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Until proven otherwise collected by Dr. Abdulmateen
- 1. Until or unless proven otherwise Prepared by: Dr. Abdulmateen A. Shukri
- 2. Fever in infants less than 3 months old should be assumed to be due to ……………… until proven otherwise.
- 4. Child with syphilis, …………… should be assumed until proven otherwise
- 5. Sexual abuse
- 6. Child abuse until proven otherwise
- 7. Child abuse until proven otherwise: i Circumferential burns in child <3 years ii Punched out, circular burns implying cigarette burns iii Forced immersion causing a doughnut pattern on the buttocks iv Gravity pattern of pouring hot fluids, particularly in areas the child could not cause v Uniform patterns
- 8. All major trauma patients should be assumed to have a ……………………… until proven otherwise.
- 10. Any child in the proper setting with the sudden onset of choking, stridor, or wheezing has …………………………………. until proven otherwise.
- 12. Jaundice during the 1st 24 hr of life should be considered to be due to ……………… until proven otherwise.
- 13. Hemolysis Causes of jaundice in the 1st 24 hrs of life: Hemolysis Septicemia Intrauterine infections.
- 14. Any child who presents with fever or unexplained systemic illness and has traveled or resided in a malaria-endemic area within the previous year should be assumed to have life-threatening malaria until proven otherwise. Malaria should be considered regardless of the use of chemoprophylaxis.
- 16. A cardiac arrhythmia that develops in a child who is taking digitalis may also be related to the primary cardiac disease rather than the drug, however, any arrhythmia occurring after the institution of digitalis therapy must be considered to be drug related until proven otherwise.
- 17. Any child with sickle cell disease, fever, and reticulocytopenia should be considered to have …………………………. until proven otherwise.
- 19. The acute onset of a focal neurologic deficit in a child is ……………. until proven otherwise.
- 20. Stroke
- 21. Any alteration in the level of consciousness whether delirium, lethargy, obtundation, stupor, or coma must be managed as a life- threatening emergency until proven otherwise.
- 22. In a neonate, bilious vomiting is a ……………………. until proven otherwise.
- 23. Surgical emergency malrotation with midgut volvulus
- 24. A history of deterioration in a previously well neonate should be considered sepsis or an inborn error until proven otherwise.
- 25. An injured child who cannot easily breathe, cough, cry, or speak has upper airway obstruction until proven otherwise.
- 26. As with patients with asplenia, infection in neutropenic patients can progress rapidly, and all febrile and neutropenic patients should be presumed to have an invasive infection until proven otherwise.
- 27. Because of the severe sequelae of gonococcal ophthalmia, infants with eye discharge should be assumed to have this infection until proven otherwise. Untreated, the infection can progress to corneal ulceration and to globe rupture within 24 hours of infection. Topical therapy is not adequate for either gonococcal or chlamydial ophthalmia neonatorum.
- 28. Refusal to eat and blood-tinged sputum in the child younger than 5 and a history of ingestion coupled with vomiting, vague sensation of foreign body, and odynophagia in the child older than 5 indicates an ingested foreign body until proven otherwise.
- 29. Children with hemolytic disease or sickle cell anemia who have upper abdominal pain have …………….. until proven otherwise.
- 30. cholelithiasis
- 31. Respiratory distress in a patient with a tracheostomy indicates ……………….. until proven otherwise.
- 32. Tube obstruction
- 33. Following drainage of pl. effusion or pneumothorax by chest tube, any sudden change in the patient’s cardiorespiratory status should be considered to be a ……………………………………………. until proven otherwise.
- 34. recurrence of the collection
- 35. A male child with a liver abscess should be considered to have …………………………. until proven otherwise.
- 37. Amenorrhea with unilateral abdominal or pelvic pain, irregular vaginal bleeding, and a positive pregnancy test is indicative of …………………. until proven otherwise.
- 39. Any child with fever, acute onset of pain, and limited motion of a joint should be presumed to have ………………. until proven otherwise.
- 40. Septic arthritis
- 41. The acute scrotum is a urologic surgical emergency until proven otherwise. It is most imperative to rule out torsion of the spermatic cord.
- 42. Solid masses within the substance of the testis should be considered …………. until proven otherwise.
- 43. Malignant Testicular ultrasound is helpful in the evaluation of testicular masses.
- 44. The combination of hypospadias and bilateral or unilateral cryptorchidism should be considered as ………………… until proven otherwise.
- 45. Intersex
- 46. Treat ambiguous genitalia as the ………………………. until proven otherwise.
- 47. salt-wasting form of CAH
- 48. Frank colitis in term newborn: HD until proven otherwise.
