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Part I: The Field of Pediatrics Chapter Page

Diaper Dermatitis: As the most common skin disorder of infancy and one of the most visible problems in infant care, diaper rash is frequently discussed 5 16
well child visits.
Part II: Growth and Development
Skeletal Maturation: The most commonly used standards are those of Gruelich and Pyle, which require radiographs of the left hand and wrist; knee films 15 60
are sometimes added for younger children.
Dental Development: Delayed eruption is usually considered when there are no teeth by approximately 13 mo. of age. Common causes include hypothy- 15 60
roid, hypoparathyroid, familial and (the most common) idiopathic.
Diagnostic Assessment: The medical evaluation for mental retardation and autism should include chromosomal and molecular biologic testing for fragile 16 64
X, the most commonly identified genetic cause of mental retardation.
Part III: Psychologic Disorders
Assessment and Interviewing: The clinical interview is the most common procedure in medicine, but the nature of the process is often poorly defined. 17.1 66
The most common deficiency within an interview is the failure of the clinician to define clearly the goals of the particular
Psychosomatic illness - Conversion disorder: …pseudoseizures are the most common conversion symptom. 19 71
Vegetative Disorders – Enuresis: The most common cause of daytime enuresis in the preschool child is waiting until the last minute to void urine (mictu- 20.3 72
ration deferral).
Anxiety Disorders – Obsessive-compulsive disorder: The most common compulsions are handwashing, continual checking of locks, and touching. 22 77
Suicide and Attempted Suicide: Among preadolescents, jumping from heights is the most common method, followed by self-poisoning, hanging, stabbing 24 81
and running into traffic.
Disuptive Behavioral Disorders – Truancy and Run-away behavior: During the latency years, the most common causes are related to abuse and neglect 25 83
within the home.
Reading Dysfunction: Most commonly, subtle or blatant language dysfunctions are present in children with significant reading delays. 29 97
Specific reading disability: Dyslexia is the most common and most comprehensively studied of the learning disabilities, …. 29.3 103
Dyslexia may be the most common neurobehavioral disorder affecting children, ….
Part IV: Social Issues
Abuse and Neglect of Children: Nutritional neglect is the most common cause of underweight in infancy and may account for > ½ of the cases of FTT. 35 111
Bruises are the most common manifestation of child abuse and may be found on any body surface.
The most common cause of death from physical abuse is head trauma. 112
Intra-abdominal injuries from impacts are the second most common cause of death in battered children. 113


Chapter Page
Part V : Children with Special Needs
Failure to thrive: In developed countries, the most common presentation is poor growth detected in an ambulatory setting; in developing countries, recur- 36 120
rent infections, marasmus, and kwashiorkor are more common presentations.
Part VI: Nutrition
Part VII: Pathophysiology of Body Fluids and Fluid Therapy
Perioperative Fluids: The most common error in administering parenteral fluid during and after surgery is excessive administration , particularly of dex- 55.7 220
trose in water, rather than use of isotonic solutions.
Tetany: The most common disorder of parathyroid function is transient physiologic hypoparathyroidism of the newborn infant, sometimes referred to as 55.9 224
neonatal hypocalcemia.
Part VIII: The Acutely Ill Child
Injury control: Injuries are the most common cause of death during childhood beyond the first few months of life and represent one of the most important 57 231
causes of preventable pediatric morbidity and mortality.
Fire and burn-related injuries: Fire and burn-related injuries are the third most common cause of unintentional injury death in the United States, with 57 235
about 6,000 burn injury deaths occurring each year.
Firearm injuries: Injuries to children and adolescents involving firearms occur in 3 different situations: nonintentional injury, suicide attempt, and assault. 57 236
Suicide is now the third most common cause of trauma death in teenage males and fourth in females.
Part IX: Human Genetics
Sex Chromosome Anomalies – Turner Syndrome: This is one of the most common monosomies in liveborn humans. 78 330
Fragile Sites: The fragile site located on the distal long arm of chromosome X at Xq27.3 has been associated with the fragile X syndrome, which is the 78 331
most common form of mental retardation in males.
Part X: Metabolic Diseases
OCA2 (Tyrosinase-Positive Albinism): This is the most common form of generalized albinism. 82.2 350
Homocytinuria due to cystathionine synthase deficiency (Homocystinuria Type I, Classic Homocystinuria) : This is the most common inborn error of 82.3 350
methionine metabolism.
Hartnup Disorder: Hartnup defect, with an overall prevalence of 1/24,000 ranks among the most common amino acid disorders in humans. 82.5 353
Nonketotic hyperglycinemia (NKH) : Neonatal NKH – this is the most common form of NKH. 82.7 362
Ornithine Transcarbamylase (OTC) Deficiency: This is probably the most common of all urea cycle disorders. 82.11 370
Disorders of Mitochondrial Fatty Acid oxidation: The most common presentation is an acute attack of life-threatening coma and hypoglycemia induced 83.1 377
by a period of fasting.


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Defects in the β-oxidation cycle: Medium-chain acyl-CoA dehydrogenase deficiency (MCAD) is the most common of the fatty acid oxidation disorders. 83.1 377
Primary Hypoalphalipoproteinemia: The most common inherited form of low HDL is termed primary or familial hypoalphalipoproteinemia. 83.3 396
Fabry disease (inborn error of glycosphingolipid metabolism): Cardiovascular findings - Mitral insufficiency is the most common valvular lesion. 83.4 403
Glycogen Storage Diseases: Glucose-6-phosphatase deficiency (type I), lysosomal acid α-glucosidase deficiency (type II), debrancher deficiency 84.1 406
(type III), and liver phosphorylase kinase deficiency are the most common forms that present in early childhood; myophos-
phorylase deficiency (type V, McArdle disease) is the most common in adults.
Acute Intermittent Porphyria (AIP) : AIP is probably the most common genetic porphyria. 87 435
Infants born to diabetic mothers: Of the transient hyperinsulinemic states, infants born to diabetic mothers is the most common. 88 441
Hyperinsulinism: Hyperinsulinism is the most common cause of persistent hypoglycemia in early infancy. 88 442
Ketotic Hypoglycemia: This is the most common form of childhood hypoglycemia. 88 445
Part XI: The Fetus and the Neonatal Infant
Intracranial-Intraventricular hemorrhage: The most common symptoms are diminished or absent Moro reflex, poor muscle tone, lethargy, apnea, and 95.1 489
Delivery room emergencies: The most common and important emergency related to newborn infants in the delivery room is the failure to initiate and 96 495
maintain respirations.
Circumcision: Circumcision is the most common elective surgical procedure performed on newborn boys in the United States. 100 527
Infections of the Neonatal Infant: The most common bacterial causes of neonatal meningitis are GBS, E.coli K1, and Listeria. 105.2 540
The most common causes of early-onset sepsis are GBS and enteric bacteria acquired from the maternal genital tract.
In very low birthweight infants, Candida and coagulase-negative staphylococci (CONS) are the most common
pathogens in late-onset sepsis.
The most common congenital infection in the United States is due to CMV.
Clinical Manifestations of Neonatal Infections: Fulminant infection is most commonly associated with group B streptococcal (GBS) septicemia in term 106.1 544
or premature infants.
Part XII: Special Health Problems During Adolescence
Violent Behavior: The most common behavioral diagnoses associated with aggressive behavior in adolescents are mental retardation, learning 111 560
disabilities, moderately severe language disorders, and mental disorders such as attention deficit hyperactivity, mood, anxiety, and
personality disorders.
Substance Abuse: Alcohol and cigarettes are the most prevalent drugs. Marijuana tends to be the most commonly reported illicit drug ever used, with 113 565
the exception of inhalants in younger teenagers (8th grade).


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The Breast: The most common adolescent breast disorder is a mass, the majority of which are benign cysts or fibroadenomas. 115 573
Primary Amenorrhea: When primary amenorrhea occurs with advanced pubertal development, a structural anomaly of the mullerian duct system should 116.1 574
be suspected. Imperforate hymen is most common and is associated with recurrent (monthly) abdominal pain and, after some time
has passed, a midline lower abdominal mass, the blood-filled vagina, or hematocolpos.
Injectible progestin (Depo-Provera, DMPA): The most common side effect of DMPA is menstrual disturbance, either amenorrhea or abnormal vaginal 117.4 579
Emergency Contraception: The Yuzpe method is most commonly used in the United States, consisting of combination pills totaling 200ug of ethinyl 117.5 580
estradiol and 2.0 mg of norgestrel or 1.0 mg levonorgestrel. … The most common side effect is nausea (50%) and vomiting.
Pregnancy – Diagnosis: The most commonly used method is a qualitative measurement of beta subunit for the hCG by blood or urine. The results are 118 581
positive in 98% of women within 7 days of implantation.
Sexually Transmitted Diseases: HIV and HepaB – aymptomatic patients = Asymptomatic infections with viral pathogens, such as HIV, HSV, and hepati- 119 585
tis B are the most common presentations of these disease.
Orthopedic Problems: The most common presentation for most of the (previously mentioned) conditions is pain. 121 587
Part XIII: The Immunologic System and Disorders
B-Cells: Selective IgA deficiency, the most common B-cell defect, can be ruled out by measuring serum IgA. 122 589
Selective IgA Deficiency: An isolated absence or near absence (i.e.<10mg/dL) of serum and secretory IgA is the most common well-defined immunode- 124.2 597
ficiency disorder, with a frequency of 1/333 reported among apparently healthy blood donors.
X-linked Severe Combined Immunodeficiency (XSCID): XSCID is the most common form of SCID in the United States, accounting for approximately 126.6 603
47% of cases.
Allergic Diseases: Allergy is the most common cause of eosinophilia in children in the United States. 129 614
Chronic Granulomatous Disease: Pneumonias, lymphadenitis, and skin infections are the most common infections encountered. The most common 130.5 620
pathogen is S. aureus.
Drug-induced neutropenia: Drug use remains one of the most common causes of neutropenia. 131 621
Acute lymphoblastic leukemia (ALL): ALL is the most common malignancy of childhood, and approximately 70% of cases cured by conventional 135 635
Neuroblastoma: The most common extracranial solid tumor in children is neuroblastoma. 135 636
Brain tumors: Tumors of the CNS are the most common solid tumors in children, accounting for 20% of childhood malignancies. 135 637
Part XIV: Allergic Disorders/ Part XV: Rheumatic Diseases of Childhood (Connective Tissue Diseases, Collagen-Vascular Diseases)
Juvenile Rheumatoid Arthritis (JRA): JRA is one of the most common rheumatic diseases of children and a major cause of chronic disability. 156 704


