Paediatric

pearls

prof.mobin ur rehman
head of department
paediatric unit iv
1.Questions to ask in Fits
A.Was the Child responsive
B.Were his eyes open
C.Post ictal state
2. Unresponsiveness can occur in non-epileptic seizures
3. 90% of seizures finish in 90 sec
4. Triggers of breath holding attacks: Pain, crying, fright.
5.Features of neonatal encephalopathy
A.Fits
B.Unable to feed
C.Lethargy
6. Feeding problems due to prenatal pathology
A.Down
B.Prader willi
C.Intra ventricular haemorrhage
D.Hypoglycaemia
7. Separation anxiety is more in nuclear families. Mild in
children growing in orphanages.
8.Receptive language milestones
A.Turns his head to name-5months
B.Obeys commands -10-12months
C.Looks up at common objects-10-12months
D.pointing 12-15 months
9. 2 types of pointing:
A.Protodeclarative pointing:look to parents that he
wants it, its delayed in autism
B.Affirmative pointing: point to tiger in book
10. Joint attention: shares the world with mother-absent
in autism
11. Does not turn to sound
A.Hearing impairment
B.Visual inattentiin
C.Auditory inattention
12. Visual agnosia— Failure to recognise familiar
objects.
13. Auditory agnosia—Landau kleffner syndrome Autistic
features-cant recognise own name
14. Stereotyping: repeated movement- simple or
complex-decreases anxiety-movement disorder
15.Stereotyping can occur in normal children
16.Autistic features
A.Stereotyping
B.Visual inattention
C.Auditory inattention
D.Language delay- deviant language
1.Does not answer unsimilar questions
2.Uses third person
E. Lack of pointing - hand leading
F. Obsessive compulsive discorder
17. W-sitting posture: occurs in spastic children
18. when Suspecting spasticity: do movements fast
19. Cross adductors is hyperflexion
20. Upper limb spasticity is in pronators and biceps
21. Global delay till 5years then intellectual impairment
22. Rubella can present with autistic features
23. Cortical malformations present with dysmorphic
facies because face and brain development go together
24. Static encephalopathy(metabolic)
A.PKU
B.Zellweger syndrome
25. Epileptic propensity means 1 seizure episode with
abnormal MRI or EEG (for treatment purposes)
26. OEA - screening test- if absent - refer
27. BERA absent and oea normal in kernicturus because
cochlea is normal
28. VEP: asses flashing of lights—absent in compromised
vision—-Not important in infancy
29. Best way to asses vision in infancy: make funny
faces
30. Searching eye movements means severe visual
impairment
31. All anti-epileptic drugs are of equal efficacy in
infancy
32. The most important thing that decides prognosis is
potential—if does not sit by 48 months then walking is
out.
33. Separation anxiety—Appear at 8months—-Peaks at
24 months—-Goes away by 36 months(don't separate the
child from mother)
34. Purpose of language
A.Needs }
B.Narrative} all absent in autism
C.Ideas }
35.Upward gaze is absent in
A.Neimen pick disease
B.Hydrocephalus
C.Kernictruus
36. Dyslalia- cannot understand certain constants— ra,
la
37. Test for Peripheral field vision by offering attractive
things from sides after fixing on first object
38. Checking nasal fields is difficult in children
39.Check knee jerk 10 times before declaring it absent
40. Head circumference is usually normal in
craniocynostosis
41. Abdominal distension caused by constipation and
hypotonia is waxing and waning.if its constant then its
not constipation
42.Constrictive pericarditis causes ascites and
hepatomegaly in short duration of time
43. 2 types of budd chiari: acute,chronic.
44. Hepatomegaly in 1 month
A.Inflammation
B.Congestion
45. Disseminated tb does not come with peritonitis
47. Tb peritonitis does not cause hepatosplenomegaly
48.Paediatric malignancy is of short duration and dose
not cause weight loss usually
49.Exudative ascites due to malignancy occurs very fast
50. Chronic hepatic disease causes edema early and late
jaundice
51. Acute liver disease present with early jaundice
52.Chronic liver disease presents with ascites rather
than hepatomegaly
53. When fever comes at the end of story its not
infectious but tissue damage causing low grade fever
54. Firm liver is always pathological
55.Soft liver is usually pushed liver
56. Hemophygocytic syndrome baby is very sick
57. Breathlesness comes first in pneumonia cough
comes later.
58.Bronchiolitis does not cause cough
59. Interstitial disease cough lasts longer then fever
60.Two types of developmental delay
A. Focal
B. global
1. equal
2. differential
61. Aspiration is unlikely to cause fever.
62.Grey matter disease—- seizures, vision and hearing
loss
63. White matter— increased tone, no seizuress, no
vision loss, no hearing loss.
64. Mental retardation—-social, language and fine motor
affected more than gross motor
A. Syndromic and malformations
B. Static mental retardation
65. Hypoglycaemia causes mental retardation more than
cerebral palsy
66. Difficult to differentiate static encephalopathy from
slowly progressive encephalopathy
67.receptive language is more important then expressive
language
68. Toe walking is never normal
A. Duchenne muscular dystrophy
B. Neuropathy
C. Spastic diplegia
D. Autism( do not fall)
E. Habitual( do not fall)
69. DMD sit at normal age, walk a little late, symptoms
at 5-6 years.
70. In DMD , upper limbs are involved in teen age years.
71. In some muscular diseases contractures are the first
presentation
A. Emery-Dreifuss muscular dystrophy
B. Bethlem myopathy
72. Muscle disease can affect the cranial muscles
73. Anterior horn cells and nerves don’t affect the cranial
nerves
74. Myasthenia and mitochondrial diseases affect eye
muscles
75. Eye closure is more important the than smiling and is
absent in
A. Fascio scapulo humeral
B. Myotonic dystrophy
76. Bilateral facial palsy = myotonic dystrophy
77. Late SMA does not cause tongue wasting
78. Waddling in DMD is due to gluteus Maximus
79. In DMD neck extension stronger than flexors
80. In DMD
A. Hip flexors stronger than extensors
B. Knees flexors stronger than extensors
C. Planter flexion stronger than dorsiflexion
D. Abductors stronger than adductors
This is known as differential weakness
81.DMD can present with language delay and autism
82. SMA never presents with language delay
83. Any rickets in PCM is non Nutritional
84. Non calcified cartilage is the most important sign in
rickets rather than cupping and fraying
85. Frequent falls can be both neurological and non-
neurological
86. Ankle reflexes in DMD are retained for a long time
87. Calf muscles are retained in DMD
88. Absent reflexes early— neurogenic
A. Anterior horn cells
B. Peripheral nerves
89. Absent reflexes in muscle disease— congenital
myopathy
90. Differential of DMD is SMA type 3
91. Calf hypertrophy
A. Duchenne Muscular Dystrophy
B. Becker Muscular dystrophy
C. Hypothyroidism
D. myotonia congenita
E. Polymyositis
F. Limb girdle dystrophy
G. Kugelberg walander syndrome
92. First symptom of myotonia is difficult walking after
prolonged siting
93. CPK is highest at birth or before birth if u can test
94. CPK is raised in
A. Duchenne Muscular Dystrophy
B. Becker Muscular dystrophy
C. congenital muscular dystrophy
D. Congenital myotonic dystrophy
95.CPK
A. In thousands —- dystrophy
B. Mildly elevated—-SMA
C. Normal —- structural myopathy
D. normal— hormonal
E. Normal congenital myopathy
96. Focal wasting — first thenar then hypothenar = SMA
97. NCV —- abnormal in neurogenic but normal in
myopathic
A. Axonal- small but not slow
B. Demyelinating -slow but not small
98. EMG
A. Muscle disease= many tiny potentials
B. Nerve disease Large potential and fast
99. Pulmonary dysfunction in DMD requires CPAP
100. No muscle biopsy needed in DMD if gene panel
available
101. CP is never familial
102. Epilepsy is not a diagnosis of exclusion
103. Seizures are confused with syncope
104. Syncope associated with pallor not with seizures
105. Seizures in term neonates have better prognosis
than preterm
106. Seizure pattern in neonates
A. Apnea with tonic stiffening of body
B. Focal clonic movements
C. Multifocal clonic movements
D. Myoclonic jerking
E. Proxyxmal laughing
F. Deviation of eyes to one side
G. Tonic stiffening of body
107. In paralysed newborn, Rhythmic increases in
systolic Arterial b.p, Heart rate and Oxygenation should
alert the physician to the possibility of seizures.
108.Focal seizures in alert newborn
A. Infection
B. Haemorrhage
109. Focal seizures in newborn with Altered conscious
level
A. Infarction
B. Encephalopathy
110. Multifocal clonic seizures in neonates = generalised
tonic clonic seizures in older children= HIE
111. Myoclonic seizures are uncommon and show severe
diffuse brain damage
112. Tonic seizures: extension and stiffening of body
+apnea+upward deviation of eye =structural brain
damage
113.Decerebrate posturing is sign of disturbance of
brainstem reflexes
114.Opisthotonus is not associated with eye movement
shows meningeal irritation
115.Opisthotonus occurs in
A. Kernicterus
B. Infantile gaucher disease
C. Aminoacidopathies
116.Apnea in newborn is brainstem immaturity not
pathology
117. if apnea associated with tachycardia =seizure
118. Epistaxis is usually a sign of bleeding disorder while
hematuria is not.
119. Fever that responds to antipyretics is viral
120.the response to antipyretics determines the
seriousness of illness and if it is viral or bacterial.
121. Small airway disease does not present with cough
while large airway disease does.
122. The cough is interstitial Lung disease lasts after the
inflammation is over.
123. Differential of hypothyroidism
A. At birth: lethargy = inborn errors of metabolism
B. 1st 6weeks : Hyperbilirubinemia =breast milk
jaundice/ Crigler-Najjar syndrome
C. Delayed development =down syndrome/ fragile x
D. Short stature with Facial dysmorphism =
Mucopolysaccharidoses
124. Problems after treatment with thyroxin
A. Neonates: delay in areas as reading, comprehension
and arrhythmia
B. Infant:delayed bone age, cognitive problems,
visuospatial, language and fine motor, defect in
memory and attention
125.Toxicity of thyroxine
A. Tremors
B. Insomnia
C. Hyperactivity
D. Benign intracranial hypertension
E. Craniosynostosis
F. Osteopetrosis
126. Sequela of hyperthyroidism
A. Spasticity
B. Behaviour abnormality
C. Tremors
D. Nystagmus
E. Ataxia
F. Mental retardation
127. Prognostic indicators of hypothyroidism
A. Prenatal onset
B. High TSH before treatment
C. Delayed bone age
D. Lower t4 before treatment
E. Poor compliance
F. Fluctuating t4 during first year
128. Monitoring of therapy
A. Primary TSH
B. Secondary free t4
129. Differential of gower sign
A. Duchenne Muscular Dystrophy
B. Becker Muscular dystrophy
C. Kugelberg Welander syndrome
D. Steroids
E. Polymyositis
F. Uremic myopathy
G. Inflammatory myopathy
130. Late Preservation of ankle jerk
A. Duchenne Muscular Dystrophy
B. Werdnig hoffman disease
C. Kugelberg walender disease
D. Fredrich ataxia
131. Muscle disorders with cardiac involvement
A. Duchenne Muscular Dystrophy
B. Becker Muscular dystrophy
C. Carnitine deficiency
D. Mitochondrial : MELAS,MERRF
132.Differential of ataxia
Acute
A. Post infectious
B. Drugs:anticonvulsants, anti histamine
C. Post.fossa tumour
D. Hydrocephalous
E. miller fisher variant
Recurrent
A. Urea cycle defects
B. Hartnup disease
C. Basilar artery migraine
D. Pyruvate kinase dehydrogenase deficiency
Chronic static ataxia
A. Post encephalitis
B. Agenesis of cerebellar vermis
C. Hydrocephalus
D. Cerebral palsy
Chronic progressive
A. Post.fossa tumor
B. Ataxia telangectasia
C. Fredrich ataxia
133. Risk of recurrence of spina bifida
A. After 1 affected child 3-4%
B. After 2 affected child 10%
134. Prophylaxis for spina bifida;
A. primary(0.4mg) o.d (1month before conception for
12wks)
B. Secondary: 4mg o.d
134.Prognosis of meningomylocele
A. Mortality 10-15%
B. Death before 4years
C. 70% normal intelligence
D. Decrease IQ in meningitis
135. Changes in CSF after treatment
A. Culture -ve in 24hrs
B. Sugar normal in 48-72hrs
C. Cells neutrophils 24-48hrsThen lymphos
D. Proteins are not good parameters
E. Persistent increase in neutrophils shows poor
prognosis
136. All skeletal dysplasia are disproportionate except
osteogenesis imperfecta and all endocrine disorders are
proportionate short stature except hypothyroidism
137. floppy baby
Paralytic
A. Spinal muscular atrophy
B. Congenital myopathy
C. Myotonia congenita
D. Mysthenia gravis
Non-paralytic
A. Down syndrome
B. HIE
C. Birth trauma
D. Metabolic disease
E. Benign congenital hypotonia
F. Hypothyroidism
138. Two manoeuvres to differentiate between central
and peripheral hypotonia
A. Pinch calf for power
B. Lie prone and see if neck extension
C. If limbs move spontaneously against gravity------non
paralytic
139. GBS ruled out when
A. Palpable bladder
B. Definite sensory level
C. Persistant asymmetry(9%can Present with
asymmetrical paralysis)
140. Development of Eisenmenger's syndrome
A. PDA—-11 years
B. VSD—-22 years
C. ASD—-33 years
141.Heart failure in congenital lesions
Unto 72 hours— pulmonary, aortic and mitral atresia
4 days —-1 week= hypoplastic left heart , TGA
1-4 weeks——Coarctation of Aorta, Endocardial fibrosis
1-2 months—-VSD, PDA, TAPVD, endocardial cushion
defect
142. All neuropathies are distal except spinal muscular
atrophy and all myopathies are proximal except
myotonic dystrophy
143.Hand preference before 1 year is abnormal
A. Hemiplegia
B. Erb palsy
144. Ambidextrous and left handed have learning
disorder.
145. Two antenatal screens
A. 10 weeks— down
B. 18 weeks—- Anomaly scan
146. Crying at birth is primary apnea. Only 1% of patients
who did not cry at brith have Cerebral palsy.
147. Prenatal conditions leading to feeding issues.
A. Prader willi
B. Brain malformations
C. Down syndrome
148. TEV can be causes by neuromuscular disease
149. Aspiration can be caused by neuromuscular disease
150. Language and social milestones better than motor
A. Neuromuscular
B. Spastic diplegia
151. Language and social are worse than motor
A. Autism
B. Mental retardation
152. Ehler danlos syndrome can come with only motor
delay
153. MRI performed in global developmental delay who
do not have symmetrical spasticity, microcephaly and
dystonia is useless.
154. BERA must be done in all global developmental
delay
155. Neonatal hearing screens should be performed in all
newborn
156. Neonatal screen means OEA which is a stapedial
reflex
157. TMA in all patients with global delay
158. Congenital heart disease makes neuromuscular
disease less likely and syndrome more likely.
159. If muscular disease is excluded and syndrome is
likely the child will walk.
160. Can sit by 2 years, will walk. If cannot sit by 4 years
will never walk.
161. Malabsorption child is always hungry
162. Static diarrhoea(toddler) is disturbed physiology
163. Hunger diarrhoea is green
164. Viral infections causes self limiting malabsorption
165. Atypical and tuberculous pneumonia patients are
not breathless
166. Asymmetrical iUGR are delayed, symmetrical iUGR
are not delayed
167. Well fed child with motor delay is due to rickets
168. Stress causes deformity in rickets, first ribs then
wrist then knee.
169. Occupational therapy is activity of daily living
170.Pain abdomen in nephrotic is due to ischemia
171. Diarrhoea in nephrotic is not always due to infection
could be due to bowel wall oedema
172. Pulse in nephrotic syndrome shows dehydration not
blood pressure
173. TB peritonitis occurs in older children(>10years)
174. Abdominal wall oedema does not occur in TB
abdomen as against nephrotic
175. After 2episodes of relapse label steroid
dependent.1st relapse is usually infection
176. Patients on steroids with Hepatomegaly and
cataract should be treated for steroid toxicity
177. Normal protein diet in nephrotic for growth.
decreased proteins affects growth. Steroids act
sufficiently rapidly
178. Prognosis of sitting in CP
Sitting without support before 2 years— 97% will walk
Sitting between 2-4years—-50% will walk
Sitting after 4 years——-3% will walk
179. In platelet disorder there is oozing first , in
coagulation disorder there is oozing for long time
180. BT/CT are obsolete, now only indicated in Von
willibrand disease or Snake bite
181. In hypersplenism quality and not quantity of platelet
prevents bleeding
182. Cause of hypersplenism in thallassemia is
inadequate transfusion so consider this before
splenectomy
183. Drugs causing thrombocytopenia
A. Anti histamine
B. Valproate
C. Carbamazepine
D. NSAIDS
184. Peripheral smear can determine platelet function by
clumping provided ETDA not added
185. Three causes of bleeding
A. Platelet disorder
B. Coagulation disorder
C. Vascular disorder
186. Transfusion dependent anemias
A. Aplastic anemia
B. Thallasemia major
C. Diamond blackfan anemia
D. Dyskeratosis congenita
E. Fanconi anemia
F. Herediatry spherocytosis
G. Myelodysplasia
H. Osteopetrosis
187. Monitoring in thalassemia
A. Thyroid profile and for diabetes after 3years
B. Iron overload after 5years
C. Growth failure after 7years
D. Pubertal assessment :boys 13 years; girls 12 years
188. In cow milk fed , iron deficiency anaemia may occur
before 6 months.
189. In hydrocephalus , neck holding is delayed but other
milestones are normal.
190. In visually impaired children social smile is delayed.
191. Horn cells Waste, Roots Pain, Nerves Tingle, Muscle
Weaken.
192. Eyes look towards the stroke due to destruction of
supra nuclei
193. MRI findings in cp
Quadriplegic
A. Central-basal ganglia
B. Peripheral- cerebral hemisphere
Spastic diplegic—-Periventricular leukomalacia
Hemiplegia —- Internal capsule or infarct
Choreoathetoid——Caudate nucleus
Monoplegia ——Middle cerebral artery
194. Delayed walking is not uncommon, if familial other
milestones should have been reached and legs normal on
examination.
195. Most milestones eventually reached in down
syndrome
196. Down can now live unto 50 years of age.
197. 5% of normal children will shift down two or three
centiles between birth and one year of age.
198. 5%of children on 98th gentile at birth shift down
there centiles by 6 weeks.
199. 2-3ml prepubertal testicular size
12ml maximum ht velocity
>12ml normal adult male
200.Causes of short stature
A. Familial short stature
B. Constitutional short stature
C. Psychological
D. Isolated growth hormone deficiency
201. Preterm and low socio-economic status are
important causes of SS.
202. Falling of centiles=GH deficiency
203. If Ht velocity <25th centiles over 6months period
then investigate for cause
204. Causes of delayed bone age
A. GH deficiency
B. Hypothyroidism
C. Celiac disease
205. Growth failure is indication for insulin stress test
206. Causes of thelarche

