D2

PAEDIATRICS—D2

PLEASE NOTE-
1. This document is a sum of all the importance we could find for
paediatrics.
2. It covers the 2015 Paediatrics MARCH 2021 paper.
3. If you find any mistakes then please do inform us too :)
4. RED- Indicates the probable short/long questions.
5. BLUE- Indicates the probable terms.
6. This is enough for paediatrics (acc. to us) but still, if you get enough
time and don’t want to go through the ppts then go through the file in
this link (It contains the summary of all the ppts in the most informative
format).
[Link]
edit?usp=docslist_api&filetype=mspresentation
7. ALL THE BEST!

SINGLE CHOICE QUESTIONS—

1. Preterm infants are born before E. Rotavirus
A. 40 weeks of gestation
5. Which one is the indication for oral
B. 37 weeks of gestation rehydration therapy?
C. 35 weeks of gestation A. Severe dehydration
D. 42 weeks of gestation B. Anemia
E. 34 weeks of gestation C. Mild dehydration
D. Tetralogy of Fallot
2. Which one is the most common E. Malnutrition
cause of malnutrition?
A. Sufficient food supply 6. In patients with hypertonic
B. Pneumonia dehydration, the serum sodium may
C. Inadequate food intake be
D. Neonatal sepsis A. 130-150mmol/L
E. Diarrhea B. 130mmol/L
C. 150mmol/L
3. Alopecia in occiput could be found D. 0 mmol/L
in children with E. 100 mmol/L
A. Anemia
B. Rickets 7. In which congenital heart disease,
C. Pneumonia P2 is usually weakened?
D. Diarrhea A. Tetralogy of Fallot
E. Tetralogy of Fallot B. Patent ductus arteriosus
C. Ventricular septal defect
4. Which one is the most common D. Atrial septal defect
pathogen involved in acute E. Heart failure
glomerulonephritis?
A. Influenza virus 8. A Doctor finds the continuous
B. Spirochete machinery murmur at the upper and
C. Group A,β-hemolytic streptococcus left sternal border of a child. Thus,
D. Coxsackie virus

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the doctor consider the child may E. Purulent meningitis
suffered from
A. Tetralogy of Fallot 14. Febrile seizures is a common
B. Patent ductus arteriosus disorder occurred in infants with
fever, and aged
C. Ventricular septal defect
A. 6 months
D. Atrial septal defect
B. 5-10 years
E. Pulmonary stenosis
C. 6 months to 4 years
9. Which pathological type is most D. 10 years
common in nephrotic syndrome? E. 5 years
A. Minimal change disease
B. Focal segmental glomerulonephritis
15. Nutritional iron deficiency anemia is
C. Mesangial proliferative
A. Normocytic anemia
glomerulonephritis
B. Macrocytic anemia
D. Membranous glomerulonephritis
C. Microcytic and hypochromic anemia
E. Membranoproliferative
D. Hyperchromic anemia
glomerulonephritis
E. All above-mentioned
10. Rotavirus is a major cause of
16. Nutritional megaloblastic anemia
epidemic viral enteritis in infancy,
should be treated with
especially during
A. Iron
A. Autumn
B. Vitamin B12 and folate
B. Summer
C. Vitamin C
C. Spring
D. Vitamin D
D. Winter
E. Calcium
E. Whole year
17. A child has edema, proteinuria,
11. The duration of long term steroid
hyperlipemia and hypoproteinemia.
therapy of nephrotic syndrome is
His illness may be
A. 9 months
A. Acute glomerulonephritis
B. 3-6 months
B. Renal failure
C. 6 months
C. Nephrotic syndrome
D. 3 months
D. Urinary tract infection
E. 3 months
E. Heart failure
12. Squatting phenomenon may be 18. In the patients with primary
found in patients with hypothyroidism, the laboratory tests
A. Tetralogy of Fallot may show
B. Patent ductus arteriosus A. Decreased serum T4 and
C. Ventricular septal defect TSH
D. Atrial septal defect B. Increased serum T4 and TSH
E. Pulmonary stenosis C. Decreased serum T4 and
increased TSH
13. The levels of glucose and chloride D. Increased serum T4 and
in cerebrospinal fluid may be normal decreased TSH
in patients with
E. Normal serum T4 and
A. Bacterial meningitis
increased TSH
B. Fungal meningitis
C. Tuberculous meningitis 19. Full-term infants are born between
D. Viral encephalitis A. 32-37 weeks of gestation

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B. 37-42 weeks of gestation A. Full-term infants
C. 40-42 weeks of gestation B. Pre-term infants
D. 35-40 weeks of gestation C. Post-term infants
E. 35-35 weeks of gestation D. Normal birth weight infants
E. Height birth weight infants
20. Kwashiorkor results from a severe 26. Respiratory distress syndrome is
deficiency of caused by a deficiency of
A. Vitamin D F. Oxygen Inhalation
B. Protein G. Protein
C. Vitamin B12 H. Pulmonary surfactant
D. Folate I. Glucose
E. Calcium J. Lipid
21. The thickness of subcutaneous fat 27. Hemolytic jaundice of newborn
of abdominal wall in patients with Ⅲ usually occurs in infants with
degree of malnutrition is A. Blood type A, and his
A. 0.4 cm mother’s blood type is usually
B. 0.8 cm A
C. 0 cm B. Blood type O, and his
D. 0.4-0.8cm mother’s blood type is usually
E. 0.2 cm A
C. Blood type A, and his
22. The weight of low birth weight mother’s blood type is usually
infants is B
A. less than 2000g at birth D. Blood type A or B, and his
B. less than 1500g at birth mother’s blood type is usually
C. less than 2500g at birth O
D. less than 3000g at birth E. Blood type O, and his
E. less than 3500g at birth mother’s blood type is usually
A or B
23. Which one is abnormal in neonate?
A. Apgar score is 7 at birth
B. Epstein pearls
C. Pseudo-menses 28. The subdural effusion is usually a
D. Moro reflex complication of
E. Rooting reflex A. Viral encephalitis
B. Tuberculous meningitis
24. In full-term infants with physiological C. Fungal meningitis
jaundice, the appearance of D. Purulent meningitis
jaundice disappears
E. Febrile seizures
A. By the end of the 4 weeks
B. By the end of the 3 weeks 29. Insufficiency of exposure to
C. By the end of the 2 weeks sunshine is a reason of
D. By the end of the 1 weeks A. Anemia
E. By the end of the 6 weeks B. Malnutrition
C. Rickets of vitamin D
25. Hyaline membrane disease deficiency
(respiratory distress syndrome)
D. Hypothyroidism
usually occurs in
E. Hypoglycemia

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30. Mental retardation could be usually 36. A child has seizures and fever, aged
found in patients with 1 year and without symptoms and
A. Anemia signs of nervous system. His illness
B. Pneumonia may be
C. Hypothyroidism A. Viral encephalitis
D. Growth hormone deficiency B. Febrile seizures
E. Hypoglycemia C. Bacterial meningitis
D. Fungal meningitis
31. Chromosomal karyotype of E. Brain tumor
47XY+21 could be found in patients
with 37. Neonatal period is from tying of
A. Hypothyroidism umbilical cord to:
B. Hypopituitarism A. 7 days of life
C. Down syndrome B. 14 days of life
D. Tetralogy of Fallot C. 28 days of life
E. Hypoglycemia D. 30 days of life
E. 22 days of life
32. Brain tumor may be a reason of
A. Hypoxic-ischemic 38. Factors influencing growth and
encephalopathy development include
B. Viral encephalitis A. Genetic factors
C. Hypopituitarism B. Nutrition
D. Hypertensive encephalopathy C. Maternal factors
E. Febrile seizures D. Social factors
E. All above-mentioned
33. Decreased plasma volume may
occurs in patients with
A. Acute glomerulonephritis 39. The normal age for deciduous teeth
B. Heart failure eruption is
C. Nephrotic syndrome A. From 2 months to 12 months of age
D. Urinary tract infection B. From 4 months to 10 months of age
E. Pneumonia C. From 10 months to 18 months of
age
34. Immunosuppressant and cytotoxic D. From 1 year to 2 years of age
drugs could be used in patients with E. From 1 month to 3 months of age
A. Pneumonia
B. Nephrotic syndrome
C. Acute glomerulonephritis 40. BCG vaccine is used to immunize
D. Infantile diarrhea against
E. Heart failure A. Measles
B. Hepatitis B
35. Phototherapy is the main treatment C. Tuberculosis
for the patients with D. Diphtheria
A. Neonatal sepsis E. Tetanus
B. Hyaline membrane disease
C. Hemolytic jaundice of newborn 41. Rheumatic fever is the
D. Malnutrition immunoreactivity disease which
E. Kwashiorkor occurs following the infection
caused by
A. Streptococcus pneumoniae

