-Dr.
Singaram
PAEDIATRICS
IMPORTANT MILESTONES
Copies circle: 3 years
Crawls: 11 months
Child smiles at familiar persons: 2 months
Neck control: 3 month
Sits with support: 6 months
Transfer object from one hand to other: 6 months
Says mama dada: 10 months
Self decisions: 7 years
Walks alone: 13-14 months
Knows age & sex: 3 years
Can draw a rectangle: 4 years
Can draw a triangle: 5 years
BODY PARAMETERS
Body weight doubles at: 5 months
Body weight triples at: 1 year
Body length increases in year by: 25 cm
NUTRITION
Edema is seen in: Kwashiorkar
Hepatomegaly is seen in: Kwashiorkar
Acute malnutrition is judged by: Weight for height
Chronic malnutrition is judged by: Height for age
Flag sign is seen in: Kwashiorkar
RICKETS
Craniotabes (calvariae are softened),
Rachitic rosary (prominent costochondral junction),
Pot belly,
Bow legs etc.
-Dr. Singaram
Biochemical values:
o Low S. calcium & phosphate,
o Raised alkaline phosphatase & PTH
SCURVY
Bleeding into skin & joints,
Wimberger sign,
Pseudoparalysis etc.
DOWN SYNDROME
MC trisomy,
Brachycephalic skull,
Hypotonia,
Palpebral fissure slopes upwards,
Marked epicanthic folds,
Brushfield's spots,
Increased nuchal fold thickness,
Iliac index less than 60,
Simian crease (single palmar crease),
MC associated cardiac lesions: ASD/ Endocardial cushion defects
Duodenal atresia, CML & transient myeloproliferative disorders are seen
May be associated with Alzheimer's dementia,
MC cause of down syndrome: Maternal non-disjunction
TURNER SYNDROME
Lymphedema,
Short stature,
Webbed neck,
Low posterior hairline,
Cubitus valgus (increased carrying angle),
Finger deformities,
Coarctation of aorta,
Short 4th metacarpal,
45 XO karyotype
KLINEFELTER SYNDROME
-Dr. Singaram
47 XXY
MC cause of hypergonadotrophic hypogonadism,
Subnormal intelligence
LATE CONGENITAL SYPHILIS
Hutchinson's triad:
o Hutchinson teeth,
o 8th cranial nerve deafness &
o Interstitial keratitis
IgM FTA-ABS is best to diagnose congenital syphilis,
Saddle nose, Sabre tibia &Clutton's joint
JAUNDICE
Causes of unconjugated hyperbilirubinemia:
o CrigglerNajjar syndrome I & II,
o Physiological jaundice,
o Gilbert syndrome
o Breast milk jaundice etc.
Causes of conjugated hyperbilirubinemia: Biliary atresia (extrahepatic/ intrahepatic),
MC cause of conjugated bilirubinemia in newborn: Idiopathic infantile hepatitis
Physiological jaundice appears on: 3rd day (lasts upto 7th - 10th day in term & 14th day in
preterm)
MC cause of jaundice within 24 hours after birth: Erythroblastosisfetalis
Breast milk jaundice is due to: Pregnandiole
Kernicterus: Unconjugated bilirubin, in basal ganglia
Rise in level of bilirubin in physiological jaundice: Less than 5 mg/ dl/ day
INFANTILE HYPERTROPHIC PYLORIC STENOSIS
Appears within 2-4 weeks after birth,
Hypokalemic metabolic alkalosis,
Compensated by:
o Paradoxical aciduria,
HYALINE MEMBRANE DISEASE
Manifested within first few hours of life,
Hyaline membrane is made of fibrin,
Seen in:
-Dr. Singaram
o DM,
o Premature babies
Ground glass appearance/ reticulonodular/ reticulogranular pattern on chest radiography
BRONCHIOLITIS
MC Caused by Respiratory Synctial Virus/ RSV,
MC in boys (less than 2 years),
Chest X-ray shows:
o Hyperinflation with
o Multiple areas of interstitial infiltration
May lead to asthma,
Self limiting,
DOC is ribavirin,
Oxygen is helpful,
RSV Immunoglobulins has no role in acute attacks,
Antibiotics are not used initially
ATRIAL SEPTAL DEFECT
Left parasternal heave seen,
Chest X-ray shows enlarged right atrium & ventricle (NOT Left atrium),
Associated with Holt Oram syndrome
ASD + Mitral stenosis: Lutembacher syndrome
ASD + Single atrium: Ellis Crevald syndrome
ASD + Bony abnormalities: Holt Oram syndrome
VENTRICULAR SEPTAL DEFECT
Left ventricular failure, Biventricular hypertrophy,
Left axis deviation
PATENT DUCTUS ARTERIOSUS
Seen in rubella,
Predisposed by:
o Hypoxia &
o Prematurity,
Differential cyanosis is seen (cyanosis of toes but NOT of fingers)
Prostaglandin inhibitor stimulate PDA closure
COARCTATION OF AORTA
-Dr. Singaram
MC below origin of left subclavian artery,
Associated with:
o Turners syndrome,
o Bicuspid aortic valve,
o Upper extremity hypertension,
o Lower extremity hypotension,
o Headache,
o Dizziness,
Rib notching with double bulging is seen,
Cause of death is:
o Complications of hypertension,
o Congestive heart failure etc.
