-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.
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 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
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 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
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 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
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Most common cause of neonatal meningitis : E.coli

Most common cause of aseptic/viral meningitis - JE virus