MCQ in A Blink

7/30/2019 MCQ in A Blink

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PEDIATRIC IN MAPS - MSQ IN A BLINK

Growth and Development

Period of Human Life

1. Intrauterine period: a. Embryonic : 1st trimester (organogenesis) b. Fetal : 2nd& 3rd trimesters.2. Perinatal period : From labor to 1st 24 hour.3. Neonatal period : 1st 4 wks of life.4. Infancy period : a. Early: 1st year of life. b. Late : 2nd year of life.5. Childhood period : a. Preschool age: 2 6 ys b. School age: 6 12 ys6. Adolescence : a. Male : 12 17 ys b. Female : 10 15 ys7. Adulthood period

Assessment of Growth

Weight & Height

Weight KG Weight KG

At birth 3.25 3 12 ms 1/2X (age in months + 9)

1 6 ys (age in ys X 2) + 8 7 12 ys 1/2X {(age in ys X 7) 5}

Height cm Height cm

At birth 50 At year 75

2 12 ys (age in ys X 6) + 77

N.B.

Infant double his weight at 4 m. Weight bet. 4 8 m accelerating by 1/2 kg /month Weithbet. 0 3m accelerating by 750 gm /month Weigh bet. 9 12m accelerating by 1/4 kg /month

Head Circumference5 y4 y3 y2 y1 y6 mAt birthAge

52515049464235Cm

Anterior Fontanel

Size at birth: 2.1 cm median age of closure: 13.8 monthsSize at 1 year : 1 fingerDelayed closure

Down $ Hydrocephalus Rickets Hypothyroidism Cretinism

N.B. Delayed closure of posterior fontanel in: congenital hypothyroidism & hydrocephalus


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Teething :

1- Milky teeth 2- Permanent teeth

No. of milky teeth equal 20 Every 6 months 4 teeth erupted. First milky teeth erupted are lower central

incisors. (6 10 month)

Canine erupted at 16 22 month

No. of permanent teeth equal 32. First molar erupt6 7 ys

Assessment of Development

Gross Motor Skills

Age Skill

5 m Full head control

6 m Rolls over7 8 m Sit without support

12 m Stand unsupported

15 m Walk without help

2 yrs Kick a ball walks up & down stairs

2.5 yrs Jump with both feet

Fine Motor Skills

3 m Lose grasping reflex

7 m Transfers toy from hand to hand

9 m Grasp small objects between thumb and index finger

11 m Puts object in another's hand when requested but doesn't release.

12 m As above but with release when requeste.

15 m Builds tower of two blocks.

18 m Builds tower of three blocks

Language Development

1 4 m Vowel sounds

5 6 m Babble as "ma" or "bah"

7 9 m Repeats sound

12 m One word + "mama" or "dada"

13 m Three words16 m Six words

18 24 m Two-word phrases

24 30 m Three-word phrases

Social Development

4 m Cries & smile to communicated emotional situation

8 m Respond to own name

4 y Enjoy playing with other

Sphincteric Development

2 y Bowel control

2.5 y Urine control by day

3 y Urine control by day & night


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Miscellaneous

Respiratory rate is 40/min Pulse at one year 100-110/min An IQ of 80-89 is dull normal Delayed bone age may occur in :

- hypothyroidism, GH def., psychological deprivation, constitutional delay of growth &

puberty.

One year old infant:- can walk with support, rolls a ball in floor, say mama, wave bye bye.

Hydrocephalus is recognized complication of- Intraventricular Hge, Arnold-Chiari Malformation, Achondroplasia, Meningitis.

Macrocephaly occurs in- Osteogenesis imperfect, B-thalassemia, Hydrocephalus, Rickets.

Craniotabes occurs inRickets, Osteogenesis imperfect, Hydrocephalus, normal newborn.

In a normal full term baby the normal reflexes are- Rooting, Palmar, Planter and Stepping.

