HIGH YIELD SMLE NOTES

PEDIATRICS
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HIGH YIELD SMLE NOTES

CNS:
□Cerebral palsy:
●Decrease the risk of brain damage and cerebral palsy; hypothermia
●Weakness in 4 limbs, lower limb > Upper limb; Diplegia, most common in; preterm
●Cerebral palsy associated with kernicterus; athetosis (dyskinetic)
●Highest risk factor for cerebral palsy; prematurity

□Seizure:
●EEG shows 3 Hz spikes and waves, dx; Absence seizure, Tx; Ethosuximide
●EEG shows mid temporal spikes, at morning, dx; Rolandic seizure
●Which will response to Steroid; Infantile Spasm
●Associated with future febrile seizure; iron deficiency anemia, Hyponatermia

□Aphasia, CT shows involvement of temporal lobe; HSV encephalitis

□Normal glucose and lymphocytosis; Viral meningitis (=aseptic meningitis)

●if from Africa; Epstein-Barr virus (EBV)

□EBV (infectious mononucleosis); rash after antibiotics, erythematous pharynx,

enlarged cervical lymph node and hepatosplenomegally, Mx; supportive

□Fall down from his bed, no loss of consciousness but:

●Vomiting 2 times; observe
●Vomiting 3 times + headache; CT

□Infant no response of light; infantile botulism (Tx; penicillin)

□Gowers sign, Next; Creatine kinase (will be high), Dx; Duchenne muscular dystrophy

□Eye red reflex done at; birth and at 6 weeks

□Tuberous sclerosis; 2 panel gene

Vs.
□Neurofibromatosis; 1 gene (chromosome 17q)

HIGH YIELD SMLE NOTES

CVS:
□Congenital heart disease:

□ Hypertrophic obstructive cardiomyopathy (HOCM); Young basketball player

suddenly collapsed;
●Dx by; Echo, (diastolic dysfunction)
●Mx; beta blocker

□ Atrial septal defect (ASD); fixed split of s2

□ Patent ductus arteriosus (PDA); continues machinery murmur

●Closure by; Indomethacin
●If PDA present with heart failure; Fluid and diuretics

□ Keep PDA open by: Prostaglandin,

●When you should keep PDA open; if there is Coarctation of the aorta (COA) with
heart failure or if there is Transposition of the great arteries (TGA)

□ Transposition of the great arteries (TGA); Neonate with cyanosis and no murmur
●Risk factor of TGA; mother with Gestational DM
●Tx; Prostaglandin

□ Tetralogy of Fallot (TOF); Cyanosis and murmur or spells, right axis deviation;
(should treated first)
●(decrease pulmonary blood flow in TOF, Pulmonary atresia, Tricuspid atresia)

□Tx of TOF spell; O; oxygen, S; sodium bicarbonate, squatting, A; alpha agonist;

phenylephrine, M; morphine, A: Ardengic antagonist; BB, H; hydration

□Child with distress, systolic murmur, left parasternal heaves; TOF,

●Tx; sedation and oxygen

□X-ray finding:
●Snowman heart (figure of 8 sign); total anomalous pulmonary venous return
●Egg shape; TGA,
●BOOT shape; TOF

□When to do surgery for:

●Cleft lip; 3 months
●Repair of PDA; 6 months
●Symptomatic ASD; 3-5 years

HIGH YIELD SMLE NOTES

□ECG in Osteoum Secondum ASD; Right Bundle Branch Block (RBBB)

□LBBB (V1 DOWN) Vs. RBBB (V1 UP)

□Ventricular septal defect (VSD) + acute decompensated heart failure, Mx; medical
treatment with diuretic (Greater than requirement for healthy baby)

□Infective endocarditis:
□Most common cause; VSD (Large if; Loud S2)
□Least common cause; ASD

□History of dental extraction, now fever, Known case of VSD, most important
investigation; blood culture

□Acute rheumatic fever:

●Dx by; JONES criteria + elevated ASO titer or positive throat culture
JONES criteria; arthritis, carditis, subcutaneous nodules, erythema marginatum,
chorea

●Mx; penicillin (IM not IV); if not there; long acting penicillin monthly, if not there;
oral acytlacetate acid

●Mx of rhematic fever with arthritis; NSAID like aspirin (high dose)
(no rule of aspirin or IVIG in rheumatic carditis)

□2ry prophylaxis for rheumatic fever;

