PEDIATRIC IN MAPS - MSQ IN A BLINK

Growth and Development

Period of Human Life
1. 2. 3. 4. 5. 6. 7. Intrauterine period: a. Embryonic : 1st trimester (organogenesis) b. Fetal : 2nd& 3rd trimesters. Perinatal period : From labor to 1st 24 hour. Neonatal period : 1st 4 wks of life. Infancy period : a. Early: 1st year of life. b. Late : 2nd year of life. Childhood period : a. Preschool age: 2 6 ys b. School age: 6 12 ys Adolescence : a. Male : 12 17 ys b. Female : 10 15 ys Adulthood period

Assessment of Growth
Weight & Height Weight At birth 1 6 ys Height At birth 2 12 ys N.B. Infant double his weight at 4 m. Weight bet. 4 8 m accelerating by 1/2 kg /month Weithbet. 0 3m accelerating by 750 gm /month Weigh bet. 9 12m accelerating by 1/4 kg /month KG 3.25 (age in ys X 2) + 8 cm 50 (age in ys X 6) + 77 Weight 3 12 ms 7 12 ys Height At year KG 1/2X (age in months + 9) 1/2X {(age in ys X 7) 5} cm 75

Head Circumference Age Cm At birth 35 6m 42 1y 46 2y 49 3y 50 4y 51 5y 52

Anterior Fontanel Size at birth: 2.1 cm median age of closure: 13.8 monthsSize at 1 year : 1 finger Delayed closure Down $ Hydrocephalus Rickets Hypothyroidism Cretinism

N.B. Delayed closure of posterior fontanel in: congenital hypothyroidism & hydrocephalus

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Teething : 1- Milky teeth No. of milky teeth equal 20 Every 6 months 4 teeth erupted. First milky teeth erupted are lower central incisors. (6 10 month) Canine erupted at 16 22 month 2- Permanent teeth No. of permanent teeth equal 32. First molar erupt6 7 ys

Assessment of Development
Gross Motor Skills Age Skill 5m Full head control 6m Rolls over 78m Sit without support 12 m Stand unsupported 15 m Walk without help 2 yrs Kick a ball walks up & down stairs 2.5 yrs Jump with both feet Fine Motor Skills 3m Lose grasping reflex 7m Transfers toy from hand to hand 9m Grasp small objects between thumb and index finger 11 m Puts object in another's hand when requested but doesn't release. 12 m As above but with release when requeste. 15 m Builds tower of two blocks. 18 m Builds tower of three blocks Language Development 14m Vowel sounds 56m Babble as "ma" or "bah" 79m Repeats sound 12 m One word + "mama" or "dada" 13 m Three words 16 m Six words 18 24 m Two-word phrases 24 30 m Three-word phrases Social Development 4m Cries & smile to communicated emotional situation 8m Respond to own name 4y Enjoy playing with other Sphincteric Development 2y Bowel control 2.5 y Urine control by day 3y Urine control by day & night

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Miscellaneous

Respiratory rate is 40/min Pulse at one year 100-110/min An IQ of 80-89 is dull normal Delayed bone age may occur in : - hypothyroidism, GH def., psychological deprivation, constitutional delay of growth & puberty.

One year old infant: - can walk with support, rolls a ball in floor, say mama, wave bye bye.

Hydrocephalus is recognized complication of - Intraventricular Hge, Arnold-Chiari Malformation, Achondroplasia, Meningitis.

Macrocephaly occurs in - Osteogenesis imperfect, B-thalassemia, Hydrocephalus, Rickets.

Craniotabes occurs in Rickets, Osteogenesis imperfect, Hydrocephalus, normal newborn.

In a normal full term baby the normal reflexes are - Rooting, Palmar, Planter and Stepping.