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Juvenile Dermatomyositis (JDM): JDM, the most common of the pediatric inflammatory myopathies, is a systemic vasculopathy with characteristic 160 717
cutaneous findings and focal areas of myositis resulting in progressive proximal muscle weakness that is responsive
to immunosuppressive therapy.
Henoch-Schönlein Purpura (HSP): HSP, also known as anaphylactoid purpura., is a vasculitis of small vessels. It is the most common cause of non- 167.1 728
thrombocytopenic purpura in children.
Part XVI: Infectious Diseases
Enterotoxigenic E. coli (is) the most common (commonest) cause of traveler’s diarrhea. 171 740
Clostridium difficile, (is) the most common bacterial cause of nosocomial diarrhea. 171 740
Antimicrobial susceptibility testing: The most common technique is the agar disk diffusion method (Bauer-Kirby method), in which a standardized 171 740
inoculum of the organism is seeded onto an agar plate.
Fever in patients with sickle cell anemia: Infection is the most common cause of death among children with sickle cell anemia. 172 743
CNS infections: Acute infection of the CNS is the most common cause of fever associated with signs and symptoms of CNS disease in children. 174 751
Viral Meningoencephalitis: The most common arbovirus responsible for CNS infection in the United States are St. Louis and California enceph virus. 174.2 757
Varicella-zoster virus may cause CNS infection…. The most common manifestation of CNS involvement is cerebellar ataxia,
and the most severe is an acute encephalitis.
Eosinophilic Meningitis: The most common cause of worldwide eosinophilic pleocytosis is CNS infection with helminthic parasites. 174.3 760
The most common cause is human infection with the rat lungworm Angiostrongylus cantonensis.
Pneumonia: The most common microbiologic causes of pneumonia in normal children include respiratory viruses, Mycoplasma pneumonia, and selected 175 761
Respiratory viruses are the most common cause of pneumonia during the first several years of life.
The most common bacterial causes of pneumonia in normal children are S.pneumonia, Streptococcus pyogenes (grp.A Streptococcus), and
Staphylococcus aureus.
Viral Pneumonia: The most common viruses causing pneumonia include respiratory syncytial virus (RSV), parainfluenza, influenza, and adenovirus. 175 761
RSV is the most common cause of viral pneumonia, especially during infancy.
Bacterial Pneumonia: S. pneumoniae is still the most common cause of bacterial infection of the lungs. 175 762
Gastroenteritis: G.lamblia is the most common parasitic cause of diarrhea in the United States. 176 766
Hepatitis in the neonates: HBV, the most common hepatotropic virus that infects neonates, usually results in an asymptomatic infection. 177.1 775
The most common sequence of events is for an infant to have no clinical evidence of disease and to become chronically infec-
ted and positive for HBsAg.


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Osteomyelitis and Suppurative Arthritis: In osteomyelitis, Staphylococcus aureus is the most common infecting organism in all age groups, including 178 776
The microbial spectrum is diverse in suppurative arthritis, but staphylococcal infection is most common.
Infections with primary defects in cell mediated immunity: The most commonly acquired disorder resulting from a predominanatly T-lymphocyte defect 179 782
is AIDS.
Infections with primary phagocyte-neutrophil defects: In Chédiak-Higashi syndrome, recurrent infection of the respiratory tract and skin are the most 179 782
common sites of involvement. S. aureus is the most frequent cause of these infections.
Infections in Renal Transplant Patients: Urinary tract infection is the most common infection, with the highest incidence (10%) during the 1st month 179 784
after transplantation. During this time, P.aeruginosa is the most common cause, but after the 1st month,
E. coli is more frequent.
Infections in Neutropenic patients with Cancer: Coagulase –negative staphylococci, S. aureus, and α-hemolytic streptococci are the most frequent 179 785
organisms cultured from the blood of febrile children with neutropenia. In some cases of α-hemolytic
streptococcal bacteremia, an acute septic shock syndrome may occur, resembling ARDS; this mani-
festation is most common in children receiving cytarabine or quinolone drugs. P.aeruginosa, E. coli,
and Klebsiella pneumoniae are the most common gram-negative bacillary infections.
Infection Associated with Medical Devices: CSF Shunts – The most common type of infection is colonization of the shunt. 180 789
S. aureus is the most common isolate.
Animal and Human bites: The most common type of injury from cat and rat bites is a puncture wound. 181 791
Infection is the most common complication of bite injuries, regardless of the species of biting animal.
Rat-bite fever: The most common form of rat-bite fever in the United States is caused by Streptobacillus moniliformis, a gram negative bacillus that is 181.1 792
present in the nasopharyngeal flora of approximately 50% of rats.
Staphylococcus aureus: S. aureus is the most common cause of pyogenic infection of the skin. 182.1 793
Bones and Joints: S. aureus is the most common cause of osteomyelitis and suppurative arthritis in children. 182.1 796
Coagulase-negative Staphylococci: CONS , specifically S. epidermidis, are the most common cause of nosocomial bacteremia. 182.3 798
Central Venous Catheter infection: S. epidermidis is the most common CONS, owing in part to its high rate of
cutaneous colonization.
CSF Shunts: S. epidermidis, introduced at the time of surgery, is the most common pathogen associated with CSF
shunt meningitis.
Urinary tract infection: S. epidermidis is the most common pathogen producing peritonitis in patients on continuous
ambulatory peritoneal dialysis.


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Streptococcus pneumoniae (Pneumococcus): S. pneumoniae is the most common cause of meningitis in adults. 183 799
S. pneumoniae is the most frequent bacterial cause of bacteremia, pneumonia, and otitis media and the 800
second most common cause of meningitis in infants and children.
Group A Streptococcus: Streptococci are among the most common causes of bacterial infection in infancy and childhood. 184 802
Group A Streptococcus, the most common bacterial cause of acute pharyngitis, also produces diverse other infections as well as
Non-suppurative sequelae such as rheumatic fever and glomerulonephritis.
The most common infections caused by group A β-hemolytic streptococci involve the respiratory tract, skin, soft tissues & blood. 803
The most common form of skin infection due to group A β-hemolytic streptococci is superficial pyoderma (impetigo).
Rheumatic Fever: Subcutaneous nodules: These lesions occur frequently and are most commonly observed in patients with severe carditis. 184.1 807
Laboratory: The most commonly used test is the ASO test. 808
Nocardia: Nocardiosis is a pulmonary disease in 75% of all cases. Metastatic lesions may occur anywhere in the body, but the brain is the most common 190 825
secondary site, affected in 15-40% of cases. Brain abscess is the most common presentation, with meningitis the second most common,
as manifested by pleocytosis, elevated CSF protein, and hypoglycorrhachia.
Neisseria gonorrhea (Gonococcus): Disseminated Gonococcal Infection (DGI) –The most common manifestations are asymmetric arthralgia, petechial or 192 831
pustular acral lesions, tenosynovitis, suppurative arthritis, ….
The most common initial symptoms are acute onset of polyarthralgia
with fever.
Haemophilus influenzae: The mode of transmission is most commonly by direct contact or inhalation of respiratory tract droplets containing H.influenzae. 193 833
Suppurative Arthritis: Large joints, such as the knee, hip, ankle, and elbow, are affected most commonly. 836
Otitis media: Acute otitis media is one of the most common infectious diseases of childhood. 837
The most common bacterial pathogens are S. pneumoniae, H. influenzae, and Moraxella catarrhalis.
Conjunctivitis: Acute infection of the conjunctiva is the most common eye infection in childhood.
Nontyphoidal Salmonellosis: Acute Gastroenteritis – This is the most common clinical presentation. 196.1 844
Bacteremia – S. typhimurium is the most common serotype causing Salmonella bacteremia in the United States.
Extraintestinal focal infections – Extraintestinal infections are most common in the first 3 months of life, in those with
sickle cell disease, and in those who have had prior gastrointestinal surgery.
The most common focal infections involve the skeletal system, meninges, and intravascu-
lar sites.


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Enteric Fever: In developing countries, S. typhi is often the most common Salmonella isolate, with an incidence that can reach 500/100,000. 196.2 845
Ingestion of foods or water contaminated with human feces is the most common mode of transmission.
Shigella: … the most common form of epidemic dysentery… 197 848
Although infection can occur at any age, it is most common in the 2nd and 3rd year of life.
In industrialized societies, S. sonnei is the most common cause of bacillary dysentery with S. flexneri, second in frequency.
In preindustrial societies, S. flexneri is most common , with S. sonnei second in frequency.
Neurologic findings are among the most common extraintestinal manifestations of bacillary dysentery, occurring in as many as 40% of hospita- 849
lized infected children.
The most common complication of shigellosis is dehydration with its attendant risks of renal failure and death.
Escherichia coli: The most common shigatoxin-producing E.coli (STEC) serotypes are E.coli 0157:H7, E.coli 0111:NM, and E.coli 026:H11. 198 851
Campylobacter: Human campylobacterioses most commonly result from ingestion of contaminated food or water, from direct acquisition from other 200 855
environmental sources, or from person-to-person transmission.
Yersinia enterocolitica: Disease is usually manifested in younger children as an acute enteritis. The most common presenting signs and symptoms are 201.1 858
fever (40-50%), occasionally to 40oC, abdominal pain (20-80%), that is usually colicky and sometimes localized to the right
lower quadrant, and diarrhea (80-95%)
Aeromonas: The most common clinical manifestation of infection with Aeromonas spp. is gastroenteritis. 202 861
Some studies suggest that it is the third or fourth most common cause of childhood bacterial diarrhea.
A. hydrophilia and A. sobria are the most common species causing septicemia.
Francisella tularensis: The illness caused by F. tularensis is manifested by different clinical syndromes, the most common of which consists of an 204 865
ulcerative lesion at the site of inoculation with regional lymphadenopathy or lymphadenitis.
The most common portal of entry for human infection is through the skin or mucous membrane. 866
Bacteremia may also be present, and although any organ of the body may be involved, the reticuloendothelial system is the most
commonly affected.
Patchy segmental infiltrates, hilar adenopathy, and pleural effusions are the most common abnormalities demonstrated by chest
Brucella: If abnormalities are demonstrated on physical examination, the bones and joint frequently are involved, with the sacroiliac joint as well as the 205 868
hips, knees and ankles being the most common.


