Developmental Delay and Hypocalcemia—What’s the Cause?

Case Details

A 9-year-old girl is brought to a new pediatrician by her mother over concerns regarding her weight. She has a history of developmental delay, and her mother mentions that she is noticeably shorter than her peers. She is noted to have a round face and bilaterally shortened fourth metacarpals on examination. She is in the 96th percentile for weight and below the 3rd percentile for height for her age. Laboratory testing reveals hypocalcemia. Which additional laboratory findings are associated with this patient’s most likely diagnosis?

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Q&A with Dr. Shane Quinonez, Pediatric Geneticist

Dr. Shane Quinonez is a Clinical Assistant Professor and the Associate Program Director of the Pediatric Residency Program  at The University of Michigan. He earned his MD at The University of Michigan and then completed his pediatrics, medical genetics, and biochemical genetics training there as well.

When did you first decide to become a physician? Why?
I wish I could answer this question by showing a childhood picture of myself with a toy stethoscope around my neck. The truth is not nearly as cute. As an undergraduate student at The University of Toledo, I initially enrolled in pharmacy school, thinking I would become a pharmacist. Around my sophomore year I began reflecting on what truly gave me fulfillment in all of my previous jobs, educational experiences, and extracurricular activities. I quickly realized that I was most happy when I was interacting directly with people and was presented with opportunities to improve their lives. While these elements were clearly available in pharmacy, I felt that I would be best able to explore these interests as a physician. Though my decision was fairly calculated, I do not think I would be nearly as fulfilled and happy with my choice had I not made that decision based on the person I truly am rather than the person I wanted to be. 

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20 Clinical Practice Guidelines That Medical Students Should Know

Clinical practice guidelines are the backbone of evidence-based medicine. While there are literally thousands of published guidelines, a few of them are particularly relevant to medical students. SDN Partner Guideline Central is offering free access to the top 20 clinical practice guidelines for all SDN members! 

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Why Med-Peds? A Current Resident’s Perspective

med-peds residents

The transition from eager-to-learn-everything MS3 to self-assured MS4 with a clear residency goal comes much easier for some than others. I had planned on going into Family Medicine throughout the better part of medical school, but late in third year discovered the combined specialty Internal Medicine and Pediatrics (Med-Peds). How was I supposed to explain my interest in this four year program to my friends, mentors and, toughest yet, medicine department chair when I was just beginning to understand it myself? And then the inevitable follow-up question, why not just complete the three year Family Medicine (FM) residency program? FM training remains the perfect choice for many students looking to get broad-based, comprehensive training on how to care for people of all ages. The purpose of this article is to point out the subtle differences between these residency paths and give my top five reasons for why Med-Peds (MP) is a unique, exciting and attractive residency option for about 400 budding young doctors every year.

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Pediatrics In Review: A Look at Clerkship #2

Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.
In my first rotation, Women’s Health, I wrote about the humbling experience of helping with the birth of a child. This miracle of life is what attracts many people to the field of obstetrics, but working directly with the baby during the newborn period and throughout his/her childhood is, of course, the role of the pediatrician. As I’ve heard many times on this clerkship, “children are not simply small adults,” and understanding human development, the unique diseases of childhood, and the specific needs of young humans is often complex. For this reason, pediatrics is one of the oldest medical specialties, and remains the third largest by volume in the United States.[1]

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Reflections On An Encounter During My Elective in Vanuatu

Despite being on the top of a hill, the hospital was remarkably unimposing and unimpressive: just one floor high and composed largely of corrugated iron and brick. It consisted of a handful of wards, an A and E “department” and a few small rooms to see outpatients in. It contained several courtyards. Outdoor corridors connected the different wards. The courtyards and corridors were lined by people, patients, families and extended families. Mothers breastfed, children ran around playing games, other adults dished out food or did their washing in a nearby sink in the grounds, whilst some simply sat. By contrast the hospital wards were quite empty—only a few inpatients in each of the four specialities (pediatrics, general medicine, general surgery, and obstetrics and gynaecology). Many of the rooms in the wards were empty. Faded, once-colourful, patterned curtains hang limply. Paint flaked, and biblical quotes peeled off the dirt-washed walls. In the stifling heat even the ceiling fans seemed to be taking a siesta. The hospital was basic to say the least: there were no computers, no observation machines and I had little confidence in when the bed sheets were last changed. Instead a manual blood pressure cuff lay dusty in the corner of the cupboard, adult oxygen saturation probes were clamped onto children’s feet and thermometers were used from patient to patient without cleaning. Inhaler spacers were replaced by plastic bottles with a hole cut in the bottom. Ventilators were replaced by a dedicated doctor bagging the patient throughout the whole operation. Intensive care simply did not exist.