A. Isolated
B. Variant
C. Precocious puberty
207. In thelarche ask about mood swings, pubic hair,
rapid growth for 1-2 years, family history
208. Increased bone age +breast development+ other
signs of puberty =Thelarche Variant
209. Thelarche variant can develop precious puberty.
210. If with other signs of puberty like pubic hair warrant
investigations
A. Abdominal ultrasound for ovarian failure
B. LHRH test
211. Delayed menarche
A. Familial
B. Turner syndrome
C. Chronic systemic illness
D. Anorexia nervosa
212. Turner syndrome must be excluded in female with
short stature and delayed puberty
A. Karyotyping
B. LHRH test--for intact axis and exclude primary gonadal
failure
C. Bone age
213.Indication of GH
A. GH deficiency
B. Prader willi syndrome
C. Turner syndrome
D. Russel silver
E. Chronic renal failure
214. Many children with GH deficiency recover normal
GH level by puberty
215. After GH replacement there is increased well being
and increased cardiac contractility
216. Over weight child
A. History of tiredness and lethargy----- hypothyroidism
B. Growth failure-----cushings syndrome
C. Increased b.p——cushings syndrome
D. Uniform fat distribution----exogenous source
E. Acanthosis nigricans---simple obesity
F. Increased diet---simple obesity
G. Phenotype of parents—- simple obesity
217.Simple obesity having rapid growth and advance
bone age
218. Delayed sitting and not weight bearing
A. Cerebral palsy
B. Neuromuscular disorders
C. Metabolic disorders
219. MRI brain indicated when cranial u/s is abnormal
220. Causes of speech delay
A. Maturational language delay
B. Hearing impairment
C. Developmental language disorder
D. Mental retardation
E. Psychological deprivation
F. Autism spectrum disorder
221. In speech delay Ask about non-verbal
communication, failure of comprehension, family history
of deafness
222. Maturational delay is the most common cause of
speech delay---with excellent prognosis
223. 5% of Failure to thrive are found to have and organic
cause.
224. Poor feeding behaviour and poor feeding derive are
the commonest causes. look for oromotor dysfunction
that is difficulty in swallowing and chewing
225. Cough and spurting during feeding suggest
oromotor dysfunction, GERD or TEF
226. Fecal alpha 1 Antitrypsin is tested for fat
malabsorption
227.Phases of childhood growth
Infancy phase: birth-3years:Growth is determined by
nutritional status
Childhood phase: 3years-puberty-Determined by
hormones; GH, thyroxine, insulin
Adolescent growth spurt: puberty: Fusion of Epiphysis;
determined by GH and sex hormones
228. Septicaemia, meningitis and UTI are difficult to
diagnose on history in infants and should be considered
in all young children with acute severe illness
229. Absence of irritability and bulging fontanelle does
not rule out meningitis
230. H/o consanguinity +previous sids------look for intern
errors of metabolism
231. Birth weight reflects placental function
232. Catch down growth is normal
233. Infants aged less than 6months are obligate nasal
breathers
234. Cellular and biochemical changes remain in CSF for
44-68hrs after starting antibiotic therapy
235. Septicaemia must be considered in all infants
presenting with fever, drowsiness and poor feeding
236. Indication of neuroimaging in headache
A. Altered consciousness
B. Focal deficit
C. Hypertension
D. Deteriorating school performance
E. Papilledema
F. Behavioural changes
237. 50%children with migraine have family history of
1st degree affected relative with the same diagnosis
238. Severe progressive headache+ focal neurological
signs =intracranial pathology
239. Headache uncommon in preschool children
240. Fits may be missed when they are not generalised
tonic clonic
241.Critical aortic stenosis and coarctation of aorta are
exceptional acynotic duct dependent lesions
242. Consider iatrogenic and non-accidental injury in
SIDS
243. SIDS is diagnosis of exclusion
244. risk factors of SIDS
Modifiable
A. Co sleeping
B. Bedding and clothing
C. Pre and post maternal smoking
Non modifiable
A. Young mother
B. Lbw
C. Prematurity
D. No antenatal care
E. Single parent
F. High parity
G. Low socio economic status
245. Timing of operation
A. Hydrocephalus|spina bifida =at diagnosis
B. Encephalocele =at diagnosis
C. Cystic hygroma | thyroglossal cyst =at diagnosis
D. Cleft lip =at 10-12 weeks
E. Cleft palate = at 12 – 18 months
F. Torticollis|sternomastoid tumour= after 15 months or
earlier if causing hemihypoplasia
G. Brachial cyst= at 6 months
H. Brachial sinus =at diagnosis
I. Tongue tie =after 18-24 months
J. Tracheoesophageal fistula =at birth
K. Congenital diaphragmatic hernia = at birth
L. Eventuration of diaphragm| congenital lobar
emphysema| duplication of foregut =at diagnosis
M. Foreign body|tumor = at diagnosis
N. Pectus excavatum|carinatum= at infancy
O. Gynaecomastia in males = after puberty if persists
P. Umblical hernia = after 5 years
Q. Umblical granuloma= conservative
R. Umblical polyp|urachal cyst|persistant urachus= at
diagnosis
S. Congenital cysted hydrocele = after 2 years
T. Inguinal hernia = at diagnosis
U. Undescended testis= after 1 year of age or earlier if
associated with hernia
V. Ectopic testis = at diagnosis
W. Torsion testis = immediately
X. Omphalocele minor|major with ruptured membrane =
at birth
Y. Omphalocele major associated with major birth
defects =conservative at birth or repair of ventral
hernia at later age
Z. Low anomalies =at birth
AA. Intermediate | high anomalies = sigmoid colostomy
=at birth
BB. Hirschsprung disease = Colostomy at diagnosis -
Definitive surgery after 6-8 months—Neonatal single
stage surgery
CC. Infantile obstruction colangiopathy =as early as
possible
DD. Hypertrophic pyloric stenosis =at diagnosis
EE. Neonatal intestinal obstruction (atresia meconium
ileus) =at diagnosis
FF. Preputial adhesion=after 2 years earlier if
 ballooning
GG. Labial adhesions-=at diagnosis
HH. Neonatal circumcision=after 6 months if no
hypospadias
II. Hypospadias =6-18 months |complete before school
age
JJ. extrophy bladder =Bladder closer-48-72 hours -
Epispadias repair – 1 year-Continence antireflux -3-4
years|> 60ml capacity
KK. PUJ obstruction =at diagnosis
LL. VUR =after 1-2 year of age
MM. Wilm tumor /neuroblastoma=at diagnosis
246. Adequate chelation means
A. Serum ferritin<2500ug|l
B. T2 heart >20 ms
C. Liver iron concentration < 7mg fe|g dw
247. Inadequate chelation
A. Serum ferritin >2500 ug |l
B. T2 heart < 20ms
C. Liver iron concentration >7 mg fe|g dw
248. Thalessemia facies are more extensive in
thalassemia intermedia
249. MCH is preferable to mcv because it is less
susceptible to storage changes
250. Hemoglobinopathies such as hb constant spring will
have normal MCV and MCH and will be missed.
251. Rdw is low in thalessemia trait versus iron
deficiency anaemia, but rdw is increased in thalessemia
intermedia and thalessemia major.
252. Severe thalessemia major HB a2 4-9%, in mild
thalessemia major it is 3.6-4.2 %
253. If iron deficiency is excluded and HBA2 % is normal,
the diagnosis of alpha thalessemia should be considered.
254. Thalessemia indices with a normal HBA2 may be
due to co existing beta and alpha thalassemia.
255. HBA2 may be falsely lowered by iron deficiency so
the correction is warranted before excluding
thalessemia trait.
256. If hb a2 level is >10% this suggests HBE
257. HBH disease presents as thalessemia intermedia
258. DNA analysis is required when
A. Normal hb a2 b thalessemia
B. A* thalessemia
C. Some a+ thalessemia
D. Silent b thalessemia
259. MCH level of <27 pg should be used as a threshold
for identification of carriers in thalessemia screening
260. After presentation patient should be monitored to
ascertain ability to maintain HB above 7g|dl over 2 week
period.
261. Regular transfusions in thalassemia intermedia is
indicated when there is growth failure, bone deformities
or extra medullary masses such as paraspinals.
262. Splenectomy can reduce the blood consumption
significantly up to 30-50% but delay till 5 years of age
because of the risk of over whelming sepsis.
263. Splenectomy should be considered
A. If there is increased transfusion requirements * 1.5
times then the usual or exceeding 200-250ml|kg|year
of pure red blood cells
B. Evidence of hypersplenism
C. Massive splenomegaly causing discomfort
264. Thromboembolic risk is more common in
thalessemia intermedia (4-10%) than thalessemia major
(0.9-4%), In the splenectomised thalassemia intermedia
the risk can increase up-to 30%
265. Desferroximine continuous infusions can be used
as reserve therapy in patients with acute cardiac
problems and has been shown to reserve
cardiomyopathy.
266. is used in children > 6 years old.
A. risk of agranulocytosis is 0.6/100 patients /year
B. Risk of neutropenia is 5.4/100 patients/year.
C. This is reversible defriprone should be stopped and
never rechallanged.
267. deferasirox can be used from 2 years onwards 268.
adequate response to chelation is reflected by reduction
in serum ferritin level below 100ug/l over 12 months
270. Defriprone patients should have weekly CBC
271. deferasirox patients should have LFTs, proteins,
serum cretinine monitored monthly. Reduce dose by
10mg/kg dpx if serum creatinine rises above normal. 38%
affected
272. For dfo & dfx audiometry and eye assessment
annually
273. Dfp patients lfts every 3 months
274. Thrombocytopenia can occur in 45% of children <7
years old
275. joints affected in 28-37.5% of patients on dfp
276. Haematopoitic stem cell transplantation risk factor
A. Inadequate iron chelation therapy
B. Presence of liver fibrosis
C. Hepatomegaly
Class 1. One risk factor
Class 2. Two risk factors
Class 3. Three risk factors
277. siblings who are carriers are potential donors
278. Short stature in thalassemia is 31-64%
279. Thalassemia patients have growth retardation in the
presence of low serum IGF-i and normal GH response to
pharmacological stimulation
280. Hypogonadism occur in 59% of patients. they do not
respond to pulsatile GNRH therapy, therefore
testosterone should be the mainstay of therapy.
281. Hypothyroidism 6.2-51.7% no obvious signs and
symptoms despite abnormal thyroid function
282. overt DM is preceded by a long period of insulin
resistance and hyperinsulinism
283. Main risk factors for DM are hepatitis c, severe
fibrosis/ cirrhosis, delayed age at start of chelation, poor
compliance with dfo therapy.
284. prevalence of DM 10.4-19.5% 3.1% patients with
diabetes presents with DKA
285. 30.9% have 25-oh vitamin d3 levels below the
normal range
286. zinc- 84.8% of patients aged 10-20 years have been
reported to be zinc deficient while 44.7% have severely
low levels.
287. DEXA scan is the method of choice to asses the
Bone marrow density
288. Incidence of hypothyroidism is 4.5- 20%
289. Hypoadrenalism is 0-45%
290. cardiac contribution to mortality is 71% LVEF<56%
indicates impaired cardiac function
291. t2 level <20ms iron overload, <10ms severe iron
overload. Repeat every two years if normal , yearly if
between 10-20ms and 6 monthly if < 10 ms
292. chronic hepatitis b infection in thalassemia
A. HBsAG +ve> 6 months and
B. Serum hbv dna >20000 iu|ml in HBEAG +ve, serum HBV
dna > 2000 iu|ml in the HBeAg –ve
C. Persistent/ intermediate elevation in the ALT/AST level
> 2 times normal. Normal or significant liver disease
on biopsy.
293. in hepatitis b peg inf 6 months for hbeag +ve and 12
months for hbeag –ve patients.
294. Chronic hepatitis c infection
A. Persistent HCV +ve > 6 months And
B. Serum HCV RNA +ve And
C. Significant liver disease on biopsy
294. Hemolysis caused by ribavirin increases the
transfusion requirements in hcv thalassemia patients
295. both deferiprone and interferone causes hemolysis
296. apart from heart failure, infection is the main cause
of death in thalessemia , 3rd generation cephalosporin
with or with out aminoglycosides are the main stay of
treatment.
297. vitamin e therapy 10mg/kg for 4 weeks significantly
improves HB
298. Vitamin c 3mg/kg/day during dfo infusion to increase
the iron excretion
299. Indication of IVIG in GBS
A. Rapid progressive GBS
B. Diaphragmatic involvement
C. Axonal variety
D. Miller fisher variant
300. Except for axonal and miller fisher all other forms of
GBS are not associated with specific antibodies
301. Involvement of corpus striatum causes a specific
hammer shape of big toe
302. ALL
A. Most common childhood malignancy
B. Increased risk with down syndrome,
immunodeficiency and radiation exposure
C. Survival >80% for 5 years after completing tx
D. Most common site of relapse
Bone marrow
CNS
Testis
303. High risk groups in ALL
A. Male
B. Age<1yr >10 yr
C. Hypoploidy
D. Mature b&t cell leukaemia
E. CNS involvement
304. Neuroblastoma
A. Most common extra-cranial solid tumour
B. Majority before 4 years
C. Poor prognosis >1year age, myc-n gene
D. Associated with paraneoplastic syndrome and
opsoclonus myoclonic ataxia
305. Suspect immune deficiency
A. Failure to thrive
B. Persistent cough
C. Candidial infection
D. Absolute lymphocyte count <2000/mm3
306. Differential bulging anterior fontanelle
A. Crying infant
B. Pseudotumor cereberi: vitamin A , steroids,
tetracycline
C. Metabolic: galactocemia, maple syrup urine disease
Hyperthyroidism, vit d dependent rickets, congenital
hypophosphatemia
D. Raised ICP: meningitis, intracranial bleed, tumour,
hydrocephalus
307. Causes of craniotabes
A. Physiological
B. Rickets
C. Congenital syphilis
D. Hydrocephalus
E. Osteogenesis imperfecta
308. dysmature baby:small at birth in relation to duration
of pregnancy is likely to be smaller in later years.
309. critical period in physical growth after which even
normal diet will not restore the child to average size.
310. breast feed baby are more likely to suffer from
underfeeding.
311. most common cause of underfeeding is fear of
overfeeding
312. overfeeding of young full term baby is virtually
impossible
313. overfeeding a premature baby causes vomiting and
loss of weight
314. always be skeptic about the mother account of
dietary history
315. excessive crying causes defective weight gain
because of use of energy and loss of fluids through lungs
316. poor appetite in a well child is always due to food
forcing
317. in most cases of cystic fibrosis and celiac disease
mother has not noticed anything unusual
318. do not suspect cystic fibrosis when a child develops
a cough when he has cold
319. suspect Cystic Fibrosis when there is
bronchiectasis, persistent radiological abnormality
unexplained generalised oedema or prolapse of rectum
320. you can not diagnose CF by inspecting stool
321. giardiasis and salmonella cause fat malabsorption
322. tuberculous abdomen may cause steatorrhea
323. congenital lactose intolerance starts as soon as
breast feeding is initiated
324. in fructosemia symptoms start after breast feeding
is over
325. fits with eating sugar=fructosemia
326. in glactosemia Benedict is positive but clinitest is
not
327. acidic stool = diahaccharidase deficiency
328. one of presentation of hirshsprung disease is severe
diarrhoea and vomiting
329. polyuria+constipation=RTA or idiopathic
hypercalcemia or diabetes insipidus
330. acidic blood+alkaline urine =RTA
331. hypospadias may be one of the presentation of CAH
in boys
332. children with severe asthma are small in height and
below average weight
333. acute infection even if recurrent don not cause
defective weight gain
334. in hypopitutrism the proportions are normal while in
hypothyroidism they can not
335. Cushing disease is rare in paediatrics
336. well child +emaciated looks+appearance of weight
loss=lipodystrophy
337. any disease that causes persistent vomiting or
persistent diarrhoea causes loss of weight
338. in weight loss never forget two tests:urine D/R with
culture and mountoux
339. normal temperature variations are frequently
treated as infection
340. a high ESR in the face of fever mean that disease is
present.A normal ESR makes its unlikely
341. dehydration fever of newborn is sudden rise of
temperature a day after two after birth;Treatment is
increased fluid intake
342. nephrogenic diabetes inspidus ,ectodermal
dysplasia and idiopathic hypercalcemia have high fever
343. the most important common cause of fever in a child
without abnormal physical sign is UTI
344. roseola infantum: rash appears when fever subsides
345. joint effusion+petechiae= meningococcal
septicemia
346. closed off abscesses e.g sub phrenic, perinephric
abscess, pulmonary, brain cause prolonged fever
347. prolonged fever+sign of infection=osteitis
348. corticosteroids can lead to apical tooth infection
349. amoebic liver abscess should be considered in PUO
350. continuous or intermittent fever may last for months
before a diagnosis of rheumatoid arthritis is made
351. many children with celiac disease do not respond to
gluten free diet until lactose and sucrose are also
excluded
352. the initial symptoms of celiac disease is vomiting
353. appetite in celiac is poor but cystic fibrosis has
good appetite
354. it takes 8weeks of gluten free diet before
improvement is noted
355. low grade anaemia is an important organic cause of
lack of energy and easy fatiguability
356. chronic UTI is common cause of fatigue and vague
unwellness
357. persistent haemolytic streptococcal infection may
result in tiredness and lack of energy.
358. always look for an incompletely resolved pneumonia
in a child with tiredness
359. a useful nonspecific test for fatigue in ESR
360. over-clothing is the most common cause of
excessive sweating
361. excessive sweating around the head=rickets
362. unexplained attacks of excessive sweating not
associated with fainting = hypoglycaemia,
pheochromocytoma and neuroblastoma
363. pulmonary TB is unlikely cause of night sweats.
364. the most important causes of splenic enlargement
are infection and anaemia