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Bartonella henselae: The most common presentation of Bartonella infection is Cat-Scratch Disease (CSD), a subacute, regional lymphadenitis caused by 207.2 872
B. henselae. It is the most common cause of chronic lymphadenitis, lasting for more than 3 weeks.
The most common atypical presentation, noted in 2-17% of patients, is Parinaud’s occuloglandular syndrome, which is unilateral
conjunctivitis followed by preauricular lymphadenopathy.
Tetanus: The most common form, neonatal (umbilical) tetanus, kills approximately 500,000 infants each year because the mother was not immunized. 209 878
Other Anaerobic Infections: Anaerobic periodontal disease is most common in patients with poor dental hygiene and in those who are receiving drugs 211 882
that result in hypertrophy of the gum.
Lemierre’s syndrome, a postanginal sepsis, is a suppurative infection of the lateral pharyngeal space and septic thrombophle-
bitis of the jugular vein leading to septic embolization to the lungs and CNS. Fusobacterium necrophorum is the most
commonly involved organism.
Bacteroides fragilis is one of the more virulent of the anaerobes. The most common infection in children is infection 884
associated with appendicitis.
Tuberculosis: Congenital tuberculosis is rare because the most common result of female genital tract tuberculosis is infertility. 212 887
The most common reasons for a false-negative tuberculin skin test are poor technique or misreading the results.
The most common form of cardiac tuberculosis is pericarditis. 889
Miliary tuberculosis … this form of disease is most common in infants and malnourished or immunosuppressed patients…
TB of the middle ear … the most common signs and symptoms are painless unilateral otorrhea, tinnitus, decreased hearing, facial paralyis,
and a perforated tympanic membrane. 890
Tuberculosis of the superficial lymph nodes, often referred to as scrofula, is the most common form of extrapulmonary tuberculosis in
Tuberculosis of the oral cavity or pharynx is quite unusual. The most common lesion is a painless ulcer on the mucosa, palate, or tonsil w/ 891
enlargement of the regional lymph nodes.
Tuberculus enteritis: The jejunum and ileum near Peyer’s patches and the appendix are the most common sites of involvement.
Tuberculosis of the genital tract: the most common symptoms are lower abdominal pain and dysmenorrhea or amenorrhea. 892
TB in HIV-infected children: Nonspecific respiratory symptoms, fever, and weight loss are the most common complaints.
Perinatal Disease: the most common signs and symptoms are respiratory distress, fever, hepatic or splenic enlargement, poor feeding,
lethargy or irritability, lymphadenopathy, abdominal distention, failure to thrive, ear drainage, and skin lesions.
Isoniazid: the most common physical manifestation of peripheral neuritis (INH side effect) is numbness and tingling in the hands or feet. 893
Corticosteroids: the most commonly prescribed regimen is prednisone, 1-2 mg/kg/24hr in 1-2 div. doses for 4-6 wks w/ gradual tapering. 895
Drug Susceptible TB: the most common regimen is INH, RIF, EMB. 897


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Nonvenereal Treponemal Infections: Yaws (caused by Treponema pertenue) is the most common of the nonvenereal spirochetal diseases. 216.1 907
Borrelia burgdorferi (Lyme Disease): Lyme Disease is the most common vector-borne disease in the United States. 219 910
Mycoplasma pneumoniae: Bronchopneumonia is the most commonly recognized clinical syndrome occurring after M. pneumoniae infections. 220 915
Cryptococcus neoformans: Cryptococcosis - Cryptococcus neoformans var. neoformans is the most common etiologic agent worldwide and is the predo- 231 935
minant pathogenic fungal infection among individuals infected with HIV.
Pneumonia is the most common form of cryptococcosis.
HIV infection is the most common predisposing factor for disseminated cryptococcosis. 936
Subacute or chronic meningitis is the most common clinical manifestation of disseminated cryptococcosis.
Invasive Aspergillus infection: Sinusitis: Fever, cough, epistaxis, headache, and sinus pain are the most common clinical signs. 233 938
Pneumonia and Disseminated infection: Invasive pulmonary aspergillosis is the most common form of Aspergillus infec-
tion and usually occurs in immunocompromised patients.
Bone: Involvement of the vertebrae is most common. 939
Blastomyces dermatitidis: Acute pneumonia is the most common form of human blastomycosis. 235 941
Rubella: Congenital Rubella affects virtually all organ systems. The most common manifestation is intrauterine growth retardation. 241 952
Mumps: Enzyme immunoassay for mumps immunoglobulin IgG and IgM antibodies are most commonly used for diagnosis. 242 954
Complications: Meningoencephalomyelitis is the most frequent. Arthritis most commonly affects the knees, ankles, shoulders and wrists. 955
Poliomyelitis : Differential diagnosis: Guillain-Barré is the most common diseases and the most difficult to distinguish from poliomyelitis. 243.1 958
Nonpolio Enteroviruses: Clinical Manifestations: Vomiting is most common in meningitis and least common in pleurodynia (Bornholm’s disease) and 243.2 963
uncomplicated exanthematous disease.
Aseptic meningitis resulting from enterovirus occurs in epidemics and as isolated cases. Epidemics
have most commonly with Coxsackievirus B5 and echovirus 4, 6, 9, and 11.
In pericarditis and myocarditis, the group B Coxsackieviruses have been most frequently implicated,
and B5 has been the most common causative agent.
In orchitis and epididymitis, Group B coxsackieviruses are second only to mumps as causative agents
of orchitis; B5 is the most commonly associated Coxsackievirus, but B2 and B4 (can be also).
Parvovirus B19: The most common manifestation of parvovirus B19 is erythema infectiosum, also known as fifth disease, which is a benign, self-limited 244 965
exanthematous illness of childhood.
Herpes Simplex Virus: Acute Herpetic Gingivostomatitis – this primary infection, probably the most common cause of stomatitis in children 1-3 yr. of 245 968
age, can also occur in older children and adults.


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Cytomegalovirus (CMV): CMV is the most common congenital infection, which occasionally causes the syndrome of cytomegalic inclusion disease 248 981
(hepatosplenomegaly, jaundice, petechia, purpura, and microcephaly).
Clinical manifestation: In immunocompromised hosts, illness with a primary infection includes pneumonitis (most common) 982
hepatitis, chorioretinitis, gastrointestinal disease, or fever with leucopenia as isolated entities or as
manifestations of generalized disease, which is often fatal.
Human herpesvirus 8 (HHV8)) : 3 malignancies occurring primarily in adults with AIDS are associated with HHV8: Kaposi Sarcoma (KS), multicentric 250 987
Castleman disease and primary effusion lymphoma. KS is the most common neoplasm associated with AIDS(adults).
Respiratory Syncytial Virus (RSV): Bronchiolitis is the most common clinical diagnosis in infants hospitalized with RSV infections, although the 253 992
syndrome is often indistinguishable from RSV pneumonia in infants, and indeed, the two frequently coexist.
Adenovirus: Mucosal surfaces are the primary target early in infection and typically the site of the most common pathology. 254 994
Acute respiratory disease is the most common manifestation of adenovirus infection in children and adults.
Adenovirus is one of the most common causes of follicular conjunctivitis and keratoconjunctivitis.
Rhinoviruses: Rhinoviruses are collectively the most common cause of the “common cold” in adults. 255 995
Rotavirus and other agents of viral gastroenteritis: Isotonic dehydration with acidosis is the most common finding in children with severe viral enteritis. 256 997
Dengue Fever/ Dengue Hemorrhagic Fever: The most common hematologic abnormalities during dengue hemorrhagic fever and dengue shock syndrome 260 1007
are hemoconcentration with an increase of more than 20% in hematocrit, thrombocytopenia, prolonged
bleeding time, and moderately decreased prothrombin level that is seldom less than 40% of control.
Acquired Immunodeficiency Syndrome (HIV): Clinical manifestations: 268
Bacterial infections: The most common serious infections are bacteremia, sepsis, and pneumonia, 1026
accounting for more than 50% of infections in HIV-infected children.
Fungal infections: Oral candidiasis is the most common fungal infection seen in HIV-infected 1026
children. 1026
CNS: The most common presentation is progressive encephalopathy with loss or plateau of develop-
mental milestones, cognitive deterioration, impaired brain growth resulting in acquired
microcephaly, and symmetric motor dysfunction. 1027
Respiratory tract: Lymphocytic interstitial pneumonitis (LIP) is the most common chronic lower res-
piratory tract abnormality, occurring in 30-50% of HIV-infected children.
Most HIV-infected children experience at least one episode of pneumonia. S.
pneumoniae is the most common bacterial pathogen .
P.aeruginosa pneumonia occurs most commonly in severely symptomatic children


(C3 category) and is often associated with acute respiratory failure and death.
Chapter Page
P. carinii pneumonia is the most common opportunistic infection, but other patho- 268 1027
gens including CMV, Aspergillus, Histoplasma and Cryptococcus, can cause
pulmonary disease.
Gastrointestinal and Hepatobiliary tract: The most common symptoms of gastrointestinal disease are
chronic or recurrent diarrhea with malabsorption, abdomi- 1027
nal pain, dysphagia, and failure to thrive.
Renal Disease: Nephrotic syndrome is the most common manifestation of renal disease, with edema, 1027
hypoalbuminemia, proteinuria, and azotemia with normal blood pressure.
Malignancy: Non-hodgkin’s lymphoma, primarily CNS lymphoma, and leiomyosarcomas are the most 1028
commonly reported neoplasms in children. EBV is associated with most lymphomas
and with all leiomyosarcomas.
Amebiasis: Food and drink contaminated with Entamoeba cysts and direct fecal-oral contact are the most common means of infection. 271 1035
African trypanosomiasis: Clinical manifestation: 276 1045
Hemolytic Stage: The most common presenting features of acute African trypanosomiasis occur at the time of invasion of
the bloodstream by the parasites, approximately 2-3 weeks after infection.
Malaria: P.falciparum malaria is the Plasmodium malaria most commonly associated with serious complications. 278 1050
Toxoplasmosis: Clinical manifestation: 280 1055
Acquired toxoplasmosis: The most common manifestation is enlargement of one or a few lymph nodes in the cervical region.
Treatment: Neutropenia is the most common side effect in treated infants. 1061
Toxocariasis: Patients with ocular toxocariasis most commonly present with decreased visual acuity (75% of cases) and occasionally strabismus or peri- 285 1068
orbital edema.
Angiostrongylus cantonensis: The most common infectious cause of eosinophilic meningitis is inadvertent human infection with Angiostrongylus canto- 289 1071
nensis, the rat lungworm.
Trichuriasis: Trichuris trichiura, or whipworm, causes one of the most common helminthic infections of humans. 295 1073
Trichuriasis is most common in poor rural communities lacking sanitary facilities.
Cysticercosis: Cysticercosis is the most common parasitic cause of CNS disease, known as neurocysticercosis. 299 1078
The fourth ventricle is the most common site for obstruction and symptoms.
Child care and Communicable Diseases: Skin Diseases – The most commonly recognized skin infections or infestations in children in childcare are 303 1093
impetigo due to Staphylococcus aureus or group A Streptococcus, pediculosis, scabies, and


tinea capitis and tinea corporis (ringworm).

