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. Auditor y 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 5year s T hen 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 Cir cumfer ence Is Usuall y Nor mal 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 Impor tant 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 Seizur es 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. S h o r t S t a t u r e W i t h F a c i a l D y s m o r p h i s m =
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. Per sistant Asymmetr y(9%Can Pr esent W ith
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 —- Inter nal 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
2 2 1 . I n S p e e c h D e l a y A s k A b o u t N o n - Ve r b a l
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: 3year s-Puber ty-Deter mined 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 Histor y 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 W hen T hey Ar e 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.P r e p u t i a l A d h e s i o n = A f t e r 2 Ye a r s E a r l i e r i f
 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
D e f i c i e n cy A n a e m i a , b u t R d w I s I n c r e a s e d i n
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 W hen T here Is Growth Failure, Bone
Defor mities or Extra Medullar y 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. T hromboembolic 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
P r o b l e m s a n d H a s B e e n S h o w n To R e s e r v e
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. V itamin E T her a py 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. I n c r e a s e d R i s k W i t h D o w n S y n d r o m e ,
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 Cer eberi: V itamin a , Ster oids,
Tetracycline
C. Metabolic: Galactocemia, Maple Syrup Urine Disease
H y p e r t h y r o i d i s m , V i t D D e p e n d e n t R i c ke t s ,
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. Giar diasis 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
3 2 9 . Po l y u r i a + C o n s t i p a t i o n = R TA o r I d i o p a t h i c
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 ,Ectoder mal
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 Ef fusion+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 W ith Fainting = Hypogl ycaemia,
Pheochromocytoma and Neuroblastoma
363. Pulmonary TB Is Unlikely Cause of Night Sweats.
364. The Most Impor tant 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. T he 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 Childr en and T hose W ith
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
3 9 7 . M yo p i a i n C h i l d h o o d I s A s s o c i at e d W i t h
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
Re s e m b l i n g S t a r t l e + S l e e p = N o r m a l , + A wa ke =
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. Par kinsonian Movements Results Fr om
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 W ith 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
Obstr uction. Examine the Her nial 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. T he Commonest Adr enocor tical 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 Secondar y 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
M e n s t r u at i o n = A b s e n c e o f Va g i n a , U t e r u s ,
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
5 1 6 . O r a l T h r u s h + Va g i n a l D i s c h a r g e = Va g i n a l
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 Pr acticall y 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
5 4 9 . O c c i p i t a l C e p h a l h e m a t o m a H a s To B e
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, Pituitar y 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. Shor t 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. Shor t+Overweight+Delayed Bone Age+
Constipation+ Dry Skin=Hypothyroidism
618. CAH: Precocious Puber ty+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+Dysmor phism=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+Or thostatic
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 Hypochlor emic Meta bolic
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
6 6 0 . U n i l at e r a l Pa i n + Feve r + n o D i s ch a r g e + n o
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
6 6 6 . I n c T S H + D e c T 4 + Pa i n l e s s F i r m G o i t r e +
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 W ith Ad dison 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+Hyper tension+Nor mal
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
7 0 1 . M at e r n a l Au n t S t e r i l e T h e n i t s Te s t i c u l a r
Feminisation
702. No Female Inter nal Str uctures 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
7 3 4 . S oya M i l k I s t h e Tr e at m e n t fo r L a c t o s e
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. M e t a b o l i c D e c o m p e n s at i o n D u e t o C a r b o n i c
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 Ever y 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 Bor n 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 Recur rent 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.
8 6 5 . B l o o d i n S t o o l s + S c r e a m i n g A t t a ck s I s
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. Nor mal 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 , Pulmonar y
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. T he Most Impor tant 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. Failur e of Recover y 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 Temper atur e 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. Entir el y Inspir ator y Stridor= Supr a glottic,
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 Ver y Rarely in Primar y
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 W ith 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 (ulcer ations /
periodontitis)

977. Chr onic g r anulomatous 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 pr ematur e ventricular contr actions ar e

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. Pr olong QT= Melt Pc (↓Mg, Er ythr omycin,

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 pulmonar y

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 mur mur 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 le g 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 hear t. (Critical aor tic 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
 s y m p at h o m i m e t i c s ( A m p h e t a m i n e c o c a i n e ,
phenecycline).

