Neonatal jaundice with breast feeding< 6 times/d: breastfeeding jaundice.
TTT Of breast feeding jaundice: increase frequency of breast feeding.
Neonatal jaundice with breast feeding>8 times/d: breast milk jaundice.
TTT of breast milk jaundice: temporary cessation of breast feeding for 2ds then
resume breast feeding.
Jaundice at 1st day: hemolytic disease of new born(DT Rh incompatability).
Jaundice at 3rd day: physiological jaundice.
Direct Jaundice after 7th day: biliary atresia.
1st step in management Of neonatal jaundice: total& direct billirubin.
Bilirubin> 270 micromol/L : phototherapy.
Bilirubin> 340 micromol/L : exchange transfusion.
Asymptomatic Indirect hyperbilirubinemia in healthy adult: gilbert $.
TTT of neonatal hypoglycemia… 1st line: IV glucose.. if failed: IM glucagon.
Cyanosis with feeding which improve with crying… Dx: choanal atresia.
Test of choice if choanal atresia suspected: catheter test.
Inv. Of choice for Dx of choanal atresia: CT scan with contrast.
1st step in management of choanal atresia: airway to keep mouth open.
Neonate with microcephaly, pigmented retina: congenital CMV infection.
Inv of choice of congenital CMV infection….urine antigen
innocent murmur management: reassure; BUT, refer to pediatrician is the right
answer if found.
MCC of omphalitis : staph. Aureus.
MC source of infection in omphalitis: umbilicus.
MCC of cleft lip, cleft palate: genetic.
Fused labia: leave it alone (if DOC is asked: estrogen cream)… never to pull them
apart.
MCC of club foot: postural (esp. in primigravida).
3 days of fever followed by maculopapular rash.. Dx: roseola infantum.
VURTI+ koplik spot on buccal mucosa then maculopapular rash.. Dx: measeles.
After Dx of measles, you must notify.
Most imp. Complication of measles: OM.
Most imp. Vitamin to be given in measles: vit. A.
VURTI+ slapped check… Dx: erythema infectiosum. CO: parvovirus B19.
Parvovirus B19 infection in pt with SCA or HS: aplastic anemia.
Parvovirus B19 infection in pregnancy: hydrobs fetalis in fetus.
No school exclusion for pt with parvovirus B19 inf. (pregnant teacher shouldn’t go
to school).
Strawberry tongue+ circumoral pallor+ sandpaper rash= scarlet fever.
Ulceration on post. Pharynx, uvula, palate only: herpangina.
The same+ ulceration on hand and foot= hand foot mouth disease.
School exclusion in hand, foot and mouth disease….till all lesions crust
CO of herpangina & hand foot mouth diseases: coxsakie virus.
Ulceration on lips only: HSV infection.
Wheezes in child<2ys with URTI… Dx: bronchiolitis …… CO: RSV.
Child with bronchiolitis is at greater risk of bronchial asthma.
TTT of bronchiolitis: only supportive (O2 by nasal cannula& fluid)…. No abs.
Inspiratory stridor worse on lying down+ barking cough = croup.
CO of croup: para-influenza virus.
TTT of Mild to moderate croup: inhaled cortisone.
TTT of severe croup: inhaled “nebulized” adrenaline.
Very high fever, expiratory stridor, drooling of saliva..Dx: epiglottitis.
CO of epiglottitis: [Link].
TTT of epiglottitis: admission& intubation.
Fever for 5ds+ 4 of the following (CREAM; Conjunctivitis, Rash, Erythema,
Adenopathy& MM involvement) = Kawasaki disease.
Most imp. Inv: echo
Most serious complication: myocarditis, coronary aneurysm.
1st line of TTT of Kawasaki: IVIG and 2nd line: aspirin.
Child with fever, crying& pulling on his ear… Dx: OM.
MCC of OM: stept. Pneumonia.
Most specific finding on otoscopy: loss of mobility of ear drum.
Drug of choice of otitis media ( current updates)………paracetamol only
If no response……….amox
If still no response,………amox-clav
Most imp test after recovery : hearing assessment.
Swelling behind the ear after PM.. Dx: mostoiditis.. inv of choice: CT scan.
TTT of chronic OM: aural toilet.
Druf of choice for chronic OM……ciprofloxacin drops
Varicella post-exposure proph: vaccine for immune-competent within 72 hs &
IVIG for pregnant& immune-compromised.
School exclusion for avricella: until blisters dried or at least 5 ds after the rash.
