PEDIATRICS

FMGE MARATHON 2023

Dr Meenakshi
General Pediatrics
Important Developmental Milestones

Gross Fine
motor motor

Social Language
Important Gross motor milestones:
Milestones Usual age
Neck control 5m
3m
Sitting with support 6m
Sitting without support 8m
Standing with support 9m
Creeping 10 11m
Standing without support 12m
Walking with support 12m
Walking without support 13m
Rides a tricycle 3 yr
Important Fine motor milestones:
Milestones Usual age
Hand regard 3m
Bi-dextrous grasp 5m
Palmar grasp Gm
Transfers objects 7m
Immature Pincer Grasp 9m
Mature Pincer Grasp 12m
Scribbles spontaneously 15m
Tower of 6-7 cubes 2yr
Handedness appears 24 months
Handedness established 36 months A
 DRAWING SKILLS OF A CHILD

2
yr

By
a

a o 4y
n

sup
Important social milestones:
Milestones Usual age
Social smile 2m
Mirror play Gm
Stranger anxiety Fm
Waves bye bye 9m
Plays peek a boo 10m
Plays a simple ball game
lyr
Points to objects 15m
Domestic mimicry 18m
Dry during daytime 18m
Parallel play
Zyr
Joins in play
3yd
Important language milestones:

Milestones Usual age

Vocalises 2m
Cooing 3m
Mono-syllablic babbling Gm
Bi-syllablic babbling 9m
2-3 words with meaning
ly
Jargon speech 15m
10 words with meaning 18m
2 word sentences
Zyr
3 word sentences 3 yr
Q. Which of the following statements are true?
A. First hand to hand transfer appears, then palmer reflex
disappears
B. First Palmer reflex disappears, then hand to hand
transfer appears
C. Both Palmer reflex and hand to hand transfer appears
at the same time x
D. Both disappear at the same time x
Q. When does handedness get established?
a. 6 to 12 months
b. 15 to 18 months
c. 18 to 24 months
d. 36 to 40 months
 Primary Dentition Secondary Dentition
Also called
Milk teeth Permanent teeth
Begins at
6 7m
Gyr
First tooth to appear
lower central 1st molar
incisor
Last tooth to appear
2nd molar 3rd molar

Completes at except
212 3m lapmolar
3rd
Total number of
teeth 20 28 32
Q. Which is the first tooth to appear in a child?
A. Lower central incisor
B. First molar
C. Upper central incisor
D. Canine
Q. What is the number of primary teeth in a 3 year old
child?
a. 20
b. 24
c. 16
d. 32
Breast milk & Breastfeeding
• Exclusive breastfeeding → 6 months

• Signs of adequate Breastfeeding →

Contraindications to Breastfeeding:
Related to:
Baby Mother
Absolute Relative
Galactosemia I
Mat HIV
Cong Lactose On chemotherapy
intolerance
o mat Untreated
or Radiotherapy TB
met Varicelle
Breast abscess
 Composition of Breast milk

Carbohych vs 4 5
yall cm
BM 7gal
Proteins Bm I
glad us 3.5gal CM

BM richer in whey pr
BM Methre
cysteine Taurine
lipids BM richer in PUFA
DHA P in BM
Minerals Cap BM

AH vitamins exaptgyi.Y.DE
Colostrum:
1st 72 hr

Thick Yellowish

Rich in IgA macrophages proteins

1st Immunist

Poorer in lactose
Q. All are signs of adequate breast feeding in a 2 month
old infant EXCEPT?

a. Baby Sleeps for 2-3 hours after feeding

b. Urinates 6-8 times per day
c. Gains weight
d. Has normal hemoglobin level
Q. Breast feeding should be continued for minimum how
many months?
From
a. 6 months
b. 2 months

m
c. 12 month
d. 5 months
Q. All are true about human colostrum except?
e

A. Thick and yellow color

B. IgA high
C. High amino acids and minerals
D. High sugar
Q. Absolute contraindication to breastfeeding?

A. Galactosemia in the infant

B. Maternal Hepatitis C
C. Maternal CMV
D. Herpes not involving the breast
Q. Nutrient deficient in breast milk is?
a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin D
Malnutrition:
WHO Classification- Edema Edematous
Weight for Height Height for age
Between -2 to -3 z score or Between -2 to -3 z score or
Eet
Between 70-79 % of expected Between 85-89 % of expected