Part XVII: The Digestive System Chapter Page
Gastrointestinal hemorrhage: Erosive damage to the mucosa of the GI tract is the most common cause of bleeding, although variceal bleeding secondary 306 1107
to portal hypertension occurs frequently enough to require consideration.
Malocclusion: Class II occlusion (receding chin/ retrognathia) , is the most common occlusal discrepancy with approximately 45% of the population 309 1110
exhibiting some degree of this condition.
Other Disorders of the Esophagus: External compression – the most common masses impinging on the esophagus are enlarged lymph nodes in the subca- 320 1123
rinal area, which may be due to tuberculosis, histoplasmosis, other forms of pulmonary
suppuration, or lymphoma.
Esophagitis: Peptic Esophagitis due to reflux of gastric acid with pain, blood loss, and occasional stricture formation is the most common form of 324 1126
Esophageal candidiasis (moniliasis) is the most common esophageal infection and is not limited to immunocompromised patients.
Foreign bodies in the esophagus: Coins are the most commonly ingested object, especially in children younger than 5 yr. 327 1127
Pyloric stenosis and other congenital anomalies of the stomach: The most common cause of non-bilous vomiting is infantile hypertrophic pyloric stenosis. 329 1130
The most common clinical manifestations of gastric duplication are associated with 329.3 1132
partial or complete gastric outlet obstruction.
Duodenal obstruction: The membranous form of (duodenal) atresia is most common , with obstruction occurring distal to the ampulla of Vater in the 330.1 1134
majority of patients.
Malrotation: The most common type of malrotation involves failure of the cecum to move into the right lower quadrant. 330.3 1136
Intestinal Duplication: Localized duplications may occur in any area of the GI tract but are most common in the ileum and jejunum. 331.1 1137
Meckel Diverticulum: Meckel diverticulum is the most common of these structures (remnants of the omphalomesenteric duct) and is the most frequent 331.2 1137
congenital GI anomaly, occurring in 2-3% of all infants.
The most common mechanism of obstruction occurs when the diverticulum acts as the lead point of an intussusception.
Chronic intestinal pseudo-obstruction: The most common symptoms are abdominal distention and vomiting, which are present in 75% of affected infants. 332.1 1138
Congenital Aganglionic Megacolon (Hirschsprung Disease): Hirschsprung Disease is the most common cause of lower intestinal obstruction in neonates, 332.3 1139
with an overall incidence of 1/5,000 live births.
Intussusception: Intussusception is the most common cause of intestinal obstruction between 3 mos. and 6 yr. of age. 333.3 1142
Foreign bodies in the stomach and intestine: Coins are the most common foreign body ingested by young children. 334.1 1144
In older children, teenagers, and adults, fish or chicken bones are the most common objects accidentally


Inflammatory bowel disease (IBD): The most common time of onset of IBD is during adolescence and young adulthood. 337 1150
Chapter Page
Crohn Disease: Among children with Crohn disease, the initial presentation most commonly involves ileum and colon (ileocolitis) but may involve the 337.2 1154
small bowel alone in about 40% (50% of these patients have terminal ileitis alone) or colon alone in about 10%(granulomatous colitis)
Malabsorptive disorders: The disaccharidase deficiencies are the most common of these entities. 340 1159
Intestinal Infections: Giardiasis is the most common infectious cause of chronic malabsorption. 340.4 1164
Other Malabsorptive Disorders: Cystic fibrosis (pancreatic insufficiency) is the most common congenital disorder associated 340.10 1167
with malabsorption. The next most common cause of pancreatic insufficiency in children,
although much rarer, is Shwachman syndrome.
Microvillus inclusion disease (Congenital Microvillus Atrophy) appears to be the most
common cause of persistent diarrhea that begins in the neonatal period.
Chronic Diarrhea: The most common cause of chronic diarrhea associated with malabsorption is postgastroenteritis malabsorption syndrome. 341 1176
Acute Appendicitis: Acute appendicitis is the most common condition requiring emergency abdominal operation in childhood. 343 1178
Juvenile Colonic Polyp (Retention polyp, Inflammatory polyp): This is the most common childhood bowel tumor, present in 3-4% of people younger 345 1183
than 21 yr.
Peutz-Jeghers Syndrome: Cancer develops in up to 50% of people having Peutz-Jeghers Syndrome, most commonly middle-aged adults. 345 1184
Lymphoma: Lymphoma is the most common malignancy of the gastrointestinal tract in children. About 30% of children with non-hodgkin lymphoma 345 1184
present with abdominal tumors.
Inguinal Hernias: An inguinal hernia is the most common condition requiring operation in the pediatric age group. 346 1185
The most common inguinal hernia in children is an indirect inguinal hernia.
Disorders of the Exocrine Pancreas: Cystic Fibrosis - is the most common lethal genetic disease and the most common cause of malabsorption among 349 1190
white American children.
Pancreatitits: After cystic fibrosis, acute pancreatitis is probably the most common pancreatic disorder in children. 351 1191
Neonatal Cholestasis: Alagille syndrome (arteriohepatic dysplasia) is the most common syndrome incorporating intrahepatic bile duct paucity. 356.1 1204
Liver Abscess: Hepatic abscesses occur in infants in association with sepsis, umbilical vein infection, or vessel cannulation. Beyond infancy, hepatic 358 1212
abscesses occur most commonly in immunocompromised patients.
Cholestasis associated with Total parenteral nutrition (TPN) : The most common metabolic complication of total parenteral nutrition in premature 359 1213
infants is, the development of various degrees of liver dysfunction. Cholestasis is the
most severe form and is potentially fatal.
Reye Syndrome: Reye syndrome was most commonly at approximately 6 yr of age, with most cases in the 4-12 yr. age range. 360 1215
Autoimmune (Chronic) hepatitis: The most common pattern (of serum antibodies) is the formation of non-organ specific antibodies, such as anti-actin 361 1217


(smooth muscle), anti-nuclear, and anti-mitochondrial antibodies.

Chapter Page
Portal Hypertension: Bleeding from esophageal varices is the most common presentation. 366 1226
Acute Secondary Localized Peritonitis (Peritoneal Abscess): Most commonly, periappendiceal and pelvic abscesses arise from a perforation of the 370.3 1231
Part XVIII: The Respiratory System
Choanal atresia: This is the most common congenital anomaly of the nose and has a frequency of approximately 1/7,000 live births. 378 1258
Epistaxis: The most common location for bleeding is in the area of Kiesselbach’s plexus, an area in the anterior septum where vessels from both the 379.2 1260
internal and external carotid arteries converge.
Nasal polyps: Cystic fibrosis is the most common childhood cause of nasal polyposis and should be suspected in any child less than 12 yr. with nasal 380 1260
polyps, even in the absence of typical respiratory and digestive symptoms.
Upper Respiratory Infections/ Colds/ Nasopharyngitis: URIs are the most common medical reason for school or work absenteeism. 381.1 1261
Sinusitis: Cough and nasal discharge are the most common clinical manifestations of acute sinusitis in children. 381.2 1264
Retropharyngeal abscess: Group A hemolytic streptococci, oral anaerobes, and S. aureus, in descending order of occurrence, are the most common 381.5 1266
Tonsils and adenoids: Rhabdomyosarcomas are the most common malignant nasal tumor in children, and the nasopharynx is a common presenting site. 382 1267
Obstructive Sleep Apnea and Hypoventilation: Habitual snoring, the most common symptom, occurs in 8-10% of young school children. 383 1268
In children, the most common anatomic factor associated with obstruction is adenotonsillar hypertrophy. 1269
Congenital Laryngeal Stridor: The most common of these, laryngomalacia and tracheomalacia, are congenital deformities or flabbiness of the epiglottis 384.2 1271
and supraglottic aperture and weakness of the airway walls, leading to collapse and some airway obstruction with
inspiration. Laryngomalacia is the most common congenital laryngeal anomaly.
Bronchogenic cysts: They are most commonly found on the right and near a midline structure (e.g. trachea, esophagus, carina)… 384.6 1273
Croup (Laryngotracheobronchitis) : The incidence of croup is higher in males, and it occurs most commonly during the cold season of the year. 385.1 1275
Croup, the most common form of acute upper airway obstruction, is caused primarily by viruses.
The most common complication of viral croup is extension of the infectious process to involve other regions of the 1277
respiratory tract, such as the middle ear, the terminal bronchioles, or the pulmonary parenchyma.
Laryngeal foreign bodies: Hotdogs and bread are two of the most common causes of fatal aspiration. 386.1 1279
Chronic Subglottic Stenosis: The most common cause is neonatal endotracheal intubation. 387.2 1282
Neoplasms of the Larynx and Trachea: Papilloma is the most common tumor of the larynx in childhood; it rarely becomes malignant and often disappears 389 1283
after puberty.
Bronchiolitis: Bronchiolitis occurs most commonly in male infants between 3 and 6 mo of age who have not been breast-fed and who live in crowded 391 1285