365. In infant and young children splenic enlargement of
slight degree is caused by very many infection
366. as the child grows older infections are less likely to
cause enlargement of spleen, though they are a common
cause
367. in infective hepatitis enlargement of spleen is
invariable
368. spleen is almost always palpable in typhoid fever
369. in infant slight enlargement of spleen and liver is
common in upper respiratory tract infection
370. severe nutritional anaemia can result in spleen
enlargement
371. in purpura if you can feel the spleen its not ITP or
HSP
372. in heart failure sometimes the spleen can be felt
373. the most common cause of lymph node enlargement
is infection
374. BCG vaccination may give rise to axillary lymph
node enlargement
375. almost all persons have palpable inguinal lymph
nodes. if they are really enlarged examine perianal area
376. Tuberculosis can cause general lymph node
enlargement.
377. in new born baby the usual cause of anaemia is Rh-
incompatibility
378. dyspnea on exertion is not a common symptom
except in asthmatic children and those with congenital
heart disease
379. severe progressive dyspnea occurs in cystic fibrosis
380. pulmonary stenosis(with or withoutTOF) is the
common cause of chronic breathlessness in the first 3-4
yrs of life
381. paroxysmal tachycardia usually masquerades as
bronchopneumonia on account of rapid breathing and
cough due to heart failure.missed in infants especially in
neonates
382. diplopia should lead to CNS examination for SOL and
fundal examination for papilledema
383. iridocyclitis causes diplopia
384. mentally retarded child is mistaken for blind for not
taking interest in objects
385. optic disc of normal babies is pale and mistaken as
optic atrophy
386. if squint is not corrected by the age of 9-12 months
,the child will suppress the squinting eye and become
blind in it
387. by for the commonest cause of nystagmus in an
infant is defect of vision such as optic atrophy
388. phenytoin, phenobarbitone and primidrone can
cause nystagmus
389. when you diagnose sub dural hematoma, look for
large retinal haemorrhages
390. some degree of strabismus is normal before the age
of 6months
391. epicanthic fold causes pseudostrasbismus
392. concomitant squint does not have diplopia(non
paralytic)
393. the rapid development of squint should alert for
cerebral tumour
394. the most common cause of proptosis in children is
craniosynostosis
395. neuroblastoma is the most common tumour causing
proptosis 2nd is osteoma
396. orbital cellulitis is confused with cavernous sinus
thrombosis clues for the later are toxic child, rigours and
fever
397. myopia in childhood is associated with prematurity
and eclampsia
397. most common causes of ear pain are otitis media or
a boil in meatus. 2nd is referred pain.
398. patient with athetoid cp are more likely to be deaf
then spastic CP
399. deafness syndromes
A. alport syndrome
B. wardenberg syndrome
C. pendred syndrome
D. treacher Collin syndrome
E. klippel feil syndrome
F. retinitis pigmentosa
400. meningitis and recurrent otitis media cause
deafness
401. cleft children patients may develop deafness in later
years
402. tinnitus in children is usually psychological
403. vertigo occurs in all anaemic children
404. in every case of ataxia fundus should be examined
to rule out cerebral tumour or abscess
405. clumsiness +poor writing+emotional disturbance =
early chorea
406. moro and startle reflex are excessive in babies
suffering from cerebral irritability
407. first few weeks+sudden jerky movements
resembling startle+sleep=normal ,+ awake = convulsion
408. newborn jittery movements of limbs= tetany,
hypoglycaemia, IDDM
409. jaw trembling is normal in young infants
410. there is no carpopedal spasm in tetany among
infants
411. in hemiplegic child there is twitching of affected
limb
412. tics when complex can be confused with chorea, in
tics same movements is repeated again and again while
in chorea any movement can occur
413. tremors of hands is common in children especially
mentally retarded one
414. athetoid movements become obvious around 4
years of age however tongue protrusion appears in early
months
415. spasmus nutans seen 3-24 months, rhythmical
jerking of neck, stoping when child concentrates on an
object, disappear by age 4
416. parkinsonian movements results from encephalitis
417. fits occur in 50% of children with spastic
hemiplegia, 40%in spastic quadriplegia, but only 15% in
spastic diplegia and 10% in athetoid CP
418. convulsions are not due to teething
419. cyanotic attack is usually a convulsion in newborn
420. cerebral haemorrhage in full term occurs on 3rd day
of life
421.sudden warming of cold child can result in
convulsions due to hypoglycaemia
422. physiological hypocalcemia can occur on 3-5days of
life
423. loss of appetite in newborn is sepsis. do not miss
the sticky umbilicus
424. simple febrile convulsions can occur with in 12
hours of onset of fever
425. in breath holding attacks the child become blue,
then has a fit. in epilepsy the child has fit then become
blue
426. all small children bump their head that result in
small subdural effusion this is not child abuse
427. tetany due to rickets occurs especially between the
ages of 4 months and 3 years
428. tetany in resistant rickets is rare
429. sickle cell anaemia may cause convulsion during
crises
430. the most cause of fits after 2nd year of life is
epilepsy
431. there is no sleep after absence seizures
432. there is no colour change in infantile spasm
433. a sudden headache or abdominal pain lasting for few
minutes and followed by sleep could be epilepsy
434. fit resemble a faint is GTC not absence
435. a fit may take months or years to develop after head
trauma, cerebral abscess and subdural effusion
436. remember AGN when evaluating for fits
437. the lower eyelid should be examined for petechiae
in meningococcemia
438. facial palsy in newborn clears after a few days
439. polio should always be considered in facial nerve
palsy
440. facial weakness may occur after a fit(todd)
441. facial palsy may occur in 20% of hypertensive
patients(haemorrhage into facial canal)
442. congenital muscular dystrophy resembles in SMA
type 1(except tongue fasciculation)
443. the child with SMA type 1 cries feebly when foot is
pricked but a child with injury of cervical cord does not
444. in atonic CP reflexes are exacerbated ,ankle clonus
and upgoing planters are present
445. the commonest cause of increase muscle tone
(persistent) is spastic CP
446. do not confuse erb's palsy with spastic hemiplegia
447. the most important cause of weakness of limbs in
infancy is meningiomylocele
448. todd’s paralysis may last from few hours to few days
449. transient synovitis of hip 18months -7 years. follow
URTI. lasts for 13 days
450. both severe spasticity and severe hypotonia can
predispose to DDH
451. scurvy causes acute limb pain in infancy
452. strains are the most important cause of joint pain
453. hip joint is never involved in rheumatic fever
454. a well child with arthritis does not have rheumatic
fever
455. a normal ESR rules out rheumatic fever
456. a raised sleeping pulse rate is Rheumatic arthritis
457. 1 in 2 of all children have innocent murmur
458. febrile aches and pains are often labelled RF
459. morning stiffness is JIA not RF
460. neck and small joints are involved in JIA not in RF
461. longer duration of joint involvement is JIA not RF
462. iridocyclitis is JIA not RF
463. under 5 and especially under 3 RF is rare
464. limb wasting is less in spastic hemiplegia than polio
465. true microcephaly is sloping forehead
466. the obvious cause of crying in an infant is hunger
and most likely cause of hunger is fear of over feeding
467. sudden loud noise, wet diaper, extreme heat and
cold can make the infant cry
468. crying when passing urine is normal till 6 months
469. crying after weaning is food forcing
470. unwell crying baby is due to infection or intestinal
obstruction. examine the hernial orifices and remember
Intussusception
471. celiac and PKU patients cry excessively
472. crying of new onset should alert one to chorea
473. high pitched shrill cry = meningitis/
kernicterus/hydrocephalus
474. hoarse cry= hypothyroidism
475. hoarseness+stridor =vocal cord paralysis, web,
papilloma
467. SMA= weak cry
468. grunting cry= pneumonia
469. half of population has IQ <100
470. an infant may be retarded in all aspects of
development, yet prove to be normal later——except
when there is microcephaly
471. preferring toys to persons is autism
472. blind child smiles late
473. benign congenital myotonia walk at 5-6 years of age
474. DDH does not cause delayed walking
475. constant dribbling incontinence; look for PUV,
bladder obstruction in boys and ectopic ureter in girls
476. deafness causing delayed speech is high tone
deafness
477. severe hypoglycaemia can cause irreversible
mental deficiency
478. young babies and mentally subnormal children may
not show thirst and become dehydrated
479. discomfort on micturition is not always UTI.
Consider meatal ulcer, balanitis in boys and soreness of
vulval region in girls
480. discomfort on micturition is an exception rather
than a rule in UTI
481. UTI can cause febrile convulsion
482. chronic UTI has only poor appetite and lack of
energy
483. frequency is not a symptom of UTI
484. frequency may occur in any polyuria
484. AGN is the commonest cause of hematuria
485. raised ESR indicates nephritis when BP and urea
normal
486. gross hematuria is un usual in pyelonephritis
487. renal vein thrombosis occur in first few months of
life
488. blood at the end of micturition; meatal ulcer in boys
and urethral caruncles in girls
489. any acute infection can cause albuminuria
490. albuminuria is not consistent in pyelonephritis
491. well child+ facial oedema only= angioedema
492. ill child with facial oedema =sinusitis, boils, dental
abscess ,orbital cellulitis
493. newborn with oedema leg=turner syndrome
494. sternal oedema occurs at the onset of mumps
495. infant with oedema + no albumin=cystic fibrosis
496. protein losing enteropathy does not have diarrhoea
497. facial oedema in nephrotic syndrome may be
asymmetrical due to posture
498. undiluted cow's milk causes oedema due to
excessive minerals
499. constitutional precocious puberty in girls is tall and
march of event is same
500. isolated thelarche, menarche, pubarche-----average
for age
501. the commonest adrenocortical tumor is carcinoma
502. ovarian tumour causes more vaginal bleeding with
minimal breast changes and pubic hair
503. precocious puberty in girls is constitutional, in boys
organic
504. if penis fully developed and testes post pubertal, the
cause is intracranial
505. if penis fully developed but testes prepubertal, the
cause is adrenal
506. commonest cause of delayed puberty in girls is
familial
507. no secondary sexual characteristic+ dysmorphism+
dwarf girl= turner syndrome
508. no secondary sexual characteristics+long arms and
legs+normal body proportions=pituitary dwarfism
509. normal secondary sexual characteristics+ no
menstruation= absence of vagina, uterus, hematocolpos
510. the commonest cause of delayed puberty in boys is
constitutional
511. thin boys-late puberty, obese boys-early puberty
512. small testes+normal penis+no family history
=Klinefelter syndrome
513. vaginal bleeding is common between the age of 5-
10days of life
514. vaginal discharge in 1st few days of life is normal
515. after infancy clear mucoid vaginal discharge is
normal should be ignored until purulent
516. oral thrush+vaginal discharge=vaginal candidiasis
517. the most important feature precipitating thrush is
previous antibiotic therapy
518. regular mensural cycle is established after 40
periods before that 6 month interval may occur between
periods
519. tongue tie does not cause delayed speech
520. cow milk contains 4 times more calcium than
breast milk
521. there is no harm in keeping baby off the breast for
12-24 hrs if mother is tired
522. if baby stops crying when picked up he is not hungry
523. ill and premature babies should be fed on rigid
schedule since they do not demand
524. most babies obtain nearly all the milk in first 8
minutes of breast feeding
525. weaning is normally completed by 9 months
526. most effective feed is in the morning
527. rumination occurs after 3 months
528. true constipation in breast fed babies is due to
underfeeding
529. rickets and cretinism can cause constipation
530. gastroenteritis is practically confined to artificially
fed babies
531. fresh cow milk should be boiled till 6 month of age
532. evaporated milk should be stored in refrigerator
533. true constipation in bottle fed babies is due to
underfeeding/over-clothing
534. underfeeding arises from feeding the baby by actual
weight rather than expected weight
535. no baby should have bottle after 12 months of age
536. larger child matures early and small child late,
eventually both are equal.
537. head of premature baby and malnourished child
appear larger for the body
538. normally head circumference is greater than chest
circumference till 6 months of age
539. unusually small or large head is usually nothing but
a familial feature
540. larger babies have larger head and small babies
have smaller head
541.effect of moulding disappear after 2-3 days, there
after HC is reliable
542. the microcephalic head tapes towards the vertex
and has sloping forehead
543. plagiocephaly corrects itself shortly after 1st
birthday
544. anterior fontanelle is small at birth and enlarges
considerably during the 1st 2 months after that it
decreases
545. early closure of anterior fontanelle (4-5month) may
be on entirely normal variation
posterior fontanelle is closed by 2 months to palpation
546. sunset sign is seen in normal infants, so not enough
to diagnose hydrocephalus
547. caput succedenum disappears by 2-3 days
(exudation of serous fluids)
548. cephalhematoma: should not be diagnosed as
depressed fracture.does not occur in premature,
subsides 3-4 wks. very large may take 3 months
549. occipital cephalhematoma has to be differentiated
from occipital encephalocele
550. craniotabes may be normal in first born in vertex
presentation
551. as a milestone of development, teething is useless
552. teething produces nothing but teeth
553. the premature loss of deciduous teeth due to caries
is major cause of malocclusion
554. alveolar frenulum is treated at 11 years or later
555. tongue tie should be treated at 2-3 years of age if
child is unable to lick his upper lip and there is midline
depression
556. uniformed white tongue is normal in newborn unlike
the discrete areas of candida
557. black tongue is normal and due to overgrowth of
tongue papillae
558. geographic tongue :small round grey areas
coalescing . related to seborrheic dermatitis
559. tonsils are quite large by 3-4 years of age become
smaller by 7 years.no operation
560. adenoids should be removed as soon as they cause
symptoms
561. halitosis: well child = FB nose ,ill child = tonsillitis,
diphtheria
562. chronic halitosis: bronchiectasis, pulmonary
abscess, atrophic rhinitis
563. mentally normal child control their saliva by 15
months
564. sucking pads are normal in first few weeks of life
565. epithelial pearls and epstein pearls are normal
566. ammoniacal dermatitis spares the creases. Treat
with zinc oxide
567. spider nevai are common in older children and
disappear
568. Mongolian spots disappear in 2-3years
569. the falling of hair in newborn after 2-3 wks is normal
570. umbilical cord usually separates by 5-9 days
571. 93% umbilical hernia correct themselves by 1st
year, the rest by 5years of age, its a non-surgical
condition
572. Divarication of recti cures itself when child grows
older
573. congenital dermal sinus: operate if above the natal
cleft. those in the natal cleft are operated if deep
574. breast of babies of both genders enlarges after 2-3
days after birth(not in premature)
575. 99% of full term babies and 50% of premature
secretes milk on 2nd, 3rd and 4th day of life, continues
till 3rd month of life
576. enlargement of external genitalia is equally
common in both genders in the neonatal period ,subsides
in 1 month.
577. erection of penis is seen in babies with cold hands
578. the commonest cause of undescended testis is cold
hands
579. complete undescended testes may be Klinefelter,
testicular dysgenesis, pituitary dwarfism and
pseudohermaphrodism
580. In later infancy the most likely cause of anaemia
between 6-12 months is prematurity.
581. From then months onwards nutritional anaemia is
most common due to poor diet.
582. The second most important cause of anaemia in
neonates is bleeding from placental vessels.
583. gynaecomastia occurs in 50% of boys between 10-
16 years, resolves in 3 years
584. girls have adult looking breasts in SMR 3&5
585. SMR 2-5 lasts about 3-5 yeas in both sexes
586. menarche in SMR 3 or 4 presents within 2years of
onset of puberty
587. investigate amenorrhea only after 2 years of
completion of puberty
588. when menses start girls are at 2.5-5cm of adult
height
589. early puberty =short adult height
590. girls are TAMER than boys
T=thelarche
A=adrenarche
MER=menarchi
591. boys "TAP HER”
T=testicular enlargement
A=adrenarche
P=penile enlargement
HER=height
592. oestrogen causes breast enlargement
593. androgen causes pubic hair growth
594. girls with breast development and no pubic
hair=testicular feminisation
595. girls with pubic hair and no breast development
=increase androgen and decrease oestrogen
596. girls with no breast development and no pubic hair
and no menarche=turner syndrome
597. breast masses in girls are mostly benign. ultrasound
is the only test used for evaluation.no mammography, no
excision and biopsy required.
598. fibrocystic disease: most common, bilateral, tender.
Treat with OCP
