

Suggested Readings

Chapter 18: Endocrinology

Diabetes Mellitus

Definition

Type 1 Diabetes Mellitus (T1DM)

Type 2 Diabetes Mellitus (T2DM)

Treatment

Insulin Regimens:

Metformin

Blood Glucose Monitoring

Dietary Recommendations

Monitoring

Hypoglycemia and Diabetes

Table 18-1: Time Course of Action of Human Insulin Preparations

Table 18-2: Hemoglobin A1c Values and Corresponding Blood Glucose Levels

Diabetic Ketoacidosis

Etiology

Clinical Presentation

Laboratory Studies

Treatment (Fig. 18-1; Table 18-3)

Mild Diabetic Ketoacidosis or Ketosis

Moderate Diabetic Ketoacidosis

Severe Diabetic Ketoacidosis

Other Therapeutic Strategies

Intravenous Hydration

Potassium Replacement

Intravenous Insulin

Cerebral Edema

Figure 18-1

Table 18-3: Summary of DKA Management

Hypoglycemia

Definition

Clinical Presentation

History

Laboratory Studies

Evaluation (Fig. 18-2)

Transient Hypoglycemia of Infancy: Transient Neonatal Hyperinsulinism

Persistent Hypoglycemia of Infancy or Childhood

Treatment

Figure 18-2

Adrenal Insufficiency

Etiology

Clinical Presentation

Screening and Diagnosis

Treatment

Acute Adrenal Insufficiency

Chronic Adrenal Insufficiency

Corticosteroid Potencies

Table 18-4: Relative Potencies of Systemic Corticosteroids

Congenital Adrenal Hyperplasia

Table 18-5: Enzyme Defects and Phenotype of Congenital Adrenal Hyperplasia

Figure 18-3

Glucocorticoid Excess (Fig. 18-4)

Figure 18-4

Ambiguous Genitalia

Definition

History

Physical Exam

Differential Diagnosis (Figs. 18-5 and 18-6)

Management

Figure 18-5

Figure 18-6

Diabetes Insipidus

Definition

Etiology (Table 18-6)

Clinical Presentation and Laboratory Studies

Treatment

Central Diabetes Insipidus

Table 18-6: Etiology of Diabetes Insipidus

Table 18-7: Water Deprivation Test

Table 18-8: Vasopressin Test

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Etiology

Clinic Presentation

Treatment

Nephrogenic Diabetes Insipidus

Triphasic Response (After Pituitary Stalk Transection)

Hypothyroidism

Congenital Hypothyroidism

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Acquired Hypothyroidism

Clinical Presentation

Laboratory Studies

Treatment

Hyperthyroidism

Etiology

Clinical Presentation

Laboratory Studies

Treatment

Medications

Surgery

Goiter

Etiology

Diagnosis

Treatment

Short Stature

Etiology (Fig. 18-7)

History

Physical Examination

Laboratory Studies

Treatment (Growth Hormone Therapy)

Figure 18-7

Pubertal Development

Definitions

History

Physical Examination

Precocious Puberty

Etiology

Diagnosis

Initial Testing

Imaging

Treatment

Premature Adrenarche

Etiology

Diagnosis

Treatment

Benign Premature Thelarche

Delayed Puberty

Etiology

Diagnosis

Treatment

Chapter 18 Suggested Readings

Suggested Readings

Chapter 19: Hematology and Oncology

Fever and Neutropenia

General Principles

Oncologic Emergencies

Superior Vena Cava Syndrome/Superior Mediastinal Syndrome

Pleural/Pericardial Effusion

Massive Hemoptysis

Neutropenic Enterocolitis (Typhlitis)

Hemorrhagic Cystitis

Altered Consciousness

Cerebrovascular Accident (Stroke)

