Pediatrics

Congenital Anomalies

Down syndrome brushfields spots, clinodactyly, atlantoaxial dysplasia, duodenal atresia

Down syndrome dysplastic ears, broad flat face, falt occiput
Full trisomy most common type of Down syndrome
Small wrinkled tongue NOT a characteristic feature of Down syndrome
Neurogenic bladder least likely to be found in Down syndrome
Not true of Down syndrome nondisjuction of sex chromosomes, rather autosomes
Endocardial cushion defect most common cardiac anomaly in Down syndrome
Patau syndrome holoprosencephaly, microphthalmia, polydactyly
Edward syndrome rocker bottom feet, nail hypoplasia, growth retardation, severe MR, low-set ears
Cri Du Chat syndrome hypertelorism, antimongoloid slat cat-like/mewing cry
Turner syndrome redundant skin at nape, low posterior hairline, edema of dorsum of feet
Turner syndrome - cubitus valgus, wide-carrying angle
TAPVR figure of 8
Ebstein anomaly Box-like, maternal use of lithium
TOF boot shaped, CHF not common
TGA egg on its side, maternal DM or use of cocaine
TA waterfall, hilar
COA figure of 3, Turner Syndrome, 45X
PDA continuous murmur maximum in the 1 st & 2nd left ICS MCL; bounding peripheral pulses
PDA continuous, machinery-like murmur, maximal at 1st ICS, peripheral pulses bounding, wide pulse pressure
PDA 1 year after surgical ligation may not require anti-microbial prophylaxis
ASD fixed, widely spaced, split 2nd heart sound
VSD most common pathologic cardiac murmurs in childhood
Not a characteristic of large VSD normal development (usually small)
3 number of babies born w/ congenital heart disease in every 100 babies delivered according to latest study
Choanal atresia neonate is cyanotic but gets pinkish when crying
Scrotal tongue requires immediate attention
Achondroplasia typical dwarf
Talipes Equinovarus most common type of congenital clubfoot deformity
True of clubfoot may be associated w/ myelodysplasia & anthrogryposis
Bilateral clubfoot found among males
Pierre-Robin Syndrome hypoplastic mandible (micrognathia), large tongue, glossoptosis, cleft palate
Upper Airway Obstruction most urgent problem in infants w/ Pierre Robin Syndrome
DiGeorges syndrome low set ears, hypocalcemia, absence of thymic shadow on chest roentgenogram
DiGeorges syndrome - persistent candidiasis
Responsible gene found in the sex chromosome not a characteristic of autosomal recessive inheritance
True of autosomal dominant affects male & female equally, no sex predilection
Austosomal recessive inheritance both parents must be carriers of responsible gene
Austosomal recessive inheritance - may manifest in consanguinous relationship; male & female equally affected
Absent or low GH after provocative test - definitive & confirmatory in growth deficiency
Congenital Hypothyroidism

Congenital hypothyroidism apathetic, dull-looking, constipated w/ decreased bone age

Congenital hypothyroidism - feeding difficulty is an early sign, more common in boys
Na-Levothyroxine drug of choice for congenital hypothyroidism
Na-Levothyroxine - precaution of its use is observed when taken simultaneously w/ iron
Dysgenesis most common cause of congenital hypothyroidism

Congenital Hyperthyroidism

Not true of congenital hyperthyroidism birth wt & length are normal

Congenital Adrenal Hyperplasia

17dehydroxyprogesterone parameter in NB screening to detect CAH

Biochemical abnormalities in salt-wasting CAH hyponatremia, hyperkalemia, hypotension & hypoglycemia
Grossly male genitalia male NB positive for CAH, deficient in 17-beta-dehydroxylase

Congenital Syphilis

Congenital syphilis characterized by involvement of the long bones

Congenital syphilis - diffuse copper-colored maculopapular rash
Syphilis maternal disease not capable of causing mental handicap in the offspring
Bullous lesions of palms & soles most suggestive of early congenital syphilis
Hutchinsons Triad late manifestation of congenital syphilis

Congenital Rubella

Congenital Rubella Syndrome common manifestations include cataract, glaucoma, PDA,VSD & deafness
Glaucoma can be a manifestation of a congenital rubella syndrome

Inborn Errors of Metabolism

Valine, leucine, isoleucine degradation of these AA results to organic acids as intermediate metabolites
leading to organic academia
Glucose-6-phosphate dehydrogenase deficiency sometimes referred as Favism