599. fibroadenoma:unilateral, refer if persists beyond 3
cycles
600. in precocious puberty, rule out testicular and
ovarian tumours by palpation, ultrasound and serum LH
and FSH level
601. premature adrenarche is common in girls and
brought earlier to notice.
602. CAH more likely than adrenal tumours
603. premature thelarche: <8years unilateral or bilateral.
growth normal. reassure its benign
604. delayed puberty is more common in girls
605. prolactinomas should be in differential of every
patient with delayed puberty
606. CDGP:bone age <chronological age, bone age = HT
age.
607. In hypogonadotrophic ovarian failure ,consider poor
nutrition or eating disorder
608. kalman syndrome:all midline structures, nose,
pitting, penis, optic chiasma, hypogonadotrophic
hypogonadism+anosmia
609. hypergonadotrophic ovarian failure =turner
syndrome
610. 2 year delay between bone age and chronological
age is normal
611. familial short stature: birth length normal, bone
age=chronological age ,proportionate HT and wt
612. if child parents were malnourished, then mid
parental Ht is of no use in familial short stature
613. short stature+ micropenis+ hypoglycaemic fits=GH
deficiency
614. congenital GH deficiency=wt>Ht+delayed bone
age+short stature (decelerated growth rate)
615. acquired GH deficiency=normal bone age
616. if there is one pituitary hormone deficiency search
for others(FLAT PIG)
617. short+overweight+delayed bone age+ constipation+
dry skin=hypothyroidism
618. CAH: precocious puberty+accelerated
growth+Addison like picture
619. nutritional short stature:bone age=chronological
age, HT<wt,
620. gynaecomastia+small testis+long arms and
legs=Klinefelter syndrome
621. if with superior subluxation of lens its Marfan
syndrome
622. arm span > height= Marfan syndrome
623. overweight+ tall+ advanced bone age= simple
obesity
624. overweight+ short+ delayed bone age= endocrine
cause
625. obesity is risk for SCFE.
626. if patient is tall ,its not Cushing
627. microcephaly+dysmorphism=chromosomal
abnormality
628. HC+HT spared+wt falls off=caloric insufficiency
629. quick drop in weight +no drop in height consider
workup for celiac and other malabsorption syndrome,
renal or metabolic disorder
630 ht+ wt falling+ HC spared=endocrine cause
631. primary craniosynostosis=normal benign imaging
632. secondary craniosynostosis= abnormal brain
imaging
633. amenorrhea: rule out pregnancy, anatomic
obstruction and malformation
634. LH—-progesterone, FSH——oestrogen——breast
635. hypothyroidism causes increases prolactin level
636. 14-15+no breast+no menses=work up
637. 16-17 yrs+breast development+no menses=workup
638. workup means:first HCG then LH, FSH, TSH, PRL ,
(if signs of androgenisation) + testosterone+DHEA
639. delayed puberty+dec LH+dec FSH+inc exercise=
exercise induced amenorrhea
640. breast development+no hair growth+no menses=
testicular feminisation syndrome
641. low HR+hypothyroidism+orthostatic
hypotension+no menses=anorexia nervosa
642. acne+ NO menses+ hirsutism+ insulin resistance+
LH:FSH ratio>2= polycystic ovarian syndrome
643. mood disorder+somatic component 5days before
menstruation=premenstrual syndrome
644. dysmenorrhea does not have mood disorder
645. the younger the patient severe the depression
646. Marijuana can cause galactorrhea
647. don't do pap smear in STD and menses because it
will give false +ve result
648. most common STD is HPV
649. when using anabolic steroids girls look and sound
like boys and vice versa
650. prolong QT and ST depression in anorexia
651. refeeding syndrome: enamel erosion+irregular
menses+hypokalemic hypochloremic metabolic
alkalosis+inc amylase with fits, delirium+dec Mg+dec
Po4+ rhabdomyolysis
652. any painless testicular mass is cancer until proved
otherwise
653. hydroceles are painless, consider surgery after 1
year
654. spermatocele are painless and don't change with
position
655. varicocele are painless
656. inguinal hernia are painful and changes with
position
657. cremasteric reflex absent+pain on elevation of
testis is testicular torsion
658. blue dot sign+ painful= torsion of appendicular
testis
659. dysuria+frequency+fever+no discharge+unilateral
pain= epididymitis
660. unilateral pain+fever+no discharge+no
dysuria=orchitis
661. orchitis+testicular atrophy=cancer risk
662. orchitis+bilateral pain=infertility
663. age<3years+phimosis=balanitis
664. If TSH normal, no problem with thyroid. best screen
665. babies normal at birth because thyroxin crosses the
placenta
666. inc TSH+ dec T4+painless firm goitre+
antithyroglobulins= Hashimoto thyroiditis
667. if thyroxin not started till 4 wks then congenital
delay
668. thyroid nodules in kids are usually malignant
669. radioactive iodine uptake is high in Graves and low
in Hashimoto
670. PTU should not be the first line agent because of
toxicity
671. hyperactivity+ disorganised thinking+trouble
sleeping=hyperthyroidism
672. neonatal thyrotoxicosis occurs in <10% of babies of
Graves disease mother
673. inborn error of metabolism symptoms does not
occur in immediate neonatal period but symptoms of
graves do
674. polyuria+ short QT=hypercalcemia
675. Bones+Stones+Abdominal Groans+Psychiatric
Moans =Hyperparathyroidism
676. hypocalcemic seizures do not respond to
benzodiazepines
677. the most common human renal stones are calcium
oxalate stones
678. acidosis+ ca oxalate crystals in urine= ethylene
glycol poisoning
679. vit D deficiency risk groups
A. breast fed with no supplementation of vit D
B. breast fed with no exposure to light
C. malabsorption
D. anti-epileptic drugs
680. there is no single lab pattern for rickets
681. normal calcium+ low Po4+normal 25-OH vit D3+
normal PTH=familial hypophosphatemic rickets
682. low calcium+ low Po4+ inc PTH= severe vit D
deficiency
683. low ca+normal Po4= healing stage of deficiency
rickets
684. low ca+ inc Po4+ low PTH= hypoparathyroidism/
phosphorus overload/ pseudohypoparathyroidism
685. normal ca + inc Po4= renal disease/GH excess
686. treat with all 3(vit D, Po4, ca) when dealing with
rickets of prematurity
687. Cushing disease=central cause, Cushing
syndrome=peripheral cause
688. Cushing is never tall
689. tall+obese+stretch marks=high caloric intake
690. patient with Addison may have elevated ADH ,they
should not be diagnosed as SIADH
691. vomiting+ dec Na+ inc K= addison disease
692. secondary adrenal insufficiency has normal K and
Na, has midline defects
693. maintenance therapy for adrenal insufficiency does
not include fludrocortisone
694. if 17-OH progesterone level raised but physical
examination normal, then repeat 17-OH progesterone
695. if family history +ve for CAH, get gene testing done
on foetal cells
696. boys with CAH often do not present at birth, so
screening is important
697. late CAH can present with precocious puberty
698. if parents carrier, oral dexamethasone should be
given until sex of baby is determined, if male stop and if
female continue
699. ambiguous genitalia+hypertension+normal
sodium=11 hydroxylase deficiency(non-salt wasting type
700.ambiguous genitalia+ hypertension+ hypokalaemia+
metabolic alkalosis=17-OH deficiency
701. micropenis: <2cm testes present
A. hypopitutrism
B. GH deficiency
C. kallman syndrome
D. prader willi syndrome
701.maternal aunt sterile then its testicular feminisation
702. no female internal structures present in testicular
feminisation
703. no hair, no menses, normal breasts=testicular
feminisation
704. normal penis/testis+ rudimentary uterus and
fallopian tubes= MIH deficiency
705. ovarian failure is indicated by high FSH. top 2
reasons are turner and autoimmune
706. Klinefelter have low upper to lower segment ratio
and low IQ
707. HBA1C of 8 in kids is acceptable in paediatrics
>9 in bad
708. DKA has pseudohyponatremia
709. acanthosis nigricans is not part of definition of
metabolic syndrome
710. low HDL, high triglycerides+ normal glucose=
acanthosis nigricans
711. central obesity+ inc BD+ low HDL+ high
triglyceride+ FBS>100= metabolic syndrome
712. gestational diabetes is not associated with
congenital abnormality
713. a baby born to GBS +ve mother should be watched
in hospital for 48 hrs
714. AFP is raised in conditions causing broken skin
715. CVS should not be done for neural tube defects
716. amniocentesis can identify neural tube defects via
raised AFP
717. Quadruple screen:dec AFP, dec estriol, inc HCG, inc
inhibin
718. for women trying to conceive 4mg of folic acid, if
not 0.4mg/day
719. adolescent patient+ arthritis+ smelly greenish
discharge= gonorrhoea
720. pegged teeth are found in congenital syphilis and
incontinentia pigmenti
721. consider lyme disease if FTA positive but VDRL
negative
722. tzank smear is not specific for HSV ,do PCR
723. treat vaginal adhesions only if causing dysuria with
oestrogen ointment
724. food allergies occur within 2 hours after exposure
725. abdominal pain may be only sign of anaphylaxis in
food allergies
726. allergies to eggs , milk, soya will be outgrown by 5
years of age.
727. breast milk or hypoallergenic formula may delay the
onset of eczema
728. treat milk allergy with casein hydrolysate formula
not soya
729. protein induced enterocolitis resolves once GI tract
matures
730. best test for protein enterocolitis is flexible
sigmoidoscopy
731. protein enterocolitis is bloody and treated with
hydrolysate formula or amino acid formula
732. lactose intolerance is a disease of <5 years
733. hydrogen breath test is for lactose deficiency and
bacterial overgrowth
734. soya milk is the treatment for lactose intolerance ,
it contains sucrose instead of lactose
735. causes of seizures in TBM
A. raised ICP
B. electrolyte imbalance
C. Infarction
D. febrile convulsion
E. Tuberculoma
F. vasculitis
G. SIADH
H. INH therapy
736. causes of hemiplegia in TBM
A. vasculitis
B. basal exudates in sylvian fissure entrapping MCA
C. lacunar infarcts in internal capsule
D. calcification
E. tuberculoma
F. edema
737. BABY BORN TO MOTHER WITH TB
A. breast feeding to be continued
B. BCG at birth
C. if chest X ray normal, then give 6HR
D. if chestX ray abnormal then 2HRZ+4HR
E. congenital TB 2HR+7HR
738. causes of negative mountoux in TB:
A. malnutrition, TBM, miliary TB
B. viral: measles, mumps, chicken pox
C. immune-compromised: HIV, malignancy, drugs
D. CRF, young infants ,stress due to surgery, burns
739. Causes of vomiting in TBM
A. drug induced hepatitis(hepatomegaly and elevated
liver transaminase)
B. inc ICP secondary to ICP associated with spasticity,
garbled speech, brisk deep tendon reflexes, and
papilledema on fundoscopy
C. gastritis due to steroids associated with epigastric
pain
D. metabolic decompensation due to carbonic anhydrase
inhibitor(due to metabolic acidosis)
740. poor prognostic factor in TBM
A. age < 2years
B. malnutrition
C. HIV
D. altered sensorium/seizure
E. residual neurological deficit
F. inadequate treatment
G. complication like hydrocephalus
741. poor prognostic factors in APM
A. age <6month
B. 10*6 CFU in CSF
C. coma
D. seizure upto 7days
742. D/d of frontal bossing
A. Rickets
B. Thalassaemia major
C. Achondroplasia
D. Hurler syndrome
E. Ectodermal dysplasia
F. Ehler danlos syndrome
743. Causes of papilledema
A. Inc ICP ---- tumor, abscess
B. Hydrocephalus
C. Benign intracranial HTN
D. Faster kennedy syndrome optic atrophy due to
frontal lobe tumor
744. D/d of blue sclera
A. Normal variant
B. Osteogenesis imperfecta
C. Glaucoma
D. Ehler danlos syndrome
E. Marfan syndrome
745. D/d of sunset sign
A. Hydrocephalus
B. Kernicterus
C. Loran dwarfism
746. D/d of cataract
A. Prematurity
B. Trisomy 13,18,21
C. Rubella
D. Metabolic: glactosemia, diabetes, hypothyroidism,
Wilson, MPS
747. D/d of white eye reflex
A. Retinoblastoma
B. Retinal detachment
C. Retinopathy of prematurity
D. Cataract
E. Persistent hyperplastic vitreous
748. Hypertelorism >0.38
A. Racial
B. Down syndrome
C. Noonan syndrome
D. Turner syndrome
E. Ehler danlos syndrome
F. Cretinism
749. Hepatic rickets is unusual in paediatrics
750. Causes of refractory rickets
A. Ca deficiency(inc pth)
B. Vit d dependent rickets
C. CRF
D. Distal RTA
751. Po4 deficiency(normal PTH)
A. Familial hypophosphatemic rickets
B. Proximal RTA
C. Fanconi syndrome
752. Sequence of changes in rickets
A. Increase ALP
B. Dec po4
C. Dec ca
D. Radiological changes----- ulna
753. Vit d3 levels
A. Dec 25 oh and 1,25 oh vit d3-----nutritional rickets
B. Dec 25 oh vit d3-------hepatic cause
C. Dec 1-0h vit d3-------renal cause
754. Rickets with mental retardation
A. Lowe syndrome
B. Cystinuria
C. Galactosemia
D. Tyrosinemia
E. Wilson
F. Fructose intolerance
755. Delayed closure of sutures
A. Rickets
B. Cretinism
C. Hydrocephalus
756. Pigeon shaped chest
A. Skeletal dysplasia
B. Congenital
C. Emphysema
D. Mucopolysaccharidosis
E. Marfan
F. Noonan
757. Scoliosis
A. Normal vertebra on x ray
B. Poliomyelitis
C. Idiopathic in females on puberty
D. Muscular dystrophy
E. Cerebral palsy
758. Abnormal vertebra on x ray
A. Congenital
B. Hemivertebra with cardiac and renal malformations
C. Acquired
D. Kochs spine
E. Mucopolysaccharidosis
F. Spondyloepiphyseal disease
759. Hemihypertrophy
A. Idiopathic
B. Beckwith wiedmann
C. Wilms
D. Neurofibromatosis
E. Adrenocortical carcinoma
F. Lymphedema
G. Russel silver
760. Macro orchidism
A. Fragile x
B. Sexual precocity
C. Hypothyroidism
D. Testicular tumour
761. Micropenis
A. Hypogonadotrophic hypogonadism
B. Klinefelter
C. Down
D. Cornelia de lange
E. Hypopitutrism
F. Charge association
G. X linked hypogonadism
762. Cafe au lait spots
A. Neurofibromatosis
B. Tuberous sclerosis
C. Mc cune albright
D. Ataxia telangiectasia
E. Gaucher disease
F. Chediak highashi
G. Fanconi anemia
763. Micro orchidism
A. Hypopitutrism
B. Hypothalamic disease
C. Rudimentary testis syndrome
D. Klinefelter syndrome
E. Lawrence moon biedl
764. Neck rigidity
A. Meningitis
B. Sub arachnoid haemorrhage
C. Meningism
D. SOL
765. Short neck
A. Down
B. Hypothyroidism
C. Hurler
D. Klippel feil
E. Springel
F. Turner
G. Noonan
766. Oral thrush
A. Steroids
B. Antibiotics
C. Fungal
D. Hyperparathyroidism
E. Aids
767. Trismus
A. Tetanus
B. Encephalitis
C. Tumour of jaw
D. Infantile gaucher disease
E. Metochlopramide
768. Delayed dentition
A. Constitutional delay
B. PCM
C. Rickets
D. Hypothyroidism
E. Hypopitutrism
Gum hyperplasia
A. Phenytoin
B. Scurvy
C. AML
D. Hurler
E. Epulis
F. Histiocytosis x
G. Diffuse fibromatosis
769. Macroglossia
A. Cretinism
B. Down
C. Pompe
D. Hurler
E. Generalised gangliosidosis
F. Growth on tongue
G. DMD
770. Micrognathia
A. Pierre robin
B. Cri du chat
C. Fetal alcohol
D. Rubinstein tabai
E. Trisomy 13, 18
F. Teacher Collin
G. Pyknodystosis
771. Low set ears
A. Down
B. Potter
C. Turner
D. Trisomy 18, 13
E. Teacher collin
F. Cri du chat
G. Apert
772. Acute headache
A. Sol
B. Hypertension
C. ICH
D. Head injury
773. Recurrent headache
A. Tension headache
B. Migraine
C. Refractive error
D. Sol
E. Poisoning
F. Hypertension
G. Seizure
774. The only muscular disorder that is extremely painful
is myoglobinuria
775. Involvement of corpus striatum causes a specific
hammer shape of big toe
776. For portal hypertension
A. LFT, PT, viral screening
B. U/s abdomen(portal vein pressure >15mm)/colour
doppler
C. Presence of collaterals
D. direction of blood flow
777. Suspect immune deficiency
A. FTT
B. Persistent cough
C. Candidial infection
D. Absolute lymphocyte count <2000/mm3
778. Bilious vomiting in every infant consider malrotation
until proved otherwise
779. Intussusception is most common abdominal
emergency in less than 2 years of age.
780. Failure to pass meconium in first 48hrs should be
considered abnormal until proved otherwise
781. Contraindication to both bottle and breast feeding
A. R/r>80breath/mint
B. Poor suck and swallow
C. absent gag reflex
D. Sepsis or asphyxia
782. Consider G6PD if there is history of severe
hyperbilirubinemia not responding to phototherapy
783. Breast feeding jaundice; occur in first 2-4days of life
784. Breast milk jaundice; by the end of 1st week and
persist for few week
785. Maternal hepatitis b and c infections are not
contraindications for breast feeding
786. 50% patients have visible jaundice in 1st few days
of life, jaundice in first 24hrs of life is pathological until
proved otherwise
787. Pt with chronic hepatitis b &c often
A. No clinical symptoms
B. Never been jaundiced
C. Normal laboratory data
788. Hep c consider all patients for treatment , Hep b
treat only when liver function is deranged
789. In hematemesis blood is brown with low ph.
790. Rh incompatibility require prior sensitisation so
does not happen in 1st born child while ABO
incompatibility can cause jaundice in 1st born child
791. Blood pressure in paediatrics
A. Normal <90th centile
B. Prehypertensive 90th -<95th centile
C. Stage 1 HTN 95th-99th centiles +5 mm hg
D. Stage 2 HTN >99th centiles
792. Radiographic appearance of CHD
A. TOF boot shape heart
B. TGA egg on side/egg on string
C. TAPVD snowman appearance
D. Epstein anomaly wall to wall heart
793. ASD, VSD, TAPVD cause recurrent chest infections
due to increased blood flow.
794. If bleeding into cephalhematoma is excessive,
haemophilia should be considered.
795. Hiatus hernia is an important cause of bleeding and
anaemia in the face of vomiting.
796. Aspirin, if frequently used can cause severe
anaemia.
797. Hereditary spherocytosis causes unexplained
anaemia or acholuric jaundice.
798.HUS is common in the first four years.
799. Rickets is always associated with hypo chromic
microcytic anaemia.
800. Scurvy still occurs in children who are unable to
chew
801. Sepsis causes anaemia in neonates—— always
examine umbilicus.
802. In older children low grade infection eg
pyelonephritis or tuberculosis can cause anaemia.
Many cases of hypoplastic or aplastic anaemia prove
eventually to be due to leukaemia.
803. Baby whose mother has ITP will have purpura for