Seizures

Spinal Cord Compression

Hyperleukocytosis

Tumor Lysis Syndrome

Hypercalcemia

BMT Issues

Sinusoidal Obstructive Syndrome

Fluid Management

Infection

Vaccination

Graft-versus-Host Disease

Acute Lymphoblastic Leukemia

Acute Myeloblastic Leukemia

Table 19-1: Surface Markers for Acute Myeloblastic Leukemia

Non-Hodgkin Lymphoma

Table 19-2: Classification of Non-Hodgkin Lymphoma

Hodgkin Lymphoma

Wilms Tumor

Neuroblastoma

Osteosarcoma

Rhabdomyosarcoma

Ewing Sarcoma

Retinoblastoma

Hereditary Variant

Nonhereditary Variant

Sickle Cell Disease

Febrile Illness in Children with SCD

Acute Chest Syndrome

Acute Splenic Sequestration

Aplastic Crisis

Acute Stroke

Pain/Vasoocclusive Crises

Priapism

Immunizations and Prophylactic Medications

Anemia

Figure 19-1

Lead Poisoning (Plumbism)

Workup for Bleeding

Table 19-3: Abnormal Screening Tests in Various Hemorrhagic Disorders

Table 19-4: Platelet Aggregation Responses in Inherited Platelet Function Disorders

Disseminated Intravascular Coagulation

Hemophilia

von Willebrand Disease

Thrombocytopenias

Idiopathic (Immune) Thrombocytopenic Purpura

Thrombocytosis

Hypercoagulopathy

Transfusion Principles

Packed Red Blood Cells

Platelets

Fresh Frozen Plasma

Cryoprecipitate

Transfusion Reactions

Table 19-5: Recommendations for Transfusion of RBCs

Table 19-6: Recommendations for Transfusion of Platelets

Chapter 19 Suggested Readings

Suggested Readings

Chapter 20: Infectious Diseases

Common Pediatric Infections

Acute Otitis Media

Epidemiology and Etiology

Clinical Presentation

Treatment

Bronchiolitis

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies and Imaging

Treatment and Prevention

Pneumonia

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies and Imaging

Treatment and Prevention

Urinary Tract Infection

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies and Imaging

Treatment

Approach to the Febrile Infant under 90 days of Life

Table 20-1: Palivizumab Prophylaxis for Respiratory Syncytial Virus (Including 2014 Update)

Table 20-2: Approach to the Febrile Neonate

Meningitis

Clinical Presentation

Physical Examination

Laboratory Studies

Treatment

Follow-Up

Herpes Simplex Virus Encephalitis

Clinical Presentation

Laboratory Studies

Diagnostic Studies

Treatment

Table 20-3: Cerebrospinal Fluid Parameters in Suspected Meningitis

Table 20-4: Common Etiologies and Empiric Antibiotics for Meningitis

Table 20-5: Duration of Antibiotic Therapy Based for Children with Meningitisa

Figure 20-1

Infectious Mononucleosis

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Table 20-6: Serum Epstein-Barr Virus (EBV) Antibodies in EBV Infection

Childhood Rashes

The Numbered Exanthems

Erythema Multiforme

Petechial Eruptions

Table 20-7: The Numbered Exanthems of Childhood

Figure 20-2

Figure 20-3

Figure 20-4

Congenital Infections (See Table 20-8)

Toxoplasmosis

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies and Imaging

Treatment and Prevention

Rubella

Clinical Presentation

Laboratory Studies

Treatment and Prevention

Cytomegalovirus

Clinical Presentation

Laboratory Studies

Treatment

Herpes Simplex Virus Infection

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Prevention

Human Immunodeficiency Virus

Syphilis

Clinical Presentation

Laboratory Studies and Imaging

Treatment and Prevention

Varicella-Zoster Virus

Clinical Presentation

Laboratory Tests

Treatment and Prevention

Table 20-8: Diagnostic Approach to the Newborn With Suspected Congenital Infection

Figure 20-5

Hepatitis

Hepatitis A Virus

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment and Prevention

Hepatitis B Virus

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment and Prevention

Hepatitis C Virus

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Hepatitis E Virus

Table 20-9: Diagnostic Tests for Hepatitis B Virus (HBV) Antigens and Antibodies

Human Immunodeficiency Virus

Maternal Infection

Treatment

Blood-Borne Pathogen Exposure

HIV Exposure

Hepatitis B Exposure

Hepatitis C Exposure

Table 20-10: AZT Dosing in Neonates

Table 20-11: Suggested Follow-Up in an Uncomplicated HIV in an Exposed Infant

Infections Associated with Animals

Rabies

Epidemiology

Clinical Presentation

Laboratory Studies

Treatment

Cat-Scratch Disease

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Q Fever

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Brucellosis

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Psittacosis

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Rat-Bite Fever

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Leptospirosis

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Yersiniosis

Epidemiology and Etiology

Clinical Presentation

Laboratory Studies

Treatment

Figure 20-6

Tick-Borne Infections

Table 20-12: Description and Treatment of Tick-Borne Diseases

Figure 20-7

Infectious Disease and the Internationally Adopted Child

Immunizations

Intestinal Parasites

Table 20-13: Screening Tests for Infectious Diseases in Internationally Adopted Children