< -3 z score or < -3 z score or

< 70 % of expected < 85 % of expected
SEVERE WASTING Severe
stunting
Wellcome Trust Classification

O
Weight for age Edema Category

60-80 % of expected Absent

Undernutrition
60-80 % of expected Present kwashiorkor

< 60 % of expected Absent Marasmus

< 60 % of expected Present Marasmic
kwashiorkor
Definition of Severe Acute Malnutrition (SAM)

6m 5nF
or more
of a

Ht 70 L 3 Z score
o wt for of exp or

MAC C 11 5am

Symmetric bipedal edeme of

nutritional origin
Q. A 3 years old child presented to OPD with mother. His
mother reports normal breast feeding till 2 years age. Now
child has decreased milk intake. On examination malnutrition
was found alongwith edema. What is the diagnosis?

a. Kwashiorkor
b. Marasmus
c. Wasting
d. Stunting
 E I
Q A child’s Ht for age is between - 2 and – 3 z score. This child will
be classified under which of the following categories?

a. Wasting
b. Normal
c. Stunting
d. SAM (Severe Acute Malnutrition)
Q. The condition seen in this child could be due to which of
following?

A. Kwashiorkor due to less protein and calorie intake

B. Kwashiorkor due to less calorie intake
C. Marasmus due to low protein and calorie intake
D. Marasmus with low calorie intake
Q. For severe acute malnutrition, mid arm circumference should
be less than?

a. 14.5 cm
Digit
b. 13.5 cm
c. 12.5 cm
d. 11.5 cm

Shakir'stape
Vitamin A deficiency
1st symptom
1st
Sign
to
 Treatment of Vitamin A deficiency
Age Oral Vit A Dose
A < 6 months 50,000 U
6-12 months I Kc IU
> 1 year 2 Kc IU

• Dose is repeated next day & 4 weeks later

• Parenteral dose is 50% of oral dose in children > 6 months &
75% in < 6 months
Q. Pearly white lesions with foamy appearance are seen on
the sclera of a child. Which of the following other symptoms
are related to the deficiency of the same micronutrient
causing the mentioned lesion?

a. Conjunctival xerosis
b. Angular stomatitis x
c. Glossitis x
d. Photosensitive rash x
Q. Oral vitamin A dosage in 2 year old malnourished child
weighing 10 kg is?

A. 50,000 units
B. 1 lakh units
C. 1.5 lakh units
D. 2 lakh units
GENETICS
Important Autosomal Dominant diseases

“HEAVY DOMINANT”
H Hereditary spherocytosis
D Dystrophia myotonica
O Osteogenesis imperfecta
M Marfan syndrome
I Intermittent porphyria
N Neurofibromatosis
A Achondroplasia, ADPKD
a
N Noonan syndrome
T Tuberous sclerosisI
Important Autosomal Recessive diseases

A: Albinism, Alkaptonuria “A-B-C-D-E-F-G-H-I”

B: Beta thalassemia, Sickle cell anemia
C: Cystic fibrosis, Congenital adrenal hyperplasia
D: Deafness
E: Emphysema (α1-antitrypsin deficiency)
F: Friedrich’s Ataxia
G: Gaucher disease, Galactosemia Exaptthinterds
I
H: Homocystinuria

fabryd
I: Inborn errors of metabolism
Diseases with X linked recessive inheritance

Do Lan Er CHAWAL
GIL
G: G6PD deficiency
D: Duchenne muscular dystrophy
C: Color blindness
I
F: Fragile-X syndrome, Fabry disease
C: Chronic granulomatous disease
NBT
H: Hemophilia A and B, Hunter disease
A: Agammaglobulinemia
Dermatitis
W: Wiskott-Aldrich syndrome Atopic
A: Albinism
L: Lesch-Nyhan syndr, Lowe syndrome
Diseases with X linked dominant inheritance

FLEX
How to interpret Pedigree chart?

