Differential Diagnosis in PEDIATRICS (Including Color Atlas)
Differential Diagnosis in PEDIATRICS (Including Color Atlas)
Sixth Edition
Suraj Gupte MD FIAP FSAMS (Sweden) FRSTMH (London)
Professor and Head (Emeritus) Postgraduate Department of Pediatrics Mamata Medical College and Mamata General andSuperspecialty Hospitals drsurajgupte@gmail.com www.drsurajgupte.com SKhammam, Telangana, India
Editor: The Short Textbook of Pediatrics; Recent Advances in Pediatrics (Series), Textbook of Pediatric Emergencies, Neonatal Emergencies, Pediatric Nutrition, and Pediatric Gastroenterology, Hepatology and Nutrition; Pediatric Infectious Diseases; Influenza: Complete Spectrum; Case-based Reviews in Pediatric Emergencies, Clinical Problem Solving in Neonatal Emergencies and Intensive Care, etc.
Author: Pediatric Drug Directory, Instructive Case Studies in Pediatrics, Influenza, Perspectives in Influenza, Nutrition in Neonatal ICU, Speaking of Child Care, etc. Chief Editor (Gastroenterology Section): International Journal of Gastroenterology, Hepatology, Transplant and Nutrition.
Co-editor: Asian Journal of Maternity and Child Health (Manila, Philippines). Section and Guest Editor: Pediatric Today (New Delhi).
Editorial Advisor: Asian Journal of Pediatric Practice (New Delhi). Editorial Advisory Board
Member/Reviewer: Indian Journal of Pediatrics (New Delhi), Indian Pediatrics (New Delhi), Indian Journal Child Health (Gwalior), Synopsis (Detroit, USA), Maternal and Child Nutrition (Preston, UK), Journal of Infectious Diseases (Turkey), EC Pediatrics (London), Journal of Clinical Pediatrics (Patna), etc.
Examiner: Several Universities, including National Board of Examinations (NBE) for DNB, New Delhi; All India Institute of Medical Sciences (AIIMS), New Delhi; Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh; Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar; Indira Gandhi National Open University (IGNOU), New Delhi
Pediatric Faculty Selection Expert: All India Institute of Medical Sciences (AIIMS), Punjab Public Service Commission, J&K Public Service Commission, Union Public Service Commission, etc.
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© 2020, Manu Gupte, Executive Editor
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Differential Diagnosis in Pediatrics (Including Color Atlas)
First Edition: 1986
Sixth Edition: 2020
9789352702473
Printed at
My Parents
Who always gave my efforts
the necessary blessings
Their inspiration has been a
tower of strength in
bringing out
this book and other books
At the very outset, I wish to record my indebtedness to Prof Suraj Gupte, India's outstanding pediatric educationist, researcher and innovator with a multitude of high-quality books and other publications to his credit. He is gracious enough in asking me to again write a Foreword to the sixth edition of his noted book, Differential Diagnosis in Pediatrics.
Having carefully gone through the drafts of the new edition, I have no doubt that this already popular book has considerably improved its excellence and utility for the intended readership. The first section, i.e. Color Atlas, has many more high-quality photographs added to it. The contents of the 62 topics included in the second section are significantly improved and updated with fresh matter plus illustrations, tables and boxes. Additionally, incorporation of “investigative component” has further strengthened the usefulness of the book. Notably, each chapter in this section is provided with key references for further reading. The remaining three sections deal with differential diagnosis of select clinical signs, laboratory findings and radiologic signs. Prof Gupte has done well to complement these too with illustrative photographs.
Furthermore, all through this fine book, the presentation is simple, lucid, straightforward and easy-to-understand. Over and above the richness of the contents, Prof Gupte's well-known style of driving home the important points to the readers is not just profusely evident but also a very strong points of the title.
In my considered opinion, the sixth edition of Prof Suraj Gupte's Differential Diagnosis in Pediatrics is a strongly recommended treatise for the target audience (undergraduate and postgraduate medical students, residents, and practitioners of child health). By virtue of its several unique qualities, it has attained the powerful potentials to sharpen the readers’ skill in effectively dealing with signs and symptoms and quickly formulating the differential diagnoses in a given situation.
EA Robert MD PhD
Professor Emeritus
Department of Pediatrics
University School of Medicine
Formerly, WHO Regional Adviser
New York, United States
Preface to the Sixth Edition
The sixth edition of the Differential Diagnosis in Pediatrics, the pioneer and the solo textbook in the field from the Indian subcontinent stands thoroughly revised, updated, enlarged and further rendered state-of-the-art to meet the requirements of the medical students, residents, teachers and practitioner.
