Paediatrics

BIRTH TRUAMA
Caput Succedaneum Cephalohematoma

At birth At 2-4 day old

Extend over suture line Limited by suture line

Diffuse ecchymotic Normal overlying skin

Disappears spontaneously within 24 hrs. after birth Reabsorbed over 2-3 months, can calcify

 M/C bone to be fractured during birth – Clavicle.
 Sternomastoid tumour:
— Appears at 7-20 plus days
— Located at lower and upper third of muscle
— Disappears at 6 months of age.
 MC internal organ to be injured during birth is brain
> liver.
Common Nerve Palsies at Birth
 Facial nerve – asymmetrical crying face, open eye.
 Erb’s palsy – C5-6 waiters tip posture.
 Klumpke’s palsy C7-8 T1-Claw hand, flexed elbow
(plus Horner syndrome if stellate ganglion in-
volved).
 Sciatic Nerve S1-4-adopts foot drop +/– sensory
loss or dorsum of foot.
Conditions Associated with Respiratory
Distress Syndrome
 Prematurity
 Asphyxia, Intrapartum aspiration, 2nd twin.
 Maternal Factors: Antepartum hemorrhage, cae-
sarian delivery without labour, DM.
 Previous siblings with RDS.
 Severe Rh isoimmunization (Uncommon).
Prenatal Periods
 Ovum: 0-14 days.
 Embryo: 3 weeks to 8 weeks.
 Fetus: 9 weeks to birth.
Perinatal Periods
 22 weeks of gestation – 7 days after birth.

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Postnatal Periods  Indian child at 4 years: 100 cms

 Neonates: Less than 28 days after birth.  About 5 cms height gain every year till age of 10
 Early Neonatal Period: <7 days. years.
 Late Neonatal Period: from 7th to 28th day.
 Post Neonatal Period: 28-365 days of life. CHEST CIRCUMFERENCE
 Infancy: 1st year.  At birth : 3 cms < HC (about 32 cms)
 Toddler: 1-3 years.  After 1 year CC>HC.
 Preschool: 3-6 years.
 Live Born: Show any evidence of life such as breath- Normal Newborn
ing, heartbeat, pulsation of umbilical cord.  Heart Rate: 110-160/min.
 Still Birth: Fetal death, after gestation age of 20  Respiratory Rate: 40-60/min.
weeks or more.  Infant pass urine by 48 hrs. after birth and meco-
 Term Baby: Born between 37-42 weeks (259-293 nium by 24 hrs.
days).  Infant is ready to feed within half an hour after
 Pre Term Baby: Before 37 weeks. birth.
 Post Term Baby: Born at 42 weeks or more.
 LBW: Less than 2500 gms.
TETANUS NEONATORUM
 Very LBW: Less than 1500 gms.
 Usually start by 5-10 days after birth.
 Extreme LBW: Less than 1000 gms.
 Never in first 2 days of life.
 Neonatal Mortality Rate: Death if infants under
 Cause is Cl. tetani.
the first 28 days of life per 1000 live births per
year.
RDS OR HMD
WEIGHT  In preterm neonates (<36 weeks of gestation), 1/
 Normal: 2.8 kgs at birth 3rd babies die within first 3 days.
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 ×2 = 5 months  Incidence is 80% in neonates <28 weeks.

 ×3 = 1 yr.  Prenatal diagnosis: L/S ratio in amniotic fluid.
 ×4 = 2 yr.  >2.0 – adequate lung maturity.
 Weight gain: 25-30 gm/day × 1-3 months  1.5-1.99 – borderline.
 400 gm/month next 4-12 months.  1-1.5 – mild.
 <1 – severe.
 Postnatal diagnosis: Shake’s test.
LENGTH
 At Birth: 50 cms
MECONIUM ASPIRATION
 3 months: 60 cms
SYNDROME
 9 months: 70 cms
 Usually in post mature and small for dates babies.
 1 year: 75 cms
 Respiratory distress occurs within first 24 hours of
 Average height of 2 year old: 90 cms life.