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B. Group A, β-hemolytic E. Edema or erythema of hands
streptococcus and feet
C. Staphylococcus
46. Herpangina is caused by
D. Haemophilus influenzae
A. Group A coxsackie viruses
E. Escherichia coli
B. Adenoviruses
42. Acute phase reaction in rheumatic C. Coronaviruses
fever is indicated by the D. Influenza viruses
A. Accelerated erythrocyte E. Rhinoviruses
sedimentation rate
B. Elevated C-reactive protein 47. Pharyngoconjunctival fever is
caused by
C. Leukocytosis
A. Group A coxsackie viruses
D. Prolonged PR interval
B. Adenoviruses type 3 and 7
E. All above-mentioned
C. Coronaviruses
43. Which of the following is correct D. Influenza viruses
about asthma? E. Rhinoviruses
A. Asthma is a chronic
inflammatory disease of the 48. Behavioral problems in children
include
airways
A. Thumb-sucking
B. Asthma is an infectious
B. Nocturia
disease caused by different
C. Breath holding spells
pathogens
D. Syndrome of rubbing lower
C. Large airway inflammation is
limbs (Masturbation)
a major factor in asthma
E. All above-mentioned
D. Genetic factors are not
involved in the pathogenesis 49. The closure time of anterior fontanel
of asthma is usually between
E. Absence of wheezing in the A. 20 and 24 months of age
lung fields indicates less B. 12 and 18 months of age
possibility of asthma C. 6 and 12 months of age
D. 3 and 6 months of age
44. When the solid foods should be E. 1 and 2 years of age
introduced for infants?
A. 2 months of age 50. A child aged 4 years, his body
B. 4~ 6 months of age weight, and height and ossification
C. 8 months of age center in wrist bones are normally
D. D.10 months of age A. 25kg, 60cm and 4,
E. 1 year of age respectively
B. 20kg, 73cm and
7,respectively
45. The prognosis of Kawasaki disease C. 10kg, 60cm and 3,
depends on respectively
A. Fever
D. 16kg, 98cm and 5,
B. Rash
respectively
C. Lymphadenopathy
E. 30kg, 100cm and
D. Development of
8,respectively
cardiovascular complications

51. neonatal sepsis definition :

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clinical evidence of infection + evidence of 56. The standard of diagnosis for
a systemic response to the infection neonatal mild anemia is
<28 days of birth signs and symptoms : A. 121-100 g/L
a. body temperature fever or hypothermia B. 100-90 g/L
b. tone and behavior poor tone weak suck C. 140-110 g/L
c. shrill cry D. 110-90 g/L
d. skin poor perfusion cyanosis pallor E. 144-120 g/L
petechiae unexplained jaundice
e. feeding problems vomiting diarrhea 57. A/c to world health organization ,
abdominal distention hypo or the mini. Hb level for children aged
hyperglycemia 6 -14 is
f. cardiopulmonary tachypnea tachycardia A. 130 g/L
bradycardia hypotension low pO2 B. 90 g/L
retraction C. 120 g/L
g. bulging or pulsating fontanelle D. 145 g/L
E. 110 g/L
52. Iron deficiency anemia should be 58. The foll. are the characterstics on
used until: bronchiolitis , except:
A. Bubble spund
A. Use foe 1 month after hemoglobin B. Expiratory wheezing
levels returns to normal C. Asthamatic
B. 2 months after hb levels returned to D. Continued fever
normal E. Wheezing
C. Hb levels returned to normal 59. Which is not a common
D. Symptoms disappear manifestation of primary pulmonary
E. Hb and rbc count recovered tuberculosis in children?
A. Slim Down
53. The average length of neonate: B. Fever
C. Cavitation in the lung
A. 100 cm D. Highly sensitive to tuberculin
B. 60cm E. Hilar node enlargement
C. 70 cm 60. The most imp trigger foe asthma is:
D. 40 cm A. Smoke
E. 50 cm B. Environment
54. Which antibiotic is most suitable for C. Exercise
mycoplasmal pneumonia: D. Allergies
A. Compound sulfamethoxazole E. Infection
B. cephalexin 61. The highest no of deciduous teeth
C. nystatin A. 28
D. erythromycin B. 18
E. penicillin C. 24
D. 32
55. In the metabolism of vit D , the most E. 20
active is 62. Apgar score criterion for neonatal
A. 24,25-dihydroxycholecalciferol severe asphyxia was:
B. cholecalciferol A. 0~4
C. ergocalciferol B. 4~7
D. 1,25- dihydroxycholecalciferol C. 0~3
E. 25- hydroxycholecalciferol D. 5~8
E. 0~1

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63. Which of the foll. factors leads to C. Shortened neonatal red cell
neonatal hyperbilirubinemia? life span
A. Impaired excreation of D. Limited conjugation of
conjugated bilirubin bilirubin in the liver
B. Inc. enterohepatic circulation E. All of the above

TERMS & SHORT :--

1. Physiological jaundice
- yellowing skin and other tissue of the infant
- appear on the 2nd-3rd day after birth
- due to elevated unconjugated bilirubin
- occur due to breakdown of RBC and immaturity of newborn’s liver

2. Nephrotic syndrome (lab studies)-2015

Proteinuria
Urine protein excretion > 50mg/[Link]
Proteinuria +++~++++, by urine dipstick
⮚ Hypoalbuminemia
Serum albumin <30g/L
Hyperlipidemia, Hypercholesterolemia
Serum cholesterol >5.7mmol /L
⮚ Edema
⮚ ESR raised and renal function is normal

3. Eisenmenger Syndrome
- Cyanotic Heart Disease.
- Congenital heart disease of L-R shunt that cause increase flow through pulmonary
vasculature result in pulmonary hypertension which in turn raise the pressure in right side of
the heart and cause reversal of shunt to R-L shunt
.
100. Infant definations-
full-term infant
37 weeks to less than 42 weeks
- preterm infant
gestational age less than 37 weeks
late preterm, modest preterm, very preterm, extremely preterm
- post-term infant
42 weeks or more
- low birth weight infant (LBW)
< 2500g
- normal birth weight infant
2500-4000g
- high birth weight infant (macrosomia)
> 4000g

4. Tetralogy of fallot -2015

• 10% of all type of CHD
• Most common cyanosis CHD
• Including 4 malformations :

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Overriding aorta
Pulmonic stenosis
Ventricular septal defect
Right ventricular hypertrophy

5. Physiological anemia -2015

[Link]
23 months of age (Self-limited anemia)
[Link]
Breath occurs after birth PaO2 erythropoietin (EPO) hematopoiesis
Shorten life span of RBC (HbF) in fetus + RBC destroy physiologic hemolysis.

Accelerated growth 2-3 months after birth volume of circulationrelatively RBC Hb

[Link] Values: RBC 3.0×10¹²/LHb 90g/L.

6. Down syndrome
-genetic syndrome 🡪 has 3 copies of chromosome 21
-Special face similar to hypothyroidism, mental, and growth retardation, but have no
myxedema.
- Skin and hair are normal,
- T4 and TSH are normal.
- Chromosome analysis can demonstrate the 21- trisomy syndrome.