conditions. The condition most commonly confused with acute bronchiolitis is asthma.
Chapter Page
Aspiration pneumonias and GER-related respiratory disease.: The most common mechanism is increasing the gastroesophageal pressure gradient by 393 1288
increasing intragastric pressure, as occurs when the abdominal muscles are tensed with
coughing and forced expiratory maneuvers, for example, in cystic fibrosis, BPD, or asthma.
Silo Filler’s Disease.: The acute and subacute interstitial pneumonia of Silo Filler’s disease is caused by inhalation of oxides of nitrogen, gases most 394 1291
commonly encountered in freshly filled silos, especially corn silos.
Pulmonary Hemosiderosis: During infancy and prepubertal childhood, infections, trauma, and foreign bodies are probably the most common causes of 402 1295
pulmonary hemorrhage.
Subcutaneous emphysema: Whenever free air finds its way into the subcutaneous tissue, most commonly as a result of pneumomediastinum or pneumo- 407.3 1304
thorax, subcutaneous emphysema occurs.
Bronchiectasis: Cystic fibrosis is the most common underlying disease in children with generalized bronchial involvement. 410 1308
Recurrent or persistent cough: The most common cause in children is reactive airways (asthma). 415 1312
Cystic Fibrosis: It is the most common life-limiting recessive genetic trait among whites. 416 1315
Pleurisy: The most common cause of pleural effusion in children is bacterial pneumonia. 418 1329
Serofibrinous pleurisy: Serofibrinous pleurisy is most commonly associated with infections of the lung or with inflammatory conditions of the abdomen 418.2 1329
or mediastinum.
Part XIX: The Cardiovascular System
The most common innocent murmur is a medium-pitched, vibratory or “musical”, relatively short systolic ejection murmur which is heard best along the 429 1350
left lower and midsternal border and has no significant radiation to the apex, base or back.
Acyanotic congenital heart lesions: The most common lesions are those that produce a volume load, and the most common of these are the left-to-right 432 1363
shunt lesions.
The second major class of lesions causes and increase in pressure load, most commonly secondary to ventricular
outflow obstruction (pulmonic or aortic valve stenosis) or narrowing of one of the great vessels (coarctation
of the aorta.
Lesions resulting in increased volume load: The most common lesions in these group are those that cause left-to-right shunting: ASD, VSD, AVSD, PDA. 432 1363
Regurgitation of the atrioventricular valves is most commonly encountered in patients with partial or 1364
complete atrioventricular septal defects (atrioseptal defects, atrioventricular canal).
Lesions resulting from increased pressure load: The most common are obstructions to ventricular outflow: valvar pulmonic stenosis, valvar aortic 432 1364
stenosis, and coarctation of the aorta.


Chapter Page
Cyanotic lesions with increased pulmonary blood flow: Cyanosis is caused by either abnormal ventricular–arterial connections or by total mixing of 432 1364
systemic venous blood within the heart. Transposition of the great vessels is the most common of the former group of lesions.
Ostium Secundum Defect: Ostium secundum defect, in the region of the fossa ovalis, is the most common form of ASD and is associated with 433.2 1365
ly normal atrioventricular (AV) valves.
Ventricular Septal Defect: VSD is the most common cardiac malformation, accounting for 25% of congenital heart disease. Defects may occur in any 433.6 1369
portion of the ventricular septum; the majority are of the membranous type.
Pulmonary valve stenosis with intact ventricular septum: The most common is isolated valvular pulmonary stenosis, accounting for between 7-10% of 434.1 1374
all congenital heart defects.
Aortic Stenosis: A bicuspid aortic valve is one of the most common congenital heart lesions overall, identified in up to 2% of adults. In the most 434.5 1377
common form, valvular aortic stenosis, the leaflets are thickened, and the commissures are fused to varying degrees.
Congenital mitral stenosis: Congenital mitral stenosis is a rare anomaly that can be isolated or associated with other defects, the most common being 434.9 1381
aortic stenosis and coarctation of the aorta.
Total Anomalous Pulmonary venous return: In TAPVR, there is no direct pulmonary venous connection into the left atrium. The pulmonary veins may 438.7 1399
drain above the diaphragm…or may drain below the diaphragm…. This latter form of anomalous
venous drainage is most commonly associated with obstruction….
Pulmonary arteriovenous fistula: The most common form of this unusual condition is the Osler-Weber-Rendu syndrome (hereditary hemorrhagic 439.3 1407
telangiectasia), which is also manifested by angiomas of the nasal and buccal mucous membranes, GI, or liver.
Ectopia Cordis: In the most common thoracic form of ectopia cordis, the sternum is split and the heart protrudes outside the chest. 439.4 1408
Infective endocarditis: Previously, Streptococcus viridans was the agent most commonly responsible for endocarditis in pediatric patients. Staphylococ- 443 1424
cus aureus is now the leading causative agent in some series, accounting approximately 39% of episodes.
Complications: … the most common is heart failure caused by vegetations involving the aortic or mitral valve. 1426
Doxorubicin (Adriamycin) Cardiotoxicity: The most common manifestation is a severe, chronic, dose-dependent cardiomyopathy, which occurs in 30% 445.1 1432
(Dilated cardiomyopathy) of patients when the total cumulative dose exceeds 550 mg/m2 but may be seen occasionally, even in
patients with doses as low as 200mg/m2.
Mucopolysaccharridosis (a restrictive cardiomyopathy) : In this disorder, most commonly Hurler’s syndrome, mucopolysaccharides accumulate in many 445.3 1434
organs, including the heart and great vessels.
Myocarditis: The most common manifestation is heart failure, although arrhythmias and sudden death may be the first detectable signs. Viral infections 445.4 1434


are the most common cause. The most common causative agents are adenovirus and coxsackievirus B…
Chapter Page
Purulent pericarditis: The most common organisms implicated in purulent pericarditis are Staphylococcus aureus, Haemophilus influenzae type B, and 446 1438
Neisseria meningitidis.
Tumors of the heart: The most common benign cardiac tumors in children are rhabdomyomas, fibromas, and myxomas. 447 1439
Pediatric Heart Transplant: Complications of Immunosuppression: 449.1 1446
Infection: Viral infections are the most common, especially CMV, accounts for as many as 25% of infectious episodes.
Bacterial infections are the next most frequent, with the lung being the most common site of infection (35%)…
Neurologic: Intracranial infections–the most common organisms are Aspergillus, Cryptococcus neoformans, and Listeria 1447
Arteriovenous fistulas: The most common sites in infants and children are within the cranium, in the liver, in the lung, in the extremities, and in the 450.2 1449
vessels in or near the thoracic wall.
Systemic hypertension: Secondary hypertension is most common in infants and younger children. 451 1450
Part XX: Diseases of the Blood
Iron deficiency Anemia: Anemia resulting from lack of sufficient iron for synthesis of hemoglobin is the most common hematologic disease of infancy 461 1469
and childhood.
Hemolytic Anemias (Classifications): The most common cause of aplastic crises is parvovirus B19, which is erythrocytotropic in marrow culture in vitro. 463 1475
Hereditary Spherocytosis: It is the most common familial and congenital abnormality of the red blood cell (RBC) membrane. 464 1475
Deficiencies of enzymes of the glycolytic pathway: The most common glycolytic enzyme defect as a cause of hemolytic anemia is pyruvate kinase (PK) 469 1488
deficiency, although it is a rare disorder, with only 300-400 cases reported.
Hemostasis: The platelet count is essential in the evaluation of the child with a positive bleeding history because thrombocytopenia is the most common 481.2 1507
acquired cause of a bleeding diathesis in children.
Hereditary Clotting Factor Deficiencies (Bleeding Disorders): Hemophilia A (factor VIII deficiency) and hemophilia B (factor IX deficiency) are the 482 1508
most common and serious congenital coagulation factor deficiencies.
Factor VIII and Factor IX deficiencies are the most common severe inherited bleeding
von Willebrand disease: von Willebrand disease is the most common hereditary bleeding disorder, with some reports suggesting that it is present in 483 1513
1-2% of the general population. The most common form of von Willebrand disease is type I (85% of cases).
Acquired inhibitors of coagulation: The most common inhibitor is the “lupus inhibitor” that is found in patients with SLE, other collagen vascular disea- 488 1519
ses, or, most often, common viral infections, including HIV.
Idiopathic Thrombocytopenic Purpura: The most common cause for acute onset of thrombocytopenia in an otherwise well child is (autoimmune) 490.1 1520


idiopathic thrombocytopenic purpura (ITP).

Chapter Page
Acquired disorders of platelet function: …. most commonly liver disease, kidney disease (uremia), and those disorders that trigger increased amounts of 490.12 1524
fibrin degradation products.
Many drugs alter platelet function. The most commonly used drug that alters platelet function in adults is acetyl-
salicylic acid (aspirin).
Splenectomy: Encapsulated bacteria such as Streptococcus pneumoniae (>60% of cases), Haemophilus influenzae, and Neisseria meningitides are the 493 1527
most common organisms associated with postsplenctomy sepsis.
Part XXI: Neoplastic Diseases and Tumors
Leukemias: The most common childhood cancers, account for about one third of pediatric malignancies. 502 1543
Relapse: The bone marrow is the most common site of relapse, although any site can be affected. 1545
Lymphoma: Lymphoma is the 3rd most common cancer in children in the United States, with an annual incidence of 13.2 per million children. 503 1548
Hodgkin’s Disease: Painless, firm, cervical or supraclavicular adenopathy is the most common presenting sign. 503.1 1549
Neuroblastoma (NB): NB accounts for about 8% of childhood cancers and is the most common solid tumor of children outside of the CNS. 504 1552
Wilms’ Tumor: An important feature of Wilms’ tumor is its association with congenital anomalies, the most common being genitourinary anomalies 505.1 1554
(4.4%), hemihypertrophy (2.9%), and sporadic aniridia (1.1%).
Rhabdomyosarcoma: The most common pediatric soft tissue sarcoma, rhabdomyosarcoma accounts for 5-8% of childhood cancers. 506.1 1556
The most common presenting feature is a mass that may or may not be painful.
When the tumor arises in the middle ear, the most common early signs are pain, hearing loss, chronic otorrhea, or a mass in the 1557
ear canal.
Nonrhabdomyosarcoma Soft Tissue Sarcomas (NRSTS): 506.2 1557t
Fibrosarcoma: The most common soft tissue sarcoma in children younger than 1 yr.
Malignan fibrous histiocytoma: Most commonly arises in the trunk and extremities, deep in the subcutaneous layer.
Synovial sarcoma: The most common NRSTS in some series.
Leiomyosarcoma: The most common pediatric retroperitoneal soft tissue tumor.
Neoplasms of the bone: Osteosarcoma is the most common primary malignant bone tumor in children and adolescents, followed by Ewing’s sarcoma. 507 1558
Osteosarcoma: Pain and swelling are the most common presenting manifestations. 507.1 1559
Salivary gland tumors: The most common is the benign mixed tumor, which most commonly occurs in adolescent females and is curable by surgery. 511.1 1565
Carcinoma of the adrenal gland: The most common syndromes are Cushing’s, virilization and hyperaldosteronism. 512 1566
Benign Tumors: Osteochondroma (exostosis) is one of the most common benign tumors in children. 514.1 1567
Eosinophilic granuloma - usually occurs during the first 3 decades of life and is most common in boys between 5 and 10 yr of age. The 1569