●If no Carditis; either for 5Y, or till 21 y.o. (whatever is longer)
●Carditis and no valve involvement; either for 10Y, or till 21 y.o (whatever is longer)
●Carditis and valve involvement; either for 10Y, or till 40 y.o (whatever is longer)

Emergency:
□Apnea happens after feeding with 10 minutes of cyanosis, why to admit; acute life
threatening event

□Stridor and barking cough, most concerned; blue lips

□Prevention of sudden infant death syndrome; sleep in supine, use of pacifier

□Child on 100% O2, still O2 saturation: 88%; Intubation

HIGH YIELD SMLE NOTES

□Iv fluid deficit duration;
●In general; over 24 hours
●In cases of hypo or hypernatremia, DKA; Over 48 hours

□Moderate dehydration; Oral rehydration solutions (ORS) for 1 day then normal
formula

□Hypoglycemia and dehydration; dextrose

□Child with ambiguous genitalia; normal saline (and glucose if hypoglycemia)

□Ambiguous genitalia, and high level of 17 dehydr; 21 hydroxylase deficiency

□Not immunized child, has fever and cough and multiple enlarged lymph node,
grayish-white pseudomembrane; diphtheria
●Type of toxin (etiology): exotoxin induced intracellular protein ribosylation
●Most important to give; anti toxin
●Vaccine last for; 10 years

□Child with fever and cough, improved, after 1 week come with high grade fever and
drooling of saliva; bacterial tracheitis

□Child with difficulty swallowing, Next; CT (peritonsillar abscess)

□Antidotes:
□Aspirin antidote; sodium bicarbonate (urine alkalization)

□Child with gastroenteritis took metoclpramide, involuntary movement, antidote;

diphenhydramine

□Paracetamol ;
●Within 4 hours; charcoal (not used in iron or lithium),
●More than 4h; check serum level, if high serum level or symptomatic (RUQ pain,
Jaundice); N acetylcystine
Vs.
□Irons toxicity; within 4 hrs; whole bowel irrigation, more than 4 hrs; deferoxamine

□Intussusception:
●Hx; Colicky abdominal pain, currant jelly stool, exam; “sausage-shaped” mass
●Dx, initial; US (target sign), Most dx test; barium enema
●Tx; fluid then:
♦if child; Enema
♦if Adult; surgery

HIGH YIELD SMLE NOTES

□Regarding intussusception; shock is the most common complication

□Commonest cause of shock in children; hypovolemic shock

□Jaundice, pale stool; biliary atresia

□Jaundice, not resolved with phototherapy; biliary atresia
□The best way distinguish biliary atresia from neonatal hepatitis; US of liver

□Child with obstructive jaundice with, + family history; choledochal cyst

□Tracheoesophageal fistula (TEF); coil NGT,

□Complications:
●of the condition; Aspiration
●of surgery repair; GERD

□ Diaphragmatic hernia; Scafoid abdomen

●Dx; CXR
●Tx; NGT

□3D; Duodenal atresia, (double bubble), down syndrome (trisomy 21)

□Cause of Polyhydrominos; Duodenal atresia, down syndrome, anencephaly

□Respiratory distress:
□Preterm baby, respiratory distress, next; CXR;
►If ground glass; hyaline membrane disease (respiratory distress syndrome),
Tx;
●if HR ≤100 or apneic; bag ventiliation and monitor of pulse and ECG,
●if none of the above; CPAP then (Nitric oxide only if ≥10% difference between
preductal and postductal or pulmonary hypertension), then; surfactant

►If diffuse patchy infiltrate; Meconium aspiration

►If Fluid in Fissure; ransient tachypnea of the newborn (TTN); in term baby;
supportive Mx

HIGH YIELD SMLE NOTES

□Croup:
□Inspiratory stridor, subglottic narrowing, barking cough, para influenza virus,
steeple sign
●Mx; Steroid + epinephrine

□Croup after giving epinephrine:

●If improved; steroid and observe in clinic
●If not improved; again Epinephrine, if still, next; laryngoscopy

□Eczema + inspiratory stridor; Spasmodic Croup

Endocrine:
□Puberty:

□Earliest sign of puberty:

●in male; testicular enlargement
●in female; breast enlargement

□6 y.o with breast enlargement and pubic hair; central (most common cause)

Vs. peripheral (pubic hair then breast enlargement)

□Advanced bone age, pubic hair and breast enlargement,

●Next test; LH,

●if High LH, cause; central, next; order MRI brain.
●If low LH, next; order gonadotropin-releasing hormone (GnRH) stimulation test,
Then order LH :
►If high LH; central cause
►if low LH; peripheral cause

Vs.

