Precocious Puberty Marta Satin Smith INTRODUCTION Normal Pubertal Development Girls In girls, puberty usually begins at 10.5 to 11 years with a range of 9 to 11 years. Breast development…

Pleural Effusions Angela Lorts INTRODUCTION A pleural effusion is an accumulation of fluid between the parietal and visceral pleura. Normally, fluid is produced by the capillaries of the parietal pleura…

Pelvic Pain Sara Pentlicky Courtney Schreiber INTRODUCTION Knowledge regarding the location of organs in the female pelvic region and how they may cause discomfort is key to the evaluation of…

Paraplegia Lawrence W. Brown INTRODUCTION Paraplegia is any weakness of the lower extremities caused by dysfunction of the nervous system at the level of the peripheral nerves, spinal cord, or…

Pallor (Paleness) Kim Smith-Whitley INTRODUCTION Pallor (paleness) results from a decreased amount of circulating hemoglobin or vasoconstriction of dermal blood vessels. Causes can be classified as hematologic or nonhematologic. DIFFERENTIAL…

Neonatal Infections Samir S. Shah NEONATAL SEPSIS Overview The most common classification of neonatal sepsis is by age at onset. Early-onset infection. Clinical manifestations of early-onset infection occur within the…

Neck Pain/Stiffness Jill C. Posner INTRODUCTION In children, the chief complaint of neck pain often may represent neck stiffness or torticollis. Torticollis describes a characteristic malpositioning of the head and…

Neck Mass Frances Nadel Monika Goyal INTRODUCTION Neck masses are a common clinical problem in children. Although the list of potential causes is extensive, most are due to benign processes…

Murmurs Jack Rychik INTRODUCTION A murmur is an auditory vibration produced by turbulent flow within the cardiac structures. A murmur may be physiologic (i.e., a normal finding) or pathologic. Heart…

Mediastinal Mass Leslie S. Kersun INTRODUCTION The mediastinum is a potential space within the thoracic cavity, between the two pleura. It is divided into anterior, middle, and posterior regions. The…