Immunologic

Type I: Immediate hypersensitivity anaphylazis, allergies, bronchial asthma (atopic forms)

Type II: Ab-mediated hypersensitivity AIHA, Goodpasture syndrome
Type III: Immune Complex Acute poststreptococcal glomerulonephritis; SLE, Serum sickness; Arthus reaction
Type IV: Cell-mediated Contact dermatitis, multiple sclerosis, type 1 diabetes, transplant rejection, TB
Type IV tuberculin reactivity
Henoch-Schonlein Purpura crampy abdominal pain, rashes on back of legs, buttocks & extensor surfaces of
Forearm, urinalysis revealed proteinuria & microhematuria
Aqueous epinephrine IM initial treatment of choice for anaphylaxis

Neonatal

Cephalhematoma may not be visible until several hours after birth

 Subdural hemorrhage more common among term rather than premature infants
Convection heat loss to cooler surrounding air
Neonatal polycythemia may be a cause of hyperbilirubinemia
1 g Hb yields about 35 mg of bilirubin
Hypotonia, lethargy & poor suck early signs of kernicterus
Fever, seizures & opisthotonos late findings of kernicterus
Jaundice earliest & most consistent finding finding in mild HDN
< 40 mg/dL hypoglycemia in a term infant < 48 hours old
> 15 mg/dL indication for phototherapy; relative indication for phototherapy
> 20 mg/dL absolute indication for exchange transfusion
> 20 mg/dL kernicterus usually occurs
Sole of foot covered w/ creases indicate most reliably that infant was mature
1st 6 hours of life clinical signs of RDS generally 1st appear
ROP major danger assoc. w/ an arterial pO2 >100 mm Hg in premature infant receiving O2 for RDS
Premature synostosis of saggital suture usually associated with scaphocephaly
Umbilical vein carries highly oxygenated blood from the placenta towards the heart
Meconium aspiration syndrome least likely cause of respiratory distress in a term NB w/ an APGAR score
of 9, 10
Mongolian spots take months to disappear
Craniotabes may be an early sign of rickets, may be a manifestation of Vit. A toxicity, may be normal in NB
Vein of Galen malformation most common malformation in neonate
Embolization treatment of vein of Galen malformation
Suffocation type of accident usually happens among infants 0 4 months old

Newborn Care

Multiple sole creases - indicate that NB is term

Many superficial veins may indicate that the infant is preterm
Choanal, esophageal & imporferate anus - congenital anomalies rule out during routine NB care
APGAR score of 10 good respiratory movements w/ a strong cry

Reflexes

Tonic neck reflex reflex disappear allowing the infant to examine objects at midline
Rooting aid in infant feeding

Infancy (0 1 year)

6 weeks - crying in infants usually peak

6 months sit w/ slight support
8 months - infant neat pincer grasp
Infants started on solid foods by at least 4 or 5 mos. because infants are then able to be taught how to chew

Toddler (2 3 years)

Toddler bed time rituals are particularly important

Pre-school (3 6 years)
 Best describes a preschooler play increases in complexity & imagination
Preschool differentiation between good or bad
Teaching goal for a preschool decrease the number of mealtime spills
Teaching goal for a preschool enforce table manners
Enuretic when a child has not attained full bladder control by the age of 5 years

School Age (6 12 years)

6 years - conscience develops

Board game play activities appropriate for a 6-year old child
7 years 20/20 vision achieved
9 years ceiling age for sitting

Adolescence (12 20 years)

Not true of menarche occurs later in those residing in urban areas

Thelarche 1st sign of puberty in girls
Breast engorgement one of the maternal estrogenic effect in NB usu. found in fullterm, male & female infants
Therapeutic communication w/ adolescent best accomplished by relating on a peer level

Anthropometrics

35 cm average head circumference of a term infant at birth

8 cm - increment in head circumference during the 1st yr
12 normal increment in cm of the head circumference in the 1 st year of life
2 cm - increment in head circumference during the 2 nd year
Head circumference - influenced by nutritional status until 36 weeks of life
2 years of age - male infant will have its birth weight by 4x, half of mature height
kg/m2 BMI
age in yrs x 2 + 8 - best formula to approximate weight
Preterm LGA 30 weeks, 3000 grams
1 year infant triples his birth weight