- 49. Anyone with a cough lasting more than 2 weeks should be presumed to have ……….. until proven otherwise.
- 50. Pertussis
- 51. Lesions on the palms and soles are considered to be syphilitic until proven otherwise.
- 52. Meconium ileus in newborns is indicative of …………… until proven otherwise.
- 53. Cystic fibrosis
- 54. In newborns, abnormal pupillary reflexes is ……………… until proven otherwise.
- 55. Retinoblastoma
- 56. A firm neck mass in a child without signs of inflammation is considered …………….. Until proven otherwise.
- 57. malignant
- 58. All infants younger than 3 months who present in shock should be considered to be …………. until proven otherwise.
- 59. Septic
- 60. Abdominal masses should be considered malignant until proven otherwise.
- 61. Fever without source is considered a bacterial infection until proven otherwise.
- 62. Fever and bone pain is osteomyelitis until proven otherwise. Differential includes: Septic joint; Trauma or fracture; Leukemia or bone malignancy; Rheumatic etiology; Bone infarction associated with Sickle Cell disease; Toxic Synovitis.
- 63. wide QRS tachycardia in an infant or child must be considered VT until proven otherwise.
- 64. If there is generalized edema with heavy proteinuria and hypoalbuminemia, the presumptive diagnosis is always ……………….. until proven otherwise.
- 66. Neonates who present in shock in the first few weeks of life are presumed to have ductal- dependent systemic flow until proven otherwise.
- 67. Cardiac syncope frequently occurs without any warning signs, and any episode of loss of consciousness without symptoms of presyncope should be assumed to have a cardiac cause until proven otherwise.
- 68. Any outflow murmur that increases with valsalva in syncope is hypertrophic cardiomyopathy (HCM) until proven otherwise.
- 69. Since splenomegaly is a very common sign detected in children with PH at the time of GI bleeding, the association between GI bleeding and splenomegaly should be suggestive of PH until proven otherwise.
- 70. Any infant or child has plain abdominal radiograph consistent with mechanical obstruction, with no palpable hernia or history of prior surgery, has intussusception until proven otherwise.
- 71. The patient with deeply depressed consciousness (GCS score less than 9) after head trauma is presumed to have increased ICP until proven otherwise.
- 72. Aseptic meningitis with hydrocephalus or basilar meningitis should be assumed to be TB until proven otherwise.
- 73. Prolonged apnea without bradycardia & with tachycardia is a seizure until proven otherwise.
- 74. A purpuric rash in an unwell child should be treated as meningococcal septicaemia until proven otherwise.
- 75. Nasal polyps in a pediatric patient suggest CF until proven otherwise.
- 76. All infants with low T4 and high TSH levels should be considered to have congenital hypothyroidism until proved otherwise.
- 77. Patients presenting with opsoclonus– myoclonus–ataxia should be assumed to have neuroblastoma until proven otherwise.
- 78. Any child receiving intravenous fluids, especially for treatment of diabetic ketoacidosis (DKA), who develops headache and/or drowsiness and/or seizures during therapy should be considered to have raised ICP until proven otherwise.
- 79. Hypocalcemia in the setting of congenital heart disease is due to DiGeorge syndrome until proven otherwise.
- 80. Any renal dysfunction in the newborn is considered acute and reversible until proven otherwise.
- 81. Low serum calcium with low serum phosphorus is due to lack of vitamin D until proven otherwise.
- 82. Hypertension and hematuria is glomerulonephritis until proven otherwise.
- 83. Acute onset of severe chest pain in a patient with Marfan syndrome should be assumed to be aortic dissection until proven otherwise.
- 84. When evaluating a patient with acute scrotal pain, testicular torsion should be considered the diagnosis until proven otherwise.
- 85. The presence of a dense greyish infiltrate and surface ulceration in an actively inflamed eye should be considered bacterial infection until proven otherwise.
- 86. Patients with a history of hemophilia who complain of a new headache or a focal neurological deficit on physical examination are also considered to have an intracranial hemorrhage until proven otherwise by an emergent head CT at the emergency department regardless of their level of consciousness.
- 87. Any term neonate with ICH should eliminate the possibility of hemophilia until proved otherwise.
- 88. Any child with hematemesis and splenomegaly should be presumed to have esophageal variceal bleeding until proven otherwise.
- 89. The passage of a large amount of bright to dark red blood by a well child should be considered bleeding from a Meckel diverticulum until proven otherwise.
- 90. Unexplained pain in a hemophilia should be considered due to bleeding unless proven otherwise.
- 91. Retinal hemorrhages (black arrow) are diagnostic of shaken-baby syndrome until proven otherwise.
