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The first two studies in this week’s digest remind me that there is no diagnostic tool more powerful than the right question. And on that note: What can I do to improve this newsletter? Subscribe below and let me know.

Warmly,

Dr. Joshua Landy
Co-founder, Figure 1

The Differential for Pediatrics is available as a free weekly email.
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Single-Sentence Summaries

1. A new screening tool for patients presenting to pediatric EDs following acute sexual assault/abuse found that 13% were victims of child sex trafficking. Journal of Adolescent Health, October 4, 2018

2. A brief survey administered to 13-year-olds featuring questions like “Do you have a positive attitude towards yourself?” had a strong ability to identify the 16.3% of subjects who would become cigarette smokers. Pediatrics, October 2018

3.  An 88-country analysis suggests a graded association between rates of corporal punishment and physical fighting in adolescents. BMJ Open, October 2018

4. Recommendations against routine radiography in bronchiolitis from the American Academy of Pediatrics and Choosing Wisely have not decreased the practice. JAMA, October 16 2018

5. Adolescents who get less than six hours of sleep per night were three times more likely to report considering suicide than those getting eight or more hours. JAMA Pediatrics, October 2018

Clinical Quiz

A 16-year-old female presents to her family physician with a one-year history of skin changes to both palms. She describes these as transient in nature, appearing after she washes her hands, does the dishes, or takes a bath. Examination reveals pitted white papules and marked wrinkling of her palms, five minutes after her hands are immersed in water. Which of the following genetic disorders is this patient’s presentation associated with?

A. Spinal muscular atrophy

B. Cystic fibrosis

C. Canavan disease

D. Tay-Sachs disease

Answer at the bottom of this email, or click here to see the full case and discussion on Figure 1, a free physician community for viewing medical cases.

Editor’s Pearl

This week’s pearl comes a pediatric dermatologist on Figure 1 who goes by the username @MD-MB:

Have patients bring topical medication and show you what they consider to be a thick layer. I’d say about 85% of the time, what they think is thick is not enough. Most patients get scared of medications and put too thin of a layer and rub it in (spread it) until it can’t be seen.

CLINICAL QUIZ ANSWER:

C. Cystic fibrosis

This patient’s presentation is suggestive of aquagenic wrinkling of the palms (AWP), a rare condition characterized by the transient development of whitish papules and excessive wrinkling of the palms on exposure to water. The reaction occurs in up to 80% of patients with classic cystic fibrosis (CF), and has also been reported in carriers of CF-causing mutations.

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