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CHRONIC LUNG DISEASE
 Diagnosis criteria: O2 requirement beyond 36
weeks or beyond 28 days of life.
 Cause: Baro trauma or O2 toxicity.
 Cessation of respiration for 20 secs with or with-
out bradycardia and cyanosis – APNEA.
 Hypothyroidism: Persistent elevation of indirect
bilirubin, first sign of hypothyroidism.
 Complication of phototherapy treatment of hy-
pothyroidism – Bronze Baby syndrome.
 Skin, urine and serum becomes brownish black
after several days of phototherapy.
INFANT MILESTONES POINTS
 Child make line at – 2 years
 Child make O at – 3 years
 Child make X, at – 4 years
 Child make  at – 5 years
 Climb upstairs with both legs at – 2 years
 Hopping at – 4 years
 Skipping at – 5 years
 Baby is bed dry at – 5 year.
 10 year old child whom IQ of 4 year is – Imbecile.
 10 year old child with mental age of 2 year will
have IQ of–20.
 IQ 90-109-normal.
MISCELLANEOUS POINTS
 Continuous murmur is heard in – PDA.
 Loss of migration of neural crest cells causes –
Hirschprungs disease.
 Most common germ cell tumour of childhood –
Yolk sac tumours.
 Mid arm circumference for severe malnutrition is
– <11.5 cm.
 3 months old baby with fever and respiratory rate
60, irritable, and well feed, no stridor, no chest in
drawing, no convulsions. Diagnosis – Pneumonia.
 A mother with the new born is worried for her
child as the newborn hasn’t passed the meconium
till 6 hours of the birth. How much time should
she wait for the meconium to pass out – 48 hours.
 A boy presents with hemarthrosis of left knee af-
ter a history of fall. Deficiency of which factor can
lead to the following condition – Factor VIII defi-
ciency.
 Wasting – weight for height.
 Stunting – height for age.
 Gomes classification – weight for age.
 Waterlow classification – weight for height.
 Common cause of neonatal hypoglycemia is – in-
fant of diabetic mother.
 MCC of short stature – Constitutional.
 Normal healthy child-height – 100 cm, weight – 16
kg, age – 4 year.
 Head control/neck holdingis possible by – 3 month.
 Large dose of vit. K gives to newborn can lead to –
hemolytic anemia.
 MCC of congenital hypothyroidism – thyroid dys-
genesis.
 MC presentation of neonatal meningitis – Poor
feeding.
 Indication of good attachment to mother’s breast
during breast feeding –
— Only upper areola visible
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— Baby’s chin touches mother’s breast
— Baby’s mouth wide open.
 Rubella specific antibodies detected after natural
infection/vaccination-IgM.
 Congenital rubella causes –
— Cardiac malformation
— SNHL
— Cataract
 Rye’s syndrome in children is caused by – Influ-
enza virus.
 Dose of drug in a child calculated by – weight.
 Full term 89 hours old baby develops jaundice,
minimum level of S. bilirubin to start photo-
therapy should be – 20 mg%.
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 Ossification center appearing just before birth –
lower end of femur.
 Parachute reflex persist forever.
 Ponderal's index for small for gestational age child
– <2.
 Characteristic of SIRS include–
— Leucocytosis
— Infectious or non infectious cause
— Oral temp. >38°
 2 year old child feed on milk diet present with
persistent diarrhea, acidic stool on 2 separate oc-
casion and presence of reducing substance in the
stool-diagnose – Lactose intolerance.
 Short stature, antimongoloid slant, undescended
testes, delayed puberty and pulmonary atresia
with normal karyotype suggest Noonan syndrome.
 Rash of chicken pox is pleomorphic.
 Dose of zink for pediatric diarrhoea is 20 mg.
 MC cause of intestinal obstruction in children is
intussusception.
 MC cause of intestinal obstruction in newborn is
duodenal atresia.
 MC cause of intestinal obstruction in adult is post-
operative adhesions.
 MC VSD is perimembranous.
 Skimmed milk contains less fats.
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 Child with severe malnutrition after giving proper
nutrition develops edema due to hypernatremia.
 Anterior fontanelle fuses by 18 months.
 Zinc is useful in acute diarrhoea.
Aneuploidies Inhibin A
Turner’s 
Patau’s N N
Down’s  
Edward’s — 
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 Physiological jaundice in preterm babies last for
14 days.
 IOC for neonatal hypertrophic pyloric stenosis is
USG.
 I/V fluid given to a 2 year old child with severe
dehydration is 30 ml in 30 min.
 For accurate measurement of axillary temperature
in new born, thermometer is kept for 3 minutes.
 Most definitive method of estimating GFR is inu-
lin clearance
 Most commonly used method of estimating GFR
is serum creatinine.
 TOC for kawasaki disease is I/V immunoglobulins.
 Best management of 3 year child with diurnal en-
uresis and soiling of clothes is behavioural modi-
fication.
 Preferred management of a neonate with vaginal
bleeding is observation.
 Cardiothoracic ratio in TOF – normal.
 MC cause of cyanosis with normal sized heart is
TOF.
 MC cause of cyanosis with left side enlargement
of heart is tricuspid atresia.
 Spinal dyspharism is diagnosed by elevated amni-
otic fluid acetylcholinesterase.
 Tests for spina bifida occulta
— Antenatal USG showing frog sign –
Anencephaly
— Ammotic flud acetylcholinesterase
— Maternal serum a-feto protein.
hCG Estriol AFP
  