7. Definitions
• Perinatal Period
the period between 28 weeks of gestation age to 1 week after birth
• Preterm (very\moderate\late)
Gestational age less than 37 weeks
• Appropriate for Gest. Age(AGA)
Wt. Corresponds to gest. Age
• Small for Gest. Age (SGA)
Wt. Below 10th centile for gest. Age
• Large for Gest. Age (LGA)
Wt. above 90th centile for gest. Age

8. Pharyngoconjunctival fever
• Adenovirus type 3, 7
• Presents after 3-5 days incubation period
• Fever, pharyngitis, rhinitis, cervical adenitis, and conjunctivitis
• occur in small epidemics in summer camps (probably transmitted during swimming)

92. Small gestational age infant- 2015

((small-for-gestational-age infant a preterm, term, or postterm infant who is below the 10th
percentile for gestational age in head circumference, body weight, or length. term infant one
born at a gestational age of 37 to 42 completed weeks)

Newborn whose birth weight are below 10th percentile (or 3rd percentile) for gestational age,
most case full term, weighing less than 2500 g. (infant that is smaller in size than the normal

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for baby’s gestational age and gender)
Many infants who are born prematurely, are small for gestational age (SGA), have significant
perinatal asphyxia, are breech, or are born with life-threatening congenital anomalies do not
have previously identified risk factors.
For any given duration of gestation, the lower the birthweight, the higher the neonatal
mortality; for any given weight, the shorter the gestational duration, the higher the neonatal
mortality.
The highest risk of neonatal mortality occurs in infants who weigh less than 1,000 gram at
birth and whose gestation was less than 30 wk.

93. Cough variant asthma

Cough-variant asthma is a type of asthma in which the main symptom is a dry, non-
productive cough. (A non-productive cough does not expel any mucus from the respiratory
tract.) People with cough-variant asthma often have no other "classic" asthma symptoms,
such as wheezing or shortness of breath. This medication controls cough, prevents the
onset of wheeze, and reduces airway obstruction in people with CVA. If you have CVA or
chronic asthma, it's best to take inhalers daily as prescribed. Examples include budesonide
(Pulmicort) and fluticasone (Flovent).

94. Proteinuria
Proteinuria
Urine protein excretion > 50mg/[Link]
Proteinuria +++~++++, by urine dipstick

87. PEM
protein-energy malnutrition
-disease caused by deficiency of energy and protein
-weight not increased or decreased
- wasting or edema
- decreased or disappeared subcutaneous fat
- decreased function of organs
- often accompanied by deficiency of multiple micronutrients

88. Febrile seizures

- characterized by fever and acute upper respiratory tract infection, without CNS disorder
- its repeat attack of seizure usually disappears after 4 years of age

76. HMD
hyaline membrane disease
- deficiency of pulmonary surfactant
- pulmonary alveoli collapse at the end of expiration
- mainly in preterm infant

77. NRDS
neonate respiratory distress syndrome
- usually occur in premature babies
where the lungs aren’t fully developed
and they cannot provide enough oxygen
- characteristics : frosted glass-like changes and air bronchogram.
- white lung

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78. Neonates asphyxia
- asphyxia = the failure to initiate and maintain spontaneous respiration (WHO)
- hypoxia + hypercapnia + metabolic acidosis (combination)
- may lead to irreversible brain damage

61. Rheumatic fever

- inflammatory disease
- group A beta-hemolytic streptococcal infection
- involve :
heart
joints
cns
subcutaneous tissue

62. Aschoff body

are nodules found in the heart of individuals with rheumatic fever.
They result from inflammation in the heart muscle and are characteristic of rheumatic heart
disease.

59. Kawasaki disease

- an autoimmune disease in which the medium-sized blood vessels throughout the body
become inflamed
- largerly seen in children under 5 years of age
- affects many organ system, mainly those including the blood vessels, skin, mucous
membranes and. lymph nodes; however, its rare but most serious effect is on the heart
where it can cause fatal coronary artery aneurysms in untreated children
- main treatment :
IVIG (intravenous immunoglobulin)
1g/(kg.d) ivgtt x 2d
2g/(kg.d) ivgtt x 1d

[Link] stoke syndrome

sudden, transient episode of syncope
followed by seizure
caused by decrease cardiac output to the brain
due to cardiac asystole, heart block, ventricular fibrillation, etc.

51. Arterialseptal defect

An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of your heart
(atria). The condition is present at birth (congenital). Small defects might be found by chance and never cause a
problem. Some small atrial septal defects close during infancy or early childhood. The hole increases the
amount of blood that flows through the lungs. A large, long-standing atrial septal defect can damage your heart
and lungs. Surgery or device closure might be necessary to repair atrial septal defects to prevent complications.

- location 2nd intercostal space🡪 SM(systolic murmur) is best heard

- electrocardiography for final diagnosis
- complication same

52. PDA

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Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels
leading from the heart. The opening (ductus arteriosus) is a normal part of a baby's
circulatory system in the womb that usually closes shortly after birth. If it remains open, it's
called a patent ductus arteriosus.

patentductusarteriosus
- typical sign🡪”machinery” murmur
- peripheral vascular sign
- left-to-right shunting

53. TOF -2015

Tetralogy of Fallot is a rare condition caused by a combination of four heart defects that are
present at birth (congenital).

Includes-
-ventricular septal defect
-right ventricular hypertrophy
-overriding of the aorta
-pulmonary stenosis
clinical manifestation
- main symptoms : cyanosis
- dyspnea and squatting posture
- clubbing of the terminal digits
- chest radiography : boot-shaped heart

41. Cerebrospinal fluid examination

(diagnosis of tuberculous meningitis)
1. History taking
2. Clinical features
3. CSF examination
■ Pressure Increased
■ Appearance Clear or ground-glass appearance
■ Leukocyte count 50-500×106/L, mainly lymphocyte, reach 70-80%
■ Protein Quantitative analysis increase 1.0-3.0g/L
■ Glucose Decrease usually <0.3g/L
■ Chloride Decrease, 85.5-102.6mmol/L500-600mg/dl
■ Membrane Quietly place CSF 12-24 hr, spider web clot appearance,
used for film preparation and culture
Both reduction of glucose and chloride is a typical change of TB meningitis

Classification of tb mengitis

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42. Herpangina
(mouth blisters)
- group A, coxsackie viruses
- high fever, vomiting, dysphagia, and loss of appetite
- tiny vesicles or erosions on the anterior tonsillar pillars, tonsils, uvula, pharynx, and soft
palate
- erosions are typically yellow-gray in color and have a surrounding rim of erythema
- resolution of symptoms occurs in 3-7 days
- spreads via the fecal-oral route or via the respiratory droplets

20. Introduction to neonatology

⮚ Newborn : A recently born infant in the first few hours of life
⮚ Neonate :refers to infants in the first 28 days of life
⮚ Perinatal Period : the period between 28 weeks of gestation age to 1 week after birth
⮚ Live-born :signs of life after birth

65. CAP
community acquired pneumonia
🡪occurs outside of the hospital or <48hours admission in a patient who is not hospitalized or
residing in a long-term care facility for more than 14 days before the onset of symptoms.

66. HAP
hospital acquired pneumonia or NP (nosocomial pneumonia) occurs>48hours after
admission to the hospital and exclude any infection present at the time of admission.

Still born :no signs of life at delivery in a fetus at 28 weeks’ gestation or greater (ranging
from 5 per 1000 in wealthy countries to 32 per 1000 in South Asia and sub-Saharan Africa )
(Lawn et al,2009c; Stanton et al, 2006)

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Preterm (very\moderate\late) : Gestational age less than 37 weeks
Fullterm : 37 weeks to less than 42 weeks"
Postterm : 42 weeks or more

LAQS
91. Please describe the 7 age group distribution in childhood
.age group distribution in childhood
- fetal period :
formation of embryo to the birth
- neonatal period :
0 to <28d tying of umbilical cord
- perinatal period :m
28th week of gestation to 1 week after birth
- infancy period
0 to <1year including neonatal period
- toddler age
1 year to <3 years
- preschool age
3 year to 6-7 years
- school age
6-7 years of age to the starting of adolescence phase
- adolescence
boys : 13-14yr to 18-20yr
girls : 11-12yr to 17-18yr
2yr to 4yr variable among individuals

95. Nephrotic syndrome treatment

-Non-specific
oDO NOT restrict activity unless child is severely edematous
oIsolate child from child who have resp illnesses to prevent relapse
oTreat infection aggressively
oDiuretic therapy:
Furosemide 1-2 mg/kg/d IV or PO
6% Low Weight Glucoside
Dopamine (1-5mcg/kg/min)
Emergency use: use salt-poor albumin infusion

-Steroidal therapy
oModerate and long-term therapy
Everyday 2 mg/kg/d for 10weeks
Every other day 0.5 – 1 mg/kg for >9 months
oShort therapy prednisone
2 mg/kg/d (divided into 2 to 3 doses) for 4 weeks
1.5 mg/kg/d every other morning for 4 weeks

-For relapse
oContinue steroids ( to 2.5 – 5 mg/kg every other day for 1-2 years)

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oCytotoxic agents
Multiglycosidorum Tripterg II
Cyclophosphamide, CTX
Chlorambucil
oLevamisole (2.5 mg/kg/d every other day for 0.5-1 year).