Dermatologic

Inflammatory bullae initial lesions of incontinentia pigmenti

Subcutaneous fat necrosis lesions beneath fading forceps marks folloeing trauma or cold exposure
Eosinophils revealed in the wrights stain of the contents from a lesion of erythema toxicum
Pityriasis alba does not present w/ vesicobullous lesions (herpes zoster, erythema multiforme, Steven-Johnson
Syndrome)
Fungus in nails - hardest to treat
Herpes zoster - group vesicles w/ erythematous base
Varicella - no dermatomal characteristic
Wrinkled skin - NOT of a manifestation of kwashiorkor or edematous protein deficiency
Wrinkled skin marasmus

Scabies

Scabies - pruritic papules over plams & nodules, similar eruptions to other siblings, not generalized
 Scabies caused by burrowing & release of toxic substances by female mite
Scabies - 1st sign of infestation consists of 1-2 mm red papules
Permethrin - drug of choice for scabies
Not true of scabies - sites of predilection are head, neck, palms & soles

Seborrheic dermatitis

Seborrheic dermatitis - dermatosis not causing pruritus, scaly but not pruritic
Seborrheic dermatitis diffuse scaling & crusting of scalp & greasy scaly erythematous papules on face,
retroauricular areas & axillae which seem non-pruritic

Skeletal

Right scliosis curvature NOT a danger sign in children w/ back pain

Gait asymmetry - main consequence of leg length discrepancy
Not a charac. of rheumatic arthritis if left untreated, deformity most likely to occur, no deformity
Rheumatoid arthritis w/ deformity

Muscular

Douchene - difficulty climbing stairs, hypertrophied calf muscle

Extreme wasting away of fat muscles noted in severe caloric deficiency

Neurologic

Cerebral hamartoma not a neurological complication of meningitis

Pseudotumor cerebri Vitamin A excess, manifests as papilledema, drowsiness, CN palsy
Spastic most common type of cerebral palsy
Athetoid hyperbilirubinemia
Ataxia seen in kernicterus, basal ganglia involvement
Flaccid hypoxia
Febrile seizure anti-convulsants not routinely used
Group B streptococci most frequent cause of neonatal meningitis
CMV transmitted w/ greater risk among premature; microcephaly, cerebral calicifications & blindness
Anti-Ach receptors Ab implicated in Myasthenia gravis
Progressive weakness involving proximal muscles true of muscular dystrophies
Presence of meningitis not a poor prognostic sign for patient w/ meningococcemia
Poor prognostic signs of meningococcemia presence of petechiae for < 12 hours PTA; presence of shock;
normal or low peripheral WBC count
Flexion of arms not a characteristic of spasms of tetanus (painful, lasts for seconds, opisthotonos)
Involuntary movt associated w/ lesions in the brain except anterior horn cell (sensory)
Puretone - test not used in babies, you need cooperation of the px, not feasible for neonate
Rattle test testing hearing grossly

Hydrocephalus

Hydrocephalus if left untreated can cause mental retardation because gradually increasing size of the
ventricle presses the brain against the bony cranium, anoxia & decrease blood supply result
Communicating hydrocephalus most serious complication of meningitis in young children
Attention Deficit Disorder & Autism

Feeding difficulty - NOT a co-morbidity of attention deficit disorder, seen in autism

Autism associated w/ dysfunctional family environment

Special Senses

Excessive or impacted cerumen in young adolescent removed by mineral oil drop & tepid water irrigation

Oral Cavity, Phraynx, Larynx

True of laryngomalacia - associated w/ larngopharyngeal reflux

Laryngomalacia inspiratory, self-limiting
Epiglottitis commonly caused by adenovirus

Thyroid & Parathyroid

Simple goiter - 10 year-old child, lagging of upper eyelid when looked down, eyes cannot converge

Cardiovascular

Heart block manifestation of the neonatal lupus that tends to be permanent

Excessive sweating may be a manifestation of heart failure in a young infant
CHF in early infancy feature not seen in VSD
ASOT not a major criterion for diagnosis of rheumatic fever (carditis, arthritis, subcutaneous nodules)
Pulse oximeter - non-invasive way of monitoring oxygenation
True of pediatric cardiopulmonary arrest apnea usually precedes bardycardia w/ poor perfusion
Ventricular fibrillation more common in adults
1st approach to the therapy of dysrhthmia iced saline bag placed over the face to regulate rhythm back
to normal
IM erythromycin - not used as secondary prevention for rheumatic fever (given orally)
Heart failure - common manifestation of myocarditis in children
Heart less than half of the thorax average size
Peripheral edema among the last signs of heart failure in infant & child
Congenital R to L shunt cardiac defect elevated hematocrit
Audible heart murmur major common symptom in a child w/ L to R shunt of the heart
Oslers nodes bacterial endocarditis
Oslers nodes painful, tender, pea-sized nodules appearing on pads of fingers & toes in bacterial endocarditis