Table 20-14: Approaches to the Evaluation and Immunization of Internationally Adopted Children

Table 20-15: Treatment of Commonly Identified Intestinal Parasites in International Adoptees

Tuberculosis

Clinical Presentation

Laboratory Studies

Imaging

Treatment

Table 20-16: Definitions of Positive Tuberculin Skin Test Results in Infants, Children, and Adolescentsa

Other Childhood Infections

Table 20-17: Other Common Childhood Infections

Chapter 20 Suggested Readings

Suggested Readings

Other Resources

Chapter 21: Neurologic Diseases

Neurologic Examination

Head Circumference

General Examination

Mental Status

Cranial Nerves

Motor Examination

Sensory Examination

Deep Tendon Reflexes

Primitive Reflexes

Coordination

Gait

Coma Examination

Intracranial Hypertension (Increased Intracranial Pressure)

Clinical Signs and Symptoms

Treatment

Spinal Cord Compression

Symptoms and Signs

Treatment

Acute Weakness

Methods of Characterizing Weakness

Features Helpful for Localization

Differential Diagnosis Based on Localization

Diagnosis

Selected Disorders

Stroke

Guillain-Barré Syndrome

Botulism

Tick Paralysis

Transverse Myelitis

Table 21-1: Evaluation of Acute Ataxia

The Hypotonic Infant

Localizing the Lesion

Differential Diagnosis Based on Localization

Diagnosis

Paroxysmal Disorders (“SPELLS”)

Headache/Migraine

Definition

History and Physical Examination

Treatment

Seizures

Definition and Classification

Etiology

Treatment

Table 21-2: Classification of Seizures by Clinical Type

Table 21-3: Localization of Weakness

Febrile Seizures

Definitions

Epidemiology

Treatment

Status Epilepticus

General Principles

Treatment

Table 21-4: Evaluation of Altered Mental Status

Neonatal Encephalopathy

General Principles

Criteria for Hypothermia Therapy

Hypothermia Protocol

Chapter 21 Suggested Readings

Suggested Readings

Chapter 22: Pulmonary Diseases

Croup (Viral Laryngotracheobronchitis)

Definition and Epidemiology

Etiology and Pathophysiology

Clinical Presentation

Diagnosis

Treatment

Epiglottitis

Definition and Epidemiology

Etiology and Pathophysiology

Clinical Presentation

Diagnosis

Treatment

Bacterial Tracheitis

Definition and Epidemiology

Etiology and Pathophysiology

Clinical Presentation

Diagnosis

Treatment

Foreign Body Aspiration

Definition and Epidemiology

Etiology and Pathophysiology

Clinical Presentation

Diagnosis

Treatment

Bronchiolitis

Definition and Epidemiology

Etiology

Pathophysiology

Clinical Presentation

Diagnosis

Treatment

Prevention

Cystic Fibrosis

Epidemiology

Pathophysiology

Clinical Presentation

Diagnosis

Treatment

Chapter 22 Suggested Readings

Suggested Readings

Chapter 23: Rheumatologic Diseases

Chapter 23 Introduction

Approach to the Child with Joint Pain and/or Swelling

Etiology and Differential Diagnosis

Laboratory Studies

Initial Evaluation

Joint Fluid Analysis (Table 23-1)

Imaging

Treatment

Table 23-1: Properties of Synovial Joint Fluid

Table 23-2: Common Drugs Used in Rheumatology*

Juvenile Idiopathic Arthritis

Diagnosis

Treatment

Complications

Table 23-3: Classification of Juvenile Idiopathic Arthritis (JIA)