-For steroid resistant type

oPulse of methyl-prednisolone
15-30 mg/kg/d IV continued with prednisone
oCTX pulse IV or PO
oCyclosporin A
oACE-Inh

96. Complications of PURULENT MENINGITIS- 2015

[Link] effusion
(1)ManifestationPersistent or recurrent fever during treatment. Intracranial hypertension gradually intensify.

(2)Diagnosis: Transillumination of skull with electric torchCT scanning. Subdural fluid examination: Smear and culture to

(3)TreatmentSevere cases: Subdural tap. Transillumination of skull with electric torch: width >3.5cm suggest subdural eff

[Link] (Pus in Ventricle) and ependymitis:

1)Manifestation: Persistent fever and convulsion, dyspnea.
(2)Diagnosis: ▬CT: enlarged ventricles of brain. ▬Ventricle puncture: WBC>50 ×10‘/L,
glucose<1.6mmol/L, protein>0.4g/L, Smear and culture may find positive bacteria.

[Link] (syndrome of inappropriate secretion of antidiuretic hormone):

(1)Reason: Subthalamic lesion results in SIADH.
(2)Manifestation: Hyponatremia, oliguria, seizures, encephaledema .
(3)Diagnosis: Blood sodium, plasma ADH

[Link] (more water in ventricle):

(1)Manifestation: Irritability, lethargy, frequent seizures, projectile vomiting, bulging fontanelle
and increased head circumference, scalp phlebectasis, setting-sun sign in eyes.
(2)Diagnosis: CT scanning. Hydrocephalus: increased head circumference

5:Herniation: Intracranial pressure - Tonsilla of cerebellum descend out of great occipital foramen - Tonsillar her

[Link] nerve paralysis: ---blindness, ---deafness.

[Link]: ---Epilepsy, ---mental retardation, ---paralysis.

97. Diff bet PHYSIOLOGICAL & PATHOLOGICAL JAUNDICE.- 2015

Physiologic icterus - Pathologic icterus
Occurring time : 2nd--3rd day after birth - Within 24 hours after birth
Persisting time : Full term infants<2 w; Premature<3w - >2W or recurrent; >3-4W or recurrent

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UCB level : F<204umol/L(12mg/dl); P<255umol/L(15mg/dl) - >204umol/L,or increase
85umol/L (5mg/dl) per day; >255umol/L,or increase 85umol/L; (5mg/dl) per day
CB level and other clinical manifestations : <34umol/L(2mg/dl), normal general station -
>34umol/L with clinical manifestaion of primary onset

98. What is the BILIRUBIN METABOLISM SYNTHESIS IN NEONATES?/ BILIRUBIN

METABOLISM CHARACTERISTICS? -2015

When red blood cells are dead they are engulfed by the macrophages in the spleen and
bone marrow.
RBCs are degraded by macrophages and then RBCs release their hemoglobin molecules.
Hemoglobin is then broken into its two components heme & globin. Globin is a protein that
reenters the blood and again used for making new hemoglobin molecules.

The heme is broken into two parts - Unconjugated bilirubin and iron. Iron reenters circulation
and reused for erythropoeisis. UCB is not recycled and therefore needs to be removed from
the body as it is toxic. UCB is lipid soluble so in blood it requires albumin to carry it. Albumin
will carry it to liver. In liver, conjugation of UCB occurs with the help of Glucoronic acid and
form Conjugated bilirubin (CB) and now this CB is water soluble. So it can be excreted by the
liver in the bile juice. In the terminal intestine or ileum the conjugated bilirubin is converted
into Urobilinogen by removing glucoronic acid by hydrolysis or reduction reaction by
bacterias. Urobilinogen is Lipid soluble. 10-18% UB is reabsorbed by into the blood and
binds to albumin and the remaining UB is oxidised by bacteria to form Stercobilin which gives
feces the brown color and also excreted by the kidneys.

BILIRUBIN METABOLISM CHARACTERISTICS-

[Link] bilirubin synthesis
[Link] effective binding and transportation of bilirubin
[Link] hepatic function
[Link] absorption of bilirubin via the enterohepatic circulation

Neonate bilirubin about 8.8mgkg*d

Adult bilirubin about 3.8mgkg*d

Causes-
[Link] erythrocytes were destroyed as the blood oxygen content heighten after birth
[Link] life span is shorter than that of adult by 20-40 days(premature less than
70d, full term infants about 70-90d, adult about 120d)
[Link] generated from other source is more:such as the liver(catalase P450) and the
bone marrow(ineffective hematopoiesis result in increment of bilirubin product)

9. ABCDE resuscitation in asphyxia of newborn

• A (Airway) : Establish open airway, position of the infant (no extend/flexed), suction
mouth then nose, suction any blood/secretion, consider placing a guedel airway.
• B (Breathing) : Initiate breathing, tactile stimulation, PPV if necessary (+ press
ventilation), mask ventilation placed over mouth & nose.
• C (Circulation) : maintain circulation and stimulate cardiac compression
• D (Drugs) : Adrenaline 🡪low heart rate, sodium bicarbonate 🡪acidosis,
nalaxone🡪bradypnea
• E (Evaluation) : 1. Respiration: if none/gasp, give PPV 21% oxygen 15-30sec

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2. Heart Rate: >100 (reevaluate respiration)
: < 60 (continue PPV and compression)

10. Classification and main disease of congenital heart disease

(in regard to congenital heart disease, what is the three classification and main diseases
included ?)
3 classification and main disease of CHD :
• L-R shunts (latent cyanosis)
Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
Patent DuctusArteriosus (PDA)
• R-L shunts (cyanosis)
TOF (Tetralogy of Fallot), T4
TOA (transposition of great arteries)
• Non-shunts (non-cyanosis)
Pulmonary stenosis
Coarctation of aorta (CoA)

11. Classification stages of iron deficiency anemia-2015

(what is the three stages of nutritional iron deficiency anemia ?)
Stages of iron deficiency anemia :
[Link] depletion(ID):
★ reduced iron store
★ normal iron supply for hematopoiesis
★ normal blood Hb value.
[Link] deficient erythropoiesis(IDE):
★ reduced iron store
★ reduced iron supply for hematopoiesis,
★ normal blood Hb value.
[Link] deficiency anemia(IDA) :
★reduced iron store
★reduced iron supply for hematopoiesis
★reduced blood Hb value.