MC compl of mumps in children: encephalitis.
MC compl of mumps in adult: orchitis.
30 ys old Pt on sulfasalazine with H/O mumps when he was a child. now he has
abnormal semen analysis.. cause: sulfasalazine.
Long standing H/O dry cough esp. at night : BA
Long standing H/O dry cough with fever: pertussis.
Inv of choice at 1st 3 Ws of pertussis presentation: PCR of nasopharyngeal swab.
Inv of choice after 3 Ws: seology.
Prevention of pertussis: vaccine.
School exclusion for pertussis: at least 3Ws of cough or 5ds of Abs TTT.
Regardless of age or immunization status, all close contact to a case of pertussis
must receive erythromycin.
Give vaccine to non-immunized& those who received last dose in >10 ys.
Accidently discovering of abdominal mass in a child: nephroblastoma.
INV. Of choice of nephroblatoma: CT scan.
Painful mass which may crosses midline+ peri-orbital ecchymosis..
neuroblastoma.
Uneven thigh skin folds, discrepancy of leg length… Dx: DDH.
Diagnostic tests of DDH: barlow test, ortolani test.
Inv of choice of DDH: <4 ms: US …. >4 ms: x-ray.
TTT of DDH: pavlik- harness maneuver.
Painless limp with collapsed femur head in x-ray: perthe’s disease.
Painful limp in obese male teenager with limitation of movement: SCFE.
x-ray of SCFE: displaced femoral head medially& posteriorly.
TTT of SCFE: emergently surgery. (DT fear of avascular necrosis).
Limitation of movement in perthe’s& SCFE: abduction and internal rotation.
1st step in management of any child with limping: x-ray EXEPT in clear cases of
transient synovitis; 1st step: US.
H/O camping then malabsorption $... Dx: giardiasis TTT: meronidazole.
Best inv. Of giardiasis: intetstinal biopsy.
Newborn with frothy saliva& milk regurge.. Dx: esophageal atresia.
1st step: passage of wide bore catheter following by x-ray.
TTT of esophageal atresia: surgery.
Inflammation of penis+ inability to retract in backward= phimosis.
TTT of phimosis: cortisone cream.
Inflammation of penis+ inability to retract in forward= para-phimosis.
TTT of para-phimosis: urgent manual reduction… if failed: incision.
Whitish discharge on glans penis in a child= balanitis; TTT: cortisone.
From medical point of view: circumcision is NOT recommended.
Urethral opening at the ventral surface of penis: hypospadius… next step: never
to do circumcision (the foreskin will be used in the surgery).
Child with Difficulty in initiation of micturition+ H/O urinary cath.= urethral
stenosis.
Inv. Of choice for Dx of urethral stenosis: urethroscopy.
TTT : repeated dilation…. If failed: surgery.
Diarrhea in a complete healthy child<5ys old with normal inv: toddler diarrhea.
Excessive fruit juice: tooth caries, obesity, and diarrhea.
MCC of constipation in pediatric…….diet
Maximum timing of constipation….after weaning
Constipation since birth…..Meconium ileus or hirshpring
Cp……in functional constipation…..full rectum with stool
MCC of anal fissure in [Link]
MCC of rectal prolapse in [Link]
TTT of acute constipation…..enema
Most effective…….bowel training
MCC of rectal prolapse in children: constipation.
Rectal prolapse+ recurrent chest inf.+ FTT = CF.
Most imp Q to be asked in a child with rectal prolapse: bowel habit.
Abdominal cramping + diarrhea after lactation/dairy products = lactose
intolerance.
Inv. Of choice of lactase intolerance: hydrogen breath test.
TTT of lactase intolerance: lactose free diet (lactose free formula in infants).eg:
soy based formula
MCC of epistaxis in children : hot wather.
Healthy Child with leg pain that may awaken the pt from sleep, all inv. Are
normal….. Dx: growing pain… management: reassure.
Healthy child crying& pull his leg to his abdomen, all inv are normal.. Dx: infantile
colic…. Management: reassure and diet modification.
Crying followed by cyanosis and then convulsion.. Dx: breath holding spells.
Convulsion then cyanosis: epilepsy.
Involuntary passage of stool> 4ys = encopresis.
TTT: toilet training… if failed: diet modification… if failed: laxatives.
Involuntary passage of urine> 5ys = enuresis.
MCC of enuresis: psychological BUT, urine culture MUST be done 1st.
MC organic cause of enuresis: UTI.
Most imp inv. To be done in enuresis: urine culture.
