7. This is a condition in which a child, usually
under 1 year old, has a chronic, persistent
or intermittent wheeze, heard without a
stethoscope, but is happy and smiling, not
at all distressed.
HAPPY WHEEZING
9. Normal
Onset in the
second to third day
of life.
mostly in term
babies of lesions.
They are benign.
Aetiology is unknown.
ERYTHEMA TOXICUM
12. MILIA
• These commonly occur on the face and scalp, and
consist of tiny white papules which are usually
discrete. .
• They usually resolve within a few months without
treatment. Milia are inclusion cysts which contain
trapped keratinised stratum corneum.
• They may rarely be associated with other
abnormalities in syndromes including epidermolysis
bullosa and the oro-facial-digital syndrome (type 1).
• . When on the hard palate, they are referred to as
Epstein's pearls; when on the alveolar
ridges(contain the socket of teesth), they are called
alveolar cysts or Bohn's nodules.
14. caused by
the pressure
of the
presenting
part of the
scalp against
the dilating
cervix.
disappears
in first few
days
CAPUT SECUNDUM
15.
16. CEPHALHEMATOMA
doesn’t cross the suture line .
hemorrhage of blood between the skull and
the periosteum
the swelling is subperiosteal
causes of a cephalhematoma are a prolonged
second stage of labor or instrumental
delivery, particularly ventouse.
may develop jaundice, anemia or hypotension
18. SEPSIS
Syphilis and Listeria monocytogenes are
acquired by transplacental infection.
19. RADIANT WARMERS
Evaporative skin water losses can be higher
in neonates, especially premature infants
who are under radiant warmers or
undergoing phototherapy
20. HYPONATREMIA
Hyponatremia causes a fall in the osmolality of
the extracellular space. Because the
intracellular space then has a higher osmolality,
water moves from the extracellular space to the
intracellular space to maintain osmotic
equilibrium.
The increase in intracellular water may cause
cells to swell.
Brain cell swelling is responsible for most of
the symptoms of hyponatremia.
21. CENTRAL PONTINE MYELINOLYSIS
Central pontine myelinolysis is brain cell dysfunction
caused by the destruction of the layer (myelin sheath)
covering nerve cells in the middle of the brainstem
(pons).
The most common cause of central pontine
myelinolysis is a quick change in the body's sodium
levels. This most often occurs when someone is
being treated for low blood levels of sodium
(hyponatremia) and the sodium is replaced too fast. It
also can occasionally occur when high levels of
sodium in the body (hypernatremia) are corrected too
quickly.
22. INFANT GROWTH AND DEVELOPMENT
When there is baby born a premature by 2
month period , at 4 month he will be
developmentally like a 2 month old !!
We don’t say the development of the child is
10 month old , we say for example the gross
motor development of the child is 10 month
old , fine motor is 10 month , speak
&language is 6 month جرا وهلم.
23. INFANT GROWTH AND DEVELOPMENT
Delays in one domain may impair
development in another domain
•A deficit in one domain may compromise
assessment of skills in another domain
•Understanding normal development and
acceptable variations is essential
Development proceeds from cephalic to
caudal and proximal to distal
24. if the Galant reflex is asymmetrical, We can
use this reflex to assist hemiplegia .
25.
26.
27.
28.
29.
30.
31. The more severe the retardation, the more
likely an underlying cause is identified
32.
33.
34.
35.
36. CONGENITAL HYPOTHYROIDISM
Most common treatable cause of Mental
retardation.
Asymptomatic at birth, sporadic.
Most common cause is thyroid dysgenesis
(doesn’t exist or very small).
Lethargy, slow movement, hoarse cry, feeding
problems, constipation, macroglossia(large
tongue), umbilical hernia, large fontanel, delay
in the closure of the ant. fontanels,
hypotonia, dry skin, hypothermia, and
prolonged physiological jaundice.
40. RISK FACTORS FOR MENINGITES
hemoglobinopathies such as sickle cell
disease.
functional or anatomic asplenia, and
crowding such as occurs in some
households, day care centers, or college and
military dormitories.
CSF leak (fistula), resulting from congenital
anomaly or following a basilar skull fracture,
increases the risk of meningitis, especially
that caused by S. pneumoniae.
41. Poor prognosis is associated :
with young age, long duration of illness
before effective antibiotic therapy, seizures,
coma at presentation, shock, low or absent
CSF white blood cell count in the presence of
visible bacteria on CSF Gram stain, and
immunocompromised status.