□Normal bone age, Only with pubic hair (pubarche) or only bilateral breast
enlargement (thelarche);
●Next; pelvic US, if not there, pelvic MRI

□5 y.o girl with pubic hair, increased weight and height, no clitoromegally;
Dehydroepiandrosterone (DHEA)

HIGH YIELD SMLE NOTES

□Bone age less than chronological age:
●By 1 or 2 years and normal growth velocity; constitutional delay
●By more than 2y or abnormal growth velocity; growth hormone deficiency

□Bone age more than chronological age ; Congenital adrenal hyperplasia

□Male with dark scrotum:

●If pubic hair not extended to the thigh; tanner stage 4

●If pubic hair extended to the thigh; tanner stage 5

□No clear distinction between breast and areola, breast bud; tanner stage 2

□DM:

□Symptoms of DKA + elevated blood glucose, next; Urine dipstick

□First sign of diabetic nephropathy; microalbuminuria.

□Best site for insulin injection before exercise; abdomen.

□Suggest type 1 DM; low C peptide

□DKA goal of management; decrease glucose by 6 mmol/hour

□D5 route:
●If dextrose solution less than 12.5; peripheral line
●If dextrose solution more than or equal 12.5; central line

□Brittle disease; hard to control DM 1; either hypoglycemia or hyperglycemia

□Honeymoon phenomenon; attack of hypoglycemia; insulin reservoirs

VS.
□Early morning hyperglycemia; measure glucose 3 am to differentiate b/w;

►Somogyi effect; So much insulin ; low glucose at 3 am

►Down phenomenon; insulin is down (low) ; high glucose at 3 am

HIGH YIELD SMLE NOTES

Hematology:
□3 months, low Hb, normal MCV; physiological anemia of infancy
□4 days with high HB; neonatal polycythemia; hydration and monitoring
□Neonate with low platelet; Alloimmune thrombocytopenia

□Hemoglobinopathies;
□Prevent acute chest syndrome in sickle cell patient; hydroxurea
□Sickle cell anemia with vaso-occlusive crisis, Mx:
●if hemoglobin > 5; Fluid and Analgesia,
●if hemoglobin < 5, next; Blood Transfusion, definitive; splenectomy

□Hydrops fetalis; alpha thalassemia

□Low HGB and low MCV, but normal iron studies or not improved with iron, Next
step; hemoglobin electophresis; dx; thalassemia; Tx; give Erythrocytes

□Coagulation disorder;
□Hemorrhagic disease of newborn; vit K deficiency (factor 10,9,7,2 (1972)); PT and
PTT prolonged, Mx of bleeding; vit K SQ
□ Also PT and PTT prolonged if; common pathway factors deficiency (factor 10,5,1,2
(1512))
□Umbilical cord bleeding; factor 13
□Remnants of umbilical cord; leukocyte adhesion defect

□Platelet destruction disorders:

►Hemolytic uremic syndrome (HUS); proceeded by bloody diarrhea; triad;
hemolytic anemia + acute renal failure + thrombocytopenia. (sometimes convulsion)
□Dx; stool antigen, Tx; supportive

►Thrombotic thrombocytopenic purpura (TTP); same HUS triad + fever +

neurological symptom, (blood film; shistocytes)
□Tx; plasma exchange

►Immune thrombocytopenia (ITP), only low platelet count, preceded by viral

infection
□Mx; depend if:
●Only rash; follow up CBC
●Minor bleeding (epistaxis, gingival bleeding); admit for IVIG
●Major bleeding (lifesaving); platelet transfusion

HIGH YIELD SMLE NOTES

 □ Henoch-Schonlein purpura (HSP); Abdominal pain, Hematuria, Joint pain, lower
limb rash. Tx; supportive, Most common joint involved; ankle, knee

□Cured after splenectomy; ITP and H. spherocytosis

□Positive coombs test, Dx; autoimmune hemolytic anemia, Tx; Steroid

□Hereditary Spherocytosis; normocytic anemia, High MCHC, next; osmotic fragility

test, best; The eosin-5′-maleimide (EMA)