Pt with enuresis, ‘ll go camping after 1-2 ds, best management: desmopressin.
Best long term TTT of enuresis: alarm clock.
Inv of choice of hydrocephalus: CT scan (not US) “MRI>CT>US”.
Limping after VURTI or with the onset of URTI = TRANSIENT SYNOVITIS.
Most common cause of limping in kids………. TRANSIENT SYNOVITIS
Inv of choice of transient tenosynovitis: US.
TTT: analgesics, joint traction.
N.B. 1st inv of choice of limping child: X-ray.
And kid with limping should be referred
N.B. 1ST inv of choice of limping after VURTI: US.
Fluid the child need every day: 150mg/ kg.
4 Ws infant with excessive vomiting, good general condition… Dx: GERD.
4 Ws infant withexcessive vomiting, bad general condition.. Dx: CHPS.
Best inv of GERD: 24 Hs ph monitoring.
Best advice to mother with an infant with GERD: upright position after feeding.
Mother lose consciousness in daughter wedding, normal physical exam, normal
test.. most imp Q to ask: H/O separation anxiety while child.
Separation anxiety in children is NOT part of normal development; need psych
TTT.
MCC of painless bleeding in child<2ys old: meckel’s diverticulum.
TTT of mickel’s diverticulum: surgery.
TTT of choice of allergic rhinitis: intra-nasal cortisone at night.
Chronic cough + rhinorrhea which improve with antihistaminic: post-nasal drip.
Hives, Hypotension, wheezy chest+/- lip and tongue swelling after bee sting/
peanut ingestion= anaphylaxis.
Hives, pruritis, flushing after bee sting/peanut ingestion= urticaria (allergy).
MCC of anaphylaxis: food> bee sting> drugs.
MC components of cake causing anaphylaxis: nuts> sugar, egg.. etc.
TTT of anaphylaxis: IM epinephrine at the thigh.
Epinephrine dose:
1. Adult>12 ys: 0.5mg IM
2. Child 6-12 ys: 0.3mg IM
3. Child <6 ys: 0.15mg IM
Pt with recurrent anaphylaxis: epinephrine pin.
Sudden onset respiratory distress+ localized wheezes in children: FB inhalation.
Most serious cause of localized wheezes in adult: tumor.
Male child with recurrent chest, GIT infection >6ms of age + decrease in all ig and
lymphoid tissue.. Dx: X-linked agammaglobulinemia.
TTT of x-linked agammaglobulinemia: IVIG.
Recurrent infection+ recurrent suppurative lymphadenitis and multiple gingival
abscesses= CGD.
MC affected Cs in CGD: neutrophils. (enlarged LNs that may ooze pus with
neutrophils And bacteria inside).
MC organism causing infection in CGD: staph aureus.
Which Enzyme is affected in CGD? NADPH oxidase.
Specific test to diagnose CGD: nitroblue tetrazolium test.
1st step in head injury in kids: flow chart.
Head trauma Child with skull fracture (open, depressed or basal) develop
convulsion, recurrent vomiting or altered mental status… CT is a must.
Head trauma child with no loss of consc. &only 1 episode of vomiting.. reassure.
Head trauma child with persistent headache& 2 episodes of vomiting.. observe
for 4 hours.
If GCS less than 8……immediate intubation
AR diseases: pt MUST have both chromosomes in order to be affected.
AD diseases: pt need only one chromosome in order to be affected.
Assessment of child growth: always follow growth chart (not given percentage).
1tst: between 5th-85th percentile= normal growth.
2nd: between 85th-95th percentile= overweight.
3rd: >95th percentile= obese.
4th: <5th percentile= underweight.
Most affected parameter by acute malnutrition: weight.
Period of accelerated growth that follow periods of arrested growth: catch up
growth.
Best clinical indicator for overwt & underwt in children: BMI growth chart (not
numbers).
MCC of obesity overall: over feeding.
Failure To Thrive (FTT):
Most common cause…….psychological
FTT + constipation only……..hirschprung disease
FTT + constipation + recurrent chest infection….cystic fibrosis
FTT+ steatorrhea + recurrent chest infection……cystic fibrosis
FTT + steatorrhea……..celiac
If FTT is DT neglect…. Report to child protective authority.
Vaccination schedule for premature infants: the same schedule & dose as mature
infants.
Child with VURTI, now time of vaccination: give as schedule.
Child missed vaccination dose: catch up vaccine schedule (give him missed
vaccines now).
“Imp. Ex.” MMR vaccine: 1st dose at 12 m& 2nd dose at 18 m.