N 
 
 —
 PAEDIATRICS

 MC cause of tachypnea in a post term baby – Meco-  Most common clinical feature of hypoglycemia in
nium aspiration. neonates is Jitterness/Tremors.
 APGAR Score:  Precocious puberty and patchy skin pigmentation
• A – Appearance is a sign of Albright syndrome.
• P – Pulse  Mutation in NPHS1 gene cause congenital finnish
• G – Grimace type nephrotic syndrome.
• A – Activities  Keshan disease is due to selenium deficiency.
• R – Respiratory efforts  Blood volume in preterm neonate is approxi-
 Assessment of puberty in an adolescent is done mately 90 ml/kg.
using Tanner’s staging or Sexualty Maturity Rating
(SMR).

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RECENT FMGE/MCI QUESTIONS—PEDIATRIC

1. Mid arm circumference for severe malnutri- 7. A baby turns blue at birth which resolves to
tion is crying. What should be the next step?
(a) 14.5 cm (b) 13.5 cm (a) Intubation
(c) 12.5 cm (d) <11.5 cm (b) Oropharyngeal airway
2. Mid arm circumference in Malnourished child (c) C-PAP
is: (d) Tracheostomy/Nasal prog
(a) 14.5 cm (b) 13.5 cm 8. A mother delivered 33 weeks old baby, via
(c) 12.5 cm (d) <11.5 cm normal vaginal delivery with no complications
at birth. What is the preferred method of feed-
3. Months old baby with fever and respiratory
ing the neonate?
rate 60, irritable, and well feed, no stridor, no
(a) OGT feeds
chest indrawing, no convulsions. Diagnosis:
(b) Direct breastfeeding
(a) Pneumonia
(c) Paladai feeds
(b) Severepneumonia
(d) Parenteralnutrition
(c) Very severpneumonia
(d) No Pneumonia 9. A 6-year-old child presented with abdominal
pain, hematemesis and palpable spleen. He
4. A 3-year-old child presented with fever and had a history of exchange transfusion for neo-
cough and the inability to feed for 2 days. On natal jaundice. What is the probable diagno-
examination, chest indrawing is noted with a sis?
respiratory rate of 42/minute. What is the se- (a) Budd Chiarisyndrome
verity grading of respiratory infection in this (b) Cirrhosis ofliver
child? (c) Viralhepatitis
(a) No pneumonia (b) Pneumonia (d) Portal veinthrombosis
(c) Severe pneumonia
10. A 1-year-old child presents with first episode
(d) Very severe pneumonia of wheeze and breathing difficulty. Chest X-
5. A 5 months child presented with difficulty in ray shows bilateral hyperinflation. Which of
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breathing, chest indrawing, and wheeze of 1-
day duration. Previous episodes of wheezing/
MDI usage are present. What is the next step
in the management of this condition?
(a) Oxygen inhalation + Salbutamol
nebulization
(b) Oxygen inhalation + Inj. hydrocortisone
(c) Oxygen inhalation only
(d) Adrenaline nebulization
6. In a child presenting with short stature, GH
levels were found to be high but IGF-1 levels
are low. Likely abnormality?
(a) GHRH deficiency
(b) GHRH receptor defect
(c) GH receptor defect
(d) Panhypopituitarism
the following can be a causative organism in
this case?
(a) RSV (b) S. pneumoniae
(c) Influenza (d) Coxsackievirus
11. True regarding buffalo milk composition when
compared to human milk?
(a) High calorie, high protein
(b) Low calorie, low protein
(c) High calorie, low protein
(d) Low calorie, high fat
12. A 3-month-old child presents with complaints
of fever, cough, not able to feed and breath-
ing difficulty. On examination, respiratory rate
was 58/min., chest retractions were present.
What would be your next step of Manage-
ment?