Kawasaki Disease

Subacute phase MI in Kawasaki

20 - 25 % - coronary involvement in Kawasaki
6 mo to 2 yr peak occurrence of Kawasaki
Steroids controversial in the management of Kwasaki disease
2g/kg within 10 12 hr dose of IV Immunoglobulin in Kawasaki disease
Kawasaki disease bilateral conjunctivitis, dry, red, fissured lips, cervical lymphadenopathy
NOT a consistent feature of KD macula-papular rash over the buttocks & extremities
ECG

T wave inversion digitalis toxicity seen on ECG

Hematologic

Hemolysis result of blood group incompatibility

Acquired prothrombin complex deficiency generalized seizure, born at home, purely beastfed, pale, drowsy,
bulging fontanel, liver edge 4 cm below the right subcostal margin & right hemiparesis
Acute leukemia swelling of the right knee, intermittent fever, pain on right knee during ambulation, limping,
Pale conjunctivae, lever edge 3 cm below the right costal margin, splenic edge 1 cm below left costal
Margin
1 month duration of tx not true of IDA
IDA microcytic, hypochromic; caused solely by inadequate dietary iron & unsual before 4-6 months of age;
therapeutic dose of 6 mg/kg/day
Splenomegaly is common not true of ITP
ITP occurs 1-4 weeks following exposure to viral infections; BM shows normal or number of megakaryocytes
& spontaneous remission achieved by majority of cases
Uncorrected bleeding diathesis contraindication in doing a lumbar tap in a 6-month old infant
aPTT measures factor VIII
Platelet function - determined by bleeding time

Respiratory

Red nasal mucosa not a common finding in px w/ allergic rhinitis (edematous nasal turbinates, profuse clear
nasal discharge, dark circles under the eyes)
Anti-histamines most effective treatment for allergic rhinitis
Wheezing not a common finding in RDS/HMD
Child infected w/ Mycobacteria Mantoux test was done on a 2-year old child who had no previous BCG;
after 48 hours, the result was a 12 mm induration
Amoxicillin empiric treatment administered if bacterial etiology is strongly considered for PCAP A or B
Penicillin G for patients classified as PCAP C w/o previous antibiotic & has completed primary immunization
against Haemophilus influenza type B (100,000 units/kg/day Q6H)
IV Ampicillin if primary immunization against Hib has not been completed (100 mg/kg/day in 4 divided doses)
4 hours number of hours a px should fast for controlled intubation
Dopamine not given via endotracheal tube
True of pleural effusion in children often a complication of pneumococcal pneumonia
Aspiration - most common cause of lung abscess
Haemophilus influenza type C - NOT an agent of infectious croup
Staphylococcus aureus - most common cause of purulent pleuyrisy
Auscultation - most helpful in diagnosisng lung disease
Lymphadenopathy hallmark of childhood TB
Calcification, cavitation only seen in adults after 6 months of infection
Sputum culture - gold standard in the diagnosis of PTB
Low pressure aspiration or gastric aspiration - best way to collect sputum in children
5: 1 - compression-ventilation ratio for intubated children
Feed the baby in upright position best prevention for aspiration in pediatric px aged 4-7 month old
 Prevent drying & damage to mucous membrane rationale for humidifying oxygen in a px w/
Bronchopneumonia
Treatment in children w/ bronchiolitis high humidity, oxygen as needed, postural drainage & vibration
Left pneumothorax adolescent, sudden onset of resp. distress, cyanosis, retractions, breath sound left lung

RDS

RDS symptoms should be observed in an infant whose mother is Type I Diabetic

NB of few hours appears less cyanotic when crying should observe for sterna retractions of RDS

Pneumonia

Tachypnea - most consistent manifestation of pneumonia

Children at higher risk of invasive pneumococcal infection those w/ cochlear implants