- 92. An acutely inflamed joint must be considered of infectious etiology until proven otherwise.
- 93. Persistent tachycardia in the quiet and afebrile child should always be considered a sign of shock until proven otherwise.
- 94. Symptoms that include fever, tachycardia, and an elevated band count in association with an erythematous, indurated, painful lesion. With this sign/symptom complex, the presumptive diagnosis must be necrotizing fasciitis until proven otherwise.
- 95. The presence of any vesicular lesion(s) in a child with a malignancy should be treated as possible herpes or varicella infection until proven otherwise.
- 96. Any skin lesions in a dermatomal distribution, with or without associated pain and whether or not the lesions are “classic,” should be considered herpes zoster until proven otherwise.
- 97. Patients with fever and severe neutropenia (ANC <500 cell/uD) should be treated as bacterial sepsis until proven otherwise.
- 98. In view of the risk of spontaneous corneal perforation associated with gonorrheal conjunctivitis, infants should be presumed to have this infection until proven otherwise. Immediate Gram stain should be performed looking for Gram-negative diplococci.
- 99. The combination of fever, hemiparesis, and cyanotic heart disease should be considered to indicate a brain abscess until proved otherwise.
- 100. if an infant with cholestasis has a GGT in excess of 500 the diagnosis is biliary atresia until proven otherwise.
- 101. The association of acute hemolysis with liver failure in an adolescent should be diagnosed as Wilson's disease until proved otherwise.
- 102. Any liver disease of unknown origin should be considered as Wilson's disease until proved otherwise.
- 103. A spleen easily palpable below the costal margin in any child older than 3 to 4 years of age must be considered abnormal until proven otherwise.
- 104. A toddler with abdominal pain and a lower GI bleed should be assumed to have intussusception until proven otherwise.
- 105. Any child who presents with chronic unexplained diarrhea or megaloblastic anemia should be suspected to have tropical sprue syndrome until proven otherwise. ( diagnosis is made after exclusion of other causes like IDA, PCM and infection and other causes of malabsorption).
- 106. Any child, regardless of age, who presents with a history of recurrent episodes of wheezing, dyspnea, or chronic cough should be considered to be suffering from asthma until proven otherwise.
- 107. All children who are fire victims should be assumed to have CO poisoning until proven otherwise.
- 108. Chest pain in children and adolescents with a previous history of Kawasaki disease and coronary artery changes should be considered ischemic until proven otherwise.
- 109. The working diagnosis for posterior mediastinal masses in young children is neuroblastoma until proven otherwise.
- 110. A solid ovarian mass in childhood is a malignancy until proven otherwise by histology.
- 111. Any infant who fails to pass meconium by 48 hours of life should be considered to have Hirschsprung disease until proven otherwise.
- 112. Infrequently, the enema in a baby with Hirschsprung disease may be normal. Notably, this is the only condition that causes low bowel obstruction in which the enema may be normal. Thus any baby with a low obstruction and a normal enema should be presumed to have Hirschsprung disease until proven otherwise by biopsy.
- 113. Any patient with 21-hydroxylase deficiency seen with acute illness must be considered to have hypoglycemia and hyponatremia until proven otherwise.
- 114. Posttraumatic or new focal seizures are assumed to reflect an intracranial lesion until proven otherwise.
- 115. A child who cannot be consoled at some point by his mother is experiencing a medical emergency until proven otherwise.
- 116. Gastrointestinal bleeding and obstruction is dead or dying bowel until proven otherwise.
- 117. Ill patients with depressed mental status are hypoglycemic until proven otherwise.
- 118. The physician should bear in mind that recurrent DKA is the result of insulin omission, either deliberate or accidental, until proven otherwise.
- 119. Every patient with continuous peritoneal dialysis and abdominal pain has peritonitis until proven otherwise.
- 120. Fever and Sickle Cell Disease Temperature ≥ 38.5C Presume bacteremia until proven otherwise.
- 121. Delayed meconium + hx of greasy stools + FTT is basically CF until proven otherwise.
- 122. The patient with lower extremity weakness and absent reflexes should be considered to have GBS until proven otherwise.
- 123. Acute hemifacial weakness that spares the forehead is the result of stroke until proven otherwise.
- 124. Patients with recurrent rhabdomyolysis, the most likely diagnosis is metabolic myopathy until proven otherwise.
- 125. A hypotonic newborn should be considered septic until proven otherwise.
- 126. Focal seizures, unusual in neonates, should be considered stroke until proven otherwise.
- 127. A palpable abdominal mass in the newborn should be considered renal until proven otherwise (usually hydronephrosis or MCDK).