2
Down syndrome
• MC chromosomal abnormality

• Genetics:

✓95% Non-disjunction
✓3% Translocation
✓1-2% Mosaicism

00
Turner syndrome 45
“See there is A Baby CLOWN”
• S: Short stature, Sensorineural hearing loss, Short 4th
metacarpal
• A: Amenorrhea (Primary)
• B: Barr body absent
• C: Cardiac anomalies, Cystic Hygroma
• L: Lymphedema, Low thyroid
• O: Ovaries under developed (streak ovaries)
• W: Webbed neck

I
• N: Nipples widely placed
Q. Which of the following has Autosomal Recessive
inheritance?

a. Hereditary spherocytosis AD
b. Sickle cell anemia
c. Osteogenesis imperfecta AD
d. Von Willebrand disease AD
Q. Which of the following is an Autosomal Dominant
disease?

a. Von Willebrand disease

b. Wilson disease AT PTB AR
c. Cystic fibrosis CFTR AR
d. T
Friedrichs ataxia
Q. A 16-year-old girl presents with short height, primary
amenorrhea with widely spaced nipples. Her probable
karyotype is?

a. 45, XO
b. 46, XO
c. 47, XXX
d. 46, XY
 INBORN ERRORS OF METABOLISM
Disorder Enzyme deficient Important clinical features
Phenylketonuria Phenylalanine Hypopigmented Neurology
hydroxylase
Alkaptonuria Homogentist urinetromsblackon standing
acid oxides Oochronis arthritis
Galactosemia GALT Hepatic dyfi Cataract
galactokinese
Epimerase
Von Gierke
Glucose 6 Phosphatase Hypoglycemic
disease Hypertipidemie Hepatomegely
Gaucher disease Glucocerebrosidase Gauchercells Splenohepatomeps
Pancytopenie Bonepam
Lesch Nyhan HGPRT Der deley
syndrome mutilation
Self
Muricacidwes
IEMs with peculiar odour
IEM URINE ODOR

Glutaric acidemia
Sweaty feet odom
Maple syrup urine disease
Burnt sugar
Tyrosinemia boiled cabbage
Multiple carboxylase
To meet

Phenylketonuria
mousy musty
Q. A child is brought to the OPD with complain of change in
colour of urine after some time. Mother gives history that she
noticed a dark black colour on diapers when her baby was few
months old. Which enzyme deficiency is present in the given
patient?

a. Phenylalanine hydroxylase
b. Homogentisic acid oxidase
c. Tyrosine aminotransferase
d. 4-hydroxy phenyl pyruvate dioxygenase
Q. A child with hypoglycemia was found to have burnt sugar urine
odor. Which enzyme is deficient in this child?
A. Branched chain alpha keto acid dehydrogenase
B. Homogentisic acid oxidase
C. Phenylalanine hydroxylase
D. Glucose 6 phosphatase
Q. Which enzyme is deficient in Lesch Nyhan syndrome?
A. Hypoxanthine guanine phosphoribosyl transferase
B. Xanthine oxidase
C. Biotinidase
D. Aspartate aminotransferase
Q. A 2 year old girl presented with history of recurrent episodes of
early morning lethargy and seizures. On examination, the child had
doll like facies and hepatomegaly. Investigations revealed
hypoglycemia, lactic acidosis and hyperlipidemia. Which enzyme is
deficient?
A. Glucose 6 phosphatase Judy

B. Muscle phosphorylase
C. Glucose 6 phosphate dehydrogenase
D. Hepatic phosphorylase
Q. A child presented with palpable rash on limbs,
hematuria, joint pain. There was a history of
respiratory infection one week ago. What is the
probable diagnosis?

A. Henoch Schonlein purpura

B. Rheumatoid arthritis
A
C. Hemolytic uremic syndrome
D. Reactive arthritis
INFECTIOUS DISEASES
Disease Important clinical features

Erythemat maculo papules rash

Measles

IPA
Chicken pox
hoplite spots
Coryza conjunctivitis
Pleomorphic skin rash

Mumps
Fever Parotid smelly
Orchitis Aseptic meringue
Eryrthema
infectiosum Slapped Cheek appearance
Q. Koplik spots are seen in?

a. Mumps
b. Measles
c. Rubella
d. Varicella
Q. Subacute Sclerosing Panencephalitis is a rare and
dangerous complication of?

a. Measles
b. Mumps
c. Rubella
d. Varicella
Q. A male child presents to you with swelling below
the ear, along with low grade fever. There have been
two other similar cases in the friends of this child in
the same village. What will you do?