Determine skeletal maturity is best evaluated by x-ray on wrist. Normal infant recognize his mother since birth. Most infant start teething at 6 m = 7.5 KG


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PEDIATRIC IN MAPS - MCQ IN A BLINK

Nutrition & Nutritional Disorders

1- Protein Calorie Malnutrition CCC By :

Body Wight Anemia & Signs of Vitamin Deficiency Serum Albumin Edema Start in Dorsa of Hand & Feet

2- Abnormal Low Body Wieght Considerd When Whight is :

Below 5th % pf Age 2 Standard Deviation Below Mean Value Less Than 60 % of Expected for Age

3- Rickets :

Signs: Delayed Walking Nutritional Type CCC By:

- S. Phosphat

- NormoCalcemic , HypoPhosphatemic

Lab Values of Vit. D Deficiency Rickets:- S. Alkaline Phosphatase

- S. Phosphorus

Early Manifistations Include :- Craniotabes

- Rachitic Rosary

- Sweating

- Anorexia & Irrotability

4- Vitamin D :

Daily Requirement In Normal Infant is 400-800 IU In Absence of Vit. D S. Calcium is Maintained By ParaThyroid H. Secreations Vit. D Deficiency

- In Infant Can Present e` Convulsions

- Can Cause Osteomalacia in Non-Growing Bone

Cl/P ass. e` Vit. D. Deficiency :- Hepatic Ds.

- Celiac Ds.

- Renal Osteodystrophy

- Chr. Anti-Epileptic Therapy

- Obesity is Not ass. e` Vit. D. Deficiency

Vit. D NOT Stored or Metabolized in Liver


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5- Kwashiorkor :

Edema Start When S. Albumen is 2.5 mg/dl or Less Hepatomegally is dt. Fatty Infiltration Zinc Supplement Is Needed in Management . Skin Changes dt.

- Trace Elements

- Essential Fatty Acids

- Essential A.A especially ( Sulfur Containing A.A )

6 - Breast Feeding ( B.F ) :

Colostrum is CCC By :- Protien Content Than Mature Milk ( esp. Whey )

- CHO ( esp. Lactose )

- Vit. A Content Than Mature Milk

Absolute Contraindication of B.F is :- PhenylKetonuria of Neonates

- Galactosemia of Neonates

- Mapple Syrup Urine Ds.

- Cancer Breast of Mother

- NB: Cleft Lip or Palat not a Contraindications

Breast Milk Criteria :- Contain Protective Anti-Bodies

- Promotes Growth of Bifidobacteria in Gut

- Is The Best For Pre-Term

Gout Milk is Deficient in Folic a.


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7- Marasmus

Infant is Below Expected Wt. For age By at least 40 % Earliest Changes In Growth Chart is Flat ( Plateaue ) Wt. Curve Complication :

- Hypothermia

- Purpra

- Repeated Infections

8- Tetany

Caused By :- HypoParaThyroidism

- HypoMagnesemia

- Vit. D Def.

- HyperVentilation

- Infected Umbilical Stump

NOT Caused By : Acidosis


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Neonatology

Neonatal Jaundice

1st 24 hr := pathological jaundice, dt RH incompatibility, not dt breast milk jaundice

Physiologic jaundice- appears on 2nd - 3rd days, peak at the 5th day & no bile in urine in the 2nd day

Phototherapy :Act by Changing Indirect Bilirubin to easily excreted structure & don't cause hyponatremia

Exchange transfusion not indicated if S.Bilirubin > 0.2mg/hr Direct conjugated bilirubin 60 % of total bilirubin Direct hyperbilirubinemia

- not caused by gilbert $ , not ttt by phototherapy & exchange transfusion

Indirect hyperbilirubinemia not associated with galactosemia Drug induced neonatal jaundice Sulphisoxazole Drug treat neonatal jaundice phenobarbitone Biliary Atrasia

- jaundice dt conjugated hyperbilirubinemia

- diagnosed by HIDA scan

- Persistent for 2 w + dark urine & ttt is not supportive type

Kernicterus- dt passage of indirect bilirubin through immature BBB

- order of birth is not important in it

- doesn't occur after the 5th day

Breast milk jaundice- appears on the 7th day

- persistent unconjugated hyperbilirubinemia

- doesn't associated with increase conjugated bilirubin

- not ccc by clay colored stool

- ttt by cessation of breast milk for 1-2 d


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ABO Incompatibility

Suspected in sever early Jaundice Not persistent jaundice Doesn't occur after the 1st day