Determine skeletal maturity is best evaluated by x-ray on wrist. Normal infant recognize his mother since birth. Most infant start teething at 6 m = 7.5 KG

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Nutrition & Nutritional Disorders

1- Protein Calorie Malnutrition CCC By :
Body Wight Anemia & Signs of Vitamin Deficiency Serum Albumin Edema Start in Dorsa of Hand & Feet

2- Abnormal Low Body Wieght Considerd When Whight is :

Below 5th % pf Age 2 Standard Deviation Below Mean Value Less Than 60 % of Expected for Age

3- Rickets :
Signs: Delayed Walking Nutritional Type CCC By: - S. Phosphat - NormoCalcemic , HypoPhosphatemic Lab Values of Vit. D Deficiency Rickets: - S. Alkaline Phosphatase - S. Phosphorus Early Manifistations Include : - Craniotabes - Rachitic Rosary - Sweating - Anorexia & Irrotability Daily Requirement In Normal Infant is 400-800 IU In Absence of Vit. D S. Calcium is Maintained By ParaThyroid H. Secreations Vit. D Deficiency - In Infant Can Present e` Convulsions - Can Cause Osteomalacia in Non-Growing Bone Cl/P ass. e` Vit. D. Deficiency : - Hepatic Ds. - Celiac Ds. - Renal Osteodystrophy - Chr. Anti-Epileptic Therapy - Obesity is Not ass. e` Vit. D. Deficiency Vit. D NOT Stored or Metabolized in Liver

4- Vitamin D :

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5- Kwashiorkor :
Edema Start When S. Albumen is 2.5 mg/dl or Less Hepatomegally is dt. Fatty Infiltration Zinc Supplement Is Needed in Management . Skin Changes dt. - Trace Elements - Essential Fatty Acids - Essential A.A especially ( Sulfur Containing A.A )

6 - Breast Feeding ( B.F ) :

Colostrum is CCC By : - Protien Content Than Mature Milk ( esp. Whey ) - CHO ( esp. Lactose ) - Vit. A Content Than Mature Milk

Absolute Contraindication of B.F is : - PhenylKetonuria of Neonates - Galactosemia of Neonates - Mapple Syrup Urine Ds. - Cancer Breast of Mother - NB: Cleft Lip or Palat not a Contraindications

Breast Milk Criteria : - Contain Protective Anti-Bodies - Promotes Growth of Bifidobacteria in Gut - Is The Best For Pre-Term

Gout Milk is Deficient in Folic a.

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7- Marasmus
Infant is Below Expected Wt. For age By at least 40 % Earliest Changes In Growth Chart is Flat ( Plateaue ) Wt. Curve Complication : - Hypothermia - Purpra - Repeated Infections

8- Tetany
Caused By : - HypoParaThyroidism - HypoMagnesemia - Vit. D Def. - HyperVentilation - Infected Umbilical Stump

NOT Caused By : Acidosis

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Neonatology
Neonatal Jaundice
1st 24 hr : = pathological jaundice, dt RH incompatibility, not dt breast milk jaundice Physiologic jaundice - appears on 2nd - 3rd days, peak at the 5th day & no bile in urine in the 2nd day Phototherapy : Act by Changing Indirect Bilirubin to easily excreted structure & don't cause hyponatremia Exchange transfusion not indicated if S.Bilirubin > 0.2mg/hr Direct conjugated bilirubin 60 % of total bilirubin Direct hyperbilirubinemia - not caused by gilbert $ , not ttt by phototherapy & exchange transfusion Indirect hyperbilirubinemia not associated with galactosemia Drug induced neonatal jaundice Sulphisoxazole Drug treat neonatal jaundice phenobarbitone Biliary Atrasia - jaundice dt conjugated hyperbilirubinemia - diagnosed by HIDA scan - Persistent for 2 w + dark urine & ttt is not supportive type Kernicterus - dt passage of indirect bilirubin through immature BBB - order of birth is not important in it - doesn't occur after the 5th day Breast milk jaundice - appears on the 7th day - persistent unconjugated hyperbilirubinemia - doesn't associated with increase conjugated bilirubin - not ccc by clay colored stool - ttt by cessation of breast milk for 1-2 d

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ABO Incompatibility
Suspected in sever early Jaundice Not persistent jaundice Doesn't occur after the 1st day