A. Immediate hospitalisation
B. Incision and drainage
C. Mouthwash
D. Give antipyretics and send home
Q. A boy presents with features of shock and cold,
clammy skin. The next step in management is?
A. IV Normal saline
B. IV Dextrose

Fhidbohf
C. Inj Adrenaline
D. IV Ringer lactate
IMMUNISATION National Immunization Schedule of India
Age Vaccines given
Birth Bacillus Calmette Guerin (BCG)
Oral Polio Vaccine (OPV)-0 dose
Hepatitis B birth dose
6 Weeks OPV-1, Rotavirus Vaccine (RVV)-1
Pentavalent-1
Fractional dose of Inactivated Polio Vaccine (fIPV)-1
Pneumococcal Conjugate Vaccine (PCV) -1
10 weeks OPV-2, RVV-2, Pentavalent-2
14 weeks OPV-3, RVV-3, Pentavalent-3, fIPV-2, PCV-2
9-12 months Measles & Rubella (MR)-1, PCV-Booster
It
Japanese Encephalitis (JE)-1* [in endemic Districts only]
16-24 months MR-2, Diphtheria, Pertussis & Tetanus (DPT)-Booster-1, OPV –
Booster, JE-2*
5-6 years DPT-Booster-2
10 yrs & 16 yrs Tetanus & adult Diphtheria (Td)
Latest update: An additional dose of fIPV vaccine at 9 months
age w.e.f. 1st January 2023
Q. Which vaccines are given at birth?

a. IPV birth dose, Hep B birth dose, DPT birth dose

b. BCG, Hep B birth dose, MR birth dose
c. BCG, Hep B birth dose, DPT birth dose
d. BCG, OPV birth dose, Hep B birth dose
Q. Which of the following vaccines is recommended at birth?
a. Measles
b. JE
r
c. BCG
d. Vitamin A
Q. First dose of measles vaccine was given on 7 month of age
due to some reason. When will you schedule the child for
next dose?

a. Next dose at 16 -24 months

b. 1st dose at 9 months and next at 16-24 months
c. No dose at 9 months
d. Booster at 9 months
Q. Hep B vaccine should be given?

a. At birth
b. 3 month
c. 6 month
d. 1 year
Management of an Infant Born to Hepatitis B +ve Mother
• If mother is HBsAg +ve → Baby should be given HBIg (0.5 ml
IM) & Hep B vaccine within 12 hours of birth, using 2 separate
syringes
• HBIg may be given up to 7 days of birth
• 3 more doses of Hep B vaccine should be administered at 6–
10–14 weeks
• If mother’s HBsAg status is not known → Hep B vaccination
should begin within a few hours of birth so that perinatal
transmission can be prevented.
• Efficacy of prophylaxis with both HBIg and hepatitis B vaccine
is 85–95% & with hepatitis B vaccine alone is 70–75%.
Q. A primigravida patient, came to hospital without any antenatal
check-up, at 37 weeks of gestation, and presented with onset of
labour. On investigation, the mother is Hep B positive, what
management should be given to the neonate?

a. Hep B vaccine only

b. Hep B vaccine + Immunoglobulin
c. First Immunoglobulin, then Hep B vaccine after 1 month
d. Only Immunoglobulin
Open vial policy

I
used
Reuse of partially
vials certain
multictose of
vaccines
Points to be checked as per “Open vial policy”

• Expiry date has not passed

• Vaccines are stored under appropriate cold chain
conditions both during transportation and storage
• Vaccine vial septum has not been submerged in water
or contaminated in any way
• Aseptic technique has been used to withdraw vaccine
doses ine vial monitor
• VVM has not reached/crossed the discard point
 putff

60
war
Q. 2 open vials of pentavalent vaccine and one open vial of MMR
vaccine is given back after an immunization session. What should
be done with those vials?
A. Both should be discarded
B. Pentavalent can be used and MMR must be discarded
C. MMR can be used and Pentavalent should be discarded
D. Both vials can be reused
Q. Which vaccine doesn't follow open vial policy?
A. BCG
B. Oral Polio Vaccine
C. Pentavalent
D. Hep B
All the Best..!