1.

Head circumference:- During infancy head circumference is usually a reliable indicator of brain
growth ． At birth ， head circumference measures approximately 34 to 35 cm ， increases 11 cm ～ 12cm
during the first year，reaching46cm．Subsequently growth slows down，and in the second year for life the
head circumference grows 2cm，reaching 48cm．After 2 years till maturity head circumference grows 6-7cm
more．At the age of 5，the median head circumference is 50cm．At age 0f 15 average head circumference
is 54-58cm. The maximum circumference of the head from the occipital protuberance to the
forehead(through eyebrows)should be recorded．If the head growth exceeds 1 cm in 2 weeks during the first
3 months，hydrocephalous should be suspected．
2.The chest circumference is measured at the level of the nipples ， midway between inspiration and
expiration，while a child is in recumbent position．At birth，chest circumference is 1~2 cm less than head
circumference；around the age of 1 year，head and chest circumference is almost the same；from age of 1
year to adolescence the chest circumference exceeds the head circumference. (chest circumference=head
circumference+age-lcm)．
3.Anterior fontanal:-The anterior fontanel which normally measures approximately 2×2 cm 。at birth is
open for a longer period．closing between 12 and 18 months．A slight separation of the bones of the skull
may be noted at birth，but most sutures close by the end of the 6 months．
4.Active Immunization:-The subject produces antibody against the administered material and is capable
of rapidly increasing the concentration of this antibody on subsequent exposure against the same material．
5. Specific dynamic action of food:- refer to the increase in metabolisum over that basal rate brought
by the ingestion and assimilation of food 7-8% infant 5%,children 30% calories for protein 4%,for fat 6%, for
carbohydrate.
6.Nephrotic syndrome (NS):- is the clinical state that results from persistent heavy proteinuria.The
classic features, namely hypoalburninemia and edema , are the direct consequence of this loss of protein
through the kidneys
Although proteinuria resulting from increased permeability of the glomeruli to serum proteins is the most
essential feature.It represents only one manifestation of various types of glomerular pathology
Proteinuria increase , Edelman increase , hyperproteinemia decrease , hyperlipidemia increase .
7.Jaundice due to breast milk: data suggest that the risk of breast milk jaundice is significantly increase
in infant who have genetic poly morphisms in the coding cause this phenomenon is not yet agreed upon
evidence suggest that supplementation with certain breast milk substitutes may reduce the degree of breast
milk jaundice
8. Physiologic weight loss: represents a loss of excessive extracellular fluid and meconium ，in addition
to relative lack of food and fluid intake．Approximately 5％-10％of the weight may be lost during the first 3
to 4 days after birth．Most infants regain lost weight approximate within 1 0 days．
9. Physiolocal and pathological juandice: physiological jaundice:-jaundice occure in at least 50% of
full term infant and in over 80% preterm infant during the first week of life . Bilirubin impart a yellow tinge to
the baby’s skin . Jaundice generally manifests on the second or third day postpartum and which is fading by
14 days needs no investigation or treatment
Pathological Jaundice: 1. Appears earlier (first 24 hours of life) 2. Peaks >12.9mg/dl (full term infants),
>15mg/dl (preterm infants), Fades >2 weeks(term infants), >4 weeks (preterm infants)
3. Accumulates >5mg/dl/d 4. Direct bilirubin >2mg/dl 5.Jaundice recurrent
10. tetany of vit-D deficiency: is an occasional accompaniment of rickets.
Tetany of Vit D Deficiency occurs most frequently between the ages of 4 months to 3 years old infants , in
particular, <6 months to see more of this disease. In all cases the serum calcium reduce, and the
hyperirritability of the nervous system is the direct consequence of the hypocalcemia.
Acute infections may precipitate an attack of tetany.
1. clinical manifestation of children pneomonia due to heart failure
 Tachypnea,breath rate more than 60/mint
 Tachypnea,heart rate is quicker than 160-180 beats/mint
 Suddenly extreme restless, obvious cyanosis , pallor or gray complextion
 Heart sound decrease,gallop rhythum, high distentionof jugular vein occurs
 Liver enlarged rapidly,liver can be palpable 3 cm at right subcostal region
 Oliguria , facial edema and edema of lowe extremity appear.
4. CSF bacterial maningitis/changes in cells/ protein.........?
type Normal Bacterial Viral Meningitis TB Meningitis
CSF Meriingitis