42. Even with appropriate antibiotic therapy, the
mortality rate for bacterial meningitis in
children is significant: 25% for S.
pneumoniae, 15% for N. meningitidis, and
8% for H. influenzae.
Recurrence may indicate an underlying
immunologic or anatomic defect that
predisposes the patient to meningitis.
43. 3)Tripod sign:
when the patient is in supine position and you ask him to let his
trunk flexed 90 degrees with his hip he can’t do it and he will
put both hands on the bed towards the back to relive the pain,
in other words: tripod position is a position assumed by the
patient with abdominal weakness or meningeal irritation while
sitting in bed, supporting the body with the hands in a plane
posterior to the pelvis.
4)knee-chin sign:
here the patient can not touch his knee with his chin due to
pain.
44.
45. What is this?
Meningococcemia is a life-threatening infection that
occurs when the bacteria, Neisseria meningitidis,
invades the blood stream. Bleeding into the skin
(petechiae and purpura) usually occurs and the
tissue may die (become necrotic or gangrenous). If
the patient survives, the areas heal with scarring.
46. HYPOPLASTIC LEFT HEART SYNDROME
the most common cause of death from
cardiac defects in the first month of life.
There is usually no heart murmur.
low cardiac output gives a grayish color to
the cool, mottled مرقشskin.
A small left ventricle that is unable to support
normal systemic circulation
53. VSD
Large VSDs are not symptomatic at birth
because the pulmonary vascular resistance is
normally elevated at this time. As the pulmonary
vascular resistance decreases over the first 6 to
8 weeks of life, the amount of shunt increases,
and symptoms may develop.
Pulmonary hypertension due to either increased
flow or increased pulmonary vascular resistance
may lead to right ventricular enlargement and
hypertrophy.
71. Anasarca, or extreme
generalized edema, is a
medical condition
characterized by
widespread swelling of
the skin due to effusion
of fluid into the
extracellular space.
81. Any signs of puberty and at which time they commenced? As if they
had early puberty: this mean they used to be tall in early life but due to
early epiphyseal closure they’ll be short later on.
Medication history (long term steroid) Steroids = antigrowth hormones
Dietary history
School performance : As worsened school performance may be
indicative of Hypothyroidism;
Family history: Parents’ Height
Parents’ ages of Puberty
Family History of Short Stature
Family History of delayed growth or Puberty
Family History of endocrinopathis or systemic illness that may affect growth
82. : Is the range above or below the mid-
parenteral height by 8.5 cm
Target height
83. in any endocrine related short stature the bone age is
lower than chronological age except in 3 cases:
1. Precocious puberty : early puberty due to excess
sex hormone level
2. Congenital hyperplasia
3. Hyperthyroidism
In these cases the bone age is higher than or equal
the chronological age because these conditions
cause acceleration of bone ossification early in life. In
this period the child seems to get tall stature but
because the epiphyseal plate become ossified earlier
>> the child height stop increasing in the early age
and become shorter than still up-growing child.
84. TRIDENT HAND DEFORMITY
the hands
are short
with stubby
fingers with
separation
between
middle and
ring finger
In
Achondropl
..
85. IGF-1 is evaluated as a marker for growth
hormone deficiency rather than GH itself
because GH secretion is pulsatile
Indication of GH therapy
GH deficiency/ insufficiency
Chronic renal insufficiency : for short
stature pt.
Turner syndrome
IUGR
Idiopathic short stature
Prader- willi syndrome.
Response after GH
therapy
1/3 poor responders,
1/3 respond as expected (gain
5-10 cm)
1/3 excellent responders
Good Predictors:
Good growth velocity-
1st year
Tall parents
Adverse effects of GH therapy
Intracranial Hypertension
Oedema
Worsening of scoliosis
Gynaecomatia
Slipped capital femoral epiphysis : the
rapid growth of femur causes separation
of epiphysis results in severe pain and
limbing
99. RACEMIC EPINEPHRINE
Racemic epinephrine is a racemic mixture
of epinephrine and is a sympathomimetic
bronchodilator that is delivered by aerosol.[1]
Commonly used in croup
(laryngotracheobronchitis) and when stridor
is present after removal of an endotracheal
tube (extubation).
100. BANDEMIA
Bandemia refers to an excess of band cells
(immature white blood cells) released by the
bone marrow into the blood.