TETRALOGY OF FALLOT
Components:
o VSD,
o Pulmonary stenosis,
o Over-riding of aorta,
o Right ventricular hypertrophy,
Chest X-ray: Boot shaped heart/ couren sabot heart,
Single S2,
Ejection systolic murmur,
Right sided aortic arch,
Pentalogy of fallot
TOF + ASD IRON
DEFICIENCY ANEMIA/ IDA
MC type of anemia in children: IDA
Time to start iron supplementation to a term, breast fed baby: 6 weeks
First indicator of response after iron therapy: Increased reticulocyte count
ANEMIA
Hypochromic, microcytic anemia with decreased serum iron & raised TIBC: Iron deficiency
anemia
Hypochromic, microcytic anemia with raised serum ferritin & decreased TIBC: Anemia of
chronic diseases
Early indicator of iron deficiency anemia: Serum ferritin
THALASSEMIA
-Dr. Singaram
Features:
o Splenomegaly,
o Hemolyticfacies,
o Decreased osmotic fragility (NOT increased),
o Hair on end appearance (X-ray)
Diagnostic test: Electrophoresis
Microcytosis&hypochromia,
Target & tear drop cells
VON WILLEBRAND DISEASE
Autosomal disease,
MC hereditary bleeding disorder,
APTT may be prolonged,
BT prolonged,
Factor VIII levels may be reduced
Defective platelet aggregation with ristocetin
THROMBOTIC THROMBOCYTOPENIC PURPURA/ TTP
Pentad of TTP:
o Fever,
o Thrombocytopenia,
o Microangiopathichemolyticanemia,
o Neurological symptoms &
o Renal failure
Lab features:
o BT prolonged,
o Normal PT, PTT & complement
VESICO-URETERAL REFLEX/ VUR
MC cause of renal scarring in children,
Presentation:
o Straining & dribbling of urine
o In a male child with
o Recurrent UTI
Diagnosis is by: MCUG/ micturatingcystourethrogram
NEPHROTIC SYNDROME
-Dr. Singaram
MC of nephrotic syndrome in children: Minimal change disease (In adults, its Membranous
GN)
Characterized by:
o Proteinuria (more than 3.5 gm/ day),
o Hypoalbuminemia,
o Edema,
o Hyperlipidemia,
o Lipiduria
o Hypercoagulability,
PAEDIATRIC ONCOLOGY
MC inherited malignancy: Retinoblastoma
MC malignant neoplasm in infancy: Neuroblastoma
MC viral tumour: Warts
MC malignant tumour (childhood): Leukemia
NEUROBLASTOMA
MC presentation: Large abdominal mass
May present as:
Lytic lesion in skull with
Sutural diasthesis,
MC mass in posterior mediastinum (children),
Metastasizes to bone most commonly,
Associated with hypertension &
VMA &catecholamines are seen in urine
WILM TUMOUR
Also known as nephroblastoma,
MC presenting symptom: Palpable abdominal mass
Involves chromosome 11,
Highest cure rates,
Chemotherapy is with:
Actinomycin-D &
Vincristine
GLYCOGEN STORAGE DISEASES
Von gierkes disease is due to deficiency of: Glucose-6-phosphatase deficiency
-Dr. Singaram
Features of Von gierkes disease:
Hyperuricemia,
Lactic acidosis etc (NO muscles involvement)
Andersen disease is due to deficiency of: Branching enzyme
McArdles disease is due to deficiency of: Muscle phosphorylase
Galactosemia:
It is due to deficiency of GPUT/ galactose-1-phosphate-uridyl transferase; Reducing sugars
are seen in
PHENYLKETONURIA
Deficiency of: Phenyl-Alanine Hydroxylase,
Manifests as: Mental retardation, seizures etc.