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 PAEDIATRICS

(a) Severe pneumonia – Give antibiotics and (a) Chickenpox (b) HSV
refer immediately (c) HPV (d) Measles
(b) Very severe pneumonia and refer 18. Which curvature develops after the baby starts
urgently to walk?
(c) Pneumonia – Start antibiotics and send (a) Primary cervical curvature
child home (b) Secondary sacral curvature
(d) No pneumonia (c) Primary sacral curvature
13. All of the following are components of TOF (d) Secondary lumbar curvature
except? 19. Child presents with sores in the mouth and a
(a) Over riding aorta rash on the hands and feet as shown in the
(b) Sub pulmonic stenosis image below. What is the causative organism
(c) VSD for it?
(d) Tricuspid stenosis
14. A neonate was found to have Grimace on in-
serting a catheter into nose, some flexion of
limbs was noted. Heart rate – 120/minute,
blue extremities were noted with irregular
breathing. Find out the APGAR Score?
(a) 4 (b) 6
(c) 8 (d) 10
15. A patient’s mother while bathing her child
noticed there was no testes in the scrotum (a) Coxsackie virus A16
and on examination-one right testes was in (b) Poxvirus
Inguinal region and left was in perineum. What (c) Herpes virus
is the DIAGNOSIS? (d) Human papillomavirus
(a) Bilateral undescended testes 20. Child presents with fever and pleomorphic
(b) Bilateral ectopictestes rash as shown in the image. Diagnosis?
(c) Right undescended and left ectopic testes

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(d) Left undescended and right ectopic testes
16. A 4-year-old child presented with fever, run-
ning nose and following lesions. Probable eti-
ology?
(a) HSV1 (b) HSV2
(c) Coxsackievirus
(d) Streptococci pneumoniae
17. Identify the clinical condition from the skin
finding as given below:

(a) Chickenpox (b) Smallpox

(c) Measles (d) Rubella
21. A mother with the new born is worried for her
child as the newborn hasn’t passed the meco-
nium till 6 hours of the birth. How much time
should she wait for the meconium to passout?

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(a) 48 hours (b) 24 hours 24. A child had chocolate pastry and got diarrhea
(c) 12 hours (d) 72 hours within 3 hours of consumption. Which micro-
22. A boy presents with hemarthrosis of left knee organism is responsible for this?
after a history of fall. Deficiency of which fac- (a) Staph Aureus
tor can lead to the following condition? (b) MISSING
(c) MISSING
(d) MISSING
25. A 12 year old girl with irritability, dry mouth
and slow skin pinch. Next step of management
is?
(a) Ringer’s Lactate
(b) MISSING
(c) MISSING
(d) MISSING
26. Which of the following is determining factor
(a) Van-Willebrand disease for severity of TOF?
(b) Vitamin K deficiency (a) Pulmonary Stenosis
(c) Thrombocytopenia (b) MISSING
(d) Factor VIII deficiency (c) MISSING
23. A mother complains that her child has diar- (d) MISSING
rhea with repetitive changing of diapers. Urine 27. How much protein percentage of cow milk dif-
leaking but child is constipated and has ab- fer from human milk?
dominal pain. What could be the diagnosis?
(a) 3 times
(a) Psychological polydipsia
(b) MISSING
(b) Diabetes insipidus
(c) MISSING
(c) SIADH
(d) Cerebral salt wasting syndrome (d) MISSING
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ANSWER KEYS
1. (d) 2. (d) 3. (a) 4. (c) 5. (a) 6. (c) 7. (b) 8. (c) 9. (d) 10. (a)
11. (a) 12. (a) 13. (d) 14. (b) 15. (c) 16. (c) 17. (a) 18. (d) 19. (a) 20. (a)
21. (a) 22. (d) 23. (?) 24. (a) 25. (a) 26. (a) 27. (a)

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