[Link] do you diagnose the congestive heart failure in a child with severe
pneumonia?-2015
(Criteria for diagnosis of congestive heart failure in pneumonia)
1. Tachypnea, 60/min
2. Tachycardia, 180/min
3. Extreme agitation with cyanosis and/or
duskiness
4. Soft heart sound, gallop rhythms, and
engorgement of neck veins
5. Rapid hepatomegaly
6. Oliguria, anuria, edema of the face or extremities

13. Severe manifestation of AGN

(what is the three kinds of severe manifestation of acute glomerulonephritis?)
Severe Symptoms of Acute Glomerulonephritis :
Hypertensive encephalopathy(approximately 5% of hospitalized children)

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• In these patients, hypertension usually is severe and is accompanied by signs of
central nervous system dysfunction
• such as headache, vomiting, depressed sensorium, confusion, visual disturbances,
aphasia, memory loss, coma, and convulsions.
Circulatory congestion
• Dyspnea, orthopnea, and cough may be present.
• Pulmonary rales often are audible.
• In the patient with an otherwise normal cardiovascular system, cardiac failure is
unusual.
• Pallor is common at onset and is not explained entirely by the anemia
Acute insufficiency
• Glomerular inflammation (ie, cellular proliferation, edema)
• The capillary loop is narrowed
• Glomerular filtration reduce

14. Bone deformity change in active stage of rickets vit. D deficiency

Bone Change in Active stageExcitation period
Bone change at the part of rapid growth of bone
< 6 months
lesion mainly at skull
craniotabes
ping-pong-ball sensation

> 6 months mainly osteoid tissue accumulation

rachitic rosary
widening of wrists (bracelet) and ankles (anklet)
caput quadratum
wide open anterior fontanels
Entire body muscle slack
Muscle force and tone dropped
Pigeon breast deformity
Harrison’s groove
Bow legs
Eruption of teeth: delayed
O type leg（genu varum）
X type leg（genu valgum）

15. Steroid therapy moderate and long term (nephrotic syndrome)

treatment steroid therapy

moderate to long term:

everyday : 2mg/kg/d 🡪<10 week
every other day : 4w
tapped every 2-4w 🡪0.5-1mg/kg x 3m
*moderate : for more than 6 months
*long : more than 9 months

short term : prednisone

everyday : 2mg/kg/day divided into 2-3 doses🡪4 week

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every other day : 1.5mg/kg/d every other morning🡪4 week

Treatment for Relapse :

- Continue to use steroid
● Prolong to use prednisone 2.5~5mg
● (0.75~0.25mg/kg/d) every other day
● for 1or 2 years
- cytotoxic agents
⮚ MultiglycosidorumTriptergll—-1~1.5mg/kg/d orally for 3~6 months
⮚
Cyclophosphamide(CTX)—- 2~3mg/kg/d, divided into 2~3 times orally for 8 ~12 weeks.
⮚ Chlorambucil—- 0.2mg/kg/d, divided into 2~3 times orally for 8 weeks.
- Levamisole
2.5mg/kg/d, orally, every other day for 6 months to 1 year

16. Complication of malnutrition- 2015

■ Common complications
- Nutritional anemia- microcytic hypochromic anemia
-Vitamin deficiency- fat-soluble vitamin A and D deficiency
- Zinc deficiency - (around 3/4 children) may lead to lower immunal function
- Infection repeated respiratory infection, thrush, pneumonia, tuberculosis,otitis media,
urinary tract infection, diarrhea and infection, often protracted course of disease, malnutrion
worsen and a vicious circle forms
- Spontaneous hypoglycemia happens suddenly, pale, unconciousness, slow pulse
rate, apnea, low temperature, no seizure death may happen if no injection of glucose IV
without delay

17. What are the four deformities which compose tetralogy of fallot ?
a. Overriding aorta
aorta displaced toward the anterior/above the septal defect, connected to both left and right
ventricle abnormally to the right of pulmonary artery root.
b. Pulmonic stenosis
narrowing of LV outflow tract can happen on pulmonary valve or below it (infundibular
stenosis).
Mostly caused by heart wall overgrowth.
It is the major cause of malformations, with other malformations, acting as compensatory
mechanism to pulmonary stenosis.
c. Ventricular septal defect (VSD)
hole between 2 ventricles, mostly single and large.
L : mostly near the superior aspect (ventricular outlet), membranous type.
d. Right ventricular hypertrophy
RV more muscular than usual, with boot shape appearance on xray, it increased in … to deal
with increased obstruction to right outflow tract.

18. What is the three abnormalities which compose the primary complex of pulmonary
tuberculosis ?
Primary syndrome :
• Tubercule bacillus enter lung to form primary lesion
• Parts of TB invade the lymph nodes through lymphatic vessels to cause caseous
necrosis

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• Primary lesion, enlarged lymph node and the linking lymphangitis exist at the same
time (3 abnormalities that compose primary complex of pulmonary TB)
• Dumb bell shape or bipolar shadow

19. What is the three signs which could be found in patients with latent tetany of
vitamin D deficiency ?
tetany serum Ca fall below 7mg/dL
tetany ionic fall below 1.0mmol/L
Concealing type manifestation of latent tetany in vit. D deficiency :
Total blood Ca 1.751.88mmol/L( 7-7.5 mg/dL)
•
Chvostek’s sign+: Unilateral contraction reflex of facial muscle around eye, nose, mouth when the facial nerve is t

•
Trousseau sign +: elicited by maintaining firm constriction of the upper arm for 5 minutes by cuff of sphygmoman

•
Peroneal sign+: elicited by tapping the peroneal nerve just below the head of fibula with reflex hammer while the

- chvostek sign (+)

facial spasm induced by tapping the angle of the jaw (facial nerve)
- trousseau sign (+)
carpal spasm induced by BP cuff
- peroneal sign
pedal spasm induced by tapping the head of fibula (peroneal nerve)

21. Characteristics of rotavirus enteritis

Rotavirus E. Characteristics :
▲Acute diarrhea occurred in infants between 6 months and 2 years of age.
▲Mostly occurred in autumn and winter.
▲Fever, upper respiratory tract infection and vomiting and fever for 1 to 2 days, followed by
profuse watery diarrhea for 3 to 8 days.
▲Dehydration and acidosis are common.
▲The stools are profuse, frequent, watery, yellow-water or egg soup-like, with a small
amount of mucus.
▲Mostly stools are normal under microscope without blood (RBC) or pus (WBC).
▲Usually self-limited.
DIAGNOSIS
-Electron microscopy (ID rotavirus)
-ELISA
-RT-PCR (ID rotavirus rna in serum)

22. Levels of asthma control

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catatan :

23. Age groups and the characters

- fetal period
formation of embryo to the birth
- perinatal period
28th week of gestation to 1 week after birth
- neonatal period
0 to <28d
tying of umbilical cord
- infancy
0 to <1 year including neonatal period
- toddler age
1 year to <3 years
- preschool age
3 years to 6-7 years
- school age
6 to 7 years of age to the starting of adolescence phase
- adolescence
boys age 13-14yr to 18-20yr
girls 11-12yr to 17-18yr
2 yr to 4 yr variable among individuals

24. Development of pediatrics

• Establish medical institutes
• Monitoring of growth and development
• Screening of congenital hereditary diseases
• Vaccine inoculation
• Prevention and treatment of common diseases
Anemia
Rickets
Pneumonia
Diarrhea

25. Rules of growth and development

a. G & D are a continuous and stage-by-stage process

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b. Unbalanced development of systems and organs
c. Individual differences of G &D :
● Growth “track” among children are different
● Caused by inherited potential and environmental factors
d. general principles of G & D :
⮚ Up to down: raise head, sit, stand
⮚ From near to far: arm to hand
⮚ From gross to fine: palm to finger
⮚ From elementary to senior
Observe, feeling, remember, analyze
⮚ From simple to complex
Line, circle, whole picture

26. The factors influencing growth and development

a. genetic factors :
- one of the important factors
- inherited factors from parents decide the track, or characters, potential and trends of
children
b. environmental factors :
- nutrition
- diseases
- maternal factors
- social factors

27. Indicators of physical growth

Weight,
recumbent length and standing height,
sitting height,
head circumference,
chest circumference,
upper arm circumference,
and subcutaneous fat

28. Dental development

two kinds of teeth in a life :
- deciduous teeth (20) eruption in 4 to 10 month old
- permanent teeth (32)

eruption of deciduous teeth :

4-10 month old
erupt completely : 2.5 years old
individual differences

29. Response to disease

extramedullary hematopoiesis.
In some cases (infection, anemia), the liver, lymph nodes, and spleen may resume their
hematopoietic function.
It may cause these organs to increase in size substantially.