Egg allergy is NOT a contra-indication to MMR vaccine.
Somalian kid previously received doses of OPV comes to u, WT NEXT?? Give IPV.
Mam refused to give vaccines to her kid. 1st step: talk 2 her, if refused: refer for
counseling, if still refused: report to child protective authority?????????.
MCC of short stature: normal variant “constitutional”.
1st step in assessment of short stature, delayed puberty, precocious puberty : x-ray
to detect bona age (BA).
If CA> BA: REASSURE… if BA>CA: very bad.
TTT of Obese child: exercise prog (NOT diet as food is vital 4 development).
MCC of iron deficiency anemia in infants: prolonged exclusive breast feeding.
Start weaning at 4 ms (very imp. To start give iron fortified cereals).
MCC of decreased breast milk: decreased frequency.
Frequency of breast feeding: at least 8 times/ day.
Chocking in infants……… slapping on the back.
Chocking in adults…… hemlick maneuver.
Sudden onset cough, dyspnea+ localized wheezes= FB aspiration (1st step: x-ray).
Unilateral offensive nasal discharge in mentally retarded kid= FB in the nose.
TTT of FB in the nose: removal under anesthesia.
Infant with an insect in ear.. 1st step: kill it by oil.. then removal with forceps or
ear toilet.
Child with fish bone in larynx: laryngoscopy.
Child ingests battery; x-ray shows it at the esophagus: remove it by endoscope.
MCC of bloody vaginal discharge in infants: FB in the vagina.
TTT of FB in the vagina: removal under general anesthesia.
Immigrant infant from Sudan; most imp to check: Ca& vit. D (high risk of rickets).
Cause of neonatal gynecomastia: passage of maternal hormones.
Management of neonatal gynecomastia: observe (never squeeze).
Best way to asses fetal IUG: US.
Defect in both BPD, abdominal width= Symmetrical IUGR (MCC: chromosomal
abnormalities, congenital infection).
Defect in abdominal width, normal BPD= asymmetrical IUGR (MCC: placental
problems as preeclampsia).
MCC of RDS: prematurity.
Risk of high flow O2 to premature: [Link] of prematurity. 2. Lung
dysplasia.
1st step in management of Meconium stained amniotic fluid: CTG & scalp pH
monitoring
suction NOT recommended any more in cases with meconium staining
1st step in meconium stating………mask ventilation
If very low apgar score with no response : intubation.
IM vitamin K is given routinely to all neonates (to avoid neonatal bleeding).
Tachypnea in neonate delivered by CS with normal CXR: transient tachypnea of
neonate……. TTT: O2.
Subconjunctival Hge in neonate: reassure.
MCC of facial n. palsy in neonates: forceps delivery.
Bluish discolouration on buttocks since birth= Mongolian spots.
Management of Mongolian spot: reassure.
Red strawberry mass raising above surface of face of neonate= hemangioma.
TTT of hemangioma: reassure (‘ll spontaneously disappear at 7-8 ys)… if not:
cortisone is the 1st line TTT.
Dark purple color at face of neonate (at trigeminal distribution) not raising above
the skin= port wine stain= capillary malformation.
Most imp inv to be done for pt with port wine stain: brain CT (to exclude sturge-
weber $).
Translucent cyst since birth= cystic hygroma.
MC site of cystic hygroma: face.
Cyst at neck side= branchial cyst…. TTT: remove by surgery.
Most common fate of brachial cyst….infection
Firm painless swelling at birth & later, head tilt to one side= congenital torticollis.
Excessive watery diarrhea in infants.. Dx: blocked naso-lacrimal duct.
Most imp advice: massage of the duct several times/day (improvement occurs at
6-12 ms).
Dyspnea, cyanosis at birth with scaphiod abdomen, intestinal sound at chest,
intestinal shadow IN THE CHEST at X-ray… Dx: Congenital diaphragmatic hernia.
TTT: decompression, resuscitation and immediate surgery.
MC complication in infant of diabetic mother: hypoglycemia.
Neonate to mother with DM.1st: good apgar score then: depressed……………..MCC:
hypoglycemia.
MCC of neonatal RDS: prematurity.
Prevention of RDS: antenatal cortisone.
TTT of RDS: surfactant.
Persistent non-bilious vomiting at 2-6 Ws of age: CHPS.
Persistent Bilious vomiting since birth.. Dx: duodenal atresia.
Inv of choice in duodenal atresia: abdominal x-ray (double bubble sign).