Pressure(mmH20) 60-160 elevated elevated Elevated

Appearance Clear Turbid Clear Ground glass

WBC ( 106) 0-20 More than 0-20 More than 1000

1000Polymor
phonuclear Polymorphonuclear

Protein (g/L) 0.2 -0.4 1 -5 Normal/Slightly high High

Glucose(mmol/l) 2.2-4.4 Less then2.2 normal Low

Chloride 117-127 Low normal Low

5. Characteristics of pathological juandice

1. Appears earlier (first 24 hours of life).
2 serum bilirubin concentration in higher than 204~256µmol/L(12~15mg/dl)
3.serum bilirubin concentration daily increase is more than 85µmol/l(5mg/dl)
4.Jaundice lasts more than 2 week in mature or more than 3-4 weeks in premature
5.Jaundice recurrent
6. Direct bilirubin(conjugated)concentration is higher than 34µmol/l(2mg/dl)
6. Diagnosis of Kawasaki disease
1.Fever for at least 5 days ,At least 4 of the following 5 features:
Changes in the extremities,Edema, erythema, desquamation
2. Polymorphous exanthem, usually truncal,3. Conjunctival injection
4. Erythema&/or fissuring of lips and oral cavity,5. Cervical lymphadenopathy
Illness not explained by other known disease process
Differntial diaganosis:-Infectious:-Measles & Group A beta-hemolytic strep can closely resemble KD,Bacterial:
severe staph infections w/toxin release
Viral: adenovirus, enterovirus, EBV, roseola
Spirocheteal: Lyme disease, Leptospirosis
Parasitic: ToxoplasmosisRickettsial: Rocky Mountain spotted fever,
TyphusImmunological/Allergic
JRA (systemic onset),Atypical ARF
Hypersensitivity reactions
Stevens-Johnson syndrome,Toxins,Mercury
Treatment: within first week of illness at least in first 10 days start on aspirin and gamma globulin.
- conjunctival infection ( bilateral )
-cervical lymphadenopathy (>1.5)
2. What vaccination should be done before the age of ONE
1. Hepatitis B 2. Diphtheria 3. Tetanus 4. Pertussis 5. Polio 6. HIB 7. Rotavirus
8. PCV 9. Influenza 10. Measles 11. Mumps 12.Rubella 13. Varicella 14.Hepatitis A

Age Vaccine

0 week ( birth ) BCG, OPVO

6 weeks DPT1,OPV1,HBV1,H
influenza

10 weeks DPT2,OPV2,HBV12,H
influenza

14 weeks DPT3,OPV3,HBV3,H
influenza

8 months Measles

3. Clinical manifestation of rickets due to vit-D deficiency

bone deformities. 2.muscle weakness;potbelly 3. Irritaion of nervous system,
even abnormal in digestion heart and lung function and immunity mental development
5. temporary teeth eruption delayed 6. Anterior fontanel closure delayed
6.Head:- carniotabes , ping pong ball , caput quadeatum ,
7.Chest;-beading of ribs , pigeon breast deformity, harrison groove , limb:-thickening of the wrists and ankles ,
bow leg , knock -knees
8.Muscle lack of tone
7.Chatacteristics of children growth and development?
1．Up to down：for example，a baby raises head first，then sits，then stands，and finally walks．
2 ． From proximal to distal ： an infant moves its extremities from shoulder joint to elbow joint to
hands，from legs to feet.
3．From gross to fine：babies always use their palms as early as fingers when they want something．
4．From elementary to advanced：children often learn to observe their surroundings at first,then have their
own feelings ，remember them，produce their own thoughts，and try to analyze by themselves．
5．From simple to complex：for instances，if a child draws pictures，he can express his thoughts from lines
to circles，and to whole pictures at last．
1.The advantages of breast-feeding?
1.Better nutritional qualities:Easily digested ,Protein: whey proteins (lactalbumin and lactoglobulins) account
for 2/3 ,
2.Fat: unsaturated fatty acids, linoleic acid, rich in lipase
3.Lactose: higher concentrations ,
4.Low renal solute load: ash content of human milk (0.2%) is less than one-third that of cow milk (0.7%),
5.Favorable calcium to phosphate ratio: ensure calcium absorption ,Better iron, zinc
6.Anti-infective properties, 7.Secretory Ig A, 8.Lysozyme 9.Phagocytic cells
10.Iron-binding protein Lactoferrin 11.Low-polysaccharid 12.Zinc 13.Vitamin B12
14.Bifidus factor
15.Psychologic benefit :-Promotes maternal-infant bonding .Gain a sense of security
Constitute the foundation for the development of all human social relationships and communications
16.others:-Economy, convenience,Lack of contamination.
2. CASE Solution:
Diagnosis: acute diarrhea (viral origin)
Dehydration (moderate: weight descent<10%) hypotonichypokalemia(hypopotassemia)
U+E: K 3.5 mmol/l, Na <130 (hypotonic dehydration), Ca normal
Treatment: Not suitable for antibiotic Rx because its viral infection
Antiviral Rx
ORS or IV infusion (because of severe vomiting)
Physiologic maintanance 70-90ml/kg
Correct the deficit loss, mild 50 ml/kg, moderate 50-100ml/kg, severe 100-120 ml/kg
Correct ongoing loss of water and electolytes
1- For Hypertonic 2- For hypotonic
10 % Nacl 80ml 10 % Nacl 16ml
5 % dextrose glucose 250 ml 5 % dextrose glucose 250ml
80/250 = 1/3 16/250 = 2/3
Virus : rota virus
Lap test : stool culture serous assay , SMAC agar.
Symptoms: vomit , watery and soft stools , sever dehydration, fever , electrolyte imbalance , acidosis ,
malnutrition.
1. At what age head to chest circumpherance is equal (one year)
2. Age for measles vaccine (8-9 months)
3. At what age anterior frontel lobe closes (1-1.5 years)
4. Gross motor development (grasp finger, sitting, walking)
5. Fetus congenital heart diseases (early pregnancy)
6. At age one, average water requirement (150ml/kg)
7. Not fat soluble vitamens (vitamin B and C)
8. In malnutrition, which body part subcutaneous fat decrease first –(abdomen)
9. Most important indicator to reflect bone development (height)
10. Most common virus for diarrhea (rotavirus)
11. Definition of persistant diarrhea (2 weeks-2 months)
12. Acute nephritis complication are not due to (electrolyte disturbance)
13.Lab findings for IDA are not true (percentage starvation face erytrocyte (FEP) decreases)
14. Etiology of neonatal injury syndrom not true (fat)
15. Drug not used for Kawasaki disease (antibiotics)
16. Mycoplasma pneumonia first drug choice (erythromyocin)
17. Diagnostic criteria for nephrotic syndrom (50 mg/kg/d)
18. Chronic diarrhea more than 2 months ( more than 2 months )
19. Which is not true for IDA? ( % saturation of free erythrocytes decrease