skull is the most commonly affected, but any bone may be involved.
Chapter Page
Hemangiomas: Hemangiomas are the most common benign tumors of infancy and are found in 1% of neonates. 514.2 1569
The most common lymphatic malformation seen in children is cystic hygroma of the neck, which presents as a painless soft tissue
Part XXII: Nephrology
Glomerular Diseases: Pathogenesis : Immunologic injury is the most common cause and results in glomerulonephritis, which is both a generic term for 516.3 1575
several diseases and a histopathologic term signifying inflammation of the glomerular capillaries.
Pathology: … certain forms of glomerulonephritis show glomerular exudation of blood cells, most commonly neutrophils, …. 1576
Evaluation of the Child with hematuria: In children, microscopic hematuria is most commonly discovered at periodic health examinations, by dipstick or 517 1577
or by microscopic examination of the urine sediment.
Recurrent Gross Hematuria : Alport Syndrome: This is the most common of several types of hereditary nephritis. 518 1580
Patients with Alport Syndrome most commonly present with asymptomatic microscopic hematuria,
but recurrent episodes of hematuria are common.
Acute Poststreptococcal Glomurolenephritis: It was the most common cause of gross hematuria in children; IgA nephropathy is now the most common 519.1 1581
cause of gross hematuria.
Membranous Glomerulopathy: Membranous glomerulopathy is the most common cause of nephritic syndrome in adults, but it is uncommon in childhood 520 1582
and a rare cause of hematuria.
In children, membranous glomerulopathy is most common in the 2nd decade of life. 1583
Systemic Lupus Erythematosus: Kidney disease, one of the most common manifestations of SLE in childhood, may occasionally be the only 521 1583
manifestation. WHO class IV (diffuse proliferative lupus nephritis) is the most common and most severe form of lupus nephritis.
Membranoproliferative (Mesangiocapillary) glomerulonephritis: Membranoproliferative glomerulonephritis (MPGN) is the most common cause of 522 1584
chronic glomerulonephritis in older children and young adults.
Type I MPGN is the most common form; the glomeruli reveal an accentuation of the
lobular pattern, due to a generalized increase in mesangial cells and matrix.
MPGN is most common in the 2nd decade of life.
Hemolytic-Uremic Syndrome: The hemolytic-uremic syndrome is the most common cause of acute renal failure in young children. 526 1586
The syndrome is most common in children younger than 4 yr.
Glomerular proteinuria: The most common cause of proteinuria is increased permeability of the glomerular capillary wall. 533.2 1592


Chapter Page
Nephrotic syndrome: Most (90%) children with nephrosis have some form of idiopathic nephrotic syndrome; minimal change dse (85%); mesangial pro- 535 1592
liferation (5%), and focal sclerosis (10%). In the remaining 10% of children with nephrosis, the nephrotic syndrome is largely
mediated by some form of glomerulonephritis, membranous and membranoproliferative being most common.
Idiopathic Nephrotic Syndrome: The idiopathic nephrotic syndrome is more common in boys than girls (2:1) and most commonly appears between the 535.1 1593
ages of 2 and 6 yr.
Complications: Infection is the major complication of nephrosis. For reasons that are unclear, spontaneous peritonitis is 1594
the most frequent type of infection; Streptococcus pneumoniae is the most common organism
causing peritonitis.
Glomerulonephritis: Nephrotic Syndrome may develop during the course of any type of glomerulonephritis but is most common in association with 535.2 1595
membranous, membranoproliferative, poststreptococcal, lupus, chronic infection (including malaria and schistosomiasis),
and Henoch-Schönlein purpura glomerulonephritis.
Congenital Nephrotic Syndrome: Causes of nephrosis developing during the first 6 mo of life include congenital nephrotic syndrome, congenital infect’n, 535.5 1595
and diffuse mesangial sclerosis of unknown cause. Nephrosis developing during the last half of the 1st year is most
commonly associated with the idiopathic nephritic syndrome or drugs. The congenital nephrotic syndrome (Finnish 1596
type) is an autosomal recessive disorder that is most common in populations of Scandinavian descent.
Interstitial nephritis: In hospitalized patients, drugs are the most common cause of acute interstitial nephritis. 540 1603
Acute renal failure: Acute dehydration and the hemolytic-uremic syndrome are the most common causes of acute renal failure in toddlers. 543.1 1605
Part XXIII: Urologic Disorders in Infants and Children
Congenital Anomalies and Dysgenesis of the kidneys: Multicystic dysplastic kidney is the most common cause of an abdominal mass in the newborn. 545 1620
Urinary Tract Infection: Imaging Studies: A voiding cystourethrogram (VCUG) is also indicated an all children younger than 5 yr. with UTI, any child 546 1624
with a febrile UTI, school-aged girls who have had two or more UTIs, and any male with a UTI. The most
common finding is vesicoureteral reflux, which is identified in approximately 40% of patients.
Vesicoureteral reflux: (Reflux nephropathy) is one of the most common causes of hypertension in children. 547 1626
Obstructions of the Urinary Tract: Urinary tract obstruction is often silent. In the newborn, a palpable abdominal mass is most commonly a hydro-
nephritic or multicystic dysplastic kidney.
Radioisotope studies: Renal scintigraphy is used to assess renal anatomy and function. The two most common radio-
pharmaceuticals are mercaptoacetyl triglycine (MAG-3) and technetium-99m-dimercaptosuc-
cinic acid (DMSA).


Chapter Page
Ureteropelvic Junction (UPJ) Obstruction: This is the most common obstructive lesion in childhood and is usually caused by intrinsic stenosis. 548 1632
UPJ obstruction most commonly presents: (1) on maternal US revealing fetal hydronephrosis (2) as a pal-
pable renal mass in a newborn/infant (3) as abodominal, flank, or back pain; (4) as a febrile UTI;
(5) as hematuria after minimal trauma
Posterior Urethral Valves: The most common cause of severe obstructive uropathy in children is posterior urethral valves, occurring only in boys. 548 1636
Voiding Dysfunction: Nocturnal Enuresis: treatment - Imipramine – a pharmacologic agent which is a tricyclic antidepressant has mild anticholinergic 551 1643
and α-adrenergic effects and may alter the sleep pattern also. In addition, the drug
is one of the most common causes of poisoning by prescription medication in
younger siblings.
Diurnal Incontinence : The most common cause of daytime incontinence is a pediatric unstable bladder (also termed uninhibited 1643
bladder, bladder spasms).
Vaginal Voiding: Incontinence typically occurs following urination after the girl stands up. Usually the volume is 5-10mL. One of 1645
the most common causes is labial adhesion.
Voiding Disorders without Incontinence: some children have the abrupt onset of severe urinary frequency, voiding as often as 1645
every 10-15min during the day, without dysuria, UTI, daytime incontinence, or nocturia.
The most common age for these symptoms to occur is 4-6 yr, after the child is toilet-
trained. This condition is termed the daytime frequency syndrome of childhood or
Anomalies of the Penis and Urethra: Micropenis: Micropenis results from a hormonal abnormality that occurs after 14 wk of gestation. The most 552 1648
common causes include (1) hypogonadotropic hypogonadism (2) hypergonadotropic hypogonadism
(primary testicular failure) , and (3) idiopathic micropenis.
The most common cause of micropenis is failure of the hypothalamus to produce an adequate amount
of gonadotropin-releasing hormone, and typically occurs in Kallmann syndrome, Prader-Willi
syndrome, and Lawrence-Moon-Biedl syndrome.
Megalourethra: This condition is most commonly associated with prune-belly syndrome. 1649
Urethral Prolapse (female): The most common signs are bloody spotting on the underwear or diaper, although dysu-
ria or perineal discomfort may also occur.
Disorders and anomalies of the scrotal contents: Undescended Testes: An undescended testis is the most common disorder of sexual differentiation in 553 1650
boys. At birth, approximately 4.5% of boys have undescended testis.


Chapter Page
Disorders and anomalies of the scrotal contents: Undescended Testes: Some boys have secondary cryptorchidism following repair of an inguinal hernia. 553 1650
This complication of hernia repair is most common in neonates and young
young infants and affects as many as 1-2% of patients.
The most common tumor developing in an undescended testis is a seminoma 1650
(65%); the peak age for this tumor is 15-45 yr; in contrast, following
orchidopexy, seminomas represent only 30% of testis tumors.
Testicular (spermatic cord) Torsion: Torsion is the most common cause of testicular pain in boys 12 yr 1651
and older and is uncommon in those less than 10yr.
Torsion of the appendix testis: Torsion of the appendix testis is the most common cause of testicular 1652
pain in boys between 2 and 11 yr but is rare in adolescents.
Varicocele: Varicocele is the most common surgically correctable cause of subfertility in men. 1653
Urinary Lithiasis: Calcium Stones: Most urinary calculi in children in the US are composed of calcium oxalate or calcium phosphate, or both. The most 555 1656
common metabolic abnormality in these individuals is hypercalciuria.
Nephrocalcinosis: Nephrocalcinosis refers to calcium deposited within the renal tissue. The most common causes are furosemide 1658
(administered to neonates), distal RTA, hyperparathyroidism, medullary sponge kidney, hypophosphatemic
rickets, sarcoidosis, cortical necrosis, hyperoxaluria, prolonged immobilization, Cushing syndrome, hyper-
uricosuria and renal candidiasis.
Part XXIV: Gynecologic Problems of Childhood
Vulvovaginitis: Vulvovaginitis is the most common childhood or adolescent gynecologic problem. 557 1660
Nonspecific Vulvovaginitis: In 68% of reported cases, this vaginitis is associated with coliform bacteria secondary to contamination.
The next most common bacterial organisms associated with nonspecific vulvovaginitis are hemolytic
Streptococcus and coagulase-positive Staphylococcus.
Specific Vulvovaginitis: Gardnerella vaginalis is the most common organism cultured in pediatric or adolescent patients with vulvo- 1660
vaginitis, followed by Candida.
Vulvar Psoriasis: Vulvar lesions usually are poorly demarcated and may present as scaly patches, most commonly on the mons pubis. 1663
Bleeding: Foreign Body: A foreign body is commonly responsible for vaginal bleeding in pediatric patients. Wadded toilet paper is the most common 558 1663
foreign body identified in the vagina.
Neoplasms: The most common gynecologic neoplasm found in children is of ovarian in origin and usually presents as an abdominal mass. 561 1667


Ovaries: In adolescents, the most common ovarian neoplasm is the teratoma.