Systemic Lupus Erythematosus

Definition and Epidemiology

Diagnosis and Laboratory Studies

Treatment

Complications

Table 23-4: Classification Criteria for Systemic Lupus Erythematous

Neonatal Lupus

Juvenile Dermatomyositis

Definition and Epidemiology

Clinical Presentation

Treatment

Complications

Henoch-Schönlein Purpura

Definition and Epidemiology

Clinical Presentation and Diagnosis

Treatment

Results

Acute Rheumatic Fever

Etiology and Epidemiology

Laboratory Studies and Imaging

Diagnostic Criteria

Treatment

Poststreptococcal Reactive Arthritis

Table 23-5: The Jones Criteria for Rheumatic Fever

Kawasaki Disease

Clinical Presentation and Diagnosis

Atypical Kawasaki Disease

Laboratory Studies and Imaging

Treatment

Complications

Periodic Fever Syndromes

Clinical Presentation and Diagnosis

Treatment

Complications

Chronic Pain Syndromes

Clinical Presentation and Diagnosis

Treatment

Chapter 23 Suggested Readings

Suggested Readings

Rheumatology Web Sites

Chapter 24: Renal Diseases

Renal Function and Urine Studies

History

Physical Examination

Urinalysis

Calculating Creatinine Clearance

Table 24-1: Laboratory Differentiation of Oliguria

Table 24-2: Normal Glomerular Filtration Rate (GFR) by Age

Table 24-3: Summary of Diagnostic Renal Evaluation by Function

Acute Renal Failure

Etiology

Laboratory Studies

Metabolic Acidosis

Table 24-4: Types of Renal Tubular Acidosis

Proteinuria

Definition and Epidemiology

History

Physical Examination

Laboratory Studies

Imaging

Indications for Renal Biopsy

Differential Diagnosis

Treatment

Nephrotic Syndrome

Definition and Epidemiology

Classification

Treatment (Primary or Idiopathic)

Complications (Table 24-6)

Indications for Renal Biopsy/Genetic Testing

Table 24-5: Incidence of Nephrotic Syndrome

Table 24-6: Complications of Nephrotic Syndrome

Hematuria

Definition and Epidemiology

Etiology

History

Physical Examination

Laboratory Studies and Imaging

Treatment

Table 24-7: Characteristics of Glomerular versus Nonglomerular Bleeding

Glomerulonephritis

Diagnosis

Treatment

Table 24-8: Differential Diagnosis of Glomerulonephritis

Hypertension

Definitions

Epidemiology

Etiology

History

Physical Examination

Laboratory Studies and Imaging

Treatment

Table 24-9: Differential Diagnosis of Hypertension

Chapter 24 Suggested Readings

Suggested Readings

Chapter 25: Radiology

Ordering a Radiology Examination

Safety Considerations

Radiation Considerations

Gastrointestinal Contrast Considerations

Intravenous Contrast Considerations

Magnetic Resonance Imaging Considerations

Table 25-1: Gastrointestinal Conditions: Recommended Imaging

Table 25-2: Selected Nongastrointestinal Conditions: Recommended Imaging

Chest Radiography

Evaluating for Infiltrates

Evaluating Chest Radiographs from the Neonatal Intensive Care Unit

Checking for a Free Air in the Chest

Pneumothorax

Checking for a Foreign Body

Figure 25-1: Viral bronchiolitis.

Figure 25-2: Right lower lobe pneumonia.

Figure 25-3: Pneumothorax.

Figure 25-4: Pneumomediastinum and pneumothorax.

Chest Computed Tomography and Magnetic Resonance Imaging

Abdominal Radiography

Evaluating Bowel Gas Pattern

Evaluating a Pneumoperitoneum

Evaluating the Tubes and Lines

Figure 25-5: Small bowel obstruction.

Figure 25-6: Intussusception.

Figure 25-7: Necrotizing enterocolitis.

Figure 25-8: Pneumoperitoneum.

Abdominal Imaging

Figure 25-9: Appendicitis.

Figure 25-10: Splenic trauma.

Figure 25-11: Neuroblastoma.

Figure 25-12: Crohn disease.

Gastrointestinal Fluoroscopic Examinations

Speech Swallow Study

Barium Swallow/Upper Gastrointestinal Examination

Small Bowel Follow-Through

Contrast Enema

Figure 25-13: Malrotation.

Figure 25-14: Hypertrophic pyloric stenosis.