30. Vaccination schedule

- at birth :

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BCG vaccine
hepatitis B
- 1 month :
hepatitis B
- 2 months :
TOPV (trivalent oral polio virus)
- 3 months :
TOPV
DTP (Diphtheria, tetanus, and pertussis)
- 4 months :
TOPV
DTP
- 5 months :
DTP
- 6 months :
hepatitis B
- 8 months :
measles

31. Clinical manifestation of malnutrition

- early stage : weight decreases
- followed by emaciation, subcutaneous fat gradually decrease and even disappear
- skin dry, pale and gradually loses elasticity
- wrinkle on forehead like old person
- muscle tone gradually decrease
- muscle loose and shrink and appears as skinny.
At this time the 4 limbs may have contracture

- subcutaneous fat consumption

sequence :
● first abdomen
● second body, hip, four limbs
● lastly cheek
- initially length/height is not influenced.
As worsening, bone growth slowly and height is lower than normal
- mild malnutrition :
spiritual state is normal.
Those severe lethargy, bad reaction, lower body temperature, pulse fine and weak, no
appetite, and alternate diarrhea and constipation
- severe malnutrition :
marasmus mainly caused by insufficient energy supply

- edema type, or malignant malnutrition, or named kwashiorkor

- when severely lacking protein, plasma albumin significantly decreased
* pitting edema
* shinning skin
* severe situation, ulcer, infection and forming chronic ulcer
* kwarshiorkor is derived from the language Ghana, translated as
“the sickness the baby gets when the new baby comes”,
reflecting the development of the condition in an older child
who has been weaned from the breast milk

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32. Initial stage (early stage)🡪vit. D deficiency (rickets)

- nonspecific psychiatric symptoms :
most manifestations :
increasedneuro excitability, such as irritability, anxiety, head shaking caused by
hyperhidrosis stimulating scalp
- blood biochemistry change
* serum 25-(OH)D decrease
* PTH increase
* serum calcium decrease, phosphorus decrease
* alkaline phosphatase normal or slightly increase
- xray : normal or lines calcification slightly fuzzy
Later-
- alopecia in occiput
- craniomalacia
- cephalus quadratus
- rachitis rosary
- chicken breast
- funnel breast
- Harrison groove
- “O” or “X” legs
33. Treatment of tetany (vit D deficieny)
- first aid treatment
* convulsion : oxygen administration
* laryngospasm : pull the tongue out of the mouth, mouth to mouth respiratory resuscitation
and sac pressure oxygen inhalation
* control convulsion and laryngospasm : 10% chloral hydrate, each time 0.4 to 0.5 ml/kg
- Caagent : 10% calcium gluconate 5 to 10ml+10% glucose liquid 5-20ml
- vit D : oral administration of Vit D, according to the method for Vit D deficiency rickets

34. Tuberculin test

- test procedure :
intracutaneous injection 0.1ml purified protein derivative (PPD) containing 5 tuberculin unit
- palmar surface of left forearm at lower—middle 1/3 juncture
to form a wheal with diameter of 6-10mm
- observe reaction result after 48-72 hours
determine diameter of local induration.
Take average diameter from vertical one and horizontal one to judge reaction intensity.

35. Judge criteria of tuberculin test

-No flush, no induration or diameter < 5mm
+Diameter of induration 5--9mm
++Diameter of induration10--19mm
+++Diameter of induration 20mm
++++In addition to induration, the following are visible: blister and local necrosis, edema, ulceration, lymphang

36. Clinical significance of positive reaction

■ Inoculated with BCG before, caused by artificial immunity
■ Without clinical symptoms suggests tuberculosis infection, but without active
lesion

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■ <3-year-old, especially without inoculation of BCG, indicates new tuberculosis
lesions, the younger the higher possibility of active tuberculosis
■ Strong positive suggests active tuberculosis in the body
■ The following suggest recent infection: change from negative reaction to
positive, or the reaction strength change from <10 mm to >10mm, and extent of
increase >6mm

37. Difference between inoculation reaction and natural infectious reaction

38. Clinical significance of negative reaction

■ No history of tuberculosis infection
■
Prior period of tuberculosis allergic reaction4-8 weeks after initial infection
■ False negative reaction, caused by low or suppressed immunological reaction of the
body
Parts are critical tuberculosis patients
Acute contagious diseases, such as measles, varicella, rubella, and pertussis
Constitutional debility people such as malnutrition, severe dehydration and severe
edema
During therapies with corticorsteroids or other immunosuppressants
Primary or secondary immunodeficiency diseases
■ Technical error, or tuberculin loses effectiveness

39. Treatment of TB
general treatment :
- rest
- diet
- outdoor activity
- full duration of treatment
- pay attention to reexamination
medication :
- isoniazid

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- rifampin
- streptomycin
- PZA
- ethambutol
- ETH
- PAS
standard therapy :
daily take medicine orally, therapeutic course 9-12 months
- therapy in stages :
intensive phase of treatment 3-4 months
consolidation phase of treatment 12-18 months
- directly observed therapy sort course (DOTS)

40. Clinical manifestation of TB meningitis

Early stage( prodromal stage)
■ Personality change + Symptoms of tuberculosis intoxication
■ Few words, easy to get tired, irritable, irritability, fever, night sweats, vomiting, diarrhea
■ Headache (elderly children), gaze, drowsiness (infant)
Intermediate stage (meningeal irritation sign)
■ Mainly meningeal irritation sign
■ Headache, projectile vomiting, drowsiness, convulsion, neck rigidity, Kernig
sign (+), Babinski sign(+), cranial nerve palsy, facial paralysis, optic papilla
edema, tubercular nodus of choroid
■ Infant fontanel bulging
Advanced stage (coma stage)
■ Disturbance of consciousness mainly
■ Above manifestations aggravated
■ Convulsion, coma, electrolyte disorder, cerebral hernia, death

43. Indication of ORS (oral rehydration salt) application

ORS is provided to children with mild to moderate dehydration.
(1) mild dehydration :
50-80ml/kg for first 8-12 hours to replenish the prior losses.
(1 dose/5-10 min, 10-20ml/dose)
(2) moderate dehydration :
80-100ml/kg for first 8-12 hours to replenish the prior losses.
Subsequently, ORS is diluted by double water, and provided to children that depends.

44. Intravenous rehydration based on degree of dehydration

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45. Etiology of CHD

a. genetic factor (internal factor )
gene mutation
chromosome aberration
b. environmental factor (external factor)
viral infection
maternal diabetes
alcohol consumption
other maternal teratogen exposure

46. Characteristic of fetus circulation

- the placenta provides for gas and metabolite exchange
- RV and LV exist in a parallel circuit
- little blood in pulmonary circulation
- abnormal cardiovascular structures maintain this parallel circulation
- not as efficient as adults’. Convenient to adjust to the fetal to neonatal circulatory transition.

47. Symptoms and signs of VSD

a. small VSD
- asymptomatic
- a loud, harsh, or blowing holosytolic murmur at lower left sternal border accompanied by a
thrill
b. moderate and large VSD
- dyspnea, feeding difficulties, poor growth, profuse perspiration, recurrent pulmonary
infections, cardiac failure in early infancy
- prominence of the left precordium
- a palpable parasternal lift
- theholosystolic murmur less harsh and more blowing in nature and a systolic thrill
- the pulmonic component of the 2nd heart sound may be increased
- the presence of a mid-diastolic, low-pitched rumble at the apex is caused by increased
blood flow across the mitral valve

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48. Chest radiograph of VSD
- pulmonaryovercirculation
- dilated pulmonary artery segment
- cardiac enlargement

49. Electrocardiography of VSD

- left ventricular hypertrophy
- pulmonary hypertension
- right ventricular hypertrophy
ECG🡪left and right ventricular🡪final diagnosis according to this!