Ovarian adenomas are the second most common benign ovarian tumor.
Chapter Page
Neoplasms: Ovaries: With respect to germ cell tumors, the most common is the dysgerminoma, followed in incidence by malignant teratomas, endoder- 561 1667
mal sinus tumors, embryonal carcinomas, mixed cell neoplasms, and gonadoblastomas.
Part XXV: The Endocrine System
Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH): Although SIADH is one of the most common abnormalities in AVP secretion 569 1684
encountered in adult medicine, its incidence in the pediatric population is rare.
Acquired Hypothyroidism: The most common cause of acquired hypothyroidism is lymphocytic thyroiditis. 575 1703
Acute suppurative thyroiditis: Anaerobic organisms, with or without aerobes, are the most common organism. 576 1704
Sporadic Goiter: The most common cause of sporadic goiter is lymphocytic thyroiditis. 577.3 1708
Solitary Thyroid Nodule: The most common cause is benign follicular adenoma. 579.1 1713
Noonan Syndrome: The most common abnormalities are short stature, webbing of the neck, pectus carinatum or pectus excavatum, cubitus valgus, right 593.1 1747
sided congenital heart disease, and characteristic facies.
Klinefelter syndrome: The 47, XXY complement is the most common chromosomal pattern in persons with Klinefelter syndrome (80%). 593.1 1747
Type II Diabetes: Type II diabetes is the most common form of diabetes in the population at large. 599.3 1786
Part XXVI: The Nervous System
Craniosynostosis:Premature closure of the sagittal suture produces a long and narrow skull,or scaphocephaly, the most common form of craniosynostosis. 601.12 1812
Frontal plagiocephaly is the next most common form of craniosynostosis and is characterized by unilateral flattening of the forehead,
elevation of the ipsilateral orbit and eyebrow, and a prominent ear on the corresponding side.
Neonatal Seizures: The most common cause of neonatal seizures is hypoxic-ischemic encephalopathy. 602.5 1825
Movement Disorders: Ataxias: Ataxia-telangiectasia, an autosomal recessive condition, is the most common of the degenerative ataxias and is heralded 606.2 1840
by ataxia beginning at about age 2 yr. and progressing to loss of ambulation by adolescence.
Chorea: Sydenham chorea is the most common acquired chorea of childhood and is the sole neurologic manifestation of rheuma- 1840
tic fever.
Dystonias: Athetosis is most commonly associated with perinatal brain insults and is occasionally the major movement disorder 1842
of phenothiazine idiosyncrasy.
Tics: Transient tic disorder is the most common movement abnormality of childhood. 1842
Cerebral Palsy: Spastic diplegia: The most common neuropathologic finding is periventricular leukomalacia, particularly in the area where fibers inner- 607.1 1844
vating the legs course through the internal capsule.


Neurodegenerative Disorders: Neuronal Ceroid Lipofuscinoses: The late infantile type (Jansky-Bielschowsky) is the most common type of neuronal 608.2 1851
ceroid lipofuscinoses.
Chapter Page
Brain Tumors in Children: Brain tumors are second only to leukemia as the most prevalent malignancy in childhood, and they account for the most 611 1858
common solid tumors in this age group.
Infratentorial tumors: The cerebellar astrocytoma is the most common posterior fossa tumor of childhood and has the best 1859
The medulloblastoma is the next most common posterior fossa tumor in the pediatric age group and is
the most prevalent brain tumor in children younger than 7 yr.
Supratentorial tumors: Craniopharyngioma is one of the most common supratentorial tumors in children. 1861
Spinal Cord Trauma: Fracture dislocations at the C5-C6 level are the most common acute cause of spinal cord injuries and are characterized by a flaccid 613.2 1864
quadriparesis, loss of sphincter function, and a sensory level corresponding to the upper sternum.
Part XXVII: Neuromuscular Disorders
Duchenne Muscular Dystrophy: Duchenne muscular dystrophy is the most common hereditary neuromuscular disease affecting all races and ethnic grp. 616.1 1874
Myotonic Muscular Dystrophy: Myotonic dystrophy (Steinert disease) is the second most common muscular dystrophy in N. America, Europe, and 616.3 1878
Australia, having an incidence of 1:30,000 general population.
Congenital Muscular Dystrophy: One form of congenital muscular dystrophy, the Fukuyama type, is the 2nd most common muscular dystrophy in Japan 616.6 1881
(following Duchenne dystrophy).
Hereditary Motor-Sensory Neuropathies: 620.1 1889
Peroneal Muscular Atrophy (Charcot-Marie-Tooth Disease; HMSN Type I): This Disease is the most common genetically determined neuro-
pathy and has an overall prevalence of 3.8/100,000.
Autonomic Neuropathies: Reflex Sympathetic Dystrophy: The most common preceding event is local trauma in the form of a contusion, laceration, 622.2 1892
sprain, or fracture that occurred days or weeks earlier.
Part XXVIII: Disorders of the Eye
Abnormalities of refraction and accommodation: The most common cause of paralysis of accommodation in children is intentional or inadvertent use of 627 1899
cycloplegic substances, topically or systemically; included are all the anticholinergic drugs and poisons,
as well as plants and plant substances having these effects.
Abnormalities of Pupil and Iris: Dilated Fixed Pupil : The most common cause of a dilated unreactive pupil is purposeful or accidental instillation of a 629 1902
cycloplegic agent, particularly atropine and related substances.
Disorders of Eye movement and alignment: Esodeviations: Esodeviations are the most common type of ocular misalignment in children and represent


well over 50% of all ocular deviations.

Disorders of Eye movement and alignment: Esodeviations: Pseudostrabismus (pseudoesotropia) is one of the most common reasons a pediatric ophthal- 630 1905
mologist is asked to evaluate an infant.
Exodeviations: Exodeviations are the 2nd most common type of misalignment.
Intermittent exotropia is the most common exodeviation in childhood.
Disorders of the Lacrimal system: Dacryostenosis: Congenital nasolacrimal duct obstruction (CNLDO), or dacryostenosis, is the most common disorder 632 1911
of the lacrimal system, occurring in up to 6% of newborn infants.
Disorders of the conjunctiva: Ophthalmia neonatorum: Ophthalmia neonatorum, a form of conjunctivitis occurring in infants younger than 4 wk, is the 633 1911
most common eye disease in the newborn.
Abnormalities of the Cornea: Megalocornea (>12 mm in diameter): All modes of inheritance have been described, although X-linked recessive is most 634 1915
common; therefore, this disorder most commonly afflicts males. Systemic abnorma-
lities that may be associated with megalocornea include Marfan’s syndrome, cranio-
synostosis, and alport’s syndrome.
Abnormalities of the Lens: Cataracts: Many cataracts unassociated with other diseases are hereditary. The most common mode of inheritance is autoso- 635 1917
mal dominant.
Disorders of the Retina and Vitreous: Retinoblastoma: Retinoblastoma is the most common primary malignant intraocular tumor of childhood. 637 1927
Ocular Abnormalities: Tumors of the orbit: Among benign tumors, the most common are vascular lesions (principally hemangiomas) and dermoids. 640 1935
Part XXIX: The Ear
Hearing Loss: Peripheral hearing loss can be conductive (CHL), sensorineural (SNHL), or mixed. CHL, the most common type of hearing loss in chil- 643 1940
dren, occurs when sound transmission through the external or middle ear or both is physically impeded.
Rubella, once the most common viral cause of congenital SNHL, is now very uncommon because of effective vaccination programs. 1941
Streptococcus pneumoniae is the most common cause of bacterial meningitis that results in SNHL after the neonatal period.
Haemophilus influenzae, once the most common cause of meningitis resulting in SNHL, is now rare owing to the Hib vaccine.
Diseases of the External Ear: Otitis Externa: External otitis (swimmer’s ear) is most commonly caused by P. aeruginosa, but S. aureus, Enterobacter 645 1948
aerogenes, Proteus mirabilis, Klebsiella pneumoniae, streptococci, CONS, diphteroids, and fungi such
as Candida and Aspergillus may also be isolated.
P. aeruginosa is the most common causative organism of necrotizing otitis externa.
Perichondritis/chondritis: The most commonly isolated organism in perichondritis/ chondritis is P. aeruginosa. 1949


Otitis Media (OM): It is the most common diagnosis for children in the United States and the second most common in medicine overall. 646 1950

Chapter Page
Otitis Media (OM): The most commonly identified pathogens associated with OM are Streptococcus pnemoniae (30-50%), non-typable Haemophilus 646 1951
influenzae (20-30%), and Moraxella catarrhalis (1-5%).
Treatment: Amoxicillin is the initial antibiotic of choice, because it is usually effective against the most commonly encountered 646.1 1952
bacteria, has the best pharmacodynamic profile against multiple-drug resistant S. pneumoniae of any of the
available oral agents, has a long record of safety, and is inexpensive.
Complications: Hearing loss: This is the most common complication and morbid outcome of OM that may be caused by one or 646.6 1955
more of the intratemporal complications.
Chronic suppurative otitis media with mastoiditis: The most common bacterial species isolated are P. aeruginosa, 1956
and S. aureus.
The most common anaerobic species isolated are Bacteroides,
Peptostreptococcus, and Peptococcus.
Part XXX: The Skin
Vascular Disorders: Hemangiomas are the most common tumor of infancy, occurring in 1-2% of newborns and 10% of white infants in the 1st yr of life. 656 1975
Cutaneous Nevi: Atypical Melanocytic nevus: These nevi are most common on the posterior trunk, suggesting that intermittent, intense sun exposure 657 1980
has a role in their genesis.
Melanoma: Malignant Melanoma accounts for 1-3% of all pediatric malignancies and is the most common cancer in young adults 1981
age 25-29 yr.
Halo Nevus (Leukoderma Acquisitum Centrifugum): Halo Nevi occur primarily in children and young adults, most commonly on the
Spitz Nevus (Spindle and epithelioid cell nevus): Spitz nevus presents most commonly during the first 2 decades of life as a pink to red
,smooth, dome-shaped, firm, hairless papule on the face, shoulder, or upper limb.
Hypopigmented lesions: Tuberous Sclerosis: Adenoma sebaceum is the most commonly recognized cutaneous marker of tuberous sclerosis. 659 1986
Vesiculobullous Disorders: Erythema multiforme (EM): EM is characterized by an abrupt, symmetric cutaneous eruption most commonly on the exten- 660 1989
sor upper extremities; lesions are relatively sparse on the face, trunk, and legs.
Among the numerous factors implicated in the etiology of EM, infection with herpes simplex
virus (HSV) is the most common.
Dermatitis herpetiformis: This is seen most commonly in 2-7 yr. of age. 1993