Figure 25-15: Hirschsprung disease.

Figure 25-16: Meconium ileus.

Genitourinary Imaging

Voiding Cystourethrogram (VCUG)

Ultrasound

Genitourinary Computed Tomography and Magnetic Resonance Imaging

Extremity Imaging

Figure 25-17: Osteomyelitis.

Figure 25-18: Slipped capital femoral epiphysis.

Figure 25-19: Child abuse.

Figure 25-20: Child abuse.

Figure 25-21: Achondroplasia.

Neuroimaging

Figure 25-22: Grade IV hemorrhage in preterm infant.

Figure 25-23: Subdural hemorrhage.

Figure 25-24: Epidural hemorrhage.

Nuclear Medicine

Intervention Radiology

Chapter 25 Suggested Readings

Suggested Readings

Chapter 26: Sedation

Chapter 26 Introduction

Definitions

Stages of Sedation and Recovery

Discharge/Transfer Criteria

Table 26-1: Aldrete Scoring System for Recovery from Sedation*

Presedation Evaluation

History

Classification Systems

Mallampati Classification System

ASA Physical Status Classification

High-Risk Problems

Screening for Acute Illness

Figure 26-1: Mallampati classification system for use during presedation evaluation.

Pediatric Airway and Positioning

Anatomy

Positioning Techniques

Identifying the Potentially Difficult Airway

Airway Equipment, Medications, and Personnel

Equipment

At Bedside or Immediately Available

In Room

Medications (Immediately Available)

Personnel Required

Table 26-2: Common Sedation and Analgesic Medications

Table 26-3: Antinausea Agents*

Table 26-4: Emergency Drugs*

Recognizing Ineffective Ventilation

Sedation Checklist

Table 26-5: Nothing-by-Mouth (NPO) Guidelines for Elective Sedation*

Adverse Events during Sedation

Upper Airway Obstruction/Laryngospasm

Apnea with or without Hypoxia

Hypotension (a decrease in systolic blood pressure by >20%.)

Hypovolemia

Allergic Reaction

Aspiration

Chapter 26 Suggested Readings

Suggested Readings

Chapter 27: Patient Safety and Quality Improvement

Chapter 27 Introduction

Handoffs and Sign-Outs

Written Communication

Table 27-1: Official “Do Not Use” List*

Resident Role in Patient Safety

Quality Improvement

Chapter 27 Suggested Readings

Suggested Readings

Formulary

Formulary

Suggested Readings

Exhibit 505

Appendix A: Immunization Guidelines, 2015

Appendix A: Immunization Guidelines, 2015

Figure A-1

Figure A-2

Figure A-3

Appendix B: Developmental Milestones

Appendix B: Developmental Milestones

Exhibit 511

Appendix C: Growth Charts

Appendix C: Growth Charts

Figure C-1

Figure C-2

Figure C-3

Figure C-4

Figure C-5

Figure C-6

Figure C-7

Figure C-8

Figure C-9

Figure C-10

Appendix D: Tanner Stages

Appendix D: Tanner Stages

Figure D-1

Figure D-2

Appendix E: Phototherapy/Exchange Transfusion Guidelines

Appendix E: Phototherapy/Exchange Transfusion Guidelines

Figure E-1

Figure E-2

Figure E-3

Appendix F: Hypertension in Children and Adolescents

Appendix F: Hypertension in Children and Adolescents

Table F-1: Blood Pressure Levels for Boys by Age and Height Percentile

Table F-2: Blood Pressure Levels for Girls by Age and Height Percentile

Table F-3: Classification of Hypertension in Children and Adolescents, with Measurement Frequency and Therapy Recommendations

Appendix G: Common Procedures

Appendix G: Common Procedures

Umbilical Artery Catheterization

Umbilical Vein Catheterization

Lumbar Puncture

Chest Tube Placement and Thoracentesis

Suturing

Application of Skin Adhesives

Suggested Readings

Table G-1: Suture Requirements for Lacerations by Location

Appendix

Remarks

Glossary

 

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An aparitie	2016
Autor	Susan Dusenbery
Dimensiuni	13.2 x 1.8 x 22.1 cm
Editura	Wolters Kluwer
Format	Paperback
ISBN	9780781785761
Limba	Engleza
Nr pag	544