- 128. Unilateral or bilateral hydroureteronephrosis with a trabeculated/thick-walled bladder and abnormal renal parenchyma (hyperechoic, cystic changes), with or without oligohydramnios (prenatal setting) in the male, is PUV until proven otherwise with a cystogram.
- 129. Girls with continuous wetting should be considered to have an ectopic ureteral orifice until proved otherwise.
- 130. Thrombocytopenia presenting in a neonate after the first 3 days of life should be presumed to be due to sepsis or NEC until proven otherwise.
- 131. A well-appearing newborn with isolated thrombocytopenia (platelet count <100 x 109/L) without an obvious cause must be presumed to have neonatal alloimmune thrombocytopenia until proven otherwise.
- 132. Patients with MAHA and thrombocytopenia of unknown etiology is suspected of TTP-HUS until proven otherwise.
- 133. A thalassemic patient in heart failure should be assumed to have cardiac iron overload until proven otherwise.
- 134. Thalassemic patients who deteriorate should be assumed to have adrenal insufficiency until proven otherwise, with stress dose steroids initiated empirically after cortisol levels have been drawn.
- 135. No need for biopsy in every child with nephrotic syndrome because they can be treated invariably as MCNS until proven otherwise.
- 136. All acute renal failure patients are considered dehydration or prerenal failure until proven otherwise.
- 137. When you see RBC cast in urine, it's GN until proven otherwise.
- 138. Metaphyseal spiral fractures, except in toddlers, are considered the result of child abuse until proven otherwise.
- 139. In prolonged neonatal jaundice with a raised conjugated bilirubin fraction, the diagnosis must be extrahepatic biliary atresia until proven otherwise.
- 140. Back pain in children should be assumed to be organic until proven otherwise.
- 141. All babies with respiratory distress should be assumed to have GBS infection until proven otherwise.
- 142. Children with hematuria and proteinuria have renal parenchymal disease until proven otherwise.
- 143. Hyperthermia in an infant during the fi rst week of life should be considered to be due to herpesvirus infection until proven otherwise.
- 144. Children with CO poisoning may have extreme levels of tissue hypoxia yet will not be cyanotic. Thus, all children who are fi re victims should be assumed to have CO poisoning until proven otherwise.
- 148. Anterior mediastinal mass: 15-year-old girl with a cough and chest pain. Frontal radiograph (A) demonstrates widening of the mediastinum. Lateral radiograph (B) localizes this to the anterior mediastinum. Contrast CT (C) demonstrates a homogeneous attenuation mass anterior to the aortic arch in the anterior mediastinum. This is too large to be a normal thymus in a teenager. Homogeneous anterior mediastinal masses are lymphoma until proven otherwise.
- 149. A supraclavicular node is cancer until proven otherwise.
- 150. A headache is a brain tumor until proven otherwise when: Child 7 or less years. Particularly bad in the early morning. Awakening at night from headache. Progressively getting worse over time. Associated with increased ICP or other neurologic symptoms and signs – vomiting, ataxia, nystagmus, deteriorating developmental milestones or school performance. In an infant (<1 year) the head circumference is getting larger due to non-closure of the fontanelles and sutures.
- 151. In almost all medical/surgical emergencies, consider hypovolemia to be the primary cause of shock unless proven otherwise.
- 152. Bradycardia in a child should be considered a sign of hypoxia until proven otherwise.
- 153. Any person presenting with an itchy rash which covers the body but spares the face, can be considered to have scabies until proven otherwise.
- 154. Tinea capitis. Seborrhoeic pattern. dandruff- like scaling on the scalp; Prepubertal children present with suspected seborrhoeic dermatitis on the scalp: presumed to have tinea capitis until proven otherwise.
- 155. Every child with infantile spasms has tuberous sclerosis complex until proven otherwise.
- 156. Patients suspected of having encephalitis should be assumed to have herpes simplex virus until proven otherwise and started on intravenous acyclovir.
- 157. Any person presenting with suspected meningitis should therefore be managed as having bacterial meningitis until proved otherwise.
- 158. Presence of white blood cells in the cerebrospinal fluid of a seizing patient represents meningitis until proven otherwise.
- 159. Unless a systemic illness is found, dysphagia should be considered to be from an anatomic cause, unless proven otherwise.
- 160. Cloudy corneas represent glaucoma until proven otherwise and require prompt ophthalmologic evaluation even if obvious enlargement of the cornea and globe (buphthalmos) is not present.
- 161. In the typical sexually active adolescent male, dysuria and urethral discharge suggest the presence of an STI unless proven otherwise.
- 162. Bats,raccoons, skunks, coyotes, and foxes should be considered rabid unless proven otherwise.