Bronchial Asthma

Inhaled corticosteroids - cornerstone in management of persistent asthma

Long acting beta agonist moderate to persistent type of asthma
Short acting beta agonist mild, intermittent type of asthma
Theophylline alternative treatment
Not true in bronchial asthma - silent chest is a good sign
Viral infection - most common precipitant of asthma in infancy
RR of 55 cpm is considered tachypnea true regarding asthma in a 6-month old

Gastrointestinal

Vomiting usual manifestation of intestinal malrotation & annular pancreas in childhood

NEC began to vomit on 3rd day of life, abdominal distention & bloody stools; repeated episodes of hypoxia
or poor perfusion; hypoxia & ischemia of the bowel sets for invasion of bowel by certain bacteria
Pyloric stenosis - 2 week old infant, frequent postrandial vomiting, non-bilious, upper GI series showed string
sign (narrowing or obstruction)
Hyperthropic pyloric disease - string sign, double tract sign
Volvolus non-bilous vomiting, beak-sign
Malrotation bilious vomiting
Duodenal atresia bilious vomiting, double bubble sign
Duodenal atresia hx of polyhydramnios, no abdominal distention
Hypokalemia (ileus) - 2 yr old child w/ diarrhea & vomiting, distended abdomen, hypoactive bowel sounds
Small amounts of uncojugated plasma bilirubibin does not cause BBB because it is tightly bound in albumin
Cholera is the least likely cause - 2 yr old child, bloody mucoid diarrhea, fever, crampy abdominal pain
History of eating spoiled food vomiting & fever are anticipated
Failure to thrive long-term consequence of gastric ulcers in infant

Hepatic

Biliary atresia - bile plugs, fibrosis, absence of bile, acholic stools

Persistent acholic stool most common manifestation of biliary atresia
True of biliary atresia surgical reconstruction w/in 60 days (8 weeks o flife)
Kasai procedure best mangement
 90% prognosis - before 8 weeks of life
Point ot probable dx of extrahepatic biliary atresia except poor hepatic uptake of radiographic nuclei marker
(this is seen in intrahepatic)
Spider angiomata sign of portal HTN
Blue muffin appearance in infants w/ TORCH infection most likely represents metastatic hepatic tissue

Meckels Diverticulitis

Meckels diverticulum persistence of yolk sac

Meckels diverticulitis - painless rectal bleeding, currant jelly stool
Meckels diverticulum often confused w/ acute appendicitis
Meckel scan test to be requested in a 2 yr old boy, passage of grossly bloody stools, pale, no fever, w/ pain &
Vomiting

Hirschsprungs Disease

Hirschsprungs disease congenital aganglionic megacolon

Intestinal obstruction most common presentation of Hirschsprungs disease in newborn

Intussusception

Intussusception in pain repeated periodically w/ periods of sleep, palpable mass around the umbilicus
Intussusception suspected in an infant who experiences bloody diarrhea

Constipation

Constipation seen in megacolon, hirschprung, Vitamin B deficiency

Constipation seen in hypercalcemia
Constipation not seen in hypocalcemia & hypokalemia

Typhoid Fever

Blood or BM culture reliable diagnostic measure for Typhoid fever

Bone marrow - best & most sensitive specimen for salmonella, present throughout the illness
In the BM- present althroughout the course of typhoid
Blood most helpful specimen in the 1st week of typhoid
Urine & stool 2nd week of typhoid
Salmonella typhi - serotype of salmonella causing typhoid fever

Shigellosis

Shigellosis - common cause of bloody, mucoid diarrhea

Shigellosis convulsion, high grade fever; passed large volume of watery stools w/ blood & mucus

Pheochromocytoma

Pheochoromocytoma growth failure seen, VMA

Not true of pheochromocytoma proteinuria & hematuria are common findings

Urinary
 Suprapubic tap - an E. coli count of 2,000 cfu/mm3 would be a definite evidence of UTI if sampled urine was
collected through this
Hyperlipidemia least likely in a 6-year old boy w/ tea-colored urine & healing impetigo (periorbital edema,
Hypertension & red cell cast)
Cushingoid appearance not a complication of Acute Post-strep GN (CHF, ARF, hypertensive encephalopathy)
Polycystic renal disease - NOT associated w/ intracranial bleed
Not true of nephritic syndrome hypertension, proteinuria, edema
Bilateral renal agenesis amnion nodosum on placental membranes
Living related donor renal transplantation best treatment for pediatrics showing evidence of ESRD