Urine: Musty odour
Tests:
o Ferric chloride,
o Guthrie's test
CONGENITAL HYPOTHYROIDISM
Large & open posterior fontanelle,
Absent social smile & eyebrows,
Growth retardation,
Delayed puberty,
Cold extremities,
Large tongue,
Prolongation of physiological jaundice &
Epiphyseal dysgenesis
MENINGITIS
MC presentation of neonatal meningitis: Poor breast feeding
MC cause (in neonates) of bacterial meningitis: Group B streptococci/ E. coli
Causes of aseptic meningitis:
o Mumps virus,
o Polio virus etc.
Low CSF protein is seen in:
o Infants,
o Pseudotumourcerebri etc.
NEONATAL SEIZURES
-Dr. Singaram
MC cause of seizure in newborn: Hypoxic ischemic encephalopathy
MC type of seizure in newborn: Subtle (MC type of seizures in children: Generalized Tonic
Clonic)
DUCHENNE MUSCULAR DYSTROPHY
Disease of sarcolemmal proteins (Dystrophin gene)
Gowers sign (patient tries to climb on himself)
Summary
1. Child can copy a circle at the age of: 3 years
2. Body weight of a child triples at: 1 year
3. Flag sign (hair) is suggestive of: Kwashiorkar
4. Rachitic rosary is a feature of: Rickets
5. Mongolian facies is seen in: Down syndrome
6. Karyotype in case of Turner syndrome: 45 XO
7. Hutchinson triad is seen in: Late congenital syphilis
8. MC cause of jaundice within 24 hours of life: Erythroblastosisfetalis
9. Rise of bilirubin in physiological jaundice: Less than 5 mg/ dl/ day
10. MC cause of bronchiolitis: Respiratory Synctial virus
11. MC hear disorder in Down syndrome: ASD
12. MC type of anemia in children: Iron deficiency anemia
13. Hair on end appearance (radiograph) is seen in: Thalassemia
14. Height of 100 cm is achieved by to age of: 4 years
15. MC cause of nephrotic syndrome in children: Minimal change disease
16. MC malignant neoplasm in infancy: Neuroblastoma
17. MC presentation of neuroblastoma: Abdominal mass
18. MC cause of meningitis in neonates: E. coli/ Group B streptococcus
19. Enzyme deficient in Von-Gierke's disease: G-6-phosphatase
20. Urine in phenylketonuria: Mousy/ musty odour
21. Urine turns/ dark on exposure to atmosphere in: Alkaptonuria
22. MC type of seizure in newborn: Subtle
23. MC type of seizure in childhood: Generalized tonic clonic
24. Most of the babies are bed-dry at the gae of: 5 years
25. Condition in which unconjugated bilirubin gets deposited in basal ganglia: Kernicterus
Few suggestions:
On milestones:
Child smiles at human faces (social smile) : 2 months
Walk alone : 15 months
Draws Cross/plus : 4 years
Body length increases in 1st year by 25 cm.
Pyloric stenosis: Appears by 2 - 4 weeks
PDA with Eisenmenger syndrome - Differential cyanosis is seen.
Iron supplementation is not required for term babies.
(Only for preterms)
von Willwbrand - Autosomal dominant usually
MC cause nephrotic in adults is FSGS
Proteinuria in children is >40mg/m2/day
-Dr. Singaram
Most common cause of neonatal meningitis : E.coli
Most common cause of aseptic/viral meningitis - JE virus