□12 hours baby with jaundice; Glucose-6-phosphate dehydrogenase (G6PD); need

folic acid

□Jaundice (increase Reticulocytes) or anemia; G6pD, avoid; Aspirin

□IDA screen, Low or high risk; 9-12 months

□Time of giving iron supplement; 4 months

□Introduce peanut to avoid allergy; 6m, if not there; 10M (the sooner, the better)

□Child with Low IQ, encephalopathy-anemia-basophilic stippling on RBCs; Lead

poisoning
●Child pale, low IQ, eat dirt, iron normal, Next; lead level, Tx; penicillamine

□Jaundice and :
●Increase indirect bilirubin, normal LFT; Gilbert syndrome and Crigler-Najjar
syndrome
●Increase indirect bilirubin and high LFT; infective hepatitis

□ Familial Mediterranean fever; episodic fever, high ESR ,CRP and WBC, 3Ps(pain in
joint, peritonitis, pluritis);
●Tx; clochicine
●Avoid; Macrolides, if not there; amoxicillin

HIGH YIELD SMLE NOTES

Neonatology:
□Prolonged QT interval; hearing assessment
□Newborn, what to examine; hearing
□2 month infant, with no risk factors, screen for; Head circumference

□A child known to have bloody diarrhea and refuse to eat meat. His 2 sisters having
same problem; Chromosomal test
□The most common cause of seizure in the neonatal period; hypoxic ischemic
encephalopathy

□Risk factor for neonatal sepsis; preterm

□Highest risk factor for increase morality in twins; premature, Most common;
hypoxia

□Necrotizing enterocolitis (infection); air in bowel wall

●risk factors; Premature, Weight below 1500g

□Breast milk jaundice; start on day 4, peaks by 5-15 days of life

□Breastfeeding jaundice, first week of life
►Both; continue breastfeeding

□UTI in uncircumcised boy; oral cefuroxime, if not there; ceftriaxone

□Risk factors of UTI;
●Uncircumcised male
●Female
●Age ≤1 y
●Temp ≥39

□Primary immunodeficiency:
□ Chronic granulomatosis disease; recurrent chest and skin infection, dx by;
neutrophil count, tetrazolim dye test
Vs.
□Complement deficiency; recurrent Neisseria infection (C8 deficiency), dx by;
complement level and CH 50
Vs.
□ X-linked agammaglobulinemia; Recurrent respiratory infections (AOM, sinusitis,
pneumonia), diarrhea 2dry to enteroviruses or Giardia, dx by; immunoglobulin levels

HIGH YIELD SMLE NOTES

□Malnutrition:
●Kwashiorkor; deficiency of proteins - there is edema
Vs.
●Marasmus; deficiency of proteins and calories - there is no edema, Tx; high caloric

□Scrotal swelling:
●If transilluminate, dx; hydrocele
●No transillumination, next; ultrasound

□Neonate with fever or meningitis;

►Organism; GB strep, E. coli, listeria
►Tx; Ampicillin and gentamicin or Ampicillin and cefotaxime

□Tracheomalacia; barking cough, inspiratory monophasic wheeze

●dx by; flexible broncoscopy

Vs.

□Larygomalacia; noisy breath increase with supine; resolve at 1 year

●Mx; Reassurance
□When require endoscopic confirmation by flexible laryngoscopy?
►If there is; significant or progressive stridor, apnea, cyanotic episodes, or poor
growth

Infectious Disease:

□Child w/ fever, vomiting and rash on 2nd day rash become over all body, Dx; Rocky

mountain fever

□Erythema in base and pale in center, multinucleated giant cells on Tzank smear, Dx;

Herpes simplex virus, Tx; IV acyclovir + fluids

□Fever and tender splenomegaly; repeat blood culture (typhoid)

□Patient came from Africa, can’t move (extend) his legs; Poliovirus

HIGH YIELD SMLE NOTES

□Worms like rice ( in diaper); Entrobius Vermicularis
□Oral thrush; topical fluconazole
□Sensitive indicator of factitious fever; pulse rate

□Measles (rubeola); 3 C's (cough, coryza, conjunctivitis), rash behind ear and
Koplik’s spot (small, white spots that occur on the inside of the cheeks)
Vs.
□Rubella; 3-day disease, rash start from face and spread downward, enlarged lymph
nodes (retroauricular, cervical and post occipital)
Vs.
□Roseola; Fever disappear then rash appear

□Most commonly affected in chicken pox and measles and pertussis; lung
□Child with flu symptoms then vesicular rash all over body; next; V.Z.V igM