50. Complications of VSD

- bronchopneumonia
- congestive heart failure
- pulmonary edema
- infective endocarditis

54. Complication of TOF

- cerebral thrombosis
- brain abscess
- bacterial endocarditis

55. Treatment of CHD (each type)

a. ASD
- surgical or transcatheter device closure
- time for elective closure :
after the 1st year and before entry into school
b. VSD
- small VSD 🡪monitored until VSD has closed spontaneously
- large VSD 🡪control heart failure; prevent the development of pulmonary vascular disease
- surgery
c. PDA
irrespective of age, patients with PDA require surgical or catheter closure
d. TOF
treatment depends on the severity of the right ventricular outflow tract obstruction

57. Summary of glomerular disease

⮚ APSGN is postinfectious and follows a streptococcal throat or skin infection with
Group Aβ-hemolytic streptococci.
⮚ The peak incidence between ages of 5 and 10 years
⮚ Some evidences strongly suggest that APSGN is mediated by immune complexes.
⮚ The symptoms and signs are Haematuria, Edema, Hypertension, proteinuria and
Renal insufficiency

58. Complications of nephrotic syndrome

a. infection
Loss of IgG, Complements in urine

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Edema and immuno-suppressed drugs
❖ Respiratory tract infection (RTI)
❖ Skin infection
❖ Peritonitis
❖ Urinary tract infection(UTI)
b. hypovolemic shock
plasma volume reduced
Vomiting and diarrhea
Administration of diuretics
c. misbalance of electrolyte
● Hyponatremia& Hypokalemia
● Hypocalcemia
d. thrombosis
⮚ Loss of anticoagulase III in urine
⮚ Evaluate coagulate factor IV, V,VII and fibrinogen in serum
⮚ Hyperlipidemia
⮚ Plasma volume reduced
e. acute renal failure
- Plasma volume reduced
- Diuretic drugs

60. Diagnosis of kawasaki disease

Fever persisting at least 5 days
4 of the following 5 principal features:
1 Changes in extremities
2 Polymorphous exanthema
3 Bulbar conjunctival injection without exudate
4 Changes in lips and oral cavity
5 Cervical lymph node swelling
Other diagnoses should be excluded

63. Diagnosis of rheumatic fever

Jones criteria
Major criteria :
- carditis
- polyarthritis
- chorea
- skin rash
- skin nodules
Minor criteria :
- fever
- arthralgia (pain in the joint)
- increased ESR
- CRP
- ECG changes
- previous rheumatic fever

*two major or

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*two minors + one major

64. Extramedullary hematopoiesis

[Link]:
★ Infants suffer from infectious anemia or hemolytic anemia
need enhanced hematopoiesis activity
trigger extramedullary hematopoiesis
reinstatement to the embryonic hematopoiesis.
[Link] manifestation:
★ Hepatomegaly,
★ Splenomegaly
★Lymphadenosis.
★ Erythroblasts and leukoblasts may appear in the peripheral blood.

67. Nutritional iron deficiency anemia diagnosis and treatment

definition :
iron deficiency anemia is generally defined as
a microcytic and hypochromic anemia caused by iron deficiency.
Age :
6-24 months

diagnosis :
a. clinical manifestation
- general manifestation :
age 6-24months
pallor, fatigue, dizziness
tinnitus, spoon-shaped nails
- extramedullary hematopoiesis :
hepatomegaly and splenomegaly
lymphadenosis
- blood examination :
low hemoglobin and iron level
blood smear 🡪microcytic and hypochromic anemia
bone marrow 🡪 an increased number of erythroblasts with delayed maturity of cytoplasm

treatment
a. general measures :
special nursing
avoid infection
b. etiologic treatment :
increased dietary intake of iron
treatment of hookworm disease, chronic diarrhea
c. iron supplement :
oral dose of elemental iron is 4-6mg/kg/d in three divided daily doses
d. efficacy observation :
- the blood Hb level begins to increase in 2 weeks after iron therapy
- the symptom and signs completely resolve within 4-6 weeks

68. To diagnose of pneumonia : tachypnea

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(depend on the baby’s age)
0-<2months 🡪>60bpm
2-12months 🡪>50bpm
1-5years 🡪>40bpm
>5years 🡪>30 or >20 bpm

69. Classification by anatomic distribution (pneumonia) :

- lobar
- interstitial
- bronchopneumonia
- bronchiolitis

70. Classification by causative agents of pnumonia

- bacterial pneumonia
oAcute onset of sudden shaking chills with high fever
oSignificant cough (productive) and chest pain
oTachypnea
oExam: dec. breath sounds, localized crackles, rhonchi early; as consolidation increases
markedly diminished breath sounds and dullness to percussion
Abnormal tactile/vocal fremitus

- viral pneumonia
oSeveral days of Upper Resp-Tract Infection (URI) with low-grade fever
oTachypnea
oIf severe cyanosis, respiratory fatigue
Exam: crackles and wheezing

- myocoplasmapneumoniae pneumonia
-Caused by Mycoplasma pneumoniae: Pleomorphic, wall-less bacteria
-Also called primary atypical pneumonia and walking pneumonia
-Common in children and young adults
-Malaise, headache, low-grade fever, persistent fever, respiratory secretions
-Cough in paroxysms, worse at night, for several weeks not severe
-Scattered crepitations or wheezes, over on lower lobes
-Treatment:
oErythromycin
oClarithromycin or azithromycin

- chalamydia
- mycotic infections
- aspiration of
food/gastric acid
foreign bodies
dust
lipoid substances

71. Clinical findings of pneumonia

- fever
- generalized toxicity
- cough, sputum production, wheezing or stridor
- rales, decreased breath sounds, dullness to percussion

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- abnormal tactile or vocal fremitus
- meningismus, abdominal pain

72. Differential diagnosis of pneumonia

- acute bronchitis
- pulmonary tuberculosis
- foreign body aspiration

73. Complication of pneumonia

- empyema
- pyopneumothorax
- tension pneumothorax
- pneumatocele
- lung abscess

74. Physiological characteristic of neonatology

o Wt. 2500g
oGood activity- Sucking well
No pallor, cyanosis, deep jaundice or Congenital gross anomaly
- respiratory rate : 40-60bpm
- heart rate : 120-140bpm
- WBC 15-20 x 10 pangkat 9/L
- neutrophils predominate at birth and in the older child
- lymphocytes predominate between 6days and 4 years
- sucking reflex elicited by placing a sterile nipple in the mouth
- rooting reflex
- grasp reflex elicited in the palms and soles by placing a fingers at the bases of the fingers
and toes—flexing
- moro reflex elicited by slapping the examining table or jerkin the underlying blanket--
extension-flexion
- physiological jaundice : 2-3days of life
- enlargement of breasts : 3-5 days of life
- pseudomenses : 5-7days persisting 7 days

75. HIE clinical manifestation or cerebral hypoxia

HIE = hypoxic-ischemic encephalopathy
- clinical signs and symptoms depend on the severity, timing, and duration of the insult
- seizure onset usually occurs <24hrs of life
- during the 12 to 24hrs period after injury :
an apparent increase in the level of alertness, not associated with improvement in neurologic
function exaggerated Moro reflex and deep tendon reflexes
- after 24 to 72 hours :
infant’s level of consciousness deteriorates, followed by respiratory arrest and signs of
brainstem dysfunction

79. Neonatal asphyxia evaluation

APGAR SCORE

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80. Criteria for perinatal asphyxia

• Prolonged metabolic or mixed acidemia (pH < 7.00) on an umbilical cord arterial blood
sample
• Persistence of an Apgar score of 0-3 for > 5 minutes
• Clinical neurological manifestations e.g. seizure, hypotonia, coma or hypoxic-
ischaemic encephalopathy in the immediate neonatal period
• Evidence of multiorgan system dysfunction in the immediate neonatal periods

81. Etiology of neonatal icterus

- infective icterus
- non-infective icterus
- other :
hunger, hypoxia, dehydration, acidosis, constipation, skull hematoma, etc

82. HIE in term infants

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83. Treatment of pneumonia

- antimicrobial therapy
- oxygen
- hydration
- electrolyte supplementation

84. Bacterial meningitis clinical manifestation :

Infectious manifestation:
---Fever, upper respiratory tract infection,
---irritability, poor feeding,
---vomiting, drowsiness, malaise,
---petechia (meningococcal meningitis) ,etc, in early stage.
CNS manifestation:
---headache, projectile vomiting,
---bulgingfontanelle,
---increased head circumference in babies,
---lethargy, confusion, coma,
---stiff neck, photophobia,
---convulsion, seizures, papilledema,
---Kernig and Brudzinski signs (+)

85. CSF differences

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86. Guidelines of antibiotic therapy (bacterial meningitis)

(1)Choose bacteriocidal antibiotics.
(2)Choose antibiotics that can penetrate the blood-brain barrier.
(3)Administered as soon as possible.
(4)Therapy should continued for a minimum of 10-14 days generally.
(5)Broad-spectrum intravenous antibiotic treatment is initiated.
Afterspecific organisms are identified, antibiotic therapy can be
Tailoredbased on antibiotic sensitivity patterns.