unto 12 weeks and then they recover.
804. Always consider sepsis in newborn purpura.
805. HSP is more common in boys then girls.
806.In HSP, face is usually spared , except in infants.
807. It would b a disaster to diagnose HSP when the child
had infant meaningococemia.
808. The possibility of uraemia should be remembered in
an ill child with unexplained purpura at any age including
infancy.
809. Purpura may occur in combination with measles,
chicken pox, rubella.
810. Most normal babies lack control of flow of saliva
until 12 months of age.
811. Teething causes increase in salivation.
812. In some normal children drooling continues for
some years without reason. These children are usually
mouth breathers.
813. Stomatitis is one cause for drooling.
814. The commonest cause of poor appetite, other than
cute infection is food forcing.
815. Average weight is not the same as normal weight.
The weight remains excessive even when appetite has
returned to normal in obese children.
816. Fat children are tall for their age, but eventual height
is less then average
817. Puberty occurs at usual time for fat boys but penis
may appear small.
818. Subclinical hepatitis should always be considered
when there is nausea and lassitude of recent onset.
819.UTI may present with vague unwellness and nausea.
820. If the vomitus is small , the baby is well, feeding well
and gaining weight then it is posseting.
821. Dangerous features in vomiting
A. Persistent vomiting
B. Bilious vomiting
C. Bloody vomiting
D. Drowsiness, failure to suck well, failure to demand
feeds
E. Abdominal distention—- lower GI obstruction. Upper GI
obstruction —- no distention.
F. Failuree to gain weight or loss of weight
G. Dehydration
H. Fever
I. Visible peristalsis
J. Palpable mass
K. Bulging frontella
L. Failure to pass meconium in first 24 hours.
822. The passage of stools in the first 24 hours does not
exclude obstruction
823. Suspect duodenal stenosis when baby vomits
repeatedly without distention
834. Suspect lower GI obstruction when distention
severe but vomiting latter and less profuse
835. In neonatal septicaemia always examine the
umbilicus.
Moist umbilicus is septic umbilicus.
836. The vomitus may be green in severe infection much
like obstruction
837. In young baby drowsiness, loss of appetite, vomiting
are enough to suggest meningitis.
838. In kernicterus , apart from vomiting , there is
pronation of wrist.
839. In boys with CAH , enlargement of penis usually
occurs later
840. In infancy weight determines if vomiting is to be
taken seriously.
841. Blood in vomitus means hiatus hernia or
reflux/Aclasia.
842. The commonest non- organic cause of vomiting is
excessive wind.
843. Vomiting due to over feeding is a hall mark of
preterm babies not term ones.
844. Giving solids before chewing age leads to vomiting.
This is very obvious in the retarded child.
845. Organic cause of vomiting is present with there is
inadequate weight gain, weight loss , blood in vomitus,
ill or febrile.
846. If vomiting occurs after the age of 10 weeks, it is
unlikely to be due t o pyloric stenosis.
847. Winter vomiting; sudden vomiting in a well child
without nausea. The child is afebrile and vomiting occurs
at night.
848. In older children, vertigo and headache also occur
in winter vomiting.
849. Constipation occurs in undiluted cows milk,
insufficient milk or insufficient sugar.
850. If the baby is mercy bringing small quantities up at
intervals between one feed and the next, pyloric stenosis
can be excluded.
851. Infectious causes of vomiting ; otitis media,
gastroenteritis, UTI, pertussis, meningitis.
853. The whoop in hooping cough appears one to two
weeks after the cough or may not appear at all.
854. If the child is failing to thrive and there are faecal
mass, consider the following
A. Diabetes inspidus
B. Hypercalcemia
C. RTA
D. Salt losing CAH
855. Fully breast fed babies virtually never suffer from
gastroenteritis although their stools may be soft.
856. Starvation stools; loose, green, frequent, small
containing little fecal matter. They are due to gross
deficiency of food intake.
857. Artificially fed babies have diarrhoea due to excess
of sugar in the feed or gastroenteritis.
858. Diarrhoea may develop in association with upper
respiratory tract infections, otitis media. Urinary tract
infection.
859. Toddlers diarrhoea clears after the age of 3 years.
860. Protein losing enteropathy= diarrhoea + edema.
861. Faecal + urinary incontinence is psychological
862. Cons tipation with overflow is not diarrhoea
863. Candida, cardia and salmonella all cause chronic
diarrhoea
864. After the neonatal period , the most common cause
of blood in stools is constipation.
865. Blood in stools + screaming attacks is
intussusception .
866. Chronic intussusception= intermittent abdominal
pain+ blood and mucus in stools.
867. Painless dark red blood is meddles diverticulum.
868. If the crying stops when the infant is picked up, it is
not severe.
869. Headache + neurological signs is not migraine eg
aphasia, paresthesia or weakness of limbs.
870. Normal fundus examination makes an SOL unlikely
although does not rule it out.
The occupy headaches is more likely to be due to organic
lesion than a frontal one.
871. No examination for headaches is complete without
blood pressure recording.
872. Eye strain is unlikely cause for headache.
873. CSOM is unlikely to be a cause for headache.
874. If the child is well between episodes of headache it
is less likely an organic disease .
875. Infantile colic starts within a week or two after
birth.
876. The further the pain is away from the umbilicus , the
more likely will there be an underlying organic disorder.
877.Pleurisy over the right lower lobe region is referred
to right iliac fossa.
878. Truly severe pain is hardly organic in nature.
879. Headache is present in fever of any origin.
880. Tenderness over the defending colon is not
important.
881. Diarrhoea+ severe abdominal pain= appendicitis or
intussusception.
882. Appendicitis is rare under the age of three.
883. Renal colic and cholecystitis is rare in children.
884. HSP is a rare cause of intussusception.
885. Crohn’s disease is rare in children.
886. Torsion of testis commonly occurs in the first year.
887. Intussusception commonly occurs between 5-9
months of age and is rare after 2 years.
888. The pain of hydronephrosis is not always localised
to the loins.
889. Abdominal epilepsy; sleep after attacks of sudden
onset of abdominal pain.
890. Crying is a cause of abdominal distention in infants
due to air swallowing.
891. Jaundice after day 4 of life is caused by infection.
892. Physiological jaundice does not last into the second
week.
893. Corticosteroids given to the mother may increase
the depth of jaundice.
894. Jaundice is sometime an early feature of CAH.
895. ABO incompatibility jaundice may occur in first
pregnancy.
896. Cephalhematoma results in jaundice due to
absorption of blood.
897. Jaundice after infancy is infective.
898. Severe chest disease is unlikely to cause cyanosis ,
the exception being a acute illness
899. Cyanosis without cause is methemaglobinemia.
900. In older child , the likely cause of persistent
cyanosis is cyanotic heart disease , pulmonary
hypertension ion or severe pulmonary fibrosis.
901. In newborn, cyanotic attacks are common during
feeding because of milk entering the trachea.
902. Cerebral edema, subdural or cerebral haemorrhage
or serious congenital brain defects may cause apnea.
903. Obstruction of airways is the major cause of
apneiac attacks.
904. Many cyanotic attacks are convulsions in newborns.
905. Peripheral cyanosis is normal in newborns.
906. In newborns, congenital heart disease rarely
causes cyanotic attacks.
907. The most important cause of dyspnea in newborns
is RDS.
908. Meconium aspirated babies are usually shocked due
to anoxia.
909. Epistaxis occurs in whooping cough, measles, URTI.
910. Halitosis occurs in acute tonsillitis, diphtheria,
foreign body.
911. Snuffles is clear mucoid nasal dischargee in first
few weeks of life. Cures itself.
912. Sneezing is normal in the newborn.
913. If the child is never free of nasal discharge, then it
is allergic rhinitis.
914. Cough is an unusual symptom in the newborn.
915. After neonatal life the usual cause of infection is
viral infection.
916. A cough which is worse at night and which
repeatedly makes the child sick is whooping cough until
proved otherwise.
917. Typical whoop not heard if attack is mild, in partial
vaccination and in the first two months.
918. Post nasal discharge causes cough at night when
the child lies down.
919. Failure of recovery at the end of acute respiratory
infection is due to incomplete resolved pneumonia.
920. There is no cough in pulmonary tuberculosis
without bronchial obstruction.
921. Persistent rattling is an early sign of ashma.
922. Asthmatic bronchitis ceases to respond to cold by
wheezing by five years of age, while asthmatic child
does.
923. The absence of wheeze usually rules out asthma as
does absence of prevues attacks
924. An elevated temperature is in favour of bronchiolitis
rather than asthma.
925. A purely inspiratory stridor is benign compared to
expiratory or both inspiratory and expiratory stridor.
926. Entirely inspiratory stridor= supraglottic, expiratory
= trachea
927. If hoarseness or weakness of force, the stridor is
glottic.
928. Normal voice with stridor is supraglottic or tracheal
930. Laryngomalacia; shortly after birth, worse till 6 m,
disappears by age 24 months.
931. Babies with laryngomalacia are more likely to have
regurgitation and choking.
932. Both microganthima and macroglossia have stridor.
933. Stridor in hydrocephalus is due to stretching of vagi
in Arnold chair Malformation.
934. Tracheal stridor is expiratory.
935. Opisthotonus may occur in face presentations but
muscle tone is normal.
936. If there is hoarseness it is crowd, which is absent
in asthma.
937. Stich is cramp like pain on one side of lower part of
chest, occurring on exertion after a meal.
938. Hemoptysis occurs very rarely in primary
tuberculosis although it may occur in adult type of
tuberculosis in older child .
939.Anticonvulsant hypersensitivity syndrome due to
carbamazipene, phenytoin, phenobarbital= Fever + Rash
+ lymphadinopathy + visceral involvement
940. Cefalor, amoxicillin, antivenom causes serum
sickness =Fever, rash, polyarthritis+ nephritis.
941. 11 months old with ANC of 1050 is not neutropenic.
942. Tonsils are present in Hyper IgM but absent in
Bruton’s and SCID.
943. T Cell defect = recurrent viral / fungal and bacterial.
945. Combined deficiency = chronic or recurrent
candida.
946. T cell defect increased risk of lymphoma / cancer as
they age.
947. If PPD is negative, then consider further testing
(candida, tetanus).
948. SCID = Small thymus present around 3 months.
949. Pure B cell deficiency after 6 months.
950. PC Pneumonia = Consider SCID and HIV
951. If Thymus is present BMC can be done.
952. Both SCID and WAS have no lymph nodes.
953. Lymphopenia = Combined or T cell defect
953. Wiskott Aldrich = ↑ IgM, ↓IgA
954. Digeorge Syndrome = Has no thymus so No BMT
possible
955. Velocardiofacial Syndrome present only in some
patients of Digeorge
956. Velo (cleft uvula/palate)cardio (VSD, TOF, TA,
Interrupted aorticarch )Facial (narrow upper lip, broad
nose, unusual palpebral fissure).
957. No live vaccines in SCID and Digeorge.
958. Ataxia - telangiectasia = Recurrent Pneumonia /
Sinusitis + ↑AFP + mainly neurologic symptoms in
childhood.
959. Common variable immune deficiency. Deficiency of
all immunoglobulins + some T-cell defect.
960. Encapsulated organism = common in Bruton and
Sickle cell. S. pneumonia, N meningitis, H influenza,
Klebsiella, Salmonella, Pareugenosa, cyptococcus
neoformans. Total six.
961. Hyper IgM Syndrome = 6 Months of age,
Neutropenia, lymphocytosis, Apart from IgM, all other immunoglobulins
short.
962. HIV negative patient + PCP = Hyper IgM.
963. Bruton’s: - No tonsils and lymph nodes
964. PCP: SCID or Hyper IgM never Bruton.
965. 80% of patients with isolated IgA deficiency are asymptomatic.
966. Hyper - IgE Syndrome = Eczema + Eosinophils + high IgE + delayed
dentation + coarse facies pneumatoceles and recurrent cold abscess
should alter one to Hyper IgE.
967. If CH-50 normal, than all complement pathways normal.
968. C1-4 deficiency presents like Bruton agammaglobulinemia.
969. C5-9 deficiency. Both N. Meningitis and N. gonorrhea common.
970. C-1 esterase deficiency patient don't have pruritis.
971. Recurrent swelling + Abdominal pain = Hereditary Angioedema.
972. Low complement levels.
a) Past streptococal GN b) SLE c) Cryoglobinemia d) Hepatitis C e)
Membranoproliferative GN f) Multiple Myeloma g) Leukemia h)
Lymphoma
973.Normal complement levels. a) Henoch-Scholein purpura b) IgA
nephropathy c) Haemolytic uremic syndrome d) Rapidly progressive
GN.
974. Neutropenia is always associated with mucosal ulcerations.
975. Chronic benign neutropenia cures by 2 years of age.
976. Cyclic Neutropenia = Prone to clostridium perfringens + anal lesions
(ulcerations / periodontitis)
977. Chronic granulomatous deficiency = No lymphopenia + No neutropenia
+ catalase positive organisms (Staph Ecoli, Serretia - Aspergillous,
candida) + Liver abscess / osteomylitis / recurrent skin +
lymphadenitis).
978. CGD present at 5 years.
979. Leukocyte adhesion defect = Infected umbilical cord without pus +
delayed separation of cord + delayed wound healing.
980. LAD die by 1 year if BMT not done.
981. Abcesses in chronic granulomatous, LAD, Hyper Ig.
983. Chediak - Higashi Syndrome = Oculocutaneous albinism + skin / lung
infections
984. Neotropenia + large neutrophils granules = chediak Higashi.
985. Neutropenia + Lymphocytosis =Hyper IgM
986. Shwachman - Diamond is differentiated from cystic fibrosis by
pancytopenia / Neutropenia.
987. Diamond blackfan = 3 Months + macrocytic anemia + triphalangeal
thumb.
988. If anemia +ve + jaundice then it can't be diamond blackfan.
989. B cell deficiencies present at 6 Month because of presence of maternal
antibodies.
990. If premature ventricular contractions are monomorphic and diminish
with exercise = Benign
991. β-Blocks, verapamil, digoxin are contraindicted in WPW. Use
procrainamide.
992. Atrial tachycardias do not respond to adenosine or vagal maneuver.
993. Prolong QT= Melt Pc (↓Mg, Erythromycin, Levofloxacin, TCA, ↓K,
↓Ca).
994. In 3rd degree heart Block the child is bradycardic except when crying .
995. A shunt of less than 2:1 is not a contraindication to getting pregnant in
ASD
996. ASD are more common in Trisomy 18 or 21 than VSD.
997. Operate VSD when there is pulmonary hypertension, Failure to thrive
and a shunt > 2:1
998. AV canal defect is strongly associated with down and digeorge.
999. Stenosis murmur heard in middle of cycle
1000. Regurgitation murmurs at the beginning of cycle except a) AR b) MVP
1001.Pulmonary stenosis does not progress and does not cause sudden
death.
1002. Mitral regurgitation is associated with Marfan and Ehlers Danlos
Syndrome.
1003. Murmur of MVP & HOCM both increase with standing and decrease
with squatting.
1004. Hand grip increase the MVP murmur and diminishes HOCM murmur.
1005. Austin flint murmur is caused by AR.
1006. Still murmur diminishes with standing.
1007. Venous hum decreases with supine.
1008. Wide pulse pressure in AR and PDA.
1009. Carotid bruit are benign in children.
1010. Paradoxical split of S2 occurs in LBBB and Aortic stenosis.
1011. Right leg pulse weaker then right arm=Coarctation
1012. Cyanosis is mild in TA
1013. Cyanosis on Day 1 = TGA
1014. Cyanosis occurs within minutes in Tricuspid atresia and pulmonary
atresia.
1015. In persistent fetal circulation there is decreased oxygen saturation in
right leg compared to right arm.
1016. Children with cyanotic congenital heart disease have more
developmental problems than children with acyanotic disease.
1017. Left axis deviation = AV canal defect or Tricuspid atresia.
1018. Order ASOT or Streptozyme in RF because it correlates better with
recent infection. Do not order culture as streptococcal screen.
1019. RF is caused only by streptococal pharyngitis, not skin infections.
1020. In Kawsaki disease ANA is negative and 'Fever of unknown origin' type
of presentation is common.
1021. Life long prophylaxis a) Prior endocarditis b) Prosthetic material used
in value. c) Unrepaired cyanotic congenital heart disease.
1022. 6 Month prophylaxis. a) Any other prosthetic material (Not value)
1023. Pulsus paradoxus is seen in severe asthma, myocarditis, pericardial
effusion with temponade.
1024. Chest pain on lying down is pericarditis.
1025. Early heart failure = obstructive lesions on the left side of heart.
(Critical aortic stenosis, coarctation, hypoplastic left heart ) and Great
vein of Galen.
1026. HOCM is more likely in IDDM and Noonan.
1027. HOCM = septal hypertrophy + pulmonary stenosis.
1028. Cardiomegaly is a normal finding in HOCM while septal hypertrophy is
not.
1029. Kartagener and cystic fibrosis history is similar except for medically
displaced apex beat.
1030. Start BP at 3 years of age.
1031. First non-fasting total cholesterol. If > 170, obtain a fasting LDL.
1032. If LDL > 160 + family History / risk factor OR > 190 start medications.
Before that change life style.
1033. If rash not improving with steroids / Antibiotics, it could be Eczema
herpeticum.
1034. Seborrheic dermatitis is nonpruritic and first 2 months.
1035. Psoriatic each involves the inguinal folds while atopic dermatitis
spaces.
1036. Eczema/seborrheic dermatitis + high urine output = Histiocytosis.
1037. Eczema and contact dermatitis spares inguinal folds.
1038. Pruritic rashes are = scabies, tinea, varicella, eczema, atopic dermatitis.
1039. Pruritis rash on Labia= Lichen sclerosis.