□ Scarlet fever; Complication of tonsillitis, exudates, sandpaper rash, strawberry

tongue:
●Organism; strep pyogenes
●Tx; penicillin

□Mumps infection;
●Most affected organ; parotid
●Most complication; Orchitis

□ Acute otitis media (AOM) vs. Otitis media with effusion (OME):
□Most common organism in AOM; bacteria,
□Most common viral organism causing AOM; RSV then rhino then adeno
□AOM and swimming; pseudomonas
□Acute otitis externa (AOE); pain in pinna or tragus, organsism; pseudomonas, Tx;
topical ciprofloxacin, if not there; topical neomycin
□Mx of AOM:
●if age less than 6 months; start Tx
●If age more than 6m; start Tx if its bilateral, severe or more than 48h

□OME; no fever or pain or pus discharge, Next; Refer to ENT for tympanostomy tube

HIGH YIELD SMLE NOTES

□Staccato cough vs. Whooping cough:
►Staccato cough (inspiration between each single cough):
●Organism; chlamydia
►Whooping cough (paroxysmal cough, cycle with continuous then relived):
●if only whooping cough; pertussis
●if whooping cough with diarrhea; adeno virus.

□Pertussis “whooping cough” :

●Dx by; respiratory culture (gold standard), if not in the choices, choose;
nasopharyngeal swab (PCR)
●Tx and Prophylaxis; Macrolide
●Complication; pneumonia

□Which organism:
□Most common cause of orbital cellulitis; sterp. Milleri
□Most common organism in meningitis and swim; Naegleria fowleri
□The most common cause of pneumonia in preschool-age (3 months- 4 years) is;
Viruses

□Bleeding after tonsillectomy, cause;

●if after 5-6 days; infection and dehydration
●if after 2 weeks; coagulopathy

□ Bronchiolitis; Post URTI, SOB and wheezing:

●Common age; less than 2 years
●Organism: Respiratory syncytial virus (RSV); dx by; nasopharyngeal swab
●Tx; supportive Mx, IV hydration, respiratory monitoring for hypoxia.

□Who need prophylaxis:

□Group A strep pharyngitis. What will you do with his brother; Observation
□Acute epiglottitis (transfer to pediatric ICU); need antibiotics for contacts
□Pertussis; need prophylaxis for contact; Macrolide

□Kawasaki disease;
●Fever > 5days and 4 of the following (CRASH); Conjunctivitis (non-purelent), Rash,
Adenopathy (cervical above 1.5 cm), Strawberry tongue, Hands and foot swelling
●Next; ECHO
●Complications; Coronary artery aneurysms
●Treatment; Intravenous immunoglobulin (IVIG) (reduces the incidence of coronary
artery aneurysms) + Aspirin
□ IVIG response indicators; high CRP, duration of fever and Neutrophillia

HIGH YIELD SMLE NOTES

Nephrology:

□Hydronephrosis and distended bladder and proximal urethra; posterior urethral

valve
●If with bilateral cryptochisim; prune belly syndrome

□Renal scarring; DMSA

□Bilateral hydronephrosis; MCUG

□WAGR (wilms tumor- aniraida- undescended testis- mental retardation)

association; nephroblastoma

□Burn sugar smelling urine (characteristic smell) and seizure; marpel syrup urine
disease
□Garlic odor, excessive secretion, Dx ; organophosphate poisoning, antidote;
atropine

□8 y.o with nocturnal enuresis; 1st; Urine analysis and culture Then; behavior
therapy for 6 months then; alarms
□Muscle affective in bed wetting; Detrusor muscle
□Age of nocturnal enuresis that is alarming; 7 Y,
● normal; until 5 Y

□UTI, 1st time; Renal US, 2nd time (recurrent); US and VCUG
□Most common organism of UTI with renal stones; proteus
□Low risk of UTI; low urine osmolality and low urine PH
□Vesicouretral reflux grade 4; continues antibiotics prophylaxis; 12 months

□Hematuria and foul smelling urine and palpable left loin mass; polycystic kidney
disease

□PSGN (low C3, normal C4) after 1-2W of URTI ,after 4W of impetigo
●Rationale use of furosemide in PSGN; for HTN
VS.
□IgA nephropathy; same time of infection
►Next step for both (PSGN, IgA nephropathy); urinalysis