89. Neonatal sepsis

definition :
clinical evidence of infection + evidence of a systemic response to the infection
<28 days of birth
signs and symptoms :
a. body temperature
fever or hypothermia
b. tone and behavior
poor tone
weak suck
c. shrill cry
d. skin
poor perfusion
cyanosis
pallor
petechiae
unexplained jaundice
e. feeding problems
vomiting

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diarrhea
abdominal distention
hypo or hyperglycemia
f. cardiopulmonary
tachypnea
tachycardia
bradycardia
hypotension
low pO2
retraction
g. bulging or pulsating fontanelle

CLINICAL MANIFESTATION
-Early stage:
oWeight decrease
-Then, emaciation, subcutaneous fat
-Skin dry, pale and gradually loses elasticity
-Wrinkled forehead
-Muscle tone
-Muscle is loose and shrink, appears skinny
-Subcutaneous fat consumption
oSequence:
Abdomen
Body, hip, 4 limbs
Cheek

-When worsening bone growth slowly, height lower than normal

-Mild or severe malnutrition
-Edema
oPitting edema
oShining skin
oSevere: ulcer, infection, chronic ulcer
oKwoshiorkor

90. Features of acute glomerulonephritis

pathogen :
hemolytic streptococcus
4 features :
-hematuria
-hypertension
-oliguria
edema

99. FORMULAS AND KEY POINTS FOR SOME MCQS

[Link] for calculating the normal weight of children aged 2 to 12 years :
weight (kg) = years of age x 2 + 8

B. formulas for calculating the normal height of children aged 2 to 12 years :

height (cm) = years of age x 7 + 70

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C. closure time of anterior fontanel :

12-18 months of age

D. eruption age of deciduous teeth :

4 to 10 months of age.
Normal children erupt 20 deciduous teeth by the age of 2.5 years.
<= 2 years of age number of deciduous teeth = months of age - 5

E. 1 to 9 years of age normal ossification centers =

normal ossification centers = years of age + 1

F.. nutritional megaloblastic anemia

lack of vitamin B12 and folate

G. bacterial meningitis complication

subdural effusion

H. viral encephalitis
CSF may be normal

I. febrile seizures
- 6 months to 4 years
- fever without signs of nervous system

J. hypothyroidism
T4TSH

K. GDH(?)
short stature but normal mental development
(GHD=growth hormone deficiency)

L. acute upper respiratory tract infection

- herpangina group A coxsackie viruses
- pharyngoconjunctival fever adenovirus

M. asthma
chronic inflammatory disease induced by allergic reaction

101. Special states of newborn :

- physiological jaundice
(full term infant < 2 weeks, preterm infant < 4 weeks)
- Epstein pearls
- enlargement of breasts
- pseudomenses

102. Respiratory distress syndrome

definition :
-hyaline membrane disease (HMD)

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-deficiency of pulmonary surfactant, PS
-pulmonary alveoli collapse at the end of expiration
-progressively aggravated respiratory distress shortly after birth
mainly in preterm infant
-Cardinal signs:
oTachypnea (inc. exchange of oxygen and carbon dioxide)
oGrunting (create positive pressure in lungs to reduce collapse of air sac)
increased work of breathing (including nasal flaring and retraction of respiratory muscles)

103. Hemolytic diseases of the newborn (non-infective icterus)

blood group incompatibility (ABO):
-maternal blood group O, A or B infants
-A or B blood type substances widely exist in nature
O mothers subject to be stimulated by A and B substances before 1st pregnancy and
produce IgG (anti-A or anti-B)

104. Type of dehydration

1. Isotonic dehydration:
▲Water is relatively lost same as solute (electrolytes),
▲It usually occurs in acute diarrhea in children over 3 months of age.
2. Hypotonic dehydration:
▲ More solute (electrolytes) is relatively lost than water, resulting in decreased osmotic
pressure of plasma.
▲ It usually occurs in persistent or chronic diarrhea, or diarrhea with malnutrition.
3. Hypertonic dehydration:
▲ More water is relatively lost than solute (electrolytes), resulting in enhanced osmotic
pressure of plasma.
▲ It usually occurs in infants under 3 months of age, or diarrhea with high fever or
pneumonia, which promote his evaporative loss of water.

105. Rickets- clinical manifestation and imaging

-Initial Stage (early stage)
oNon-specific psychiatric syndromes
Increased neuroexcitability (irritability, anxiety, etc)
oBlood Chemistry change
Serum 25-(OH)D
PTH
Serum Ca P
Alkaline phosphatase normal or slight
oX-ray
Normal or slightly fuzzy calcification lines
oAlopecia

-Active stage (Excitation period)

oBone change at part of rapid growth
o< 6 months
Lesions mainly at skull
Craniotabes
Ping pong ball sensation
o> 6 months mainly osteoid tissue accumulation

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Rachitic rosary
Widening of wrists and ankles
Caput quadratum
Wide open anterior fontanels
oMuscle force and tone
oPigeon breast deformity
oBow legs
oEruption of teeth delayed
oBlood Chemistry change:
Serum 25-(OH)D
PTH significantly
Serum Ca slightly
Alkaline phosphatase significantly
oX-Ray
Long bone calcification zone disappear
Metaphysis presents as brush-like and glass shaped
Epiphyseal cartilage plate widened (> 2mm)
Osteoporosis
Backbone bending deformity (or greenstick fracture)

-Recovery Period
oSigns and symptoms alleviate or disappear after sunshining and treatment
oBlood chemistry change
Serum calcium and phosphorus return to normal
oX-Ray
Irregular calcified line 2 to 3 weeks after treatment
Epiphyseal cartilage disc gradually return to normal

-Sequela Period
oMostly seen in >2 yrs old
oBlood chem: totally recovered
oX-Ray: bone metaphyseal lesion disappear and bone deformities in different degrees
residue

106. IDA
-Def:
oIron deficiency anemia is generally defined as a microcytic and Hypochromic anemia
caused by iron deficiency.
oAge: 6-24 months.
-Etiology:
oIron Store Deficiency
oMalabsorption
oChronic blood loss
oRapid growth
oPoor dietary intake of iron
-Pathophysio:
oIron deficiency Hb synthesis mycrocytic hypochromic anemia
Myoglobin and enzyme synthesis
-Clinical Manifestation:
oGeneral:
pallor, fatigue, dizziness, tinnitus, spoon-shaped nails.

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oExtramedullary hematopoesis
Hepatomegaly and splenomegaly
Lymphadenosis
oOther:
Loss of apetite, Pica (eat paper, mud, lime etc)
Angular stomatitis
Tachycardia, tachypnea, cardiomegaly, Systolic murmur, cardiac failure
Vertigo, irritability, infection
Developmental delay, Poor muscle tone
-Treatment
oGeneral measure: special nursing, avoid infection
oEtiologic treatment: dietary iron, treat hookworm, diarrhea, etc
oIron supplement: 4-6 mg/kg/d PO in 3 divided doses
Blood transfusion (if Hb < 60g/L)

107. Meningitis – clinical findings

[Link] manifestation: ---Fever, upper respiratory tract infection, ---irritability, poor

feeding, ---vomiting, drowsiness, malaise, ---petechia (meningococcal meningitis) ,etc, in
early stage.
[Link] manifestation: ---headache, projectile vomiting, ---bulging fontanelle,---increased
head circumference in babies, ---lethargy, confusion, coma, ---stiff neck, photophobia, ---
convulsion, seizures, papilledema, ---Kernig and Brudzinski signs (+).

homework

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