1.Physiologic anemia:-Within the first few days of life, erythrocyteproduction decreases, and the levels of
hemoglobinand hematocrit fall to a nadir at about 2-3 months, known as physiologic anemia of infancy.
Hemoglobins: 100 g/L (Premature infants: 70-80g/L)
RBC: 3.0×1012/L .
2.perinatal period:-the perinatal period is a peculiar time around birth, often defined as the fetuses from the
28th week of gestation to infants of the 7th day of life
3.Hypotonic dehydration:-in hypotonic dehydration more sodium than water is lost serum sodium is less than
130 ml/l. During the hypotonic dehydration the skin color---pale, skin temperature--- cold , duration of
vomiting and diarrhea is very long thirsty --- no mucous membrane--- moist
4.Infancy period:-The most rapid growth period.-height 50% ， weight 300%,-brain developnent rapidly,1yr
learn walking ， be good for contact with their surroundings ， Understand something, there is awareness
made a few sounds ,Greater nutritional and energy requirements ， Contradiction between supply and
demand, prone to cause malnutrition and digestive disorders ,after be born 6 months passive immunization
gradually disappeared, susceptible to infectious diseases
5.TORCH:-Infection include is toxoplasmosis,syphilis, rubella, cyto megalovirus(CMV),Herpes simplex
virus(HSV).
6.Growth:- Sequence or pattern of growth in children is comparable but the rate is not always uniform.The
increment in growth over a unit time is not always equal.In the early postnatal period the velocity of growth is
high during the first three months ． There is a steady growth during mid-childhood ． A second phase of
accelerated growth is during puberty．Growth decelerates step by step after that and then ceases.
Q:-1.What cause of IDA(iron deficiency anemia)?
Ans:-Iron Deficiency Anemia (IDA) resulting from lack of sufficient iron for synthesis of hemoglobin is the most
common hematologic disease of infancy and childhood. Its frequency is related to certain basic aspects of
iron metabolism and nutrition.
Q:-2. Charcteristics of neonatal pathological jaundice?
Ans:-1. Appears earlier (first 24 hours of life).
2 serum bilirubin concentraction in higher than 204~256µmol/L(12~15mg/dl)
6.serum bilirubin concentration daily increase is more than 85µmol/l(5mg/dl)
7.Jaundice lasts more than 2 week in mature or more than 3-4 weeks in premature
8.Jaundice recurrent
9.Direct bilirubin(conjugated)concentration is higher than 34µmol/l(2mg/dl)