1040. Contact dermatitis needs multiple exposure e.g. Ivy leaf.
1041. Rash + Alopecia + Neuological signs (ataxia, coma) + Lactic acidosis =
Biotinidase deficiency.
1042. Recurrent crops is papular urticaria, even when umbilicated.
1043. Newborn + No eye lashes + eyelids inverted = Lamellar icthyosis.
1044. Nectrotic, blue ulcers = pyoderma gangrenosum.
1045. Neutropenic patient + necoticulcerativelesions + diaper area =Ecthyma
gangrenosum.
1046. Ringworm + No scaling = Granuloma Annulare.
1047. Rash with central clearing = urticaria, Tinea, Erythema marginatum.
1048. Rash with central darkness = STS / TEN, Lyme.
1049. Acne before 8 years = exogenous steroids use, precocious puberty,
tuberous sclerosis.
1050. Apthous ulcers in Bachet disease or schwachman diamond syndrome.
1051. Peg shaped teeth in Incontinentia pigmentosa and hypohidrotic
Ectodermal dysplasia.
1052. Vascular malformations are morbid, homogenous are not.
1053. Hemihypertrophy + portwine stain = Klippel trenaunay syndrome.
1054. Hypertrophy syndromes = Beckwith - Wiedmans Klippel - Trenaunay,
Russel silver, proteus.
1055. Dandy walker and spinal dyraphism have congenital melenocytic
nevus.
1056. Adenoma Sabeceum is misdiagnosed as acne and spares the forehead.
1057. Tubecous sclerosis and neurofibromatosis have high rate of mutation
so family history may be absent.
1058. Delayed dentation in hypohidrotic ectodermal dysplasia and
incontinentia pigmenta.
1059. In SJS/TEN lesions are in the eye and month while in SSSS the lesions
are around the eyes and mouth.
1060. In pityrasis rosea, no lesions on palm and soles as against secondary
syphyllis.
1061. HPV 16 and 18 - cervical
1062. Blue berry muffin is seen in Rubella, CMV, HSV, Privovirus and
coxasachie.
1063. Erythema nodusom = CUTIS ,crohn, UC, Drgs, Infections, steroids.
1064. Unwell baby + cutis marmorata = sepsis.
1065. Zinc deficiency starts after breast feeding over.
1066. Alopecia + Rash + poor taste = Zinc deficiency
1067. Alopecia + scalp dermatitis + thrombocytopenic =
Essential fatty acid deficiency.
1068. In aplasia cutis, look for underlying skull defects, and underlying spinal
dysraphism.
1069. In full term baby, expected weight gain of 20-30gm / day.
1070. In preterm 15-20gms / day weight gain.
1071. In most cases the finding of normal development + Macrocephaly =
Familial.
1072. If development abnormal + macrocephaly = Hydrocehaly.
1073. Bulging frontella = Hydraencephly more likely then macrocephaly.
1074. Papilledema not present in macrocephaly and hydrocephaly
1075. Protein requirement in preterm 3.5g /kg/day. While full term need just
2.5g/kg/day.
1076. Look for Vit D and vitamin K deficiencies in exclusively breast fed
babies.
1077. Breast fed babies 4001U, Rickets 1600IU/day
1088. Supplement with iron at 2 months for preterms and 6 months for
terms.
1089. Whey in breast milk, Caesin in formula milk
1090. Do not give whole milk before 1 year of age.
1091. Corrections in development milestones no longer necessary after 2
years.
1092. Age and weight should be guide to Retinopathy of prematurity need
for oxygen (<32wks<1500gm)
1093. ABO incompatibility can occur in first born.
1094. Apnea of prematurity is not associated with increased risk of sudden
infant death syndrome.
1095. CAH, sepsis, inborn errors, complex congenital heart disease can all
present with shock.
1096. After 4 months, colic needs to be worked up.
1097. Pregnancy associated hypertension is associated with ↓wt, ↓Lt ↑HC.
1098. In respiratory depression due to opiates, use naloxone when actually
given only.
1099. If mother addicted to opiods, naloxone can result in seizures in
newborn.
1100. Renal tublar Acidosis very common reason for failure to thrive.
1101. Delayed umbilical cord separation = Leucocyte adhesion defect OR
leucopenia.
1102. Single Umbilical artery = VACTERL
1103. Hypospadias = SLOB = Silver Russel, Lawrence - Moon Biedle, opitz and
Backwith- Wiedeman syndrome.
1104. In undescended testes, risk of malignancy in both testes even after
operation.
1105. Normal pupil size is 3mm.
1106. Meiosis = COPS = clonidine and cholinergics, opaites and
organophosphous, phenothiazines and pilocapine, sedative and
barbiturates.
1107. Mydriasis = AAAs = Antihistamines, Antidepressant, Anticholinergic
and sympathomimetics (Amphetamine cocaine, phenecycline).
1108. Diaphoresis = ↑ sweating = SOAP = sympathomimetic,
organophosphates, Aspirin, phynecycldine
1109. Nystagmus caused by anticonvulsants, pheneyclidine.
1110. Syrup of Ipecac is no longer recommended
1111. Charcoal = use within one hour of ingestion = AAAAm = Aspiring,
anticholinergics, Acetaminophen and Asthma med (theophylline)
1112. Dont’ use charcoal in MML metals (Iron or lead), liquid (Ethanol,
organophosphates, Acid, Alkalis, cyanide), Lithium
1113. Gastric Lavage within 60 minutes of presentation.
1114. No gastric lavage in hydrocarbon, acid and base.
1115. Use Haloperidol in amphetamine, cocaine, and phencyclidine.
1116. Osmolar gap is very high > 20 in ethylene glycol and calcium oxalate
crystals in urine.
1117. The anion gap is high in all alcohols except in isopropyl Alcohol.
1118. N-acetylcysteinic can be given 1V or PO with 8 hours of ingestion.
1119. Cholinergic = DUMBELLS = Diarrhoea, Urination, Meiosis,
Bronchospasm, emesis, lacrimation, lethargy, salivation.
1120. Anticholinergics = Mad as a halter, blind as a bat, dry as a bone, red as
beet, hot as a hare.
1121. Treat TCA toxicity with sodium bicarbonate alone. Which is also used
in Aspirin toxicity.
1122. Given charcoal even after 1 hour in Aspirin and anticholinergics
poisoning and theophylline.
1123. Obtain Abdominal X-ray at presentation in iron poisoning.
1124. Stages of Iron Toxicity - IRON = Indigestion, Recovery, Cardiovascular
collapse and liver damage, Narrowing of pylorus.
1125. In carbon-monoxide poisoning pulse oximetry is normal.
1126. Cyanide poisoning presentation is similar to CO poisoning.
1127. In Methemaglobinemia. Pulse oximetry is normal.
1128. Chest X-ray is normal at 6 hours of post ingestion of hydrocarbons.
1129. If Acid / base ingestion is suspected, undergo upper GI endoscopy.
1130. Acids are bitter, alkalis are tasteless.
1131. Alkalis injure the oesophagus and are neutralised in stomach.
1132. Acids leave both, oesophageal and stomach burns.
1133. Rabbits, rats and squirrels are not associated with rabies.
1134. Brown recluse cause ulcer while black widow causes pain.
1135. 20% of paediatric burns from abuse.
1136. Near drowning patients die after a asymptomatic period.
1137. The most common cause of death in epileptic patients is drowning.
1138. The patient who crashes or ventilator has DOPE=Displacement,
obstruction, pneumothorax, equipment failure
1139. Pulse oximetry is unreliable in case of impaired perfusion or
hypovolumia, Hypotension is a late finding.
1140. High quality compression are more important then breath in CPR.
1141. Fat soluble vitamins = FAKED.
1142. ↑ ICP (Pseudotumor Cerebri) is caused by excessive Vit A thyroxine,
isotretinoin & tetracycline.
1143. Vit K deficiency is more common in breast fed.
1144. Oral vit K at birth does not prevent Hemorrhagic disease of newborn.
1145. Antibiotics and diarrhoea precipitate late vitamin K deficiency.
1146. Polyuria and polydipsia are caused by vitamin D excess.
1147. 25-OH Vit D3 is good for deficiency but treat like 1, 25 vitamin D3.
1148. Normal Calcium + Low phosphate = X- Linked hypophosphatemic
rickets.
1149. Low Calcium + Low Phosphate = Vitamin D deficiency.
1150. Low Calcium + High phosphorus = hypoparathyroidism, phosphorus
overload.
1151. Normal calcium + high phosphorus = renal disease, growth hormone
excess, high phosphorus diet.
1152. Phototherapy can decrease riboflavin levels, important for premature
hyperbilirubinemia baby.
1153. Hartnup disease has pellagra like rash.
1154. Macroglossia in folate and pyridoxine deficiency.
1155. Bone fractures + bleeding gums = vitamin C deficiency.
1156. Deficiency of both C & D causes nephrolithiasis.
1157. Zinc deficiency can occur after weaning from breast milk.
1158. Crohn’s disease is likely to suffer from zinc-deficiency (in case of
diarrhoea).
1158. Rash + Alopecia + Neurologic signs = Biotin deficiency.
1159. Kinky hair = copper deficiency.
1160. Alopecia + Scaly dermatitis + thrombocytopenia = Essential fatty acids.
1161. Hepatomegaly = 1 cm below costal margin or liver that crosses the
midline.
1162. Gall bladder hydrops = Fasting, HSP, Kwasaki, TPN, Streptococcol,
Pharyngitis.
1163. Hepatoblastoma, 3 years, poor prognosis ↑ AFP.
1164. Ulcerative colitis + ↑ PANCA = Primary sclerosing cholangitis.
1165. PSC = Bilirubin late , GGT early.
1166. HIDA Scan – no gall bladder= Cystic duct obstruction or cholecystitis.
1167. Transaminases – thousands = viral hepatitis, hundreds = viral infection/
enteric.
1168. ALT>AST = Viral hepatitis, AST> ALT = Alcoholic hepatitis.
1169. Alkaline phosphatase ↑ + ↑ GGT= hepatic disease, Alkaline
phosphatase ↑ + Normal GGT = Bone disease.
1170. Billiary obstruction = AST first then alkaline phosphatase.
1171. Hepatic disease + jaundice = hepatocellular if increase transaminases,
Hepatic disease + jaundice = cholestatic if increase Alkaline
phosphatase.
1172. Choledochal cysts = Jaundice + abdominal mass + RUQ pain + nausea,
vomiting.
1173. Progressive familial intrahepatic cholestasis = severe pruritus + Direct
hyperbilirubinemia. GGT levels increased only on Type iii.
1174. Allagille syndrome = Jaundice + Liver + heart (Pulmonary stenosis).
1175. Idiopathic neonatal hepatitis resolve by 8 months.
1176. Hepatitis A can be asymptomatic in children.
1177. HBsAg > 6m = chronic infection.
1178. Criggler – Najjar Type I = no direct bilirubin (zero).
1179. Rye syndrome occurs are once in life only.
1180. Cholecystitis causes jaundice in children unlike adults.
1181. Cholelithiasis can present with hepatoplenomegaly unlike
cholecystitis.
1182. cystic fibrosis, TPN, ceftriaxone increases risk of cholelithiasis.
1183. ↑ Gastrin levels = Zollinger ellison syndrome = MEN 1= PPP (pituitary,
pancreas, parathyroid).
1184. Ulcerative colitis can turn into cancer while crohn’s does not.
1185. Consider appendicitis in any child > 2years with abdominal pain. (who
is not hungry).
1186. Pancreatitis can cause increased bowel sound.
1187. Intussception =3 month – 6 years no fever.
1188. Hydrogen breath test = lactose intolerance.
1189. Urea breath test = H.pylori.
1190. Lactose intolerance diarrhoea is not malodorous, does not contain
food particles, does not have an associated rash.
1191. Bacterial overgrowth = ↑ D-Lactic acid level ↑ + hydrogen breath test
(fasting).
1192. Celiac disease = reducing substance because of villous atrophy.
1193. If diabetic patient loses weight = celiac.
1194. Diarrhoea + bloating + constipation = IBS= irritable bowel syndrome.
1195. Constipation + delay closure of Anterior fontanelle + horse cry + poor
growth + umbilical hernia = congenital hypothyroidism.
1196. Newborn + no stools for 48 hours = cystic fibrosis.
1197. If there is soiling it is not hirshsprung.
1198. Consider Hirshsprung in all patients with down and cystic fibrosis.
1199. Birth + Abdominal distension + vomiting = Meconium ileus.
1200. Metoclopromide and sitting upright during feeds does not decreases
reflux.
1201. Non-Billious vomiting + Hungry child = Hypertrophic pyloric stenosis.
1202. If serum PH is normal or acidotic = not pyloric stenosis.
1203. Confirm volvulus with Barium enema rather than upper GI series
because it can lead to aspiration.
1204. Neonate + polyhydrominos + vomiting = Annular pancreas.
1205. Newborn + bilious vomiting on Day I = Duodenal atresia or Malrotation.
1206. Newborn + bilious vomiting at 2M = pyloric stenosis.
1207. There is no risk of cancer in juvenile polyp.
1208. Painless rectal bleeding = Anal fissures, polyps, hemorrhoids and
Meckels diverticulum.
1209. Large volume painless bleed Meckels.
1210. Small volume painless bleed = polyps, fissures, hemorrhoids.
1211. Painless Meckel rectal bleeding more common then polyps.
1212. Juvenile polyps before 10 years = genetic testing fo adenomatous
polyposis late mutations.
1213. Esophageal perforation is common in Marfans, Ehler Danlos,
epidermolysis bullosa.
1214. No feeding for NEC kids for 3 weeks.
1215. Older child + NEC like picture + Neutropenia = typhilitis.
1216. MgSO4 infusions given to mothers can cause severe hypocalcemia and
hypomagensemia.
1217. Terbutaline causes maternal hyperglycemia and neonatal
hypocalcemia.
1218. ACE inhibitors can cause PDA.
1219. Anti seizure, medication = TAP, TOF, AS, PS.
1220. Carbamazepine Exposure = spina bifida + facial deformities.
1221. Valproic acid = small mouth, small eyes, small chin, mid facial
hypoplasia, spina bifida.
1222. Vitamin A exposure = TGA.
1223. Isotretinion Exposure = small ears, small eyes, small head, small jaw,
small thymus+ TOF + hydrocephalus.
1224. Do not give oral antibiotics in stye.
1225. Refer chalazion to ophthalmology.
1225. Do not order eye patch in corneal abrasion.
1226. If vision is 20/20 the patient may still have papilledema.
1227. Unilateral papilledema is not caused by raised ICP.
1228. Papillitis can cause loss of vision, pain in photophobia and can be
unilateral.
1229. Cataracts = Galactosemia/ Rubella Neurofibromatosis type 2.
1230. Estropia is common until 3 months of age.
1231. Exotropia is also common until 3 months of age.
1232. Colour vision at 3 months of age.
1233. 4 months baby look at patterns and faces.
1234. Autosomal dominant disorders = MANTRA, Marfan, Apert, Nail patella,
Noonan, Tuberous sclerosis, Retinoblastoma, Achondroplasia.
1235. Consider Noonan in HOCM.
1236.Only 20% of Achondroplasia are autosomal dominant, rest are
spontaneous mutations.
1237. Peutz jeghers syndrome can cause intestinal obstructon.
1238. Gadner= Supernumerary teeth, polyps though-out the intestine,
tumours in other body parts.
1239. First Retinoblastoma then osteosarcoma.
1240. Retinoblastoma is a prime disorder example due to spontaneous
mutations. So positive family history is not forth coming.
1241. Male neonate + jaundice after 24 hours= G6PD deficiency.
1242. In ITP, platelets are bigger.
1243. The most common cause of mental retardation is Down syndrome.
1244. The most common inherited case of mental retardation is fragile X.
1245. Small phallus = Down + Prader willi.
1246. Male down is infertile , female are not.
1247. Trisomy 18 are dead by 1 year, Trisomy 13 by 6 months.
1248. The recurrence risk for cleft disorder is 5%.
1249. Cleft palate is more likely to be associated with other anomalies then
cleft lip.
1250. Get a Karyotype in cleft palate.
1251. Cleft lip / palate associations=PAD, CT = Pierre- Robin, Apert, Digeorge,
Cruzon, Treacher Collins.
1252. Bifid uvula is associated with submucous cleft palate.
1253. Rett syndrome is X-Linked but girls more affected.
1254. Subluxation of lens in Ehlers-Donlas, Marfans, Homocytinuria.
1255. Skin laxity is the difference between Ehler Danlos and Marfans.
1256. Upward subluxation of lens = Marfan, Downward i.e homocystinuria.
1257. Puppet gait is angle man syndrome
1258. Prader Willi- paternal genes deleted- FISH, Anglican- maternal genes
deleted= FISH
1259.Hypospadias= SLOB= silver-russet, Lawrence Moon, Opitz, Beckwith
wiedeman.
1260. Hemihypertrophy in bechiwht wiedeman, Kippel-tranauy, Proteus
1261. Premature ageing = cockanyne, progeria
1262. The workup for autism starts with a hearing test.
1263. There is no language or cognitive defect in Asperger compared to
Autism.
1264. Vacter have normal IQ.
1265. Clinodactaly = Down, Fetal alcohol syndrome, Russel Silver and Pierre
robin syndrome.
1266. 2-3 syndactaly = smith – Lemi opitz syndrome.
1267. Small 5th finger nail = Fetal alcohol syndrome.
1268. Short 4th and 5th finger = Turner.
1269. Triphalengeal thumbs = Holt orm syndrome and Diamond Blackfan
syndrome.
1270. Both Leukemias and lymphomas lymphoblastic disorder of B and T
cells.
1271. Leukemia = BMB > 25% BLAST, Lymphoma = BMB <25% blast + Non
tender lymphadenopathy t (4:11) = ALL, t (9,22) = CML.
1272. Teen + Nontender lymphadenopathy (cervical or supraclavicular) +
Fever = Hodgkins lymphoma.
1273. PPD>10=TB, 5-10 = Atypical, < 5
1274. Growing pain = bilateral + Night + better with NSAIDS + No oedema.
1275. Unilateral bone pain + Growth spurt = osteogenic sarcoma.
1276. Unilateral post traumatic bone pain getting worse = osteogenic
sarcoma
1277. Ewing Sarcoma is extremely painful + pelvic bones.
1278. Night time both pain is good, if bilateral = growing pains, if unilateral =
osteoid osteoma, Both Benign.
1279. All children with hemihypertrophy are at increased risk of having
Wilms tumours and hepatoblastoma.
1280. Flank mass < 10 years + Asymptomatic = Wilms tumour.
1281. The most common abdominal malignancy is Wilms tumor.
1282. The most common extracranial solid tumor is Neuroblastoma.
1283. Regular headache feel better when they lie down, Brain tumor feel
better standing up.
1284. Medulloblastoma is most common posterior fossa tumor.
1285. Eczema + high urine output = langerhens.
1286. Histiocytosis lesions are papular with petechie and occurs in folds
(inguinal, suprapubic, perianal).
1287. In worsening past traumatic pain, rule out rhabdomyosarcoma.
1288. In newborn, any Hb < 13 is anaemia.
1289. Hypoglycaemia in polycythemia may not correct with 1/v Dextrose.
1290. Physiologic anaemia (6-16 weeks) should not be lower than 9mg/dl for
term and less than 7 for premature.
1291. Rh+ve moms are supposed to get Rhogam at 20week and again after
delivery if baby is Rh+ve.
1292. Pyruvate Kinase deficiency have good exercise tolerance because oxy-
Hb curve to right because ↑ 2,3 DP6.
1293. Hereditary spherocytosis is intermittent and ↑ MCHC ..
1294. Hereditary spherocytosis with aplastic crises=