Section 1 exclusively presents Color Atlas comprising over 300 instructive clinical photographs with explanatory legends.
Section 2 presents chapters dealing with differential diagnosis of as many as 62 common presenting clinical manifestations such as abdominal distention, abdominal pain, chronic diarrhea, headache, short stature, jaundice, ambiguous genitalia, wheezing, etc. Each and every chapter is now complemented with key information about the investigative part over and above the clinical details.
Section 3 deals with the differential diagnosis of select clinical signs. Addition of clinical photographs has further enhanced its utility.
Section 4 is an illustrated spotlight on select laboratory findings and their significance.
Section 5 focuses on select radiologic signs. To enhance the impact, a multitude images are provided as illustrations.
Hopefully, the new revised, updated and enlarged edition of the Differential Diagnosis in Pediatrics shall receive yet warmer welcome and prove yet more beneficial to the target readership.
Preface to the First Edition
The vital importance of differential diagnosis, the backbone of deductive reasoning process and professional skill in clinical medicine, is widely recognized. Yet, for one or the other reason, the pediatric textbooks are not able to deal with this important aspect in a reasonably comprehensive way. A couple of books devoted exclusively to differential diagnosis are written by the European authors. These provide only very little information on problems relevant to the children of the developing countries and are, therefore, only of limited value in our settings.
The sustained and overwhelming demand from various quarters to fill this glaring “vacuum” has given birth to this new textbook, the first and the only one of its kind. I have designed it to provide a comprehensive up-to-date discussion on topics of day-to-day practical importance with special emphasis on problems encountered in the pediatric population in India and rest of the Third World.
As many as 48 topics ranging from abdominal distention, abdominal pain or anemias through diarrhea, failure to thrive or hepatomegaly to splenomegaly, vomiting or wheezing, are covered. Each topic organized alphabetically as a separate Section, starts off with an introductory note and sets out to highlight salient points in the history and physical examination having bearing on the differential diagnosis. Finally, I have discussed the various conditions that fall in the differential diagnosis, laying special stress on clinical features of particular diagnostic value. As and when indicated, a suitable reference is made to the investigative aspect.
All through this problem-oriented work, I have tried to be simple, straight-forward and lucid as also comprehensive and yet-to-the point. Hopefully, the volume would fulfill its aims and objectives and provide stimulating and informative reading for clinical diagnosis to the readers.
The book is addressed primarily to the medical students (both undergraduates and postgraduates), pediatric residents, junior pediatricians, family doctors and general practitioners whose clientage includes infants and children.
The eminent pediatric teacher, Dr N Sundaravalli, President, Indian Academy of Pediatrics, has done me great honor in writing the Foreword to this textbook at a time when she is extremely busy and preoccupied with, among the other things, affairs of the Academy. My salutation to her for recommending the volume so warmly!
The preparation of this textbook has needed cooperation of many people, including colleagues in and outside the country. I acknowledge my gratitudes to each one of them.
I record my sincere gratitudes to my parents and other family folks for providing generous help and encouragement while I was working on the manuscript. My wife, Shamma; daughter; Novy, and son, Manu; were gracious enough to make available to me the “time” that indeed needed to be spent with them. Their forbearance and understanding have contributed considerably to the entire endeavour taking the present solid shape.
Thanks are also due to the publishers, M/s Jaypee Brothers and their staff, for the excellent production qualities of the book.
Last, but in no way the least, any feedback for enhancing the practical utility of this textbook will be most welcome.
Suraj Gupte MD
November 1986
“Gupte House”
60 Lower Gumat
Jammu 180001
Special Acknowledgments
Grateful acknowledgments are hereby made to:
- Professor EA Robert, Professor Emeritus (Pediatrics), University School of Medicine, and Former WHO Regional Advisor, New York, for writing the Foreword and warmly recommending the book.
- World Health Organization, UNICEF, Recent Advances in Pediatrics, The Short Textbook of Pediatrics, Instructive Case Studies in Pediatrics, Dr EW Warner, Dr Sheffali Kapoor, Dr Arnold Bake, etc. for allowing access to some color images.
- Dr Gagan Hans, Dr Novy Gupte, Shamma-Bakshi Gupte and Shivanu Mahendru for voluntarily helping us in various ways in taking the project to its logical conclusion.
- Various journals and periodicals for critical reviews of previous editions of the book and for permission to use their references in the state-of-the-art chapters
- The readers who provided us the feedback to maintain and enhance the excellence of the book.
- M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, and their dedicated staff deserve our appreciation for the skilful and commendable production qualities of the book.
Finally, though all attempts have been made to acknowledge the source of information correctly here or in the text per se, error, if any, is unintentional and regretted.