HIGH YIELD SMLE NOTES

□Suggest prerenal disease;
●Urine Na less than 20,
●FeNa less than 1%
●Only 2 are high; 1: urine osmolality > 500, 2; BUN/crea ratio > 20

□Nephrotic syndrome:

□ Minimal change disease; Most common nephrotic syndrome in children

●Highly diagnostic test; Serum albumin
●Tx; Steroid
●Advisable to avoid; NSAID but Ibuprofen should be particularly avoided

□In nephrotic syndrome:

●Steroid resistant if; no response after 4 weeks of daily steroid
●Steroid sensitive age; 24-96 Months

□Most common nephrotic syndrome in adult; Focal SGS

Oncology:

□Low platelets, low HGB, epistaxis, fever, definitive dx; Bone marrow aspiration
□MC tumor in Down syndrome and in pediatric; Acute lymphoblastic leukemia (ALL)
□Most common lymphoma; Non-hodgkin lymphoma
□Positive cd10 (calla); Acute lymphoblastic leukemia (ALL)
□Jaw mass (starry sky appearance); overexpression of c-myc
□BCR ABL gene associated with; Chronic myelogenous leukemia (CML)
□Radio sensitive testicular tumor; seminomas

□Child with abdominal mass, Initial; US, Best; CT

□Most common abdominal malignancy; Neuroblastoma (most common below 2Y),
●Most common above 5 y; wilims tumor

□Neuroblastoma;
Cross midline, there is history of eye proptosis
Vs.
□Wilims tumor;
Does not cross midline, there is history of hematuria

HIGH YIELD SMLE NOTES

Gastroenterology:

□Non-bilious vs. bilious vomiting:

► Pyloric stenosis; projectile non-bilious vomiting
●Metabolic abnormality; hypochloremic, hypokalemic metabolic alkalosis.
●Found in urine; acidurea, if not there; high K
●Dx by; US (gold standard)
●Mx; normal saline then NPO, NGT, polypmyotomy (definitive)

► Volvulus; bilious vomiting, dx; initial; US, best; Upper GIT with contrast

□Chronic diarrhea (greasy stool), stool exam shows antigen to trophozoite, sickle
shaped parasite; chronic giardiasis
●Confirm diagnosis; 3 stool samples on different days
Vs.
□Watery diarrhea, green in color; Rota virus; stool antigen

□Cystic fibrosis:
●Initial presentation in neonate; meconium ileus
●Not associated with; Lung cancer
●There is decrease in; vitamin (ADEK) absorption

□Anterior uveitis screening in Juvenile idiopathic arthritis;

●if positive antinuclear antibodies (ANA); every 3 months
●if negative antinuclear antibodies (ANA); every 6 months

□Minimal time to diagnose juvenile rheumatoid arthritis; 6 weeks

□ Galactosemia; cataract, metabolic acidosis and Ketones, in urine analysis:

aminoaciduria and glycosuria, E. Coli in urine; dx; liver biopsy

□Seizure, Bilateral cataract with positive reducing substance,

●Highest dx value; positive urine reducing substance,
●Gold standard; galactose-1-phosphate uridyl transferase (GALT) activity in red
blood cells (RBCs)

HIGH YIELD SMLE NOTES

□After giving fruit, lethargy, vomiting, hepatosplenomegaly, Dx; fructose intolerance

□1 month present with fresh blood and foul smelling, best dx; technetium scan
)radioisotope scan)

□Less than 10 Y.O + lower GI bleeding + bleeding in iliocecal valve + no other

symptoms; Meckel's diverticulum; dx by; technetium scan (radioisotope scan)

□Blood in diapers + IDA; Meckle

●If no IDA + recurrent, age from 2y-10y; Juvenile polyposis syndrome

□Continuous diarrhea after gastroenteritis; lactose intolerance, dx; hydrogen test

after giving lactose
□3 Y.O with diarrhea at day only; toddlers diarrhea
□Passing stool without control, condition; encopresis (fecal incontinence)

□Celiac disease:
□Celiac screening in DM pt; at diagnosis then every 2y
□if celiac pt has IDA, not improved on oral iron; IV iron

□Hirschsprung disease:

●Constipation, delay passage of meconium, gush of stools, seedy stool or pellet

stool, Dx; hirschsprung disease,
●Which layer affected; submucosa
●Dx, initial; contrast enema, confirm; rectal biopsy,
●Tx; surgery (leveling colostomy)

HIGH YIELD SMLE NOTES

Miscellaneous:

□Swollen lips, deficiency of; C1 esterase

□Gum hyperplasia side effects of; phenytoin
□Problem in phagocytosis, which protein defected give problem in oxygenation;
decrease in NADH

□Autosomal recessive ;
●Sickle cell disease,
●Cystic Fibrosis
●17 beta hydrox steroid deficiency
●Congenital adrenal hyperplasia; (25% to have genetic disease)

□Autosomal dominant;

●Neurofibromatosis (NF):
□Few Café au lait spots + common in family; reassure.
□Multiple Café au lait spots + common in family; genetic testing
□Few or multiple Café au lait spots + mother has NF; genetic counseling

□X linked recessive;
●Wiskot Aldrich syndrome (triad of immunodeficiency, thrombocytopenia, eczema)
●Duchenne muscular dystrophy; chance to boy; 50%

□Eczema site;
●less than 6M; scalp-face
●6M to 2-5 Y; extensors
●2 to 16 years; flexors

□Psoriasis site ; scalp

(Facial eczema not responded to low steroids; tacrolimus cream)
□Psoriasis; scaly erythematous pruritic rash
●Dx; clinical diagnosis, definitive in vulva; biopsy
●If less than 10% of BSA; topical steroid
●If more than 10% of BSA; steroid for 3 months, if failed; phototherapy

HIGH YIELD SMLE NOTES

□Human milk contain; more antibodies (igA)
Vs.
□Cow milk contain; more protein
Vs.
□Colostrum contain; more protein

□Young with vaginal itching and few vaginal bleed; foreign body
Vs.
□Young with fecal incontinence and bruises; Sexual abuse

Vaccination:

□Vaccine should be given at actual age not the corrected age, Except HBV vaccine:
●If mother HB –ve; Wait until; Baby be 1 month Or Baby reach 2 kg (Which comes
first)
●If mother HB +ve; Give HBV vaccine and HBV Ig (Regardless of the weight)

□Vaccine types:
●LIVE ATTENUATED (I live in a Very Big ROOM)
V= Varicella
B= BCG
R= Rota
O= OPV
M= MUMPS,MEASLES, RUBELLA (MMR)

●Killed (I Killed A Dragon By my High Power)

I = IPV
A = hepatitis A
D = DTaP
B = hepatitis B
H = Hib
P = PCV

□Route of Administration:
• Live vaccines: Subcutanous
• Killed vaccines: Intramusular
• BCG: Intradermal
• Oral: polio, rota

HIGH YIELD SMLE NOTES

□General Contraindications:
●Live attenuated vaccines are generally contraindicated in immunocompromised
patients
●OPV should not be given if there is a family member with immunocompromised
conditions (can be disseminated by fecal-oral route to other individual)
●Anaphylaxis reaction

□Specific Contraindications:
●Contraindicated in Intussusception; Rota
●Contraindicated in egg allergy; yellow fever
●Contraindicated in gelatin and neomycin allergy; varicella and MMR
●Contraindicated in lactating mother; small pox and yellow fever
●DTP Contraindications: 3 D's; Developmental delay, Dysmorphic features, Neurological
system Disorder (encephalopathy within 7 days or uncontrolled seizure)
- DTP Immunization expires in; 10 years

□Regarding contraindicated vaccine in HIV patient :

●if CD4 more than 200; Only OPV, BCG vaccines are contraindicated
●if CD4 less than 200 (AIDS); All live attenuated vaccines are contraindicated

□Related to Guillain-Barré syndrome; flu vaccine

□Related to measles; subacute scelrosing panencephalitis

□Regarding live vaccine in pregnant taking anti-TNF;

●In 2nd trimester; delay 6 months
●In 3rd trimester; delay 12 months

HIGH YIELD SMLE NOTES

□Immunodeficiency:

□SCID (bacteria, viral and fungal infections), All vaccine are contraindicated
□ X linked aggamaglublmemua; only live vaccines are contraindicated
□Chronic granulomatosis disease; only live bacterial vaccine is contraindicated (BCG,
Typhoid, plague)
□IgA deficiency; most common, Protozoal infections and chronic diarrhea from
giardiasis; can receive all types of vaccine
□Complement deficiency; can receive all types of vaccine

□Live vaccine after stopping;

●Steroid, MMF, cyclosporine; 4 weeks
●Chemotherapy, cyclophosphamide; 3 months
●Bood transfusion; 6 months
●IVIG; 11 months