Endocrine

Epiphyseal dysgenesis most suggestive of hypothyroidism

Primary hypothyroidism - T3 & T4, TSH
Hypoparathyroid state not true of Hashimotos thyroiditis
Adrenal carcinoma - most common cause of Cushing syndrome
Storage of substrate risk of developing hypoglycemia among preterms & SGA
Thyroid releasing hormone not secreted by the anterior pituitary gland (GH, LH-FSH, ACTH)
Gynecomastia - not common in young children
Diabetid ketoacidosis in a 3-year old female IDDM px confusion, paresthesia
Polyuria & breath odor NOT consistent symptoms of diabetid ketoacidosis in a 3-year old female IDDM px

Metabolic

Hypocalcemia 24-hour-old infant noted to have irritability, apnea, cardiac arrhythmias & finally seizures
Hypercalcemia unusual in pxs w/ simple (nutritional) rickets
Alkalosis observed in cases of uncontrolled vomiting

Reproductive

5-alpha-reductase responsible for abnormal development of genitalia among males

Systemic

True of fever of unknown origin cannot be identified after 1 week evaluation in the hospital

Human Milk

Low in human breast milk Vitamin K, iron (but better absorbed than cows milk), Vitamin D, Chloride
20 calories per ounce - caloric density of human milk

Fluids & Electrolytes

20 mEq/L potassium content of ORS

Oral rehydration therapy NOT indicated in ileus, coma or shock
Old ORS component Na : 90, K : 20, Cl : 80, citrate : 10, osmolality : 311
New ORS component Glucose 75, Na : 75, K : 20, Cl : 65, citrate : 10, osmolality : 245
D5LR Na content per liter is 130 - half of that is 65, since 500 mL was given
D5LR 1st choice of fluid in a 10 month old baby boy who lost 10 % of weight
 PNSS 154 Na
IMB 20,20,25

Degree of Dehydration

Mild dehydration w/ vomiting choice of IV : D5 0.3 NaCl for 6 hours

Mild wt loss w/ mild dehydration - episode of vomiting 2 hours prior to consult, 12kg to 11.5 kg after
Moderate to severe dehydration - D5LR is the 1st fluid of choice
Hypernatremic dehydration associated w/ warm, doughy skin
Severe dehydration - passed 5 watery stools, irritable, sunken eye, rapid pulses, skin retratcted slowly
Severe dehydration PLR is the fluid of choice, give fluids by 30 cc per kg in first 30 min, next 70 cc per kilo
given in the next 2 and hours based on IMCI
Hypertonic dehydration diarrhea of 2 days duration & irritability; irritable infant w/ doughy, warm skin &
rapid pulse
Thirst remain useful in assessing dehydration among malnourished children

Nutritional

400 ug recommended daily dietary allowance of Vit. A for an infant

10 ug - recommended daily dietary allowance of Vit. D for an infant
Biotin - vitamin deficiency common among those eating raw egg white biotin
Nyctalopia (night blindness) - early symptom of Vitamin A deficiency
Pyridoxine added to prevent peripheral neuritis
Vit B12 deficient in a strict vegan diet
Vit E dietary supplementation advisable for premature infants
Vit. K vitamin higher in concentration in cows milk than human milk
Vit. K - this vitamin deficiency could be life threatening in px w/ cholestatsis
Dermatitis commonly found in areas exposed to sunlight not true of edematous PEM
Edematous PEM edema usually develops early; flag sign is reversible
Vegan diet low energy, deficient in 1 or more amino acids, low Vit. B 12
Hormonal therapy not a widely recommended step in promoting lactation
6 calories a fun-loving teenager loses when he laughs

Immunization & Counselling

Live attenuated vaccines more likely to induce immune response stimulating response to natural infection
Vaccination administration of live vaccine, breastfeeding, administration of immunoglobulin
Lifelong immunity follows w/ the ff type of poliomyelitis: abortive, non-paralytic, paralytic
Interruption of immunization schedule resume regardless of duration of delay
In children you can give all vaccines at one time
Right after birth - best time to give preconception counseling
Fever 5 days after immunization reassure the father of the px & advice him to give an antipyretics as the fever
Will last only 1 3 days
Contraindications for smallpox vaccination
- nursing & pregnant mothers
- AIDS, HIV, immunocompromised pxs, those on chemotherapy
- px w/ eczema
OPV