RH incompatibility
Occurs dt. transplacental passage of maternal Ab against infant RBC Ag +ve comb's test ttt by : Exchange transfusion , Phototherapy

Congenital Rubella $
Cause CHD (VSD) don't cause premature + IgM not large for date, doesn't cause AS not ccc by renal abnormalities

RD$
Not Respond to Steroids Sot Caused by Sickle Cell Anemia O2 therapy is NOT Essential & safe in high doses Surfactant = not produced by pneumocyte type 1

Preterm infant
Ain't Complicated by Meconium Aspiration $ Doesn't have small surface area compared to body weight Not Caused by caffeine

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Misalliance

Infant of diabetic mother - Has no Increased risk of hyperglycemia - Doesn't complicated by SGA Neonatal hypoglycemia in premature infants - dt inadequate stores, not caused by Cephalhematoma Cephalhematoma swelling limited to parietal bone Vaginal discharge in 3 days old girl dt withdrawal bleeding dt maternal hormones Neonatal convulsions not caused by hypothermia Gastrocolic reflex not primitive neonatal reflex Congenital syphilis in childhood = not manifested by jaundice CMV = doesn't cause hydrocephalus Fever in neonates M/C Dehydration Staph. Aureus = can't cross placental barrier Newborn with oral moniliasis = 1ry SOI is maternal (vaginal) Hydrops fetalis not caused by down $ Mongolian spots = not permanent NEC = not diagnosed by scaphoid abdomen Vaccine given after birth or during 1st m = BCG RBCs life span = 120 days Fetal circulation = RT-LT shunt at atrial level Cyanosis in newborn = not caused by PDA Neonatal screening of hyperthyroidism = not by T4 test

Genetics
Down $
Trisomy 21 Autosomal abnormality Not sex linked Not autosomal dominant nor recessive Translocation is not the M/C genetic cause Translocation 21/21 is the worst prognosis Ccc by MR , Microcephaly , Semian creases ( Dermatoglyphic chromosomal disorder) Multiple congenital anomalies (endocardial cushion defect, duodenal atresia....) The M/C congenital anomaly is complete AV canal Complicated by leukemia The M/C malignancy is acute lymphoblastic leukemia Not ccc by Overweight , Hypertonia science birth , Hyperplasia of distal phalanx of fifth finger, Absent thumb

Monosomy
Loss of chromosome Some can be compatible with life

Klienfelter $
Associated with abnormal no. Of x chromosomes 22 pairs of autosomal & XXY sex chromosomes Affect both sexes Not ccc by MR , hirsutism , shortness

Duchenne myopathy
Not ccc by MR

Turner $
Associated with abnormal no. Of x chromosomes Affect both sexes , Usually females Ccc by non pitting edema Not ccc by puffy hands & feet , fertility

Barr body
Sex chromatin Non factorial Y chromosome Present in about 1/2 of buccal cells from normal female Present in buccal smear of females with Noonan $

Hereditary spherocytosis
Not autosomal recessive

Edward $
Sex chromosome abnormality (trisomy 18) Not inborn error of metabolism Not frequent as down $ Not associated with macrognathia

Phenylketonuria
Screened by Guthrie test Not ccc by CHD Not dt block in converting tyrosine to dopamine Not dt block in converting phenylalanine to phenylpyruvate

Mosaicism
Non disjunction in mitotic division after fertilization

Cretinism
Serum T4 not increased

Achondroplasia
Not x linked recessive

Autosomal recessive inheritance

Heterozygous parents has 25% chance of affected childs E.g. = sickle cell disease Can be diagnosed without karyotype

X linked recessive inheritance

Females is always affected

1ry hypophosphatemic rickets

Not ccc by hydrocephalus

G6PD
Not autosomal dominant inheritance

Hemophilia A
X linked recessive Affected father = carrier daughter Can be diagnosed without karyotype Amniocentesis Not recommended for routine determination of fetal sex

Criduchat $
46 XY 5PNot sex linked Abnormal chromosome 5 Clift lip & clift palate abnormalities Depend on multiple genetic factors Autosomal dominance Heterozygous parents = affect 50% sons & 50% daughters