Photosensitivity: Acute sunburn reaction: The most common photosensitive reaction seen in children is acute sunburn. 662 1998
Diseases of the Epidermis: Lichen planus: Acute eruptive lichen planus is probably the most common form in children. 663 2006
Chapter Page
Diseases of the dermis: Mastocytosis: Urticaria pigmentosa si the most common form of mastocytosis and occurs primarily in infants and children. 665 2015
Diseases of the Subcutaneous Tissue: Panniculitis: Pancreatic panniculitis presents most commonly on the pretibial regions, thighs, or buttocks as tender 666 2017
, erythematous nodules that may be fluctuant and occasionally discharge a yellowish oily
Factitial panniculitis results from subcutaneous injection by self or proxy of a foreign substance, the 2018
most common types of which include organic materials such as milk or feces; ….
Disorders of the sweat glands: Fox-fordyce disease: This disease is most common in females and presents during puberty or the 3rd decade of life with 667 2021
pruritus in the axillae and, occasionally, in the anogenital region and around the breasts.
Disorders of the Hair: Trichorrhexis nodosa: This is the most common of all hair shaft abnormalities. 668 2023
Pili torti : This is the 2nd most common hair shaft abnormality.
Disorders of the Mucous Membranes: Cheilitis: Inflammation of the lips (cheilitis) and angles of the mouth (angular cheilitis or perlèche) are most 670 2026
commonly due to dryness, chapping, and lip licking;…
Vincent Gingivitis: Also called acute necrotizing ulcerative gingivitis, fusospirochetal gingivitis, trench mouth. It 2027
presents most commonly during the 2nd and 3rd decade, particularly in the context of poor
dental hygiene, scurvy, and pellagra.
Cutaneous bacterial infection: Nonbullous impetigo: The most common lesions that precede nonbullous impetigo include insect bites, abrasions, lacera- 671 2028
tions, chickenpox, scabies pediculosis, and burns.
Cellulitis: Streptococcus pyogenes and S. aureus are the most common etiologic agents. 2029
Blastomycosis-like pyoderma (pyoderma vegetans): The organisms isolated most commonly from lesions are S. aureus 2032
and GABHS.
Perianal dermatitis: This presents most commonly in boys (70% of cases) between the ages 6 mo and 10 yr as perianal 2032
dermatitis (90% of cases) and pruritus (80% 0f cases).
Cutaneous fungal infections: Dermatophytoses: T. rubrum is the most common dermatophyte pathogen overall. 672 2036
Tinea pedis (athlete’s foot) : most commonly, the lateral toe webs (3rd to 4th and 4th-5th interedigital 2039
spaces) and the subdigital crevice are fissured, with maceration and
peeling of the surrounding skin.
Cutaneous viral infections: Wart (Verruca): Common warts (verruca vulgaris) , caused most commonly by HPV types 2 and 4, occur most frequently on 673 2041


the fingers, dorsum of the hands, paronychial areas, face, knees, and elbows.

Chapter Page
Arthropod bites: Papular urticaria : the most common culprits are species of fleas, mites, bedbugs, gnats, mosquitoes, chiggers, and animal lice. 674 2043
One of the most commonly encountered arthropod bites is that due to human, cat, or dog fleas. 2044
Pediculosis capitis: Lice are not always visible, but nits are detectable on the hairs, most commonly in the occipital region and above the 2046
ears, rarely on beard or pubic hair.
Part XXXI: Bone and Joint Disorders
Torsional variations: In-toeing and out-toeing – are the most common gait disturbances that cause parents to seek advice from pediatrician. 679 2056
The foot and toes: Tarsal coalition: The most common tarsal coalitions occur at the medial talocalcaneal (subtalar) facet and between the calcaneus and 680.6 2061
navicular (calcaneonavicular) tarsal bones.
Curly toes: The most common lesser toe deformity of childhood is curly toes. 680.10 2063
Torsional and angular deformities: The most common torsion and angular changes of the lower extremity are related to normal in utero positioning or 681.1 2065
acquired disorders.
Internal Femoral Torsion: Internal femoral torsion is the most common cause of in-toeing in children ≥ 2 yr of age. 681.2 2067
Internal Tibial Torsion: Internal tibial torsion is the most common cause of in-toeing in children younger than 2 yr
and is secondary to normal in utero positioning. 681.3 2068
The knee: Pain around the knee is one of the most common presenting complaints in older children and adolescents. 683 2075
The hip: Slipped Capital Femoral Epiphysis (SCFE): It is the most common adolescent hip disorder. 684.4 2081
The neck: Torticollis: Muscular torticollis is the most common variety and is presumed to result from injury to the sternocleidomastoid muscle during 686.1 2090
Common Fractures: Distal Radius and Ulna Fractures: Torus, or buckle, fractures of the distal radial metaphysic are among the most common fractures 689.4 2096
of childhood.
Growth plate injuries: The most common epiphyseal injuries are to the distal radius, followed by phalangeal and distal tibial fractures. 691.1 2103
Avulsion fractures: The most common areas affected are the knee (Osgood-Schlatter and Sindig-Larsen-Johannsen disease), the
ankle (Sever disease), and the medial epicondyle (Little league elbow).
Shoulder Injuries: Acriomioclavicular (AC) separation: This injury most commonly occurs when an athlete falls or collides with another player or 691.2 2103
object and the point of contact is the distal clavicle.
Elbow Injuries: The most common elbow dislocation is a posterior dislocation. 691.3 2104
Hip and Pelvis injuries: Avulsion Fractures: The most common sites of avulsion fractures (and the muscles that attach there) are the iliac crest (abdomi- 691.5 2105


nal muscles), anterior superior iliac spine (sartorius), anterior inferior iliac spine (rectus femoris), lesser
femoral trochanter (iliopsoas), and ischial tuberosity (hamstrings).
Chapter Page
Knee Injuries: Iliotibial band tendinitis is the most common cause of chronic lateral knee pain. 691.6 2106
Ankle Injuries: Ankle injuries are the most common acute athletic injury. 691.8 2106
Head Injuries:The most common head injury is the concussion, which is characterized by immediate and transient alteration of consciousness, disturbance 692 2107
of vision and equilibrium, and other similar symptoms as a result of mechanical force.
Heat Injuries: After heart disease, the second most common cause of non-traumatic death is heat illness. 693 2108
Heat cramps, the most common heat injury, usually affect the calf and hamstring muscles.
Specific sports and associated injuries: Swimming: Shoulder injury (swimmer shoulder) is the most common overuse injury of competitive swimmers. 696 2110
Baseball: Throwing injuries of the elbow and shoulder (especially among pitchers) are the most common baseball
Wrestling: Patellar bursitis is the most common knee problem.
Basketball and volleyball: Ankle sprain is the most common injury and is usually caused by inversion with 2111
plantar flexion, placing the lateral ligaments at high tension.
Skeletal Dysplasias:
Disorders Involving Transmembrane Receptors: 699 2120
Achondroplasia group: This group represents a substantial percentage of patients with chondrodysplasias and contains thanatophoric
dysplasia , the most common lethal chondrodysplasia with an incidence of 1 in 35,000 births; achondroplasia,
the most common nonlethal chondrodysplasia with an incidence of 1 in 15,000 to 1 in 40,000 births, and
Osteogenesis Imperfecta (OI): OI (brittle bone disease) , the most common genetic cause of osteoporosis, is a generalized disorder of connective 704 2128
tive tissue caused by defects in type I collagen.
Familial Hypophosphatemia: Also known as Vitamin D-resistant rickets / X-linked hypophosphatemia. The most commonly encountered 711 2136
non-nutritional form of rickets is familial hypophosphatemia.
Part XXXII: Unclassified Diseases
Sudden Infant Death Syndrome (SIDS): It is the most common cause of infant mortality in the United States after congenital anomalies and disorders 714 2139
relating to short gestation/ low birthweight. SIDS is the most common cause of postneonatal infant mortality in
developed countries, accounting for 35-55% of infant deaths between 1 mo and 1 yr of age and about 20% of all
deaths in infants discharged from a neonatal intensive care unit (NICU).


Part XXXIII: Environmental Hazards Chapter Page

Pediatric Radiation Injuries: 718 2149
Localized Irradiation: The hand is the most common site for accidental localized irradiation injuries, usually as a result of picking up or playing
with lost radiation sources.
The second most common site is the thigh and buttocks, predominately from placing unsuspected highly radioactive
radiography sources in the pockets.
Poisonings: Drugs, Chemicals , and Plants:
Ingestion is the most common route of poisoning exposure (75% of cases), with the dermal, ophthalmic, and inhalation routes each occurring 718 2149
in about 6% of cases.
60% of cases involve nondrug products, most commonly cosmetics and personal care products, cleaning substances, plants, foreign bodies, 722 2160
and hydrocarbons.
Iron: Iron poisoning is the most common cause of childhood death due to poisoning. 722.6 2167
Plants: Exposure to plants, both inside the home and outside in backyards and fields, is one of the most common causes of accidental poisoning 722.11 2170
in children.
Nonbacterial food poisoning: Scombroid (pseudoallergic) fish poisoning: The most common symptoms include diarrhea, flushing, diaphoresis, 723.3 2173
urticaria, nausea, and headache.
Part XXXIV: Laboratory Medicine, Drug Therapy, and Reference Tables

Prepared by:

Ramon (Gerry) C. Santos, M.D.

St. Luke’s Medical Center
E. Rodriguez Ave,
Quezon City

Last Updated: March 6, 2003