□Live vaccine: If not given at the same time → You should wait 4 weeks to give another
live vaccine

□Minimal interval between same vaccine is 4 weeks Except;

●Hepatitis A: 6 months
●Meningiococcus: 8 weeks
●Varicella vaccine: 3 months

□Vaccines in Special Population;

●In Sickle cell diseae, splenectomy, nephrotic syndrome; Pneumococcal vaccine,

Menegiococcal vaccine, HiB

●In CF, CLD, CLD, CKD; Pneumococcal vaccine and Influenza

□Catch up schedule for varicella vaccine:

●Less than 7 year old; 2 doses with 3 months apart
●More than 7 year old; 2 doses with 1 month apart

HIGH YIELD SMLE NOTES

Syndromes;

□Rett syndrome; wringing, loss of speech (Regression)

□Tourette syndrome; repetitive eye movement and vocal

Vs.
□Tics; repetitive eye movement (motor only, no vocal)

□Di-George syndrome; Recurrent infection (thymus hypoplasia), tetany; TOF

□Marfan syndrome; tall, thin, Mitral valve prolapse (MVP), lens dislocation.

□Edward (trisomy 18); prominent occiput, rocker bottom foot, overlapping finger

□Fragile X syndrome; marcrogonadisim, MVP, large ears, prominent mandible

□Parder Willi syndrome; hypotonia, hypgonadisim, hyperphagia

□Noonan syndrome; Male + Turner syndrome

□Congenital rubella syndrome; cataract (absent red reflex), deafness, PDA, muffin

rash, HSM, Jaundice

□Posterior embryotoxin in; allagile syndrome

□Sturge Weber syndrome; glaucoma is the most common eye manifestation, MRI

□Wiskott aldrich syndrome triad; low platelets, eczema and recurrent URTI

□Anemia and triphalanegal thumb; Diamond blackfan syndrome

□CHARGE association; coloboma of eye, heart defect (TOF), atresia choanae,

retarted growth, genital hypoplasia, ear anomalies

□Fanconi anemia; short stature, microcephaly, micropthalmia,

hypo/hyperpigmentation

HIGH YIELD SMLE NOTES

□New born just delivered was found microcephaly and hepatosplenomegaly next;

congenital screening (TORCH), if not there, choose; liver function test

□Cyanosis, enlarged heart, oliogemic lungs. Ehco showed Ebstien anomaly,

What's the Cause; mother taking lithium

□Turner syndrome (45xo); short stature and amenorrhea

●Associated with; bicuspid aortic valve (MC) and coarctation of aorta; fold skin at
nape of neck,
●Come with turner syndrome; hypothyroidism

□Down syndrome (trisomy 21):

●Mild features; mosaicism
●Most striking feature; hypotonia
●High inhibin A, high hCG, low estriol, low AFP [the 2 h are high]
●Down syndrome cardiac disease; AV canal defect (endocardial cushion defect), if
not there choose; VSD

□A woman who has a child with Down syndrome is more likely to have another child
with the same condition by; 1%,
□Baby with cleft palate, chance of having a second baby with cleft palate or cleft lip;
4%

Reflexes:

2nd month; disappear of stepping reflex

4th month; disappear of sucking reflux+ rooting reflex

6th month; disappear of moro reflex (absent in Erb's palsy)

HIGH YIELD SMLE NOTES

Milestones:

2m; smile, follow objects

3m; raise head

4m; laugh, control head

5m; reach things

6m; tripod position, sits without support, stranger anxiety (squeal), babbling

7m; transfer object, Palmer grasp

9m; wave bye bye, begin crawl, separation anxiety immature pincer grasp (Can't put
things in cup), stand holding furniture

10m; pull to stand

12m; know few words, good pincer grasp (put things in cup), walk without support
(walk holding furniture)

15m; throw ball, point to what he need, jargon, put crayon in line

18m; play role model, start feeding dolls, say 6-10 words, recognize two body parts,
run

2y; draw a straight line, refer to me, know body parts, jump in both legs, 2 words
sentence

3y; know colors, ride tricycle, climb stairs (Descent like adult), alternating feet, 3
words sentence, draw circles

4y; toilet trained (dress himself), tell a story, cooperative play, draw man (1) with (3)
parts=4, hope on one leg, draw square

5y; Tie his shoes, skipping, draw triangle

6Y; draw 6 parts

HIGH YIELD SMLE NOTES