1108. Diaphor esis = ↑ sweating = SOAP =

sympathomimetic, organophosphates, Aspirin,
phynecycldine

1 1 0 9 . N y s t a g m u s c a u s e d b y a n t i c o nv u l s a n t s ,
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,

Recover y, 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

exc e s s i ve V i t A t h y r ox i n e , i s o t r e t i n o i n &
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.

1 2 0 1 . N o n - B i l l i o u s vo m i t i n g + H u n g r y ch i l d =
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 hemihyper trophy 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 aler t 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 + nor mal lungs + nor mal

electrolytes = shwachman- diamond.

1308. Macrocytic aplastic anemia = fanconi and

Diamond Blackfan.

1309. Normocytic aplastic anemia = sickle + Parvovirus,

hereditary spherocytosis + Parvovirus.

1310. T hr ombocytopenia in childr en = <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 spectr um 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, rhinor rhea 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 g r oup 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. Dr ooling + hyper extension 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 Scr atch disease no tr eatment 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 phar yngitis 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, Mor axella catar rhalis, str eptococcal
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=Chorior etinitis, 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.
1 3 8 7 . H U S = FAT R N , F e v e r, A n a e m i a ,
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.
1 3 9 1 . Ye r s e n i a E n t e r o c o l i t i c a C a u s e s P s e u d o
A ppendicitis, Er ythema Nodosum and Reactive
Arthritis.
1392. Bloody Diarrhoea : e Coli, Salmonella, Shigella,
Campylobacter , C Difficile.
1394. Chronic Diar rhoea+Abdominal Distention+
Malabsorption= Giardia
1395. CMPI Resolves When GI Tract Matures.
1395. In Lactose Intoler ance , the Stools Ar e
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
Re gar dless 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= Ever y Lab
Abnor mal( Hypogl ycaemia, Hyper ammonemia,
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=Hereditar y Fr uctose
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. Hereditar y Fr uctose 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+
Hepatome galy+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
1 4 8 1 . I n a Pat i e n t W i t h M e t a b o l i c A l k a l o s i s +
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
C a u s e H y p o k a l e m i c , H y p o ch l o r e m i c M e t a b o l i c
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
1 5 1 3 . Fe m a l e + Te e n + N e w O n s e t H y p e r t e n s i o n =
Firbromuscular Dysplasia/Renal Artery Stenosis
1514. Glomerulonephritis Patient Will Always Have
Hematuria
1515. If Proteinuria, IgA Nephropathy =Nor mal
Complement Levels, PSGN= Dec C3 Levels
1516. Nephr otic+ Hematuria=FSGN/Membr anous
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. Or der EMG W hen You Suspect Muscular
Dystrophy
1524. MRI Is for Detailed Imaging of Spinal Cord and
Brain.
1 5 2 5 . C T I s C h e a p a n d Fa s t , E s p e c i a l l y fo r
Haemorrhage, Inc ICP, Tumour
1526. Spinal Ultrasound in Newborn for Neural Tube
Defects Until 6 Months of Age.
1527. Erbs Palsy= C5-c’= Par al ysis 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 Cor d Compr ession, 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. Tr ansver se Myelitis Can Look Like Cor d
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
1 5 6 1 . I n H e a d Tr a u m a , n o Fo c a l S i g n s + n o
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)
1 5 6 5 . I n M ye l o m e n i n g o c e l e Ru l e o u t C h a i r I I
Malformation.
1566. Distal Humer al Fr actur es 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 Hur ler
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
❖