Low Hb +low Retic count + high MCHC.

1295. Two Rashes in erythema infectiosum, first slapped

cheek then diffuse macular erythema or extensor
surfaces.
1296. Dark coloured urine in the morning is Paroysmal
nocturnal hemoglobinemia

1297. In sickle cell anemia, any macrocytosis or

microcytosis should alert you to B12, folate or
concomitant thalassemia.

1298. Healthy child + 18-24 months + normocytic anemia

= Transient erythro-blastopenia.

1299. Dysmorphic + Macrocytic anemia + 3-12 years =

Diamond blackfan.

1300. ABO and Rh anaemia and jaundice may last for

weeks as maternal antibodies clear slowly.

1301. An MCV of 70-90 is normal upto 2 years of age.

1302. In Iron deficiency anaemia RDW is high, Menterz

index > 12, tranferrin satuation low.

1303. Alpha thalassemia can cause microcytic anemia

and cannot be diagnosed on Hb electrophoresis.

1304. High ferritin is inflammation or anemia of chronic

disease.

1305. Goat milk or vegetarian = Folate acid deficiency.

1306. Diamond Blackfan does not have jaundice because

no hemolysis.

1307. Cell line issue + normal lungs + normal electrolytes

= shwachman- diamond.

1308. Macrocytic aplastic anemia = fanconi and Diamond

Blackfan.
1309. Normocytic aplastic anemia = sickle + Parvovirus,
hereditary spherocytosis + Parvovirus.

1310. Thrombocytopenia in children = <250 in adolescent

adults =<150.

1311. Epistaxis is due to dry air and usually does not

require a follow up.

1312. Bleeding after circumcision = factor deficiency +

maternal medication (Antibiotics, seizure medication,
Warfarin).

1313. Penicillin is the treatment of choice for streptoccal

pharyngitis, dental infections.

1314. Enterococus is only covered by vancomycin,

Linzolid ampicillin.

1315. First generation cephalosporins = PECK + Staph +

Strepto = Proteus, ecoli, Klebsiella.

1316. Second generation cephalosponin = HEN PECK=

Hemophilus, Enterobacter, Nisseria, Proteus, Ecoli,
Klebsiella. No Gram Postive.

1317. Third generation = No gram positive, good for

hospital acquired gram negative infections.

1318. 4th generation = Both gram positive and gram

negative. More resistant to b Lactamases.

1319. Carbopenum for extended spectrum beta

Lactamase producing orgamism e.g Enterobacter.

1320. Most worm infestation require multiple doses of

antihelminthic except pinworm (one dose).
1321. Metronidozole = GET BCG Giardia, Entameoba,
Trichomonas, Bacteriodes, Clostridum, Gardenella.

1322. Progessive ptosis + baby = Botulism.

1323. Coughing , sneezing, rhinorrhea are viral symptoms

so absent in streptococcal pharyngitis.

1324. Antibiotics in streptococcal pharyngitis are not

given to shorten the duration of illness but to prevent
rheumatic fever. Give antibiotics ever after 9 days of
onset of symptoms.

1325. Rheumatic fever is not due to group A

streptococcal skin infections.

1326. Antibiotics for GAS can prevent Rheumatic fever

but not post streptococcal glomerulonephritis.

1327. Acute post streptococcal glomerulonephritiss can

occur after skin or throat infection but Rheumatic fever
occur only after throat infection.

1328. If C3 level close not come back normal after 6

weeks consider membranoproliferative or lupus.

1329. If renal impairment, do biopsy for rapidly

progressive glomerulonephritis

1330. Drooling + hyperextension of Neck =

Reteropharyngeal abscess.

1331. Drooling + leaning forward posture = epiglotittis.

1333. In Scarlet fever, look for the rash on hidden parts

(Axilla and groin).
1334. D/D of neonatal sepsis = heart failure, Inborn errors
of metabolism, Congenital Adrenal hyperplasia.

1335. The band: Neutrophil Ratio is more important than

WBC in Neonatal sepsis.

1336. Any baby born to a mother who is GBS +ve should

be observed in hospital for 48 hours.

1337. In secondary bacterial shunt, assure MRSA and

treat with Vancomycin.

1338. Cat Scratch disease no treatment until

hepatosplenomegaly present.

1339. Bird exposure + Atypical pneumonia = Chlamydia

psittaci.

1340. Diagnose Mycoplasma pneumonia with serum IgM

titers not cold agglutinins.

1341. All fungal septicaemia should be treated with

Amphotericin B.

1342. Bird Exposure + Pneumonia / meningitis =

cryptococcus.

1343. Histoplasmosis presents like miliary TB, on

physical Examination and chest x-rays.

1344. Exacerbation of Asthma + appropriate treatment =

Allergic bronchopulmonary Aspergellosis.

1345. Herpengina has no skin lesions.

1346. Flu like symptoms + diarrhea = Adenovirus.

1347. Severe bronchiolitis needs steroids.

1348. Palatal petechiae are present both in
streptococcal pharyngitis and infectious mononucleosis.

1349. Streptococcal screen and culture are positive in

carriers.

1350. Look for lymphadenopathy in herpes simplex

ginginositomatitis.

1351. Varicella is limited to face and extremities.

1352. Negative pressure isolation is required for

measles, Mycobacterium, tuberculosis and varicella.

1353. In HIV, Do DNA PCR at Birth, 2 months, 4 months

and 6 months. If all negative, baby negative.

1354. Pregnant mothers with HIV should get Zidovudin or

Nevirapine prevent transmission.

1355. If mother had no prophylaxis, start Zidovidine to

baby with 72 hours and continue for 6 weeks.

1356. Start PCP prophylaxis if child diagnosed with HIV,

irrespective of CD4 count.

1357. If doctor gets stuck with HIV positive needle, 2

medications for prophylaxis.

1358. HIV can get MMR, VZV, Flu vaccines but no BCG.

1360. In Measles first 3c, then koplick spots then rash.

1361. Most measles exposures result in Measles

immunoglobulin being given because rash is the last
thing to appear.

1362. In Rubella the facial rash disappears as the body

rash appears (disappear in 3 days).
1363. Shifting infiltrates on chest x-ray is Ascaris
lumbricoids.

1364. Ground glass appearance + neonate = Respiratory

distress syndrome Or Group B streptococcus.

1365. Ground glass appearance + immunocompromised

= pneumocystitis pneumonia = HIV /Leukemia. Hyper
IgM/ server combined immunodeficiency.

1366. Under inflated lungs + air bronchograms =

RDS/GBS = Groundglass appearance.

1367. Fever + hypotension + skin infection = toxic shock

syndrome.

1368. Acute sinusitis (< 4weeks) = HMS = Hemophilus

influenza, Moraxella catarrhalis, streptococcal
pneumonia.

1369. Chronic sinusitis (>4 weeks) =,cystic fibrosis,

immotile cilia, immunodeficiency, hay fever.