101. STEEPLE SIGN
found on a frontal neck radiograph where
subglottic tracheal narrowing produces the
shape of a church steeple.
102.
103.
104. NONINFECTIOUS CAUSES OF STRIDOR
include mechanical and anatomic causes
(foreign body aspiration, laryngomalacia,
subglottic stenosis, hemangioma, vascular
ring, vocal cord paralysis).
112. ALLERGIC RHINITIS مرشح طول على
Allergic rhinitis is a diagnosis associated with a
group of symptoms affecting the nose. These
symptoms occur when you breathe in
something you are allergic to, such as dust,
animal dander, or pollen.
Symptoms:
Itchy nose, mouth, eyes, throat, skin, or any
area
Problems with smell
Runny nose
Sneezing
Watery eyes
118. PYLORIC STENOSIS
Pyloric stenosis can lead to
forceful vomiting, dehydration
and weight loss. Babies with
pyloric stenosis may seem to
be hungry all the time.
Signs of pyloric stenosis usually appear
within three to five weeks after birth
119. PYLORIC STENOSIS
Signs and symptoms include:
- Vomiting after feeding (projectile vomiting).
- Stomach contractions. You may notice wave-
like contractions (peristalsis) that ripple across
your baby's upper abdomen soon after feeding,
but before vomiting.
- Changes in bowel movements. Since pyloric
stenosis prevents food from reaching the
intestines, babies with this condition might be
constipated.
120. PYLORIC STENOSIS
Risk factors
Sex. more often in boys — especially firstborn children.
Race. more common in Caucasians of northern European
ancestry,
Premature birth.
Family history.
Smoking during pregnancy.
Early antibiotic use. Babies given certain antibiotics in
the first weeks of life — erythromycin to treat whooping
cough, for example — have an increased risk of pyloric
stenosis. In addition, babies born to mothers who took
certain antibiotics in late pregnancy also may have an
increased risk.
137. RHEUMATIC FEVER
It is due to an immunologic reaction that is a delayed
sequela of group A beta-hemolytic streptococcal
infections of the pharynx.
*Minor criteria include fever (temperatures of [38.2°–
38.9°C]), arthralgias, previous rheumatic fever,
leukocytosis, elevated erythrocyte sedimentation
rate/C-reactive protein, and prolonged PR interval.
†One major and two minor, or two major, criteria with
evidence of recent group A streptococcal disease
(e.g., scarlet fever, positive throat culture, or elevated
antistreptolysin O or other antistreptococcal
antibodies) strongly suggest the diagnosis of acute
rheumatic fever.
138.
139.
140. SCARLET FEVER
Other signs and symptoms associated with
scarlet fever include: Difficulty swallowing,
enlarged glands in the neck, Nausea or
vomiting, Headache.
Flushed face: The face appears flushed
with a pale ring around the mouth.
Red rash:
The rash looks like a sunburn and feels like
sandpaper.
141. HENOCH-SCHÖNLEIN PURPURA
The immune complexes associated with HSP
are predominantly composed of IgA.
the most common systemic vasculitis of
childhood and cause of nonthrombocytopenic
purpura.
It occurs primarily in children 3 to 15 years of
age, although it has been described in adults.
slightly more common in boys than girls and
occurs more
frequently in the winter than in the summer
142. HENOCH-SCHÖNLEIN PURPURA
The hallmark of HSP is palpable purpura.
The rash is classically found : below the waist,
on the buttocks, and lower extremities.
Arthritis occurs in 80% of patients with HSP and
is most common in the lower extremities,
particularly the ankles and knees.
The platelet count is the most important test,
because HSP is characterized by
nonthrombocytopenic purpura with a normal, or
even high, platelet count.
148. BECKWITH–WIEDEMANN SYNDROME
an overgrowth disorder usually present at birth,
characterized by an increased risk of childhood cancer
and certain congenital features.
Most children (>80%) with BWS do not develop cancer;
however, children with BWS are much more likely (~600
times more) than other children to develop certain
childhood cancers, particularly Wilms' tumor
(nephroblastoma), pancreatoblastoma and
hepatoblastoma.
Children with BWS are most at risk during early childhood
and should receive cancer screening during this time.
In general, children with BWS do very well and grow up to
become adults of normal size and intelligence, usually
without the syndromic features of their childhood.