RH incompatibility

Occurs dt. transplacental passage of maternal Ab against infant RBC Ag +ve comb's test ttt by : Exchange transfusion , Phototherapy

Congenital Rubella $

Cause CHD (VSD) don't cause premature + IgM not large for date, doesn't cause AS not ccc by renal abnormalities

RD$

Not Respond to Steroids

Sot Caused by Sickle Cell Anemia O2 therapy is NOT Essential & safe in high doses Surfactant = not produced by pneumocyte type 1

Preterm infant

Ain't Complicated by Meconium Aspiration $ Doesn't have small surface area compared to body weight Not Caused by caffeine


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Misalliance

Infant of diabetic mother- Has no Increased risk of hyperglycemia

- Doesn't complicated by SGA

Neonatal hypoglycemia in premature infants- dt inadequate stores, not caused by Cephalhematoma

Cephalhematoma swelling limited to parietal bone Vaginal discharge in 3 days old girl dt withdrawal bleeding dt maternal hormones Neonatal convulsions not caused by hypothermia Gastrocolic reflex not primitive neonatal reflex Congenital syphilis in childhood = not manifested by jaundice CMV = doesn't cause hydrocephalus Fever in neonates M/C Dehydration Staph. Aureus = can't cross placental barrier Newborn with oral moniliasis = 1ry SOI is maternal (vaginal) Hydrops fetalis not caused by down $ Mongolian spots = not permanent NEC = not diagnosed by scaphoid abdomen Vaccine given after birth or during 1st m = BCG RBCs life span = 120 days Fetal circulation = RT-LT shunt at atrial level Cyanosis in newborn = not caused by PDA Neonatal screening of hyperthyroidism = not by T4 test


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Genetics

Down $

Trisomy 21

Autosomal abnormality

Not sex linked

Not autosomal dominant nor recessive

Translocation is not the M/C genetic cause

Translocation 21/21 is the worst prognosis

Ccc by

MR , Microcephaly , Semian creases ( Dermatoglyphic chromosomal disorder)

Multiple congenital anomalies (endocardial cushion defect, duodenal atresia....)

The M/C congenital anomaly is completeAV canal

Complicated by leukemia

The M/C malignancy is acute lymphoblastic leukemia

Not ccc by

Overweight , Hypertonia science birth , Hyperplasia of distal phalanx of fifth finger, Absent thumb

Monosomy

Loss of chromosome

Some can be compatible with life

Klienfelter $

Associated with abnormal no. Of x chromosomes

22 pairs of autosomal & XXY sex chromosomes

Affect both sexes

Not ccc by MR , hirsutism , shortness

Duchenne myopathy

Not ccc by MR


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Turner $

Associated with abnormal no. Of x chromosomes

Affect both sexes , Usually females

Ccc by non pitting edema

Not ccc by puffy hands & feet , fertility

Barr body

Sex chromatin

Non factorial Y chromosome

Present in about 1/2 of buccal cells from normal female

Present in buccal smear of females with Noonan $

Hereditary spherocytosis

Not autosomal recessive

Edward $

Sex chromosome abnormality (trisomy 18)

Not inborn error of metabolism

Not frequent as down $

Not associated with macrognathia

Phenylketonuria

Screened by Guthrie test

Not ccc by CHD

Not dt block in converting tyrosine to dopamine

Not dt block in converting phenylalanine to phenylpyruvate

Mosaicism

Non disjunction in mitotic division after fertilization

Cretinism

Serum T4 not increased

Achondroplasia

Not x linked recessive


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Autosomal recessive inheritance

Heterozygous parents has 25% chance of affected childs

E.g. = sickle cell disease

Can be diagnosed without karyotype

X linked recessive inheritance

Females is always affected

1ry hypophosphatemic rickets

Not ccc by hydrocephalus

G6PD

Not autosomal dominant inheritance

Hemophilia A

X linked recessive

Affected father = carrier daughter

Can be diagnosed without karyotype

Amniocentesis

Not recommended for routine determination of fetal sex

Criduchat $

46 XY 5P-

Not sex linked

Abnormal chromosome 5

Clift lip & clift palate abnormalities

Depend on multiple genetic factors

Autosomal dominance

Heterozygous parents = affect 50% sons & 50% daughters

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