1370. Negative pressure isolation is required for

measles, Mycobacterium tuberculosis and varicella.
1371. Chtonic parotitis: TB, HIV, cat scratch, idiopathic
1372. Otitis externa: Ofloxacin+ ateridos
1373. Recurrent otitis media: > 5 attacks require
myringotomy tubes
1374. Meningitis: No formal deficits— do LP—CT, focal
deficit—Antibiotics—CT—LP
1375. Vancomycin in meningitis is given for resistant
strep and not Staph areas coverage
1376. Meningitis+Seizures=immediate Acyclovir, even if
CSF is 100% suggestive of bacterial meningitis, then
send HSV DNA PCR
1377. A good neonate may present later with seizures
cognitive issues and deafness and still have
Toxoplasmosis.
1378. Chicken pox: trunk—face—-extremities
1379.if FTA +iVE but VDRL negative, consider lyme
disease too.
1380. Rubella rash starts on the face—-trunk—-
extremities wishing 24 hours. Lasts for 3 days.
1381. CMV=CCC=chorioretinitis, calcifications,
censorineural hearing loss
1382. Toxoplasmosis=calcifications, chorioretinitis,
hydrocephalus
1383.Blue berry muffin syndrome: rubella, coxsakie,
CMV, HSV, Parvovirus, Toxoplasmosis
1384. In acute watery diarrhoea if WBC, neutrophils,
mucous or blood present=bacterial. Always treat shigella
1385. Rotavirus is not associated with food or water
intake. Norwalk with sea food.
1386. Rotavirus is not associate with food or water
intake. Norwalk with sea food.
1387. HUS= FAT RN, fever, anaemia, thrombocytopenia,
renal failure and neurologic symptoms.
1388. Shigella dysenteriae patients are sick—
ceftrioxone.
1389. Always treat tenesmus, caused by shigella, E
histolytica.
1390. The persistent fever after the diarrhoea is unique
in salmonella typhi and is from persistence of organisms
in liver, gall bladder and spleen.
1391. Yersenia enterocolitica causes pseudo
appendicitis, Erythema nodosum and Reactive arthritis.
1392. bloody diarrhoea : E coli, salmonella, shigella,
campylobacter , C difficile.
1394. Chronic diarrhoea+Abdominal distention+
malabsorption= giardia
1395. CMPI resolves when GI tract matures.
1395. In lactose intolerance , the stools are malodorous,
does not have food particles, do not vomit and do not
have associated rash.
1396. Intestinal lyphangectasia= protein losing
enteropathy=steatorrhea+decreased serum protein +
decreased gammaglobulin level +edema+ lymphopenia
1397. Conjunctivitis + preauricular lymphadenopathy=
adenovirus
1398. Cat scratch disease lymph nodes are tender and
draining
1399. Lymph nodes are painless
1400. Atypical TB lymph nodes are excised.
1401. Splenectomy = HNS bugs
1402. DFA and ELIZA are faster than PCR in diagnosis of
most viruses.
1403. Latex agglutination is second line test for GBS,
Hemophilus, Nisseria or streptococcus.
1404. ulcer= Bechet , Schwachmann diamond syndrome
1405. If steroids are given for < 14 days, then regardless
of dose, any vaccination is allowed( including live
vaccines)
1406. If >20mg/day or > 2 mg/kg/day of prednisone is
given for > 14 ays, then hold vaccinations for one month.
1407. Except for Hepatitis B and Rotavirus, premature
babies are vaccinated like full term.
1408. Hepatitis B is delayed until one month of age or
hospital discharge( in preterm)
1409. Rotavirus is shed in stools and cannot be given
hospital
1410. Live vaccines are MMR, OPV, VZV, Adenovirus,
Yellow fever, Inhaled influenza and Rotavirus.
1411. No live vaccines in pregnant and severely
immunocompromised.
MMR and varicella are given in HIV who are doing well.
MMR and PPD. if MMR given < 6 weeks ago, don’t give
PPD.
1412. Rotavirus vaccine first does should NOT be given
prior to 6 weeks and after 15 weeks.
1413. Inhaled influenza vaccine over two years, NOT
pregnant or immunocompromised or Asthmatic.
1414. If mother Hepatitis B status unknown , give
hepatitis B vaccine within 12 hours of birth.
1415. HBIG is given no later than 7th day of life.
1416. HPV— 3 doses starting at 11 years. 0-1-6.
Recommended for both genders.
1417. Meningococcal vaccine can be given after two
months although usual age is after 11 years.
1418. Rifampin/ ceftrioxone tithing 24 hours of diagnosis
in close intimate contact of meningitis.
1419. Close intimate contacts include nursery school but
not elementary school or health providers.
1420. meningococcus and H influenza meningitis require
rifampin prophylaxis.
1421. For pertussis prophylaxis azithromycin < 6 week of
age( pyloric stenosis), for > 6 weeks of age ,
erythromycin.
1422. For hepatitis A ,HAIG to unimmunised family
members.
1423. Give VZIG to exposed pregnant,
immunocompromised, some infants.
1424. Give MIG for exposure > 72 hours in measles and
don’t give MMR for 5 months.
1425. 6 vaccines at 2,4,6 months( DTP,IPV,Hep B) , Hib,
pneumococcal, rotavirus
1426. 6 vaccines at 12 months MMR-1, VZV-1, Hep A-1,
Hib-1, and two booster of Prevenar-4 and DTap-4 of 5.
1427. 4 vaccines at 4 years MMR-2, VZV-2, DTap, IPV
1428. 2nd MMR can be given after 1 month of 1st dose,
VZV after 3 months of 1st dose
1429. In catch up immunisation PVC-13 , Hit not given
after 5 years. Rota to none after 12 weeks.
1430. Stridor+coryza+non toxic + barking cough= Croup
1431. stridor+ no viral symptoms= spasmodic croup
1432. Stridor+high fever + supine + pat viral symptoms
=bacterial tracheatis
1433. fever+drooling+tongue protruding+ toxic+ leaning
forward= epiglottis
1434. Encephalopathy/ Prolonged seizure within one
week of getting DTaP , the pertussis component is
contraindicated in future.
1435. Progressive neurologic disorder or seizure
disorder not under control precludes DTaP.
1436. Inborn errors= acute symptoms eg lethargy ,
vomiting , seizures+ absence of fever( except
glactosemia)
1437. organicacidemia= every lab abnormal(
hypoglycaemia, hyperammonemia, ketoaciosis and
lactic acidosis) +thrombocytopenia+ granulocytopenia+
presentation at day 2.
1438. Urea cycle defects= ammonia in thousand+rest of
labs normal+hypotonia+no acidosis
1439. Fatty acid metabolism disorders= hypoglycemia+
metablocic acidosis+ hyperammonemia+no ketoacidosis
1440.storage disorders take months to develop. Later in
infancy or early in childhood.
1441. GSD -I presents during fasting during long sleep.
1442. Mitochondrial disorders= inc lactic acid+ inc
pyruvate+ Inc Uric acid+hepatomegaly
1443. aminoacidopathies= no significant elevation of
Ammonia+no fuel issues( carbohydrates and fat
metabolism Intact)
1445. Maple syrup urine disease= hypoglycaemia+
hyperammonemia+ acidosis+ist week presentation———
neurological sequelae in 2-3 weeks.
1446.glactosemia presents with gram negative sepsis
1447. Hyperglycinemia= encephlopathy+seizures+burst
suppression on EEG+normal Labs+ hiccups
1448. All IEM are S linked recessive except hunter and
Ornithine transcarbamalase.
1449. Inc respiratory rate= acidosis in the setting of IEM
1450. Isovaleric acidemia does not have lactic acidosis
1451. Methylmalonic acidemia and propionic acidemia =
confused with pyloric stenosis due to poor feeding,
vomiting , dehydration, lethargy, tachypnea
1452. Mitochondrial disorders= hearing loss+ lactate+
hepatomegaly. Autosomal recessive.
1453. Fatty acid metabolism disorder do not present in
1st week.
1454. Glycogen storage diseases do not present in first
week.
1455. Pompe disease does not have hypoglycaemia
because other glycogen stores can be broken down. LAD
on ECG
1456. Phenylketonuria=albine+Autism
1457. Overrating PKU can result in rash, lethargy and
diarrhoea.
1458. Seizure after eating=hereditary fructose
intolerance.
1459. Mosquito and Mantoux lamy have no mental
retardation.
1460. Tay sachs have macrocephaly
1461. Fabrys disease have no organomegaly.
1462. Cherry red spot+ hepatomegaly= miemann pick
1463. Tay-sachs and fairy do not have organomegaly
1464. In IDDM, hypoglycaemia may not occur until one or
two days after birth.
1465. For hypocalcemia look for jettriness, prolonged QT,
chvostek sign, trousseau sign
1466. Calcium channel blockers do not work in children
with hypoglycaemia due to hyperinsulinism
1467.Adrenal insufficiency= hypoglycaemia+ ketones+
abnormal electrolytes.
1468. Hereditary fructose intolerance=
hypoglycaemia+ketones+vomiting after feed
1469. Fatty acid defect= hypoglycaemia+ no ketosis
1470. GSD-1= hypoglycaemia+ ketones+ lactic acidosis+
inc uric acid+ Normal Ammonia
1471. glactosemia= hypoglycaemia+
hepatomegaly+reducing substances in urine + FTT+early
presentation.
1472. Lesch- Nyhan syndrome= self mutilation+
choreiform movements+ mental retardation+ inc uric
acid
1473. Adenosine deaminase deficiency= recurrent
infections+ developmental delay
1474. Abnormal eye movements + KF rings + visual acuity
normal = Wilson
1475. Painless visual loss= retinal vein occlusion.
1476. Urea cycle defects have no acidosis but primary
respiratory alkalosis
1477. Non anion gap acidosis+ urine PH >5.5+ dec
Potassium+ inc chloride= type 1 RTA
1478. Type 1 RTA can occur in Sjogrens, rheumatoid
arthritis and SLE
1479. Type 2 RTA can occur in Multiple myeloma and
paroxysmal nocturnal hemoglobuuria
1480. Urine chloride is low <15 in RTA and high in
diarrhoea
1481. In a patient with metabolic alkalosis+
hypokalaemia, correct potassium first otherwise
alkalosis would not correct.
1482. Loop diuretics can cause hypochloremic,
hypokalemic metallic alkalosis but CAN also cause
hypernatremic dehydration, hypercalcuria without
hypocalcemia and hypomagnesemia.
1483. Thiazides cause sodium, chloride and potassium
losses but bicarbonate is not lost.
1484. laxatives, diuretics and excessive vomiting all
cause hypokalemic, hypochloremic metabolic alkalosis.
1485. barter= dec BP. Gitleman= normal BP, Liddle= inc
BP(b,g,L)
1486. In respiratory acidosis or alkalosis, always
calculate for compensation. There could be concurrent
metabolic acidosis or alkalosis if if compensations
overshoots or undershoots.
1487. Heat exhaustion does not present with high
temperature and patient is sweaty.
1488. For hypercalcemia due to immobilization, treat
with iv fluids and loop diuretics.
1489. Both hypokalaemia and hypercalcemia cause
polyuria.
1490. Hypocalcemic seizures don’t respond to
benzodiazeines.
1491. If hypokalemia and hypomagnesemia present
simultaneously suspect renal dysfunction.
1492. dont give free water to babies until 6 months of
age.
1493. Diabetes insidious causes failure to thrive, but is
unlikely if urine specific gravity is > 1.008.
1494. Diabetes inspidus babies have hypernatremia
while older children (>10 years) will not have
hypernatremia.
1495. Cystoscopy if rarely needed for hematuria in
pediatrics.
1496. 24 hours urine protein collection is no longer
recommended.
1497. WBC casts= interstitial nephritis and
pyelonephritis, RBC casts = glomerulonephritis
1498. Uric acid crystals are seen in breast fed babies and
are normal. Cause red discolouration of diaper.
1499. UPJ is the most common cause of urinary
obstruction in children. MAG-3 scan is the definitive test.
1500. MAG-3 scans should only e ordered in unilateral
hydronephrosis.
1501. PUV = midline abdominal mass
1502. Abdominal mass at birth=renal
mass=hydronephrosis/multicystic dysplastic kidney
disease
1503. MCDK is unilateral and that kidney is non
functional and contralateral kidney has 25% of VUR
1504. Positive nitrites= gram Negative organism=e coli,
K pneumonia , proteus
1505. Amoxicillin alone is not enough for febrile UTI
1506. Febrile UTI—-1st test= renal U/S then MCUG
1507. Febrile UTI has high rate of VUR
1508. PSGN can occur after pharyngitis or skin infections
but rheumatic fever only after pharyngitis.
1509. Antibiotics given for group A streptococcal
infection can prevent rheumatic fever but not PSGN
1510. In PSGN if C3 does not return after 6 weeks,
consider MPGN( dec C3&c4) or lupus nephritis( +ive ANA,
dec C3&c4)
1511. In PSGN+severe renal impairment =RPGN
1512. HUS= coombs -Ive +complement levels normal
1513. female+teen+new onset hypertension=
firbromuscular dysplasia/renal artery stenosis
1514. Glomerulonephritis patient will always have
hematuria
1515. If proteinuria, IgA nephropathy =normal
complement levels, PSGN= dec C3 levels
1516. nephrotic+ hematuria=FSGN/membranous
nephropathy
1517. Recurrent stones+ hematuria= Medullary sponge
disease
1518. polyuria+polydipsia+ retinitis pigmentosa+ FTT+
metabolic acidosis+ very low bicarbonate= medullary
cystic kidney disease
1519. In fanconi syndrome= normal/low sodium levels,
diabetes inspidus= inc sodium
1520. boy+hematuria+deaf+vision problem= alport
1521.order somatosensory evoked potentials(SEP) test if
you suspect demyelinating process
1522. Order NCV when concerned about peripheral
neuropathy
1523. Order EMG when you suspect muscular dystrophy
1524. MRI is for detailed imaging of spinal cord and brain.
1525. CT is cheap and fast , especially for haemorrhage,
inc ICP, Tumour
1526. Spinal ultrasound in newborn for neural tube
defects until 6 months of age.
1527. Erbs palsy= C5-C’= paralysis of upper arm=waiters
tip+ unilateral diaphragmatic paralysis
1528. Klumpke palsy = c7-t1= lower arm and hand = claw
hand = inability to grasp
1529. Horner syndrome is associated with klumpke palsy
1530. Spastic CP is rarely due to asphyxia. More due to
prematurity , IUGR and intrauterine infections
1531. Erbs palsy is associated with LGA babies, breech
deliveries and C- section.
1532. GBS maintains rectal tone, bowel/bladder
continence and sensation+decreased reflexes.
1533. In cord compression, sensation, tone , continence
are lost and + increased reflexes
1534. tick paralysis= lack of fever, normal CSF and quick
progression of symptoms(hours—2 days)
1535. Todds paralysis is focal motor weakness after a
seizure
1536. Transverse myelitis can look like cord
compression syndrome( bladder/bowel dysfunction and
increased reflexes)
1537. Epidural abscess of spine may seem similar to GBS
but lack of sensations, poor rectal tone and lack of
blower and bladder control in epidural abscess.
1538. Congenital myasthenia gratis is life long. Transient
myasthenia graves is due to maternal antibodies and
does not include ptosis.
1539. Progressive ptosis in a baby< 6 months = botulism
1540. Papilledema is a late finding in raised ICP
1541. Dandy walker is associated with PHACES and
congenital melanocystic nevi
1542. Migrant is a diagnosis of exclusion.
1543. Attention deficit medications can unmask a tic
1544. chorea cant be suppressed and often worsen with
focussed activities.
1545. Rheumatic chorea disappears during sleep.
1546. CPK is normal in werdnick Hoffmann disease.
1547. CPK is normal in myotonic dystrophy
1548. After a single seizure , the chance of future
epilepsy is > 30%
1549. First seizure+>1st year+ generalised+ otherwise
healthy = no workup
1550. Most neonatal seizures have no long term issues
1551. In neonatal seizures rule out metabolic disease
1552. Infantile spasms can be confused with moro reflex
which disappears by 4 months.
1553. In simple febrile seizures, the chances of epilepsy
are twice than that of general population.
1554. Order drug levels for all break through seizures.
1555. Inc AFP+ataxia+ recurrent infections= ataxia
telengectasia
1556. Clumsy around the time of puberty= Frederick
ataxia
1557. Pale scared child + ataxia+ nystagmus+age < 3
years = benign positional vertigo
1558. Perilympahatic fistula= ataxia+ hearing loss after
coughing
1559. Jaw clonus and ankle clonus are normal in new
borns
1560. In head trauma order a CT scan rather than MRI
1561. In head trauma, no focal signs+ no
unconciousness+no vomiting= discharge
1562. In stroke, MRI is better than CT since it shows both
thrombotic and hemorrhagic stroke.
1563. Lucid interval following trauma= epidural
1564. stroke+ headache= sub arachnoid haemorrhage
(CT can be negative)
1565. In myelomeningocele rule out chair II
malformation.
1566. Distal humeral fractures can result in
compartment syndrome .
1567. Genu varum ( bow legs) is physiologic and resolves
by 1 year. Pathologic if unilateral, persists after 2 year or
presents after 2 years.
1568. Blount disease should be suspected in patients
with bowed legs and fractures.
1569. intoeing= tibial torsion/femoral
anteversion/metararsus adductus .
1570. Tibial torsion in toddlers around 2 years of age.
Benign and resolves by 5-6 years of age.
1571. Femoral anteversion is present in all infants.
Resolves by 10 years.
1572. Metatarsus adducts is in infancy. Usually resolves
by itself.
1573. Pes cavus = Friedrich ataxia and hurler syndrome
1574. SCRE= referred kneee pain with normal knee
examination . Obese , adolescent male.
1575. Legg-clave-perthes disease= painless limp
1576. Osgood schlauer disease is unilateral.
1577. Scoliosis needs surgery if curvature > 40 degrees.
1578. Common backaches are relieved of pain on
standing while spondylosis has pain on standing.
Straight leg raising test is positive on both.
1579. In DDH, the cut off age of U/S is 4 months, after
that plain X ray.
1580. Transient synovitis has pain on active range of
movement not passive.
1581. urticaria+ arthralgia =serum sickness
1582. Congenital torticollis is associated with DDH.
1583. Pre axial polydactyl is associated with syndrome
while post axial polydactyl is not.
1584. In comparison to leukaemia, JIA has pain morning,
in joints, mild haematological abnormalities, symptoms
wax and wane and are insidious.
1585. PSGN has low C3, MPGN has low C3 &C4.
1586. SLE patients on steroids can have steroids
psychosis.
1587. Ankylosing spondylitis pain is worse with rest so
patients will have pain at night morning stiffness.
1588. Apathous ulcers+ genital ulcers+ uveitis+
arthritis+GIT symptoms = beeches syndrome.
1589. RTA+ dry eyes+dry mouth=sjogrens syndrome
1590. In cystic fibrosis, start Vitamin E supplementation
prior to age 5.
1591. There is strong association between trisomy 21
and CF
1592. Hemoptysis can occur in CF, CHD and chest
trauma.
1593. Nasal polyps + asthma + aspirin hypersensitivity =
CF
1594. Nasal polyps can occur in allergic rhinitis and
sinusitis
1595. Onset of laryngomalacia at 1 min , resolves by 12
months.
1596. Tracheomalacia has expiratory stridor while
laryngomalacia has inspiratory stridor.
1597. Recurrent unilateral pneumonia is congenital
pulmonary malformations.
1598. Sputum production does not rule out asthma .
1599. Recurrent pneumonia can occur in ataxia
telangiectasia, Burton, severe combined, hyper IgM
syndrome, hyper IgE syndrome, common variable
immunodeficiency.
1600. Large tonsils or adenoids can lead to OSA.
1601. If RDS baby not getting better in 2-3 days consider
PDA
1602. ADHD is a diagnosis of exclusion.
1603. Stuttering is okay till 4 years.
1604. Letter reversal after 7 years of age is dyslexia.
1605. Night terrors in first 1/3 of sleep and forgotten.
1606. Night mares last 1/3 of sleep and child remembers.
1607. Enuresis is not the diagnosis until child 3 years of
age.
cardiology
Facts about pda
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