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What You Should Know: Talking to Parents about their Obese Children

obese children

According to the Center for Disease Control, childhood obesity is reaching what some are calling an epidemic proportion in America: nearly two out of every three children under the age of 18 are considered to be either overweight or obese. Because of this, many doctors will find themselves in the potentially awkward position of having to talk to parents about their child’s weight problem. Because of the potential for negative parental reactions to this, it is a topic some doctors will avoid.
However, doctors who are planning to practice in family medicine or pediatrics in particular need to be able to have meaningful and positive conversations with parents so that they can work together to help the obese child to achieve a healthy body weight. Here are some things to keep in mind while having this conversation.

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What You Should Know: Connecting With Pediatric Patients

What You Should Know is an ongoing series covering a range of informational topics relevant to current and future healthcare professionals.
Even for student doctors who are in training to be pediatricians or specialists in pediatric health, connecting meaningfully with these small patients can sometimes be difficult. However, this connection is necessary to establish if a doctor’s goal is to give their patient the best care possible.
It is helpful, then, to take a look at what experts say about how doctors can connect to their pediatric patients.

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The Med-Peds Residency: Big and Small, We Care for Them All

med-peds

As third year medical students you’re rotating through your general specialties and you think you’re seeing familiar faces but in new places. Isn’t that your newborn nursery resident who assigned APGAR scores, now leading the code in the medical ICU? Some of you may have had similar déjà vu experiences but rest assured, your mind isn’t fooling you. At 79 programs across the USA and Puerto Rico, Combined Internal Medicine and Pediatric residents walk (briskly) through the halls of the hospital carrying both PALS and ACLS cards in our coat pockets. Our minds have been shaped to think broadly and decisively. We carry an air of calmness from our critical care rotations yet we know when to appropriately turn to our goofy side to connect with our patients. Through four years of versatile training, we are training to be the 21st century physician.

The Combined Internal Medicine-Pediatrics (commonly referred to as “Med-Peds”) is a four-year residency-training program that leads to dual board certification in Internal Medicine and Pediatrics. While there are many combined training programs offered in the US, the Med-Peds residency is by far the most ubiquitous and popular program available. During the four years of training, residents undergo a rigorous schedule of rotations ranging from adult and pediatric wards, MICU, PICU, NICU, CCU, Med-Peds clinic and specialty electives. By graduation, residents will have completed a total of 2 years of adult and 2 years of pediatric training. The frequency at which residents switch from one “side” to another changes depending on the individual residency program. The end product is the same: Individuals who are prepared to deal with acute, complex, chronic and preventive care for both adult and pediatric medical conditions. The broad training creates an endless list of career possibilities. We each carve out a niche that best fits the career interest we have in mind.

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20 Questions: John Hunt, MD, Peds Pulmonology/Allergy/Immunology

John Hunt, MD is a pediatric pulmonologist/allergist/immunologist from Charlottesville, VA. He received his bachelor’s degree from Amherst College before going on to George Washington University School of Medicine, where he earned his MD. He served in the Medical Corps with the US Naval Reserve from 1992-2003. During that time he completed his residency in pediatrics at the San Diego Naval Medical Center, and two fellowships at the University of Virginia, one in Allergy and Immunology and one in Pediatric Pulmonology. Since then he served in a number of roles, from professor at the University of Virginia to entrepreneur to researcher to author.
1. When did you first decide to become a physician? Why?
Throughout my childhood I had bad asthma and my pediatrician was wonderful so I decided by fourth grade to be a pediatrician. By 9th grade, I was cured of that desire because there was no way in hell I was going to put up with all the years of school needed to become a doctor. I didn’t even consider medicine again until my college senior year, during which I decided to be a surgeon. But somehow, in the end of it all I grew up into a pediatric asthma specialist. My wonderful childhood pediatrician quit medicine to open a chocolate factory.
2. What surprised you most about your medical studies?
That the premedical work was pretty much unnecessary, and that I was very glad that I studied in college all sorts of broad liberal arts as opposed to wasting excessive time with undergraduate chemistry and biology. You learn what you need to in medical school and then in residency, and then in fellowship and then every day through a medical career. So, take as few pre-med courses as you can and don’t waste your valuable college education being a pre-med major. There is so much to learn in college that will help you be a better doctor that has nothing to do with chemistry and biology.

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