TTT of duodenal atresia: surgery.
No passing of stool since birth, no anal opening..Dx: imperforate anus.
Inv of choice of imperforate anus: x-ray with the pt upside down.
Neonate with High pitched cry, sweating, tremor, vomiting, diarrhea and may be
convulsion….Dx: neonatal abstinence $ (neonate to opoid abusing mother).
TTT of neonatal abstinence $: opoids.
Neonate with low apgar score, confusion, decrease in RR, BP, PR and may be
pinpoint pupil. cause: passage of opoid to fetus during labor (maternal
anesthesia)……TTT: naloxone.
School exclusion:
Chicken pox………………………………………… until vesicles dried.
Hand foot mouth disease…………………… until vesicles dried.
Impetig……………………………………………… until 24hs from starting abs TTT.
Measles……………………………………………. for 4 ds after rash appearance.
Pertussis………………………………………….. for 5 ds after abs TTT or 3 Ws of cough.
Eryhema infctiosum………………………….exclusion of pregnant teacher not the
infected kid.
Child living in low socioeconomic status environment develop abdominal pain,
constipation & change in bahaviour…Dx: lead poisoning.
When u suspect paracetamol toxicity; assessment of paracetamol level in blood 4
hs after ingestion:
- If paracetamol ingested is <200mg/kg… no TTT.
- If paracetamol ingested is >200mg/kg… give antidote.
- Antidote for paracetamol toxicity: IV N-acetyl cysteine.
Pt presented with symptoms of Paracetamol toxicity, time of ingestion is not
known…. Next step: give antidote.
Vomiting, tinnitus, hyperventilation after ingestion of large dose of
medication………..Dx: aspirin toxicity.
Metabolic changes in Aspirin toxicity:
1st>> respiratory alkalosis DT hyperventilation
Then>> metabolic alkalosis DT defect in metabolism.
Pt work in close garage, BBQ party with geadache, irritability, lethargy and cherry
red skin color…Dx: CO poisoning…. TTT: high flow O2.
Farmer presented with lacrimation, salivation, urination, defecation, rhinorrhea,
bronchorrhea/wheezy chest, decrease in BP, PR and may be pin point
pupil……………….Dx: OPC poisoning.
1st step in TTT of OPC poisoning: remove pt clothes.
Antidote of OPC poisoning: oximes.
Child ingested pills which appear opaque in abdominal x-ray.. iron poisoning.
TTT of iron poisoning: deferoxamine.
Child ingest white pills develop arrhythmia….1st step: ECG… then if ECG changes:
give NAHCO3.
Genetics of important diseases:
Hemophilia…….x-linked
G6PD…………….x-linked
Duchenne…….x-linked
Huntington…….AD
Gilbert…………AD
Spherocytosis……..AD
Essential tremors……AD
Ehler-danlos…….AD
Marfan syndrome……AD
Adult Polycystic kidney disease……..AD
Familial adenomatous polyps……AD
Peutz-jehers……..AD
HOCM……..AD
Tourrete syndrome…….AD
CYTIC FIBROSIS……AR
Thalassemia……AR
Galactossemia……AR
Sickle cell anemia……AR
Wilson…….AR
Hemochromatosis……AR
Type of toothpaste used under 17 ys old ………..low fluoride
Preferred type of milk in lactose intolerance…..soy based milk
Most common cause of delayed milestones is prematurity.
Delayed milestones + H/O prolonged jaundice or prolonged stay in the ICU……
consider neurological problem
First step in dehydrated in kid ….oral feeding if failed then Iv feeding
When to say direct hyperbilirubinemia……..when direct is more than 20% of the
total
Direct hyperbilirubinemia after 1st week………biliary atresia
prolonged jaundice, constipation, hypotonia, enlarged tongue, umbilical
or inguinal hernia, mental retardation…..congenital hypothyrodism
Most common cause of delayed milestones is prematurity.
After sting bite if the child develops?????
Rash only or limited swelling…………oral antihistamine(oral promethazine)
Rash+wheezy chest+hypotension or vomiting……IM adrenaline
Most imp inv with a drowsy kid in the morning ….blood sugar
9 ys kid started menstruation……….normal puberty
2 ys kid started menstruation……….precocious puberty
2 ys kid with breast enlargement only…..thelarche
Head increased rapidly in size in a baby …..hydrocephalus
Tall boy, infertile, gynecomastia with mental retardation…..klienfelter SYNDROME
1ST inv in infertility in this boy………testosterone level