149. BECKWITH–WIEDEMANN SYNDROME
Children conceived through In vitro
fertilization have a three to fourfold increased
chance of developing Beckwith–Wiedemann
syndrome. It is thought that this is due to
genes being turned on or off by the IVF
procedures.
151. PERTUSSIS
Classic pertussis (whooping cough) is caused
by B. pertussis,a gram-negative pleomorphic
bacillus with fastidious growth requirements.
The peak incidence of pertussis in the United
States is among those less than 4 months of
age—infants.
Infants may not display the classic findings, and
the first sign in the neonate may be apnea.
radiographic signs of segmental lung atelectasis
may develop during pertussis, especially during
the paroxysmal stage. Atelectasis may develop secondary to
mucous plugs.
152. PERTUSSIS
The
progression of
the disease
catarrhal
stage
nonspecific signs
(increased nasal
secretions and
low-grade fever)
lasting 1 to 2 weeks
paroxysmal
stage
the most
distinctive stage
of pertussis and
lasts 2 to 4 weeks.
Coughing occurs
convalescent
stage
marked by gradual
resolution of
symptoms
over 1 to 2 weeks.
153. ROCKY MOUNTAIN SPOTTED FEVER
rickettsial disease transmitted by ticks.
The rash starts at the soles and palms.
156. BRUCELLOSIS,
Brucellosis is a
highly contagious
zoonosis caused by
ingestion of
unpasteurized milk
or undercooked meat
from infected animals,
or close contact with
their secretion.
Osteomyelitis is the most common complication.
158. SUBCONJUNCTIVAL HEMORRHAGE
usually a harmless condition that disappears
within 10 to 14 days.
You may not realize you have a
subconjunctival hemorrhage until you look in
the mirror and find the white part of your
eye is bright red.
Subconjunctival hemorrhage often occurs
without any injury to your eye, or it may be
the result of a strong sneeze or cough that
caused a broken blood vessel.
160. SEBORRHOEIC DERMATITIS
Seborrhoeic dermatitis primarily affects the scalp
and intertriginous areas. It is most common in the
first 6 weeks of life. Involvement of the scalp is
frequently termed "cradle cap", and manifests as
greasy, yellow plaques on the scalp.. The aetiology
is unknown. Treatment includes the use of a mild
tar shampoo, and avoidance of
soaps. Occasionally, a mild topical steroid may be
indicated.
163. SUCKING BLISTERS
These lesions are present at birth, most often
over the dorsal and lateral aspect of the
wrist.. They can be either bilateral or
unilateral. The infant is noted to exhibit
excessive sucking activity.
164. Cause :
Unknown
Description :
Characterized by 3 stages of lesions:
1) 2-4 mm nonerythematous pustules with milky fluid
2) Ruptured vesiculopustules with collarettes of scale
3) Hyperpigmented macules
Treatment :
Reassure parents this is a benign, self-limited condition with no known sequelae that
requires no treatment. Vesiculopustular lesions disappear in 24 48 hours and
hyperpigmented macules generally regress by 3 months of age.
Extra :
”, more in black
165.
166. Also known as (port-wine stain)
commonly seen on the face and should cause the examiner to consider
(Sturge-Weber Syndrome)
Extra :
Sturge-Weber Syndrome ( proliferation of brain arteries that causes angiomas)
Symptoms : trigeminal angiomatosis, convulsion, and ipsilateral intracranial
“Tram-line” calcifications
171. EPIPHYSIAL DISPLACEMENT
Separation of humeral or femoral epiphysis.
The diagnosis is clinically based on swelling
around the shoulder, crepitus, and pain when
the shoulder is moved.
Management consists of immobilizing the
arm for 8-10 days.
175. Q3:
A) What is the criteria for the diagnosis of this disease?
B) What are the 2 most important drugs for the treatment of this
patient?
Answers:
A) Fever > 5 days & 4 out of 5: 1.Polymorphous rash, 2. Cervical
lymphadenitis, 3. Changes in the lips and mucus membranes, 4. Extremity skin
changes (redness, swelling, peeling of the skin), 5. Non-purulent bulbar
conjunctivitis.
B) Aspirin & IVIG
176. Q5: This is a peripheral blood smear, What is the deficient nutrient?
Answer: Vitamin B12
177. Q6: What is your diagnosis?
Answer: Esophageal Atresia
*This is exactly the same picture we had in the exam