OPV immunization not given to an immunocompromised child

IgA on entry into the gut, OPV produces local immunity by producing this Ig

BCG

BCG keloid scar

BCG & Hepatitis B - most number of vaccine given in neonates

Measles

Measles given as ealy as 6 weeks

Measles could flare up latent TB (same w/ Pertussis)
Measles - fever an expected finding 5 to 6 days after injection
Rashes in measles at the height of fever
Measles high fever & presence of Kopliks spots

Pertussis

Pertussis causes seizure

Pertussis - could flare up latent TB
Pertussis NB exposed to some infectious diseases would probably come down w/ this disease; mother
received the recommended immunization

Tetanus

Immunization of tetanus toxoid on pregnant women method of control of tetanus among infants
Tetanus - requires periodic booster to acquire immunity
Tetanus & Diphtheria - Recovery from infectious disease, w/c will not confirm life-long immunity
5 optimum number of TT doses that gives protection throughout childbearing
Td, no pertussis most appropriate management in a 15 yr old boy, sustaining abrasions ,2 nd DPT boster
at age of 5
nd
2 booster at 10 years - no need to give TIG, booster every 10 years
Respiratory distress most serious complication in a child who develops an acute tetanus infection
Tetanus neonatorum
- prognosis is worse when diagnosed late
- portal of entry is usually the umbilical cord
- incubation period: 1-30 days
- NOT : risus sardonicus commonly observed

Rabies

Rabies not routinely recommended vaccine

Drugs

Chloramphenicol gray baby syndrome

Vancomycin redman syndrome
Clindamycin - most common cause of antibiotic-associated diarrhea in infants & children
 Metronidazole disulfiram-like reaction
Diphenylhydantoin anti-epilectic drug causing gingival hypertrophy & hirsutism
Inhaled corticosteroids cornerstone in the management of persistent asthma
Convulsions - might respond to a pharmacologic dose of pyridoxine
Term & full size infants infants born to Phenobarbital-abusing mothers
Intravenously safest route of administration of acetaminophen to a child following febrile seizure

Viral

Mumps fever, malaise & headache; pain over the area from the back of mandible towards the mastoid
Space; earlobe on affected side appears to be sticking upward & outward
Rubeola 5 days fever associated w/ cough & coryza; developed maculopapular rashes over the face & nape;
Pinpoint lesions on a bright red buccal mucosa in the area opposite the lower molar
Rubella mild sore throat & low grade fever 3 days PTC; tender swelling of wrists & redness of lip 2 days PTC;
rash on face & anterior chest; mild tenderness & marked swelling of posterior cervical & occipital lymph
nodes & diffuse generalized blanching maculopapular rash
Dengue - hemoconcentration, leokopenia
DHF - high grade fever, 3 day, 4th day px become afebrile, weak, poor suck, sleeps most of the time
Roseola infantum runny nose, cough, remain active & playful
Rotavirus - most common viral etiology of acute gastroenteritis among infants & children
Encephalitis can be a complication of chickenpox

Fungal

Candida albicans intensely erythematous confluent plaque w/ sharply demarcated border & satellite papules

Poisoning

Saxitoxin abdominal pain & nausea, followed by perioral numbness; had respiratory arrest & was intubated;
Patient had eaten shellfish about 2 hours before the onset of symptoms

Antidote

Lead EDTA
Iron Deferoxamine
Acetaminophen Acetylcysteine
Organophosphate Atropine
Cyanide Sodium Nitrite
Ethylene glycol Ethanol
Morphine Naloxone
Isoniazid Pyridoxine
Organochlorine No antidote

Radiologic Findings

TTNB sunburst pattern; perihilar streaking; wet lung; type II RDS

Pneumomediatinum angel wing appearance
Meconium Ileus/Plug soap bubble area
Intussusception coil spring appearance
 Wilson-Mikity Syndrome reticulonodular & bubbly changes
Ascitis ground-glass appearance
Pneumothorax mediastinal shift to the opposite side

Diagnostic Procedures

India Ink Preparation capsule of Cryptococcus neoformans in the CSF is best seen
Mantoux tuberculin skin test results interpreted in 48 72 hours

Tables from nelsons

Most common type of CP? among premature infant diplegia

Not an early in cerebral palsy absence of bubbling at 8

Aspiring may exacerbate asthma

Questions from IMCI

Colostrum secretion of breast

3 month old baby,2nd DPT & OPV dose seizure after 2nd hour of DPT & OPV pertussis causes seizure, next time give